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Cesarean section rates in Brazil: Trend analysis using the Robson classification system.

Edson Luciano Rudey1, Maria do Carmo Leal2, Guilhermina Rego1

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Cesarean section (CS) rates in Brazil are high, with over half of births being CS deliveries. Unnecessary CS in low-risk groups (Robson groups 1 and 2) significantly increases overall rates, necessitating policy changes.

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Area of Science:

  • Obstetrics and Gynecology
  • Public Health
  • Epidemiology

Background:

  • Cesarean section (CS) is a vital surgical procedure but carries risks, and rising rates necessitate careful monitoring.
  • The Robson classification system provides a standardized framework for analyzing and comparing CS rates globally.
  • Limited large-scale epidemiological studies using the Robson classification exist for Brazil, highlighting a research gap.

Purpose of the Study:

  • To analyze Cesarean section rates in Brazil using the Robson classification system.
  • To identify key Robson groups contributing to high CS rates in the Brazilian obstetric population.
  • To propose evidence-based strategies for optimizing CS rates in Brazil.

Main Methods:

  • Analysis of 11,774,665 live births from Brazil's Live Birth Information System (2014-2017).
  • Classification of all births according to the Robson classification system.
  • Epidemiological analysis of CS rates across different Robson groups and demographic factors.

Main Results:

  • Brazil's overall CS rate was 55.8% between 2014-2017, with higher rates in regions with high Human Development Index.
  • Robson Group 5 (RG5) contributed the highest proportion (31.3%) to the overall CS rate and showed significant growth.
  • CS rates in low-risk Robson groups 1 and 2 were disproportionately high (nearly 50% of births in these groups) compared to international benchmarks.

Conclusions:

  • High CS rates in Brazil, particularly in low-risk groups, indicate potential for unnecessary interventions.
  • Targeted interventions in Robson groups 1 and 2 are crucial for reducing the overall CS rate.
  • Implementation of health policies focused on avoiding unnecessary CS in low-risk pregnancies is recommended to decrease national rates.