Morbidade neonatal e maternas relacionada ao tipo de parto

Indicações de cesárea nas gestantes classificadas como Robson 1

Objetivos: os objetivos foram identificar as indicações mais prevalentes de cesárea em parturientes Robson 1, comparando variáveis maternas, antecedentes obstétricos e resultados perinatais.Métodos: estudo analítico observacional transversal, onde avaliou-se o Livro de Partos e prontuários eletrônicos das gestantes em trabalho de parto, classificadas como Robson 1. As variáveis quantitativas foram comparadas utilizando-se Teste T de Student ou Mann Whitney, às qualitativas foi empregado teste Qui-quadrado ou Exato de Fisher.Resultados: elegíveis 2267 gestantes, sendo 570 (25,1%) cesáreas. As indicações mais prevalentes de cesariana foram: sofrimento fetal, em 213 (37,4%) dos casos, e desproporção cefalopélvica, em 212 (37,2%). As variáveis relevantes para o desfecho do parto foram: idade materna (razão de chance 1,0), idade gestacional (1,4), índice de massa corpórea pré-gestacional (1,6 em sobrepeso e 1,8 em obesidade) e presença de síndrome hipertensiva (aumentou 3,6).Conclusão: conclui-se que algumas características maternas e obstétricas afetam diretamente a indicação de cesariana.

Acquisition of microbiota according to the type of birth: an integrative review

OBJECTIVE

to analyze scientific evidence regarding the relationship between the type of birth and the microbiota acquired by newborns.

METHOD

this integrative review addresses the role of the type of delivery on newborns' microbial colonization. A search was conducted in the Medical Literature Analysis and Retrieval System Online/PubMed and Virtual Health Library databases using the descriptors provided by Medical Subject Headings (MeSH) and Health Science Descriptors (DeCS).

RESULTS

infants born vaginally presented a greater concentration of Bacteroides, Bifidobacteria, and Lactobacillus in the first days of life and more significant microbial variability in the following weeks. The microbiome of infants born via C-section is similar to the maternal skin and the hospital setting and less diverse, mainly composed of Staphylococcus, Streptococcus, and Clostridium.

CONCLUSION

the maternal vaginal microbiota provides newborns with a greater variety of colonizing microorganisms responsible for boosting and preparing the immune system. Vaginal birth is the ideal birth route, and C-sections should only be performed when there are medical indications.

Associated factors with neonatal near miss in twin pregnancies in a public referral maternity unit in Brazil

Objective

The aim was to analyze the factors associated with neonatal near miss (NNM) in twin pregnancies in a public referral maternity unit in Brazil.

Material and Methods

This retrospective, cross-sectional study included 697 twin newborns. Cases of fetal and neonatal deaths were excluded. Neonates were divided into those meeting NNM criteria (5 min Apgar score <7, birth weight <1,500 g, gestational age at delivery <32 weeks, use of mechanical ventilation or congenital malformation, transfer before 28 days of life) and those who did not. In the bivariate analysis, the chi-square and Fisher's exact tests were used. Variables with a p-value ≤0.20 were subjected to the multiple analyses, which followed the Poisson regression model.

Results

The cohort consisted of 130 (18.7%) neonates meeting NNM criteria and 567 (81.3%) with no NNM criteria after multiple analyses, the following variables were associated with NNM: no previous pregnancy, prevalence ratio (PR): 1.38 [95% confidence interval (CI), 1.03-1.85]; >3 previous pregnancies, PR: 1.93 (95% CI, 1.38-2.69); premature rupture of membranes, PR: 1.50 (95% CI, 1.70-2.12); intrauterine growth restriction, PR: 2.28 (95% CI, 1.53-3.33); premature labor, PR: 1.63 (95% CI, 1.13-2.35); resuscitation in the delivery room, PR: 1.80 (95% CI, 1.24-2.62); and transfusion of blood products, PR: 4.44 (95% CI, 3.14-6.28).

Conclusion

The study findings indicate that having had 0 or >3 previous pregnancies, premature rupture of the membranes, intrauterine growth restriction, resuscitation in the delivery room, premature labor, and transfusion of blood products were associated with NNM in twin pregnancies.

