Hospitalization during pregnancy according to childbirth financial coverage: a population-based study

Falavina, Larissa Pereira; Oliveira, Rosana Rosseto de; Melo, Emiliana Cristina; Varela, Patrícia Louise Rodrigues; Mathias, Thais Aidar de Freitas

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Sumário

Original Article • Rev. esc. enferm. USP 52 • 2018 • https://doi.org/10.1590/S1980-220X2017032403317 copy

Hospitalization during pregnancy according to childbirth financial coverage: a population-based study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To analyze the occurrence, profile and main causes of hospitalization during pregnancy according to the type of childbirth financial coverage.

Method

A cross-sectional population-based study carried out with puerperal women through a stratified sample, calculated according to the hospital and the type of childbirth financial coverage source: public sector (SUS) or private (not SUS). The sociodemographic profile, the rate of obstetric complications and the causes of hospitalization were analyzed, coded according to International Classification of Diseases.

Results

A total of 928 postpartum women were interviewed, of whom 32.2% reported at least one hospitalization during pregnancy. Those with childbirth covered by SUS were less favored because they were the majority among hospitalized women (57.2%), with a higher percentage of adolescents (18.1%), lower education level (91.8%), low family income (39.3%) and fewer prenatal consultations (25.3%). The most frequent causes of hospitalization were “other maternal diseases that complicate pregnancy” (24.6%) (with emphasis on anemia and influenza), urinary tract infection (13.1%), preterm labor (8.7%) and hypertension (7.2%).

Conclusion

Anemia, influenza, urinary tract infection, preterm labor and hypertension should especially be prevented and treated to avoid hospital admissions during pregnancy, especially among pregnant women covered by SUS.

DESCRIPTORS
Pregnancy; Hospitalization; Pregnancy Complications; Obstetric Nursing; Maternal-Child Nursing

Hospitalizations	SUS (n=489)		Not by SUS (n=439)		Total
Hospitalizations	N 171	% 34.9	N 128	% 29.2	N 299	% 32.2
1	116	38.8	100	33.4	216	72.2
2	30	10.0	16	5.4	46	15.4
3 or more	25	8.4	12	4.0	37	12.4
Total	171	57.2	128	42.8	299	100

Hospitalizations		SUS (n=489)				Not by SUS (n=439)				RR^* * RR: Relative risk.	CI^ CI: 95% confidence interval.
Hospitalizations		Yes		No		Yes		No
Variables		n	%	n	%	n	%	n	%
Age
	≤ 19 years	31	18.1	46	14.5	7	5.5	1	0.3	0.5	0.83-0.25
	20 to 34 years	119	69.6	233	73.2	104	81.3	249	80.1	1.1	0.92-1.43
	35 or more	21	12.3	39	12.3	17	13.3	61	19.6	1.6	0.94-2.75
Education level
	< 12 years	157	91.8	287	90.3	63	49.2	123	39.5	1.0	0.82-1.32
	≥ 12 years	14	8.2	31	9.7	65	50.8	188	60.5	1.2	0.74-1.99
Race/skin color
	White	63	36.8	138	43.4	88	68.8	215	69.1	1.1	0.82-1.41
	Not white	108	63.2	180	56.6	40	31.3	96	30.9	1.3	0.95-1.71
Monthly family income ^* ***** Monthly family income per capita – Minimum wage/salary in force in the period of data collection: R$678.00 (BRL). Four women did not report their income.
	< 3 wages	66	39.3	120	38.6	9	7.1	36	12.0	1.8	1.01-3.12
	3 or more wages	102	60.7	191	61.4	118	92.9	265	88.0	1.1	0.91-1.40
Partner
	Yes	146	85.4	275	86.5	121	94.5	306	98.4	1.2	1.00-1.49
	No	25	14.6	43	13.5	7	5.5	5	1.6	0.6	1.20-0.33
Prenatal consultations ^& & One woman did not report the number of prenatal consultations.
	< 7 consultations	43	25.3	70	22.5	10	7.8	9	2.9	0.8	1.33-0.44
	7 or more	127	74.7	241	77.5	118	92.2	302	97.1	1.2	1.00-1.51

