WHO Global Survey on Maternal and Perinatal Health in Latin America: classifying caesarean sections

Abstract

BackgroundCaesarean section rates continue to increase worldwide with uncertain medical consequences. Auditing and analysing caesarean section rates and other perinatal outcomes in a reliable and continuous manner is critical for understanding reasons caesarean section changes over time.MethodsWe analyzed data on 97,095 women delivering in 120 facilities in 8 countries, collected as part of the 2004-2005 Global Survey on Maternal and Perinatal Health in Latin America. The objective of this analysis was to test if the "10-group" or "Robson" classification could help identify which groups of women are contributing most to the high caesarean section rates in Latin America, and if it could provide information useful for health care providers in monitoring and planning effective actions to reduce these rates.ResultsThe overall rate of caesarean section was 35.4%. Women with single cephalic pregnancy at term without previous caesarean section who entered into labour spontaneously (groups 1 and 3) represented 60% of the total obstetric population. Although women with a term singleton cephalic pregnancy with a previous caesarean section (group 5) represented only 11.4% of the obstetric population, this group was the largest contributor to the overall caesarean section rate (26.7% of all the caesarean sections). The second and third largest contributors to the overall caesarean section rate were nulliparous women with single cephalic pregnancy at term either in spontaneous labour (group 1) or induced or delivered by caesarean section before labour (group 2), which were responsible for 18.3% and 15.3% of all caesarean deliveries, respectively.ConclusionThe 10-group classification could be easily applied to a multicountry dataset without problems of inconsistencies or misclassification. Specific groups of women were clearly identified as the main contributors to the overall caesarean section rate. This classification could help health care providers to plan practical and effective actions targeting specific groups of women to improve maternal and perinatal care.

How Referred Patients Influence Cesarean Sections Rate Pattern: Analysis according to the Robson Classification

“…The rate of caesarean section in this group (20.5%) is higher than those observed by Betrán et al [12] and Kelly et al [4], who found 12.6% and 13.19% respectively in Latin America and Canada. This difference could be put down to the fact that these are highly medicalized countries and the figures come from statistics at the country and continent levels.…”

Systemic Lupus Erythematosus and Outcomes in First and Subsequent Births Based on Data From a National Birth Registry

“…The risk of cesarean section (CS) in nulliparous women with spontaneous start of labor, cephalic presentation, and no previous scar has been reported to be 2.5 times higher than for comparable parous women (15). The reason why nulliparous women carry higher risks is not fully understood even though it has been known for more than 40 years (16,17).…”

A clinical audit and confidential enquiry of caesarean section indications at rural tertiary health care centre

“…WHO global survey on maternal and perinatal health in Latin America, in fact, unveiled that rate of caesarean delivery was positively associated with severe maternal and neonatal morbidity and mortality, even after adjustment of demographic characteristics, risk factors, type of institution and proportion of referrals. 1 Also, unneeded caesareans beget higher expenditure at individual and national levels and have the potential to divert human and financial resources. In spite of these facts, CS is high and continues to hike in the developed world and in many developing countries.…”