Analysis of cesarean section rates and indications using ten group classification

Abstract

Introduction and aim: We performed a retrospective observational study to identify the obstetric parameters of all women submitted to cesarean section in January/February and June/July of 2011 in our institution and the indications to perform it.

Material and Methods: We reviewed the clinical records of these women and categorized them in ten obstetric groups (Robson´s classification) based on the following parameters: single/multiple pregnancy, nulliparity/multiparity/multiparity with a previous cesarean section, cephalic/non-cephalic presentation, spontaneous/induced labour/cesarean section without labour and preterm/term delivery. In each group we analyzed the reason(s) why the cesarean section was performed except for multiple gestations.

Results: There were 1167 single deliveries, 391 by cesarean section and a cesarean section rate of 33,5% (36% elective). Cesarean section was more common in term nulíparas with induced labor and in women with a previous cesarean section. During labor, the most common reasons named by the physician were labor arrest, suspected cephalopelvic disproportion and nonreassuring fetal status. Fetal mal presentation represents 4,4% of cesarean section rate. This contribution is superior to the one of the preterm group (3%). Among term multiparas without a previous scar there were less cesarean sections.

Conclusions: The analysis of these results suggests that avoiding a fi rst elective cesarean section and allowing a spontaneous labor onset are essential for long term decrease in cesarean section rates. Efforts should be made to convert subjective indications into objective ones, trough well defi ned evidence-based guidelines regarding intrapartum fetal monitoring and labor arrest.