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Commentary

The World Health Organization (WHO) previously recommended a population caesarean section rate of 10–15% to ensure mortality rates are kept low for mothers and babies.1 However in 2015, the WHO guidelines were revised. Caesarean section rates at population level can be determined by the type of hospital(s) in that particular area, for example, larger hospitals tend to receive referrals of most complicated pregnancies or deliveries which in turn, may need more caesarean sections. On the other hand, some small facilities may not even be equipped to conduct caesarean sections.2 The WHO recommends that, rather than a population-based estimate of caesarean section rate, the Robson classification (also called the 10-group classification) be used to evaluate and compare caesarean section rates between groups of women.1 3 The Robson classification allows the comparison of caesarean section rates amount births with similar clinical characteristics. This classification system groups women into 10 mutually exclusive groups based on obstetric characteristics, such as parity (number of previous pregnancies), onset of labour, whether there has been a previous caesarean section, and the baby’s gestational age.1 

Further subclassifications in each group have been proposed, the most common  using the classification groups 2 and 4 into induced (2a and 4a) and caesarean section before labour (2b and 4b).4

References

1 Department of Reproductive Health and Research 2015. WHO statement on caesarean section rates. WHO/RHR/15.02. Geneva: WHO. 

2 WHO Statement on Caesarean Section Rates: Frequently asked questions http://www.who.int/reproductivehealth/topics/maternal_perinatal/faq-cs-s...

3 Australian Commission on Safety and Quality in Health Care 2017. The Second Australian Atlas of Healthcare Variation. Sydney.

4. Betrán AP, Vindevoghel N, Souza JP, Gülmezoglu AM1, Torloni MR.​ A systematic review of the Robson classification for caesarean section: what works, doesn't work and how to improve it.PLoS One. 2014 Jun 3;9(6):e97769. doi: 10.1371/journal.pone.0097769. eCollection 2014.

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