Survival analysis of women with cervical cancer treated at a referral hospital for oncology in Espírito Santo State, Brazil, 2000-2005

Uterine cervical cancer is a leading cause of death from cancer in the female population worldwide. The aim of this study was to analyze survival of women with cervical cancer treated at the Santa Rita de Cássia Hospital/Women's Association for Cancer Education and Control (HSRC/AFECC) in Espírito Santo State, Brazil, from 2000 to 2005 and to describe associated prognostic factors. This was a cohort study using retrospective secondary data with a sample of 964 cases. The Kaplan-Meier curve and Cox model were used to evaluate survival and for multiple logistic analysis. There were 421 deaths (43.6%) during the minimum 5-year follow-up, with an overall 5-year survival of 58.8%. Risk factors were place of residence in the Serrana Region of the State (HR: 1.94; 95%CI: 1.09-3.45) and advanced staging. Women with stages III and IV at diagnosis showed an increased risk of 4.33 (95%CI: 3.00-6.24) and 15.40 (95%CI: 9.72-24.39), respectively, for lower survival when compared to stage I. The results show that early diagnosis and treatment are essential for reducing mortality from cervical cancer

PREVALENCIA DE LAS DISPARIDADES RACIALES EN LA ATENCIÓN PRENATAL Y EL PARTO EN BRASIL EN EL PERÍODO COMPRENDIDO ENTRE 2007 Y 2018

Objetivo: Avaliar a disparidades raciais na assistência pré-natal e no parto no Brasil no período entre 2007 e 2018. Metodologia: Realizou-se um estudo quantitativo, analítico, de dados secundários provenientes do Sistema de Informação sobre Nascidos Vivos (SINASC) do Brasil, no período de 2007 a 2018.  Os dados foram obtidos através do sítio eletrônico do Departamento de Informática do SUS (DATASUS) e organizados no programa Excel for Windows, analisados no programa estatístico STATA 13.0. Foram calculadas as prevalências de adequação do pré-natal, tipo de parto, Apgar no 1º minuto de vida e peso ao nascer e calculado de acordo com a raça/cor. As prevalências de acordo com a raça/cor foram calculadas por todo território brasileiro. Resultados: Os resultados mostraram que existe diferença significativa entre mulheres brancas e negras para os desfechos: adequação do pré-natal, número de consultas pré-natal, cor/raça, Apgar no 1º minuto de vida e peso ao nascer. Percebe-se que mulheres negras apresentam piores indicadores relacionados a saúde na gestação, parto e puerpério. Expondo a disparidades na assistência prestada as mulheres negras no Brasil quando comparadas as brancas. Conclusão: O presente estudo foi capaz de apontar que ainda que com melhores índices no decorrer dos anos, a população negra continuou com piores desfechos quando comparadas a brancas. Indicando o resultado do racismo e de toda sua estruturação no Brasil.Objective: To assess racial disparities in prenatal care and childbirth in Brazil in the period between 2007 and 2018. Methodology: Conducted a quantitative, analytical study of secondary data from the Information System on Live Births (SINASC) of Brazil, in the period from 2007 to 2018.  The data were obtained through the electronic site of the Department of Informatics of the SUS (DATASUS) and organized in the Excel for Windows program, analyzed in the statistical program STATA 13.0. The prevalences of prenatal adequacy, type of delivery, Apgar score in the 1st minute of life, and birth weight were calculated and calculated according to race/color. The prevalences according to race/color were calculated for the whole Brazilian territory. Results: The results showed that there is significant difference between white and black women for the outcomes: adequacy of prenatal care, number of prenatal visits, color/race, Apgar in the 1st minute of life and birth weight. It is perceived that black women have worse indicators related to health during pregnancy, delivery, and puerperium. This exposes the disparities in the assistance provided to black women in Brazil when compared to white women. Conclusion: This study was able to point out that even with better rates over the years, the black population continued to have worse outcomes when compared to whites. Indicating the result of racism and all its structuring in Brazil.Objetivo: Evaluar las disparidades raciales en la atención prenatal y el parto en Brasil en el período comprendido entre 2007 y 2018. Metodología: Se realizó un estudio cuantitativo, analítico, de datos secundarios provenientes del Sistema de Información sobre Nacimientos Vivos (SINASC) de Brasil, en el período de 2007 a 2018.  Los datos fueron obtenidos a través de la sede electrónica del Departamento de Informática del SUS (DATASUS) y organizados en el programa Excel para Windows, analizados en el programa estadístico STATA 13.0. Se calcularon las prevalencias de la adecuación prenatal, el tipo de parto, la puntuación de Apgar en el primer minuto de vida y el peso al nacer y se calcularon según la raza/color. Las prevalencias según la raza/color se calcularon para todo el territorio brasileño. Resultados: Los resultados mostraron que existe una diferencia significativa entre las mujeres blancas y las negras en los resultados: adecuación de la atención prenatal, número de consultas prenatales, color/raza, Apgar en el primer minuto de vida y peso al nacer. Se percibe que las mujeres negras presentan mayores indicadores relacionados con la salud en la gestación, el parto y el puerperio. Exponer las disparidades en la asistencia prestada a las mujeres negras en Brasil en comparación con las blancas. Conclusión: Este estudio pudo señalar que incluso con mejores tasas a lo largo de los años, la población negra siguió teniendo peores resultados en comparación con los blancos. Indicando el resultado del racismo y toda su estructuración en Brasil

