An assessment of the caesarean section rate at Charlotte Maxeke Johannesburg Academic Hospital according to the Robson classification

Abstract

Abstract:

Background: Caesarean section (CS) rates continue to rise worldwide. There is growing concern regarding the possible negative impact on maternal and fetal health.

Objective: To assess the CS rate and its contributors using the Robson ten group classification at Charlotte Maxeke Johannesburg Academic Hospital, a tertiary hospital in Gauteng. In addition, primary postpartum haemorrhage (PPH), neonatal Apgar scores, neonatal ICU admissions and perinatal deaths were recorded in an attempt to audit the service.

Methods: A retrospective review of all deliveries for neonates ≥500g occurring during September and October 2016 was undertaken. 1443 deliveries were assessed. The data was analysed using SPSS version 23 (IBM, NY USA).

Results: There were 730 (50.6%) CS delivering 765 neonates and 713 (49.4%) normal vaginal deliveries (NVD) where 728 neonates were born. The greatest contributor to the CS rate was group 5 (15.8%). 8.3% of women with CS developed PPH with an odds ratio (OR) of 1.861 for PPH at CS (95% CI 1.194-2.900). A significant difference in Apgar scores was found only at 1 minute with higher scores in the NVD group (CS mean=7.74 SD 2.25 and NVD mean=8.10 SD 2.11, p=0.002). Eighty-nine (11.6%) neonates delivered by CS required high care admission with an OR 1.865 (95% CI 1.292-2.692) for neonates delivered at CS.

Conclusion: A rate of 50.6%, which is higher than many international and local rates, may not be justified when reviewing maternal and fetal outcomes. Although an understanding of the possible influences on the CS rate can be obtained, further research into indications for CS and protocol generation regarding ways to optimise this rate are needed.