Abstract
ObjectiveRobson'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.DesignObservational study using routine data.SettingTwenty‐seven EU member states plus Iceland, Norway, Switzerland and the UK.PopulationAll births at ≥22 weeks of gestational age in 2015.MethodsNational statistical offices and medical birth registers derived numbers of caesarean births in TGCS groups.Main outcome measuresOverall caesarean rate, prevalence and caesarean rates in each of the TGCS groups.ResultsOf 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.ConclusionsAlthough 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 abstractMany European countries can provide Robson's Ten‐Group Classification to improve caesarean rate comparisons.
Highlights
Caesarean birth rates differ by a factor of three in European countries from just over 15% to over 45%, as shown in recent data from the Euro-Peristat project.[1]
Euro-Peristat developed a set of 30 indicators on perinatal health based on national-level data, which have been used to produce three European perinatal health reports, including a report on core indicators in 2015.15 Using a common protocol, data are compiled from routine sources such as medical birth registers, civil registration of births, hospital discharge systems and nationally representative survey data.[1,16]
We described the overall caesarean birth rate for each country as calculated by Euro-Peristat in its reports and assessed countries’ capacity to provide data using the Ten-Group Classification System (TGCS) groups
Summary
Caesarean birth rates differ by a factor of three in European countries from just over 15% to over 45%, as shown in recent data from the Euro-Peristat project.[1]. The Ten-Group Classification System (TGCS), proposed in 2001 by Michael Robson, provides a clinically relevant framework for assessing differences in the caesarean rate and, as stated by Robson, ‘serves as the initial structure within which additional epidemiological variables, processes, perinatal events and outcomes in addition to caesarean sections can be analysed.’[5,6] It has been recommended by the World Health Organization (WHO) for comparisons of the caesarean rate between hospitals[7] and is increasingly used for comparisons of rates between healthcare units and countries and trends over time.[8,9,10,11,12] The classification divides women into ten mutually exclusive groups, two of which can be disaggregated further into an expanded 12-group version These groups cover all situations based on six maternal and fetal characteristics (parity, gestational age, plurality, fetal presentation, mode of onset and previous caesarean section).[13]
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