Características Del Peso, Edad Gestacional Y Tipo De Parto De Recién Nacidos en El Sistema Público Y Privado

Abstract

RESUMENObjetivo: Comparar la edad gestacional, el peso y tipo de parto de recién nacidos atendidos en el sistema público y privado de salud, Concepción, Chile. Método: Se incluyeron 2.540 recién nacidos de embarazos únicos, entre las 28 y 42 semanas, desde octubre de 2004 a julio 2005; 1.531 pertenecientes al sistema público y 1.009 del privado. Se utilizó el sistema de salud como variable independiente y la edad gestacional, peso y tipo de parto, como variables dependientes. Resultados: La tasa de prematurez en el sistema público fue significativamente mayor (10,68% vs 5,32%), como también el peso neonatal promedio menor (2.383 g vs 2.786 g). Los recién nacidos de término del sistema privado tuvieron peso promedio al nacer inferior (3.326 g vs 3.458 g). La tasa global de cesárea fue 51,8%; 81% en el sistema privado y 32,6% en el público. En el sistema privado el 55,4% fueron cesáreas electivas y 63,1% de ellas realizadas entre las 37 y 38 semanas. Conclusión: El acceso de pacientes beneficiarias del sistema público al sistema privado, aparece como un avance en lograr igualdad en salud, pero eso no se refleja en mejores resultados perinatales y en la tasa de cesáreas.PALABRAS CLAVES: Desigualdad en salud, tasa de cesárea, sistema público de salud, sistema privado de salud SUMMARY Aims: To compare the gestational age, weight and delivery of newborn belonging to public and private health system, Concepción, Chile. Method: This study included 2540 newborn from the same number of pregnant woman with gestational age between 28 and 42 weeks from October 2004 to July 2005; 1531 newborn from public and 1009 from private health system. We use the health system as independent variable and gestational age, weight and delivery type as independent variable. Results: The premature rate was significantly higher in public system (10.68% versus 5.32%) and the mean neonatal weight was lower (2383 g versus 2786 g). The mean weight of term newborn from the private system was lower than the public system (3326 g versus 3458 g). The cesarean rate in the private system was 81.1%; 55.4% were elective and 63.1% of them were performed between 37 and 38 weeks. Conclusion: The access of public patients to the private system looks like an advance to get equality in health, but that doesn't reflect in better perinatal result and in the cesarean rate.KEY WORDS: Health inequity, cesarean rate, public health system, private health system Trabajos Originales

Childbirth in Santiago de Chile: Stratification, Intervention, and Child Centeredness

“… 15. This is consistent with Cabrera and colleagues' (2006:95) quantitative finding, which suggests that in Concepción, Chile, when considering only women with possibilities of a vaginal birth and excluding elective cesarean, for every two women who achieve a vaginal birth in the public system, only one does in the private system.…”

“…Chile has one of the highest rates of cesarean births in the world (40 percent), with a strong difference between public hospitals (28 percent) and private clinics (60 or even 80 percent; see Agenja et al 2006; Cabrera et al 2006; Murray 2000). As in other contexts with lower c‐section rates, 1 there is a marked difference in types of birth according to income and place of birth.…”

“…These physicians concentrated their patients in as few locations as possible and programmed births (mostly c‐sections) as a time‐management strategy, in contrast to physicians working at public hospitals where the number of births did not affect personnel income—a situation that remains true today. At the same time, when asked, most women in Chile said that they would prefer a vaginal birth (80 percent) 2 with no difference among those giving birth in hospitals and private clinics, income, or education (Angeja et al 2006; Cabrera et al 2006; Murray 2000).…”

Trends in gestational age and birth weight in Chile, 1991–2008. A descriptive epidemiological study

“…The effect of obstetric interventions on mothers and babies has been evaluated [39,43], and studies have shown, for example, that the decline in the category of weight greater than 4000 g is due to deliveries induced before completion of the cycle of major weight gain that occurs after week 37 and can reach 600 g [45]. …”

Caracterización de madres deprimidas en el posparto

“…Por otra parte, se ha señalado que las mujeres con DPP, presentan una mayor frecuencia de complicaciones obstétricas y alteraciones neonatales 31 . En nuestra muestra de puérperas deprimidas, la distribución por tipo de parto fue similar a la encontrada en la población general (sistema público) 32 ; sin embargo, el porcentaje de prematuridad fue 18%, es decir, tres veces más alto en comparación con la población general. En Chile, según cifras del 2003, 5,6% de los nacimientos se produjeron antes de las 38 semanas (Minsal, 2003).…”