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DOI: 10.1055/s-0038-1676524
Exploring Obstetrical Interventions and Stratified Cesarean Section Rates Using the Robson Classification in Tertiary Care Hospitals in the United Arab Emirates
Publikationsverlauf
27. August 2018
22. Oktober 2018
Publikationsdatum:
14. März 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00030576/201903/lookinside/thumbnails/10-1055-s-0038-1676524_180280-1.jpg)
Abstract
Objective The objective of the present study was to explore obstetric management in relation to clinical, maternal and child health outcomes by using the Robson classification system.
Methods Data was collected from obstetrics registries in tertiary care hospitals in Dubai, United Arab Emirates (UAE).
Results The analysis of > 5,400 deliveries (60% of all the deliveries in 2016) in major maternity hospitals in Dubai showed that groups 5, 8 and 9 of Robson’s classification were the largest contributors to the overall cesarean section (CS) rate and accounted for 30% of the total CS rate. The results indicate that labor was spontaneous in 2,221 (45%) of the women and was augmented or induced in almost 1,634 cases (33%). The birth indication rate was of 64% for normal vaginal delivery, of 24% for emergency CS, and of 9% for elective CS. The rate of vaginal birth after cesarean was 261 (6%), the rate of external cephalic version was 28 (0.7%), and the rate of induction was 1,168 (21.4%). The prevalence of the overall Cesarean section was 33%; with majority (53.5%) of it being repeated Cesarean section.
Conclusion The CS rate in the United Arab Emirates (UAE) is higher than the global average rate and than the average rate in Asia, which highlights the need for more education of pregnant women and of their physicians in order to promote vaginal birth. A proper planning is needed to reduce the number of CSs in nulliparous women in order to prevent repeated CSs in the future. Monitoring both CS rates and outcomes is essential to ensure that policies, practices, and actions for the optimization of the utilization of CS lead to improved maternal and infant outcomes.
Keywords
obstetrical interventions - cesarean section rate - robson classification - united arab emirates - womenContributions
Abdulrahman M., Tahlak M. A., Hubaishi N. M., and Carrick F. designed the study, performed the data interpretation, wrote the first draft of the manuscript, and critically reviewed the final draft. Abdullah S. S., Alaani A. F. K, AlAbdool N. H., Sherif F. E. Y., Ahmed Z. S., and Al-Rawi H. I. contributed to the recruitment of the files of the patients files, to the data analysis and interpretation, and to the writing the manuscript. Abdulrahman M. and Carrick F. monitored the data analysis and reviewed the manuscript. All of the authors revised the manuscript critically and gave the final approval for the submission for publication.
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References
- 1 Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. the increasing trend in cesarean section rates: global, regional and national estimates: 1990–2014. PLoS One 2016; 11 (02) e0148343 . Doi: 10.1371/journal.pone.0148343
- 2 Appropriate technology for birth. Lancet 1985; 2 (8452): 436-437 . Doi: 10.1016/S0140-6736(85)92750-3
- 3 Vogel JP, Betrán AP, Vindevoghel N. , et al; WHO Multi-Country Survey on Maternal and Newborn Health Research Network. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health 2015; 3 (05) e260-e270 . Doi: 10.1016/S2214-109X(15)70094-X
- 4 Blondel B, Kaminski M. [The increase in multiple births and its consequences on perinatal health]. J Gynecol Obstet Biol Reprod (Paris) 2002; 31 (08) 725-740
