Understanding Cesarean Section Trends A Comparative Study Using Robson Classification in Ethiopian Hospitals

Introduction

Cesarean section (CS) practices have become a central topic in maternal healthcare, raising important discussions around safety, necessity, and healthcare access. A recent comparative analysis conducted in Addis Ababa, Ethiopia, used the globally endorsed Robson’s Ten-Group Classification System (RTCGS) to evaluate CS trends in public and private hospitals.

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Key Findings from the Study

• CS Rate Disparity: The study found a stark contrast in cesarean delivery rates66.8% in private hospitals vs. 34.8% in public hospitals.
• Top Contributing Groups: Robson groups 1, 2, 3, and 5 accounted for over 73% of all CS cases.
• Medical Drivers: While non-reassuring fetal status (NRFS) was the leading cause in public hospitals, previous CS scars dominated private sector indications.

Robson Classification: A Framework for Accountabilit

The World Health Organization supports RTCGS as a tool to monitor cesarean use. The system classifies women into ten groups based on:

• Parity
• Gestational age
• Fetal presentation
• Onset of labor
• Number of fetuses

This enables better cross-institutional comparisons and the identification of trends that may indicate non-medical influences in clinical decision-making.

Public vs Private Hospital Trends

• Private Sector:
  • Higher CS rates often linked to maternal request and non-laboring deliveries.
  • Group 5 (previous CS, singleton, term pregnancies) alone contributed over 26% to the CS rate.
  • Maternal request and pregnancy-induced hypertension were significantly associated with higher CS probability.
• Public Sector:
  • Emphasis on managing deliveries through vaginal birth when possible.
  • NRFS (39.1%) remained the top clinical indication, emphasizing fetal monitoring challenges.

External Reference on Maternal Imaging and Safety

The American College of Obstetricians and Gynecologists (ACOG) supports reducing unnecessary cesarean deliveries and encourages evidence-based labor management strategies to enhance maternal and fetal safety.

(Anchor reference: ACOG Committee Opinion on Cesarean Delivery Rates)

Learn More About the Study

A detailed analysis of this research is available at:
https://doi.org/10.29328/journal.cjog.1001093

The study concludes that efforts to reduce CS rates should target primary cesareans by promoting:

• Safe labor induction protocols
• Vaginal birth after cesarean (VBAC)
• Evidence-driven patient counseling, especially in private facilities

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