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Eur J Obstet Gynecol Reprod Biol. 2011 Feb;154(2):136-40. doi: 10.1016/j.ejogrb.2010.09.005.

Medical audit using the Ten Group Classification System and its impact on the cesarean section rate.

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Department of the Valparaiso University, Hontaneda 2653, Valparaiso, V región, Chile.



The aim of this study is to implement the Ten Group Classification System (TGCS) and evaluate whether the introduction of the medical audit cycle reduces the cesarean section (CS) rate without increasing maternal-fetal risk.


A prospective cohort study was performed including all women who gave birth during 21 months. The study was subdivided into three consecutive periods: (1) implementation of the TGCS identifying the major CS rate contributor groups (three months), (2) audit and report changes in the CS rates to the medical and midwifery staff according to the TGCS (6 months) and (3) discontinue interventions but continue auditing the CS rates (6 months).


The first period CS rate of 36.8% was reduced to 26.5% after the introduction of interventions in the second period (RR 0.71 IC 0.63-0.81). After the intervention was stopped, the CS rate increased again to 31.8% (RR 1.19 IC 1.09-1.32). This is a decrease of 5.08% from the basal period (RR 0.86 IC 0.76-0.97). The asphyxia rate remained unchanged for the periods studied.


Auditing through the TGCS and feedback is an effective, safe, and easy-to-implement strategy to reduce the CS rate. Its diffusion would allow reduction of the CS rates in countries as ours, and by means of the TGCS, figures can be compared within individual entities and others.

[Indexed for MEDLINE]

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