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Using Robson's Ten‐Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro‐Peristat study

Zeitlin, J., Durox, M., Macfarlane, A. J. ORCID: 0000-0003-0977-7214 , Alexander, S., Heller, G., Loghi, M., Nijhuis, J., Sól Ólafsdóttir, H., Mierzejewska, E., Gissler, M., Blondel, B., Haidinger, G., Klimont, J., Vandervelpen, G., Zhang, W-H., Jordanova, E., Kolarova, R., Filipovic‐Grcic, B., Drausnik, Z., Rodin, U., Kyprianou, T., Scoutellas, V., Velebil, P., Mortensen, L., Sakkeus, L., Heino, A., Chantry, A., Deneux Tharaux, C., Lack, N., Antsaklis, A., Berbik, I., Bonham, S., Kearns, K., Sikora, I., Cuttini, M., Misins, J., Zile, I., Isakova, J., Billy, A., Couffignal, S., Lecomte, A., Weber, G., Gatt, M., Achterberg, P., Broeders, L., Hindori‐Mohangoo, A., Akerkar, R., Klungsøyr, K., Szamotulska, K., Barros, H., Horga, M., Tica, V., Cap, J., Tul, N., Verdenik, I., Bolumar, F., Jané, M., Alcaide, A. R., Vidal, M. J., Zurriaga, O., Kallen, K., Nyman, A., Berrut, S., Riggenbach, M., Rihs, T. A., Smith, L., Woods, R., Delnord, M. & Hocquette, A. (2020). Using Robson's Ten‐Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro‐Peristat study. BJOG: An International Journal of Obstetrics & Gynaecology, 128(9), pp. 1444-1453. doi: 10.1111/1471-0528.16634


Robson'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.

Observational study using routine data.

Twenty‐seven EU member states plus Iceland, Norway, Switzerland and the UK.

All births at ≥22 weeks of gestational age in 2015.

National statistical offices and medical birth registers derived numbers of caesarean births in TGCS groups.

Main outcome measures
Overall caesarean rate, prevalence and caesarean rates in each of the TGCS groups.

Of 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.

Although 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 abstract
Many European countries can provide Robson's Ten‐Group Classification to improve caesarean rate comparisons.

Publication Type: Article
Additional Information: © 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Publisher Keywords: Caesarean birth, Europe, health information systems, perinatal health indicators, Robson classification, Ten-Group Classification System
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RG Gynecology and obstetrics
R Medicine > RJ Pediatrics
R Medicine > RT Nursing
Departments: School of Health & Psychological Sciences > Midwifery & Radiography
SWORD Depositor:
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