Rationalizing the use of caesarean section in Egypt through implementing 10 group Classification system

Different authors have created and proposed several types of CS classification systems for use at facility level for different purposes, with the overall aim of providing a consistent and standardized framework to look at CS (27). In 2011 the World Health Organization (WHO) conducted a systematic review that identified 27 different systems to classify CS. These classifications looked at “who” (woman-based), “why” (indication- based), “when” (urgency-based), as well as “where”, “how” and “by whom” a CS was performed. This review concluded that women-based classifications in general, and the 10-Groups classification in particular, were in the best position to fulfill current international and local needs(28)

Unlike classifications based on indications for CS, the Robson Classification is for “all women” who deliver at a specific setting (e.g. a maternity or a region) and not only for the women who deliver by CS. It is a complete perinatal classification.

Since this system can be used prospectively and its categories are totally inclusive and mutually exclusive, every woman who is admitted for delivery can be immediately classified, based on a few basic characteristics which are usually routinely collected by obstetric care providers worldwide. The strength of this classification came from being simple, robust, reproducible, clinically relevant, and prospective.

Values of using Robson Classification

• Identify and analyze the groups of women which contribute most and least to overall

CS rates.

• Compare practice in these groups of women with other units who have more desirable

results and consider changes in practice.

• Assess the effectiveness of strategies or interventions targeted at optimizing the use of

CS.

• Assess the quality of care and of clinical management practices by analyzing outcomes

by groups of women.