Cesarean-section rates in Brazil from 2014 to 2016: cross-sectional Aanalysis using the robson classification / Taxas de cesariana no Brasil de 2014 a 2016: análise transversal utilizando a classificação de robson

Abstract Objective To obtain cesarean-section (CS) rates according to the Robson Group Classification in five different regions of Brazil. Methods A descriptive epidemiological study using data from secondary birth records fromthe Computer Science Department of the Brazilian Unified Health System (Datasus, in Portuguese) between January 1st, 2014, and December 31st, 2016, including all live births in Brazil. Results The overall rate of CSwas of 56%. The sample was divided into 11 groups, and vaginal births were more frequent in groups 1 (53.6%), 3 (80.0%) and 4 (55.1%). The highest CS rates were found in groups 5 (85.7%), 6 (89.5%), 7 (85.2%) and 9 (97.0%). The overall CS rate per region varied from 46.2% in the North to 62.1% in the Midwest. Group 5 was the largest obstetric population in the South, Southeast and Midwest, and group 3 was the largest in the North and Northeast. Group 5 contributed the most to the overall CS rate, accounting for 30.8% of CSs. Conclusion Over half of the births in Brazil were cesarean sections. The Midwest had the highestCS rates,while theNorth had the lowest. The largestobstetric population in the North and in the Northeast was composed of women in group 3, while in the South, Southeast and Midwest it was group 5. Among all regions, the largest contribution to the overall CS rate was from group 5.

Resumo Objetivo Identificar as taxas de cesárea de acordo com a Classificação de Robson nas cinco regiões do Brasil. Métodos Estudo epidemiológico descritivo utilizando dados secundários obtidos do Departamento de Informática do Sistema Único de Saúde (Datasus) entre 1° de janeiro de 2014 e 31 de dezembro de 2016, incluindo todos os nascidos vivos no Brasil. Resultados Cesáreas representaram 56% de todos os nascimentos. A amostra foi dividida em 11 grupos, e partos vaginais forammais frequentes nos grupos 1 (53,6%), 3(80,0%) e 4 (55,1%). As maiores taxas de cesárea foram encontradas nos grupos 5 (85,7%), 6 (89,5%), 7 (85,2%) e 9 (97,0%). A taxa geral de cesárea variou de 46,2% no Norte a 62,1% no Centro-Oeste. O grupo 5 representou a maior população obstétrica no Sul, Sudeste e Centro-Oeste, e o grupo 3, no Norte e Nordeste. O grupo 5 contribuiu mais para a taxa geral de cesárea, totalizando 30,8%. Conclusão Mais da metade dos nascimentos no Brasil ocorreu por cesárea. O Centro- Oeste apresentou a maior taxa, e o Norte, a mais baixa. A maior população obstétrica no Norte e no Nordeste foi o grupo 3, enquanto no Sul, Sudeste e Centro-Oeste foi o grupo 5. Entre todas as regiões, amaior contribuição para a taxa geral de cesárea foi do grupo 5.

Frecuencia e indicaciones del parto por cesárea en un hospital docente de Lima, Perú / Frequency and indications of cesarean delivery in a public teaching hospital in Lima, Peru / Frequency and indications of cesarean delivery in a public teaching hospital in Lima, Peru

RESUMEN Introducción . La cesárea es una operación reservada inicialmente para casos en los que el parto eutócico puede comprometer la vida de la gestante o del producto. Por diversas razones, se ha aceptado a la cesárea como método de parto de elección, aumentando su frecuencia. La OMS estableció un margen de tasa de cesáreas de 15% para las cesáreas primarias, ya que valores mayores no representan una disminución en la morbimortalidad fetal. Mundialmente se ha evidenciado tasas de hasta 21% (países europeos) y, en el Perú, 36% en el año 2015. Objetivos . Determinar la frecuencia e indicaciones más frecuentes de cesáreas en un hospital público docente de Lima. Métodos . Estudio descriptivo, tipo serie de casos, de pacientes sometidas a cesárea y sus indicaciones. Se incluyó a pacientes sometidas a cesáreas, electivas o de emergencia, desde enero 2013 hasta diciembre 2017. Resultados . La cesárea fue realizada con una frecuencia de 50,2%, siendo las indicaciones más frecuentes una cesárea previa y la desproporción cefalopélvica. Conclusiones . El estudio halló que se superó la tasa de cesáreas recomendada por la OMS. La indicación más frecuente en el período estudiado fue la cesárea previa.

