Benchmarking Cesarean Section Trends: A Case Study from Tu Du Hospital Using Robson's Model.

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Surgical Outcomes

Background:

• Cesarean section (CS) rates are rising globally, with significant increases observed in Vietnam's urban tertiary hospitals.
• Limited standardized data hinders effective interventions to manage high CS rates.
• The Robson 10-Group Classification System offers a standardized approach to analyze CS determinants.

Purpose of the Study:

• To assess Cesarean section (CS) rates and identify key contributing groups using the Robson 10-Group Classification System at Tu Du Hospital, Vietnam.
• To evaluate the utilization and success of vaginal birth after cesarean (VBAC) and trial of labor after cesarean (TOLAC).
• To provide evidence for targeted interventions aimed at reducing unnecessary CS procedures.

Main Methods:

• A cross-sectional descriptive study was conducted over one month in 2017 at Tu Du Hospital.
• Deliveries were classified into Robson's 10 groups based on parity, gestational age, labor onset, presentation, fetal number, and prior CS.
• CS rates, indications, and group-specific contributions were analyzed, with a focus on Group 5 (previous CS) and TOLAC/VBAC utilization.

Main Results:

• The overall CS rate was 42.6% among 5287 deliveries.
• Robson Groups 5 (previous CS), 2 (nulliparous, induced/pre-labor CS), and 1 (nulliparous, spontaneous labor) were the largest contributors to CS.
• Only 22% of eligible women underwent TOLAC, despite a 67% VBAC success rate, indicating significant underutilization of this option.

Conclusions:

• This study provides crucial Robson-based data from Vietnam, identifying specific groups for targeted CS reduction strategies.
• Findings support increased access to VBAC and stricter criteria for labor induction to optimize obstetric outcomes.
• Further research into the behavioral and systemic factors driving high CS rates is recommended to inform national policy development.