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

Abstract

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.

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

“…We found this an interesting study and appreciate the value of comparisons across the European continent. We did, however, notice that although a comparison of caesarean rates between the countries and the Robson’s Ten‐Group Classification System groups was provided, interpretation of the underlying reasons for these differences could not be made 1 . Recording data such as these without analysis of the clinical context and patient population does not allow for holistic patient care.…”

International comparisons and holistic patient care

“…The letter by Emms and colleagues 1 raises concerns that comparing caesarean birth rates across countries, as we did in our article on Robson's Ten Group Classification System (TGCS) published in BJOG , 2 will compromise holistic patient care by promoting target rates. They claim that comparisons that do not account for population sociodemographic and clinical characteristics lead to misleading conclusions.…”

Investigating Caesarean Section Practice among Teenage Romanian Mothers Using Modified Robson Ten Group Classification System

“…Romania is missing from the European map of data for the TGCS, as the Euro-peristat project, which aims to monitor perinatal health indicators across the continent, has recently been noted [3]. This research is a contribution towards our country stepping up its reporting system of obstetrical practice through the mTGCS.…”

“…The year before, Cyprus and Romania were the two countries reporting the highest rates of CS *54.8% and 44.1%, respectively), whereas in Finland only 16.5% of all live births came through CS [2]. These prominent differences have been suggested to be related to a variety of factors, ranging from extreme maternal age and their associated obstetrical comorbidities, to the clinician's experience, fear of litigation or the financial management of maternity care; the economic, social and cultural environment; and the women's preference and education are also determinant factors for CS practice [3][4][5]. However, overall CS rates conflate multiple groups associating differing levels of risk.…”