Clinical Significance of Implementing Robson’s Classification at Al-Azhar University Hospital in Assiut

Background: Due to the unexplainable and concerning increase in caesarean section (CS) rates, the WHO suggested Robson classification system as a global standard monitoring system for the trend, to be used between different facilities and within the same facility over time. Objective: This study aimed to assess the clinical significance of the 10 Group Robson classification system in Al-Azhar Assiut University Hospital and its ability to influence our practice. Patients and methods: This study was observational, analytic and longitudinal. The data were collected form patients’ records in the Department of Obstetrics and Gynecology and the Patients’ Affairs Department of Al Azhar Assiut University Hospital through the period from August 2021 to August 2022. All women admitted for delivery were classified using Robson classification. Results: 1200 women were included, 69.4% gave birth by Cesarean section while 30.6% by normal vaginal delivery. The top contributors to CS rate were group 5 with relative contribution of 62.2%, followed by group 2 (2a) with relative contribution of 14.3% then group 4 (4a) with relative contribution of 10.4% and the rest of the groups’ relative contribution ranged from 0 to 2.6%. The top indications for CS in our department were previous CS with 54%, pathological cardiotocography (CTG) (12%) and oligohydramnios (8%). The top indications for the nulliparous women in groups 1 and 2 were cephalopelvic disproportion (CPD) (33%), pathological CTG (21%) and failure of progress (8.5%) while the top indications for the multiparous women in groups 3 and 4 were pathological CTG (43%), Oligohydramnios (27%) and severe preeclampsia (10.3%). Conclusion: Robson’s classification system serves as an outstanding common starting point to compare practices overtime, preform audits, provide feedback and reveal areas of potential interventions to optimize the provided care.