AUDIT OF CAESAREAN SECTION RATES USING THE ROBSON TEN-GROUP CLASSIFICATION SYSTEM IN A TERTIARY CARE CENTRE: A RETROSPECTIVE OBSERVATIONAL STUDY

Caesarean section (CS) is an essential obstetric intervention that, used for appropriate indications, reduces maternal and perinatal morbidity and mortality. Rising CS rates worldwide have raised concerns about overuse and the risks attendant on unnecessary surgery. The World Health Organization (WHO) recommends use of the Robson Ten-Group Classification System (TGCS) as a standardised tool for monitoring, auditing and comparing institutional CS rates. The study was conducted to determine the overall CS rate in a tertiary care teaching hospital in southern India and to identify the principal contributing groups using the Robson TGCS. A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology over a six-month period. Data on parity, previous CS, gestational age, onset of labour, fetal presentation, number of fetuses and mode of delivery were retrieved from delivery registers and case records, and every delivery was classified into one of the ten Robson groups. Group size, group-specific CS rate and contribution to the overall CS rate were calculated using descriptive statistics. Of 1,240 deliveries during the study period, 456 were by CS, giving an overall CS rate of 36.8%. Most women were aged 20–30 years (66.1%), and pregnancies were predominantly term (87.1%) and singleton (95.2%). Group 5 (women with at least one previous CS) was the largest contributor to the overall CS rate (28.9%), with a within-group CS rate of 88.0%. Nulliparous women in Robson Groups 1 and 2 together accounted for approximately 29% of the overall CS rate. Group-specific CS rates were higher in induced labour (Group 2: 44.4%; Group 4: 28.3%) than in the corresponding spontaneous labour groups (Group 1: 20.0%; Group 3: 7.8%). The leading documented indications for CS were previous CS (32.9%), non-reassuring fetal status (19.7%) and non-progress of labour (15.4%). The institutional CS rate substantially exceeded the WHO-recommended population threshold, with previous CS (Group 5) emerging as the dominant contributor. Strategies aimed at reducing primary CS in nulliparous women, optimising induction practices and structured promotion of trial of labour after caesarean (TOLAC) are likely to have the greatest impact in lowering overall CS rates. The Robson TGCS proved a practical, internationally comparable framework for institutional audit and is recommended for routine use in obstetric quality improvement.