Cesarean Delivery in Nulliparous, Singleton, Cephalic Term Pregnancies: Indication Patterns and a Structured Plan for Reduction

Background/Objectives: Cesarean delivery, while potentially life-saving, is associated with significant short- and long-term risks. Particularly in nulliparous, singleton, cephalic pregnancies at term, unnecessary Cesarean delivery should be avoided, to prevent—among others—complications in potential subsequent pregnancies. This study aimed to identify the most common indications for Cesarean delivery in women classified as group 1 or 2 of the Robson-Ten Group Classification System and to develop a protocol for safely reducing Cesarean delivery rates in this population. Methods: We conducted a retrospective data analysis of all deliveries in Robson group 1 or 2 at the Medical University of Vienna in 2023. Based on these data, we performed a literature review to develop a narrative protocol addressing the most frequent indications for Cesarean delivery according to the selected evidence. Results: We included 890 women, 558 of whom delivered vaginally (62.7%), whereas 332 underwent Cesarean delivery (37.3%). The most frequent indications for Cesarean delivery were pathological fetal tracings, prolonged labor or labor arrest, maternal primary disease and unsuccessful induction of labor. Higher maternal age (p < 0.01) and underlying disease like hypertensive (p = 0.04) or glycemic (p = 0.01) disorders were associated with an increased risk for Cesarean delivery. Conclusions: We identified the most common indications for Cesarean delivery among women in Robson group 1 and 2 and generated a proposed framework to achieve a safe reduction in Cesarean delivery rates, based on this study’s findings and selected current evidence. Safety and effectiveness of this protocol need to be validated in prospective studies.