Association between Robson classification groups and cesarean delivery: a longitudinal analysis in Mongolia

Ulambayar Shinejil; Junko Kiriya; Akira Shibanuma; Russell Miller; Durrenbileg Avirmed; Masamine Jimba

doi:10.1016/j.xagr.2022.100071

Association between Robson classification groups and cesarean delivery: a longitudinal analysis in Mongolia

AJOG Glob Rep. 2022 Jul 17;2(3):100071. doi: 10.1016/j.xagr.2022.100071. eCollection 2022 Aug.

Authors

Ulambayar Shinejil¹, Junko Kiriya¹, Akira Shibanuma¹, Russell Miller¹, Durrenbileg Avirmed², Masamine Jimba¹

Affiliations

¹ Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Urguu Maternity Hospital, Ulaanbaatar, Mongolia.

Abstract

Background: The number of cesarean deliveries has increased sharply worldwide over the last 3 decades. The World Health Organization recommends using the Robson classification as the best tool for monitoring and auditing cesarean delivery rates and to safely reduce the rate of avoidable cesarean deliveries.

Objective: This study aimed to identify the association between the Robson classification groups and cesarean delivery in 2008 and 2018 at the Urguu Maternity Hospital, Ulaanbaatar, Mongolia, and to examine the changes in this association over 10 years.

Study design: This cross-sectional study was conducted using 21,225 participants' electronic birth records (9544 in 2008 and 11,681 in 2018) from the Urguu Maternity Hospital. Birth records were categorized into 10 groups using the Robson classification report table. Multiple logistic regressions were conducted to examine the association between the Robson classification group and the cesarean delivery rate for 2008 and 2018. The same regression analysis was subsequently conducted using a pooled data set to capture the changes in the association among the Robson classification group, a birth-year dummy, and the cesarean delivery rate.

Results: The odds of having a cesarean delivery when classified in group 1 in 2018 (adjusted odds ratio, 3.02; 95% confidence interval, 1.85-4.94; P<.001) was 3 times greater than that in 2008. Moreover, the odds of having a cesarean delivery when classified in group 2 (adjusted odds ratio, 0.66; 95% confidence interval, 0.51-0.85; P=.001), group 3 (adjusted odds ratio, 0.21; 95% confidence interval, 0.16-0.29; P<.001), or group 4 (adjusted odds ratio, 0.33; 95% confidence interval, 0.25-0.45; P<.001) declined in 2018 when compared with 2008. The odds of having a cesarean delivery were the lowest among mothers classified in group 3 and the highest among mothers in group 5 in both study years.

Conclusion: The high percentage of mothers classified as group 5 who gave birth via cesarean delivery suggests that healthcare providers should work with mothers in group 5 to increase their willingness to give birth vaginally after a previous cesarean delivery in an attempt to reduce the overall cesarean delivery rates. Further research is needed to better understand the factors that may influence the increasing rates of birth through cesarean delivery.

Keywords: 10 group classification; birth mode; cesarean delivery; longitudinal change; surgical birth.