scholarly journals Implementation of the WHO manual for Robson classification: an example from Sri Lanka using a local database for developing quality improvement recommendations

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e027317 ◽  
Author(s):  
Hemantha Senanayake ◽  
Monica Piccoli ◽  
Emanuelle Pessa Valente ◽  
Caterina Businelli ◽  
Rishard Mohamed ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Sri Lanka ◽  
Pathological Condition ◽  
Fetal Distress ◽  
Quality Of Data ◽  
Robson Classification ◽  
Group 5 ◽  
Failed Induction ◽  
Group 1

ObjectivesThis study aimed at describing the use of a prospective database on hospital deliveries for analysing caesarean section (CS) practices according to the WHO manual for Robson classification, and for developing recommendations for improving the quality of care (QoC).DesignObservational study.SettingUniversity Obstetric Unit at De Soysa Hospital for Women, the largest maternity unit in Sri Lanka.Data collection and analysisFor each childbirth, 150 variables were routinely collected in a standardised form and entered into a database. Data were routinely monitored for ensuring quality. Information on deliveries occurring from July 2015 to June 2017 were analysed according the WHO Robson classification manual. Findings were discussed internally to develop quality improvement recommendations.Results7504 women delivered in the hospital during the study period and at least one maternal or fetal pathological condition was reported in 2845 (37.9%). The CS rate was 30.0%, with 11.9% CS being performed prelabour. According to the Robson classification, Group 3 and Group 1 were the most represented groups (27.0% and 23.1% of population, respectively). The major contributors to the CS rate were group 5 (29.6%), group 1 (14.0%), group 2a (13.3%) and group 10 (11.5%). The most commonly reported indications for CS included abnormal cardiotocography/suspected fetal distress, past CS and failed progress of labour or failed induction. These suggested the need for further discussion on CS practices. Overall, 18 recommendations were agreed on. Besides updating protocols and hands-on training, activities agreed on included monitoring and supervision, criterion-based audits, risk management meetings and appropriate information for patients, and recommendations to further improve the quality of data.ConclusionsThis study provides an example on how the WHO manual for Robson classification can be used in an action-oriented manner for developing recommendations for improving the QoC, and the quality of data collected.

scholarly journals Caesarean section audit in a tertiary hospital of North India using Robson’s classification

2019 ◽  
Vol 8 (4) ◽  
pp. 1426
Author(s):  
Ruchi Gupta
Keyword(s):  
Caesarean Section ◽  
Fetal Distress ◽  
Tertiary Hospital ◽  
Group Classification ◽  
North India ◽  
Effective Strategies ◽  
Group 5 ◽  
Group 2 ◽  
Failed Induction ◽  
Group 1

Background: In view of upsurging Caesarean section (CS) rate worldwide WHO conducted two multicountry surveys to diagnose the driving determinants. In two WHO surveys increased overall CS rate was observed from 26.4% to 31.2% worldwide except Japan. Both WHO 2014 and FIGO 2016 recommend Robson ten- group classification for monitoring caesarean rate over time because of its clarity, tenacity, resilience and pliability. Our Aim is to classify women delivered in our Hospital as per Robson ten –group classification and access the factor driving caesarean rate in each group.Methods: This is a retrospective study 1671 caesarean section conducted in tertiary hospital over 6 months (July- December) 2018. All the delivering women were classified according to Robson ten-group classification and data was analyzed using Microsoft excel and SPSS 23 software.Results: During the study period there were 5917 deliveries. Of these 1671 deliveries were CS accounting for CS rate of 28.24% . The major contributor to CS rate were women in group 5 followed by primigravida’s in group 1 and 2. Increasing  CS rate was observed in group 1 ,2, 3 and 5. Most common indication for caesarean section was fetal distress , failed induction , previous caesarean , breech and Antepartum hemorrhage.Conclusions: Increasing trend in CS rate is observed in group 1,2 ,3 and 5. In order to reduce CS rate among group 2 better patient selection is required for induction of labour based on Bishop score. In order to reduce CS rate in group 5 promotion of  VBAC deliveries should be encouraged. By classifying women according to Robson group 10 classification  helps in identification of women likely to deliver by caesarean  and to identify effective strategies to optimize the CS rate.

