Caesarean delivery rate changes after audit and feedback with the Ten
Group Classification System in a French perinatal network: a
retrospective pre–post study
Abstract
Objective : To study changes in caesarean delivery (CD) rates between
maternity wards in a perinatal network after implementation of the Ten
Group Classification System (TGCS) in an audit with feedback. Design A
retrospective pre–post study of all births from 1 January 2012 to 31
December 2018. Setting A French perinatal network of 10 maternity wards
in the Yvelines district of France. Population All live births of
gestational age ≥24 weeks in the network. Methods During the pre-period
(1 January 2012 to 31 December 2014), the audit and feedback provided
only overall CD rates. During the post-period (1 January 2015 to 31
December 2018), CD rates for each TGCS group were provided. Regression
models, adjusted for maternal characteristics and maternity ward, were
used to compare CD rates globally and for each TGCS group. Variability
of CD rates between maternity wards was analysed using the coefficients
of variation. Main outcome measure CD rates. Results There were 51 082
women who delivered during the pre-period and 63 964 during the
post-period. The overall CD rate did not decrease (24.5% during the
pre-period versus 25.1% during the post-period). There were no
significant differences in CD rates for any TGCS group after adjustment
for maternity, maternal age and socio-demographic characteristics. Nor
did audit implementation decrease CD rate variability between maternity
wards or within TGCS groups. Conclusion Implementation of an
audit-and-feedback cycle using the TGCS did not decrease either CD rates
or variability between maternity wards.