Journal of Obstetric and Gynaecological Practices POGS

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 2 , ISSUE 1 ( January-June, 2024 ) > List of Articles

Original Article

Analysis of Increasing Cesarean Section Rate by Robson's 10-group Classification System in a Tertiary Care Public Charitable Hospital in Haryana

Kranti K Kulkarni, Mansi Kumar, Soniya Nagar, AS Dhillon

Keywords : Cesarean section, High-risk pregnancy, Maternal outcome

Citation Information : Kulkarni KK, Kumar M, Nagar S, Dhillon A. Analysis of Increasing Cesarean Section Rate by Robson's 10-group Classification System in a Tertiary Care Public Charitable Hospital in Haryana. J Obstet Gynaecol 2024; 2 (1):3-7.

DOI: 10.5005/jogyp-11012-0030

License: CC BY-NC 4.0

Published Online: 29-05-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Over the past few decades, delivery by cesarean section (CS) has increased dramatically in most of the countries. Rising CS rates are a major public health concern and leading worldwide health debate regarding potential causes of increased maternal and perinatal morbidity and mortality, associated with cesarean section. Robson's 10-group classification system (RTGCS) helps us to identify the main groups of subjects who contribute most to the overall CS rate. A retrospective cross-sectional study was carried out over 1 year from November 21, 2022 to November 20, 2023, in the mother and child health unit of a tertiary care charitable hospital of Palwal, Haryana: Shree Satya Sai Sanjeevani Hospital and Research Center. Being a tertiary care center with NO BILLING POLICY, Shree Satya Sai Sanjeevani Hospital and Research Center automatically eliminates unnecessary C-sections, thereby adhering to standard treatment guidelines. Also, indications like CS on demand or unindicated LSCS are not entertained as per the ethical standards of our institution. Using the RTGCS, we audited all admissions and appreciated that the incidence of cesarean delivery in our setup was 52.1%, exceeding the set standard by World Health Organization (WHO), by approximately 15%. However, these rates are comparable with other similar studies in India. Our study also reflects the need to define separate standards for maternal outcome and mode of delivery depending upon the level of care…primary or tertiary center, with many referrals for high-risk obstetrics.