Peningkatan Kualitas Data Bidang Tanah di Kantor Pertanahan Kota Administrasi Jakarta Selatan

Tunas Agraria ◽  
2021 ◽  
Vol 4 (2) ◽  
pp. 168-174
Author(s):  
Maslusatun Mawadah
Keyword(s):  
Quality Improvement ◽  
Data Quality ◽  
Research Method ◽  
The South ◽  
Quality Of Data ◽  
Regional Division ◽  
Land Administration ◽  
Problems And Solutions ◽  
Descriptive Approach

The South Jakarta Administrative City Land Office is one of the cities targeted to be a city with complete land administration in 2020. The current condition of land parcel data demands an update, namely improving the quality of data from KW1 to KW6 towards KW1 valid. The purpose of this study is to determine the condition of land data quality in South Jakarta, the implementation of data quality improvement, as well as problems and solutions in implementing data quality improvement. The research method used is qualitative with a descriptive approach. The results showed that the condition of the data quality after the implementation of the improvement, namely KW1 increased from 86.45% to 87.01%. The roles of man, material, machine, and method have been fulfilled and the implementation of data quality improvement is not in accordance with the 2019 Complete City Guidelines in terms of territorial boundary inventory, and there are still obstacles in the implementation of improving the quality of land parcel data, namely the absence of buku tanah, surat ukur, and gambar ukur at the land office, the existence of regional division, the boundaries of the sub district are not yet certain, and the existence of land parcels that have been separated from mapping without being noticed by the office administrator.

scholarly journals Robsons Ten Group Classification of Cesarean Section at a Tertiary Center in Nepal

2021 ◽  
Vol 19 (1) ◽  
pp. 91-96
Author(s):  
Gehanath Baral ◽  
Alish Shrestha ◽  
Arati Sah ◽  
Aswani Kumar Gupta
Keyword(s):  
Cesarean Section ◽  
Classification System ◽  
Group Classification ◽  
Quality Of Data ◽  
Cesarean Birth ◽  
Robson Classification ◽  
Tertiary Center ◽  
Preterm Group ◽  
Obstetric Population

Background: Increasing trend in Ceasarean birth is the issue of both demand and supply side. One of the recommended tools to characterize every pregnancy admitted for childbirth is Robson ten-group classification system that may evaluate obstetric practice. The aim of the study was to assess the cesarean section pattern based on Robson’s classification in a central referral hospital.Methods: A retrospective census of childbirths at Paropakar Maternity and Women’s Hospital in Kathmandu performed from September 2018 to February 2019 based on obstetric record. Robson ten-group classification system was the research tool to collect data and Robson Classification Report Table was used to evaluate the data.Results: There were 10500 births with 34% (32-35%) overall cesarean section rate. Excluding spontaneous and induced labor the supposedly total prelabor CS is 14.5%. Group 1+2+3 size is 81% and 21% CS; 5+10 had 11.3% and 23.3% respectively. Prelabor CS (2b+4b) is 3.54% and additional 11% from malpresentation and preterm. Group CS rate from Class 5 onwards, and ratio of 1 and 2 are as recommended by Robson; 67% of CS were not picked up by Robson class due to indications evolved as the labor progresses and the attributes not pre-classified.Conclusions: The assessed quality of data and the type of obstetric population by Robson reference values prove this study as a representative research. But the indications of cesarean sections can be predicted for only one-third of pregnancy attributes classified by Robson class. To supplement this tool to reduce rising cesarean birth requires audit of indications at decision making level.Keywords: Cesarean section; indication; prediction; robson classification

scholarly journals Rising trends of caesarean section in modern obstetrics: analysis by Robson classification

2020 ◽  
Vol 9 (11) ◽  
pp. 4468
Author(s):  
Shery Angel Rajakumar ◽  
Sindhura Myneni ◽  
Kamala Roshini M.
Keyword(s):  
Caesarean Section ◽  
Group Classification ◽  
Health Concern ◽  
Public Health Concern ◽  
Robson Classification ◽  
Obstetrics And Gynaecology ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Group 1

