Analysis of Cesarean Section Rates and Indications Using Robson's Classification at St. Kizito Hospital in Matany, Rural Uganda

Background: Cesarean section (CS) is a vital surgical intervention for addressing obstetric emergencies and it serves as a critical global indicator for evaluating access to obstetric health services. Despite its lifesaving potential, CS is associated with intraoperative and postoperative risks. An increase in CS rates without appropriate indications can lead to higher mortality and morbidity, particularly in resource-limited settings. The Ten Group Classification System (TGCS) facilitates the comparison of CS outcomes across different healthcare facilities and regions, making it a valuable tool for quality assessment. The World Health Organization (WHO) endorses this classification to help healthcare facilities analyze CS rates, compare practices and evaluate care quality. Aim and Objective: This study aims to analyze the distribution of CS at St. Kizito Hospital-Matany (SKHM) through the TGCS, contributing to a better understanding of healthcare practices and a potential improvement of maternal and neonatal outcomes with targeted interventions. Additionally, through a comparison with Mengo Hospital in Kampala, the study aim to assess trends between urban and rural settings evaluating strategies to minimize unnecessary interventions. Material and Methods: This prospective observational study collected data from women who delivered at SKHM between 1 March and 31 August 2024. Information gathered included maternal age, obstetric history, mode of delivery, onset of labor, indications for CS, and the attending staff. Data on newborn outcomes, including birth weight and APGAR scores, were recorded. Exclusion criteria included birth weights under 500 grams and incomplete obstetric records. Data were compiled from patient files, ward registers, and operating theatre logs, and entered a secure electronic database. Each case was classified according to the TGCS, with data analyzed following WHO guidelines. Results were compared to a previous cross-sectional study conducted in an urban setting at Mengo Hospital (Kampala). Results: We included in the study 908 women; CS rate was 26,3%. Classes 3 (43,7%) and 5 (12,1%) were most represented. Class 10 consistently had many cases (11,9%). The highest CS rate on the total was in class 5 (33,6%) with a rate inside the group of 71%. MMR was 0.2%, NDR was 1,1%. At Mengo Hospital the population was similarly distributed, but Group 10 was smaller and CS rate was higher (66%); Group 5 contributed the most to it(35,5%) with a recurrency rate of 98% inside the group; Number of induced labor was higher. Conclusions: Low CS rate in low-risk groups, skilled assistance to breech vaginal deliveries, and relatively low recurrency of CS in class 5 emerged from the data. Comparisons with Mengo Hospital emphasized the results, confirmed the disparities between rural and urban settings and revealed the need to enhance records on induction of labor and management of pre-term high risk pregnancies. Augmentation protocols under cardiotocography for Trial of Labor After Cesarean (TOLAC), cephalic version of breech at term and training for assisted vaginal delivery (operative and breech) appeared to be possible tools to reduce unnecessary CS.