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

Abstract

Background Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson’s Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. Methods Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. Results Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). Conclusion Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR.

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

“…Therefore, the RTGCS data, as based on a perinatal classification system, can provide valuable insight regarding not only the CS rate but also obstetric populations and outcomes. 37 – 41 , 64 Hence, this effective system has the potential to improve obstetric practices in Israel; for the first time, it will be possible to compare and characterize Israeli CS rates and usage patterns, and so the great importance of its implementation in health services. The RTGCS provides an initial structure for analyzing additional epidemiological variables, processes, and perinatal outcomes as well as CS.…”

Do we still need to talk about maternal morbidity and near miss?

“…Two letters to the editors in response to the article discuss the strengths and the weaknesses of the proposal and bring new contributions to monitoring, extending it to severe maternal morbidity 3 , 4 . The adoption of a system similar to the Latin American Perinatal Information System (SIP; http://www.sipplus.org/ ), linked to the Latin American Center for Perinatology, Women and Reproductive Health (CLAP/SMR; https://www.paho.org/en/clap ), is perhaps the most appropriate proposal for the Brazilian reality, considering the national expertise in information systems 10 , the specificities of obstetric events, and the possibilities of joint analysis of data from countries in the region 11 , 12 , 13 . Some Brazilian institutions have already established surveillance and research partnerships using SIP 14 , 15 .…”

¿Aún tenemos que hablar de morbilidad materna y near miss?

“…Dos cartas a las editoras en respuesta al artículo argumentaron fortalezas y debilidades de la propuesta y trajeron nuevos aportes al seguimiento, expandiéndose al morbilidad materna grave 3,4 . La adopción de un sistema similar al latinoamericano Sistema Informático Perinatal (SIP; http://www.sipplus.org/), vinculado al Centro Latinoamericano de Perinatología, Salud de la Mujer y Reproductiva (CLAP/SMR; https://www.paho.org/es/clap), es quizás la propuesta más adecuada a la realidad brasileña, teniendo en cuenta la experiencia nacional en sistemas de información 10 , las especificidades de los eventos obstétricos y las posibilidades de análisis conjunto de datos de los países de la región 11,12,13 . Algunas instituciones brasileñas ya establecieron alianzas en vigilancia e investigación utilizando el SIP 14,15 .…”