The Robson Classification: Monitoring and Comparing Cesarean Delivery Rates [2P]

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In April 2015, the WHO recommended the Robson Classification for monitoring and comparing Cesarean delivery (CD) rates. This classification categorizes CD into 10 mutually exclusive groups based on pregnancy characteristics. This study aimed to apply this classification to a US data set to monitor CD rates over time and target quality improvement.


Prospective cohort of consecutive deliveries at one institution during two one-year periods (2012 and 2014). Chart abstracted data were collected as part of the Obstetrics Clinical Outcomes Program (OB COAP), a clinician-led, quality initiative. CD rates were calculated for patient groups as described by Robson. Relative risks and confidence intervals were calculated comparing CD rates in 2012–2014.


A total of 8,662 deliveries were included: 4,206 (singletons) in 2012 and 4,456 (4,339 singletons and 117 multiples) in 2014. During the study period, the overall CD rate in singletons decreased from 37.2% to 32.4% (P<.001). The CD rate significantly decreased in Group 1 (term singleton cephalic nulliparas in spontaneous labor) (26.4%–18.8% RR 0.8 CI 0.7–0.9) but rates were largely unchanged in other groups, including Group 5 (term singleton cephalic multiparas with a previous CD), the group contributing most to CD.


Applying the Robson classification to our data clearly highlighted targets for quality improvement as well as groups in which practice changes had been effective. The Robson also facilitated a standardized comparison with data at an international level and could be used similarly within the USA.

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