Use of the Robson model to characterize the need for cesarean sections in a level III healthcare institution in Medellin, Colombia. Cross-sectional study
DOI:
https://doi.org/10.18597/rcog.115Keywords:
Cesarean section, classification system, delivery, pregnancyAbstract
Objective: Excess use of cesarean section (C section) increases the risk of maternal and perinatal morbidity and mortality. In order to reduce the rate of C section and establish a threshold, there is a need to adequately characterize the conditions of the population receiving care. To assess the performance of the Robson model as a tool to identify priority groups and estimate a rational threshold for C sections.
Materials and methods: Descriptive cross-sectional study conducted in a general high-complexity institution providing care to patients with insurance health system subsidied by the state. The Robson model for C section classification was used to estimate the relative size, the specific proportion and the contribution of each group to the overall proportion of C sections. The local characterization results are compared with the results of other institutions that have applied the classification, in order to estimate a rational threshold for cesarean sections. The study was approved by the Institutional Research Committee.
Results: Of 1319 deliveries, 43.1% were by C section. Using the model, it was possible to determine that excess numbers of C sections in our institution occur in nulliparous and multiparous women with no prior history of C section, term pregnancies and fetuses in cephalic position (Robson groups 1 to 4). C section proportions in those groups were 35.6%, 55.4%, 15.0% and 49.5%, respectively, higher than those reported by other level III hospitals. The rational rate of cesarean sections in the institution was estimated at 27.6%
Conclusions: The Robson model is easy to use and is a useful tool when it comes to identify the women, the procedures and the practices requiring priority interventions in order to arrive at a rational proportion of C sections, suited to the conditions of the institution and of the women receiving institutional care.
Author Biographies
John Jairo Zuleta-Tobón
Fredy Quintero-Rincón
Ana María Quiceno-Ceballos
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