Analysis of cesarean section rates in two German hospitals applying the 10-Group Classification System

Abstract Objectives In Germany, cesarean section (CS) rates more than doubled within the past two decades. For analysis, auditing and inter-hospital comparison, the 10-Group Classification System (TGCS) is recommended. We used the TGCS to analyze CS rates in two German hospitals of different levels of care. Methods From October 2017 to September 2018, data were prospectively collected. Unit A is a level three university hospital, unit B a level one district hospital. The German birth registry was used for comparison with national data. We performed two-sample Z tests and bootstrapping to compare aggregated (unit A + B) with national data and unit A with unit B. Results In both datasets (national data and aggregated data unit A + B), Robson group (RG) 5 was the largest contributor to the overall CS rate. Compared to national data, group sizes in RG 1 and 3 were significantly smaller in the units under investigation, RG 8 and 10 significantly larger. Total CS rates between the two units differed (40.7 vs. 28.4%, p<0.001). The CS rate in RG 5 and RG 10 was different (p<0.01 for both). The most relative frequent RG in both units consisted of group 5, followed by group 10 and 2a. Conclusions The analysis allowed us to explain different CS rates with differences in the study population and with differences in the clinical practice. These results serve as a starting point for audits, inter-hospital comparisons and for interventions aiming to reduce CS rates.

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Analysis of Cesarean Sections using Robson’s Ten Group Classification System

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.2.3823 ◽

2021 ◽

Vol 37 (2) ◽

Author(s):

Rashida Parveen ◽

Mehnaz Khakwani ◽

Anum Naz ◽

Rabia Bhatti

Keyword(s):

Cesarean Section ◽

Classification System ◽

Fetal Distress ◽

Group Classification ◽

Care Hospital ◽

Cesarean Sections ◽

Previous Cesarean Section ◽

Group 10 ◽

Group 5 ◽

Previous Cesarean

Objective: To analyze trends of CSs and evaluating them according to Robson’s Ten Groups Classification System (TGCS) at a leading government tertiary care hospital of South Punjab, Pakistan. Methods: This cross-sectional study was conducted at Department of Obstetrics and Gynaecology, Nishtar Medical University Hospital, Multan Pakistan, from October 2019 to March 2020.The study population included a total of 167 women who underwent CS in the hospital during the specified study period. For each case, we collected data regarding maternal characteristics and pregnancy-related information. The dependent variable was Robson classification group. Results: Overall, mean age was 26.53+5.1 years. Majority of the women, 116 (69.5%) belonged to urban areas of residence, 74 (44.3%) gestational aged between 37-42 years while 108 (64.7%) had history of cesarean section. Most of the patients, 85 (50.9%) turned out to be from TGCS Group-10. Group-5 and Group-1 were the 2nd and 3rd most common group, accounted for 24 (14.4%) and 19 (11.4%) cases respectively. Previous cesarean section (20.4%) and fetal distress (19.8%) were found to be most common indications leading to cesarean section. Conclusion: As per Robson’s Ten-Group Classification, Group-10 and Group-5 were found to be the most contributing among deliveries done. Previous cesarean section and fetal distress were the most common indications of cesarean section. doi: https://doi.org/10.12669/pjms.37.2.3823 How to cite this:Parveen R, Khakwani M, Naz A, Bhatti R. Analysis of Cesarean Sections using Robson’s Ten Group Classification System. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3823 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.04.3383 ◽

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.

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Retrospective study of cesarean section by using the Robson’s ten group classification system

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180891 ◽

2018 ◽

Vol 7 (3) ◽

pp. 1054

Author(s):

Manoj Bhatt ◽

Gunvant Kadikar ◽

Dipti C. Parmar ◽

Medha Kanani

Keyword(s):

Cesarean Section ◽

Classification System ◽

Group Classification ◽

Cesarean Section Rate ◽

Vaginal Birth After Cesarean ◽

Relative Contribution ◽

Study Institute ◽

Group 5 ◽

Previous Cesarean ◽

Group 1

Background: The present study was done to determine the relative contribution of each of ten groups of robson´s classification to overall cesarean section rate and identify modifiable group for intervention to reduce the cesarean rate.Methods: Retrospective review of record of cesarean section from the statistical Dept of Obstetrics and Gynecology sir T. hospital, Bhavnagar from January 2017 to October 2017 and classify them in to Robson´s ten group classification system to find out total number of cesarean among total number of delivery in above 10 months duration.Results: Total number of delivery in my study institute in 10 months was 3804 out of them 1182 was cesarean section, so the overall cesarean section rate in Sir T. hospital, Bhavnagar was 31%. Group 1 (Nulliparous, single cephalic, >37 weeks in spontaneous labor), 2 (Nulliparous, single cephalic, >37 weeks, induced or CS before labor) and 5 (Previous CS, single cephalic, >37 weeks) contributes for around 66% of total cesarean. Group 5 (Previous CS, single cephalic, >37 weeks) was the major contributor among all. Least common cause of cesarean was group 8 (All multiple pregnancies (including previous CS)) and group 9 (All abnormal lies including previous CS).Conclusions: Incidence of cesarean was more common with patient having previous cesarean section. So, to decrease cesarean rate trial of labour should be given to the patient who was suitable for vaginal birth after cesarean section. Adequate assessment of pelvis and giving trial to patient having borderline pelvis also decrease the rate of cesarean in primi gravid (group 1).

