Point and interval estimates (CI 95%) of the indicators of good practices, health outcomes and adverse events indicators in childbirth care in Brazil and Mexico, 2015 and 2016
| Indicator | Brazil % (n/N) (CI 95%) | Mexico % (n/N) (CI 95%) | P value |
| Good practice indicators | |||
| Good practices general | |||
| Management of antibiotics during labour | 80.5 (318/395) (77.6 to 83.4) | 6.1 (130/2136) (5.2 to 7.0) | 0.000* |
| Management of magnesium sulfate at delivery for preeclampsia/eclampsia control | 7.4 (25/339) (5.5 to 9.3) | 14.0 (27/193) (12.7 to 15.3) | 0.014† |
| Management of antibiotics in the newborn | 90.7 (39/43) (88.6 to 92.8) | 73.2 (90/123) (71.5 to 74.9) | 0.017† |
| Good practices in admission | |||
| Partograph opening and filling | 44.9 (323/720) (41.3 to 48.5) | 88.7 (2400/2707) (87.5 to 89.9) | 0.000* |
| Good practices in the pre-expulsive phase of labour | |||
| Resolution of justified caesarean delivery | 91.7 (331/361) (89.7 to 93.7) | 61.3 (476/777) (59.5 to 63.1) | 0.000* |
| Performed justified instrumented childbirth | 50.0 (1/2) (46.3 to 53.7) | 72.5 (29/40) (70.8 to 74.2) | 0.513 |
| Performed justified episiotomy | 13.2 (7/53) (10.7 to 15.7) | 6.0 (49/823) (5.1 to 6.9) | 0.036† |
| Good practices in the immediate postpartum (Composite indicators) | |||
| Good practices in women | 28.0 (1009/3600) (24.7 to 31.3) | 65.8 (8903/13535) (64.0 to 67.6) | – |
| Good practices in newborns | 25.7 (1112/4320) (22.5 to 28.9) | 51.9 (8432/16242) (50.0 to 53.8) | – |
| Good practices in women and newborns | 26.8 (2121/7920) (23.6 to 30.0) | 58.2 (17335/29777) (56.3 to 60.1) | – |
| Health outcomes and adverse events indicators | |||
| Complications/Morbidity | |||
| Incidence of obstetric haemorrhage | 1.1 (8/720) (0.3 to 1.9) | 3.4 (91/2707) (2.7 to 4.1) | 0.00† |
| Incidence of pre-, intra- and postpartum blood pressure disorders | 47.1 (339/720) (43.5 to 50.7) | 7.1 (193/2707) (6.1 to 8.1) | 0.000* |
| Incidence of maternal postpartum infection | 2.5 (18/720) (1.4 to 3.6) | 3.9 (106/2707) (3.2 to 4.6) | 0.071 |
| Incidence of neonatal infection | 4.0 (29/720) (2.6 to 5.4) | 3.1 (84/2707) (2.4 to 3.8) | 0.217 |
| Incidence of neonatal asphyxia | 1.9 (14/720) (0.9 to 2.9) | 7.7 (208/2707) (6.7 to 8.7) | 0.000* |
| Interventions | |||
| Percentage of deliveries with caesarean section | 50.1 (361/720) (46.4 to 53.8) | 29.0 (777/2681) (27.3 to 30.7) | 0.000* |
| Percentage of instrumented deliveries | 0.6 (2/359) (0.3 to 1.2) | 2.1 (40/1904) (0.3 to 2.6) | 0.023† |
| Percentage of deliveries with episiotomy | 14.8 (53/359) (12.2 to 17.4) | 43.2 (823/1904) (41.3 to 45.1) | 0.000* |
| Adverse events in the women (Composite indicator) | 7.8 (56/720) (5.8 to 9.8) | 2.8 (75/2707) (2.2 to 3.4) | 0.000* |
| Blood transfusion | 1.4 (10/720) (0.5 to 2.3) | 1.0 (28/2707) (0.6 to 1.4) | 0.419 |
| Third- or fourth-degree laceration | 1.7 (6/359) (0.4 to 3.0) | 0.1 (3/1904) (0.0 to 0.2) | 0.000* |
| Maternal admission to ICU | 4.0 (29/720) (2.6 to 5.4) | 0.7 (19/2707) (0.4 to 1.0) | 0.000* |
| Postpartum hysterectomy | 1.4 (10/720) (0.5 to 2.3) | 0.3 (7/2707) (0.1 to 0.5) | 0.001† |
| Uterine rupture | 0.4 (3/720) (-0.1 to 0.9) | 0.1 (3/2707) (0.0 to 0.2) | 0.116 |
| Return to hospital after discharge | 0.6 (4/720) (0.0 to 1.2) | 0.6 (17/2707) (0.3 to 0.9) | 0.823 |
| Maternal death | 0.1 (1/720) (-0.1 to 0.3) | 0.1 (2/2707) (0.0 to 0.2) | 0.621 |
| Adverse events in newborns (Composite indicator) | 10.0 (72/720) (7.8 to 12.2) | 11.1 (300/2707) (9.9 to 12.3) | 0.407 |
| Admission to neonatal ICU >2500 g and for >24 hours | 1.5 (11/720) (0.6 to 2.4) | 2.2 (60/2707) (1.6 to 2.8) | 0.249 |
| Apgar<7 at 5 min | 1.9 (14/720) (0.9 to 2.9) | 0.7 (18/2707) (0.4 to 1.0) | 0.002† |
| Birth trauma (eg, head trauma, fracture, neurological injury, haemorrhage or laceration) | 0.1 (1/720) (-0.1 to 0.3) | 0.3 (9/2707) (0.1 to 0.5) | 0.352 |
| Newborn hospitalised for more than 7 days | 5.1 (37/720) (3.5 to 6.7) | 5.2 (140/2707) (4.4 to 6.0) | 0.972 |
| Foetal or neonatal death | 2.5 (18/720) (1.4 to 3.6) | 0.9 (25/2707) (0.5 to 1.3) | 0.001† |
| Adverse events in women and newborns (Composite indicator) | 16 (115/720) (13.3 to 18.7) | 12.9 (350/2707) (11.6 to 14.2) | 0.034† |
The case numbers of the composite indicators of good practice are higher than the total number of deliveries evaluated because, in each medical record, up to five good practices are performed for the mother and up to six good practices for the newborn (total of 11 good practices for the mother-child binomial).
The composite indicators were calculated by aggregating the simple good practices and adverse events indicators, which are described in table 1.
*Variable with p<0.001
†Variable with p<0.05.
n, numerator; N, denominator.