scholarly journals Appropriate cesarean rates using Robson’s Ten-Group Classification System in a Brazilian private practice

2021 ◽  
Author(s):  
Andrea Silveira de Queiroz Campos ◽  
Daphne Rattner ◽  
Carmen Simone Grilo Diniz
Keyword(s):  
Access To Health Care ◽  
Obstetric Care ◽  
Multidisciplinary Care ◽  
Cross Sectional Study ◽  
Evidence Based ◽  
Cesarean Sections ◽  
Cross Sectional ◽  
Childbirth Experience ◽  
Group 5 ◽  
Group 2

Abstract Background The increasing rates of cesarean sections (CS) in places with adequate access to health care are a global concern because they are related to higher rates of maternal and neonatal complications and do not provide a positive childbirth experience for women. The objective is to highlight the possibility of achieving CS rates acceptable by WHO standards, such as Nordic countries, following evidence-based protocols in Brazil. Methods A cross-sectional study evaluated CS rates by Robson Groups for women who sought vaginal delivery in a private health practice in Brazil, comparing the rates with Swedish data. A collaborative practice with midwives and obstetricians adopting evidence-based guidelines was offered. The overall CS rate, CS rate by Robson group, contribution of each Robson group to the overall CS rate, clinical and nonclinical interventions and vaginal birth, pre-labour CS and intrapartum CS proportions were estimated. The expected CS rate for the population was calculated by the WHO c-model tool. The analysis used Microsoft EXCEL and the software "R Studio" (version 1.2.1335. 2009-2019). Results The overall CS rate was 15.1% (as expected by the WHO c-model tool) in a population composed of 43.7% women in Robson Group 1, 11.4% in Group 2 and 14.9% in Group 5, the greatest responsible for higher rates of CS, who altogether contributed to 75.4% of all cesarean sections. Conclusions Multidisciplinary care following evidence-based protocols, associated with a high motivation of both women and professionals of childbirth care for a vaginal route for delivery, may lead to a significant and safe reduction of CS rates, obtaining better results even in contexts such as Brazil, where there is high medicalization of obstetric care and excess of CS.

scholarly journals Appropriate cesarean rates using Robson’s Ten-Group Classification System in a Brazilian private practice

2021 ◽  
Author(s):  
Andrea Silveira de Queiroz Campos
Keyword(s):  
Access To Health Care ◽  
Obstetric Care ◽  
Multidisciplinary Care ◽  
Cross Sectional Study ◽  
Evidence Based ◽  
Cesarean Sections ◽  
Cross Sectional ◽  
Childbirth Experience ◽  
Group 5 ◽  
Group 2

Abstract Background The increasing rates of cesarean sections (CS) in places with adequate access to health care is a global concern because they are related to higher rates of maternal and neonatal complications and do not provide a positive childbirth experience for women. The objective is to highlight the possibility of achieving CS rates acceptable by WHO standards, like Nordic countries, following evidence-based protocols in Brazil. Methods A cross-sectional study evaluated CS rates by Robson Groups for women who sought vaginal delivery in a private health practice in Brazil, comparing the rates with Swedish data. A collaborative practice with midwives and obstetrician, adopting evidence-based guidelines, was offered. The overall CS rate, CS rate by Robson group, contribution of each Robson group to the overall CS rate, clinical and non-clinical interventions and vaginal birth, pre-labor CS and intrapartum CS proportions were estimated. The expected CS rate for the population by the WHO c-model tool was calculated. The analysis used Microsoft EXCEL and the software "R Studio" (version 1.2.1335. 2009-2019). Results The overall CS rate was 15.1% (within the expected by the WHO c-model tool) in a population composed of 43.7% of women in Robson Group 1, 11.4% in Group 2 and 14.9% in Group 5, the greatest responsible for higher rates of CS, who altogether contributed to 75.4% of all cesarean sections. Conclusions Multidisciplinary care following evidence-based protocols, associated to a high motivation of both women and professionals of childbirth care for a vaginal route for delivery may lead to a significant and safe reduction of CS rates, obtaining better results even in contexts such as Brazil, where there is high medicalization of obstetric care and excess of CS.

scholarly journals Using the Robson Classification to Explain the Fluctuations in Cesarean Section

