É viável diminuir cesariana em mulheres hipertensas em hospitais privados?

Abstract

In the prevalence of cesarean section is usually higher compared to normal-risk pregnant women. However, it is important to In pregnancies of hypertensive womenote that performing a cesarean section can increase the risk of death and serious complications for the health of the woman and the newborn, both in low-risk hypertensive women and in more severe cases. When analyzing data from the Supplementary Health System in Brazil, a large discrepancy in cesarean section rates between the private and public sectors is noticed. In view of the above, this Dissertation sought to evaluate the effectiveness of the “Adequate Birth Project” (PPA) in reducing the cesarean section rate in hypertensive women, as well as maternal morbidity and neonatal near miss. This is a cross-sectional study involving 4,878 women from twelve private maternity hospitals. For the analysis of this study, only hypertensive women who arrived at the maternity ward during their shift were selected. Women with twin pregnancies, HIV positive, with placenta previa, with placental abruption, and Robson groups from 6 to 9 were excluded. The final sample included 465 women, who were divided into the intervention group (participation in the PPA) and “care usual". The following outcomes were evaluated: going into labor, mode of delivery, maternal morbidity and neonatal near miss. The analysis was carried out using a logistic regression model based on a previously prepared DAG where education, age, race/skin color, previous uterine scar and pre-pregnancy BMI were considered a minimum adjustment for the relationship between the intervention of interest and the outcomes, separately. The intervention increased women's chances of going into labor (OR= 3.6; 95%CI 2.2 – 5.7) and of having a vaginal birth (OR=5.9; 95%CI 2.9 – 12 ,1). The intervention was not associated with severe maternal morbidity (OR=0.9; 95% CI 0.4 – 1.8). However, the intervention increased the chance of neonatal near miss (OR=3.9, 95%CI 1.1 – 13.3). Knowing that spontaneous preterm infants cannot be attributed to PPA, a sensitivity analysis was performed, excluding these cases. Thus, the chance of neonatal near miss associated with PPA loses statistical significance regardless of the method evaluated. The "Adequate Birth Project" proved to be effective in increasing the chances of hypertensive women treated in the private sector going into labor and having a vaginal birth. Sensitivity analyzes ruled out any association between PPA and neonatal near miss.