Repeated cesarean section and vaginal delivery after cesarean section in São Paulo State in 2012

Brunacio, Karoline Honorato; Silva, Zilda Pereira da

doi:10.1590/1806-93042021000200004

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Instituto de Medicina Integral Prof. Fernando Figueira 21 (2) • Apr-Jun 2021 • https://doi.org/10.1590/1806-93042021000200004 copy

Repeated cesarean section and vaginal delivery after cesarean section in São Paulo State in 2012

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

describe mothers, pregnancies and newborns’ characteristics according to the type of childbirth history and to analyze repeated cesarean section (RCS) and vaginal delivery after cesarean section (VBACS), in São Paulo State in 2012.

Methods:

data are from the Sistema de Informações sobre Nascidos Vivos (Live Birth Information Systems). To find the RCS’s group, the current type of childbirth equal to cesarean section was selected and from these all the previous cesareans. To identify the VBACS’s group all live birth with current vaginal delivery were selected and from these all previous cesareans. Mothers with a history of RCS and VBACS were analyzed according to the characteristics of the pregnancy, newborn and the childbirth hospital.

Results:

273,329 mothers of live birth with at least one previous child were studied. 43% of these were born of RCS and 7.4% of VBACS. Mothers who underwent RCS are older and higher educated and their newborns presented a lower incidence of low birth weight. Early term was the most frequent rating for gestational age born of RCS. Live births were of VBACS and had greater proportions of late term. The RCS was more common in hospitals not affiliated with the Sistema Único de Saúde (SUS) (Public Health System) (44.1%).

Conclusion:

the high RCS’s rates, especially in the private sector, highlight the necessity of improvements in childbirth care model in São Paulo.

Keywords:
Repeated cesarean section; Vaginal birth after cesarean; Cesarean section; Childbirth; Public Health System

Variables	Type of delivery history^ RCS = repeated cesarean section; CAVD = cesarean after vaginal delivery; VBACS = vaginal birth after cesarean section; RVD = repeated vaginal delivery.
Variables	RCS	CAPD	VBACS	RVD	Total
Mother's age group^* * p<0.05 (for proportions, chi-square test; for means, ANOVA). (years old)
< 20	2.80%	2.80%	5.50%	7.10%	4.60%
≥ 35	25.20%	23.20%	17.30%	14.10%	20.30%
Mean	30.3	30	28.5	27.7	29.2
Mother's schooling^* * p<0.05 (for proportions, chi-square test; for means, ANOVA).
Up to incomplete elementary school	16.20%	22.90%	28.10%	29.90%	23.00%
Complete higher education and more	19.60%	8.40%	5.40%	3.70%	11.20%
Mother's marital status^* * p<0.05 (for proportions, chi-square test; for means, ANOVA).
With partner	68.10%	60.80%	54.70%	52.60%	60.50%
Mother's race/color^* * p<0.05 (for proportions, chi-square test; for means, ANOVA).
White	65.20%	55.90%	49.20%	47.20%	56.20%
Black^* ***** Black race/color represents the sum of black plus mixed.	34.00%	43.50%	49.90%	51.70%	42.90%
Parity^* * p<0.05 (for proportions, chi-square test; for means, ANOVA).
Up to 2	80.50%	77.90%	67.70%	72.00%	76.10%
5 and more	3.00%	4.70%	8.80%	7.10%	5.10%
Birth weight^* * p<0.05 (for proportions, chi-square test; for means, ANOVA). (g)
Mean	3,232.60	3,181.60	3,152.00	3,195.50	3,206.00
Low birth weight (≤ 2,499 g)	6.30%	10.70%	8.40%	6.90%	7.20%
High birth weight (≥ 4,000g)	5.60%	7.00%	3.70%	4.20%	5.10%
Gestational age^* * p<0.05 (for proportions, chi-square test; for means, ANOVA).
Preterm (< 36)	11.00%	14.70%	12.80%	11.50%	11.70%
Term (37 - 41)	86.80%	82.50%	83.90%	85.20%	85.40%
Late term (> 41)	2.20%	2.80%	3.40%	3.40%	2.80%
Trimester that started prenatal care^* * p<0.05 (for proportions, chi-square test; for means, ANOVA).
1^st trimester	83.9%	82.7%	74.4%	74.7%	79.7%
Number of prenatal visits^* * p<0.05 (for proportions, chi-square test; for means, ANOVA).
None	1.00%	1.00%	3.50%	2.40%	1.70%
From 1 to 3	3.20%	3.90%	8.70%	8.00%	5.50%
From 4 to 6	17.20%	19.00%	24.00%	24.50%	20.60%
7 or more	78.60%	76.20%	63.80%	65.10%	72.30%
Fetal presentation^* * p<0.05 (for proportions, chi-square test; for means, ANOVA).
Cephalic	95.2%	91.0%	97.4%	99.3%	96.4%

Affiliation of the hospital with the SUS	Mothers' of live births of previous cesarean section	Type of delivery history^* * RCS = repeated cesarean section; VBACS = vaginal birth after cesarean section.
		RCS		VBACS
		N	Rate/100	N	Rate/100
Public	44,352	31,606	71.3	12,746	28.7
Mixed	39,805	34,477	86.6	5,328	13.4
Private	54,365	52,044	95.7	2,321	4.3
Total	138,522	118,127	85.3	20,395	14.7

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[1] Authors' contribution

Brunacio KS and Silva ZP contributed to the conception and design of the study. Brunacio KH performed data analysis and interpretation and prepared drafts of the manuscript. Silva ZP contributed to the analysis and interpretation of data and critically reviewed the manuscript. All authors approved the final version of the article.