Associated Factors for Cesarean Sections in Group 1–4 Robson Classification in Phrachomklao Hospital, Phetchaburi

Abstract

          Objective: The aims are to study cesarean section rate and to analyze factors and outcomes of pregnancy associated with cesarean sections in group 1–4 Robson Classification.

          Methods: A retrospective cross-section study was done on the medical records of delivery women in Phrachomklao Hospital from July 2022 to June 2023. The patients were classified to group 1–4 Robson Classification. Data reviewed and collected from 800 women including maternal demographic data, obstetric characteristics, and labor characteristics were reported as number, percentage, mean, and standard deviation. Associated factors for cesarean sections determined by multivariable logistic regression and 95% CI were estimated. Outcomes of pregnancy were compared between those with cesarean sections and vaginal deliveries by using chi-square test.

          Results: Majority of pregnant women were in group 1 Robson Classification (41.3%). The overall cesarean section rate was 40%. Cephalopelvic disproportion (CPD) was the most common indication. The factors associated with cesarean sections were body mass index, as compared to normal body mass index criteria; the incidence decreased to 0.61 times (95% CI 0.45, 0.83; p = .002) and 0.52 times (95% CI 0.34, 0.81; p = .004) in the body mass index were below 18.5 kg/m² and 23–50 kg/m² respectively. The pregnant women, who were overt diabetes mellitus, had increased risk for cesarean section (adjusted OR 6.66, 95% CI 1.06, 41.67; p = .043). Another factor was size of cervical dilation at admission, as compared to cervical dilation of less than or equal to 3 centimeters; the incidence increased to 3.73 times (95% CI 1.94, 7.15; p < .001) in the 4 to 5 centimeters. The outcomes of pregnancy associated with cesarean sections included birth weight of newborn, those requiring neonatal intensive care unit (NICU) admission, those with birth asphyxia, those with hypoglycemia, those with respiratory distress, and those with sepsis; all of which were statistically significant (p < .05).

          Conclusion: The result indicated that body mass index, underlying disease such as overt diabetes mellitus, and size of cervical dilation at admission were associated with cesarean sections in group 1–4 Robson Classification in Phrachomklao Hospital.