Perin Paulo Otavio Maluf, Berbel Cassia, Costa Maria Laura, Guida José Paulo de Siqueira
Departament of Obstetrics and Gynecology, Universidade Estadual de Campinas - UNICAMP, Campinas, Brazil.
J Obstet Gynaecol. 2025 Dec;45(1):2522867. doi: 10.1080/01443615.2025.2522867. Epub 2025 Jun 25.
The rising caesarean section rates are a global concern, highlighted by the World Health Organisation due to the adverse impacts associated with the overuse of this intervention. This study assessed the use of Robson Classification (RC) in a Brazilian university hospital from 2016 to 2020.
A retrospective observational study was conducted from 2016 to 2020, including 9723 deliveries in a tertiary maternity hospital located in southeastern Brazil. Demographic, obstetric, and delivery data were considered to ascertain the RC. Caesarean section rates were calculated for each group and their absolute and relative contributions to the overall rate. Additionally, indications for induction and caesarean section were described.
The overall caesarean section rate was 38.9%, with a predominance of Group 5 (women with a previous caesarean section), which accounted for 37.1% of all caesarean sections. Group 1 (nulliparous women with spontaneous labour) had a caesarean section rate of 17%, while Group 10 (preterm pregnancies) showed a rate of 50.7%. The main indications for caesarean sections were foetal distress (24.5%), repeat caesarean section (16.8%), and dystocia (10.9%). Labour inductions occurred in 22% of cases, primarily due to post-term pregnancy (35.7%) and premature rupture of membranes (23.4%).
The RC was an effective tool for monitoring and comparing obstetric practices, identifying the groups with the highest contributions to caesarean section rates. Specific strategies, such as protocols to encourage vaginal birth after caesarean (VBAC) and improvements in induction management, could help reduce unnecessary interventions. This study underscores the importance of implementing evidence-based guidelines to improve obstetric and neonatal outcomes.
剖宫产率不断上升是一个全球关注的问题，世界卫生组织强调了过度使用这种干预措施所带来的不利影响。本研究评估了2016年至2020年巴西一家大学医院对罗布森分类法（RC）的使用情况。
进行了一项2016年至2020年的回顾性观察研究，纳入了巴西东南部一家三级妇产医院的9723例分娩病例。考虑人口统计学、产科和分娩数据以确定RC分类。计算了每组的剖宫产率及其对总剖宫产率的绝对和相对贡献。此外，还描述了引产和剖宫产的指征。
总体剖宫产率为38.9%，其中第5组（有剖宫产史的女性）占主导，占所有剖宫产的37.1%。第1组（初产妇自然分娩）的剖宫产率为17%，而第10组（早产妊娠）的剖宫产率为50.7%。剖宫产的主要指征是胎儿窘迫（24.5%）、再次剖宫产（16.8%）和难产（10.9%）。22%的病例进行了引产，主要原因是过期妊娠（占35.7%）和胎膜早破（占23.4%）。
RC分类法是监测和比较产科实践、确定对剖宫产率贡献最大的组别的有效工具。特定策略，如鼓励剖宫产术后阴道分娩（VBAC）的方案和引产管理的改进，有助于减少不必要的干预。本研究强调了实施循证指南以改善产科和新生儿结局的重要性。
