OBJECTIVEThe objective of this study was to determine the risks of severe acute maternal complications associated with cesarean section without medical indication.METHODSA systematic review was carried out with meta-analysis. The literature search was performed systematically, in multiple stages, in the PubMed, Lilacs, and Web of Science databases using the following descriptors: (postpartum period) and (cesarean section or natural childbirth) and ((morbidity or mortality) or (postpartum hemorrhage) or (puerperal infection) or (surgical infection) or (puerperal disorders)). The protocol of the study was registered at PROSPERO as CRD42016032933. A total of 1,328 articles were found; after selection, eight publications that met the study objective and inclusion criteria were selected, with information on 1,051,543 individuals.RESULTSThe results obtained in the meta-analyses indicate that women with cesarean section have a higher chance of maternal death (OR = 3.10, 95%CI 1.92–5.00) and postpartum infection (OR = 2.83, 95%CI, 1.585.06), but they have a lower chance of hemorrhage (OR = 0.52, 95%CI 0.48–0.57). For the blood transfusion outcome, the group effect was not associated with the type of delivery (95%CI 0.88–2.81).CONCLUSIONSThe quality of evidence was considered low for hemorrhage and blood transfusion and moderate for postpartum infection and maternal death. Thus, cesarean sections should be performed with caution and safety, especially when its benefits outweigh the risks of a surgical procedure.

Abstract

BackgroundThe current literature indicates increasing concern regarding the number of safe cesarean sections which a woman can undergo, mainly in face of the high cesarean section rates, which are growing in Brazil and worldwide. Aimed to describe the prevalence and associated factors of repeat cesarean section in a cohort of Brazilian women who had a cesarean section in the first birth.MethodsThis is a prospective cohort study using data from the 2004 Pelotas Birth Cohort. The sample included 480 women who had their first delivery in 2004, regardless of the form of delivery, and who had a second delivery identified in the cohort’s follow-ups (in 2005, 2006, 2008, and 2010). Descriptive, bivariate and multivariate analyses using Poisson regression with robust error variance were carried out.ResultsAmong the women who underwent a cesarean section in their first delivery (49.47%), 87.44% had a second surgical delivery. The risk factors for repeat cesarean section included ages 21–34 (PR 1.67, CI 95% 1.07–2.60), not being seen by SUS (Public Healthcare System) in 2004 (PR 2.27, CI 95% 1.44–3.60), and the number of prenatal medical visits, i.e., women with ten or more visits were at 2.33 times higher risk (CI 95% 1.10–4.96) compared to those who had five or fewer visits. ConclusionsThe proportion of cesarean sections both in the first and in the subsequent delivery is quite high. This high rate may compromise the reproductive future of the women who undergo consecutive cesarean sections with possible consequent complications and changes in care policies for pregnant women should be implemented.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-017-0356-8) contains supplementary material, which is available to authorized users.

Due to the risk of associated complications, cesarean sections should be performed with caution, when their benefits outweigh the risks.

Resumo Objetivo Analisar a associação entre determinantes sociais e morbidades para os desfechos de internação, internação em unidade de terapia intensiva e óbito por COVID-19 no Espírito Santo, Brasil. Métodos Estudo transversal, com dados secundários de casos confirmados de COVID-19 notificados no Sistema de Informação de Agravos de Notificação. Utilizou-se regressão de Poisson para estimar as razões de prevalências. Resultados Foram estudados 104.384 casos, notificados entre 28 de fevereiro e 1º de setembro de 2020. Os desfechos em estudo foram mais frequentes entre indivíduos do sexo masculino, idosos, de raça/cor da pele amarela ou preta, sem escolaridade, com multimorbidade. Todas as morbidades associaram-se a maior risco de desfechos desfavoráveis. Observou-se maior risco de óbito entre pessoas com idade superior a 60 anos (RP=56,31 - IC95% 34,24;92,61), multimorbidades (RP=3,63 - IC95% 3,16;4,17), doença renal (RP=3,42 - IC95% 2,81;4,15) e neoplasias (RP=3,15 - IC95% 2,41;4,13). Conclusão Evidencia-se o efeito dos determinantes sociais e morbidades em internação e óbitos por COVID-19.

