Sakae Thiago Mamôru, Freitas Paulo Fontoura, d'Orsi Eleonora
Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil.
Rev Saude Publica. 2009 Jun;43(3):472-80. doi: 10.1590/s0034-89102009000300011.
To assess factors associated to cesarean section.
A cross-sectional study was conducted in a university hospital in Florianópolis, Southern Brazil, from 2001 to 2005. Socioeconomic, reproductive, obstetric and institutional information were collected. Data from 7,249 deliveries was obtained from medical records and admission, delivery and post-delivery records. Cox regression was used in the analysis to estimate cesarean prevalence ratios in the categories of variables studied.
Cesarean rates increased from 27.5% to 36.5% during the period studied and they were higher than those associated with medical indications. After adjustment for confounders cesarean rates were positively associated with previous cesarean section (PR=2.65, 95% CI: 2.31;3.05), non-cephalic presentation (PR=2.23, 95%CI: 1.69;2.95), oxytocin use (PR=1.77, 95%CI: 1.43;2.19), dilatation at admission (PR=2.74, 95%CI: 2.18;3.44), and obstetrician profile (>35% of cesarean sections) (PR=1.82, 95%CI: 1.36;2.42).
The factors associated with cesarean section indicate the need of interventions focusing on women and their reproductive experience and changes in obstetrician practice as well.
评估与剖宫产相关的因素。
2001年至2005年在巴西南部弗洛里亚诺波利斯的一家大学医院进行了一项横断面研究。收集了社会经济、生殖、产科和机构方面的信息。从医疗记录以及入院、分娩和产后记录中获取了7249例分娩的数据。分析中使用Cox回归来估计所研究变量类别中的剖宫产患病率比。
在所研究期间,剖宫产率从27.5%上升至36.5%,且高于与医学指征相关的剖宫产率。在对混杂因素进行调整后,剖宫产率与既往剖宫产史(患病率比=2.65,95%置信区间:2.31;3.05)、非头先露(患病率比=2.23,95%置信区间:1.69;2.95)、使用缩宫素(患病率比=1.77,95%置信区间:1.43;2.19)、入院时宫颈扩张情况(患病率比=2.74,95%置信区间:2.18;3.44)以及产科医生剖宫产比例(>35%)(患病率比=1.82,95%置信区间:1.36;2.42)呈正相关。
与剖宫产相关的因素表明,需要开展针对女性及其生殖经历的干预措施,同时产科医生的执业方式也需要改变。