WHO (10 April 2015): Perform Caesarean sections only when medically necessary; Use Robson Classification

The World Health Organization (WHO) has recently (10 April 2015) issued a statement regarding  the globally rising caesarean section rates.

Key messages:

Ideal Caesarean Section (CS) rates:

Since 1985, the ‘ideal rate’ for CS has been considered to be between 10-15%.

Studies indicate that when CS rates rise towards 10% across a population, maternal and newborn deaths decrease. However, when the rates exceed 10%, there is no evidence that mortality rates improve.

Due to their increased cost, high rates of unnecessary caesarean sections can pull resources away from other services in overloaded and weak health systems.

International use of Robson Classification:

The lack of a standardized internationally-accepted classification system to monitor and compare caesarean section rates in a consistent and action-oriented manner is one of the factors that has hindered a better understanding of this trend.

WHO proposes adopting the Robson classification as an internationally applicable caesarean section classification system.

The Robson system classifies all women admitted for delivery into one of 10 groups based on characteristics that are easily identifiable,

The Robson ten-group Classification system:

1. Nulliparous, singleton, cephalic, ≥37 weeks’ gestation, in spontaneous labour

2 Nulliparous, singleton, cephalic, ≥37 weeks’ gestation, induced labour or caesarean section before labour

  2a Nulliparous, singleton, cephalic, ≥37 weeks’ gestation, induced labour

  2b Nulliparous, singleton, cephalic, ≥37 weeks’ gestation, caesarean section before labour

3 Multiparous (excluding previous caesarean section), singleton, cephalic, ≥37 weeks’ gestation, in spontaneous labour

4 Multiparous without a previous uterine scar, with singleton, cephalic pregnancy, ≥37 weeks’ gestation, induced or caesarean section before labour

  4a Multiparous without a previous uterine scar, with singleton, cephalic pregnancy, ≥37 weeks’ gestation, induced labour

  4b Multiparous without a previous uterine scar, with singleton, cephalic pregnancy, ≥37 weeks’ gestation, caesarean section before labour

5 Previous caesarean section, singleton, cephalic, ≥37 weeks’ gestation

6 All nulliparous with a single breech

7 All multiparous with a single breech (including previous caesarean section)

8 All multiple pregnancies (including previous caesarean section)

9 All women with a single pregnancy in transverse or oblique lie (including those with previous caesarean section)

10 All singleton, cephalic, <37 weeks’ gestation pregnancies (including previous caesarean section) 

The WHO proposes the use of the Robson Classification and the computation of CS rates for each group. This will facilitate comparisons within and between groups across populations.

Useful Links:

Link to the WHO News Release:

http://www.who.int/mediacentre/news/releases/2015/caesarean-sections/en/

Link to the WHO Statement on Caesarean Sections:

http://www.who.int/reproductivehealth/topics/maternal_perinatal/cs-statement/en/

Link to a related article in The Lancet (10 April 2015):

http://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(15)70094-X.pdf

Link to a comment in The Lancet on the same topic:

http://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(15)70111-7.pdf

Link to WHO Statement on Caesarean Section Rates (Executive Summary [7 pages- contains a pictorial representation of the Robson 10 group classification system]):

http://apps.who.int/iris/bitstream/10665/161442/1/WHO_RHR_15.02_eng.pdf?ua=1

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