A third of cesarean deliveries were nulliparous term singleton vertex in Tigray, Ethiopia: Employing the Robson classification

Abstract

Background: Cesarean section rates continue to increase even in developing countries. Community-andinstitution-based studies conducted in Ethiopia reportedthat cesareansection rate was above the recommended rate (15%). Knowing only rates, however, remain atopic ofdebate as does not help incontrolling themagnitude of cesarean deliveries. Identification of specific contributors to the total cesarean section rate willimprove care, and avoid unnecessary cesareandeliveries, which isnot benefiting the mothersandnewborns. The objective of this study wasto assess the magnitude of cesareansection according to Robson10category classification system in Tigray, Ethiopiawithaview to developing anauditing tool.

Methods: Institution-basedcross-sectionalstudy design wasemployed andenquired information from mothers in about 5months. Allmothers who appearedandregistered fordeliveryservices inselected publichealth facilities during the period were the source population for the study and those who underwentcesareansection were included in the analysis. Information was collected through face-to-face interviews post-cesarean section and from records. The Robson Ten Category Classification System divides women into ten categories. Cesarean section rates of each hospital and the contribution of each category to the total cesarean section rate were calculated using descriptive analysis. A Chi-Square test was employed to investigate relationships among the ten categoriescesarean sections of the hospitals. The coefficient of variation was calculated to identify variation in the Robson categories among seven hospitals.

Results: Out of the seven hospitals of the Tigray region, the difference in contributing to the overall cesarean section  (CS) rate was observed. From 9,491 deliveries, 1,684 cesarean sections  (CSs) were performed which gives a total CS rate of 17.74%. Categories 1, 3, and 5 were the three largest contributors(26.4%, 20.4%, and 16.4% respectively). The proportion of Nulliparous term singleton vertex (NTSV) cesareandeliveries(Categories 1 and 2) was 32.2% which makes one-third of the overall.

Conclusion: Nulliparous women with singlecephalicterm pregnancy are the highest contributor to the total rate of cesareandeliveries. Reducing CS rates in nulliparous women is a perinatal quality measure.