Curso de Obstetrícia, Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, SP, Brasil.
Rev Saude Publica. 2012 Feb;46(1):77-86. doi: 10.1590/s0034-89102012000100010.
To compare maternal and neonatal outcomes in low-risk women assisited in an alongside birth center and at a hospital.
A cross-sectional study was conducted with a representative sample of low-risk women in São Paulo (Southeastern Brazil), from 2003 to 2006. The study included 991 women who delivered a child at the alongside birth center and 325 who delivered a child at a hospital. Data were obtained from medical records. A comparative analysis was performed for all of the women, who were stratified according to parity. The chi-square test and Fisher's exact test were used to compare outcomes between women who delivered in alongside birth center and those who gave birth in the hospital.
There was a homogeneous distribution of women according to parity (45.4% were nulliparous, and 54.6% had one or more previous deliveries). Statistically significant differences were found in the frequency of amniotomy (more frequent in nulliparous women treated at the hospital), the use of oxytocin during labor, and the use of postpartum analgesia (both more frequent among women of any parity treated at the hospital). The rate of episiotomy was higher in nulliparous women, both in the alongside birth center and at the hospital. Neonatal interventions were more frequent at the hospital and included aspiration of the upper airways, gastric aspiration, gastric lavage, and the use of an open oxygen mask. Other events that occurred with greater frequency at the hospital included caput succedaneum, respiratory discomfort, and admittance to the neonatal unit. There was no difference in Apgar scores at the fifth minute or cases of maternal or perinatal death.
Care at the alongside birth center involved fewer interventions and had maternal and neonatal outcomes similar to those of the hospital setting.
比较在辅助分娩中心和医院分娩的低危产妇及新生儿结局。
本研究为 2003 年至 2006 年在巴西东南部圣保罗进行的一项以低危产妇为研究对象的代表性横断面研究。共纳入 991 名在辅助分娩中心分娩的产妇和 325 名在医院分娩的产妇。数据来源于病历。对所有产妇进行了比较分析，并按照产次进行了分层。采用卡方检验和 Fisher 确切概率法比较了在辅助分娩中心分娩和在医院分娩的产妇的结局。
根据产次，产妇的分布基本均衡（45.4%为初产妇，54.6%为经产妇）。在医院分娩的初产妇行人工破膜的频率更高，产程中使用催产素和产后使用镇痛剂的频率也更高，差异均有统计学意义。辅助分娩中心和医院分娩的初产妇行会阴切开术的比例均较高。辅助分娩中心和医院分娩的经产妇行会阴切开术的比例均较高。在医院分娩的新生儿行气管内吸引、胃抽吸、洗胃和使用开放式氧气面罩的比例更高。在医院分娩的新生儿还更容易出现前囟膨隆、呼吸窘迫和入住新生儿病房，这些事件的发生率更高。两组新生儿的第 5 分钟 Apgar 评分和产妇及围产儿死亡例数差异无统计学意义。
辅助分娩中心的护理干预较少，母婴结局与医院分娩相似。
