Evaluation of Robson’s Ten Group Classification to Optimise Caesarean Delivery Rates: A Comparative Study"

Abstract

ABSTRACT  

Introction

The rising global rates of caesarean deliveries (CS) have raised concerns regarding their appropriateness and impact on maternal and neonatal health. To address this, the WHO recommends the Robson Ten Group Classification System (RTGCS) as a standardized framework to audit CS rates. This study, conducted at Gandhi Memorial Hospital, Shyam Shah Medical College, Rewa, aimed to analyze CS indications and assess the applicability of RTGCS before and after an educational intervention.

Material and method

This cohort study included all CS cases from September 2021 to September 2023. Deliveries were categorized using RTGCS, based on obstetric variables. A training program on RTGCS was introduced in September 2022. The study compared retrospective data (Sept 2021–Aug 2022) with prospective data (Oct 2022–Sept 2023) to evaluate the impact of training and classification on clinical decision-making.

Result

Of 18,948 total deliveries, 36.3% were caesarean. Group 1 and Group 2 comprised the largest share but showed similar CS rates (\~36%). Groups 5 (previous CS) and 9 (transverse/oblique lie) had the highest CS rates, though Group 5 showed a significant reduction post-intervention (from 98.6% to 60.2%), suggesting improved decision-making. The primary indications included previous CS, fetaldistress, and hypertensive disorders.

Conclusion

The study concludes that RTGCS is a valuable tool for monitoring CS rates and guiding clinical practice. Recommendations include promoting VBAC/TOLAC where safe, enhancing antenatal counselling, addressing socio-economic barriers, and adopting RTGCS routinely to reduce unnecessary caesareans and improve maternal outcomes in low-resource settings.