The ten group Robson classification: a retrospective study to identify strategies to optimise caesarean section rates

Background: Caesarean section rates have been increasing worldwide. For proper assessment, the ten group Robson classification is recommended by WHO for assessing CS rates. We are analyzing the caesarean section rates by classifying the caesarean sections using modified Robson’s ten group classification. Objective of the current study was to estimate caesarean section rates in our hospital and to classify caesarean section using modified Robson’s ten group classification system.Methods: Current retrospective study was conducted in the department of obstetrics and gynaecology in a tertiary care hospital. The medical records were reviewed for a period of 12 months.Results: Total number of deliveries during the study period was 315. The total numbers of caesarean section were 159 and total vaginal deliveries were 156. The caesarean section rate was 50.47%. The main contributors to overall caesarean section rate were group 5 (18.10%), group 2 (13.96%) and group 1 (5.71%). Women with one previous LSCS contributed majorly to the caesarean section rate. Higher CS rate was also seen in both group 2A (69.40%) and group 4A (47.30%) which had underwent induction of labour. More inclination towards trial of labour following CS for women with previous one LSCS can lower CS rates.Conclusions: Modified Robson’s classification is easily implementable and an effective tool for ongoing surveillance. The results can be compared between Institutions, states and countries. Having implemented the Robson classification and identified groups which contributed the most to the overall CS rate, interventions to reduce the same has to be our prime objective

The clinical study of vaginal birth after caesarean section

Background: VBAC has reduced the rate of repeat caesarean section in modern medicine. VBAC-TOL is successful in 60-80% of acceptable candidates if applied to all patients presenting with prior caesarean procedure (8.2-8.5%), there is potential to increase the overall vaginal delivery rate by 5%. Though the safety of VBAC in carefully selected patients have been demonstrated in several studies, controversy continues over when to advise patients who had caesarean section to undergo TOL. The purpose of current study was to know the success of VBAC, to know the maternal morbidity and mortality and foetal outcome in VBAC group.Methods: It was a prospective study performed on women with one previous LSCS admitted to tertiary care hospital for a period of one year from August 2018 to August 2019 at DM Waynad institute of medical sciences, Waynad.Results: In the present study 292 women with one previous LSCS were selected, among them 32 women had elective LSCS for various indications, 260 women underwent TOL. Among 260 women, 152 women achieved VBAC (58.46%) and 108 women underwent LSCS following failed TOL. Maternal morbidity was 9.61%. The incidence of scar dehiscence was 2.69% and uterine rupture was 0.38%. There was no maternal and foetal mortality in this study. NICU admission was 4.6%.Conclusions: Trial of labour should be encouraged in women with one previous LSCS with no obstetric complications