Benchmarking Cesarean Section Trends: A Case Study from Tu Du Hospital Using Robson's Model

Background: Cesarean section (CS) is a critical surgical procedure in obstetrics but is increasingly overused worldwide. Vietnam has seen rising CS rates, especially in urban tertiary hospitals, with limited standardized analysis to guide interventions. This study assesses CS rates at Tu Du Hospital using the WHO-endorsed Robson 10-Group Classification System. Methods: A cross-sectional descriptive study was conducted over one month in 2017 at Tu Du Hospital, a major obstetrics referral center in southern Vietnam. All women who delivered during this period were classified into Robson's 10 groups based on parity, gestational age, labor onset, presentation, fetal number, and prior CS. CS rates and group-specific contributions were analyzed. Results: Among 5287 deliveries, the overall CS rate was 42.6%. Group 5 (previous CS) contributed 29.7% of all CSs, followed by Group 2 (nulliparous, induced/pre-labor CS, 26.2%) and Group 1 (nulliparous, spontaneous labor, 12.8%). Failed induction, fetal distress, and cephalopelvic disproportion were common indications. Only 22% of eligible women in Group 5 were offered a trial of labor after cesarean (TOLAC), although the success rate for vaginal birth after cesarean (VBAC) was 67%, indicating underutilization of this option. Conclusions: This study provides rare Robson-based evidence from Vietnam, identifying key target groups for intervention. The findings support expanded use of VBAC and more stringent criteria for induction. Future research should explore behavioral and systemic drivers of high CS rates to guide national policy.