Caesarean sections and maternal mortality in Sao Paulo.
OBJECTIVE
To evaluate caesarean section in both public and private sectors; maternal mortality associated with mode of delivery in the public sector (Sistema Unico de Saude, SUS) in Sao Paulo State, Brazil.


METHODS
610,630 births in both public and private sectors for 2003; 1,153,034 deliveries and 314 maternal deaths in the public sector for 2001-2003. The study estimated caesarean section rates and odds ratios for caesarean section in association with maternal characteristics in both public and private sectors; maternal mortality associated with mode of delivery in the public sector, adjusted for hypertension, other disorders, problems and complications, as well as maternal age.


RESULTS
The caesarean section rate was 32.9% in the public sector, and 80.4% in the private sector. The odd ratio for caesarean section was 2.6 (95% CI: 2.6-2.7) for women with 12 or more years of education. The odd ratio for maternal mortality associated with caesarean section in the public sector was 3.3 (95% CI: 2.6-4.3).


CONCLUSIONS
Sao Paulo presented high caesarean section rates. Caesarean section compared to vaginal delivery in the public sector presented higher risk for mortality even when adjusted for hypertension, other disorders, problems and complications, as well as maternal age.
Kilsztajn
Samuel
S
Laboratório de Economia Social (LES), R. Mq. Paranaguá 164/602, 01303-050 São Paulo, SP, Brazil. skilmail@gmail.com
Carmo
Manuela S N do
MS
Machado
Luis C
LC
Lopes
Erika S
ES
Lima
Luciana Z
LZ
D000328:Adult; D001719:Birth Certificates; D001938:Brazil / Q000453:epidemiology; D002585:Cesarean Section / Q000401:mortality*; D005260:Female; D006753:Hospital Records; D006801:Humans; D008428:Maternal Mortality / Q000639:trends; D016017:Odds Ratio; D011247:Pregnancy; D012189:Retrospective Studies