RESUMO
OBJECTIVES: to evaluate the trends in cesarean sections from 2014 to 2020 across both public and private sectors, utilizing the Robson Classification. METHODS: this time series study analyzed the proportion of women who underwent cesarean sections between 2014 and 2020, considering both the Robson classification and the type of healthcare service. Trend analysis was conducted using the Prais-Winsten regression. RESULTS: higher proportions of cesarean sections were observed in all Robson groups within the private sector compared to the public sector. This was despite a decreasing trend in the private sector and an increasing trend in the public sector. Notably, elevated proportions of cesarean sections were recorded in groups that are typically favorable to normal childbirth (Robson 1, 4, and 5). CONCLUSIONS: although there was a decreasing trend in cesarean sections within the private sector, an increasing trend was observed in the public sector. Additionally, there was a high proportion of cesarean sections among women with conditions favorable to normal childbirth. It is crucial to continuously monitor these indicators to evaluate and implement interventions aimed at reducing unnecessary cesarean sections.
Assuntos
Cesárea , Setor Privado , Setor Público , Cesárea/estatística & dados numéricos , Cesárea/tendências , Cesárea/classificação , Brasil , Humanos , Feminino , Gravidez , Setor Público/estatística & dados numéricos , Setor Público/tendências , Setor Privado/estatística & dados numéricos , Setor Privado/tendências , AdultoRESUMO
Cesarean delivery is major surgery associated with higher costs and adverse outcomes, such as surgical complications, compared with vaginal delivery (1-3). The cesarean delivery rate in Puerto Rico rose from just over 30% in the early to mid-1990s to over 40% by the early 2000s (4,5). During this time, cesarean delivery rates in Puerto Rico were 40%-70% higher than rates in the U.S. mainland and up to 78% higher than rates for Hispanic women in the U.S. mainland (4,5). This report describes trends in Puerto Rico's cesarean delivery rate from 2010 to 2022 and explores changes by maternal age, gestational age, and municipality from 2018 to 2022.
Assuntos
Cesárea , Parto Obstétrico , Hispânico ou Latino , Feminino , Humanos , Gravidez , Cesárea/estatística & dados numéricos , Cesárea/tendências , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Parto Obstétrico/tendências , Idade Gestacional , Porto Rico/epidemiologiaRESUMO
Objetivo: identificar os fatores sociodemográficos associados à via de parto. Método: trata-se de revisão sistemática com busca nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, PubMed e Cochrane em maio de 2021. O protocolo do estudo foi registrado na PROSPERO sob o nº CRD42021257340. Os artigos selecionados foram posteriormente analisados pelos sistemas Joanna Briggs Institute e Sistema Grading of Recommendations Assessment, Development and Evaluation. Resultados: mulheres com maior nível socioeconômico, maior nível de escolaridade, com idade acima de 35 anos e parto em instituições privadas possuem maior chance de realizar cesariana comparado ao parto vaginal. A qualidade da evidência para variável de prestador hospitalar foi baixa, para idade e escolaridade materna a qualidade é moderada e classe econômica a qualidade é alta. Conclusões: os fatores sociodemográficos contribuem para o aumento da taxa de cesárea e reforçam o cenário encontrado na literatura.
Objective: to identify the sociodemographic factors associated with the mode of delivery. Method: this is a systematic review with a search in the Latin American and Caribbean Literature on Health Sciences, PubMed and Cochrane databases in May 2021. The study protocol was registered with PROSPERO under number CRD42021257340. The selected articles were analyzed by the Joanna Briggs Institute and the Grading System of Recommendations Assessment, Development and Evaluation systems. Results:women with a higher socioeconomic level, higher education, aged over 35 years and private institutions have a greater chance of having a cesarean section compared to the vaginal level. The quality of quality of quality for the service provider variable was low and the quality of maternal schooling is low and the quality of economic class is high. Conclusion: Sociodemographic conclusions in the literature.
Objetivo: identificar los factores sociodemográficos asociados a la modalidad de parto. Método: se trata de una revisión sistemática con búsqueda en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud, PubMed y Cochrane en mayo de 2021. El protocolo de estudio fue registrado en PROSPERO con el número CRD42021257340. Los artículos seleccionados fueron analizados por el Instituto Joanna Briggs y los sistemas Grading System of Recommendations Assessment, Development and Evaluation. Resultados: las mujeres con mayor nivel socioeconómico, educación superior, mayores de 35 años e instituciones privadas tienen mayor probabilidad de tener una cesárea en comparación con el nivel vaginal. La calidad de calidad de calidad para la variable proveedor de servicios fue baja y la calidad de escolaridad materna es baja y la calidad de clase económica es alta.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Cesárea/tendências , Fatores Sociodemográficos , Parto Normal/tendências , Fatores Socioeconômicos , Trabalho de Parto , Determinantes Sociais da Saúde/tendênciasRESUMO
BACKGROUND: In Haiti where there are high rates of maternal and neonatal mortality, efforts to reduce mortality and improve maternal newborn child health (MNCH) must be tracked and monitored to measure their success. At a rural Haitian hospital, local surveillance efforts allowed for the capture of MNCH indicators. In March 2018, a new stand-alone maternity unit was opened, with increased staff, personnel, and physical space. We aimed to determine if the new maternity unit brought about improvements in maternal and neonatal outcomes. METHODS: We conducted an interrupted time series analysis using data collected between July 2016 and October 2019 including 20 months before the opening of the maternity unit and 20 months after. We examined maternal-neonatal outcomes such as physiological (vaginal) births, caesarean birth, postpartum hemorrhage (PPH), maternal deaths, stillbirths and undesirable outcomes (eclampsia, PPH, perineal laceration, postpartum infection, maternal death or stillbirth). RESULTS: Immediately after the opening of the new maternity, the number of physiological births decreased by 7.0% (ß = - 0.070; 95% CI: - 0.110 to - 0.029; p = 0.001) and there was an increase of 6.7% in caesarean births (ß = 0.067; 95% CI: 0.026 to 0.107; p = 0.002). For all undesirable outcomes, preintervention there was an increasing trend of 1.8% (ß = 0.018; 95% CI: 0.013 to 0.024; p < 0.001), an immediate 14.4% decrease after the intervention (ß = - 0.144; 95% CI: - 0.255 to - 0.033; p = 0.012), and a decreasing trend of 1.8% through the postintervention period (ß = - 0.018; 95% CI: - 0.026 to - 0.009; p < 0.001). No other significant level or trend changes were noted. CONCLUSIONS: The new maternity unit led to an upward trend in caesarean births yet an overall reduction in all undesirable maternal and neonatal outcomes. The new maternity unit at this rural Haitian hospital positively impacted and improved maternal and neonatal outcomes.
