Classifications for Cesarean Section: A Systematic Review

Classifications for Cesarean Section: A Systematic Review

Author Torloni, Maria Regina Autor UNIFESP Google Scholar
Betran, Ana Pilar Google Scholar
Souza, Joao Paulo Google Scholar
Widmer, Mariana Google Scholar
Allen, Tomas Google Scholar
Gulmezoglu, Metin Google Scholar
Merialdi, Mario Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Brazilian Cochrane Ctr
World Hlth Org
Abstract Background: Rising cesarean section (CS) rates are a major public health concern and cause worldwide debates. To propose and implement effective measures to reduce or increase CS rates where necessary requires an appropriate classification. Despite several existing CS classifications, there has not yet been a systematic review of these. This study aimed to 1) identify the main CS classifications used worldwide, 2) analyze advantages and deficiencies of each system.Methods and Findings: Three electronic databases were searched for classifications published 1968-2008. Two reviewers independently assessed classifications using a form created based on items rated as important by international experts. Seven domains (ease, clarity, mutually exclusive categories, totally inclusive classification, prospective identification of categories, reproducibility, implementability) were assessed and graded. Classifications were tested in 12 hypothetical clinical case-scenarios. From a total of 2948 citations, 60 were selected for full-text evaluation and 27 classifications identified. Indications classifications present important limitations and their overall score ranged from 2-9 (maximum grade = 14). Degree of urgency classifications also had several drawbacks (overall scores 6-9). Woman-based classifications performed best (scores 5-14). Other types of classifications require data not routinely collected and may not be relevant in all settings (scores 3-8).Conclusions: This review and critical appraisal of CS classifications is a methodologically sound contribution to establish the basis for the appropriate monitoring and rational use of CS. Results suggest that women-based classifications in general, and Robson's classification, in particular, would be in the best position to fulfill current international and local needs and that efforts to develop an internationally applicable CS classification would be most appropriately placed in building upon this classification. the use of a single CS classification will facilitate auditing, analyzing and comparing CS rates across different settings and help to create and implement effective strategies specifically targeted to optimize CS rates where necessary.
Language English
Date 2011-01-20
Published in Plos One. San Francisco: Public Library Science, v. 6, n. 1, 10 p., 2011.
ISSN 1932-6203 (Sherpa/Romeo, impact factor)
Publisher Public Library Science
Extent 10
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000286522200007

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