Why do women in the private sector have shorter pregnancies in Brazil? Left shift of gestational age, caesarean section and inversion of the expected disparity

Diniz, Carmen Simone Grilo; Miranda, Manuel; Reis-Queiroz, Jéssica; Queiroz, Marcel Reis; Salgado, Heloisa de Oliveira

doi:10.7322/jhgd.113712

Cited by 15 publications

(29 citation statements)

References 26 publications

(37 reference statements)

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“…In Brazil, elective cesarean section without labor is a common procedure, sometimes justified by a maternal choice and protective factor for the development of PFD. 44 , 45 In some cases, cesarean section is indicated due to obstetric intercurrences such as pregnancy-specific hypertensive disease, failure to progress, or cephalopelvic disproportion, among others. 44 , 46 …”

Section: Discussionmentioning

confidence: 99%

Pelvic floor disorders in postpartum adolescents in the Western Amazon: a cross-sectional study

Zuchelo¹,

Santos²,

Figueiredo³

et al. 2018

IJWH

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PurposeTo analyze the postpartum pelvic floor disorders (PFD) and mode of delivery among adolescents, late adolescents, and young women from Western Amazon.Patients and methodsCross-sectional study was carried out in the urban area of Western Amazon in the city of Rio Branco, Acre, Brazil, from October 2016 to February 2017. This is a convenience sample of women up to 30 years who completed six months postpartum, separated in three groups according to maternal age: adolescents (age ≤19 years), late adolescents (20–24 years), and young women (25–30 years). Participants were home interviewed and answered Pelvic Floor Distress Inventory-20 (PFDI-20). Delivery clinical data were collected from patient’s medical records.ResultsIn total, 285 participants were interviewed: 41 adolescents, 103 late adolescents, and 141 young women. After controlling for confounding factors, prevalences of PFD were higher in the adolescents’ group compared with the young women’s group (urinary incontinence [UI], prevalence ratio [PR] = 1.75, 95% CI 1.14–2.69; urge urinary incontinence [UUI], PR = 1.88, 95% CI 1.02–3.47; stress urinary incontinence, PR = 2.00, 95% CI 1.11–3.62; fecal incontinence [FI], PR = 4.40, 95% CI 1.36–14.27). PFDI-20 scores also presented higher values in the adolescent group (Pelvic Organ Prolapse Distress Inventory [POPDI], PR = 2.02, 95% CI 1.49–2.75; urinary distress inventory [UDI], PR = 2.09, 95% CI 1.47–2.98; PFDI, PR = 2.12, 95% CI 1.47–2.98). Analyzing the influence of cesarean section, adolescents have higher prevalence of UI (PR = 1.84, 95% CI 1.04–3.26, P=0.037), UUI (PR = 2.36, 95% CI 1.03–5.40, P=0.042), and FI (PR = 4.09, 95% CI 1.21–13.81, P=0.023). In addition, POPDI (PR = 2.15, 95% CI 1.60–2.89, P<0.001), UDI (PR = 2.25, 95% CI 1.61–3.16, P<0.001), and PFDI (PR = 2.27, 95% CI 1.68–3.08, P<0.001) scores are also higher among adolescents where the baby is born by cesarean section.ConclusionAdolescents present higher prevalence and symptoms of PFD; furthermore, cesarean delivery has a greater negative influence on the pelvic floor of adolescents when compared with young women. This reinforces the importance of PFD investigation among the adolescent population, mainly in developing countries which have high rates of adolescent pregnancy and cesarean section.

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Section: Discussionmentioning

confidence: 99%

Pelvic floor disorders in postpartum adolescents in the Western Amazon: a cross-sectional study

Zuchelo¹,

Santos²,

Figueiredo³

et al. 2018

IJWH

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“…O tempo de gestação entre os RNs na rede não SUS foi menor, independentemente do tipo de parto. Entre os nascidos por cesárea, o desvio à esquerda foi mais acentuado e o pico de cirurgias aconteceu em 38 semanas, resultado semelhante ao encontrado por Diniz e colaboradores (2016) 7 . Não há informações suficientes no SINASC para identificar gestações de risco, porém a elevada proporção de cesáreas nestes serviços (70%) sugere que muitas foram eletivas, em desacordo ao ACOG, que recomenda que os partos eletivos sejam realizados com pelo menos 39 semanas de gestação 8 .…”

Section: The Impact Of the Type Of Hospital And Delivery On The Gestaunclassified

O impacto do tipo de hospital e tipo de parto sobre a idade gestacional ao nascer no Município de São Paulo, 2013-2014

Raspantini

Miranda

Silva

et al. 2016

Rev. bras. epidemiol.

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“…However, when the proportion of cesarean sections in a population exceeds the level between 10% and 15%, these intervention disadvantages tend to outweigh the potential benefits for mothers and infants, especially when performed before the spontaneous onset of labor and the 39 full weeks of gestation 4 , 5 . This is the case in Brazil, where GA in childbirth has decreased, as a result of the overestimation of the safety of interventions associated with the abbreviation of pregnancy (cesarean section and induction of labor) 6 , 7 .…”

Section: The Excess Of Childbirth Interventions Has Reduced the Duratmentioning

confidence: 99%

Dias potenciais de gravidez perdidos: uma medida inovadora da idade gestacional

Diniz

Reis-Queiroz²,

Kawai³

et al. 2020

Rev. saúde pública

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No Brasil, o excesso de intervenções que antecipam o parto, como cesarianas e induções, tem resultado no encurtamento da gestação, com consequências negativas nos desfechos maternoinfantis. Neste comentário apresentamos uma medida inovadora da idade gestacional que estamos desenvolvendo: a variável contínua “dias potenciais de gravidez perdidos”. Utilizando dados do Sistema de Informações de Nascidos Vivos, contamos, quando possível, os dias faltantes entre o período até o nascimento e a duração média da gestação (280 dias), ou então as semanas perdidas. Essa medida pode ser usada como variável desfecho (de características socioeconômico-demográficos da mãe, do tipo de parto, de financiamento etc.) ou de exposição (para desfechos neonatais, infantis e maternos). O indicador pode ser usado em coortes municipais e nacionais e em estudos de intervenção, para analisar hospitais e territórios. Discutimos os limites e alcances das medidas de idade gestacional e, diante de suas imprecisões, a importância de estudar suas tendências. DESCRITORES: Idade Gestacional. Recém-Nascido, crescimento & desenvolvimento. Trabalho de Parto Induzido, efeitos adversos. Cesárea. Doença Iatrogênica. Estatísticas Vitais.

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Why do women in the private sector have shorter pregnancies in Brazil? Left shift of gestational age, caesarean section and inversion of the expected disparity

Cited by 15 publications

References 26 publications

Pelvic floor disorders in postpartum adolescents in the Western Amazon: a cross-sectional study

Pelvic floor disorders in postpartum adolescents in the Western Amazon: a cross-sectional study

O impacto do tipo de hospital e tipo de parto sobre a idade gestacional ao nascer no Município de São Paulo, 2013-2014

Dias potenciais de gravidez perdidos: uma medida inovadora da idade gestacional

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