<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1646-5830</journal-id>
<journal-title><![CDATA[Acta Obstétrica e Ginecológica Portuguesa]]></journal-title>
<abbrev-journal-title><![CDATA[Acta Obstet Ginecol Port]]></abbrev-journal-title>
<issn>1646-5830</issn>
<publisher>
<publisher-name><![CDATA[Euromédice, Edições Médicas Lda.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1646-58302022000200116</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Analysis of caesarean section rate in a referral hospital in Southern Brazil: Associated factors and Robson classification]]></article-title>
<article-title xml:lang="pt"><![CDATA[Análise da taxa de cesariana em hospital de referência no sul do Brasil: fatores associados e classificação de Robson]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Milléo]]></surname>
<given-names><![CDATA[Maria Luisa Cazula]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sens]]></surname>
<given-names><![CDATA[Marilin Muller]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Traebert]]></surname>
<given-names><![CDATA[Eliane]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Seemann]]></surname>
<given-names><![CDATA[Mayara]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Traebert]]></surname>
<given-names><![CDATA[Jefferson]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Nunes]]></surname>
<given-names><![CDATA[Rodrigo Dias]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Regional Dr. Homero de Miranda Gomes  ]]></institution>
<addr-line><![CDATA[São José Santa Catarina]]></addr-line>
<country>Brasil</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidade do Sul de Santa Catarina Programa de Pós-Graduação em Ciências da Saúde ]]></institution>
<addr-line><![CDATA[Palhoça Santa Catarina]]></addr-line>
<country>Brazil</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidade do Sul de Santa Catarina  ]]></institution>
<addr-line><![CDATA[Palhoça Santa Catarina]]></addr-line>
<country>Brazil</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>06</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>06</month>
<year>2022</year>
</pub-date>
<volume>16</volume>
<numero>2</numero>
<fpage>116</fpage>
<lpage>124</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S1646-58302022000200116&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S1646-58302022000200116&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S1646-58302022000200116&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Overview and Aims:  Indiscriminate increasing number of caesarean section has raised interest worldwide and has been subject of countless discussion. The aim of this study was to analyze the caesarean section rate according to Robson classification and to identify associated factors in a referral hospital in Southern Brazil.  Study Design:  Cross-sectional study.  Population:  Data from all births occurred in one-year-period carried out at a referral hospital in the southern Brazilian state of Santa Catarina.  Methods:  Gestational characteristics were categorized according to Robson classification criteria. The dependent variable was caesarean section rate and the clinical-obstetric characteristics were the independent variables. Adjusted models were obtained through Poisson Regression analysis.  Results:  The caesarean section rate was 35.5%. According to Robson classification, group 3 showed the highest occurrence. Among the groups with greatest impact in caesarean section rates, group 5 showed the highest proportion among all cesareans. Prevalence of statistically higher caesarean section rate was found in women aged 25 and 35 years and who had previously performed caesarean section. Statistically lower prevalence was found in women who had previous vaginal delivery, with spontaneous labor and those with induced labor.  Conclusion:  The highest caesarean section rate was observed in group 3 of Robson classification. Age and previous caesarean section were shown to be associated with the higher caesarean section rates.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Visão Geral e Objetivos:  O aumento indiscriminado do número de cesarianas tem despertado interesse em todo o mundo e tem sido objeto de inúmeras discussões. O objetivo deste estudo foi analisar a taxa de cesarianas segundo a classificação de Robson e identificar os fatores associados em um hospital de referência no sul do Brasil.  Desenho do Estudo:  Estudo transversal. População: Dados de todos os partos ocorridos no período de um ano realizados em um hospital de referência no sul do estado brasileiro de Santa Catarina.  Métodos:  As características gestacionais foram categorizadas de acordo com os critérios de classificação de Robson. A variável dependente foi a taxa de cesariana e as características clínico-obstétricas foram as variáveis independentes. Os modelos ajustados foram obtidos por meio da análise de Regressão de Poisson.  Resultados:  A taxa de cesariana foi de 35,5%. De acordo com a classificação de Robson, o grupo 3 apresentou a maior ocorrência. Entre os grupos com maior impacto nas taxas de cesarianas, o grupo 5 apresentou a maior proporção entre todas as cesarianas. A prevalência de taxa de cesariana estatisticamente maior foi encontrada em mulheres com idade entre 25 e 35 anos e que já haviam realizado cesariana anteriormente. Prevalência estatisticamente menor foi encontrada em mulheres que tiveram parto vaginal prévio, com trabalho de parto espontâneo e naquelas com trabalho de parto induzido.  Conclusão:  A maior taxa de cesariana foi observada no grupo 3 da classificação de Robson. A idade e cesariana anterior mostraram-se associadas às maiores taxas de cesariana.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Caesarean section]]></kwd>
