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: 1CRESS, Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPe, INSERM, INRA, Universite de Paris, Paris, France. 2Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK. 3Perinatal Epidemiology and Reproductive Health Unit, CR2, School of Public Health, ULB, Brussels, Belgium. 4Institute for Quality Assurance and Transparency in Health Care, Berlin, Germany. 5Directorate for Social Statistics and Welfare, Italian Statistical Institute (ISTAT), Rome, Italy. 6Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, MUMC+, Maastricht, The Netherlands. 7Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland. 8Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland. 9THL Finnish Institute for Health and Welfare, Helsinki, Finland. 10Karolinska Institute, Stockholm, Sweden.
• Format: Article in Journal/Newspaper
• Language: English
• Published: Wiley-Blackwell 2021
• Subjects: Caesarean birth; Europe; Robson classification; Ten-Group Classification System; health information systems; perinatal health indicators; Keisaraskurðir; Heilbrigðisskýrslur; Cesarean Section; Norway; Iceland
• Online Access: http://hdl.handle.net/2336/621695; https://doi.org/10.1111/1471-0528.16634

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Download 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 ...