title: Cesarean 10-group classification: a tool for clinical management of the delivery ward.
abstract: OBJECTIVE
  Aim of the present study was to evaluate 10-group Robson classification for delivery ward clinical management.
  
  
  METHODS
  To evaluate cesarean section (C-section) rate following the implementation firstly of recommendations, and then of 10-group reporting and medical audit, a retrospective cohort study was performed including all women who gave birth in the years 2001, 2006 and 2010. Data were analyzed by means of 10-group classification.
  
  
  RESULTS
  C-section rate was 27.5% in 2001, 31.1% in 2006, and 30.5% in 2010. Ten-group analysis showed that from 2001 to 2006 group 1-2 size increased from 27.6% to 42.5% (P<0.01), and contribution to the overall cesarean rate from 22.3% to 29.9% (P<0.01), whereas the group 1 C-section sub-rate was reduced from 19.6% to 13.5% (P<0.05). Previous cesarean increased from 9.2% to 11.6% (P<0.05). Delivery ward 10-group monitoring showed that from January to May 2010 the C-section rate was consistently above 30%. The audit was started and the causes were analyzed. Subsequently, C-section rate dropped to the actual 30.5%.
  
  
  CONCLUSIONS
  Ten-group analysis showed that the 2006 cesarean rate increase was related to a significant shift in obstetric population toward groups 5 to 9 at higher risk of C-section, whereas after recommendation implementation a significant reduction of C-section subrates was observed in groups 1, 2a, 3, 4a, and 10 which represented more than 80% of the hospital population. In 2010, 10-group monitoring of the cesarean subrates stabilized the C-section rate. Ten-group analysis should be implemented in clinical practice to control delivery ward clinical management. It only requires the involvement of a clinical manager and of a midwife for data collection.
authors.affiliation: Division of Obstetrics and Gynecology, Santa Maria Goretti Hospital, Latina, Italy - francesco.maneschi@tin.it.
authors.forename: F
authors.initials: F
authors.lastname: Maneschi
authors.forename: M
authors.initials: M
authors.lastname: Algieri
authors.forename: S
authors.initials: S
authors.lastname: Perrone
authors.forename: R
authors.initials: R
authors.lastname: Nale
authors.forename: M
authors.initials: M
authors.lastname: Sarno
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000145:classification* / Q000706:statistics & numerical data; D015331:Cohort Studies; D003696:Delivery Rooms / Q000458:organization & administration*; D036861:Delivery, Obstetric / Q000145:classification* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult