Using a Caesarean Section Classification System based on characteristics of the population as a way of monitoring obstetric practice

Abstract

Objectiveto compare the distribution of caesarean rates in the Robson's 10 groups classification in order to see if any change occurred after the implementation of an audit and feedback intervention. Design: cross sectional, before and after an audit and feedback study. Setting: a university hospital in Brazil.Methodsclinical records of all births during two three months-periods were evaluated. Each case of CS was classified into one of ten mutually exclusive categories according to obstetric characteristics. The proportion of CS in each group was compared in both periods.Resultstotal number of deliveries and the high rate of CS were similar in both periods. Group 3 (multiparous excluding previous CS, single, cephalic, ≥ 37 weeks, spontaneous labour) accounted for the largest proportion of deliveries, 28.5 and 26.8% in both periods. Group 1 (nulliparous, single, cephalic, ≥ 37 weeks, spontaneous labour) was the second largest one, while Group 5 (previous caesarean section, single, cephalic, and ≥ 37 weeks) was the third but the largest contributor to CS, accounting for 16.6 and 14.9% among all deliveries in both periods. Groups 2 (nulliparous, single, cephalic, ≥ 37 weeks, induction or CS before labour) and 4 (multiparous excluding previous CS, single, cephalic, ≥ 37 weeks, induction or CS before labour) were less prevalent, however had higher rates of CS. Only in Group 10 (All single, cephalic, ≤ 36 weeks, including previous CS), there was a significant decrease of CS rate from 70.5 to 42.6% between periods.ConclusionRobson's classification did not identify any significant change in the pattern of CS rates with the audit and feedback process, but showed to be useful for comparing trends among similar obstetric populations.

Uso de la clasificación de Robson en un Hospital Comarcal de España para reducir la tasa de cesáreas

“…El porcentaje de cesáreas descrito en este grupo en los artículos revisados de la literatura es muy variable desde el 21,3% al 84,2%. (9,11,14,15,16). Conviene tener en cuenta que hay evidencia científica de que las gestantes con una cesárea previa (transversal en segmento inferior), tiene un riesgo de ruptura uterina bajo (0,7%) y una tasa de éxito de parto vaginal del 60-70% en estos casos (18).…”

“…Esta clasificación está basada en paráme-tros bien definidos y fáciles de controlar de cada mujer y su embarazo en lugar de la indicación de la cesárea, evitándose así mucha confusión, discrepancias y variabilidad inherente a la indicación de una cesárea. La Clasificación de Diez Grupos propuesta por Robson puede aplicarse internacionalmente y permite comparaciones en el tiempo de una misma unidad asistencial y entre distintas unidades (8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Determining Factors of Cesarean Delivery Trends in Developing Countries: Lessons from Point G National Hospital (Bamako - Mali)

“…The definition of these groups appears in table 3. Based on the review of the relevant literature about this topic [Stavrou et al, 2011;Costa et al, 2010;Brennan et al, 2009;McCarthy et al, 2007;Robson, 2001], we focused on the correlation between trends of overall cesarean delivery rates and that of the cesarean delivery rates in term single cephalic nulliparas (TSCN). The term single cephalic nulliparas gathered groups 1 and 2 during the 19 year period.…”

“…Despite the lower rates of labor induction, we observe a mean rate of post-induction cesarean delivery of approximately 90% (Robson group 2). High levels of cesarean delivery following labor induction in nulliparas have been qualified as universal [Brennan et al, 2009 ;Main et al, 2006;McCarthy et al, 2007;Robson, 2001;Costa et al 2010;Yeast et al, 1999] Unpublished data from the WHO Global Survey on Maternal and Perinatal Health, which included 373 health-care facilities in 24 countries and nearly 300 000 deliveries, showed that 9.6% of the deliveries involved labor induction. Overall, the survey found that facilities in African countries tended to have lower rates of induction of labor (lowest: Niger, 1.4%) compared with Asian and Latin American countries (highest: Sri Lanka, 35.5%) [WHO, 2010].…”

Perspectivas de dor do parto normal de primigestas no período pré-natal

“…[12][13] It was noted the relation between such increase and the current hegemonic interventionist model. This happened in public and private health systems, before an obstetric practice out of step with the international recommendations based on scientific evidences.…”