Caesarean Section Rate Clinical Trial
Official title:
Analysis of Caesarean Section Rate According to the 10 Group Robson Classification; A Multicenter Prospective Study in Egypt
A prospective cross- sectional study will be conducted to implement the Robson Classification to assess, analyze and compare Caesarean section rate of the participating hospital over the period of three months. The Robson implementation manual will be used as a tool guide for the study.
Increase rate of unnecessary caesarean sections has been a growing concern in most parts of
the world. According to the latest survey one in five women in the world now deliver by
caesarean section (CS). The Eastern Mediterranean Region (EMR) with its twenty -two Member
States (MSs) as classified by the World Health Organization is of no exception in this
respect. Within the EMR, Egypt has the highest CS rate of 54%, with no further improvement to
maternal and child mortality rates in Egypt, the association of extremely high CS rate and
its potential benefits has been questioned. This may suggest that although the necessary
numbers of CSs are performed for the population at risk but the rates higher than the
recommended threshold (10-15% according to the WHO) could be the measure of unjustified CSs
in healthy populations . However, determining the adequate caesarean section rate at the
population level - i.e. the minimum rate for medically indicated caesarean section, while
avoiding medically unnecessary operations - is a challenging task. Variations in overall CS
rate between different settings or over time are difficult to interpret and compare because
of intrinsic differences in hospital factors and infrastructure (primary versus tertiary
level), difference in the characteristics of the obstetric population (case mix) served (eg %
of women delivered by previous CS) and difference in clinical management protocols. This is
seen as one of the barriers in better understanding of CS trends and underlying causes. In
order to propose and implement effective measures to achieve optimal CS rates, it is first
essential to identify what groups of women are contributing the most towards overall CS rate
and investigate the underlying reasons for trends in different settings. Like many developing
countries, health care facilities in Egypt have no such standardized internationally accepted
classification system in place to monitor and compare facility based CS rates in a consistent
and action oriented manner.
Policy makers and health organisations have suggested the need for such classification system
that can best monitor and compare CS rates in a standardised, reliable, consistent and
action-oriented manner. WHO proposed the Robson classification system as a global standard
for assessing, monitoring and comparing caesarean section rates within healthcare facilities
over time, and between facilities. It classifies women in 10 groups based on their obstetric
characteristics (parity, previous CS, gestational age, onset of labour, fetal presentation
and number of fetuses) without needing the indication for CS. It gives an opportunity to
evaluate the prevalence of CSs among various groups of women, to compare data between
institutions, learn from each other and to create strategies for better results through audit
and feed back cycle. This classification is clinically relevant and categorizes women
prospectively which in turns allows the implementation and evaluation of interventions
targeted to specific groups. Some studies have shown that if this classification is used on a
regular basis, it can provide critical assessment to change the practice.
Aim: The study aim is, to assess, analyse and compare CSR of the participating hospital over
the period of three months according to the 10 Group Robson classification system
Participating hospitals
1: Ain Shams University Hospital 4: Mataria Teaching Hospital 4: Shatby Alexandria Hospital
5: Benha University Hospital 6: Ahmed Maher Hospital 7: El-Galaa Hospital 8: Alexandria
Hospital 9: Behira Hospital 10:Menia Hospital 11: Luxor Hospital 12: Nada Hospital 13:
Rofayda Hospital
Study design: A prospective cross- sectional study will be conducted to implement the Robson
Classification within the obstetric department of participating hospitals. The Robson
implementation manual will be used as a tool guide for the study.
The study population will include all women with live births and stillbirths of at least 28
weeks gestation at from. Two-study investigator from each participating hospital will be
assigned who will provide the ongoing support during the study period. Participants will be
invited to attend the introductory workshop for the implementation of the Robson
Classification by the study coordinators. Variables necessary to categorise women in to
Robson groups will be collected through the predesigned proforma. These variables will be
used to classify each woman in to Robson groups with the help of a flow diagram. The
collected information will be analyzed on the Excel Sheet to finalize the grouping either
manually or by an automatic calculator.The results of each group will be statistically
analyzed after entering the data in the report and will be sent on a monthly basis by e-mail
or fax to study coordinators.
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| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Completed |
NCT04898244 -
Obstetricians' Views on the Reasons for Egypt's High Caesarean Section Rates
|