Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, Poissy, France.
EA 7285, Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint- Quentin University (UVSQ), Montigny le Bretonneux, France.
Acta Obstet Gynecol Scand. 2022 Apr;101(4):388-395. doi: 10.1111/aogs.14327. Epub 2022 Mar 12.
The rise in the number of cesarean sections (CS) is a major health public problem which concerns nearly all countries. It is suggested that the Ten Group Classification System be adapted to a procedure of audit/feedback cycles, which could have an effect on CS practice. Therefore, we aimed to study changes in CS rates between maternity wards in a perinatal network after implementation of the Ten Group Classification System in an audit with feedback.
This was a retrospective pre-post study of all births from 1 January 2012 to 31 December 2018, in a French perinatal network of 10 maternity wards in the Yvelines district of France. All live births occurring at a gestational age ≥24 weeks in the network were included. During the pre-period (1 January 2012 to 31 December 2014), the audit and feedback provided only overall CS rates. During the post-period (1 January 2015 to 31 December 2018), CS rates for each Robson Ten Group Classification System group were provided. Regression models, adjusted for maternal characteristics and maternity ward, were used to compare CS rates globally and for each group of the system. Variability of CS rates between maternity wards was analyzed using the coefficients of variation.
There were 51 082 women who delivered during the pre-period and 63 964 during the post-period. The overall CS rate did not decrease (24.5% during the pre-period vs 25.1% during the post-period). There were no significant differences in CS rates for any group of the Ten Group Classification System after adjustment for maternity, maternal age and sociodemographic characteristics, nor did audit implementation decrease CS rate variability between maternity wards or within groups of the system.
Implementation of an audit-and-feedback cycle using the Ten Group Classification System did not decrease either CS rates or variability between maternity wards.
剖宫产率的上升是一个主要的公共卫生问题，几乎所有国家都对此表示关注。有人建议将 Ten Group 分类系统适应于审核/反馈循环程序，这可能对剖宫产术实践产生影响。因此，我们旨在研究在实施审核和反馈后，在围产期网络中的 10 个产科病房中，Ten Group 分类系统对剖宫产率的影响。
这是一项回顾性的产前产后研究，研究对象为 2012 年 1 月 1 日至 2018 年 12 月 31 日期间在法国伊夫林省围产期网络中的 10 个产科病房中所有活产，包括网络中胎龄≥24 周的所有活产。在前期（2012 年 1 月 1 日至 2014 年 12 月 31 日），审核和反馈仅提供剖宫产总体率。在后期（2015 年 1 月 1 日至 2018 年 12 月 31 日），提供了 Robson Ten Group 分类系统的每个组的剖宫产率。调整产妇特征和产科病房后，使用回归模型比较了总体和系统每个组的剖宫产率。使用变异系数分析了产科病房之间剖宫产率的变异性。
前期有 51082 名妇女分娩，后期有 63964 名妇女分娩。总体剖宫产率没有下降（前期为 24.5%，后期为 25.1%）。调整产科、产妇年龄和社会人口学特征后，Ten Group 分类系统的任何组之间的剖宫产率均无显著差异，审核的实施也没有降低产科病房之间或系统组内的剖宫产率变异性。
使用 Ten Group 分类系统实施审核和反馈循环既没有降低剖宫产率，也没有降低产科病房之间的变异性。
