**8. Robson's classification for CS**

As already discussed, there are concerns over the rising caesarean section rate globally. However, determining the adequate caesarean section rate at the population level, i.e. the minimum rate for medically indicated caesarean section, while avoiding medically unnecessary operations is a challenging task. At the heart of the challenge in defining the optimal caesarean section rate at any level is the lack of a reliable and internationally accepted classification system to produce standardised data, enabling comparisons across populations and providing a tool to investigate drivers of the upward trend in caesarean section.

The lack of a standardised internationally accepted classification system to monitor and compare caesarean section rates in a consistent and action-oriented manner is one of the factors that has hindered a better understanding of this trend. WHO proposes adopting Robson's classification as an internationally applicable caesarean section classification system [29].

The system classifies all women admitted for delivery into 1 of the 10 groups that are mutually exclusive and totally inclusive. This means that based on a few basic obstetric variables, every woman admitted to deliver in any facility can be classified into 1, and only 1, of the 10 groups and no woman will be left out of the classification. The 10 groups are based on 6 basic obstetric variables which are the only information needed to classify each woman as shown in **Table 2**.

Based on the 6 obstetrics, the 10 groups are as shown in **Table 3**. WHO expects that this classification will help healthcare facilities to:



**97**

**9. Conclusion**

**Table 3.**

specific caesarean section rate.

*Caesarean Section in Low-, Middle- and High-Income Countries*

Caesarean sections are effective in saving maternal and infant lives but only when they are required for medically indicated reasons. Although the operation continues to become safer, the incidence of maternal mortality and morbidity is still significant. Continued efforts on the part of the obstetrician must be made to ensure that caesarean deliveries are not performed for inappropriate indications and that each woman is counselled carefully according to her individual characteristics. Caesarean section rates have been rising over time due to multifactorial reasons. However, determining the adequate caesarean section rate is challenging due to the absence of reliable and internationally accepted classification system. WHO proposes Robson's classification system as a global standard for assessing, monitoring and comparing caesarean section rates within healthcare facilities and between facilities. However, every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a

Group 1 Nulliparous women with a single cephalic pregnancy ≥37 weeks gestation in spontaneous labour Group 2 Nulliparous women with a single cephalic pregnancy, ≥37 weeks gestation who either had labour

Group 3 Multiparous women without a previous uterine scar, with a single cephalic pregnancy ≥37 weeks

Group 4 Multiparous women without a previous uterine scar, with a single cephalic pregnancy ≥37 weeks gestation who either had labour induced or were delivered by caesarean section before labour

Group 5 All multiparous women with at least one previous uterine scar with a single cephalic pregnancy

Group 7 All multiparous women with a single breech pregnancy, including women with previous uterine

Group 9 All women with a single pregnancy with a transverse or oblique lie, including women with previous

Group 10 All women with a single cephalic pregnancy <37 weeks, including women with previous uterine

Group 8 All women with multiple pregnancies, including women with previous uterine scars

induced or were delivered by caesarean section before labour

*DOI: http://dx.doi.org/10.5772/intechopen.88573*

gestation in a spontaneous labour

Group 6 All nulliparous women with a single breech pregnancy

*Reproduced from WHO Robson classification implementation manual 2017.*

≥37 weeks gestation

scar

scar

uterine scar

*The 10 groups of the Robson classification.*

**Group Description**

#### **Table 2.**

*Obstetric variables for Robson's classification.*

*Caesarean Section in Low-, Middle- and High-Income Countries DOI: http://dx.doi.org/10.5772/intechopen.88573*


#### **Table 3.**

*Recent Advances in Cesarean Delivery*

population level, i.e. the minimum rate for medically indicated caesarean section, while avoiding medically unnecessary operations is a challenging task. At the heart of the challenge in defining the optimal caesarean section rate at any level is the lack of a reliable and internationally accepted classification system to produce standardised data, enabling comparisons across populations and providing a tool to

The lack of a standardised internationally accepted classification system to monitor and compare caesarean section rates in a consistent and action-oriented manner is one of the factors that has hindered a better understanding of this trend. WHO proposes adopting Robson's classification as an internationally applicable

1.Optimise the use of caesarean section by identifying, analysing and focusing

2.Assess the effectiveness of strategies or interventions targeted at optimising

3.Assess the quality of care, clinical management practices and outcomes by

• Multiparous

• No

• Induced

• Multiple

• Term (37 weeks or more)

• Breech presentation • Transverse lie

• No labour (prelabour caesarean section)

4.Assess the quality of the data collected while raising staff awareness about the

interventions on specific groups of particular relevance for each healthcare facility.

The system classifies all women admitted for delivery into 1 of the 10 groups that are mutually exclusive and totally inclusive. This means that based on a few basic obstetric variables, every woman admitted to deliver in any facility can be classified into 1, and only 1, of the 10 groups and no woman will be left out of the classification. The 10 groups are based on 6 basic obstetric variables which are the only

investigate drivers of the upward trend in caesarean section.

information needed to classify each woman as shown in **Table 2**. Based on the 6 obstetrics, the 10 groups are as shown in **Table 3**. WHO expects that this classification will help healthcare facilities to:

caesarean section classification system [29].

the use of caesarean section.

importance of the data and its use.

1. Parity • Nulliparous

3. Onset of labour • Spontaneous

4. Number of foetuses • Singleton

*Obstetric variables for Robson's classification.*

5. Gestational age • Preterm (less than 37 weeks)

6. Foetal lie and presentation • Cephalic presentation

*Reproduced from WHO Robson classification implementation manual 2017.*

2. Previous caesarean section • Yes (one or more)

group.

**Obstetric characteristic**

**96**

**Table 2.**

*The 10 groups of the Robson classification.*
