Audit of caesarean deliveries in a tertiary care hospital of northern Andhra Pradesh using modified Robson criteria

Prabhavathi V., Krishnamma B., Prasad D. K. V., Bhavya K., Satyavathi R.


Background: Today, there is an increased trend in the incidence of caesarean section (CS) rate worldwide particularly in India, even with the lack of evidence supporting considerable maternal and perinatal benefits with higher CS rates. The main objective of our study was to find the incidence of CS rate, auditing the data on the basis of modified Robson criteria, factors responsible for the most common group, to know the changing trends of CS and finally put forth the strategies to reduce CS rate.

Methods: This is a retrospective study of 472 CS cases carried out in a tertiary care hospital during the year 2016. All the cases were grouped according to the modified Robson criteria and the data was analyzed. The data were grouped into 3 different slots of 4 months each (FF = first four months; MF = middle four months and LF = last four months of the year 2016).

Results: A significant increasing trend was observed in the groups of 2B and 5C where as a significant decreasing trend was noticed in 6C and 7C. The most common indications for caesarean delivery were cephalo-pelvic disproportion (CPD) (28%) and fetal distress (22%) in group 1 whereas in group 2A CPD, fetal distress and failed induction were found to be 12%, 24% and 30% respectively.

Conclusions: The change in trend has been noticed in the last few months particularly in 2B and 5C groups suggesting that there is a change in the attitude of obstetricians in conducting caesarean deliveries before the onset of labour rather than performing CS after the onset of labour. Targeting 2B along with 5C would help our efforts in reducing the CS rate.


Caesarean section rate, Data auditing, Modified Robson criteria, Trend

Full Text:



World Health Organization. “Appropriate Technology for Birth”. Lancet. 1985;326(8452):436-7.

Dhillon BS, Chandhiok N, Bhatia BS, Coyaji KJ, Das MC, Das V, et al. Vaginal birth after caesarean section (VBAC) versus emergency caesarean section at teaching hospitals in India: an ICMR task force study. Int J Reprod Contracept Obstet Gynecol. 2014;3(3):592-7.

Hartmann K, Andrews J, Jerome R, Lewis R, Likis F, McKoy J, et al. Strategies to reduce cesarean birth in low-risk women. Agency Healthcare Res Qual (US) 2012; Rep. No. 12(13)-EHC128-EF.

Department of Reproductive Health and Research. WHO statement on Caesarean Section rates, 2015. World Health Organization, Geneva.

Sajjad R, Ali CA, Iqbal A, Sajjad N, Haq MZ. An audit of cesarean sections in Military Hospital Rawalpindi. Anaesth Pain and Intensive Care. 2014;18(2):172-5.

National Institutes of Health Consensus Development conference statement vaginal birth after caesarean: new insight. 2010;115(6):1279-95.

Blanchette H. The rising caesarean delivery rate in America: what are the consequences? Obstet Gynecol. 2011;118(3):687-90.

Menacker F, Hamilton BE. Recent trends in caesarean delivery in the United States. NCHS Data Brief. 2010;(35):1-8.

Betran AP, YE J, Moller AB, Zhang J. The increasing trend in caesarean section rates: global, regional and national estimates:1990-2014. PLoS ONE. 2016;11(2):e0148343.

International Institute for population Sciences, Mumbai. National Family Health Survey (NFHS-1) 1992-93.

International Institute for population Sciences, Mumbai. National Family Health Survey (NFHS-4) 2015-16 India Fact sheet; 2017.

Ye J, Zhang J, Mikolajczyk R, Torloni MR, Gulmezoglu AM, Betran AP. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a world-wide population based ecological study with longitudinal data. BJOG. 2016;123:745-53.

Baghianimoghadam MH, Zolghadar R, Moghadam BB, Darayi M, Jozy F. Related factors to choose normal vaginal delivery by mothers based on Health Belief Model. J Educ Health Promot. 2012;1:17.

National Centre for Health Statistics. Healthy People 2000 Final Review. Hyattsville, MD: Public Health Service; 2001.

U.S. Department of Health and Human Services. Healthy people 2010 2nd ed. With Understanding and improving health and objectives for improving health. 2 vols, Washington, DC: U.S. Government printing office; 2000.

U.S. Department of Health and Human Services. Healthy People 2020. Washington DC; 2011.

Cyr RM. Myth of the ideal cesarean section rate: commentary and historic perspective. Am J Obstet Gynecol. 2006;194(4):932-6.

Resnik R. Can a 29% cesarean delivery rate possibly be justified? Obstet Gynecol. 2006;107(4):752-4.

Robson M, Hartigan L, Murphy M. Methods of achieving and maintaining an appropriate caesarean section rate. Best Pract Res Clin Obstet Gynaecol. 2013;27:297-308.

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. The Lancet. 2010;375(9713):490-9.

Thomas J, Paranjothy S. Royal College of Obstetricians and Gynaecologists, Clinical Effectiveness Support Unit. The National Sentinel Caesarean Section Audit Report. London. RCOG Press; 2001.

Mackenzie IZ, Cooke I, Annan B. Indications for cesarean section in a consultant unit over the decades. J Obstet Gynecol. 2003;23:233-8.

Mylonas I, Friese K. Indications for and risks of elective cesarean section. Dtsch Arztebl Int. 2015;112:489-95.

Sahlin M, Carlander-Klint AK, Hildingsson I, Wiklund I. First-timemothers’ wish for a planned caesarean section: deeply rooted emotions. Midwifery. 2013;29:447-52.

Wiklund I. New guidelines for cesarean section on maternal request. Sex Reprod Healthc. 2012;3:97.

Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecological studies. Reproductive Health. 2015;12:57.