Impact of the COVID-19 Pandemic on Overall Cesarean Section Rate as Classified by the Robson Classification
Yada Supparoekchartkul, MD1, Arinporn Imruetaicharoenchok, MD1
Affiliation : 1Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Objective: To evaluate the impact of the COVID-19 pandemic on cesarean section (CS) rates, using the Robson classification between pre-pandemic and pandemic periods at a university hospital in Thailand.
Materials and Methods: This retrospective comparative study was conducted at the Faculty of Medicine Vajira Hospital, Navamindradhiraj
University, Bangkok, Thailand. Data were collected from pregnant women who delivered during the pre-COVID-19 period (October 2018 to
September 2019) and the COVID-19 period (October 2020 to September 2021). Pregnant women were classified into 10 groups according to the Robson classification. Maternal demographics, obstetric data, and neonatal outcomes were extracted from electronic medical records. Chi-squared and t-tests were used for statistical comparisons, with a p<0.05 considered significant.
Results: The present study included 3,649 women, 2,002 in the pre-pandemic group and 1,647 in the pandemic group. The overall CS rate
remained stable (37.56% vs. 36.49%, p=0.505). Robson groups 5a, 1, 2b remained the most prevalent group contributing to the overall CS rate, and groups 2b, 4b, 5b, and 9 had 100% CS rates in both periods. However, significant shifts in the onset of labor were observed: spontaneous labor decreased (78.7% vs. 72.6%, p<0.0001), while induced labor (5.0% vs. 8.2%, p=0.0001) and pre-labor CS (16.3% vs. 19.2%, p=0.0235) increased during the pandemic.
Conclusion: While the COVID-19 pandemic did not significantly impact overall CS rates, which remained above WHO recommendations and with a relatively stable distribution of cases within the Robson classification groups, it was associated with significant shifts in labor onset. Notably, spontaneous labor decreased while induced and pre-labor CS increased.
Received 20 May 2024| Revised 4 February 2025 | Accepted 25 February 2025
Keywords : COVID-19; Cesarean section; Robson classification; Onset of labor; Pandemic; Pregnancy; Thailand
