Resumo Objetivo Utilizar a Classificação de Dez Grupos de Robson (RTGC, na sigla em inglês) para analisar as taxas de cesárea (CS, na sigla em inglês) em uma maternidade hondurenha. Métodos Estudo de corte transversal em uma maternidade em Honduras. As mulheres internadas para o parto (agosto de 2017 a outubro de 2018) foram classificadas segundo a RTGC. Calculou-se a taxa de CS para cada grupo e a contribuição para a taxa geral de CS, com análises adicionais da indução do trabalho de parto entre as primíparas a termo (grupo 2a), multíparas a termo (grupo 4a) e casos com uma CS anterior (grupo 5.1). Resultados foram consideradas 4.356 mulheres, com uma taxa geral de CS de 26.1%. O Grupo 3 foi o maior grupo, com 38,.6% (1.682/4.356) dos casos; seguido pelo Grupo 1, com 30,8% (1.342/4.356), e pelo Grupo 5, com 10,3% (450/4,356). Considerando a contribuição para as taxas globais de CS por grupo, o Grupo 5 contribuiu com 30,4% (345/1,136) das CS, dos quais 286 (82.9%) tinha uma CS anterior, com um índice de CS > 70%. Os grupos 1 e 3, com 291/1.136 (26.6%) e 153/1.136 (13,5%), respectivamente, foram o segundo e terceiro maiores contribuintes para a taxa de CS. Os grupos 2a e 4a tiveram alto sucesso de indução, com baixas taxas de CS (18.4 e 16.9%, respectivamente). Conclusão O RTGC é uma ferramenta útil para avaliar as taxas de CS em diferentes unidades de saúde. Os grupos 5, 1 e 3 foram os principais contribuintes para a taxa de CS. Estes achados podem apoiar intervenções futuras para reduzir as CS desnecessárias, especialmente entre primíparas e em mulheres com uma CS anterior.

Abstract Objective To use the Robson Ten Group Classification (RTGC) to analyze cesarean section (CS) rates in a Honduran maternity hospital, with focus in groups that consider induction of labor. Methods Cross-sectional study. Women admitted for childbirth (August 2017 to October 2018) were classified according to the RTGC. The CS rate for each group and the contribution to the overall CS rate was calculated, with further analyses of the induction of labor among term primiparous (group 2a), term multiparous (group 4a), and cases with one previous CS (group 5.1). Results A total of 4,356 women were considered, with an overall CS rate of 26.1%. Group 3 was the largest group, with 38.6% (1,682/4,356) of the cases, followed by Group 1, with 30.8% (1,342/4,356), and Group 5, with 10.3% (450/4,356). Considering the contribution to overall CS rates per group, Group 5 contributed with 30.4% (345/1,136) of the CSs and within this group, 286/345 (82.9%) had 1 previous CS, with a CS rate > 70%. Groups 1 and 3, with 26.6% (291/1,136) and 13.5% (153/1,136), respectively, were the second and third larger contributors to the CS rate. Groups 2a and 4a had high induction success, with low CS rates (18.4 and 16.9%, respectively). Conclusion The RTGC is a useful tool to assess CS rates in different healthcare facilities. Groups 5, 1, and 3 were the main contributors to the CS rate, and groups 2 and 4 showed the impact and importance of induction of labor. These findings may support future interventions to reduce unnecessary CS, especially among primiparous and in women with previous CS.

SUMMARY OBJECTIVE: The main aim of this study was to assess the associated factors for selective mediolateral episiotomy at a tertiary, academic hospital. METHODS: A retrospective cohort analysis between 2017 and 2019 was performed. The primary outcome was the prevalence of selective mediolateral episiotomy. Independent variables were maternal, intrapartum, and neonatal characteristics. A significance level of 5% was established, and univariate and multivariate analyses with logistic regression models were performed. RESULTS: From 2,761 vaginal deliveries eligible for inclusion during this period, the prevalence of selective mediolateral episiotomy was 18.7%. Univariate analysis has shown that non-white women were protective factors (OR=0.77 [0.63–0.96]; p=0.02) for episiotomy; primiparity (OR=2.61 [2.12–3.21]; p<0.01), number of vaginal examinations between 6–10 repetitions (OR=3.16 [2.48–4.01]; p<0.01) and 11–20 repetitions (OR=5.40 [3.69–7.90]; p<0.01), longer second stage duration (OR=1.01 [1.00–1.02]; p<0.01), and women with gestational age more than 37 weeks were risk factors. Multivariate analysis reported that second stage duration (AOR=1.01 [1.00–1.03]; p<0.01), primiparity (AOR=2.03 [1.34–3.06]; p<0.01), and number of vaginal examinations between 6–10 repetitions (AOR=2.36 [1.50–3.70]; p<0.01) and 11–20 repetitions (AOR=3.29 [1.74–6.20]; p<0.01) were remained as risk factors for selective mediolateral episiotomy. CONCLUSION: A higher number of vaginal examinations during labor (over six repetitions), longer duration of second stage labor, and primiparity were risk factors associated with selective mediolateral episiotomy.

