A 10 year comparative study of caesarean deliveries using the Robson 10 group classification system in a university hospital in Austria

Bracic, T; Pfniß, I; Taumberger, N; Kutllovci-Hasani, K; Dirnagl, Ulrich; Schöll, Wolfgang; Reif, P

doi:10.1371/journal.pone.0240475

Cited by 9 publications

(15 citation statements)

References 22 publications

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“…In our analysis, every second patient in the combined RG1-4 group underwent Caesarean section. This corresponds to trends in other developed countries such as the United States -47% (10), Austria -64% (11), and Turkey -66% [16]. It is worth noting that among these patients, there are both patients whose section was performed intrapartum during spontaneous and induced labour, as well as patients whose section was performed before the onset of labour -elective Caesarean section.…”

Section: Discussionsupporting

confidence: 62%

“…In most of the works, RG5 has the largest proportionate contribution to the total Caesarean sections. In the United States, RG5 accounted for > 34% of the overall 2014 Caesarean delivery rate [10], in Austria it accounted for 26.9% with an upward trend [11], and in Brazil it was also the most common group of indications, accounting for approximately 31.3% [12]. Any attempts to limit the number of CSs should be directed at this group of patients.…”

Section: Discussionmentioning

confidence: 99%

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Robson classification of caesarean sections in two Polish centres on different levels of reference

Młodawski¹,

Mlodawska²,

Nowak³

et al. 2021

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Introduction: Caesarean section (CS) is one of the most common abdominal surgeries performed in the world. The 10-Group Classification System (TGCS, Robson classification) is a World Health Organization recommended classification assessing indications based on 5 variables (parity, previous caesarean section, labour onset, foetal presentation, gestational age, and number of fetuses). The TGCS provides the opportunity to compare indications between different countries, audit, and evaluate of the quality and impact of the recommendations. Aim of the research: Classification of CS data derived from 2 centres according to the TGCS. Material and methods: We used the above-mentioned tool to classify 2000 Caesarean sections from two centres -II and III degree of reference. Results: In both groups, group 5 (RG5 -Robson group 5) constituted the largest part of all Caesarean sections, at 39.9% and 35.17%, respectively. The sum of groups from 1 to 4 (RG 1-4) had a relative contribution to the total number of Caesarean sections in individual centres of 46.94% and 53.48%, respectively. The percentage of occurrence of particular classes was similar in both centres. Conclusions:The results of our study are an attempt to determine the trend in indications for Caesarean sections according to the TGCS in Poland and to popularize the tool used according to WHO recommendations. All activities aimed at effective reduction of the number of Caesarean sections in Poland should be aimed primarily at reducing the percentage of Caesarean sections in the RG5 group. StreszczenieWprowadzenie: Cięcie cesarskie (CC) to jedna z najczęściej wykonywanych operacji brzusznych na świecie. System Robsona oparty na 10 grupach (TGCS -The 10-Group) jest klasyfikacją CC zalecaną przez Światową Organizację Zdrowia. Pacjentki klasyfikowane są na podstawie 5 zmiennych (rodność, obecność blizny po CC na macicy, rozpoczęcie porodu, położenie i liczba płodów oraz wiek ciążowy). TGCS umożliwia porównanie wskazań między różnymi krajami, audyt ośrodków oraz ocenę wpływu zaleceń. Cel pracy: Klasyfikacja CC według TGCS. Materiał i metody: Przy użyciu TGCS sklasyfikowaliśmy 2000 CC z dwóch ośrodków -II i III stopnia referencyjności. Wyniki: W obu grupach grupa 5 (RG5 -Robson group 5) stanowiła największy odsetek wszystkich CC, odpowiednio 39,9% i 35,17%. Suma grup od 1 do 4 (RG 1-4) miała względny udział w ogólnej liczbie CC w poszczególnych ośrodkach, odpowiednio 46,94% i 53,48%. Odsetek występowania poszczególnych klas był podobny w obu ośrodkach. Wnioski: Wyniki naszego badania są próbą określenia trendu wskazań do CC według TGCS w Polsce oraz popularyzacji tego narzędzia. Wszystkie działania mające na celu efektywne zmniejszanie liczby CC w Polsce powinny być ukierunkowane na zmniejszanie liczby pacjentek klasyfikowanych do grupy 5.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Robson classification of caesarean sections in two Polish centres on different levels of reference

