The rate of cesarean delivery changes after internal audit based on the Robson Ten Group Classification System in Lebanon

Objective To evaluate the efficiency of the Robson classification as an internal clinical audit and feedback of the high rate of cesarean delivery at Hotel Dieu de France, a tertiary referral hospital. Methods A pre‐post study was conducted, with a retrospective approach in 2018 and 2019, identified as the pre‐period (before the implementation of the Robson classification), and with a prospective approach in 2020 and 2021, labeled the post‐period. Results The total number of deliveries during the study period was 2560; 1305 patients were included in the pre‐period and 1255 patients delivered in the post‐period. No significant differences between the two groups were found. No significant difference was found in the overall rate of cesarean delivery between the first and second periods (57.86% vs 56.72%; P = 0.2). However, a significant decrease in the absolute contribution of groups 3 and 4 (multiparous women without a previous uterine scar with a single cephalic pregnancy, ≥37 weeks of gestation, with spontaneous labor or induced labor) in the overall rate of cesarean delivery was remarked (P = 0.02 and 0.01, respectively). Conclusion The Robson classification seems to be appropriate to monitor and audit the rate of cesarean delivery, but not sufficient to decrease the rate and change the practice. Synopsis The adoption of the Robson classification as an internal audit and feedback does not reduce the rate of cesarean delivery but may be helpful in the analysis.