Caesarean section Robson classification, complications, and lessons learned in a rural hospital in Walikale, North Kivu, Democratic Republic of Congo: a cross-sectional study

In this conflict-affected, high-fertility, low-resource context, the CS rate is rising as well as the proportion of women with a scarred uterus. The majority of CS are performed in women with a previous CS. VBAC rates are notably high, though both VBAC and multiple repeat CS carry important safety considerations. Applying the Robson classification is challenging in low-resource settings, where gestational age is often unknown. To optimize CS care and reduce adverse outcomes, it is crucial to prevent the first unnecessary CS, ensure timely and appropriate indications through context-adapted guidelines, clinical supervision, and routine case reviews, and strengthen both basic and comprehensive antenatal and obstetric care.