Analysis of Caesarean section rate in a government teaching institute based on Robson’s ten group classification

Kavita Sambharam, Mansi Lalit Verma, Pradip W. Sambarey


Background: Caesarean section rate is a qualitative health care indicator in India. With increasing rates of caesarean sections and no defined method to audit present institutes it is the need of the hour to use tools like Robson’s classification to understand present system. The aim of this study was to determine the rate and analyse Caesarean sections in a tertiary care institute using Robson’s ten group classification system.

Methods: This is a retrospective analytical study in which all Caesarean section done over a period of 3 years (July 2014-June 2017) were included which were performed in single unit (out of 6) of Department of Obstetrics and Gynecology of Sassoon General Hospital. Women were classified in 10 groups according to Robson’s classification, using maternal characteristics and obstetrical history. For each group, authors calculated its relative size and its contribution to the overall caesarean rate.

Results: Total deliveries were 4750 out of which 985 were Caesarean section, incidence was calculated as 20.7%. The main contributors to the overall Caesarean rate were primiparous women in spontaneous labour (group 1- {18.3%}) and women with previous caesarean section (group 5- {34.9%}).

Conclusions: The Robson’s classification is an easy tool to use and identify the current changing dynamics in any hospital setup. Its implementation as an obstetric audit can help lower the Caesarean rates and improve the standards based on WHO criteria.


Caesarean section rate, Robson’s ten group classification system

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WHO. Monitoring obstetric care: a handbook. Geneva: WHO Press, World Health Organization, 2009.

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

Vogel JP, Betran 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 multicountry surveys. Lancet Glob Health. 2015;3(5):e260-70.

Litorp H, Kidanto HL, Nystrom L, Darj E, Essén B. Increasing caesarean section rates among low-risk groups: a panel study classifying deliveries according to Robson at a university hospital in Tanzania. BMC Preg Childbirth. 2013;13(1):107.

Mbaye M, Gueye M, Gueye MD, Niang NK, Moreau JC. Analysis of cesarean section rate according to Robson’s classification in an urban health centre in Senegal. Int J Reprod Contracept Obstet Gynecol. 2017;4(4):1100-2.

Kazmi T, Sarva Saiseema V, Khan S. Analysis of Cesarean section rate-according to Robson’s 10-group classification. Oman Med J. 2012;27(5):415-7.

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 multicountry surveys. Lancet Glob Heal. 2015;3(5):e260-70.

Tan JK, Tan EL, Kanagalingan D, Tan LK. Rational dissection of a high institutional cesarean section rate: an analysis using the Robson Ten Group Classification System. J Obstet Gynaecol Res. 2015;41(4):534-9.

Amatya A, Paudel R, Poudyal A, Wagle RR, Singh M, Thapa S. Examining stratified cesarean section rates using Robson classification system at Tribhuvan University Teaching Hospital. J Nepal Health Res Counc. 2013;11:255-8.

Abdel-Aleem H, Shaaban OM, Hassanin AI, Ibraheem AA. Analysis of cesarean delivery at Assiut University Hospital using the Ten Group Classification System. Int J Gynaecol Obstet. 2013;123:119-23.

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 Gynaecol Canada. 2013;35(3):206-14.

Brennan DJ, Robson MS, Murphy M, O’Herlihy C. Comparative analysis of international cesarean delivery rates using 10-group classification identifies significant variation in spontaneous labor. Am J Obstet Gynecol. 2009;201:308.

Delbaere I, Cammu H, Martens E, Tency I, Martens G, Temmerman M. Limiting the caesarean section rate in low risk pregnancies is key to lowering the trend of increased abdominal deliveries: an observational study. BMC Preg Childbirth 2011;12:3.

Betrán AP, Gulmezoglu AM, Robson M, Merialdi M, Souza JP, Wojdyla D, et al. WHO Global Survey on Maternal and Perinatal Health in Latin America: classifying Caesarean sections. Reprod Heal. 2009;6:18.