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
H. Cammu ◽  
E. Martens ◽  
G. Van Maele
Keyword(s):  
Population Based ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Induced Labor ◽  
Robson Classification ◽  
Nulliparous Women ◽  
Multiparous Women ◽  
The Absolute ◽  
Group 5 ◽  
Group 2

Purpose. As the rate of cesarean sections (CS) continues to rise in Flanders (northern part of Belgium), it is important to understand the reasons behind this evolution and to find ways to achieve appropriate CS rates. For this analysis, we categorized CS changes between 1992 and 2016, applying the Robson 10-Group Classification System (TGCS). We also applied the TGCS to analyze the information of the only clinics where between 2008 and 2016, the absolute CS rate had fallen by more than two percent. Methods. This paper is based on a population-based cross-sectional study. Robson’s TGCS was used to analyze CS rates for the years 1992, 2000, 2008, and 2016, using the Flemish population-based birth register. Results. Between 1992 and 2016, the overall CS rate increased from 11.8% in 1992 to 20.9% in 2016. The major contributors to that increase were (a) single, cephalic nulliparous women, at term in spontaneous labor (Robson group 1); (b) single, cephalic nulliparous women, at term in induced labor or CS before labor (group 2); and (c) multiparous women with single cephalic at term pregnancy with history of CS (group 5). In the subgroup of the seven clinics where the collective CS rate had decreased from 23.2% in 2008 to 19.3% in 2016, the main contributors to this decrease were Robson groups 1 and 2. Conclusions. The CS increase in Flanders between 1992 and 2016 is mainly the result of the absolute CS increase in the childbirth of nulliparous women with a single cephalic baby at term in spontaneous or induced labor and in women with a single cephalic presentation at term and a previous CS. Further research in these aforementioned groups is needed to identify the real reasons for the CS increase.

Analysis of caesarean section rates using Robsons ten group classification: the first step

2017 ◽  
Vol 6 (8) ◽  
pp. 3481 ◽  
Author(s):  
Sowmya Koteshwara ◽  
Sujatha M. S.
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Cross Sectional Study ◽  
Group Classification ◽  
Cross Sectional ◽  
Medical College ◽  
Relative Contribution ◽  
Group 5 ◽  
Group 2 ◽  
Group 1

Background: The Caesarean section (CS) rate is steadily increasing worldwide including India. The overall CS rates are reported but rarely the women are classified. According to WHO Robson ten –group classification is useful as a global standard for assessing, monitoring and comparing cesarean section rates. Our objective was to classify women delivering in our hospital according to various categories as per the 10-group classification (Robsons classification) and analyzing the CS rate in each group.Methods: This was a cross sectional study conducted at JSS Medical College, Mysore. The data was collected for all women delivering in hospital from January 2016-December 2016 and the women were classified according to Robsons 10 group classification. The proportion of women delivering in each group, the CS rate of each group, and the relative contribution to CS rate from each group was calculated.Results: Among a total of 5016 women delivering during the study period 37.65% of women were delivered by CS. Maximum no of pregnant women belonged to primigravida group (group 1 and 2). Major contributor to CS rate were primigravida (group 2) at 32.2%. Next contributors were group 5 and group 1 at 28.9 % and 18.6% respectively. Overall the three groups 1, 2 and group 5 contributed to 79.7% of the CS rate while the other group contributed to only 21.3% of CS rate.Conclusions: Applying Robsons criteria to classify pregnant women allowed for easy classification to identify the category of women most likely to have CS. Reducing primary CS rate and increasing VBAC rates will help to reduce CS rate. 

scholarly journals Analysis of Caesarean-Section rates according to Robson's ten group classification system and evaluating the indications within the groups

2017 ◽  
Vol 6 (2) ◽  
pp. 447 ◽  
Author(s):  
Amita Ray ◽  
Sumy Jose
Keyword(s):  
Classification System ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Group Classification ◽  
Health Care Facilities ◽  
Care Hospital ◽  
Cross Sectional ◽  
The Absolute ◽  
Group 5 ◽  
Group 2