Do breastfed children have a lower chance of developing mouth breathing? A systematic review and meta-analysis

OBJECTIVE

Determine the association between breastfeeding and the development of mouth breathing in children.

MATERIALS AND METHODS

Seven databases were searched for studies investigating the association between the type of feeding and the development of the breathing pattern in children. Descriptive analysis and meta-analysis were performed, with the calculation of the prevalence and likelihood (odds ratios (95% CI)) of mouth breathing according to the duration of breastfeeding.

RESULTS

The overall prevalence of mouth breathing was 44% (95% CI: 38-49) (N total = 1182). Breastfeeding was a protection factor against the development of mouth breathing (OR = 0.62; 95% CI: 0.41-0.93). The likelihood of developing mouth breathing was 41% and 34% lower among children that were breastfed for more than 12 and more than 24 months, respectively. No association was found between exclusive breastfeeding for up to 6 months and the occurrence of mouth breathing (OR = 0.60; 95% CI: 0.31-1.18).

CONCLUSIONS

Due to the scarcity of cohort studies that met the inclusion criteria and the low certainty of the evidence, no strong evidence-based conclusion can be drawn. However, breastfeeding should be encouraged due to its possible protective effect, evidenced by the substantial reduction in the prevalence of mouth breathing pattern when performed for up to 2 years. Exclusive breastfeeding was not associated with the development of the breathing pattern.

CLINICAL RELEVANCE

The results reveal that breastfeeding can protect children from the development of mouth breathing. Thus, healthcare providers should offer support so that mothers feel prepared and encouraged to perform breastfeeding.

TRIAL REGISTRATION

PROSPERO registry: CRD42017062172.

Effects of elective cesarean sections on perinatal outcomes and care practices

Abstract Objectives: to verify the effects of elective cesarean sections on perinatal outcomes and care practices, as compared to vaginal deliveries. Methods: cohort study with 591 mothers and their babies, developed in a medium-sized city in the state of São Paulo, Brazil. Data were collected from hospital records and by interviews at the neonatal screening unit in the city from July 2015 to February 2016. Data regarding childbirth, newborns, sociodemography, and current gestational history were obtained from each mother. The associations of interest were evaluated with Cox regression analyses adjusted for the covariates identified through the results of bivariate analyses presenting a statistical significance level ofp<0.20. In adjusted analyzes, relationships were considered significant ifp<0.05, with relative risk being considered as the measure of effect. Results: if compared to women who had vaginal deliveries, those who were submitted to elective cesarean sections were at a higher risk of not having skin-to-skin contact with their babies in the delivery room, of not breastfeeding in the first hour of life, and of having their babies hospitalized in a neonatal unit. Conclusions: reducing the number of elective cesarean sections is essential to foster good neonatal care practices and reduce negative neonatal outcomes.

Relationship between gestational risk and type of delivery in high risk pregnancy

OBJECTIVE

To analyze the association between gestational risk factors and type of delivery in high-risk pregnancies.

METHOD

A cross-sectional epidemiological study involving a retrospective analysis of secondary data from 4,293 medical records of high-risk pregnant women. The primary outcome was composed of risks associated with cesarean delivery and spontaneous abortion compared with normal delivery.

RESULTS

There were 3,448 women analyzed in the study. The primary outcome rates were cesarean delivery (72.8%), spontaneous abortion (0.9%) versus vaginal delivery (26.2%). Common risk factors for cesarean delivery and spontaneous abortion were age ≥35 years (OR = 1.4; 95% CI 1.1-1.7 / OR = 11.5; 95% CI 4.2-31.0), evangelical religion (OR = 1.4; 95% CI 1.2-1.7 / OR = 2.6; 95% CI 1.0-6.7), high blood pressure (OR = 1.4; 95% CI 1.1-1.8 / OR = 74.9; 95% CI 13.7-410.2) and twinning (OR = 3.1; 95% CI 1.9-5.0 / OR = 68.6, 95% CI 9.7-487.7).

