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Classifications for cesarean section: a systematic review.

Maria Regina Torloni¹, Ana Pilar Betran, Joao Paulo Souza

¹Department of Obstetrics, Sao Paulo Federal University and Brazilian Cochrane Centre, Sao Paulo, Brazil. ginecologia@terra.com.br

|February 2, 2011

Summary

This review found that woman-based cesarean section (CS) classifications, especially Robson

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Area of Science:

Obstetrics and Gynecology
Public Health
Healthcare Management

Background:

Rising cesarean section (CS) rates present a global public health challenge, necessitating effective classification systems for monitoring and intervention.
Existing CS classification systems have not undergone comprehensive systematic review, highlighting a gap in understanding their worldwide applicability and limitations.

Purpose of the Study:

To systematically identify and review major cesarean section classification systems currently in use globally.
To critically analyze the advantages and deficiencies of each identified CS classification system.

Main Methods:

A systematic search of three electronic databases was conducted for classifications published between 1968 and 2008.
Two independent reviewers assessed classifications based on seven expert-defined domains: ease, clarity, mutual exclusivity, inclusivity, prospective identification, reproducibility, and implementability.
Classifications were evaluated using 12 hypothetical clinical case-scenarios.

Main Results:

Out of 27 identified CS classifications, indications and degree of urgency types showed significant limitations, with overall scores ranging from 2-9 and 6-9, respectively.
Woman-based classifications demonstrated superior performance, achieving scores between 5-14.
Other classification types often require data not routinely collected and may lack universal relevance, scoring between 3-8.

Conclusions:

Woman-based classifications, particularly Robson's classification, are best positioned to meet current international and local needs for monitoring and rationalizing cesarean section rates.
Future development of an internationally applicable CS classification should build upon existing woman-based systems.
Adopting a single, standardized CS classification will enhance auditing, analysis, and comparison of rates across settings, facilitating targeted strategies to optimize CS utilization.