Cesearean Section Rates and Adverse Perinatal Outcomes Among Robsons Ten Groups Of Women: A Step Towards A Multidimensional Audit
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Date
2025-10-19
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Addis Ababa University
Abstract
Background
Cesarean section (CS) rates are rising globally, with wide variation across populations. The
World Health Organization recommends the Robson classification system for standardized
monitoring. However, little is known about its association with maternal morbidity and adverse
perinatal outcomes (APO) in Ethiopian referral hospitals.
Methods
We conducted a hospital-based cross-sectional study among 1,100 deliveries across three referral
hospitals in Addis Ababa. Deliveries were classified into the ten Robson groups. Maternal
morbidity and APO (including low Apgar score, NICU admission, advanced resuscitation,
stillbirth, and early neonatal death) were assessed. Logistic regression was applied to identify
independent predictors of APO.
Results
Of the 1,100 deliveries, 566 (51.5%) were by CS. Groups 5 (32.2%), 1 (18.9%), 2 (10.6%),
3(9.4) and 10 (8.8%) were the largest contributors. Maternal morbidity occurred in 25.8% of CS
deliveries, highest in Group 10 (68.0%) and Group 4 (55.9%). The overall APO rate was 19.3%,
with Group 10 (56.0%), Group 6 (47.6%), and Group 8 (36.7%) most affected. In multivariable
regression, gestational age was protective (AOR 0.83 per week, 95% CI 0.75–0.92, p<0.001),
while hypertensive disorders with intrauterine growth restriction (HDP with IUGR) (AOR 6.19,
95% CI 2.34–16.38, p<0.001) and residence outside Addis Ababa (AOR 4.51, 95% CI 1.35
15.07, p=0.02) were significant predictors of APO.
Conclusion
The study demonstrates that high CS rates alone do not equate to poor or good outcomes.
Instead, prematurity, HDP with IUGR, and delayed referral drive adverse results. Robson Groups
10, 6, and 8 carried the greatest perinatal risks, while Groups 4 and 10 had the highest maternal
morbidity. Implementing Robson-based CS audits, strengthening antenatal surveillance for HDP
and IUGR, and improving neonatal care and referral systems are critical to reducing adverse
outcomes.
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Keywords
Cesarean section, Robson classification, maternal morbidity, perinatal outcomes, Ethiopia