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JURNAL REVIEW

“SISTEM KLASIFIKASI ROBSON


SEBAGAI PARAMETER SEKSIO CAESARIA”
I Gusti Ayu Ratna Dewi
1361050238

Pembimbing:
dr. Tigor P. Simanjutak, Sp. OG., M. Kes.

KEPANITERAAN ILMU OBSTETRI DAN GINEKOLOGI


PERIODE 24 JULI – 30 SEPTEMBER 2017
FAKULTAS KEDOKTERAN UNIVERSITAS KRISTEN INDONESIA
JAKARTA
2017
Insidensi SC berdasarkan benua
Pendahuluan Insidensi SC di Indonesia

Sectio caesaria (SC) : kelahiran janin melalui


insisi pada dinding abdomen (laparotomi)
dan dinding uterus (histerotomi).

32,3%
standar rata-
rata persalinan 25%
SC di sebuah 19,2%
negara :
5 – 15%
7,3%
31,1%
2015 40,5%
Tidak ada data

OVERUSE Target WHO UNDERUSE

Sumber : :Scheler
Kementerian
A. BrazilKesehatan. Laporan
isn’t the only coutry nasional riset kesehatan
with a startlingly dasarrate:
high c-section 2013where
[internet]. Jakarta:
c-section badan
rates are too litbang kesehatan;
high, and 2013. Available from:
too low. [internet]
ttp://www.litbang.depkes.go.id/sites/download/rkd2013/laporanriskesdas2013.pdf
Huffington Post; 2014. Available from: http://www.huffingtonpost.com/2014/04/16/c-section-rates_n_5161162.html
Diskusi

Jenis sistem klasifikasi persalinan SC:


WHY 12 sistem klasifikasi
• Berdasarkan indikasi

WHEN 5 sistem klasifikasi

• Berdasarkan tingkat urgensi


WHO 4 sistem klasifikasi

• Berdasarkan karakteristik wanita hamil

WHERE, HOW, BY WHOM and combinations 6 sistem klasifikasi


• Lainnya
Diskusi
Pengelompokkan karakteristik wanita hamil
pada sistem klasifikasi Robson
Konsep Obstetrik Variabel
Janin tunggal, presentasi kepala
Janin tunggal, sungsang
Kategori kehamilan
Janin tunggal, oblik atau melintang
Janin multipel
Nullipara
Riwayat obstetrik Multipara tanpa riwayat operasi uterus
Multipara dengan riwayat operasi uterus
Spontan
Jenis persalinan Induksi
SC
Usia kehamilan ≥ 37 minggu
Usia kehamilan
Usia kehamilan ≤ 36 minggu
Sistem Klasifikasi 10-Kelompok Robson (2001)

(1.) Wanita nullipara, janin tunggal, presentasi kepala, usia kehamilan ≥ 37 minggu, dalam persalinan spontan
(2.) Wanita nullipara, janin tunggal, presentasi kepala, usia kehamilan ≥ 37 minggu dengan induksi persalinan atau
dilakukan SC sebelum dalam persalinan
(3.) Wanita multipara, tanpa riwayat operasi uterus sebelumya, janin tunggal, presentasi kepala, usia kehamilan ≥ 37
minggu, dalam persalinan spontan
(4.) Wanita multipara, tanpa riwayat operasi uterus sebelumya, janin tunggal, presentasi kepala, usia kehamilan ≥ 37
minggu dengan induksi persalinan atau dilakukan SC sebelum dalam persalinan
(5.) Wanita multipara, dengan riwayat operasi uterus sebelumya, janin tunggal, presentasi kepala, usia kehamilan ≥ 37
minggu
(6.) Semua wanita nullipara dengan janin tunggal, sungsang
(7.) Semua wanita multipara dengan janin tunggal, sungsang
(8.) Semua wanita hamil dengan janin multipel
(9.) Semua wanita hamil dengan janin tunggal, dengan posisi janin oblik atau melintang
(10.) Semua wanita hamil dengan janin tunggal, presentasi kepala, usia kehamilan ≤ 36 minggu
Sistem Klasifikasi 10-Kelompok Robson (2001)

Identifikasi karakteristik seluruh wanita hamil ke dalam klasifikasi robson,


tanpa terkecuali

Audit prevalensi persalinan SC berdasarkan klasifikasi robson pada suatu


daerah dari waktu ke waktu

Analisis prevalensi wanita hamil dengan risiko rendah


Insidensi SC berdasarkan klasifikasi Robson
Kelompok Klasifikasi Robson
Insidensi persalinan SC
Peneliti
(jml. SC / total persalinan) 1 2 3 4 5 6 7 8 9 10

