Trend Prediction for Cesarean Deliveries Based on Robson Classification System at a Tertiary Referral Unit of North India

  • Pratima Mittal
  • Divya PandeyEmail author
  • Jyotsna Suri
  • Rekha Bharti
Original Article



World Health Organization proposed use of Robson Classification as a global standard for assessing, maintaining and comparing Cesarean section (CS) rates. This paper aimed to examine CS trend at a tertiary center according to Robson Ten-Group Classification System (TGCS) over three-year period (2015–2017) and to predict future Cesarean trends.


This prospective observational study was conducted at a tertiary teaching institute and included 81,784 females who delivered at this hospital over three-year duration (2015–2017). The data compilation was done according to Robson TGCS. The main outcome measures were overall annual CS rates, Robson group-wise CS rates, future overall and Robson group-wise CS trend. These parameters were calculated, trend analysis was done and trend over future 3 years was predicted.


There were 81,784 deliveries (62,336 vaginal and 19,448 Cesarean deliveries) over the study period. The year-wise CS rate was 22.4%, 23.5% and 25.5%, respectively. The largest contribution was by group 5 followed by group 2 and group 1. Based on 3-year data, it was predicted that CS rate will increase by 0.905% annually over coming 3 years. In groups 3, 4, 6, 7 and 8, predicted trend value showed an annual increase by 0.65%, 0.05%, 0.05%, 0.05% and 0.10%, respectively; in groups 1, 2, 5, 9 and 10, it showed an annual decrease of 0.45%, 0.05%, 1.50%, 0.50% and 0.05%, respectively.


Increasing CS rate trend was seen over last 3 years with a predicted rise of 0.905% per year. Robson groups 5, 2 and 1 were at present major contributors; however, the trend analysis predicted a decreasing trend. Trend analysis predicted annual increment in groups 3, 4, 6, 7 and 8 over next 3 years, thereby suggesting need to focus on these groups as well.


Cesarean section audit Cesarean trend analysis Future Cesarean trends Maternal health policy formulation 



We would like to thank Dr. L. J. Pandey for his academic contribution while preparing and finalizing the manuscript.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Permission

The data were gathered from the individual case sheets of the antenatal females delivering at the institute. The institutional review body approved the study.


Not required.


  1. 1. Accessed January 30, 2019.
  2. 2.
    Martin JA, Hamilton BE, Ventura SJ, et al. Births: final data for 2011. Natl Vital Stat Rep. 2013;62(2):1–90.PubMedGoogle Scholar
  3. 3.
    NHS Maternity Statistics 2016–2017. Published 09 Nov, 2017. Accessed January 30, 2019.
  4. 4.
    Torloni MR, Betran AP, Souza JP, et al. Classifications for caesarean section; a systematic review. PLoS ONE. 2011;6:e14566.CrossRefGoogle Scholar
  5. 5.
  6. 6.
    Betran AP, Vindevoghel N, Souza JP, et al. A systematic review of the Robson classification for Caesarean section. What works, doesn’t work and how to improve it? PLoS ONE. 2014;9:e97769.CrossRefGoogle Scholar
  7. 7.
    Koteshwara S, Sujatha MS. Analysis of caesarean section rates using Robsons ten group classification: the first step. Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3481–5.CrossRefGoogle Scholar
  8. 8.
    Patel RV, Gosalia EV, Deliwala KJ, et al. Indications and trends of cesarean birth delivery in the current practice scenario. Int J Reprod Contracept Obstet Gynecol. 2014;3:575–80.CrossRefGoogle Scholar
  9. 9.
    Katke RD, Zarariya AN, Desai PV. LSCS audit in a tertiary care centre in Mumbai: to study indications and risk factors in LSCS and its effect on early perinatal morbidity and mortality rate. Int J Reprod Contracept Obstet Gynecol. 2014;3:963–8.CrossRefGoogle Scholar
  10. 10.
    Le Ray C, Blondel B, Prunet C, et al. Stabilising the caesarean rate: which target population? BJOG. 2015;122:690–9.CrossRefGoogle Scholar
  11. 11.
    Brennan DJ, Robson MS, Murphy M, O’herlihy C. Comparative analysis of international cesarean delivery rates using 10-group classification identifies significant variation in spontaneous labour. Am J Obstet Gynecol. 2009;201:308.e1–8.CrossRefGoogle Scholar
  12. 12.
    Brennan DJ, Murphy M, Robson MS, et al. The singleton, cephalic nulliparous woman after 36 weeks of Gestation: contribution to overall cesarean delivery rates. Obstet Gynecol. 2011;117(2pt1):273–9.CrossRefGoogle Scholar
  13. 13.
    Stivanello E, Rucci P, Carretta E, et al. Risk adjustment for inter-hospital comparison of cesarean delivery rates in low-risk deliveries. PLoS ONE. 2011;6(11):e28060. Scholar
  14. 14.
    Samba A, Mumini K. A review of Cesarean section using the ten-group-classification system (Robson classification) in Karle-Bu Teaching Hospital (KBTH), Accra, Ghana. Gynecol Obstet (Sunnyvale). 2016;6:385. Scholar
  15. 15.
    Chaillet N, Dumont A. Evidence-based strategies for reducing cesarean section rates a meta-analysis. Birth. 2007;34:53–64.CrossRefGoogle Scholar
  16. 16.
    Roberge S, Dube E, Blouin S, et al. Reporting Caesarean delivery in Quebec using the Robson classification system. J Obstet Gynaecol Can. 2017;39(3):152–6. Scholar
  17. 17.
    Tanaka K, Mahomed K. The ten group Robson classification A single centre approach Identifying strategies to optimize caesarean section rates. Obstet Gynecol Int. 2017;2017:5648938.CrossRefGoogle Scholar
  18. 18.
    Atnurkar KB, Mahale AR. Audit of caesarean section births in small private maternity homes: analysis of 15 year data applying the modified Robson criteria, Canada. J Obstet Gynecol India. 2016;66(1):289–94. Scholar
  19. 19.
    Robson M, Hartgan L, Murphy M. Methods of achieving and maintaining an appropriate caesarean section rate. Best Pract Res Clin Obstet Gynaecol. 2013;27:297–308.CrossRefGoogle Scholar
  20. 20.
    Wang JX, Sun HQ, Huang K, et al. Trend of caesarean section rate and puerpera characteristics: based on Robson classification. Zonghua Liu Xing Bing Xue Za Zhi. 2017;38(7):963–7.Google Scholar
  21. 21.
    Safe prevention of the primary cesarean delivery. Obstetric care Consensus no.1. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:693–711. Accessed 12 Sept 2019.
  22. 22.
    Cohain JS. Midwifery today Int Midwife. Winter. 2007;84:16–7.Google Scholar
  23. 23.
    Hoxha I, Syrogiannouli L, Braha M, et al. Caesarean sections and private insurance: systematic review and meta-analysis. BML Open. 2017;7:e016600. Scholar
  24. 24.
    Pai SA. Violence against doctors on the increase in India. Natl Med J India. 2015;28(4):214–5.PubMedGoogle Scholar
  25. 25.

Copyright information

© Federation of Obstetric & Gynecological Societies of India 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyVardhman Mahavir Medical College and Safdarjung HospitalNew DelhiIndia

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