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Adami ADG, da Motta LR, Sperhacke RD, Kato SK, Pereira GFM, Rahmi RM. Adequacy of prenatal care and associated factors in the State of Rio Grande do Sul, Brazil. Rev Saude Publica 2023; 57:68. [PMID: 37878854 PMCID: PMC10519679 DOI: 10.11606/s1518-8787.2023057005146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/06/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE This study aims to assess the degree of adequacy of prenatal care (PNC) in the state of Rio Grande do Sul (RS) and in its 7 macro-regions considering the time of PNC initiation and the number of appointments attended. It also aims to verify the mode of delivery prevalence and the factors associated with PNC adequacy by mode of delivery. METHODS Sub analysis from a cross-sectional study conducted among 13,432 childbearing women aged 15-49 years assisted in 66 maternity hospitals of the Unified Health System (SUS) and private associated facilities from September 2017 to October 2019. A standardized form was used to collect sociodemographic data, and information about PNC and delivery from the childbearing women's prenatal cards, hospital records, and medical reports. RESULTS The PNC coverage was (98.4%), but only 57.5% of the participants had an adequate PNC defined as the one initiated until the 12th gestational week, with attendance of at least 6 appointments. The cesarean rate was 57.2%. Among women who performed vaginal delivery, multivariate analysis showed that for each 1-year increase in the age of the parturient, the chance of having an adequate PNC increased by 5%. White parturients with higher education and fewer deliveries residing in the macro-region of Valleys were more likely to have an adequate PNC when compared with non-white parturients, who were illiterate and/or had incomplete elementary school, with 3 or more deliveries and who resided in other macro-regions. During pregnancy, 96.0% of the women performed at least one anti-HIV test, 55.8% a rapid test for syphilis, and 75.0% a Venereal Disease Research Laboratory test (VDRL). CONCLUSIONS Despite the almost universal PNC coverage in RS, the PNC offered by the SUS was adequate for just half of the population, therefore public health policies targeted at women receiving care in this setting shall be revisited.
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Affiliation(s)
- Aline De Gregori Adami
- Universidade de Caxias do SulPrograma de Pós-graduação em Ciências da SaúdeCaxias do SulRSBrazil Universidade de Caxias do Sul. Programa de Pós-graduação em Ciências da Saúde. Caxias do Sul, RS, Brazil.
- Universidade de Caxias do SulInstituto de Pesquisas em SaúdeÁrea do Conhecimento de Ciências da VidaCaxias do SulRSBrazilUniversidade de Caxias do Sul. Instituto de Pesquisas em Saúde. Área do Conhecimento de Ciências da Vida. Caxias do Sul, RS, Brazil.
| | - Leonardo Rapone da Motta
- Universidade de Caxias do SulInstituto de Pesquisas em SaúdeÁrea do Conhecimento de Ciências da VidaCaxias do SulRSBrazilUniversidade de Caxias do Sul. Instituto de Pesquisas em Saúde. Área do Conhecimento de Ciências da Vida. Caxias do Sul, RS, Brazil.
| | - Rosa Dea Sperhacke
- Universidade de Caxias do SulInstituto de Pesquisas em SaúdeÁrea do Conhecimento de Ciências da VidaCaxias do SulRSBrazilUniversidade de Caxias do Sul. Instituto de Pesquisas em Saúde. Área do Conhecimento de Ciências da Vida. Caxias do Sul, RS, Brazil.
| | - Sérgio Kakuta Kato
- Universidade de Caxias do SulInstituto de Pesquisas em SaúdeÁrea do Conhecimento de Ciências da VidaCaxias do SulRSBrazilUniversidade de Caxias do Sul. Instituto de Pesquisas em Saúde. Área do Conhecimento de Ciências da Vida. Caxias do Sul, RS, Brazil.
- Universidade Federal de Ciências da Saúde de Porto AlegreDepartamento de Saúde ColetivaPorto AlegreRSBrazil Universidade Federal de Ciências da Saúde de Porto Alegre. Departamento de Saúde Coletiva. Porto Alegre, RS, Brazil.
| | - Gerson Fernando Mendes Pereira
- Ministério da SaúdeSecretaria de Vigilância em SaúdeDepartamento de HIV/aids, Tuberculose, Hepatites Virais e Infecções Sexualmente TransmissíveisBrasíliaDFBrazilMinistério da Saúde. Secretaria de Vigilância em Saúde. Departamento de HIV/aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis. Brasília, DF, Brazil.
| | - Rosa Maria Rahmi
- Universidade de Caxias do SulPrograma de Pós-graduação em Ciências da SaúdeCaxias do SulRSBrazil Universidade de Caxias do Sul. Programa de Pós-graduação em Ciências da Saúde. Caxias do Sul, RS, Brazil.
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Pires RCR, Silveira VNDC, Leal MDC, Lamy ZC, Silva AAMD. Temporal trends and projections of caesarean sections in Brazil, its administrative macro-regions, and federative units. CIENCIA & SAUDE COLETIVA 2023; 28:2119-2133. [PMID: 37436324 DOI: 10.1590/1413-81232023287.14152022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/13/2022] [Indexed: 07/13/2023] Open
Abstract
Trend studies on the model of birth in Brazil show a scenario of successive linear increases in cesarean rates. However, they ignore possible changes in the temporal evolution of this delivery modality. Thus, this study aimed to evaluate possible inflection points in cesarean rates in Brazil, its macro-regions, and federated units, as well as to estimate projections for 2030. A time series with information on cesarean sections from 1994 to 2019 from the SUS Department of Informatics was used. Autoregressive integrated moving average and joinpoint regression models were used to obtain cesarean rate projections and trends, respectively. Caesarean rates showed a significant upward trend over the 26 study years at all levels of aggregation. On the other hand, when considering the formation of segments, a stabilization trend was observed both in the country and in the South and Midwest regions, starting in 2012. Rates tended to increase in North and Northeast and significantly decrease in Southeast. Projections show that in 2030, 57.4% of births in Brazil will be cesarean, with rates higher than 70% in Southeast and South regions.
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Affiliation(s)
- Rômulo Cesar Rezzo Pires
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão (UFMA). R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
| | - Victor Nogueira da Cruz Silveira
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão (UFMA). R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
| | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
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Del Bigio JZ, Tannuri ACA, Falcão MC, de Carvalho WB, Matsushita FY. Gastroschisis and late-onset neonatal sepsis in a tertiary referral center in Southeastern Brazil. J Pediatr (Rio J) 2022; 98:168-174. [PMID: 34153237 PMCID: PMC9432041 DOI: 10.1016/j.jped.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To analyze late-onset sepsis and to describe the etiological agents in newborns with gastroschisis. METHODS A retrospective cohort, including newborns with gastroschisis whose admissions occurred in the period between January 2012 to December 2018 in a tertiary referral center. Maternal and newborn characteristics, surgical procedures and evolution in hospitalization were verified. A bivariate analysis was performed with patients with proven late-onset neonatal sepsis and according to the simple or complex gastroschisis category, the prevalent microorganisms in positive cultures were identified, statistical tests were carried out and the significance level adopted was p < 0,05. Results are presented in proportions, averages and standard deviation or medians. The level of significance adopted was p < 0.05. RESULTS 101 newborns were analyzed, 45 (44.5%) were confirmed late-onset sepsis. The median birth weight was 2285+498 grams, and the gestational age was 35.9 +1.74weeks. The incidence of complex gastroschisis was 17.8%, the hospitalization time was 48.2+29.67 days and mortality was 9.9%. The newborns were divided into 2 groups: Group 1: late-onset sepsis (44.6%), and Group 2: no late-onset sepsis. The presence of complex gastroschisis was a factor associated with infection (p < 0.009). Fasting time (p < 0.001), parenteral nutrition time (p < 0.001), time to achieve full diet (p < 0.001), and hospitalization stay (p < 0.001) were higher in group 2. Gram-positive were the most frequent (51.1%), followed by Gram-negative (20%), and fungi (4.4%). CONCLUSIONS Newborns with gastroschisis have a higher risk of evolving with late-onset sepsis, despite this study did not calculate the risk of sepsis statistically, and the main germs detected by cultures were gram-positive bacteria, specifically Staphylococcus epidermidis.
