Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz, Laboratório de Pesquisa Clínica em DST/Aids, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, CEP 21040-360, Brazil.
Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Reprod Health. 2024 Mar 28;20(Suppl 2):188. doi: 10.1186/s12978-024-01771-8.
In 2015, a quality improvement project called "Adequate Childbirth Project" (PPA) was implemented in Brazilian private hospitals in order to reduce cesarean sections without clinical indication. The PPA is structured in four components, one of which is directed at women and families. The objective of this study is to evaluate the effects of PPA on women's preference for vaginal birth (VB) at the end of pregnancy.
Evaluative research conducted in 12 private hospitals participating in the PPA. Interviews were carried out in the immediate postpartum period and medical record data were collected at hospital discharge. The implementation of PPA activities and women's preference for type of birth at the beginning and end of pregnancy were compared in women assisted in the PPA model of care and in the standard of care model, using a chi-square statistical test. To estimate the effect of PPA on women's preference for VB at the end of pregnancy, multiple logistic regression was performed with selection of variables using a causal diagram.
Four thousand seven hundred ninety-eight women were interviewed. The implementation of the planned activities of PPA was less than 50%, but were significantly more frequent among women assisted in the PPA model of care. Women in this group also showed a greater preference for VB at the beginning and end of pregnancy. The PPA showed an association with greater preference for VB at the end of pregnancy in primiparous (OR 2.54 95% CI 1.99-3.24) and multiparous women (OR 1.44 95% CI 0.97-2.12), although in multiparous this association was not significant. The main factor associated with the preference for VB at the end of pregnancy was the preference for this type of birth at the beginning of pregnancy, both in primiparous (OR 18.67 95% CI 14.22-24.50) and in multiparous women (OR 53.11 95% CI 37.31-75.60).
The PPA had a positive effect on women's preference for VB at the end of pregnancy. It is plausible that more intense effects are observed with the expansion of the implementation of the planned activities. Special attention should be given to information on the benefits of VB in early pregnancy.
2015 年，一项名为“充分分娩项目”（PPA）的质量改进项目在巴西私立医院实施，旨在减少无临床指征的剖宫产。PPA 由四个部分组成，其中一个针对妇女及其家庭。本研究旨在评估 PPA 对孕妇在妊娠末期对阴道分娩（VB）偏好的影响。
在参与 PPA 的 12 家私立医院进行评估性研究。在产后立即进行访谈，并在出院时收集病历数据。比较了在 PPA 护理模式和标准护理模式下接受护理的妇女在 PPA 活动实施情况和妊娠开始及结束时对分娩方式的偏好，并使用卡方检验进行比较。为了估计 PPA 对孕妇在妊娠末期对 VB 偏好的影响，使用因果图选择变量进行多因素逻辑回归分析。
共采访了 4798 名妇女。PPA 计划活动的实施率低于 50%，但在 PPA 护理模式下接受护理的妇女中更为常见。该组妇女在妊娠开始和结束时也表现出对 VB 的更大偏好。PPA 与初产妇（OR 2.54，95%CI 1.99-3.24）和经产妇（OR 1.44，95%CI 0.97-2.12）对 VB 的更大偏好相关，尽管在经产妇中这种关联不显著。与对 VB 的偏好相关的主要因素是妊娠开始时对 VB 的偏好，这在初产妇（OR 18.67，95%CI 14.22-24.50）和经产妇（OR 53.11，95%CI 37.31-75.60）中均如此。
PPA 对孕妇在妊娠末期对 VB 的偏好产生了积极影响。随着计划活动实施范围的扩大，可能会观察到更明显的效果。应特别注意在妊娠早期提供 VB 的益处的信息。