Makhanya dkk25 1085/2553 (42.4%) 27,4 7,9 15,2 6,1 17,2 9 5 1,6 0 23,4
Chong dkk14 6463/26817 (24.1%) 21,2 8,5 8,2 6,6 27,0 5.3 5.9 5.0 1.3 10.9
Ray dkk18 474/1624 (28.9%) 5.3 17.1 2.5 4.6 28.7 8.4 4.2 16,4 4.2 5.3
Suliman dkk27 776/4224 (18.4%) 32.6 3.5 15.5 5.8 31.8 3.5 3.1 1.6 0.4 2.3
Kazmi dkk28 518/2545 (20.3%) 18.7 9.1 6.4 6.4 33.7 5.8 7.2 5.0 19.4 7.4
Abha dkk6 1355/6548 (20.7%) 40.1 7.7 2.4 3.4 31.9 3.0 2.0 2.6 2.1 4.6
Scarella dkk30 231/627 (36.8%) 15.1 17.3 4.3 7.8 33.3 1.7 5.2 4.3 0.4 10.3
Samba dkk31 4331/9215(46.9%) 5.5 14.2 7.1 14.9 26.7 4.5 6.5 4.4 3.9 12.6
Robson dkk9 1977/9250 (21.4%) 9.0 24.0 1.5 5.5 28.9 10.3 5.7 6.8 1.8 6.42
Panicker dkk10 1038/2500 (41.5%) 13.2 19.6 4.3 4.9 42.8 2.5 1.3 1.0 1.1 9.0
Betran P dkk12 33900/95804 (35.4%) 18.2 15.2 9.0 8.3 26.7 3.7 4.4 2.0 3.9 8.6
Koteshwara dkk17 1889/5016 (37.6%) 18.6 32.2 4.4 3.3 28.9 2.4 1.4 1.4 1.6 5.7
Ciriello dkk32 1503/8420 (17.8%) 13.6 22.2 2.6 3.7 19.3 12.4 3.7 6.9 0.9 14.6
Tanaka dkk24 618/2663 (23.5%) 9.4 12.3 4.2 9.7 46.4 3.4 4.2 3.2 2.3 4.8
Litorp dkk33 42201/137094 (31%) 27.4 1.2 26.2 1.4 25.2 1.1 1.1 4.5 1.1 10.6
Klasifikasi Robson
(+) Kelebihan (-) Kekurangan

Mudah

Jelas Pada data/informasi dengan kualitas yang


kurang baik

Saling eksklusif

Benar-benar inklusif Ketidakmampuan mengevaluasi hubungan


antara tingkat klasifikasi dengan mortalitas dan
morbiditas ibu dan perinatal
Reprodusibilitas

