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

Abstract

Aim:Cesarean section rates are increasing worldwide and Robson’s classification system allows a practicalapproach to study this phenomenon. C-section in Chile has been indicated as unexpectedly high, withimportant variability within the country and payment systems. The aim was to report our data using Rob-son’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 deliverieswere classified into Robson groups. Time changes were analyzed with Pearson’s correlation.Pvalue <0.05was considered significant. A‘relevance index’(RI) for each group was calculated as 100×C-S rate×rela-tive contribution.Results:The overall C-section rate increased from 24 to 27% (P< 0.05) in 53 571 deliveries, with a greaterincrease in groups 1 (nulliparous, single, term cephalic, spontaneous labor), 3 (multiparous, single, no previ-ous 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 grouphad 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’sclassification and the RI allowed prioritization. Although increase in groups 1, 3 and 4, group 5 needs atten-tion because of stronger impact on overall C-S rate. This analysis allowed to define how to lower C-S rate inour institution