Cesarean Section Trends: A Longitudinal Analysis Using the Robson Classification in Dubai

Objective: To analyse the evolution of cesarean section rates over three separate years, decades apart at Dubai Hospital using the Robson classification. Design: Retrospective observational study Setting: Tertiary care hospital in Dubai Population: 9,998 women who delivered at a during three distinct periods: 2002, 2012, and 2022 Method: Deliveries were categorized into ten mutually exclusive Robson groups based on six obstetric parameters- number of fetus, parity, gestational age, previous cesarean, fetal lie and onset of labour. We evaluated group size, group-specific cesarean section rates, absolute and relative contributions to the overall cesarean rate, alongside shifts in maternal demographics and instrumental delivery trends. Results: The overall cesarean section rate was 24.65% in 2002, 27.77% in 2012 and 40.17% in 2022. Notably, cesarean section rates in unscarred multipara (Group 3) were found to be considerably low, at 5.97% in 2002, 4.00% in 2012 and 5.36% in 2022. Group 5b (women with more than one prior cesarean section) demonstrated a progressive increase in size, from 3.15% in 2002 to 6.77% in 2012 and 7.32% in 2022. Group 10 (preterm, cephalic presentation) similarly expanded in proportion, rising from 6.18% in 2002 to 7.53% in 2012 to 12.41% in 2022, with a corresponding escalation in cesarean section rate from 32.5% in 2002 to 44.76% in 2012 to 61.05% in 2022. The cesarean section rate among nulliparous women in spontaneous labor (Group 1) increased from 20.5% in 2002 to 26.6% in 2022. Conclusions: This retrospective analysis demonstrates the disproportionate contribution of Group 5b and Group 10 to the rising cesarean section rates observed over the study period. The progressive accumulation of women with multiple prior cesarean sections reflects the compounding obstetric consequences of primary cesarean delivery, emphasizing the critical importance of judicious decision-making at the time of first cesarean. The concurrent expansion of Group 10 in both proportional size and cesarean section rate signals an increasing preterm birth burden.