Factors associated with obstetric interventions in public maternity hospitals

a cross-sectional study with 344 puerperal women, from two public maternity hospitals, referring to childbirth by Sistema Único de Saúde (SUS) (Public Health Service System) in Londrina City, Paraná, Brazil, between January and June 2017. The medical records were the data source. The following obstetric interventions were considered: oxytocin use, artificial rupture of the membranes, instrumental childbirth and episiotomy. Multivariate Poisson regression was used to analyze associated factors, with p<5% being significant.

Results:

the prevalence of obstetric intervention was 55.5%, the maximum number of interventions in the same parturient woman was three. The most frequent interventions were the use of oxytocin (50.0%) and artificial rupture of membranes (29.7%). The variables associated on maternal disease (p=0.005) and intrapartum meconium (p=0.022) independently increased, the risk of obstetric intervention, while dilation was equal to or greater than 5 cm at admission, there was a protective factor against this outcome (p=0.030).

Conclusion:

the prevalence of obstetric interventions was high. In the case of maternal disease and intrapartum meconium, special attention should be given to the parturient woman, in order to avoid unnecessary interventions. Thus, the maternity hospitals need to review their protocols, seeking good practices in childbirth care.

Key words:
Natural childbirth; Labor; Medicalization; Maternal and child health.

Variables	N	%
Age group (years)
10-19	68	19.8
20-34	250	72.6
≥35	26	7.6
Schooling (years)
< 8	59	17.4
≥ 8	285	82.6
Marital status
With a partner	312	90.7
Without a partner	32	9.3
Paying job
Yes	127	36.9
No	217	63.1
Parity
Primigravidae	84	24.4
Multigravidae	260	75.6
Previous abortion
Yes	42	12.2
No	302	87.8
Previous Cesarean section
Yes	32	9.3
No	312	90.7
Prenatal
Yes	338	98.2
No	6	1.8
Number of prenatal visits^* * The sample varied due to the lack of information in the medical record;
≤ 5	57	16.7
≥ 6	287	83.3
Cervical dilation at admission (cm) ^* * The sample varied due to the lack of information in the medical record;
<5	203	60.8
≥5	131	39.2
Uterine dynamics at admission
Yes	248	67.7
No	96	32.3
State of membranes at admission
Whole	270	73.6
Damaged	74	26.4
Maternal disease^ Includes: syphilis, hypothyroidism, obesity, gestational diabetes, gestational hypertension and depression.
Yes	66	19.2
No	278	80.8
Gestational age (weeks)
< 37	13	3.8
≥37	331	96.2
Presence of companion at childbirth
Yes	320	93.0
No	24	7.0
Delivery position
Lithotomic	335	97.4
Non-lithotomic	9	2.6
Newborn's weight (g)
≤ 2499	14	4.1
≥ 2500	330	95.9
Intrapartum meconium
Yes	24	7.0
No	320	93.0

