Health Sciences Post Graduate Program, Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil.
Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil.
BMC Pregnancy Childbirth. 2023 Jun 20;23(1):455. doi: 10.1186/s12884-023-05768-2.
The rate of Cesarean section (CS) deliveries has been increasing worldwide for decades. Brazil exhibits high rates of patient-requested CS deliveries. Prenatal care is essential for reducing and preventing maternal and child morbidity and mortality, ensuring women's health and well-being. The aim of this study was to verify the association between the level of prenatal care, as measured by the Kotelchuck (APNCU - Adequacy of the prenatal care utilization) index and CS rates.
We conducted a cross-sectional study based on data from routine hospital digital records and federal public health system databases (2014-2017). We performed descriptive analyses, prepared Robson Classification Report tables, and estimated the CS rate for the relevant Robson groups across distinct levels of prenatal care. Our analysis also considered the payment source for each childbirth - either public healthcare or private health insurers - and maternal sociodemographic data.
CS rate by level of access to prenatal care was 80.0% for no care, 45.2% for inadequate, 44.2% for intermediate, 43.0% for adequate, and 50.5% for the adequate plus category. No statistically significant associations were found between the adequacy of prenatal care and the rate of cesarean sections in any of the most relevant Robson groups, across both public (n = 7,359) and private healthcare (n = 1,551) deliveries.
Access to prenatal care, according to the trimester in which prenatal care was initiated and the number of prenatal visits, was not associated with the cesarean section rate, suggesting that factors that assess the quality of prenatal care, not simply adequacy of access, should be investigated.
剖宫产率在全球范围内几十年来一直在上升。巴西的患者要求剖宫产率很高。产前保健对于降低和预防母婴发病率和死亡率、确保妇女的健康和福祉至关重要。本研究旨在验证产前保健水平（通过 Kotelchuck 指数（APNCU - 产前保健利用的充分性）衡量）与剖宫产率之间的关联。
我们基于常规医院数字记录和联邦公共卫生系统数据库（2014-2017 年）进行了一项横断面研究。我们进行了描述性分析，编制了 Robson 分类报告表，并根据不同水平的产前保健估计了相关 Robson 组的剖宫产率。我们的分析还考虑了每位产妇的分娩支付来源 - 公共医疗保健或私人健康保险公司 - 以及产妇社会人口统计学数据。
按产前保健获取水平划分的剖宫产率分别为无保健 80.0%、不足 45.2%、中等 44.2%、充分 43.0%和充分加 50.5%。在任何最相关的 Robson 组中，无论是公共医疗保健（n=7359）还是私人医疗保健（n=1551）分娩，都没有发现产前保健的充分性与剖宫产率之间存在统计学显著关联。
根据开始产前保健的孕早期和产前检查次数来评估产前保健的获取情况，与剖宫产率无关，这表明应该调查评估产前保健质量的因素，而不仅仅是获取情况。
