Mendes Yluska Myrna Meneses Brandão E, Rattner Daphne
University of Brasilia Brasilia Brazil University of Brasilia. Brasilia, Brazil.
Rev Panam Salud Publica. 2021 Feb 26;45:e16. doi: 10.26633/RPSP.2021.16. eCollection 2021.
To determine the distribution of cesarean sections performed in teaching hospitals participating in the Project for Improvement and Innovation in the Care and Teaching of Obstetrics and Neonatology (Apice ON) using the Robson Classification.
Cross-sectional descriptive study on cesarean sections performed at Apice ON hospitals according to the Robson Classification, using secondary data from the 2017 Live Births Information System on the year prior to project implementation, hence a baseline study. Hospitals are described according to their geographic distribution and cesarean section rates, using absolute and relative frequencies.
The proportions of newborns by Robson groups were similar to those proposed by the World Health Organization, except for Group 5 (with previous cesarean section) and Group 10 (preterm), with regional differences. The teaching hospitals' average cesarean section rates ranged from 24.8% to 75.1%, exceeding by far the recommended values, even in Robson groups considered low risk for cesarean section (Groups 1 to 4).
Brazilian teaching hospitals displayed cesarean section rates higher than those recommended by the World Health Organization for all groups; a worrisome fact, as by teaching they induce attitudes in future professional practices. These results highlight the importance of a reliable information system. Monitoring and evaluation of cesarean sections using the Robson Classification can be an important tool to guide management and propose actions to reduce rates. Countries with high cesarean section rates might explore this hypothesis in their teaching hospitals in order to define policies for the reduction of their rates.
使用罗布森分类法确定参与产科和新生儿护理与教学改进及创新项目（Apice ON）的教学医院中剖宫产的分布情况。
根据罗布森分类法，对Apice ON医院进行的剖宫产进行横断面描述性研究，使用项目实施前一年2017年活产信息系统的二手数据，因此是一项基线研究。根据医院的地理分布和剖宫产率，使用绝对频率和相对频率对医院进行描述。
除第5组（有剖宫产史）和第10组（早产）外，按罗布森分组的新生儿比例与世界卫生组织提出的比例相似，存在地区差异。教学医院的平均剖宫产率在24.8%至75.1%之间，远远超过推荐值，即使在被认为剖宫产低风险的罗布森组（第1至4组）也是如此。
巴西教学医院所有组的剖宫产率均高于世界卫生组织推荐的水平；这是一个令人担忧的事实，因为通过教学，它们会在未来的专业实践中引发一些态度。这些结果凸显了可靠信息系统的重要性。使用罗布森分类法对剖宫产进行监测和评估可以成为指导管理并提出降低剖宫产率行动的重要工具。剖宫产率高的国家可能在其教学医院探索这一假设，以便制定降低剖宫产率的政策。
