Sivaranjani, K (2022) Analytical study of Robson Classification After its Implementation in a Tertiary Care Hospital. Masters thesis, Coimbatore Medical College, Coimbatore.
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Abstract
There is clear evidence from this finding that repeat LSCS being the major contributor to the overall rate. Failed induction and revised induction protocols will help in reducing the rate of primary c section. ❖ Trial of labour after caesarean section (TOLAC) is the only remedy to decreasing group 5s contribution to caesarean section rates but the criteria for TOLAC has never being straight forward and tends to be at the discretion of individual obstetrician and risk taking attitude. And often times counseling of the patient is undirected towards this attitude. And in the event of untoward outcome, labour wards staffs (residents and midwives) are so chastised so severely that it kills their initiative and boldness to manage such cases appropriately and so they tend to intervene too soon. However, it must be made clear that decreasing the primary caesarean section rates is the key to reducing overall caesarean section rates. And so attempts should be made to perform most caesarean sections for obstetric reasons. For all other groups optimizing maternal health and inducing labour appropriately would work especially for group 10. ❖ Making available blood and blood products as well as emergency drugs would be imperative, not forgetting multidisciplinary approach to patient care. ❖ There has been much concern about the appropriate management of the first stage of labour, when the active phase actually begins and therefore when to intervene. The important thing is to individualize every labour and so long as monitoring is good and mother and fetus are well, don’t set a time limit while patient is in a tertiary center. ❖ However, remember to involve patients in the decision-making process. One wonders looking back, how many patients had caesarean sections on account of prolonged latent phase. And therefore, is history not telling us in a subtle way to be careful at setting time limits for labour. There is the general reluctance to offer ECV despite clear protocols and instruction on the procedure, and yet the surgeon’s knife awaits the breech in labour. Generally the fear and reluctance to carry out ECV is also translated to the fear and reluctance to carry out an assisted vaginal breech delivery. Both skills must be taught and reinforced by whatever means appropriate. ❖ Group 11 which represents unclassified group for various reasons including missing data and hysterectomies contributes a high percentage (13%) to the overall caesarean section rates, this implies the enormous challenge of data collection and cleaning that low resource centers still face. That notwithstanding, excluding group 11 from the analysis did not change the trends and ranking of the groups in their contribution to the overall caesarean section rates, making the forgone discussion still appropriate and valid. ❖ Lack of definition or consensus on the core variables used in the classification: For example, it is necessary to reach an agreement on when labour starts and how to clarify the difference between augmentation (acceleration) versus induction of labour. We therefore recommend that each hospital creates a clear written definition (a glossary) of the variables that may vary in different settings (such as spontaneous onset of labour or induction) and add these definitions as a footnote of the Robson Report Table (see Table 5). Quality of the data used to classify women: If the data used is unreliable, the real value of recommendations based on the classification is questionable. Ensuring good quality of the data should not be taken for granted and it can be challenging even in high resource settings. Misclassification of women in wrong groups: This is a real possibility however you collect your data. In all settings, data collectors need to be carefully trained and audited periodically, for example by another person reviewing and re-classifying a sample of records from women in each of the 10 groups. By looking carefully at the Report Table and following the interpretation rules, users can find important clues about possible misclassification of specific groups. Cases that cannot be classified due to missing data: The size of ―Unclassifiable‖ category is an important indicator of the quality of the data in the individual patient records. The lack of validation of the interpretation rules: A simple set of rules for interpretation was provided by Robson to help users explore all the information provided by this classification, especially when using it to compare data between different settings or changes over time. However, these rules still need to be validated to ensure that the figures proposed (especially regarding expected CS rates per groups) are associated with good maternal and perinatal outcomes. We strongly encourage users of the classification to collect their own data on maternal as well as perinatal morbidity and mortality per Robson group and analyze these data regularly. CONCLUSION: Hence after implementation of Robson classification in a Tertiary care hospital, will help in reducing the caesarean section rates by revising our induction protocols and effective fetal monitoring. So attempts should be made to perform most caesarean sections for obstetric reasons. For all other groups optimizing maternal health and inducing labour appropriately would reduce caesarean section rates. Being a tertiary care hospital, referral centre for all high risk cases, decision regarding delivery will depend on both maternal and fetal indication, there by reducing maternal and neonatal morbidity and mortality.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221816307 |
| Uncontrolled Keywords: | Analytical study, Robson Classification, Implementation, Tertiary Care Hospital. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology > MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 16 Apr 2022 03:34 |
| Last Modified: | 08 Dec 2023 03:20 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/19282 |
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