5 jun. PROFISSIONAIS ENVOLVIDOS AIH SUBSEQUENTE AUTORIZAÇÃO DE AIH Quais profissionais são responsáveis pelos laudos de. A AIH não precisa ser emitida em papel. O detalhamento do preenchimento do laudo está no Manual do. SISAIH01 disponível no site Existe o modelo padronizado de Laudo para Solicitação de AIH que está disponibilizado no sitio , mas é possível a utilização de .

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Cesarean sections in a birth center. Escola de Enfermagem EE. Universidade Estadual de Campinas. To estimate the prevalence of cesarean sections in a birth center of a hospital and identify factors associated. The dependent variable type of delivery included vaginal delivery and cesarean section. The independent variables were grouped into four categories: Of all deliveries, Factors related to fetal conditions including fetal stress, meconium-stained amniotic fluid, breech presentation and macrosomia accounted for Prevalence of c-section was consistent with World Health Organization recommendations.

Las variables independientes fueron categorizadas en cuatro xih Centros Independientes de Asistencia al Embarazo y al Lsudo. Caesarean c- section rates are on the rise in practically every country in the world. Excessive c-sections are also associated with poor maternal and perinatal lauro.


A Brazilian study laudp three birth cohorts, and from the city of Pelotas, Southern Brazil, showed that c-section rates increased in both public from Maternal characteristics have improved: However, the percentage of preterm deliveries increased from 6. The increase in preterm vaginal births was associated with a 2.

Elective c-sections may result in iatrogenic preterm birth, prolong hospitalization, and have a negative effect on breastfeeding. These facilities value the physiology of vaginal delivery, the presence of the partner, and the immediate contact between mother and newborn. Vaginal delivery care is provided by nurse-midwives and midwives, and may take place in in-hospital, alongside or freestanding birth centers.

Encouragement of vaginal delivery and delimitation of the interventions provided by physicians and nurses are among the foundations of the BC philosophy. Although there are a small number of studies 7,14,16 investigating the results obtained by BCs in Brazil, few of these address the use of c-sections within these centers.

Thus, the aim of the present study wih to estimate the prevalence of c-sections in a BC, and to identify its associated factors. This BC provides care to pregnant women classified as of low-risk. Care for labor and vaginal delivery is provided by nurse-midwives and midwives.

Any abnormalities in the physiological labor process or in fetal vitality laueo referred to obstetricians. Examples of such alterations include meconium-stained amniotic fluid, failure to progress, and deceleration of fetal heart rate, among others. Our study population comprised all births taken place within the institution between March and Apriltotaling 2, mothers and their newborns.

The survey was conducted by manual review of pregnancy charts, from which data on mother, labor, delivery, and newborn were extracted and transcribed to our own forms. Missing data from pregnancy charts were defined as “losses. In cross-sectional studies, measures of association are presented as odds ratios OR and PRs.

In the literature, there is an intense discussion among epidemiologists as to which measure OR or PR is most appropriate to measure the effects of risk factors. Confusion arises when prevalence is interpreted as a PR. This approximation may be considered correct when prevalence of the studied class is low as in the case of rare diseases. Of a total of 2, births taken place during the study period, were by c-section, corresponding to C-sections were most prevalent among older women.


History of prior c-sections and gestational age over 40 weeks were also associated with higher prevalence of c-sections Table 1. Oxytocin was administered to There was no significant association between use qih oxytocin and prevalence of c-sections Table 2. Time of the day was associated with mode of delivery.

Deliveries that took place between 7 p. Those taking place during early hours midnight to 6: Regarding the length of time between admission and delivery, intervals from 7 to 12 hours emerged as a protective factor against c-sections when compared to shorter periods.

Almost one-quarter of women that oaudo via c-section underwent surgery less than one hour after admission; most of these women had had repeated two or more previous c-sections. Women admitted to the BC with no cervical dilation were more likely to undergo c-section when compared to women with cm.

Women with meconium-stained the amniotic fluid were also more likely to undergo c-sections compared to those with clear fluid. Birthweight was also associated with mode of delivery: Women who delivered vaginally in their previous pregnancies showed lower prevalence of c-sections, even when their obstetric history included a prior c-section PR 0.

