scholarly journals Restricting the timing of Elective CS: evidence from Brazil

2021 ◽  
Vol 51 (2) ◽  
pp. 245-283
Author(s):  
Lucas Melo

Abstract Brazil has one of the highest Cesarean Section (CS) rates in the world. It is a share of 58.3% reported by the Living Births Information System (SINASC) 2015-2017. It is well above the maximum rate of 15% recommended by the World Health Organization (WHO). In this paper, we estimate impacts and unintended consequences of the Resolution 2,144 from the Federal council of Medicine (CFM) on outcomes of Low Risk First Born births (LRFB). The Resolution introduces a minimum of 39th weeks of gestation for Elective CS. Elective CS before the 39th week rate dropped 2.78 percentage points, which is statistically significant and equivalent to a 24% decrease in this outcome’s mean. We also find increases in birth’s time length: the percentage of births happening before the 39th week decreased 2.34 percentage points, which is a decrease of 6% in its average. Our results suggest that Elective CS’s were postponed from the 37-38th week to after the begin of the 39th week. We show that the policy had an unintended consequence once it seems to have changed the way potential spontaneous Natural Deliveries are anticipated from weekends to weekdays through Scheduled CS.

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Silvina Ramos ◽  
Mariana Romero ◽  
Carla Perrotta ◽  
Yanina Sguassero ◽  
Cecilia Straw ◽  
...  

Abstract Background While cesarean section is an essential life-saving strategy for women and newborns, its current overuse constitutes a global problem. The aim of this formative research is to collect information from hospitals, health professionals and women regarding the use of cesarean section in Argentina. This article describes the methodology of the study, the characteristics of the hospitals and the profile of the participants. Methods This formative research is a mixed-method study that will be conducted in seven provinces of Argentina. The eligibility criteria for the hospitals are (a) use of the Perinatal Information System, (b) cesarean section rate higher than 27% in 2016, (c) ≥ 1000 deliveries per year. Quantitative and qualitative research techniques will be used for data collection and analysis. The main inquiry points are the determining factors for the use of cesarean section, the potential interventions to optimize the use of cesarean section and, in the case of women, their preferred type of delivery. Discussion It is expected that the findings will provide a situation diagnosis to help a context-sensitive implementation of the interventions recommended by the World Health Organization to optimize cesarean section use. Trial registration IS002316 Plain English Summary Cesarean section is an essential medical tool for mothers and their children, but nowadays its overuse is a problem worldwide. Our purpose is to get information from hospitals, health professionals and women about how cesarean section is used in Argentina. In this protocol we describe how we will carry out the study and the characteristics of the hospitals and participants. We will implement this study in seven provinces of Argentina, in hospitals that have more than 1,000 births each year, had a cesarean section rate higher than 27% in 2016 and use the Perinatal Information System. We will gather information using forms, surveys and interviews. We want to identify the factors that decide the use of a cesarean section, the potential interventions that can improve the use of cesarean section and, in the case of women, the type of delivery they prefer. We expect that this study will give us a diagnosis of how cesarean section is used in Argentina, and that this will help to apply the interventions that the World Health Organization recommends to optimize the use of cesarean section in our specific context.


2021 ◽  
Vol 45 ◽  
pp. 1
Author(s):  
Yluska Myrna Meneses Brandão e Mendes ◽  
Daphne Rattner

Objective. To determine the distribution of cesarean sections performed in teaching hospitals participating in the Project for Improvement and Innovation in the Care and Teaching of Obstetrics and Neonatology (Apice ON) using the Robson Classification. Methods. Cross-sectional descriptive study on cesarean sections performed at Apice ON hospitals according to the Robson Classification, using secondary data from the 2017 Live Births Information System on the year prior to project implementation, hence a baseline study. Hospitals are described according to their geographic distribution and cesarean section rates, using absolute and relative frequencies. Results. The proportions of newborns by Robson groups were similar to those proposed by the World Health Organization, except for Group 5 (with previous cesarean section) and Group 10 (preterm), with regional differences. The teaching hospitals’ average cesarean section rates ranged from 24.8% to 75.1%, exceeding by far the recommended values, even in Robson groups considered low risk for cesarean section (Groups 1 to 4). Conclusions. Brazilian teaching hospitals displayed cesarean section rates higher than those recommended by the World Health Organization for all groups; a worrisome fact, as by teaching they induce attitudes in future professional practices. These results highlight the importance of a reliable information system. Monitoring and evaluation of cesarean sections using the Robson Classification can be an important tool to guide management and propose actions to reduce rates. Countries with high cesarean section rates might explore this hypothesis in their teaching hospitals in order to define policies for the reduction of their rates.