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20192636 ◽

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.

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Analysis of caesarean section rate in tertiary care hospital according to Robson`s 10 groups classification

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181023 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1380

Author(s):

Varija T. ◽

Veerendra Kumar C. M. ◽

Chandrasekhar Tarihalli

Keyword(s):

Caesarean Section ◽

Classification System ◽

Caesarean Section Rate ◽

Tertiary Care ◽

Case Series ◽

Breech Presentation ◽

Group Classification ◽

Care Hospital ◽

Case Series Study ◽

Group 5

Background: The caesarean section (CS) delivery rate is steadily increasing worldwide, including India. Identifying the proportion of women in various categories as per Robson's ten group classification system and CS rate among them is important to bring down the increasing CS rate.Methods: This case series study was conducted at Vijayanagar Institute of Medical Sciences (VIMS), a tertiary care teaching hospital in Ballari, Karnataka, India. All pregnant women who have been admitted for delivery were enrolled and the data was collected for the women delivered by CS during January 2016 to December 2016 and proportions in various groups as per Robson’s ten-group classification system were calculated.Results: Among a total of 6980 women delivered during study period, 2992 (42.8%) delivered by CS. The CS rates among various groups varied from 100% among women with abnormal lies and group 6-95% (all nulliparous breeches) group 5-94% (Previous CS, single cephalic, >37 weeks) to 10 to 15% among multiparous women with spontaneous labour having single cephalic pregnancy (group 3). Among women with previous section, CS rate was very high (89.6%). Women with previous CS (group 5) contributed maximum (40.24%) to the total number of CS.Conclusions: In the present study, all women with breech presentation and abnormal lies delivered by CS and repeat CS was the highest contributor to all CS deliveries.

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The Ten Group Classification System (TGCS) - a common starting point for more detailed analysis

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/1471-0528.13267 ◽

2015 ◽

Vol 122 (5) ◽

pp. 701-701 ◽

Cited By ~ 21

Author(s):

M Robson

Keyword(s):

Detailed Analysis ◽

Classification System ◽

Group Classification ◽

Starting Point

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Analysis of Cesarean Section at a Tertiary care centre in Eastern Nepal according to Robson's Ten Group classification System (TGCS): A hospital based cross sectional study.

Birat Journal of Health Sciences ◽

10.3126/bjhs.v5i3.33688 ◽

2020 ◽

Vol 5 (3) ◽

pp. 1171-1175

Author(s):

Anamika Das ◽

Ajay Agrawal ◽

Sangeeta Bhandari ◽

Sanyukta Rajbhandari ◽

Surya Prasad Rimal

Keyword(s):

Cesarean Section ◽

Classification System ◽

Tertiary Care ◽

Relative Size ◽

Group Classification ◽

Health Care Facilities ◽

Cesarean Section Rate ◽

Sectional Study ◽

Tertiary Care Centre ◽

The Absolute

Introduction: Cesarean sectionis on the rising trend,so WHO proposes that health care facilities uses the Robson's 10 group classification system to audit their Cesarean section rates. This classification will helpto developstrategies to reduce these rates. Objective: The objective of this study was to classify the women coming for delivery into the 10 Robson’s group,to interpret the 10 group classification and to know the highest rate of cesarean section in the group. Methodology: This was a hospital basedcross sectional study carried out in the Department of Obstetrics and Gynaecology, for a period of 6months. All women undergoing deliverywere recruited for study .Based onthe patient’s obstetric parameters, women were assigned to one of 10 groups as per Robson’s 10-group classification system.The relative size of each group, the cesarean section rate in each group, and the absolute and relative contributions to the overall cesarean section rate was then reported. Results: During the study period, the overall Cesarean Section rate was 33.40%.Highest contribution was by Robson's Group 2(Nulliparous, single cephalic, ≥ 37 weeks, induced or CS before labor(9.84%) followed by Group 1(Nulliparous, single cephalic, ≥ 37 weeks, in spontaneous labor)(7.73%) and Group 5(Previous CS, single cephalic, ≥ 37 weeks) (5.75%). Least contribution was by Groups 8(All multiple pregnancies (including previous CS)and 9[All abnormal lies (including previous CS)]0.20% and 0.27% respectively. All women in group 9(all abnormal lies including previous CS)had 100% Cesarean rate. Conclusions: With reductions in the primary cesarean section rates and encouragingpatients forVBACcould reduce the contribution of Robson's groups towards the absolute Cesarean Section rates.

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