Abstract:
INTRODUCTION:To analyze the cesarean section rate evolution in a tertiary hospital and the main indications for cesarean section. MATERIAL AND METHODS:A retrospective study was conducted at a major academic hospital and included 5 751 women who had a cesarean section from 2005 to 2011. The rates of overall, primary and repeat cesarean sections were analyzed. A linear regression and adjusted R-square were used to access the relative contribution of each indication to the variation in primary cesarean section. RESULTS:During the 7-year period of the study the cesarean section rate decreased from 30.9% to 27.6%. This was due to a decrease in primary cesarean section (21.9% to 18.2%), although an increase in repeat cesarean section was observed (9.0% to 9.4%). Among the indications for primary cesarean section, maternal-fetal indications and malpresentation were the ones that decreased the most with adjusted R-square of 0.70 and 0.55, respectively. DISCUSSION:The collected data identified that the decrease in the cesarean section rate at the hospital resulted from a decrease in primary cesarean section deliveries, especially the ones performed for maternal-fetal indications and malpresentation. CONCLUSION:The decrease in primary cesarean section rate may be attributed to several changes in medical policies in the Department, such as the implementation of an external fetal version program, the induction of labor only after the 41st week of gestation in low-risk pregnancies and the trial for vaginal birth in maternal-fetal disease. Nevertheless subjective indications such as labor arrest disorders and nonreassuring fetal heart rate are still major contributors for primary cesarean section rate. :Introdução: Analisar a evolução da taxa de cesarianas e as principais indicações para cesariana num centro terciário.Material e Métodos: Estudo retrospectivo conduzido num hospital universitário que incluiu 5751 grávidas submetidas a cesariana entre 2005 e 2011. Analisaram-se as taxas de cesarianas, incluindo a taxa de primeiras cesarianas e de cesarianas repetidas. Para avaliar a contribuição relativa de cada uma das indicações na variação da taxa de primeiras cesarianas recorreu-se à regressão linear e determinou-se o valor do r2 ajustado.Resultados: Durante o período do estudo a taxa de cesarianas diminuiu de 30,9% para 27,6%. Esta descida deveu-se à diminuição da taxa de primeiras cesarianas (21,9% para 18,2%), apesar de se ter constatado um ligeiro aumento da taxa de cesarianas repetidas (9,0 para 9,4%). Entre as indicações para primeiras cesarianas, as causas materno-fetais e de apresentação anómala foram as que diminuiram mais, com valores de r2 ajustado de 0,70 e 0,55, respectivamente.Discussão: Os dados coligidos permitiram identificar a hipótese de que a diminuição da taxa de cesarianas se deveria a uma retração detectada sobretudo a nível das primeiras cesarianas, em particular as decorrentes de causas materno-fetais e apresentação anómala.Conclusão: A diminuição da taxa de primeiras cesarianas pode ser atribuída a várias modificações na prática clínica do Departamento, como a implementação da versão cefálica externa, a indução do trabalho de parto a partir das 41 semanas de gestação, em gravidezes de baixo risco e da realização de provas de trabalho de parto em casos de patologia materno-fetal. No entanto, indicações subjectivas, como a paragem de progressão do trabalho de parto e a suspeita de sofrimento fetal são ainda causas major de primeiras cesarianas.
journal_name
Acta Med Portjournal_title
Acta medica portuguesaauthors
Costa A,Policiano C,Clode N,Graça LMsubject
Has Abstractpub_date
2013-11-01 00:00:00pages
649-54issue
6eissn
0870-399Xissn
1646-0758journal_volume
26pub_type
杂志文章abstract:INTRODUCTION:Progressive multifocal leucoencefalopathy (PML) is a subacute demielinating disease of the Central Nervous System caused by the neurotropic virus John Cunningham (JC), common in immunodeficient patients, namely in HIV infection. PML encephalic lesions have a progressive nature that needs characterization a...
journal_title:Acta medica portuguesa
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journal_title:Acta medica portuguesa
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doi:
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