Evaluation of caesarean deliveries using the modified Robson’s classification: a prospective observational study at a tertiary care hospital
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20252742Keywords:
Caesarean section, Obstetric audit, Robson classification, Vaginal birth after caesareanAbstract
Background: Caesarean section (CS) is one of the most frequently performed obstetric procedures, crucial for reducing maternal and perinatal morbidity and mortality when indicated. However, rising global and national CS rates, surpassing the World Health Organization’s recommended 10-15%, have raised concerns about potential overuse. The Robson Ten-Group Classification System (RTGCS) provides a standardized method for auditing and analyzing CS rates. This study aimed to determine the caesarean section rate and identify the Robson groups contributing most to CS rates at a tertiary care hospital in Himachal Pradesh.
Methods: In the Department of Gynecology and obstetrics at Dr. R.P.G.M.C., Kangra (Tanda), a prospective observational study was performed, spanning from May 1, 2024 to October 31, 2024. The study included all pregnant women at 28 weeks of gestation or more who underwent cesarean section. Participants were categorized into ten groups based on the modified Robson classification system. Real-time data collection was followed by statistical analysis using SPSS version 27. Chi-square test was applied, with p<0.05 considered statistically significant.
Results: Among 3755 deliveries, 1296 were caesarean sections, yielding a CS rate of 34.51%. Group 5 (previous CS, singleton, cephalic, ≥37 weeks) was the leading contributor (30.4%), followed by Group 2 (24.5%) and Group 1 (14.5%). Groups 6 and 10 contributed 7.9% and 6.9%, respectively.
Conclusions: The study highlights a high CS rate, with repeat and primary caesareans in low-risk groups as major contributors. Targeted strategies, including reducing primary CS, promoting vaginal birth after caesarean (VBAC), and adopting standardized labour management protocols, are urgently needed.
Metrics
References
Betrán AP, Torloni MR, Zhang JJ, Gülmezoglu AM, Aleem HA, Althabe F, et al. WHO statement on caesarean section rates. Bjog. 2015;123(5):667. DOI: https://doi.org/10.1111/1471-0528.13526
National Family Health Survey (NFHS-5). Available at: https://rchiips.org/nfhs/factsheet_NFHS-5.shtml. Accessed 15 April 2025.
Robson MS. Classification of caesarean sections. Fet Mater Medi Revi. 2001;12(1):23-39. DOI: https://doi.org/10.1017/S0965539501000122
World Health Organization. Robson classification: implementation manual. In: Robson classification: implementation manual; 2017.
Torres JA, Ruiz M, Narvaez A, Mazzoni A, Betran AP. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicounty surveys. Int J Gynecology Obstet. 2015;129(S1):S23-7.
Nair NV, Sathe AV, Mahajan NN, Kadam YR, Deshpande S. Application of Robson ten group classification system for caesarean sections in a medical college hospital in India: a retrospective study. J Clin Diagn Res. 2016;10(3):QC01-4.
Yadav RG, Maitra N, Ghosh S. Critical analysis of caesarean section using Robson’s ten group classification system in a teaching hospital in South Gujarat, India. Int J Reprod Contracept Obstet Gynecol. 2016;5(9):3029-33.
Mishra N, Gupta R, Yadav S, Aggarwal R. Evaluation of caesarean section using Robson’s ten group classification system in a tertiary care hospital in Northern India. Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3283-7.
Villar J, Valladares E, Wojdyla D, Zavaleta N, Carroli G, Velazco A, et al. Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet. 2006;367(9525):1819-29. DOI: https://doi.org/10.1016/S0140-6736(06)68704-7
Sharma R, Thakur PS, Sood A, Gupta R. Analysis of caesarean section rates and its indications according to Robson’s ten group classification system in a tertiary care teaching hospital of Himachal Pradesh, India. Int J Reprod Contracept Obstet Gynecol. 2019;8(8):3113-7.
Chhabra S, Gandhi D, Jaiswal M, Chandrawanshi R. Analysis of caesarean section rates using Robson ten group classification system in a rural medical college of central India. J Obstet Gynaecol India. 2020;70(2):138-43.
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 205: Vaginal birth after cesarean delivery. Obstet Gynecol. 2019;133(2):e110-27. DOI: https://doi.org/10.1097/AOG.0000000000003078
Thomas J, Paranjothy S, Royal College of Obstetricians and Gynecologists Clinical Effectiveness Support Unit. The National Sentinel Caesarean Section Audit Report. Int J Obstet Anesth. 2001;10(4):241-5.
World Health Organization. WHO recommendations: intrapartum care for a positive childbirth experience, 2018. Available at: https://www.who.int/publications/i/item/9789241550215. Accessed 01 June 2025.
Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomized multicenter trial. Lancet. 2000;356(9239):1375-83. DOI: https://doi.org/10.1016/S0140-6736(00)02840-3
Kotaska A. Informed consent and refusal for obstetric intervention: beyond the risks, benefits, and alternatives. Obstet Gynecology Clin North Am. 2019;46(1):61-74.
Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicounty surveys. BJOG. 2015;122(5):661-71. DOI: https://doi.org/10.1016/S2214-109X(15)70094-X
Downloads
Published
How to Cite
Issue
Section
