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Leal MDC, Esteves-Pereira AP, Bittencourt SA, Domingues RMSM, Theme Filha MM, Leite TH, Ayres BVDS, Baldisserotto ML, Nakamura-Pereira M, Moreira MEL, Gomes MADSM, Dias MAB, Takemoto MLS, Pacagnella RDC, Gama SGND. Protocol of Birth in Brazil II: National Research on Abortion, Labor and Childbirth. CAD SAUDE PUBLICA 2024; 40:e00036223. [PMID: 38695459 PMCID: PMC11057480 DOI: 10.1590/0102-311xpt036223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/26/2023] [Accepted: 08/07/2023] [Indexed: 05/06/2024] Open
Abstract
Brazil has made advances in obstetric care in public and private hospitals; however, weaknesses in this system still require attention. The Brazilian Ministry of Health, aware of this need, funded the second version of the Birth in Brazil survey. This study aimed to evaluate: prenatal, labor and birth, postpartum, and abortion care, comparing the results with those of Birth in Brazil I; and analyze the main determinants of perinatal morbidity and mortality; evaluate the care structure and processes of obstetrics and neonatology services in maternity hospitals; analyze the knowledge, practices, and attitudes of health professionals who provide birth and abortion care; and identify the main barriers and facilitators related to care of this nature in Brazil. With a national scope and a 2-stage probability sample: 1-hospitals and 2-women, stratified into 59 strata, 465 hospitals were selected with a total planned sample of around 24,255 women - 2,205 for abortion reasons and 22,050 for labor reasons. Data collection was conducted using six electronic instruments during hospital admission for labor or abortion, with two follow-up waves, at two and four months. In order to expand the number of cases of severe maternal morbidity, maternal and perinatal mortality, three case control studies were incorporated into Birth in Brazil II. The fieldwork began in November 2021 and is scheduled to end in 2023. It will allow a comparison between current labor and birth care results and those obtained in the first study and will evaluate the advances achieved in 10 years.
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Affiliation(s)
- Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, 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 Elisabeth Lopes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Marcos Augusto Bastos Dias
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Pasokpuckdee K, Boriboonhirunsarn D. Incidence of Preeclampsia and Cesarean Section Rate According to the Robson Classification. Cureus 2023; 15:e49845. [PMID: 38169664 PMCID: PMC10758345 DOI: 10.7759/cureus.49845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Objectives The objective of this study was to determine the incidence of preeclampsia and associated cesarean section (CS) rate according to the Robson classification. Methods A retrospective cross-sectional study was conducted on a total of 670 women who delivered at a tertiary care hospital in Thailand during January to March 2023. All women were classified into 10 groups according to the Robson classification, and preeclampsia was identified. Overall and group-specific incidence of preeclampsia and CS rate were estimated. Comparison of CS rate was made between those with and without preeclampsia using the Chi-squared test. Relative risks (RR) and corresponding 95% confidence intervals were estimated. Results The majority of women were in group 1 (34%) and group 3 (30.7%). Overall CS rate was 40.6% with highest contribution from group 1, 5, and 10. Incidence of preeclampsia was 9.1%, and the majority were in groups 10 (29.5%) and 1 (23%). Preeclampsia significantly increased the rate of overall CS (RR 1.8, p<0.001). The risk of CS significantly increased in group 1 (RR 1.8, p=0.043), group 3 (RR 3.5, p=0.025), and group 10 (RR 1.9, p=0.006). Preeclampsia accounted for 15.4% of all CS, with the highest contribution in group 2 (37.5%), group 10 (31.1%), group 3 (16.7%), and group 1 (10.8%). Without preeclampsia, the overall CS rate was relatively reduced by 6.9%, with the largest relative reduction in group 10 (14.3%), group 3 (11.5%), group 2 (6.3%), and group 1 (5.2%). Conclusion The incidence of preeclampsia was 9.1%, and preeclampsia significantly increased the rate of overall CS. Without preeclampsia, overall CS rate relatively reduced by 6.9% but did not significantly change the relative contribution of CS according to the Robson classification.
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Affiliation(s)
- Kritpol Pasokpuckdee
- Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THA
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Alvarenga MB, da Gama SGN, Nakamura-Pereira M. Characteristics of women who underwent one or more previous cesarean sections according to Nascer no Brasil. Rev Saude Publica 2023; 57:89. [PMID: 37971073 PMCID: PMC10681529 DOI: 10.11606/s1518-8787.2023057004819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/02/2022] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To descriptively analyze Brazilian parturient women who underwent previous cesarean section and point out the factors associated with Vaginal Birth After Cesarean (VBAC) in Brazil. METHODS The study used data from women with one, two, or three or more cesarean sections from the survey Nascer no Brasil (Birth in Brazil). Differences between categories were assessed through the chi-square test (χ2). Variables with significant differences (p < 0.05) were incorporated into logistic regression. FINDINGS Out of the total of 23,894 women, 20.9% had undergone a previous cesarean section. The majority (85.1%) underwent another cesarean section, with 75.5% occurring before the onset of labor. The rate of Vaginal Birth After Cesarean (VBAC) was 14.9%, with a success rate of 60.8%. Women who underwent three or more cesarean sections displayed greater social vulnerability. The chances of VBAC were higher among those who opted for a vaginal birth towards the end of gestation, had a prior vaginal birth, underwent labor induction, were admitted with over 4 centimeters of dilation, and without partner. Receiving care from the private health care system, having two or more prior cesarean sections, obstetric complications, and deciding on cesarean delivery late in gestation reduced the chances of VBAC. Age group, educational background, prenatal care adequacy, and the reason for the previous cesarean section did not result in significant differences. CONCLUSION The majority of women who underwent a previous cesarean section in Brazil are directed towards another surgery, and a higher number of cesarean sections is linked to greater social inequality. Factors associated with VBAC included choosing vaginal birth towards the end of gestation, having had a previous vaginal birth, higher cervical dilation upon admission, induction, assistance from the public health care system, absence of obstetric complications, and without a partner. Efforts to promote VBAC are necessary to reduce overall cesarean rates and their repercussions on maternal and child health.