Background: With Caesarean sections on the rise WHO proposes that health care facilities use the Robson's 10 group classification system to audit their C-sections rates. This classification would help understand the internal structure of the CS rates at individual health facilities identify key population groups, indications in each group and formulate strategies to reduce these rates.Methods: This was a cross sectional study for a period of 24 months at a tertiary care hospital in a tribal area of Kerala South India. Women who delivered during this period were included and classified into 10 Robson's classes and percentages were calculated for the overall rate, the representation of groups, contribution of groups and Caesarean percentage in each group.Results: Highest contribution was by Group 5 and Group 2. Together these two groups contributed to 38% of the total Caesareans. Followed by Group 8 and 10. All four added contributed to 63% of the section rate The least contribution was by Group 3. Groups 6, 7 and 9 by themselves did not contribute much but within their groups had a 100% C-Section rate.Conclusions: The contribution of the various Robson's Group to the absolute C-Section rates needs to be looked into. Reducing primary section rates, adequate counselling and encouraging for VBAC, changing the norms for dystocia and non-reassuring fetal status, training and encouraging obstetricians to perform versions when not contraindicated could reduce the contribution of Robson's groups towards the absolute C-Section rates.

Desigualdade social em doentes renais crônicos/ Social inequality in chronic renal patients

1970 ◽  
Vol 1 (1) ◽  
pp. 44-49
Author(s):  
Beatriz Bertolaccini Martínez ◽  
Fernanda Marcelino Da Silva ◽  
Vinícius Tavares Veiga ◽  
Rodrigo Pereira Custódio ◽  
José Vítor Da Silva
Keyword(s):  
Social Inequality ◽  
Access To Health Care ◽  
Young Patients ◽  
Cross Sectional Study ◽  
Access To Health Services ◽  
Access To Treatment ◽  
Cross Sectional ◽  
Economic Class ◽  
Access To Health ◽  
Clinical Background

Introdução: A pobreza influencia na evolução dos pacientes com doenças crônicas, porque contribui para o seu agravamento e dificulta o acesso à assistência médica. O objetivo deste trabalho foi avaliar os aspectos relacionados à desigualdade social de pacientes em hemodiálise. Métodos: Estudo transversal com 123 pacientes em hemodiálise no Hospital Samuel Libânio – Pouso Alegre, MG, divididos, de acordo com a classe econômica, em 3 grupos: AB (n=23), C (n=60) e DE (n=40),. Foram coletados dados sociodemográficos e econômicos, antecedentes clínicos e informações sobre o acesso a serviços de saúde. Para a análise dos resultados, foi utilizada estatística analítica e descritiva. Adotou-se p £ 0,05. Resultados: O grupo AB apresentou um menor número de pacientes jovens (4,3% em AB vs 40% em C e 25% em DE, p < 0,05), um maior número de indivíduos com mais anos de escolaridade (65,3% em AB vs 18,3% em C e 2,5% em DE; p < 0,05), predomínio de pacientes com menos de um ano em tratamento de hemodiálise (65,2% em AB vs 10% em C e 5% em DE, p < 0,05), menor número de usuários do SUS (40% em C e 25% em DE vs 4,3% em AB; p < 0,05) e maior acesso ao tratamento com nefrologista (73,9% em AB vs 46,7% em C e 52,5 em DE; p < 0,05). Conclusão: Classes economicamente desfavorecidas agregam indivíduos mais jovens, com menor escolaridade, usuários do SUS, com maior tempo em hemodiálise e pior acesso ao tratamento com nefrologista.Introduction: The poverty influence on the evolution of patients with chronic diseases because it contributes to your aggravation and hinders access to health care. Our goal was to evaluate the aspects related to social inequality on hemodialysis patients. Methods: cross-sectional study with 123 patients on hemodialysis in Samuel Libânio Hospital – Pouso Alegre, MG, divided according to the economic class, into 3 groups: AB (n = 23), C (n = 60) and DE (n = 40). Were collected socio-demographic and economic data, clinical background and information about access to health services. For analysis of the results has been used statistical analytical and descriptive. We take p £ 0,05.  Results: The AB group has fewer young patients (4,3% in AB vs 40% in C and 25% in DE, p< 0,05), a greater number of individuals with more years of schooling (65,3% in AB vs 18,3% in C and 2,5% in DE; p< 0,05), predominance of patients with less than a year on haemodialysis treatment (65,2% in AB vs 10% in C and 5% in DE, p< 0,05), smaller number of users of SUS (40% in C and 25% in DE vs 4,3% in AB; p< 0,05), greater access to treatment with nephrologist (73,9% in AB vs 46,7% in C and 52,5% in DE; p< 0,05). Conclusion: Economically disadvantaged classes bring younger patients, with less schooling, users of SUS, patients with greater time on hemodialysis and worse access to treatment with nephrologist. 