Maternal complications and cesarean section without indication: systematic review and meta-analysis

OBJECTIVE: The objective of this study was to determine the risks of severe acute maternal complications associated with cesarean section without medical indication. METHODS: A systematic review was carried out with meta-analysis. The literature search was performed systematically, in multiple stages, in the PubMed, Lilacs, and Web of Science databases using the following descriptors: (postpartum period) and (cesarean section or natural childbirth) and ((morbidity or mortality) or (postpartum hemorrhage) or (puerperal infection) or (surgical infection) or (puerperal disorders)). The protocol of the study was registered at PROSPERO as CRD42016032933. A total of 1,328 articles were found; after selection, eight publications that met the study objective and inclusion criteria were selected, with information on 1,051,543 individuals. RESULTS: The results obtained in the meta-analyses indicate that women with cesarean section have a higher chance of maternal death (OR = 3.10, 95%CI 1.92–5.00) and postpartum infection (OR = 2.83, 95%CI, 1.585.06), but they have a lower chance of hemorrhage (OR = 0.52, 95%CI 0.48–0.57). For the blood transfusion outcome, the group effect was not associated with the type of delivery (95%CI 0.88–2.81). CONCLUSIONS: The quality of evidence was considered low for hemorrhage and blood transfusion and moderate for postpartum infection and maternal death. Thus, cesarean sections should be performed with caution and safety, especially when its benefits outweigh the risks of a surgical procedure.OBJETIVO: Determinar os riscos de complicações maternas agudas graves associadas ao parto cesárea sem indicação médica. MÉTODOS: Foi conduzida uma revisão sistemática com meta-análise. A busca na literatura ocorreu de forma sistemática, em múltiplas etapas, nas bases de dados PubMed, Lilacs e Web of Science, utilizando os descritores: (postpartum period) and (cesarean section or natural childbirth) and ((morbidity or mortality) or (postpartum hemorrhage) or (puerperal infection) or (surgical infection) or (puerperal disorders)). O protocolo de estudo foi registrado na PROSPERO sob o número CRD42016032933. Foram encontrados 1.328 artigos, permanecendo, após seleção, oito publicações que atendiam ao objetivo do estudo e critérios de inclusão, com informações de 1.051.543 indivíduos. RESULTADOS: Os resultados obtidos nas meta-análises indicam que mulheres de parto cesárea tem maior chance de morte materna (OR = 3,10; IC95% 1,92–5,00) e infecção pós-parto (OR = 2,83; IC95% 1,58–5,06), mas possuem menor chance de hemorragia (OR = 0,52; IC95% 0,48–0,57). Para o desfecho transfusão de sangue, o efeito agrupado não foi associado à via de parto (IC95% 0,88–2,81). CONCLUSÕES: A qualidade da evidência foi considerada baixa para os desfechos hemorragia e transfusão de sangue e moderada para infecção pós-parto e morte materna. Assim, as cesáreas devem ser realizadas com prudência e segurança, principalmente quando seus benefícios superam os riscos de um procedimento cirúrgico