- 5 Noguchi A. Lowering the premature birth rate: what the U.S. experience means for Japan. Keio J Med 2008; 57 (01) 45-49 . Doi: 10.2302/kjm.57.45
- 6 Dursun P, Yanik FB, Zeyneloglu HB, Baser E, Kuscu E, Ayhan A. Why women request cesarean section without medical indication?. J Matern Fetal Neonatal Med 2011; 24 (09) 1133-1137 . Doi: 10.3109/14767058.2010.531327
- 7 Scarella A, Chamy V, Sepúlveda M, Belizán JM. Medical audit using the Ten Group Classification System and its impact on the cesarean section rate. Eur J Obstet Gynecol Reprod Biol 2011; 154 (02) 136-140 . Doi: 10.1016/j.ejogrb.2010.09.005
- 8 World Health Organization. Monitoring Emergency Obstetric Care: A Handbook . Geneva: World Health Organization; 2009
- 9 Stoll K, Kornelsen J. Midwifery care in rural and remote British Columbia: a retrospective cohort study of perinatal outcomes of rural parturient women with a midwife involved in their care, 2003 to 2008. J Midwifery Womens Health 2014; 59 (01) 60-66 . Doi: 10.1111/jmwh.12137
- 10 Hartmann KE, Andrews JC, Jerome RN. , et al. Strategies to Reduce Cesarean Birth in Low-Risk Women . Rockville, MD: Agency for Healthcare Research and Quality (US); 2012. . Report No.: 12(13)-EHC128-EF
- 11 Tahlak MA, Abdulrahman M, Hubaishi NM. , et al. Emergency peripartum hysterectomy in the Dubai health system: A fifteen year experience. Turk J Obstet Gynecol 2018; 15 (01) 1-7 . Doi: 10.4274/tjod.55492
- 12 Robson MS. Classification of caesarean sections. Fetal Matern Med Rev 2001; 12: 23-39 . Doi: 10.1017/S0965539501000122
- 13 Hatam N, Tourani S, Homaie Rad E, Bastani P. Estimating the relationship between economic growth and health expenditures in ECO countries using panel cointegration approach. Acta Med Iran 2016; 54 (02) 102-106
- 14 Yazdizadeh B, Nedjat S, Mohammad K, Rashidian A, Changizi N, Majdzadeh R. Cesarean section rate in Iran, multidimensional approaches for behavioral change of providers: a qualitative study. BMC Health Serv Res 2011; 11: 159 . Doi: 10.1186/1472-6963-11-159
- 15 Emamgholipour Sefiddashti S, Homaie Rad E, Arab M, Bordbar S. Female labor supply and fertility in Iran: a comparison between developed, semi developed and less developed regions. Iran J Public Health 2016; 45 (02) 186-193
- 16 Maternity Care Working Party. Making normal birth a reality: Consensus Statement from the Maternity Care Working Party: Our Shared Views About the Need to Recognise, Facilitate and Audit Normal Birth . London: NCT/RCM/RCOG; 2007
- 17 Kinnear A. Towards normal birth in NSW. Women Birth 2011; 24: S2-S3 . Doi: 10.1016/j.wombi.2011.07.027
- 18 Pirhonen J, Samuelsson E, Pirhonen T, Odeback A, Gissler M. Interventional program to reduce both the incidence of anal sphincter tears and rate of Caesarean sections. Eur J Obstet Gynecol Reprod Biol 2018; 223: 56-59 . Doi: 10.1016/j.ejogrb.2018.02.010
- 19 Desai G, Anand A, Modi D. , et al. Rates, indications, and outcomes of caesarean section deliveries: A comparison of tribal and non-tribal women in Gujarat, India. PLoS One 2017; 12 (12) e0189260 . Doi: 10.1371/journal.pone.0189260
- 20 Khunpradit S, Tavender E, Lumbiganon P, Laopaiboon M, Wasiak J, Gruen RL. Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev 2011; (06) CD005528 . Doi: 10.1002/14651858.CD005528.pub2
- 21 Celik F, Cosar E, Akbas P. , et al. Cesarean section: requested mode of delivery?. Clin Exp Obstet Gynecol 2017; 44 (01) 85-87 . Doi: 10.12891/ceog3272.2017
- 22 Behruzi R, Hatem M, Fraser W, Goulet L, Ii M, Misago C. Facilitators and barriers in the humanization of childbirth practice in Japan. BMC Pregnancy Childbirth 2010; 10: 25 . Doi: 10.1186/1471-2393-10-25