Consensus for the Rationalization of Cesarean Section Use in Colombia. Federación Colombiana de Obstetricia y Ginecología (FECOLSOG) and Federación Colombiana de Perinatología (FECOPEN). Bogotá, 2014
DOI:
https://doi.org/10.18597/rcog.62Keywords:
Pregnancy, cesarean section, maternal mortality, maternal morbidity, risk, national strategiesAbstract
Objectives: Identifying the cesarean section rate, classification, maternal-perinatal risk factors associated with this procedure and to propose strategies to rationalize the use of c-sections in Colombia.
Materials and methods: We conducted a review of the vital statistics from the Departamento Administrativo Nacional de Estadísticas (DANE) from 1998 to 2013 to estimate the rate of caesarean section and an electronic database search in Medline via PubMed, The Cochrane Library, Embase, Lilacs, with the terms “cesarean section”, “rate”, “maternal mortality”, “neonatal mortality”, “maternal risk”, “perinatal risk”, “trial of labor”, “vaginal birth after cesarean section”, “education”, “audit”, “second opinion”, “strategy”, “multiple strategy” and “multifaceted intervention” to identify relevant systematic reviews, meta-analysis and clinical studies published in the last ten years in English or Spanish. The search results and conclusions were discussed in a non-formal consensus on May 9, 2014 in Bogotá D.C and socialized in the 29th National Congress of Obstetrics and Ginecology held on May 29th to 31st of 2014 in Medellín, Colombia.
Results: The rate of caesarean sections in Colombia step of 24.9% in 1998 to 45.7% in 2013. C-section increases the risk of death, severe maternal complications and neonatal respiratory morbidity compared with vaginal delivery. Medical, social-cultural and economic factors increase the use of cesarean section. Multifaceted strategies have shown the greatest effectiveness in reducing the rate.
Conclusions: Strategies such as education, audit, quality improvement and involvement of other stake holders should be promoted to generate a cultural change and rationalize the rate of cesarean section in Colombia.
References
Rubio-Romero JA, Angel-Muller E. Operación Cesárea. En: Parra MO, Angel-Muller E. editores. Obstetricia Integral Siglo XXI. Tomo II. Bogotá: Universidad Nacional de Colombia Disponible en: http://www.bdigital.unal.edu.co/2795/19/9789584476180.16.pdf
Sakala C. Medically Unnecessary Cesarean Section Births: Introduction to a Symposium. Soc Sci Med. 1993;37:1177-98.
Niino Y. The increasing cesarean rate globally and what we can do about it. Biosci Trends. 2011;5:139-50.
Dickens BM, Cook RJ. The legal effects of fetal monitoring guidelines. Int J Gynaecol Obstet. 2010; 108:170-3.
Cyr RM. Myth of the ideal cesarean section rate: Commentary and historic perspective. Am J Obstet Gynecol. 2006;194:932-6.
Pickering PD. Myth of the ideal cesarean section rate: Commentary and historic perspective. Am J Obstet Gynecol. 2007;196: e17.
Goldengerg RL, McClure EM, Bann CM. The relationship of intrapartum and antepartum stillbirth rates to measures of obstetric care in developed and developing countries. Acta Obstet Gynecol Scandinavica. 2007;86:1303-9.
Brown HC, Paranjothy S, Dowswell T, Thomas J. Package of care for active management in labour for reducing caesarean section rates in low-risk women. Cochrane Database Syst Rev. 2008;(4):CD004907. doi: 10.1002/14651858.CD004907.pub2.
República de Colombia. Departamento Administrativo Nacional de Estadística (DANE). Nacimientos por tipo de parto según departamento de ocurrencia (visitado 2014 mayo 9). Disponible en: www.dane.gov.co
Profamilia. Encuesta Nacional de Demografía y Salud ENDS 2010 [visitado 2014 mayo 9] Disponible en: http://www.profamilia.org.co/encuestas/Profamilia/Profamilia/
Clark SL, Belfort MA, Dildy GA, Herbst MA, Meyers JA, Hankins GD. Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J Obstet Gynecol. 2008;199:36.e1-5; discussion 91-2. e7-11. doi: 10.1016/j.ajog. 2008. 03.007.
Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS. Maternal Health Study Group of the Canadian Perinatal Surveillance System. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007;176:455-60.
Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al. World Health Organization 2005. Global Survey on Maternal and Perinatal Health Research Group. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ. 2007;335:1025. Epub 2007 Oct 30.
The American College of Obstetricians and Gynecologists (ACOG) - Obstetric Care Consensus. Safe Prevention of Primary Cesarean Delivery. 2014; 123: 693-711.
Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine UnitsNetwork. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107:1226-32.
Hannah ME, Whyte H, Hannah WJ, Hewson S, Amankwah K, Cheng M, et al. Term Breech Trial Collaborative Group. Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial. Am J Obstet Gynecol. 2004;191:917-27.
Gregory KD, Jackson S, Korst L, Fridman M. Cesarean versus vaginal delivery: whose risks? Whose benefits? Am J Perinatol. 2012;29:7-18. doi: 10.1055/s-0031-1285829. Epub 2011 Aug 10.
Torloni MR, Betran AP, Souza JP, Widmer M, Allen T, et al. Classifications for cesarean section: a systematic review. PLoS ONE. 2011;6:e14566.
