Factors associated with vaginal birth after cesarean in a maternity hospital of Rio de Janeiro.

OBJECTIVES: Identifying characteristics associated with vaginal birth after cesarean. STUDY DESIGN: Case-control study based on medical records. STUDY POPULATION: women with previous cesarean, who had delivered in a public Rio de Janeiro maternity hospital between 1992 and 1996. SAMPLE: 141 cases (vaginal births after cesarean) and 304 controls (a new cesarean after other(s)). Multivariate analysis with logistic regression was carried out. RESULTS: The following characteristics were associated with greater probability of vaginal birth (IC=95%): only one previous cesarean (OR=19.05; IC=6.88-52.76); cervical dilatation at admission above 3 cm (OR=8.86; IC=4.93-15.94); gestational age below 37 weeks (OR=3.01; IC=1.40-6.46); history of at least one previous vaginal birth (OR=2.12; IC=1.18-3.82); level of education below high school (OR=1.94; IC=1.02-3.69). Chronic hypertension reduced the chances of vaginal birth (OR=0.44; IC=0.22-0.88). CONCLUSIONS: Among the factors that can be modified to reduce the number of repeated cesareans are: trial of labor promotion, reducing admission of women at early stages of labor and adequate hypertension management during pregnancy. CONDENSATION: Among the factors that can be modified to reduce the number of repeated cesareans are: the trial of labor promotion for women who present previous cesarean, reducing admission of women at early stages of labor and adequate hypertension management during pregnancy.

Differential trends in mortality from AIDS in men and women in Brazil (1984-1995).

OBJECTIVE: To analyse trends in AIDS mortality in men and women in Brazil, for the period 1984-1995. DESIGN AND METHODS: National statistics on yearly numbers of reported deaths by cause, in conjunction with census population counts and inter-censory estimates, were used to calculate age- and sex-specific AIDS mortality rates for Brazil as a whole and for São Paulo and Rio de Janeiro, the two largest cities in Brazil, and those most affected by the AIDS epidemic to date. RESULTS: Numbers of reported deaths from AIDS have increased yearly in Brazil since 1984, to approximately 15,000 in 1995. The data suggest that after a very dramatic rise in mortality rates, the epidemic may have started to slow even before the introduction of freely available highly-active anti-retroviral therapy, although unequally in terms of both geographical and sex distributions. Women also tended to die at relatively younger ages than men in all areas studied, and by 1995 the impact of AIDS on overall mortality was practically the same for men and women aged 25-34 years (21% in São Paulo). CONCLUSIONS: Trends in mortality from AIDS in Brazil reflect both the geographical expansion of the epidemic outwards from its original epicentres, and the fact that women are becoming increasingly affected by the AIDS epidemic.

Birth profile for the city of rio de janeiro: a spatial analysis

This article analyzes the birth profile by neighborhood in the city of Rio de Janeiro, using data for 1994 from the Data Base on Live Births. Pattern maps were employed in addition to the Moran I statistical test to detect spatial clustering. Proportions of live newborns with an Apgar score of 8-10, cesareans, mothers with greater than a secondary school education, and teenage mothers displayed visually identifiable spatial patterns and significant spatial self-correlation. Low birth weight displayed a random pattern, indicating that on this scale of analysis, this indicator does not distinguish risk groups, despite its unquestionable predictive value for child morbidity/mortality at the individual level. The Apgar score, despite the high number of non-responses in some neighborhoods, showed a pattern more consistent with the distribution of the neighborhoods and should thus be used more extensively. The methodology expanded the available knowledge on the birth profile in the city, showing potential for orienting measures devoted to specific geographic areas.

[A survey of demand for medical care in three public health clinics in Rio de Janeiro, Brazil]. / Demanda ambulatorial em três serviços da rede pública do município do Rio de Janeiro, Brasil.

A sample survey was conducted in three public ambulatory medical care units in Rio de Janeiro in order to show the demographic and nosological aspects of the clientele as well as to evaluate the quality of clinic records. The sample included 2,029 patients registered in the health clinics and 3,980 consultants from October 1, 1990 to September 30, 1991. The diagnoses were coded according to the 9th revision of the International Classification of Dieases. Females accounted for about 60% of the sample, and more than a half were between 15 and 49 years of age. Children under 10 years old made up 28% of the total. About 38% of the patients came from the poor areas of the city: the "favelas". The case files were poorly filled out, frequently lacking useful information. The most frequent cause was classified in the XVIo chapter of the ICD - ill-defined causes, followed by respiratory, infectious, genitourinary and circulatory diseases. External causes predominated in one of the health clinics, which is an emergency service. There was a great demand for preventive measures, such as prenatal care and child care, even at the clinic that was traditionally devoted only to curative medicine. The most frequent specific diagnoses were upper respiratory tract infection, hypertension, gynecological problems, prenatal care, and skin diseases. There were no records for referrals to other health services. The poor quality of the medical records causes problems in terms of quality of health care. Use of such record-keeping systems, even while criticizing them, is essential to improve them.