Research Article: Robson 10-groups classification system to access C-section in two public hospitals of the Federal District/Brazil

Date Published: February 20, 2018

Publisher: Public Library of Science

Author(s): Cláudia Vicari Bolognani, Lílian Barros de Sousa Moreira Reis, Adriano Dias, Iracema de Mattos Paranhos Calderon, Yu Ru Kou.

http://doi.org/10.1371/journal.pone.0192997

Abstract

The global increase in C-section rates is real. In Brazil, these indices correspond to 58.94% in the Midwest region and 52.77% in the Federal District.

To evaluate the C-section rates and identify the groups with the greatest risk at two reference hospitals in the public network of Federal District/Brazil, using 10-Group Robson System.

A cross-sectional study of 6579 births assisted at the Hospital A (HA) and the Hospital B (HB) during 2013. The C-section rates in each group and its respective contribution to the total hospital C-sections was compared between HA and HB. To this, was used the proportion difference test (similar to chi-square test), with RR and 95% CI, and the logistic regression analysis (OR; 95% CI) among the groups with higher C-section/total C-section. The significance limit of p < 0.05 was defined for all tests. The C-section rates were 50.8% at the HA and 42.3% at the HB, with 1.20 RR (95%CI = 1.13–1.28) at the HA. The highest rates were observed in Robson groups G5, G1, and G2. At the HA, G1 had a 21.5% C-section rate, which was greater than at the HB (13.8%; p < 0.05); the cesarean rates for groups G2 and G5 were higher at the HB (respectively, 18.6 and 38.1%) than at the HA (14.8 and 32.5%, respectively; p < 0.05). These results point out specific goals to be achieved in order to reduce abusive cesarean rates in both A and B hospitals, especially in the primigravida and in those with previous C-section.

Partial Text

The global increase in cesarean rates is real. High cesarean rates are becoming a public health problem and a reason for debate about the potential maternal and perinatal risks and the risks related to the costs of and inequalities in access to obstetric care [1,2]. Based on the rates of nations with low maternal and perinatal mortality, the WHO recommended in 1985 that the rate of cesarean births should not exceed 15% [3]. Since then, this rate has become a global goal.

During the period studied, 6579 births occurred; 3398 (51.6%) were vaginal births, and 3181 (48.4%) were C-sections. The Table 1 show the baseline characteristics of mothers at the hospital HA and hospital HB. The HA was responsible for 4659 (70.8%) of these births, of which 2290 (49.2%) were vaginal and 2369 (50.8%) were C-sections. At the HB, there were 1920 (29.2%) births, of which 1108 (57.7%) were vaginal and 812 (42.3%) were C-sections. The difference in cesarean rates between these two hospitals was statistically significant (p < 0.0001), with a greater frequency and risk at the HA (RR = 1.2; CI95% = 1.13–1.28) (Table 2). The results of this study showed high rates of C-sections at the both hospital HA (50.8%) and the hospital HB (42.3%) in the study period. The occurrence of C-section in the 10 Robson groups [7] was also high; group G3 was the only exception. These rates, whether the totals at the hospital level or broken down according to Robson group, are far higher than the 15% recommended by the WHO [3] and the average of 38.5% cesarean rates registered in the SES-DF/Brazil for this same period [17]. In this study, the C-section rates were 50.8% at the HA and 42.3% at the HB, with 1.20 RR (95%CI = 1.13–1.28) at the HA. The groups G5, G1 and G2 were the major contributes to these elevated rates. These results point out goals to be achieved in order to reduce abusive cesarean rates in both A and B hospitals, especially in the primigravida and in those with previous C-section. Among them, avoid the first C-section and wait for the natural spontaneous labor; break the paradigm "once cesarean always cesarean" and include the VBAC in the care protocol. Moreover, institute the partogram and the C-section second opinion should support these goals.   Source: http://doi.org/10.1371/journal.pone.0192997

 

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