Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Programa de Epidemiologia em Saúde Pública, Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Rio de Janeiro, RJ, Brasil.
Rev Saude Publica. 2023 Nov 13;57:89. doi: 10.11606/s1518-8787.2023057004819. eCollection 2023.
To descriptively analyze Brazilian parturient women who underwent previous cesarean section and point out the factors associated with Vaginal Birth After Cesarean (VBAC) in Brazil.
The study used data from women with one, two, or three or more cesarean sections from the survey Nascer no Brasil (Birth in Brazil). Differences between categories were assessed through the chi-square test (χ2). Variables with significant differences (p < 0.05) were incorporated into logistic regression.
Out of the total of 23,894 women, 20.9% had undergone a previous cesarean section. The majority (85.1%) underwent another cesarean section, with 75.5% occurring before the onset of labor. The rate of Vaginal Birth After Cesarean (VBAC) was 14.9%, with a success rate of 60.8%. Women who underwent three or more cesarean sections displayed greater social vulnerability. The chances of VBAC were higher among those who opted for a vaginal birth towards the end of gestation, had a prior vaginal birth, underwent labor induction, were admitted with over 4 centimeters of dilation, and without partner. Receiving care from the private health care system, having two or more prior cesarean sections, obstetric complications, and deciding on cesarean delivery late in gestation reduced the chances of VBAC. Age group, educational background, prenatal care adequacy, and the reason for the previous cesarean section did not result in significant differences.
The majority of women who underwent a previous cesarean section in Brazil are directed towards another surgery, and a higher number of cesarean sections is linked to greater social inequality. Factors associated with VBAC included choosing vaginal birth towards the end of gestation, having had a previous vaginal birth, higher cervical dilation upon admission, induction, assistance from the public health care system, absence of obstetric complications, and without a partner. Efforts to promote VBAC are necessary to reduce overall cesarean rates and their repercussions on maternal and child health.
对巴西有剖宫产史的产妇进行描述性分析，并指出与巴西剖宫产术后阴道分娩（VBAC）相关的因素。
本研究使用了来自巴西生育调查（Nascer no Brasil）的有一次、两次或三次剖宫产史的妇女数据。通过卡方检验（χ2）评估类别之间的差异。具有显著差异的变量（p < 0.05）被纳入逻辑回归。
在总共 23894 名妇女中，20.9%有剖宫产史。大多数（85.1%）再次接受剖宫产，其中 75.5%在分娩开始前进行。VBAC 的成功率为 14.9%，成功率为 60.8%。经历三次或更多剖宫产的妇女社会脆弱性更高。那些选择在妊娠末期进行阴道分娩、有过阴道分娩史、进行引产、宫口扩张超过 4 厘米、没有伴侣的妇女，VBAC 的机会更高。选择私立医疗保健系统、有两次或更多剖宫产史、产科并发症以及在妊娠晚期决定剖宫产的妇女，VBAC 的机会较低。年龄组、教育背景、产前保健充足性以及上次剖宫产的原因均未导致显著差异。
巴西有剖宫产史的大多数妇女被引导进行另一次手术，剖宫产次数越多，社会不平等程度越高。与 VBAC 相关的因素包括在妊娠末期选择阴道分娩、有过阴道分娩史、入院时宫颈扩张程度较高、引产、接受公共医疗保健系统的援助、没有产科并发症以及没有伴侣。有必要努力促进 VBAC，以降低总体剖宫产率及其对母婴健康的影响。