Early Puerperal Complications and in the First Six Years after Childbirth Associated with Mode of Delivery: 2004 Pelotas Cohort

This volume is part of the requirements for qualifying for and obtaining the doctorate degree in Epidemiology. This is a study investigating maternal complications after childbirth. The main objective was to investigate early maternal complications and up to six years after childbirth according to the mode of delivery employed. The secondary objectives were (1) to systematically review the literature on severe acute maternal complications associated with Cesarean section childbirth with no medical indication compared to vaginal childbirth and (2) to describe the prevalence of repeat Cesarean section in subsequent pregnancies among primiparae and identify factors associated with it. The study used data from the 2004 Pelotas birth cohort. The analyses were descriptive with calculations of prevalences, means, and proportions, as well as of association and multivariable analyses. From the results of the analyses, three papers were written, one of which a systematic review, to be published and publicized to the scientific community.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESEste volume faz parte dos requisitos para qualificação e obtenção do título de Doutor em Epidemiologia. Trata-se de um estudo abordando as complicações maternas após o parto. O objetivo principal foi investigar as complicações maternas precoces e por até seis anos após o parto de acordo com a via de parto utilizada ao nascimento. Os objetivos secundários foram (1) revisar sistematicamente a literatura sobre as complicações maternas agudas graves associadas ao parto cesárea sem indicação médica, em relação ao parto vaginal e (2) descrever a prevalência de cesárea de repetição em gestações subsequentes entre primíparas e identificar os fatores associados. Foram utilizados no estudo os dados da Coorte de nascimentos de Pelotas de 2004. As análises foram descritivas com cálculos de prevalências, médias, proporções, bem como de associação e análises multivariadas. A partir dos resultados das análises foram elaborados três artigos, sendo um deles uma revisão sistemática, a serem publicados e divulgados para a comunidade científica

Maternal complications and cesarean section without indication: systematic review and meta-analysis

ABSTRACT OBJECTIVE The objective of this study was to determine the risks of severe acute maternal complications associated with cesarean section without medical indication. METHODS A systematic review was carried out with meta-analysis. The literature search was performed systematically, in multiple stages, in the PubMed, Lilacs, and Web of Science databases using the following descriptors: (postpartum period) and (cesarean section or natural childbirth) and ((morbidity or mortality) or (postpartum hemorrhage) or (puerperal infection) or (surgical infection) or (puerperal disorders)). The protocol of the study was registered at PROSPERO as CRD42016032933. A total of 1,328 articles were found; after selection, eight publications that met the study objective and inclusion criteria were selected, with information on 1,051,543 individuals. RESULTS The results obtained in the meta-analyses indicate that women with cesarean section have a higher chance of maternal death (OR = 3.10, 95%CI 1.92–5.00) and postpartum infection (OR = 2.83, 95%CI, 1.585.06), but they have a lower chance of hemorrhage (OR = 0.52, 95%CI 0.48–0.57). For the blood transfusion outcome, the group effect was not associated with the type of delivery (95%CI 0.88–2.81). CONCLUSIONS The quality of evidence was considered low for hemorrhage and blood transfusion and moderate for postpartum infection and maternal death. Thus, cesarean sections should be performed with caution and safety, especially when its benefits outweigh the risks of a surgical procedure