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Affiliation(s)
- Juliana Zoboli Del Bigio
- Universidade de São Paulo, Faculdade de Medicina, Instituto da Criança e do Adolescente, Unidade de Terapia Intensiva Neonatal, São Paulo, SP, Brazil.
| | - Ana Cristina Aoun Tannuri
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Divisão de Cirurgia Pediátrica, São Paulo, SP, Brazil
| | - Mário Cícero Falcão
- Universidade de São Paulo, Faculdade de Medicina, Instituto da Criança e do Adolescente, Unidade de Terapia Intensiva Neonatal, São Paulo, SP, Brazil
| | - Werther Brunow de Carvalho
- Universidade de São Paulo, Faculdade de Medicina, Instituto da Criança e do Adolescente, Unidade de Terapia Intensiva Neonatal, São Paulo, SP, Brazil
| | - Felipe Yu Matsushita
- Universidade de São Paulo, Faculdade de Medicina, Instituto da Criança e do Adolescente, Unidade de Terapia Intensiva Neonatal, São Paulo, SP, Brazil
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D'Agostini Marin DF, da Rosa Wernke A, Dannehl D, de Araujo D, Koch GF, Marçal Zanoni K, Baschirotto Dorigon Coral K, Valeriano Guimarães N, Feuerschuette O, Pinto Moehlecke Iser B. The Project Appropriate Birth and a reduction in caesarean section rates: an analysis using the Robson classification system. BJOG 2021; 129:72-80. [PMID: 34529333 DOI: 10.1111/1471-0528.16919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to assess caesarean section (CS) rates before and after the implementation of the Project Appropriate Birth (PPA), based on the Robson ten group classification system. DESIGN A before-and-after study. SETTING Maternity hospital in South Brazil. POPULATION All pregnant women attending from April 2016 to April 2017 (period 1, pre-implementation of PPA) and from June 2017 to June 2018 (period 2, post-implementation of PPA). METHODS Maternal and obstetric characteristics were evaluated, including Robson's classification, based on the characteristics of pregnancy and childbirth. A chi-square test and crude and adjusted relative rates were used to analyse the study variables. The significance level was set at 5%. MAIN OUTCOME MEASURES The CS rate for each group, their contribution to the overall CS rate and the differences in these contributions before and after PPA implementation. RESULTS The CS rates decreased from 62.4 to 55.6%, which represented a 10.9% reduction after the implementation of the PPA. Pregnant women in Robson classification groups 1-4 had a 21.4% reduction in CS rates, ranging from 49.1 to 38.6%. The greatest contributors to the overall CS rates were group 5 and group 2, accounting for more than 60% of the CS deliveries. CONCLUSION The study results suggest that Project Appropriate Birth had an impact on the reduction of CS rates, especially in Robson classification groups 1 through 4, which indicates that providing mothers with evidence-based interventions for labour and childbirth assistance contributed to reduce CS rates. TWEETABLE ABSTRACT The Project Appropriate Birth is an innovative project that has demonstrated promising results, suggesting that interventions based on scientific evidence can lead to real changes in childbirth care, contributing to reduce CS rates. The aim of the PPA is to promote activities to improve childbirth care and encourage vaginal delivery. In this study, 6238 pregnant women admitted to the hospital for delivery were included and classified into one of the Robson 10-group classification. Findings revealed a 10.9% reduction in the overall CS rate and a 21.4% reduction for pregnant women in Robson classification groups 1 through 4, after the implementation of the PPA.
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Affiliation(s)
- D F D'Agostini Marin
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - A da Rosa Wernke
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - D Dannehl
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - D de Araujo
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - G F Koch
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - K Marçal Zanoni
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - K Baschirotto Dorigon Coral
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - N Valeriano Guimarães
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - O Feuerschuette
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - B Pinto Moehlecke Iser
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
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Abstract
OBJECTIVES The objective of this study is to explore the association of health financing indicators with the proportion of births by caesarean section (CS) across countries. DESIGN Ecological cross-country study. SETTING This study examines CS proportions across 172 countries. MAIN OUTCOME MEASURES The primary outcome was the percentage excess of CS proportion, defined as CS proportions above the global target of 19%. We also analysed continuous CS proportions, as well as excess proportion with a more restrictive 9% global target. Multivariable linear regressions were performed to test the association of health financing factors with the percentage excess proportions of CS. The health financing factors considered were total available health system resources (as percentage of gross domestic product), total contributions from private households (out-of-pocket, compulsory and voluntary health insurance contributions) and total national income. RESULTS We estimate that in 2018 there were a total of 8.8 million unnecessary CS globally, roughly two-thirds of which occurred in upper middle-income countries. Private health financing was positively associated with percentage excess CS proportion. In models adjusted for income and total health resources as well as human resources, each 10 per cent increase in out-of-pocket expenditure was associated with a 0.7 per cent increase in excess CS proportions. A 10 per cent increase in voluntary health insurance was associated with a 4 per cent increase in excess CS proportions. CONCLUSIONS We have found that health system finance features are associated with CS use across countries. Further monitoring of these indicators, within countries and between countries will be needed to understand the effect of financial arrangements in the provision of CS.
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Affiliation(s)
- Ilir Hoxha
- Kolegji Heimerer, Pristina, Kosovo
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzlerland
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6
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Lamus MN, Pabon S, MPoca C, Guida JP, Parpinelli MA, Cecatti JG, Vidarte MF, Costa ML. Giving women WOICE postpartum: prevalence of maternal morbidity in high-risk pregnancies using the WHO-WOICE instrument. BMC Pregnancy Childbirth 2021; 21:357. [PMID: 33952188 PMCID: PMC8097898 DOI: 10.1186/s12884-021-03727-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background There are no accurate estimates of the prevalence of non-severe maternal morbidities. Given the lack of instruments to fully assess these morbidities, the World Health Organization (WHO) developed an instrument called WOICE. We aimed to evaluate the prevalence of non-severe maternal morbidities in puerperal women and factors associated to impaired clinical, social and mental health conditions. Method A cross-sectional study with postpartum women at a high-risk outpatient clinic in southeast Brazil, from November 2017 to December 2018. The WOICE questionnaire included three sections: the first with maternal and obstetric history, sociodemographic data, risk and environment factors, violence and sexual health; the second considers functionality and disability, general symptoms and mental health; and the third includes data on physical and laboratory tests. Data collection was supported by Tablets with REDCAP software. Initially, a descriptive analysis was performed, with general prevalence of all variables contained in the WOICE, including scales on anxiety and depression (GAD-7 and PHQ-9- impaired if ≥10), functionality (WHODAS- high disability scores when ≥37.4) and data on violence and substance use. Subsequently, an evaluation of cases with positive findings was performed, with a Poisson regression to investigate factors associated to impaired non-clinical and clinical conditions. Results Five hundred seventeen women were included, majority (54.3%) multiparous, between 20 and 34 years (65.4%) and with a partner (75,6%). Over a quarter had (26.2%) preterm birth. Around a third (30.2%) reported health problems informed by the physician, although more than 80% considered having good or very good health. About 10% reported any substance use and 5.9% reported exposure to violence. Anxiety was identified in 19.8% of cases, depression in 36.9% and impaired functioning in 4.4% of women. Poisson regression identified that poor overall health rating was associated to increased anxiety/depression and impaired functioning. Having a partner reduced perception of women on the presence of clinical morbidities. Conclusion During postpartum care of a high-risk population, over one third of the considered women presented anxiety and depression; 10% reported substance use and around 6% exposure to violence. These aspects of women’s health need further evaluation and specific interventions to improve quality of care.
