Classifications for Cesarean Section: A Systematic Review

Torloni, Maria Regina; Betrán, Ana Pilar; Souza, João Paulo; Widmer, Mariana; Allen, Tomas; Gülmezoglu, Metin; Merialdi, Mario

doi:10.1371/journal.pone.0014566

Cited by 340 publications

(309 citation statements)

References 22 publications

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“…32 Hence, the variations found in our study (1.5-fold to 2-fold) are within the variability expected in multicenter studies. [30][31][32][33] Analysis of the TOCOS cohort led to three main results that could be used as a guide for prenatal counseling and for tailoring clinical surveillance in pregnancy ( Figures 3 and 4, Tables 3-5). The first result is confirmatory, on a much larger scale, of previously reported data.…”

Section: Discussionsupporting

confidence: 80%

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Risk of Adverse Pregnancy Outcomes in Women with CKD

Piccoli¹,

Cabiddu²,

Attini³

et al. 2015

Journal of the American Society of Nephrology

306

335

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CKD is increasingly prevalent in pregnancy. In the Torino-Cagliari Observational Study (TOCOS), we assessed whether the risk for adverse pregnancy outcomes is associated with CKD by comparing pregnancy outcomes of 504 pregnancies in women with CKD to outcomes of 836 low-risk pregnancies in women without CKD. The presence of hypertension, proteinuria (.1 g/d), systemic disease, and CKD stage (at referral) were assessed at baseline. The following outcomes were studied: cesarean section, preterm delivery, and early preterm delivery; small for gestational age (SGA); need for neonatal intensive care unit (NICU); new onset of hypertension; new onset/doubling of proteinuria; CKD stage shift; "general" combined outcome (preterm delivery, NICU, SGA); and "severe" combined outcome (early preterm delivery, NICU, SGA). The risk for adverse outcomes increased across stages (for stage 1 versus stages 4-5: "general" combined outcome, 34.1% versus 90.0%; "severe" combined outcome, 21.4% versus 80.0%; P,0.001). In women with stage 1 CKD, preterm delivery was associated with baseline hypertension (odds ratio [OR], 3.42; 95% confidence interval [95% CI], 1.87 to 6.21), systemic disease (OR, 3.13; 95% CI, 1.51 to 6.50), and proteinuria (OR, 3.69; 95% CI, 1.63 to 8.36). However, stage 1 CKD remained associated with adverse pregnancy outcomes (general combined outcome) in women without baseline hypertension, proteinuria, or systemic disease (OR, 1.88; 95% CI, 1.27 to 2.79). The risk of intrauterine death did not differ between patients and controls. Findings from this prospective study suggest a "baseline risk" for adverse pregnancy-related outcomes linked to CKD.

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Section: Discussionsupporting

confidence: 80%

“…[30][31][32] Cesarean section is a main marker of such differences, and the variability is enormous even within the same country. In a recent study in 593 US hospitals, rates varied almost 10-fold across hospitals.…”

Section: Discussionmentioning

confidence: 99%

Risk of Adverse Pregnancy Outcomes in Women with CKD

Piccoli¹,

Cabiddu²,

Attini³

et al. 2015

Journal of the American Society of Nephrology

306

335

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“…This classification would help understand the internal structure of these rates at individual health facilities and specific population groups. [11][12][13] Identifying the indications that lead to each group's contribution to the section rates would help in formulating guidelines to reduce rates. Within groups without compromising maternal and fetal welfare In 2015, the WHO issued an official statement concerning CS rates and promoting the use of the Robson classification as a tool for optimizing the CS rate at health care facilities.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Caesarean-Section rates according to Robson's ten group classification system and evaluating the indications within the groups

Ray

Jose

2017

Int J Reprod Contracept Obstet Gynecol

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Background: With Caesarean sections on the rise WHO proposes that health care facilities use the Robson's 10 group classification system to audit their C-sections rates. This classification would help understand the internal structure of the CS rates at individual health facilities identify key population groups, indications in each group and formulate strategies to reduce these rates.Methods: This was a cross sectional study for a period of 24 months at a tertiary care hospital in a tribal area of Kerala South India. Women who delivered during this period were included and classified into 10 Robson's classes and percentages were calculated for the overall rate, the representation of groups, contribution of groups and Caesarean percentage in each group.Results: Highest contribution was by Group 5 and Group 2. Together these two groups contributed to 38% of the total Caesareans. Followed by Group 8 and 10. All four added contributed to 63% of the section rate The least contribution was by Group 3. Groups 6, 7 and 9 by themselves did not contribute much but within their groups had a 100% C-Section rate.Conclusions: The contribution of the various Robson's Group to the absolute C-Section rates needs to be looked into. Reducing primary section rates, adequate counselling and encouraging for VBAC, changing the norms for dystocia and non-reassuring fetal status, training and encouraging obstetricians to perform versions when not contraindicated could reduce the contribution of Robson's groups towards the absolute C-Section rates.

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“…7 In a systemic review conducted by WHO 2011, on various classification system it was found that a woman based classification in general and robsons classification in particular was best for auditing, analyzing and comparing CS rates across different setting and to implement effective strategies to optimize CS rate. 8 The aim of the study was to analyse the CS rate in various groups after classifying the deliveries in our institution according to Robson' ten group classifications. By this we aimed to identify specific group of women to be targeted to reduce CS rates.…”

mentioning

confidence: 99%

Analysis of caesarean section rates using Robsons ten group classification: the first step

Koteshwara

Sujatha

2017

Int J Reprod Contracept Obstet Gynecol

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Background:The Caesarean section (CS) rate is steadily increasing worldwide including India. The overall CS rates are reported but rarely the women are classified. According to WHO Robson ten -group classification is useful as a global standard for assessing, monitoring and comparing cesarean section rates. Our objective was to classify women delivering in our hospital according to various categories as per the 10-group classification (Robsons classification) and analyzing the CS rate in each group. Methods: This was a cross sectional study conducted at JSS Medical College, Mysore. The data was collected for all women delivering in hospital from January 2016-December 2016 and the women were classified according to Robsons 10 group classification. The proportion of women delivering in each group, the CS rate of each group, and the relative contribution to CS rate from each group was calculated. Results: Among a total of 5016 women delivering during the study period 37.65% of women were delivered by CS. Maximum no of pregnant women belonged to primigravida group (group 1 and 2). Major contributor to CS rate were primigravida (group 2) at 32.2%. Next contributors were group 5 and group 1 at 28.9 % and 18.6% respectively. Overall the three groups 1, 2 and group 5 contributed to 79.7% of the CS rate while the other group contributed to only 21.3% of CS rate. Conclusions: Applying Robsons criteria to classify pregnant women allowed for easy classification to identify the category of women most likely to have CS. Reducing primary CS rate and increasing VBAC rates will help to reduce CS rate.

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Classifications for Cesarean Section: A Systematic Review

Cited by 340 publications

References 22 publications

Risk of Adverse Pregnancy Outcomes in Women with CKD

Risk of Adverse Pregnancy Outcomes in Women with CKD

Analysis of Caesarean-Section rates according to Robson's ten group classification system and evaluating the indications within the groups

Analysis of caesarean section rates using Robsons ten group classification: the first step

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