PDF Share
  1. Robson Classification: Implementation Manual. Geneva: World Health Organization; 2017. Available at:
  2. Mittal P, Pandey D, Suri J, et al. Trend prediction for cesarean deliveries based on Robson Classification System at a Tertiary Referral Unit of North India. The Journal of Obstetrics and Gynecology of India 2020; 70:111–118. DOI: 10.1007/s13224-019-01275-7.
  3. Abubeker FA, Gashawbeza B, Gebre TM, et al. Analysis of cesarean section rates using Robson ten group classification system in a tertiary teaching hospital, Addis Ababa, Ethiopia: A cross-sectional study. BMC Preg Childb 2020;20(1):1–7. DOI: 10.1186/s12884-020-03474-x.
  4. World Health Organization. WHO statement on caesarean section rates, vol. WHO/RHR/15.02. Geneva: World Health Organization; 2015. (WHO/RHR/15.02).
  5. Robson M, Hartigan L, Murphy M. Methods of achieving and maintaining an appropriate caesarean section rate. Best Pract Res Clin Obstet Gynaecol 2013;27(2):297–308. DOI: 10.1016/j.bpobgyn.2012.09.004.
  6. Torloni MR, Betran AP, Souza JP, et al. Classifications for cesarean section: A systematic review. PLoS ONE 2011;6(1):e14566. DOI: 10.1371/journal.pone.0014566.
  7. Robson MS. Classification of caesarean sections. Fetal Maternal Med Rev 2001;12(1):23–39. DOI: 10.1017/S0965539501000122.
  8. Monitoring Emergency Obstetric Care: A Handbook. Geneva: World Health Organization; 2009.
  9. Harrison MS, Pasha O, Saleem S. A prospective study of maternal, fetal and neonatal outcomes in the setting of cesarean section in low-and middle-income countries. Acta Obstet Gynecol Scand 2017;96(4): 410–420. DOI: 10.1111/aogs.13098.
  10. Gomathy E, Radhika K, Kondareddy T. Use of the Robson classification to assess caesarean section trends in tertiary hospital. Int J Reprod Contracept Obstet Gynecol 2018;7(5):1796–1800. DOI: 10.18203/2320-1770.ijrcog20181905.
  11. Varija T, Kumar VCM, Tarihalli C. Analysis of caesarean section rate in tertiary care hospital according to Robson's 10 groups classification. Int J Reprod Contracept Obstet Gynecol 2018;7(4): 1380–1384. DOI: 10.18203/2320-1770.ijrcog 2018 1023.
  12. Reddy AY, Dalal A, Khursheed R. Robson ten group classification system for analysis of cesarean sections in an Indian hospital. Res J Obstet Gynecol 2018;11(1):1–8. DOI: 10.3923/rjog.2018.1.8.
  13. Patil SB, Rajitha D. Robson classification: Beyond caesarean rates. Int J Reprod Contracept Obstet Gynecol 2023;12(7):2241–2246. DOI: 10.18203/2320-1770.ijrcog20231941.
  14. Akadri AA, Imaralu JO, Salami OF, et al. Robson classification of caesarean births: Implications for reducing caesarean section rate in a private tertiary hospital in Nigeria. BMC Pregnancy and Childbirth 2023;23:243. DOI: 10.1186/s12884-023-05557-x.
  15. Laya MK, Vijaya Sree M. Analysis of caesarean sections with the Robson's ten group classification system. Int J Reprod Contracept Obstet Gynecol 2023;12(4):1083–1087. DOI: 10.18203/2320-1770.ijrcog20230817.
  16. Parveen R, Khakwani M, Naz A, et al. Analysis of cesarean sections using Robson's Ten Group Classification System. Pak J Med Sci 2021;37(2):567–571. DOI: 10.12669/pjms.37.2.3823.
  17. Sah S, Goel R, Goel JK. Analysis of caesarean section rate according to Robson's criteria in tertiary care centre. International Journal of Reproduction Contraception Obstetrics Gynecology 2018;7(8): 3060–3064. DOI: 10.5001/omj.2012.102.
  18. Costa ML, Cecatti JG, Souza JP, et al. Using a Caesarean Section Classification System based on characteristics of the population as a way of monitoring obstetric practice. Reprod Health 2010;7:13. DOI: 10.1186/1742-4755-7-13.
  19. Litorp H, Kidanto HL, Nystrom L, et al. Increasing caesarean section rates among low-risk groups: A panel study classifying deliveries according to Robson at a university hospital in Tanzania. BMC Pregnancy Childbirth 2013;13:107. DOI: 10.1186/1471-2393-13-107.
  20. Triunfo S, Ferrazzani S, Lanzone A, et al. Identification of obstetric targets for reducing cesarean section rate using the Robson Ten Group Classification in a tertiary level hospital. Eur J Obstet Gynecol Reprod Biol 2015;189:91–95. DOI: 10.1016/j.ejogrb.2015.03.030.
  21. Mittal P, Pandey D, Suri J, et al. Trend prediction for cesarean deliveries based on Robson classification system at a tertiary referral unit of North India. J Obstet Gynaecol India 2020,70:111–118. 10.1007/s13224- 019-01275-7.
  22. Naik M, Rani S, Ratnani R. Assessing cesarean section trends in a tertiary care teaching hospital using Robson's ten group classification. Int J Health Clin Res 2021;4(8):215–218. e-ISSN: 2590–3241, p-ISSN: 2590–325X.
  23. Vogel JP, Betrán AP, Vindevoghel N, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: A secondary analysis of two WHO multicountry surveys. Lancet Glob Health 2015;3:e260–270. DOI: 10.1016/S2214-109X(15)70094-X.
  24. Pati T, Marandi S, Mohapatra S. Analysis of caeserian section rate using Robson's classification in a tertiary care hospital of eastern Odisha. J Med Sci Clin Res 2018;6:157–161. DOI: 10.18535/jmscr/v6i9.28.
  25. Sungkar A, Santoso BI, Surya R, et al. Classifying cesarean section using Robson classification: An Indonesian tertiary hospital survey. Maj Obs Gin 2019;27:66–70. DOI: 10.20473/mog.V27I22019. 66-70.
  26. Bernardes J, Costa-Pereira A, Ayres-de-Campos D, et al. Evaluation of interobserver agreement of cardiotocograms. Int J Gynaecol Obstet 1997;57(1):33–37. DOI: 10.1016/S0020-7292(97)02846-4.
  27. Stavrou EP, Ford JB, Shand AW, et al. Epidemiology and trends for Caesarean section births in New South Wales, Australia: A population-based study. BMC Pregnancy Childbirth 2011;11:8. DOI: 10.1186/1471-2393-11-8.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.