Variables	Obstetric Intervention
	No		Yes		PR (CI95%)	p
	n	%	n	%	PR (CI95%)	p
Age group (years)
20 - 34	113	45.2	137	54.8	1.00
10 - 19	31	45.6	37	54.4	1.00 (0.75-1.35)	0.954
≥ 35	9	34.6	17	65.4	0.76 (0.44-1.32)	0.338
Schooling (years)
≥ 8	137	48.2	147	51.8	1.00
< 8	16	26.7	44	73.3	0.55 (0.35-0.85)	0.008
Marital status
With a partner	134	42.9	178	57.1	1.00
Without a partner	19	59.4	13	40.6	1.38 (1.01-1.89)	0.043
Paying job
Yes	59	46.5	68	53.5	1.00
No	94	43.3	123	56.7	0.93 (0.73-1.18)	0.569
Parity
Primigravidae	107	41.1	153	58.9	1.00
Multigravidae	42	50.0	42	50.0	1.21 (0.96-1.54)	0.099
Previous abortion
Yes	141	46.7	161	53.3	1.00
No	12	28.6	30	71.4	1.63 (0.99-2.67)	0.051
Previous Cesarean section
Yes	140	44.9	172	55.1	1.00
No	13	40.6	19	59.4	0.90 (0.58-1.40)	0.655
Prenatal
Yes	150	44.4	188	55.6	1.00
No	3	50.0	3	50.0	1.12 (0.49-2.51)	0.784
Number of prenatal visits^* * The sample varied due to the lack of information in the medical record;
≤ 5	122	42.9	164	57.1	1.00
≥ 6	31	53.4	27	46.6	1.24 (0.94-1.63)	0.119
Cervical dilation at admission (cm) ^* * The sample varied due to the lack of information in the medical record;
<5	66	50.4	65	49.6	1.00
≥5	79	38.9	124	61.1	0.77 (0.60-0.98)	0.037
Uterine dynamics at admission
Yes	106	42.8	142	57.2	1.00
No	35	36.5	61	63.5	0.76 (0.56-1.03)	0.079
State of membranes at admission
Whole	116	43.0	154	57.0	1.00
Damaged	27	36.5	47	63.5	0.78 (0.56-1.09)	0.151
Maternal disease^ Includes: syphilis, hypothyroidism, obesity, gestational diabetes, gestational hypertension and depression.
Yes	114	41.1	164	58.9	1.00
No	38	57.6	28	42.4	1.39 (1.08-1.79)	0.009
Gestational age (weeks)
≥ 37	151	45.6	180	54.4	1.00
< 37	2	15.4	11	84.6	0.33 (0.09-1.21)	0.096
Newborn's weight (grams)
≥ 2500	150	45.5	180	54.5	1.00
≤ 2499	3	21.4	11	78.6	0.47 (0.17-1.30)	0.148
Intrapartum meconium
No	139	43.4	181	56.6	1.00
Yes	14	58.3	10	41.7	1.34 (0.93-1.92)	0.109

Variables	Obstetric Intervention
	No		Yes		PR (CI95%)	p
	n	%	n	%	PR (CI95%)	p
Schooling (years)
≥ 8	137	48.2	147	51.8	1.00
< 8	16	26.7	44	73.3	0.63 (0.38-1.05)	0.076
Marital status
With a partner	134	42.9	178	57.1	1.00
Without a partner	19	59.4	13	40.6	1.22 (0.81-1.83)	0.328
Parity
Multigravidae	107	41.1	153	58.9	1.00
Primigravidae	42	50.0	42	50.0	0.96 (0.70-1.32)	0.841
Previous abortion
No	141	46.7	161	53.3	1.00
Yes	12	28.6	30	71.4	1.61 (0.94-2.74)	0.078
Number of prenatal visits
≥ 6	122	42.9	164	57.1	1.00
≤ 5	31	53.4	27	46.6	1.20 (0.88-1.64)	0.228
Cervical dilation at admission (cm) ^* * The sample varied due to the lack of information in the medical record;
≥ 5	66	50.4	65	49.6	1.00
< 5	79	38.9	124	61.1	0.72 (0.54-0.97)	0.030
Uterine dynamics at admission
Yes	106	42.8	142	57.2	1.00
No	35	36.5	61	63.5	0.70 (0.50-1.00)	0.050
State of membranes at admission
Whole	116	43.0	154	57.0	1.00
Damaged	27	36.5	47	63.5	1.04 (0.75-1.44)	0.798
Maternal disease^ Includes: syphilis, hypothyroidism, obesity, gestational diabetes, gestational hypertension and depression.
Yes	114	41.1	164	58.9	1.00
No	38	57.6	28	42.4	1.60 (1.15-2.24)	0.005
Gestational age (weeks)
≥ 37	151	45.6	180	54.4	1.00
< 37	2	15.4	11	84.6	0.98(0.22-4.21)	0.980
Newborn's weight (grams)
≥2500	150	45.5	182	54.5	1.00
≤2499	3	21.4	11	78.6	0.57 (0.19-1.72)	0.326
Intrapartum meconium
No	139	43.4	181	56.6	1.00
Yes	14	58.3	10	41.7	1.55 (1.06-2.27)	0.022

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