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

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

doi:10.1590/1518-8345.2156.2949

Abstract

ABSTRACTObjective: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.

Highlights

Gestation is a physiological event in the women’s life usually free from complications
Premature Membrane Rupture (PMR) and placenta previa were observed most often in women who had non-scope of the Unified Health System (SUS) births. These results show a higher frequency of vaginal bleeding among women who had non-SUS births, it was reported by women who had SUS births
The fact that the severity of the complications was not classified and that the financing of the childbirth service categorized as non-SUS included all private health plans, without differentiation of the types of coverage, which are known to be variable, should be considered as a limitation

Summary

Introduction

Gestation is a physiological event in the women’s life usually free from complications. Hundreds of thousands of women die every year due to pregnancy and childbirth complications[1]. Health problems during pregnancy have increased worldwide, mainly due to complex interactions between demographic factors and lifestyle, as well as advances in modern medicine[2], with new diagnostic and therapeutic practices. Among the main clinical pregnancy complications reported in the literature are Urinary Tract Infections (UTIs)(3-4), pregnancy-induced hypertension (PIH), anemia and hyperemesis[5,6]. In the United States, a multicenter study of hospitalizations during pregnancy showed a 71% increase in the occurrence of PIH between 1994 and 2011(7). Another study carried out in the United States pointed out that the main intercurrences associated with maternal mortality were pre-eclampsia and obstetric hemorrhage[8]

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Conclusion