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Affiliation(s)
- Marina Barreto Alvarenga
- Fundação Oswaldo CruzEscola Nacional de Saúde Pública Sérgio AroucaPrograma de Epidemiologia em Saúde PúblicaRio de JaneiroRJBrasilFundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Programa de Epidemiologia em Saúde Pública, Rio de Janeiro, RJ, Brasil
| | - Silvana Granado Nogueira da Gama
- Fundação Oswaldo CruzEscola Nacional de Saúde Pública Sérgio AroucaDepartamento de Epidemiologia e Métodos Quantitativos em SaúdeRio de JaneiroRJBrasilFundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Rio de Janeiro, RJ, Brasil
| | - Marcos Nakamura-Pereira
- Fundação Oswaldo CruzEscola Nacional de Saúde Pública Sérgio AroucaPrograma de Epidemiologia em Saúde PúblicaRio de JaneiroRJBrasilFundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Programa de Epidemiologia em Saúde Pública, Rio de Janeiro, RJ, Brasil
- Instituto Fernandes FigueiraRio de JaneiroRJBrasilInstituto Fernandes Figueira, Rio de Janeiro, RJ, Brasil
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Albarqouni L, Abukmail E, MohammedAli M, Elejla S, Abuelazm M, Shaikhkhalil H, Pathirana T, Palagama S, Effa E, Ochodo E, Rugengamanzi E, AlSabaa Y, Ingabire A, Riwa F, Goraya B, Bakhit M, Clark J, Arab-Zozani M, Alves da Silva S, Pramesh CS, Vanderpuye V, Lang E, Korenstein D, Born K, Tabiri S, Ademuyiwa A, Nabhan A, Moynihan R. Low-Value Surgical Procedures in Low- and Middle-Income Countries: A Systematic Scoping Review. JAMA Netw Open 2023; 6:e2342215. [PMID: 37934494 PMCID: PMC10630901 DOI: 10.1001/jamanetworkopen.2023.42215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/22/2023] [Indexed: 11/08/2023] Open
Abstract
Importance Overuse of surgical procedures is increasing around the world and harms both individuals and health care systems by using resources that could otherwise be allocated to addressing the underuse of effective health care interventions. In low- and middle-income countries (LMICs), there is some limited country-specific evidence showing that overuse of surgical procedures is increasing, at least for certain procedures. Objectives To assess factors associated with, extent and consequences of, and potential solutions for low-value surgical procedures in LMICs. Evidence Review We searched 4 electronic databases (PubMed, Embase, PsycINFO, and Global Index Medicus) for studies published from database inception until April 27, 2022, with no restrictions on date or language. A combination of MeSH terms and free-text words about the overuse of surgical procedures was used. Studies examining the problem of overuse of surgical procedures in LMICs were included and categorized by major focus: the extent of overuse, associated factors, consequences, and solutions. Findings Of 4276 unique records identified, 133 studies across 63 countries were included, reporting on more than 9.1 million surgical procedures (median per study, 894 [IQR, 97-4259]) and with more than 11.4 million participants (median per study, 989 [IQR, 257-6857]). Fourteen studies (10.5%) were multinational. Of the 119 studies (89.5%) originating from single countries, 69 (58.0%) were from upper-middle-income countries and 30 (25.2%) were from East Asia and the Pacific. Of the 42 studies (31.6%) reporting extent of overuse of surgical procedures, most (36 [85.7%]) reported on unnecessary cesarean delivery, with estimated rates in LMICs ranging from 12% to 81%. Evidence on other surgical procedures was limited and included abdominal and percutaneous cardiovascular surgical procedures. Consequences of low-value surgical procedures included harms and costs, such as an estimated US $3.29 billion annual cost of unnecessary cesarean deliveries in China. Associated factors included private financing, and solutions included social media campaigns and multifaceted interventions such as audits, feedback, and reminders. Conclusions and Relevance This systematic review found growing evidence of overuse of surgical procedures in LMICs, which may generate significant harm and waste of limited resources; the majority of studies reporting overuse were about unnecessary cesarean delivery. Therefore, a better understanding of the problems in other surgical procedures and a robust evaluation of solutions are needed.
