<?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>1688-0390</journal-id>
<journal-title><![CDATA[Revista Médica del Uruguay]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Méd. Urug.]]></abbrev-journal-title>
<issn>1688-0390</issn>
<publisher>
<publisher-name><![CDATA[Sindicato Médico del Uruguay]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-03902019000200004</article-id>
<article-id pub-id-type="doi">10.29193/rmu.35.2.1</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Análisis de la vía del parto en los diferentes escenarios asistenciales en Uruguay]]></article-title>
<article-title xml:lang="en"><![CDATA[Analysis of ways of delivery in the different health scenarios in Uruguay]]></article-title>
<article-title xml:lang="pt"><![CDATA[Análise da via de parto nos diferentes setores assistenciais no Uruguai]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Briozzo]]></surname>
<given-names><![CDATA[Leonel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Tomasso]]></surname>
<given-names><![CDATA[Giselle]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Colistro]]></surname>
<given-names><![CDATA[Valentina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de la República Facultad de Medicina Hospital de la Mujer, Centro Hospitalario Pereira Rossell]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de la República Facultad de Medicina Hospital de la Mujer, Centro Hospitalario Pereira Rossell]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidad de la República Facultad de Medicina Departamento de Métodos Cuantitativos]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2019</year>
</pub-date>
<volume>35</volume>
<numero>2</numero>
<fpage>4</fpage>
<lpage>31</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-03902019000200004&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-03902019000200004&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-03902019000200004&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Antecedentes:  en Uruguay, el Ministerio de Salud ha seleccionado la disminución de las cesáreas innecesarias como uno de los objetivos sanitarios nacionales por considerarlo un problema de salud pública.  Objetivos:  analizar las tasas de cesáreas por sector asistencial: público versus privado y Montevideo versus interior, usando la clasificación de Robson como insumo para su disminución.  Material y método:  estudio descriptivo de corte transversal que categoriza cada nacimiento ocurrido en Uruguay en 2017 en uno de los diez grupos de Robson, según el sector de asistencia y el lugar geográfico donde ocurrió, informando el tamaño relativo, la tasa de cesáreas y las contribuciones absolutas y relativas hechas por cada grupo a la tasa global de cesáreas.  Resultados: la tasa de cesáreas en 2017 fue de 44%. Los grupos que más contribuyeron a la tasa global de cesáreas (70% de las cesáreas practicadas en el país) fueron: mujeres con una o más cesáreas previas, cesáreas electivas o inducciones fallidas en nulíparas y el grupo de nulíparas de término con inicio espontáneo. Luego de ajustar por las variables pronósticas, la probabilidad de terminar en cesáreas en el sector privado fue 18% mayor que en el sector público, sin mostrar diferencias en los resultados perinatales. Las tasas de cesáreas por grupos de Robson en Montevideo y en el interior se muestran muy similares.  Conclusiones:  fomentar el parto vaginal después de una cesáreas, evitar cesáreas electivas e inducciones innecesarias y disminuir la primera cesáreas son las medidas propuestas para bajar las tasas de cesáreas innecesarias. Guías clínicas basadas en la mejor evidencia científica que sistematicen estas intervenciones ayudarán a implementar los cambios.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Background: in Uruguay, the Ministry of Public Health has set the reduction of unnecessary C-sections as one of the &#8220;National Health Goals&#8221;, 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.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Antecedentes: o Ministério da Saúde do Uruguai (MS) definiu como um dos &#8220;Objetivos sanitários nacionais&#8221; a redução do número de cesáreas (CS) necessárias por considerar que este é um problema de saúde pública.  Objetivos: analisar as taxas de CS por setor assistencial: público vs privado e geográfico: Montevideo vs Interior usando a classificação de Robson, como insumo para sua redução.  Material e métodos:  estudo descritivo transversal que classifica cada nascimento ocorrido no Uruguai em 2017, em um dos 10 grupos de Robson de acordo com o setor de assistência e o lugar onde aconteceu, informando tamanho relativo, taxa de CS e as contribuições absolutas e relativas de cada grupo à taxa global de CS.  Resultados: a taxa de CS em 2017, foi de 44%. Os grupos que mais contribuíram para a taxa global de CS (70% das CSs realizadas no país) foram: as cesareadas previas, as cesáreas eletivas ou induções falidas em nulíparas e o grupo de nulíparas a termo com início espontâneo. Depois de ajustar pelas variáveis prognósticas, a probabilidade de terminar em CS no setor privado foi 18% maior que no setor público, sem diferenças nos resultados perinatais. As taxas de CS por grupos de Robson em Montevideo e no Interior foram similares.  Conclusões: fomentar o parto vaginal depois de uma CS, evitar CS eletivas e induções desnecessárias e diminuir a quantidade de primeira CS, são las medidas propostas para reduzir as taxas de cesáreas desnecessárias. Pautas clínicas baseadas na melhor evidência científica que sistematizem estas intervenções ajudarão a implementar as mudanças propostas.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Parto]]></kwd>
<kwd lng="es"><![CDATA[Cesárea]]></kwd>
<kwd lng="es"><![CDATA[Prevalencia]]></kwd>
<kwd lng="es"><![CDATA[Clasificación de Robson]]></kwd>
<kwd lng="es"><![CDATA[Servicios de salud]]></kwd>
<kwd lng="en"><![CDATA[Parturition]]></kwd>
<kwd lng="en"><![CDATA[Cesarean section]]></kwd>
<kwd lng="en"><![CDATA[Prevalence]]></kwd>
<kwd lng="en"><![CDATA[Robson classification]]></kwd>
<kwd lng="en"><![CDATA[Health services]]></kwd>
<kwd lng="pt"><![CDATA[Parto]]></kwd>
<kwd lng="pt"><![CDATA[Cesárea]]></kwd>
<kwd lng="pt"><![CDATA[Prevalência]]></kwd>
<kwd lng="pt"><![CDATA[Classificação de Robson, Serviços de saúde]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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