ABSTRACT Introduction : Cesarean delivery was an option initially reserved for cases where vaginal delivery could compromise the life of the pregnant woman or the fetus. Due to diverse socioeconomic or cultural causes, cesarean delivery has become more accepted as an elective birth procedure. The WHO has established a marginal cesarean rate of 15% in primary cesarean deliveries, as higher rates do not decrease fetal morbidity and mortality. Worldwide, there have been rates as high as 21% (European countries), and 36% in Peru in 2015. Objectives : To determine the frequency of cesarean section and the most frequent indications in a public teaching hospital. Methods : Descriptive, retrospective series of case studies of patients who underwent elective or emergency cesarean section between January 2013 and December 2017 at a public teaching hospital in Lima, Peru. Results : The frequency of cesarean section was of 50.2%, and the most frequent indications were previous cesarean delivery and cephalopelvic disproportion. Conclusions : In the Peruvian public hospital studied, the rate of cesarean section exceeded that recommended by the WHO. The most frequent indication was repeat cesarean section.

Validation of a predictive model for successful vaginal birth after cesarean section / Validación de modelos predictivos para parto vaginal exitoso después de cesárea

Abstract Introduction: A strategy for reducing the number of cesarean sections is to allow vaginal delivery after cesarean section. Objective: To validate two predictive models, Metz and Grobman, for successful vaginal delivery after a cesarean section. Methods: Retrospective cohort study involving women with previous history of a previous segmental cesarean section, single pregnancy ≥37 weeks and cephalic presentation. The proportion of vaginal delivery in all pregnant women was determined, and it was compared with those (women) with successful delivery after cesarean section. Then, there were elaborated the models, and their predictive capacity was determined by curve-receiver-operator. Results: The proportion of successful delivery in pregnant women with a previous cesarean section and indication of vaginal delivery was 85.64%. The observed proportion of birth for each decile predicted in the Grobman model was less than 15%, except for the 91-100% decile, where it was 64.09%; the area under the curve was 0.95. For the Metz model, the actual successful delivery rate was lower than predicted in scores between 4 and 14, and within expected for a score between 15 and 23; the area under the curve was 0.94. Conclusions: The vaginal delivery rate after cesarean was lower than expected according to the predictive models of Grobman and Metz. The implementation of these models in a prospective way can lead to a higher rate of successful birth.

Resumen Introducción: Una estrategia de reducción del número de cesáreas es permitir el parto vaginal después de cesárea. Objetivo: Validar dos modelos predictivos, Metz y Grobman, para el parto vaginal exitoso después de una cesárea. Métodos: Estudio de cohorte retrospectivo con mujeres con antecedente de una cesárea segmentaria previa, embarazo único ≥37 semanas y presentación cefálica . Se determinó la proporción de parto vaginal en todas las gestantes y se comparó con aquellas con parto exitoso después de cesárea, se elaboró los modelos y se determinó la capacidad predictiva de ellos mediante curva-receptor-operador. Resultados: La proporción de parto exitoso en gestantes con cesárea previa e indicación de parto vaginal fue 85.64%. La proporción de parto observado para cada decil predicho en el modelo de Grobman fue inferior al 15%, excepto para el decil 91-100%, en el que fue 64.09%, el área bajo la curva fue 0.95. Para el modelo de Metz, la proporción de parto exitoso real fue menor a lo predicho en puntajes entre 4-14 y dentro de lo esperado para puntaje entre 15-23, con un área bajo la curva de 0.94. Conclusiones: La tasa de parto vaginal después de cesárea fue menor a lo esperado de acuerdo a los modelos predictivos de Grobman y Metz. La implementación de estos modelos en forma prospectiva puede llevar una mayor tasa de parto exitoso.

Vesicouterine fistula (Youssef syndrome): case report and literature review / Fístula vesico-uterina (síndrome de Youssef): descrição de caso e revisão da literatura

Abstract Objective To describe a case of vesicouterine fistula and to review the literature related to this condition. Methods For the review, we accessed the MEDLINE, BIREME and LILACS databases; the references of the searched articles were also reviewed. Results A 38-year-old woman, in the 1st day after her 3rd cesarean, presented heavy hematuria, which was considered secondary to a difficult dissection of the bladder. A total of 6 months after delivery, she failed to resume her regular menstrual cycles and presented cyclic menouria and amenorrhea. At this time, she had two episodes of urethral obstruction by blood clots. She remained without a correct diagnosis until about two years postdelivery, when a vesicouterine fistula was confirmed through cystoscopy. A surgical correction through open abdominal route, coupled with hysterectomy, was performed. After the surgery, the symptoms disappeared. The review showed a tendency of change in the relative frequency of the different types of genitourinary fistulae. Vesicovaginal fistulae, usually caused by inadequate care during labor, are becoming less frequent than those secondary tomedical procedures, such as vesicouterine fistulae. The most common cause of this latter kind of fistula is cesarean section, especially repeated cesarean sections. The diagnosis is confirmed through one or more imaging exams, or through cystoscopy. The most common treatment is surgical, and the routes are: open abdominal, laparoscopic, vaginal or robotic. There are some reports of success with the conservative treatment. Conclusion Vesicouterine fistulae are becoming more common because of the increase in the performance of cesarean sections, and the condition must be considered a possible complication thereof.

