TITLE:
Cesarean Sections according to the Robson’s Classification in Two University Hospitals of Yaoundé: Indications and Maternofetal Outcome
AUTHORS:
Noa Ndoua Claude Cyrille, Ndongo Ivan Alfred, Essiben Felix, Toukam Louise, Kemfang Ngowa Jean Dupont
KEYWORDS:
Robson’s Classification, Indication for Cesarean Section, Materno-Fetal Outcome
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.13 No.11,
November
16,
2023
ABSTRACT: Introduction: Cesarean section is a surgical intervention which consists in the extraction of a fetus from the uterus after its incision. The rate
of cesarean section varies depending on the country and the health facility. For
this reason, in 2015, the World Health Organization (WHO) recommended the use of
Robson’s classification to evaluate the practice of cesarean sections in order to
identify the groups of women who had abnormally high rates. The objective of our
study was to evaluate cesarean sections using the Robson’s classification in CHRACERH
and in the Yaoundé Central Hospital (YCH). Methodology: We carried out a
retrospective cross sectional and descriptive study in two (02) university hospitals
in Yaoundé which took place from December 2017 to May 2018. We included in our study
all women who gave birth over a period of two (02) years from January 2016 to December
2017 in these two health facilities. Our sampling was exhaustive over
the study period. The parturients’ information was collected using an anonymous and pretested questionnaire.
The Robson’s group of every parturient was determined. Descriptive parameters like
mean and proportions were calculated. We compared the rates and indications of cesarean
sections between the both hospitals using Chi2 test. Results: Out of 330 deliveries realized in CHRACERH, we had 90 cesarean sections; hence,
a rate of 27.2%. Out of 1863 deliveries carried out at the YCH, 462 were by cesarean
section, hence a rate of 24.8%. The women who belonged to groups 1, 3 and 5 contributed to the highest rates of cesarean sections in both hospitals:
in CHRACERH, group 5 (31.1%), group 3 (20%)
and group 1 (15.6%), at YCH: group 3 (22.5%), group 1 (21.6%) and group 5 (17.3%). The indications of the cesarean sections varied depending on the Robson’s group
and the hospital, the principal indication in group 1 was acute fetal distress (28.6%)
in CHRACERH and cephalopelvic disproportion (36.7%) at YCH. Cephalopelvic disproportion
was the predominant indication in groups 3 of CHRACERH (44.4%) and YCH (39.2%).
In groups 5, CHRACERH
and of YCH, a scarred uterus was the principal indication for the cesarean section
at 82.4% and 78.4% respectively. At CHRACERH, the maternofetal complications were more frequent in groups 1 and 2 at the YCH,
this was the case mostly in groups 1 and 3. Conclusion: The Robson’s classification
is an adequate tool for the evaluation and comparison of the rates of cesarean sections.
The rates of cesarean section in CHRACERH (27.2%) and at YCH (24.8%) were higher
than the rates recommended by WHO. Robson’s groups 1, 3 and 5 were identified as
the groups most at risk for cesarean sections in the both hospitals.