Caesarean section rates: applying the modified ten-group Robson classification in an Australian tertiary hospital

Mayne, Leah; Liu, Cathy Z.; Tanaka, Keisuke; Amoako, Akwasi

doi:10.1080/01443615.2021.1873923

Cited by 7 publications

(14 citation statements)

References 24 publications

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“…Among our study groups, R1 and R3 were the largest, with overall CB rates of 17% and 3%, respectively. This study is consistent with other studies from high‐ and middle‐income countries that report these two groups as the most numerous in their sample 23,25,28–33 . However, reported CB rates for these groups vary among countries, from 9.8% (group R1) and 2.1% (group R3) in Iceland, where the total CB rate was among the lowest, to 32.0% (group R1) and 11.2% (group R3) in Turkey, where CB rates are among the highest.…”

Section: Discussionsupporting

confidence: 90%

“…[23][24][25]28,[30][31][32] Differences were reported in the CB rate for group R5 across these studies, which ranged from 55% in Iceland 25 to 87% in a tertiary hospital in Australia. 32 In our study, the overall CB rate in group R5 was 74.2% and did not show any statistically significant changes over the study period. However, there was a statistically significant decrease in the CB rate among women with more than one CB (R5b).…”

Section: Discussionmentioning

confidence: 89%

“…In the first study from a tertiary hospital for the period 2010-2015, 34 the group R2 was considerably smaller (6.4% of the total study population) and had a considerably lower absolute CB contribution rate of 2.3%, in line with studies from Canada and Australia. 30,32 The other study analyzed CB contribution rates for Robson groups from two hospitals in Poland and reported similarly high rates for group 2 in the tertiary hospital setting. 35 Data from more hospitals in Poland are needed to examine whether the high rate of prelabor CB for nulliparous women at term is specific to Polish maternity care.…”

Section: Discussionmentioning

confidence: 95%

“…For example, in a study from Australia that reported a total CB rate of 35.7% (higher than in our study), group 2b constituted 2.3% of the total sample and had an absolute contribution rate of 2.3%. 32 In a study from Canada, with a total CB rate of 29.1%, group 2b constituted 0.9% of the total sample. 30 This study suggests that in our sample, considerably more nulliparous women at term with single cephalic lies were referred for a prelabor CB.…”

Section: Discussionmentioning

confidence: 97%

“…This study is consistent with other studies from high-and middle-income countries that report these two groups as the most numerous in their sample. 23,25,[28][29][30][31][32][33] However, reported CB rates for these groups vary among countries, from 9.8% (group R1) and 2.1% (group R3) in Iceland, where the total CB rate was among the lowest, to 32.0% (group R1) and 11.2% (group R3) in Turkey, where CB rates are among the highest. In a study from Canada reporting a total CB rate of 29.1%, the closest to the rate in our study, the CB rates for groups 1 and 3 were 18.4% and 2.9%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Using Robson classification to analyze cesarean section and induction rates in relation to changes in the standards of perinatal care in one hospital in Poland

