Caesarean section indications and outcomes at a tertiary level hospital in South Africa

Abstract

Caesarean section rates have increased over the past 30 years and there has been lack of understanding of the drivers of these increased rates. The World Health Organisation has recommended the use of the Robson ten group classification as a system for assessing, monitoring, and comparing caesarean section rates at all levels. AIM : The aim of this study was to determine the indications and caesarean section rate at a tertiary referral hospital. METHODS : This was a retrospective analysis of deliveries between 1 January 2014 and 31 December 2018 at a tertiary level hospital in Pretoria, South Africa. The Robson’s 10 group classification was used in classifying the caesarean sections. RESULTS : A total of 15 295 deliveries took place during the study period: 6 883 women delivered vaginally (NVD) and 8 412 women by caesarean sections (CS). The average CS rate was 55%. Robson’s 10 Group 5 (all multiparous, ≥1 previous CS, ≥ 37 weeks, single cephalic pregnancy) was the greatest contributor to the CS rate (29%). Most women who delivered were between the ages 20-35yrs (n= 12000, 78.6%), with majority delivering via CS deliveries (n=6616, 55.1%) compared to NVDs (n=5388, 44.9%). The CS rate for women with underlying medical disease was 19% and women with hypertensive disorders of pregnancy were the largest contributor to this group (n=1241, 14.8%). The caesarean section rate for women classified as a maternal near miss was 69.6%. There was no statistically significant difference in the rate of postpartum haemorrhage between women who delivered vaginally NVD (n=173) compared to those who delivered by CS (n=245) p=0.132). CONCLUSION : Strategies to reduce the primary caesarean deliveries and steps to improve VBAC success rates should be considered and implemented. In a tertiary hospital, Robson’s 10 group classification alone does not give a full description of the caesarean section rate; other causes like medical conditions need to be considered. Health care workers should follow local guidelines to reduce the risk of complications related to hypertensive disorders in pregnancy.