Cesarean section prevalence at a baby-friendly hospital in southern Brazil: current context in the face of COVID-19
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Abstract
Objective
To analyze cesarean prevalence at a baby-friendly hospital in Southern Brazil between 2017 and 2020 and possible annual and monthly changes due to the novel coronavirus (COVID-19) pandemic.
Methods
Descriptive cross-sectional study using secondary data retrieved from the electronic information system of a Baby-Friendly Hospital in the municipality of Rio Grande, RS, Brazil. Data was retrieved for all hospitalizations at the obstetric center between January 1 st 2017 and December 31 st 2020. Data on COVID-19 deaths were obtained from the municipal government website. Annual and monthly cesarean prevalence rates were calculated in comparison to the same periods in 2017, 2018 and 2019. Differences in prevalence rates were tested using a chi-square test, taking a significance level of less than 5%. Prevalence ratios were estimated for 2018/2017, 2019/2018, and 2020/2019.
Results
7,294 childbirths were included. Cesarean prevalence was 42.6% in 2017, 44.3% in 2018, 40.2% in 2019, and 51.0% in 2020. In 2018/2017, there was no statistically significant difference in cesarean prevalence (95%CI: 0.90-1.20). Between 2019/2018, there was a reduction of approximately 20% in prevalence (95%CI: 0.69-0.93). The scenario changes between 2020/2019 with a 40% increase in cesareans (95%CI: 1.20-1.62). The period comprising July to December 2020 was the only period in which over half the deliveries were done by cesarean section, exceeding 60% in July.
Conclusion
Cesarean prevalence rates increased in 2020 in relation to the three preceding years. The data highlight the need to reinforce compliance with childbirth protocols to reduce cesarean sections in baby-friendly hospitals.
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SciScore for 10.1101/2021.05.03.21256516: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethical aspects: The research project was submitted and approved by the Research Ethics Committee of the Universidade Federal de Pelotas (Approved file N° 4.281.378) and by the Section of Teaching and Research Administration of the HU-FURG. Sex as a biological variable For the present study, we selected all pregnant women who gave live birth at the HU-FURG maternity hospital. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources The data on hospitalizations at the obstetrics center held on the HU-FURG electronic system were exported to Excel® and statistical analyses were performed using Stata statistical … SciScore for 10.1101/2021.05.03.21256516: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethical aspects: The research project was submitted and approved by the Research Ethics Committee of the Universidade Federal de Pelotas (Approved file N° 4.281.378) and by the Section of Teaching and Research Administration of the HU-FURG. Sex as a biological variable For the present study, we selected all pregnant women who gave live birth at the HU-FURG maternity hospital. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources The data on hospitalizations at the obstetrics center held on the HU-FURG electronic system were exported to Excel® and statistical analyses were performed using Stata statistical package version 16.0. Statasuggested: (Stata, RRID:SCR_012763)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Some limitations need to be considered. The first refers to the absence of information on the electronic system about the indication of cesarean section, whether due to medical indication or other factors, such as medical convenience or patient’s choice. Another limitation is external validity. The data presented refer to a municipality in the extreme south of Brazil and are not representative for cities and regions where the repercussions of COVID-19 have been alarming. The results of this study show high cesarean prevalence rates in a BFHI hospital during the first year of the COVID-19 pandemic, worsening even more the cesarean section epidemic in Brazil. Mode of delivery and cesarean section are subjects widely discussed in the literature, as child delivery is a moment of extreme importance for mothers and their families, whereby each woman’s individual context must be considered. Repercussions of the pandemic on the mode of delivery are still scarce in Brazil. Further studies are needed to investigate possible changes in childbirth protocols in maternity hospitals in the context of the COVID-19 pandemic, especially in baby-friendly hospitals. We emphasis the need to plan actions to keep cesarean prevalence within BFHI recommended rates to minimize the deleterious effect of the pandemic in possible excessive cesarean section and future consequences for maternal and child health.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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