Analysis of Cesarean Section Rates Based on Robson's Classification and its Outcomes at a Governmental Tertiary Referral Teaching Hospital in the Sistan and Baluchestan Province, Iran

Document Type : Original Article


Department of Midwifery, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran



Timely cesarean section (CS) can be lifesaving, but its overuse may lead to health risks. Robson classification is a standard tool for monitoring and comparing CS rates at all levels.
The objective of this study is to analyze the CS rates based on Robson classification and its outcomes in a governmental tertiary referral teaching hospital in Zahedan city, Iran.
A cross-sectional study was carried out on all CS (n = 1763) performed in Ali-Ibn-Abitaleb Hospital of Zahedan city from September 22 to March 19, 2019. Data were extracted from women's paper-based files. Descriptive analyses were performed. The Chi-square test was used to test the differences between groups. The odds ratio was used to calculate the risk of adverse maternal and perinatal outcomes in women with and without a previous CS.
The overall rate of CS was 44.81%. Women with previous CS (Robson group 5) were the largest contributors to the overall CS rate (39.82%), followed by Robson group 10 (i.e., women with a single cephalic pregnancy at ≤36 weeks' gestation: 19.45%). The CS rate in women in Robson groups 1 and 2 was 9.93% and 5.61%, respectively. The main indications for CS among nulliparous women were fetal distress (42.99%), malpresentation (14.95%), and prolonged and obstructed labor (10.98%). Adverse maternal outcomes were similar in women with and without a previous CS.
The Robson classification system showed a high rate of CS in the study setting, and many CSs were performed in women with low-risk pregnancies.