Analysis of Caesarean Sections According to Robson’s Classification System in Rio De Janeiro

Abstract

Objectives: Since 2016, FIGO has stated, reaffirming the 2015 WHO recommendation, that the Robson's Ten Group Classification System (TGCS) should be instituted in all healthcare facilities in the maternity and delivery field. The TGCS is a robust method, with great analytical power, low cost and simple implementation. It can also provide an overview of an institution's obstetric profile, making it possible to analyze the quality of the service, which results in assisting improvements. The main objective of the study was to use the TGCS to outline for the first time the cesarean profile of the Petrópolis Teaching Hospital (PTH). Method: This is a retrospective, quantitative, cross-sectional study, that has analytical character. It is based on the analysis of medical records from 40% of total deliveries (1180 women) in 2016, at PTH (Rio De Janeiro state, Brazil), the only local high risk maternity hospital. The analyzed groups were: 2 (nulliparous, single cephalic, ≥37 weeks, induced or CS before labor), 5 (previous CS, single cephalic, ≥37 weeks) and 10 (all single cephalic, ≤36 weeks, including previous CS). This data was compared with Ireland and general Brazil studies and presented in Windows Excel spreadsheets. Results: The groups with the biggest relative sizes were: 2 (20.48%), 5 (20.22%), 10 (16.11%), which represents the profile of obstetric assistance in PTH: nulliparous, multiparous with previous CS and premature births. This pattern is also found in Brazil and Ireland. These groups were also the ones with the highest relative contribution rates on the overall CS rate: 2 (23.58%), 5 (32.42%), 10 (20.63%). In Ireland the relative contribution of the same groups on the total CS rate is, respectively: 23.83%, 28.97%, 6.54%, whereas in Brazil they are, 28.6%, 31.1%, 9.8%. 13 records were unable to classify. Conclusions: Learning the obstetric profile is a useful instrument to improve PTH's assistance. The high contribution to the overall CS rate in group 2 results in multiparous with previous CS, which often leads to a new CS, making group 5 the highest CS rate contributor. In order to end this domino effect, new policies to reduce these rates should be created, such as a more complete adhesion of induction protocols. PTH is indeed a high risk maternity hospital, resulting in the discrepancy of group 10 contribution to CS rate, when compared to Ireland and Brazil. Even so, premature CS indications should be more carefully considered.