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Affiliation(s)
- Loai Albarqouni
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Eman Abukmail
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Majdeddin MohammedAli
- Medicine & Health Sciences Faculty, Department of Medicine, An-Najah National University, Nablus, Palestine
| | - Sewar Elejla
- Faculty of Medicine, Islamic University of Gaza, Gaza Strip, Palestine
| | | | | | - Thanya Pathirana
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Australia
| | - Sujeewa Palagama
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Australia
| | - Emmanuel Effa
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kismu City, Kenya
- Centre for Evidence-Based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Eulade Rugengamanzi
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yousef AlSabaa
- Faculty of Medicine, Al-Azhar University of Gaza, Gaza Strip, Palestine
| | - Ale Ingabire
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Francis Riwa
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Burhan Goraya
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Mina Bakhit
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - C. S. Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Eddy Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Korenstein
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karen Born
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Tabiri
- Department of Surgery, University for Development Studies–School of Medicine and Tamale Teaching Hospital, Tamale, Ghana
| | - Adesoji Ademuyiwa
- Paediatric Surgery Unit, Department of Surgery, Faculty of Clinical Sciences, College of Medicine of the University of Lagos and Lagos University Teaching Hospital, Idi Araba, Lagos
| | - Ashraf Nabhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ray Moynihan
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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Campos ASDQ, Rattner D, Diniz CSG. Achievement of appropriate cesarean rates using Robson's 10-Group classification system in Brazilian private practice. BMC Pregnancy Childbirth 2023; 23:504. [PMID: 37430192 PMCID: PMC10332037 DOI: 10.1186/s12884-023-05803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/21/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Increasing cesarean section (CS) rates are a global concern because they are related to higher maternal and neonatal complication rates and do not provide positive childbirth experiences. In 2019, Brazil ranked second globally, given its overall CS rate of 57%. According to the World Health Organization (WHO), populational CS rates of 10-15% are associated with decreased maternal, neonatal, and infant mortality rates. This study aimed to investigate whether multidisciplinary care following evidence-based protocols associated with a high motivation of both women and professionals for a vaginal birth leads to less overuse of CS in a Brazilian private practice (PP). METHODS This cross-sectional study evaluated CS rates by Robson group for women who sought vaginal birth in a private practice in Brazil comparing with Swedish data. Collaborative care of midwives and obstetricians who adopted evidence-based guidelines was offered. CS rates, overall and by Robson group, contribution of each Robson group to the overall CS rate, clinical and nonclinical interventions, vaginal birth, pre-labor CS, and intrapartum CS proportions were estimated. The expected CS rate was calculated using the World Health Organization C-model tool. The analysis used Microsoft Excel and R Studio (version 1.2.1335. 2009-2019). RESULTS The PP overall CS rate was 15.1% (95%CI, 13.4-17.1%) versus the 19.8% (95%CI, 14.8-24.7%) rate expected by the WHO C-model tool. The population included 43.7% women in Robson Group 1 (nulliparous, single, cephalic, at term, spontaneous labor), 11.4% in Group 2 (nulliparous, single, cephalic, at term, induced labor or CS before labor), and 14.9% in Group 5 (multiparous women with previous CS), the greatest contributors to higher CS rates (75.4% of them). The Swedish overall CS rate was 17.9% (95%CI, 17.6-18.1%) in a population of 27% women in Robson Group 1, 10.7% in Group 2, and 9.2% in Group 5. CONCLUSIONS Multidisciplinary care following evidence-based protocols, associated with high motivation of both women and professionals for vaginal birth, may lead to a significant and safe reduction of CS rates even in contexts such as Brazil, with high medicalization of obstetric care and excess CS.
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Affiliation(s)
- Andrea Silveira de Queiroz Campos
- Faculdade de Saúde Pública, Universidade de São Paulo, Av. Doutor Arnaldo, 715, 2º andar, Cerqueira César, São Paulo, 01246904 SP Brasil
| | - Daphne Rattner
- Faculdade de Ciências da Saúde, Universidade de BrasÃlia, Campus Universitário Darcy Ribeiro, Asa Norte, BrasÃlia, 70910900 DF Brasil
| | - Carmen Simone Grilo Diniz
- Faculdade de Saúde Pública, Universidade de São Paulo, Av. Doutor Arnaldo, 715, 2º andar, Cerqueira César, São Paulo, 01246904 SP Brasil
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Fernandes LMM, Mishkin KE, Lansky S. Doula support among brazilian women who attended the senses of birth health education intervention - a cross sectional analysis. BMC Pregnancy Childbirth 2022; 22:765. [PMID: 36224541 PMCID: PMC9558943 DOI: 10.1186/s12884-022-05069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While maternal health is a priority in international goals, maternal health outcomes remain poor in many regions of the world. In Brazil, maternal mortality has decreased over the past decades, but the country's maternal mortality ratio is higher than over half of all countries at 59 deaths per 100,000 live births. The Brazilian maternal health care model facilitates high rates of medical interventions during labor and childbirth; 56% of births are by cesarean birth. Doula support is considered a potential strategy to reduce medically unnecessary interventions during childbirth that contribute to maternal mortality. METHODS The cross-sectional study analyses associations with use of doula support and normal birth among Brazilian women who participated in a health education intervention named the Senses of Birth (SoB). The SoB intervention, implemented in five cities from 2015 to 2017, was developed to educate about normal birth and to evidence-based practices (EBP) reduce medically in childbirth. Chi-Square tests were performed to identify the relationship between doula support during childbirth and sociodemographic characteristics, childbirth information, perceived knowledge, and use of EBPs during labor. Logistic regression was performed to identify associations in adjusted analysis. RESULTS Controlling for covariates, doula support was associated with vaginal delivery (OR 2.47, 95% CI: 1.37-4.45.) Findings also suggest that women who had doula support were more likely to use non-pharmacological pain relief methods during labor (OR 9.68, 95% CI: 2.67-34.61), deliver in a public hospital (OR 2.02, 95% CI: 1.09-3.72), and be low and mid-level income compared to women with high income. CONCLUSION This study's findings suggest that doula support is significantly associated with vaginal birth. The results may be useful for advocating for changes to the childbirth care model in Brazil. Incorporating EBPs, such as doula support, for all women who desire may improve maternal and child outcomes.
