Subscribe to RSS
DOI: 10.1055/s-0038-1667340
Robson Classification System Applied to Induction of Labor
Classificação de Robson aplicada à indução do trabalho de partoPublication History
18 January 2018
21 May 2018
Publication Date:
02 August 2018 (online)
Abstract
Objective Induction of labor (IL) is a common obstetric procedure, but it is questionable whether or not it results in higher cesarean section (CS) rates. The present study aims to evaluate the impact of IL in the overall CS rates and to analyze these rates according to the method of IL employed and to the Robson group in which it was applied.
Methods We have conducted a retrospective study including pregnant women whose labor was induced at a tertiary hospital in 2015 and 2016. All women were classified according to the Robson Classification System (RCS). The CS rates were analyzed and compared regarding the method of IL employed.
Results A total of 1,166 cases were included. The CS rate after IL was 20.9%, which represented 23.1% of the total of CSs performed in 2015 and 2016. The highest CS rates were recorded in RCS groups 5 (65.2%) and 8 (32.3%). Group 2 was the highest contributor to the overall CS rate, since it represented 56.7% of the population. The intravaginal prostaglandins method was the most used (77%). Transcervical Foley catheter was the preferred method in group 5 and intravaginal prostaglandins in all the other groups. The CS rate was higher when transcervical Foley catheter was used (34.1%).
Conclusion Transcervical Foley catheter induction was associated with a higher rate of CS, probably because it was the preferred method used in group 5.
Resumo
Introdução A indução do trabalho de parto é uma prática comum e sua associação com o aumento da taxa de cesarianas tem sido questionada. O presente estudo surge com o objetivo de avaliar o impacto da indução do trabalho de parto na taxa global de cesarianas e de analisar as taxas de cesarianas de acordo com o método de indução do trabalho de parto utilizado e com o grupo de Robson.
Métodos Realizamos um estudo retrospectivo com inclusão de grávidas submetidas a indução do trabalho de parto em um hospital terciário em 2015 e 2016. Todas as mulheres forram classificadas de acordo com a classificação de Robson. As taxas de cesarianas foram analisadas e comparadas em função do método de indução de trabalho de parto utilizado.
Resultados Foram incluídos 1.166 casos. A taxa de cesarianas após a indução do trabalho de parto foi de 20,9%, correspondendo a 23,1% do total de cesarianas realizadas em 2015 e 2016. Os grupos 5 e 8 da classificação de Robson foram os que apresentaram as maiores taxas de cesarianas (65,2% e 32,3%, respectivamente). O grupo 2 foi o que mais contribuiu para a taxa global de cesarianas, por representar 56,7% do total da população. As prostaglandinas intravaginais foram o método mais utilizado (77%). O cateter de Foley transcervical foi o método mais utilizado no grupo 5 e as prostaglandinas intravaginais nos restantes. A taxa de cesarianas foi superior quando se utilizou o cateter de Foley transcervical (34,1%).
Conclusão A indução do trabalho de parto com cateter de Foley transcervical associou-se a uma maior taxa de cesarianas, em provável relação com a sua maior utilização no grupo 5.
Contributions
Vargas S., Rego S., Clode N. contributed with the project and the interpretation of data, the writing of the article, the critical review of the intellectual content and the final approval of the version to be published.
-
References
- 1 World Health Organization. WHO Recommendations for Induction of Labour . Geneva: WHO; 2011
- 2 Boulvain M, Marcoux S, Bureau M, Fortier M, Fraser W. Risks of induction of labour in uncomplicated term pregnancies. Paediatr Perinat Epidemiol 2001; 15 (02) 131-138 . Doi: 10.1046/j.1365-3016.2001.00337.x
- 3 Jacquemyn Y, Michiels I, Martens G. Elective induction of labour increases caesarean section rate in low risk multiparous women. J Obstet Gynaecol 2012; 32 (03) 257-259 . Doi: 10.3109/01443615.2011.645091
- 4 Rayburn WF, Zhang J. Rising rates of labor induction: present concerns and future strategies. Obstet Gynecol 2002; 100 (01) 164-167 . Doi: 10.1016/S0029-7844(02)02047-1
- 5 ACOG Committee on Practice Bulletins – Obstetrics. ACOG Practice Bulletin No. 107: induction of labor. Obstet Gynecol 2009; 114 (2 Pt 1): 386-397 . Doi: 10.1097/AOG.0b013e3181b48ef5
- 6 Wood S, Cooper S, Ross S. Does induction of labour increase the risk of caesarean section? A systematic review and meta-analysis of trials in women with intact membranes. BJOG 2014; 121 (06) 674-685 , discussion 685. Doi: 10.1111/1471-0528.12328
