Bicol Regional Hospital and Medical Center

Department of Obstetrics and Gynecology

A CROSS-SECTIONAL STUDY ON CAESAREAN SECTION

RATES ADOPTING THE ROBSON TEN GROUP
CLASSIFICATION FOR PATIENTS ADMITTED IN BICOL
REGIONAL TRAINING AND TEACHING HOSPITAL FROM 2017
1

TO 2019

Remelou G. Alfelor, MD
Researcher

December 13, 2022

Date Completed
 Introduction

Ba ckg r o u n d
• Cesarean section (CS) is a vital indicator of
the quality of maternal health services in a
country
• Based on the statistics of WHO, the overall
CS rates differ significantly between different
institutions and countries

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ROBSON CLASSIFICATION Introduction
SYSTEM

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 Introduction

Sig n ifica n ce
This study would be of great help to the persons involved in the health
care delivery process as well as to other individuals and groups

a) Pregnant Mothers

b) Obstetricians/Gynecologists

c) BRTTH Administrators

d) Future Researchers

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 Introduction

OBJ ECTIVES
1 Obstetric characteristics
2 3
of women who delivered
at BRTTH by Cesarean Overall CS Proportion
Section in terms of rate at of each
 Parity BRTTH in Robson
 Onset of labor each time
 Gestational age
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group
frame.
 Fetal presentation
 Number of fetuses
 Previous Cesarean
Section
 METHODOLOGY

Hospital-based Cross-sectional Research

Design

Collection of data All women who Determination and

through chart review underwent Cesarean analyzation of relative
(January 2017 – Section we size, CS rate of each
December 2019) categorized into group and contribution
Robson Groups to the overall CS rate
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 Table 1
RESULTS
Obstetric Characteristics of Women Who Delivered at
BRTTH by Cesarean Section (n= 5523)
PROFILE FREQUENCY PERCENTAGE RANK
PARITY
P0 2104 38.1 1
P1 1703 30.8 2
P2 863 15.1 3
P3 337 6.1 5
P4 203 3.7 6
P>5 340 7
6.2 4
TOTAL 5523 100
ONSET OF LABOR
Spontaneous 2881 52.2 1
Induced 1943 35.2 2
Pre-labor 699 12.6 3
TOTAL 5523 100
 Table 1
RESULTS
Obstetric Characteristics of Women Who Delivered at
BRTTH by Cesarean Section (n= 5523)

PROFILE FREQUENCY PERCENTAGE RANK

GESTATIONAL AGE
Preterm 1067 19.3 2
Term 4456 80.7 1
TOTAL 5523 100
FETAL PRESENTATION
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Cephalic 4327 78.3 1

Breech 963 17.4 2
Transverse 233 4.3 3
TOTAL 5523 100
 RESULTS
Table 1
Obstetric Characteristics of Women Who Delivered at
BRTTH by Cesarean Section (n= 5523)

PROFILE FREQUENCY PERCENTAGE RANK

NUMBER OF FETUS
Single 5449 98.7 1
Multiple 74 1.3 2
TOTAL 5523 100
PREVIOUS CESAREAN SECTION
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Yes 1678 30.4 2

No 3845 69.6 1
TOTAL 5523 100
 RESULTS

Table 2
Overall Cesarean Rate at BRTTH in Each Timeframe
(n= 5523)
YEAR FREQUENCY PERCENTAGE
2019 1714 21.9
2020 1900 22.9
2021 1909 22.6

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 RESULTS
Table 3
Proportion of Robson Groups (n= 5523)
FREQUENCY OVERALL CS
GROUP
2017 2018 2019 RATE
1 114 206 152 8.4
2 331 425 341 19.1
3 88 45 121 4.6
4 185 198 187 10.3
5 520 499 683 29.7
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6 138 141 114 7.1

7 110 158 167 7.5
8 32 66 38 2.5
9 44 72 73 3.4
10 152 91 163 7.4
 Discussion

• Parity
• Majority (2104 or 38.1%) have no history of delivery sharply followed
by Parity-1 with a frequency of 1703 or 30.8%.
• Primiparous women had an increased risk of CS delivery
• Onset of Labor
• More than half of the respondents (2881 or 52.2%) have experienced
labor spontaneously followed by induced labor with 1943 or 35.2%. It
should be noted that only 699 or 12.6% were classified under pre-
labor.

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 Discussion

• Gestational Age
• Most of the women (4456 or 80.7%) were already in the term during
delivery while the remaining 1067 or 19.3% have delivered preterm.
• Fetal Presentation
• In this study, 4327, or 78.3% have a cephalic presentation followed by
963, or 17.4%. Only 233 or 4.3% of the population have pregnancy
lying transversely.

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 Discussion

• Number of Fetuses
• Women with singleton pregnancy made the largest contribution to the
obstetric population accounting for 5549 or 98.7% of all CS deliveries.
• Previous CS
• The highest number (3845 or 69.6) of women have previous CS
history
• This agrees with the study of Mascarello et al. (2017) that among the
women who underwent a cesarean section in their first delivery
(49.47%), 87.44% had a second surgical delivery.

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Overall Cesarean Section Rate at Discussion
BRTTH in Each Timeframe

• Over the three-year period, a total of 5523 CS cases were recorded.

• 2020 marked the highest CS rate reaching 22.9% closely followed by 2021
with a 22.6% CS rate.
• The average CS rate for the three-year period at BRTTH (22.5%) exceeded
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the baseline endorsed by WHO.

• It is vital for BRTTH to keep evaluating CS rates to compare past data to
distinguish possible areas of improvement to lessen the overall CS rates.
• .
The Proportion of Robson Groups Discussion

• Based in the result, the following groups turned

out to be the most prevalent groups
• Group 5 29.7%
• Group 2 19.1%
• Group 4 14.6%
• BRTTH, as the leading tertiary hospital in the
region, most cases are referred patient that are
high risks and with repeat cesarean section.

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 Concl u s io n

1. Most women who were delivered at BRTTH by CS have no history of

delivery, the majority have experienced labor spontaneously, have already
reached term pregnancy, with a cephalic presentation, mostly singleton
pregnancy and with previous cesarean section.
2. The average CS rate for the three-year period at BRTTH exceeded the
baseline of <15% endorsed by WHO.
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3. Robson Ten Groups Classification Group 5 was the leading contributor to

the overall CS rate of BRTTH.
 Recommendation s

• Pregnant mothers are encouraged to be participative and

responsive to the management plan of their OB physicians
through the entire course of pregnancy to prevent progressing to
CS
• Since RTGCS group 5 was the leading contributor to the overall
CS rate of BRTTH, it is recommended to encourage
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implementation of Trial of Labor After Cesarean Section (TOLAC)

to those applicable patients
 Recommendations

• Strengthening the completeness and quality of data collected is

highly recommended to the administrators of BRTTH to develop
an effective institutional data collection system for the best use of
the data contained.
• Future researchers can assess maternal and fetal outcomes CS
rates in each of the 10 groups to be able to establish an optimal
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range of CS rates for best outcomes. They can also compare the
data gathered in this study with other institutions
THANK YOU…   
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