Background: Rising caesarean section (CS) rates are a major public health concern worldwide. The main objective of our study was to analyse the CS rates according to Robson ten group classification system (TGCS).Methods: This was a retrospective study conducted in the department of obstetrics and gynaecology at Chettinad hospital and research institute, during a period of 5 years from May 2015 to April 2020. All the women who delivered by CS were included in the study. The data regarding parity, gestational age, onset of labour, number of foetuses and presentation was collected and classified according to Robson TGCS and analysed.Results: A total of 4199 women delivered during the study period. Out of 4199 women 2149 (51.18%) underwent CS. All the women who underwent caesarean section were classified according to Robson TGCS. Group 5 contributed the most (40.81%). Group 2 had the second highest contribution of 33.36%. Group 1 had 6.24%, group 3 and 4 contributed for 1.16% and 4.65% respectively. Group 6 and 7 had 2.84% and 1.68% respectively. Group 8 had 2.28%, group 9 had 0.23% and group 10 constituted 6.75%.Conclusion: As contribution of repeat CS is high among the overall CS rate it is important to reduce the primary CS rates. More analytical studies need to be done based on Robson TGCS to evaluate the indication of CS within each group.

Analysis of Cesarean Delivery at Ain Shams Maternity Hospital Using the Ten Group Classification System

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hazem Amin Elzenini ◽  
Radwa Mansour ◽  
Ismail Mohamed Ismail Elnagar
Keyword(s):  
Cesarean Delivery ◽  
Classification System ◽  
Mode Of Delivery ◽  
Multiple Pregnancy ◽  
Fetal Distress ◽  
Maternity Hospital ◽  
Group Classification ◽  
Medical Complication ◽  
Quality Of Data ◽  
Robson Classification

Abstract Background Cesarean section is an invasive surgical procedure in which a baby is delivered through an abdominal and uterine incision & carries with it many immediate and delayed morbidity and mortality risks. Objective To evaluate the feasibility of using the Robson Ten Group Classification System (TGCS) for cesarean delivery indications at Ain Shams Maternity hospital. Methods This is a retrospective study on women who delivered by cesarean delivery at Ain Shams Maternity hospital between July 1, 2016 and June 30, 2018. All patient files have been revised and data has been collected then categorized. The indications for this mode of delivery: suspected fetal growth impairment, fetal distress, preeclampsia/eclampsia, pregnancy duration in weeks or more pre-partum hemorrhage, cephalopelvic disproportion, dystocia, failure of progress, multiple pregnancy, suspected/imminent uterine rupture, breech or other malpresentations, previous cesarean delivery, failed induction of labor, tubal ligation, sterilization, maternal request genital herpes, extensive condyloma, any other obstetric complication, any other fetal indication or any other maternal medical complication. Results 15808 women delivered in the hospital during the study period, The CS rate was 58.04%. According to the Robson classification, Group5 and Group 10 were the most represented groups (31.72% and 29.91% of population, respectively). The major contributors to the CS rate were group 5 (27.10%), group10 (14.02%).The most commonly reported indications for CS included past CS, suspected fetal distress, preeclampsia, eclampsia.These suggested the need for further discussion on CS practices Conclusion This study provides an example on how the WHO manual for Robson classification can be used in an action-oriented manner for developing recommendations for improving the QoC, and the quality of data collected.

scholarly journals Audit of caesarean deliveries in a tertiary care hospital of northern Andhra Pradesh using modified Robson criteria

2018 ◽  
Vol 7 (7) ◽  
pp. 2796
Author(s):  
Prabhavathi V. ◽  
Krishnamma B. ◽  
Prasad D. K. V. ◽  
Bhavya K. ◽  
Satyavathi R.
Keyword(s):  
Andhra Pradesh ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Fetal Distress ◽  
Care Hospital ◽  
Changing Trends ◽  
Increasing Trend ◽  
Common Group ◽  
Failed Induction ◽  
Group 1

