An Audit for Caesarean section
The World Health Organization stated in 1985 that no region should exceed rates of caesarean section higher than 10-15% . However, those goals seem no longer to be greatly achievable, both in developed and developing countries. Caesarean section rates are increasing worldwide with rates as higher than 30% reported for several countries in Europe, US and Latin America. Rising caesarean section rates have medical consequences that remain uncertain.
Regular audit of caesarean sections is one way to constantly evaluate caesarean section rates and to strategize to control or minimize caesarean sections. A medical indication based audit is often performed; however, a limitation of the indication based audit is the relative inability to use such information to change care prospectively. Additionally, the documentation of indications may not always be uniform (despite best efforts).
The Robson or the ten group classification system was described in 2001. The Robson system is simple to understand and implement with clinically relevant groups. The 10 groups are give an initial overview of caesarean section rates that can be compared with rates either in different units or in the same unit over time. These groups can also be studied further in greater detail.
The Robson or the 10-group classification system offers the following outputs for evaluation
- The relative size of each group in the practice
- The caesarean section rate in each group
- The contribution of each group to the overall caesarean section rate
We have developed an MS Excel tool that simplifies the ten group classification(for a caesarean section audit) by automating the categorization and reporting. The tool is meant for use by institutes/units that conduct <30,000 deliveries each year.
We have developed the tool in MS Excel 2007 and 2003. Data entry can be done in the sheet named enter data and the reports are produced in the sheet named reports. The Robson category for each woman can be viewed in the same row (will be seen as TRUE corresponding to the category).
The tools can be downloaded from
ps: Excel can sometimes drive one up the wall, so please let us know if there are any bugs. The panes are frozen and the sheet has been protected to prevent inadvertent mixups of formulas.
Praveen Nirmalan MBBS, DO, MPH