Caesarean Section Audit Using Robson's Ten-Group Classification System And Identification Of High-Contribution Subgroups At A Tertiary Care Hospital: A Cross-Sectional Observational Study
DOI:
https://doi.org/10.48047/7s5zqd63Keywords:
Caesarean section, Robson classification, obstetric audit, primary caesareanAbstract
Background: The use of caesarean section (CS) has increased worldwide, even in India, where the all-India CS rate is reported to be 21.5% by the National Family Health Survey (NFHS-5) and the CS rate varies significantly between states. The WHO has recommended using the Robson Ten-Group Classification System (TGCS) as a standard audit tool, which can be used to compare institutions and identify those high-contribution subgroups which can be targeted for quality improvement. In this study, CS rates were audited using the Robson TGCS, and factors that could be modified were identified at a tertiary care hospital.
Methods: This was a cross sectional observational study of all consecutive deliveries (2380 in 12 months) in a tertiary care hospital. Deliveries were grouped into the 10 Robson groups according to parity, gestational age, fetal presentation, onset of labour and the number of fetuses. Group-specific CS rates, absolute contributions to CS rates and relative contributions of each group to the CS rate were estimated. Multiple logistic regression analysis found independent factors associated with primary CS in Robson Group 1.
Results: Overall CS rate was 38.1% (n=907/2380). The biggest group was Robson Group 5 (previous CS, singleton cephalic, term) with 12.3% absolute contribution (92.1% of individuals within-group CS). Groups 1+2 together contributed 10.1%. Group 10 (preterm) contributed 4.0%. Risk factors for primary CS independent of the others were: non-progression of labour (aOR 4.8), fetal distress (aOR 3.6), nulliparous age ≥35 years (aOR 2.1) and BMI ≥30 (aOR 1.8). Elective repeat CS made up 58.3% of the total Group 5 CS.
Conclusions: Robson Groups 5 and 1 account for the majority of the above average CS rate at this institution. There is a need for targeted interventions, such as VBAC counselling, active labour management, and support for nulliparous women, to attain a clinically relevant CS rate
Downloads
References
World Health Organization. WHO statement on caesarean section rates. Geneva: WHO; 2015. WHO/RHR/15.02.
Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM; WHO Working Group on Caesarean Section. WHO statement on caesarean section rates. BJOG. 2016;123(5):667-70.
Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.
Robson MS. Classification of caesarean sections. Fetal Matern Med Rev. 2001;12(1):23-39.
Vogel JP, Betrán AP, Vindevoghel N, 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.
Choudhary D, Parihar DS. Audit of caesarean section using Robson's classification at a tertiary care hospital. J Family Med Prim Care. 2024;13(2):710-6.
Singh N, Tripathi R, Mala YM. Caesarean section audit using Robson classification: a prospective study. Indian J Obstet Gynecol Res. 2025;12(1):45-52.
National Health Systems Resource Centre. Intrapartum care quality improvement in India. New Delhi: NHSRC/MoHFW; 2018.
Betran AP, Vindevoghel N, Souza JP, Gulmezoglu 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.
Royal College of Obstetricians and Gynaecologists. Birth after previous caesarean birth. Green-top Guideline No. 45. London: RCOG; 2015.
FIGO Committee on Safe Motherhood. FIGO position statement on caesarean sections. Int J Gynaecol Obstet. 2019;145(3):258-9.
Federation of Obstetric and Gynaecological Societies of India. FOGSI position statement on caesarean section. Mumbai: FOGSI; 2019.
Torloni MR, Betran AP, Souza JP, et al. Classifications for cesarean section: a systematic review. PLoS One. 2011;6(1):e14566.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation .
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
