与巴西医院剖宫产相关的因素。

Factors associated with cesarean sections in Brazilian hospitals.

机构信息

Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas, Campinas, SP, Brasil.

出版信息

Rev Saude Publica. 2010 Feb;44(1):70-9. doi: 10.1590/s0034-89102010000100008.

DOI:10.1590/s0034-89102010000100008

PMID:20140331

Abstract

OBJECTIVE

To assess the prevalence of cesarean sections in Brazilian hospitals.

METHODS

A cross-sectional study was carried out with data from the World Health Organization's Global Data System for Maternal and Perinatal Health, for the Brazilian states of São Paulo, Pernambuco and the Federal District. Data relating to 15,354 women who gave birth between September/2004 and March/2005 were analyzed, according to sociodemographic, reproductive, and hospital-related characteristics. Bivariate analyses - with calculations of the prevalence ratios and respective confidence intervals - and multivariate Poisson regression analyses were performed.

RESULTS

The prevalence ratio of cesarean sections was significantly higher among older women, who were married/living with a partner and with higher body mass index. The following conditions during pregnancy or birth were associated with higher cesarean section prevalence ratio: parturient being diagnosed as HIV-positive, heavier weight and greater head circumference of the newborn, and more prenatal consultations. In regression analysis, the following variables showed direct association with the outcome: parturient being older and with higher schooling level, presence of hypertension/eclampsia, chronic condition or some other medical condition, newborn's greater head circumference, being primiparous, having had a cesarean in the last pregnancy and having received an epidural block or rachidian analgesic during labor. Although the proportion of cesareans was higher in hospitals with a high complexity index, the difference was not statistically significant, as well as for other characteristics of hospitals.

CONCLUSIONS

The conditions of the pregnancy, newborn and the sociodemographic and reproductive characteristics of the parturient were independently associated with cesarean delivery. The hospital complexity index was not associated with cesarean delivery, probably due to the homogeneity of the hospital sample.

摘要

目的

评估巴西医院剖宫产的流行情况。

方法

本研究为横断面研究，数据来自世界卫生组织全球孕产妇和围产儿健康数据系统，分析了巴西圣保罗州、伯南布哥州和联邦区 2004 年 9 月至 2005 年 3 月间 15354 名产妇的资料，分析内容包括社会人口学、生殖和医院相关特征。采用二变量分析（计算比值比及其置信区间）和多变量泊松回归分析。

结果

剖宫产的流行比与产妇年龄较大、已婚/与伴侣同居和体质量指数较高有关。妊娠或分娩期间的以下情况与剖宫产的流行比升高相关：产妇 HIV 阳性、新生儿体重较重和头围较大，以及产前检查次数较多。回归分析显示，以下变量与结局呈直接相关：产妇年龄较大、文化程度较高、存在高血压/子痫前期、慢性疾病或其他医学情况、新生儿头围较大、初产妇、上次妊娠行剖宫产术、分娩时使用硬膜外阻滞或椎管内镇痛。尽管高复杂指数医院的剖宫产比例较高，但差异无统计学意义，医院的其他特征也无统计学差异。