scholarly journals Variation between hospital caesarean delivery rates when Robson’s classification is considered: An observational study from a French perinatal network

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0251141
Author(s):  
Thibaud Quibel ◽  
Patrick Rozenberg ◽  
Camille Bouyer ◽  
Jean Bouyer
Keyword(s):  
Classification System ◽  
Organizational Factors ◽  
Population Based ◽  
Group Classification ◽  
Maternal Characteristics ◽  
Logistic Regression Models ◽  
Perinatal Network ◽  
Paris Area ◽  
Variation Explained ◽  
Hospital Characteristics

Introduction WHO has recommended using Robson’s Ten Group Classification System (TGCS) to monitor and analyze CD rates. Its failure to take some maternal and organizational factors into account, however, could limit the interpretation of CD rate comparisons, because it may contribute to variations in hospital CD rates. Objective To study the contribution of maternal socioeconomic and clinical characteristics and hospital organizational factors to the variation in CD rates when using Robson’s ten-group classification system for CD rate comparisons. Methods This prospective, observational, population-based study included all deliveries at a gestational age > 24 weeks at the 10 hospitals of the French MYPA perinatal network in the Paris area. CD rates were calculated for each TGCS group in each hospital. Interhospital variations in these rates were investigated with hierarchical logistic regression models to quantify the variation explained by differences in patient and hospital characteristics when the TGCS is considered. Variations in CD rates between hospitals were estimated with median odds ratios (MOR) to express interhospital variance on the standard odds ratio scale. The percentage of variation explained by TGCS and maternal and hospital characteristics was also calculated. Results The global CD rate was 24.0% (interhospital range: 17–32%). CD rates within each TGCS group differed significantly between hospitals (P<0.001). CD was significantly associated with maternal age (>40 years), severe preeclampsia, and two organizational factors: hospital status (private maternities) and the deliveries per staff member per 24 hours. The MOR in the empty model was 1.27 and did not change after taking the TGCS into account. Adding maternal characteristics and hospital organizational factors lowered the MOR to 1.14 and reduced the variation between hospital CD rates by 70%. Conclusion Maternal characteristics and hospital factors are needed to address variation in CD rates among the TGCS groups. Therefore, comparisons of these rates that do not consider these factors should be interpreted carefully.

scholarly journals Caesarean delivery rate changes after audit and feedback with the Ten Group Classification System in a French perinatal network: a retrospective pre–post study

2021 ◽  
Author(s):  
Thibaud Quibel ◽  
Marion Chesnais ◽  
Camille Bouyer ◽  
Patrick Rozenberg ◽  
Jean Bouyer
Keyword(s):  
Classification System ◽  
Caesarean Delivery ◽  
Group Classification ◽  
Audit And Feedback ◽  
Maternal Characteristics ◽  
Feedback Cycle ◽  
Perinatal Network ◽  
Coefficients Of Variation ◽  
Network Methods ◽  
Post Period

Objective : To study changes in caesarean delivery (CD) rates between maternity wards in a perinatal network after implementation of the Ten Group Classification System (TGCS) in an audit with feedback. Design A retrospective pre–post study of all births from 1 January 2012 to 31 December 2018. Setting A French perinatal network of 10 maternity wards in the Yvelines district of France. Population All live births of gestational age ≥24 weeks in the network. Methods During the pre-period (1 January 2012 to 31 December 2014), the audit and feedback provided only overall CD rates. During the post-period (1 January 2015 to 31 December 2018), CD rates for each TGCS group were provided. Regression models, adjusted for maternal characteristics and maternity ward, were used to compare CD rates globally and for each TGCS group. Variability of CD rates between maternity wards was analysed using the coefficients of variation. Main outcome measure CD rates. Results There were 51 082 women who delivered during the pre-period and 63 964 during the post-period. The overall CD rate did not decrease (24.5% during the pre-period versus 25.1% during the post-period). There were no significant differences in CD rates for any TGCS group after adjustment for maternity, maternal age and socio-demographic characteristics. Nor did audit implementation decrease CD rate variability between maternity wards or within TGCS groups. Conclusion Implementation of an audit-and-feedback cycle using the TGCS did not decrease either CD rates or variability between maternity wards.