<kwd lng="en"><![CDATA[Prevalence ratio]]></kwd>
<kwd lng="en"><![CDATA[Robson criteria]]></kwd>
<kwd lng="pt"><![CDATA[Cesárea]]></kwd>
<kwd lng="pt"><![CDATA[Taxa de prevalência]]></kwd>
<kwd lng="pt"><![CDATA[Classificação de Robson]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Freitas]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<source><![CDATA[Rotinas em Obstetrícia]]></source>
<year>2017</year>
<publisher-loc><![CDATA[Porto Alegre ]]></publisher-loc>
<publisher-name><![CDATA[Artmed]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Betrán]]></surname>
<given-names><![CDATA[AP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Rates of Cesarean: analysis of global, regional and national estimates]]></article-title>
<source><![CDATA[Paediatr Perinat Epidemiol]]></source>
<year>2007</year>
<volume>21</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>98-113</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<collab>World Health Organization</collab>
<article-title xml:lang=""><![CDATA[Appropriate technology for birth]]></article-title>
<source><![CDATA[Lancet]]></source>
<year>1985</year>
<volume>2</volume>
<numero>8452</numero>
<issue>8452</issue>
<page-range>436-7</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="book">
<collab>WHO Statement on Caesarean Section Rates</collab>
<source><![CDATA[]]></source>
<year>2018</year>
<publisher-loc><![CDATA[Geneva ]]></publisher-loc>
<publisher-name><![CDATA[World Health Organization]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Betrán]]></surname>
<given-names><![CDATA[AP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The increasing trend in caesarean rates: global, regional and national estimates: 1990-2014]]></article-title>
<source><![CDATA[PLoS One]]></source>
<year>2016</year>
<volume>11</volume>
<numero>2</numero>
<issue>2</issue>
</nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ribeiro]]></surname>
<given-names><![CDATA[VS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Why are the rates of cesarean in Brazil higher in more developed cities than in less developed ones?]]></article-title>
<source><![CDATA[Braz J Med Biol Res]]></source>
<year>2007</year>
<volume>40</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>1211-20</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="">
<collab>Ministério da Saúde</collab>
<source><![CDATA[MS/SVS/DASIS - Dados de 2012. Sistema de Informações sobre Nascidos Vivos SINASC e SIP/ANS]]></source>
<year>2018</year>
</nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mylonas]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Friese]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Indications for and risks of elective cesarean section]]></article-title>
<source><![CDATA[Dtsch Arztebl Int]]></source>
<year>2015</year>
<volume>112</volume>
<numero>29-30</numero>
<issue>29-30</issue>
<page-range>489-95</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Souza]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Maternal near miss and maternal death in the World Health Organization's 2005 global survey on maternal and perinatal health]]></article-title>
<source><![CDATA[Bull World Health Organ]]></source>
<year>2010</year>
<volume>88</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>113-9</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="book">
<collab>World Health Organization</collab>
<source><![CDATA[WHO Statement on Caesarean Rates]]></source>
<year>2015</year>
<publisher-loc><![CDATA[Geneva ]]></publisher-loc>
<publisher-name><![CDATA[World Health Organization]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="">
<collab>World Health Organization</collab>
<source><![CDATA[Robson Classification: Implementation Manual]]></source>
<year>2020</year>
</nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Robson]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Classification of caesarean]]></article-title>
<source><![CDATA[Fetal Mat Med Rev]]></source>
<year>2001</year>
<volume>12</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>23-39</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sakae]]></surname>
<given-names><![CDATA[TM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Factors associated with cesarean rates in a university hospital]]></article-title>
<source><![CDATA[Rev Saude Publica]]></source>
<year>2009</year>
<volume>43</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>472-80</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Villar]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America]]></article-title>
<source><![CDATA[Lancet]]></source>
<year>2006</year>
<volume>367</volume>
<numero>9525</numero>
<issue>9525</issue>
<page-range>1819-29</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ferreira]]></surname>
<given-names><![CDATA[EC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Robson ten-group classification system for appraising deliveries at a tertiary referral hospital in Brazil]]></article-title>
<source><![CDATA[Int J Gynaecol Obstet]]></source>
<year>2015</year>
<volume>129</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>236-9</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Moura]]></surname>
<given-names><![CDATA[VA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Avaliação de cesáreas na Maternidade Escola Assis Chateaubriand utilizando o sistema de classificação de Robson em dez grupos]]></article-title>
<source><![CDATA[Rev Med UFC]]></source>
<year>2017</year>
