The effects of a quality improvement project to reduce caesarean sections in selected private hospitals in Brazil.

Background: Brazil is one of the countries with the highest rates of caesarean sections (CS), reaching almost 90% of births in the private sector. A quality improvement project called "Adequate Childbirth Project (PPA)" was conceived to reduce CS in the private sector. This project consisted of four primary components: "Governance", "Participation of Women", "Reorganization of Care" and "Monitoring".

Maternal mortality: protocol of a study integrated to the Birth in Brazil II survey.

The Maternal Mortality Study conducts a hospital investigation of maternal deaths that occurred in 2020/2021 in the maternity hospitals sampled by the Birth in Brazil II survey, with the following objectives: estimate the maternal mortality underreporting; calculate a correction factor and the corrected (MMR); validate the causes of maternal mortality reported in the death certificate (DC); and analyze the factors associated with maternal mortality. The Birth in Brazil II includes approximately 24,250 puerperal women distributed in 465 public, private, and mixed hospitals with ≥ 100 live births/year in the five macroregions of Brazil. The Maternal Mortality Study data will be completed using the same Birth in Brazil II questionnaire, from the consultation of hospital records.

Birth in Brazil II: a postpartum maternal, paternal and child health research protocol.

Pregnancy, parturition and birth bring major changes to the lives of mothers and fathers. This article presents a research protocol for estimating the prevalence of postpartum mental health outcomes in mothers and fathers, abuse and satisfaction in delivery/abortion care, and the correlations between them and socioeconomic, obstetric, and child health factors. As a 2-component research, it consists of a prospective cohort study with all postpartum women interviewed in the 465 maternity hospitals included at the Birth in Brazil II baseline survey conducted from 2021 to 2023, and a cross-sectional study with the newborns' fathers/partners.

Perinatal mortality, severe maternal morbidity and maternal near miss: protocol of a study integrated with the Birth in Brazil II survey.

Brazil presents high maternal and perinatal morbidity and mortality. Cases of severe maternal morbidity, maternal near miss, and perinatal deaths are important health indicators and share the same determinants, being closely related to living conditions and quality of perinatal care. This article aims to present the study protocol to estimate the perinatal mortality rate and the incidence of severe maternal morbidity and maternal near miss in the country, identifying its determinants.

Protocol of Birth in Brazil II: National Research on Abortion, Labor and Childbirth.

Brazil has made advances in obstetric care in public and private hospitals; however, weaknesses in this system still require attention. The Brazilian Ministry of Health, aware of this need, funded the second version of the Birth in Brazil survey. This study aimed to evaluate: prenatal, labor and birth, postpartum, and abortion care, comparing the results with those of Birth in Brazil I; and analyze the main determinants of perinatal morbidity and mortality; evaluate the care structure and processes of obstetrics and neonatology services in maternity hospitals; analyze the knowledge, practices, and attitudes of health professionals who provide birth and abortion care; and identify the main barriers and facilitators related to care of this nature in Brazil.

An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals.

Background: Brazil has one of the highest prevalence of cesarean sections in the world. The private health system is responsible for carrying out most of these surgical procedures. A quality improvement project called Adequate Childbirth Project ("Projeto Parto Adequado"- PPA) was developed to identify models of care for labor and childbirth, which place value on vaginal birth and reduce the frequency of cesarean sections without a clinical indication.

Characteristics of women who underwent one or more previous cesarean sections according to Nascer no Brasil.

Objective: To descriptively analyze Brazilian parturient women who underwent previous cesarean section and point out the factors associated with Vaginal Birth After Cesarean (VBAC) in Brazil.

Methods: The study used data from women with one, two, or three or more cesarean sections from the survey Nascer no Brasil (Birth in Brazil). Differences between categories were assessed through the chi-square test (χ2).

Agreement between maternal self-report of birth-related information and medical records in Brazil: A comparison study between public, mixed, and private hospitals.

Background: The study aims to assess agreement between data obtained from interviews with postpartum women and their health records about labor and birth characteristics, newborn care, and reasons for cesarean birth.

Methods: The present study analyzes the Birth in Brazil study dataset, a nationwide hospital-based survey that included 23,894 postpartum women. Reliability was assessed using kappa coefficients and 95% confidence intervals.

Impact of an intrapartum care quality improvement intervention in Brazilian private hospitals on care safety measures and adverse outcomes.

Background: In 2015, a quality improvement (QI) intervention to reduce cesarean sections (CS)-the Adequate Childbirth Project (PPA)-was implemented in the private sector in Brazil. This analysis aims to compare safety care measures and adverse outcomes between women exposed to the PPA intervention to those receiving standard care.

