Cesarean rates in a Chilean public hospital and the use of a new prioritization criteria: The relevance index.

AIM: Cesarean section rates are increasing worldwide and Robson's classification system allows a practical approach to study this phenomenon. C-section in Chile has been indicated as unexpectedly high, with important variability within the country and payment systems. The aim was to report our data using Robson's system and the evolution of local C-section rate in a public hospital during a 9-year period. METHODS: Retrospective analysis (2005-April 2014), in a metropolitan hospital in Santiago. All deliveries were classified into Robson groups. Time changes were analyzed with Pearson's correlation. P value <0.05 was considered significant. A 'relevance index' (RI) for each group was calculated as 100 × C-S rate × relative contribution. RESULTS: The overall C-section rate increased from 24 to 27% (P < 0.05) in 53 571 deliveries, with a greater increase in groups 1 (nulliparous, single, term cephalic, spontaneous labor), 3 (multiparous, single, no previous C-S, term cephalic, spontaneous labor) and 4 (multiparous, single, no previous C-S, term cephalic, induced or no labor). Despite no increase in Group 5 (women with one or more previous C-S) this group had the highest RI (20.3), which defined priority for intervention over others. CONCLUSION: C-S rate was lower than that reported in other centers from Chile and Latin America. Robson's classification and the RI allowed prioritization. Although increase in groups 1, 3 and 4, group 5 needs attention because of stronger impact on overall C-S rate. This analysis allowed to define how to lower C-S rate in our institution.

[Under diagnosis of fetal growth restriction by the new growth curves of the Chilean Ministry of Health]. / Subdiagnóstico de restricción de crecimiento fetal mediante la aplicación de las curvas de crecimiento intrauterino del Ministerio de Salud.

BACKGROUND: Fetal growth restriction (FGR) is associated with increased risk of perinatal morbidity or death. Nationwide implementation of new fetal growth charts, requires a lower fetal weight for the diagnosis of FGR, compared to previous ones. This may lead to an under diagnosis of FGR in a large proportion of neonates. AIM: To compare the morbidity, mortality and anthropometry of neonates with FGR, diagnosed by MINSAL and Juez curves, with normal weight newborns in the same period (2000-2004). MATERIAL AND METHODS: Revision of medical records of all births occurring in a maternity hospital between 2000 and 2004. The number of neonatal deaths, and the presence of hyperbilirubinemia, polyglobulia, hypoglycemia and hypothermia, were compared among children classified to be below percentile 10 of fetal growth according to both growth charts. RESULTS: FGR was diagnosed in 4,4% (502/11.289) and 9% (1.029/11.289) of newborns by MINSAL and Juez curves respectively. Compared to normal weight controls, the 527 newborns without FGR according to MINSAL curves, but below percentile 10 of Juez curves, had an odds ratio (OR) for polyglobulina of 8.14 (95% confidence intervals (CI): 1.01-65.34), an OR for neonatal hypoglycemia of 5.10 (95% CI: 1.11-23.39) and an OR for a ponderal index below 10th percentile of 10.98 (95% CI: 6.84-17.64). CONCLUSIONS: Newborns without a diagnosis of FGR by MINSAL curves but below 10th percentile by Juez curves, have neonatal outcomes suggesting a true FGR. Juez curves should be maintained as a standard for the evaluation of fetal growth in our population.