What does this research mean for the field?

Women with previous cesarean scars and nulliparous women undergoing induction of labor are the major contributors to overall cesarean section rates in tertiary care settings. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This audit aims to evaluate cesarean section patterns and identify contributors to rising rates using the Modified Robson Classification System.

June 18, 2026Open Access

Audit of Cesarean Section Rates in a Tertiary Care Hospital Using the Modified Robson Classification System

Key Points

This audit aims to evaluate cesarean section patterns and identify contributors to rising rates using the Modified Robson Classification System.
Retrospective audit conducted from March 2023 to February 2025
Included 493 women who underwent cesarean section
Categorized cases using the Modified Robson Classification System
51.9% of cesarean sections were from women in Group 5C (previous cesarean scar)
31.8% of cesarean deliveries indicated fetal distress as the leading cause
97.6% of neonates had favorable outcomes with live births

Abstract

Background The increasing rate of cesarean section (CS) has become a significant public health concern worldwide because of its association with increased maternal morbidity and healthcare burden. The Modified Robson Classification System is an internationally accepted tool for auditing and monitoring CS practices. Objective To evaluate CS patterns and identify the major contributors to rising CS rates in a tertiary care hospital using the Modified Robson Classification System. Methodology This retrospective audit was conducted in the Department of Obstetrics and Gynecology at Shifa College of Medicine from March 2023 to February 2025. A total of 493 women who underwent CS were included. Maternal demographic characteristics, obstetric history, indications for CS, and neonatal outcomes were obtained from medical records. Cases were categorized according to the Modified Robson Classification System, where Group 5C comprised women with previous cesarean scar(s) with singleton cephalic pregnancy at term, and Group 2A included nulliparous women with singleton cephalic term pregnancy undergoing induction of labor. Data were analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2016; IBM Corp., Armonk, New York, United States). Results The mean maternal age was 29.5 ± 5.9 years. Women with previous cesarean scars constituted the majority of cases, with Group 5C contributing 51.9% (256/493) of all CS, followed by Group 2A contributing 23.5% (116/493). Fetal distress was the leading indication for CS in 31.8% (157/493) of cases, followed by previous multiple cesarean scars in 28.0% (138/493) and refusal of trial of labor after cesarean in 18.5% (91/493). Among primigravida women, fetal distress accounted for 64.4% (85/132) of cesarean deliveries. Favorable neonatal outcomes were observed in most cases, with live births occurring in 97.6% (481/493) and NICU admissions in 2.2% (11/493) of neonates. Conclusion Women with previous cesarean scars and nulliparous women undergoing induction of labor were the major contributors to the overall CS rate. The Modified Robson Classification System is an effective tool for identifying high-contributing groups and guiding strategies aimed at reducing unnecessary cesarean deliveries while maintaining safe maternal and neonatal outcomes.

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