Use of the Robson Classification System for the Improvement and Adequacy of the Ways of Delivery in Maternities and Hospitals. An Opportunity to Reduce Unnecessary Cesarean Rates

Abstract

Rev Bras Ginecol Obstet 2018;40:377-378. In the last decade, childbirth care in Brazil has undergone profound changes, which when properly applied in the daily practice of doctors and administrators of maternity wards will undoubtedly bring a great benefit to our patients. During this period, we also had intense debates and questions, focused mainly on the high rates of cesarean deliveries throughout Brazil, and without any doubts this is a situation that really mustchange.However, for an adequate decision making, it is imperative that the measures to be taken are based on reliable data and on a simple analysis, so that we have an easier way to reach the goal of adjusting the cesarean delivery rates. In this sense, stratifying each of the women who arrive at our hospitals for delivery is of fundamental importance. Monitoring the indications for cesarean delivery is an essential strategy, among other measures, to achieve cesarean delivery rates at the appropriate levels. Over the years, several classifications have been tried.

Trends in national and subnational wealth related inequalities in use of maternal health care services in Nepal: an analysis using demographic and health surveys (2001–2016)

“…However, the complete analysis also requires the systematic analysis of the fact that CS are effective in saving maternal and infant lives only when they are required for medically indicated reasons. Such analysis requires the Robson classification at admission [63] for the pregnancy cases which is not available in the current dataset. However, inequality in utilization of CS services itself reflects useful information to the policy makers for taking pro-poor actions to bridge the gap.…”

Clasificación de cesáreas según el modelo de Robson, unidad obstétrica, Hospital General San Felipe, Honduras, abril-junio de 2017

“…En el grupo sin riesgo la indicación obstétrica de cesárea más frecuente fue la baja reserva fetal, 22/89 (24,7 %; IC 95 %: 16,2-35,0). En los casos clasificados como "embarazo con riesgo de cesárea" la indicación más frecuente fue DCP y presentación pélvica, 8/89 (9 %; IC 95 %: [4][5][6][7][8][9][10][11][12][13][14][15][16]9).…”

“…En 2014, el Human Reproduction Programme de la OMS recomendó el modelo de Robson para evaluación inicial, investigación de procesos y definición de estrategias de disminución de realización de cesáreas en unidades obstétricas, además del seguimiento y la comparación entre unidades respecto a la frecuencia de cesáreas de acuerdo con el riesgo o la necesidad inicial de la embarazada, este modelo se basa en categorías derivadas de antecedentes obstétricos, curso del trabajo de parto y edad gestacional (2,5,6,8,11,12). Se ha descrito que para una adecuada toma de decisiones sobre las altas tasas de cesáreas es imperativo que las medidas por tomar estén basadas en datos confiables y en un análisis simple; además, cada unidad puede establecer criterios según los grupos de Robson donde se concentran el mayor número de cesáreas (13).…”

Brazilian andforeign cesareas in frontier city: robson classification / Cesáreas de brasileiras e estrangeiras em município de fronteira: classificação de robson

“…13 Researchers highlight the need to create clear criteria and guidelines for this specific group, aiming to increase vaginal birth attempts after a previous cesarean section, considering cultural aspects and care changes, which require well-trained and safe care teams to conduct this situation. [13][14] For example, a study in Lisbon showed that cesarean rates can be reduced to approximately 20% when labor induction is attempted in a proper, monitored manner and in a safe environment. 15 When the results between general births and cesarean sections were compared between Brazilians and foreigners, differences between nationalities were found (possibly due to differences in prenatal services), and the analyses were significant for groups 6 and 8.…”

“…9 It is necessary to reduce cesarean sections, but not at any cost, and factors such as Apgar scores below 7, the need for hospitalization of the newborn in NICU and maternal and fetal mortality rates should be observed and constantly monitored. 14 A study in Ethiopia found that the cesarean rates are higher for groups 1, 3 and 5, justifying that the main reason for such procedure was the presence of fetal distress, followed by the fact that the mother had a previous cesarean section. 11 Similar results occurred in South Africa.…”