Factors associated with cesarean sections in Brazilian hospitals.
OBJECTIVE
To assess the prevalence of cesarean sections in Brazilian hospitals.


METHODS
A cross-sectional study was carried out with data from the World Health Organization's Global Data System for Maternal and Perinatal Health, for the Brazilian states of São Paulo, Pernambuco and the Federal District. Data relating to 15,354 women who gave birth between September/2004 and March/2005 were analyzed, according to sociodemographic, reproductive, and hospital-related characteristics. Bivariate analyses - with calculations of the prevalence ratios and respective confidence intervals - and multivariate Poisson regression analyses were performed.


RESULTS
The prevalence ratio of cesarean sections was significantly higher among older women, who were married/living with a partner and with higher body mass index. The following conditions during pregnancy or birth were associated with higher cesarean section prevalence ratio: parturient being diagnosed as HIV-positive, heavier weight and greater head circumference of the newborn, and more prenatal consultations. In regression analysis, the following variables showed direct association with the outcome: parturient being older and with higher schooling level, presence of hypertension/eclampsia, chronic condition or some other medical condition, newborn's greater head circumference, being primiparous, having had a cesarean in the last pregnancy and having received an epidural block or rachidian analgesic during labor. Although the proportion of cesareans was higher in hospitals with a high complexity index, the difference was not statistically significant, as well as for other characteristics of hospitals.


CONCLUSIONS
The conditions of the pregnancy, newborn and the sociodemographic and reproductive characteristics of the parturient were independently associated with cesarean delivery. The hospital complexity index was not associated with cesarean delivery, probably due to the homogeneity of the hospital sample.
Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas, Campinas, SP, Brasil. simonia@unicamp.br
Karla Simônia de
KS
Pádua
Maria José Duarte
MJ
Osis
Anibal
A
Faúndes
Avelar Holanda
AH
Barbosa
Olímpio Barbosa
OB
Moraes Filho
D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002585:Cesarean Section / Q000379:methods / Q000706:statistics & numerical data*; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D012959:Socioeconomic Factors; D055815:Young Adult