Audit and feedback using the Robson classification to reduce caesarean section rates: a systematic review

Abstract

BackgroundIn most regions worldwide, caesarean section (CS) rates are increasing. In these settings, new strategies are needed to reduce CS rates.ObjectivesTo identify, critically appraise and synthesise studies using the Robson classification as a system to categorise and analyse data in clinical audit cycles to reduce CS rates.Search strategyMedline, Embase, CINAHL and LILACS were searched from 2001 to 2016.Selection criteriaStudies reporting use of the Robson classification to categorise and analyse data in clinical audit cycles to reduce CS rates.Data collectionData on study design, interventions used, CS rates, and perinatal outcomes were extracted.ResultsOf 385 citations, 30 were assessed for full text review and six studies, conducted in Brazil, Chile, Italy and Sweden, were included. All studies measured initial CS rates, provided feedback and monitored performance using the Robson classification. In two studies, the audit cycle consisted exclusively of feedback using the Robson classification; the other four used audit and feedback as part of a multifaceted intervention. Baseline CS rates ranged from 20 to 36.8%; after the intervention, CS rates ranged from 3.1 to 21.2%. No studies were randomised or controlled and all had a high risk of bias.ConclusionWe identified six studies using the Robson classification within clinical audit cycles to reduce CS rates. All six report reductions in CS rates; however, results should be interpreted with caution because of limited methodological quality. Future trials are needed to evaluate the role of the Robson classification within audit cycles aimed at reducing CS rates.Tweetable abstractUse of the Robson classification in clinical audit cycles to reduce caesarean rates.

Analysing trends in caesarean sections at a tertiary care teaching hospital in South India: findings from a clinical audit using Robson criteria

“…This is evident from its recent widespread use in systematic reviews and clinical audits. 1,11 Boatin et al in their systematic review concluded that Robson provides a stable framework, both alone and in conjunction with other approaches for categorizing and analyzing data in audit cycles. 1 Several authors have sub classified Robson so that the circumstances that lead to a CS in a particular class can be well elucidated.…”

“…1,11 Boatin et al in their systematic review concluded that Robson provides a stable framework, both alone and in conjunction with other approaches for categorizing and analyzing data in audit cycles. 1 Several authors have sub classified Robson so that the circumstances that lead to a CS in a particular class can be well elucidated. 12,13 This audit also used the modified Robson criteria as it maintains the essence of Robson apart from demonstrating additional information for most of the classes of Robson.…”

“…When such a CS is performed the mother and the child are placed at an unreasonable risk of morbidity and mortality. 1,2 Moreover it also burdens the healthcare system by increasing expenditure of public resources and avoidable bed occupancy apart from deteriorating the quality of life of women in terms of post-operative morbidity and a reduction in their reproductive potential. 3,4 The department of reproductive health and research, World Health Organisation (WHO) established, by the way of systematic reviews, in 2014 that CS rates in population more than 10% up to 30% have no additional benefits in terms of maternal and neonatal survival.…”

Auditing the appropriateness of cesarean delivery using the Robson classification among women experiencing a maternal near miss

“…To our knowledge, the present study was the first to use a combination of audit and the TGCS for assessing the appropriateness of cesarean delivery in settings within Iran where this mode of delivery is considered to be overused. This combination offered a logical framework to analyze and understand cesarean delivery appropriateness and its impact on maternal health outcomes . Moreover, the audit comparison between Iranian and Swedish professionals was an original idea to illustrate the marked variation in obstetric decision making in countries with high and low rates of cesarean delivery.…”

“…Cesarean deliveries, specifically those performed in low‐risk obstetric populations, could result in MNM, and without a medically justifiable indication, can be a harmful choice in childbirth. The Robson classification and audits are valuable tools in tackling questionable indications for cesarean delivery, and they can be used to improve the appropriateness and therefore lower the rates of cesarean delivery . To keep childbirth as safe as possible, cesarean delivery should only be performed when clear maternal and perinatal health benefits exist.…”