SynthesisBMC pregnancy and childbirth2025
Variation in caesarean section rates according to the Robson classification in four low- and middle-income countries: a meta-analysis of groups 1 to 4.
Synthesis in BMC pregnancy and childbirth, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Primary cesarean section in Sub-Saharan Africa: A systematic review and meta-analysis using the Robson Ten-Group Classification System.PloS one · 2026Pooled it
- The uterine scar dilemma: Outcomes of a restricted elective repeat cesarean section policy in a high-fertility, resource-limited setting.Acta obstetricia et gynecologica Scandinavica · 2026Observational
- Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
backgroundCaesarean section (CS) rates have increased globally, with substantial variations across healthcare settings. Monitoring CS rates using Robson's Ten Group Classification System (RTGCS) provides insights into obstetric practices. This study examines the variation in CS rates among women classified in Groups 1 to 4 of the RTGCS across hospitals in four low- and middle-income countries (LMICs) and explores hospital-level factors associated with these variations.
methodsThis observational study analyzed CS rates in 32 hospitals (8 per country) in Argentina, Burkina Faso, Thailand, and Vietnam. Data were collected from hospital records between January and December 2020. A meta-analysis assessed hospital-level heterogeneity in CS rates, and meta-regression models explored potential determinants, including hospital characteristics such as staffing levels, equipment availability, and birth volume.
resultsThe overall CS rate in the 32 hospitals was 45.4%, with nearly half (46.5%) of CS performed on women in Groups 1 to 4. There was substantial heterogeneity in CS rates among hospitals (I
conclusionsHospital characteristics appear to influence CS rates among low-risk groups, highlighting the need to consider institutional factors when implementing CS reduction strategies. Routine monitoring using the RTGCS, alongside tailored interventions addressing hospital-specific challenges, could support efforts to optimize CS use in LMICs. Further research is needed to confirm the role of organizational factors and guide policy decisions.
trial registrationThe QUALI-DEC trial is registered with the Current Controlled Trials database (ISRCTN67214403), registration date: 30/03/2020.
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