Classification of Cesarean Section Through Robson Criteria: An Emerging Concept to Audit the Increasing Cesarean Section Rate in a Tertiary Care Hospital

Abstract

Background

Cesarean section rates have increased markedly worldwide, exceeding the World Health Organisation recommended optimal range of 10–15% in many settings. Unnecessary cesarean deliveries are associated with increased maternal morbidity and healthcare costs. The Robson Ten-Group Classification System provides a standardised and reproducible method to audit cesarean section rates and identify obstetric groups contributing most to the overall burden. This study aimed to audit cesarean section rates using the Robson classification in a tertiary care hospital.

Methods

A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care hospital from January 2024 to December 2025. All women who underwent cesarean section during the study period were included. Cesarean deliveries were classified according to the Robson Ten-Group Classification System. Data were analysed using descriptive statistics, and cesarean section rates and group-wise contributions were calculated.

Results

During the study period, 1,593 deliveries were recorded, of which 858 were cesarean sections, resulting in an overall cesarean section rate of 53.86%. The largest contributions to the overall cesarean section rate came from Robson Group 2, which contributed 36.71%, and Robson Group 5, which contributed 36.0%. Groups involving spontaneous labour without prior cesarean section (Groups 1 and 3) contributed relatively less to the total cesarean section rate.

Conclusion

The cesarean section rate in this tertiary care hospital was substantially higher than recommended levels, with Robson Groups 2 and 5 being the major contributors. The Robson Ten-Group Classification System proved to be an effective tool for auditing cesarean section practices and identifying priority obstetric groups. Routine use of this classification may support targeted, evidence-based interventions to optimise cesarean section use while ensuring maternal and perinatal safety.