CONCLUSION

Identifying the relationship of gestational risks with the type of delivery and abortion can contribute to developing strategies and assist in planning actions in women's healthcare networks, developing specific and individualized lines of care for each gestational risk.

Ciência & Saúde Coletiva - 25 years: contributions to pregnancy, delivery, and childhood studies

We reviewed the scientific production on maternal health and the health of children under ten years of age, published in Journal Ciência & Saúde Coletiva during the last 25 years, focusing on quantitative studies. The authors' characteristics, populations under study, thematic areas, and methodology are described. A total of 170 publications were identified and grouped into 12 major themes. Pregnancy, delivery, and puerperium were the subject of 47 studies, followed by child anthropometric assessments (29), breastfeeding (24), and mortality (13). The selected publications represented 3.5% of the total original papers published by the Journal since its creation in 1996 and about 5% of the publications in the 2015-2020 period. The primary data sources were health service records, information systems, and population surveys. The cross-sectional design was used in 113 of the 170 articles, and 70% covered only one municipality. The Southeast and Northeast Regions of Brazil were the target of most studies, and the North Region was the least represented. The publications reflect the complexity of maternal and child health themes, with a particular focus on the importance of the Unified Health System and showing how open access data can contribute to public health research.

Type of Childbirth and its Association with the Maternal-Filial Interaction

OBJECTIVE

 The purpose of the present study was to evaluate the quality of mother-child bonding in three different contexts related to the labor, that is, vaginal delivery, elective cesarean section, and intrapartum cesarean section.

METHODS

 This was an observational, cross-sectional clinical study conducted in two cities within the state of São Paulo, Brazil. The study sample consisted of 81 babies born without any major complications during pregnancy and labor, aged 3 to 4 months, and their respective mothers, aged between 20 and 35 years old, primiparous, living in the cities of Palmital and Ourinhos, state of São Paulo, Brazil. The evaluation of the quality of the maternal-filial interaction was performed through video-image analysis, using the Mother-baby Interaction Observation Protocol from 0 to 6 months (POIMB 0-6, in the Portuguese acronym).

RESULTS

 Mothers who had vaginal delivery had higher amount of visual contact or attempted visual contact (p = 0.034), better response to the social behavior of the child (p = 0.001) and greater sensitivity (p = 0.007) than the others. Their children also showed more interaction with them, as they looked more frequently at the mother's face (p ≤ 0.008) and responded more frequently to the mother's communicative stimulus (p < 0.001).

CONCLUSION

 Considering the occurrence of vaginal delivery, it is concluded that the interaction between the mother-child dyad is quantitatively larger and qualitatively better when compared with intrapartum or elective cesarean section.

Cost-effectiveness analysis of natural birth and elective C-section in supplemental health

OBJECTIVE

To conduct a cost-effectiveness analysis of natural childbirth and elective C-section for normal risk pregnant women.

METHODS

The study was conducted from the perspective of supplemental health, a health subsystem that finances private obstetric care, represented in Brazil by health plan operators. The reference populations were normal risk pregnant women, who could undergo natural childbirth or elective C-section, subdivided into primiparous and multiparous women with previous uterine scar. A decision analysis model was constructed including choice of delivery types and health consequences for mother and newborn, from admission for delivery to maternity hospital discharge. Effectiveness measures were identified from the scientific literature, and cost data obtained by consultation with health professionals, health plan operators’ pricing tables, and pricing reference publications of health resources.

RESULTS

Natural childbirth was dominant compared with elective C-section for primiparous normal risk pregnant women, presenting lower cost (R$5,210.96 versus R$5,753.54) and better or equal effectiveness for all evaluated outcomes. For multiparous women with previous uterine scar, C-section presented lower cost (R$5,364.07) than natural childbirth (R$5,632.24), and better or equal effectiveness; therefore, C-section is more efficient for this population.

CONCLUSIONS

It is necessary to control and audit C-sections without clinical indication, especially with regard to primiparous women, contributing to the management of perinatal care.