2013 ◽  
Vol 18 (41) ◽  
Author(s):  
S G Sullivan ◽  
H Kelly

Twice each year the World Health Organization makes a recommendation for the composition of the influenza vaccine, based on circulating strains of influenza A(H3N2), A(H1N1) and B. Strain selection has always been based on immunogenicity studies with limited human data. Immunogenicity can be considered as a proxy for vaccine effectiveness (VE). However, only interim VE estimates for the target hemisphere can be considered in time for the strain selection meeting. Using surveillance data from Victoria, Australia, we retrospectively estimated and compared interim and final VE estimates for 2007 to 2012. In general, interim estimates were within five percentage points of final estimates. However, estimates made too early or in years of low influenza activity may be unreliable.


2021 ◽  
Vol 9 (03) ◽  
pp. 607-611
Author(s):  
Khalloufi C. ◽  
◽  
Ibnoulkhatib S. ◽  
El Kebir A. ◽  
Karkouri M. ◽  
...  

The debate persists about the inflammatory or tumoral, benign or malignant nature of the Inflammatory myofibroblastic tumors (TMI). Radioclinically, they can mimic a malignant neoplasm, although they are classified as intermediate by the World Health Organization (WHO). The diagnosis is almost always made by pathological examination. The treatment is poorly codified but the management is usually surgical. The removal of these tumors is a challenge when the mass is developed at the expense of or in the vicinity of noble organs. Several therapies have been tested to overcome the limitations of surgery, the results are variable. These tumors rarely affect the digestive tract. We propose the study of a case of myofibroblastic tumor developed at the expense of the omentum, five months after a cesarean section, in order to try to determine if it is a rare complication of the postpartum or a fortuitous combination.


Author(s):  
Antonio Hernández-Martínez ◽  
Juan Martínez-Galiano ◽  
Julián Rodríguez-Almagro ◽  
Miguel Delgado-Rodríguez ◽  
Juan Gómez-Salgado

The type of hospital (public or private) has been associated with the type of clinical practice carried out. The purpose of this study was to determine the association between the type of hospital (public or private) and delivery attendance with practices based on the recommendations by the World Health Organization (WHO). A cross-sectional study with puerperal women (n = 2906) was conducted in Spain during 2017. The crude Odds Ratios (OR), adjusted (aOR) and their 95% confidence intervals (CI) were calculated through binary logistic regression. For multiparous women in private centers, a higher rate of induced labor was observed (aOR: 1.49; 95% CI: 1.11–2.00), fewer natural methods were used to relieve pain (aOR: 0.51; 95% CI: 0.35–0.73), and increased odds of cesarean section (aOR: 2.50; 95% CI: 1.81–3.46) were found as compared to public hospitals. For primiparous women in private centers, a greater use of the epidural was observed (aOR: 1.57; 95% CI: 1.03–1.40), as well as an increased likelihood of instrumental birth (aOR: 1.53; 95% CI: 1.09–2.15) and of cesarean section (aOR: 1.77; 95% CI: 1.33–2.37) than in public hospitals. No differences were found in hospitalization times among women giving birth in public and private centers (p > 0.05). The World Health Organization birth attendance recommendations are more strictly followed in public hospitals than in private settings.


