Prevalência e fatores associados ao parto cesárea no contexto regional brasileiro em mulheres de idade reprodutiva

Abstract

Introduction: Caesarean section is becoming more and more frequent all over the world. If indicated correctly, it is effective in reducing maternal and perinatal mortality. However, it has been performed without real indications, increasing its prevalence and may lead to unnecessary risks, both for the mother and the baby. There are several factors that may be associated with this increasing rate, but these are little explored on the optics of the Brazilian regions. Objective: To estimate the prevalence and factors associated with cesarean sections in the Brazilian regions context. Methodology: A recort of national database of the National Health Survey (PNS), a national domiciliary study conducted by the IBGE in partnership with the Ministry of Health in 2013, was included. data from women aged 18 To 49 years, totaling 16,175 records of women who were pregnant and gave birth at some time in life. Descriptive analysis of the variables of interest, bivariate analysis using the chi-square test, and logistic regression were performed to estimate the magnitude of the association between the variables and cesarean delivery. A level of significance was adopted or p value <0.05. Results: The prevalence in Brazil of women who had cesarean delivery was 53.03%. Over the years (from 1974 to 2013), there was an increase in the chances of having this type of delivery, mainly in the Northeast (2,21, IC95:1,42-3,46) and South (2,75, IC95:1,44-5,23). Regarding private health care, women who had health insurance were 3 times more likely to undergo cesarean section (IC95:1,6–5,3) than those without health insurance (1,4, IC95: 1,0 – 2,0), as well as those with arterial hypertension (2,77, IC95: 1,5-4,8), chronic column problem (2,0;IC95 1,01–4,05). Regarding the age of first gestation and menarche, it was observed that women who were older than 20 years in the first pregnancy were twice as likely (IC95: 1,2-3,3) and those whose age at menarche was higher or Equal to 12 years 1,7 times more chances (IC95: 1,2-2,3). In addition, women who self-reported their health as good had 1,8 times (IC95: 1,2-2,6) and those with higher levels of education had 2,05 times (IC95: 1,2-3,3) more Cesarean, highlighting those of the North and South regions, while in the Northeast this probability increased independently of the level of schooling. Conclusion: The rate of cesarean delivery in Brazil remains high, associated factors such as time, educational level, maternal age at first pregnancy, menarche, self-reported health, appear to contribute to the increase of this prevalence, behaving distinctly among the regions of the country.