Changes in Cesarean Section Rates Following a Multifaceted Institutional Obstetric Quality Improvement Strategy: A Robson Ten-Group Classification Analysis

AbstractObjective: To evaluate changes in overall and Robson group-specific cesarean section (CS) rates following implementation of a multifaceted institutional obstetric quality improvement strategy in a tertiary referral center.Methods: This single-center, retrospective, quasi-experimental before-and-after study included 13,595 deliveries: 11,238 before intervention (October 2023–November 2025) and 2,357 after intervention (December 2025–June 2026). The intervention integrated national clinical guidance into routine practice through multidisciplinary education, standardized labor management, assessment of failed induction, reassessment of fetal heart rate monitoring before CS, review of CS indications, strengthened midwifery involvement, and expanded antenatal education. Deliveries were classified using the Robson Ten-Group Classification System. Overall and group-specific CS rates were compared, with risk differences (RDs), relative risks (RRs), and 95% confidence intervals calculated.Results: The overall CS rate decreased significantly from 68.4% to 62.4% after intervention (RD, −6.0 percentage points; 95% CI, −8.1 to −3.9; RR, 0.91; 95% CI, 0.88–0.94; p