Obstetric interventions in a maternity hospital with a collaborative model of care: a comparative observational study

Zaiden, Laura; Nakamura-Pereira, Marcos; Gomes, Maria Auxiliadora Mendes; Esteves-Pereira, Ana Paula; Matos, Caio Pereira de; Barros, Lucas de Araujo; Takemoto, Maíra Libertad Soligo; Leal, Maria do Carmo

doi:10.1590/1413-81232022277.20632021

Laura Zaiden

Faculdade de Medicina de Petrópolis, Universidade Faculdades Arthur Sá Earp Neto. Av. Barão do Rio Branco 1003, Centro. 25680-120 Petrópolis RJ Brasil. mnakamurapereira@gmail.com

Maternidade Escola, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil.

http://orcid.org/0000-0001-5074-708X

Marcos Nakamura-Pereira

Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (Fiocruz). Rio de Janeiro RJ Brasil.

http://orcid.org/0000-0002-4231-0205

Maria Auxiliadora Mendes Gomes

Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (Fiocruz). Rio de Janeiro RJ Brasil.

http://orcid.org/0000-0001-5908-1763

Ana Paula Esteves-Pereira

Escola Nacional de Saúde Pública Sergio Arouca, Fiocruz. Rio de Janeiro RJ Brasil.

http://orcid.org/0000-0002-0236-2043

Caio Pereira de Matos

Faculdade de Medicina de Petrópolis, Universidade Faculdades Arthur Sá Earp Neto. Av. Barão do Rio Branco 1003, Centro. 25680-120 Petrópolis RJ Brasil. mnakamurapereira@gmail.com

http://orcid.org/0000-0001-9157-2271

Lucas de Araujo Barros

Faculdade de Medicina de Petrópolis, Universidade Faculdades Arthur Sá Earp Neto. Av. Barão do Rio Branco 1003, Centro. 25680-120 Petrópolis RJ Brasil. mnakamurapereira@gmail.com

http://orcid.org/0000-0003-1243-2110

Maíra Libertad Soligo Takemoto

Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho. Botucatu SP Brasil.

http://orcid.org/0000-0002-7016-2879

Maria do Carmo Leal

Escola Nacional de Saúde Pública Sergio Arouca, Fiocruz. Rio de Janeiro RJ Brasil.

http://orcid.org/0000-0002-3047-515X

Collaborations

L Zaiden and M Nakamura-Pereira contributed to conceptualization, data acquisition, analysis, interpretation, writing the first draft of the manuscript and preparation of the final version. MAM Gomes contributed to conceptualization, analysis, and critical revision of the manuscript. AP Esteves-Pereira contributed to data curation; statistical analysis and writing the first draft of the manuscript. CP Matos and LA Barros contributed to data acquisition and critical revision of the manuscript. MLS Takemoto contributed to interpretation of data and preparation of the final version of the manuscript. MC Leal contributed to cconceptualization, funding acquisition, and critical revision of the manuscript. All authors approved the final version.

Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva

		Low-risk women					High-risk women
		NB		MRJ		p- value^a	NB		MRJ		p- value^a
		n (5,842)	%	n (1,895)	%		n (2,029)	%	n (557)	%
Age
	10-19 years	1,270	21.7	343	18.4	0.002	290	14.3	58	10.4	0.001
	20-34 years	4,169	71.4	1,365	73.0		1,442	71.0	389	69.8
	35-39 years	324	5.5	130	7.0		248	12.2	83	14.8
	≥40 years	79	1.4	32	1.7		49	2.4	27	4.9
Skin colour
	White	1,955	33.5	648	34.9	<0.001	666	32.8	138	24.8	<0.001
	Black	586	10.0	258	13.9		262	12.9	99	17.7
	Brown	3,213	55.0	935	50.4		1,076	53.0	319	57.3
	Others	84	1.4	16	0.9		26	1.3	1	0.2
Education (years)
	<8 years	1,436	24.7	232	12.6	<0.001	506	24.9	65	11.7	<0.001
	8-10 years	1,792	30.8	691	37.4		610	30.1	186	33.4
	11-14 (middle school)	2,425	41.7	835	45.2		846	41.7	284	51.0
	≥15 (higher education)	166	2.9	91	4.9		68	3.3	22	3.9
Previous births
	0	2,627	45.0	968	51.1	<0.001	894	44.0	233	41.9	0.215
	1-2	2,638	45.2	805	42.5		873	43.0	261	46.9
	≥3	577	9.9	122	6.4		262	12.9	62	11.2
Previous C-sections
	0	4,707	80.6	1,596	84.2	0.004	1,487	73.3	402	72.1	0.331
	1	828	14.2	235	12.4		391	19.3	103	18.6
	≥2	306	5.2	65	3.4		151	7.5	52	9.3

