Objectives: To determine the relative contributions of each of the 10 groups to overall caesarean section rate and identify modifiable groups for intervention to reduce caesarean section rates.
Methods: Retrospective record review of the Robson Ten-Group Classification System (RTGCS) for caesarean sections from the statistical department of the Obstetrics and Gynaecology department.
Results: The overall caesarean section rate is 46.9%. The contribution to the overall caesarean section rate in descending order is as follows: Group 5 (previous CS, single, cephalic, >37 weeks), group 2 (nulliparous, single cephalic, >37 weeks, induced or CS before labor), group 4 (multiparous (excluding previous CS), single cephalic, >37 weeks, induced or CS before labor), group 10 (all single cephalic, <36 weeks (including previous CS), group 3 (Multiparous (excluding previous CS), single cephalic, >37 weeks in spontaneous labor), group 7 (All multiparous breeches (including previous CS)), group 1 (Nulliparous, single cephalic, >37 weeks in spontaneous labor), group 6 (All nulliparous breeches), group 8 (All multiple pregnancies (including previous CS)), and group 9 (All abnormal lies (including previous CS).
Conclusion: Groups 2, 4 and 5 were found to be the major contributors to the overall caesarean section rates and the modifiable factors for consideration in reducing caesarean section rates would be to improve the number of successful inductions of labour. This will decrease primary caesarean section rates, and decrease the numbers for trial of labour after caesarean section (TOLAC). TOLAC should be offered as per protocols and not left to individual obstetrician discretion.