Classifications for Cesarean Section: A Systematic Review
ABSTRACT Rising cesarean section (CS) rates are a major public health concern and cause worldwide debates. To propose and implement effective measures to reduce or increase CS rates where necessary requires an appropriate classification. Despite several existing CS classifications, there has not yet been a systematic review of these. This study aimed to 1) identify the main CS classifications used worldwide, 2) analyze advantages and deficiencies of each system.
Three electronic databases were searched for classifications published 1968-2008. Two reviewers independently assessed classifications using a form created based on items rated as important by international experts. Seven domains (ease, clarity, mutually exclusive categories, totally inclusive classification, prospective identification of categories, reproducibility, implementability) were assessed and graded. Classifications were tested in 12 hypothetical clinical case-scenarios. From a total of 2948 citations, 60 were selected for full-text evaluation and 27 classifications identified. Indications classifications present important limitations and their overall score ranged from 2-9 (maximum grade =14). Degree of urgency classifications also had several drawbacks (overall scores 6-9). Woman-based classifications performed best (scores 5-14). Other types of classifications require data not routinely collected and may not be relevant in all settings (scores 3-8).
This review and critical appraisal of CS classifications is a methodologically sound contribution to establish the basis for the appropriate monitoring and rational use of CS. Results suggest that women-based classifications in general, and Robson's classification, in particular, would be in the best position to fulfill current international and local needs and that efforts to develop an internationally applicable CS classification would be most appropriately placed in building upon this classification. The use of a single CS classification will facilitate auditing, analyzing and comparing CS rates across different settings and help to create and implement effective strategies specifically targeted to optimize CS rates where necessary.
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ABSTRACT: To evaluate the distribution of women with severe maternal morbidity according to Robson Ten Group Classification System (RTGCS). Secondary analysis of a multicenter cross-sectional study in 27 obstetric units in Brazil, using RTGCS. Cases were classified into potentially life-threatening condition or a maternal near miss or death, according to severity. Certain groups were subdivided for further analysis. Cesarean delivery (CD) rates were reported. Among 7,247 women with severe maternal morbidity, 73.2 percent underwent CD. Group 10 (single, cephalic, preterm) was the most prevalent (33.9%). Groups mostly associated with a severe maternal outcome were: 7 (multiparous, breech), 9 (all abnormal lies, single, term), 8 (all multiple), and 10. Groups 1 (nulliparous, single, cephalic, term, spontaneous) and 3 (multiparous, single, cephalic, term, spontaneous) were associated with better maternal outcome. Group 3 had one severe maternal morbidity to 29 cases of potentially life-threatening, but the ratio was 1:10 for women undergoing CD, indicating a worse outcome. Group 4a (multiparous, no previous CD, single, cephalic, term, induced labor) had a better maternal outcome than those delivered by CD before labor (group 4b). Hypertension was the most common condition of severity. The RTGCS was useful to consider severe maternal morbidity, showing groups with higher CD rates and worse maternal outcomes. © 2015 Wiley Periodicals, Inc.Birth 03/2015; 42(1):38-47. DOI:10.1111/birt.12155 · 2.05 Impact Factor
01/2014; 4(16):3022-3030. DOI:10.9734/BJMMR/2014/8514
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ABSTRACT: Introduction: Considering the side-effects of Cesarean Section, attempts have been made to reduce the rate in different societies. The present study aimed to explore the issue. Particularly, the study focused on what it is that makes Cesarean as the first childbirth option. Material &Method: This is a descriptive study. The participants of the study were 226 pregnant women referring to a Tehran-located clinic, Iran, during Jan to March 2012that were selected based on purposeful method. Qualitative content analysis was used to analyze the data. A questionnaire consisting of open-ended and demographic-related items was employed to collect data. SPSS (Ver. 16) was used for statistical analysis. Results: A total of 226 pregnant women studied that 101 (44.7%) and 125 (55.3%) selected vaginal delivery and Cesarean Section, respectively. The women selecting Cesarean Section mentioned fear of vaginal delivery and its side-effect (55.3%), vaginal delivery inability (16.78%), and past Cesarean Section experience as the reasons behind their preference. Conclusion: Given that requests for Cesarean Section have been associated with fear of a vaginal delivery and its side-effects, it is recommended that Cesarean seekers be provided with technical counseling in hospitals and clinics.