Audit of caesarian deliveries in a tertiary care center, in rural Bangalore, India


  • Rajiv K. Saxena Department of Obstetrics and Gynecology, MVJ Medical College and Research Hospital, Hoskote, Bangalore, India
  • Anju Balan Department of Obstetrics and Gynecology, MVJ Medical College and Research Hospital, Hoskote, Bangalore, India



Caesarean section rates, Clinical audit, Robson’s classification, Ten group classification system


Background: The Robson’s Ten-Group Classification System allows critical analysis of caesarean deliveries according to characteristics of pregnancy. The objective was to analyze caesarean section rates in a rural tertiary care teaching hospital in Bangalore, using Robson’s ten groups classification.

Methods: This study was done in MVJ Medical College and Research Hospital, a rural tertiary care teaching hospital. All patients who underwent caesarean delivery, between November 2017 and October 2018, were included in the study. Women were classified in 10 groups according to Robson’s classification. For each group, authors calculated its relative contribution to the overall caesarean rate.

Results: The overall caesarean section rate was 46.7%. The main contributors to this high caesarean rate were primiparous women in spontaneous labour (group 1) and women with previous caesarean section (group 5).  52.1% of CS were conducted on women who were unbooked or booked at a peripheral health facility and referred to present institution due to complications in labor. Strategies to lower CS rates would include encouraging women with previous CS, to undergo trial of labor to reduce CS rates for group 5C. Sensitization of staff in peripheral medical facilities for early referral of high-risk pregnancies to a tertiary care center for better control of medical complications like hypertensive disorders of diabetes mellitus. Other strategies include offering external cephalic version to eligible women with breech presentation and consider offering vaginal breech delivery to suitable women in groups 6 and 7.

Conclusions: The Robson’s classification is easy to use. It is time to implement obstetric audit to lower the overall CS rates.


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(1):e14566.

Betran AP, Vindevoghel N, Souza JP, Gülmezoglu AM, Torloni MR. A systematic review of the Robson classification for caesarean section: what works, doesn’t work and how to improve it. PLoS One. 2014;9(6):e97769.

World Health Organization. WHO Statement on Caesarean Section Rates. WHO/RHR/15.02; 2015.

FIGO working group on challenges in care of mothers and infants during labour and delivery. Best practice advice on the 10-group classification system for cesarean deliveries. Int J Gynaecol Obstet. 2016;135:232-3.

Reddy AY, Dalal A, Khursheed R. Robson ten group classification system for analysis of cesarean sections in an Indian hospital. Res J Obstet Gynecol. 2018;11:1-8.

Kant A, Mendiratta S. Classification of cesarean section through Robson criteria: an emerging concept to audit the increasing cesarean section rate. Int J Reprod Contracept Obstet Gynecol. 2018;7:4674-7.

Mahomed K, Pungsornruk K, Gibbons K. Induction of labour for postdates in nulliparous women with uncomplicated pregnancy–is the caesarean section rate really lower?. J Obstet Gynaecol. 2016;36(7):916-20.

Jacob KJ, Jayaprakash M, Hibina KP. TMC (Thrissur Medical College) modified Robson criteria for caesarean sections. Int J Reprod Contracept Obstet Gynecol. 2017;6:5038-43.

Tanaka K, Mahomed K. The Ten-Group Robson Classification: A single centre approach identifying strategies to optimise caesarean section rates. Obstet Gynecol Int. 2017;2017.

Royal College of Obstetricians and Gynaecologists, Birth after Previous Caesarean Birth (Green Top Guideline 45), RCOG, London, UK, 2015.

The Society of Obstetricians and Gynaecologists of Canada (SOGC), “Guidelines for vaginal birth after previous caesarean birth,” 2005. Available at:

The American College of Obstetricians and Gynecologists (ACOG), “Vaginal birth after previous cesarean delivery,” 2010. Available at:

Grobman WA, Lai Y, Landon MB, Spong CY, Rouse DJ, Varner MW, et al. The change in the VBAC rate: an epidemiologic analysis. Paediatr Perinatal Epidemiol. 2011;25(1):37.

Yeh J, Wactawski-Wende J, Shelton JA, Reschke J. Temporal trends in the rates of trial of labor in low-risk pregnancies and their impact on the rates and success of vaginal birth after cesarean delivery. Am J Obstet Gynecol. 2006;194(1):144-e1.

Peel A, Bhartia A, Spicer N, Gautham M. ‘If I do 10-15 normal deliveries in a month I hardly ever sleep at home.’ A qualitative study of health providers’ reasons for high rates of caesarean deliveries in private sector maternity care in Delhi, India. BMC Preg Childbirth. 2018;18:470.

Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR, et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Lancet. 2000;356(9239):1375-83.

Hehir MP. Trends in vaginal breech delivery. J Epidemiol Community Health. 2015;69(12):1237-9.

Glezerman M. Five years to the term breech trial: the rise and fall of a randomized controlled trial. Am J Obstet Gynecol. 2006;194(1):20-5.

Dhodapkar SB, Bhairavi S, Daniel M, Chauhan NS, Chauhan RC. Analysis of caesarean sections according to Robson’s ten group classification system at a tertiary care teaching hospital in South India. Int J Reprod Contracept Obstet Gynecol. 2015;4:745-9.

Zhang J, Troendle JF, Yancey MK. Reassessing the labor curve in nulliparous women. Am J Obstet Gynecol. 2002;187(4):824-8.

Zhang J, Landy HJ, Branch DW, Burkman R, Haberman S, Gregory KD, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol. 2010;116(6):1281.

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.

Farine D, Shepherd D. Classification of caesarean sections in Canada: the modified Robson criteria. J Obstet Gynecol Canada. 2012;34(10):976-9.

Prameela RC, Farha A, Bhanumathi PM, Prajwal S. Analysis of caesarean section rate in a tertiary hospital according to Robson’s ten group classification system. IOSR J Dent Med Sci. 2015;14(2):46-9.






Original Research Articles