Background The caesarean section (CS) rate continues to rise in many countries around the world even though this increase is not associated with improvement in maternal and perinatal mortality or morbility. The CS rate can be analysed by using the Robson Ten Group Classification System (TGCS), which categorizes women in ten mutually exclusive groups. We decided to concentrate on the first four Robson groups as primary caesarean deliveries are an important target for reduction and there is no clear evidence about risks and benefits of CS in pre-term birth or breech presentation. The aim was to identify an overall predictive model for CS in order to perform a risk adjusted hospital comparison. Methods All women who delivered in Emilia-Romagna from 1 January 2003 to 31 December 2004 were identified by linking Hospital Discharge Abstracts and Birth Certificate databases. Sociodemographic variables and maternal and neonatal clinical factors were collected. We considered all the identified groupspecific risk factors and the statistically significant risk differences of CS determinants among groups and constructed an overall predictive model to perform a risk adjusted comparison among birth units. Results In total, 64 672 women were enrolled. The first four TGCS groups included 79.6% of total deliveries and 47.1% of CS. Considering the overall predictive model the highest adjusted RRs were found for ante-partum haemorrhage and severe co-morbid illness of mothers. The first and third Robson groups had the higher RRs than the second and fourth groups. After risk-adjusted comparison the Units ranking varied considering the four TGCS groups together or separately. Conclusions In order to improve comparisons among hospital performances to promote a reduction of unnecessary CS, our study focused on the first four TGCS groups. Examining the overall predictive model in each group, it will be possible to understand differences in order to implement specific audit activities.
Risk adjusted inter-hospital comparison for caesarean section considering the first four Robson classification groups / Pieri G.; Carretta E.; Dallolio L.; Colais P.. - In: EUROPEAN JOURNAL OF PUBLIC HEALTH. - ISSN 1101-1262. - STAMPA. - 19 (1):(2009), pp. 138-139. (Intervento presentato al convegno 2nd European Public Health Conference. “Human ecology and public health” tenutosi a Lodz, Poland nel 25-28 November 2009).
Risk adjusted inter-hospital comparison for caesarean section considering the first four Robson classification groups
PIERI, GIULIA;DALLOLIO, LAURA;
2009
Abstract
Background The caesarean section (CS) rate continues to rise in many countries around the world even though this increase is not associated with improvement in maternal and perinatal mortality or morbility. The CS rate can be analysed by using the Robson Ten Group Classification System (TGCS), which categorizes women in ten mutually exclusive groups. We decided to concentrate on the first four Robson groups as primary caesarean deliveries are an important target for reduction and there is no clear evidence about risks and benefits of CS in pre-term birth or breech presentation. The aim was to identify an overall predictive model for CS in order to perform a risk adjusted hospital comparison. Methods All women who delivered in Emilia-Romagna from 1 January 2003 to 31 December 2004 were identified by linking Hospital Discharge Abstracts and Birth Certificate databases. Sociodemographic variables and maternal and neonatal clinical factors were collected. We considered all the identified groupspecific risk factors and the statistically significant risk differences of CS determinants among groups and constructed an overall predictive model to perform a risk adjusted comparison among birth units. Results In total, 64 672 women were enrolled. The first four TGCS groups included 79.6% of total deliveries and 47.1% of CS. Considering the overall predictive model the highest adjusted RRs were found for ante-partum haemorrhage and severe co-morbid illness of mothers. The first and third Robson groups had the higher RRs than the second and fourth groups. After risk-adjusted comparison the Units ranking varied considering the four TGCS groups together or separately. Conclusions In order to improve comparisons among hospital performances to promote a reduction of unnecessary CS, our study focused on the first four TGCS groups. Examining the overall predictive model in each group, it will be possible to understand differences in order to implement specific audit activities.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
