A step towards better audit: The Robson Ten Group classification system for outcomes other than cesarean section
Abstract Introduction The Robson Ten Group Classification System is widely used for the audit of cesarean section (CS) rates. However, CS rate alone is a poor quality indicator and should be balanced with other obstetric endpoints. The aim of this study was to evaluate whether Swedish national data...
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Wiley
2022-07-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14350 |
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| author | Julia Savchenko Lars Ladfors Linda Hjertberg Eric Hildebrand Sophia Brismar Wendel |
| author_facet | Julia Savchenko Lars Ladfors Linda Hjertberg Eric Hildebrand Sophia Brismar Wendel |
| author_sort | Julia Savchenko |
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| description | Abstract Introduction The Robson Ten Group Classification System is widely used for the audit of cesarean section (CS) rates. However, CS rate alone is a poor quality indicator and should be balanced with other obstetric endpoints. The aim of this study was to evaluate whether Swedish national data on obstetric outcomes other than CS, stratified by the Robson classification, could be analyzed in a useful way. Material and methods All births in Sweden from 2017 through 2020 recorded in the nationwide Swedish Pregnancy Register were categorized using the Robson classification with subdivision of some groups. Five outcomes were explored: CS, operative vaginal delivery, postpartum hemorrhage, obstetric anal sphincter injury (OASIS) and Apgar score <7 at 5 minuteutes. Rates of each outcome and contribution of each group to the total outcome rate were calculated. Results The largest Robson groups were nulliparous and multiparous women with single‐term cephalic pregnancies, unscarred uterus and spontaneous labor. Intrapartum CS rates were highest for multiple pregnancies, women with induced labor after previous CS, and nulliparous women with induced labor. Nulliparous women and multiparous women with a previous CS with attempted vaginal birth had the highest operative vaginal delivery and OASIS rates. The postpartum hemorrhage rate was highest for multiple pregnancies and transverse lie, followed by prelabor CS in nulliparous and multiparous women with single‐term cephalic pregnancies and unscarred uterus. The highest rates of Apgar score <7 at 5 minute were observed in preterm deliveries, multiple pregnancies, transverse lie and breech presentation. The largest contribution to the total CS rate was made by women with previous CS delivered by prelabor CS, and nulliparous women with induced or spontaneous labor. The largest contribution to all other outcomes was made by nulliparous women with spontaneous or induced labor and, notably, multiparous women with spontaneous labor and unscarred uterus. Conclusions The Robson classification provides a useful framework for analyzing CS rates along with rates of operative vaginal delivery, OASIS, postpartum hemorrhage and low Apgar score. Parallel interpretation of several outcomes allows a systematic and multidimensional audit, helpful for families and healthcare professionals, and can be used for comparisons, assessment of trends and subpopulations. |
| format | Article |
| id | doaj-art-69d87f5de9f34f7e8175f33d620d49c5 |
| institution | DOAJ |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-69d87f5de9f34f7e8175f33d620d49c52025-08-20T03:22:18ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122022-07-01101782783510.1111/aogs.14350A step towards better audit: The Robson Ten Group classification system for outcomes other than cesarean sectionJulia Savchenko0Lars Ladfors1Linda Hjertberg2Eric Hildebrand3Sophia Brismar Wendel4Department of Obstetrics and Gynecology Stockholm South General Hospital Södersjukhuset Stockholm SwedenDepartment of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy Gothenburg University, Sahlgrenska University Hospital Gothenburg SwedenDepartment of Obstetrics and Gynecology Vrinnevi Hospital Norrköping SwedenDepartment of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences Linköping University Linköping SwedenDepartment of Obstetrics and Gynecology Danderyd Hospital Stockholm SwedenAbstract Introduction The Robson Ten Group Classification System is widely used for the audit of cesarean section (CS) rates. However, CS rate alone is a poor quality indicator and should be balanced with other obstetric endpoints. The aim of this study was to evaluate whether Swedish national data on obstetric outcomes other than CS, stratified by the Robson classification, could be analyzed in a useful way. Material and methods All births in Sweden from 2017 through 2020 recorded in the nationwide Swedish Pregnancy Register were categorized using the Robson classification with subdivision of some groups. Five outcomes were explored: CS, operative vaginal delivery, postpartum hemorrhage, obstetric anal sphincter injury (OASIS) and Apgar score <7 at 5 minuteutes. Rates of each outcome and contribution of each group to the total outcome rate were calculated. Results The largest Robson groups were nulliparous and multiparous women with single‐term cephalic pregnancies, unscarred uterus and spontaneous labor. Intrapartum CS rates were highest for multiple pregnancies, women with induced labor after previous CS, and nulliparous women with induced labor. Nulliparous women and multiparous women with a previous CS with attempted vaginal birth had the highest operative vaginal delivery and OASIS rates. The postpartum hemorrhage rate was highest for multiple pregnancies and transverse lie, followed by prelabor CS in nulliparous and multiparous women with single‐term cephalic pregnancies and unscarred uterus. The highest rates of Apgar score <7 at 5 minute were observed in preterm deliveries, multiple pregnancies, transverse lie and breech presentation. The largest contribution to the total CS rate was made by women with previous CS delivered by prelabor CS, and nulliparous women with induced or spontaneous labor. The largest contribution to all other outcomes was made by nulliparous women with spontaneous or induced labor and, notably, multiparous women with spontaneous labor and unscarred uterus. Conclusions The Robson classification provides a useful framework for analyzing CS rates along with rates of operative vaginal delivery, OASIS, postpartum hemorrhage and low Apgar score. Parallel interpretation of several outcomes allows a systematic and multidimensional audit, helpful for families and healthcare professionals, and can be used for comparisons, assessment of trends and subpopulations.https://doi.org/10.1111/aogs.14350auditchildbirth carelaborobstetric deliveryperinatal outcomesquality indicators |
| spellingShingle | Julia Savchenko Lars Ladfors Linda Hjertberg Eric Hildebrand Sophia Brismar Wendel A step towards better audit: The Robson Ten Group classification system for outcomes other than cesarean section Acta Obstetricia et Gynecologica Scandinavica audit childbirth care labor obstetric delivery perinatal outcomes quality indicators |
| title | A step towards better audit: The Robson Ten Group classification system for outcomes other than cesarean section |
| title_full | A step towards better audit: The Robson Ten Group classification system for outcomes other than cesarean section |
| title_fullStr | A step towards better audit: The Robson Ten Group classification system for outcomes other than cesarean section |
| title_full_unstemmed | A step towards better audit: The Robson Ten Group classification system for outcomes other than cesarean section |
| title_short | A step towards better audit: The Robson Ten Group classification system for outcomes other than cesarean section |
| title_sort | step towards better audit the robson ten group classification system for outcomes other than cesarean section |
| topic | audit childbirth care labor obstetric delivery perinatal outcomes quality indicators |
| url | https://doi.org/10.1111/aogs.14350 |
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