Pregnancy complications in Brazilian puerperal women treated in the public and private health systems 1

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

doi:10.1590/1518-8345.2156.2949

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 25 • 2017 • https://doi.org/10.1590/1518-8345.2156.2949 copy

Pregnancy complications in Brazilian puerperal women treated in the public and private health systems ¹ 1 Paper extracted from Doctoral Dissertation “Intercorrências na gestação: prevalência e fatores associados”, presented to Departamento de Enfermagem, Universidade Estadual de Maringá, Maringá, PR, Brazil. Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil, process #473708/2012-4.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze the prevalence of pregnancy complications and sociodemographic profile of puerperal patients with complications, according to the form of financing of the childbirth service.

Method:

cross-sectional study with interview of 928 puerperal women whose childbirth was financed by the Unified Health System, health plans and private sources (other sources than the Unified Health System). The sample was calculated based on the births registered in the Information System on Live Births, stratified by hospital and form of financing of the childbirth service. Data were analyzed using the chi-square and Fisher’s exact tests.

Results:

the prevalence was 87.8% for all puerperal women, with an average of 2.4 complications per woman. In the case of deliveries covered by the Unified Health System, urinary tract infection (38.2%), anemia (26.0%) and leucorrhea (23.5%) were more frequent. In turn, vaginal bleeding (26.4%), urinary tract infection (23.9%) and leucorrhoea (23.7%) were prevalent in deliveries that were not covered by the Unified Health System. Puerperal women that had their delivery covered by the Unified Health System reported a greater number of intercurrences related to infectious diseases, while women who used health plans and private sources reported intercurrences related to chronic diseases. A higher frequency of puerperal adolescents, non-white women, and women without partner among those assisted in the Unified Health System (p < 0.001).

Conclusion:

the high prevalence of complications indicates the need for monitoring and preventing diseases during pregnancy, especially in the case of pregnant women with unfavorable sociodemographic characteristics.

Descriptors:
Pregnancy Complications; Pregnancy; Morbidity; Prenatal Care; Healthcare Financing

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Patrícia Louise Rodrigues Varela Universidade Estadual do Paraná. Departamento de Enfermagem Rua Gabriel Speridião s/n Bairro: Jardim Morumbi CEP: 87703-000, Paranavaí, PR, Brasil E-mail:patricialouisev@yahoo.com.br

Hospital		N	%	Total	Total+10%
	Hospital 1 (SUS*)	394	9.8	83	91
	Hospital 2 (SUS*)	1727	43.0	362	398
Total SUS		2121	-	445	489
	Hospital 2 (Non-SUS*)	742	18.5	156	172
	Hospital 3 (Non-SUS*)	388	9.7	81	89
	Hospital 4 (Non-SUS*)	498	12.4	105	116
	Hospital 5 (Non-SUS*)	269	6.7	56	62
Total non-SUS*		1897	-	398	439
Total		4018	100	843	928

Complications	SUS*		Non-SUS*		Total		p
Complications	n	%	n	%	n	%	p
None	72	14,7	41	9,3	113	12,2	0,012
1	93	19,0	93	21,2	186	20,0	0,411
2	73	14,9	90	20,5	163	17,6	0,026
3	81	16,6	72	16,4	153	16,5	0,947
4 or more	170	34,8	143	32,6	313	33,7	0,481
Total	489	100,0	439	100,0	928	100,0

