Abstract

Research Article

Comparative analysis of cesarean section using the Robson's Ten-Group Classification System (RTCGS) in private and public hospitals, Addis Ababa, Ethiopia

Endalkachew Mekonnen Assefa*, Adem Janbo and Yirgu Ghiwot

Published: 29 June, 2021 | Volume 4 - Issue 2 | Pages: 081-091

Objectives: We analyzed the indications of cesarean section (CS) using Robson Ten-Group.

Classification Systems (RTGCS) and comparison between private and public health facilities in Addis Abeba hospitals, Ethiopia, 2017.

Methods: Facility-based retrospective cross-sectional study was carried out between January 1 and December 31, 2017, including 2411 mothers who delivered by CS were classified using the RTGCS. Data were entered into SPSS version 20 for cleaning and analyzing. Binary logistic regression and AOR with 95% CI were used to assess the determinants of the CS.

Results: The overall CS rate was 41% (34.8% and 66.8% in public & private respectively, p < .0001). The leading contributors for CS rate in the private were Robson groups 5,1,2,3 whereas in the public 5,1,3,2 on descending order. Robson group 1 (nulliparous, cephalic, term, spontaneous labor) and group 3 [Multiparous (excluding previous cesarean section), singleton, cephalic, ≥ 37 weeks’ gestation& spontaneous labor], the CS rate was over two-fold higher in the private than the public sector. Women in Robson groups 1, 2, 5 & 9 are two and more times higher for the absolute contribution of CS in private than public. The top medical indications of CS were non-reassuring fetal status (NRFS, 39.1%) and repeat CS for previous CS scars (39.4%) in public and private respectively. Mothers who delivered by CS in private with history of previous CS scar (AOR 2.9, 95% CI 1.4-6.2), clinical indications of maternal request (AOR 7.7, 95% CI 2.1-27.98) and pregnancy-induced hypertension (AOR 4.2, 95% CI 1.6-10.7), induced labor (AOR 2.5, 95% CI 1.4-4.6) and pre-labored (AOR 2.2, 95% CI 1.6-3.0) were more likely to undergo CS than in public hospital.

Conclusion: The prevalence of CS was found to be high, and was significantly higher in private hospitals than in a public hospital. Having CS scar [having previous CS scar, Robson group 5(Previous CS, singleton, cephalic, ≥ 37 weeks’ gestation) and an indication of repeat CS for previous CS scar] is the likely factor that increased the CS rate in private when compared within the public hospital.

Recommendation: It is important that efforts to reduce the overall CS rate should focus on reducing the primary CS, encouraging vaginal birth after CS (VBAC). Policies should be directed at the private sector where CS indication seems not to be driven by medical reasons solely. 

Read Full Article HTML DOI: 10.29328/journal.cjog.1001093 Cite this Article Read Full Article PDF

Keywords:

Addis Ababa; Cesarean section; Robson classification; Indications; Private; Public