Penerapan bergantung kepada tujuan utama para


profesional yang akan menggunakannya.
Kesimpulan
• Sistem Klasifikasi 10-Kelompok Robson ditetapkan WHO pada tahun 2015 dan
FIGO pada tahun 2016 sebagai standar internasional untuk menilai, memantau,
dan membandingkan insidensi SC dalam suatu daerah.
• Klasifikasi Robson mengelompokkan wanita hamil pada saat persalinan
berdasarkan konsep obstetriknya, yaitu jumlah janin, presentasi janin, riwayat
obstetrik, jenis persalinan, dan usia kehamilan yang kemudian dibagi menjadi 10
kelompok. 46,7 %
• Kelompok 5 merupakan kontributor terbesar terhadap kenaikan insidensi CS.
• Kelebihan sistem klasifikasi Robson dibandingkan sistem klasifikasi lainnya
terletak pada kesederhanaan dan ketegasan desainnya, kemudahan dalam
implementasi, dan validitas data yang digunakan.
Daftar Pustaka
1. Cunningham FG, Leveno KJ, Bloom SL, et al. Cesarean delivery and peripartum hysterectomy. Williams Obstetrics, 23rd ed. New York,McGraw-Hill, 2010.
2. Mylonas I, Friese K. Indications for and risks of elective cesarean indication. Dtsch arztebl int 2015; 112: 489–95.
3. Gonen R, Tamir A, Degani S et al. Variables associated with successful vaginal birth after one cesarean section: a proposed vaginal birth after cesarean section score.Am J Perinatol 2004;21:447-53.
4. Tapia V, Betran AP, Gonzales GF. Caesarean section in peru: analysis of trendsusing the robson classification system. Plos one 11(2): 1 – 18.
5. Betran AP, Vindevoghel N, Souza JP, et al. A systematic review of the robson classification for caesarean section: what works, doesn’t work, and how to improve it. Plos one 2014; 9 (6): 1 – 10.
6. Abha S, Reema C. Recent way of evaluating caesarean birth. J obstet gynecol india 2009; 59(6) : 547-51.
7. Suryati T. Analisis lanjut data riskesdas 2010 persentase opeasi caesaria di indonesia melebihi standard maksimal, apakah sesuai indikasi medis? Buletin penelitian sistem kesehatan 2012; 15(4): 331–338.
8. Vagel JP et al. Use of the robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two who multicountry surveys. Lancet glob health 2015; 3: e260–70 .
9. Robson MS, Hartigan L, Murphy M. Methods of achieving and maintaining an appropriate caesarean section rate. Best practice & research clinical obstetrics and gynaecology 2013; 27: 297–308.
10. Panicker S, Chitra TV. Analysis of caesarean delivery rates using ten group classification system in a tertiary care hospital. Int j reprod contracept obstet gynecol. 2016; 5(9):3153-7 .
11. Farine D, Toronto ON, Shepherd D, regina SK. Classification of caesarean section in canada: the modified robson criteria. J obstet gynaecol can 2012;34(10):976–79 .
12. Betrán AP, Gulmezoglu AM, Robson MS, et al. Who global survey on maternal and perinatal health in latin america: classifying caesarean sections. Reproductive health 2009; 6: 1 – 18.
13. Robson MS. Classification of caesarean sections. Fetal and maternal medicine review 2001; 12:1 23-39.
14. Chong C, Su LL, Biswas A. Changing trends of cesarean section births by the robson ten group classification in a tertiary teaching hospital. Nordic federation of societies of obstetrics and gynecology 2012; 91: 1422–7 .
15.
46,7 %
Costa ML, Cecatti JG, Souza JP, et al. Using a caesarean section classification system based on characteristics of the population as a way of monitoring obstetric practice. Reproductive health 2010; 7:13 .
16. Althabe F, Belizán JM. Caesarean section: the paradox. Lancet 2006; 368(9546): 1472-3 .
17. Koteshwara S, sujatha ms. Analysis of caesarean section rates using robsons ten group classification: the first step. Int j reprod contracept obstet gynecol 2017; 6(8):3481-5 .
18. Kazmi T, Saiseema S, Khan S. Analysis of caesarean section rate – according to robsons 10 group classification. Oman Medical Journal 2012; 27(5): 415-17 .
19. Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. 2016. PLoS ONE 11 (2): e0148343. doi:10.1371/journal.pone.0148343.
20. Festin MR, Laopaiboon M, Pattanittum P, Ewens MR, Henderson-Smart DJ, Crowther CA. Caesarean section in four South East Asian countries: reasons for, rates, associated care practices and health outcomes. BMC Pregnancy and Childbirth 2009; 9(17): 1-17.
21. Betrán AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, Wagner M. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007 Mar; 21(2):98-113.
22. Kementerian Kesehatan. Laporan nasional riset kesehatan dasar 2013 [internet]. Jakarta: badan litbang kesehatan; 2013. Available from: http://www.litbang.depkes.go.id/sites/download/rkd2013/laporanriskesdas2013.pdf
23. Torloni MR, betran AP, souza JP, et al. Classifications for cesarean section: a systematic review. Plos one 2011; 6(1): 1 – 10.
24. Tanaka K, Mahomed K.The ten-group robson classification: a single centre approach identifying strategies to optimise caesarean section rates. Obstetrics and gynecology international 2017;5 : 1 – 5.
25. Makhanya V. Utility of the robson ten group classification system to determine appropriateness of caesarean section at a rural regional hospital in kwazulu-natal, south africa. Samj 2015; 105 (4): 292-5 .
26. Robson MS. Classification of caesarean sections. Cambridge core 2001; 12 (1): 23 – 39.
27. Suliman S, Soma-Pillay P, McDonald AP, Pattinson RC. Factors associated with caesarean section using the Robson Ten Group Classification System. Presented at the 29th Priorities in Perinatal Care Conference, Goudini Spa, Western Cape, 9-12 March 2010.
28. Ray A, Jose S. Analysis of caesarean-section rates according to Robson’s ten group classification system and evaluating the indications within the groups. Int J Reprod Contracept Obstet Gynecol 2017. Feb;6(2): 447 – 51.
29. Betran AP, Torloni MR, Zhang J, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies 2015. Reproductive Health; 12: 57.
30. Scarella A, Chamy V, Sepulveda M, et al. Medical audit using the ten group classification system and its impact on the cesarean section rate. European Journal of Obstetrics and Gynecology and Reproductive Biology 2011; 154: 136 – 40.
31. Samba A, Mumuni K. A Review of Caesarean Sections Using the Ten-group Classification System (Robson Classification) in the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana 2016. Gynecol Obstet (Sunnyvale) 6: 385.
32. Ciriello E, Locatelli A, Incerti M, et al. Comparative analysis of cesarean delivery rates over a 10-year period in a single institution using 10-class classification 2012. The Journal of Maternal-Fetal and Neonatal Medicine; 25(12): 2717 – 20.
33. Litorp H, Kidanto HL, Nystrom L, et al. Increasing caesarean section rates among low-risk groups: a panel study classifying deliveries according to Robson at a university hospital in Tanzania 2013. BMC Pregnancy and Childbirth; 13: 107.
34. Singh A, Das S. A comparative study of efficacy of cervical priming agents. Obstet Gynecol Today 2005;9:519-21.

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