Análise de custo-efetividade do parto vaginal espontâneo e da cesariana eletiva para gestantes de risco habitual no Sistema Único de Saúde

Resumo: O objetivo deste estudo foi realizar uma análise de custo-efetividade do parto vaginal espontâneo comparado à cesariana eletiva, sem indicação clínica, para gestantes de risco habitual, sob a perspectiva do Sistema Único de Saúde. Um modelo de decisão analítico foi desenvolvido e incluiu a escolha do tipo de parto e consequências clínicas para mãe e recém-nascido, da internação para o parto até a alta hospitalar. A população de referência foi gestantes de risco habitual, feto único, cefálico, a termo, subdivididas em primíparas e multíparas com uma cicatriz uterina prévia. Os dados de custos foram obtidos de três maternidades públicas, duas situadas no Rio de Janeiro e uma em Belo Horizonte, Minas Gerais, Brasil. Foram identificados custos diretos com recursos humanos, insumos hospitalares, custos de capital e administrativos. As medidas de efetividade foram identificadas com base na literatura científica. O estudo evidenciou que o parto vaginal é mais eficiente para gestantes primíparas, com menor custo (R$ 1.709,58) que a cesariana (R$ 2.245,86) e melhor efetividade para três dos quatro desfechos avaliados. Para multíparas, com uma cicatriz uterina prévia, a cesariana de repetição foi custo-efetiva para os desfechos morbidade materna evitada, ruptura uterina evitada, internação em UTI neonatal evitada e óbito neonatal evitado, mas o resultado não foi suportado pela análise de sensibilidade probabilística. Para o desfecho óbito materno não houve diferença de efetividade e o trabalho de parto se mostrou com o menor custo. Este estudo pode contribuir para a gestão da atenção perinatal, ampliando medidas que estimulem o parto adequado de acordo com as características da população.

Healthcare and sociodemographic conditions related to severe maternal morbidity in a state representative population, Federal District, Brazil: A cross-sectional study

Background

The concept of severe maternal morbidity (SMM)—a potentially life-threatening condition during pregnancy, childbirth or after termination of pregnancy—can be used as a quality indicator of the health care provided to mothers and children. The aim of this study was to investigate the SMM rate and the main factors associated with this condition among women living in the Federal District, Brazil.

Methods

We conducted a cross-sectional population-based sample survey using a structured questionnaire about the sociodemographic characteristics of the participants’ families. The data investigated included receipt of financial aid from the Federal Government, age, race, maternal educational level, prenatal care, mode of delivery, and serious complications during pregnancy and postpartum (SMM). 1042 mothers of children up to 1 year old were interviewed, representing a weighted estimated population of 36,724 mothers. The sample was representative of the whole Federal District state.

Results

Mothers were between 19 and 34 years old (69%), most of them were brown or black (59.7%), and they had more than 9 years of education (81.2%). Prenatal care was adequate for 91.9% of them, the most common mode of delivery was Cesarean section (61.3%), and most deliveries took place in public hospitals (57.3%). The prevalence of low birth weight (< 2,500 g) was 8.1%. We found 2072 events of SMM in 2060 mothers (SMM rate: 5.6%). There was an association between higher occurrence of SMM and older age (OR: 1.40; 1.26–1.56), lower maternal educational level (OR: 3.29; 2.78–3.90), and inadequate prenatal care (OR: 1.28; 1.09–1.51). Receipt of financial aid was also associated to increased risk for SMM (OR: 1.31; 1.16–1.48). Cesarean section and low birth weight reduced the risk of SMM (decrease of 49.0% and 46.0%, respectively).

Conclusions

The SMM rate in the Federal District was positively associated with higher maternal age, lower maternal educational level, inadequate prenatal care, and government financial aid program. Conversely, SMM was inversely associated with Cesarean delivery and low birth weight. This study showed that specific demographic groups are at higher risk for SMM. Therefore, actions should be focused primarily on those groups for greater effectiveness at reducing maternal mortality and providing better quality of maternal health care.

Mortality among children under the age of one: analysis of cases after discharge from maternity

OBJECTIVE

To analyze infant death after discharge from maternity in the time period between 2000 and 2013.