Młodawski¹,

Mlodawska²,

Nowak³

et al. 2021

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“…However, in our study, Group 5 played a prevailing role, with a rate of >90%, and the relative group contribution for CS was four times higher than that of the MCS [ 6 ] reference population (30.7% vs. 7.2%). Our findings are consistent with the CS rates reported from Turkey [ 30 ], Cyprus [ 22 ], and Brazil [ 26 ]. The CS rates for Groups 6 and 7 were 99.3% and 96.2%, respectively, whereas those were reported to be 78.5% in Robson Group 6 and 73.8% in Group 7 for the MCS reference population.…”

Section: Discussionsupporting

confidence: 92%

“…Though a CS rate of about 39.9% was reported to be achievable for Group 2 in the MSC reference population, the total CS rate was 61,0% in the Greek population, while the WHO CS rate is recommended to be about 20–35% in the latest published standards [ 22 ]. Group 1 + Group 2 accounted for 1/3 of the obstetric population, and similar results have been found in Brazil (33,3%) [ 26 ], Sri Lanka (38,1%) [ 27 ], France (38,2%) [ 28 ], and Canada (39,7%) [ 29 ]. In terms of multiparous women (excluding previous CSs), single cephalic, ≥37 weeks, and in spontaneous labor, induced labor, or CS before labor in Groups 3 + 4, the sum of the relative group contribution was 1.2%.…”

Section: Discussionsupporting

confidence: 74%

Implementation of the Robson Classification in Greece: A Retrospective Cross-Sectional Study

et al. 2023

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Cesarean sections have become the most commonly performed operations around the world. The World Health Organization recommended the use of the Robson classification system as a universal standard to establish a joint control system in healthcare facilities. The aim of this study was to implement the Robson classification for the first time in Greece to identify trends in cesarean births and examine the groups of women who are the main contributors to the increasing rates. Moreover, the indicators for cesarean sections will be evaluated as per the Robson classification. In the sample analysis, we included the records of 8572 women giving birth in one private health facility in Greece. A total of 8572 women gave birth during the study period, of which 5224 (60.9%) were cesarean section births and 3348 (39.1%) were vaginal births. In our study, according to the Robson classification, the largest contributors to the overall CS rate were as follows: (a) nulliparous women with a single cephalic term pregnancy, who were either labor induced or delivered by cesarean section before labor—Group 2 (34.6%); (b) multiparous women with a single cephalic term pregnancy and at least one previous cesarean section—Group 5 (30.7%); (c) women with a single cephalic preterm pregnancy—Group 10 (11.7%); (d) women with multiple pregnancies—Group 8 (7.0%). Our study is expected to assist policymakers in Greece in planning further interventions for each subgroup of women in order to reduce the overall CS rate and unnecessary CSs.

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“…However, research from other high-income countries indicates that increasing induction rates may be a more universal trend. [23][24][25] We found no significant changes in CB rates except for in group R5b (multiparous women with more than one prior CB), which showed a significant decrease from 100% in 2010 to 81.1% in 2020. There is no official data on the total rate of CB for this group of women in Poland.…”

Section: Discussioncontrasting

confidence: 51%

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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A 10 year comparative study of caesarean deliveries using the Robson 10 group classification system in a university hospital in Austria

Cited by 9 publications

References 22 publications

Robson classification of caesarean sections in two Polish centres on different levels of reference

Robson classification of caesarean sections in two Polish centres on different levels of reference

Implementation of the Robson Classification in Greece: A Retrospective Cross-Sectional Study

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

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