Increasing rates of cesarean section, an upcoming public health problem: an audit of cesarean section in a tertiary care center of North India based on Robson classification

Vinita Das, Namrata Kumar, Varsha Kumari, Anjoo Agarwal, Amita Pandey, Smriti Agrawal


Background: Increasing rates of cesarean section during last three decades has become a cause of alarm since and a need for ongoing studies. Objective of present study was to investigate cesarean section rates as per modified Robsons Criteria and to determine area of concern which requires maximum focus to decrease overall caesarean rate

Methods: This cross sectional study was conducted over a period of one year (From January 2016 to December 2016) in the Department of Obstetrics and Gynecology at King George’s Medical University, Lucknow.

Results: Total number of deliveries for one year was 8526. Out of them, 4275 (50.1%) were vaginal and 4251 (49.9%) were abdominal. Overall maximum caesarean section rate was contributed by group 5 of modified Robsons criteria i.e. previous section, singleton, cephalic, ≥37 weeks (17.7%).

Conclusions: Robson 10 group classification provides easy way in collecting information about Cesarean section rate which obtains good insight into certain birth groups. It is important that efforts to reduce the overall CS rate should focus on reducing the primary CS rate (group 1 and 2) and on increasing vaginal birth after CS (group 5). The caesarean rate is commonest in group 5 that is previous section (17.7%).


Cesarean, Robson, Vaginal birth after cesarean

Full Text:



World Health Organisation. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.

Fatusic J, Hudic I, Fatusic Z, Zildzic-Moralic A, Zivkovic M. Cesarean Section Rate Analysis in University Hospital Tuzla-According to Robson’s Classification. Med Arch. 2016 Jun;70(3):213-16.

Robson MS. Can we reduce the caesarean section rate? Best Pract Res Clin Obstet Gynecol. 2001;15(1):179-94.

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-S27.

Jayot A, Nizard J. Evolution of caesarean categories in a modified Robson classification in a single centre from 2002 to 2012 due to high rate of maternal pathology. J Obstet Gynecol Res. 2016;42(6):648-54.

Yadav RG, Maitra N. Examining Cesarean delivery rates using Robson’s Ten group classification. J Obstet Gynecol India. 2016;66(1):1-6.

Ono T, Matsuda Y, Sasaki K, Satoh S, Tsuji S, Kimura F et al. Comparative analysis of caesarean section rates using Robson Ten Group Classification System and Lorenz curve in the main institutions in Japan. J Obstet Gynecol Res. 2016;42(10):1279-85.

Tan JK, Tan EL, Kanagalingam D, Yu SL, Tan LK. Multiple pregnanciesis the leading contributor to caesarean sections in in vitro fertilization pregnancies: An analysis using the Robson 10 group classification system. J Obstet Gynecol Res. 2016;42(9):1141-5.

Brennan DJ, Robson MS, Murphy M and O’Herlihy C. Comparitive analysis of international caesarean delivery rates using 10- group classification identifies significant variation in spontaneous labour. Am J Obstet Gynecol. 2009;201(3):308.e1-8.

McCarthy FP, Rigg L, Cady L and Cullinane F. A new way of looking at Caesarean section births. Aust N Z J Obstet Gynecol. 2007;47(4):316-20.

Howell S, Johnston T, Macleod SL. Trends and determinants of caesarean sections births in Queensland, 1997-2006. Aust N Z J Obstet Gynecol. 2009;49(6):606-11.

Brennan DJ, Robson MS, Murphy M, O’Herlihy C. The singleton, cephalic nulliparous women after 36 weeks of gestation: contribution to overall caesarean and delivery rates. Obstet Gynecol. 2011;117(2):273-9.

Chong C, Su LL, Biswas A. Changing trends of caesarean section births by the Robson Ten Group Classification in a tertiary care teaching hospital. Acta Obstet Gynecol Scand. 2012;91(12):1422-7.

Triunfo S, Ferrazzani S, Lanzone A, Scambia G. Identification of Obstetrics targets for reducing caesarean section rate using the Robson Ten Group Classification in a tertiary level hospital. Eur J Obstet Gynecol Reprod Biol. 2015;189:91-5.

Tapia V, Betran AP, Gonzales GF. Caesarean section in Peru: analysis of trends using the Robson classification system. PLoS One. 2016;11(2):e0148138.

Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Global Health. 2015;3(5):e260-70.

Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver national institute of child health and human development, society for maternal-fetal medicine, and American college of obstetricians and gynecologists workshop. Obstet Gynecol. 2012 Nov;120(5):1181-93.

Blomberg M. Avoiding the first caesarean section – result of structured organizational and cultural changes. Acta Obstet Gynecol Scand. 2016;95(5):580-6.