Analysis Of The Rate of Lower Segment Caesarean Section As Per Robson's 10 Group Classification at IIMS & R, Lucknow: A Retrospective Study
DOI:
https://doi.org/10.63682/jns.v14i4.8874Keywords:
Analysis, Lower Segment, Caesarean Section, Robson's 10 Group Classification, VbacAbstract
Background: The global rise in caesarean section (CS) rates, surpassing the WHO-recommended threshold of 10–15%, has prompted a critical need for standardized assessment. Robson’s 10-Group Classification System (TGCS) offers a structured approach to evaluate and compare CS rates across different obstetric populations.
Objective: To analyze the frequency and indications of lower segment caesarean sections (LSCS) at IIMS&R, Lucknow, using Robson's TGCS over a two-year period and to identify target groups for intervention to reduce CS rates.
Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynaecology, IIMS&R, from January 2018 to December 2019. Data from delivery records of women with viable pregnancies were collected and categorized into Robson’s 10 groups. Statistical analysis was conducted using SPSS v16.
Results: Among 1,128 deliveries reviewed, the overall CS rate was 36%. The largest contributors to the CS rate were Group 5 (previous CS, single cephalic, ≥37 weeks) with 34.4%, Group 2 (nulliparous, single cephalic, ≥37 weeks, induced or pre-labour CS) with 20.0%, and Group 3 (multiparous without previous CS, single cephalic, ≥37 weeks in spontaneous labour) with 17.5%. These three groups collectively accounted for 71.9% of all CSs.
Conclusion: Robson’s TGCS is an effective tool for identifying high-risk groups contributing to the rising CS rate. Targeted interventions in Groups 2 and 5, particularly promoting vaginal birth after caesarean (VBAC) and refining induction protocols, could help reduce unnecessary CSs.
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World Health Organization Statement on Caesarean Section rates. 2015 WHO Reference Number: WHO/RHR/15.02.2015.
Bhoi NR, Nayak L, Sethy M, Pradhan K, Mishra P, Mahapatra T, Bera P. Lower segment cesarean section in second stage of labor: comparison of Patwardhan method with conventional pushing method (a 3-year study). J South Asian Feder Obst Gynae. 2019;11(4):263–5.
Guilmoto CZ, Dumont A. Trends, Regional Variations, and Socioeconomic Disparities in Cesarean Births in India, 2010-2016. JAMA Netw Open. 2019;2(3):e190526
Siddhi S. Kore, Fatema Shams1, Jayanth Chilkund1, Gauri Kore2. A retrospective study to analyse the rate of caesarean section according to Robson's 10 group classification in a peripheral hospital in a metropolitan city.2021;10.18203/2320-6012.ijrms20213086.
Hanson C, Betrán A, Opondo C, et al. Trends in caesarean section rates between 2007 and 2013 in obstetric risk groups inspired by the Robson classification: results from population‐based surveys in a low‐resource setting. BJOG. 2019; 126:690–700.
Robson, M. Classification of caesarean sections. Fetal and Maternal Medicine Review. 2001;12(1):23-39.
WHO, Robson classification: implementation manual, 2017; ISBN: 978-92-4-151319-7.
Manoj Bhatt, Gunvant Kadikar, Dipti C. Parmar, Medha Kanani.Retrospective study of cesarean section by using the Robson's ten group classification system 2018;10.18203/2320- 1770.ijrcog20180891.
Guilmoto CZ, Dumont A. Trends and disparities in cesarean births in India, 2010–2016. JAMA Netw Open. 2019;2(3):e190526.
Maeda E, Ishihara O, Tomio J, et al. Cesarean delivery rates for overall and multiple pregnancies in Japan: A descriptive study using nationwide health insurance claims data. J Obstet Gynaecol Res. 2021;47:2099–109. doi: 10.1111/jog.14772.
Bhatt M, Kadikar G, Parmar DC, Kanani M. Retrospective study of cesarean section by using Robson's ten group classification system. Int J Reprod Contracept Obstet Gynecol. 2018;7(3):803–7.
Spandana S, Shivanna AK. The ten group Robson classification: a retrospective study to optimise caesarean section rates. Int J Reprod Contracept Obstet Gynecol. 2020;9(10):4176–80.
Analysis of Cesarean Section Rate using Robson’s TGCS in Mysore Medical College, Karnataka. Int J Reprod Contracept Obstet Gynecol. 2016;5(7):2155–60.
Bharadwaj M, Modi JN. A four-year audit of caesarean section deliveries at a medical college hospital in Central India. Int J Reprod Contracept Obstet Gynecol. 2012;1(1):8–12.
ACOG Committee Opinion No. 559. Cesarean Delivery on Maternal Request. Obstet Gynecol. 2013 Apr;121(4):904-7.
Robson M. Classification of caesarean sections. Fetal Matern Med Rev. 2001;12(1):23–39.
Nair S, Kumari S, Thomas A, Ramesh S, Bhatia K. Impact of structured VBAC protocol on caesarean section rates in Robson Group 5: A multicentric study from South India. Int J Gynaecol Obstet. 2025;168(1):45-51. doi:10.1002/ijgo.15234.
Sharma R, Gupta P, Meena R, Singh S. Analysis of caesarean section rates in North Indian tertiary hospitals using Robson’s TGCS: Focus on Group 2 interventions. J Obstet Gynaecol India. 2024;74(3):210-217. doi:10.1007/s13224-023-01944-0.
Patel M, Desai P, Joshi R, Chavda D. Optimizing labour induction to reduce primary caesarean section rates: A prospective quality improvement study. Int J Reprod Contracept Obstet Gynecol. 2024;13(5):1289-1296. doi:10.18203/2320-1770.ijrcog20241123.
Shrestha B, Karki A, Lama S, Tamang R. Robson’s classification audit in a tertiary hospital in Nepal: Reducing caesarean section rates in Groups 1 and 3. BMC Pregnancy Childbirth. 2024;24(1):505. doi:10.1186/s12884-024-06672-9.
Anderson J, Murphy DJ, Robson M. International trends in caesarean section rates in Robson Groups 1–5: A cross-national comparison. BJOG. 2025;132(2):324-333. doi:10.1111/1471-0528.17654.
Li X, Wang Y, Chen H, Zhang Q. Cultural and systemic barriers to reducing caesarean section rates: Lessons from China’s TGCS implementation. Lancet Reg Health West Pac. 2025;45:100825. doi:10.1016/j.lanwpc.2025.100825.
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