		Low-risk women (RH)					High-risk women (AR)
		NB		MRJ		p- value^a	NB		MRJ		p- value^a
		n	%	n	%		n	%	n	%
Type of birth		[5,842]	[100.0]	[1,895]	[100.0]		[2,029]	[100.0]	[557]	[100.0]
	Vaginal birth	3,810	65.2	1,460	77.1	<0.001	698	34.4	262	47,0	<0.001
	Intrapartum caesarean or with attempted induction	665	11.4	251	13.2		998	49.2	111	19.9
	Caesarean without labour or attempted induction	1,367	23.4	184	9.7		334	16.4	184	33.1
Labour onset		[5,842]	[100.0]	[1,895]	[100.0]		[2,029]	[100.0]	[557]	[100.0]
	Spontaneous	3,407	58.3	1,503	79.3	<0.001	657	32.4	199	35.7	<0.001
	Successfully or unsuccessfully induced	1,068	18.3	208	11.0		374	18.5	174	31.2
	Without labour and induction	1,367	23.4	184	9.7		998	49.2	184	33.1
Management during labour on the hospital		[4,111]	[100.0]	[1,630]	[100.0]		[890]	[100.0]	[321]	[100.0]
	Companion during labour	2,150	52.3	1,597	97.9	<0.001	396	44.5	310	96.6	<0.001
	Care provided by nurse/nurse midwife	1,678	40.8	946	58.0	<0.001	342	38.4	36	11.2	<0,001
	Complete partograph on medical records	2,810	68.4	1,114	68.3	0.987	579	65.1	174	54.2	0.001
	Use of non-pharmacological methods for pain relief	1,632	39.7	1,161	71.2	<0.001	332	37.3	166	51.7	<0.001
	Allowed to eat or drink	1,620	39.4	1,495	97.2	<0.001	346	38.9	284	88.5	<0.001
	Use of peripheral intravenous catheter	2,872	69.9	417	25.6	<0.001	641	72.0	158	49.2	<0.001
	Analgesia	312	7.6	87	5.3	<0.001	77	8.7	22	6.9	0.009
	Use de synthetic oxytocin	2,261	55.0	354	21.7	<0.001	469	52.7	103	32.1	<0.001
	Amniotomy	1,613	53.8	151	19.0	<0.001	351	51.5	46	21.4	<0.001
Management of vaginal birth		[3.800]	[100.0]	[1.460]	[100.0]		[698]	[100.0]	[262]	[100.0]
	Companion during birth	1,669	43,9	1,424	97,3	<0,001	310	44,4	249	95,0	<0,001
	Assisted by nurse/nurse midwife	900	23,7	801	54,8	<0,001	178	25,5	20	7,6	<0,001
	Vertical or lateral position	105	2,8	393	26,9	<0,001	21	3,0	21	8,0	0,007
	Episiotomy	2,077	54,7	48	3,3	<0,001	362	51,9	10	3,8	<0,001
	Use of vacuum extractor/forceps	179	4,7	50	3,4	0,040	26	3,7	11	4,2	0,730

			MRJ low-risk (n=1,895)	MRJ high-risk (n=558)	p-value^a
			%	%	p-value^a
Type of birth
	Vaginal birth		77.2	47.0	<0.001
	Intrapartum caesarean section or with attempted induction		13.1	19.0
	Caesarean section without labour or attempted induction		9.7	33.0
Labour onset
	Spontaneous		79.3	35.7	<0.001
	Induced with or without success		11.0	31.2
	No labour nor attempted induction		9.7	33.0
Management during labour in the hospital
	Companion during labour		97.9	96.6	0.107
	Care provided by nurse/nurse midwife		58.0	11.2	<0.001
	Complete partograph in medical records		68.3	54.2	<0.001
	Use of non-pharmacological methods for pain relief		71.2	51.7	<0.001
	Allowed to eat or drink		97.2	89.9	<0.001
	Use of peripheral venous catheter		25.6	49.4	<0.001
	Use of synthetic oxytocin		21.7	32.2	<0.001
	Amniotomy		19.0	21.4	0.251
Vaginal birth management
	Had a companion during vaginal birth		97.3	94.7	<0.001
	Assisted by nurse/nurse midwife		54.8	7.6	<0.001
	Analgesia		3.6	5.7	0.074
	Labour position
		Vertical or lateral decubitus	26.9	8.0	<0.001
		Semi-vertical	72.6	90.8
		Dorsal or lithotomic decubitus	0.5	1.2
	Episiotomy		3.3	3.8	0.386
	Use of vacuum extractor/forceps		3.4	4.2	0.100

