Classifications for Cesarean Section: A Systematic Review

Show simple item record Torloni, Maria Regina [UNIFESP] Betran, Ana Pilar Souza, Joao Paulo Widmer, Mariana Allen, Tomas Gulmezoglu, Metin Merialdi, Mario 2016-01-24T14:06:03Z 2016-01-24T14:06:03Z 2011-01-20
dc.identifier.citation Plos One. San Francisco: Public Library Science, v. 6, n. 1, 10 p., 2011.
dc.identifier.issn 1932-6203
dc.description.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. en
dc.format.extent 10
dc.language.iso eng
dc.publisher Public Library Science
dc.relation.ispartof Plos One
dc.rights Acesso aberto
dc.title Classifications for Cesarean Section: A Systematic Review en
dc.type Artigo
dc.contributor.institution Universidade Federal de São Paulo (UNIFESP)
dc.contributor.institution Brazilian Cochrane Ctr
dc.contributor.institution World Hlth Org
dc.description.affiliation Universidade Federal de São Paulo, Dept Obstet, São Paulo, Brazil
dc.description.affiliation Brazilian Cochrane Ctr, São Paulo, Brazil
dc.description.affiliation World Hlth Org, Dept Reprod Hlth & Res, Geneva, Switzerland
dc.description.affiliation World Hlth Org, Dept Knowledge Management & Sharing, Geneva, Switzerland
dc.description.affiliationUnifesp Universidade Federal de São Paulo, Dept Obstet, São Paulo, Brazil
dc.identifier.file WOS000286522200007.pdf
dc.identifier.doi 10.1371/journal.pone.0014566
dc.description.source Web of Science
dc.identifier.wos WOS:000286522200007


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