2008 ◽  
Vol 3 (1) ◽  
pp. 18
Author(s):  
Lucilane Sales da Silva ◽  
Magda Ferreira Queiroga ◽  
Marcelo Costa Fernandes ◽  
Leilson Lira de Lima

ABSTRACTObjective: to investigate the cesarean epidemiological profile of hospital public at Quixeramobim, Ceará, Brasil. Method: documental, descriptive and exploratory study, from quantitative approach, in a health institution located in the Alto Boqueirão in Quixeramobim, Ceará, Brazil. For data collection has drawn up a form with six points, implemented from July to December 2006. 2324 were consulted medical records of pregnant women. Data were organized in tables and discussed according to the literature scientific. Results: from January to December 2005 were performed 1137 births, of which 818 normal and 319 Cesarea, while in the same months of 2006 were performed 1187 childbirths, of which 836 normal and 351 cesarea. These results indicate that the normal deliveries were the most performed annually in the institution. However, when compared with the index suggested by the World Health Organization on the acceptable standard of performance of cesarean section, it appears that this institution the index is above the established reference rate for the number of caesareans in which to hospital in small size is 15% and medium and large corporations is 25%. The indices were respectively of 28.2% for 2005 and 29.8% for the year 2006. Conclusion: in conclusion be essential to the institution, reducing the rate of cesarean sections to meet the target suggested by the World Health Organization and encourage normal birth and humanized. Descriptors: cesarean section; natural childbirth; health profile.RESUMOObjetivo: investigar o perfil epidemiológico dos partos cesáreos em instituição hospitalar pública de Quixeramobim, Ceará, Brasil. Método: estudo documental, descritivo e exploratório, de abordagem quantitativa, realizado em instituição situada no Alto do Boqueirão em Quixeramobim, Ceará, Brasil. Para a coleta de dados foi elaborado um formulário com seis questões, aplicado entre julho a dezembro de 2006. Foram consultados 2324 prontuários de gestantes. Os dados foram organizados em tabelas e os dados discutidos com a literatura disponível. Resultados: os resultados revelaram que, de janeiro a dezembro de 2005, foram realizados 1137 partos, dos quais 818 normais e 319 cesáreos, enquanto nos mesmos meses de 2006 foram realizados 1187 partos, dos quais 836 normais e 351 cesáreos. Estes resultados indicam que os partos normais foram à maioria dos realizados anualmente na instituição. Entretanto, quando comparado com o índice sugerido pela Organização Mundial de Saúde, relativo ao padrão aceitável de realização de partos cesáreos, verifica-se que o índice está acima do estabelecido na taxa de referência para o número de cesarianas em que para hospital de pequeno porte é 15% e médio e grande porte é de 25%. Os índices encontrados foram de 28,2% para o ano de 2005 e de 29,8% para o ano de 2006, respectivamente. Conclusão: concluímos ser imprescindível à instituição, reduzir o índice dos partos cesarianos para atingir a meta sugerida pela Organização Mundial de Saúde e incentivar o parto normal e humanizado. Descritores: cesárea; parto normal; perfil de saúde.RESUMENObjetivo: investigar el perfil epidemiológico de la cesárea en el hospital público de Quixeramobim, Ceará, Brasil. Método: estudio documental, descritivo y exploratorio de abordagem cuantitativa. Dirigido em una institución del Alto Boqueirão en Quixeramobim, Ceara, Brasil. Para la recopilación de datos ha elaborado un formulario con seis puntos, ejecutado entre julio y diciembre de 2006, se incluyeron todas las entregas realizadas. Hemos encontrado 2.324 registros médicos de las mujeres embarazadas. Los datos fueron organizados en tablas y debatido los datos con la bibliografía disponible. Resultados: los resultados mostraron que de enero a diciembre de 2005, se realizaron 1.137 partos, de los cuales 818 normales y 319 Cesare, mientras que en los mismos meses de 2006 se realizaron 1.187 partos, de los cuales 836 normales y 351 Cesarea. estos resultados indican que los partos normales son los más realizados anualmente en la institución. Sin embargo, si se compara con el índice sugerido por la Organización Mundial de la Salud sobre el nivel aceptable de rendimiento de la cesárea, parece que esta institución el índice está por encima de la tasa de referencia establecido para el número de cesáreas en el hospital para que en los pequeños tamaño es de 15% y medianas y grandes empresas es del 25%. Los índices fueron, respectivamente, del 28,2% para 2005 y 29,8% para el año 2006. Conclusión: en conclusión esencial a la institución, la reducción de la tasa de cesáreas para cumplir el objetivo propuesto por la Organización Mundial de la Salud y fomentar el parto normal y humanizado. Descriptores: cesárea; parto normal; perfil de salud.


Sign in / Sign up

Export Citation Format

Share Document