Application of Robson's classification in clinical practice: a tool for quality improvement in obstetrics

Authors

  • Nafeesa Farheen S. K. Department of Obstetrics and Gynaecology, Vydehi Institute of Medical Science and Research Center, Bengaluru, Karnataka, India
  • Shravya Monica K. Department of Obstetrics and Gynaecology, Vydehi Institute of Medical Science and Research Center, Bengaluru, Karnataka, India
  • Priya Chhikara Department of Obstetrics and Gynaecology, Vydehi Institute of Medical Science and Research Center, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20251750

Keywords:

Robson’s classification, High caesarean rates, VBAC

Abstract

Background: The global rise in caesarean section (CS) rates has raised concerns regarding the overuse of the procedure in low-risk pregnancies, leading to potential maternal and neonatal risks. Robson’s classification offers a standardized method to assess CS rates and identify the groups contributing most to these high rates, facilitating targeted quality improvement interventions.

Methods: A retrospective observational study was conducted at Vydehi Institute of Medical Sciences, Bengaluru, from June 2024 to December 2024, including 265 deliveries. Data were collected from the hospital's obstetric registry, and studies under Robson’s classification.

Results: The overall CS rate was 54.7%, with 145 out of 265 deliveries being caesarean sections. The highest CS rates were observed in two groups, group 5 (multiparous women with a previous CS, 80%) and group 8 (all multiple pregnancies, including previous CS, 80%). Group 6 showed a 66.7% CS rate (nulliparous breech presentations). Groups 2 and 4 (induced labour) also exhibited elevated CS rates, with 62.5% and 50.0%, respectively. Lower CS rates were noted in multiparous women with spontaneous labour (group 3), which had a rate of 30%. The data revealed that induction of labour and previous caesarean sections were significant contributors to higher CS rates.

Conclusions: The study highlights the specific high-risk groups to the overall CS rate. The findings emphasize the need for targeted interventions to reduce unnecessary CS while maintaining maternal and neonatal safety. Future efforts should focus on promoting vaginal birth after caesarean (VBAC).

 

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References

Ye J, Betrán AP, Guerrero Vela M, Souza JP, Zhang J. Searching for the optimal rate of medically necessary cesarean delivery. Birth. 2014;41(3):237-44. DOI: https://doi.org/10.1111/birt.12104

Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, et al; WHO Multi-Country Survey on Maternal and Newborn Health Research Network. 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(5):e260-70. DOI: https://doi.org/10.1016/S2214-109X(15)70094-X

World Health Organization. Neonatal and Perinatal Mortality Country, Regional, and Global Estimates. 2006. Available at: https://www.who.int/maternal _child_adolescent/documents/9789241563587/en/. Accessed on 15 April 2025.

Robson M, Murphy M, Byrne F. Quality assurance: The 10-Group Classification System (Robson classification), induction of labor, and cesarean delivery. Int J Gynaecol Obstet. 2015;131(1):S23-7. DOI: https://doi.org/10.1016/j.ijgo.2015.04.026

Wahane A, Ghaisas AS. Analysis of caesarean sections according to Robson’s criteria at a tertiary care teaching hospital in central India. Int J Reprod Contracept Obstet Gynecol. 2020;9(10):4221. DOI: https://doi.org/10.18203/2320-1770.ijrcog20204317

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. DOI: https://doi.org/10.7759/cureus.23133

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. DOI: https://doi.org/10.1371/journal.pone.0014566

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;6(2):447-53. DOI: https://doi.org/10.18203/2320-1770.ijrcog20170066

American College of Obstetricians and Gynecologists (College); Society for Maternal-Fetal Medicine; Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014;210(3):179-93. DOI: https://doi.org/10.1016/j.ajog.2014.01.026

Goleman D, Boyatzis R, McKee A. Robson Classification, Implementation Manual. J Chem Informat Model. 2019;59(3):1689-99.

Shankar P, Raju V. A clinical study on the analysis of caesarean section rates using Robson's ten group classification in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol, 2019;8(2):488-93. DOI: https://doi.org/10.18203/2320-1770.ijrcog20190032

Reddy AY, Dalal A, Khursheed R. Robson ten group classification system for analysis of cesarean sections in an Indian hospital. Res J Obstet Gynecol. 2018;11(1):1-8. DOI: https://doi.org/10.3923/rjog.2018.1.8

Renukadevi OBMHN. One-year study of caesarean section rate in Govt. District Hospital with Robson TEN Group Classification. Int J Sci Res. 2018;7(1):110-4.

Kazmi T, Saiseema S 5th, Khan S. Analysis of Cesarean Section Rate - According to Robson's 10-group Classification. Oman Med J. 2012;27(5):415-7. DOI: https://doi.org/10.5001/omj.2012.102

American College of Obstetricians and Gynecologists. Safe prevention of the primary cesarean delivery. 2014. Available at: https://www. acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2014/03/safe-prevention-of-the-primary-cesarean-delivery. Accessed on 15 April 2025.

Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015;2015(7):CD000166. DOI: https://doi.org/10.1002/14651858.CD000166.pub2

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Published

2025-06-05

How to Cite

S. K., N. F., K., S. M., & Chhikara , P. (2025). Application of Robson’s classification in clinical practice: a tool for quality improvement in obstetrics. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 14(7), 2145–2149. https://doi.org/10.18203/2320-1770.ijrcog20251750

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Original Research Articles