Ten Group Classification System: using data to understand and optimize caesarean section rates in Romania

28–29 March 2019, Bucharest, Romania

Following the 2018 landmark meetings in Tbilisi, Georgia, that addressed the alarming increase in caesarean sections in the WHO European Region, the Ministry of Health of Romania and WHO have co-organized a workshop on implementing the Robson classification, also known as the Ten Group Classification System for caesarean section. The Bucharest event will actively involve more than 30 leading obstetrics and gynaecology specialists and senior midwives working in the main public and private maternities across the country.

Hosted by Dr Cristian Grasu, Secretary of State of the Romanian Ministry of Health, and Dr Miljana Grbic, WHO Representative in Romania, the event will be attended by international experts from WHO collaborating centres for maternal and child health in Czechia and Italy, as well as by national policy-makers and key representatives of professional associations, such as the Romanian Society of Obstetrics and Gynecology.

The workshop will discuss the Robson classification, an important tool developed by WHO as a global standard for assessing, monitoring and comparing caesarean section rates. Introducing this system in Romania will help to identify and analyse the groups of women that contribute most and least to this rate, compare practices and quality of care between facilities, and assess the effectiveness of interventions targeted at optimizing the caesarean section rate.

Alarmingly, the evidence suggests that in Romania caesarean section is performed in more than half of births. Data published by the National Institute of Public Health, states that the percentage of caesarean sections is approximately 48%; however, the actual rate is estimated to be higher because this does not cover births in private hospitals, in the Ministry of Internal Affairs’ health facilities or home births. Romania also has the highest rate of maternal and child mortality among European Union member states.

The aim of the workshop is also to help formulate an action plan and recommendations on caesarean sections, while discussing global and regional perspectives on the use of the procedure and the health consequences of its misuse; the practices of caesarean section in Romania and other countries; and practical examples of the benefits of using Robson classification.