Robson Ten-Group Classification Study of Cesarean Section Rates in Assiut Hospitals
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: No Intervention (subjects were previously treated with Onglyza®).
- Who it may be relevant to
- Registry conditions: Cesarean Section, Maternal Health. Basic parameters: 18 years — 45 years · Female.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Center list to be confirmed — check the primary protocol.
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
A Survey Study Using the Ten-Group Robson Classification System to Evaluate Cesarean Section Rates and Maternal-Neonatal Outcomes in Assiut University Hospital and Assiut General Hospital
Overview
Cesarean section (C-section) rates have increased worldwide, and Egypt is among the countries with the highest rates. In some hospitals, more than half of all births are done by cesarean delivery. The World Health Organization (WHO) recommends using the "Robson Ten Group Classification System" to better understand and compare C-section rates. This study will use the Robson classification system to evaluate the rate of cesarean deliveries in two hospitals in Assiut, Egypt: Assiut University Hospital and Assiut General Hospital. The study will collect information from medical records of women who delivered by cesarean section between January and December 2026. The main goal is to identify which groups of women contribute most to the high C-section rate and to compare practices between the two hospitals. The study will also look at outcomes for both mothers and newborns. By doing this, we hope to provide useful information that can help improve obstetric care, reduce unnecessary cesarean deliveries, and improve health outcomes for mothers and babies in Egypt.
Detailed description
Cesarean section (C-section) rates have risen dramatically worldwide, with Egypt showing one of the fastest increases, from 4.6% in 1992 to nearly 52% in 2014. Current national data indicate a rate of 51.8%, placing Egypt among the top three countries globally in C-section prevalence. This upward trend highlights an urgent need for systematic evaluation and targeted interventions.
In 2015, the World Health Organization (WHO) endorsed the Robson Ten Group Classification System (TGCS) as the international standard for assessing, monitoring, and comparing cesarean section rates. The TGCS categorizes all women into ten mutually exclusive and totally inclusive groups based on five basic obstetric characteristics: parity, previous cesarean section, onset of labor, gestational age, and fetal presentation. This approach allows for meaningful comparisons within and across institutions, identification of the main contributors to cesarean rates, and evaluation of adherence to evidence-based clinical practice.
Studies worldwide consistently report that Groups 5 (previous cesarean, single cephalic, ≥37 weeks), 2 (nulliparous, induced or elective), and 1 (nulliparous, spontaneous labor) are the major contributors to rising C-section rates. In Egypt, substantial variation exists across hospitals, with facility-specific C-section rates ranging from 22.9% to 94.3%. Previous studies at Assiut University Hospital showed an increase from 32% in 2008 to 38% in 2011, yet comparative analyses across different institutions remain scarce.
This prospective cross-sectional survey will be conducted between January and December 2026 in Assiut University Hospital and Assiut General Hospital. All women delivering by cesarean section during the study period will be eligible, with exclusion of incomplete medical records or deliveries before 28 weeks. The estimated sample size is 770 cases, accounting for incomplete records. Data will be extracted using a standardized Robson-based form and entered electronically.
Primary outcomes include:
Distribution of cesarean deliveries across Robson groups
Comparison of C-section rates within Robson groups between hospitals
Contribution of each Robson group to the overall C-section rate
Secondary outcomes include:
Maternal outcomes (mortality, complications, ICU admission, postpartum hemorrhage, length of stay)
Neonatal outcomes (birth weight, Apgar score, NICU admission, perinatal complications)
Analysis of C-section indications within Robson groups
Identification of potentially avoidable cesarean deliveries
Assessment of adherence to clinical guidelines
Data analysis will be performed using SPSS v29.0. Statistical methods include descriptive analysis, chi-square tests, Fisher's exact tests, t-tests, logistic regression, and propensity score matching. A p-value \<0.05 will be considered significant.
The results of this study will provide evidence on institutional differences in cesarean section practices in Assiut, inform local health policies, and support interventions aimed at optimizing the use of cesarean delivery to improve maternal and neonatal outcomes.
Interventions
- Other No Intervention (subjects were previously treated with Onglyza®)
no intervention
Primary outcome measures
- Distribution of cesarean deliveries by Robson Ten Group Classification [Time frame: January 2026 - December 2026]
Secondary outcome measures (1)
- Comparison of cesarean section rates within Robson groups between hospitals [Time frame: January 2026 - December 2026]
Eligibility criteria
Inclusion criteria
- Women who delivered by cesarean section at Assiut University Hospital or Assiut General Hospital during the study period (January-December 2026).
Gestational age ≥ 28 weeks.
Complete medical records available.
Exclusion criteria
- Vaginal deliveries.
Cesarean deliveries before 28 weeks of gestation.
Incomplete or missing medical records.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Other
Study locations
Center list to be confirmed — check the primary protocol.
Publications
- 3. World Health Organization. Robson classification: implementation manual. Geneva: WHO; 2017.
- Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021 Jun;6(6):e005671. doi: 10.1136/bmjgh-2021-005671. PMID 34130991
- Elnakib S, Abdel-Tawab N, Orbay D, Hassanein N. Medical and non-medical reasons for cesarean section delivery in Egypt: a hospital-based retrospective study. BMC Pregnancy Childbirth. 2019 Nov 8;19(1):411. doi: 10.1186/s12884-019-2558-2. PMID 31703638
Identifiers
NCT: NCT07194876 · AUN-OBGYN-RobsonCS-2026