Assuntos
Cesárea/estatística & dados numéricos , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Cesárea/tendências , Feminino , Haiti/epidemiologia , Hospitais Rurais , Humanos , Recém-Nascido , Análise de Séries Temporais Interrompida , Mortalidade Materna/tendências , Gravidez , Serviços de Saúde RuralRESUMO
BACKGROUND: Applying the Robson classification to all births in Brazil, the objectives of our study were to estimate the rates of caesarean section delivery, assess the extent to which caesarean sections were clinically indicated, and identify variation across socioeconomic groups. METHODS: We conducted a population-based study using routine records of the Live Births Information System in Brazil from January 1, 2011, to December 31, 2017. We calculated the relative size of each Robson group; the caesarean section rate; and the contribution to the overall caesarean section rate. We categorised Brazilian municipalities using the Human Development Index to explore caesarean section rates further. We estimated the time trend in caesarean section rates. RESULTS: The rate of caesarean sections was higher in older and more educated women. Prelabour caesarean sections accounted for more than 54 % of all caesarean deliveries. Women with a previous caesarean section (Group 5) made up the largest group (21.7 %). Groups 6-9, for whom caesarean sections would be indicated in most cases, all had caesarean section rates above 82 %, as did Group 5. The caesarean section rates were higher in municipalities with a higher HDI. The general Brazilian caesarean section rate remained stable during the study period. CONCLUSIONS: Brazil is a country with one of the world's highest caesarean section rates. This nationwide population-based study provides the evidence needed to inform efforts to improve the provision of clinically indicated caesarean sections. Our results showed that caesarean section rates were lower among lower socioeconomic groups even when clinically indicated, suggesting sub-optimal access to surgical care.
Assuntos
Coeficiente de Natalidade , Cesárea/estatística & dados numéricos , Cesárea/tendências , Adulto , Brasil/epidemiologia , Cesárea/classificação , Cidades/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Dados de Saúde Coletados Rotineiramente , Fatores Socioeconômicos , Adulto JovemRESUMO
Resumen: Las estadísticas mundiales muestran una tendencia al alza en las tasas de cesáreas que superan el 15% recomendado por la OPS/OMS. Esta cirugía se ha convertido en la más frecuente en los países de ingresos medios y altos. Algunos estudios sugieren que no todas estas cesáreas estarían justificadas. Al respecto se plantean algunas reflexiones sobre los dilemas éticos que se pueden observar desde varias posiciones teóricas, como el consecuencialismo, el kantianismo, la ética de la virtud y la teoría feminista. A su vez, estos dilemas están inmersos en múltiples factores individuales, sociales y culturales, entre otros. Desde la salud pública se debe revisar el parámetro actual definido como "rango aceptable" de cesáreas, ya que puede ser demasiado bajo. Igualmente se recomienda la aplicación de medidas para fortalecer en los pacientes el deseo de un parto normal, cuando sea posible, a través de información y educación oportuna durante la atención prenatal. Las decisiones del profesional de la salud y de las mujeres deben estar respaldadas por la mejor información disponible.
Abstract: World statistics show an upward trend in Cesarean section rates that exceed the 15% recommended by PAHO / WHO. This surgery has become the most common in high- and middle-income countries. Some studies suggest that not all these caesarean sections would be justified. In this regard, some reflections are made on the ethical dilemmas that can be observed from various theoretical positions such as consequentialism, Kantianism, the ethics of virtue and feminist theory. In turn, these dilemmas are immersed in multiple individuals, social and cultural factors, among others. From Public Health, the current parameter defined as the "acceptable range" of Caesarean sections should be reviewed as it may be too low. It is also recommended that measures be applied to strengthen patients' desire for a normal delivery whenever possible through timely information and education during prenatal care. The decisions of the health professional and women must be supported by the best information available.
Resumo: As estatísticas mundiais mostram uma tendência de alta nas taxas de cesáreas que superam em 15% o recomendado pela OPAS/OMS. Esta cirurgia se converteu na mais frequente em países de renda média e alta. Alguns estudos sugerem que não todas estas cesáreas seriam justificadas. A esse respeito se colocam algumas reflexões sobre os dilemas éticos que se podem observar desde várias posiciones teóricas, como o consequencialismo, o kantianismo, a ética da virtude e a teoria feminista. Por sua vez, estes dilemas estão imersos em múltiplos fatores individuais, sociais e culturais, entre outros. Deve-se revisar, a partir da saúde pública, o parâmetro atual definido como "faixa aceitável" de cesáreas, já que pode ser demasiado baixo. Igualmente se recomenda a aplicação de medidas para fortalecer nas pacientes o desejo de um parto normal, quando possível, através de informação e educação oportuna durante a assistência pré-natal. As decisões do profissional da saúde e das mulheres devem estar respaldadas pela melhor informação disponível.