scholarly journals Risk of cesarean delivery in ongoing pregnancies of nulliparous women after 37 weeks of gestation: a prospective cohort study

2021 ◽  
Author(s):  
Thibaud Quibel ◽  
Camille Bouyer ◽  
Patrick Rozenberg ◽  
Jean Bouyer
Keyword(s):  
Cohort Study ◽  
Regression Models ◽  
Outcome Measure ◽  
Population Based ◽  
Maternal Characteristics ◽  
Nulliparous Women ◽  
Perinatal Network ◽  
Gestational Week ◽  
Labor Onset ◽  
Caesarean Delivery Rate

Objective: To study the risk of CD for each gestational week among ongoing pregnancies of nulliparous women at term. Design: A retrospective, population-based cohort study from January 1, 2016, through December 31, 2017 Setting: a French perinatal network of the Yvelines district, France Population: 11 308 nulliparous women with a singleton fetus in a cephalic presentation and delivered at term (≥37-week +0 day) Methods: for each week of gestation at term, we defined ongoing pregnancies as all pregnancies undelivered at the start of each week. Regression models adjusted by maternal characteristics and hospital status were used to compare the CD risk between ongoing pregnancies and the pregnancies delivered the preceding week. The same methods were applied to subgroups defined by the mode of labor onset. Main outcome measure: The caesarean delivery rate (CD) Results: Ongoing pregnancies > 40 weeks+0 days were associated with a higher risk of CD compared with pregnancies delivered the previous week: 24.3% in ongoing pregnancies ≥ 40 weeks +0 days versus 19.9% in deliveries between 39 weeks +0 days and 39 weeks+6 days (Odd ratio adjusted of 1.28, 95%CI [1.15-1.44]; 30.4% in ongoing pregnancies ≥ 41 weeks +0 days versus 19.6% in deliveries between 40 weeks +0 days and 40 weeks+6 days (OR 1.73, 95%CI [1.51-1.96]). This was also shown for all modes of labor onset and in every maternity unit. Conclusions: CD rates increased starting at 40 weeks +0 days in ongoing pregnancies, regardless of the mode of labor onset.

Cesarean delivery in the United States 2005 through 2014: a population-based analysis using the Robson 10-Group Classification System

2018 ◽  
Vol 219 (1) ◽  
pp. 105.e1-105.e11 ◽  
Author(s):  
Mark P. Hehir ◽  
Cande V. Ananth ◽  
Zainab Siddiq ◽  
Karen Flood ◽  
Alexander M. Friedman ◽  
...  
Keyword(s):  
United States ◽  
Cesarean Delivery ◽  
Classification System ◽  
The United States ◽  
Population Based ◽  
Group Classification

scholarly journals Assessing the risk of preterm birth for newborns with congenital heart defects conceived following infertility treatments: a population-based study

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000836 ◽  
Author(s):  
Karim Tararbit ◽  
Nathalie Lelong ◽  
François Goffinet ◽  
Babak Khoshnood
Keyword(s):  
Preterm Birth ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Population Based ◽  
Multiple Pregnancies ◽  
Maternal Characteristics ◽  
Paris Area ◽  
Infertility Treatments

ObjectivesTo quantify the risk of preterm birth (PTB) for newborns with congenital heart defects (CHDs) conceived following infertility treatments, and to examine the role of multiple pregnancies in the association between infertility treatments and PTB for newborns with CHD.MethodsWe used data from a population-based, prospective cohort study (EPICARD EPIdémiologie des CARDiopathies congénitales) including 2190 newborns with CHD and excluding cases with atrial septal defects born to women living in the Greater Paris area between May 2005 and April 2008. Statistical analysis included logistic regression to take into account potential confounders (maternal characteristics, invasive prenatal testing, CHD prenatal diagnosis, medically induced labour/caesarean section before labour, birth year). The role of multiple pregnancies was assessed using a path-analysis approach, allowing decomposition of the total effect of infertility treatments on the risk of PTB into its indirect (mediated by the association between infertility treatments and multiple pregnancies) and direct (mediated by mechanisms other than multiple pregnancies) effects.ResultsPTB occurred for 40.6% (95% CI 28.7 to 52.5) of newborns with CHD conceived following infertility treatments vs 12.7% (95% CI 11.3 to 14.2) for spontaneously conceived newborns (p<0.001). After taking into account potentially confounding factors, infertility treatments were associated with a 5.0-fold higher odds of PTB (adjusted OR=5.0, 95% CI 2.9 to 8.6). Approximately two-thirds of this higher risk of PTB associated with infertility treatments was an indirect effect (ie, due to multiple pregnancies) and one-third was a direct effect (ie, not mediated by multiple pregnancies).ConclusionNewborns with CHD conceived following infertility treatments are at a particularly high risk of PTB, exposing over 40% of them to the ‘double jeopardy’ of CHD and PTB.

