[Comparison of cesarean section rates at the facility level using the Robson classification: A retrospective cohort...

A reduction in the cesarean section rate is warranted from both medical and health policy perspectives. With the introduction of the Robson classification into the national obstetric quality reporting by the German Institute for Quality Assurance and Transparency in Health Care (IQTIG) in 2020, a standardized instrument became available that enables transparent presentation of obstetric data. However, comparative analyses at the hospital level remain scarce. The aim of this study was to systematically describe cesarean section rates at two sites of a single tertiary university perinatal center using the modified Robson classification and to compare site-specific differences.

A total of 16,937 births between 2019 and 2021 at the two obstetric sites of a single tertiary university perinatal center were retrospectively analyzed and assigned to one of twelve groups according to the modified Robson classification. In addition to descriptive analyses of group-specific cesarean section rates and their contribution to the overall cesarean section rate, cesarean section rates between sites were compared across Robson groups using relative risks (RR), and logistic regression models including site, Robson group, and their interaction were calculated.

The overall cesarean section rates were similar at both sites (Site A 37.8 %, Site B 37.1 %). Group 5 (previous cesarean section) made the largest contribution to the overall cesarean section rate at both sites, while the highest group-specific cesarean section rates were observed in group 6 (nulliparous women, breech presentation). Significant site-specific differences were found in groups 1 and 9, with higher cesarean section rates at Site B, and in group 6, with higher rates at Site A. Supplementary logistic regression models showed a significantly different group-specific cesarean section pattern between sites (p < 0.001), which persisted after adjustment for selected maternal covariates. Despite their large group sizes, the low-risk groups 1 and 3 had the lowest contributions to the overall cesarean section rate.

The findings suggest that the modified Robson classification not only enables a differentiated analysis of cesarean section rates but can also reveal site-specific patterns of cesarean section practice. This provides a basis for further analyses and targeted interventions to reduce cesarean section rates.