Download PDF
CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(09): 830-837
DOI: 10.1055/s-0042-1753547
Original Article
Obstetrics

Robson's Ten Group Classification System to Evaluate Cesarean Section Rates in Honduras: The Relevance of Labor Induction

Sistema de classificação de dez grupos de Robson para avaliar taxas de parto cesárea: A importância da indução do trabalho de parto
Lester David Castro Paz 
1   Department of Obstetrics, University of Campinas, Campinas, SP, Brazil
,
Rigoberto Castro Banegas 
2   Department of Obstetrics and Gynecology, Hospital Dr. Roberto Suazo Cordova, La Paz, Honduras
,
Adriana Gomes Luz 
1   Department of Obstetrics, University of Campinas, Campinas, SP, Brazil
,
Maria Laura Costa 
1   Department of Obstetrics, University of Campinas, Campinas, SP, Brazil
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective To use the Robson Ten Group Classification (RTGC) to analyze cesarean section (CS) rates in a Honduran maternity hospital, with focus in groups that consider induction of labor.

Methods Cross-sectional study. Women admitted for childbirth (August 2017 to October 2018) were classified according to the RTGC. The CS rate for each group and the contribution to the overall CS rate was calculated, with further analyses of the induction of labor among term primiparous (group 2a), term multiparous (group 4a), and cases with one previous CS (group 5.1).

Results A total of 4,356 women were considered, with an overall CS rate of 26.1%. Group 3 was the largest group, with 38.6% (1,682/4,356) of the cases, followed by Group 1, with 30.8% (1,342/4,356), and Group 5, with 10.3% (450/4,356). Considering the contribution to overall CS rates per group, Group 5 contributed with 30.4% (345/1,136) of the CSs and within this group, 286/345 (82.9%) had 1 previous CS, with a CS rate > 70%. Groups 1 and 3, with 26.6% (291/1,136) and 13.5% (153/1,136), respectively, were the second and third larger contributors to the CS rate. Groups 2a and 4a had high induction success, with low CS rates (18.4 and 16.9%, respectively).

Conclusion The RTGC is a useful tool to assess CS rates in different healthcare facilities. Groups 5, 1, and 3 were the main contributors to the CS rate, and groups 2 and 4 showed the impact and importance of induction of labor. These findings may support future interventions to reduce unnecessary CS, especially among primiparous and in women with previous CS.

Resumo

Objetivo Utilizar a Classificação de Dez Grupos de Robson (RTGC, na sigla em inglês) para analisar as taxas de cesárea (CS, na sigla em inglês) em uma maternidade hondurenha.

Métodos Estudo de corte transversal em uma maternidade em Honduras. As mulheres internadas para o parto (agosto de 2017 a outubro de 2018) foram classificadas segundo a RTGC. Calculou-se a taxa de CS para cada grupo e a contribuição para a taxa geral de CS, com análises adicionais da indução do trabalho de parto entre as primíparas a termo (grupo 2a), multíparas a termo (grupo 4a) e casos com uma CS anterior (grupo 5.1).

Resultados foram consideradas 4.356 mulheres, com uma taxa geral de CS de 26.1%. O Grupo 3 foi o maior grupo, com 38,.6% (1.682/4.356) dos casos; seguido pelo Grupo 1, com 30,8% (1.342/4.356), e pelo Grupo 5, com 10,3% (450/4,356). Considerando a contribuição para as taxas globais de CS por grupo, o Grupo 5 contribuiu com 30,4% (345/1,136) das CS, dos quais 286 (82.9%) tinha uma CS anterior, com um índice de CS > 70%. Os grupos 1 e 3, com 291/1.136 (26.6%) e 153/1.136 (13,5%), respectivamente, foram o segundo e terceiro maiores contribuintes para a taxa de CS. Os grupos 2a e 4a tiveram alto sucesso de indução, com baixas taxas de CS (18.4 e 16.9%, respectivamente).

Conclusão O RTGC é uma ferramenta útil para avaliar as taxas de CS em diferentes unidades de saúde. Os grupos 5, 1 e 3 foram os principais contribuintes para a taxa de CS. Estes achados podem apoiar intervenções futuras para reduzir as CS desnecessárias, especialmente entre primíparas e em mulheres com uma CS anterior.

Keywords

cesarean section - labor - induced - childbirth

Palavras-chave

cesárea - trabalho de parto - indução - parto

Contributions

Costa M. L., Paz L. D. C, and Banegas R. C. had the original idea for the present study; Paz L. D. C. and Banegas R. C. performed data collection and data analysis, under supervision of Costa M. L. and Luz A. G. Paz L. D. C. wrote the first draft, which was approved by all authors.




