Analysis of Cesarean section rates using Robson’s ten-group classification system in comparison with the MCS population reference

Abstract

Background: The escalating global prevalence of Cesarean section (CS) deliveries raises concerns. To address this, the World Health Organization (WHO) suggests employing Robson’s ten-group classification system (RTGCS) for assessing and comparing CS rates among obstetric units. The aim of our study was to assess our hospital’s CS rate per group and juxtapose it with WHO Multi-Country Survey (MCS) population reference data. Furthermore, we delve into prevalent obstetric Indications for CS and examine potential strategies for mitigating the high CS rate. Materials and Methods: This observational cross-sectional study occurred at an Indian tertiary care teaching hospital from October 2018 to May 2020. Women delivering during this period were classified based on RTGCS, and Cesarean rates were computed across various groups. These rates were then compared with the WHO’s MCS population reference guidelines. Additionally, we investigated obstetric Indications for CS within these groups. Results: Of 2994 deliveries during the study period, 42.55% were CS. Notably, group 5 (29.75%) and group 1 (21.74%) had the highest CS rates. The CS rate of nulliparous women was 40.9%. Primary CS groups frequently cited fetal distress as the reason, while group 5 showed repeat CS due to previous CS with obstetric complications, on-demand CS, and scar integrity concerns. Conclusion: Despite our hospital’s overall high CS rate, group-specific contributions align with existing research. High-risk pregnancies, previous CS cases, and preterm CS for neonatal care notably contribute. Efforts should target in reducing CS in low-risk groups.