Assuntos
Humanos , Feminino , Cesárea/tendências , Cesárea/ética , Bioética , Cesárea/estatística & dados numéricos , Saúde Pública , Tomada de Decisões , Consentimento Livre e EsclarecidoRESUMO
Se realizó un analisis de la tasa de cesáreas en dos maternidades públicas de referencia de Uruguay (Hospital de Clínicas y Centro Hospitalario Pereira Rossell) utilizando la clasificación de Robson para compararlas entre sí, mediante un estudio observacional, descriptivo, retrospectivo y transversal en un periodo de 10 años y 10 meses (2009-2019). Se analizaron 85.526 nacimientos (7.685 (8,9%) en el Clínicas vs 77.841 (91.1%) Pereira Rossell). El porcentaje de cesáreas por año en el Clínicas fue 49,2% ± 5 vs 29,3% ± 3 en Pereira Rossell. Los grupos de Robson más prevalentes fueron 1, 5A y 10 en el Clínicas vs 3, 1 y 5A en Pereira Rossell. En ambos centros los grupos con mayor contribución relativa a la tasa global de cesáreas fueron: 5A, 10 y 1. Ambos centros presentan un aumento en la tasa de cesárea en la última década, pese a que se asisten poblaciones dispares entre cada uno de ellos. Se debe seguir buscando estrategias que ayuden a reducir la tasa de cesáreas principalmente en pacientes sin cesáreas anteriores o con una única cesárea previa, en caso de no presentan contraindicaciones para el parto vaginal.
An analysis of the caesarean section rate was carried out in two reference public maternity wards in Uruguay (Hospital de Clínicas and Centro Hospitalario Pereira Rossell) using Robson's classification to compare them with each other, through an observational, descriptive, retrospective and cross-sectional study in a period 10 years and 10 months (2009-2019). 85,526 births were analyzed (7,685 (8.9%) in the Clinics vs 77,841 (91.1%) Pereira Rossell). The percentage of caesarean sections per year in the Clinics was 49.2% ± 5 vs 29.3% ± 3 in Pereira Rossell. The most prevalent Robson groups were 1, 5A and 10 in the Clinicas vs 3, 1 and 5A in Pereira Rossell. In both centers, the groups with the highest relative contribution to the overall rate of cesarean sections were: 5A, 10 and 1. Both centers show an increase in the rate of cesarean section in the last decade, despite the fact that different populations are attended between each of them. Strategies should continue to be sought to help reduce the rate of cesarean sections, mainly in patients without previous cesarean sections or with a single previous cesarean section, if they do not present contraindications for vaginal delivery.
Foi realizada análise da taxa de cesárea em duas maternidades públicas de referência do Uruguai (Hospital de Clínicas e Centro Hospitalario Pereira Rossell), utilizando a classificação de Robson para compará-las, por meio de estudo observacional, descritivo, retrospectivo e transversal. em um período de 10 anos e 10 meses (2009-2019). Foram analisados 85.526 partos (7.685 (8,9%) nas Clínicas vs 77.841 (91,1%) Pereira Rossell). A porcentagem de cesarianas por ano nas Clínicas foi de 49,2% ± 5 vs 29,3% ± 3 em Pereira Rossell. Os grupos de Robson mais prevalentes foram 1, 5A e 10 nas Clínicas vs 3, 1 e 5A em Pereira Rossell. Em ambos os centros, os grupos com maior contribuição relativa para a taxa global de cesárea foram: 5A, 10 e 1. Ambos os centros apresentam aumento da taxa de cesárea na última década, apesar de diferentes populações serem atendidas entre cada um deles. Estratégias devem continuar a ser buscadas para ajudar a reduzir a taxa de cesárea, principalmente em pacientes sem cesárea anterior ou com cesárea única, se não apresentarem contra-indicações para parto normal.
Assuntos
Humanos , Feminino , Gravidez , Cesárea/estatística & dados numéricos , Maternidades/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Uruguai/epidemiologia , Cesárea/tendências , Prevalência , Estudos Transversais , Estudos Retrospectivos , Hospitais Públicos/estatística & dados numéricosRESUMO
This article traces the historical processes by which Brazil became a world leader in cesarean sections. It demonstrates that physicians changed their position toward and use of different obstetric surgeries, in particular embryotomies and cesarean sections, over the course of the nineteenth and twentieth centuries. The authors demonstrate that Catholic obstetricians, building upon both advancements in cesarean section techniques and new civil legislation that gave some personhood to fetuses, began arguing that fetal life was on par with its maternal counterpart in the early twentieth century, a shift that had a lasting impact on obstetric practice for decades to come. In the second half of the twentieth century, cesarean sections proliferated in clinical practice, but abortions remained illegal. Most importantly, women remained patients to be worked on rather than active participants in their reproductive lives.
Assuntos
Aborto Induzido/história , Cesárea/história , Obstetrícia/história , Aborto Induzido/tendências , Brasil , Catolicismo , Cesárea/estatística & dados numéricos , Cesárea/tendências , História do Século XIX , História do Século XX , HumanosRESUMO
Cesarean section (CS) is a surgical procedure used to deliver babies that is medically indicated to prevent maternal and neonatal mortality. However, it is associated with short- and long-term risks. CS rates have increased, and efforts are being made to ensure that CS is performed only when necessary. The Robson classification system is considered useful for studying, evaluating, monitoring, and comparing CS rates within and between healthcare facilities. In Brazil, there are few studies on this subject, and no large epidemiological studies on this topic utilizing the Robson classification have been reported. This study aimed to report and analyze CS rates in Brazil using the Robson classification system, and subsequently suggest possible measures to address it.Data were collected from the Brazilian Live Birth Information System (Sistema de Informações sobre Nascidos Vivos) that contains data of the entire obstetric population, from 2014 to 2017. All births in the country during this period were analyzed according to the Robson classification.A total of 11,774,665 live births were reported in Brazil during 2014 to 2017, most of which were mostly via CS (55.8%). Regions with high human development indexes had significantly higher CS rates than those with low human development indexes. The Robson group (RG) 1 to 4 accounts for 60.2% of live births and 47.1% of all CSs. RG5 was larger than all the other groups and contributed to the highest global rate of CS (31.3%), in addition to being the group who presented the largest growth.Although RG 1 to 4 present favorable initial conditions for vaginal delivery, CS accounted for almost half of births in these groups. The size of RG1 and RG2 in Brazil was comparable to that in countries with low CS rates; however, CS rates in these groups were 3 times higher in Brazil. Nulliparous women in RG1 and RG2 who undergo CS are subsequently categorized into RG5, increasing the global CS rate by 1% annually.We suggest the implementation of health policies to avoid the unnecessary performance of CS in RG1 and RG2 to decrease the CS rates in Brazil.
