Abstract: Background: The global rise in Cesarean Section (CS) rates is a significant public health concern, as rates exceeding the recommended 10-15% are not associated with improved maternal or neonatal outcomes. The World Health Organization (WHO) advocates for the use of the Robson Ten-Group Classification System (TGCS) to standardize the monitoring and analysis of CS rates, allowing for targeted quality improvement.
Objective: This retrospective study aimed to analyze the institutional CS rate at a tertiary care teaching hospital using the Robson TGCS, identify the major contributing groups, analyze important indicators, and suggest practical strategies for optimizing delivery outcomes.
Methods: The study was conducted retrospectively at the Department of Obstetrics and Gynecology at S N Medical College and HSK Hospital. Data for all pregnant women who delivered past the period of viability (>28 weeks) between January 2024 and December 2024 (N=1427 total deliveries) were collected from hospital registries and case files. Deliveries were classified into the ten mutually exclusive Robson groups, and relative CS rates and contributions to the overall CS rate were calculated.
Results: The overall institutional Cesarean Section rate was 62.3%, significantly exceeding the WHO recommendation. Group V (multiparous, $ge$1 previous CS, singleton, cephalic, term) was the largest contributor, accounting for 28.24% of all deliveries and 45.33% of all CSs (CS rate: 99.75%). Group II (nulliparous, singleton, cephalic, term, induced/pre-labor CS) was the second largest contributor (19.41% of deliveries, 26.88% of CSs; CS rate: 86.28%). Groups I and III (spontaneous labor, low-risk) showed appropriately low CS rates (8.51% and 1.49%, respectively) and contributed significantly to vaginal deliveries. The leading indications for CS were Previous Cesarean (45.33%) and Fetal Distress (20.25%).
Conclusion: The institutional CS rate is alarmingly high, primarily driven by the high CS rate and large size of Robson Group V (previous CS) and Group II (induced nulliparous women). Targeted interventions, including promoting Trial of Labor After Cesarean (TOLAC/VBAC) to reduce the CS rate in Group V, and strict adherence to evidence-based labor induction protocols with adequate time for labor progression to reduce the primary CS rate in Group II, are critical steps to reduce the overall institutional CS rate. Improved, judicious intrapartum fetal monitoring may also help mitigate overdiagnosis of fetal distress.
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