scholarly journals Effect of the Cut-Off Level for Thyroid-Stimulating Hormone on the Prevalence of Subclinical Hypothyroidism among Infertile Mexican Women

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 417
Author(s):  
Lidia Arce-Sánchez ◽  
Salvatore Giovanni Vitale ◽  
Claudia Montserrat Flores-Robles ◽  
Myrna Souraye Godines-Enriquez ◽  
Marco Noventa ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Subclinical Hypothyroidism ◽  
Thyroid Autoimmunity ◽  
Cross Sectional Study ◽  
Thyroid Stimulating Hormone ◽  
Mexican Women ◽  
Cross Sectional ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The primary aim of this study was to compare the prevalence of subclinical hypothyroidism (SCH) using two different cut-off levels for TSH values (≥2.5 mIU/L versus ≥4.1 mIU/L). The secondary objective was to analyze the clinical-biochemical characteristics in women with and without SCH. This was a retrospective cross-sectional study. In total, 1496 Mexican women with infertility were included: Group 1, women with TSH levels ranging between 0.3 and 2.49 mIU/L, n = 886; Group 2, women with TSH between 2.5 and 4.09 mIU/L, n = 390; and Group 3, women with TSH ≥4.1 mIU/L n = 220. SCH prevalence was 40.7% (CI 95%: 38.3–43.3%) with TSH cut-off ≥ 2.5 mIU/L, and 14.7% (CI 95%: 12.7–16.5%) with TSH cut-off ≥ 4.1 mIU/L, (p = 0.0001). The prevalence of overweight was higher in Group 2 than in Groups 1 and 3. Thyroid autoimmunity, obesity and insulin resistance were higher in Group 3 than in Group 1 (p < 0.05). No other differences were observed between groups. Conclusions: The prevalence of SCH in our selected patients increased almost three times using a TSH cut-off ≥ 2.5 mIU/L compared with a TSH cut-off ≥ 4.1 mIU/L. Women with TSH ≥4.1 mIU/L compared with TSH cut-off ≤ 2.5 mIU/L more often presented with obesity, thyroid autoimmunity and insulin resistance.

scholarly journals The correlation between uremic pruritus and blood lead levels in prevalent hemodialysis patients and its relation to the severity of pruritus using visual analog score

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Sahar Mahmoud Shawky ◽  
Reeham Abdel Aziz Abdel Hamid ◽  
Lina Essam Khedr
Keyword(s):  
Blood Lead ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Visual Analog Score ◽  
Blood Lead Levels ◽  
Cross Sectional ◽  
Uremic Pruritus ◽  
Significant Difference ◽  
Lead Levels ◽  
Group 2

Abstract Background Pruritus is a common and often distressing symptom in patients with chronic kidney disease. Though the pathogenesis of uremic pruritus remains poorly understood, systemic inflammation has presented itself as one of the possible explanations. High blood lead levels (BLLs) have been noted to be associated with inflammation and poor nutritional status in hemodialysis patients. Our aim is to study the relation between blood lead levels and uremic pruritus. This is a cross-sectional study that enrolled 50 patients; all were on regular hemodialysis 3 times per week for at least 6 months. Patients were divided into 2 groups, group 1 (n =10) with no pruritus and group 2 (n=40) with varying degrees of pruritus. Group 2 was further divided according to intensity of pruritus by visual analog score (VAS) into mild (n=10), moderate (n=20), and severe pruritus (n=10). Results There was a significant difference in serum lead levels and ferritin levels between groups 1 and 2 (p value < 0.01 and < 0.05, respectively). There was a statistically significant difference in serum lead levels in the groups with varying intensity of pruritus, having higher serum lead levels in patients who exhibited severe pruritus (p value < 0.005) Moreover, a statistically significant relation between elevated blood lead levels and the duration of dialysis was observed in this study. Conclusion Uremic pruritus is a multi-factorial phenomenon, and our study showed that blood lead levels in hemodialysis patients might be associated with increased intensity of pruritus.

scholarly journals Knowledge, attitude and practice of evidence-based medicine among primary care practitioners in Malaysia: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044372
Author(s):  
Mat Nawi Zanaridah ◽  
Mohd Noor Norhayati ◽  
Zakaria Rosnani
Keyword(s):  
Primary Care ◽  
Evidence Based Medicine ◽  
Primary Care Physicians ◽  
Cross Sectional Study ◽  
Evidence Based ◽  
Sectional Study ◽  
Primary Care Practitioner ◽  
Cross Sectional ◽  
Primary Care Practitioners ◽  
Based Medicine

