Analysis of caesarean section rates using Robsons ten group classification: the first step

Sowmya Koteshwara, Sujatha M. S.


Background: The Caesarean section (CS) rate is steadily increasing worldwide including India. The overall CS rates are reported but rarely the women are classified. According to WHO Robson ten –group classification is useful as a global standard for assessing, monitoring and comparing cesarean section rates. Our objective was to classify women delivering in our hospital according to various categories as per the 10-group classification (Robsons classification) and analyzing the CS rate in each group.

Methods: This was a cross sectional study conducted at JSS Medical College, Mysore. The data was collected for all women delivering in hospital from January 2016-December 2016 and the women were classified according to Robsons 10 group classification. The proportion of women delivering in each group, the CS rate of each group, and the relative contribution to CS rate from each group was calculated.

Results: Among a total of 5016 women delivering during the study period 37.65% of women were delivered by CS. Maximum no of pregnant women belonged to primigravida group (group 1 and 2). Major contributor to CS rate were primigravida (group 2) at 32.2%. Next contributors were group 5 and group 1 at 28.9 % and 18.6% respectively. Overall the three groups 1, 2 and group 5 contributed to 79.7% of the CS rate while the other group contributed to only 21.3% of CS rate.

Conclusions: Applying Robsons criteria to classify pregnant women allowed for easy classification to identify the category of women most likely to have CS. Reducing primary CS rate and increasing VBAC rates will help to reduce CS rate.



Caesarean rate, Primary CS rate, Robsons classification

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World Health Organization. Monitoring emergency obstetric care: a handbook. Geneva, Switzerland; 2009.

Kambo I, Bedi N, Dhillon BS, Saxena NC. A critical appraisal of cesarean section rates at teaching hospitals in India. Int J Gynecol Obstet. 2002;79:151-8.

Althabe F, Belizán JM. Caesarean section: the paradox. (comment). Lancet. 2006;368(9546):1472-3.

Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ. 2007;335:1025.

McCarthy FP, Rigg L, Cady L, Cullinane F. A new way of looking at Caesarean section births. Aust N Z J Obstet Gynaecol. 2007;47:316-20.

Robson M. Classification of caesarean sections. Fetal Matern Med Rev. 2001;12:23-39.

Robson MS. Can we reduce the caesarean section rate? Best Pract Res Clin Obstet Gynaecol. 2001;15(1):179-194.

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:e14566.

Patel RV, Gosalia EV, KJ, Vasa PB, Pandya VM. Indications and trends of caesarean birth delivery in the current practice scenario. Int J Reprod Contracept Obstet Gynecol. 2014;3:575-80.

Katke RD, Zarariya AN, Desai PV. LSCS audit in a tertiary care center in Mumbai: to study indications and risk factors in LSCS and it’s effect on early perinatal morbidity and mortality rate. Int J Reprod Contracept Obstet Gynecol. 2014;3:963-8.

Le Ray C, Blondel B, Prunet C, Khireddine I, Deneux-Tharaux C, Goffinet F. Stabilising the caesarean rate: which target population? BJOG. 2015;122:690-9.

Kelly S, Sprague A, Fell DB, Murphy P, Aelicks N, Guo Y et al. Examining Caesarean Section Rates in Canada Using the Robson Classification System. J Obstet Gynecol Can. 2013;35(3):206-214.

Wanjari SA. Rising caesarean section rate: a matter of concern? Int J Reprod Contracept Obstet Gynecol. 2014;3:728-31.

Shirsath A, Risbud N. Analysis of cesarean section rate according to Robson’s 10-group classification system at a tertiary care hospital. Int J Sci Res. 2014;3(1):401-2.

Kansara V, Patel S, Aanand N, Muchhadia J, Kagathra B, Patel R. A recent way of evaluation of cesarean birth rate by Robson’s 10-group system. J Med Pharmaceut Allied Sci. 2014;01:62-70.

Russillo B, Sewitch MJ, Cardinal L, Brassard N. Comparing rates of trial of labour attempts, VBAC success, and fetal and maternal complications among family physicians and obstetricians. J Obstet Gynaecol Can. 2008;30(2):123-128.

Stavrou EP, Ford JB, Shand AW, Morris JM, Roberts CL. Epidemiology and trends for Caesarean section births in New South Wales, Australia: a population-based study. BMC Pregnancy Childbirth. 2011;11:8.

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):490-9.

Robson M, Murphy M, Byrne F. Quality assurance: The 10-Group Classification System (Robson classification), induction of labor, and cesarean delivery. Int J Gynecol Obstet. 2015;131:S23-7.