Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

Dr Bismeen Jadoon, a Healthcare Researcher and Consultant Obstetrician and Gynaecologist, discusses caesarean section rates in Egypt.

Doctor holding a baby after a c-section.

Caesarean section (CS) is the most commonly used surgical intervention. A caesarean section rate of 10-15% is associated with a notable decline in maternal and neonatal mortality rate (MMR, NMR). According to the latest evidence, the maternal and neonatal morbidity and mortality secondary to caesarean section are much more devastating in low and middle-income countries due to the limited resources.

Egypt has the third-highest CSR globally after Brazil (55%) and Dominican Republic (58%). The proportion of births by CS in Egypt has increased from 22% in 2000 to 52% in 2014. With such extreme trends, women exposed to CS are at increased risk of complications in their subsequent pregnancy, including abnormal placentation, uterine rupture, blood transfusion, hysterectomy, and death. The financial impact of such a high number of CSS poses a serious threat to Egyptian healthcare expenditure. In 2014, overuse of CS deliveries cost the Egyptian health care system 929,664,000 Egyptian pounds.

Like many developing countries, Egypt's health care facilities have no standardized, internationally accepted classification system to monitor and compare facility-based CS rates in a consistent and action-oriented manner. We used the 10 –Group Robson classification system (TGRCS) in twelve tertiary hospitals of Egypt in 2019 for three months to analyse, assess and compare the CSRs. The 10 Group Robson classification is a global standard classification system recommended by the World Health Organization (WHO) to analyse CSRs. It classifies women in 10 groups based on their obstetric characteristics (parity, previous CS, gestational age, onset of labour, fetal presentation and number of fetuses) without needing the indication for CS. 

Results showed an average CSR of 62%. Group 5 (women with previous CS) was the most significant contributor (57%) to the overall CSR, followed by group10 (preterm births, 13.7%) and group 2 (primipara with induction of labour/ pre-labour CS, 7.9%).

We found that the Robson classification can be implemented effectively in resource limited settings. The careful selection of women and balancing their risks and benefits for the trial of labour after one CS can reduce the risk of having a repeat CS. Qualitative research is required in future to explore the underlying factors for CS in identified groups. 

The full article is under review for publication.

You can access other related articles on our similar work in Egypt with the following references:

  1. Jadoon, B., Mahaini, R. & Gholbzouri, K., 2019. Determinants of over and underuse of caesarean births in the Eastern Mediterranean Region: an updated review. Eastern Mediterranean Health Journal, 25(11), pp.837–846.
  2. Jadoon, B. et al., 2019. Analysis of the caesarean section rate using the 10-Group Robson classification at Benha University Hospital, Egypt. Women and birth: journal of the Australian College of Midwives.

For further information, please email Dr Bismeen Jadoon

Global Surgery Stories

The ethical impacts of international medical electives on local students and patient care

Magdalena Chmura, a former Student Rep of OUGSG and current Foundation Year doctor shares a paper recently published with Dr Shobhana Nagraj.

Supporting exams and training in Ethiopia

Professor Kokila Lakhoo was recently invited to the College of Surgeons of East, Central and Southern Africa (COSECSA) as an external examiner for the Paediatric Surgery Fellowship Exams. In addition to the exams contribution, Professor Lakhoo and colleagues ran the BAPS HG neonatal skills course and a research seminar for beginners and advance participants. Read the full report below.

Our contribution to the Francophone Africa meeting in Cameroon

Professor Kokila Lakhoo reports on the Francophone Africa meeting in Cameroon from 25 to 30 November 2023, which was represented by 10 central African countries. As well as giving a keynote speech and various talks, Professor Lakhoo and colleagues ran the BAPS HG neonatal skills course, Oxford Global Surgery research seminar and a BAPS-Oxford laparoscopic course.

Children’s Surgical Course for regional hospitals in Tanzania

Professor Kokila Lakhoo reports on her latest visit to Tanzania, the first country in Africa chosen by Oxford University Global Surgery Group to host its new Children's Surgical Course.

Women as a driver to address gaps in the global surgical workforce

Isabella Busa, a medical student at the University of Oxford, shares her recently published article written with Dr Shobhana Nagraj as part of the Global Surgery Special Study Theme.

OUGSG members run OX5 for Oxford Children's Hospital

Two of our Oxford University Global Surgery Group (OUGSG) members, Professor Chris Lavy and Dr Shobhana Nagraj, completed the OX5 Run on Sunday 20 March 2022 for the Children’s Centre at the John Radcliffe Hospital.