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CC BY 4.0 · Rev Bras Ginecol Obstet 2021; 43(02): 084-090
DOI: 10.1055/s-0040-1718446
Original Article
Obstetrics

Gestational Risk as a Determining Factor for Cesarean Section according to the Robson Classification Groups

Risco gestacional como fator determinante para cesariana de acordo com os grupos da Classificação Robson
Karina Biaggio Soares 
1   Department of Gynecology and Obstetrics, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
,
Vanessa Cristina Grolli Klein 
1   Department of Gynecology and Obstetrics, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
,
José Antônio Reis Ferreira de Lima 
1   Department of Gynecology and Obstetrics, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
,
Lucas Gadenz 
1   Department of Gynecology and Obstetrics, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
,
Larissa Emile Paulo 
1   Department of Gynecology and Obstetrics, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
,
Cristine Kolling Konopka 
1   Department of Gynecology and Obstetrics, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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Abstract

Objective To analyze and compare the frequency of cesarean sections and vaginal deliveries through the Robson Classification in pregnant women attended at a tertiary hospital in two different periods.

Methods Cross-sectional, retrospective study of birth records, comprising 4,010 women, conducted from January 2014 to December 2015 in the only public regional referral hospital for the care of high- risk pregnancies, located in Southern Brazil.

Results The overall cesarean section rate reached 57.5% and the main indication was the existence of a previous uterine cesarean scar. Based on the Robson Classification, groups 5 (26.3%) and 10 (17.4%) were the most frequent ones. In 2015, there was a significant increase in the frequency of groups 1 and 3 (p < 0.001), when compared with the previous year, resulting in an increase in the number of vaginal deliveries (p < 0.0001) and a reduction in cesarean section rates.

Conclusion The Robson Classification proved to be a useful tool to identify the profile of parturients and the groups with the highest risk of cesarean sections in different periods in the same service. Thus, it allows monitoring in a dynamic way the indications and delivery routes and developing actions to reduce cesarean rates according to the characteristics of the pregnant women attended.

Resumo

Objetivo Analisar e comparar a frequência de partos cesáreos e vaginais através da classificação de Robson em gestantes atendidas em um hospital terciário em dois períodos distintos.

Métodos Estudo transversal retrospectivo de registros de nascimento, compreendendo 4.010 mulheres, realizado de janeiro de 2014 a dezembro de 2015 no único hospital público de referência regional para atendimento de gestações de alto risco, localizado no sul do Brasil. A via de parto foi avaliada e as mulheres foram classificadas de acordo com a Classificação de Robson.

Resultados A taxa geral de cesariana foi de 57,5% e a principal indicação foi a existência de cicatriz uterina por cesariana prévia. Quando aplicada a Classificação de Robson, os grupos mais frequentes foram o 5 (26,3%) e o 10 (17,4%). No ano de 2015, ocorreu um aumento significativo da frequência dos grupos 1 e 3 (p < 0,001), quando comparado ao ano anterior, resultando em aumento do número de partos vaginais (p < 0,0001) e redução das taxas de cesariana.

Conclusão A Classificação de Robson mostra ser uma ferramenta útil para identificar o perfil das parturientes e os grupos com maior risco de cesariana em diferentes períodos em um mesmo serviço. Desta forma, permite monitorar de forma dinâmica as indicações e vias de parto e desenvolver ações para redução das taxas de cesariana conforme as características das gestantes atendidas.

Keywords

pregnancy - high-risk pregnancy - parturition - cesarean section - robson classification

Palavras-chave

gestação - gravidez de risco - trabalho de parto - cesárea - classificação de robson

Contributors

All authors participated in the concept and design of the present study; analysis and interpretation of data; drafting or revising of the manuscript, and they have approved the manuscript as submitted. All authors are responsible for the reported research.