Robson M. Classification of caesarean sections. Fetal Matern Med Rev. 2001;12:23-39.
Zuleta JJ, Quintero F, Quiceno AM. Aplicación del modelo de Robson para caracterizar la realización de cesáreas en una institución de tercer nivel de atención en Medellín, Colombia: estudio de corte transversal. Rev Colomb Obstet Ginecol. 2013;64:90-9.
Amaya J, Díaz LA, Cardona A, Rodríguez DM, Osorio D, Barrera A. Guía de Práctica Clínica para la prevención y detección temprana de las alteraciones del embarazo. Rev Colomb Obstet Ginecol. 2013;64:245-88.
Rubio JA, Ruiz AI, Martínez F, Muñoz J, Muñoz LA, Arévalo I et al. Guía de práctica clínica para la detección temprana de las anomalías durante el trabajo de parto, atención del parto normal y distócico. Rev Colomb Obstet Ginecol. 2013;64:379-424.
Salinas H, Carmona S, Albornoz J, Veloz P, Terra R, Marchant R, et al. ¿Se puede reducir el índice de cesárea? Experiencia del hospital clínico de la universidad de Chile. Rev Chil Obstet Gynecol. 2004;69:8-13.
Chaillet N, Dumont A. Evidence-Based Strategies for Reducing Cesarean Section Rates: A Meta-Analysis. Birth. 2007;34:53-64.
Chu SY, Kim SY, Schmid CH, Dietz PM, Callaghan WM, Lau J, et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev. 2007;8:385-94.
Stotland NE, Hopkins LM, Caughey AB. Gestational weight gain, macrosomia, and risk of cesarean birth in non diabetic nulliparas. Obstet Gynecol. 2004;104:671-7.
Durie DE, Thornburg LL, Glantz JC. Effect of secondtrimester and third-trimester rate of gestational weight gain on maternal and neonatal outcomes. Obstet Gynecol. 2011;118:569-75.
Weight gain during pregnancy. Committee Opinion No. 548. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2013;121:210-2.
Vahratian A. et al. Labor progression and risk of cesarean delivery in electively induced nulliparas. Obstet Gynecol. 2005;105:698-704.
Mishanina E, Rogozinska E, Thatthi T, Uddin-Khan R, Khan KS, Meads C. Use of labour induction and risk of cesarean delivery: a systematic review and metaanalysis. CMAJ. 2014 May 5. (Epub ahead of print).
Chauhan SP, Grobman WA, Gherman RA, Chauhan VB, Chang G, Magann EF et al. Suspicion and treatment of the macrosomic fetus: a review. Am J Obstet Gynecol. 2005;193:332-46.
Intrapartum Care: care of healthy women and their babies during childbirth. NICE. September; 2007.
Le Ray C, Serres P, Schmitz T, Cabrol D, Goffinet F. Manual rotation in occiput posterior or transverse positions: risk factors and consequences on the cesarean delivery rate. Obstet Gynecol. 2007;110: 873-9.
Shaffer BL, Cheng YW, Vargas JE, Caughey AB. Manual rotation to reduce caesarean delivery in persistent occiput posterior or transverse position. J Matern Fetal Neonatal Med. 2011;24:65-72.
Cheng YW, Hubbard A, Caughey AB, Tager IB. The association between persistent fetal occiput posterior position and perinatal outcomes: an example of propensity score and covariate distance matching. Am J Epidemiol. 2010;171:656-63.
Hofmeyr GJ, Kulier R. External cephalic version for breech presentation at term. Cochrane Database Syst Rev. 2012 Oct 17;10:CD000083. doi: 10.1002/14651858.CD000083.pub2.
Choudary D, Bano I, Ali SM. Does amnioinfusion reduce caesarean section rate in meconium-stained amniotic fluid. Arch Gynecol Obstet. 2010;282: 17-22.
The American College of Obstetricians and Gynecologists (ACOG).Vaginal birth after previous cesarean delivery. Washington DC: ACOG; 2010.
Horey D, Kealy M, Davey MA, Small R, Crowther CA. Interventions for supporting pregnant women decision-making about mode of birth after a caesarean. The Cochrane Library. 2013;Issue 7:1-54.
Fonseca Chon I, Cavazos J, De la Vega E, Pico B. Estrategias no intervencionistas para disminuir la tasa de cesáreas. Caso HIMES. México: Universidad Popular Autónoma del estado Puebla; 2012.
Flamm BL, Berwick DM, Kabcenell A. Reducing cesarean section rates safely: lessons from a “breakthrough series” collaborative. Birth. 1998; 25:117-24.
Soto C, Teuber H, Cabrera C, Marín M, Cabrera J, Da Costa M et al. Educación prenatal y su relación con el tipo de parto: una vía hacia el parto natural. Rev Chil Obstet Ginecol. 2006;71:98-103.
Hodnett ED, Gates S, Hofmeyr G, Sakala C. Continuos support for women during childbirth. Cochrane Database of Systematic Reviews. 2013;Issue 7.
Gagnon A, Meier K, Waghorn K. Continuity of Nursing Care and Its Link to Cesarean Birth Rate. Birth. 2007;34:26-31.
Klein MC. Quick fix culture: the cesarean-section-ondemand debate. Birth. 2004;31:161.
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