	NB					MRJ
	All	%	CS	%	95%CIa	All	%	CS	%	95%CIa
All groups	5,842	100.0	2,032	34.8	31.1-38.7	1,895	100.0	435	23.0	20.8-25.2
1 - Nulliparous, single cephalic pregnancy, ≥37 weeks, spontaneous labour	1,280	21.9	138	10.8	7.7-14.8	698	36,8	93	13.3	11.0-16.0
2 - Nulliparous, single cephalic pregnancy, ≥37 weeks, induced labour or CS before labour	998	17.1	627	62.9	53.2-71.5	170	9.0	102	60,0	52.5-67.1
2a - Nulliparous, single cephalic pregnancy, ≥37 weeks, induced labour	577	9.9	206	35,7	27.1-45.5	108	5.7	40	37,0	28.5-46.5
3 - Multiparous, without previous CS, single cephalic pregnancy, ≥37 weeks, spontaneous labour	1,460	25.0	41	2,8	1.7-4.7	489	25.8	9	1,8	1.0-3.5
4 - Multiparous, without previous CS, single cephalic pregnancy, ≥37 weeks, induced labour or CS before labour	381	6.5	133	34.9	27.2-43.6	78	4.1	33	42.3	25.7-60.7
4a - Multiparous, without previous CS, single cephalic pregnancy, ≥37 weeks, induced labour	277	4.7	29	10.5	7.0-15.4	50	2,6	5	10.0	4.0-22.7
5 - Previous CS, single cephalic pregnancy, ≥37 weeks	1,060	18.2	785	74.0	67.8-79.5	272	14,4	134	49.3	42.3-56.3
8 - All multiple pregnancies, including previous CS	47	0.8	35	73.7	56.2-87.0	22	1.2	16	72.7	49.5-87.3
10 - All single cephalic pregnancies, ≤36 weeks, including previous CS	432	7.4	102	23.6	17.1-32.0	108	5.7	2	1.9	0.5-7.2
6, 7 and 9 - All single non-cephalic pregnancies	183	3.1	171	93.4	89.5-96.9	58	3.1	46	79.3	65.9-89.2

	NB					MRJ
	All	%	CS	%	95%CI^a	All	%	CS	%	95%CI^a
All groups	2,029	100.0	1,331	65.6	60.4-70.4	557	100.0	295	53.0	48.2-57.7
1 - Nulliparous, single cephalic pregnancy, ≥37 weeks, spontaneous labour	214	10.5	88	41.1	32.4-51.7	67	12.0	14	20.9	12.8-32.2
2 - Nulliparous, single cephalic pregnancy, ≥37 weeks, induced labour or CS before labour	430	21.2	359	83.5	77.2-88.3	115	20.6	72	62.6	53-4-71.0
2a - Nulliparous, single cephalic pregnancy, ≥37 weeks, induced labour	159	7.8	88	55.3	43.5-66.9	81	14,5	38	46.9	36.3-57.8
3 - Multiparous, without previous CS, single cephalic pregnancy, ≥37 weeks, spontaneous labour	272	13.4	28	10.3	6.2-17.0	66	11.8	5	7.6	3.1-17.2
4 - Multiparous, without previous CS, single cephalic pregnancy, ≥37 weeks, induced labour or CS before labour	219	10.8	129	58.9	48.8-68.0	70	12.6	24	34.3	20.5-50.6
4a - Multiparous, without previous CS, single cephalic pregnancy, ≥37 weeks, induced labour	118	5.8	28	23.7	16.6-32.7	55	9,9	9	16.4	6.0-36.7
5 - Previous CS, single cephalic pregnancy, ≥37 weeks	462	22.8	397	85.9	80.7-89.7	127	22,8	109	85.8	78.3-91.0
8 - All multiple pregnancies, including previous CS	21	1.0	21	100,0	-	11	2.0	8	72.7	41.4-91.0
10 - All single cephalic pregnancies, ≤36 weeks, including previous CS	308	15.2	216	70,1	59.2-79.2	81	14.5	47	58.0	46.2-69.6
6, 7 e 9 - All single non-cephalic pregnancies	103	5.1	93	90.3	76.4-96.7	21	3,8	16	76.2	47.8-93.3

[1] Collaborations

L Zaiden and M Nakamura-Pereira contributed to conceptualization, data acquisition, analysis, interpretation, writing the first draft of the manuscript and preparation of the final version. MAM Gomes contributed to conceptualization, analysis, and critical revision of the manuscript. AP Esteves-Pereira contributed to data curation; statistical analysis and writing the first draft of the manuscript. CP Matos and LA Barros contributed to data acquisition and critical revision of the manuscript. MLS Takemoto contributed to interpretation of data and preparation of the final version of the manuscript. MC Leal contributed to cconceptualization, funding acquisition, and critical revision of the manuscript. All authors approved the final version.

Brasil

Brasil

Obstetric interventions in a maternity hospital with a collaborative model of care: a comparative observational study

Intervenções obstétricas em uma maternidade com modelo colaborativo: estudo observacional comparativo

Abstract