indications of cesarean births in hospitals affiliate to the unified health system: low and high risks

Objective: To analyze indications for cesarean births in patients of the Unified Health System (SUS) in low- (HSL) and high-risk (CHS) in Sorocaba, São Paulo, Brazil. Methods: Retrospective study of the medical records of patients hospitalized in these hospitals undergoing cesareans from March 1st, 2014 to March 3rd, 2015. The research evaluated maternal socio-epidemiological, reproductive and clinical parameters, indications of cesarean sections and neonatal data of the newborns. Results: From the total births, cesareans were indicated in 56.3% (CHS) and 32.4% (HSL), with statistical significance (p<0.001). Patients with previous cesarean prevailed in HSL (77.0%) compared to the CHS (56.4%), with statistically significant proportions (p=0.0009). The prevalent cesareans indications HSL were: fetal distress (24.0%), failure to induce labor (22.0%), and cephalopelvic disproportion (18.7%). In CHS the highest proportions were: fetal distress (35.3%) and iterativity (25.3%), revealing statistical significance (p<0.0001). Conclusions: The study shows that the proportions of cesarean deliveries in both maternities are higher than those recommended by the World Health Organization (WHO). The probable reduction in the proportion of cesarean deliveries in the low-risk maternity unit could come with precise indications of parturition induction, the use of analgesia during childbirth, and even the proper practice of low transvaginal fetal extraction by forceps. In relation to high-risk patients, such a decrease in cesarean sections will be subordinated to the best attention given by public health care politics to Brazilian women.