Introdução: O câncer do colo do útero apresenta-se como importante problema de saúde pública mundial, principalmente nas regiões menos desenvolvidas. Objetivo: Descrever os perfis sociodemográfico e clínico das mulheres com câncer do colo do útero atendidas no Hospital Santa Rita de Cássia/Associacao Feminina de Educação e Combate ao Câncer (HSRC /AFECC) entre 2000 e 2005, associados ao estadiamento inicial. Método: Trata-se de um estudo analítico de dados secundários. Foram estudadas 964 mulheres. Resultados: Houve predominância de casos na faixa etária de 40 a 59 anos (49,3%), cor não branca (76,8%), com até primeiro grau incompleto (70,9%), casadas (48.3%), com encaminhamento do Sistema Único de Saúde (SUS) (84,2%). O estadiamento III esteve presente em 44% dos casos, seguido do II (31,4%). A maioria das pacientes realizou radioterapia exclusiva (52,1%), 133 (28,2%) tiveram recidiva local e 218 (43,4%) metástases a distância. As variáveis significantes com o estadiamento inicial foram faixa etária, escolaridade, tipo histológico, recidiva, presença de metástase, número de metástases e desfecho (p<0,05). Conclusão: Os resultados apontam para a necessidade de novas estratégias na implementação das políticas de saúde no que diz respeito a prevenção primária e secundária, tendo em vista o grande número de mulheres diagnosticadas com a doença. Maiores investimentos em educação também são necessários visando a uma mudança no perfil de morbimortalidade da doença.

Uterine cervical cancer is a leading cause of death from cancer in the female population worldwide. The aim of this study was to analyze survival of women with cervical cancer treated at the Santa Rita de Cássia Hospital/Women's Association for Cancer Education and Control (HSRC/AFECC) in Espírito Santo State, Brazil, from 2000 to 2005 and to describe associated prognostic factors. This was a cohort study using retrospective secondary data with a sample of 964 cases. The Kaplan-Meier curve and Cox model were used to evaluate survival and for multiple logistic analysis. There were 421 deaths (43.6%) during the minimum 5-year follow-up, with an overall 5-year survival of 58.8%. Risk factors were place of residence in the Serrana Region of the State (HR: 1.94; 95%CI: 1.09-3.45) and advanced staging. Women with stages III and IV at diagnosis showed an increased risk of 4.33 (95%CI: 3.00-6.24) and 15.40 (95%CI: 9.72-24.39), respectively, for lower survival when compared to stage I. The results show that early diagnosis and treatment are essential for reducing mortality from cervical cancer.

Uterine cervical cancer is a leading cause of death from cancer in the female population worldwide. The aim of this study was to analyze survival of women with cervical cancer treated at the Santa Rita de Cássia Hospital/Women's Association for Cancer Education and Control (HSRC/AFECC) in Espírito Santo State, Brazil, from 2000 to 2005 and to describe associated prognostic factors. This was a cohort study using retrospective secondary data with a sample of 964 cases. The Kaplan-Meier curve and Cox model were used to evaluate survival and for multiple logistic analysis. There were 421 deaths (43.6%) during the minimum 5-year follow-up, with an overall 5-year survival of 58.8%. Risk factors were place of residence in the Serrana Region of the State (HR: 1.94; 95%CI: 1.09-3.45) and advanced staging. Women with stages III and IV at diagnosis showed an increased risk of 4.33 (95%CI: 3.00-6.24) and 15.40 (95%CI: 9.72-24.39), respectively, for lower survival when compared to stage I. The results show that early diagnosis and treatment are essential for reducing mortality from cervical cancer.