Assessment of indications of caesarean section among high risk women by Robson criteria: a prospective study


  • Kaveri Shaw Patel Department of Obstetrics and Gynecology, Shalby Multispecialty Hospitals, Jabalpur, Madhya Pradesh, India
  • Roma S. Nag Department of Obstetrics and Gynecology, Shalby Multispecialty Hospitals, Jabalpur, Madhya Pradesh, India



High risk LSCS, Induction of labour, IUGR, Pre-eclampsia, Previous section, ROBSON criteria


Background: Caesarean section (CS) is a surgical intervention for safe delivery other than natural vaginal route. World Health Organization (WHO) has recommended ten group classification systems of Robson criteria which we have used to analyse CS at our center. The objective of the study to analyse the lower section caesarian section (LSCS) data under Robson criteria for implementation in regular practice in tertiary care center and to understand the need of it for future practice.

Methods: A prospective analysis done for deliveries in Obstetric Department of Shalby Multispecialty Hospital of central India by Robson ten group classification criteria. The study was carried out for the period of two year from April 2016 to April 2018 including antenatal women attending labour room with high risks or referred cases from other centers.

Results: The study reflected overall 196 live birth of high risk cases which were having other co morbidities like pre-eclampsia, eclampsia, hypothyroidism, diabetes, acute viral hepatitis. The data compared with Robsons guidelines and reflected that the centre is dealing with high risk primigravida (47.51%, 35-42% Robson criteria) cases with high CS rate (16.8%, group 5). There was multiple pregnancy, group 8, (2.32 %, >1.5-2% Robson Criteria) and preterm births as in group 10, 18.02 % (5% in Robson Criteria), exclusively high.

Conclusions: The Robson criteria help to classify the population handled by the canter to develop the strategies for betterment of services. It has limitation in view of qualitative assessment of the data for comorbidities and severity of the disease.


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. Br Med J. 2007;335(7628):1025.

Deneux-Tharaux C, Carmona E, Bouvier-Colle MH, Bréart G Postpartum maternal mortality and cesarean delivery. Obstet Gynecol. 2006;108(3 Pt 1):541-8.

MacDorman MF, Declercq E, Menacker F, Malloy MH,Neonatal mortality for primary cesarean and vaginal births to low-risk women: application of an "intention-to-treat" model. Birth. 2008;35(1):3-8.

Coco L, Giannone TT, Zarbo G. Management of high-risk pregnancy. Minerva Ginecol. 2014;66(4):383-9.

Humphrey MD, Foxcroft KF, Callaway LK. Obstetric risk score-revalidated for triaging high-risk pregnancies in rural areas. Aust NZ J Obstet Gynaecol. 2017;57(1):63-7.

The Robson classification implementation manual, 2015 available at reproductivehealth/topics/maternal_perinatal/robson-classification-implementation/en/

Robson MS. Classification of caesarean sections. Fetal Matern Med Rev.2001;12(1):23-39.

Ioannis Mylonas and Klaus Friese, Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int. 2015;112(29-30):489-95.

Thrombophilia I. Cesarean delivery on maternal request. Obstet Gynecol. 2007;110:1209-11.

Joshi K, Saxena R, Bhat M, Lomrod Y, Verma K. Incidence of cord around the neck and its effects on labour and neonatal outcome. Adv Human Bio. 2017;7(1):15.

Zhang YQ, Zhao W, Chu KT, Zhao Y, Chen LP, Yu Y, et al. A clinical retrospective study on 160 cases of multiple umbilical cord around the neck. Zhonghua yi xue za zhi. 2018;98(15):1166-70.

Kim LH, Cheng YW, Delaney S, Jelin AC, Caughey AB. Is preeclampsia associated with an increased risk of cesarean delivery if labor is induced?. J Mater Fetal Neon Med. 2010 ;23(5):383-8.

Nassar AH, Adra AM, Chakhtoura N, Gómez-Marín O, Beydoun S. Severe preeclampsia remote from term: labor induction or elective cesarean delivery? Am J Obstet Gynecol. 1998 Nov;179(5):1210-3.

Pacher J, Brix E, Lehner R. The mode of delivery in patients with preeclampsia at term subject to elective or emergency Cesarean section. Arch Gynecol Obstet. 2014;289(2):263-7.

Alanis MC, Robinson CJ, Hulsey TC, Ebeling M, Johnson DD. Early-onset severe preeclampsia: induction of labor vs elective cesarean delivery and neonatal outcomes. Am J Obst Gynecol. 2008;199(3):262-e1.

Gupta P, Jahan I, Jograjiya GR. Is vaginal delivery safe after previous lower segment caesarean section in developing country?. Nig Medical J: J Nig Med Assoc. 2014;55(3):260.

Guleria K, Send to, Dhall K.Pattern of cervical dilatation in previous lower segment caesarean section patients. J Indian Med Assoc. 1997;95(5):131-4.

McNally OM, Turner MJInduction of labour after 1 previous Caesarean section. Aust N Z J Obstet Gynaecol. 1999;39(4):425-9.

Rietberg CC, Elferink-Stinkens PM, Visser GH. The effect of the Term Breech Trial on medical intervention behaviour and neonatal outcome in The Netherlands: an analysis of 35,453 term breech infants. BJOG: Int J Obstet Gynecol. 2005; 112: 205-9.

Daviss BA, Johnson KC, Lalonde AB. Evolving evidence since the term breech trial: Canadian response, European dissent, and potential solutions. J Obstet Gynaecol Canada. 2010;32(3):217-24.

Bachhav AA, Waikar M. Low amniotic fluid index at term as a predictor of adverse perinatal outcome. J Obstet Gynecol India. 20141;64(2):120-3.

Muniyar N, Kamble V, Kumar S (2017) IUGR Pregnancies- feto-maternal outcome. Gynecol Obstet (Sunnyvale) 7:440.






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