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Affiliation(s)
| | | | - Sônia Lansky
- Department of Health, City Hall, Belo Horizonte, Minas Gerais, Brazil
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Ferreira Júnior AR, Brandão LCDS, Teixeira ACDMF, Cardoso AMR. Potencialidades e limitações da atuação do enfermeiro no Centro Parto Normal. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo Conhecer as potencialidades e limitações da atuação do enfermeiro no Centro de Parto Normal (CPN). Método abordagem qualitativa, do tipo exploratório e descritivo, realizado em 2018, com seis enfermeiras atuantes em CPN intra-hospitalar público na região metropolitana de Fortaleza, Ceará, Brasil. A coleta das informações ocorreu por meio de entrevista individual, com análise a partir dos pressupostos da sociologia das profissões, com foco nos temas: conhecimento e autonomia; credencialismo; divisão do trabalho; mercado de trabalho e quadro de valores. Resultado A atuação do enfermeiro no CPN potencializa as boas práticas para o parto e nascimento, bem como amplia a importância e visibilidade deste profissional no cuidado materno-infantil. O cuidado clÃnico e a gestão emergem como foco da ação do enfermeiro no CPN. No entanto, mesmo com a indução do Estado para essa atuação, ainda há a necessidade de reconhecimento das competências e autonomia do enfermeiro no cuidado obstétrico por outros profissionais. Conclusão e implicações para a prática Há desafios que precisam ser superados como a ampliação da autonomia e do respeito ao credenciamento do enfermeiro para atuação no CPN e a harmonização entre a gestão do processo de trabalho e gestão do cuidado clÃnico por este profissional.
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Guida JP, Cralcev C, Costa Santos J, Marangoni-Junior M, Sanchez MP, Laura Costa M. Validation of the fullPIERS model for prediction of adverse outcomes in preeclampsia at a referral center. Pregnancy Hypertens 2020; 23:112-115. [PMID: 33310390 DOI: 10.1016/j.preghy.2020.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/21/2020] [Accepted: 11/28/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To validate the use of fullPIERS to predict maternal and perinatal adverse outcomes in a referral center. METHODS Cross-sectional study including all pregnant women with preeclampsia (PE) at a referral center in southeast Brazil. The prevalence of PE and adverse outcomes were assessed. The fullPIERS score was tested on three composites of adverse outcomes: maternal adverse outcome; fetal adverse outcomes; and the combination of these two. Furthermore, the fullPIERS risk calculator, was considered to define the cutoff that better estimates adverse outcomes. RESULTS 2839 women were screened in a one year period, with 208 (7.3%) cases of PE; most were preterm (56.7%); with severe features (74.5%). HELLP syndrome (6.7%), eclampsia (3.8%) and placental abruption (2.4%) were the most frequent complications. FullPIERS assessement had a median of 1.2% (0.45 - 2.3%) and the score had an excelent performance to predict adverse maternal outcome (AUC = 0.845, confidence interval 0.776 - 0.914, p-value < 0.01). For perinatal adverse outcomes (AUC = 0.699, confidence interval 0.581 - 0.816, p-value < 0.01) and the composite of maternal and perinatal adverse outcome (AUC = 0.804, confidence interval 0.736 - 0.872, p-vale < 0.01), fullPIERS score had a suboptimal performance. The cutoff value that best performed for the assessment of maternal adverse outcome was 2.15% (sensitivity of 75% and specificity of 83%). CONCLUSION Preeclampsia was a significant complication during pregnancy. The fullPIERS model was an excellent tool to predict maternal adverse outcomes; with a cutoff value of 2.15% in the tested population.
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Affiliation(s)
| | - Christopher Cralcev
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Juliana Costa Santos
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | | | | | - Maria Laura Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
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Lucena FS, Garcia MT, Duarte LS. Cesarean section rates in São Paulo State: regional inequalities in SUS obstetric care. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000400012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: to analyze the relation between cesarean section rates in SUS childbirth care establishments in São Paulo State and urbanization conditions, according to Robson group classification system. Methods: Sistema de Informação sobre Nascidos Vivos (Live Births Information System) and Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Establishments) 2016 databases were analyzed. The studied outcome was cesarean section rates in the establishments, grouped by administration type (public or nonprofit entities) and urbanization condition. Results: the cesarean section rate in SUS childbirth care establishments was 50.5%, ranging from 41.1% in metropolitan regions up to 75.2% in the low urbanized regions. Cesarean section rates in public administration establishments (38.2%) were significantly lower than the nonprofit administration maternity hospitals (62.3%). Robson groups 5 and 2 contributed mostly to the cesarean section global rate (36.6% and 21.5%, respectively). Conclusions: The less urbanized regions showed significantly higher cesarean section rates than the metropolitan and highly urbanized regions. Cesarean section rates of public administration establishments were significantly lower than the nonprofit administration establishments. However, when separated by urbanization condition its difference was only observed in the metropolitan regions.
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Sanchez MP, Guida JP, Simões M, Marangoni-Junior M, Cralcev C, Santos JC, Dias TZ, Luz AG, Costa ML. Can pre-eclampsia explain higher cesarean rates in the different groups of Robson's classification? Int J Gynaecol Obstet 2020; 152:339-344. [PMID: 32920856 DOI: 10.1002/ijgo.13370] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/17/2020] [Accepted: 09/04/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the impact of pre-eclampsia on cesarean delivery by using the Robson classification. METHODS A retrospective cross-sectional study including all women who delivered in a referral maternity hospital in southeast Brazil from January 2017 to February 2018. Women were classified into 1 of 10 Robson groups and then further subdivided into pre-eclampsia (PE) and non-PE (NPE) groups. Frequency of cesarean was determined for each group and compared by using χ2 and prevalence ratio. RESULTS Overall, 3102 women were included, of whom 1578 (50.9%) delivered by cesarean. Classification in Robson group 5 was the most frequent among all women (n=727, 23.4%). In the PE group (n=258, 8.3%), group 10 was the most frequent classification (n=120, 46.5%); in NPE, Robson group 5 was the most frequency (n=682, 24.0%). Pre-eclampsia was associated with a higher occurrence of cesarean (77.5% vs 48.4%; prevalence ratio, 2.29; 95% confidence interval, 1.82-2.82), owing to higher rates in Robson groups 1, 5, and 10. CONCLUSION Pre-eclampsia was associated with a higher occurrence of cesarean delivery in some Robson groups. Robson classification may be used to evaluate the impact of specific conditions at a facility level to help plan future interventions to optimize the use of cesarean.