Background: Today, there is an increased trend in the incidence of caesarean section (CS) rate worldwide particularly in India, even with the lack of evidence supporting considerable maternal and perinatal benefits with higher CS rates. The main objective of our study was to find the incidence of CS rate, auditing the data on the basis of modified Robson criteria, factors responsible for the most common group, to know the changing trends of CS and finally put forth the strategies to reduce CS rate.Methods: This is a retrospective study of 472 CS cases carried out in a tertiary care hospital during the year 2016. All the cases were grouped according to the modified Robson criteria and the data was analyzed. The data were grouped into 3 different slots of 4 months each (FF = first four months; MF = middle four months and LF = last four months of the year 2016).Results: A significant increasing trend was observed in the groups of 2B and 5C where as a significant decreasing trend was noticed in 6C and 7C. The most common indications for caesarean delivery were cephalo-pelvic disproportion (CPD) (28%) and fetal distress (22%) in group 1 whereas in group 2A CPD, fetal distress and failed induction were found to be 12%, 24% and 30% respectively.Conclusions: The change in trend has been noticed in the last few months particularly in 2B and 5C groups suggesting that there is a change in the attitude of obstetricians in conducting caesarean deliveries before the onset of labour rather than performing CS after the onset of labour. Targeting 2B along with 5C would help our efforts in reducing the CS rate.

scholarly journals Analysis of Cesarean Section Using Robson’s 10-Group Classification at a Tertiary Level Hospital in Nepal

2018 ◽  
Vol 17 (2) ◽  
pp. 4-11
Author(s):  
Rosy Vaidya Malla ◽  
Chanda Hamal ◽  
Bibhusan Neupane ◽  
Ratna Khatri
Keyword(s):  
Breech Presentation ◽  
Fetal Distress ◽  
Group Classification ◽  
Close Monitoring ◽  
Multiparous Women ◽  
Obstetric Services ◽  
Group 3 ◽  
Group 5 ◽  
Level Hospital ◽  
Group 1

Introduction: Obstetric Services commenced at the teaching institute where this study was conducted from Aug 2012. Hence, a review of the data of C-section in this hospital is needed for standardisation of the obstetric services in terms of the rate of C-section, its various clinical indications and maternal and fetal outcomes.Methods: This is a retrospective study carried out over a period of 5 years from Aug 13, 2012 to Aug 11, 2017. All hospital deliveries conducted during the study period were included in this study and the patients’ details obtained from hospital records. All data obtained was recorded in master charts and analysed using SPSS version 23. The caesarean rate, its indications were calculated and categorised into groups according to Robson’s 10-group classification. Results: A total number of 4892 deliveries were conducted over this 5-year study period. C-section was performed in 1104 patients, giving a C-section rate of 22.57%. The most common indications were previous C-section (25.4%), fetal distress (14.3%) and breech presentation (10.3%). Robson’s Group 1 was the highest contributors to the overall CS rate, contributing 28% of all C-sections, followed by Group 5 (26.8%) and Group 3 (15.5%).Conclusions: Nulliparous and multiparous women in term pregnancy in labor and women with previous C-section contribute to more than 70% of overall C-sections at our centre. Hence, close monitoring of these groups of patients, increasing the use of instrumental delivery and practice of vaginal birth after C-section can significantly reduce the C-section rate in our centre. 

Quality Improvement on an Academic Autopsy Service

2001 ◽  
Vol 125 (2) ◽  
pp. 237-245 ◽  
Author(s):  
John H. Sinard ◽  
Deborah J. Blood
Keyword(s):  
Quality Improvement ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Physician Satisfaction ◽  
Quality Improvement Program ◽  
Autopsy Rate ◽  
Quality Of Data ◽  
Improvement Program

Abstract Context.—Autopsy rates continue to decline in the United States. Objective.—Although many of the causes of this decline are external to pathology departments, we hypothesized that intradepartmental efforts to improve the quality of the service we provide to our clinical colleagues could increase our autopsy rate. Method.—We developed a multifaceted quality improvement program for our autopsy service aimed at increasing the visibility of the service, improving the service's reporting, and increasing the amount and quality of data available from the service. Setting.—A large academic medical center that performs approximately 250 autopsies each year. Results.—After implementation of our quality improvement program, the decline in our autopsy rate has not only stopped, but rates have even begun to increase. Additionally, physician satisfaction surveys conducted before and after implementation of our quality improvement initiatives showed an across-the-board improvement in clinician perception of the service. Conclusion.—Pathologists can and should be proactive in addressing the declining autopsy rate, rather than viewing it as someone else's problem or hoping that someone else will protect this important quality assurance tool for medical care.

