International Clinical and Medical Case Reports Journal (ISSN: 2832-5788) | Volume 4, Issue 3 | Research Article | Open Access DOI
Daniel Nkungu*
Daniel Nkungu1,*, Deodata Ruganuza1, Margaret Machange1,Magdalena Focus2,Federica Laurenti3,Esneth Novart1, Pendo Komba1, Paul Kazyoba4, Caroline Damian5, Julius Massaga6, Emanuel G. Rhobi1, and Peter Ng’wagi1
1Morogoro regional referral hospital, Tanzania
2Sight savers- Tanzania
3SolidarMed- Tanzania
4National Institute for Medical Research
5Ministry of Health-Tanzania
6Editorial Office, TPHB
*Correspondence to: Daniel Nkungu
Fulltext PDFIntroduction: Caesarean section (CS) rates have drastically increased globally even among low-risk pregnant women. As a result, more mothers and babies are subjected to potential complications associated with CS. Therefore, the World Health Organization recommends different measures to address over medicalization of CS. The Tanzania DHS 2022 reports a 15% CS rate in Morogoro region.Situation at Morogoro Regional Referral Hospital (MRRH) portrays the same tendency, and necessitatesthe need to review the situation by classifying CS undertaken based on ten group classification byRobson and study its drivers. Therefore, this paper reports CS rates and its drivers for women whodelivered at MRRH based on WHO Robson Classification, from 1st January to 31st December 2022. It also looks into routine admission and delivery data capture tools for completeness and comprehensiveness.
Methodology: A retrospective cross-sectional study conducted at MRRH covering all women who delivered from 1st January to 31st December 2022. Data was collected from MTUHA books number 13and 14 for admission and delivery records from the maternity ward respectively. All patients’ records admitted for delivery during the study period were extracted and entered in a standardized form.MTUHA books were reviewed and examined to identify gaps or shortcomings that might affect full classification of obstetric population based on WHO Robson classification. Data was aggregated usingRobson classification report table and analyzed using excel software, to gain meaningful insight on groupsize, number of CS in each group and absolute contribution of each group to overall CS rate.
Results: The overall CS rate at MRRH was 46.4%, significantly higher than the recommended rate of 10-15%. It was noted that 65.0% of the obstetric population served at MRRH was low-risk women, which is unexpected for a referral hospital. Based on WHO Robson classification, low-risk groups (G1, G2, G3, andG4) contributed 21.7% to the overall CS rate, suggesting potential overuse of CS interventions in thesegroups. Group G5 (previous caesarean section) had the highest contribution to overall CS accounting to18.8%, indicating underutilization of trial of labour after caesarean section (TOLAC) and vaginal birthafter caesarean section (VBAC). Data quality issues were identified, with small group sizes in G2 and G4suggesting incomplete or inaccurate data capture through MTUHA books. These books do not capture information on gestation age, labor onset, lie, presentation, induction of labor of elective CS, so they arenot sufficient for Robson classification.
Conclusions: The rate of CS at MRRH is high, with high proportion of previous CS whereby low-risk group pregnant women are unnecessarily being referred and end up with unnecessary CS. The results had improved our understanding on what could be the reason of the constantly increase in CS rates at the majority of RRHs in Tanzania. Therefore, to minimize this we recommend implementation and observation of the WHO Robson classification manual for consistent monitoring and comparison of CS rates within and across facilities and optimization of CS interventions, as well as promote VBAC or TOLAC, especially among low-risk groups.
Robson classification, cesarean section rate, MRRH, MTUHA
Daniel Nkungu, DeodataRuganuza, Margaret Machange, Magdalena Focus, Federica Laurenti, EsnethNovart, PendoKomba, Paul Kazyoba, Caroline Damian, Julius Massaga, Emanuel G. Rhobi, and Peter Ng’wagi. Robson Classification System for Assessment of Intra-facility Caesarean Section Rates at Morogoro Regional Referral Hospital-Tanzania.Research Article. Int ClincMed Case Rep Jour. 2025;4(3):1-11.