[Characteristics related to the first and last cesarean delivery among women from a Campinas University Hospital].
OBJECTIVE
To study the association between first and last caesarian sections with tubal sterilization; to determine length of reproductive life after the first delivery.


METHODS
From February to October 2001 in a university hospital, interviews were carried out with 653 women having had at least two pregnancies. Of these women, 172 had a first caesarian section; 294 had a last caesarian section. Variables were social demographic characteristics, obstetric history and characteristics of the first and last deliveries and tubal sterilization. Bivariate analysis was performed, followed by multiple regression analysis calculating the adjusted odds ratio. Women who had undergone tubal sterilization were divided into age groups of 25 to 44 and >45 years in a percentile distribution. The Wilcoxon test was used to analyze age at tubal sterilization and length of reproductive life after the last delivery. The study was approved by the Ethics Committee.


RESULTS
Of these women, 89% completed<8 years of school education and 78% were Caucasian. On multiple regression analysis, there was an association between the first and last caesarian section (OR=15.28, 95%CI 8.54 to 27.36), having a partner (OR=3.87, CI95% 1.63 to 9.17) and giving birth in the '70s, '80s or '90s (OR=4.43, 95%CI 1.37 to 14.27), (OR=6.11, 95%CI 1.47 to 25.47) and (OR=6.67, 95%CI 1.21 to 40.26), respectively. The last caesarian section was associated with intrapartum tubal sterilization (OR=14.09, 95%CI 7.37 to 26.97), giving birth in the '70s, '80s or '90s (OR=1.81, 95%CI 1.06 to 3.09), (OR=5.53, 95%CI 3.18 to 9.61) and (OR=5.90, 95%CI 3.03 to 11.48), respectively, family income of >5 minimum wages (OR=2.41, 95%CI 1.42 to 4.08) and age at first delivery>25 years (OR=1.80, 95%CI 1.01 to 3.22). Mean age at sterilization was 29.0 and 33.2 years in women aged 25 to 44 years and >45 years, respectively (p<0.001). The duration of the reproductive period after the first delivery was 9.0 and 11.4 years for the same groups (p<0.001).


CONCLUSIONS
The first caesarian section was associated with the last caesarian section. The last caesarian section was associated with intrapartum tubal sterilization. Age at sterilization was lower and the reproductive period was shorter among younger women.
dos Santos Fernandes
Arlete Maria
AM
Area de Tocoginecologia, Faculdade de Ciências Médicas, Pontifícia Universidade Católica de Campinas, SP, Brazil. arlete@fcm.unicamp.br
Bedone
Aloísio José
AJ
Leme
Larissa Capochin Paes
LC
Fonsechi-Carvasan
Gislaine Aparecida
GA
D000328:Adult; D000367:Age Factors; D001938:Brazil / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D012959:Socioeconomic Factors; D013246:Sterilization, Tubal / Q000706:statistics & numerical data; D013997:Time Factors; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data