Analysis of caesarean section referrals in a normal-risk public maternity hospital in southern Brazil

The World Health Organization recommends the Robson Classification1 as a standard instrument for classifying cesarean section referrals. The aim of this study was to analyze cesarean section referrals in a public normal-risk maternity hospital in Curitiba, capital of Paraná, Brazil. This was a retrospective cross-sectional documentary study with a quantitative approach. Data on clinical conditions and obstetric history were collected from medical records of 186 women who underwent cesarean sections, as well as the reasons for their referral, from August 2017 to January 2018. Data were subjected to frequency analyses. The groups with the highest concentration of cesarean sections were: Group 5 (31.2%) of multiparous women with a previous cesarean section, and Groups 2 (26.3%) and 4 (14%), of nulliparous and multiparous women without previous caesarean section, respectively, whose deliveries were induced or the cesarean section occurred before labor began. The main reasons for cesarean sections were related to complications of labor, such as breech presentation and failure to induce labor; maternal conditions such as iterativity and cephalopelvic disproportion; and fetal conditions, in which fetal distress and other associated conditions stood out. The analysis of the contribution of each group in the total number of cesarean sections, associated with the analysis of their reasons recorded in the medical records, provides clinical and legal support to justify or recommend the appropriate indication of this procedure, with a view to safe and good quality obstetric care, centered on women, in their clinical condition and obstetric history, and based on current scientific evidence.