Eric SsennuniFelix BongominElvis AkumaKizito LukujjaHenry KuleKeneth OpiroSilvia AworBaifa ArwinyoSande OjaraJimmyy OpeeAyikoru JacklineAkello JacklinePebalo Francis Pebolo2024-07-252024-07-252024https://doi.org/10.1186/s12884-024-06689-4http://hdl.handle.net/20.500.14270/482The funder had no role in the design of the study; the collection, analysis, or interpretation of the data; or the writing of the manuscript.Background: The Robson Ten Groups Classification System (RTGCS) is increasingly used to assess, monitor, and compare caesarean section (CS) rates within and between healthcare facilities. We evaluated the major contributing groups to the CS rate at Gulu Regional Referral Hospital (GRRH) in Northern Uganda using the RTGCS. Methods: We conducted a retrospective analysis of all deliveries from June 2019 through July 2020 at GRRH, Gulu city, Uganda. We reviewed files of mothers and collected data on sociodemographic and obstetric variables. The outcome variables were Robson Ten Groups (1–10) based on parity, gestational age, foetal presentation, number of foetuses, the onset of labour, parity and lie, and history of CS. Results: We reviewed medical records of 3,183 deliveries, with a mean age of 24.6 ± 5.7 years. The overall CS rate was 13.4% (n = 427). Most participants were in RTGCS groups 3 (43.3%, n = 185) and 1 (29.2%, n = 88). The most common indication for CS was prolonged labour (41.0%, n = 175), followed by foetal distress (19.9%, n = 85) and contracted pelvis (13.6%, n = 58). Conclusion: Our study showed that GRRH patients had a low-risk obstetric population dominated by mothers in groups 3 and 1, which could explain the low overall CS rate of 13.4%. However, the rates of CS among low-risk populations are alarmingly high, and this is likely to cause an increase in CS rates in the future. We recommend group specific interventions through CS auditing to lower group-specific CS rates.enCaesarean section ratesRobson ten group classification systemTertiary teaching hospitalsLow-risk obstetric populationArticle