A CROSS-SECTIONAL STUDY OF CAESAREAN SECTION RATES IN A TERTIARY CARE HOSPITAL USING ROBSON’S TEN-GROUP CLASSIFICATION SYSTEM

Abstract

Background: Rising caesarean section (CS) rates are a global public health concern. Robson’s Ten Group Classification System (RTGCS) is the WHO-endorsed standard for auditing, monitoring, and comparing CS rates across healthcare facilities. This study aimed to analyse CS rates using RTGCS at a tertiary care hospital in Chennai, India, and identify the major contributing groups. Methods: A cross-sectional study was conducted among 900 women who delivered in CS at Sree Balaji Medical College and Hospital from July 2024 to December 2025. Data on maternal demographics, obstetric history, and mode of delivery were collected. Each delivery was classified into one of ten Robson groups. Group size, group-specific CS rate, absolute and relative contribution to overall CS were calculated. Results: The largest Robson groups were Group 1 (nulliparous, term, cephalic, spontaneous labour) – 24.0%, and Group 3 (multiparous without scar, term, cephalic, spontaneous labour) – 22.0%. Group-specific CS rates were highest in Group 9 (abnormal lie) – 100%, Group 6 (nulliparous breech) – 75.0%, Group 5 (previous CS) – 71.4%, and Group 7 (multiparous breech) – 70.0%. The major contributors to overall CS were Group 5 (28.6% relative contribution), Group 2 (nulliparous induced/prelabour) – 22.9%, and Group 1 – 17.1%. Together, Groups 1, 2, and 5 accounted for 68.6% of all caesarean sections. The most common indication for CS was previous CS (47.4%), followed by fetal distress (13.7%) and hypertensive disorders (9.7%). Conclusion: The overall CS rate at this tertiary care centre is 35.0%, exceeding WHO recommendations. Robson Groups 5, 2, and 1 are the predominant contributors, accounting for more than two-thirds of all CS. Targeted interventions to promote trial of labour after caesarean and to reduce primary CS in nulliparous women are essential. RTGCS is a valuable tool for identifying areas for quality improvement in obstetric care.