Este artigo avaliou o uso das boas práticas (alimentação, deambulação, uso de métodos não farmacológicos para alívio da dor e de partograma) e de intervenções obstétricas na assistência ao trabalho de parto e parto de mulheres de risco obstétrico habitual. Foram utilizados dados da pesquisa Nascer no Brasil, estudo de base hospitalar realizada em 2011/2012, com entrevistas de 23.894 mulheres. As boas práticas durante o trabalho de parto ocorreram em menos de 50% das mulheres, sendo menos frequentes nas regiões Norte, Nordeste e Centro-oeste. O uso de ocitocina e amniotomia foi de 40%, sendo maior no setor público e nas mulheres com menor escolaridade. A manobra de Kristeller, episiotomia e litotomia foram utilizada, em 37%, 56% e 92% das mulheres, respectivamente. A cesariana foi menos frequente nas usuárias do setor público, não brancas, com menor escolaridade e multíparas. Para melhorar a saúde de mães e crianças e promover a qualidade de vida, o Sistema Único de Saúde (SUS) e, sobretudo o setor privado, necessitam mudar o modelo de atenção obstétrica promovendo um cuidado baseado em evidências científicas.
This study aims to describe prenatal care provided
O objetivo deste artigo é descrever os fatores referidos para a preferência pelo tipo de parto no início da gestação e reconstruir o processo de decisão pelo tipo de parto no Brasil. Dados de uma coorte de base hospitalar nacional com 23.940 puérperas, realizada em 2011-2012, foram analisados, segundo fonte de pagamento do parto e paridade, com utilização do teste χ2. A preferência inicial pela cesariana foi de 27,6%, variando de 15,4% (primíparas no setor público) a 73,2% (multíparas com cesariana anterior no setor privado). O principal motivo para a escolha do parto vaginal foi a melhor recuperação desse tipo de parto (68,5%) e para a cesariana o medo da dor do parto (46,6%). Experiência positiva com parto vaginal (28,7%), parto cesáreo (24,5%) e realização de laqueadura tubária (32,3%) foram citadas por multíparas. Mulheres do setor privado apresentaram 87,5% de cesariana, com aumento da decisão pelo parto cesáreo no final da gestação, independentemente do diagnóstico de complicações. Em ambos os setores, a proporção de cesariana foi muito superior ao desejado pelas mulheres.
Resumo: O objetivo foi estimar a incidência de sífilis congênita ao nascimento e verificar os fatores associados à transmissão vertical da sífilis. Estudo nacional, de base hospitalar, realizado em 2011-2012 com 23.894 puérperas, por meio de entrevista hospitalar, dados de prontuário e cartão de pré-natal. Realizada regressão logística univariada para verificar os fatores associados à sífilis congênita. Estimada incidência de sífilis congênita de 3,51 por mil nascidos vivos (IC95% 2,29-5,37) e taxa de transmissão vertical de 34,3% (IC95%: 24,7-45,4). Casos de sífilis congênita estiveram associados à menor escolaridade materna, cor da pele preta e maior proporção de fatores de risco para prematuridade, bem como ao início mais tardio do pré-natal, menor número de consultas e menor realização de exames sorológicos. A mortalidade fetal foi seis vezes superior nos casos de sífilis congênita, e recém-natos com sífilis congênita apresentaram maior frequência de internação. A sífilis congênita persiste como problema de saúde pública, estando associada à maior vulnerabilidade social e falhas na assistência pré-natal.
BackgroundCesarean section (CS) rates are increasing worldwide but there is some concern with this trend because of potential maternal and perinatal risks. The Robson classification is the standard method to monitor and compare CS rates. Our objective was to analyze CS rates in Brazil according to source of payment for childbirth (public or private) using the Robson classification.MethodsData are from the 2011–2012 “Birth in Brazil” study, which used a national hospital-based sample of 23,940 women. We categorized all women into Robson groups and reported the relative size of each Robson group, the CS rate in each group and the absolute and relative contributions made by each to the overall CS rate. Differences were analyzed through chi-square and Z-test with a significance level of < 0.05.ResultsThe overall CS rate in Brazil was 51.9 % (42.9 % in the public and 87.9 % in the private health sector). The Robson groups with the highest impact on Brazil’s CS rate in both public and private sectors were group 2 (nulliparous, term, cephalic with induced or cesarean delivery before labor), group 5 (multiparous, term, cephalic presentation and previous cesarean section) and group 10 (cephalic preterm pregnancies), which accounted for more than 70 % of CS carried out in the country. High-risk women had significantly greater CS rates compared with low-risk women in almost all Robson groups in the public sector only.ConclusionsPublic policies should be directed at reducing CS in nulliparous women, particularly by reducing the number of elective CS in these women, and encouraging vaginal birth after cesarean to reduce repeat CS in multiparous women.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0228-7) contains supplementary material, which is available to authorized users.