Assuntos
Cesárea/estatística & dados numéricos , Adolescente , Adulto , Brasil , Cesárea/tendências , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Parto Obstétrico/tendências , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Procedimentos Desnecessários/normas , Procedimentos Desnecessários/estatística & dados numéricosRESUMO
OBJECTIVE: to measure prevalence, evaluate trends and identify socioeconomic differences of on-demand cesarean section in the municipality of Rio Grande (RS), extreme south of Brazil, in 2007, 2010, 2013 and 2016. METHODS: all the puerperae residing in this municipality who had cesarean deliveries in one of the only two local maternity hospitals in the period 01/01-31/12 of the aforementioned years were part of this transversal study. Puerperae were interviewed using a single, standardized questionnaire at the hospital within 48 hours after delivery. The outcome was assessed based on the mothers' report that the cesarean section was performed according to their request. The analysis consisted of the observation of the outcome's frequency in each year and the evaluation of its prevalence throughout this period through the chi-square linear trend test. Socioeconomic inequalities were assessed based on household income and women's schooling using the Slope Index of Inequality and the Relative Index of Inequality. RESULTS: In these four years, 5,721 cesarean deliveries were recorded among mothers living in this municipality (1,309 in 2007, 1,341 in 2010, 1,626 in 2013 and 1,445 in 2016). In this period, the rate of on-demand cesarean sections increased by 107%, from 10.5% (95%CI: 8.9% -12.2%) of the deliveries in 2007 to 21.7% (95%CI: 19.5% -23.8%) in 2016. This increase was more evident among those with lower household income and schooling level. Absolute inequality also increased, especially regarding schooling, while relative inequality sharply declined when assessed by household income. CONCLUSIONS: The increased on-demand cesarean sections in the study location is unsettling, despite the decreasing gap between extreme categories as a consequence of higher levels of this procedure among women of lower income and worse schooling.
Assuntos
Cesárea/tendências , Adolescente , Adulto , Fatores Etários , Brasil , Cesárea/estatística & dados numéricos , Criança , Estudos Transversais , Feminino , Humanos , Gravidez , Fatores Socioeconômicos , Inquéritos e Questionários , Saúde da Mulher , Adulto JovemRESUMO
ABSTRACT OBJECTIVE: to measure prevalence, evaluate trends and identify socioeconomic differences of on-demand cesarean section in the municipality of Rio Grande (RS), extreme south of Brazil, in 2007, 2010, 2013 and 2016. METHODS: all the puerperae residing in this municipality who had cesarean deliveries in one of the only two local maternity hospitals in the period 01/01-31/12 of the aforementioned years were part of this transversal study. Puerperae were interviewed using a single, standardized questionnaire at the hospital within 48 hours after delivery. The outcome was assessed based on the mothers' report that the cesarean section was performed according to their request. The analysis consisted of the observation of the outcome's frequency in each year and the evaluation of its prevalence throughout this period through the chi-square linear trend test. Socioeconomic inequalities were assessed based on household income and women's schooling using the Slope Index of Inequality and the Relative Index of Inequality. RESULTS: In these four years, 5,721 cesarean deliveries were recorded among mothers living in this municipality (1,309 in 2007, 1,341 in 2010, 1,626 in 2013 and 1,445 in 2016). In this period, the rate of on-demand cesarean sections increased by 107%, from 10.5% (95%CI: 8.9% -12.2%) of the deliveries in 2007 to 21.7% (95%CI: 19.5% -23.8%) in 2016. This increase was more evident among those with lower household income and schooling level. Absolute inequality also increased, especially regarding schooling, while relative inequality sharply declined when assessed by household income. CONCLUSIONS: The increased on-demand cesarean sections in the study location is unsettling, despite the decreasing gap between extreme categories as a consequence of higher levels of this procedure among women of lower income and worse schooling.
Assuntos
Humanos , Feminino , Gravidez , Criança , Adolescente , Adulto , Adulto Jovem , Cesárea/tendências , Fatores Socioeconômicos , Brasil , Cesárea/estatística & dados numéricos , Estudos Transversais , Inquéritos e Questionários , Saúde da Mulher , Fatores EtáriosRESUMO
Objetivo: Analizar comparativamente la incidencia de las cesáreas en los subsistemas de salud de Uruguay y en relación con los estándares de la Organización Mundial de la Salud (OMS) considerando las características médico-obstétricas de los partos, en especial la clasificación de Robson. Método: Se emplean 190.847 nacimientos registrados en el Sistema Informático Perinatal de Uruguay entre 2009 y 2014 por tipo de subsector sanitario. Mediante modelos logit se analiza la probabilidad de cesárea considerando la clasificación de Robson, otros factores de riesgo y las características de las madres. Se comparan las tasas de cesárea predichas por los distintos subsectores sanitarios para una población común. Asimismo, se contraponen las tasas de cesáreas observadas en cada subsistema con las que, hipotéticamente, se encontrarían si los hospitales siguiesen las pautas de la muestra de hospitales de referencia de la OMS. Resultados: El subsector privado, en términos generales, presenta una incidencia de cesáreas mucho más elevada que el público, incluso después de considerar las características médico-obstétricas de los nacimientos. Las tasas de cesáreas en Uruguay están más de un 75% por encima del valor que cabría esperar de acuerdo con el modelo de la OMS. Conclusiones: La incidencia de cesáreas en Uruguay es muy alta respecto a los estándares definidos por la OMS, en especial en el subsector privado. Este hecho no se explica por las características clínicas de los nacimientos.
