{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T22:14:18Z","timestamp":1780611258127,"version":"3.54.1"},"reference-count":38,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T00:00:00Z","timestamp":1647388800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The Robson Ten Group Classification System is widely used for the audit of cesarean section (CS) rates. However, CS rate alone is a poor quality indicator and should be balanced with other obstetric endpoints. The aim of this study was to evaluate whether Swedish national data on obstetric outcomes other than CS, stratified by the Robson classification, could be analyzed in a useful way.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>All births in Sweden from 2017 through 2020 recorded in the nationwide Swedish Pregnancy Register were categorized using the Robson classification with subdivision of some groups. Five outcomes were explored: CS, operative vaginal delivery, postpartum hemorrhage, obstetric anal sphincter injury (OASIS) and Apgar score\u00a0&lt;7 at 5 minuteutes. Rates of each outcome and contribution of each group to the total outcome rate were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The largest Robson groups were nulliparous and multiparous women with single\u2010term cephalic pregnancies, unscarred uterus and spontaneous labor. Intrapartum CS rates were highest for multiple pregnancies, women with induced labor after previous CS, and nulliparous women with induced labor. Nulliparous women and multiparous women with a previous CS with attempted vaginal birth had the highest operative vaginal delivery and OASIS rates. The postpartum hemorrhage rate was highest for multiple pregnancies and transverse lie, followed by prelabor CS in nulliparous and multiparous women with single\u2010term cephalic pregnancies and unscarred uterus. The highest rates of Apgar score\u00a0&lt;7 at 5 minute were observed in preterm deliveries, multiple pregnancies, transverse lie and breech presentation. The largest contribution to the total CS rate was made by women with previous CS delivered by prelabor CS, and nulliparous women with induced or spontaneous labor. The largest contribution to all other outcomes was made by nulliparous women with spontaneous or induced labor and, notably, multiparous women with spontaneous labor and unscarred uterus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The Robson classification provides a useful framework for analyzing CS rates along\u00a0with rates of operative vaginal delivery, OASIS, postpartum hemorrhage and low Apgar score. Parallel interpretation of several outcomes allows a systematic and multidimensional audit, helpful for families and healthcare professionals, and can be used for comparisons, assessment of trends and subpopulations.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14350","type":"journal-article","created":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T07:57:20Z","timestamp":1647417440000},"page":"827-835","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["A step towards better audit: The Robson Ten Group classification system for outcomes other than cesarean section"],"prefix":"10.1111","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8285-3055","authenticated-orcid":false,"given":"Julia","family":"Savchenko","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Stockholm South General Hospital S\u00f6dersjukhuset  Stockholm Sweden"},{"name":"Department of Clinical Science and Education Stockholm South General Hospital S\u00f6dersjukhuset, Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7512-2059","authenticated-orcid":false,"given":"Lars","family":"Ladfors","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy Gothenburg University, Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Hjertberg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Vrinnevi Hospital  Norrk\u00f6ping Sweden"},{"name":"Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences Link\u00f6ping University  Link\u00f6ping Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0969-5470","authenticated-orcid":false,"given":"Eric","family":"Hildebrand","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences Link\u00f6ping University  Link\u00f6ping Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9401-8062","authenticated-orcid":false,"given":"Sophia","family":"Brismar Wendel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Danderyd Hospital  Stockholm Sweden"},{"name":"Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,16]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14774"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13284"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16634"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-027317"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/beog.2000.0156"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318204521a"},{"key":"e_1_2_11_8_1","unstructured":"WHO Statement on Caesarean Section Rates.2015. 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