Abstract
To determine changes in the incidence of vaginal deliveries, cesarean sections, and forceps deliveries and their potential association with fetal, early neonatal, and perinatal mortality rates over time. A retrospective study was carried out and the occurrence of deliveries supervised by university services between January 1991 and December 2000 was determined. Data regarding fetal, early neonatal, and perinatal deaths were assessed using obstetric and pediatric records and autopsy reports. Of a total of 33,360 deliveries, the incidence of vaginal deliveries, cesarean sections, and forceps deliveries was relatively steady (around 60, 30, and 10%, respectively) while, at the same time, there was a marked reduction in fetal mortality (from 33.3 to 13.0 per thousand), early neonatal mortality (from 30.6 to 9.0 per thousand), and perinatal mortality (from 56.4 to 19.3 per thousand). The marked reduction in perinatal mortality rates seen during the study period without an increase in cesarean sections indicates that the decrease in perinatal mortality was not impacted by cesarean section rates. The plausible hypothesis seems to be that the reduction in perinatal mortality of deliveries performed under the supervision of university services was more likely to be associated with better neonatal care rather than the mode of delivery.
Highlights
A remarkable development is currently seen in medicine due to technical advancements and better understanding of physiological processes
The study focused on variations in the occurrence of cesarean sections and their impact on perinatal mortality rates
A retrospective study was carried out to determine the occurrence of vaginal deliveries, cesarean sections, and forceps deliveries, as well as fetal, early neonatal, and perinatal mortality rates from January 1991 to December 2000
Summary
Of a total of 33,360 deliveries, the incidence of vaginal deliveries, cesarean sections, and forceps deliveries was relatively steady (around 60, 30, and 10%, respectively) while, at the same time, there was a marked reduction in fetal mortality (from 33.3 to 13.0‰), early neonatal mortality (from 30.6 to 9.0‰), and perinatal mortality (from 56.4 to 19.3‰). Resultados Em um total de 33.360 partos realizados, houve relativa manutenção das taxas de parto normal, cesárea e fórceps (em torno de 60%, 30% e 10%, respectivamente), ao mesmo tempo em que houve nítida redução das taxas de mortalidade fetal (de 33,3 para 13,0‰), neonatal precoce (de 30,6 para 9,0‰) e perinatal (de 56,4 para 19,3‰). Conclusões Verificou-se evidente redução das taxas de mortalidade perinatal, sem aumento das taxas de parto cesárea. Parece que a redução da taxa de mortalidade perinatal dos partos realizados e supervisionados seja mais uma relação direta da melhora do atendimento neonatal do que da via de parto
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