Sosa Claudio, de Mucio Bremen, Colomar Mercedes, Mainero Luis, Costa Maria L, Guida Jose P, Souza Renato T, Luz Adriana G, Cecatti José G, Sousa Maria H, Cruz Carmen M, Chevez Luz M, Lopez Rita, Carrillo Gema, Rizo Ulises, Saint Hillaire Erika E, Arriaga William E, Guadalupe Rosa M, Ochoa Carlos, Gonzalez Freddy, Castro Rigoberto, Stefan Allan, Moreno Amanda, Serruya Suzanne J
Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), Montevideo, Uruguay.
Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil.
BMC Pregnancy Childbirth. 2023 Aug 24;23(1):605. doi: 10.1186/s12884-023-05937-3.
Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS.
Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity.
Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%).
Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR.
拉丁美洲的剖宫产率（CSR）是全球最高的。罗布森十组分类系统（RTGCS）的开发是为了便于理解不同女性群体的剖宫产率，这些女性群体根据产科特征被分为十组中的一组。每个剖宫产组的规模可能会提供有关特定地区或环境中医疗质量的有用数据。这些数据有可能用于比较诸如孕产妇发病率等情况对剖宫产率的影响。本研究的目的是了解严重孕产妇发病率（SMM）对RTGCS十个不同组中剖宫产率的影响。
对2018年至2021年的分娩信息进行二次分析，数据来自拉丁美洲和加勒比地区5个国家（玻利维亚、危地马拉、洪都拉斯、尼加拉瓜和多米尼加共和国）的8家医疗机构，使用在拉丁美洲不同地区实施的监测数据库（西班牙语的围产期信息系统SIP）。女性被分为RTGCS中的一组。描述了每组的频率及其各自的剖宫产率。此外，根据孕产妇结局将样本分为两组：无严重孕产妇发病率的女性和经历严重孕产妇发病率的女性，将潜在危及生命的情况、孕产妇接近死亡和孕产妇死亡视为发病的连续体。
使用罗布森分类法从92,688例分娩中获得了可用数据。总体剖宫产率约为38%。第5组占剖宫产总数的近三分之一。6.7%的病例发生了严重孕产妇发病率。在这些病例中，该组的总体剖宫产率几乎为70%。第10组起主要作用（早产）。第5组（既往剖宫产史）在组内的剖宫产率非常高，无论是否发生孕产妇发病率（超过80%）。
在拉丁美洲，经历严重孕产妇发病率的女性的剖宫产率高于未经历严重孕产妇发病率的女性。严重孕产妇发病率与较高的剖宫产率相关，尤其是在第1组和第3组。然而，第5组是总体剖宫产率的主要贡献者。
