Analysis of deliveries using the Robson Classification System in a Brazilian hospital: a cross-sectional observational study

The rising caesarean section rates are a global concern, highlighted by the World Health Organisation due to the adverse impacts associated with the overuse of this intervention. This study assessed the use of Robson Classification (RC) in a Brazilian university hospital from 2016 to 2020. A retrospective observational study was conducted from 2016 to 2020, including 9723 deliveries in a tertiary maternity hospital located in southeastern Brazil. Demographic, obstetric, and delivery data were considered to ascertain the RC. Caesarean section rates were calculated for each group and their absolute and relative contributions to the overall rate. Additionally, indications for induction and caesarean section were described. The overall caesarean section rate was 38.9%, with a predominance of Group 5 (women with a previous caesarean section), which accounted for 37.1% of all caesarean sections. Group 1 (nulliparous women with spontaneous labour) had a caesarean section rate of 17%, while Group 10 (preterm pregnancies) showed a rate of 50.7%. The main indications for caesarean sections were foetal distress (24.5%), repeat caesarean section (16.8%), and dystocia (10.9%). Labour inductions occurred in 22% of cases, primarily due to post-term pregnancy (35.7%) and premature rupture of membranes (23.4%). The RC was an effective tool for monitoring and comparing obstetric practices, identifying the groups with the highest contributions to caesarean section rates. Specific strategies, such as protocols to encourage vaginal birth after caesarean (VBAC) and improvements in induction management, could help reduce unnecessary interventions. This study underscores the importance of implementing evidence-based guidelines to improve obstetric and neonatal outcomes. Caesarean delivery rates are increasing around the world, raising concerns because unnecessary cesareans can pose risks for both mothers and babies. The World Health Organisation recommends reducing caesarean sections when they are not medically needed. In this study, researchers looked at deliveries at a university hospital in Brazil between 2016 and 2020 to better understand the reasons for caesarean births. They used the Robson Classification, a system that groups pregnant women based on factors like previous cesareans, labour onset, and baby’s position. The overall caesarean rate was 38.9%. Women with a previous caesarean (Group 5) were the largest contributors to this number. Other important findings included a 17% caesarean rate among first-time mothers in spontaneous labour and a high caesarean rate (50.7%) among preterm births (Group 10). The main reasons for caesarean deliveries were foetal distress, repeat cesareans, and labour problems. Labour was induced in about 22% of cases, mostly due to post-term pregnancy or water breaking before labour started. The study highlights the need for careful management of conditions like hypertension and diabetes during pregnancy, which can help prevent early deliveries. Promoting vaginal birth after caesarean (VBAC) and improving induction practices could help reduce unnecessary caesarean sections. Tools that predict a woman’s chances of successful vaginal delivery can support better decision-making. This research shows how important it is to follow evidence-based practices to improve the safety and outcomes of childbirth for mothers and their babies.