OBJETIVO: avaliar a prevalência e os fatores de risco associados à morbidade materna grave numa maternidade terciária. MÉTODOS: trata-se de um estudo de corte transversal dos casos de morbidade materna grave atendidos no Hospital e Maternidade Celso Pierro entre outubro de 2005 e julho de 2006, identificados a partir dos livros de controle das unidades de internação, pronto atendimento e centro obstétrico. Foram estudadas gestantes e puérperas que apresentavam condições definidoras de morbidade materna grave a partir dos diagnósticos clínicos segundo critérios propostos por Waterstone. Posteriormente, os casos de maior gravidade clínica, chamados de morbidade extremamente grave, foram reclassificados utilizando-se os critérios definidores de Mantel, baseados em disfunção orgânica e manejo. RESULTADOS: foram identificadas 114 mulheres com morbidade materna grave entre 2.207 partos, com razão de outra morbidade grave e morbidade extremamente grave de 44,9 e 6,8 casos por 1.000 partos, respectivamente. A média da idade gestacional no parto foi de 35 semanas e 87% das mulheres vieram de área de cobertura da maternidade no município. A hipertensão (pré-eclâmpsia grave) representou 96% de outras morbidades graves e a hemorragia esteve presente em 60% dos casos de morbidade extremamente grave, seguida de hipertensão. A prevalência de morbidade extremamente grave entre os casos de morbidade grave não se associou com estado marital, escolaridade, idade materna, tipo de parto, gestações, idade gestacional e distrito de saúde de moradia. CONCLUSÕES: as outras morbidades graves foram 6,6 vezes mais freqüentes que os casos extremamente graves, sem diferenças entre os grupos por fatores de risco epidemiológicos.

PURPOSE: to assess the prevalence and risk factors associated with near miss and other severe maternal morbidity at a reference tertiary maternity. METHODS: this is a cross-sectional study on severe maternal morbidity at the Hospital e Maternidade Celso Pierro, Campinas, São Paulo, between October 2005 and July 2006, identified from infirmary, admission and delivery unit logbooks. Pregnant and post-partum women with severe maternal morbidity were identified according to clinical criteria proposed by Waterstone. Later, cases with more severe morbidity, called extremely severe maternal morbidity, were reclassified using Mantel criteria, based on organic dysfunction and clinical management. RESULTS: there were 114 severe maternal morbidity cases among 2,207 birth deliveries, with a ratio of other severe morbidity and extremely severe morbidity near miss of 44.9 and 6.8 cases/1,000 live births, respectively. Mean gestational age at delivery was 35 weeks, and 87% came from the reference area for the maternity service. Hypertension (severe pre-eclampsia) represented 96% of other severe morbidity, while hemorrhage represented 60% of all extremely severe cases, followed by hypertension. The prevalence of extremely severe morbidity among the severe morbidity cases was not associated with marital status, schooling, maternal age, type of delivery, parity, gestational age at birth and home place. CONCLUSIONS: the other morbidities were 6.6 times more frequent than near miss, and it was not possible to differentiate both groups by epidemiological risk factors.

No Brasil, onde 90% dos partos ocorrem em hospitais, 67,1% das mortes são devidas a causas obstétricas diretas, predominando transtornos hipertensivos, enquanto as causas obstétricas indiretas são responsáveis por um quarto do total. Como a morte materna é um evento incomum, estimado em 76/100.000, o estudo da morbidade materna grave, seguindo a tendência da literatura, pode contribuir para qualificar o cuidado obstétrico. A morbidade materna é um continuum que termina na morte, podendo-se reconhecer um grupo de extrema gravidade, conhecido como "near miss". Embora os conceitos sejam claros, não há consenso na literatura quanto aos critérios definidores dos casos de morbidade grave ou mesmo morbidade extremamente grave ou near miss. Sua prevalência pode variar, de 0,80-8,23%, a depender dos critérios de definição utilizados e da assistência à saúde oferecida na região. A caracterização da morbidade grave e, particularmente, do near miss, permite o monitoramento do processo de atenção obstétrica e pode qualificar o tratamento das urgências e emergências maternas, interrompendo o processo que pode levar ao óbito.

In Brazil, where 90% of the childbirths occur in hospitals, 67.1% of the cases of maternal death are due to direct obstetric causes, mainly hypertensive disorders, but a quarter of the deaths are due to indirect obstetric causes. As maternal death is a rare event, estimated in 76/100,000, the study of severe maternal morbidity, following international literature, can contribute to qualify obstetrical care. Maternal morbidity is a continuum that ends with death, but there is a separate group, with extreme severity, known as near miss. From the literature review, there are the difficulties to obtain an operational definition of the cases of extremely severe morbidity or near miss. The prevalence ranged from 0.80-8.23%, according to the defining criteria and health care provided at the region. The characterization of severe maternal morbidity and near miss allows for monitoring the process of obstetrical care and could help to qualify treatment of maternal urgencies and emergencies, interrupting the process that can lead to death.