TY - JOUR
T1 - Using Robson's Ten-Group Classification System for comparing caesarean section rates in Europe
T2 - an analysis of routine data from the Euro-Peristat study
AU - Zeitlin, J.
AU - Durox, M.
AU - Macfarlane, A.
AU - Alexander, S.
AU - Heller, G.
AU - Loghi, M.
AU - Nijhuis, J.
AU - Sól Ólafsdóttir, H.
AU - Mierzejewska, E.
AU - Gissler, M.
AU - Blondel, B.
AU - Haidinger, Gerald
AU - Klimont, Jeannette
AU - Vandervelpen, Gisèle
AU - Zhang, Wei Hong
AU - Jordanova, Evelin
AU - Kolarova, Rumyana
AU - Filipovic-Grcic, Boris
AU - Drausnik, Zeljka
AU - Rodin, Urelija
AU - Kyprianou, Theopisti
AU - Scoutellas, Vasos
AU - Velebil, Petr
AU - Mortensen, Laust
AU - Sakkeus, Luule
AU - Heino, Anna
AU - Chantry, Anne
AU - Deneux Tharaux, Catherine
AU - Lack, Nicholas
AU - Antsaklis, Aris
AU - Berbik, István
AU - Bonham, Sheelagh
AU - Kearns, Karen
AU - Sikora, Izabela
AU - Cuttini, Marina
AU - Misins, Janis
AU - Zile, Irisa
AU - Isakova, Jelena
AU - Billy, Audrey
AU - Couffignal, Sophie
AU - Lecomte, Aline
AU - Weber, Guy
AU - Gatt, Miriam
AU - Achterberg, Peter
AU - Broeders, Lisa
AU - Hindori-Mohangoo, Ashna
AU - Akerkar, Rupali
AU - Klungsøyr, Kari
AU - Szamotulska, Katarzyna
AU - Barros, Henrique
AU - the Euro-Peristat Network
N1 - Publisher Copyright:
© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
PY - 2021/8
Y1 - 2021/8
N2 - 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.
AB - 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.
KW - Caesarean birth
KW - Europe
KW - Robson classification
KW - Ten-Group Classification System
KW - health information systems
KW - perinatal health indicators
UR - https://www.scopus.com/pages/publications/85107220587
U2 - 10.1111/1471-0528.16634
DO - 10.1111/1471-0528.16634
M3 - Article
C2 - 33338307
AN - SCOPUS:85107220587
SN - 1470-0328
VL - 128
SP - 1444
EP - 1453
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 9
ER -