Methods: The analysis included a convenience sample of 12 private hospitals that participated in the PPA (2017-2018).

Variations in cesarean and repeated cesarean section rates in Brazil according to gestational age at birth and type of hospital.

This study aimed to describe cesarean and repeated cesarean section rates in Brazil according to gestational age (GA) at birth and type of hospital. This is an ecologic study using data from the Brazilian Information System on Live Births and the 2017 National Registry of Health Facilities. Overall and repeated cesarean section rates were calculated and analyzed according to GA, region of residence, and type of hospital.

Obstetric interventions in a maternity hospital with a collaborative model of care: a comparative observational study.

Collaborative models (CM) focused on intrapartum care shared between both midwives and obstetricians have been proposed as a strategy to reduce these rates. Our aim was to compare use of evidence-based practices, obstetric interventions and c-section rates in two settings: a maternity hospital that applies a CM of care (MRJ) and data from a pool of maternity hospitals included in the Birth in Brazil Survey (NB) that do not adopt a CM. Data was abstracted from medical and administrative records in MRJ and from medical records and face-to-face interviews in NB.

Recurrent preterm birth: data from the study "Birth in Brazil".

Objective: Describe and estimate the rate of recurrent preterm birth in Brazil according to the type of delivery, weighted by associated factors.

Methods: We obtained data from the national hospital-based study "Birth in Brazil", conducted in 2011 and 2012, from interviews with 23,894 women. Initially, we used the chi-square test to verify the differences between newborns according to previous prematurity and type of recurrent prematurity.

COVID-19-related deaths among women of reproductive age in Brazil: The burden of postpartum.

Objective: To compare risk of death due to COVID-19 among pregnant, postpartum, and non-pregnant women of reproductive age in Brazil, using the severe acute respiratory syndrome surveillance system (SARS-SS).

Methods: A secondary analysis was performed of the Brazilian official SARS-SS, with data retrieved up to August 17, 2020. Cases were stratified by pregnancy status, risk factors or co-morbidities, and outcome (death or recovery).

Prelabor cesarean section: the role of advanced maternal age and associated factors.

Objective: to evaluate whether advanced maternal age (AMA) is associated with prelabor cesarean section and to identify the factors associated with prelabor cesarean section in AMA women, according to the mode of type of labor financing (private or public).

Methods: Based on the Birth in Brazil survey, the research was conducted on representative sample of mothers for the country (Brazil), regions, type of hospital and location (capital or not), in 2011/2012. This study included 15,071 women from two age groups: 20-29 years and ≥ 35 years.

The association between mistreatment of women during childbirth and postnatal maternal and child health care: Findings from "Birth in Brazil".

Background: The mistreatment of women during pregnancy, childbirth, and the puerperium is a global public health problem besides being a violation of human rights. However, research exploring the consequences of mistreatment of women and newborns is scarce.

Question: To shed light on this issue, we investigated the association between the mistreatment of women during childbirth and the subsequent use of postnatal health services by women and their newborns.

The impact of the COVID-19 pandemic on maternal mortality in Brazil: 523 maternal deaths by acute respiratory distress syndrome potentially associated with SARS-CoV-2.

During the study period, 523 pregnant or postpartum women died in Brazil due to confirmed COVID‐19 or undetermined etiology. This results in a projected COVID‐19 MMR of 17.5/100 000 or potentially even higher.

Twin pregnancy and perinatal outcomes: Data from 'Birth in Brazil Study'.

Background: Twin pregnancies account for 0.5-2.0% of all gestations worldwide.

Risk factors for adverse outcomes among pregnant and postpartum women with acute respiratory distress syndrome due to COVID-19 in Brazil.

Objective: To evaluate whether clinical and social risk factors are associated with negative outcomes for COVID-19 disease among Brazilian pregnant and postpartum women.

Methods: A secondary analysis was conducted of the official Acute Respiratory Syndrome Surveillance System database. Pregnant and postpartum women diagnosed with COVID-19 ARDS until July 14, 2020, were included.

Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID-19 in Brazil: a surveillance database analysis.

Objective: To describe clinical characteristics of pregnant and postpartum women with severe COVID-19 in Brazil and to examine risk factors for mortality.

Design: Cross-sectional study based on secondary surveillance database analysis.

Setting: Nationwide Brazil.

Worldwide maternal deaths due to COVID-19: A brief review.

160 maternal deaths due to COVID‐19 have been reported worldwide, most of them in middle‐income countries, representing a barrier to reducing maternal mortality.