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 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 The Application of the Ten Group Classification System (TGCS) in Caesarean Delivery Case Mix Adjustment. A Multicenter Prospective Study

PLoS ONE ◽  
2013 ◽  
Vol 8 (6) ◽  
pp. e62364 ◽  
Author(s):  
Gianpaolo Maso ◽  
Salvatore Alberico ◽  
Lorenzo Monasta ◽  
Luca Ronfani ◽  
Marcella Montico ◽  
...  
Keyword(s):  
Prospective Study ◽  
Classification System ◽  
Caesarean Delivery ◽  
Group Classification ◽  
Case Mix ◽  
Case Mix Adjustment ◽  
Multicenter Prospective Study

scholarly journals Association between epidural analgesia and indications for intrapartum caesarean delivery in group 1 of the 10-group classification system at a tertiary maternity hospital, Shanghai, China: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rong Lin ◽  
Peng Shi ◽  
Haibing Li ◽  
Zhiqiang Liu ◽  
Zhendong Xu
Keyword(s):  
Cohort Study ◽  
Epidural Analgesia ◽  
Classification System ◽  
Retrospective Cohort ◽  
Caesarean Delivery ◽  
Group Classification ◽  
Maternal Request ◽  
Oxytocin Augmentation ◽  
Caesarean Delivery Rate ◽  
Group 1

Abstract Background In this study, we aimed to determine whether epidural analgesia affects the indications for intrapartum caesarean delivery, such as foetal distress, dystocia, or maternal request, in nulliparous term women with spontaneous labour (Group 1 in the 10-Group Classification System). Methods We conducted a retrospective cohort study and collected data from the electronic medical records of deliveries performed in our institution between 1 January 2017 and 30 June 2017. Women conforming to the criterion of Group 1 according to the 10-Group Classification System were enrolled. We compared labour outcomes between women with and without epidural analgesia and analysed the association between epidural analgesia and indications for caesarean by using multivariate logistic regression analysis. Results A total of 3212 women met the inclusion criteria, and 2876 were enrolled in the final analyses. Women who received epidural analgesia had a significantly lower intrapartum caesarean delivery rate (16.0% vs. 26.7%, P < 0.001), higher rates of amniotomy (53.4% vs. 42.3%, P < 0.001) and oxytocin augmentation (79.5% vs. 67.0%, P < 0.001), and a higher incidence of intrapartum fever (≥38 °C) (23.3% vs. 8.5%, P < 0.001) than those who did not receive epidural analgesia. There were no significant differences between the groups for most indications, except a lower probability of maternal request for caesarean delivery (3.9% vs. 10.5%, P < 0.001) observed in women who received epidural analgesia than in those who did not. Epidural analgesia was revealed to be associated with a decreased risk of maternal request for caesarean delivery (adjusted odds ratio [aOR], 0.30; 95% confidence interval [CI], 0.22–0.42; P < 0.001); however, oxytocin augmentation was related to an increased risk of maternal request (aOR, 2.34; 95%CI, 1.47–3.75; P < 0.001). Regarding the reasons for the maternal request for caesarean delivery, significantly fewer women complained of pain (0.5% vs. 4.6%, P < 0.001) or had no labour progress (1.3% vs. 3.6%, P < 0.001) among those who received analgesia. Conclusions Among the women in Group 1, epidural analgesia was associated with a lower intrapartum caesarean delivery rate, which may be explained by a reduction in the risk of maternal request for an intrapartum caesarean delivery.

scholarly journals Analysis of caesarean sections using Robson’s classification system in a tertiary care centre in Northern India: an emerging concept to audit the increasing caesarean section rate

2021 ◽  
Vol 10 (6) ◽  
pp. 2281
Author(s):  
Deepika Jamwal ◽  
Pallavi Sharma ◽  
Anil Mehta ◽  
Jiteshwar Singh Pannu
Keyword(s):  
Caesarean Section ◽  
Classification System ◽  
Caesarean Delivery ◽  
Tertiary Care ◽  
Group Classification ◽  
Health Concern ◽  
Medical College ◽  
Clinical Scenarios ◽  
Group 5 ◽  
Group 2