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Affiliation(s)
- M N Lamus
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Rua Alexander Fleming 101, Campinas, São Paulo, 13083-891, Brazil.,Department of Obstetrics and Gynecology, Foundation Valle del Lilli, Cali, Colombia
| | - S Pabon
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Rua Alexander Fleming 101, Campinas, São Paulo, 13083-891, Brazil.,Department of Obstetrics and Gynecology, Foundation Valle del Lilli, Cali, Colombia
| | - C MPoca
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Rua Alexander Fleming 101, Campinas, São Paulo, 13083-891, Brazil
| | - J P Guida
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Rua Alexander Fleming 101, Campinas, São Paulo, 13083-891, Brazil
| | - M A Parpinelli
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Rua Alexander Fleming 101, Campinas, São Paulo, 13083-891, Brazil
| | - J G Cecatti
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Rua Alexander Fleming 101, Campinas, São Paulo, 13083-891, Brazil
| | - M F Vidarte
- Department of Obstetrics and Gynecology, Foundation Valle del Lilli, Cali, Colombia
| | - M L Costa
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Rua Alexander Fleming 101, Campinas, São Paulo, 13083-891, Brazil.
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Kiilerich P, Cortes R, Lausten-Thomsen U, Borbye-Lorenzen N, Holmgaard S, Skogstrand K. Delivery Modality Affect Neonatal Levels of Inflammation, Stress, and Growth Factors. Front Pediatr 2021; 9:709765. [PMID: 34631615 PMCID: PMC8492985 DOI: 10.3389/fped.2021.709765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: As part of the study CODIBINE, Correlations and Diagnoses for Biomarkers in New-borns, the main objective of the study was to explore neonatal inflammation, stress, neurodevelopment, and growth factors after in-labor and pre-labor cesarean section compared to vaginal delivery. Increasing evidence has shown that birth delivery mode has an impact on imminent and long-term child health. However, the effect of the timing of cesarean section is insufficiently elucidated. The main objective of the study was to explore the effect of different delivery modes, vaginal delivery compared to cesarean section with or without initiation of labor, on the infants. Methods: We designed a retrospective cohort study, including dried blood spot samples from mature (gestational age ≥ 37) newborns delivered in the years 2009-2011. The newborns were divided into three groups after delivery mode: (1) pre-labor cesarean section (n = 714), i.e., cesarean delivery without initiation of labor, (2) in-labor cesarean section (n = 655), i.e., cesarean section after initiation of labor, and (3) vaginal delivery (n = 5,897). We measured infant levels of inflammatory (IL-18, MCP-1, CRP, sTNF RI), stress (HSP-70), growth (EGF, VEGF-A), and neurotrophic factors (BDNF, NT-3, S100B) 2-4 days after birth. Results: The neonatal levels of inflammatory and stress markers were significantly lower, while the levels of growth factors were higher after pre-labor cesarean section compared to vaginal delivery. The biomarker levels were similar after in-labor cesarean section and vaginal delivery. Removing cases with pre-labor rupture of membranes and artificial rupture of membranes in the calculations did not change the results. The levels of neurotrophic factors were unaffected by delivery form. Males had generally higher levels of inflammation and lower levels of growth and neurotrophic factors. Overall, the levels of inflammatory markers increased, and the growth factors decreased with increasing gestational age. Conclusion: The present study of the biomarker levels after birth suggests that the labor process has an important effect on the fetal immune system and level of stress, regardless if the delivery ends with cesarean section or vaginal birth.
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Affiliation(s)
- Pia Kiilerich
- Department for Congenital Disorders, Danish Center for Neonatal Screening, Statens Serum Institute, Copenhagen, Denmark
| | - Rikke Cortes
- Department for Congenital Disorders, Danish Center for Neonatal Screening, Statens Serum Institute, Copenhagen, Denmark
| | - Ulrik Lausten-Thomsen
- Neonatal Intensive Care Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Nis Borbye-Lorenzen
- Department for Congenital Disorders, Danish Center for Neonatal Screening, Statens Serum Institute, Copenhagen, Denmark
| | - Solveig Holmgaard
- Department for Congenital Disorders, Danish Center for Neonatal Screening, Statens Serum Institute, Copenhagen, Denmark
| | - Kristin Skogstrand
- Department for Congenital Disorders, Danish Center for Neonatal Screening, Statens Serum Institute, Copenhagen, Denmark
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Silva TPRD, Dumont-Pena E, Moreira AD, Camargos BA, Meireles MQ, Souza KVD, Matozinhos FP. Factors associated with normal and cesarean delivery in public and private maternity hospitals: a cross-sectional study. Rev Bras Enferm 2020; 73 Suppl 4:e20180996. [PMID: 32756742 DOI: 10.1590/0034-7167-2018-0996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/04/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES to investigate the factors associated with the mode of delivery in pregnant women in the city of Belo Horizonte. METHODS cross-sectional study developed with data from the study "Being born in Belo Horizonte: survey on childbirth and birth" carried out in seven maternity hospitals in Belo Horizonte - Minas Gerais. The final sample consisted of 1088 pregnant/postpartum women. In this study, to verify the magnitude of the association between the outcome variable and its possible determinants (exposure variables) logistic regression models were constructed to estimate the Odds Ratio. RESULTS increasing age, the lack of companionship, the hospital's private financing for performing delivery and being a first-time pregnant woman increased the chance of delivery by cesarean section. Final Considerations: the knowledge of factors associated with the prevalence of cesarean sections can support reflections among health professionals about this surgical procedure in certain situations, especially when there are no precise clinical indications.
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Affiliation(s)
| | - Erica Dumont-Pena
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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9
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Silva TPRD, Pinheiro BLS, Kitagawa KY, Couto RC, Pedrosa TMG, Simão DADS, Matozinhos FP. Influence of maternal age and hospital characteristics on the mode of delivery. Rev Bras Enferm 2020; 73 Suppl 4:e20180955. [PMID: 32756745 DOI: 10.1590/0034-7167-2018-0955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/01/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to analyze the relationship between maternal age and the source of healthcare payment with mode of delivery in public and private national hospitals between the years 2012 to 2017, and the length of hospital stay. METHODS cross-sectional study of 91,894 women who had children in public and private hospitals between 2012 and 2017. Data were collected from the Diagnosis-Related Groups Brazil system and a comparative analysis was performed between patients in public care and those in supplementary healthcare. RESULTS in public care, the majority were vaginal deliveries and the reverse occurred in supplementary health. The proportion of cesarean sections was higher in the age group 31 to 40 years old in both services. The hospital stay was longer among women who underwent a cesarean section. CONCLUSIONS high maternal age and the source of healthcare payment influence the mode of delivery, which interfere with the length of hospital stay.