Objective: To analyse on a comparative basis the incidence of caesarean sections among the different health care systems in Uruguay and with respect to the World Health Organization's (WHO) standards, taking into account the medical-obstetric characteristics of the births, particularly, the Robson classification. Methods: We examine 190,847 births registered by the Perinatal Information System in Uruguay between 2009 and 2014 by type of health care system. Using logit models, we analyse the probability of caesarean section taking into account the Robson classification, other risk factors and the mothers' characteristics. We compared the caesarean rates predicted by the different subsystems for a common population. Furthermore, we contrast the caesarean rates observed in each subsystem with the rates that resulted if the Uruguayan hospitals followed the guidelines of the sample of WHO reference hospitals. Results: Private health systems in Uruguay exhibit a much higher incidence of caesarean sections than public ones, even after considering the medical-obstetric characteristics of the births. Caesarean rates are more than 75% higher than those observed if the WHO standards are applied. Conclusions: Uruguay has a very high incidence of caesarean sections with respect to WHO standards, particularly, in the private sector. This fact is unrelated to the clinical characteristics of the births.
Assuntos
Humanos , Feminino , Gravidez , Cesárea/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Padrões de Referência , Uruguai , Organização Mundial da Saúde , Gravidez , Cesárea/classificação , Cesárea/normas , Cesárea/tendências , Coeficiente de Natalidade , Probabilidade , Bases de Dados Factuais , Idade MaternaRESUMO
This article aims to describe the preliminary results of two evaluations studies, one about the Stork Network program and the other about the Adequate Birth program, called Stork Network Assessment and Healthy Birth, and to identify possible improvements in comparison to the Birth in Brazil study. Both studies used a cross-sectional design and were conducted in 2017. The Stork Network Assessment study included all 606 public and mixed maternity hospitals from the Stork Network and a total of 10,675 postpartum women. The Healthy Birth study included a convenience sample of 12 private hospitals and 4,798 women. Indicators of labour and childbirth care were: presence of a companion person, care by obstetric nurse, use of partograph, use of non-pharmacological methods, walking during labor, eating, use of peripheral venous catheter, position for delivery, episiotomy, and Kristeller maneuver. The indicators were compared to those verified in Birth in Brazil, a nationwide population-based study in 2011-2012, before the start of the two intervention programs. Comparisons used the chi-square test for independent samples and 95% confidence interval. There was a significant increase in the number of women with access to appropriate technology for labour and childbirth from 2011 to 2017 and a reduction in harmful practices. The private sector also showed a decrease in cesarean rates and an increase in gestational age at birth. The study's results show that properly conducted public policies can change the scenario of care for labor and childbirth, helping to reduce in negative maternal and neonatal outcomes.
Este artigo tem como objetivo descrever os primeiros resultados de dois estudos avaliativos, um sobre a Rede Cegonha e outro sobre o projeto Parto Adequado, denominados, respectivamente, de avaliação da Rede Cegonha e Nascer Saudável, e identificar possíveis melhorias em comparação ao estudo Nascer no Brasil. Ambos os estudos têm desenho seccional, realizados em 2017. O estudo avaliação da Rede Cegonha incluiu todas as 606 maternidades públicas e mistas envolvidas na Rede Cegonha e um total de 10.675 puérperas. O estudo Nascer Saudável incluiu uma amostra de conveniência de 12 hospitais da rede privada e um total de 4.798 mulheres. Os indicadores de atenção ao parto e nascimento avaliados foram: presença de acompanhante, atendimento por enfermeira obstétrica, preenchimento de partograma, uso de métodos não farmacológicos, deambulação, alimentação, uso de cateter venoso periférico, analgesia, posição da mulher para o parto, episiotomia e manobra de Kristeler. Esses indicadores foram comparados aos encontrados no Nascer no Brasil, estudo de base nacional realizado em 2011-2012, antes do início dos dois programas de intervenção. Para as comparações utilizamos o teste do qui-quadrado para amostras independentes e nível de 95% de confiança. Houve um aumento significativo do número de mulheres com acesso à tecnologia apropriada ao parto entre os anos de 2011 e 2017 e redução de práticas consideradas prejudiciais. No setor privado, observou-se também redução nas taxas de cesariana e aumento da idade gestacional ao nascer. Os resultados deste estudo mostram que políticas públicas bem conduzidas podem mudar o cenário da atenção ao parto e nascimento, promovendo a redução de desfechos maternos e neonatais negativos.
El objetivo de este artículo es describir los primeros resultados de dos estudios evaluativos, uno sobre la Red Cigüeña y otro sobre el proyecto Parto Adecuado, denominados respectivamente como evaluación de la Red Cigüeña y Nacer Sano, e identificar posibles mejorías en comparación con el estudio Nacer en Brasil. Ambos estudios tienen un diseño transversal, realizados en 2017. El estudio evaluación de la Red Cigüeña incluyó todas las maternidades públicas (606) y mixtas implicadas en la Red Cigüeña y a un total de 10.675 puérperas. El estudio Nacer Sano incluyó una muestra de conveniencia de 12 hospitales privados y a un total de 4.798 mujeres. Los indicadores de atención al parto y nacimiento evaluados fueron: presencia de acompañante, atención por enfermera obstetra, cumplimentación de partograma, uso de métodos no farmacológicos, deambulación, alimentación, uso de catéter venoso periférico, analgesia, posición de la mujer para el parto, episiotomía y maniobra de Kristeler. Estos indicadores se compararon con los encontrados en Nacer en Brasil, un estudio a nivel nacional, realizado en 2011-2012, antes del inicio de los dos programas de intervención. Para las comparaciones utilizamos el test del chi-cuadrado para muestras independientes y nivel de confianza de un 95%. Hubo un aumento significativo del número de mujeres con acceso a la tecnología apropiada para el parto entre los años de 2011 y 2017 y una reducción de las prácticas consideradas perjudiciales. En el sector privado, se observó también una reducción en las tasas de cesárea y aumento de la edad gestacional al nacer. Los resultados de este estudio muestran que las políticas públicas bien dirigidas pueden cambiar el escenario de la atención al parto y nacimiento, promoviendo la reducción de desenlaces maternos y neonatales negativos.
