Observational studyBMJ open2019
Implementation of the WHO manual for Robson classification: an example from Sri Lanka using a local database for developing quality improvement recommendations.
Observational study in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- Development and evaluation of an online cardiotocography course tailored to LMIC settings: a feasibility study conducted in a tertiary care hospital in Sri Lanka.BMC research notes · 2025Article
- Evaluation of caesarean rates according to Robson classification using a newly developed smart phone application in a tertiary center in Sri Lanka: a comparative study.BMC pregnancy and childbirth · 2025Article
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- Applying the Modified Ten-Group Robson Classification in a Spanish Tertiary Hospital.Journal of clinical medicine · 2023Article
- Observation of a quality improvement initiative to contextually adapt and use Robson classification in real time to collect data around CS delivery and to develop strategies to reduce CS rate.BMJ open quality · 2023Article
- [Classification of caesarean sections by 10 Robson groups in a second level hospital].Revista medica del Instituto Mexicano del Seguro Social · 2023Observational
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- Implementation of the Robson Classification in Greece: A Retrospective Cross-Sectional Study.Healthcare (Basel, Switzerland) · 2023Article
- Feasibility and readiness to implement Robson classification to monitor caesarean sections in public hospitals in Myanmar: Formative research.PLOS global public health · 2023Article
- A step towards better audit: The Robson Ten Group classification system for outcomes other than cesarean section.Acta obstetricia et gynecologica Scandinavica · 2022Article
- Outcomes of induction versus spontaneous onset of labour at 40 and 41 GW: findings from a prospective database, Sri Lanka.BMC pregnancy and childbirth · 2022Article
- Quality of surgical management of placenta accreta spectrum in a tertiary center in Sri Lanka: baseline study for quality improvement project: problems and solutions.BMC pregnancy and childbirth · 2022Article
- Using the Robson classification to assess caesarean section rates in Brazil: an observational study of more than 24 million births from 2011 to 2017.BMC pregnancy and childbirth · 2021Observational
- Gestational Risk as a Determining Factor for Cesarean Section according to the Robson Classification Groups.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2021Article
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Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
objectivesThis study aimed at describing the use of a prospective database on hospital deliveries for analysing caesarean section (CS) practices according to the WHO manual for Robson classification, and for developing recommendations for improving the quality of care (QoC).
designObservational study.
settingUniversity Obstetric Unit at De Soysa Hospital for Women, the largest maternity unit in Sri Lanka. DATA COLLECTION AND ANALYSIS: For each childbirth, 150 variables were routinely collected in a standardised form and entered into a database. Data were routinely monitored for ensuring quality. Information on deliveries occurring from July 2015 to June 2017 were analysed according the WHO Robson classification manual. Findings were discussed internally to develop quality improvement recommendations.
results7504 women delivered in the hospital during the study period and at least one maternal or fetal pathological condition was reported in 2845 (37.9%). The CS rate was 30.0%, with 11.9% CS being performed prelabour. According to the Robson classification, Group 3 and Group 1 were the most represented groups (27.0% and 23.1% of population, respectively). The major contributors to the CS rate were group 5 (29.6%), group 1 (14.0%), group 2a (13.3%) and group 10 (11.5%). The most commonly reported indications for CS included abnormal cardiotocography/suspected fetal distress, past CS and failed progress of labour or failed induction. These suggested the need for further discussion on CS practices. Overall, 18 recommendations were agreed on. Besides updating protocols and hands-on training, activities agreed on included monitoring and supervision, criterion-based audits, risk management meetings and appropriate information for patients, and recommendations to further improve the quality of data.
conclusionsThis study provides an example on how the WHO manual for Robson classification can be used in an action-oriented manner for developing recommendations for improving the QoC, and the quality of data collected.
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