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Affiliation(s)
| | | | | | - Renato Camargo Couto
- Instituto de Acreditação e Gestão em Saúde, Belo Horizonte, Minas Gerais, Brazil
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10
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Flosi FB, da Silva FC, de Jesús GR, Velarde LGC, de Sá RAM. Assessment of Fetal Lung Maturity Using Quantitative Ultrasound Analysis in Patients with Prelabor Rupture of Membranes. Fetal Diagn Ther 2020; 47:636-641. [PMID: 32653881 DOI: 10.1159/000507550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 03/25/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Prelabor rupture of membranes (PROM) is a frequent clinical situation, and the decision about the best time for delivery remains controversial, mainly due to the risk of neonatal respiratory morbidity (NRM). Assessment of fetal lung maturity using ultrasound, a safe method and widely used in current obstetrical practice, could change this scenario. This study was designed to evaluate the ability of quantitative ultrasound method QuantusFLM® to predict NRM in patients with PROM and whether maternal BMI, gestational age, occurrence of the disease, and presence of oligohydramnios influenced the performance. METHODS Patients with singleton gestations, diagnosis of PROM, and gestational age between 24 and 38 weeks and 6 days were included. Fetal lung image was acquired by ultrasound within 48 h prior to delivery and analyzed by QuantusFLM®. The results were then paired with neonatal outcomes to assess the program's ability to predict the NRM in this specific group. A logistic regression model was created to analyze factors that could affect the test results. RESULTS Fifty-four patients were included. Mean maternal BMI was 28.99 kg/m2, and in 25 patients (46.2%), oligohydramnios was observed at the time of examination. Mean gestational age at delivery was 35 weeks and 4 days, and the NRM prevalence was of 18.5%. QuantusFLM® predicted NRM with a 60% sensitivity, 79.5% specificity, 40% positive predictive value, 89.7% negative predictive value, and 75.6% accuracy. Maternal BMI, disease occurrence, presence of oligohydramnios, and gestational age did not interfere with the evaluation. CONCLUSION This study demonstrates a good accuracy of QuantusFLM® as a NRM predictor in patients with PROM, with particular reliability in identifying that pulmonary maturity has already occurred.
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Affiliation(s)
| | - Fernanda Campos da Silva
- Department of Obstetrics, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Guilherme Ramires de Jesús
- Department of Obstertics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Obstetrics, Instituto Fernandes Figueira - FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Renato Augusto Moreira de Sá
- Medical Sciences Post Graduation, Universidade Federal Fluminense, Niterói, Brazil, .,Department of Obstetrics, Instituto Fernandes Figueira - FIOCRUZ, Rio de Janeiro, Brazil,
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Knobel R, Lopes TJP, Menezes MDO, Andreucci CB, Gieburowski JT, Takemoto MLS. Cesarean-section Rates in Brazil from 2014 to 2016: Cross-sectional Analysis Using the Robson Classification. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:522-528. [PMID: 32559791 PMCID: PMC10309242 DOI: 10.1055/s-0040-1712134] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To obtain cesarean-section (CS) rates according to the Robson Group Classification in five different regions of Brazil. METHODS A descriptive epidemiological study using data from secondary birth records from the Computer Science Department of the Brazilian Unified Health System (Datasus, in Portuguese) between January 1st, 2014, and December 31st, 2016, including all live births in Brazil. RESULTS The overall rate of CS was of 56%. The sample was divided into 11 groups, and vaginal births were more frequent in groups 1 (53.6%), 3 (80.0%) and 4 (55.1%). The highest CS rates were found in groups 5 (85.7%), 6 (89.5%), 7 (85.2%) and 9 (97.0%). The overall CS rate per region varied from 46.2% in the North to 62.1% in the Midwest. Group 5 was the largest obstetric population in the South, Southeast and Midwest, and group 3 was the largest in the North and Northeast. Group 5 contributed the most to the overall CS rate, accounting for 30.8% of CSs. CONCLUSION Over half of the births in Brazil were cesarean sections. The Midwest had the highest CS rates, while the North had the lowest. The largest obstetric population in the North and in the Northeast was composed of women in group 3, while in the South, Southeast and Midwest it was group 5. Among all regions, the largest contribution to the overall CS rate was from group 5.
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Affiliation(s)
- Roxana Knobel
- Department of Gynecology and Obstetrics, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Thiago Jose Pinheiro Lopes
- Department of Gynecology and Obstetrics, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Mariane de Oliveira Menezes
- Postgraduate Program in Tocogynecology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | | | - Juliana Toledo Gieburowski
- Department of Gynecology and Obstetrics, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Zaiden L, Nakamura-Pereira M, Gomes MAM, Esteves-Pereira AP, Leal MDC. Influence of hospital characteristics on the performance of elective cesareans in Southeast Brazil. CAD SAUDE PUBLICA 2020; 36:e00218218. [PMID: 31939550 DOI: 10.1590/0102-311x00218218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 07/08/2019] [Indexed: 11/22/2022] Open
Abstract
This article aims to assess the influence of hospital characteristics on the odds of performing an elective cesarean in the Southeast region of Brazil. Data were obtained from the Birth in Brazil study, conducted from February 2011 to October 2012. The current analysis includes the sample from Southeast Brazil, with 10,155 women. The group of women that underwent elective cesareans was compared to the women who went into labor or underwent labor induction, regardless they had intrapartum cesarean or vaginal delivery. Except for gestational age, all the obstetric characteristics analyzed were associated with elective cesarean. In this group, 60.5% had no prior cesarean and 64.7% had low-risk gestations. Among the births with public financing, there were higher odds of elective cesareans in women treated at hospitals with < 1,500 births/year (OR = 2.11; 95%CI: 1.37-3.26) and 1,500-2,999 births/year (OR = 1.45; 95%CI: 1.04-2.02) and in mixed hospitals (OR = 1.81; 95%CI: 1.37-2.39). In the mixed hospitals, the association was stronger when located in non-capital cities with > 3,000 births/year (OR = 3.45; 95%CI: 1.68-7.08), reaching the highest level in hospitals in non-capital cities with < 3,000 births/year (OR = 4.08; 95%CI: 2.61-6.37). Meanwhile, no association was seen between elective cesarean and public hospitals located in non-capital cities of the Southeast region. Prevalence rates of elective cesareans in public hospitals in Southeast Brazil are high when compared to other countries, and they are heavily influenced by hospital characteristics.