References

  1. Cesarean Delivery: Overview, Preparation, Technique. 2019. https://emedicine.medscape.com/article/263424-overview
  2. Lyell DJ, Power M, Murtough K, Ness A, Anderson B, et al. Surgical Techniques at Cesarean Delivery: A U.S. Survey. Surg J (NY). 2016; 2: e119–25. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553495/
  3. Management protocol on selected obstetrics topics. Federal Democratic Republic of Ethiopia Ministry of Health. https://www.academia.edu/40819328/MANAGEMENT_PROTOCOL_ON_SELECTED_OBSTETRICS_TOPICS_Federal_Democratic_Republic_of_Ethiopia_Ministry_of_Health
  4. Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, et al. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PloS One. 2016; 11: e0148343. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0148343
  5. Boatin AA, Schlotheuber A, Betran AP, Moller AB, Barros AJD, et al. Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries. BMJ. 2018; k55. http://www.bmj.com/lookup
  6. Hanson C, Betrán AP, Opondo C, Mkumbo E, Manzi F, et al. Trends in caesarean section rates between 2007 and 2013 in obstetric risk groups inspired by the Robson classification: results from population-based surveys in a low-resource setting. BJOG. 2019; 126: 690–700. PubMed: https://pubmed.ncbi.nlm.nih.gov/30461161/
  7. Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, et al. Global epidemiology of use of and disparities in caesarean sections. The Lancet. 2018; 392: 1341–1348. PubMed: https://pubmed.ncbi.nlm.nih.gov/30322584/
  8. Harrison MS, Goldenberg RL. Cesarean section in sub-Saharan Africa. Maternal Health, Neonatology and Perinatology. 2016; 2: 6. PubMed: https://pubmed.ncbi.nlm.nih.gov/27398224/
  9. Chu K, Cortier H, Maldonado F, Mashant T, Ford N, et al. Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres. PLoS One. 2012; 7: e44484. PubMed: https://pubmed.ncbi.nlm.nih.gov/22962616/
  10. Dikete M, Coppieters Y, Trigaux P, Fils JF, Englert Y, et al. Variation of caesarean section rates in Sub-Saharan Africa: A literature review. J Gynecol Res Obstet. 2019; 5: 042-047. https://www.peertechz.com/articles/JGRO-5-171.php
  11. Ethiopia - Demographic and Health Survey 2016. https://microdata.worldbank.org/index.php/catalog/2886
  12. Yisma E, Smithers LG, Lynch JW, Mol BW. Cesarean section in Ethiopia: prevalence and sociodemographic characteristics. J Matern Fetal Neonatal Med. 2019; 2: 1130-1135. PubMed: https://pubmed.ncbi.nlm.nih.gov/29103331/
  13. Fesseha N, Getachew A, Hiluf M, Gebrehiwot Y, Bailey P. A national review of cesarean delivery in Ethiopia. Int J Gynecol Obstetr. 2011; 115: 106–111. https://obgyn.onlinelibrary.wiley.com
  14. WHO Statement on caesarean section rates. Reproductive Health Matters. 2015; https://www.tandfonline.com/doi/abs
  15. Almeida MA, Araujo Júnior E, Camano L, Peixoto AB, Martins WP, et al. Impact of cesarean section in a private health service in Brazil: indications and neonatal morbidity and mortality rates. Ceska Gynekol. 2018; 83: 4–10.
  16. Phadungkiatwattana P, Tongsakul N. Analyzing the impact of private service on the cesarean section rate in public hospital Thailand. Arch Gynecol Obstet. 2011; 284: 1375-1379. PubMed: https://pubmed.ncbi.nlm.nih.gov/21359844/
  17. Tura AK, Pijpers O, de Man M, Cleveringa M, Koopmans I, et al. Analysis of caesarean sections using Robson 10-group classification system in a university hospital in eastern Ethiopia: a cross-sectional study. BMJ Open. 2018; 8: e020520. PubMed: https://pubmed.ncbi.nlm.nih.gov/29622577/
  18. Nakamura-Pereira M, do Carmo Leal M, Esteves-Pereira AP, Domingues RMSM, Torres JA, et al. Use of Robson classification to assess cesarean section rate in Brazil: the role of source of payment for childbirth. Reprod Health. 2016; 13(Suppl 3): 128. PubMed: https://pubmed.ncbi.nlm.nih.gov/27766941/
