What are the implications of using Robson’s classification system in a Moroccan case study?

Abstract

Today, cesarean section rates are increasing worldwide for varied and complex reasons. To examine this more closely, several countries have adopted the 10-group classification of cesarean sections, also known as the Robson classification. This classification aims to monitor and compare cesarean section rates in a standard, reliable, and indication-based way. In the vision of improving the quality of care and especially rationalizing cesarean section rates, this descriptive and retrospective study, which lasted ten months, considered a population of parturients who had given birth by cesarean section at the maternity ward of the Cheikh Khalifa Hospital in Casablanca. Using Robson’s classification system, data on deliveries can be compared between different regions of Morocco or between different time periods. This allows assessment of trends, geographic outcomes, and temporal variations in environment-related obstetric outcomes, which can help identify specific maternal health issues and develop targeted policies. We first listed all cesarean deliveries and then classified them into ten groups (Robson’s classification) to highlight the contribution of each group to the overall cesarean rate and to explain the discrepancies for which we proposed recommendations. This study considered 890 cases, of which 541 required a cesarean section, a 61% rate higher than that recommended by the WHO (15%) and the national rate (21%). Robson’s classification identified group 10 as contributing most to the overall cesarean rate (43.4%). Namely, this group included singleton pregnancies with a cephalic presentation, gestational age < 37 weeks, and a scarred uterus. This group’s relative size and cesarean section rate were 68% and 63%, respectively. Cesarean section should be considered a surgical procedure, considering the potential maternal and neonatal risks involved and ensuring that the indication for cesarean section is tangible, based on the Robson classification, among other things.