Survival analysis of women with cervical cancer treated at a referral hospital for oncology in Espírito Santo State, Brazil, 2000-2005 Análisis de la supervivencia de mujeres con cáncer de cuello de útero atendidas en un hospital oncológico de referencia en Espírito Santo, Brasil, desde 2000 a 2005 Análise da sobrevida de mulheres com câncer do colo do útero atendidas em hospital de referência para oncologia no Espírito Santo, Brasil, nos anos de 2000 a 2005

Uterine cervical cancer is a leading cause of death from cancer in the female population worldwide. The aim of this study was to analyze survival of women with cervical cancer treated at the Santa Rita de Cássia Hospital/Women's Association for Cancer Education and Control (HSRC/AFECC) in Espírito Santo State, Brazil, from 2000 to 2005 and to describe associated prognostic factors. This was a cohort study using retrospective secondary data with a sample of 964 cases. The Kaplan-Meier curve and Cox model were used to evaluate survival and for multiple logistic analysis. There were 421 deaths (43.6%) during the minimum 5-year follow-up, with an overall 5-year survival of 58.8%. Risk factors were place of residence in the Serrana Region of the State (HR: 1.94; 95%CI: 1.09-3.45) and advanced staging. Women with stages III and IV at diagnosis showed an increased risk of 4.33 (95%CI: 3.00-6.24) and 15.40 (95%CI: 9.72-24.39), respectively, for lower survival when compared to stage I. The results show that early diagnosis and treatment are essential for reducing mortality from cervical cancer.<br>El cáncer de cuello de útero corresponde a una de las principales causas de muerte por neoplasias en la población femenina mundial. El objetivo de este estudio fue analizar la supervivencia de mujeres con cáncer de cuello de útero, atendidas en el Hospital Santa Rita de Cássia/Asociación Femenina de Educación y Combate al Cáncer (HSRC/AFECC), durante el período de 2000 a 2005 y describir los factores pronósticos asociados. Se trata de un estudio de cohorte con utilización de datos secundarios retrospectivos, con una muestra de 964 casos. Se utilizaron la curva de Kaplan-Meier y el modelo de Cox para la evaluación de la supervivencia y para el análisis logístico múltiple. Se produjeron 421 (43,6%) óbitos durante un período mínimo de 5 años de seguimiento, con una sobrevida global de 58,8% en 5 años. Se identificó como un riesgo la procedencia de Región Serrana (1,94 veces, IC95%: 1,09-3,45) e internamientos hospitalarios crecientes. Las mujeres con internamientos hospitalarios III y IV presentaron un riesgo de 4,33 (IC95%: 3,00-6,24) y 15,40 (IC95%: 9,72-24,39) veces mayor, respectivamente, de tener menor supervivencia cuando se comparaban al estadio I. Los resultados demuestran que el diagnóstico y tratamiento precoces son fundamentales en la reducción de la mortalidad por cáncer de cuello de útero.<br>O câncer do colo do útero corresponde a uma das principais causas de morte por neoplasias na população feminina mundial. O objetivo deste estudo foi analisar a sobrevida de mulheres com câncer do colo do útero atendidas no Hospital Santa Rita de Cássia/Associação Feminina de Educação e Combate ao Câncer (HSRC/AFECC) durante o período de 2000 a 2005 e descrever os fatores prognósticos associados. Trata-se de um estudo de coorte com utilização de dados secundários retrospectivos, com amostra de 964 casos. Foram utilizados a curva de Kaplan-Meier e o modelo de Cox para avaliação da sobrevida e para análise logística múltipla. Ocorreram 421 (43,6%) óbitos no período mínimo de 5 anos de seguimento, com sobrevida global de 58,8% em 5 anos. Identificaram-se como risco a procedência Região Serrana (1,94 vez, IC95%: 1,09-3,45) e estadiamento crescente. As mulheres com estadiamento III e IV apresentaram risco de 4,33 (IC95%: 3,00-6,24) e 15,40 (IC95%: 9,72-24,39) vezes maior, respectivamente, de terem menor sobrevida quando comparadas ao estádio I. Os resultados demonstram que o diagnóstico e tratamento precoces são fundamentais na redução da mortalidade por câncer do colo do útero