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Affiliation(s)
- Laura Zaiden
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.,Faculdade de Medicina de Petrópolis, Petrópolis, Brasil
| | - Marcos Nakamura-Pereira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Maria Auxiliadora Mendes Gomes
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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13
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Silva TPRD, Carmo ASD, Novaes TG, Mendes LL, Moreira AD, Pessoa MC, Cosenza L, Pereira JFC, Matozinhos FP. Hospital-acquired conditions and length of stay in the pregnancy and puerperal cycle. Rev Saude Publica 2019; 53:64. [PMID: 31432929 PMCID: PMC6705548 DOI: 10.11606/s1518-8787.2019053000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 10/02/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the impact of the Hospital-Acquired Conditions (HAC) in women in the puerperal and pregnancy cycle during length of stay. METHODS This cross-sectional study was conducted with 113,456 women, between July 2012 and July 2017, in Brazil's national hospitals of the supplementary healthcare networks and philanthropists accredited to the Unified Health System (SUS). Data on hospital discharges were collected using the Diagnosis-Related Groups (DRG Brasil®) system. All DRGs of the major diagnostic category 14 (MDC14), including pregnancy, childbirth and puerperium, were included. The impact of HAC on length of stay was estimated by Student's t-test, and the effect size by Cohen's d, which allows to assess clinical relevance. RESULTS The most prevalent diagnostic categories related to MDC14 were vaginal and cesarean deliveries without complicating diagnoses, both at institutions accredited to SUS and those for supplementary health care. The prevalence of HAC was 3.8% in supplementary health and 2.5% in SUS. Hospitals providing services to supplementary health care providers had a longer length of stay considering HAC for patients classified as DRG: cesarean section with complications or comorbidities at admission (p < 0.001; Cohen's d = 0.74), cesarean section without complications or comorbidities at admission (p < 0.001, Cohen's d = 0.31), postpartum and post abortion without listed procedure (p < 0.001, Cohen's d = 1.05), and other antepartum diagnoses with medical complications (p < 0.001; Cohen's d = 0.77). CONCLUSIONS This study showed that the prevalence of HAC was low both in the institutions accredited to attend by SUS and in those of supplementary health; however, its presence contributes to increasing the length of stay in cases of cesarean sections without complications or comorbidities in supplementary health institutions.
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Affiliation(s)
- Thales Philipe Rodrigues da Silva
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Belo Horizonte, MG, Brasil
| | - Ariene Silva do Carmo
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Belo Horizonte, MG, Brasil
| | - Taiane Gonçalves Novaes
- Universidade Federal de Viçosa. Departamento de Nutrição. Programa de Pós-Graduação em Saúde e Nutrição de Grupos Populacionais. Viçosa, MG, Brasil
| | - Larissa Loures Mendes
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Nutrição. Belo Horizonte, MG, Brasil
| | - Alexandra Dias Moreira
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, MG, Brasil
| | - Milene Cristine Pessoa
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Nutrição. Belo Horizonte, MG, Brasil
| | - Luna Cosenza
- Instituto de Acreditação e Gestão em Saúde (IAG Saúde). Belo Horizonte, MG, Brasil
| | | | - Fernanda Penido Matozinhos
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, MG, Brasil
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Abstract
OBJECTIVE To investigate the association of caesarean section rates with the health system characteristics in the public hospitals of Kosovo. DESIGN Cross-sectional survey. SETTING Five largest public hospitals in Kosovo. PARTICIPANTS 859 women with low-risk deliveries who delivered from April to May 2015 in five public hospitals in Kosovo. OUTCOME MEASURES The prespecified outcomes were the crude and adjusted OR of births delivered with caesarean section by health system characteristics such as delivery by the physician who provided antenatal care, health insurance status and other. Additional prespecified outcomes were caesarean section rates and crude ORs for delivery with caesarean in each public hospital. RESULTS Women with personal monthly income had increased odds for caesarean (OR 1.55, 95% CI 1.06 to 2.27), as did women with private health insurance coverage (OR 3.44, 95% CI 1.20 to 9.85). Women instructed by a midwife on preparation for delivery had decreasing odds (OR 0.32, 95% CI 0.19 to 0.51) while women having preference for a caesarean had increasing odds for delivery with caesarean (OR 3.84, 95% CI 1.96 to 7.51). The odds for caesarean increased also in the case of delivery by a physician who provided antenatal care (OR 2.06, 95% CI 1.16 to 3.67) and delivery during office hours (OR 2.36, 95% CI 1.37 to 4.05), while delivery at the University Clinical Centre of Kosovo decreased the odds for caesarean (OR 0.46, 95% CI 0.24 to 0.90). CONCLUSIONS We found that several health system characteristics are associated with the increase of caesarean sections in a low-risk population of delivering women in public hospitals of Kosovo. These findings should be explored further and addressed via policy measures that would tackle provision of unnecessary caesareans. The study findings could assist Kosovo to develop corrective policies in addressing overuse of caesareans and may provide useful information for other middle-income countries.
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Affiliation(s)
- Ilir Hoxha
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Heimerer College, Prishtina, Kosovo
- Action for Mother and Children, Prishtina, Kosovo
| | | | - Mrika Aliu
- Action for Mother and Children, Prishtina, Kosovo
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Department of Medicine, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David C Goodman
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
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Werlang ICR, Mueller NT, Pizoni A, Wisintainer H, Matte U, Costa SHDAM, Ramos JGL, Goldani MZ, Dominguez-Bello MG, Goldani HAS. Associations of birth mode with cord blood cytokines, white blood cells, and newborn intestinal bifidobacteria. PLoS One 2018; 13:e0205962. [PMID: 30388115 PMCID: PMC6214518 DOI: 10.1371/journal.pone.0205962] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/04/2018] [Indexed: 01/15/2023] Open
Abstract
The associations of Cesarean delivery with offspring metabolic and immune-mediated diseases are believed to derive from lack of mother-to-newborn transmission of specific microbes at birth. Bifidobacterium spp., in particular, has been hypothesized to play a health-promoting role, yet little is known about how delivery mode modifies colonization of the newborn by this group of microbes. The aim of this research was to examine the presence of Bifidobacterium in meconium and in the transitional stool, and to assess cytokine levels and hematological parameters in the venous cord blood of infants born by elective, pre-labor Cesarean section vs. vaginal delivery in Southern Brazil. We recruited 89 mother-newborn pairs (23 vaginal delivery and 66 elective cesarean delivery), obtained demographic information from a structured questionnaire and clinical information from medical records. We obtained umbilical cord venous blood and meconium samples following delivery and the transitional stool (the first defecation after meconium) before discharge. We determined plasma levels of IL-1β, IL-10, IL-6, GM-CSF, IL-5, IFN-γ, TNF-α, IL-2, IL-4 and IL-8 in the cord blood, and presence of stool Bifidobacterium by real time PCR. Compared to vaginally-delivered neonates, Cesarean-delivered neonates had a lower leukocyte count (p = 0.037), lower hemoglobin (p = 0.04), and lower levels of the cytokine GM-CSF (p = 0.009) in the cord blood. Moreover, Bifidobacterium was detected less often in the transitional stool of Cesarean-delivered neonates compared to vaginally-delivered neonates (p = 0.001). The results indicate that pre-labor Cesarean birth may be associated with microbial and hematological alterations in the neonate. The clinical significance of these findings remains to be determined in larger prospective birth cohort studies.
