Cesarean sections in Brazil's teaching hospitals: an analysis using Robson Classification

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Healthcare Management

Background:

• Cesarean section rates are a global public health concern.
• The Robson Classification is a standardized method for analyzing cesarean section distribution.
• Teaching hospitals play a crucial role in shaping future obstetric practices.

Purpose of the Study:

• To assess cesarean section distribution in Brazilian teaching hospitals using the Robson Classification.
• To establish a baseline for cesarean section rates within the Apice ON project.
• To identify potential areas for intervention in obstetric care.

Main Methods:

• A cross-sectional descriptive study was conducted.
• Secondary data from the 2017 Live Births Information System were analyzed.
• Cesarean sections were categorized according to the Robson Classification.

Main Results:

• Proportions of newborns by Robson groups were largely consistent with WHO recommendations, with notable exceptions in Group 5 (previous cesarean) and Group 10 (preterm).
• Average cesarean section rates in teaching hospitals ranged widely (24.8% to 75.1%), surpassing recommended levels even in low-risk groups (1-4).
• Regional variations in cesarean section distribution were observed.

Conclusions:

• Brazilian teaching hospitals exhibit excessively high cesarean section rates across all Robson groups.
• These high rates, particularly in educational settings, may influence future professional practices.
• The Robson Classification is a valuable tool for monitoring, evaluating, and guiding interventions to reduce cesarean section rates in high-prevalence countries.