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Caesarean Section in Peru: Analysis of Trends Using the Robson Classification System

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dc.contributor.author Tapia Aguirre, Vilma Lucrecia
dc.contributor.author Betran, Ana-Pilar
dc.contributor.author Gonzales Rengifo, Gustavo Francisco
dc.date.accessioned 2019-02-06T14:48:07Z
dc.date.available 2019-02-06T14:48:07Z
dc.date.issued 2016
dc.identifier.uri https://hdl.handle.net/20.500.12866/5168
dc.description.abstract INTRODUCTION: Cesarean section rates continue to increase worldwide while the reasons appear to be multiple, complex and, in many cases, country specific. Over the last decades, several classification systems for caesarean section have been created and proposed to monitor and compare caesarean section rates in a standardized, reliable, consistent and action-oriented manner with the aim to understand the drivers and contributors of this trend. The aims of the present study were to conduct an analysis in the three Peruvian geographical regions to assess levels and trends of delivery by caesarean section using the Robson classification for caesarean section, identify the groups of women with highest caesarean section rates and assess variation of maternal and perinatal outcomes according to caesarean section levels in each group over time. MATERIAL AND METHODS: Data from 549,681 pregnant women included in the Peruvian Perinatal Information System database from 43 maternal facilities in three Peruvian geographical regions from 2000 and 2010 were studied. The data were analyzed using the Robson classification and women were studied in the ten groups in the classification. Cochran-Armitage test was used to evaluate time trends in the rates of caesarean section rates and; logistic regression was used to evaluate risk for each classification. RESULTS: The caesarean section rate was 27% and a yearly increase in the overall caesarean section rates from 2000 to 2010 from 23.5% to 30% (time trend p<0.001) was observed. Robson groups 1, 3 (nulliparous and multiparas, respectively, with a single cephalic term pregnancy in spontaneous labour), 5 (multiparas with a previous uterine scar with a single, cephalic, term pregnancy) and 7 (multiparas with a single breech pregnancy with or without previous scars) showed an increase in the caesarean section rates over time. Robson groups 1 and 3 were significantly associated with stillbirths (OR 1.43, CI95% 1.17-1.72; OR 3.53, CI95% 2.95-4.2) and maternal mortality (OR 3.39, CI95% 1.59-7.22; OR 8.05, CI95% 3.34-19.41). DISCUSSION: The caesarean section rates increased in the last years as result of increased CS in groups with spontaneous labor and in-group of multiparas with a scarred uterus. Women included in groups 1 y 3 were associated to maternal perinatal complications. Women with previous cesarean section constitute the most important determinant of overall cesarean section rates. The use of Robson classification becomes an useful tool for monitoring cesarean section in low human development index countries. en_US
dc.language.iso eng
dc.publisher Public Library of Science
dc.relation.ispartofseries PLoS ONE
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Cesarean Section en_US
dc.subject Databases, Factual en_US
dc.subject Adolescent en_US
dc.subject Adult en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Peru en_US
dc.subject Pregnancy en_US
dc.title Caesarean Section in Peru: Analysis of Trends Using the Robson Classification System en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1371/journal.pone.0148138
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.02
dc.relation.issn 1932-6203


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