Background: There has been an increase in rate of caesarean section over last five decades. This is a matter of international public health concern as it increases the caesarean section related maternal morbidity. The aim of the present study was to evaluate that in a new medical college which clinical situation contributed and led to caesarean deliveries as per Robson’s classification system and to audit the increasing rate of caesarean section.Methods: This study was performed in Government Medical College Kathua in the Union territory of Jammu and Kashmir from November 2020 to April 2021. In the present study, all cases delivered by caesarean section during the period of six months were recorded and classified according to Robson's 10 group classification system.Results: Out of total 1366 women delivered, 630 underwent CS (46.12%). It was observed that majority of caesarean sections belonged to group 2 and group 5 of Robson criteria. Group 5 comprised of patients with one or more previous caesarean section with cephalic presentation according to Robson criteria and maximum number of caesarean sections done in the present study belonged to this group that is 40.3%. Group 2 that is nulliparous singleton cephalic >37 week induced labour or caesarean section before labour comprised 29.2%. Breech pregnancies (groups 6 and 7) had >90% caesarean rates.Conclusions: Women with a previous caesarean delivery represent an increasing proportion of caesarean deliveries. Use of the Robson criteria allows standardized comparisons of data and identifies clinical scenarios driving changes in caesarean rates. Hospitals and health organizations can use the Robson 10-Group Classification System to evaluate quality and processes associated with caesarean delivery.

scholarly journals Analysis of caesarean delivery using Robson ten group classification system at a tertiary care teaching institute in Kerala, India

2019 ◽  
Vol 8 (5) ◽  
pp. 1990
Author(s):  
Heera Shenoy T. ◽  
Sheela T. Shenoy ◽  
Anaswara T. ◽  
Remash K.
Keyword(s):  
Caesarean Section ◽  
Classification System ◽  
Caesarean Delivery ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Group Classification ◽  
College Hospital ◽  
Robson Classification ◽  
Group 5 ◽  
Group 2

Background: Globally, the caesarean delivery rate is rising continuously, making caesarean one of the most common surgical procedures. The Robson classification, appreciated by WHO in 2014 and FIGO in 2016 is widely accepted, risk-based, ten-group classification system (TGCS) developed specifically to assess caesarean section rates. The aim of this study was to know the rate of Caesarean section in present hospital, to analyse the Caesarean sections based on Robson’s classification and to determine the contribution and significance of each group on the overall number of Caesarean sections.Methods: All women, who gave birth by Caesarean deliveries done over a period of 1 year (January 2018-December 2018) in Travancore Medical College Hospital in South Kerala India.Results: Group 5 (previous LSCS, single, cephalic >37 weeks) made the greatest contribution to the Caesarean section rate (27.24%). The second highest contributor was Group 2 (Nulliparous, singleton, cephalic, >37 weeks induced labour or caesarean section before labour followed by Group 10 (all single cephalic <36 weeks including previous CS) 18.78%.Conclusions: Limiting the CS rate in low-risk pregnancies is key to lowering the trend of increased CS. If TGCS is used uniformly, CS rates can be compared over time and between units, both nationally and internationally.

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 Interinstitutional Variation of Caesarean Delivery Rates According to Indications in Selected Obstetric Populations: A Prospective Multicenter Study

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Gianpaolo Maso ◽  
Monica Piccoli ◽  
Marcella Montico ◽  
Lorenzo Monasta ◽  
Luca Ronfani ◽  
...  
Keyword(s):  
Caesarean Delivery ◽  
Relative Size ◽  
Group Classification ◽  
Prospective Multicenter Study ◽  
Nulliparous Women ◽  
Spontaneous Labour ◽  
Multiparous Women ◽  
Regional Centers ◽  
Spearman’S Correlation ◽  
Failure To Progress

The aim of the study was to identify which groups of women contribute to interinstitutional variation of caesarean delivery (CD) rates and which are the reasons for this variation. In this regard, 15,726 deliveries from 11 regional centers were evaluated using the 10-group classification system. Standardized indications for CD in each group were used. Spearman’s correlation coefficient was used to calculate (1) relationship between institutional CD rates and relative sizes/CD rates in each of the ten groups/centers; (2) correlation between institutional CD rates and indications for CD in each of the ten groups/centers. Overall CD rates correlated with both CD rates in spontaneous and induced labouring nulliparous women with a single cephalic pregnancy at term (P=0.005). Variation of CD rates was also dependent on relative size and CD rates in multiparous women with previous CD, single cephalic pregnancy at term (P<0.001). As for the indications, “cardiotocographic anomalies” and “failure to progress” in the group of nulliparous women in spontaneous labour and “one previous CD” in multiparous women previous CD correlated significantly with institutional CD rates (P=0.021,P=0.005, andP<0.001, resp.). These results supported the conclusion that only selected indications in specific obstetric groups accounted for interinstitutional variation of CD rates.

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

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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