Department of Obstetrics, Sao Paulo Federal University and Brazilian Cochrane Centre, Sao Paulo, Brazil.
PLoS One. 2011 Jan 20;6(1):e14566. doi: 10.1371/journal.pone.0014566.
Rising cesarean section (CS) rates are a major public health concern and cause worldwide debates. To propose and implement effective measures to reduce or increase CS rates where necessary requires an appropriate classification. Despite several existing CS classifications, there has not yet been a systematic review of these. This study aimed to 1) identify the main CS classifications used worldwide, 2) analyze advantages and deficiencies of each system.
Three electronic databases were searched for classifications published 1968-2008. Two reviewers independently assessed classifications using a form created based on items rated as important by international experts. Seven domains (ease, clarity, mutually exclusive categories, totally inclusive classification, prospective identification of categories, reproducibility, implementability) were assessed and graded. Classifications were tested in 12 hypothetical clinical case-scenarios. From a total of 2948 citations, 60 were selected for full-text evaluation and 27 classifications identified. Indications classifications present important limitations and their overall score ranged from 2-9 (maximum grade =14). Degree of urgency classifications also had several drawbacks (overall scores 6-9). Woman-based classifications performed best (scores 5-14). Other types of classifications require data not routinely collected and may not be relevant in all settings (scores 3-8).
This review and critical appraisal of CS classifications is a methodologically sound contribution to establish the basis for the appropriate monitoring and rational use of CS. Results suggest that women-based classifications in general, and Robson's classification, in particular, would be in the best position to fulfill current international and local needs and that efforts to develop an internationally applicable CS classification would be most appropriately placed in building upon this classification. The use of a single CS classification will facilitate auditing, analyzing and comparing CS rates across different settings and help to create and implement effective strategies specifically targeted to optimize CS rates where necessary.
剖宫产率的上升是一个主要的公共卫生问题，并在全球范围内引发了争论。为了提出和实施必要的有效措施来降低或增加剖宫产率，需要进行适当的分类。尽管已经有几种现有的剖宫产分类，但尚未对这些分类进行系统评价。本研究旨在：1）确定全球范围内使用的主要剖宫产分类；2）分析每个系统的优点和缺点。
检索了 1968 年至 2008 年发表的分类文献，使用根据国际专家认为重要的项目制定的表格，由两名审查员独立评估分类。评估了 7 个领域（容易、清晰、互斥类别、完全包容分类、前瞻性类别识别、可重复性、可实施性）并进行了评分。在 12 个假设的临床病例情景中测试了分类。从总共 2948 条引文中，选择了 60 篇全文进行评估，并确定了 27 种分类。指征分类存在重要局限性，总体评分范围为 2-9 分（最高等级=14 分）。紧急程度分类也存在一些缺点（总体评分 6-9 分）。基于妇女的分类表现最好（评分 5-14 分）。其他类型的分类需要收集常规数据，并且可能在所有情况下都不相关（评分 3-8 分）。
对剖宫产分类的审查和评估是建立适当监测和合理使用剖宫产的基础的一项合理方法。结果表明，一般来说，基于妇女的分类，特别是 Robson 分类，最能满足当前国际和地方的需求，而努力制定一种国际适用的剖宫产分类，最适合在这一分类的基础上进行。使用单一的剖宫产分类将有助于在不同环境中审核、分析和比较剖宫产率，并有助于制定和实施专门针对优化必要的剖宫产率的有效策略。