Węgrzynowska,

Baranowska,

Sys

et al. 2023

Birth

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BackgroundPoland has one of the highest cesarean birth (CB) rates in Europe. For this study, we used the Robson Ten‐Group Classification System (TGCS) to analyze trends in the induction and CB rates in one hospital in Poland over a period of 11 years. We compare these trends with changes in National Legislative and Medical Guidelines introduced during this time that were aimed at lowering rates of unnecessary medical interventions.MethodsWe conducted a retrospective study including all births after 24 weeks' gestation between 2010 and 2020 from one tertiary hospital (n = 66,716 births). After the deletion of records with missing data, 66,678 births were included in the analysis. All births were classified according to the Robson TGCS. The size, CB rate, and contribution of each group for every year were calculated. Linear regression analyses were used to analyze trends over time.ResultsThe total CB rate varied from 29.6% to 33.0% during the study period, with a linear increase of 0.045 percentage points annually (R2 = 0.021; F(1) = 0.189; p = 0.674). This study was considerably lower than the total CB rate for Poland, which rose from 33.9% in 2010 to 45.1% in 2020, increasing at a rate of 1.13 percentage points per year (R2 = 0.93; F(1) = 61.88; p < 0.001). Induction rates among both nulliparous (R1 + R2) and multiparous (R3 + R4) women at term also increased. Study groups R5 (previous cesarean birth), R2 (nulliparous in induced or prelabor cesarean delivery), and R1 (nulliparous women at term with single cephalic pregnancy in spontaneous labor) were the highest contributors to the overall CB rate. The greatest decrease in the CB rate was detected in group R5b (more than one previous CB). None of the groups showed statistically significant increases in CB rates over the study period.ConclusionsThe CB rate in the hospital where the study was conducted was considerably lower than the total CB rate in Poland. When compared with countries with similar CB rates, group R2b (women with nulliparous, prelabor cesarean birth) in our study was considerably larger. More comparisons across different hospital settings in Poland are needed. However, as hospitals are not encouraged to routinely collect the data needed to construct TGCS, such comparisons are very difficult to conduct.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Using Robson classification to analyze cesarean section and induction rates in relation to changes in the standards of perinatal care in one hospital in Poland

Węgrzynowska,

Baranowska,

Sys

et al. 2023

Birth

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Looking back to look forward: Has the time arrived for active management of obstetricians in placenta accreta spectrum?

Bartels,

Downey,

Brennan

2024

Intl J Gynecology & Obste

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Placenta accreta spectrum (PAS) is a relatively new obstetric condition which, until recently, was poorly understood. The true incidence is unknown because of the poor quality and heterogeneous diagnostic criteria. Classification systems have attempted to provide clarity on how to grade and diagnose PAS, but these are no longer reflective of our current understanding of PAS. This is particularly true for placenta percreta, which referred to extrauterine disease, as recent studies have demonstrated that placental villi associated with PAS have minimal potential to invade beyond the uterine serosa. It is accepted that PAS is a direct consequence of previous iatrogenic uterine injury, most commonly a previous cesarean section. Here, we “look back to look forwards”—starting with the primary predisposing factor for PAS, an iatrogenic uterine injury and subsequent wound healing. We then consider the evolution of definitions and diagnostic criteria of PAS from its first description over a century ago to current classifications. Finally, we discuss why modifications to the current classifications are needed to allow accurate diagnosis of this rare but life‐threatening complication, while avoiding overdiagnosis and potential patient harm.

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Why is the implementation of Robson’s classification required in Morocco?

Chrifi,

Boudallaa,

Assarag

et al. 2023

E3S Web Conf.

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In Morocco, the Ministry of Health has mobilized several efforts to improve maternal and newborn health over the past decades. Despite progress, the high risk of death during pregnancy, childbirth, and postnatal is still a concern. Obstetricians highly regard this and require them to undertake ongoing research to promote optimal pregnancy and birth outcomes. Medical techniques such as cesarean section have led to significant progress. However, the frequency of cesarean sections has increased recently, despite World Health Organisation (WHO) recommendations to stay within 15%. Controlling the rate of cesarean sections has become a significant public health concern, given the risk of morbidity and mortality associated with cesarean sections and the associated costs. Through a review of the literature, this research interprets and analyses the relevant data to highlight the contribution of Robson’s classification to controlling C-section indications and, consequently, their rates. Indeed, several original scientific studies recommend its adoption because of its objectivity and contribution to the effective reduction of cesarean section rates. Finally, as a main recommendation, the adoption of Robson’s classification in Morocco as a simple tool for evaluation, monitoring, and audit of cesarean section rates and its use is strongly recommended for better control of cesarean section rates and indications. The training of practitioners should support it.

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Caesarean section rates: applying the modified ten-group Robson classification in an Australian tertiary hospital

Cited by 7 publications

References 24 publications

Using Robson classification to analyze cesarean section and induction rates in relation to changes in the standards of perinatal care in one hospital in Poland

Using Robson classification to analyze cesarean section and induction rates in relation to changes in the standards of perinatal care in one hospital in Poland

Looking back to look forward: Has the time arrived for active management of obstetricians in placenta accreta spectrum?

Why is the implementation of Robson’s classification required in Morocco?

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