Analysis of cesarean section rates using the Robson Ten-Group Classification System in a secondary-level hospital in Türkiye

Abstract

This study aimed to analyze cesarean section (CS) rates in a secondary-level hospital in Türkiye using the Robson Ten-Group Classification System and to identify the major contributing groups. This retrospective study included 8,112 women who delivered at a secondary-level state hospital between January 1, 2020, and December 31, 2024. After applying the inclusion criteria, 7,740 patients were included in the analysis. Patient information was obtained from hospital records and patient files. Cases were evaluated using the Robson Ten-Group Classification System; cases with missing data required for classification were excluded from group-based analyses. Cesarean section (CS) rates, as well as the absolute and relative contributions of each Robson group, were calculated. Descriptive statistics and chi-square tests were used for analysis. A total of 7,740 deliveries were analyzed, with an overall cesarean section (CS) rate of 32.5%. Among classifiable cases (n=6,494), the CS rate was 28.4%. The largest Robson groups were Group 3 (50.2%), Group 5 (20.0%), and Group 1 (12.8%). The greatest contribution to the overall CS rate was from Group 5 (absolute 20.0%; relative 70.3%), followed by Group 10 (absolute 2.8%; relative 9.9%) and Group 7 (absolute 1.4%; relative 5.1%). CS rates were significantly higher in women aged ≥35 years, multiparous women, preterm deliveries, those with a history of previous CS, non-cephalic presentations, and multiple pregnancies (p<0.001 for all). Group 5 remains the primary contributor to cesarean section rates, reflecting the substantial impact of previous cesarean delivery on current obstetric practice. In Türkiye, where cesarean rates remain high, these findings may help guide targeted strategies, including consideration of vaginal birth after cesarean (VBAC) in appropriate cases and improved labor management in low-risk pregnancies. The Robson classification provides a valuable framework for identifying priority areas and informing strategies to optimize cesarean section practices.