Analysis of ways of delivery in the different health scenarios in Uruguay

Abstract

Background:

In Uruguay, the Ministry of Public Health has set the reduction of unnecessary C-sections as one of the “National Health Goals”, as it considers this a public health issue.

Objectives:

To analyse the C-section rates by health sector: the private sector versus the public sector and Montevideo versus the rest of the country, using the Robson classification and an input to be used to reduce the rate.

Method:

Transversal descriptive study that categorizes every birth in Uruguay during 2017 according to the Robson criterion in one of the 10 groups, depending on the healthcare center and the geographical place of birth, reporting the relative size, the C-section rate and the absolute and relative contributions of each group to the global CS rate.

Results:

In 2017 the CS rare was 44%. The groups that contributed the most to the global CS rate (70% of the CS in the country) were the following: women with previous CS, elective CS or failed induced labor in nulliparous women and the term nulliparous women with spontaneous initiation of labor group.

After adjusting the prognostic variables, the possibility of ending up in CS in the private sector was 18% higher than in the public sector, without there being any differences in terms of the perinatal results. CS rates by Robson group in Montevideo and the rest of the country are very similar.

Conclusions:

Vaginal birth must be encouraged after a CS, elective CS and unnecessary induction of labor must be avoided, and the number of first CS needs to be reduced. These are the measures proposed to reduce the unnecessary CS rates. Clinical guidelines based on the best scientific evidence that systematize these interventions will contribute to the implementation of changes.