Resumo Objetivo Apresentar um caso de fístula vesico-uterina e realizar revisão da literatura sobre esta condição. Métodos Revisão realizada consultando-se as bases MEDLINE, BIREME e LILACS, além das referências dos artigos consultados. Resultados Uma mulher de 38 anos, após sua terceira cesárea, no puerpério imediato, apresentou hematúria importante, que foi atribuída a uma dificuldade na dissecção da bexiga durante o procedimento. Seis meses pós-parto, emvez de retomar os ciclos menstruais regulares, apresentou menúria cíclica e amenorreia (síndrome de Youssef). A paciente chegou a apresentar obstrução uretral por coágulos, e permaneceu sem diagnóstico correto até cerca de anos pós-parto, quando este foi feito por cistoscopia. Ela foi então submetida a correção cirúrgica por via abdominal, associada a uma histerectomia, com desaparecimento dos sintomas. A revisão mostrou que tem havido mudança na frequência dos vários tipos de fístulas urogenitais. As fístulas vesicovaginais, normalmente secundárias à má assistência durante o parto, têm sido mais raras, enquanto aquelas secundárias a procedimentos médicos, como as vesicouterinas, têm sido mais frequentes. A causa mais comum deste tipo de fístula é a cesárea, especialmente a de repetição. A apresentação pode ser de amenorreia e menúria e/ou perda urinária. O diagnóstico é feito por um ou maismétodos de imagem ou cistoscopia. O tratamento mais comum é cirúrgico, por via abdominal aberta, laparoscópica, transvaginal ou robótica. Existem relatos de cura com tratamento conservador. Conclusão As fístulas vesicouterinas têm sido mais comuns devido ao aumento da proporção de cesáreas. Deve-se ter em mente a possibilidade deste diagnóstico e considerá-las uma das possíveis complicações da cesárea.

Tasa de cesáreas por grupos de Robson en una institución de mediana complejidad de la ciudad de Bogotá, 2012-2014 / Cesarean section rate by Robson groups in an intermediate complexity centre in the city of Bogotá, 2012-2014

Introducción: la clasificación de Robson permite caracterizar las mujeres a las que se les realiza cesárea con el fin de implementar estrategias focalizadas con éxito. El objetivo fue determinar las tasas específicas de cesárea según la clasificación de Robson en una institución hospitalaria de mediana complejidad. Materiales y métodos: estudio descriptivo transversal que incluyó mujeres atendidas en un hospital público de atención general, que recibe pacientes del aseguramiento subsidiado por el Estado, entre 2012 y 2014. Se llevó a cabo muestreo aleatorio estratificado según la vía del parto, basado en la razón parto/cesárea encontrada en el periodo, clasificando las mujeres atendidas en los 10 grupos de Robson. Se realizó el análisis descriptivo de las variables demográficas, indicaciones clínicas reportadas y las proporciones global y específica de uso de cesárea en cada grupo. El estudio contó con aprobación del comité de ética institucional. Resultados: se seleccionaron 1.190 de 6.558 nacimientos ocurridos durante el periodo. La proporción global de cesárea fue de 36,9 %. Las mujeres nulíparas contribuyeron con el 38,5 % de las cesáreas, seguidas por el grupo con cesárea anterior (36,4 %) que tuvo una proporción específica del 100 %. La proporción específica de cesárea en el grupo de mujeres nulíparas en trabajo de parto espontáneo fue 36,6 % y la del grupo de partos prematuros 43,3 %. Conclusiones: las mujeres con cesárea anterior, con embarazo pretérmino y las nulíparas en parto espontáneo o inducido tienen las proporciones específicas más elevadas de cesárea. Estos grupos podrían ser susceptibles de intervención para impactar las tasas de cesárea de la institución.

Introduction: The Robson classification is useful for characterizing women taken to Cesarean section with the aim of implementing successful focused strategies. The objective was to determine specific Cesarean section rates according to the Robson classification in an intermediate complexity hospital. Materials and methods: cross-sectional descriptive study that included women of the state-subsidized health insurance regime seen at a general public hospital between 2012 and 2014. A stratified random sampling was performed on the basis of the birth route, per delivery, based on the delivery/Cesarean section ratio found during the time period. The women were classified under 10 Robson groups. A descriptive analysis was conducted of the demographic variables, the clinical indications reported, and the overall and specific proportions of Cesarean sections in each group. The study was approved by the Ethics Committee of the Institution. Results: Out of 6558 deliveries during the study period, 1190 were selected. The overall proportion of Cesarean sections was 36.9%. Nulliparous women accounted for 38.5% of the Cesarean sections, followed by the group with previous Cesarean sections (36.4%) for which the specific proportion was 100%. The specific proportion of Cesarean sections in nulliparous women in spontaneous labour was 36.6%, whereas it was 43.3% in the premature delivery group. Conclusions: The highest specific proportions of Cesarean section were found among women with a previous Cesarean section, women with pre-term delivery and nulliparous women with spontaneous or induced delivery. These groups could lend themselves for intervention in order to have an impact on the rates of Cesarean section in the Institution.