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Reproductive Health

, 8:34

First Online: 23 November 2011Received: 31 August 2011Accepted: 23 November 2011DOI: 10.1186-1742-4755-8-34

Cite this article as: Rudge, M.V., Maestá, I., Moura, P.M. et al. Reprod Health 2011 8: 34. doi:10.1186-1742-4755-8-34


BackgroundIn 2000, the eight Millennium Development Goals MDGs set targets for reducing child mortality and improving maternal health by 2015.

ObjectiveTo evaluate the results of a new education and referral system for antenatal-intrapartum care as a strategy to reduce the rates of Cesarean sections C-sections and maternal-perinatal mortality.

MethodsDesign: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical School, Sao Paulo State University-UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data collection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures: Yearly rates of C-sections, maternal -100,000 LB and perinatal -1000 births mortality rates at both hospitals. Data analysis: Simple linear regression models were adjusted to estimate the referral system-s annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis Shapiro-Wilk test and the influence of possible conflicting observations was evaluated by a diagnostic test Leverage, with p < 0.05.

ResultsOver the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths maternal mortality ratio = 109.5-100,000 LB and 660 perinatal deaths perinatal mortality rate = 23.7-1000 births. The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66-1000 births and from 60.8 to 39.6-1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3-100,000 LB and 185.1-100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of maternal mortality.

ConclusionsThis safe motherhood referral system was a good strategy in reducing perinatal mortality and direct causes of maternal mortality and decreasing the overall rate of C-sections.

KeywordsReferral system antenatal-intrapartum care cesarean section perinatal mortality Electronic supplementary materialThe online version of this article doi:10.1186-1742-4755-8-34 contains supplementary material, which is available to authorized users.

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Autor: Marilza VC Rudge - Izildinha Maestá - Paula MSS Moura - Cibele VC Rudge - Glilciane Morceli - Roberto AA Costa - Joelci


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