The objective of this study was to analyze Caesarean section (CS) rate trends and maternal and perinatal outcomes in an Ethiopian hospital using Robson criteria groups and subdividing further based on urgency.METHODS:
This was a retrospective study of deliveries at a national referral hospital between 2002/01/01 and 2006/13/05 (Ethiopian calendar) using cluster sampling of deliveries of gestational age ≥28 weeks. (N=4,816). Women were categorized into 10 Robson groups (RGs) with CS deliveries further classified by urgency. Perinatal mortality and neonatal distress rates were used to characterize perinatal outcomes. Maternal morbidity rate was used to characterize maternal outcomes.RESULTS:
The total CS rate rose from 24.5% to 32.8% (p=0.001). The only RG showing a significant change in CS rate was RG1 (15.9% - 24.1%; p= 0.02), which experienced a 51% relative increase. RG1 contributed most to the total CS rate in all 5 years (7.8%), followed by RG3 and RG5. The “Scheduled” urgency subgroup was largest within the majority of RGs. Neonatal outcomes did not significantly change over time. Overall maternal morbidity rate increased from 3.5% to 4.1% (p=0.02).CONCLUSION:
The threshold for medically indicated CS has decreased in this publicly funded hospital, especially in low-risk women. We did not see increased complications, but CS without medical indication can result in harm and strain on already limited resources. As primary CS rates increase, more women will require repeat CS. Evidence-based interventions to reduce primary and repeat CS should be studied and implemented at this Ethiopian hospital.