Assuntos
Parto Obstétrico/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Adolescente , Adulto , Brasil , Cesárea/estatística & dados numéricos , Cesárea/tendências , Criança , Parto Obstétrico/métodos , Parto Obstétrico/tendências , Estudos de Avaliação como Assunto , Feminino , Idade Gestacional , Maternidades , Humanos , Trabalho de Parto , Saúde Materna/tendências , Enfermeiros Obstétricos/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Assistência Perinatal/tendências , Gravidez , Dados Preliminares , Apoio Social , Adulto JovemRESUMO
Caesarean delivery rates in Mexico are among the highest in the world. Given heightened public and professional awareness of this problem and the updated 2014 national guidelines to reduce the frequency of caesarean delivery, we analysed trends in caesarean delivery by type of facility in Mexico from 2008 to 2017. We obtained birth-certificate data from the Mexican General Directorate for Health Information and grouped the total number of vaginal and caesarean deliveries into five categories of facility: health-ministry hospitals; private hospitals; government employment-based insurance hospitals; military hospitals; and other facilities. Delivery rates were calculated for each category nationally and for each state. On average, 2 114 630 (95% confidence interval, CI: 2 061 487-2 167 773) live births occurred nationally each year between 2008 and 2017. Of these births, 53.5% (1 130 570; 95% CI: 1 108 068-1 153 072) were vaginal deliveries, and 45.3% (957 105; 95% CI: 922 936-991 274) were caesarean deliveries, with little variation over time. During the study period, the number of live births increased by 4.4% (from 1 978 380 to 2 064 507). The vaginal delivery rate decreased from 54.8% (1 083 331/1 978 380) to 52.9% (1 091 958/2 064 507), giving a relative percentage decrease in the rate of 3.5%. The caesarean delivery rate increased from 43.9% (869 018/1 978 380) to 45.5% (940 206/2 064 507), giving a relative percentage increase in the rate of 3.7%. The biggest change in delivery rates was in private-sector hospitals. Since 2014, rates of caesarean delivery have fallen slightly in all sectors, but they remain high at 45.5%. Policies with appropriate interventions are needed to reduce the caesarean delivery rate in Mexico, particularly in private-sector hospitals.
Les taux d'accouchements par césarienne au Mexique sont parmi les plus élevés au monde. Au vu de la sensibilisation accrue de la population et des professionnels à ce problème et de la mise à jour des directives nationales de 2014 visant à diminuer la fréquence des accouchements par césarienne, nous avons analysé l'évolution des accouchements par césarienne selon le type d'établissement entre 2008 et 2017 au Mexique. Nous avons obtenu des données issues d'actes de naissance auprès de la Direction générale mexicaine des informations sur la santé et regroupé le nombre total d'accouchements par voie basse et par césarienne en cinq catégories d'établissement: hôpitaux relevant du ministère de la Santé, hôpitaux publics, hôpitaux relevant de l'assurance liée à l'emploi public, hôpitaux militaires et autres établissements. Les taux d'accouchements ont été calculés pour chaque catégorie à l'échelle nationale et pour chaque État. En moyenne, 2 114 630 (intervalle de confiance, IC, à 95%: 2 061 487-2 167 773) naissances vivantes ont eu lieu chaque année entre 2008 et 2017 à l'échelle nationale. Parmi ces naissances, 53,5% (1 130 570; IC à 95%: 1 108 068-1 153 072) étaient des accouchements par voie basse, et 45,3% (957 105; IC à 95%: 922 936-991 274) étaient des accouchements par césarienne, avec peu de variations dans le temps. Au cours de la période étudiée, le nombre de naissances vivantes a augmenté de 4,4% (de 1 978 380 à 2 064 507). Le taux d'accouchements par voie basse est passé de 54,8% (1 083 331/1 978 380) à 52,9% (1 091 958/2 064 507), ce qui correspond à une diminution relative du taux de 3,5%. Le taux d'accouchements par césarienne est passé de 43,9% (869 018/1 978 380) à 45,5% (940 206/2 064 507), ce qui correspond à une augmentation relative du taux de 3,7%. Le changement le plus important concernant les taux d'accouchements a été constaté dans les hôpitaux du secteur privé. Depuis 2014, les taux d'accouchements par césarienne ont légèrement diminué dans tous les secteurs, mais demeurent élevés (45,5%). Des politiques et des interventions appropriées sont nécessaires pour réduire le taux d'accouchements par césarienne aux Mexique, en particulier dans les hôpitaux de secteur privé.
Las tasas de parto por cesárea en México están entre las más altas del mundo. Dada la creciente concienciación pública y profesional sobre este problema y las directrices nacionales actualizadas de 2014 para reducir la frecuencia de los partos por cesárea, se analizaron las tendencias de los partos por cesárea según el tipo de establecimiento en México entre 2008 y 2017. Se obtuvieron datos de los certificados de nacimiento de la Dirección General de Información Sanitaria de México y se agrupó el número total de partos vaginales y por cesárea en cinco categorías de establecimientos: hospitales del ministerio de salud pública, hospitales privados, hospitales gubernamentales para asegurados por empleo, hospitales militares y otras instalaciones. Se calcularon los índices de partos para cada categoría a nivel nacional y según cada estado. De media, 2 114 630 (intervalo de confianza, IC, del 95 %: 2 061 4872 167 773) nacimientos vivos se produjeron a nivel nacional al año entre 2008 y 2017. De estos nacimientos, el 53,5 % (1 130 570; IC del 95 %: 1 108 0681 153 072) fueron partos vaginales y el 45,3 % (957 105; IC del 95 %: 922 936991 274) fueron partos por cesárea, con poca variación a lo largo del tiempo. Durante el periodo de estudio, el número de nacidos vivos aumentó un 4,4 % (de 1 978 380 a 2 064 507). La tasa de partos vaginales disminuyó del 54,8 % (1 083 331/1 978 380) al 52,9 % (1 091 958/2 064 507), lo que supone una disminución porcentual relativa de la tasa del 3,5 %. La tasa de partos por cesárea aumentó del 43,9 % (869 018/1 978 380) al 45,5 % (940 206/2 064 507), lo que representa un aumento porcentual relativo de la tasa del 3,7 %. El mayor cambio en las tasas de partos se produjo en los hospitales del sector privado. Desde 2014, las tasas de parto por cesárea se han reducido ligeramente en todos los sectores, pero siguen siendo elevadas (45,5 %). Se necesitan políticas con intervenciones apropiadas para reducir la tasa de partos por cesárea en México, especialmente en los hospitales del sector privado.
