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Rev Bras Ginecol Obstet. 2013;35(10):447-452
DOI 10.1590/S0100-72032013001000004
PURPOSE: To analyze prenatal care in public and private services. METHODS: A cross-sectional, retrospective and analytic study was conducted based on the audit of files of pregnant women who had given birth at a reference hospital for low risk cases in the area of Campos Gerais - Paraná State, in the first semester of 2011. The Yates chi-squared test or exact Fisher test were used to determine the association between the lack of registration files for pregnant women regarding prenatal assistance in the public and private services, with the level of significance set at p≤0.05. The quality of prenatal care was determined based on the percentile of non-registrations. RESULTS: A total of 500 prenatal files were analyzed. There was a significant attendance of six or more prenatal visits, with a larger proportion in the private service (91.9%). The laboratory and obstetric exams most frequently not registered in the public and in the private services were, respectively: hepatitis B (79.3 and 48.4%), hemoglobin and hematocrit values (35.6 and 21.8%), anti-HIV serology (29.3 and 12.9%), fetal movement (84.3 and 58.9%) and length (60.4 and 88.7%), edema verification (60.9 and 54.8%), and fetal presentation (52.4 and 61.3%). The audit of the files of pregnant women allowed to determine the quality of the prenatal care provided and confirmed differences in assistance according to the place, showing excellent and good quality of private care, and regular public care for ultrasonography and blood type/Rh factor; regular quality of private care and poor quality of public care for urine tests and weight. For the other types of laboratory and obstetric exams and vaccines, the quality was poor or very poor in both types of services. CONCLUSION: The differences between the services showed that there is a need for actions aiming at the improvement of the prenatal care provided by public services.
Summary
Rev Bras Ginecol Obstet. 2013;35(10):447-452
DOI 10.1590/S0100-72032013001000004
PURPOSE: To analyze prenatal care in public and private services. METHODS: A cross-sectional, retrospective and analytic study was conducted based on the audit of files of pregnant women who had given birth at a reference hospital for low risk cases in the area of Campos Gerais - Paraná State, in the first semester of 2011. The Yates chi-squared test or exact Fisher test were used to determine the association between the lack of registration files for pregnant women regarding prenatal assistance in the public and private services, with the level of significance set at p≤0.05. The quality of prenatal care was determined based on the percentile of non-registrations. RESULTS: A total of 500 prenatal files were analyzed. There was a significant attendance of six or more prenatal visits, with a larger proportion in the private service (91.9%). The laboratory and obstetric exams most frequently not registered in the public and in the private services were, respectively: hepatitis B (79.3 and 48.4%), hemoglobin and hematocrit values (35.6 and 21.8%), anti-HIV serology (29.3 and 12.9%), fetal movement (84.3 and 58.9%) and length (60.4 and 88.7%), edema verification (60.9 and 54.8%), and fetal presentation (52.4 and 61.3%). The audit of the files of pregnant women allowed to determine the quality of the prenatal care provided and confirmed differences in assistance according to the place, showing excellent and good quality of private care, and regular public care for ultrasonography and blood type/Rh factor; regular quality of private care and poor quality of public care for urine tests and weight. For the other types of laboratory and obstetric exams and vaccines, the quality was poor or very poor in both types of services. CONCLUSION: The differences between the services showed that there is a need for actions aiming at the improvement of the prenatal care provided by public services.
Summary
Rev Bras Ginecol Obstet. 2014;36(12):548-554
DOI 10.1590/So100-720320140005038
To analyze the time trend of the rates of cesarean and vaginal delivery according to the source of financing.
This was an ecological study of the time series analysis of cesarean and vaginal delivery rates according to the financing source, carried out in Maringá, Paraná State, Brazil, from 2002 to 2012. Information available at the System of Information on Live Births and at the System of Hospital Information of the Brazilian Unified Health System (SUS) was used for data collection. Moving averages were calculated for all mode of delivery rates in order to smooth random fluctuations in the series, dispersion diagrams were designed between the coefficients and years of the study, and polynomial regression models were estimated from the functional relation observed, with the level of significance set at p<0.05.
Throughout the 11 years of the study there were 48,210 births, 77.1% by cesarean delivery and only 22.9% by vaginal delivery. A total of 22,366 procedures were financed by SUS, 54.6% of them being cesareans. Trend analysis was significant for all the regression models, demonstrating an ascending trend for cesarean delivery and a descending trend for vaginal delivery for both types of financing. The non-SUS cesarean rates always exceeded 90.0% and were more frequent than the SUS cesarean rates, even with a 36.0% increase of the latter during the study period.
Based on trend analysis, cesarean deliveries will continue to increase in both health financing sources unless new actions and strategies of reduction are implemented, involving the sociocultural, demographic and obstetric characteristics of women, the training and activity of professionals in the area of obstetrics and an adequate structure of health services for providing vaginal delivery.
Summary
Rev Bras Ginecol Obstet. 2014;36(12):548-554
DOI 10.1590/So100-720320140005038
To analyze the time trend of the rates of cesarean and vaginal delivery according to the source of financing.
This was an ecological study of the time series analysis of cesarean and vaginal delivery rates according to the financing source, carried out in Maringá, Paraná State, Brazil, from 2002 to 2012. Information available at the System of Information on Live Births and at the System of Hospital Information of the Brazilian Unified Health System (SUS) was used for data collection. Moving averages were calculated for all mode of delivery rates in order to smooth random fluctuations in the series, dispersion diagrams were designed between the coefficients and years of the study, and polynomial regression models were estimated from the functional relation observed, with the level of significance set at p<0.05.
Throughout the 11 years of the study there were 48,210 births, 77.1% by cesarean delivery and only 22.9% by vaginal delivery. A total of 22,366 procedures were financed by SUS, 54.6% of them being cesareans. Trend analysis was significant for all the regression models, demonstrating an ascending trend for cesarean delivery and a descending trend for vaginal delivery for both types of financing. The non-SUS cesarean rates always exceeded 90.0% and were more frequent than the SUS cesarean rates, even with a 36.0% increase of the latter during the study period.
Based on trend analysis, cesarean deliveries will continue to increase in both health financing sources unless new actions and strategies of reduction are implemented, involving the sociocultural, demographic and obstetric characteristics of women, the training and activity of professionals in the area of obstetrics and an adequate structure of health services for providing vaginal delivery.
