Caesarean Section Rates for January 2017,
Total Deliveries – 712
Reflections on C Section Rate - January 2017
With reference to Group 1 (Nulliparous with single, cephalic pregnancy > 37 weeks – spontaneous labour) our rate has shown a steep rise to almost 30% – too high for our own benchmark of wanting to keep it below 20%. On analyzing we found that 10 of the 44 were maternal requests and 7 were non-progress of labour. 25 were performed for presumed fetal compromise. In this group of women, wherever it is possible, we assess fetal scalp lactate levels to help make the right decision. Despite our efforts this group is unacceptably high. We plan to review this group in more detail. In Group 5 (multiparous with previous Caesarean, cephalic presentation, > 37 weeks) 21 opted for a trial of labour, of which 9 (42.9%) had a successful VBAC.
In 2001, Michael Robson proposed a system that classifies women into 10 groups, based on their obstetric characteristics (parity, previous CS, gestational age, onset of labour, fetal presentation and the number of fetuses). Since the system can be applied prospectively and its categories are totally inclusive and mutually exclusive, every woman that is admitted for delivery can be immediately classified based on these few basic characteristics which are usually routinely collected worldwide in obstetric wards. In 2015, WHO2 suggested Robson classification to be used worldwide as an audit tool.