ArticleReproductive health2011
The safe motherhood referral system to reduce cesarean sections and perinatal mortality - a cross-sectional study [1995-2006].
Article in Reproductive health, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Caesarean deliveries and double burden of malnutrition: a multicountry analysis in South and Southeast Asia.Journal of public health (Oxford, England) · 2025Article
- Half of the mothers had poor delivery referral practices in public hospitals of Bahir Dar City Northwest, Ethiopia.Frontiers in public health · 2025Article
- Surgical referral systems in low- and middle-income countries: A review of the evidence.PloS one · 2019Review
- Risk factors for perinatal death in two different levels of care: a case-control study.Reproductive health · 2014Article
- Prevalence of urinary incontinence and pelvic floor muscle dysfunction in primiparae two years after cesarean section: cross-sectional study.Sao Paulo medical journal = Revista paulista de medicina · 2013Article
- [Risk factors for maternal and perinatal mortality among women undergoing cesarean section in Lubumbashi, Democratic Republic of Congo II].The Pan African medical journalArticle
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Authors and funding
11 authors.
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Abstract
backgroundIn 2000, the eight Millennium Development Goals (MDGs) set targets for reducing child mortality and improving maternal health by 2015.
objectiveTo evaluate the results of a new education and referral system for antenatal/intrapartum care as a strategy to reduce the rates of Cesarean sections (C-sections) and maternal/perinatal mortality.
methods
designCross-sectional study.
settingDepartment of Gynecology and Obstetrics, Botucatu Medical School, Sao Paulo State University/UNESP, Brazil. POPULATION: 27,387 delivering women and 27,827 offspring. DATA COLLECTION: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system.
main outcome measuresYearly rates of C-sections, maternal (/100,000 LB) and perinatal (/1000 births) mortality rates at both hospitals. DATA ANALYSIS: Simple linear regression models were adjusted to estimate the referral system's annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis (Shapiro-Wilk test) and the influence of possible conflicting observations was evaluated by a diagnostic test (Leverage), with p < 0.05.
resultsOver the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths (maternal mortality ratio = 109.5/100,000 LB) and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births). The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of maternal mortality.
conclusionsThis safe motherhood referral system was a good strategy in reducing perinatal mortality and direct causes of maternal mortality and decreasing the overall rate of C-sections.
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