Examining Cesarean Section Rates in Canada Using the Modified Robson Classification

Gu, Jing; Karmakar-Hore, Sunita; Hogan, Mary‐Ellen; Azzam, Hussam; Barrett, Jon; Brown, Alan; Cook, Jocelynn L.; Jain, Venu; Melamed, Nir; Smith, Graeme N.; Zaltz, Arthur; Gurevich, Yana

doi:10.1016/j.jogc.2019.09.009

Cited by 40 publications

(34 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The results of this study are comparable with those obtained by another high-income country. A recent study in Canada found that the group with the highest contribution to the overall CS rate was group 5 (29). Our study also shows the increased representation of group 5, and while in 2018 this group accounted for approximately 20% of the obstetric population (Fig.…”

Section: Discussionsupporting

confidence: 74%

CS in Uruguay From 2008 to 2018: Country Analysis Based on the Robson Classification

Colomar¹,

Colistro

Sosa

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: The use of caesarean section has steadily increased all over the globe, with Latin America being the region with the highest rates. Multiple factors account for that increase. The Robson classification is appropriate to systematically evaluate and compare determinants at the clinical level for caesarean section rates over time, as well as to account for local and international needs. The purpose of this study is to describe the evolution of caesarean section rates by Robson groups in Uruguay from 2008 to 2018 using a country level database.Methods: Caesarean section rates were calculated by Robson groups for each of the years included, disaggregated by care sector (public/private) and by geographical area (Capital City/Non-Capital).Results: Among the groups at lower risk of caesarean section (1 to 4), the highest rates of caesarean section were seen in women in group 2B, followed by those in group 4B. Women in groups 2B, 3 and 4 (A and B) (Figure 2) had a significant increase in the number of caesarean section in those 11 years. A significant growth was also observed in groups 5, 8, and 10. A tendency towards a relative increased was seen in groups 2A, 3, 4A-B, and 5 (Figure S5 – Supplementary Material). The private sector had higher rates of caesarean section for all groups throughout the period, except for women in group 9. The private sector in Montevideo presented the highest rates in the groups with the lowest risk of caesarean section 1, 2A, 3 and 4A, followed by the private sector outside of the capital. The analysis of the relative contribution to the overall caesarean section rate, showed that group 5 was the one with the highest contribution, and it kept growing steadily over the years, while there was a decrease in the relative contribution of group 1 to the overall caesarean section rate.Conclusion: Uruguay is no exception to the increasing caesarean section trend, even in groups of women who have lower risk of requiring caesarean section. The implementation of interventions aimed at reducing caesarean section in the groups with lower obstetric risk in Uruguay is warranted.

show abstract

Section: Discussionsupporting

confidence: 74%

CS in Uruguay From 2008 to 2018: Country Analysis Based on the Robson Classification

Colomar¹,

Colistro

Sosa

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…These births should be uncommon (<0.5%) and their caesarean rates should be close to 100%, which was not the case in several countries, as observed elsewhere. 10 , 23 Underreporting can also occur for non‐cephalic fetal presentations and previous caesarean sections, especially if these are based on a check box or the addition of a specific code. Misclassification of mode of onset affects the ability to distinguish between groups 1 and 2(a/b) and 3 and 4(a/b), whereas underreporting of previous caesarean section and breech presentation is likely to inflate groups 4b (for both variables) and 2b (breech only).…”

Section: Discussionmentioning

confidence: 99%

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

Zeitlin

Durox

Macfarlane

et al. 2021

BJOG

View full text Add to dashboard Cite

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.

show abstract

“…In the late post introduction group the CS rate was 3.9%. That is much lower than in the most recent publications on CS rates in Robson group 1, for example in Lithuania 11.6%, 21 La Ribera University Hospital, Spain, 11.5%, 22 Islamabad, Pakistan 22.2%, 23 Canada 18.4% 24 and Tosamaganga Hospital, Tanzania, 27.4% 25 . The reason for such enormous variations is certainly multifactorial and highlights the lack of evidence of a fixed CS rate that is optimal everywhere.…”

Section: Discussionmentioning

confidence: 86%

“…19 Children born by CS are exposed to more short-term risks related to a different hormonal, bacterial and medical exposure that might affect immune development, allergy, asthma and the microbiome in the gut in comparison with vaginally born infants. 24 and Tosamaganga Hospital, Tanzania, 27.4%. 25 The reason for such enormous variations is certainly multifactorial and highlights the lack of evidence of a fixed CS rate that is optimal everywhere.…”

Section: Re Sultsmentioning

confidence: 99%

Long‐term effects of the nine‐item list intervention on obstetric and neonatal outcomes in Robson group 1 – A time series study

Hildebrand

Nelson

Blomberg

2020

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

Introduction The nine‐item list, with organizational and cultural changes, was implemented at the delivery unit in Linköping, Sweden between 2007 and 2010, aiming at improving the quality of care by offering more women a safe and attractive vaginal delivery. The target group for the intervention was nulliparous women at term with spontaneous onset of labor and cephalic presentation (Robson group 1). The aim of this study was to evaluate pregnancy outcomes before, during, early post and late post introduction of the nine‐item list. Material and methods Robson group 1 births (n = 12 763) from 2004 to 2018 were divided into four time periods; before the nine‐item list (2004‐2006), during introduction of the nine‐item list (2007‐2010), early post introduction of the nine‐item list (2011‐2014) and late post introduction of the nine‐item list (2015‐2018). The nine‐item list consists of monitoring of obstetric results, midwife coordinator, risk classification of women, three midwife‐competence levels, teamwork—the midwife, obstetrician and nurse working as a team with the common goal of a normal delivery, obstetric morning round, fetal monitoring skills and obstetric skills training. Perinatal outcomes before, during, early post and late post introduction were compared using a Student's t test for numerical variables and a Pearson chi‐squared test for categorical variables. Results Apgar score <7 at 5 minutes, Apgar score <4 at 5 minutes and umbilical cord arterial pH <7 did not differ significantly between the four time periods. Between before introduction and early post introduction, instrumental vaginal delivery decreased from 19.8% to 12.2% and cesarean section from 9.6% to 4.5%. The late post introduction period showed a maintained effect with 10.7% instrumental deliveries and 3.9% cesarean sections. Obstetric anal sphincter injury grade III decreased instantly during the introduction of the nine‐item list from 7.8% to 5.1% and thereafter remained unchanged. Conclusions Implementation of the nine‐item list increased the proportion of spontaneous vaginal deliveries by reducing the number of instrumental deliveries and cesarean sections without affecting the neonatal outcomes in nulliparous women with spontaneous onset of labor. The nine‐item list intervention seems to provide long‐term sustainable results.

show abstract

Examining Cesarean Section Rates in Canada Using the Modified Robson Classification

Cited by 40 publications

References 15 publications

CS in Uruguay From 2008 to 2018: Country Analysis Based on the Robson Classification

CS in Uruguay From 2008 to 2018: Country Analysis Based on the Robson Classification

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

Long‐term effects of the nine‐item list intervention on obstetric and neonatal outcomes in Robson group 1 – A time series study

Contact Info

Product

Resources

About