A PEER-REVIEWED JOURNAL OF RESEARCH AND CLINICAL MEDICINEISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
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Using the Robson Classification to Reduce Rates of Cesarean Section and Perinatal Loss in a 3A-Level Hospital

DOI:10.31550/1727-2378-2019-159-4-8-13
For citation: Guriev D.L., Okhapkin M.B., Gurieva M.S., Kabanov I.V., Gurieva D.D., Asadova S.A. Using the Robson Classification to Reduce Rates of Cesarean Section and Perinatal Loss in a 3A-Level Hospital. Doctor.Ru. 2019; 4(159): 8–13. DOI: 10.31550/1727-2378-2019-159-4-8-13

Objective of the Study: To use the 10-group Robson classification to assess the possibility of reducing rates of cesarean section (CS) and perinatal mortality (PM) in a 3A-level obstetrical hospital.

Study Design: This was a retrospective group study.

Materials and Methods: Retrospective analysis was done of the labor and delivery histories of patients, divided into 10 groups according to the Robson classification. A total of 7,629 labor and delivery histories were analyzed, including 3,605 from 2012 and 4,024 from 2017.

Study Results: The rate of CS was 17.1% in 2012 and 16.9% in 2017. The major contributors to the overall CS rate were groups 1 and 5 in 2012 and groups 2 and 5 in 2017. Compared with 2012, the proportion of abdominal deliveries in 2017 was significantly reduced in groups 1, 2, 4, and 5 and significantly higher in group 7. The reason for this reduction was a change in attitudes toward programmed labor. The rate of programmed labor increased from 11.9% in 2012 to 13.6% in 2017; the share of cases based on maternal and fetal indications increased from 37.7% to 72.4%; and the share of cases based on the indication “signs of prolonged gestation” was reduced from 62.3% to 27.6%. The rate of vaginal delivery in women with a history of CS increased from 20.2% in 2012 to 32.8% in 2017. In sum, the measures taken at the Perinatal Center (Yaroslavl) to reduce the rate of CS led to a reduction in the rates of PM by a factor of 1.9, stillbirth by a factor of 1.5, and early neonatal mortality by a factor of 2.9. The CS rate at the perinatal center was the lowest among all hospitals using the 10-group Robson classification.

Conclusion: The following measures are required to reduce the rate of PM and CS in a 3A-level institution: a) analysis of all delivery and labor histories based on the 10-group Robson classification; b) an audit of the indications for programmed labor and CS, especially in full-term pregnancies; c) reduction in the frequency of emergency CS at full term through identifying appropriate candidates for programmed labor and using correct techniques to induce labor; d) containment of the rate of abdominal delivery in women with a history of CS through identifying appropriate candidates for conservative delivery; and e) giving women complete information about the strategies employed by the medical institution for managing labor in women with a uterine scar and the benefits and risks of vaginal delivery in individual patients.

The authors declare that they do not have any conflict of interests.

D.L. Guriev — Regional Perinatal Center; 31B Tutayevskoye Highway, Yaroslavl, Russian Federation 150042. Yaroslavl State Medical University, Russian Ministry of Health, 5 Revolutsionnaya St., Yaroslavl, Russian Federation 150000. E-mail: d_guriev@ mail.ru

M.B. Okhapkin — Yaroslavl State Medical University, Russian Ministry of Health; 5 Revolutsionnaya St., Yaroslavl, Russian Federation 150000. E-mail: doctor.ru@mail.ru

M.S. Gurieva — Regional Perinatal Center; 31B Tutayevskoye Highway, Yaroslavl, Russian Federation 150042. E-mail: guryeva_ms@mail.ru

I.V. Kabanov — Yaroslavl State Medical University, Russian Ministry of Health; 5 Revolutsionnaya St., Yaroslavl, Russian Federation 150000. E-mail: doctor.ru@mail.ru

D.D. Gurieva — Yaroslavl State Medical University, Russian Ministry of Health; 5 Revolutsionnaya St., Yaroslavl, Russian Federation 150000. E-mail: dashaguryeva@gmail.com

S.A. Asadova — Regional Perinatal Center; 31B Tutayevskoye Highway, Yaroslavl, Russian Federation 150042. E-mail: doctor.ru@mail.ru

Доктор.ру
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