  19. World Health Organization. Robson Classification: Example of Robson Report Table with Interpretation. WHO/RHR/1722. 2017; www.who.int/reproductivehealth/publications/maternal_perinatal_health/robson-classification/en/
  20. Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, et al. Use of the Robson classifi cation to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health. 2015; 3: e260-270. PubMed: https://pubmed.ncbi.nlm.nih.gov/25866355/
  21. Maskey S, Bajracharya M, Bhandari S. Prevalence of Cesarean Section and Its Indications in A Tertiary Care Hospital. JNMA J Nepal Med Assoc. 2019; 57: 70–73. PubMed: https://pubmed.ncbi.nlm.nih.gov/31477935/
  22. Chaudhary R, Raut KB, Pradhan K. Prevalence and Indications of Cesarean Section in a Community Hospital of Western Region of Nepal. JNMA J Nepal Med Assoc. 2018; 56: 871–874. PubMed: https://pubmed.ncbi.nlm.nih.gov/31065123/
  23. Gedefaw G, Demis A, Alemnew B, Wondmieneh A, Getie A, et al. Prevalence, indications, and outcomes of caesarean section deliveries in Ethiopia: a systematic review and meta-analysis. Patient Safety in Surgery. 2020; 14: 11. PubMed: https://pubmed.ncbi.nlm.nih.gov/32292491/
  24. Wondie AG, Zeleke AA, Yenus H, Tessema GA. Cesarean delivery among women who gave birth in Dessie town hospitals, Northeast Ethiopia. PLoS ONE. 2019; 14: e0216344. PubMed: https://pubmed.ncbi.nlm.nih.gov/31059526/
  25. Aman H, Negash S, Yusuf L. Cesarean delivery practices in teaching public and non-government/private MCH hospitals, Addis Ababa. Ethiopian J Health Develop. 2014; 28: 22–28. https://www.ajol.info/index.php/ejhd/article/view/115406
  26. Gebremedhin S. Trend and socio-demographic differentials of Caesarean section rate in Addis Ababa, Ethiopia: analysis based on Ethiopia demographic and health surveys data. Reprod Health. 2014; 11: 14. PubMed: https://pubmed.ncbi.nlm.nih.gov/24563907/
  27. Tsega F, Mengistie B, Dessie Y, Mengesha MM. Prevalence of Cesarean Section in Urban Health Facilities and Associated Factors in Eastern Ethiopia: Hospital Based Cross Sectional Study. J Pregnancy Child Health. 2015; 2: 1–5. https://www.omicsonline.org/open-access/prevalence-of-cesarean-section-in-urban-health-facilities-and-associated-factors-in-eastern-ethiopia-hospital-based-cross-sectional-study-2376-127X-1000169.php?aid=54258
  28. Melesse MB, Geremew AB, Abebe SM. High prevalence of caesarean birth among mothers delivered at health facilities in Bahir Dar city, Amhara region, Ethiopia. A comparative study. PLoS ONE. 2020; 15: e0231631. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162673/
  29. Alonso BD, da Silva FMB, do Rosário M, et al. Caesarean birth rates in public and privately funded hospitals: a cross-sectional study. Rev Saude Publica. 2017; 51: 101. PubMed: https://pubmed.ncbi.nlm.nih.gov/29166449/
  30. M N, G A, K A, A K, D O, Ns M, et al. Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal. BMJ open. 2014; 4. PubMed: https://pubmed.ncbi.nlm.nih.gov/25550293/
  31. Eyi EGY, Mollamahmutoglu L. An Analysis of the High Cesarean Section Rates in Turkey by Robson Classification. J Matern Fetal Neonatal Med. 2021; 34: 2682-2692. PubMed: https://pubmed.ncbi.nlm.nih.gov/31570019/
  32. Einarsdóttir K, Haggar F, Pereira G, Leonard H, Klerk N de, Stanley FJ, et al. Role of public and private funding in the rising caesarean section rate: a cohort study. BMJ Open. 2013; 3: e002789. https://bmjopen.bmj.com/content/3/5/e002789
  33. Elena SV, Marta U, Fern AV, Yazmin LBI, Hazel HRC. The Epidemic of the Cesarean Section in Private Hospital in Puebla, México. 2015.
