Impact of Targeted Interventions on Cesarean Section Rates: A Four-Year Audit Using the Robson 10-Group Classification System at MCH, PIMS

Abstract

Objective: To analyze cesarean section rates using the Robson Ten-Group Classification System and assess the impact of targeted interventions on reducing CS rates. 

Study Design: Retrospective clinical audit.

Place and Duration: MCH, Pakistan Institute of Medical Sciences, Islamabad, from January 2021 to December 2024.

Methodology: A total of 8,653 deliveries were recorded throughout the study period and assigned to 10 Robson groups. Cesarean section rates were evaluated at each Robson group level. Moreover, the proportion of cesarean burden by each group to the total cesarean cases were calculated. An intervention was conducted after analysis of these audits in the first year, including the implementation of standardized labor induction protocols, structured vaginal birth after cesarean counseling, adjusted vaginal birth after cesarean selection criteria, and obstetric resident training. Descriptive statistics were used to compare the pre and post intervention outcomes.

Results: The overall cesarean section rate was 34.07% (2,948/8,653); however, a declining trend was observed from 36.10% in 2021 to 32.27% in 2024. Robson group 5 was the largest contributor of all cesarean section cases (38%). Groups 6, 7, and 9 had the highest within-group cesarean rates (94.23%, 93.05%, and 92.53%, respectively). The post-intervention analysis showed that “vaginal birth after cesarean” success rate was improved from 28% to 38%, and emergency cesarean rates declined from 29.28% to 21.03%.

Conclusion: Robson Ten-Group Classification System-guided targeted interventions effectively reduced cesarean rates, particularly among the high-burden groups. Institutional audits using Robson classification is useful standard practice for monitoring and optimizing cesarean section rates.