Objective
To evaluate the impact of pre‐eclampsia on cesarean delivery by using the Robson classification.
Methods
A retrospective cross‐sectional study including all women who delivered in a referral maternity hospital in southeast Brazil from January 2017 to February 2018. Women were classified into 1 of 10 Robson groups and then further subdivided into pre‐eclampsia (PE) and non‐PE (NPE) groups. Frequency of cesarean was determined for each group and compared by using χ2 and prevalence ratio.
Results
Overall, 3102 women were included, of whom 1578 (50.9%) delivered by cesarean. Classification in Robson group 5 was the most frequent among all women (n=727, 23.4%). In the PE group (n=258, 8.3%), group 10 was the most frequent classification (n=120, 46.5%); in NPE, Robson group 5 was the most frequency (n=682, 24.0%). Pre‐eclampsia was associated with a higher occurrence of cesarean (77.5% vs 48.4%; prevalence ratio, 2.29; 95% confidence interval, 1.82–2.82), owing to higher rates in Robson groups 1, 5, and 10.
Conclusion
Pre‐eclampsia was associated with a higher occurrence of cesarean delivery in some Robson groups. Robson classification may be used to evaluate the impact of specific conditions at a facility level to help plan future interventions to optimize the use of cesarean.
RESUMOO oferecimento de serviços à população pelo governo é um aspecto amplamente discutido dentro do cenário brasileiro. O transporte público, foco de grandes discussões há alguns anos, está diretamente conectado com vários outros elementos dentro de uma cidade. Este trabalho apresenta um estudo de caso de uma cidade do interior do estado de São Paulo, com enfoque sistêmico, utilizando a metodologia de sistemas soft, discutindo as relações entre os problemas atuais da gestão do transporte público e possíveis melhorias para satisfazer as necessidades dos usuários. Pôde-se verificar vários pontos falhos importantes do sistema analisado, e a escolha da aplicação da SSM contribuiu para a compreensão da situação-problema existente, porque foram feitas ligações entre o mundo sistêmico e o real, o que proporcionou a modelagem de soluções que envolvessem todas as partes interessadas no sistema.
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