A step towards better audit: The Robson Ten Group classification system for outcomes other than cesarean section

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Maternal-Fetal Medicine

Background:

• The Robson Ten Group Classification System is a standard for auditing cesarean section (CS) rates.
• CS rates alone are insufficient quality indicators and require evaluation alongside other obstetric outcomes.
• Analyzing obstetric data by Robson classification can reveal nuanced insights into maternal and infant health.

Purpose of the Study:

• To assess the utility of Swedish national obstetric data, stratified by Robson classification, beyond just CS rates.
• To evaluate the analysis of outcomes such as operative vaginal delivery, postpartum hemorrhage, obstetric anal sphincter injury (OASIS), and Apgar scores within the Robson framework.

Main Methods:

• Utilized nationwide Swedish Pregnancy Register data from 2017-2020.
• Categorized all births using the Robson classification, with some group subdivisions.
• Calculated rates and contributions of five key outcomes: CS, operative vaginal delivery, postpartum hemorrhage, OASIS, and low Apgar score (<7 at 5 minutes).

Main Results:

• Nulliparous and multiparous women with spontaneous labor and unscarred uterus comprised the largest Robson groups.
• Highest intrapartum CS rates were observed in multiple pregnancies, induced labor post-CS, and nulliparous induced labor.
• Nulliparous and multiparous women with previous CS had the highest operative vaginal delivery and OASIS rates.
• Postpartum hemorrhage rates were highest in multiple pregnancies and transverse lie.
• Lowest Apgar scores were most frequent in preterm deliveries, multiple pregnancies, transverse lie, and breech presentations.

Conclusions:

• The Robson classification serves as a valuable framework for a comprehensive audit of obstetric care, integrating CS rates with other critical outcomes.
• Parallel analysis of multiple outcomes (operative vaginal delivery, OASIS, postpartum hemorrhage, low Apgar score) provides a systematic, multidimensional audit.
• This approach aids in comparing care, assessing trends, and evaluating specific subpopulations, benefiting families and healthcare providers.