Using Robson's Ten‐Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro‐Peristat study

• Published in: BJOG: An International Journal of Obstetrics & Gynaecology
• Main Authors: Zeitlin, J, Durox, M, Macfarlane, A, Alexander, S, Heller, G, Loghi, M, Nijhuis, J, Sól Ólafsdóttir, H, Mierzejewska, E, Gissler, M, Blondel, B
• Other Authors: Obstetrical, Perinatal and Pediatric Epidemiology, Centre for Research in Epidemiology and Statistics, Conservatoire National des Arts et Métiers CNAM (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers CNAM (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Epidemiology of Ageing and Neurodegenerative diseases (EpiAgeing CRESS - U1153 / UMR_A 1125 ), Centre for Maternal and Child Health Research London, UK, City University London, Ecole de Santé Publique Université Libre de Bruxelles, Université libre de Bruxelles (ULB), Institute for Quality Assurance and Transparency in the Healthcare Berlin, Germany (IQTIG), Istituto Nazionale di Statistica (ISTAT), ISTAT, Maastricht University Medical Centre (MUMC), Maastricht University Maastricht, Landspitali National University Hospital of Iceland, University of Iceland Reykjavik, Institute of Mother and Child, Finnish Institute for Health and Welfare (FIHW), Karolinska Institute, Euro-Peristat Network: Gerald Haidinger, Jeannette Klimont, Gisèle Vandervelpen, Wei-Hong Zhang, Evelin Jordanova, Rumyana Kolarova, Boris Filipovic-Grcic, Zeljka Drausnik, Urelija Rodin, Theopisti Kyprianou, Vasos Scoutellas, Petr Velebil, Laust Mortensen, Luule Sakkeus, Anna Heino, Anne Chantry, Catherine Deneux Tharaux, Nicholas Lack, Aris Antsaklis, István Berbik, Sheelagh Bonham, Karen Kearns, Izabela Sikora, Marina Cuttini, Janis Misins, Irisa Zile, Jelena Isakova, Audrey Billy, Sophie Couffignal, Aline Lecomte, Guy Weber, Miriam Gatt, Peter Achterberg, Lisa Broeders, Ashna Hindori-Mohangoo, Rupali Akerkar, Kari Klungsøyr, Katarzyna Szamotulska, Henrique Barros, Mihai Horga, Vlad Tica, Jan Cap, Natasa Tul, Ivan Verdenik, Francisco Bolumar, Mireia Jané, Adela Recio Alcaide, Maria José Vidal, Oscar Zurriaga, Karin Källén, Anastasia Nyman, Sylvan Berrut, Mélanie Riggenbach, Tonia A Rihs, Lucy Smith, Rachael Wood, Marie Delnord, Alice Hocquette
• Format: Article in Journal/Newspaper
• Language: English
• Published: HAL CCSD 2021
• Subjects: Caesarean birth; Europe; Robson classification; Ten-Group Classification System; health information systems; perinatal health indicators; [SDV]Life Sciences [q-bio]; Norway; Iceland
• Online Access: https://inserm.hal.science/inserm-04195699; https://doi.org/10.1111/1471-0528.16634

International audience Objective Robson's Ten Group Classification System (TGCS) creates clinically relevant sub‐groups for monitoring caesarean birth rates. This study assesses whether this classification can be derived from routine data in Europe and uses it to analyse national caesarean rates. Design Observational study using routine data. Setting Twenty‐seven EU member states plus Iceland, Norway, Switzerland and the UK. Population All births at ≥22 weeks of gestational age in 2015. Methods National statistical offices and medical birth registers derived numbers of caesarean births in TGCS groups. Main outcome measures Overall caesarean rate, prevalence and caesarean rates in each of the TGCS groups. Results Of 31 countries, 18 were able to provide data on the TGCS groups, with UK data available only from Northern Ireland. Caesarean birth rates ranged from 16.1 to 56.9%. Countries providing TGCS data had lower caesarean rates than countries without data (25.8% versus 32.9%, P = 0.04). Countries with higher caesarean rates tended to have higher rates in all TGCS groups. Substantial heterogeneity was observed, however, especially for groups 5 (previous caesarean section), 6, 7 (nulliparous/multiparous breech) and 10 (singleton cephalic preterm). The differences in percentages of abnormal lies, group 9, illustrate potential misclassification arising from unstandardised definitions. Conclusions Although further validation of data quality is needed, using TGCS in Europe provides valuable comparator and baseline data for benchmarking and surveillance. Higher caesarean rates in countries unable to construct the TGCS suggest that effective routine information systems may be an indicator of a country's investment in implementing evidence‐based caesarean policies. Tweetable abstract Many European countries can provide Robson's Ten‐Group Classification to improve caesarean rate comparisons.