Comparison of Cesarean Section Rates and Indications Between two Obstetric Departments of a University Hospital Using the Modified Robson Ten-Group Classification System

The cesarean section (CS) rate is widely monitored as an indicator of obstetric practice; however, crude institutional rates are difficult to interpret without accounting for case mix and maternal and neonatal outcomes. This retrospective study compared CS rates and indications between two obstetric departments within University Hospital Bratislava, Slovakia, using the modified Robson ten-group classification system (MRTGCS). Anonymized data from all deliveries between January 1, 2018, and December 31, 2021, were analyzed. The analysis focused particularly on nulliparous, term, singleton, vertex (NTSV) pregnancies corresponding to MRTGCS Groups 1 and 2. During the study period, 12,008 deliveries were recorded in Department A and 12,231 in Department B. The overall CS rate was significantly higher in Department A than in Department B (44.5% vs. 19.2%; OR 3.37, 95% CI 3.18–3.57; p < 0.0001). Marked differences were also observed in MRTGCS Group 1 (26.2% vs. 8.5%; OR 3.82, 95% CI 3.36–4.35) and Group 2 A (49.1% vs. 18.0%; OR 4.40, 95% CI 3.67–5.28). Despite comparable proportions of NTSV parturients, Department B had a lower CS rate and a higher rate of operative vaginal delivery (OVD). The lower CS rate in Department B despite a comparable NTSV proportion points to differences in labor management, thresholds for CS, and use of OVD as likely contributors to institutional variation. Routine MRTGCS-based audit, combined with maternal and neonatal outcome monitoring, could support department-level review of CS indications and OVD practice.