Exploring Obstetrical Interventions and Stratified Cesarean Section Rates Using the Robson Classification in Tertiary Care Hospitals in the United Arab Emirates

Abstract Objective The objective of the present study was to explore obstetric management in relation to clinical, maternal and child health outcomes by using the Robson classification system. Methods Data was collected from obstetrics registries in tertiary care hospitals in Dubai, United Arab Emirates (UAE). Results The analysis of > 5,400 deliveries (60% of all the deliveries in 2016) in major maternity hospitals in Dubai showed that groups 5, 8 and 9 of Robson’s classification were the largest contributors to the overall cesarean section (CS) rate and accounted for 30% of the total CS rate. The results indicate that labor was spontaneous in 2,221 (45%) of the women and was augmented or induced in almost 1,634 cases (33%). The birth indication rate was of 64% for normal vaginal delivery, of 24% for emergency CS, and of 9% for elective CS.The rate of vaginal birth after cesarean was 261(6%), the rate of external cephalic version was 28 (0.7%), and the rate of induction was 1,168 (21.4%). The prevalence of the overall Cesarean section was 33%; with majority (53.5%) of it being repeated Cesarean section. Conclusion The CS rate in the United Arab Emirates (UAE) is higher than the global average rate and than the average rate in Asia, which highlights the need for more education of pregnant women and of their physicians in order to promote vaginal birth. A proper planning is needed to reduce the number of CSs in nulliparous women in order to prevent repeated CSs in the future. Monitoring both CS rates and outcomes is essential to ensure that policies, practices, and actions for the optimization of the utilization of CS lead to improved maternal and infant outcomes.

摘要
研究目的：本研究旨在借助Robson分类系统（Robson classification system），探讨产科管理与临床、孕产妇及儿童健康结局的关联。
研究方法：数据采集自阿拉伯联合酋长国（United Arab Emirates，UAE）迪拜地区三级医院的产科登记系统。
研究结果：对迪拜主要妇产医院2016年逾5400例分娩病例（占当年总分娩量的60%）进行分析后显示，Robson分类中的第5、8、9组是总体剖宫产（cesarean section，CS）率的主要贡献群体，占剖宫产总例数的30%。结果表明，2221名（45%）产妇为自然临产，近1634例（33%）接受了产程加强或引产。正常阴道分娩的分娩指征率为64%，急诊剖宫产为24%，择期剖宫产为9%。剖宫产后阴道分娩率为261例（6%），外倒转术（external cephalic version）率为28例（0.7%），引产率为1168例（21.4%）。总体剖宫产率达33%，其中多数（53.5%）为重复性剖宫产。
研究结论：阿拉伯联合酋长国（UAE）的剖宫产率高于全球平均水平及亚洲地区平均水平，这凸显了需加强对孕产妇及其接诊医师的宣教，以推广阴道分娩。需制定合理规划以降低初产妇的剖宫产数量，从而预防未来出现重复性剖宫产。监测剖宫产率及妊娠结局，对于确保优化剖宫产使用的政策、实践与措施能够改善孕产妇及婴儿结局至关重要。