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The rate of cesarean delivery changes after internal audit based on the Robson Ten Group Classification System in
Wael Abdallah1, Georges Abi Tayeh1, Assaad Kesrouani1
1Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon.
Insights
The Robson classification can monitor cesarean delivery rates but did not reduce them in this hospital audit. While overall rates remained similar, specific subgroups showed a decrease in cesarean delivery contributions.
Area of Science:
- Obstetrics and Gynecology
- Clinical Audit
- Maternal Health
Background:
- High rates of cesarean delivery are a global concern.
- The Robson classification is a standardized tool for auditing cesarean rates.
- Evaluating its effectiveness in clinical practice is crucial.
Purpose of the Study:
- To assess the Robson classification's efficiency for internal audit.
- To analyze its impact on high cesarean delivery rates at a tertiary hospital.
Main Methods:
- A pre-post study design was employed.
- Data collected retrospectively (2018-2019) and prospectively (2020-2021).
- Robson classification implemented between the pre- and post-periods.
Main Results:
- Total deliveries: 2560 (1305 pre-period, 1255 post-period).
- Overall cesarean delivery rate showed no significant change (57.86% vs 56.72%).
- Significant decrease in cesarean contributions from Robson groups 3 and 4 was observed (P=0.02 and P=0.01).
Conclusions:
- The Robson classification is suitable for monitoring and auditing cesarean delivery rates.
- It appears insufficient on its own to decrease cesarean rates or alter clinical practice.
- Further strategies may be needed to reduce cesarean delivery rates effectively.
Objective:
To evaluate the efficiency of the Robson classification as an internal clinical audit and feedback of the high rate of cesarean delivery at Hotel Dieu de France, a tertiary referral hospital.
Methods:
A pre-post study was conducted, with a retrospective approach in 2018 and 2019, identified as the pre-period (before the implementation of the Robson classification), and with a prospective approach in 2020 and 2021, labeled the post-period.
Results:
The total number of deliveries during the study period was 2560; 1305 patients were included in the pre-period and 1255 patients delivered in the post-period. No significant differences between the two groups were found. No significant difference was found in the overall rate of cesarean delivery between the first and second periods (57.86% vs 56.72%; P = 0.2). However, a significant decrease in the absolute contribution of groups 3 and 4 (multiparous women without a previous uterine scar with a single cephalic pregnancy, ≥37 weeks of gestation, with spontaneous labor or induced labor) in the overall rate of cesarean delivery was remarked (P = 0.02 and 0.01, respectively).
Conclusion:
The Robson classification seems to be appropriate to monitor and audit the rate of cesarean delivery, but not sufficient to decrease the rate and change the practice.
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