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Affiliation(s)
- Mariana P Sanchez
- Departament of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Jose P Guida
- Departament of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Marcela Simões
- Departament of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Marcos Marangoni-Junior
- Departament of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Christopher Cralcev
- Departament of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Juliana C Santos
- Departament of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Tabata Z Dias
- Departament of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Adriana G Luz
- Departament of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Maria L Costa
- Departament of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
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Gattás DSMB, de Amorim MMR, Feitosa FEL, da Silva-Junior JR, Ribeiro LCG, Souza GFA, Souza ASR. Misoprostol administered sublingually at a dose of 12.5 μg versus vaginally at a dose of 25 μg for the induction of full-term labor: a randomized controlled trial. Reprod Health 2020; 17:47. [PMID: 32272959 PMCID: PMC7147027 DOI: 10.1186/s12978-020-0901-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/27/2020] [Indexed: 12/04/2022] Open
Abstract
Background Labor induction is defined as any procedure that stimulates uterine contractions before labor begins spontaneously. The vaginal and oral routes of administration of misoprostol are those most used for the induction of labor in routine practice, with the recommended dose being 25 μg. Nevertheless, the sublingual route may reduce the number of vaginal examinations required, increasing patient comfort and lowering the risk of maternal and fetal infection. Based on a previous systematic review, the objective of this study was to compare the frequency of tachysystole as the main outcome measure when misoprostol is administered sublingually at the dose of 12.5 μg versus vaginally at a dose of 25 μg to induce labor in a full-term pregnancy with a live fetus. Methods A randomized, placebo-controlled, triple-blind clinical trial was conducted at two maternity hospitals in northeastern Brazil. Two hundred patients with a full-term pregnancy, a live fetus, Bishop score ≤ 6 and an indication for induction of labor were included. Following randomization, one group received 12.5 μg misoprostol sublingually and a vaginal placebo, while the other group received a sublingual placebo and 25 μg misoprostol vaginally. The primary outcome was the frequency of tachysystole. Student’s t-test, the chi-square test of association and Fisher’s exact test were used, as appropriate. Risk ratios and their 95% confidence intervals were calculated. Results The frequency of tachysystole was lower in the group using 12.5 μg misoprostol sublingually compared to the group using 25 μg misoprostol vaginally (RR = 0.15; 95%CI: 0.02–0.97; p = 0.002). Failure to achieve vaginal delivery within 12 and 24 h was similar in both groups. Sublingual administration was preferred to vaginal administration by women in both groups; however, the difference was not statistically significant. Conclusion The effectiveness of labor induction with low-dose sublingual misoprostol was similar to that achieved with vaginal administration of the recommended dose; however, the rate of tachysystole was lower in the sublingual group, and this route of administration may prove a safe alternative. Trial registration Registration number: NCT01406392, ClinicalTrials.gov. Date of registration: August 1, 2011.
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Affiliation(s)
- Daniele S M B Gattás
- Postgraduate Program in Comprehensive Healthcare at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua Dom Sebastião Leme 171/ 2702, Graças, Recife, Pernambuco, 52011-160, Brazil.
| | - Melania M R de Amorim
- Postgraduate Program in Comprehensive Healthcare at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua Dom Sebastião Leme 171/ 2702, Graças, Recife, Pernambuco, 52011-160, Brazil.,Department of Obstetrics and Gynecology, Federal University of Campina Grande (UFCG) and Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESq), Campina Grande, ParaÃba, Brazil
| | - Francisco E L Feitosa
- Assis Chateaubriand Maternity Teaching Hospital, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| | - José R da Silva-Junior
- Postgraduate Program in Comprehensive Healthcare at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua Dom Sebastião Leme 171/ 2702, Graças, Recife, Pernambuco, 52011-160, Brazil.,Department of Obstetrics and Gynecology, Faculdade Pernambucana de Saúde (FPS), Recife, Pernambuco, Brazil
| | - LÃvia C G Ribeiro
- Assis Chateaubriand Maternity Teaching Hospital, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| | - Gustavo F A Souza
- Undergraduate medical student, Centre for Biological Sciences and Health, Catholic University of Pernambuco (UNICAP), Recife, Pernambuco, Brazil
| | - Alex S R Souza
- Postgraduate Program in Comprehensive Healthcare, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Department of Maternal and Child Health, Federal University of Pernambuco (UFPE), Centre for Biological Sciences and Health, Catholic University of Pernambuco (UNICAP), Recife, Pernambuco, Brazil
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12
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Franzon ACA, Oliveira-Ciabati L, Bonifácio LP, Vieira EM, Andrade MS, Sanchez JAC, Braga GC, Nogueira-Pileggi V, Fernandes M, Souza JP. A communication and information strategy in health and preparation for childbirth: a randomized cluster trial (PRENACEL). CAD SAUDE PUBLICA 2019; 35:e00111218. [PMID: 31618382 DOI: 10.1590/0102-311x00111218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 03/29/2019] [Indexed: 11/22/2022] Open
Abstract
PRENACEL is a study that incorporates two innovative approaches to maternal and perinatal health: the need to improve women's level of satisfaction with the birthing experience and an assessment of the impacts of information and communication technologies in health. The approaches involve a communication program via short cellphone text messages, developed for Brazilian pregnant women in prenatal care in the Brazilian Unified National Health System. The analysis aims to determine whether the program contributes positively to women's perceived preparedness for childbirth. A randomized cluster trial was performed in 20 primary care units in Ribeirão Preto, São Paulo State, in 2015 and 2016. Data were collected for 1,210 women from interviews and patient charts. The data were submitted to two analytical models, per protocol and intention-to-treat. Women that had received information from the PRENACEL program during pregnancy were more likely to feel prepared for labor and delivery and to feel that prenatal care had helped them feel more prepared. There were also positive impacts on bonding with the newborn and breastfeeding in the delivery room and on knowledge of obstetric interventions. No differences were seen in the other maternal and perinatal outcomes, including women's satisfaction with the birthing care. PRENACEL can help expand women's access to strategic information for them to feel better prepared for the birthing experience.