Publication History

Received: 08 January 2020

Accepted: 13 August 2020

Article published online:
19 January 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Patah LEM, Malik AM. Modelos de assistência ao parto e taxa de cesárea em diferentes países. Rev Saude Publica 2011; 45 (01) 85-94
    CrossrefPubMedSearch in Google Scholar
  • 2 Silver RM. Implications of the first cesarean: perinatal and future reproductive health and subsequent cesareans, placentation issues, uterine rupture risk, morbidity, and mortality. Semin Perinatol 2012; 36 (05) 315-323
    CrossrefPubMedSearch in Google Scholar
  • 3 Kozhimannil KB, Arcaya MC, Subramanian SV. Maternal clinical diagnoses and hospital variation in the risk of cesarean delivery: analyses of a National US Hospital Discharge Database. PLoS Med 2014; 11 (10) e1001745
    CrossrefPubMedSearch in Google Scholar
  • 4 Organização Mundial da Saúde. Declaração da OMS sobre taxas de cesáreas [Internet]. Genebra: Organização Mundial da Saúde; 2015 [cited 2019 Mar 01]. Available from: https://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_por.pdf
    PubMedSearch in Google Scholar
  • 5 Nakamura-Pereira M, do Carmo Leal M, Esteves-Pereira AP. et al. Use of Robson classification to assess cesarean section rate in Brazil: the role of source of payment for childbirth. Reprod Health 2016; 13 (Suppl. 03) 128
    CrossrefPubMedSearch in Google Scholar
  • 6 Dias MAB, Domingues RMSM, Pereira APE, Fonseca SC, da Gama SGN, Theme Filha MM. et al. Trajetória das mulheres na definição pelo parto cesáreo: estudo de caso em duas unidades do sistema de saúde suplementar do estado do Rio de Janeiro. Cien Saude Colet 2008; 13 (05) 1521-1534
    CrossrefPubMedSearch in Google Scholar
  • 7 Ministério da Saúde, DATASUS. Indicadores e dados básicos [Internet]. 2016 [cited 2019 Mar 01]. Available from: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?idb2012/f08.def
    PubMedSearch in Google Scholar
  • 8 Valadares C. Pela primeira vez número de cesarianas não cresce no país. Agência Saúde [Internet]. 2017 Mar 10 [cited 2019 Mar 01]. Available from: http://portalms.saude.gov.br/noticias/%20agencia-saude/27782
    PubMed
  • 9 Robson MS. Classification of cesarean sections. Fetal Matern Med Rev 2001; 12 (01) 23-39
    CrossrefPubMedSearch in Google Scholar
  • 10 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
    CrossrefPubMedSearch in Google Scholar
  • 11 Ferreira EC, Pacagnella RC, Costa ML, Cecatti JG. The Robson ten-group classification system for appraising deliveries at a tertiary referral hospital in Brazil. Int J Gynaecol Obstet 2015; 129 (03) 236-239
    CrossrefPubMedSearch in Google Scholar
  • 12 Torloni MR, Betrán AP, Souza JP, Widmer M, Allen T, Gulmezoglu M, Merialdi M. Classifications for cesarean section: a systematic review. PLoS One 2011; 6 (01) e14566
    CrossrefPubMedSearch in Google Scholar
  • 13 Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J. 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
    CrossrefPubMedSearch in Google Scholar
  • 14 Zahumensky J, Psenkova P, Nemethova B, Halasova D, Kascak P, Korbel M. Evaluation of cesarean delivery rates at three university hospital labor units using the Robson classification system. Int J Gynaecol Obstet 2019; 146 (01) 118-125
    CrossrefPubMedSearch in Google Scholar
  • 15 Senanayake H, Piccoli M, Valente EP, Businelli V, Mohamed R, Fernando R. et al. Implementation of the WHO manual for Robson classification: an example from Sri Lanka using a local database for developing quality improvement recommendations. BMJ Open 2019; 9 (02) e027317
    CrossrefPubMedSearch in Google Scholar
  • 16 Betrán AP, Gulmezoglu AM, Robson M, Merialdi M, Souza JP, Wojdyla D. et al. WHO global survey on maternal and perinatal health in Latin America: classifying caesarean sections. Reprod Health 2009; 6: 18
    CrossrefPubMedSearch in Google Scholar
  • 17 Tapia V, Betrán AP, Gonzales GF. Caesarean section in Peru: analysis of trends using the Robson classification system. PLoS One 2016; 11 (02) e0148138
    CrossrefPubMedSearch in Google Scholar
  • 18 Yadav RG, Maitra N. Examining cesarean delivery rates using the Robson's ten-group classification. J Obstet Gynaecol India 2016; 66 (Suppl. 01) 1-6
    CrossrefPubMedSearch in Google Scholar
  • 19 Vargas S, Rego S, Clode N. Robson classification system applied to induction of labor. Rev Bras Ginecol Obstet 2018; 40 (09) 513-517
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Vrouenraets FP, Roumen FJ, Dehing CJ, van den Akker ES, Aarts MJ, Scheve EJ. Bishop score and risk of cesarean delivery after induction of labor in nulliparous women. Obstet Gynecol 2005; 105 (04) 690-697
    CrossrefPubMedSearch in Google Scholar
  • 21 Thangarajah F, Scheufen P, Kirn V, Mallmann P. Induction of labour in late and postterm pregnancies and its impact on maternal and neonatal outcome. Geburtshilfe Frauenheilkd 2016; 76 (07) 793-798
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Bettiol H, Barbieri MA, da Silva AA. [Epidemiology of preterm birth: current trends]. Rev Bras Ginecol Obstet 2010; 32 (02) 57-60
    CrossrefPubMedSearch in Google Scholar
  • 23 Gabbay-Benziv R, Hadar E, Ashwal E, Chen R, Wiznitzer A, Hiersch L. Induction of labor: does indication matter?. Arch Gynecol Obstet 2016; 294 (06) 1195-1201
    CrossrefPubMedSearch in Google Scholar
  • 24 Gerli S, Favilli A, Franchini D, De Giorgi M, Casucci P, Parazzini F. Is the Robson's classification system burdened by obstetric pathologies, maternal characteristics and assistential levels in comparing hospitals cesarean rates? A regional analysis of class 1 and 3. J Matern Fetal Neonatal Med 2018; 31 (02) 173-177
    CrossrefPubMedSearch in Google Scholar
  • 25 Brunherotti MAA, Prado MF, Martinez EZ. Spatial distribution of Robson 10-group classification system and poverty in southern and southeastern Brazil. Int J Gynaecol Obstet 2019; 146 (01) 88-94
    CrossrefPubMedSearch in Google Scholar
  • 26 Bolognani CV, Reis LBSM, Dias A, Calderon IMP. Robson 10-groups classification system to access C-section in two public hospitals of the Federal District/Brazil. PLoS One 2018; 13 (02) e0192997
    CrossrefPubMedSearch in Google Scholar