Ways to reduce the frequency of cesarean sections using the Robson’s ten group classifi cation system in a tertiary obstetric hospital

Introduction. Over the past decades, obstetrics around the world has faced an urgent problem – a signifi cant increase in the prevalence of cesarean sections (CS). In Russia, the proportion of this surgical procedure in the structure of childbirths is steadily increasing. Today, reducing the proportion of CS is considered one of the priorities of the Ministry of Health of the Russian Federation, healthcare offi cials of obstetric facilities of the Russian Federation, obstetricians-gynecologists of maternity departments at all levels.

Aim . A retrospective analysis of maternal records of patients in the Maternity Department of the Regional Perinatal Center (State Novosibirsk Regional Clinical Hospital) for July 2022 using the Robson’s ten group classifi cation system to fi nd possible ways to reduce the frequency of CS in a tertiary obstetric hospital. Materials and methods. The retrospective analysis of 387 maternal records of patients at the Maternity Department of the Regional Perinatal Center (State Novosibirsk Regional Clinical Hospital) in 2022 using the Robson’s ten group classifi cation system.

Results. The groups with the maximal and minimal impact on the overall frequency of CS in the tertiary obstetric hospital were identifi ed. In the structure of indications for CS, the most numerous was the group 5a, i.e. every fi fth delivery occurred in patients with at least one previous CS. Subject to a number of conditions, in accordance with current clinical guidelines and a professional approach to the management of labor with one previous CS, ensuring safe delivery, it is possible to expand the indications for vaginal delivery in patients with some relative contraindications. Groups 2b and 4b – women previously delivered by CS – have a signifi cant impact on the overall frequency of CS, which is associated with changes in the management tactics of high-risk pregnant women. Reducing the number of CS in these groups is possible only through more careful selection of pregnant women for programmed labor, the use of labor induction methods and rational interdisciplinary management of pathological labor. Group 10 (<37 weeks gestation patients) turned out to be signifi cant. According to current protocols for the management of preterm birth for this group, it is necessary to hold a case conference to clarify the term and mode of delivery, taking into account the gestational age, obstetric state, as well as current clinical protocols.

Conclusion. The main reserves for reducing abdominal delivery are groups 5a, 2b, 4b and 10 according to the Robson’s ten group classifi cation system. Expanding the indications for spontaneous labor in patients with previous CS is the main reserve for reducing the proportion of CS. Preterm birth currently does not always involve abdominal delivery. The Robson’s ten group classifi cation system is a robust tool for analyzing the frequency and structure of abdominal deliveries and identifying possible ways to reduce it.

1. Filippov O.S., Pavlov K.D. Results of the analysis of the frequency and causes of caesarean section based on Robson’s classification in obstetric hospitals of the Federal Medical and Biological Agency of Russia. Russian Bulletin of Obstetrician-Gynecologist. 2023;23(5):7-12. DOI: 10.17116/rosakush2023230517. (In Russ.)

2. Buyanova S.N., Shchukina N.A., Chechneva M.A. et al. Current diagnostic techniques for inconsistent uterine sutures or scar after cesarean section. Russian Bulletin of Obstetrician-Gynecologist. 2013;13(1):73-77. (In Russ.)

3. Radzinskiy V.E. (2017). Obstetric Aggression. V. 2.0. Мoscow. 871 с. URL: https://akusher-lib.ru/wpcontent/uploads/2018/11/Akusherskaya-agressiya-v.-2.0.pdf?ysclid=l8wfwsuab1560156980 (accessed 19.03.2024).

4. Lebedenko E.Yu., Bespalaya A.V., Feoktistova T.E., Rymashevskiy M.A. Analysis of global trends in caesarean section rates using the Robson classifi cation. Medical Herald of the South of Russia. 2021;12(2):16- 21. DOI: 10.21886/2219-8075-2021-12-2-16-21. (In Russ.)

5. Robson M.S. Classifi cation of caesarean sections. Fetal and Maternal Medicine Review. 2001;12(1):23-39. DOI: 10.1017/S0965539501000122.

6. Postoperative uterine scar, requiring medical care for the mother during pregnancy, childbirth and the postpartum period. Clinical recommendations. 2021 / Russian Society of Obstetricians and Gynecologists. URL: https://mz.mosreg.ru/download/document/10106571 (accessed 19.03.2024).

7. Singleton birth, cesarean delivery. Clinical recommendations. 2021 / Russian Society of Obstetricians and Gynecologists; Association of Anesthesiologists and Resuscitators; Association of Obstetric Anesthesiologists and Resuscitators. URL: https://mz.mosreg.ru/download/document/10106574 (accessed 19.03.2024).

8. Preterm birth. Clinical recommendations. 2020 / Russian Society of Obstetricians and Gynecologists; Association of Obstetric Anesthesiologists and Resuscitators. URL: https://www.dzhmao.ru/spez/klin_recom/akushGinekol/2020/prehd_rody.pdf (accessed 19.03.2024).

9. Multiple gestation. Clinical recommendations. 2021 / Russian Society of Obstetricians and Gynecologists URL: https://www.dzhmao.ru/spez/klin_recom/akushGinekol/2021/KR_mnogoplod_nBer.pdf?ysclid=l8wi0tgwqb584495163 (accessed: 19.03.2024).