title: Rational dissection of a high institutional cesarean section rate: an analysis using the Robson Ten Group Classification System.
abstract: OBJECTIVE
  Cesarean section (CS) rates have risen far in excess of the optimal 15% recommended by the World Health Organization. The Robson Ten Group Classification System (TGCS) allows meaningful analysis of a CS rate. The aim of this study is to identify the leading patient categories contributing to our institution's CS rate.
  
  
  METHODS
  Prospective study of all women who delivered at the Singapore General Hospital from January 2008 to December 2011. The following data was recorded: parity, singleton/multiple pregnancy, previous CS, mode of labor onset and gestational age at delivery. CS rates were computed for each group, as well as their relative contribution to the overall CS rate.
  
  
  RESULTS
  There were 6074 deliveries, in which 2011 (33.1%) women had CS delivery. Group 5 was the largest contributor to the overall CS rate (25.9%). Of the patients in this group, 18.8% had a successful vaginal birth after cesarean (VBAC). Group 2 was the second largest contributor to the overall CS rate at 18.0%. Group 10 had a high contribution of 16.1%.
  
  
  CONCLUSIONS
  The TGCS allows easy identification of the leading contributing patient groups. The surprisingly high contribution of group 10 suggests that our institution, a tertiary multidisciplinary teaching hospital, manages a sizeable group of high-risk patients in its obstetric case mix accounting for the high CS rate. Almost one in five term pregnancies with one previous CS had a successful vaginal delivery, suggesting that the institutional attempted VBAC rate is higher than 20%.
authors.affiliation: Deparment of Obstetrics and Gynaecology, Singapore General Hospital, Singapore.
authors.forename: Jarrod K H
authors.initials: JK
authors.lastname: Tan
authors.forename: Eng Loy
authors.initials: EL
authors.lastname: Tan
authors.forename: Devendra
authors.initials: D
authors.lastname: Kanagalingan
authors.forename: Lay Kok
authors.initials: LK
authors.lastname: Tan
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006784:Hospitals, Teaching; D006801:Humans; D010298:Parity; D011247:Pregnancy; D011272:Pregnancy, Multiple; D011446:Prospective Studies; D012846:Singapore; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Ten Group Classification System (TGCS); cesarean section; cesarean section rates; pregnancy