- 7 Saccone G, Berghella V. Induction of labor at full term in uncomplicated singleton gestations: a systematic review and metaanalysis of randomized controlled trials. Am J Obstet Gynecol 2015; 213 (05) 629-636 . Doi: 10.1016/j.ajog.2015.04.004
- 8 Mishanina E, Rogozinska E, Thatthi T, Uddin-Khan R, Khan KS, Meads C. Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis. CMAJ 2014; 186 (09) 665-673 . Doi: 10.1503/cmaj.130925
- 9 Cunningham FG, Leveno KJ, Bloom SL. , et al. Williams Obstetrics. 24a ed. New York, NY: McGraw-Hill Education; 2014
- 10 Gonçalves I, Lopes S, Casanova J, Fortuna J, Silva P. Impact of strategies in reducing cesarean section rate. Acta Obstet Ginecol Port 2014; 8: 29-35
- 11 Robson MS. Can we reduce the caesarean section rate?. Best Pract Res Clin Obstet Gynaecol 2001; 15 (01) 179-194 . Doi: 10.1053/beog.2000.0156
- 12 FIGO Working Group On Challenges In Care Of Mothers And Infants During Labour And Delivery. Best practice advice on the 10-Group Classification System for cesarean deliveries. Int J Gynaecol Obstet 2016; 135 (02) 232-233 . Doi: 10.1016/j.ijgo.2016.08.001
- 13 Direcção-Geral da Saúde. Norma N° 1/2015 de 19 de janeiro de 2015. Registo de indicações de cesariana. 2015. http://www.saudereprodutiva.dgs.pt/normas-e-orientacoes/gravidez/norma-n-12015-de-19012015-registo-de-indicacoes-de-cesariana.aspx . Accessed April 12, 2017
- 14 Vogel JP, Betrán AP, Vindevoghel N. , et al; WHO Multi-Country Survey on Maternal and Newborn Health Research Network. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health 2015; 3 (05) e260-e270 . Doi: 10.1016/S2214-109X(15)70094-X
- 15 Robson M, Murphy M, Byrne F. Quality assurance: The 10-Group Classification System (Robson classification), induction of labor, and cesarean delivery. Int J Gynaecol Obstet 2015; 131 (Suppl. 01) S23-S27 . Doi: 10.1016/j.ijgo.2015.04.026
- 16 Hofmeyr GJ, Gulmezoglu AM. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev 2001; (03) CD000941 . Doi: 10.1002/14651858.CD000941
- 17 Jozwiak M, Bloemenkamp KW, Kelly AJ, Mol BW, Irion O, Boulvain M. Mechanical methods for induction of labour. Cochrane Database Syst Rev 2012; (03) CD001233 . Doi: 10.1002/14651858.CD001233.pub2
- 18 Policiano C, Pimenta M, Martins D, Clode N. Efficacy and safety of Foley catheter balloon for cervix priming in term pregnancy. Acta Med Port 2017; 30 (04) 281-284 . Doi: 10.20344/amp.8003
- 19 Policiano C, Pimenta M, Martins D, Clode N. Outpatient versus inpatient cervix priming with Foley catheter: A randomized trial. Eur J Obstet Gynecol Reprod Biol 2017; 210: 1-6 . Doi: 10.1016/j.ejogrb.2016.11.026
- 20 Alfirevic Z, Kelly AJ, Dowswell T. Intravenous oxytocin alone for cervical ripening and induction of labour. Cochrane Database Syst Rev 2009; (04) CD003246 . Doi: 10.1002/14651858.CD003246.pub2
- 21 Robson M, Hartigan L, Murphy M. Methods of achieving and maintaining an appropriate caesarean section rate. Best Pract Res Clin Obstet Gynaecol 2013; 27 (02) 297-308 . Doi: 10.1016/j.bpobgyn.2012.09.004
- 22 Guise JM, Eden K, Emeis C. , et al. Vaginal birth after cesarean: new insights. Evid Rep Technol Assess (Full Rep) 2010; (191) 1-397 (Full Rep)
- 23 West HM, Jozwiak M, Dodd JM. Methods of term labour induction for women with a previous caesarean section. Cochrane Database Syst Rev 2017; 6: CD009792 . Doi: 10.1002/14651858.CD009792.pub3
- 24 American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 115: Vaginal birth after previous cesarean delivery. Obstet Gynecol 2010; 116 (2 Pt 1): 450-463 . Doi: 10.1097/AOG.0b013e3181eeb251
- 25 Dodd JM, Crowther CA, Grivell RM, Deussen AR. Elective repeat caesarean section versus induction of labour for women with a previous caesarean birth. Cochrane Database Syst Rev 2017; 7: CD004906 . Doi: 10.1002/14651858.CD004906.pub5
- 26 Dodd JM, Crowther CA, Huertas E, Guise JM, Horey D. Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth. Cochrane Database Syst Rev 2013; (12) CD004224 . Doi: 10.1002/14651858.CD004224.pub3
- 27 Feghali M, Timofeev J, Huang CC. , et al. Preterm induction of labor: predictors of vaginal delivery and labor curves. Am J Obstet Gynecol 2015; 212 (01) 91.e1-91.e7 . Doi: 10.1016/j.ajog.2014.07.035
- 28 Jonsson M. Induction of twin pregnancy and the risk of caesarean delivery: a cohort study. BMC Pregnancy Childbirth 2015; 15: 136 . Doi: 10.1186/s12884-015-0566-4
- 29 Vaz de Macedo C, Clode N, Mendes da Graça L. Prediction of success in external cephalic version under tocolysis: still a challenge. Acta Med Port 2015; 28 (05) 554-558
- 30 Fonseca A, Silva R, Rato I. , et al. Breech presentation: vaginal versus cesarean delivery, which intervention leads to the best outcomes?. Acta Med Port 2017; 30 (06) 479-484 . Doi: 10.20344/amp.7920