Analysis of caesarean rate and indications of university hospitals in sub-Saharan African developing countries using Robson classification system: the case of Cocody’s hospital center, Abidjan-Cote d’Ivoire

Background: According to the World Health Organization (WHO), it has become imperative to monitor caesarean rates in hospitals since these rates continue to increase; WHO recommends this monitoring by the Robson’s system. The study objective was  to describe caesarean rates in a level 3 maternity of developing country using this system, to identify the groups likely increase overall rate of caesarean. Methods: A retrospective and comparative study made in Cocody University Hospital Center (Abidjan-Cote d’Ivoire) over a period of twelve years.  A total of 21,067 women who delivered during this period by caesarean were included. Results: The overall rate of caesarean during the study period was 38.7% with a significant increase from Period I to Period II (34.8 vs. 41.7%; p ˂0.000). The subgroup 2 (nulliparas, single cephalic term pregnancy, caesarean before labor) made the greatest contribution to the overall CS rate with an increase of +5% (10.1 vs. 15.1%; p˂0,000). Women with previous CS (groups 5, 7, 8, 9, 10) increased the caesarean rate of +3.4% (7 vs. 10.4%; p˂0.000). The group 6 increased it of +2.9% (4.7 vs 7.6%; p˂0.000). Caesarean indications were dominated by fetal acute distress (24.5 vs. 22.6%; p˂0,000), then followed by fetal-pelvic disproportion (21.8 vs. 10.7%), severe preeclampsia/eclampsia (13.5 vs. 17.5%; p˂0.000), scarred uterus and breech presentation. Conclusions: Robson classification has identified the groups led to a significant increase in caesarean rates in our service and therefore has good focus our preventive actions.