<volume>57</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>25-9</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Robson]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Quality assurance: the 10-Group Classification System (Robson classification), induction of labor, and cesarean delivery]]></article-title>
<source><![CDATA[Int J Gynaecol Obstet]]></source>
<year>2015</year>
<volume>131</volume>
<numero>Suppl 1</numero>
<issue>Suppl 1</issue>
<page-range>S23-7</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Faundes]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A operação cesárea no Brasil: incidência, tendências, causas, conseqüências e propostas de ação]]></article-title>
<source><![CDATA[Cad Saude Publica]]></source>
<year>1991</year>
<volume>7</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>150-73</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Barber]]></surname>
<given-names><![CDATA[EL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Indications contributing to the increasing CS delivery rate]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2011</year>
<volume>118</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>29-38</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Briand]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Individual and institutional determinants of caesarean in referral hospitals in Senegal and Mali: a cross-al epidemiological survey]]></article-title>
<source><![CDATA[BMC Pregnancy Childbirth]]></source>
<year>2012</year>
<volume>12</volume>
<page-range>114</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Delnord]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Varying gestational age patterns in cesarean delivery: an international comparison]]></article-title>
<source><![CDATA[BMC Pregnancy Childbirth]]></source>
<year>2014</year>
<volume>14</volume>
<page-range>321</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[HR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Risk of CS after induced versus spontaneous labor at term gestation]]></article-title>
<source><![CDATA[Obstet Gynecol Sci]]></source>
<year>2015</year>
<volume>58</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>346-52</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kelly]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Examining caesarean rates in Canada using the Robson Classification System]]></article-title>
<source><![CDATA[J Obstet Gynaecol Can]]></source>
<year>2013</year>
<volume>35</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>206-14</page-range></nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Betran]]></surname>
<given-names><![CDATA[AP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[WHO global survey on maternal and perinatal health in Latin America: classifying caesarean sections]]></article-title>
<source><![CDATA[Reprod Health]]></source>
<year>2009</year>
<volume>6</volume>
<numero>18</numero>
<issue>18</issue>
</nlm-citation>
</ref>
<ref id="B25">
<label>25</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vogel]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Use of the Robson classification to assess caesarean trends in 21 countries: a secondary analysis of two WHO multicountry surveys]]></article-title>
<source><![CDATA[Lancet Glob Health]]></source>
<year>2015</year>
<volume>3</volume>
<numero>5</numero>
<issue>5</issue>
</nlm-citation>
</ref>
<ref id="B26">
<label>26</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[CHM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Use of the Robson Classification System for the improvement and adequacy of the ways of delivery in maternities and hospitals. An opportunity to reduce unnecessary cesarean rates]]></article-title>
<source><![CDATA[Rev Bras Ginecol Obstet]]></source>
<year>2018</year>
<volume>40</volume>
<page-range>377-8</page-range></nlm-citation>
</ref>
<ref id="B27">
<label>27</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ferreira]]></surname>
<given-names><![CDATA[EC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Robson ten-group classification system for appraising deliveries at a tertiary referral hospital in Brazil]]></article-title>
<source><![CDATA[Int J Gynecol Obstet]]></source>
<year>2015</year>
<numero>129</numero>
<issue>129</issue>
<page-range>236-9</page-range></nlm-citation>
</ref>
<ref id="B28">
<label>28</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vargas]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Robson Classification System applied to induction of labor]]></article-title>
<source><![CDATA[Rev Bras Ginecol Obstet]]></source>
<year>2018</year>
<volume>40</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>513-7</page-range></nlm-citation>
</ref>
<ref id="B29">
<label>29</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Freitas]]></surname>
<given-names><![CDATA[PF]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Inequalities in cesarean delivery rates by ethnicity and hospital accessibility in Brazil]]></article-title>
<source><![CDATA[Int J Gynaecol Obstet]]></source>
<year>2009</year>
<volume>107</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>198-201</page-range></nlm-citation>
</ref>
<ref id="B30">
<label>30</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Boatin]]></surname>
<given-names><![CDATA[AA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Audit and feedback using the Robson classification to reduce caesarean section rates: a systematic review]]></article-title>
<source><![CDATA[BJOG]]></source>
<year>2018</year>
<volume>125</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>36-42</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
