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

Grou p

Parit y

Previou s CS

Numb er of fetuses

Fetal presentatio

n or lie

Gestationa l age (weeks)

Onset of labour

1

0

No

1

Cephalic

≥ 37

Spontaneou s

2

0

No

1

Cephalic

≥ 37

Inducedor CSbefore labour

3

≥ 1

No

1

Cephalic

≥ 37

Spontaneou s

4

≥ 1

No

1

Cephalic

≥ 37

Inducedor CSbefore labour

5

≥ 1

Yes

1

Cephalic

≥ 37

Any

6

0

No

1

Breech

Any

Any

7

≥ 1

Any

1

Breech

Any

Any

8

Any

Any

≥

2

Any

Any

Any

9

Any

Any

1

Transverse or Oblique

Any

Any

10

Any

Any

1

Cephalic

< 37

Any

Parity senarios

Robson Group and Explanation

Emergency     cs     for     full     term                              nullipara cephalic single due to fatal distress

Robson 1

G5P4 28 weeks vaginal delivery

10

G4P0+3 spontaneous labor 38 weeks single cephalic

1

G2P1     with     previous                myomectomy         ,for elective CS 38 weeks single cephalic

2 ( only if previous scar uterus due to cs should we consider class 5 )

Onset of labour senarios

G1P0 39 weeks single cephalic presentation in labour (3 contractions /10 min                                                                             and

rupture memberanes )

1

The same previous case ( monitor after 4 hours showed no progress of cervical dilatation so oxytocin was infused for augmentation of labor .will this change the

group

NO still it is group 1

G3P2 gestional DM planned for elective cs on 39 weeks .came on spontaneous labour 38 weeks cephalic single

Group 3 (actual status is spontaneous and the classification always considers howlabourstartedin thecurrent pregnancy, regardless of how delivery wasplanned.

G4P3 full term single cephalic .planned foe

elective cs due to marked oligohydramnios

2

Multiple pregnancy senarios

G2P1 twin first breech

8 ( All women with multiple pregnancies

regardless of the first baby presentation )

G1P0 twin pregnancy at 8 weeks then vanishing twin and at at 39 weeks in spontaneous  labour,  the  live  fetus  is  in

cephalic presentation

1     (     the     current     situation     is        single pregnancy )

A 42 year old multipara (2 previous CS) was diagnosed by ultrasound with a twin pregnancy at 10 weeks. At 31 weeks, she is admitted because of severe preeclampsia and fetal growth restriction, with both fetuses alive. On the second day, one of the fetuses dies. She is immediately taken to the labour ward for a pre-labour CS. The presenting fetus is breech and dead.The surviving fetus is cephalic. How should I classify this woman: in Group 5.2, Group 7 or Group 8?

8 as twin ( the death of one twin occur after medico legal viability age )

Presentation senarios

G4P3 in spontaneous labour at 39 weeks, 5 cm dilated, with ruptured membranes, and a singleton fetus in cephalic presentation with a hand alongside the head. Should I classify her in Group 3 or in Group 9?

This woman should be in Group 3. As long as the presenting part is the fetal head, this is considered a cephalic presentation. Group 9 is only for women in transverse or oblique lie possible with a prolapsed arm which is not the case here.

G1P0 in spontaneous labour at 38 weeks, 8 cm dilated, with a face presentation?

This woman belongs in Group 1. All face, brow or compound cephalic presentations should be categorized in Group 1. As long as the presenting part is the fetal head, this is considered a cephalic presentation.

Fetal age and malformation

G1P0 32 weeks, fully dilated, with a live singleton cephalic fetus and umbilical cord prolapse. Should this woman be classified in Group 1, 10 or Group 9?

Group 10 because it includes all preterm singleton, cephalic pregnancies. Group 1 is not for her because her pregnancy is not at term (37 weeks or more) and Group 9 is only for transverse or oblique lies, which is not her case.

G3P2 previous 2 CS

30 weeks, with severe pre- eclampsia, not in labour, with a dead fetus in breech presentation.

Should this woman be included in the Robson Classification at all since her fetus is dead? If we classify her, does she belong in Group 5, Group 7 or Group 10?

The Robson Classification does not exclude stillbirths; therefore, this woman should be included in the classification.

She belongs in Group 7 because it

includes “All multiparous women with a

single breech including those with

previous CS”. She does not belong in Group 5 or Group 10 because the fetus is breech and these groups only include cephalic presentations.

G3P2 with an anencephalic fetus is admitted at 28 weeks for induction. The fetus is dead and in a cephalic presentation.

Should we classify her at all in the Robson Classification? If we classify her, should she be categorized in Group 2 or Group 10?

The Robson Classification does not exclude malformed or dead fetuses; therefore, this woman should be included in the classification.

She belongs in Group 10, which includes all women with a single cephalic preterm fetus; the fact that the fetal head has a malformation does not change the fact that the presentation is still cephalic. Group 2 is for term, cephalic presentation, which is not the case here.