Experience of implementation of Robson classification at Riga Maternity Hospital

Substantial increase of Caesarean section (CS) in developed countries increase health care costs without significant improvement of perinatal and maternal morbidity. The aim of the study was to analyse the dynamics of delivery patient profile and CS in specific patient groups in order to develop a strategy for reducing CS rate. Since 2011 all deliveries in Riga Maternity hospital were classified according to the Robson classification using the electronic medical data basis. The most important factors influencing the number of CS were searched for and a strategy for changing the labour management was developed. CS section rate in Riga Maternity hospital 2011-2019 was 20.3±1.5%. According to the Robson classification,Group 1 (nulliparous women with a single cephalic pregnancy, ≥37 weeks gestation in spontaneous labour) and Group 3 (multiparous women without a previous CS,with a single cephalic pregnancy, ≥37 weeks gestation in spontaneous labour) were the most represented groups. From 2011 to 2014 Group 1 was the biggest - 34.2±0.7% from all deliveries. The leading position changed - starting from 2015 Group 3 had a dominant role - 33.7±1.6%. Despite the increasing rate of successful vaginal delivery in the group with previous uterine scar from 2.3% in 2011 to 18.6% in 2019,during the whole period the CS of Group 5 had the largest contribution to all deliveries (8.1±0.7%). The second biggest contribution had Group 1 (4.5±0.7%). The profile of patients in the Riga Maternity hospital during last 9 years has changed. The Robson classification is helpful tool for healthcare facilities to identify and analyse delivery patient profile and CS rate within the groups. Although, rate of vaginal delivery after previous CS has increased, the CS rate in the Group 1 stays constant. To develop strategy for decrease of CS rate deeper understanding of reasons of CS in the Group 1 is needed.