METHOD

A cross-sectional retrospective quantitative study in a municipality northward in the state of Paraná. Data were analyzed using the SPSS®, and were subjected to Chi-square test, logistical regression, 95% confidence interval, and a significance level of p <0.05.

RESULTS

Two hundred forty-nine children were born, discharged from maternity and subsequently died; 10.1% in the neonatal period and 89.9% in the post-neonatal period. Pregnancy follow-up, birth, and child monitoring took place mainly in the public health system. There was a statistically significant association between the infant component and place of delivery (p =0.002; RR=1.143; IC95%=1.064-1.229), and a lower number of childcare medical visits (p =0.001; RR=1.294; IC95%=1.039-1.613). The causes of death in the neonatal period were perinatal conditions (40%); external causes (32%); and congenital malformations (20%). In the post-neonatal period, congenital malformations (29.9%), external causes (24.1%); and infectious-parasitic diseases (11.2%) were the causes of death.

CONCLUSION

Virtually all children were born in conditions of good vitality that were worsened due to potentially preventable diseases that led to death.

OBJETIVO

Analisar as mortes infantis após alta das maternidades ocorridas entre 2000 e 2013.

MÉTODO

Pesquisa quantitativa retrospectiva transversal, em município no norte do Paraná. Os dados foram analisados no SPSS®. .Aplicaram-se teste qui-quadrado, regressão logística, intervalo de confiança 95% e nível de significância p <0,05.

RESULTADOS

249 crianças nasceram, receberam alta e evoluíram para óbito, 10,1% no período neonatal e 89,9% no pós-neonatal. O acompanhamento gestacional, nascimento e seguimento da criança ocorreram, predominantemente, no serviço público. Houve associação estatisticamente significativa entre componente infantil e local de parto (p =0,002; RR=1,143; IC95%=1,064-1,229); realizar menos consultas de puericultura (p =0,001; RR=1,294; IC95%=1,039-1,613). As causas de morte no período neonatal foram afecções perinatais (40%), causas externas (32%) e malformações congênitas (20%). No pós-neonatal, malformações congênitas (29,9%), causas externas (24,1%) e doenças infectoparasitárias (11,2%).

CONCLUSÃO

A quase totalidade das crianças nasceu em boas condições de vitalidade, apresentou agravos por doenças potencialmente preveníveis que culminaram no óbito.

[Factors associated with neurodevelopment in children 6-18 months of age in public daycare centers in João Pessoa, Paraíba State, Brazil]

This study aimed to determine the prevalence of altered neurodevelopment in children in public daycare centers in João Pessoa, Paraíba State, Brazil, and to analyze factors associated with child development. A cross-sectional study was conducted in a sample of children 6 to 18 months of age enrolled in daycare. Child development was assessed by the Denver II Screening Test. Biological, riables were studied with a questionnaire and form. Associations were adjusted using logistic regression. Altered development was present in 52.7% of the children and was associated with age > 12 months (OR = 4.3), vaginal delivery (OR = 4.4), neonatal phototherapy (OR = 7.9), and daycare centers not supported by the Family Health Strategy (OR = 2.9). The findings suggest that child development reflects the family's conditions and the care received from educational and healthcare services.

[Preference and factors associated with the type of delivery among new mothers in a public maternity hospital]

OBJECTIVE

To identify reproductive and socioeconomic factors that influence the preference for a method of childbirth.

METHOD

Data were collected using semi-structured interviews with 233 women in postpartum care. Data were analyzed using association tests, namely the Chi-square test and multiple logistic regression.

RESULTS

The preference for vaginal childbirth was cited by 58% of women. The main reasons for this preference were quick postpartum recovery, a negative experience in Caesarean childbirth and fulfilment through motherhood. Analysis of the logistic models of preference for vaginal delivery according to the independent variables revealed a greater occurrence in women who had previous experience of this type of delivery (PR: 1.91; CI: 1.15-3.17) and had received prior guidance (PR: 1.76; CI: 1.06-2.90).

CONCLUSION

Findings highlight the need to transform the model of care provided during pregnancy and childbirth.

