Introduction:
Cesarean section (CS) has become the most performed operation around the world and in some countries has reached the epidemic level. The World Health Organization recommended the use of the Robson ten-group classification system (RTGCS) as a universal standard to establish a joint control system in healthcare facilities. The purpose of this study was to implement the RTGCS for the first time in Greece to identify trends in cesarean delivery.

Material and Methods:
In the sample analysis, we included the records of 8572 women giving birth (pregnancies ≥22 weeks and weights ≥500 g) in one private health facility in Greece, between 1 January 2019 and 31 December 2019. The data was collected retrospectively from the digital medical records of the women.

Results:
8572 women gave birth during the study period, 60,9% were cesarean section deliveries. According to RTGCS, in our study, the main contributions to the overall rate of CS rate were: (a) single, cephalic nulliparous women, at term in induced labor or cesarean section before labor - Group 2 (34,6%%), (b) multiparous women with single cephalic at term pregnancy with history of at least one CS - Group 5.1 (30,7%), and (c) women with singleton cephalic <37 weeks - Group 10 (11,7%). Cephalopelvic disproportion and previous cesarean section were the most common indication leading to cesarean section (41,7% and 34,6% respectively).

Conclusions:
The frequency of cesarean sections in Greece was high compared to RTGCS and WHO data. Our study is expected to assist policymakers to identify effective strategies for specific subgroups of women to reduce the CS rate in Greece and improve outcomes.