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Affiliation(s)
- Isabel Cristina Ribas Werlang
- Laboratory of Translational Pediatrics, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul. Porto Alegre–RS, Brazil
- Post-Graduate Program in Health of Child and Adolescent, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. Porto Alegre–RS, Brazil
| | - Noel Theodore Mueller
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America
| | - Aline Pizoni
- Laboratory of Translational Pediatrics, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul. Porto Alegre–RS, Brazil
- Post-Graduate Program Sciences in Gastroenterology and Hepatology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. Porto Alegre–RS, Brazil
| | | | - Ursula Matte
- Department of Genetics, Universidade Federal do Rio Grande do Sul. Porto Alegre–RS, Brazil
| | - Sergio Hofmeister de Almeida Martins Costa
- Department of Gynecology and Obstetrics, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul and Hospital Mae de Deus. Porto Alegre–RS, Brazil
| | - Jose Geraldo Lopes Ramos
- Department of Gynecology and Obstetrics, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul and Hospital Mae de Deus. Porto Alegre–RS, Brazil
| | - Marcelo Zubaran Goldani
- Laboratory of Translational Pediatrics, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul. Porto Alegre–RS, Brazil
- Post-Graduate Program in Health of Child and Adolescent, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. Porto Alegre–RS, Brazil
| | - Maria Gloria Dominguez-Bello
- Department of Biochemistry and Microbiology and of Anthropology, Rutgers University, New Brunswick, New Jersey, United States of America
| | - Helena Ayako Sueno Goldani
- Laboratory of Translational Pediatrics, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul. Porto Alegre–RS, Brazil
- Post-Graduate Program in Health of Child and Adolescent, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. Porto Alegre–RS, Brazil
- Post-Graduate Program Sciences in Gastroenterology and Hepatology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. Porto Alegre–RS, Brazil
- * E-mail:
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O'Donovan C, O'Donovan J. Why do women request an elective cesarean delivery for non-medical reasons? A systematic review of the qualitative literature. Birth 2018; 45:109-119. [PMID: 29105822 DOI: 10.1111/birt.12319] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cesarean rates have increased significantly over the past decade. The reasons for this are both complex and context specific, and have significant consequences for health resources. The aim of this systematic review was to assess published, peer-reviewed, and gray qualitative literature on the reasons behind cesarean delivery on maternal request (CDMR). METHODS A systematic search of MEDLINE, EMBASE, CINAHL, LILACS, and PsycINFO databases was performed for all relevant articles published between January 2006 and June 2016. Reference lists of all included studies were also searched in addition to select web-based sources. Studies were included if they qualitatively evaluated women's preferences for CDMR, with no geographic restriction. Findings from the studies were narratively and thematically synthesized. RESULTS Sixteen studies were included in this review. Three themes were identified as to why women choose CDMR, which were: social norms, emotional experiences, and personal experiences. A woman's decision was often shaped by various influences including family, friends, and the media. In addition, previous experience of childbirth and interactions with health care professionals contributed to a strong preference for CDMR. CDMR provided women with a sense of control over the birth and diminished feelings of fear. CONCLUSIONS The reasons behind CDMR are multifactorial and complex. Situation-specific cultural factors, fear of pain during childbirth, previous experience, and interactions with health care professionals are likely to have led to the increase in CDMR. Multifaceted, context-specific approaches are required if there is to be a reduction in CDMR rates.
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Affiliation(s)
- Charles O'Donovan
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK
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17
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Eufrásio LS, Souza DED, Fonsêca AMCD, Viana EDSR. Brazilian regional differences and factors associated with the prevalence of cesarean sections. FISIOTERAPIA EM MOVIMENTO 2018. [DOI: 10.1590/1980-5918.031.ao08] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Brazil presents high C-section prevalence rates. Several factors may be associated with such high rates. Objective: To observe and analyze factors associated with the prevalence of cesarean sections in Brazil, according to their occurrence in Brazilian regions. Methods: An ecological study, having C-section as the outcome, from 1990 to 2013, in Brazilian regions, using data from the Brazilian National Health Survey, 2013. Records of women in their reproductive period, aged between 18 and 49 years, were included, totaling a sample of 16,175 women. Descriptive and bivariate analysis was carried out with logistic regression. Results: The prevalence of cesarean sections in Brazil was 53.03%. Vaginal delivery was more prevalent in the North (52.74%) and Northeast (51.06%) regions, while C-section was more prevalent in the Southeast (59.32%), South (56.96%) and Midwest (61.48%) regions. Over the years, an increased probability of cesarean sections was observed, particularly in the following regions: Northeast (2.21 times more, CI95%: 1,42 - 3,46) and South (2.75 times more, CI95%: 1,44 - 5,23). Women with higher levels of education are 2.05 times (CI95%: 1.27 - 3.30) more likely to have a C-section, especially those in the Northern and Southern regions. In the Northeast, this probability increased, regardless of the level of education. Conclusion: The prevalence of cesarean sections in Brazil is high and, over the years, factors such as level of education, maternal age and having health insurance, seem to contribute to the increase in surgical deliveries.
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Witteveen T, Kallianidis A, Zwart JJ, Bloemenkamp KW, van Roosmalen J, van den Akker T. Laparotomy in women with severe acute maternal morbidity: secondary analysis of a nationwide cohort study. BMC Pregnancy Childbirth 2018; 18:61. [PMID: 29482505 PMCID: PMC5828385 DOI: 10.1186/s12884-018-1688-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 02/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although pregnancy-related laparotomy is a major intervention, literature is limited to small case-control or single center studies. We aimed to identify national incidence rates for postpartum laparotomy related to severe acute maternal morbidity (SAMM) in a high-income country and test the hypothesis that risk of postpartum laparotomy differs by mode of birth. METHODS In a population-based cohort study in all 98 hospitals with a maternity unit in the Netherlands, pregnant women with SAMM according to specified disease and management criteria were included from 01/08/2004 to 01/08/2006. We calculated the incidence of postpartum laparotomy after vaginal and cesarean births. Laparotomies were analyzed in relation to mode of birth using all births in the country as reference. Relative risks (RR) were calculated for laparotomy following emergency and planned cesarean section compared to vaginal birth, excluding laparotomies following births before 24 weeks' gestation and hysterectomies performed during cesarean section. RESULTS The incidence of postpartum laparotomy in women with SAMM in the Netherlands was 6.0 per 10,000 births. Incidence was 30.1 and 1.8 per 10,000 following cesarean and vaginal birth respectively. Compared to vaginal birth, RR of laparotomy after cesarean birth was 16.7 (95% confidence interval [95% CI] 12.2-22.6). RR was 21.8 (95% CI 15.8-30.2) for emergency and 10.5 (95% CI 7.1-15.6) for planned cesarean section. CONCLUSIONS Risk of laparotomy, although small, was considerably elevated in women who gave birth by cesarean section. This should be considered in counseling and clinical decision making.
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Affiliation(s)
- Tom Witteveen
- Department of Obstetrics, Leiden University Medical Center, building 1, room K-6-P-35, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Athanasios Kallianidis
- Department of Obstetrics, Leiden University Medical Center, building 1, room K-6-P-35, P.O. Box 9600, 2300 RC Leiden, The Netherlands
- Department of Obstetrics and Gynecology, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 AA Den Haag, The Netherlands
| | - Joost J. Zwart
- Department of Obstetrics and Gynecology, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE Deventer, The Netherlands
| | - Kitty W. Bloemenkamp
- Department of Obstetrics, Wilhelmina Children’s Hospital Birth Centre, University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics, Leiden University Medical Center, building 1, room K-6-P-35, P.O. Box 9600, 2300 RC Leiden, The Netherlands
- Athena Institute, Faculty of Science, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, building 1, room K-6-P-35, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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Bolognani CV, Reis LBDSM, Dias A, Calderon IDMP. Robson 10-groups classification system to access C-section in two public hospitals of the Federal District/Brazil. PLoS One 2018; 13:e0192997. [PMID: 29462215 PMCID: PMC5819776 DOI: 10.1371/journal.pone.0192997] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 02/02/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The global increase in C-section rates is real. In Brazil, these indices correspond to 58.94% in the Midwest region and 52.77% in the Federal District. OBJECTIVE To evaluate the C-section rates and identify the groups with the greatest risk at two reference hospitals in the public network of Federal District/Brazil, using 10-Group Robson System. METHOD A cross-sectional study of 6579 births assisted at the Hospital A (HA) and the Hospital B (HB) during 2013. The C-section rates in each group and its respective contribution to the total hospital C-sections was compared between HA and HB. To this, was used the proportion difference test (similar to chi-square test), with RR and 95% CI, and the logistic regression analysis (OR; 95% CI) among the groups with higher C-section/total C-section. The significance limit of p < 0.05 was defined for all tests. RESULTS The C-section rates were 50.8% at the HA and 42.3% at the HB, with 1.20 RR (95%CI = 1.13-1.28) at the HA. The highest rates were observed in Robson groups G5, G1, and G2. At the HA, G1 had a 21.5% C-section rate, which was greater than at the HB (13.8%; p < 0.05); the cesarean rates for groups G2 and G5 were higher at the HB (respectively, 18.6 and 38.1%) than at the HA (14.8 and 32.5%, respectively; p < 0.05). CONCLUSION These results point out specific goals to be achieved in order to reduce abusive cesarean rates in both A and B hospitals, especially in the primigravida and in those with previous C-section.