OBJECTIVE:To evaluate antenatal care in reducing the vertical transmission of syphilis. METHODS:A cross-sectional study was designed to be representative of lowrisk pregnancies in women cared for at the Brazilian Unifi ed Health System (SUS) network in the city of Rio de Janeiro, from November 2007 to July 2008. Pregnant women diagnosed with syphilis were identifi ed through interviews, checking their antenatal care card and searching for reported cases in the public health information systems. Cases of congenital syphilis were sought at the disease reporting system (Sinam), the Mortality Information System (SIM) and the SUS's Hospital Information System (SIH). RESULTS:Syphilis was identifi ed in 46 of the pregnancies, and 16 cases of congenital syphilis were identifi ed, resulting in a prevalence of 1.9% (95%CI 1.3;2.6) of syphilis in pregnancy and an incidence of 6/1,000 (95%CI 3;12/1,000) of congenital syphilis. The vertical transmission rate was 34.8% with three cases resulting in death (1 abortion, 1 stillborn and 1 neonatal death) and high proportions of prematurity and low birth weight. The healthcare pathway of those women revealed fl aws in the care they received, such as late entry to antenatal care, syphilis remaining undiagnosed during pregnancy and lack of treatment for the partner. CONCLUSIONS:Innovative strategies are needed to improve the outcomes of syphilis in pregnancy, including improving the laboratory network, the quality of care delivered to the pregnant women and their sexual partners and, most important of all, investigating every case of congenital syphilis as a sentinel event in the quality of antenatal care.
BackgroundThe rate of preterm birth has been increasing worldwide, including in Brazil. This constitutes a significant public health challenge because of the higher levels of morbidity and mortality and long-term health effects associated with preterm birth. This study describes and quantifies factors affecting spontaneous and provider-initiated preterm birth in Brazil.MethodsData are from the 2011–2012 “Birth in Brazil” study, which used a national population-based sample of 23,940 women. We analyzed the variables following a three-level hierarchical methodology. For each level, we performed non-conditional multiple logistic regression for both spontaneous and provider-initiated preterm birth.ResultsThe rate of preterm birth was 11.5 %, (95 % confidence 10.3 % to 12.9 %) 60.7 % spontaneous - with spontaneous onset of labor or premature preterm rupture of membranes - and 39.3 % provider-initiated, with more than 90 % of the last group being pre-labor cesarean deliveries. Socio-demographic factors associated with spontaneous preterm birth were adolescent pregnancy, low total years of schooling, and inadequate prenatal care. Other risk factors were previous preterm birth (OR 3.74; 95 % CI 2.92–4.79), multiple pregnancy (OR 16.42; 95 % CI 10.56–25.53), abruptio placentae (OR 2.38; 95 % CI 1.27–4.47) and infections (OR 4.89; 95 % CI 1.72–13.88). In contrast, provider-initiated preterm birth was associated with private childbirth healthcare (OR 1.47; 95 % CI 1.09–1.97), advanced-age pregnancy (OR 1.27; 95 % CI 1.01–1.59), two or more prior cesarean deliveries (OR 1.64; 95 % CI 1.19–2.26), multiple pregnancy (OR 20.29; 95 % CI 12.58–32.72) and any maternal or fetal pathology (OR 6.84; 95 % CI 5.56–8.42).ConclusionThe high proportion of provider-initiated preterm birth and its association with prior cesarean deliveries and all of the studied maternal/fetal pathologies suggest that a reduction of this type of prematurity may be possible. The association of spontaneous preterm birth with socially-disadvantaged groups reaffirms that the reduction of social and health inequalities should continue to be a national priority.
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