Centro Nacer, Salud Sexual y Reproductiva, adscrito al Departamento de Ginecología y Obstetricia de la Facultad de Medicina, Universidad de Antioquia, Medellín (Colombia)..
Rev Colomb Obstet Ginecol. 2021 Dec 30;72(4):396-406. doi: 10.18597/rcog.3649.
To carry out an academic exercise based on real local data regarding the application of the C-Model v1.0 to determine how data are gathered and used to generate the model, how the model is applied in order to identify potential excess numbers of cesarean sections in an institution, and when identified, how the model is applied to distribute deliveries according to the Robson Classification system and explain excess numbers.
The standardized ratio and absolute difference between the observed proportion and the expected probability of c-sections according to the C-Model v1.0 were estimated for each institution using real databases of five hospitals in Colombia. Convenience selection was used to meet the objectives. Based on the assumptions underpinning group distributions according to the Robson classification, proposed explanations for excess numbers and differences among institutions are presented.
Applying the C-Model, the c-section standardized ratio identified different excess numbers of the procedure in the presence of similar institutional c-section proportions. Important variability was found in the proportion of c-sections among women with similar clinical and obstetric characteristics, which might explain the excess numbers identified.
The C-Model allows to estimate expected c-section proportions according to the specific characteristics of the women seen at each institution; their distribution according to the Robson Classification is a way to explore the origin and particulars of those differences.
基于真实的本地数据，开展一项关于 C-Model v1.0 应用的学术研究，以了解如何收集和使用数据来生成模型，如何应用模型以识别机构中潜在的剖宫产过多，以及在识别出模型后，如何根据 Robson 分类系统应用模型来分配分娩，并解释过多的原因。
使用哥伦比亚五家医院的真实数据库，对每个机构的 C-Model v1.0 进行标准化比值和实际比例与模型预期概率之间的绝对差异估计。采用方便抽样来满足目标。根据 Robson 分类分组分布的假设，提出了对过多数量和机构间差异的解释。
应用 C-Model，在机构剖宫产比例相似的情况下，识别出手术的标准化剖宫产率存在不同的过多数量。具有相似临床和产科特征的女性中剖宫产比例存在重要差异，这可能解释了识别出的过多数量。
C-Model 允许根据每个机构所见女性的具体特征来估计预期的剖宫产比例；根据 Robson 分类进行分布是探索这些差异的起源和特点的一种方法。
