title: WHO global survey on maternal and perinatal health in Latin America: classifying caesarean sections.
abstract: BACKGROUND
  Caesarean section rates continue to increase worldwide with uncertain medical consequences. Auditing and analysing caesarean section rates and other perinatal outcomes in a reliable and continuous manner is critical for understanding reasons caesarean section changes over time.
  
  
  METHODS
  We analyzed data on 97,095 women delivering in 120 facilities in 8 countries, collected as part of the 2004-2005 Global Survey on Maternal and Perinatal Health in Latin America. The objective of this analysis was to test if the "10-group" or "Robson" classification could help identify which groups of women are contributing most to the high caesarean section rates in Latin America, and if it could provide information useful for health care providers in monitoring and planning effective actions to reduce these rates.
  
  
  RESULTS
  The overall rate of caesarean section was 35.4%. Women with single cephalic pregnancy at term without previous caesarean section who entered into labour spontaneously (groups 1 and 3) represented 60% of the total obstetric population. Although women with a term singleton cephalic pregnancy with a previous caesarean section (group 5) represented only 11.4% of the obstetric population, this group was the largest contributor to the overall caesarean section rate (26.7% of all the caesarean sections). The second and third largest contributors to the overall caesarean section rate were nulliparous women with single cephalic pregnancy at term either in spontaneous labour (group 1) or induced or delivered by caesarean section before labour (group 2), which were responsible for 18.3% and 15.3% of all caesarean deliveries, respectively.
  
  
  CONCLUSIONS
  The 10-group classification could be easily applied to a multicountry dataset without problems of inconsistencies or misclassification. Specific groups of women were clearly identified as the main contributors to the overall caesarean section rate. This classification could help health care providers to plan practical and effective actions targeting specific groups of women to improve maternal and perinatal care.
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. betrana@who.int
authors.forename: Ana P
authors.initials: AP
authors.lastname: Betrán
authors.forename: A Metin
authors.initials: AM
authors.lastname: Gulmezoglu
authors.forename: Michael
authors.initials: M
authors.lastname: Robson
authors.forename: Mario
authors.initials: M
authors.lastname: Merialdi
authors.forename: João P
authors.initials: JP
authors.lastname: Souza
authors.forename: Daniel
authors.initials: D
authors.lastname: Wojdyla
authors.forename: Mariana
authors.initials: M
authors.lastname: Widmer
authors.forename: Guillermo
authors.initials: G
authors.lastname: Carroli
authors.forename: Maria R
authors.initials: MR
authors.lastname: Torloni
authors.forename: Ana
authors.initials: A
authors.lastname: Langer
authors.forename: Alberto
authors.initials: A
authors.lastname: Narváez
authors.forename: Alejandro
authors.initials: A
authors.lastname: Velasco
authors.forename: Anibal
authors.initials: A
authors.lastname: Faúndes
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Acosta
authors.forename: Eliette
authors.initials: E
authors.lastname: Valladares
authors.forename: Mariana
authors.initials: M
authors.lastname: Romero
authors.forename: Nelly
authors.initials: N
authors.lastname: Zavaleta
authors.forename: Sofia
authors.initials: S
authors.lastname: Reynoso
authors.forename: Vicente
authors.initials: V
authors.lastname: Bataglia