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Affiliation(s)
- Cláudia Vicari Bolognani
- Medical School Coordination, Graduate School of Health Sciences/FEPECS/SES, Brasília, Federal District, Brazil
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School/UNESP, Botucatu, São Paulo, Brazil
| | | | - Adriano Dias
- Graduate Program in Gynecology, Obstetrics and Mastology, Botucatu Medical School/UNESP, Botucatu, São Paulo, Brazil
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Ramos-Rangel GE, Ferrer-Zaccaro LE, Mojica-Manrique VL, González La Rotta M. Management of post-cesarean delivery analgesia: Pharmacologic strategies. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ramos-Rangel GE, Ferrer-Zaccaro LE, Mojica-Manrique VL, González La Rotta M. Manejo analgésico durante el postoperatorio de cesárea: estrategias farmacológicas. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Management of post-cesarean delivery analgesia: Pharmacologic strategies☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201710000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Zhao Y, Zhang J, Zamora J, Vogel JP, Souza JP, Jayaratne K, Ganchimeg T, Ortiz-Panozo E, Hernandez B, Oladapo OT, Torloni MR, Morisaki N, Mori R, Pileggi-Castro C, Tunçalp Ö, Shen X, Betrán AP. Increases in Caesarean Delivery Rates and Change of Perinatal Outcomes in Low- and Middle-Income Countries: A Hospital-Level Analysis of Two WHO Surveys. Paediatr Perinat Epidemiol 2017; 31:251-262. [PMID: 28474743 DOI: 10.1111/ppe.12363] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Maternal and neonatal outcomes have improved substantially. During the same period, the caesarean delivery rate soared. The aim of this analysis was to determine whether an increase in caesarean rate was associated with an improvement in perinatal outcome at an institutional level in low- and middle-income countries. METHODS The WHO Global Survey on Maternal and Perinatal Health (WHOGS) and the WHO Multi-Country Survey on Maternal and Newborn Health (WHOMCS) were two multi-country, facility-based, cross-sectional surveys conducted in 2004-08 and 2010-11, respectively. The increase in caesarean rate and the change of prevalence of adverse perinatal outcomes were calculated using a two-point estimator of percent change annualized (PCA) method. Maternal, perinatal, and neonatal composite indexes were used as the outcomes. A linear mixed model was used to assess the association between the change of caesarean rate and the change of perinatal outcome. RESULTS A total of 259 facilities in 20 countries participated in both surveys, with 217 844 women in WHOGS and 227 734 women in WHOMCS. The caesarean rate in these facilities increased, on average, by 4.0% annually, while the prevalence of adverse perinatal outcomes decreased by 4.6% annually. However, after adjustments for potential confounders, no association was found between the increase in caesarean rate and the change of adverse outcome indexes, regardless of whether starting caesarean rates were already high (above 10%) or not. CONCLUSIONS In low- and middle-income countries, the increases in caesarean rates were not associated with improved perinatal outcomes regardless of whether the starting caesarean rate was already high or not.
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Affiliation(s)
- Yanjun Zhao
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Javier Zamora
- Clinical Biostatistics Unit, Hospital Ramon y Cajal, CIBER Epidemiology and Public Health, Madrid, Spain.,Women Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University, London, UK
| | - Joshua Peter Vogel
- UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - João P Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Eduardo Ortiz-Panozo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Olufemi T Oladapo
- UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Maria R Torloni
- Evidence Based Health Care Post Graduate Program, Department of Medicine, Sao Paulo Federal University, Sao Paulo, Brazil
| | - Naho Morisaki
- Division of Lifecourse Epidemiology, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Cynthia Pileggi-Castro
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Özge Tunçalp
- UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Xiaoming Shen
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ana Pilar Betrán
- UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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24
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Morisaki N, Zhang X, Ganchimeg T, Vogel JP, Souza JPD, Cecatti JG, Torloni MR, Ota E, Mori R, Mittal S, Tough S, Dolan S, Kramer MS. Provider-initiated delivery, late preterm birth and perinatal mortality: a secondary analysis of the WHO multicountry survey on maternal and newborn health. BMJ Glob Health 2017; 2:e000204. [PMID: 28589019 PMCID: PMC5444091 DOI: 10.1136/bmjgh-2016-000204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/05/2017] [Accepted: 02/01/2017] [Indexed: 12/18/2022] Open
Abstract
Introduction In high-income countries, a reduced clinical threshold for obstetric interventions such as labour induction (LI) and prelabour caesarean delivery (PLCD) has played a substantial role in increasing rates of late preterm births. However, the association between provider-initiated delivery and perinatal outcomes have not been studied in a multicountry setting including low-income and middle-income countries. Methods 286 hospitals in 29 countries participated in the WHO Multi-Country Survey on Maternal and Newborn Health and yielded 2 52 198 singleton births of at least 34 weeks in 2010–2011. We used an ecological analysis based on generalised estimating equations under multilevel logistic regression to estimate associations between hospital rates of PLCD and LI with rates of late preterm birth (34–36 weeks), stillbirth and intrahospital early neonatal death, in relation to country development based on the Human Development Index (HDI). Results Rates of LI were higher in hospitals from very high-HDI (median 10.9%) and high-HDI (11.2%) countries compared with medium-HDI (4.0%) or low-HDI (3.8%) countries. Rates of PLCD were by far the lowest in low-HDI countries compared with countries in the other three categories (5.1% vs 12.0%–17.9%). Higher rates of PLCD were associated with lower perinatal death rates (OR 0.87 (0.79, 0.95) per 5% increase in PLCD) and non-significantly with late preterm birth (1.04 (0.98, 1.10)) regardless of country development. LI rates were positively associated with late preterm birth (1.04 (1.01, 1.06)) regardless of country development and with perinatal death (1.06 (0.98, 1.15)) only in middle-HDI and low- HDI countries. Conclusion PLCD was associated with reduced perinatal mortality and non-significantly with increased late preterm birth. LI was associated with increases in both late preterm birth and, in less-developed countries, perinatal mortality. Efforts to provide sufficient, but avoid excessive, access to provider-initiated delivery should be tailored to the local context.
