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      CESAREAN SECTION CLASSIFICATION ACCORDING TO THE ROBSON MODEL, OBSTETRICS UNIT, SAN FELIPE GENERAL HOSPITAL, HONDURAS, APRIL-JUNE, 2017 Translated title: CLASIFICACIÓN DE CESÁREAS SEGÚN EL MODELO DE ROBSON, UNIDAD OBSTÉTRICA, HOSPITAL GENERAL SAN FELIPE, HONDURAS, ABRIL-JUNIO DE 2017

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          Abstract

          ABSTRACT Objective: To classify cesarean sections according to the Robson Model in the obstetrics unit of an intermediate complexity hospital. Materials and methods: Descriptive cross-sectional study conducted in the obstetrics unit of the San Felipe General Hospital (HGSF), Tegucigalpa, Honduras, between April and June 2017. Out of 477 clinical records of patients undergoing elective and/ or emergency surgery during the study period, 89 were selected using probabilistic random selection. A descriptive analysis of sociodemographic variables, clinical/obstetric indications, and categories of the Robson model was conducted. Authorization from the institution was obtained. Results: The proportion of cesarean sections during the study period was 59.8% (477/797; 95% CI:56.3-63.3). Of the cases studied, 48/89 (53.9%) were classified as “no risk pregnancy” (categories 1-4); the most frequent indications in this group were low fetal reserve in 22/48 (22/48*100%) and cephalopelvic disproportion in 16/48 (16/48*100%). In the “risk group” (categories 5-10), in 41/89 (46.1%), indications were cephalopelvic disproportion and breech presentation, (8/41) (8/41*100%), respectively. The main contributors to cesarean section were groups 1 (17/89; 19.1%), 2 (20/89, 22.5%) and 5 (20/89; 22.5%), for a total of 64.1%. Conclusion: The Robson model is applicable in our setting and the classification provides information that can be used as a diagnostic and surveillance tool for cesarean sections in a level II institution.

          Translated abstract

          RESUMEN Objetivo: clasificar las cesáreas según el modelo de Robson en la unidad obstétrica de un hospital de nivel medio de complejidad. Materiales y métodos: estudio descriptivo, transversal, llevado a cabo en unidad obstétrica del HGSF, Tegucigalpa, Honduras, entre abril y junio de 2017. Se seleccionan 89 de 477 historias clínicas de pacientes sometidas a cesárea electiva o de emergencia en el periodo del estudio mediante selección aleatoria probabilística. Se realiza análisis descriptivo de variables sociodemográficas, indicaciones clínicas/obstétricas y categorías del modelo de Robson. Se obtuvo autorización institucional. Resultados: la proporción de cesáreas en el periodo fue 59,8 % (477/797; IC 95 %:56,3-63,3). Se clasificaron 48/89 (53,9%) cesáreas estudiadas como embarazo “sin riesgo” (categorías 1-4); la indicación más frecuente en este grupo fue baja reserva fetal 22/48 (22/48*100 %) y desproporción céfalo-pélvica 16/48 (16/48*100 %). En el grupo “de riesgo” (categorías 5-10) en 41/89 (46,1 %) las indicaciones fueron desproporción céfalo-pélvica y presentación pélvica (8/41) (8/41*100 %) respectivamente. Los principales aportantes de cesárea fueron los grupos 1 (17/89; 19,1 %), 2 (20/89, 22,5 %) y 5 (20/89; 22,5 %) para totalizar 64,1 %. Conclusión: el modelo de Robson es aplicable en nuestro medio y la clasificación aporta información como herramienta de diagnóstico y vigilancia en la realización de cesáreas en una institución de segundo nivel.

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          Quality assurance: The 10-Group Classification System (Robson classification), induction of labor, and cesarean delivery

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            WHO Global Survey on Maternal and Perinatal Health in Latin America: classifying caesarean sections

            Background Caesarean section rates continue to increase worldwide with uncertain medical consequences. Auditing and analysing caesarean section rates and other perinatal outcomes in a reliable and continuous manner is critical for understanding reasons caesarean section changes over time. Methods We analyzed data on 97,095 women delivering in 120 facilities in 8 countries, collected as part of the 2004-2005 Global Survey on Maternal and Perinatal Health in Latin America. The objective of this analysis was to test if the "10-group" or "Robson" classification could help identify which groups of women are contributing most to the high caesarean section rates in Latin America, and if it could provide information useful for health care providers in monitoring and planning effective actions to reduce these rates. Results The overall rate of caesarean section was 35.4%. Women with single cephalic pregnancy at term without previous caesarean section who entered into labour spontaneously (groups 1 and 3) represented 60% of the total obstetric population. Although women with a term singleton cephalic pregnancy with a previous caesarean section (group 5) represented only 11.4% of the obstetric population, this group was the largest contributor to the overall caesarean section rate (26.7% of all the caesarean sections). The second and third largest contributors to the overall caesarean section rate were nulliparous women with single cephalic pregnancy at term either in spontaneous labour (group 1) or induced or delivered by caesarean section before labour (group 2), which were responsible for 18.3% and 15.3% of all caesarean deliveries, respectively. Conclusion The 10-group classification could be easily applied to a multicountry dataset without problems of inconsistencies or misclassification. Specific groups of women were clearly identified as the main contributors to the overall caesarean section rate. This classification could help health care providers to plan practical and effective actions targeting specific groups of women to improve maternal and perinatal care.
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              Consideraciones sobre el índice de cesárea primitiva

              Introducción: el aumento del indicador de cesárea constituye un problema a escala mundial, con elevado incremento de la morbilidad y mortalidad maternas. Objetivo: mostrar la incidencia de la operación cesárea en nuestro país en el periodo comprendido de 1970 a 2011, así como hacer un breve análisis de sus principales indicaciones. Métodos: se realizó un estudio descriptivo, retrospectivo y longitudinal, durante el periodo de 1970-2011. Resultados: se evidenció un incremento sostenido de la cesárea en el país, en correspondencia con todas las provincias, de alrededor de 1 % anual en los últimos años. El aumento de la tasa de cesáreas se hizo más marcado entre los años 2002-2010 y 4 provincias muestran los indicadores más altos. En el último bienio (2010-2011), el indicador presentó los valores más elevados, de 30,6 y 30,4 %, respectivamente. Conclusiones: la evolución de la cesárea en Cuba mostró un aumento sostenido y constituye un motivo de preocupación que exige el análisis y la toma de decisiones que permitan su buen control, basado en el estudio científico en cada institución, de manera que se aseguren, además, indicadores adecuados tanto de morbilidad y mortalidad materna como perinatal.
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                Author and article information

                Contributors
                Role: ND
                Journal
                rcog
                Revista Colombiana de Obstetricia y Ginecología
                Rev Colomb Obstet Ginecol
                Federación Colombiana de Obstetricia y Ginecología; Revista Colombiana de Obstetricia y Ginecología (Bogotá, Cundinamarca, Colombia )
                0034-7434
                2463-0225
                March 2019
                : 70
                : 1
                : 19-26
                Affiliations
                Managua orgnameUniversidad Nacional Autónoma de Nicaragua orgdiv1Centro de Investigaciones y Estudios de la Salud Honduras aizb2013@ 123456gmail.com
                Article
                S0034-74342019000100019
                10.18597/rcog.3186

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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