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CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(02): 076-083
DOI: 10.1055/s-0038-1675572
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Apgar Scoring System in Brazil's Live Births Records: Differences between Home and Hospital Births

Escala de Apgar nos registros de nascidos vivos do Brasil: discordância entre parto normal hospitalar e parto domiciliar
Jordana de Faria Bessa 
1   Department of Gynecology, Clínica Humana, Guarulhos, SP, Brazil
,
Naieli Bonatto
2   Department of Radiology and Oncology, Universidade de São Paulo, São Paulo, SP, Brazil
› Author Affiliations
Further Information

Publication History

28 May 2018

31 August 2018

Publication Date:
12 December 2018 (online)

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Abstract

Objective To promote informed choice for women and to compare home and hospital births in relation to the Apgar score.

Methods Mother's profile and Apgar score of naturally born infants (without forceps assistance) in Brazil between 2011 and 2015, in both settings—hospital or home—were collected from live birth records provided by the Informatics Department of the Unified Health System (DATASUS, in the Portuguese acronym). For the analysis, were included only data from low-risk deliveries, including gestational time between 37 and 41 weeks, singleton pregnancy, at least four visits of prenatal care, infants weighing between 2,500 g, and 4,000 g, mother age between 20-40 years old, and absence of congenital anomalies.

Results Home birth infants presented significantly higher risk of 0-5 Apgar scores, both in 1 minute (6.4% versus 3%, odds ratio [OR] = 2.2, confidence interval [CI] IC 2–2.4) and in 5 minutes (4.8% versus 0.4%, OR = 11.5, CI 10.5–12.7). Another finding is related to recovery estimates when from an initially bad 1-minute Apgar (< 6) to a subsequently better 5-minute Apgar (> 6). In this scenario, home infants had poorer recovery, Apgar score was persistently < 6 throughout the fifth minute in most cases (71% versus 10.7%, OR 20.4, CI 17–24.6).

Conclusion The results show worse Apgar scores for babies born at home, compared with those born at the hospital setting. This is a pioneer and preliminary study that brings attention concerning differences in Apgar score related to home versus hospital place of birth in Brazil.

Resumo

Objetivo Promover a escolha informada para as mulheres, comparando os resultados de partos domiciliares e hospitalares em relação à escala de Apgar.

Métodos Foram coletadas as informações maternas e a pontuação Apgar de nascidos de parto normal (pela definição, sem auxílio de fórcipe) no Brasil, de 2011 a 2015, a partir de registros de nascidos vivos disponibilizados pela plataforma do Departamento de Informática do Sistema Único de Saúde (DATASUS). Para a análise, incluímos somente dados de partos de baixo risco ocorridos em hospitais ou residências, incluindo tempo de gestação entre 37 e 41 semanas, gestação única, pelo menos quatro consultas de pré-natal, crianças com peso entre 2.500 g e 4.000 g, e idade materna entre 20 anos e 40 anos e ausência de anomalias congênitas.

Resultados Em comparação ao nascido em ambiente hospitalar, o nascido em domicílio apresentou risco significativamente maior de pontuação 0 a 5, tanto no primeiro minuto (6,4% versus 3%, razão de chance [RC] = 2,2, intervalo de confiança [IC] 2-2,4) como no quinto minuto (4,8% versus 0,4%; RC = 11,5; IC 10,5–12,7). Outro achado que merece destaque é em relação às estimativas de recuperação quando de um Apgar inicialmente ruim ao primeiro minuto (< 6) para um subsequente melhor (> 6) no quinto minuto. Neste cenário, os nascidos em domicílio apresentaram menor recuperação até o quinto minuto, persistindo em Apgar < 6 na maior parte dos casos (71% versus 10,7%; OR 20,4; IC 17-24,6).

Conclusão Os resultados indicam piores escalas de Apgar para bebês nascidos em ambiente domiciliar, em comparação àqueles nascidos em ambiente hospitalar. Este é um estudo pioneiro e preliminar que atenta para as diferenças na escala de Apgar em relação ao local de nascimento domiciliar versus hospitalar no Brasil.

Keywords

home birth - normal birth - apgar score

Palavras-chave

parto domiciliar - parto normal - escala apgar

Contributors

Bessa J. F. and Bonatto N. contributed with project and interpretation of data, writing of the article, critical review of the intellectual content and final approval of the version to be published.


 

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