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The Project Appropriate Birth and Reduction of Cesarean Section Rates: an analysis using the Robson classification system
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  • Daniela Ferreira D’Agostini Marin,
  • Amanda Wernke,
  • Daniela Dannehl,
  • Dyulie Araujo,
  • Gustavo Koch,
  • Karizy Zanoni,
  • Katiane Coral,
  • Nathan Guimarães,
  • Otto Feuerschuette,
  • Betine Iser
Daniela Ferreira D’Agostini Marin
UNISUL
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Amanda Wernke
UNISUL
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Daniela Dannehl
UNISUL
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Dyulie Araujo
UNISUL
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Gustavo Koch
UNISUL
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Karizy Zanoni
UNISUL
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Katiane Coral
UNISUL
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Nathan Guimarães
UNISUL
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Otto Feuerschuette
UNISUL
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Betine Iser
UNISUL
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Abstract

OBJECTIVE: The objective of this study was to evaluate C-section rates, before and after the implementation of the Project Appropriate Birth based on the Robson 10-group classification system. DESIGN: An observational, cross-sectional study. SETTING: Maternity hospital in South Brazil. POPULATION: All pregnant women attending, April 2016 through April 2017 (phase 1, pre-implementation of the Project Appropriate Birth) and June 2017 through June 2018 (phase 2, post-implementation of the Project Appropriate Birth). METHODS: Maternal and obstetric characteristics were evaluated, including Robson’s classification, based on the characteristics of pregnancy and childbirth. Chi-square test and crude and adjusted prevalence ratios were used to analyze study variables. The significance level was set at 5%. MAIN OUTCOME MEASURES: C-section rate for each group, their contribution to the overall c-section rate and the differences in these contributions before and after PPA implementation. RESULTS: C-section rates decreased from 62.4% to 55.6%, which represented a 10.9% reduction after the implementation of the Project Appropriate Birth. Pregnant women in Robson classification groups 1 through 4 had the greatest decrease in C-section rates, ranging from 49.1% to 38.6%, which represents a 21.5% reduction. The greatest contributors to the overall C-section rates were group 5 and group 2, accounting for more than 60% of the C-section deliveries. CONCLUSION: The Project Appropriate Birth had an important impact on the reduction of C-section rates, especially in Robson classification groups 1 through 4, which indicates that providing mothers with evidence-based interventions for labor and childbirth assistance will contribute to reduce C-section rates.

Peer review status:ACCEPTED

07 Feb 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
08 Feb 2021Submission Checks Completed
08 Feb 2021Assigned to Editor
16 Feb 2021Reviewer(s) Assigned
10 Mar 2021Review(s) Completed, Editorial Evaluation Pending
10 Apr 2021Editorial Decision: Revise Major
11 May 20211st Revision Received
11 May 2021Submission Checks Completed
11 May 2021Assigned to Editor
11 May 2021Review(s) Completed, Editorial Evaluation Pending
11 May 2021Reviewer(s) Assigned
28 May 2021Editorial Decision: Revise Minor
29 May 20212nd Revision Received
01 Jun 2021Submission Checks Completed
01 Jun 2021Assigned to Editor
01 Jun 2021Review(s) Completed, Editorial Evaluation Pending
18 Jun 2021Editorial Decision: Accept