الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Cesarean section (CS) is a vital, life-saving procedure for both mothers and newborns and has become the most performed major surgery worldwide. It is so routine that it is often among the first surgical procedures undertaken by residents in the field of obstetrics. As a result, the World Health Organization (WHO) recommended the use of Robson’s Ten group Classification by 2015 to better understand and manage the trends in CS procedures.
In this study, we applied this classification to assess the CS trends in our hospital, EL-Shatby Maternity University Hospital, over a period from September 2021 to March 2022. The study included 5682 pregnant women who met the inclusion criteria. Notably, most of these women (65.8%) belonged to groups 5, 3, and 10, with group 5 accounting for the highest proportion at 30.7%. In contrast, group 9 contributed the least, making up only 1.2% of the cases.
Approximately 70% of the CS procedures in our facility were performed on women from groups 5 and 10. group 5 alone accounted for nearly half (47.6%) of all CS cases and roughly 28.5% of all deliveries at the hospital during this period. group 10 was the second-largest contributor to the overall CS rate, making up 12.3% of total cs deliveries.
Our findings emphasize the importance of considering a trial of labor after a cesarean delivery (TOLAC) and operative vaginal delivery (OVD) as strategies to reduce the cesarean section rate in group 5. TOLAC plays a crucial role in decreasing the contribution of group 5 to the overall CS rates. Out of 1176 patients, only 126 opted for vaginal birth after cesarean (VBAC). The increase in CS rates in group 10 may be attributed to the fact that our study was conducted at a specialized tertiary referral hospital with a dedicated maternal-fetal medicine unit. This hospital primarily serves mothers with complex obstetric and medical conditions, often requiring medical interventions. Preeclampsia emerged as the most common reason for CS in this group at EL-Shatby hospital, accounting for 231 out of 701 preterm deliveries.
The cesarean section (CS) rates in Robson group 1 and group 3 are quite similar, with rates of 14.5% and 11.9%, respectively. This slight difference was expected because nulliparous women in group 1 often encounter more challenges related to labor difficulties than multiparous women in group 3, who have prior childbirth experience. The potential to lower CS rates lies in revising our protocols for managing prolonged labor within the facility and providing more training on operative vaginal delivery (OVD).
Approximately half of the cases in group 3 and group 4 resulted in CS deliveries. The high CS rates in these groups were primarily attributed to the subgroups 2b and 4b (pre-labor CS), which collectively make up over 60% of each group. More efforts to understand the factors contributing to groups 1-4, especially subgroups 2b and 4b, can lead to a further reduction in the size of group 5, which is the largest contributor to our study, accounting for nearly one-third of the cases. Additionally, promoting and providing family planning options can be of great benefit in reducing the overall CS rate.
On the other hand, groups 6 and group7 made a minimal contribution to our study. To potentially reduce CS rates in these groups, considering external cephalic version (ECV) for suitable candidates beyond 36 weeks gestation could be beneficial.