Rudey Edson Luciano, Leal Maria do Carmo, Rego Guilhermina
Faculty of Medicine of Porto University, Porto, Portugal.
Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.
Medicine (Baltimore). 2020 Apr;99(17):e19880. doi: 10.1097/MD.0000000000019880.
Cesarean section (CS) is a surgical procedure used to deliver babies that is medically indicated to prevent maternal and neonatal mortality. However, it is associated with short- and long-term risks. CS rates have increased, and efforts are being made to ensure that CS is performed only when necessary. The Robson classification system is considered useful for studying, evaluating, monitoring, and comparing CS rates within and between healthcare facilities. In Brazil, there are few studies on this subject, and no large epidemiological studies on this topic utilizing the Robson classification have been reported. This study aimed to report and analyze CS rates in Brazil using the Robson classification system, and subsequently suggest possible measures to address it.Data were collected from the Brazilian Live Birth Information System (Sistema de Informações sobre Nascidos Vivos) that contains data of the entire obstetric population, from 2014 to 2017. All births in the country during this period were analyzed according to the Robson classification.A total of 11,774,665 live births were reported in Brazil during 2014 to 2017, most of which were mostly via CS (55.8%). Regions with high human development indexes had significantly higher CS rates than those with low human development indexes. The Robson group (RG) 1 to 4 accounts for 60.2% of live births and 47.1% of all CSs. RG5 was larger than all the other groups and contributed to the highest global rate of CS (31.3%), in addition to being the group who presented the largest growth.Although RG 1 to 4 present favorable initial conditions for vaginal delivery, CS accounted for almost half of births in these groups. The size of RG1 and RG2 in Brazil was comparable to that in countries with low CS rates; however, CS rates in these groups were 3 times higher in Brazil. Nulliparous women in RG1 and RG2 who undergo CS are subsequently categorized into RG5, increasing the global CS rate by 1% annually.We suggest the implementation of health policies to avoid the unnecessary performance of CS in RG1 and RG2 to decrease the CS rates in Brazil.
剖宫产（CS）是一种用于分娩婴儿的外科手术，在医学上用于预防孕产妇和新生儿死亡。然而，它与短期和长期风险相关。剖宫产率有所上升，目前正在努力确保仅在必要时才进行剖宫产。罗布森分类系统被认为有助于研究、评估、监测和比较医疗机构内部及之间的剖宫产率。在巴西，关于这个主题的研究很少，且尚未有利用罗布森分类的大型流行病学研究报告。本研究旨在使用罗布森分类系统报告和分析巴西的剖宫产率，并随后提出可能的应对措施。
数据收集自巴西活产信息系统（Sistema de Informações sobre Nascidos Vivos），该系统包含2014年至2017年整个产科人群的数据。在此期间该国的所有分娩均根据罗布森分类进行分析。
2014年至2017年巴西共报告了11,774,665例活产，其中大部分是通过剖宫产（55.8%）。人类发展指数高的地区剖宫产率明显高于人类发展指数低的地区。罗布森组（RG）1至4占活产的60.2%和所有剖宫产的47.1%。RG5比所有其他组都大，导致全球剖宫产率最高（31.3%），此外它也是增长最大的组。
尽管RG 1至4具备阴道分娩的有利初始条件，但这些组中剖宫产占分娩的近一半。巴西RG1和RG2的规模与剖宫产率低的国家相当；然而，这些组在巴西的剖宫产率高出3倍。RG1和RG2中接受剖宫产的未产妇随后被归类为RG5，使全球剖宫产率每年增加1%。
我们建议实施卫生政策，避免在RG1和RG2中进行不必要的剖宫产，以降低巴西的剖宫产率。
