Published: 2019-04-29

Analysis of caesarean delivery using Robson ten group classification system at a tertiary care teaching institute in Kerala, India

Heera Shenoy T., Sheela T. Shenoy, Anaswara T., Remash K.


Background: Globally, the caesarean delivery rate is rising continuously, making caesarean one of the most common surgical procedures. The Robson classification, appreciated by WHO in 2014 and FIGO in 2016 is widely accepted, risk-based, ten-group classification system (TGCS) developed specifically to assess caesarean section rates. The aim of this study was to know the rate of Caesarean section in present hospital, to analyse the Caesarean sections based on Robson’s classification and to determine the contribution and significance of each group on the overall number of Caesarean sections.

Methods: All women, who gave birth by Caesarean deliveries done over a period of 1 year (January 2018-December 2018) in Travancore Medical College Hospital in South Kerala India.

Results: Group 5 (previous LSCS, single, cephalic >37 weeks) made the greatest contribution to the Caesarean section rate (27.24%). The second highest contributor was Group 2 (Nulliparous, singleton, cephalic, >37 weeks induced labour or caesarean section before labour followed by Group 10 (all single cephalic <36 weeks including previous CS) 18.78%.

Conclusions: Limiting the CS rate in low-risk pregnancies is key to lowering the trend of increased CS. If TGCS is used uniformly, CS rates can be compared over time and between units, both nationally and internationally.


Caesarean delivery, Contribution, Indication, Induction of labour, Previous caesarean, Robson TGCS

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Betrán AP, Ye J, Moller AB. The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PLoS One. 2016;11:e0148343.

Bragg F, Cromwell DA, Edozien LC. Variation in rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study. BMJ. 2010;341:c5065.

Organization WH. Appropriate technology for birth. Lancet. 1985;2:436–7.

UNICEF, WHO, UNFPA, New York: United Nations Children’s Fund. 1997:1.

Choudhury CR. Caesarean births: the Indian scenario. Population Association of America. 2008:1-8.

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

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

Padmadas SS, Kumar S, Nair SB, Kumari A. “Caesarean section delivery in Kerala, India: evidence from a National Family Health Survey.” Social Science and Medicine. 2000;51(4):511-21.

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.

Jogia PD, Lodhiya KK. Analysis of caesarean sections according to modified Robson’s ten group classification system at a tertiary care centre in Western India. Int J Reprod Contracept Obstet Gynecol. 2019;8:433-9.

Pereira MN, Leal MC, Pereira AP, Domingues RM, Torres JA, Dias MA, et al. Use of Robson classification to assess cesarean section rate in Brazil: the role of source of payment for childbirth. The Author(s) Reproductive Health. 2016;13(Suppl 3):128.

Kansara V, Patel S, Aanand N, Muchhadia J, Kagathra B, Patel R. A recent way of evaluation of cesarean birth rate by Robson’s 10-group system. J Med Pharmaceut Allied Sci. 2014;01:62-70.

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.

Shirsath A, Risbud N. Analysis of cesarean section rate according to Robson’s 10-group classification system at a tertiary care hospital. Int J Sci Res. 2014;3(1):401-2.

Patel RV, Gosalia EV, Vasa PB, Pandya VM. Indications and trends of caesarean birth delivery in the current practice scenario. Int J Reprod Contracept Obstet Gynecol. 2014;3:575-80.

Katke RD, Zarariya AN, Desai PV. LSCS audit in a tertiary care center in Mumbai: to study indications and risk factors in LSCS and its effect on early perinatal morbidity and mortality rate. Int J Reprod Contracept Obstet Gynecol. 2014;3:963-8.

Abdel-Aleem H, Shaaban OM, Hassanin Al, Ibraheem AA. Analysis of cesarean delivery at Assiut University Hospital using the ten group classification system. Int J Gynaecol Obstet. 2013;123(2):119-23.

Wanjari SA. Rising caesarean section rate: a matter of concern? Int J Reprod Contracept Obstet Gynecol. 2014;3:728-31.

Samba A, Mumuni K. A review of caesarean sections sections using the ten-group classification system (Robson classification) in the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana. Gynecol Obstet. 2016;6:385

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 Health. 2009;29(6):18.

Lafitte AS, Dolley P, Le Coutour X. Rate of caesarean sections according to the Robson classification: Analysis in a French perinatal network - Interest and limitations of the French medico-administrative data (PMSI). J Gynecol Obstet Hum Reprod. 2018;47:39-44.

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. The Lancet Globel Health. 2015;3(5):e260-70.

Stavrou EP, Ford JB, Shand AW. Epidemiology and trends for Caesarean section births in New South Wales, Australia: a population-based study. BMC Pregnancy Childbirth. 2011;11(8):2393.

Vogel JP, Souza JP, Gülmezoglu AM. Patterns and Outcomes of Induction of Labour in Africa and Asia: a secondary analysis of the WHO Global Survey on Maternal and Neonatal Health. PLoS One. 2013;8:e65612.

Brennan DJ, Murphy M, Robson MS, O'Herlihy C. The singleton, cephalic, nulliparous woman after 36 weeks of gestation: contribution to overall cesarean delivery rates. Obstet Gynecol. 2011;117:273-9.

Stavrou EP, Ford JB, Shand AW. Epidemiology and trends for caesarean section births in New South Wales, Australia: a population- based study. BMC Pregnancy Childbirth. 2011;11(1):8.