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Affiliation(s)
- Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Research, Setagaya-ku, Tokyo, Japan
| | - Xun Zhang
- Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Togoobaatar Ganchimeg
- Department of Global Health Nursing, Faculty of Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Joshua P Vogel
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Joo Paulo Dias Souza
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Maria Regina Torloni
- Evidence Based Healthcare post-graduate program, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Science, St Luke's International University, Chuo-ku, Tokyo, Japan.,Department of Health Policy, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Suneeta Mittal
- Department of Obstetrics and Gynecology, Fortis Memorial Research Institute Gurgaon, Gurgaon, Haryana, India
| | - Suzanne Tough
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Siobhan Dolan
- Department of Obstetrics and Gynecology and Womens Health, Albert Einstein College of Medicine / Montefiore Medical Center, New York, NY, USA
| | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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25
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Nakamura-Pereira M, do Carmo Leal M, Esteves-Pereira AP, Domingues RMSM, Torres JA, Dias MAB, Moreira ME. Use of Robson classification to assess cesarean section rate in Brazil: the role of source of payment for childbirth. Reprod Health 2016; 13:128. [PMID: 27766941 PMCID: PMC5073850 DOI: 10.1186/s12978-016-0228-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Cesarean section (CS) rates are increasing worldwide but there is some concern with this trend because of potential maternal and perinatal risks. The Robson classification is the standard method to monitor and compare CS rates. Our objective was to analyze CS rates in Brazil according to source of payment for childbirth (public or private) using the Robson classification. Methods Data are from the 2011–2012 “Birth in Brazil” study, which used a national hospital-based sample of 23,940 women. We categorized all women into Robson groups and reported the relative size of each Robson group, the CS rate in each group and the absolute and relative contributions made by each to the overall CS rate. Differences were analyzed through chi-square and Z-test with a significance level of < 0.05. Results The overall CS rate in Brazil was 51.9 % (42.9 % in the public and 87.9 % in the private health sector). The Robson groups with the highest impact on Brazil’s CS rate in both public and private sectors were group 2 (nulliparous, term, cephalic with induced or cesarean delivery before labor), group 5 (multiparous, term, cephalic presentation and previous cesarean section) and group 10 (cephalic preterm pregnancies), which accounted for more than 70 % of CS carried out in the country. High-risk women had significantly greater CS rates compared with low-risk women in almost all Robson groups in the public sector only. Conclusions Public policies should be directed at reducing CS in nulliparous women, particularly by reducing the number of elective CS in these women, and encouraging vaginal birth after cesarean to reduce repeat CS in multiparous women. Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0228-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marcos Nakamura-Pereira
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation, Avenida Rui Barbosa 716 - Flamengo, CEP 22.250-020, Rio de Janeiro, RJ, Brazil. .,National School of Public Health - Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, sala 809, Manguinhos, Rio de Janeiro, CEP 21041-210, Brazil.
| | - Maria do Carmo Leal
- National School of Public Health - Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, sala 809, Manguinhos, Rio de Janeiro, CEP 21041-210, Brazil
| | - Ana Paula Esteves-Pereira
- National School of Public Health - Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, sala 809, Manguinhos, Rio de Janeiro, CEP 21041-210, Brazil
| | | | - Jacqueline Alves Torres
- National Health Agency - Ministry of Health, Av. Augusto Severo, 84 - Glória, Rio de Janeiro, RJ, 20021-040, Brazil
| | - Marcos Augusto Bastos Dias
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation, Avenida Rui Barbosa 716 - Flamengo, CEP 22.250-020, Rio de Janeiro, RJ, Brazil
| | - Maria Elisabeth Moreira
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation, Avenida Rui Barbosa 716 - Flamengo, CEP 22.250-020, Rio de Janeiro, RJ, Brazil
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26
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Leal MDC, Esteves-Pereira AP, Nakamura-Pereira M, Torres JA, Domingues RMSM, Dias MAB, Moreira ME, Theme-Filha M, da Gama SGN. Provider-Initiated Late Preterm Births in Brazil: Differences between Public and Private Health Services. PLoS One 2016; 11:e0155511. [PMID: 27196102 PMCID: PMC4873204 DOI: 10.1371/journal.pone.0155511] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 05/01/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A large proportion of the rise in prematurity worldwide is owing to late preterm births, which may be due to the expansion of obstetric interventions, especially pre-labour caesarean section. Late preterm births pose similar risks to overall prematurity, making this trend a concern. In this study, we describe factors associated with provider-initiated late preterm birth and verify differences in provider-initiated late preterm birth rates between public and private health services according to obstetric risk. METHODS This is a sub-analysis of a national population-based survey of postpartum women entitled "Birth in Brazil", performed between 2011 and 2012. We included 23,472 singleton live births. We performed non-conditional multiple logistic regressions assessing associated factors and analysing differences between public and private health services. RESULTS Provider-initiated births accounted for 38% of late preterm births; 32% in public health services and 61% in private health services. They were associated with previous preterm birth(s) and maternal pathologies for women receiving both public and private services and with maternal age ≥35 years for women receiving public services. Women receiving private health services had higher rates of provider-initiated late preterm birth (rate of 4.8%) when compared to the ones receiving public services (rate of 2.4%), regardless of obstetric risk-adjusted OR of 2.3 (CI 1.5-3.6) for women of low obstetric risk and adjusted OR of 1.6 (CI 1.1-2.3) for women of high obstetric risk. CONCLUSION The high rates of provider-initiated late preterm birth suggests a considerable potential for reduction, as such prematurity can be avoided, especially in women of low obstetric risk. To promote healthy births, we advise introducing policies with incentives for the adoption of new models of birth care.
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Affiliation(s)
- Maria do Carmo Leal
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ana Paula Esteves-Pereira
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Marcos Nakamura-Pereira
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | - Marcos Augusto Bastos Dias
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maria Elizabeth Moreira
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Mariza Theme-Filha
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Silvana Granado Nogueira da Gama
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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27
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Esteves-Pereira AP, Deneux-Tharaux C, Nakamura-Pereira M, Saucedo M, Bouvier-Colle MH, Leal MDC. Caesarean Delivery and Postpartum Maternal Mortality: A Population-Based Case Control Study in Brazil. PLoS One 2016; 11:e0153396. [PMID: 27073870 PMCID: PMC4830588 DOI: 10.1371/journal.pone.0153396] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/29/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cesarean delivery rates continue to increase worldwide and reached 57% in Brazil in 2014. Although the safety of this surgery has improved in the last decades, this trend is a concern because it carries potential risks to women's health and may be a modifiable risk factor of maternal mortality. This paper aims to investigate the risk of postpartum maternal death directly associated with cesarean delivery in comparison to vaginal delivery in Brazil. METHODS This was a population-based case-control study performed in eight Brazilian states. To control for indication bias, deaths due to antenatal morbidity were excluded. We included 73 cases of postpartum maternal deaths from 2009-2012. Controls were selected from the Birth in Brazil Study, a 2011 nationwide survey including 9,221 postpartum women. We examined the association of cesarean section and postpartum maternal death by multivariate logistic regression, adjusting for confounders. RESULTS After controlling for indication bias and confounders, the risk of postpartum maternal death was almost three-fold higher with cesarean than vaginal delivery (OR 2.87, 95% CI 1.63-5.06), mainly due to deaths from postpartum hemorrhage and complications of anesthesia. CONCLUSION Cesarean delivery is an independent risk factor of postpartum maternal death. Clinicians and patients should consider this fact in balancing the benefits and risks of the procedure.
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Affiliation(s)
- Ana Paula Esteves-Pereira
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, Paris, France
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Catherine Deneux-Tharaux
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Marcos Nakamura-Pereira
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Monica Saucedo
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Marie-Hélène Bouvier-Colle
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Maria do Carmo Leal
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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