Robson Classification Analysis of C-section Rates In A Tertiary Hospital In India

Priyanka N - Senior Registrar, Department Of Obstetrics And Gynaecology, Apollo Speciality Hospital, Chennai, India

 

INTRODUCTION:

The Caesarean section (CS) rate has seen a steady rise worldwide, with significant variation between public and private healthcare settings. The World Health Organization (WHO) recommends an optimal CS rate of 10–15%, beyond which there is no additional improvement in maternal or neonatal outcomes.(1)

 

OBJECTIVES:

To analyse Caesarean section trends in a private tertiary care hospital in Chennai.

To evaluate the contribution of different Robson groups to the overall CS rate.

To standardize CS indications and propose evidence-based recommendations for reducing unnecessary CS procedures.

 

METHODOLOGY:

Retrospective observational study done in a tertiary care hospital in South India for a period of 2 years.

 

RESULTS:

The overall Caesarean section (CS) rate at our hospital (70.2%) exceeds the national average and WHO recommendations. The NFHS-5 (2023) reported private hospitals in India having CS rates above 50%, particularly in urban settings.(2)

Multiparous women (Groups 3 & 4) had relatively lower CS rates, indicating that prior vaginal deliveries increase the likelihood of successful future vaginal births.

Previous CS (Group 5) was the leading contributor in this study. A 2022 study on Robson Classification (Rao et al, 2022) also reported Group 5 as the largest contributor, emphasizing the need for VBAC promotion to reduce repeat C-sections.(3)

High CS rates in nulliparous women (Groups 1& 2) suggest a need for better labour management strategies, including reducing unnecessary inductions and supporting vaginal deliveries. A 2024 IIT Madras study found that C-section rates among first- time mothers in private hospitals exceeded 60%, consistent with our findings. (4)

Our study found all cases in Group 9 (abnormal lie) resulted in CS, which is expected due to the medical necessity of surgical delivery in these cases. The Betrán et al. (2016) study on global CS trends also reported that Group 9 consistently shows near-100% CS rates worldwide, confirming the predictability of this category. (5)

 

CONCLUSION:

Given that our hospital is a tertiary care centre managing more complex and high-risk deliveries, the higher rate may, in part, reflect the complexity of the cases we typically handle.

Factors such as maternal requests for painless deliveries, legal concerns and defensive medical practices were discounted.

Robson classification does not consider maternal health conditions, foetal distress and does not differentiate between an elective and an emergency CS limiting its abilities to justify all CS cases.

Nevertheless, a shift towards active birth management - focusing on supporting natural labour processes, improving continuous care, reevaluating risk factors, and enhancing provider training - could help reduce the CS rates and improve maternal and foetal outcomes.

 

REFERENCES:

World Health Organization. WHO statement on caesarean section rates. WHO Report. 2015.

International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5), 2019-21: India. Mumbai: IIPS; 2023

Rao J, Patel P, Sharma K. Caesarean audit using Robson classification at a tertiary care centre: A retrospective study. Int J Reprod Contracept Obstet Gynecol. 2022;11(3):765-771

Indian Institute of Technology Madras (IIT Madras). Study finds an increase in number of C-section deliveries in India. Press Information Bureau, Government of India. 2024.

Betrán AP, Ye J, Moller A-B, Zhang J, Gulmezoglu AM, Torloni MR. The increasing trend in cesarean section rates: Global, regional, and national estimates. PLoS One. 2016;11(2):e0148343.