USE OF ROBSON CLASSIFICATION FOR ANALYSIS THE WORKOF MUNICIPAL STATE ENTERPRISE ON THE RIGHTOF ECONOMIC MANAGEMENT "PAVLODAR REGIONAL PERINATALCENTER №1" AND FINDING WAYS TO REDUCE THE FREQUENCYOF SURGICAL INTERVENTION

Abstract

Introduction. Caesarean section (CS) is the most common operation in the world, the rate of which, according to WHO,
has reached a maximum in the last decade and amounted to 25-30% in economically developed countries [14]. In many
countries, there is growing concern among obstetrician-gynecologists about the increasing frequency of long-term
complications after one or more CS operations, such as placenta ingrowth, placental retention in the uterus after childbirth,
and uterine rupture with possible subsequent hysterectomy [22].
The aim. Retrospective analysis of work of Municipal state enterprise on the right of economic management "Pavlodar
regional perinatal center №1" in 2018 by using Robson classification in order to find ways to reduce the frequency of CS in
the hospital of 3rd level.
Materials and methods: Study design - retrospective study. Аnalysis of childbirth histories of patients of Municipal state
enterprise on the right of economic management "Pavlodar regional perinatal center №1" in 2018 by using of Robson
classification and analysis of indications for operative delivery in accordance with the Robson classification.
The total number of analyzed birth histories in 2018 year was equal to 4101, from which caesarean section deliveries
were 1106 (26.97%). The formation of a database of research and calculation of statistical indicators has been produced with
the help of a licensed program SPSS 20.0 (IBM Ireland Product Distribution Limited, Ireland). For the statistical results using
Student's t-test.
Results. In Municipal state enterprise on the right of economic management "Pavlodar regional perinatal center №1" for
2018, the increase in the frequency of CS with respect to the total number of operative births occurs mainly due to 3 groups:
multiparous with a scar on the uterus - 498 (45.03%) № 5; women with gestational age ≤ 36 weeks -140 (12.66%) №10;
primiparous, elective CS or induced labor- 93 (8.41%) №2.
The smallest number of abdominal delivery in relation to the total number of operative delivery is presented in the
following 3 groups: women with a single pregnancy with a transverse or oblique position of the fetus, including women with a
scar on the uterus -15 (1.36%) №9; primiparous with singleton pregnancies in pelvic presentation of the fetus -50 (4.52%)
№6; multiparous, without a scar on the uterus with a gestational period ≥ 37 weeks, singleton pregnancy, head presentation
of the fetus, induced labor or elective CS -51 (4.61%) №4.
It should be noted that among the 10 groups represented by Robson, the largest number was in the category of
multiparous women with a scar on the uterus- 498 (45.03%) №5, and the smallest in the group of women with a single
pregnancy , including women with a scar on the uterus -15 (1.36%) №9.
Conclusion. The share of the caesarean section in the total structure of delivery methods in Municipal state enterprise
on the right of economic management "Pavlodar regional perinatal center №1" for 2018 was 1106 (26.97%), wherein the
most dynamic over a given period of time was multiparous group with scar on the uterus - 498 (45.03%) №5.
In this regard, in our opinion, to prevent the growth of the share of abdominal delivery or to reduce it in the hospital of 3rd
level a change is required in the management of pregnant women and parturients. Reducing the frequency of CS in group 5
is a reserve for restraining the growth of abdominal delivery, because over time the number of women with a scar on the
uterus will increase. In order to reduce the number of births by the operation of the CS in this group, efforts should be
directed to increase the frequency of delivery through the birth canal in women with a scar on the uterus.
The Robson classification can facilitate the analysis of the distribution of women into groups and subgroups, thereby
revealing the dynamics of changes in the field of application of caesarean section and the features of the clinical
characteristics of pregnant women.