Abstract

Objectives: To determine the prevalence of caesarean section in our tertiary care centre using Robson groups and to categorise the caesarean section births in Robson’s classification system. Methodology: A retrospective analysis was conducted in the Department of Obstetrics & Gynaecology, our hospital over six months (January–June) in year 2025. All women who underwent caesarean delivery were classified into Robson’s ten groups based on standard criteria. Data were analysed to determine groupwise contributions to overall CS rate. Results: A total of 239 caesarean sections were analysed during the study period. Caesarean sections accounted for 63.23% of all deliveries. 17.15% of all caesarean sections were electives while the rest (82.84%) were performed as emergency procedures. Robson Group 5 (previous CS, singleton, cephalic, ≥37 weeks) was the leading contributor, accounting for 28.5% of all CS (68 cases). • Group 1 (nulliparous, singleton, cephalic, ≥37 weeks, spontaneous labor) contributed 20.9% (50 cases) Group 4 (multiparous, singleton, cephalic, ≥37 weeks, induced/CS before labor), Group 3 (multiparous, singleton, cephalic, ≥37 weeks, spontaneous labor), and Group 10 (singleton, cephalic, preterm) contributed 11.7%, 10.9%, and 11.3%, respectively. • Groups 6–8 accounted for less than 3% each, while Group 9 (abnormal lie) had 0 cases. Conclusions: Repeat caesarean sections (Group 5) remain the predominant indication in this audit, underscoring the need for focused strategies to reduce primary CS and promote safe vaginal birth after caesarean (VBAC) when appropriate. The Robson classification proved valuable in identifying key contributing groups, facilitating data-driven quality improvement efforts at NEIGRIHMS

