Faculdade de Saúde Pública, Universidade de São Paulo, Av. Doutor Arnaldo, 715, 2º andar, Cerqueira César, São Paulo, 01246904, SP, Brasil.
Faculdade de Ciências da Saúde, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, 70910900, DF, Brasil.
BMC Pregnancy Childbirth. 2023 Jul 10;23(1):504. doi: 10.1186/s12884-023-05803-2.
Increasing cesarean section (CS) rates are a global concern because they are related to higher maternal and neonatal complication rates and do not provide positive childbirth experiences. In 2019, Brazil ranked second globally, given its overall CS rate of 57%. According to the World Health Organization (WHO), populational CS rates of 10-15% are associated with decreased maternal, neonatal, and infant mortality rates. This study aimed to investigate whether multidisciplinary care following evidence-based protocols associated with a high motivation of both women and professionals for a vaginal birth leads to less overuse of CS in a Brazilian private practice (PP).
This cross-sectional study evaluated CS rates by Robson group for women who sought vaginal birth in a private practice in Brazil comparing with Swedish data. Collaborative care of midwives and obstetricians who adopted evidence-based guidelines was offered. CS rates, overall and by Robson group, contribution of each Robson group to the overall CS rate, clinical and nonclinical interventions, vaginal birth, pre-labor CS, and intrapartum CS proportions were estimated. The expected CS rate was calculated using the World Health Organization C-model tool. The analysis used Microsoft Excel and R Studio (version 1.2.1335. 2009-2019).
The PP overall CS rate was 15.1% (95%CI, 13.4-17.1%) versus the 19.8% (95%CI, 14.8-24.7%) rate expected by the WHO C-model tool. The population included 43.7% women in Robson Group 1 (nulliparous, single, cephalic, at term, spontaneous labor), 11.4% in Group 2 (nulliparous, single, cephalic, at term, induced labor or CS before labor), and 14.9% in Group 5 (multiparous women with previous CS), the greatest contributors to higher CS rates (75.4% of them). The Swedish overall CS rate was 17.9% (95%CI, 17.6-18.1%) in a population of 27% women in Robson Group 1, 10.7% in Group 2, and 9.2% in Group 5.
Multidisciplinary care following evidence-based protocols, associated with high motivation of both women and professionals for vaginal birth, may lead to a significant and safe reduction of CS rates even in contexts such as Brazil, with high medicalization of obstetric care and excess CS.
剖宫产率的上升是一个全球性的问题，因为这与更高的母婴并发症发生率有关，而且不能提供积极的分娩体验。2019 年，巴西的剖宫产率总体上为 57%，位居全球第二。根据世界卫生组织（WHO）的说法，人口剖宫产率在 10-15%之间与母婴、新生儿和婴儿死亡率的降低有关。本研究旨在调查在巴西的私人诊所中，是否遵循基于证据的方案进行多学科护理，并结合妇女和专业人员对阴道分娩的高度意愿，是否会导致剖宫产的过度使用减少。
本研究采用回顾性队列研究，比较了在巴西的一家私人诊所中寻求阴道分娩的妇女的剖宫产率，并与瑞典的数据进行了比较。提供了助产士和产科医生的协作护理，他们采用了基于证据的指南。估计了剖宫产率、总体剖宫产率和 Robson 组、每个 Robson 组对总体剖宫产率的贡献、临床和非临床干预、阴道分娩、产前剖宫产和产时剖宫产的比例。使用世界卫生组织 C 模型工具计算了预期的剖宫产率。分析使用了 Microsoft Excel 和 R Studio（版本 1.2.1335. 2009-2019）。
该私人诊所的总体剖宫产率为 15.1%（95%CI，13.4-17.1%），而世界卫生组织 C 模型工具预计的剖宫产率为 19.8%（95%CI，14.8-24.7%）。该人群中 43.7%的妇女属于 Robson 组 1（初产妇、单胎、头位、足月、自发性分娩），11.4%属于组 2（初产妇、单胎、头位、足月、引产或产前剖宫产），14.9%属于组 5（有既往剖宫产史的多产妇），这些组是导致剖宫产率升高的最大因素（占 75.4%）。瑞典的总体剖宫产率为 17.9%（95%CI，17.6-18.1%），在 Robson 组 1 中有 27%的妇女，组 2 中有 10.7%，组 5 中有 9.2%。
遵循基于证据的方案的多学科护理，结合妇女和专业人员对阴道分娩的高度意愿，可能会导致剖宫产率显著且安全地降低，即使在巴西这样的医疗化产科护理和剖宫产率过高的背景下也是如此。
