WHO Global Survey on Maternal and Perinatal Health in Latin America: classifying caesarean sections

Betrán, Gulmezoglu, Robson Michael, Merialdi Mario, Souza, Wojdyla Daniel, Widmer Mariana, Carroli Guillermo, Torloni, Langer Ana, Narváez Alberto, Velasco Alejandro, Faúndes Anibal, Acosta Arnaldo, Valladares Eliette, Romero Mariana, Zavaleta Nelly, Reynoso Sofia, Bataglia Vicente

Description

Caesarean section rates continue to increase worldwide with uncertain medical consequences. Auditing and analysing caesarean section rates and other perinatal outcomes in a reliable and continuous manner is critical for understanding reasons caesarean section changes over time. Methods We analyzed data on 97,095 women delivering in 120 facilities in 8 countries, collected as part of the 2004-2005 Global Survey on Maternal and Perinatal Health in Latin America. The objective of this analysis was to test if the "10-group" or "Robson" classification could help identify which groups of women are contributing most to the high caesarean section rates in Latin America, and if it could provide information useful for health care providers in monitoring and planning effective actions to reduce these rates. Results The overall rate of caesarean section was 35.4%. Women with single cephalic pregnancy at term without previous caesarean section who entered into labour spontaneously (groups 1 and 3) represented 60% of the total obstetric population. Although women with a term singleton cephalic pregnancy with a previous caesarean section (group 5) represented only 11.4% of the obstetric population, this group was the largest contributor to the overall caesarean section rate (26.7% of all the caesarean sections). The second and third largest contributors to the overall caesarean section rate were nulliparous women with single cephalic pregnancy at term either in spontaneous labour (group 1) or induced or delivered by caesarean section before labour (group 2), which were responsible for 18.3% and 15.3% of all caesarean deliveries, respectively. Conclusion The 10-group classification could be easily applied to a multicountry dataset without problems of inconsistencies or misclassification. Specific groups of women were clearly identified as the main contributors to the overall caesarean section rate. This classification could help health care providers to plan practical and effective actions targeting specific groups of women to improve maternal and perinatal care.

Informations

• Publié par: biomed
• Publié le: 01 janvier 2009
• Nombre de lectures: 12
• Langue: English

Extrait

Reproductive Health

BioMedCentral

Open Access Research WHO Global Survey on Maternal and Perinatal Health in Latin America: classifying caesarean sections 1 1 2 1 Ana P Betrán* , A Metin Gulmezoglu , Michael Robson , Mario Merialdi , 1 3 1 3 João P Souza , Daniel Wojdyla , Mariana Widmer , Guillermo Carroli , 4 5 6 7 Maria R Torloni , Ana Langer , Alberto Narváez , Alejandro Velasco , 8 9 10 11 Anibal Faúndes , Arnaldo Acosta , Eliette Valladares , Mariana Romero , 12 13 14 Nelly Zavaleta , Sofia Reynoso and Vicente Bataglia

1 2 Address: Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland, National Maternity Hospital, 3 4 Dublin, Ireland, Centro Rosarino de Estudios Perinatales, Rosario, Argentina, Department of Obstetric and Gynecology, Federal University of 5 6 7 Sao Paulo, Sao Paulo, Brazil, EngenderHealth, New York, USA, Fundación Salud, Ambiente y Desarrollo, Quito, Ecuador, Hospital Docente 8 Ginecobstétrico "America Arias", La Habana, Cuba, Centro de Pesquisas em Saúde Reprodutiva de Campinas (CEMICAMP), Campinas, Brazil, 9 10 Department of Obstetrics and Gynecology, Universidad Nacional de Asunción, Asunción, Paraguay, Universidad Nacional Autónoma de 11 12 Nicaragua, León, Nicaragua, Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina, Instituto de Investigación Nutricional, Lima, 13 14 Peru, The Population Council, Latin America Office, Mexico City, Mexico and Department of Obstetrics and Gynecology, Hospital Nacional de Itaguá, Asunción, Paraguay

Email: Ana P Betrán*  [e-mail]; A Metin Gulmezoglu  [e-mail]; Michael Robson  [e-mail]; Mario Merialdi  [e-mail]; João P Souza  [e-mail]; Daniel Wojdyla  [e-mail]; Mariana Widmer  [e-mail]; Guillermo Carroli  [e-mail]; Maria R Torloni  [e-mail]; Ana Langer  [e-mail]; Alberto Narváez  [e-mail]; Alejandro Velasco  [e-mail]; Anibal Faúndes  [e-mail]; Arnaldo Acosta  [e-mail]; Eliette Valladares  [e-mail]; Mariana Romero  [e-mail]; Nelly Zavaleta  [e-mail]; Sofia Reynoso  [e-mail]; Vicente Bataglia  [e-mail] * Corresponding author

Published: 29 October 2009 Received: 28 August 2009 Accepted: 29 October 2009 Reproductive Health2009,6:18 doi:10.1186/17424755618 This article is available from: http://www.reproductivehealthjournal.com/content/6/1/18 © 2009 Betrán et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Background:Caesarean section rates continue to increase worldwide with uncertain medical consequences. Auditing and analysing caesarean section rates and other perinatal outcomes in a reliable and continuous manner is critical for understanding reasons caesarean section changes over time.

Methods:We analyzed data on 97,095 women delivering in 120 facilities in 8 countries, collected as part of the 20042005 Global Survey on Maternal and Perinatal Health in Latin America. The objective of this analysis was to test if the "10group" or "Robson" classification could help identify which groups of women are contributing most to the high caesarean section rates in Latin America, and if it could provide information useful for health care providers in monitoring and planning effective actions to reduce these rates.

Results:The overall rate of caesarean section was 35.4%. Women with single cephalic pregnancy at term without previous caesarean section who entered into labour spontaneously (groups 1 and 3) represented 60% of the total obstetric population. Although women with a term singleton cephalic pregnancy with a previous caesarean section (group 5) represented only 11.4% of the

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