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

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.

SUBMITTER: Bolognani CV

PROVIDER: S-EPMC5819776 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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

Bolognani Cláudia Vicari CV Reis Lílian Barros de Sousa Moreira LBSM Dias Adriano A Calderon Iracema de Mattos Paranhos IMP

PloS one 20180220 2

<h4>Background</h4>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.<h4>Objective</h4>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.<h4>Method</h4>A cross-sectional study of 6579 births assisted at the Hospital A (HA) and the Hospital B (HB) during 2013. The ...[more]

PMID: 29462215

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Project description:BackgroundRising caesarean section (CS) rates have been observed worldwide in recent decades. This study sought to analyse trends in CS rates and outcomes among a variety of obstetric groups at a university hospital in a low-income country.MethodsWe conducted a hospital-based panel study at Muhimbili National Hospital, Dar es Salaam, Tanzania. All deliveries between 2000 and 2011 with gestational age ≥ 28 weeks were included in the study. The 12 years were divided into four periods: 2000 to 2002, 2003 to 2005, 2006 to 2008, and 2009 to 2011. Main outcome measures included CS rate, relative size of obstetric groups, contribution to overall CS rate, perinatal mortality ratio, neonatal distress, and maternal mortality ratio. Time trends were analysed within the ten Robson groups, based on maternal and obstetric characteristics. We applied the χ2 test for trend to determine whether changes were statistically significant. Odds ratios of CS were evaluated using multivariate logistic regression, accounting for maternal age, referral status, and private healthcare insurance.ResultsWe included 137,094 deliveries. The total CS rate rose from 19% to 49%, involving nine out of ten groups. Multipara without previous CS with single, cephalic pregnancies in spontaneous labour had a CS rate of 33% in 2009 to 2011. Adjusted analysis explained some of the increase. Perinatal mortality and neonatal distress decreased in multiple pregnancies (p < 0.001 and p = 0.003) and nullipara with breech pregnancies (p < 0.001 and p = 0.024). Although not statistically significant, there was an increase in perinatal mortality (p = 0.381) and neonatal distress (p = 0.171) among multipara with single cephalic pregnancies in spontaneous labour. The maternal mortality ratio increased from 463/100, 000 live births in 2000 to 2002 to 650/100, 000 live births in 2009 to 2011 (p = 0.031).ConclusionThe high CS rate among low-risk groups suggests that many CSs might have been performed on questionable indications. Such a trend may result in even higher CS rates in the future. While CS can improve perinatal outcomes, it does not necessarily do so if performed routinely in low-risk groups.

Project description:BackgroundThe concept of severe maternal morbidity (SMM)-a potentially life-threatening condition during pregnancy, childbirth or after termination of pregnancy-can be used as a quality indicator of the health care provided to mothers and children. The aim of this study was to investigate the SMM rate and the main factors associated with this condition among women living in the Federal District, Brazil.MethodsWe conducted a cross-sectional population-based sample survey using a structured questionnaire about the sociodemographic characteristics of the participants' families. The data investigated included receipt of financial aid from the Federal Government, age, race, maternal educational level, prenatal care, mode of delivery, and serious complications during pregnancy and postpartum (SMM). 1042 mothers of children up to 1 year old were interviewed, representing a weighted estimated population of 36,724 mothers. The sample was representative of the whole Federal District state.ResultsMothers were between 19 and 34 years old (69%), most of them were brown or black (59.7%), and they had more than 9 years of education (81.2%). Prenatal care was adequate for 91.9% of them, the most common mode of delivery was Cesarean section (61.3%), and most deliveries took place in public hospitals (57.3%). The prevalence of low birth weight (< 2,500 g) was 8.1%. We found 2072 events of SMM in 2060 mothers (SMM rate: 5.6%). There was an association between higher occurrence of SMM and older age (OR: 1.40; 1.26-1.56), lower maternal educational level (OR: 3.29; 2.78-3.90), and inadequate prenatal care (OR: 1.28; 1.09-1.51). Receipt of financial aid was also associated to increased risk for SMM (OR: 1.31; 1.16-1.48). Cesarean section and low birth weight reduced the risk of SMM (decrease of 49.0% and 46.0%, respectively).ConclusionsThe SMM rate in the Federal District was positively associated with higher maternal age, lower maternal educational level, inadequate prenatal care, and government financial aid program. Conversely, SMM was inversely associated with Cesarean delivery and low birth weight. This study showed that specific demographic groups are at higher risk for SMM. Therefore, actions should be focused primarily on those groups for greater effectiveness at reducing maternal mortality and providing better quality of maternal health care.

Dataset Information

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

Publications

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

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