  34. Vieira GO, Fernandes LG, de Oliveira NF, Silva LR, Vieira T de O. Factors associated with cesarean delivery in public and private hospitals in a city of northeastern Brazil: a cross-sectional study. BMC Pregnancy Childbirth. 2015; 15: 132. PubMed: https://pubmed.ncbi.nlm.nih.gov/26043857/
  35. Kazmi T, Sarva Saiseema V, Khan S. Analysis of Cesarean Section Rate - According to Robson’s 10-group Classification. Oman Med J. 2012; 27: 415–417. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472574/
  36. Tognon F. Analysis of caesarean section and neonatal outcome using the Robson classification in a rural district hospital in Tanzania: an observational retrospective study. MJ Open. 2019; 9: e033348.
  37. Zimmo MW, Laine K, Hassan S, Bottcher B, Fosse E, et al. Caesarean section in Palestine using the Robson Ten Group Classification System: a population-based birth cohort study. BMJ Open. 2018; 8: e022875. PubMed: https://pubmed.ncbi.nlm.nih.gov/30361403/
  38. Naidoo N, Moodley J. Rising rates of Caesarean sections: an audit of Caesarean sections in a specialist private practice. South African Family Practice. 2009; 51. https://www.ajol.info/index.php/safp/article/view/44790
  39. Betrán AP, Temmerman M, Kingdon C, Mohiddin A, Opiyo N, et al. Interventions to reduce unnecessary caesarean sections in healthy women and babies. The Lancet. 2018; 392: 1358–1368. https://linkinghub.elsevier.com/retrieve/pii/S0140673618319275
  40. Safe Prevention of the Primary Cesarean Delivery. 2020. https://www.acog.org/en/Clinical/Clinical Guidance/Obstetric Care Consensus/Articles/2014/03/
  41. Rossi AC, D’Addario V. Maternal morbidity following a trial of labor after cesarean section vs elective repeat cesarean delivery: a systematic review with metaanalysis. Am J Obstet Gynecol. 2008; 199: 224–231. PubMed: https://pubmed.ncbi.nlm.nih.gov/18511018/
  42. Buchmann EJ. Trial of labour after previous caesarean section in sub-Saharan Africa. BJOG. 2016; 123: 2156.
  43. Kietpeerakool C, Lumbiganon P, Laopaiboon M, Rattanakanokchai S, Vogel JP, et al. Pregnancy outcomes of women with previous caesarean sections: Secondary analysis of World Health Organization Multicountry Survey on Maternal and Newborn Health. Sci Rep. 2019; 9. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611838/
  44. Rudey EL, do Carmo Leal M, Rego G. Cesarean section rates in Brazil Trend analysis using the Robson classification system. 2020; 99: 17: e19880. PubMed: https://pubmed.ncbi.nlm.nih.gov/32332659/
  45. Tapia V, Betran AP, Gonzales GF. Caesarean Section in Peru: Analysis of Trends Using the Robson Classification System. PLoS One. 2016; 11: e0148138. PubMed: https://pubmed.ncbi.nlm.nih.gov/26840693/
  46. Barčaitė E, Kemeklienė G, Railaitė DR, Bartusevičius A, Maleckienė L, et al. Cesarean Section Rates in Lithuania Using Robson Ten Group Classification System. Medicina (Kaunas). 2015; 51: 280–285.
  47. Tsegaye H, Desalegne B, Wassihun B, Bante A, Fikadu K, et al. Prevalence and associated factors of caesarean section in Addis Ababa hospitals, Ethiopia. Pan African Med J. 2019; 34. https://www.panafrican-med-journal.com/content/article/34/136/full/
  48. Hanvoravongchai P, Letiendumrong J, Teerawattananon Y, Tangcharoensathien V. Implications of Private Practice in Public Hospitals on the Cesarean Section Rate in Thailand. 2020; 11.
  49. Alonso BD, Silva FMB da, Latorre M do RD de O, Diniz CSG, Bick D. Caesarean birth rates in public and privately funded hospitals: a cross-sectional study. Rev Saude Publica. 2017; 51: 101. PubMed: https://pubmed.ncbi.nlm.nih.gov/29166449/

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