Published: 2021-05-27

Analysis of caesarean sections using Robson’s classification system in a tertiary care centre in Northern India: an emerging concept to audit the increasing caesarean section rate

Deepika Jamwal, Pallavi Sharma, Anil Mehta, Jiteshwar Singh Pannu


Background: There has been an increase in rate of caesarean section over last five decades. This is a matter of international public health concern as it increases the caesarean section related maternal morbidity. The aim of the present study was to evaluate that in a new medical college which clinical situation contributed and led to caesarean deliveries as per Robson’s classification system and to audit the increasing rate of caesarean section.

Methods: This study was performed in Government Medical College Kathua in the Union territory of Jammu and Kashmir from November 2020 to April 2021. In the present study, all cases delivered by caesarean section during the period of six months were recorded and classified according to Robson's 10 group classification system.

Results: Out of total 1366 women delivered, 630 underwent CS (46.12%). It was observed that majority of caesarean sections belonged to group 2 and group 5 of Robson criteria. Group 5 comprised of patients with one or more previous caesarean section with cephalic presentation according to Robson criteria and maximum number of caesarean sections done in the present study belonged to this group that is 40.3%. Group 2 that is nulliparous singleton cephalic >37 week induced labour or caesarean section before labour comprised 29.2%. Breech pregnancies (groups 6 and 7) had >90% caesarean rates.

Conclusions: Women with a previous caesarean delivery represent an increasing proportion of caesarean deliveries. Use of the Robson criteria allows standardized comparisons of data and identifies clinical scenarios driving changes in caesarean rates. Hospitals and health organizations can use the Robson 10-Group Classification System to evaluate quality and processes associated with caesarean delivery.


Caesarean section, Robson’s classification

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Hellerstein S, Feldman S, Duan T. China’s 50% caesarean delivery rate: is it too high? BJOG. 2015;122:160-64.

Mazzoni A, Althabe F, Liu NH, Bonotti AM, Gibbons L, et al. Women’s preference for caesarean section: a systematic review and meta-analysis of observational studies. BJOG. 2011;118:391-99.

Tanaka K, Mahomed K. The Ten-Group Robson Classification: A Single Centre Approach Identifying Strategies to Optimise Caesarean Section Rates. Obstet Gynecol Int. 2017;64-8.

Aminu M, Utz B, Halim A, Broek NVD. Reasons for performing a caesarean section in public hospitals in rural Bangladesh. BMC Pregnancy Childbirth. 2014;14:130-31.

Lumbiganon P, Laopaiboon M, Gulmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08. Lancet. 2010;375(9713):490-93.

Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol. 2011;205(3):262e1-8.

Souza JP, Gülmezoglu AM, Lumbiganon P, Laopaiboon M, Carroli G, Fawole B, et al. Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004–2008 WHO Global Survey on Maternal Perinatal Health. BMC Med. 2010;8(1):71.

WHO Statement on Cesarean Section Rates; WHO/RHR/15.02. health/publications/maternal_perinatal_heal th/cs-statement/en/. Accessed on 12 April 2021.

Cagan M, Tanacan A, Hakli AD, Beksac MS. Changing rates of the modes of delivery over the decades (1976, 1986, 1996, 2006, and 2016) based on the Robson-10 group classification system in a single tertiary health care center. J Matern.-Fetal Neonatal Med. 2019;7058:1-8.

Ties B, Carine R, Dessalegn MY, Aluisio BJD, Fernando BC, Liang J et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392(10155)1341-8.

Robson M, Murphy M, Byrne F. Quality assurance: the 10-group classification system (Robson classification), induction of labour and cesarean delivery. Int J Gynecol Obstet. 2015:S23-7.

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):e97.

Makhanya V, Goender L, Moodley J. Utility of Robson ten group classification system to determine appropriateness of caesarean sections at a rural region hospital in Kwazulu-Natal, South Africa. South Africa Med J. 2015;105.

Uniceforg 1. UNICEF DATA.[Online]. Accessed on 12 April 2021.

MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol. 2008;35(2):293-307.

Ray A, Jose S. Analysis of caesarean section according to Robson’s ten group classification system and evaluating the indications within the groups. Int J Reprod Contracept Obstet Gynecol. 2017;6(2):447-51.

Kazmi T, Saiseema SV, Khan S. Analysis of caesarean section rate according to Robson’s 10 group classification, Oman Med J. 2012;27(5):415-7.

Litorp H, Kidanto HL, Nystrom L, Darj E, Essen B. Increasing caesarean section rates among low-risk groups: a panel study classifying deliveries according to Robson at a university hospital in Tanzania. Bio Med Centre Pregnancy Childbirth. 2013;13-17.

Davey MA, King J. Caesarean section following induction of labor in uncomplicated first births a population based cross sectional analysis of 42950 births. Bio Med Central Pregnancy Childbirth. 2016;16:92.

Dhodapkar SB, Bhairavi S, Daniel M, Chauhan NS, Chauhan RC. Analysis of caesarean sections according to Robson’s ten group classification system at a tertiary care teaching hospital in south India. Int J Reprod Contracept Obstet Gynecol. 2015;4(3):745-49.