Association of Robson Ten Group Classification System with neonatal/postneonatal mortality: an analysis for the effect of the mass migration

Abstract

Background

Türkiye is the largest host country for refugees and asylum seekers and provides comprehensive maternal care, including antenatal, intrapartum, and postpartum services. However, there is a notable gap in comparative data regarding neonatal and postneonatal mortality for cesarean sections among Turkish citizens and refugees/asylum seekers.

Objective

The study aims to: (1) Compare neonatal and postneonatal mortality rates across Robson groups among Turkish citizens and refugees/asylum seekers. (2) Identify risk factors related to neonatal and postneonatal deaths, considering Robson Classification, clinical obstetric parameters, and demographics. (3) Investigate the primary causes of neonatal/postneonatal deaths in a hospital with a cesarean section rate of 48.43%.

Study Design

A retrospective cross-sectional study based on hospital electronic data was conducted, analyzing 25,631 cesarean section births. The participants included 89% Turkish citizens and 11% refugees/asylum seekers. Student's t-test, χ² -test, Mann-Whitney U test, Kruskal-Wallis analysis, and logistic regression were applied to identify risk factors and make comparisons.

Results

Neonatal Deaths: Out of 26,474 live births, 513 newborns died. Mortality rates were 21.94 per 1000 live births for refugees/asylum seekers and 19.05 per 1000 live births for Turkish citizens. Robson Group Distribution: The distribution of cesarean births across Robson groups was varied, with the highest mortality rates observed in groups R8, R9, R10, R6, and R7 (p=.001). Risk Factors: Logistic regression analysis identified Robson groups, fetal presentation, gestational age, Apgar scores, and newborn weight/height as significant risk factors for neonatal /postneonatal mortality. However, no significant associations were found with demographic factors, including maternal age, parity, and nationality. Main Causes of Deaths: The leading causes were prematurity (452 cases), congenital abnormalities (160 cases), infections (78 cases), asphyxia (17 cases), and meconium aspiration syndrome (9 cases).

Conclusion

The integration of the Robson Classification with neonatal and postneonatal mortality data offers a structured method to assess cesarean section outcomes, emphasizing the significant variation in mortality rates across different Robson groups. Notably, the highest risks were linked to multiple pregnancies, abnormal fetal presentations, and preterm births.