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[良好实践、干预措施与结果:巴西东南部地区巴西统一国家卫生系统中一家分娩中心与医院的比较研究]

[Good practices, interventions, and results: a comparative study between a birthing center and hospitals of the Brazilian Unified National Health System in the Southeastern Region, Brazil].

作者信息

Medina Edymara Tatagiba, Mouta Ricardo José Oliveira, Carmo Cleber Nascimento do, Filha Mariza Miranda Theme, Leal Maria do Carmo, Gama Silvana Granado Nogueira da

机构信息

Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

出版信息

Cad Saude Publica. 2023 Apr 17;39(4):e00160822. doi: 10.1590/0102-311XPT160822. eCollection 2023.

DOI:10.1590/0102-311XPT160822
PMID:37075342
Abstract

This study aims to compare obstetric care in a birthing center and in hospitals of the Brazilian Unified National Health System (SUS) considering good practices, interventions, and maternal and perinatal results in the Southeast Region of Brazil. A cross-sectional study was conducted with comparable retrospective data from two studies on labor and birth. A total of 1,515 puerperal women of usual risk of birthing centers and public hospitals in the Southeast region were included. Propensity score weighting was used to balance the groups according to the following covariates: age, skin-color, parity, membrane integrity, and cervix dilation at hospitalization. Logistic regressions were used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) between the place of birth and outcomes. In birthing centers, compared to hospitals, the puerperal woman had a higher chance of having a companion (OR = 86.31; 95%CI: 29.65-251.29), eating or drinking (OR = 862.38; 95%CI: 120.20-6,187.33), walking around (OR = 7.56; 95%CI: 4.65-12.31), using non-pharmacological methods for pain relief (OR = 27.82; 95%CI: 17.05-45.40), being in an upright position (OR = 252.78; 95%CI: 150.60-423.33), and a lower chance of using oxytocin (OR = 0.22; 95%CI: 0.16-0.31), amniotomy (OR = 0.01; 95%CI: 0.01-0.04), episiotomy (OR = 0.01; 95%CI: 0.00-0.02), and Kristeller maneuvers (OR = 0.01; 95%CI: 0.00-0.02). Also, in birthing centers the newborn had a higher chance of exclusive breastfeeding (OR = 1.84; 95%CI: 1.16-2.90) and a lower chance of airway (OR = 0.24; 95%CI: 0.18-0.33) and gastric aspiration (OR = 0.15; 95%: 0.10-0.22). Thus, birthing centers offers a greater supply of good practices and fewer interventions in childbirth and birth care, with more safety and care without influence on the outcomes.

摘要

本研究旨在比较巴西统一国家卫生系统(SUS)中分娩中心和医院的产科护理情况,考量巴西东南部地区的良好实践、干预措施以及孕产妇和围产期结局。采用横断面研究方法,对两项关于分娩的研究中的可比回顾性数据进行分析。纳入了巴西东南部地区分娩中心和公立医院共1515名具有正常分娩风险的产后妇女。使用倾向得分加权法,根据以下协变量平衡各组:年龄、肤色、产次、胎膜完整性以及住院时宫颈扩张情况。采用逻辑回归估计出生地点与结局之间的比值比(OR)和95%置信区间(95%CI)。与医院相比,在分娩中心,产后妇女有更高的几率有陪伴者(OR = 86.31;95%CI:29.65 - 251.29)、进食或饮水(OR = 862.38;95%CI:120.20 - 6187.33)、四处走动(OR = 7.56;95%CI:4.65 - 12.31)、使用非药物方法缓解疼痛(OR = 27.82;95%CI:17.05 - 45.40)、处于直立姿势(OR = 252.78;95%CI:150.60 - 423.33),而使用缩宫素(OR = 0.22;95%CI:0.16 - 0.31)、人工破膜(OR = 0.01;图95%CI:0.01 - 0.04)、会阴切开术(OR = 0.01;95%CI:0.00 - 0.02)和克里斯特勒手法(OR = 0.01;95%CI:0.00 - 0.02)的几率较低。此外,在分娩中心,新生儿进行纯母乳喂养的几率更高(OR = 1.84;95%CI:1.16 - 2.90),气道问题(OR = 0.24;95%CI:0.18 - 0.33)和胃内容物误吸(OR = 0.15;95%CI:0.10 - 0.22)的几率更低。因此,分娩中心在分娩和分娩护理方面提供了更多的良好实践,干预措施更少,安全性和护理性更高,且不影响结局。