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Affiliation(s)
| | | | | | | | - Magna Santos Andrade
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brasil
| | | | - Giordana Campos Braga
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brasil
| | - Vicky Nogueira-Pileggi
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brasil
| | - Mariana Fernandes
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brasil
| | - João Paulo Souza
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brasil
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13
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Prevalence of spontaneous, induced labour or planned caesarean section and factors associated with caesarean section in low-risk women in southern Brazil. Midwifery 2019; 79:102530. [PMID: 31479799 DOI: 10.1016/j.midw.2019.102530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 08/12/2019] [Accepted: 08/15/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study aimed to examine the prevalence of spontaneous labour, induced labour and planned caesarean section in low-risk women; to identify the contribution of each group to the overall caesarean section rate; and to estimate factors associated with caesarean section in low-risk women according to spontaneous labour, induced labour and planned caesarean section. DESIGN Cross-sectional hospital-based study of postpartum women and newborns, using data from the survey Birth in Brazil, Southern region. In the sample of 2,668 low-risk women, a descriptive analysis was undertaken and a Multinomial Logistic Regression model was applied to verify associations among caesarean section and spontaneous labour, induced labour and planned caesarean section in comparison with vaginal birth. MEASUREMENTS AND FINDINGS The results showed the prevalence of spontaneous labour (48.0%), induced labour (14.0%) and planned caesarean sections (38.0%); these frequencies contributed to an overall caesarean section rate of 50.5%. Obstetric characteristics like previous vaginal birth or previous caesarean section were differentially associated with caesarean section, independently of the labour. Caesarean section without labour was significantly associated with age ≥ 35 years (ORadj 5.45 95%CI 3.16-9.39), economic class A and B (ORadj 3.10 95%CI 1.92-4.99), pregnancy between 37 and 38 weeks (ORadj 1.65 95%CI 1.22-2.24), same obstetrician in prenatal and childbirth (ORadj 13.83 95%CI 8.85-21.61) and private payment source at birth (ORadj 11.50 95%CI 6.64-19.93). KEY CONCLUSION For low-risk women in Southern Brazil, the results identify high planned caesarean section rates, not associated with socioeconomic, obstetric, institutional or prenatal factors that justify these rates.
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14
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Lansky S, Oliveira BJ, Peixoto ER, Souza KV, Fernandes LM, Friche AA. The Senses of Birth intervention to decrease cesarean and prematurity rates in Brazil. Int J Gynaecol Obstet 2019; 145:91-100. [PMID: 30671949 PMCID: PMC7473078 DOI: 10.1002/ijgo.12765] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 10/05/2018] [Accepted: 01/21/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To increase knowledge and promote cultural change toward valuing normal birth, and to lower rates of cesarean and unnecessary interventions during childbirth in Brazil via the Senses of Birth (SoB) exhibition. METHODS The SoB intervention targeted 22Â 621 participants in three Brazilian cities in 2015. The effects of the exhibition in knowledge, perceptions, and preferences regarding childbirth were analyzed in a multi-method study. Pre- and post-exhibition survey responses of 17Â 501 (77.0%) visitors, 1947 (8.6%) non-pregnant women, and all pregnant women (n=1287) were collected at the exhibition. A follow-up survey was completed by 555 (43.0%) postpartum women who had participated at SoB while pregnant. Univariate analyses were used to compare before and after changes. RESULTS There was a significant increase in knowledge about normal birth, varying from 10.0% to 25.0% among general visitors (P<0.001) and 27.3% to 42.0% among pregnant women (P<0.001). Perceptions and preferences for normal birth also changed, reaching 83.0% of general visitors and 87.4% of pregnant women. CONCLUSION SoB was found to effectively improve knowledge about and preference for normal birth. Scaling-up the intervention might contribute to cultural change toward valuing normal birth, and might decrease the rate of unnecessary cesarean and premature birth in Brazil.
