Caesarean section analysis using the Robson classification in two major
hospitals in Victoria: an observational study
Background The global increase in caesarean section (CS) rates is
concerning and a better understanding of this phenomenon can allow us to
identify strategies to reduce it. Aims To determine the CS rate in two
hospitals in Victoria-Australia, and analyse the contribution of
specific obstetric population to changes in CS rates over time using the
Robson classification. Materials and Methods Retrospective observational
study of all women delivering at two hospitals in Victoria between July
2014 and June 2019. The overall CS rate, the size of each Robson group,
the CS rate per group, and the absolute and relative contribution of
each group to the overall CS rate were calculated. Additionally, trends
over time and comparison between the two hospitals were also analysed.
Results There were 7894 CS during the study period, giving an overall CS
rate of 32.7%. The greatest contributor was Robson group 5 with 35.2%,
followed by group 2 with 26.6% and lastly group 1 with 10.3%. Over the
five-year period, CS rates at both hospitals increased 1.5% per year
(95% CI: 0.1-2.9, p-value: 0.04) from 30.7% in 2015 to 36.0% in 2019.
There were not major differences in the CS between the two hospitals.
Conclusion The major groups contributing to our CS rate are groups 5, 2
and 1 and efforts aiming to reduce our CS rate should therefore target
these groups. Strategies to reduce CS rates should include increasing
the availability of VBAC, reviewing our protocols for IOL, and improving
management and surveillance of labour.