Assuntos
Cesárea/tendências , Adulto , Declaração de Nascimento , Feminino , Humanos , México , Gravidez , Resultado da GravidezRESUMO
BACKGROUND: Antenatal care and correctly indicated caesarean section can positively impact on health outcomes of the mother and newborn. Our objective was to describe how coverage and inequalities for these interventions changed from 1982 to 2015 in Pelotas, Brazil. METHODS: Using perinatal data from the 1982, 1993, 2004 and 2015 Pelotas birth cohorts, we assessed antenatal care coverage and caesarean section rates over time. Antenatal care indicators included the median number of visits, the prevalence of mothers attending at least six visits and the proportion who started antenatal care in the first trimester of pregnancy and attended at least six visits. We described these outcomes according to income quintiles and maternal skin colour, to identify inequalities. We described overall, private sector and public sector caesarean section rates. Differences in prevalence were tested using chi-square testing and median differences using Kruskal-Wallis testing. RESULTS: From 1982 to 2015, the median number of antenatal care visits and the prevalence of mothers attending at least six visits increased in all income quintiles and skin colour groups. Inequalities were reduced, but not eliminated. The overall proportion of caesarean births increased from 27.6% in 1982 to 65.1% in 2015, when 93.9% of the births in the private sector were by caesarean section. Absolute income-related inequalities in caesarean sections increased over time. CONCLUSIONS: Special attention should be given to the antenatal care of poor and Black women in order to reduce inequalities. The explosive increase in caesarean sections requires radical changes in delivery care policies, in order to reverse the current trend.
Assuntos
Cesárea/estatística & dados numéricos , Renda/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Brasil/epidemiologia , Cesárea/tendências , Criança , Feminino , Humanos , Renda/tendências , Modelos Logísticos , Estudos Longitudinais , Gravidez , Cuidado Pré-Natal/tendências , Adulto JovemRESUMO
BACKGROUND: Ecuador's cesarean delivery rate far exceeds that recommended by the Pan American Health Organization (PAHO) and the World Health Organization (WHO). Using data from three iterations of Ecuador's nationally representative, population-based survey Encuesta Nacional de Salud y Nutrición (ENSANUT/ENDEMAIN), spanning 23 years, this study examines women's mode of delivery outcomes by sociodemographic characteristics and hospital type (private, public, social security) in light of Ecuador's major health care reform over the past two decades. METHODS: Using data from the 1994, 2004, and 2012 iterations of the data set, we analyzed trends in cesarean delivery based on province, year, and institution of care. Logistic regression was used to test the odds of cesarean delivery based on hospital type, sociodemographics, and birth complications for the full sample and primiparous women. Predicted probabilities were derived from this model. RESULTS: Ecuador's cesarean rate increased from 22% in 1989 to 41% in 2012. From 2008 to 2012, the probability of cesarean delivery in private centers was significantly higher than in public centers, and from 2009 to 2012, the probability of cesarean delivery in social security centers was significantly higher than in public centers. Higher maternal age, income, education, and parity, earlier prenatal care initiation, and more prenatal visits were associated with risk for cesarean delivery. CONCLUSIONS: To decrease the adverse effects of cesarean delivery for women and their babies, cesarean delivery should be reduced. Future research should investigate how incentive structures are used and how medical indication is defined within health institutions in Ecuador.
Assuntos
Cesárea/estatística & dados numéricos , Cesárea/tendências , Hospitais , Paridade , Adolescente , Adulto , Equador/epidemiologia , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Idade Materna , Pessoa de Meia-Idade , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Fatores de Risco , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVE: To analyse on a comparative basis the incidence of caesarean sections among the different health care systems in Uruguay and with respect to the World Health Organization's (WHO) standards, taking into account the medical-obstetric characteristics of the births, particularly, the Robson classification. METHODS: We examine 190,847 births registered by the Perinatal Information System in Uruguay between 2009 and 2014 by type of health care system. Using logit models, we analyse the probability of caesarean section taking into account the Robson classification, other risk factors and the mothers' characteristics. We compared the caesarean rates predicted by the different subsystems for a common population. Furthermore, we contrast the caesarean rates observed in each subsystem with the rates that resulted if the Uruguayan hospitals followed the guidelines of the sample of WHO reference hospitals. RESULTS: Private health systems in Uruguay exhibit a much higher incidence of caesarean sections than public ones, even after considering the medical-obstetric characteristics of the births. Caesarean rates are more than 75% higher than those observed if the WHO standards are applied. CONCLUSIONS: Uruguay has a very high incidence of caesarean sections with respect to WHO standards, particularly, in the private sector. This fact is unrelated to the clinical characteristics of the births.
Assuntos
Cesárea/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Coeficiente de Natalidade , Cesárea/classificação , Cesárea/normas , Cesárea/tendências , Bases de Dados Factuais , Feminino , Humanos , Idade Materna , Gravidez , Probabilidade , Padrões de Referência , Uruguai , Organização Mundial da SaúdeRESUMO
Purpose To evaluate trends and factors associated with mode of delivery in the rural Southwest Trifinio region of Guatemala. Description We conducted a retrospective analysis of self-reported antepartum factors and postpartum outcomes recorded in a quality improvement database among 430 women enrolled in a home-based maternal healthcare program between June 1, 2015 and August 1, 2017. Assessment Over the study period, the rates of cesarean delivery (CD) increased (from 30 to 45%) and rates of vaginal delivery (VD) decreased (70-55%) while facility-based delivery attendance remained stable around 70%. Younger age (23.5 years for VD vs. 21.6 years for CD, p < 0.001), nulliparity (25.1% for VD vs. 45.0% for CD, p < 0.001), prolonged/obstructed labor (2.4% for VD vs. 55.6% for CD, p < 0.001), and fetal malpresentation (0% for VD vs. 16.3% CD, p < 0.001) significantly influenced mode of delivery in univariate analysis. The leading indications for CD were labor dysfunction (47.5%), malpresentation (14.5%), and prior cesarean delivery (19.8%). The CD rate among the subpopulation of term, nulliparous women with singleton pregnancies in vertex presentation also increased from 20% of all CD in 2015, to 38% in 2017. Conclusion Among low-income women from rural Guatemala, the CD rate has increased above the World Health Organization (WHO) recommendations in a period of 3 years. Additional research on the factors affecting this trend are essential to guide interventions that might improve the appropriateness of CD, and to determine if reducing or stabilizing rates is necessary.