• 1.   WHO statement on caesarean section rates . (2021). Accessed: April 12, 2021: http://www. who.int/reproductivehealth/publications/ maternal_perinatal_health/cs-statement/en/.
• 2.   Betran A, Torloni M, Zhang J, Gu€lmezoglu A. 2016. WHO statement on caesarean section rates. BJOG: An International Journal of Obstetrics and Gynaecology 123:667–670.
• 3.   Mayne L, Liu C, Tanaka K, Amoako A. Caesarean section rates: applying the modified ten-group Robson classification in an Australian tertiary hospital. J Obstet Gynaecol. 2022 Jan;42(1):61- 66. doi: 10.1080/01443615.2021.1873923.
• 4.   Tontus HO, Nebioglu S. Improving the Caesarean Decision by Robson Classification: A Population-Based Study by 5,323,500 Livebirth Data. Annals of Global Health. 2020; 86(1): 101, 1–11. DOI: https://doi.org/10.5334/aogh.2615
• 5.   Pravina P, Ranjana R, Goel N. Cesarean Audit Using Robson Classification at a Tertiary Care Center in Bihar: A Retrospective Study. Cureus. 2022 Mar 13;14(3):e23133. doi: 10.7759/ cureus.23133.
• 6.   Cagan M, Tanacan A, Aydin Hakli D, Beksac MS: Changing rates of the modes of delivery over the decades (1976, 1986, 1996, 2006, and 2016) based on the Robson-10 group classification system in a single tertiary health care center. J Matern Fetal Neonatal Med. 2021, 34:1695-702. 10.1080/14767058.2019.1644619
• 7.   Khan MA, Sohail I, Habib M. Auditing the cesarean section rate by robson’s ten group classification system at tertiary care hospital. Professional Med J. 2020;27(4):700-706. doi: 10.29309/TPMJ/2020.27.04.3383
• 8.   Naeem M, Khan MZ, Abbas SH, Khan A, Adil M, Khan MU. Rate and Indication of elective and emergency cesarean section: A study in a Tertiary Care Hospital of Peshawar. J Ayub Med Coll Abbottabad. 2015;27:151-154.
• 9.   Amin N, Malik NJ. Role of antenatal checkup on caesarean section rate – study at CMH Attock. Pak Armed Forces Med J. 2017;67(4):599-603.
• 10.   Jabeen J, Mansoor MH, Mansoor A. Analysis of indications of caesarean sections. J Rawalpindi Med Coll (JRMC). 2013;17(1):101-103
• 11.   Stavrou EP, Ford JB, Shand AW, Morris JM, Roberts CL. Epidemiology and trends for Caesarean section births in New South Wales, Australia: A population-based study. BMC Pregnancy Childbirth. 2011;11:8. doi: 10.1186/1471- 2393-11-8
• 12.   Kolas T, Hofoss D, Daltveit AK, Nilsen ST, Henriksen T, Hager R, et al. Indications for cesarean deliveries in Norway. Am J Obstet Gynecol. 2003;188(4):864-870. doi: 10.1067/ mob.2003.217
• 13.   MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol 2008;35(2):293-307. doi: 10.1016/j. clp.2008.03.007
• 14.   Betran AP, Ye J, Moller AB, Souza JP, Zhang J: Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021, 6: 10.1136/bmjgh-2021-005671
• 15.   Radhakrishnan T, Vasanthakumari KP, Babu PK: Increasing trend of caesarean rates in India: evidence from NFHS-4. J Med Sci Clin Res. 2017, 5:26167-76. 10.18535/jmscr/v5i8.31
• 16.   Leno DWA, Bah ME, Moumbagna JC, Millimouno TM, Lamah D, Delamou A, et al. Evaluation of caesarean section practices according to Robson's 10-group classification at a level two maternity ward in Conakry, Guinea. Int J Reprod Contracept Obstet Gynecol. 2019;8:4468–73. 17. Patra K, Chattopadhyay S, Samanta P, Mondal C. A retrospective analytical study of caesarean section in intrauterine foetal death cases in a rural medical college. Int J Reprod Contracept Obstet Gynecol. 2018;7:2583–5.
• 18.   Gadappa S, Gemavat H, Deshpande S, Shah A. Interventions to reduce caesarean section rates at government medical college and hospital Aurangabad, India. Int J Reprod Contracept Obstet Gynecol. 2020;9:1563. https://doi. org/10.18203/2320-1770.ijrco g20201224. 19. Gomathy E, Radhika K, Kondareddy T. Use of the Robson clas- sification to assess caesarean section trends in tertiary hospital. Int J Reprod Contracept Obstet Gynecol. 2018;7:1796–800.
• 20.   Das V, Kumar N, Kumari V, Agarwal A, Pandey A, Agrawal S. Increasing rates of cesarean section, an upcoming public health problem: an audit of cesarean section in a tertiary care center of North India based on Robson classification. Int J Reprod Contra- cept Obstet Gynecol. 2017;6:4998–5002.
• 21.   Ray A, Jose S. Analysis of caesarean-section rates according to Robson's ten group classification system and evaluating the19 IJOG / Volume 14, Number 1 / January - April 2026 indications within the groups. Int J Reprod Contracept Obstet Gynecol. 2017;6:447–51.
• 22.   Bhatt M, Kadikar G, Parmar DC, Kanani M. Retrospective study of cesarean section by using the Robson’s ten group classification system. Int J Reprod Contracept Obstet Gynecol. 2018;7:1054–7.
• 23.   Gilani S, Mazhar SB, Zafar M, Mazhar T. The modified Robson criteria for Caesarean Section audit at Mother and Child Health Center Pakistan Institute of Medical Sciences Islamabad. J Pak Med Assoc. 2020;70(2):299- 303. doi: 10.5455/JPMA.293708
• 24.   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;4:745-749. doi: 10.18203/2320- 1770. ijrcog20150085
• 25.   Tan JKH, 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):534-539. doi: 10.1111/jog.12608
• 26.   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:e260-70. 10.1016/ S2214-109X(15)70094-X
• 27.   Tura AK, Pijpers O, de Man M, et al. Analysis of caesarean sec- tions using Robson 10-group classification system in a university hospital in eastern Ethiopia: a crosssectional study. BMJ Open. 2018;8: e020520. https://doi. org/10.1136/bmjopen-2017-020520.
• 28.   Gautam P, Karki C, Adhikari A. Robson's group 2 criteria among total caesarean sections in a Tertiary Care Hospital: a descriptive cross-sectional study. JNMA J Nepal Med Assoc. 2021;59(243):1098–101. https://doi.org/10.31729/jnma.7138. PMID:35199745;PMCID:PMC9124328. 29. Parveen R, Khakwani M, Naz A, Bhatti R. Analysis of cesarean sections using Robson’s ten group classification system. Pak J Med Sci. 2021;37(2):567–71. https://doi.org/10.12669/ pjms.37.2. 3823.
• 30.   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.
• 31.   Singh A, Malik R. Changing trends and determinants of caesarean section using robson criteria in a government tertiary level hospital. Int J Reprod Contracept Obstet Gynecol. 2021;10:1066–72.
• 32.   Yerra AK, Khan MI. Analysing trends in caesarean sections at a tertiary care teaching hospital in South India: findings from a clinical audit using Robson criteria. Int J Reprod Contracept Obstet Gynecol. 2020;9:1463–9.
• 33.   Patel MK, Prajapati SM. A study of cesarean section rate by using modified Robson's ten group classification system. Int J Reprod Contracept Obstet Gynecol. 2019;8:2610–6.
• 34.   Wahane A, Ghaisas AS. Analysis of caesarean sections according to Robson’s criteria at a tertiary care teaching hospital in central India. Int J Reprod Contracept Obstet Gynecol. 2020;9:4221–6.
• 35.   Heera ST, Shenoy ST, Anaswara T, Remash K. Analysis of cae- sarean delivery using Robson ten group classification system at a tertiary care teaching institute in Kerala, India. Int J Reprod Con- tracept Obstet Gynecol. 2019;8:1990. https://doi.org/10.18203/ 2320- 1770.ijrcog20191956.
• 36.   Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery . Obstet Obstet Gynecol. 2014, 123:693-711. 10.1097/01. AOG.0000444441.04111.1d
• 37.   Trojano G, Damiani GR, Olivieri C, Villa M, Malvasi A, Alfonso R, Loverro M, Cicinelli E. VBAC: antenatal predictors of success. Acta Biomed. 2019;90(3):300–9. https://doi.org/10.23750/abm. v90i3.7623. PMID:31580319;PMCID:PMC7233729.
• 38.   Rajput H, Changede P, Chavan N, Nayak A, Shikhanshi, Mirza H, Mahapatra S. Study of Caesarean Section Births in a Tertiary Care Hospital in Mumbai Using Robson Classification System. J Obstet Gynaecol India. 2023 Dec;73(6):496-503. doi: 10.1007/s13224- 023-01851-y

Data Sharing Statement

Funding