Publication History

Received: 05 December 2021

Accepted: 19 May 2022

Article published online:
10 October 2022

© 2022. 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/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 World Health Organization. WHO Statement on Caesarean Section Rates. Geneva: World Health Organization; 2015
    Search in Google Scholar
  • 2 Souza JP, Betran AP, Dumont A, de Mucio B, Gibbs Pickens CM, Deneux-Tharaux C. et al. A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study. BJOG 2016; 123 (03) 427-436
    CrossrefPubMedSearch in Google Scholar
  • 3 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: Final Data for 2017. Natl Vital Stat Rep 2018; 67 (08) 1-50
    PubMedSearch in Google Scholar
  • 4 Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. PLoS One 2016; 11 (02) e0148343
    CrossrefPubMedSearch in Google Scholar
  • 5 Robson M. Classification of caesarean section. Fetal Matern Med Rev 2001; 12 (01) 23-39
    CrossrefPubMedSearch in Google Scholar
  • 6 Consejo Monetario Centroamericano. Secretaria Ejecutiva. GDP of Honduras [Internet]. 2018 [cited 2020 Dec 9]. Available from: http://www.secmca.org/pib-de-honduras/
  • 7 United Nations Development Programme. Human Development Report 2019: beyond income, beyond averages, beyond today: inequalities in human development in the 21st century [Internet]. 2019 [cited 2020 Dec 20]. Available from: https://hdr.undp.org/sites/default/files/hdr2019.pdf
  • 8 Panamericana de la Salud O. Centro Latinoamericano de Perinatologia, Salud de la Mujer y Reproductiva. Sistema de Información Perinatal [Internet]. 2020 [cited 2020 Nov 14]. Available from: https://www3.paho.org/clap/index.php?option=com_content&view=article&id=84:sistema-informatico-perinatal&Itemid=242&lang=es
  • 9 Yamamoto M, Latorre R, Rojas J, Walker B, Jordán F, Carrillo J. et al. Cesarean rates in a Chilean public hospital and the use of a new prioritization criteria: The relevance index. J Obstet Gynaecol Res 2019; 45 (03) 578-584
    CrossrefPubMedSearch in Google Scholar
  • 10 Kacerauskiene J, Bartuseviciene E, Railaite DR, Minkauskiene M, Bartusevicius A, Kliucinskas M. et al. Implementation of the Robson classification in clinical practice:Lithuania's experience. BMC Pregnancy Childbirth 2017; 17 (01) 432
    CrossrefPubMedSearch in Google Scholar
  • 11 Abdulrahman M, Abdullah SS, Alaani AFK, AlAbdool NH, Sherif FEY, Ahmed Z SE. et al. Exploring obstetrical interventions and stratified cesarean section rates using the Robson classification in tertiary care hospitals in the United Arab Emirates. Rev Bras Ginecol Obstet 2019; 41 (03) 147-154
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Nakamura-Pereira M, do Carmo Leal M, Esteves-Pereira AP, Domingues RMS, Torres JA, Dias MAB. 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
  • 13 Pyykönen A, Gissler M, Løkkegaard E, Bergholt T, Rasmussen SC, Smárason A. et al. Cesarean section trends in the Nordic Countries - a comparative analysis with the Robson classification. Acta Obstet Gynecol Scand 2017; 96 (05) 607-616
    CrossrefPubMedSearch in Google Scholar
  • 14 Fatusic J, Hudic I, Fatusic Z, Zildzic-Moralic A, Zivkovic M. Cesarean Section Rate Analysis in University Hospital Tuzla - According to Robson's Classification. Med Arch 2016; 70 (03) 213-216
    CrossrefPubMedSearch in Google Scholar
  • 15 Haddad SM, Cecatti JG. Estratégias dirigidas aos profissionais para a redução das cesáreas desnecessárias no Brasil. Rev Bras Ginecol Obstet 2011; 33 (05) 252-262
    CrossrefPubMedSearch in Google Scholar
  • 16 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
    CrossrefPubMedSearch in Google Scholar
  • 17 ACOG Practice Bulletin No. 205: vaginal birth after cesarean delivery. Obstet Gynecol 2019; 133 (02) e110-e127
    CrossrefPubMedSearch in Google Scholar
  • 18 Hehir MP, Mackie A, Robson MS. Simplified and standardized intrapartum management can yield high rates of successful VBAC in spontaneous labor. J Matern Fetal Neonatal Med 2017; 30 (12) 1504-1508