Assuntos
Parto Obstétrico/tendências , Gestantes/psicologia , Adulto , Cesárea/métodos , Cesárea/tendências , Distribuição de Qui-Quadrado , Comportamento de Escolha , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Guatemala , Humanos , Gravidez , Melhoria de Qualidade/estatística & dados numéricos , Estudos Retrospectivos , População Rural/tendênciasRESUMO
Resumo: Este artigo tem como objetivo descrever os primeiros resultados de dois estudos avaliativos, um sobre a Rede Cegonha e outro sobre o projeto Parto Adequado, denominados, respectivamente, de avaliação da Rede Cegonha e Nascer Saudável, e identificar possíveis melhorias em comparação ao estudo Nascer no Brasil. Ambos os estudos têm desenho seccional, realizados em 2017. O estudo avaliação da Rede Cegonha incluiu todas as 606 maternidades públicas e mistas envolvidas na Rede Cegonha e um total de 10.675 puérperas. O estudo Nascer Saudável incluiu uma amostra de conveniência de 12 hospitais da rede privada e um total de 4.798 mulheres. Os indicadores de atenção ao parto e nascimento avaliados foram: presença de acompanhante, atendimento por enfermeira obstétrica, preenchimento de partograma, uso de métodos não farmacológicos, deambulação, alimentação, uso de cateter venoso periférico, analgesia, posição da mulher para o parto, episiotomia e manobra de Kristeler. Esses indicadores foram comparados aos encontrados no Nascer no Brasil, estudo de base nacional realizado em 2011-2012, antes do início dos dois programas de intervenção. Para as comparações utilizamos o teste do qui-quadrado para amostras independentes e nível de 95% de confiança. Houve um aumento significativo do número de mulheres com acesso à tecnologia apropriada ao parto entre os anos de 2011 e 2017 e redução de práticas consideradas prejudiciais. No setor privado, observou-se também redução nas taxas de cesariana e aumento da idade gestacional ao nascer. Os resultados deste estudo mostram que políticas públicas bem conduzidas podem mudar o cenário da atenção ao parto e nascimento, promovendo a redução de desfechos maternos e neonatais negativos.
Resumen: El objetivo de este artículo es describir los primeros resultados de dos estudios evaluativos, uno sobre la Red Cigüeña y otro sobre el proyecto Parto Adecuado, denominados respectivamente como evaluación de la Red Cigüeña y Nacer Sano, e identificar posibles mejorías en comparación con el estudio Nacer en Brasil. Ambos estudios tienen un diseño transversal, realizados en 2017. El estudio evaluación de la Red Cigüeña incluyó todas las maternidades públicas (606) y mixtas implicadas en la Red Cigüeña y a un total de 10.675 puérperas. El estudio Nacer Sano incluyó una muestra de conveniencia de 12 hospitales privados y a un total de 4.798 mujeres. Los indicadores de atención al parto y nacimiento evaluados fueron: presencia de acompañante, atención por enfermera obstetra, cumplimentación de partograma, uso de métodos no farmacológicos, deambulación, alimentación, uso de catéter venoso periférico, analgesia, posición de la mujer para el parto, episiotomía y maniobra de Kristeler. Estos indicadores se compararon con los encontrados en Nacer en Brasil, un estudio a nivel nacional, realizado en 2011-2012, antes del inicio de los dos programas de intervención. Para las comparaciones utilizamos el test del chi-cuadrado para muestras independientes y nivel de confianza de un 95%. Hubo un aumento significativo del número de mujeres con acceso a la tecnología apropiada para el parto entre los años de 2011 y 2017 y una reducción de las prácticas consideradas perjudiciales. En el sector privado, se observó también una reducción en las tasas de cesárea y aumento de la edad gestacional al nacer. Los resultados de este estudio muestran que las políticas públicas bien dirigidas pueden cambiar el escenario de la atención al parto y nacimiento, promoviendo la reducción de desenlaces maternos y neonatales negativos.
Abstract: This article aims to describe the preliminary results of two evaluations studies, one about the Stork Network program and the other about the Adequate Birth program, called Stork Network Assessment and Healthy Birth, and to identify possible improvements in comparison to the Birth in Brazil study. Both studies used a cross-sectional design and were conducted in 2017. The Stork Network Assessment study included all 606 public and mixed maternity hospitals from the Stork Network and a total of 10,675 postpartum women. The Healthy Birth study included a convenience sample of 12 private hospitals and 4,798 women. Indicators of labour and childbirth care were: presence of a companion person, care by obstetric nurse, use of partograph, use of non-pharmacological methods, walking during labor, eating, use of peripheral venous catheter, position for delivery, episiotomy, and Kristeller maneuver. The indicators were compared to those verified in Birth in Brazil, a nationwide population-based study in 2011-2012, before the start of the two intervention programs. Comparisons used the chi-square test for independent samples and 95% confidence interval. There was a significant increase in the number of women with access to appropriate technology for labour and childbirth from 2011 to 2017 and a reduction in harmful practices. The private sector also showed a decrease in cesarean rates and an increase in gestational age at birth. The study's results show that properly conducted public policies can change the scenario of care for labor and childbirth, helping to reduce in negative maternal and neonatal outcomes.