Research

WHO Global Survey on Maternal and Perinatal Health in Latin America: classifying caesarean sections

Ana P Betrán¹ , A Metin Gulmezoglu¹ , Michael Robson² , Mario Merialdi¹ , João P Souza¹ , Daniel Wojdyla³ , Mariana Widmer¹ , Guillermo Carroli³ , Maria R Torloni⁴ , Ana Langer⁵ , Alberto Narváez⁶ , Alejandro Velasco⁷ , Anibal Faúndes⁸ , Arnaldo Acosta⁹ , Eliette Valladares¹⁰ , Mariana Romero¹¹ , Nelly Zavaleta¹² , Sofia Reynoso¹³ and Vicente Bataglia¹⁴

¹  Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

²  National Maternity Hospital, Dublin, Ireland

³  Centro Rosarino de Estudios Perinatales, Rosario, Argentina

⁴  Department of Obstetric and Gynecology, Federal University of Sao Paulo, Sao Paulo, Brazil

⁵  EngenderHealth, New York, USA

⁶  Fundación Salud, Ambiente y Desarrollo, Quito, Ecuador

⁷  Hospital Docente Ginecobstétrico "America Arias", La Habana, Cuba

⁸  Centro de Pesquisas em Saúde Reprodutiva de Campinas (CEMICAMP), Campinas, Brazil

⁹  Department of Obstetrics and Gynecology, Universidad Nacional de Asunción, Asunción, Paraguay

¹⁰  Universidad Nacional Autónoma de Nicaragua, León, Nicaragua

¹¹  Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina

¹²  Instituto de Investigación Nutricional, Lima, Peru

¹³  The Population Council, Latin America Office, Mexico City, Mexico

¹⁴  Department of Obstetrics and Gynecology, Hospital Nacional de Itaguá, Asunción, Paraguay

author email corresponding author email

Reproductive Health 2009, 6:18doi:10.1186/1742-4755-6-18

Published:	29 October 2009

Abstract

Background

Caesarean section rates continue to increase worldwide with uncertain medical consequences. Auditing and analysing caesarean section rates and other perinatal outcomes in a reliable and continuous manner is critical for understanding reasons caesarean section changes over time.

Methods

We analyzed data on 97,095 women delivering in 120 facilities in 8 countries, collected as part of the 2004-2005 Global Survey on Maternal and Perinatal Health in Latin America. The objective of this analysis was to test if the "10-group" or "Robson" classification could help identify which groups of women are contributing most to the high caesarean section rates in Latin America, and if it could provide information useful for health care providers in monitoring and planning effective actions to reduce these rates.

Results

The overall rate of caesarean section was 35.4%. Women with single cephalic pregnancy at term without previous caesarean section who entered into labour spontaneously (groups 1 and 3) represented 60% of the total obstetric population. Although women with a term singleton cephalic pregnancy with a previous caesarean section (group 5) represented only 11.4% of the obstetric population, this group was the largest contributor to the overall caesarean section rate (26.7% of all the caesarean sections). The second and third largest contributors to the overall caesarean section rate were nulliparous women with single cephalic pregnancy at term either in spontaneous labour (group 1) or induced or delivered by caesarean section before labour (group 2), which were responsible for 18.3% and 15.3% of all caesarean deliveries, respectively.

Conclusion

The 10-group classification could be easily applied to a multicountry dataset without problems of inconsistencies or misclassification. Specific groups of women were clearly identified as the main contributors to the overall caesarean section rate. This classification could help health care providers to plan practical and effective actions targeting specific groups of women to improve maternal and perinatal care.