Analysis of caesarean section rate using WHO’s Robson’s 10-group classification system: a hospital based retrospective study

Devika V. Desai, Nigamananda Mishra, Santoshi Prabhu, Vaishali Jadhav, Gayatri Savani


Background: Maternal morbidity and mortality has been an utmost priority worldwide as it is an indicator of healthcare system. In order to bring it down, it has become the need of the hour to decrease the number of caesarean sections as it is one of the most common cause of morbidity among women. Every institution should have an audit to determine the rate of caesarean section and corresponding indications in order to implement new protocols or modify existing ones to improve caesarean section rates.

Methods: All women who underwent caesarean section between time period Jan 2015- Dec 2019 were included. All vaginal deliveries were excluded. Delivery and operative registers, logbooks and online entries were used for data collection in the obstetric and gynecologic department. A retrospective data collection was done, tabulated and entered in excel sheet.

Results: Robson’s group 1, group 2, group 5 were the main contributors to overall caesarean section rate. The major indications for caesarean section were found to be as previous caesarean section (33%), non-progress of labor (22%) followed by meconium stained liquor, cephalopelvic disproportion both around 10%.

Conclusions: Robson’s group 1, group 2, group 5 were the main contributors to the overall caesarean section rate. The major indications for caesarean section were found as previous caesarean section and non-progress of labor. Further studies are needed for comparison and to make amendments to protocols.


Caesarean section, Robson’s classification, Retrospective study

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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. PLoS One. 2016;11(2):e0148343.

Robson M. Classification of caesarean sections. Fetal Maternal Med Rev. 2001;12(1):23-39.

Betran AP, Vindevoghel N, Souza JP, Gulmezoglu AM, Torloni MR. 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):e97769.

Torloni MR, Betran AP, Souza JP, Widmer M, Allen T, Gulmezoglu M, et al. Classifications for cesarean section: a systematic review. PLoS ONE 2011;6(1):e14566.

World Health Organization. WHO Statement on Caesarean Section Rates. WHO/RHR/. 2015.

FIGO Working Group on Challenges in Care of Mothers and Infants during Labour and Delivery. Best practice advice on the 10-group classification system for cesarean deliveries. Int J Gynaecol Obstet. 2016;135:232-3.

World Health Organization. Appropriate Technology for Birth. Lancet. 1985;326(8452):436-7.

Radhakrishnan T, Vasanthakumari KP, Babu PK, Vasanthakumari P. Increasing Trend of Caesarean Rates in India: Evidence from NFHS-4. 2017;5(8):26167-76.

Bolognani CV, Reis LB, Dias A, Calderon ID. Robson 10-groups classification system to access C-section in two public hospitals of the Federal District/Brazil. 2018;13(2):e0192997. PLoS ONE.

Yadav RG, Maitra N. Examining Cesarean Delivery Rates Using the Robson’s Ten-group Classification. J Obstet Gynecol India. 2016;66(1):S1.

De, A, Tripathi R, Gupta N. Analysis of cesarean sections using Robsons classification system in a tertiary hospital in New Delhi. Ind J Obstet and Gynec Res. 2020;7(1):7-11.

Elimian A, Figueroa R, Tejani N. Intrapartum assessment of fetal well-being: a comparison of scalp stimulation with scalp blood pH sampling Obstet Gynecol. 1997;89(3):373-6.

Wingert A, Johnsonc C, Featherstone S, Sebastianski M, Hartling L, R, Wilson RD. Adjucnt clinical interventions that influence vaginal birth after cesarean rates: a systemic review. BMC Pregnancy Childbirth. 2018;18(1):452.