SISTEMA DE CLASSIFICAÇÃO DE ROBSON: ANÁLISE DAS INDICAÇÕES DE CESARIANAS EM UMA MATERNIDADE DE REFERENCIA NO SUL DO MARANHÃO

Abstract

Cesarean section is an essential surgical procedure in situations of maternal-fetal risk; however, its excessive use represents a public health challenge due to potential risks for both mother and baby. The World Health Organization (WHO) recommends that the cesarean rate should not exceed 15% of total births. Nevertheless, data from 2022 indicate that in Brazil, 58.1% of deliveries were performed by cesarean section, highlighting a considerable discrepancy between the recommended rate and the observed reality. In this context, the Robson Classification System emerges as a standardized tool to identify, monitor, and audit cesarean rates, thus helping to identify priority groups for interventions, enabling the reduction of unnecessary cesarean practices and promoting vaginal delivery. This study aimed to analyze the indications for cesarean sections in a referral maternity hospital in southern Maranhão based on the Robson Classification System. It is a cross-sectional, observational, quantitative, and retrospective study that analyzed data from the medical records of 2,665 births registered in 2023, with data collection conducted between March and July 2024. The variables analyzed included sociodemographic and obstetric profiles, mode of delivery, medical description of cesarean indications, and Robson Classification groups and subgroups. Statistical analysis was performed using IBM SPSS software, employing the Chi-square test with a significance level of 5%. The study revealed a cesarean rate of 44%, higher than the WHO recommendation, which can be partially justified by the nature of the maternity hospital, which handles high-risk cases. Variables such as advanced maternal age, higher education, paid employment, multiparity, history of abortion, and certain comorbidities showed significant associations with the occurrence of cesarean sections. Groups 3, 1, and 5.1 of the Robson Classification contributed the most to the cesarean rates, with the main clinical indications being fetal conditions, previous cesarean section, and hypertensive syndromes. The results highlight the need for more individualized obstetric care to reduce unnecessary interventions, promoting vaginal delivery when indicated. This study reinforces the relevance of the Robson Classification for obstetric management and the necessity to improve clinical records and staff training to optimize decisions regarding the mode of delivery.