Analysis of caesarean sections with the Robson’s ten group classification system


  • Meka Kamala Laya Department of Obstetrics and Gynecology, Mamata Medical College, Khammam, Telangana, India
  • M. Vijaya Sree Department of Obstetrics and Gynecology, Mamata Medical College, Khammam, Telangana, India



Caesarean section/delivery, Robsons, Classification


Background: Caesarean section rates are increasing globally. For feedback and audit of the caesarean section rate and its optimization in clinical setups worldwide, there was a lack of a classification tool that can be used internationally for which WHO recommended the Robson classification as a tool for monitoring and auditing caesarean delivery rates in 2016.

Methods: All women who underwent caesarean section in our institute were included in our study. Exclusion criteria include all mothers who underwent vaginal delivery in our institute and those women with missing records. The study population included 82 women who underwent caesarean in our hospital during the January 2022 to December 2022 period.

Results: History of previous section was seen in 45 (54.88%) women. Distribution of all deliveries performed during the study period in accordance to Robsons criteria showed majority of women (29.7%) belonged to category 5a and category 10, followed 21 (25.61%) women in category 1. Data did not categorize any women in category 3 and 7. The most common indication for caesarean seen in our study was previous LSCS seen in 39 (47.56%) women.

Conclusions: According to Robsons criteria group 5 and group 10 were the groups found to be majorly contributing the most to the caesarean section in our study. There is a need to evaluate existing management protocols and further studies need to be conducted into the indications of CS and outcomes in our setting are needed to design tailored strategies and improve outcomes.


Chen I, Opiyo N, Tavender E, Mortazhejri S, Rader T, Petkovic J, et al. Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev. 2018;9(9):CD005528.

Souza JP, Gulmezoglu A, 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 and Perinatal Health. BMC Med. 2010;8:71.

Cagan M, Tanacan A, Aydin Hakli D, 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 Fet Neonat Med. 2021;34(11):1695-702.

Betrán AP, Vindevoghel N, Souza JP, Gülmezoglu 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.

Colomar M, Colistro V, Sosa C, de Francisco LA, Betrán AP, Serruya S, et al. Cesarean section in Uruguay from 2008 to 2018: country analysis based on the Robson classification. An observational study. BMC Pregnancy Childbirth. 2022;22(1):471.

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; Geneva (Switzerland): 2017. Robson Classification: Implementation manual. Available from: i/item/9789241513197. Accessed on 1 December 2022.

WHO, UNFPA, UNICEF, AMDD. Monitoring emergency obstetric care: a handbook. Geneva: World Health Organization; 2009.

Abubeker FA, Gashawbeza B, Gebre TM, Wondafrash M, Teklu AM, Degu D, et al. Analysis of cesarean section rates using Robson ten group classification system in a tertiary teaching hospital, Addis Ababa, Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth. 2020;20(1):767.

Bello OO, Agboola AD. Utilizing the Robson 10-group classification system as an audit tool in assessing the soaring caesarean section rates in Ibadan, Nigeria. J West Afr Coll Surg. 2022;12:64-9.

Parveen R, Khakwani M, Naz A, Bhatti R. Analysis of cesarean sections using Robson’s Ten Group Classification System. Pak J Med Sci. 2021;37(2):567-71.

Pravina P, Ranjana R, Goel N. Cesarean audit using robson classification at a tertiary care center in Bihar: a retrospective study. Cureus. 2022;14(3):e23133.

Pourshirazi M, Heidarzadeh M, Taheri M, Esmaily H, Babaey F, Talkhi N, et al. Cesarean delivery in Iran: a population-based analysis using the Robson classification system. BMC Pregnancy Childbirth. 2022;22(1):185.

Khan MA, Sohail I, Habib M. Auditing the cesarean section rate by Robson’s ten group classification system at tertiary care hospital. Profess Med J. 2020;27(4):700-6.

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;4:745-9.






Original Research Articles