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Affiliation(s)
- Sônia Lansky
- Department of Health, Belo Horizonte City Hall, Belo Horizonte, Brazil
| | - Bernardo J. Oliveira
- School of Education, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Eliane R.M. Peixoto
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kleyde V. Souza
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Amélia A.L. Friche
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Shirzad M, Shakibazadeh E, Betran AP, Bohren MA, Abedini M. Women's perspectives on health facility and system levels factors influencing mode of delivery in Tehran: a qualitative study. Reprod Health 2019; 16:15. [PMID: 30736792 PMCID: PMC6368775 DOI: 10.1186/s12978-019-0680-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iran has one of the highest national caesarean section rates worldwide. Few studies explored in-depth the health-facility and health-system level factors that affect women's choices on mode of delivery in Iran. The aim of this study was to explore the health-facility and health-system level factors affecting women's preferences on mode of delivery in Tehran. METHODS We conducted a qualitative study using in-depth face-to-face interviews with women between October 2017 and May 2018. Study participants were sampled purposively from a range of health service settings to include women of varying experiences regarding childbirth. Eligibility criteria were Persian-speaking, women with or without childbirth experiences. All interviews were audio-recorded and lasted 30-45 min. After verbatim transcription of the interviews, we created a preliminary thematic framework to analyze the data. A combined inductive (themes emerging from the data) and deductive (key concepts across existing frameworks) approach was used during data analysis. RESULTS In total, 26 in-depth interviews were conducted. Five central themes influencing women's preferences on mode of delivery emerged from the analysis: (1) health system conditions (important differences between the quality of care provided at private and public hospitals; staff shortages, skills, competency, motivation and also accessibility to staff during the longer time required for a vaginal delivery; policies and protocols on vaginal birth after cesarean, pain relief for vaginal birth, and having companion during labor; (2) standards of care in facilities (physical condition in facilities; physical examinations and procedures; continuous and organized care; ethics); (3) interaction between women and providers (communicating in a supportive manner with women and communication women's partners/families); (4) preserving women's dignity (delivering high quality and respectful care); (5) provision of information (education about pregnancy and childbirth including environment in facility, labor processes/procedures, and the risks and benefits of both vaginal delivery and caesarean section). CONCLUSIONS Our study suggests, there are barriers to increasing demand for and satisfaction with vaginal birth, such as women's perceived sub-optimal quality of care during labor and birth, understaffed facilities that lack standard protocols and have limited physical space, and lack of privacy and dignity. The multifactorial nature of the increase of unnecessary Cesarean section calls for multicomponent interventions to revert this trend. These interventions need to address the health-systems' and health-facilities' deficiencies behind women's preference for Cesarean section.
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Affiliation(s)
- Mahboube Shirzad
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Shakibazadeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ana Pilar Betran
- Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
| | - Meghan A. Bohren
- School of Population and Global Health, Centre for Health Equity, Gender and Women’s Health Unit, University of Melbourne, Melbourne, Australia
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Moreira AIM, Sousa PRMD, Sarno F. Low birth weight and its associated factors. EINSTEIN-SAO PAULO 2018; 16:eAO4251. [PMID: 30427482 PMCID: PMC6223941 DOI: 10.31744/einstein_journal/2018ao4251] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 02/22/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To calculate the frequency and evaluate the factors associated with low birth weight. METHODS A retrospective study, with data from pregnant women who participated in the Programa de Atenção às Gestantes do Programa Einstein na Comunidade de Paraisópolis, between 2011 and 2014, and who returned for the postpartum evaluation of their newborns. Variables related to the pregnant woman, pregnancy, and newborn were evaluated. The outcome variable was low birth weight, defined as <2.5kg. The associations between the independent variables and low birth weight were assessed by χ2 and Mann-Whitney tests. Logistic regression models analyzed the combined effects of the independent variables on low birth weight. RESULTS Data of 794 pregnant women and their newborns (52.1% males) were analyzed. The age of pregnant women varied from 13 to 44 years (median of 24 years), and the majority reported being married or living in cohabitation (74.7%), and having between 9 to 11 years of schooling (53.4%). The proportion of low birth weight was 7.6% (newborn mean weight of 3.2kg) and, in multivariate analysis, presence of twinning, age group of the pregnant women (showing protection for low birth weight between ages ≥18 years and <35 years), and cesarean section were associated with low birth weight. CONCLUSION The proportion of low birth weight was 7.6% and twining, age of the pregnant woman, and cesarean delivery were associated with the occurrence of low birth weight.
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Affiliation(s)
| | | | - Flavio Sarno
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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17
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Nakamura-Pereira M, Esteves-Pereira AP, Gama SGN, Leal M. Elective repeat cesarean delivery in women eligible for trial of labor in Brazil. Int J Gynaecol Obstet 2018; 143:351-359. [PMID: 30182481 DOI: 10.1002/ijgo.12660] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/04/2018] [Accepted: 09/03/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the hospital, maternal, and obstetric characteristics associated with elective repeat cesarean delivery (ERCD) among women eligible for trial of labor after cesarean (TOLAC) delivery in Brazil. METHODS The present data were retrieved from the Birth in Brazil study, a national hospital-based cohort study conducted during 2011-2012. Data were collected from medical records and by interview. Univariate and hierarchical multiple logistic regression analyses were performed to analyze factors associated with ERCD among women with a previous cesarean delivery who were eligible for TOLAC. RESULTS Among 2295 women considered eligible for TOLAC, 1516 (66.1%) had an ERCD; the overall cesarean delivery rate was 79.4%. In the private sector, almost all deliveries (95.3%) were performed by ERCD. In the public sector, ERCD was associated with socioeconomic (more years of schooling), obstetric (women's preference, no previous vaginal delivery, macrosomia), and hospital (mixed hospital, location in noncapital city, fewer than 1500 deliveries per year) characteristics. CONCLUSION The ERCD rate in Brazil was high even in a low-risk group, indicating that nonclinical factors may be driving the decision for cesarean delivery. Efforts aiming to reduce cesarean deliveries in Brazil should target women with a previous cesarean delivery.