scholarly journals Exploring variation in the use of feedback from national clinical audits: a realist investigation

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Natasha Alvarado ◽  
Lynn McVey ◽  
Joanne Greenhalgh ◽  
Dawn Dowding ◽  
Mamas Mamas ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Healthcare Providers ◽  
Realist Evaluation ◽  
Quality Of Data ◽  
Improvement Strategy ◽  
Quality Improvement Strategy ◽  
Healthcare Settings ◽  
Context Shapes ◽  
Clinical Audits

Abstract Background National Clinical Audits (NCAs) are a well-established quality improvement strategy used in healthcare settings. Significant resources, including clinicians’ time, are invested in participating in NCAs, yet there is variation in the extent to which the resulting feedback stimulates quality improvement. The aim of this study was to explore the reasons behind this variation. Methods We used realist evaluation to interrogate how context shapes the mechanisms through which NCAs work (or not) to stimulate quality improvement. Fifty-four interviews were conducted with doctors, nurses, audit clerks and other staff working with NCAs across five healthcare providers in England. In line with realist principles we scrutinised the data to identify how and why providers responded to NCA feedback (mechanisms), the circumstances that supported or constrained provider responses (context), and what happened as a result of the interactions between mechanisms and context (outcomes). We summarised our findings as Context+Mechanism = Outcome configurations. Results We identified five mechanisms that explained provider interactions with NCA feedback: reputation, professionalism, competition, incentives, and professional development. Professionalism and incentives underpinned most frequent interaction with feedback, providing opportunities to stimulate quality improvement. Feedback was used routinely in these ways where it was generated from data stored in local databases before upload to NCA suppliers. Local databases enabled staff to access data easily, customise feedback and, importantly, the data were trusted as accurate, due to the skills and experience of staff supporting audit participation. Feedback produced by NCA suppliers, which included national comparator data, was used in a more limited capacity across providers. Challenges accessing supplier data in a timely way and concerns about the quality of data submitted across providers were reported to constrain use of this mode of feedback. Conclusion The findings suggest that there are a number of mechanisms that underpin healthcare providers’ interactions with NCA feedback. However, there is variation in the mode, frequency and impact of these interactions. Feedback was used most routinely, providing opportunities to stimulate quality improvement, within clinical services resourced to collect accurate data and to maintain local databases from which feedback could be customised for the needs of the service.

Methods to Monitor and Improve the Performance of Specimen Holders for Transmission Electron Cryomicroscopy

1996 ◽  
Vol 54 ◽  
pp. 454-455
Author(s):  
B. L. Armbruster ◽  
B. Kraus ◽  
M. Pan
Keyword(s):  
Electron Microscopy ◽  
Electron Beam ◽  
Electron Beam Irradiation ◽  
Beam Irradiation ◽  
Quality Of Data ◽  
Electron Cryomicroscopy ◽  
Thermal Equilibration ◽  
Transmission Electron ◽  
Electron Microscopes

One goal in electron microscopy of biological specimens is to improve the quality of data to equal the resolution capabilities of modem transmission electron microscopes. Radiation damage and beam- induced movement caused by charging of the sample, low image contrast at high resolution, and sensitivity to external vibration and drift in side entry specimen holders limit the effective resolution one can achieve. Several methods have been developed to address these limitations: cryomethods are widely employed to preserve and stabilize specimens against some of the adverse effects of the vacuum and electron beam irradiation, spot-scan imaging reduces charging and associated beam-induced movement, and energy-filtered imaging removes the “fog” caused by inelastic scattering of electrons which is particularly pronounced in thick specimens.Although most cryoholders can easily achieve a 3.4Å resolution specification, information perpendicular to the goniometer axis may be degraded due to vibration. Absolute drift after mechanical and thermal equilibration as well as drift after movement of a holder may cause loss of resolution in any direction.

Sign in / Sign up

Export Citation Format

Share Document