الفهرس 
CESAREAN SECTIONOnly 14 pages are availabe for public view
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Abstract
E
gypt has the third highest caesarean section rate (54%) in the world and lacks a standard classification system to analyse caesarean section rates. The World Health Organization (WHO) recommends the Robson classification as an effective caesarean section analysis and monitoring tool.
This exceptionally high caesarean section (CS) rate without a corresponding improvement in maternal and child mortality suggests that although CS is available for populations at risk, numbers of medically unjustified CSs are on the rise.
A systematic review on classifications for CS conducted by the WHO suggests that the 10-group Robson classification system can be used to monitor and compare facility- based CS rates in a consistent and action-oriented manner and determine trends over time. The WHO determined that it is evidence based, and clinically relevant system with clearly defined categories that are totally inclusive and mutually exclusive.
The aim of this study is to report on an analysis of the CS rate, using the 10 group Robson classification in the maternity department of Ain Shams University Hospital, Cairo, Egypt.
This retrospective clinical audit on women who delivered at Ain Shams Maternity hospital was conducted between July 1, 2016 and June 30, 2018. The study population included women giving birth to a live or stillborn baby of at least 28 weeks gestation during the study period. The study used the Robson 10-group classification system to categorise all women giving birth at or more than 28 weeks gestation during our study period. The study used the Robson implementation manual, as a tool guide for the study.
During the study period 15808 women gave birth at the facility, 9175 (58.04%) by CS. Women classified into group 5 (all multiparous women with at least one CS with a single cephalic pregnancy, > or = 37 weeks gestation) made the greatest contribution to the overall CS rate (46.69%relative contribution). On further analysis, 7.02% of these women had one previous CS and 39.67% had a history of previous two or more CS.
Women in group 10 (women with single cephalic pregnancy <37 weeks gestation, including women with previous CS) made the second largest contribution (24.16% relative contribution) to the overall CS rate. This can be explained by the fact that Ain Shams Maternity hospital is one of the largest tertiary referral hospitals in Cairo where most of the population served by the hospital are high risk population, with the increased chance of preterm labour and maternal co morbidities. Women in group 2 (all nulliparous women with single cephalic term pregnancy with induced labour or planned caesarean delivery) made the third most common contribution to the relative rate of CS; with a relative contribution of 8.17%to the overall CS rate. This reflects the high rate of prelabor induction and CS in the high risk population served by the hospital.
Different policies are recommended to face such a high rate of CS; with its entire burden on maternal health and health care system including health care providers. Revising hospital protocols and settings to encourage vaginal birth after caesarean section, induction of labor protocol, instrumental deliveries, indication of caesarean deliveries in high risk population, in a way to prevent primary caesarean section are highly encouraged. Interventions according to the given capacities, resources, and population characteristics are required to optimize the CS rates. Strong political commitment for improved healthcare infrastructure is needed to allow implementation of suggested solutions.