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Affiliation(s)
- Marcos Nakamura-Pereira
- Fernandes Figueira National Institute for Women's, Children's and Adolescents' Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,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
| | - Silvana G N Gama
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maria Leal
- 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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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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Stubert J, Peschel A, Bolz M, Glass Ä, Gerber B. Accuracy of immediate antepartum ultrasound estimated fetal weight and its impact on mode of delivery and outcome - a cohort analysis. BMC Pregnancy Childbirth 2018; 18:118. [PMID: 29716537 PMCID: PMC5930666 DOI: 10.1186/s12884-018-1772-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/24/2018] [Indexed: 11/29/2022] Open
Abstract
Background The aim of the study was to investigate the accuracy of ultrasound-derived estimated fetal weight (EFW) and to determine its impact on management and outcome of delivery. Methods In this single-center cohort analysis, women with a singleton term pregnancy in the beginning stages of labor were included. Women with immediately antepartum EFW (N = 492) were compared to women without ultrasound (N = 515). Results EFW was correct (deviation from birth weight ≤ 10%) in 72.2% (355/492) of patients with fetal biometry; 19.7% (97/492) were underestimated, and 8.1% (40/492) were overestimated. Newborns with a lower birth weight were more frequently overestimated, and newborns with higher birth weight were more frequently underestimated. The mean difference between EFW and real birth weight was − 114.5 g (standard deviation ±313 g, 95% confidence interval 87.1–142.0). The rate of non-reassuring fetal heart tracing (9.8% vs. 1.9%, P < 0.001) and of caesarean delivery (9.1% vs. 5.0%, P = 0.013) was higher in women with EFW. Overestimation was associated with an increased risk for delivery by caesarean section (odds ratio 2.80; 95% confidence interval 1.2–6.5, P = 0.017). After adjustment, EFW remained associated with increased non-reassuring fetal heart tracing (odds ratio 4.73; 95% confidence interval 2.3–9.6) and caesarean delivery (odds ratio 1.86; 95% confidence interval 1.1–3.1). The incidence of perineal tears of grade 3/4, shoulder dystocia, postnatal depression and neonatal acidosis did not differ between groups. Conclusions Antepartum ultrasound-derived EFW does not improve maternal and fetal outcome and is therefore not recommended.
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Affiliation(s)
- Johannes Stubert
- Department of Obstetrics and Gynecology, University of Rostock, Suedring 81, 18059, Rostock, Germany.
| | - Adam Peschel
- Department of Radiology, Hospital Asklepios Klinik Barmbek, Hamburg, Germany
| | - Michael Bolz
- Department of Obstetrics and Gynecology, University of Rostock, Suedring 81, 18059, Rostock, Germany
| | - Änne Glass
- Institute for Biostatistics and Informatics in Medicine, University of Rostock, Rostock, Germany
| | - Bernd Gerber
- Department of Obstetrics and Gynecology, University of Rostock, Suedring 81, 18059, Rostock, Germany
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Giordano JC, Nascimento SL, Godoy-Miranda AC, Surita FG. The misleading choice for safer births in Brazilian's most developed region: a cross-sectional study. J Matern Fetal Neonatal Med 2017; 32:718-723. [PMID: 28988503 DOI: 10.1080/14767058.2017.1390558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze the Cesarean Section (CS) rate in Brazilian women according to category of health insurance and individual characteristics associated with the mode of delivery. MATERIALS AND METHODS A cross-sectional study was performed in three maternity services (one public tertiary referral center, one maternity service for both public and private care, and one private maternity service) in Campinas city, Brazil. Eligibility criteria were: inpatient during the immediate postpartum period, hospital birth, single pregnancy, and live newborn. Sociodemographic and anthropometric data, reproductive history, pregnancy planning, and prenatal care information was obtained from participants. Comorbidities, type of birth, and newborn data were collected from medical records. The mode of delivery was categorized as either CS or vaginal delivery. RESULTS A total of 1276 women were included in this study. The overall CS rate was 57.5%. CS rates were 41.6, 54.8, and 90.1% for public, mixed (public and private), and private maternity services, respectively. Mean age was higher in women who had a CS (28.0 ± 6.0 years versus 25.9 ± 6.5 years, p < .0001) as was the mean Body Mass Index (25.2 ± 5.3 kg/m2 versus 23.8 ± 4.5 kg/m2, p < .0001). CS was related to higher education, employment, white skin color, planned pregnancy, antenatal care in a private service, and primiparity. CONCLUSIONS The overall CS rate was high (greater than 50%); in the private service, almost all participants had a CS delivery (90.1%). Better socioeconomic conditions and primiparity were associated with higher CS rates in Brazil. Political pressure for the management of unnecessary CSs is vital in Brazil. Together with the provision of real incentives for normal deliveries in public and, most importantly, private services.
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Torloni MR, Betrán AP, Belizán JM. Born in Brazil: shining a light for change. Reprod Health 2016; 13:133. [PMID: 27756402 PMCID: PMC5070232 DOI: 10.1186/s12978-016-0247-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 11/17/2022] Open
Abstract
The Birth in Brazil study is the largest national hospital-based survey in Brazil regarding birth practices. Conducted in 2011–2012, it collected information from 266 public and private healthcare facilities and interviewed nearly 24,000 postpartum women. It is also the latest effort to map out how labor and delivery are managed in this county in the 21st century. The journal Reproductive Health has published a supplement including 10 articles presenting the results of a series of analyses using this valuable resource. These articles describe a range of practices, determinants and risk factors that affect women and their babies in Brazil, a country of paradoxes. In the era of overmedicalization and high-tech medicine – arguably –, these articles highlight the unprecedented rates of cesarean sections in Brazil and differences between the public and the private sectors. It provides evidence for the need for adequate human resources, medications and emergency care equipment in many settings; and explains the use of non-evidence based interventions during labor and delivery. On the other hand, these studies also point to promising interventions that could be used to change this situation not only in Brazil but also in other countries facing similar challenges.
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Affiliation(s)
- Maria Regina Torloni
- Department of Internal Medicine, Evidence Based Healthcare Post-Graduate Programme, São Paulo Federal University, São Paulo, Brazil.
| | - Ana Pilar Betrán
- Department of Reproductive Health and Research, UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - José M Belizán
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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