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Racene L, Rostoka Z, Kise L, Kacerauskiene J, Rezeberga D. In-Depth Analysis of Caesarean Section Rate in the Largest Secondary Care-Level Maternity Hospital in Latvia. J Clin Med 2023; 12:6426. [PMID: 37835069 PMCID: PMC10573868 DOI: 10.3390/jcm12196426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
There is no surgical intervention without risk. A high rate of caesarean sections (CSs) impacts on maternal and newborn mortality and morbidity. For optimisation of the CS rate, regular monitoring is necessary. In 2015, the World Health Organization recommended the Robson classification as a global standard for assessing, monitoring, and comparing CS rates. We analysed all births in 2019 in the Riga Maternity Hospital-a secondary-level monodisciplinary perinatal care hospital in Latvia-according to the Robson classification, seeking to identify which groups make the biggest contribution to the overall CS rate. In total, 5835 women were included. The overall CS rate was 21.5%. In our study, the largest contributors to the overall CS rate were as follows: Group 5 (33.3%); Group 2 (20.8%); and Group 1 (15.6%). The results of our deeper analysis of individual groups (Group 1 and 5) from our study may help to develop targeted interventions for specific subgroups of the obstetric population, effectively reducing both the overall rate of CS and the number of unnecessary CSs performed. The CS rate reduction strategy should be based on decreasing CSs in Group 1 and encouraging VBAC, thus decreasing the number of women undergoing two or more CSs in future.
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Affiliation(s)
- Laura Racene
- Department of Obstetrics and Gynaecology, Rīga Stradiņš University, LV-1007 Riga, Latvia; (Z.R.); (L.K.); (D.R.)
- Riga Maternity Hospital, LV-1013 Riga, Latvia
| | - Zane Rostoka
- Department of Obstetrics and Gynaecology, Rīga Stradiņš University, LV-1007 Riga, Latvia; (Z.R.); (L.K.); (D.R.)
- Riga Maternity Hospital, LV-1013 Riga, Latvia
| | - Liva Kise
- Department of Obstetrics and Gynaecology, Rīga Stradiņš University, LV-1007 Riga, Latvia; (Z.R.); (L.K.); (D.R.)
- Riga Maternity Hospital, LV-1013 Riga, Latvia
| | - Justina Kacerauskiene
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, 50167 Kaunas, Lithuania;
| | - Dace Rezeberga
- Department of Obstetrics and Gynaecology, Rīga Stradiņš University, LV-1007 Riga, Latvia; (Z.R.); (L.K.); (D.R.)
- Riga Maternity Hospital, LV-1013 Riga, Latvia
- Riga East Clinical University Hospital, LV-1038 Riga, Latvia
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Sosa C, de Mucio B, Colomar M, Mainero L, Costa ML, Guida JP, Souza RT, Luz AG, Cecatti JG, Sousa MH, Cruz CM, Chevez LM, Lopez R, Carrillo G, Rizo U, Saint Hillaire EE, Arriaga WE, Guadalupe RM, Ochoa C, Gonzalez F, Castro R, Stefan A, Moreno A, Serruya SJ. The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson's Ten Group Classification System. BMC Pregnancy Childbirth 2023; 23:605. [PMID: 37620835 PMCID: PMC10464484 DOI: 10.1186/s12884-023-05937-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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%). CONCLUSION 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.
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Affiliation(s)
- Claudio Sosa
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), Montevideo, Uruguay
| | - Bremen de Mucio
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), Montevideo, Uruguay
| | - Mercedes Colomar
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), Montevideo, Uruguay
| | - Luis Mainero
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), Montevideo, Uruguay
| | - Maria L Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Jose P Guida
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Adriana G Luz
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - José G Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil.
| | - Maria H Sousa
- Jundiaí School of Medicine - HU/FMJ, Jundiaí, SP, Brazil
| | | | - Luz M Chevez
- Hospital Berta Calderon Roque, Managua, Nicaragua
| | - Rita Lopez
- Hospital Berta Calderon Roque, Managua, Nicaragua
| | | | | | | | | | | | | | | | | | - Allan Stefan
- Hospital Leonardo Martinez Valenzuela, San Pedro Sula, Honduras
| | | | - Suzanne J Serruya
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), Montevideo, Uruguay
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Savchenko J, Ladfors L, Hjertberg L, Hildebrand E, Brismar Wendel S. Towards safer childbirth: a journey of a thousand miles. Acta Obstet Gynecol Scand 2022; 101:837-838. [PMID: 35570393 DOI: 10.1111/aogs.14381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Julia Savchenko
- Department of Obstetrics and Gynecology, Stockholm South General Hospital (Södersjukhuset), Stockholm, Sweden.,Department of Clinical Science and Education, Stockholm South General Hospital (Södersjukhuset), Karolinska Institutet, Stockholm, Sweden
| | - Lars Ladfors
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linda Hjertberg
- Department of Obstetrics and Gynecology, Vrinnevi Hospital, Norrköping, Sweden.,Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Eric Hildebrand
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sophia Brismar Wendel
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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Guida JPDS, Costa ML. Including outcomes other than cesarean section: An innovative perspective on Robson Classification. Acta Obstet Gynecol Scand 2022; 101:836. [PMID: 35470420 DOI: 10.1111/aogs.14370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
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