Robson Classification for cesarean section in a Public Hospital in Distrito Federal

Abstract

Objectives: to evaluate cesarean taxes by looking at Robson classification on 10 groups (G) and the principal indications at the prevalent groups and at G10. Methods: cross-sectional, observational, retrospective study, including all deliveries performed in a public hospital in Distrito Federal in 2019. Data were collected from medical records and pregnant women were classified in 10 groups. Pearson’s chi-squared test was used to calculate the p-value. The risk estimate for cesarean was defined by common odds ratio of Mantel-Haenszel, with calculation of odds ratio (OR) and 95% confidence interval (CI95%). Results: there were 2,205 deliveries, 1,084 (49.1%) of which were cesarean and 1,121 (50.9%) vaginal deliveries. The principal factors for cesarean were G5 (39.3%), G2 (21.2%) and G1 (13.6%). At G10, cesarean had 51.5% of births, not differing statistically from the other groups (p>0.05). Considering all preterm births, G6 to G10 and the other groups, there is a bigger chance of cesarean happening in relation to normal labor (OR=1.4; CI95%= 1.011-2.094; p=0.042). Dystocia remained at G1 and G2, previous cesarean at G5 and hypertensive syndrome at G10. Conclusion: cesarean was most prevalent delivery route, showing elevated rates even in primiparous and preterm births. Preponderance of dystocia and acute fetal distress suggests better evaluation of the diagnostic criteria, mainly in G1, G2 and G10.

Optimizing caesarean section use and feasibility of implementing the Robson classification system: Perspectives of healthcare providers and policymakers

“…Despite its proven advantages, CS can lead to increased medical risks for both mothers and newborns, especially when performed without a medical indication. 1 – 3 …”

“… 7 – 9 In addition, the hormonal, physical, and bacterial exposures of newborns delivered by CS are different from those delivered by VB, which can lead to changes in physiology, a higher risk of developing allergies, breathing problems, a low Apgar score, childhood onset of type 1 diabetes, and even obesity in adulthood. 2 , 8 Furthermore, increased rates of CS are associated with significantly higher costs than VB thus imposing an economic burden on the healthcare system, resulting from extended hospital stays, an increased probability of re-hospitalization, and more. 5 , 8 , 10 , 11 …”

“…These easy and simple indicators are routinely collected during hospital admission for delivery. 2 , 35 , 36 The RTGCS serves as an overall prospective structure for characterizing, evaluating, monitoring, and comparing CS rates within and between hospitals, in a standard, reliable, and indication-based way. 23 , 37 Implementation of the system is associated with optimized CS use and reduced rates.…”

Trends in cesarean section rates in Brazil by Robson classification group, 2014-2020

“…Additionally, other Brazilian studies using the Robson Classification were localized ( 21 - 22 ) , restricted to specific institutions ( 23 - 24 ) , or had different objectives, such as evaluating the association between cesareans and prematurity ( 25 ) or the association between access to prenatal care and the occurrence of cesareans ( 26 ) . Other studies employed the Robson Classification to assess the occurrence of cesareans in the country but during periods close to its implementation as a strategy, such as from 2011 to 2017 ( 20 ) , and from 2014 to 2016 ( 27 ) .…”

“…Ainda, outros estudos brasileiros que utilizaram a classificação de Robson foram locais ( 21 - 22 ) , restritos a instituições ( 23 - 24 ) , ou tiveram outros objetivos como avaliar a associação entre cesarianas e prematuridade ( 25 ) ou a associação entre acesso ao pré-natal e ocorrência de cesáreas ( 26 ) . Outros estudos utilizaram a classificação de Robson para avaliar a ocorrência de cesáreas no país, mas em períodos anteriores, muito próximos da sua implementação enquanto estratégia, tais como de 2011 a 2017 ( 20 ) , e de 2014 a 2016 ( 27 ) .…”