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 classifi cation 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 classifi cation 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 classifi ed
as a maternal near miss was 69.6%. There was no statistically signifi cant 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 classifi cation 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.