The study of the mother-child binomium: description and general
               results

Data collection was conducted for a period of three months in 2011, in six maternity hospitals in the State of São Paulo. The data were obtained in an interview with the women after the end of the pregnancy and collected from hospital records. The sample included 7,058 women hospitalized for abortion or childbirth in five hospitals from SUS (Unified Health System) and from only one hospital for private health insurance patients and their 6,602 conceptuses (live births and stillborns). Statistical analysis was based on χ² tests, with a significance level of α = 5%.

RESULTS:

It was observed that 6,530 women gave birth and 528 showed interruption of pregnancy. Regarding age, 1,448 were teenagers (20.5%). There were no deaths during hospitalization and 99.8% of women received a medical discharge. Maternal morbidity in the current pregnancy was analyzed, showing urinary tract infection, anemia and excessive vomiting as the main problems. The rate of cesarean sections accounted for 31.1% and complications in childbirth and postpartum were shown, respectively, by 834 (12.8%) and 265 (4.1%) women. The characteristics of the conceptuses were also studied: gestation length (9.3% of preterm among live births, and 68% among the stillborn); birth weight (underweight in 8.2% among live births, and 66% among the stillborn) and morbidity, measured by congenital anomalies and other diseases; these diseases were responsible for ICU stay, transfers to better-equipped hospitals (10 cases) and 37 deaths. Thirteen live births were still hospitalized at the end of the investigation.

Pregnancy; Parturition; Postpartum Period; Live Birth; Stillbirth; Epidemiology

Problems	10 to 19		20 to 34		35 +		Total
Problems	n	%	n	%	n	%	n	%
Yes (quantity)
1	499	34.5	1,624	33.2	215	30.0	2,338	33.1
2	290	20.0	977	20.0	156	21.8	1,423	20.2
3	102	7.0	370	7.6	58	8.1	530	7.5
4	28	1.9	138	2.8	34	4.8	200	2.8
5	8	0.6	44	0.9	13	1.8	65	0.9
6	3	0.2	15	0.3	2	0.3	20	0.3
7	–	–	8	0.2	1	0.1	9	0.1
8	–	–	2	0.0	–	–	2	0.1
9	–	–	1	0.0	–	–	1	0.0
n ignored	1	–	2	2.0	–	–	3	0.1
SUB-TOTAL	931	64.3	3,181	65.0	479	66.9	4,591	65.0
No	512	35.4	1,686	34.5	235	32.8	2,433	34.5
Ignored	5	0.3	27	0.5	2	0.3	34	0.5
TOTAL	1,448	100.0	4,894	100.0	716	100.0	7,058	100.0

Problems	10 to 19		20 to 34		35 +		Total
Problems	n	%	n	%	n	%	n	%
Suggested
Threat of abortion	27	1.7	119	2.1	19	2.1	165	2.0
Anemia	255	16.4	716	12.7	98	10.7	1,069	13.2
Seizure attacks	3	0.2	6	0.1	3	0.3	12	0.1
Diabetes	17	1.1	165	2.9	72	7.8	254	3.1
Prolonged pregnancy	8	0.5	27	0.5	5	0.5	40	0.5
Hemorrhaging/bleeding	76	4.9	360	6.4	60	6.5	496	6.1
Hepatitis	3	0.2	21	0.4	5	0.5	29	0.4
Urinary tract infection	561	36.1	1,659	29.5	184	20.0	2,404	29.7
HIV/AIDS infection	6	0.4	22	0.4	3	0.3	31	0.4
High-blood pressure	92	5.9	492	8.7	144	15.6	728	9.0
Syphilis	14	0.9	54	1.0	11	1.2	79	1.0
Toxoplasmosis	17	1.1	31	0.5	5	0.5	53	0.6
Varicose/thromboses	10	0.7	84	1.5	17	1.9	111	1.4
Worms	5	0.3	9	0.2	1	0.1	15	0.2
Excessive vomiting	176	11.3	608	10.8	87	9.5	871	10.7
Sub-total	1,270	81.7	4,373	77.7	714	77.5	6,357	78.4
Reported	285	18.3	1,258	22.3	207	22.5	1,750	21.6
Total	1,555	100.0	5,631	100.0	921	100.0	8,107	100.0

Causes	Birth		Postpartum period
Causes	n	%	n	%
Maternal causes*
O00 to O08	–	–	1	0.4
O10 to o16	38	4.1	34	12.4
O20 to O29	7	0.8	19	6.9
O30 to O48	99	10.7	16	5.9
O60 to O75	607	65.6	58	21.3
O80 to O84	2	0.2	–	–
O85 to O92	2	0.2	27	9.9
O94 to O99	4	0.4	30	11.0
Sub-total	759	82.0	185	67.8
Other natural causes^**
Infectious Diseases	150	16.2	3	1.1
Neoplasms	1	0.1	–	–
Endocrine Diseases	1	0.1	1	0.4
Mental Disorders	2	0.2	7	2.6
Diseases of the Nervous System	–	–	2	0.7
Diseases of the Circulatory System	–	–	1	0.4
Diseases of the Respiratory System	1	0.1	2	0.7
Diseases of the Digestive System	–	–	1	0.4
Diseases of the Skin and Subcutaneous Tissue	–	–	6	2.2
Diseases of the Genitourinary System	2	0.2	–	–
Ill-defined	10	1.1	65	23.8
Sub-total	167	18.0	88	32.2
Total***	926	100.0	273	100.0

Type of outcome/ type of delivery	10 to 19		20 to 34		35 +		Total
Type of outcome/ type of delivery	n	%	n	%	n	%	n	%
Stillbirths
Cesarean	2	12.5	3	10.7	2	16.7	7	12.5
Vaginal	14	87.5	25	89.3	10	83.3	49	87.5
Vaginal-forceps	–	–	–	–	–	–	–	–
Sub-total	16	100.0	28	100.0	12	100.0	56	100.0
Live births
Cesarean	323	23.6	1,445	31.6	280	46.3	2,048	31.3
Vaginal	878	64.2	2,804	61.3	292	48.3	3,974	60.7
Vaginal-forceps	166	12.2	325	7.1	33	5.4	524	8.0
Sub-total	1,367	100.0	4,574	100,0	605	100.0	6,546	100.0
Total
Cesarean	325	23.5	1,448	31.5	282	45.7	2,055	31.1
Vaginal	892	64.5	2,829	61.5	302	48.9	4,023	60.9
Vaginal-forceps	166	12.0	325	7.0	33	5.4	524	8.0
Total	1,383	100.0	4,602	100.0	617	100.0	6,602	100.0

Associação Brasileira de Saúde Coletiva Av. Dr. Arnaldo, 715 - 2º andar - sl. 3 - Cerqueira César, 01246-904 São Paulo SP Brasil , Tel./FAX: +55 11 3085-5411 - São Paulo - SP - Brazil
E-mail: revbrepi@usp.br

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[1] Corresponding author: Maria Helena Prado de Mello Jorge. Departamento de Epidemiologia da Faculdade de Saúde Pública da Universidade de São Paulo. Avenida Dr. Arnaldo, 715, CEP: 01246-904, São Paulo, SP, Brasil. E-mail: mhpjorge@usp.br