Analysis of caesarean section through Robson classification system: An emerging concept to audit the increasing caesarean section rate

Background: Caesarean section (CS) is one of the most common surgical interventions worldwide. In the past few decades, the rate of CS surgeries has increased across the whole world. For patients whose spontaneous vaginal delivery (SVD) is contraindicated or not possible, CS is carried out to protect the lives of both foetus and the mother. However, in reality, CS is also being performed without following standard indications or based on vague indications like obstructed labour with intact membranes. Although CSs are known to be life-saving procedures, various risks have been found attached to CS concerning present or future pregnancies. Aims and Objectives: The aims and objectives of this study are the following: Classifying women undergoing CS as per the Robson criteria, analysing the CS rate using the Robson criteria, determining the groups which contribute the most to CS, identifying commonalities among these groups, and studying the foeto-maternal outcomes in CS patients. Methods: Prospective observational studies of all CSs conducted at Lala Lajpat Rai Memorial LLRM Medical College, Meerut were classified using RTGCS. The duration of the study period was one year, and all of the patients who delivered via CS at LLRM Medical College during the said period were included in the study. Results: Out of the total 3,343 deliveries, 2,059 deliveries were by CS. The analysis by applying Robson’s classification revealed that approximately 37.9% of the patients belonged to Robson group 5, followed by 25.2% that belonged to Robson group 10 and then Robson groups 1, 2 and 3 followed. Of the various indications of CS, previous LSCS with scar tenderness was the most common indication (30.8%). Conclusion: Robson classification helps analyse the trend of increasing CS rate and provides an outlook on how to reduce this increasing trend. Good labour monitoring, proper ANC care regarding methods of delivery and encouraging TOLAC and DOULA (birth companion) can help to reduce CS rate.