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

Soares, Karina Biaggio; Klein, Vanessa Cristina Grolli; Lima, José Antônio Reis Ferreira de; Gadenz, Lucas; Paulo, Larissa Emile; Konopka, Cristine Kolling

doi:10.1055/s-0040-1718446

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Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 43 (02) • Feb 2021 • https://doi.org/10.1055/s-0040-1718446 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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 allowsmonitoring 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.

Keywords:
pregnancy; high-risk pregnancy; parturition; cesarean section; robson classification

	Total (n = 4,010)	Nulliparous (n = 1,568)	Multiparous (n = 2,442)
Maternal age	26.2 (±7.1)	21.9 (±5.78)	28.9 (±6.48)
Previous pregnancies	2.4 (±1.60)	1.1 (±0.40)	3.3 (±1.52)
Number of childbirths	1.2 (±1.44)	0 (0)	2.0 (±1.35)
Number of previous cesarean sections	0.6 (±0.98)	0 (0)	0.9 (±1.12)
Miscarriages	0.2 (±0.51)	0.1 (±0.39)	0.3 (±0.57)
Gestational age	37.8 (±4.51)	37.7 (±3.96)	37.8 (±4.83)
Hospitalization due to spontaneous labor	1,991 (49.7%)	760 (48.5%)	1,231 (50.5%)
Induced labor	1,031 (25.7%)	627 (40.0%)	404 (16.5%)
Cesarean section without labor	988 (24.6%)	181 (11.5%)	807 (33.0%)
Delivery type
Vaginal delivery	1,693 (42.2%)	782 (49.9%)	911 (37.31%)
Instrumented delivery	9 (0.2%)	6 (0.4%)	3 (0.1%)
Cesarean section	2,308 (57.6%)	780 (49.7%)	1,528 (62.6%)

Births Group	Features	2,308/4,010	Rate per group	Cesarean section rate per group	Contribution from each group
1	Nulliparous, single fetus, cephalic presentation, > 37 weeks, spontaneous labor	125/517	12.9%	24.2%	3.1%
2	Nulliparous, single fetus, cephalic presentation, > 37 weeks, induced labor or cesarean section before labor	422/642	16.0%	65.7%	10.5%
3	Multiparous, no previous cesarean section, single fetus, cephalic presentation,> 37 weeks, spontaneous labor	59/491	12.2%	12.0%	1.5%
4	Multiparous, no previous cesarean section, single fetus, cephalic presentation,> 37 weeks, induced labor or cesarean section before labor	181/364	9.1%	49.7%	4.5%
5	Multiparous with at least 1 previous cesarean section, single fetus, cephalic presentation, > 37 weeks	930/1,057	26.4%	80.0%	23.2%
6	Nulliparous, single fetus in pelvic presentation	80/81	2.0%	98.8%	2.0%
7	Multiparous, single fetus in pelvic presentation, likelihood of previous cesarean section	76/78	1.9%	97.4%	1.9%
8	Any woman with twin pregnancy; likelihood of previous cesarean section	64/68	1.7%	94.1%	1.6%
9	Any woman with oblique or transverse fetal presentation; likelihood of previous cesarean section	12/12	0.3%	100.0%	0.3%
10	Any woman with a single fetus in cephalic presentation, < 37 weeks, likelihood of previous cesarean section	359/700	17.5%	51.23%	8.9%

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[1] Address for correspondence Cristine Kolling Konopka, MD, PhD, Av. Roraima, 1000, Cidade Universitária, Camobi, Santa Maria, RS, 97105-900, Brazil (e-mail: cristine.ufsm@gmail.com).