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Ginekologia i Położnictwo medical project
ISSN 1896-3315 e-ISSN 1898-0759

Increasing Caesarean Section Rates in a Teaching Hospital in Sri Lanka and the use of a Modification of Robson Ten Group Classification System for Caesarean Sections


Abstract

Author(s): Malik Goonewardene, Balakrishna Bhabu, Imali Chethiyawardhan, Sasikade S. Kalinga, Jayamini Wickramasooriya, Ranmalie Dandeniya, Pabashani Gunathilake, Sasini Nirudika Gamage, Yamuna Amarasinghe, Miyuru Manawadu, Dv Priyaranjana

Background. The increasing Caesarean Sections (CS) rates in the Academic Obstetric Unit at Teaching Hospital Mahamodara Galle, Sri Lanka, needed to be studied. Methods. The rates of CS from 1985 to 2014, and the indications for CS during 1999 and 2010 to 2014 were studied. A modified version of Robson 10 Group Classification of CS(TGCS ) was used to study the CS from 1st March to 31st December 2010, 1st July 2011 to 31st March 2012, 1st February 2013 to 31st January 2014 and 1st February to 31st July 2014. Results. The CS rate had increased from 13% in 1985 to31.4% in 2014.In 1999, and 2010 to 2014,previous CS remained as the leading indication for CS while fetal distress and failure to progress in labour as indications decreased. Multiparae at term with one previous CS and a singleton fetus in a vertex presentation (Group 5A), Nullipara having a singleton fetus in a vertex presentation (NTSV) who underwent antepartum CS (Group 2B), NTSV in spontaneous labour undergoing CS (Group 1), NTSV with Induction of Labour (Group 2A) and Multipare with >1 previous CS scarand having a singleton fetus in a vertex presentation (Group 5B) contributed more than 60% of the high CS rates during 2010-2014. Conclusion. The CS rate in the unit had significantly increased from 1985 to 2014.Groups 5A, 2B, 2A, 5B and 1 contributed more than 60% of the high CS rates during 2010- 2014. Indepth analyses are needed to identify the underlying reasons for high CS rates in these groups, to enable the adoption of appropriate measures to reduce the increasing CS rates. Similar studies could be carried in any unit prospectively as well ascomparisons made at local, regional, national and international level.