Cesarean Section Rates Assessed Using the Robson Ten-Group Classification System: A Retrospective Observational Study in a Tertiary Care Hospital

Background: Rising cesarean section (CS) rates, especially in tertiary referral hospitals, necessitate standardised methods for meaningful evaluation. The Robson Ten-Group Classification System (TGCS) provides a straightforward and reproducible framework for analysing CS trends based on obstetric characteristics. Objective: This study aimed to audit CS rates in a tertiary care hospital of Eastern Uttar Pradesh using the Robson TGCS and to classify deliveries according to Robson groups while describing the relative size of each group and its contribution to the institutional CS rate. Methodology: This retrospective observational study included all deliveries conducted at the Government Medical College, Azamgarh, India, from August 2022 to July 2023 (n=954). Data were collected from the labour room and the operation theatre records. All women were classified into Robson's 10 groups, and descriptive analysis was performed to assess the overall CS rate and group-wise contribution. Proportions of CS and group-wise contributions were additionally reported with corresponding 95% confidence intervals (CI) for proportions to reflect the precision of the estimates. For each Robson group, percentages were clearly distinguished as (i) the relative size of the group, defined as the proportion of women in that group among all deliveries, and (ii) the contribution to the overall CS rate, defined as the proportion of CS attributable to that group among all CS deliveries. Result: The overall CS rate was 61.1% (95% CI: 58.0-64.2), with 51.8% (95% CI: 48.1-55.5) emergency and 48.2% (95% CI: 44.5-51.9) elective procedures. Previous CS was the most common indication (24.7%). Robson Group 5 represented the largest contributor to the overall CS rate (32.4%; 95% CI: 29.4-35.4) while also forming one of the largest relative obstetric groups within the study population. Groups 1 and 2 constituted substantial relative group sizes, and each contributed 20.9% (95% CI: 18.3-23.5) to the overall CS rate. Group 10 accounted for 7.5% (95% CI: 5.9-9.1) of all CS, representing a smaller relative group size but a measurable contribution to the institutional CS burden. Maternal complications were minimal, and most neonates had normal birth weight. Conclusion: The Robson TGCS provides a structured approach for describing and monitoring CS distribution across obstetric groups in a tertiary care setting. Identification of major contributing groups may support institutional audits and inform future strategies aimed at optimising CS practices.