Complications‡	SUS*		Non-SUS*		Total^†		p
Complications‡	n	%	n	%	n	%	p
Urinary tract infection	187	38,2	105	23,9	292	31,5	<0,001
Anemia	127	26,0	99	22,6	226	24,4	0,226
Leucorrhea	115	23,5	104	23,7	219	23,6	0,951
Vaginal bleeding	102	20,9	116	26,4	218	23,5	0,046
Preterm labor	107	21,9	103	23,5	210	22,6	0,566
PIH^§	106	21,7	75	17,1	181	19,5	0,078
PA^\|\|	32	6,5	80	18,2	112	12,1	<0,001
Gestational diabetes	33	6,7	46	10,5	79	8,5	0,042
Oligohydramnios	48	9,8	24	5,5	72	7,8	0,013
Placenta previa	9	1,8	38	8,7	47	5,1	<0,001
Depression	23	4,7	14	3,2	37	4,0	0,239
Polyhydramnios	8	1,6	28	6,4	36	3,9	<0,001
PMR^¶	20	4,1	8	1,8	28	3,0	0,044
Renal calculus	12	2,5	8	1,8	20	2,2	0,508
Hypothyroidism	7	1,4	10	2,3	17	1,8	0,337
Syphilis	7	1,4	1	0,2	8	0,9	0,072**
Hyperemesis	2	0,4	4	0,9	6	0,6	0,430**
Intrauterine infection	2	0,4	3	0,7	5	0,5	0,672**
Gonorrhea	5	1,0	-	-	5	0,5
Influenza A	1	0,2	4	0,9	5	0,5	0,195**
Nausea	-	-	4	0,9	4	0,4
Toxoplasmosis	3	0,6	1	0,2	4	0,4	0,626**
Vaginal herpes	1	0,2	2	0,5	3	0,3	0,605**
HIV^††	2	0,4	-	-	2	0,2
Condyloma	2	0,4	-	-	2	0,2
Hypoglycemia	1	0,2	1	0,2	2	0,2	1**
Human papilloma virus	2	0,4	-	-	2	0,2
Fetal growth restriction	-	-	2	0,5	2	0,2
Rubella	2	0,4	-	-	2	0,2
Cytomegalovirus	-	-	1	0,2	1	0,1
Dengue	-	-	1	0,2	1	0,1
Dyspnea	-	-	1	0,2	1	0,1
Gestational sac hematoma	1	0,2	-	-	1	0,1
Hepatitis B	1	0,2	-	-	1	0,1
Infection of the uterine cervix	1	0,2	-	-	1	0,1
String failure	1	0,2	-	-	1	0,1
Venous lake	-	-	1	0,2	1	0,1
Positive Papanicolaou	1	0,2	-	-	1	0,1
Blood incompatibility	1	0,2	-	-	1	0,1
Ovarian bleeding	-	-	1	0,2	1	0,1
Streptococcus vaginalis	1	0,2	-	-	1	0,1
Hyperglycemia	1	0,2	-	-	1	0,1
Intrauterine infection	1	0,2	-	-	1	0,1
Others‡‡	41	8,4	64	14,6	105	11,3	0,003
Total	1016	-	949	-	1965	-	-

		SUS* (417)		Non-SUS* (398)		Total (815)		p
		n	%	n	%	n	%	p
Age
	<20	67	16,1	8	2,0	75	9,2	<0,001^†
	20 to 34	300	71,9	323	81,2	623	76,4	0,357
	35 or more	50	12,0	67	16,8	117	14,4	0,116
Ethnic group
	White	176	42,2	269	67,6	445	54,6	<0,001
	Non-white	241	57,8	129	32,4	370	45,4	<0,001
Residence zone
	Urban	408	97,8	396	99,5	804	98,6	0,672
	Rural	9	2,2	2	0,5	11	1,35	0,035^†
Schooling
	< 8 years	55	13,2	9	2,3	64	7,8	<0,001^†
	≥ 8 years	362	86,8	389	97,7	751	92,1	0,325
Partner
	Yes	357	85,6	387	97,2	744	91,3	0,271
	No	60	14,4	11	2,8	71	8,71	<0,001
Economic class^‡
	A	4	1	37	9,3	41	5,0	<0,001^†
	B	149	35,7	291	73,1	440	54,0	<0,001
	C	237	56,8	70	17,6	307	37,7	<0,001
	D	22	5,3	-	-	22	2,7	-
	E	5	1,2	-	-	5	0,6	-
Prenatal financing
	SUS	382	91,6	2	0,5	384	47,1	<0,001
	Non-SUS* or mixed	35	8,4	396	99,5	431	52,9