Causes for hospitalization^& & The reasons for hospitalization reported by the puerperal woman were coded according to the ICD-10 groupings and categories (World Health Organization, 1998).		SUS			Not by SUS			Total
		n^¶ ¶ More than one answer were admitted, since the women may have been hospitalized more than once for different causes.	%	ROC^ ROC - Rate of Obstetric Complications = ratio between number of hospitalizations and number of deliveries according to the type of childbirth financial coverage.	n^¶ ¶ More than one answer were admitted, since the women may have been hospitalized more than once for different causes.	%	ROC^ ROC - Rate of Obstetric Complications = ratio between number of hospitalizations and number of deliveries according to the type of childbirth financial coverage.	n^¶ ¶ More than one answer were admitted, since the women may have been hospitalized more than once for different causes.	%	ROC^ ROC - Rate of Obstetric Complications = ratio between number of hospitalizations and number of deliveries according to the type of childbirth financial coverage.
Other obstetric conditions, not elsewhere classified (O95-O99)		50	25.5	10.2	46	30.9	10.5	96	27.8	10.3
	Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium^# # Other maternal diseases: anemia, stress, throat infection, food poisoning, pharyngitis, unspecified pain, weakness, gastric pain, influenza, pneumonia, pruritus, colic, asthma.	46	23.5	9.4	39	26.2	8.9	85	24.6	9.2
	Maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium	4	2.0	0.8	7	4.7	1.6	11	3.2	1.2
Other maternal disorders predominantly related to pregnancy (O20-029)		52	26.5	10.6	33	22.1	7.5	85	24.7	9.2
	Infections of genitourinary tract in pregnancy	31	15.8	6.3	14	9.4	3.2	45	13.1	4.8
	Excessive vomiting in pregnancy	9	4.6	1.8	14	9.4	3.2	23	6.7	2.5
	Diabetes mellitus in pregnancy	8	4.1	1.6	1	0.7	0.2	9	2.6	1.0
	Haemorrhage in early pregnancy	4	2.0	0.8	2	1.3	0.5	6	1.7	0.6
	Venous complications in pregnancy	-	-	-	2	1.3	0.5	2	0.6	0.2
Maternal care related to the fetus and amniotic cavity and possible delivery problems (O30-O48)		48	24.5	9.8	34	22.9	7.7	82	23.8	8.8
	Antepartum haemorrhage, not elsewhere classified	15	7.7	3.1	8	5.4	1.8	23	6.7	2.5
	Premature separation of placenta [abruptio placentae]	10	5.1	2.0	9	6.0	2.1	19	5.5	2.0
	Premature rupture of membranes	11	5.6	2.2	5	3.4	1.1	16	4.6	1.7
	Maternal care for abnormality of maternal pelvic organs	3	1.5	0.6	6	4.0	1.4	9	2.6	1.0
	Maternal care for other fetal problems	7	3.6	1.4	1	0.7	0.2	8	2.3	0.9
	Other disorders of amniotic fluid and membranes	2	1.0	0.4	5	3.4	1.1	7	2.1	0.8
Complications of labour and delivery (O60-075)		23	11.7	4.7	25	16.8	5.7	48	13.9	5.2
	Preterm labour and delivery	20	10.2	4.1	10	6.7	2.3	30	8.7	3.2
	Abnormalities of forces of labour	3	1.5	0.6	15	10.1	3.4	18	5.2	1.9
Oedema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium (O10-O16)		17	8.7	3.5	9	6.0	2.1	26	7.5	2.8
	Gestational hypertension	17	8.7	3.5	8	5.3	1.8	25	7.2	2.7
	Eclampsia	-	-	-	1	0.7	0.2	1	0.3	0.1
Other categories ⁺ + Other categories: W19 (falls), S42 (fracture), V89 (motor-vehicle accident).		6	3.1	1.2	2	1.3	0.5	8	2.3	0.9
Total		196	100.0	40.1	149	100.0	33.9	345	100.0	37.2

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E-mail: reeusp@usp.br

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[1] Corresponding author: Larissa Pereira Falavina, Universidade Estadual de Maringá, Av. Colombo, 5.790, CEP 87020-900 – Maringá, PR, Brazil falavinalarissa@gmail.com