Ways to reduce the frequency of cesarean sections using the Robson’s ten group classification system in a tertiary obstetric hospital
Authors:   Novosibirsk State Medical University, Novosibirsk, Russia, Luzan О.D. , Piven L.А. ,   Novosibirsk State Medical University, Novosibirsk, Russia, Khachatryan S.М. ,   State Novosibirsk Regional Clinical Hospital, Regional Perinatal Center, Novosibirsk, Russia, Starikov N.V. ,   Novosibirsk State Medical University, Novosibirsk, Russia, Avdiyuk G.А. ,   Novosibirsk State Medical University, Novosibirsk, Russia, Kozak Yu.V. ,   Novosibirsk State Medical University, Novosibirsk, Russia, Akhmudinova А.А. ,   Novosibirsk State Medical University, Novosibirsk, Russia, Babichev V.K. ,   Novosibirsk State Medical University, Novosibirsk, Russia
Published: September 2024

Introduction. Over the past decades, obstetrics around the world has faced an urgent problem – a significant increase in the prevalence of cesarean sections (CS). In Russia, the proportion of this surgical procedure in the structure of childbirths is steadily increasing. Today, reducing the proportion of CS is considered one of the priorities of the Ministry of Health of the Russian Federation, healthcare officials of obstetric facilities of the Russian Federation, obstetricians-gynecologists of maternity departments at all levels. Aim. A retrospective analysis of maternal records of patients in the Maternity Department of the Regional Perinatal Center (State Novosibirsk Regional Clinical Hospital) for July 2022 using the Robson’s ten group classification system to find possible ways to reduce the frequency of CS in a tertiary obstetric hospital. Materials and methods. The retrospective analysis of 387 maternal records of patients at the Maternity Department of the Regional Perinatal Center (State Novosibirsk Regional Clinical Hospital) in 2022 using the Robson’s ten group classification system. Results. The groups with the maximal and minimal impact on the overall frequency of CS in the tertiary obstetric hospital were identified. In the structure of indications for CS, the most numerous was the group 5a, i.e. every fifth delivery occurred in patients with at least one previous CS. Subject to a number of conditions, in accordance with current clinical guidelines and a professional approach to the management of labor with one previous CS, ensuring safe delivery, it is possible to expand the indications for vaginal delivery in patients with some relative contraindications. Groups 2b and 4b – women previously delivered by CS – have a significant impact on the overall frequency of CS, which is associated with changes in the management tactics of high-risk pregnant women. Reducing the number of CS in these groups is possible only through more careful selection of pregnant women for programmed labor, the use of labor induction methods and rational interdisciplinary management of pathological labor. Group 10 (<37 weeks gestation patients) turned out to be significant. According to current protocols for the management of preterm birth for this group, it is necessary to hold a case conference to clarify the term and mode of delivery, taking into account the gestational age, obstetric state, as well as current clinical protocols. Conclusion. The main reserves for reducing abdominal delivery are groups 5a, 2b, 4b and 10 according to the Robson’s ten group classification system. Expanding the indications for spontaneous labor in patients with previous CS is the main reserve for reducing the proportion of CS. Preterm birth currently does not always involve abdominal delivery. The Robson’s ten group classification system is a robust tool for analyzing the frequency and structure of abdominal deliveries and identifying possible ways to reduce it.