Cesarean section in Uruguay from 2008 to 2018: country analysis based on the Robson classification. An observational study

Abstract

Background The use of caesarean section has steadily increased, with Latin America being the region with the highest rates. Multiple factors account for that increase and the Robson classification is appropriate to compare determinants at the clinical level for caesarean section rates over time. The purpose of this study is to describe the evolution of caesarean section rates by Robson groups in Uruguay from 2008 to 2018 using a country level database. Methods We included the records of all women giving birth in Uruguay (pregnancies ≥22 weeks and weights ≥500 g) with valid data in the mode of childbirth recorded in the Perinatal Information System database between 2008 and 2018. Caesarean section rates were calculated by Robson groups for each of the years included, disaggregated by care sector (public/private) and by geographical area (Capital City/Non-Capital), with time trends and their significance analyzed using linear regression models. Results Of the total 485,263 births included in this research, the overall caesarean section rate was 43,1%. In 2018, among the groups at lower risk of caesarean section (1 to 4), the highest rates were seen in women in group 2B (98,8%), followed by those in group 4B (97,9%). A significant increase in the number of caesarean sections was seen in groups 2B (97,9 to 98,8%), 3 (8,36 to 11,1%) and 4 (A (22,7 to 26,9%) and B (95,4 to 97,9%) Significant growth was also observed in groups 5 (74,3 to 78,1%), 8 (90,6 to 95,5%), and 10 (39,1 to 46,7%). The private sector had higher rates of caesarean section for all groups throughout the period, except for women in group 9. The private sector in Montevideo presented the highest rates in the groups with the lowest risk of caesarean section (1, 2A, 3 and 4A), followed by the private sector outside of the capital. Conclusion Uruguay is no exception to the increasing caesarean section trend, even in groups of women who have lower risk of requiring caesarean section. The implementation of interventions aimed at reducing caesarean section in the groups with lower obstetric risk in Uruguay is warranted.

The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson’s Ten Group Classification System

“…A Uruguayan study, also using routine information gathered with SIP, found an overall CSR of 43.1%. In that study, Group 5 had the largest size and was the major contributor to overall CSR (30.6%) [ 14 ]. Another Mexican study found an overall CSR ranging from 53.5 to 48.7% [ 15 ].…”

Frecuencia de y cesáreas en establecimientos públicos y privados de la Provincia de Concepción, Chile, 2001-2019

“…A nivel mundial la situación no es mucho más alentadora, comparando con los datos de Uruguay el porcentaje de cesáreas fue de un 46.3% en 2014, siendo más alto en Epriv 9,10 . En India entre los años 2005 y 2016 el porcentaje de cesáreas en Epriv aumentó del 27.9 al 40.9%, mientras que en los Epub disminuyó del 15.2 al 11.9% 11 .…”

Analysis of caesarean sections with the Robson’s ten group classification system

“…4 Multiple factors account for that increase and the Robson classification is appropriate to compare determinants at the clinical level for caesarean section rates over time. 5 To safely reduce the increasing prevalence of CDs, the World Health Organization (WHO) recommended the Robson classification as a tool for monitoring and auditing CD rates in 2016. 6 The classification uses 6 basic obstetrical variables (parity, previous CD, onset of labour, gestational DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20230817 Department of Obstetrics and Gynecology, Mamata Medical College, Khammam, Telangana, India age, number of fetuses, fetal lie, and presentation) to classify each woman into 1 of 10 groups.…”