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Zuleta-Tobón JJ. Demonstration of the application of the global cesarean section rate model (C-Model) and the Robson Classification to estimate and characterize excess numbers of institutional c-sections. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2021; 72:396-406. [PMID: 35134286 PMCID: PMC8833240 DOI: 10.18597/rcog.3649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Abstract
Objective 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. Methodology 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. Results 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. Conclusion 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.
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Affiliation(s)
- John Jairo Zuleta-Tobón
- Centro Nacer, Salud Sexual y Reproductiva, adscrito al Departamento de Ginecología y Obstetricia de la Facultad de Medicina, Universidad de Antioquia, Medellín (Colombia)..
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Ioscovich A, Guasch E, Brogly N, Shatalin D, Manrique-Muñoz S, Sánchez Royo ME, Zimro S, Ginosar Y, Lages N, Weinstein J, Berkenstadt H, Greenberger C, Lazutkin A, Izakson A, Ioscovich D, Orbach-Zinger S, Weiniger CF. Peripartum anesthetic management of women with SARS-CoV-2 infection in eight medical centers across three European countries: prospective cohort observation study. J Matern Fetal Neonatal Med 2021; 35:7756-7763. [PMID: 34107853 DOI: 10.1080/14767058.2021.1937105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Several reports of obstetric anesthesia management have been published since the onset of the COVID-19 pandemic. We aimed to collect high-quality broad and detailed data from different university medical centers in several European Society of Anesthesiologist countries. METHODS This prospective observational survey was performed in eight medical centers in Spain, Israel and Portugal from 1st April to 31st July 2020. Institutional review board approval was received at each participating center. Inclusion criteria: all women with a positive test for COVID-19. Retrieved data included maternal, delivery, anesthetic, postpartum details, and neonatal outcomes. Descriptive data are presented, and outcomes were compared for women with versus without respiratory signs and symptoms. RESULTS Women with respiratory symptoms (20/12.1%) had significantly higher mean (standard deviation) temperature (37.2 °C (0.8) versus 36.8 °C (0.6)), were older (34.1 (6.7) years versus 30.5 (6.6)) and had higher body mass index kg m-2 - (29.5 (7.5) versus 28.2 (5.1)). Women with respiratory symptoms delivered at a significantly earlier gestational age (50% < 37 weeks) with a 65% cesarean delivery rate (versus 22.1% in the group without respiratory symptoms) and 5-fold increased rate of emergency cesarean delivery, 30% performed under general anesthesia. A higher rate of intrauterine fetal death (3%) was observed than expected from the literature (0.2-0.3%) in developed countries. There was no evidence of viral vertical transmission. CONCLUSION Well-functioning neuraxial analgesia should be available to manage laboring women with respiratory symptoms, as there is a higher frequency of emergency cesarean delivery. We report a higher rate of undiagnosed parturient and intrauterine fetal death.
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Affiliation(s)
- Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Emilia Guasch
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
| | - Nicolas Brogly
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
| | - Daniel Shatalin
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | | | | | - Sabastine Zimro
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Yehuda Ginosar
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Neusa Lages
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Jacob Weinstein
- The Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Haim Berkenstadt
- The Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | | | | | | | | | - Sharon Orbach-Zinger
- Beilinson Hospital, Petah Tikvah, Affiliated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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