Audit and feedback using the Robson classification to reduce caesarean section rates: a systematic review

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Healthcare Quality Improvement

Background:

• Global caesarean section (CS) rates are increasing, necessitating novel strategies for reduction.
• Clinical audit cycles are crucial for monitoring and improving healthcare practices.

Purpose of the Study:

• To synthesize evidence on the use of the Robson classification in clinical audit cycles for reducing CS rates.
• To critically appraise the effectiveness and quality of studies employing the Robson classification for CS rate reduction.

Main Methods:

• A systematic literature search was conducted across Medline, Embase, CINAHL, and LILACS from 2001 to 2016.
• Studies utilizing the Robson classification for data categorization and analysis within clinical audit cycles to reduce CS rates were selected.
• Data extracted included study design, interventions, CS rates, and perinatal outcomes.

Main Results:

• Six studies from Brazil, Chile, Italy, and Sweden were included.
• All studies used the Robson classification for monitoring performance, reporting baseline CS rates between 20% and 36.8%.
• Post-intervention CS rates ranged from 3.1% to 21.2%, indicating reductions in all included studies. However, all studies had a high risk of bias.

Conclusions:

• The Robson classification, when integrated into clinical audit cycles, appears to be associated with reduced CS rates.
• Despite reported reductions, the limited methodological quality of the included studies necessitates cautious interpretation of findings.
• Further high-quality, randomized trials are required to definitively establish the efficacy of the Robson classification within audit cycles for CS rate reduction.