    CrossrefPubMedSearch in Google Scholar
  • 19 Rozen G, Ugoni AM, Sheehan PM. A new perspective on VBAC: a retrospective cohort study. Women Birth 2011; 24 (01) 3-9
    CrossrefPubMedSearch in Google Scholar
  • 20 Blomberg M. Avoiding the first cesarean section–results of structured organizational and cultural changes. Acta Obstet Gynecol Scand 2016; 95 (05) 580-586
    CrossrefPubMedSearch in Google Scholar
  • 21 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
    CrossrefPubMedSearch in Google Scholar
  • 22 Hure A, Powers J, Chojenta C, Loxton D. Rates and predictors of caesarean section for first and second births: a prospective cohort of Australian women. Matern Child Health J 2017; 21 (05) 1175-1184
    CrossrefPubMedSearch in Google Scholar
  • 23 Chen I, Opiyo N, Tavender E, Mortazhejri S, Petkovic J, Yogasingam S. et al. Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev 2018; 9 (09) CD005528
    CrossrefPubMedSearch in Google Scholar
  • 24 Hartmann KE, Andrews JC, Jerome RN. Strategies to reduce cesarean birth in low-risk women. Rockville: Agency for Healthcare Research and Quality; 2012
    Search in Google Scholar
  • 25 Celik F, Cosar E, Akbas P, Kumru S, Kose M, Yilmazer M. et al. Cesarean section: requested mode of delivery?. Clin Exp Obstet Gynecol 2017; 44 (01) 85-87
    CrossrefPubMedSearch in Google Scholar
  • 26 Deshmukh VL, Rajamanya AV, Yelikar KA. Oral misoprostol solution for induction of labour. J Obstet Gynaecol India 2017; 67 (02) 98-103
    CrossrefPubMedSearch in Google Scholar
  • 27 Secretaria de Salud de Honduras. Normas Nacionales para la Atención Materno-Neonatal. Tegucigalpa: Secretaría de Salud; 2010
    Search in Google Scholar
  • 28 Gobillot S, Ghenassia A, Coston AL, Gillois P, Equy V, Michy T. et al. Obstetric outcomes associated with induction of labour after caesarean section. J Gynecol Obstet Hum Reprod 2018; 47 (10) 539-543
    CrossrefPubMedSearch in Google Scholar
  • 29 Sarreau M, Leufflen L, Monceau E, Tariel D, Villemonteix P, Morel O, Pierre F. et al. [Balloon catheter for cervical ripening on scarred uterus with unfavorable cervix: multicenter retrospective study of 151 patients]. J Gynecol Obstet Biol Reprod (Paris) 2014; 43 (01) 46-55
    CrossrefPubMedSearch in Google Scholar
  • 30 Rossard L, Arlicot C, Blasco H, Potin J, Mercier D, Perrotin F. et al. [Cervical ripening with balloon catheter for scared uterus: a three-year retrospective study]. J Gynecol Obstet Biol Reprod (Paris) 2013; 42 (05) 480-487
    CrossrefPubMedSearch in Google Scholar
  • 31 Sananès N, Rodriguez M, Stora C, Pinton A, Fritz G, Gaudineau A. et al. Efficacy and safety of labour induction in patients with a single previous caesarean section: a proposal for a clinical protocol. Arch Gynecol Obstet 2014; 290 (04) 669-676
    CrossrefPubMedSearch in Google Scholar
  • 32 Jozwiak M, van de Lest HA, Burger NB, Dijksterhuis MG, De Leeuw JW. Cervical ripening with Foley catheter for induction of labor after cesarean section: a cohort study. Acta Obstet Gynecol Scand 2014; 93 (03) 296-301
    CrossrefPubMedSearch in Google Scholar
  • 33 Lo JO, Mission JF, Caughey AB. Hypertensive disease of pregnancy and maternal mortality. Curr Opin Obstet Gynecol 2013; 25 (02) 124-132
    CrossrefPubMedSearch in Google Scholar
  • 34 Wagner SJ, Barac S, Garovic VD. Hypertensive pregnancy disorders: current concepts. J Clin Hypertens (Greenwich) 2007; 9 (07) 560-566
    CrossrefPubMedSearch in Google Scholar
  • 35 Sanchez MP, Guida JP, Simões M. et al. Can pre-eclampsia explain higher cesarean rates in the different groups of Robson's classification?. Int J Gynaecol Obstet 2021; 152 (03) 339-344
    CrossrefPubMedSearch in Google Scholar
  • 36 World Health Organization. Deparment of Making Pregnancy Safer. History of the Perinatal Information System [Internet]. 2010 [cited 2020 Dec 19]. Available from: https://www.paho.org/clap/dmdocuments/CLAP1576.pdf