Assessing caesarean sections using the Robson ten-group classification system: a record-based audit in a tertiary hospital in Bangladesh

Caesarean section (CS) rates are rising globally, especially in low- and middle-income countries like Bangladesh, yet the factors driving this increase remain debated. In this context, the Robson 10-group classification system stratifies women undergoing delivery into mutually exclusive, clinically relevant obstetric groups based on five obstetric characteristics, enabling standardized comparison of CS rates. This study aimed to classify and analyze CS cases of a tertiary care hospital using the Robson 10-group classification. A retrospective record-based descriptive audit was conducted at the Shaheed Suhrawardy Medical College Hospital, Dhaka, from January to June 2023. Data were collected from hospital records, and CS cases were classified using the Robson 10-group classification system. Descriptive statistics summarized maternal characteristics, pregnancy-related factors, and indications of CS. Among 1,949 deliveries, 1,269 (65%) were CS, with 1,266 included in the final analysis. The mean maternal age was 26.5 (SD 5.2) years, and 41% were nulliparous. Most pregnancies were singleton (98.5%), term (82%), and cephalic in presentation (89%). The largest contributor to CS was Group 5 (previous CS with a singleton cephalic pregnancy at term), accounting for 37% of cases, followed by Group 10 (preterm singleton cephalic pregnancies) at 14%. Nulliparous women with spontaneous labor (Group 1) contributed 11%, while induced labor or pre-labor CS (Group 2) made up 13.6%. The most common indications for CS were previous CS (43%), fetal distress (26%), and failure of labor to progress (19%). We observed a high CS rate, with previous CS being the largest contributor. Fetal distress and labor dystocia were commonly recorded indications, including among term cephalic groups, highlighting areas that warrant further prospective clinical audit.