Nascer em Belo Horizonte: cesarianas desnecessárias e prematuridade

Abstract

Brazil is the world´s leader in cesarean surgery, with a rate of 56% of total births, while the percentage recommended by the World Health Organization is 15%. This high rate is considered an epidemic in the country and is associated with increased morbidity as well as maternal and newborn mortality. In Brazil, it is estimated that almost a million women undergo this surgery without medical advice and adequate obstetric care, which affects the increase in rates of unnecessary cesarean sections and prematurity. The Southeast region stands out as the region with the highest rate of this type of birth. Objective: It is to analyze the unnecessary cesarean sections in Belo Horizonte and related prematurity. Method: This is a hospital-based study that was conducted in public and private maternity hospitals in Belo Horizonte, Minas Gerais, Brazil, from November 2011 to March 2013. The sample is comprised of hospitalized mothers for birth reasons as well as their living fetuses, regardless of the weight and gestational age, or dead fetuses that weigh more than 500 grams and obtain gestational age greater than 22 weeks. Data were collected through interviews with the mothers, based in their medical records as well as the newborn´s and prenatal card. An algorithm proposed by Pereira was used to estimate the gestational age et al (2014) and early pregnancy ultrasound (7 to 20 weeks). The unnecessary caesarean sections were analyzed through the use of Robson´s 10 groups classification, based on the following variables: Type of hospital (public or private), origin, age, race/skin color and postpartum women´s economic status, health plan, her company and justifications for conducting the caesarian. Data were analyzed by descriptive statistics and the results expressed on tables with emphasis on expected rates and unnecessary cesareans as well as the proportion of unnecessary cesareans. Prematurity was analyzed by different methods of estimation of gestational age as well as by Robson´s 10 groups classification. We used the SPSS software and Excel. Results: The early pregnancy ultrasound was considered to be the most sensitive method to calculate GI (Gestational age calculated by Ultrasound) similar to the estimate calculated through the algorithm as well as for the diagnosis of prematurity. Of mothers classified by Robson, 31% had Cesarean type birth. The occurrence of unnecessary cesarean sections has been evidenced in both public and private hospitals, but with different rates, of 5% and 36%, respectively. In both sectors, the rates of cesarean deliveries were higher in women of white race/color who were older than 32, belonged to social class A and B, who had lower gestational age, were accompanied and had private health insurance. Groups 2,5,8 and 10 of Robson´s classification accounted for the largest proportions of unnecessary C-sections. The proportion of premature births was similar when gestational age was estimated by the most accurate method and by the algorithm. This proportion was also clearly demonstrated in Robson´s 10 groups, due to the unnecessary cesareans and it was concentrated in the private sector. Conclusion: The proposed algorithm can be used as an estimator of gestational age in the absence of early pregnancy ultrasound, for analysis patterns similar to it were presented with high sensitivity and specificity. The high rates of C-sections observed in Brazil, especially in the private sector, were justified by the occurrence of unnecessary C-sections, which also increases the prematurity rates. Robson´s classification suggests that, in order to reduce the occurrence of unnecessary cesareans in Belo Horizonte, it is necessary to reduce the number of cesarean births in women with previous C-sections and wait for the onset of labor to decide the most adequate birth method.