scholarly journals Case Fatality Rate Related to Microcephaly Congenital Zika Syndrome and Associated Factors: A Nationwide Retrospective Study in Brazil †

Viruses ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 1228
Author(s):  
Maria Conceição N. Costa ◽  
Luciana Lobato Cardim ◽  
Maria Gloria Teixeira ◽  
Mauricio L. Barreto ◽  
Rita de Cassia Oliveira de Carvalho-Sauer ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Very Low Birth Weight ◽  
Clinical Manifestations ◽  
Case Fatality ◽  
Preterm Births ◽  
Population Based ◽  
Fatality Rate ◽  
Maternal Characteristics ◽  
Logistic Regression Models ◽  
Congenital Zika Syndrome

Background: The clinical manifestations of microcephaly/congenital Zika syndrome (microcephaly/CZS) have harmful consequences on the child’s health, increasing vulnerability to childhood morbidity and mortality. This study analyzes the case fatality rate and child–maternal characteristics of cases and deaths related to microcephaly/CZS in Brazil, 2015–2017. Methods: Population-based study developed by linkage of three information systems. We estimate frequencies of cases, deaths, case fatality rate related to microcephaly/CZS according to child and maternal characteristics and causes of death. Multivariate logistic regression models were applied. Results: The microcephaly/CZS case fatality rate was 10% (95% CI 9.2–10.7). Death related to microcephaly/CZS was associated to moderate (OR = 2.15; 95% CI 1.63–2.83), and very low birth weight (OR = 3.77; 95% CI 2.20–6.46); late preterm births (OR = 1.65; 95% CI 1.21–2.23), Apgar < 7 at 1st (OR = 5.98; 95% CI 4.46–8.02) and 5th minutes (OR = 4.13; 95% CI 2.78–6.13), among others. Conclusions: A high microcephaly/CZS case fatality rate and important factors associated with deaths related to this syndrome were observed. These results can alert health teams to these problems and increase awareness about the factors that may be associated with worse outcomes.

scholarly journals Auditing the cesarean section rate by Robson’s ten group classification system at Tertiary Care Hospital.

2020 ◽  
Vol 27 (04) ◽  
pp. 700-706
Author(s):  
Mehak Asim Khan ◽  
Irum Sohail ◽  
Maria Habib
Keyword(s):  
Cesarean Section ◽  
Classification System ◽  
Tertiary Care ◽  
Population Based ◽  
Group Classification ◽  
Care Hospital ◽  
Cross Sectional ◽  
Lower Segment Cesarean Section ◽  
Gynecology And Obstetrics ◽  
Group 5

Objectives: To analyze the trends of cesarean sections, categorize them into Robson’s Ten Group Classification System (RTGCS), to identify the groups contributing the most to overall lower segment cesarean section (LSCS) rate and to formulate strategies for reducing these rates. Study Design: Cross sectional population based study. Setting: Gynecology and Obstetrics Department of Kahuta Research Laboratories (KRL) hospital, Islamabad. Period: From 1st Nov, 2017 to 30th April, 2018. Material & Methods: The births during this period were distributed into the RTGCS on the basis of past obstetric history and fetal characteristics along with mode of onset of labour. Overall LSCS rate was calculated and contribution of each group was analyzed separately by SPSS version 23. Results: Our study showed 617 LSCS out of 964 deliveries making a high LSCS rate of 64%. Group 5, 2 and 10 of RTGCS contributed to the majority of LSCS performed with the percentages of 47.5%, 18.5% and 12.8% respectively. Group 5 of RTGCS which contributed to the highest LSCS rate had 354 subjects which were previous scars out of which 199 had previous 1 scar making the percentage 56.21%. It contributed 32.3% to the overall LSCS rate. Conclusion: RTGCS is a very useful tool for auditing the LSCS rate at local, national and international levels. Once the LSCS are classified into specific RTGCS, analysis can be done about the reasons for the increasing rates of LSCS and then strategies can be devised to reduce them.

