Clinical Drivers of Cesarean Sections During the COVID-19 Pandemic: A Robson Classification-Based Multivariable Analysis

Background and objective: The COVID-19 pandemic severely disrupted global maternity care, prompting concerns that logistical pressures and infection risks lowered the clinical threshold for performing cesarean sections (LSCS). This study aimed to determine whether delivering during the pandemic epoch independently increased a patient's odds of undergoing a surgical delivery, adjusting for pandemic-induced demographic shifts using the WHO Robson Ten Group Classification System. Methods: A retrospective cohort study of 3,656 deliveries was conducted at a tertiary care center, comparing pre-pandemic (n = 2,819) and pandemic (n = 837) epochs. Baseline demographics, antenatal comorbidities, and delivery outcomes were analyzed. A multivariable binomial logistic regression model was constructed to isolate the independent effect of the pandemic on delivery mode, adjusting for maternal age, comorbidities, and Robson mega-groups. Results: The pandemic induced a significant "triage effect," concentrating high-risk admissions. The pandemic cohort was significantly older (p < 0.001) and possessed a higher burden of metabolic comorbidities, including gestational diabetes mellitus (38.2% vs. 26.6%, p < 0.001). Despite this increased clinical complexity, the overall crude LSCS rate remained stable (33.5% vs. 34.8%, p = 0.518). Multivariable regression confirmed that the pandemic epoch did not independently increase the odds of a surgical delivery (aOR = 0.942; 95% CI: 0.768-1.156; p = 0.567). Surgical intervention was overwhelmingly driven by established obstetric indications, notably previous uterine scars (Robson 5; aOR = 22.45), malpresentations or multiple gestation (Robson 6-9; aOR = 10.70), and severe preeclampsia (aOR = 3.05). Unadjusted associations between metabolic comorbidities and LSCS lost significance in the adjusted model, proving them to be confounding variables mediated by age and prior uterine scars. Conclusion: While the COVID-19 lockdown fundamentally shifted the demographic profile of obstetric admissions toward a highly complex, comorbid population, evidence-based surgical thresholds were rigorously maintained. Institutional increases in surgical urgency were a direct mathematical reflection of the triaged patient profile rather than a degradation of clinical practice standards.