Classificação de Robson em uma maternidade de referência para gestação de alto risco

Abstract

Cesarean delivery, despite being a very valuable procedure for reducing maternal and neonatal morbidity and mortality in several clinical cases, is associated with greater risks for the mother and newborn when cesarean rates are greater than 15%. Brazil has been recognized worldwide for its high rate of cesarean section (CT), which has been considered the main route of birth since 2009, standing out with the second largest CT in the world. The Robson classification was created by Michael Robson in 2001 with the aim of identifying which women underwent cesarean section. For this, women are classified into 10 groups, whose distribution is based on 6 obstetric criteria, thus being a way to monitor cesarean section indications and identify whether there are specific groups of pregnant women contributing to the increase in the overall rate of surgeries. To statistically describe the distribution of deliveries according to the Robson Criteria, based on electronic data from the Obstetrics Service of Fundação Santa Casa de Misericórdia do Pará (FSCMP), in the period between January 2020 and December 2020. A cross-sectional, descriptive, and retrospective study carried out, based on Robson's groups (ANNEX IV), at the FSCMP. In addition, to compare the distribution of types of delivery in relation to the previous month, the Chi-square test of independence was applied. A total of 7492 deliveries were performed at the FSCMP, including 4327 cesarean sections and 3165 vaginal deliveries. In this context, the overall rate of cesarean sections is 57.75%, most of which comes from groups 2, 5 and 10. It is also worth mentioning, a greater increase in the number of primigravidae and a reduction in the number of premature babies in March and November 2020. With this study, it was shown that the overall rate of cesarean sections in the FSCMP (57.75%) was higher compared to that found in the State of Pará (52.01%) and the North region (48.70%) in the same period. In addition, the groups with the greatest contribution to this fact were 2, 5 and 10 of the Robson Classification, in line with several other national studies. Thus, the results indicate the need for specific interventions to reduce the high rates of cesarean sections in groups 2, 5 and 10 of the FSCMPA. Given that groups 2, 5 and 10 were the ones with the greatest contribution to the high global rate of cesarean sections in the FSCMP, future interventions with women who fit this profile are necessary to encourage a preference for the vaginal deliveries.