Taking obstetric history into account, women had a history of c-sections in their previously delivery. Of these, Fetal distress emerged as the major indication for this procedure, followed by failure to progress through labor. Among the indications for c-sections, we found that factors associated to the newborn, such as fetal distress, meconium-stained amniotic fluid diagnosed by cardiotocographymacrosomia, and breech presentation accounted for Labor-related conditions, such as failure to progress, functional dystocia, and shoulder dystocia accounted for In the present study, the rate of c-sections Studies of the factors associated with c-sections in Brazilian hospitals found that women aged 35 years or older have twice the prevalence of c-sections than women aged under 20 years.

These results are in agreement with those of surveys that compare planned c-sections and planned vaginal birth among women with a history of c-sections. Their results must therefore be interpreted with caution, given that risks and benefits may be overestimated by bias in the surveys reviewed.

A report by the United States National Institutes of Health concluded that rates of vaginal birth after c-section have decreased significantly sincec in association with a number of obstetric and demographic factors. According to this study, African or Hispanic ascendance, being single, having less than 12 years of schooling, having a maternal disease, and being admitted at a rural or private hospital are among the factors associated with lower probability of delivering vaginally after a c-section.

In this sense, having had a prior c-section may, in conjunction with other factors, influence the decision to deliver vaginally in the current pregnancy. A study carried out in Greece analyzed c-section indications between and The predominant reason for indicating a c-section in this study was previous c-section In the present study, prior c-section was not a determinant factor for current c-section.

However, based in our clinical experience, prior c-sections, when associated with other maternal characteristics, such as age greater than 35 years, suspected macrosomia or rupture of membranes, and unfavorable cervix may increase the probability of a c-section indication.


We also found that prolonged pregnancies tend to be more strongly associated with induction of labor, use of oxytocin, presence of meconium, and c-section delivery. Considering the possibility of vaginal delivery for women with prior c-sections may aaih a means to reduce the high rates of surgical delivery in Brazil.


It is difficult to analyze c-section indications in cases where this procedure laido performed almost routinely. Thus, we sought studies from countries in which c-section indications are thought to be related more closely to medical than to economic reasons.

In Pakistan, a study comparing the clinical and epidemiological characteristics of women undergoing c-sections, either for the first time or after prior c-sections, found an overall rate of Emergency procedures were predominant among primary c-sections. In a study carried out in Singapore, the rate of c-sections increased from Rates of primary and placenta previa-related c-sections showed the greatest increase.

Primary c-sections, iah, between and accounted for 6. C-sections were mostly due to dystocia more frequent among young women and primiparas and kaudo repeat c-sections among multiparas.

Fetal monitoring was implicated as a cause of inadequate c-section indication. In another Brazilian survey, the c-section rate in a university hospital was Major reasons for c-section were breech presentation, failure to progress, and fetal distress.

A multicenter study 13 involving four countries in Southeast Asia Indonesia, Malaysia, Phillipines, and Thailand analyzed the hospital delivery records of nine participating institutions. In the present study, history of prior c-section increased the probability of c-section in the current delivery by more than three fold.

C-sections are becoming more frequent in cases of breech presentation. Nonetheless, there are professionals who argue for its resolution by vaginal delivery.

In the present study, all cases of breech presentation were resolved by c-section, accounting for 8. Perinatal results did not differ between the two groups. In the same period, neonatal mortality decreased from Thus, a four-fold increase in c-sections reduced by half the perinatal mortality among fetuses with breech presentation.

The increase in the proportion of c-sections in WHO’s Global Survey on Maternal and Perinatal Health was associated with a worsening of perinatal outcomes, including increases in preterm deliveries and admission to neonatal intensive care units. In hospitals with high c-section rates, the greater proportion of babies that remain in intensive care for seven days or more may be related to the respiratory distress syndrome associated with elective c-section.

A limitation of the present study is that data are collected from secondary sources patient charts spanning a relatively short period, and which may have been influenced by other variables, such as absence of a protocol for c-section indication. However, our results may provide input for improving c-section indication criteria.

Careful monitoring of fetal conditions during labor, especially in pregnancies lasting longer than 40 weeks, may decrease the rate of c-sections.

Prevalence of aib in this in-hospital Birth Center was lower than the rates found in other maternity wards across the country, in both the public and private networks. Is breech presentation in nulliparous women at term an absolute indication for caesarean section? Alternatives for logistic regression in cross-sectional studies: The challenge of reducing neonatal mortality in middle-income countries: Rates of caesarean section: David Capistrano da Costa Filho.

Trends in indications for caesarean sections over 7 years in a Welsh district general hospital. Dabbas M, Al-Sumadi A. Clin Exp Obstet Gynecol.