Maternal complications and cesarean section without indication: systematic review and meta-analysis

ABSTRACT OBJECTIVE The objective of this study was to determine the risks of severe acute maternal complications associated with cesarean section without medical indication. METHODS A systematic review was carried out with meta-analysis. The literature search was performed systematically, in multiple stages, in the PubMed, Lilacs, and Web of Science databases using the following descriptors: (postpartum period) and (cesarean section or natural childbirth) and ((morbidity or mortality) or (postpartum hemorrhage) or (puerperal infection) or (surgical infection) or (puerperal disorders)). The protocol of the study was registered at PROSPERO as CRD42016032933. A total of 1,328 articles were found; after selection, eight publications that met the study objective and inclusion criteria were selected, with information on 1,051,543 individuals. RESULTS The results obtained in the meta-analyses indicate that women with cesarean section have a higher chance of maternal death (OR = 3.10, 95%CI 1.92–5.00) and postpartum infection (OR = 2.83, 95%CI, 1.585.06), but they have a lower chance of hemorrhage (OR = 0.52, 95%CI 0.48–0.57). For the blood transfusion outcome, the group effect was not associated with the type of delivery (95%CI 0.88–2.81). CONCLUSIONS The quality of evidence was considered low for hemorrhage and blood transfusion and moderate for postpartum infection and maternal death. Thus, cesarean sections should be performed with caution and safety, especially when its benefits outweigh the risks of a surgical procedure

Sociodemographic factors and type of delivery: systematic review / Fatores sociodemográficos e via de parto: revisão sistemática: systematic review

Objective: to identify the sociodemographic factors associated with the mode of delivery. Methods: this is a systematic review with a search in the Latin American and Caribbean Literature on Health Sciences, PubMed and Cochrane databases in May 2021. The study protocol was registered with PROSPERO under number CRD42021257340. The selected articles were analyzed by the Joanna Briggs Institute and the Grading System of Recommendations Assessment, Development and Evaluation systems. Results: women with a higher socioeconomic level, higher education, aged over 35 years and private institutions have a greater chance of having a cesarean section compared to the vaginal level. The quality of quality of quality for the service provider variable was low and the quality of maternal schooling is low and the quality of economic class is high. Sociodemographic conclusions in the literature.Objetivo: identificar los factores sociodemográficos asociados a la modalidad de parto. Métodos: se trata de una revisión sistemática con búsqueda en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud, PubMed y Cochrane en mayo de 2021. El protocolo de estudio fue registrado en PROSPERO con el número CRD42021257340. Los artículos seleccionados fueron analizados por el Instituto Joanna Briggs y los sistemas Grading System of Recommendations Assessment, Development and Evaluation. Resultados: las mujeres con mayor nivel socioeconómico, educación superior, mayores de 35 años e instituciones privadas tienen mayor probabilidad de tener una cesárea en comparación con el nivel vaginal. La calidad de calidad de calidad para la variable proveedor de servicios fue baja y la calidad de escolaridad materna es baja y la calidad de clase económica es alta. Conclusiones sociodemográficas en la literatura.Objetivo: identificar os fatores sociodemográficos associados à via de parto. Métodos: trata-se de revisão sistemática com busca nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, PubMed e Cochrane em maio de 2021. O protocolo do estudo foi registrado na PROSPERO sob o nº CRD42021257340. Os artigos selecionados foram posteriormente analisados pelos sistemas Joanna Briggs Institute e Sistema Grading of Recommendations Assessment, Development and Evaluation. Resultados: mulheres com maior nível socioeconômico, maior nível de escolaridade, com idade acima de 35 anos e parto em instituições privadas possuem maior chance de realizar cesariana comparado ao parto vaginal. A qualidade da evidência para variável de prestador hospitalar foi baixa, para idade e escolaridade materna a qualidade é moderada e classe econômica a qualidade é alta. Conclusões: os fatores sociodemográficos contribuem para o aumento da taxa de cesárea e reforçam o cenário encontrado na literatura.