The ten group Robson classification: a retrospective study to identify strategies to optimise caesarean section rates


  • Spandana S. Department of Obstetrics and Gynecology, DM Wayanad Institute of Medical Sciences, Meppadi, Kerala
  • Amarpali K. Shivanna Department of Obstetrics and Gynecology, DM Wayanad Institute of Medical Sciences, Meppadi, Kerala



Caesarean section, Robson classification, Induction of labour, Vaginal deliveries


Background: Caesarean section rates have been increasing worldwide. For proper assessment, the ten group Robson classification is recommended by WHO for assessing CS rates. We are analyzing the caesarean section rates by classifying the caesarean sections using modified Robson’s ten group classification. Objective of the current study was to estimate caesarean section rates in our hospital and to classify caesarean section using modified Robson’s ten group classification system.

Methods: Current retrospective study was conducted in the department of obstetrics and gynaecology in a tertiary care hospital. The medical records were reviewed for a period of 12 months.

Results: Total number of deliveries during the study period was 315. The total numbers of caesarean section were 159 and total vaginal deliveries were 156. The caesarean section rate was 50.47%. The main contributors to overall caesarean section rate were group 5 (18.10%), group 2 (13.96%) and group 1 (5.71%). Women with one previous LSCS contributed majorly to the caesarean section rate. Higher CS rate was also seen in both group 2A (69.40%) and group 4A (47.30%) which had underwent induction of labour. More inclination towards trial of labour following CS for women with previous one LSCS can lower CS rates.

Conclusions: Modified Robson’s classification is easily implementable and an effective tool for ongoing surveillance. The results can be compared between Institutions, states and countries. Having implemented the Robson classification and identified groups which contributed the most to the overall CS rate, interventions to reduce the same has to be our prime objective.


Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, et al. WHO multi-country survey on maternal and newborn health research network. 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.

WHO Statement on Caesarean Section Rates. Available at: health/publications/maternal_perinatal_health/cs-statement/en/. Accessed on 24 July 2020.

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

Le Ray C, Blondel B, Prunet C, Khireddine I, Deneux-Tharaux C, Goffinet F. Stabilising the caesarean rate: which target population?. BJOG. 2015;122(5):690-9.

Birth after Previous Caesarean Birth (Green Top Guideline 45). Available at: https://www.rcog. gtg45/. Accessed on 24 July 2020.

Vaginal birth after previous cesarean delivery, 2010. Available at: Accessed on 24 July 2020.

Gardner K, Henry A, Thou S, Davis G, Miller T. Improving VBAC rates: the combined impact of two management strategies. Aust N Z J Obstet Gynaecol. 2014;54(4):327-32.

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

Samba A, Mumani K. A review of caesarean sections using the ten group classification system (Robson’s classification) in the Korle-Bu teaching hospital (KBTH), Accra, Ghana. Gynecol Obstet. 2006;6:385.

Fatusic J, Hudic I, Fatusic Z, Moralic AZ. Caesarean section rate analysis in university hospital Tuzla-according to Robson’s classification. Med Arch. 2016;70(3):213-6.






Original Research Articles