Escolha do tipo de parto: fatores relatados por puérperas

RESUMO Objetivo Conhecer os fatores relatados por puérperas que concorreram na escolha do tipo de parto. Métodos Pesquisa qualitativa, desenvolvida com 25 puérperas em um Hospital Universitário de Mato Grosso do Sul, entre setembro e novembro de 2014. Utilizou-se a entrevista semiestruturada para a coleta de dados e o Discurso do Sujeito Coletivo para organizar e tabular os depoimentos. Resultados Os Discursos dos Sujeitos Coletivos resultaram nas categorias: Desejo pelo tipo de parto realizado; Respeito pelo tipo de parto escolhido e Fatores que influenciaram a escolha. A maioria das mulheres entrevistadas (76%) manifestou preferência pelo parto normal devido à recuperação rápida, menor dor e sofrimento. Conclusões Concorreram na escolha do tipo de parto: influência da família, experiências prévias com parto, interação profissional – cliente e informações via internet, o que reforça a importância da educação em saúde desde o pré-natal, destacando a necessidade de instrumentalizar a mulher para realizar uma escolha consciente.

Partos cesáreos e a escolha da data de nascimento no Município de São Paulo

O Brasil tem uma das maiores taxas de partos cesáreos do mundo, e esse valor tem aumentado anualmente. O presente estudo teve como objetivo analisar possíveis mudanças na data de nascimento decorrentes desse aumento. Foram obtidos os dados dos 1.933.137 nascidos vivos ocorridos no Município de São Paulo entre 2001 e 2010, divididos segundo tipo de parto e data exata de nascimento. Em 2001, a taxa de cesarianas foi de 48,9%, passando a 56,8% em 2010. O dia da semana com menor número de nascimentos (domingo) aumentou a diferença em relação aos outros dias de 111,4 (IC95%: 101,7 - 121,0) em 2001 para 143,1 (IC95%: 135,0 - 151,3) em 2010. Os dois dias com menos nascimentos (Natal e Dia de Finados), apresentaram diferença estatisticamente significativa em relação aos outros dias do ano (p < 0.05) durante praticamente todo o período (a exceção foi o Dia de Finados em 2009). A data com o maior número de nascimentos (Dia Internacional da Mulher) apresentou diferença significativa em 2005 e 2010. O aumento no número de partos cesáreos tem tido efeito significativo na data de nascimento, o que pode trazer consequências no planejamento administrativo de instituições de saúde.

Fatores de risco para óbito neonatal obtidos pelo modelo de regressão multivariado de Cox

OBJETIVO: Identificar os fatores associados ao óbito neonatal em São José dos Campos (SP). MÉTODOS: Estudo epidemiológico do tipo longitudinal para o qual foi construído um banco de dados com informações do recém-nascido e da mãe obtidas a partir das Declarações de Nascido Vivo e de Óbito de neonatos de mães residentes em São José dos Campos, nos anos de 2003 e 2004. Definiu-se como variável dependente o óbito até o 28º dia após o nascimento. A análise multivariada, utilizando o modelo de Cox, foi aplicada para verificar a associação entre o óbito neonatal e as seguintes variáveis independentes: sexo, peso ao nascer, duração da gestação, Apgar no 1º e 5º minuto, idade materna, nível de instrução da mãe, número de óbitos fetais e de filhos vivos prévio, tipo de parto e gestação única ou múltipla. O nível de significância adotado foi p<0,05. RESULTADOS: No período analisado, foram identificados 131 óbitos neonatais. Os resultados foram expressos por risco relativo (RR) e intervalo de confiança de 95% (IC95%). Idade gestacional <37 semanas (RR 6,92; IC95% 3,64-13,17), Apgar no 5º minuto <7 (RR 3,14; IC95% 1,95-5,04), Apgar no 1º minuto <7 (RR 3,48; IC95% 2,17-5,60) e baixo peso ao nascimento (RR 4,49; IC95% 3,36-8,53) foram as variáveis associadas significativamente com a morte, no modelo final. CONCLUSÕES: As variáveis associadas ao óbito neonatal em São José dos Campos estão relacionadas à qualidade da assistência pré-natal e perinatal.