Robson ten-group classification-based analysis of caesarean sections in Türkiye: a large-scale cross-sectional study

Caesarean section (C-section) rates are rising globally, including in Türkiye, indicating a significant shift in obstetric practices. To standardise monitoring, the World Health Organization (WHO) advocates for the Robson 10-group classification system (RTGCS), with categorises all deliveries into ten distinct groups based on obstetric history and current pregnancy characteristics, such as parity, previous C-section, and foetal presentation. This study evaluated C-section rates at a Turkish tertiary referral centre using this classification to identify targets for clinical quality improvement.

This retrospective study analysed deliveries over 12 years, between 1 July 2012 and 1 October 2024, stratified based on RTGCS. Pairwise comparisons utilised independent t-tests for numerical data and Pearson's chi-squared tests for nominal variables. Statistical significance was set at p < 0.05, with results presented alongside 95% confidence intervals (CI).

A total of 119,767 deliveries were evaluated. Of these, 84.5% (n = 101,252) involved Turkish nationals and 15.5% (n = 18,515) involved refugees. Overall, 56,986 deliveries (47.6%) were performed by C-section, with a higher rate among Turkish women (49.6%) compared with refugee women (36.4%). Within the four largest Robson groups, Group 5 provided the highest absolute contribution to the total C-section count at 21.0%. The absolute contributions for Groups 1, 3, and 10 were 5.9%, 5.8%, and 5.5%, respectively. Collectively, these four groups accounted for 38.2% of all deliveries and 80.2% of all C-section cases recorded in the study.

This study indicated that the overall C-section rate was 47.6%, predominantly driven by Group 5, followed by Groups 10, 3, and 1.