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Observational Study
. 2021 Aug;128(9):1444-1453.
doi: 10.1111/1471-0528.16634. Epub 2021 Feb 1.

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

J Zeitlin  1 , M Durox  1 , A Macfarlane  2 , S Alexander  3 , G Heller  4 , M Loghi  5 , J Nijhuis  6 , H Sól Ólafsdóttir  7 , E Mierzejewska  8 , M Gissler  8 , B Blondel  9   10 ; Euro-Peristat Network
Collaborators, Affiliations
Observational Study

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

J Zeitlin et al. BJOG. 2021 Aug.

Erratum in

  • Corrigendum.
    [No authors listed] [No authors listed] BJOG. 2022 Dec;129(13):2214. doi: 10.1111/1471-0528.17308. BJOG. 2022. PMID: 36336881 Free PMC article. No abstract available.

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.

Tweetable abstract: Many European countries can provide Robson's Ten-Group Classification to improve caesarean rate comparisons.

Keywords: Caesarean birth; Europe; Robson classification; Ten-Group Classification System; health information systems; perinatal health indicators.

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Figures

Figure 1
Figure 1
Distribution of women having live births or stillbirths by Ten‐Group Classification System group by country, ranked by overall caesarean section (CS) birth rate in 2015. Note: *at least one group has a denominator <100 women (see Tables S1‐S18).
Figure 2
Figure 2
Caesarean section (CS) rate in the Ten‐Group Classification System (TGCS) groups among women delivering live or stillborn infants by country, ordered by their overall caesarean rate, in 2015. Caesarean rates in each TGCS group are presented using a different coloured marker and connected across countries by a similarly coloured line. This makes it possible to compare slopes of the line for each group with the overall caesarean rate, represented in the figure as a dotted black line, to assess concordance in country rankings. Note: *at least one group has a denominator <100 women (see Tables S1‐S18).
Figure 3
Figure 3
Contribution of the ten groups to the overall caesarean section (CS) rate by country ranked by overall caesarean section rate in 2015. Note: *at least one group has a denominator <100 women (see Tables S1‐S18).
See this image and copyright information in PMC

Comment in

References

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