Caesarean Deliveries in Internally Displaced Parturients at a Tertiary Hospital in Sub-Saharan Africa: A Five-Year Robson-Based Review
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Keywords
Caesarean Section, Antenatal Care, Robson Classification, Sub-Saharan Africa, Displacement
Abstract
Background: Caesarean section (CS) is a common but important obstetric procedure that saves maternal and neonatal lives when complications occur. However, rising CS rates, especially among vulnerable populations such as internally displaced persons (IDPs), raise concerns about appropriate use, equity, and outcomes.
Aim: This study aimed to assess the frequency, pattern, and outcomes of caesarean deliveries among IDP women in a tertiary hospital in sub-Saharan Africa using the Robson Ten-Group Classification System.
Methodology: A retrospective, descriptive study was conducted at Benue State University Teaching Hospital, Nigeria, Sub-Saharan Africa, over a five-year period (March 2018 to February 2023). Data were obtained from clinical records of 167 IDP women who underwent CS. Deliveries were categorised using the Robson classification. Maternal, foetal, and obstetric characteristics were analysed using descriptive statistics.
Results: The mean age of respondents was 27.3 ± 6.3 years. Most were multiparous (88.0%), married (94.6%), and engaged in farming (74.9%). Only 13.2% were booked for antenatal care. Robson group 3 (multiparous, term, spontaneous labour, no previous CS) was the largest contributor to overall CS (26.3%), followed by group 5 (multiparous with previous CS; 19.2%) and group 7 (multiparous breech; 18.5%). The overall CS rate was 46.5%. Most patients (91.0%) had no postpartum complications. Live births accounted for 87.4% of deliveries, while 10.2% were stillbirths and 2.4% early neonatal deaths. APGAR scores at the 5th minute were ≥7 in 88.5% of cases.
Conclusion: The CS rate among IDP women was high, with Robson group 3 contributing the most, even though composed of women often considered low-risk. These findings show the importance of close monitoring in labour, antenatal care and audit systems to improve outcomes in displaced populations.
References
2. Vidyadhar BB. Caesarean section –why is it performed so often? IOSRPHR. 2012 Jan;2(3):534–6.
3. Butwick AJ, Ramachandran B, Hegde P, Riley ET, El-Sayed YY, Nelson LM. Risk Factors for Severe Postpartum Hemorrhage After Cesarean Delivery: Case-Control Studies. Anesth Analg. 2017 Aug;125(2):523–32.
4. Orazulike N, Alegbeleye J. Pattern and outcome of higher order caesarean section in a tertiary health institution in Nigeria. Int J Trop Dis Health. 2016 Jan 10;17(4):1–6.
5. Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World health report. 2010 Jan 1;30(1):1-31.
6. Isah AD, Adewole N, Zaman J. A five‑year survey of cesarean delivery at a Nigerian tertiary hospital. Tropical Journal of Obstetrics and Gynaecology. 2018 Oct 10;35(1):14-7.
7. O’Heir J. Pregnancy and childbirth care following conflict and displacement: care for refugee women in low-resource settings. J Midwifery Womens Health. 2004 Aug;49(4 Suppl 1):14–8.
8. Jamieson DJ, Meikle SF, Hillis SD, Mtsuko D, Mawji S, Duerr A. An evaluation of poor pregnancy outcomes among Burundian refugees in Tanzania. JAMA. 2000 Jan 19;283(3):397–402.
9. Vural T, Gölbaşı C, Bayraktar B, Gölbaşı H, Yıldırım AGŞ. Are Syrian refugees at high risk for adverse pregnancy outcomes? A comparison study in a tertiary center in Turkey. J Obstet Gynaecol Res. 2021 Apr;47(4):1353–61.
10. United Nations High Commissioner for Refugees. Global forced displacement. Global trends: forced displacement in 2023. United Nations; 2024. p. 6–14.
11. Iorbo R, Sahni SP, Bhatnagar T, Andzenge DT. Social Inclusion and Justice for the Internally Displaced by the Herdsmen-Farmers Conflict in Benue State, Nigeria. J Migr Hum Secur. 2024 Jun;12(2):96–109.
12. Discourse H, Inyang EB, Effiong EN. Humanitarian intervention in Nigeria: A case of internally displaced people in Benue State, 2018–2021. SSRN Electron J. 2022. Available from: https://doi.org/10.2139/ssrn.3998209
13. Savchenko J, Ladfors L, Hjertberg L, Hildebrand E, Brismar Wendel S. A step towards better audit: The Robson Ten Group classification system for outcomes other than cesarean section. Acta Obstet Gynecol Scand. 2022 Jul;101(7):827–35.
14. Ochejele S, Emoekpere H, Nkawu M, Alagh M. Robson classification of Caesarean sections at the Federal Medical Centre, Makurdi. Tropical Journal of Obstetrics and Gynaecology. 2021;38(3):261-5.
15. Bello OO, Agboola AD. Utilizing the Robson 10-Group Classification System as an Audit Tool in Assessing the Soaring Caesarean Section Rates in Ibadan, Nigeria. J West Afr Coll Surg. 2022 Aug 23;12(1):64–9.
16. Makinde OI, Osegi N. Towards Optimizing Caesarean Section: Robson Ten Group Analysis of Caesarean Section and It’s Determinants in a Tertiary Hospital in South-South, Nigeria. J Matern Child Health. 2023 Nov 16;8(6):682–95.
17. Adaeze CJO. Egwu C, Chukwu C, Atibinye Dotimi D. Analysis of Caesarean Delivery in General Hospitals in Sokoto State Using Robson’s Ten Classification: A Cross-Sectional Study. Texila International Journal of Public Health. 2023 Dec 29;11(4):126–39.
18. Akadri AA, Imaralu JO, Salami OF, Nwankpa CC, Adepoju AA. Robson classification of caesarean births: implications for reducing caesarean section rate in a private tertiary hospital in Nigeria. BMC Pregnancy Childbirth. 2023 Apr 12;23(1):243.
19. Malebranche M, Norrie E, Hao S, Brown G, Talavlikar R, Hull A, et al. Antenatal care utilization and obstetric and newborn outcomes among pregnant refugees attending a specialized refugee clinic. J Immigr Minor Health. 2020 Jun;22(3):467–75.
20. Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Lancet. 2000 Oct;356(9239):1375–83.
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