scholarly journals A study of cesarean section rate by using modified Robson's ten group classification system

2019 ◽  
Vol 8 (7) ◽  
pp. 2610
Author(s):  
Meha K. Patel ◽  
Saloni M. Prajapati
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Classification System ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Group Classification ◽  
Tertiary Care Centre ◽  
Maternal Characteristics ◽  
Spontaneous Labour ◽  
Group 5

Background: High caesarean section rate worldwide including India is matter of concern. The Robson’s Ten-group classification system allows critical analysis of caesarean deliveries according to characteristics of pregnancy. The objective was to analyze caesarean section rates in a tertiary care centre according to Modified Robson’s ten groups classification.Methods: This retrospective study was conducted at GMERS Gotri Medical College, Vadodara, Gujarat, India. All patients who delivered between August 2018 and March 2019, were included in the study. Women were classified in 10 groups according to modified Robson’s classification using their maternal characteristics and obstetric history. For each group, authors calculated the caesarean section rate within the group and its absolute and relative contribution to the overall caesarean rate.Results: Total number of delivery in my study institute in 8 months was 1531 out of them 456 was cesarean section, so the overall caesarean section rate was 29.78%. The main contributions to overall caesarean rate was 40.78% by group 5 (previous CS, singleton, cephalic, >37weeks) followed by 14.25% by group 1 (nullipara, singleton, cephalic, >37 weeks, spontaneous labour), 11.40% by group 2 (nullipara, singleton, cephalic,>37 weeks, induced or CS before labour). CS rates among various group ranges from 100% among women with abnormal lie (group 9) to 98.4% in previous CS (group 5), 84% in nulliparous breech (group 6), 58% in multiparous breech (group 7) and least 8.2% in multipara spontaneous labour (group 3).Conclusions: The Robson’s classification is easy to use. It is time to implement obstetric audit to lower the overall CS rates.

scholarly journals Associations between Free Sugar and Sugary Beverage Intake in Early Childhood and Adult NAFLD in a Population-Based UK Cohort

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 290
Author(s):  
Ahlia Sekkarie ◽  
Jean A. Welsh ◽  
Kate Northstone ◽  
Aryeh D. Stein ◽  
Usha Ramakrishnan ◽  
...  
Keyword(s):  
Total Energy ◽  
Hepatic Steatosis ◽  
Population Based ◽  
Free Sugar ◽  
Alcoholic Fatty Liver ◽  
Free Sugars ◽  
Logistic Regression Models ◽  
Sugar Intake ◽  
Sugary Beverages ◽  
Alcoholic Fatty Liver Disease

(1) Background: High sugar intake is prevalent among children and is associated with non-alcoholic fatty liver disease (NAFLD). The purpose of this study is to determine if a high intake of free sugars and sugary beverages (SB) in childhood is associated with NAFLD in adulthood; (2) Methods: At 24 years, 3095 participants were assessed for severe hepatic steatosis (controlled attenuation parameter >280 dB/m) and had dietary data collected via a food frequency questionnaire at age three years. Multiple logistic regression models adjusted for total energy intake, potential confounders, and a mediator (offspring body mass index (BMI) at 24 years); (3) Results: Per quintile increase of free sugar intake association with severe hepatic steatosis at 24 years after adjusting for total energy was odds ratio (OR):1.07 (95% CL: 0.99–1.17). Comparing the lowest vs. the highest free sugar consumers, the association was OR:1.28 (95% CL: 0.88–1.85) and 1.14 (0.72, 1.82) after full adjustment. The OR for high SB consumption (>2/day) compared to <1/day was 1.23 (95% CL: 0.82–1.84) and OR: 0.98 (95% CL: 0.60–1.60) after full adjustment; (4) Conclusions: High free sugar and SB intake at three years were positively but weakly associated with severe hepatic steatosis at 24 years. These associations were completely attenuated after adjusting for confounders and 24-year BMI.

Sign in / Sign up

Export Citation Format

Share Document