Série temporal da taxa de cesariana em um hospital de ensino: uma avaliação de impacto

Abstract

This study aims to evaluate the impact of the actions of the Adequate Birth Project (PPA) (Phase 1 and Phase 2) in reducing cesarean section rates according to the Robson Classification of pregnant women treated at a university hospital in Minas Gerais between 2014 and 2022. The PPA is a quality improvement (QI) initiative based on four main components (governance, participation of women and families, reorganization of care, and monitoring), through a Breakthrough Series Collaborative approach, aimed at increasing the frequency of vaginal delivery in Brazilian hospitals. Quasi-experimental study with analysis of interrupted time series and use of segmented regression models. The primary outcome was the variation in the cesarean section rate between the study periods (Before the intervention / Phase 1 / Phase 2 / Post-intervention). As a secondary outcome, we analyzed the variations in the cesarean section rates of Groups 1 to 5 of the Robson Classification. The assumptions of normality, independence and homogeneity of the residuals of the models were met for the general rate, Robson Groups 1 and 5. The estimated general cesarean rates for the studied periods ranged from 58.94% to 66.17%. There was an increase in the general cesarean rate between Phase 1 and Phase 2, in which an increase was observed (p=0.010). For Robson Group 1, the rates ranged from 4.56% to 20.57%. In this group, Phases 1 and 2 presented higher values in relation to the Before Phase, culminating in a significant increase at the end of the Post Phase (p<0.001). In Group 5, the estimated values of the cesarean rates ranged from 79.71% to 94.00%. There was an increase in the trend from Phase 1 in relation to Before (p=0.037) and from Phase 2 in relation to Phase 1 (p=0.022). In the Post Phase in relation to Phase 2 there was a decrease (p=0.002), but it still ended with very high values (84.94%). Our results demonstrate that, regardless of the actions taken at the study hospital, there was no decrease in the cesarean section rates in the period analyzed.