ObjectivesTo determine the level of knowledge and practice of evidence-based medicine (EBM) and the attitudes towards it and to identify the factors associated with its practice among primary care practitioners in Selangor, Malaysia.SettingThis cross-sectional study was conducted in randomly selected health clinics in Selangor. Data were collected from primary care physicians using self-administered questionnaires on knowledge, practice and attitudes regarding EBM.ParticipantsThe study included 225 respondents working in either government or private clinics. It excluded house officers and those working in public and private universities or who were retired from practice.ResultsA total of 32.9% had a high level of EBM knowledge, 12% had a positive attitude towards EBM and 0.4% had a good level of its practice. The factors significantly associated with EBM practice were ethnicity, attitude, length of work experience as a primary care practitioner and quick access to online reference applications on mobile phones.ConclusionsAlthough many physicians have suboptimal knowledge of EBM and low levels of practising it, majority of them have a neutral attitude towards EBM practice. Extensive experience as a primary care practitioner, quick access to online references on a mobile phone and good attitude towards EBM were associated with its practice.

scholarly journals Implementation of evidence-based practice and associated factors among nurses and midwives working in Amhara Region government hospitals: a cross-sectional study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Asrat Hailu Dagne ◽  
Mekonnen Haile Beshah ◽  
Bekalu Getnet Kassa ◽  
Eyaya Habtie Dagnaw
Keyword(s):  
Associated Factors ◽  
Evidence Based Practice ◽  
Cross Sectional Study ◽  
P Value ◽  
Evidence Based ◽  
Sectional Study ◽  
Cross Sectional ◽  
Work Index ◽  
Nurses And Midwives ◽  
Practice Skills

Abstract Background Implementation of evidence-based practice is crucial to enhance quality health care, professional development, and cost-effective health service. However, many factors influence the implementation of evidence-based practice. Therefore, this study aimed to assess the implementation of evidence-based practice and associated factors among nurses and midwives. Methods Institutional-based cross-sectional study design was conducted to assess the implementation of evidence-based practice and associated factors from February 15 to March 15, 2019, among 790 nurses and midwives. Data were entered into EpiData version 3.1 then exported to SPSS version 20 for statistical analysis. Categorical variables were presented as frequency tables. Continuous variables were presented as descriptive measures, expressed as mean and standard deviation. Cronbach’s alpha was used to measure reliability, mean, standard deviation, and inter-items correlation of the factors. Independent variables with a probability value (P-value) of less than 0.2 in the Chi-square analysis were entered in the multivariable logistic regression model. Statistically significant associated factors were identified at probability value (P-value) less than 0.05 and adjusted odds ratio with a 95% confidence interval. Results The mean age of participants was 28.35 (SD ± 4.5) years. This study revealed that 34.7% (95% CI 31.5–38%) of participants implemented evidence-based practice moderately or desirably. Age of participants (AOR = 5.98, CI 1.34–26.7), barriers of implementation of evidence-based practice (AOR = 4.8, CI 2.2–10.6), the attitude of participants (AOR = 5.02, CI 1.2–21.5), nursing/midwifery work index (AOR = 3.9, CI 1.4–10.87), self-efficacy of implementation of evidence-based practice skills (AOR = 12.5, CI 5.7–27.5) and knowledge of participants (AOR = 3.06, CI 1.6–5.77) were statistically significant associated factors of implementation of evidence-based practice Concussion Implementation of evidence-based practice of nurses and midwives was poor. Age of participants, barriers of implementation of evidence-based practice, the attitude of participants, self-efficacy of implementation of evidence-based practice skills, nursing/midwifery work index, and knowledge of participants were found to be predictors of implementation of evidence-based practice. Insufficient time and difficulty in judging the quality of research papers and reports were the most common barriers to the implementation of evidence-based practice.

scholarly journals Childbirth experience and practice changing during COVID‐19 pandemic: A cross‐sectional study

Nursing Open ◽  
2021 ◽  
Author(s):  
Annalisa Inversetti ◽  
Simona Fumagalli ◽  
Antonella Nespoli ◽  
Laura Antolini ◽  
Serena Mussi ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Childbirth Experience
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