Objective:Identifying factors associated to Caesarean sections among the residents of Maringá-PR, according to the financing source for delivery. Methods: A crosssectional study with data from 920 postpartum women interviewed between October 2013 and February 2014. Association analysis was performed by logistic regression. Results: Caesarean section rates were 55.5% in the Unified Healthcare System (SUS) and 93.8% in the private system. Factors associated with Caesarean section in the SUS were: previous Caesarean section (OR=8.9; CI=4.6-16.9), desire for Caesarean section early in pregnancy (OR=2.0; CI=1.1-3.6), pregestational overweight/obesity (OR=1.8; CI=1.1-2.8), and per capita family income higher than one minimum wage (OR=2.1; CI=1.3-3.4). In the private system, desire for Caesarean section early in pregnancy (OR=25.3) and a previous Caesarean section (OR=11.3) were strongly associated to its performance. Conclusion: It is necessary to properly orientate all pregnant women who desire a Caesarean delivery, from both the SUS and the private system, about the inherent risks of the surgical procedure without indication. In the public health sector, guidelines should be focused on pregnant women with previous Caesarean delivery, with a per capita income higher than one minimum wage and those who are overweight or obese, as these women are more likely to have a Caesarean section.

Objective:To assess the quality of prenatal care in mothers with premature and term births and identify maternal and gestational factors associated with inadequate prenatal care. Method: Cross-sectional study collecting data with the pregnant card, hospital records and interviews with mothers living in Maringa-PR. Data were collected from 576 mothers and their born alive infants who were attended in the public service from October 2013 to February 2014, using three different evaluation criteria. The association of prenatal care quality with prematurity was performed by univariate analysis and occurred only at Kessner criteria (CI=1.79;8.02). Results: The indicators that contributed most to the inadequacy of prenatal care were tests of hemoglobin, urine, and fetal presentation. After logistic regression analysis, maternal and gestational variables associated to inadequate prenatal care were combined prenatal (CI=2.93;11.09), nonwhite skin color (CI=1.11;2.51); unplanned pregnancy (CI=1.34;3.17) and multiparity (CI=1.17;4.03). Conclusion: Prenatal care must follow the minimum recommended protocols, more attention is required to black and brown women, multiparous and with unplanned pregnancies to prevent preterm birth and maternal and child morbimortality. Factors associated with the quality of prenatal care: an approach to premature birth Fatores associados à qualidade do pré-natal: uma abordagem ao nascimento prematuro Factores asociados con la calidad del prenatal: un abordaje al nacimiento prematuro DESCRIPTORS

Aiming to analyze the spatial distribution and self-correlation of data of mother-child health in Parana, Brazil, variables were selected from the Information System on Live Births, grouped into socioeconomic indicators: teenage mother, low education, high parity, race/color black of newborn; healthcare indicators: the prenatal coverage, prematurity and cesarean delivery and result indicators: low birth weight. The indicators were distributed in thematic maps and spatial self-correlation was measured using Moran's index that quantifies the degree of self-correlation. There was significant spatial self-correlation of teenage mother, low education and high parity of the "high-high" type in the macro-regions East, Campos Gerais and South; of low coverage of antenatal care in Campos Gerais, Central-south and North and of cesarean delivery in the Northwest. Elevated proportions of indicators of risk to the health of mother and child were found in the regions East, Campos Gerais and South.These results support the evaluation and planning of health services. Houve autocorrelação espacial significativa de mãe adolescente, baixa escolaridade e alta paridade do tipo "alto-alto" nas macrorregionais Leste, Campos Gerais e Sul; de baixa cobertura pré-natal em Campos Gerais, Centro-sul e Norte e de parto cesáreo na Noroeste. Proporções elevadas de indicadores de risco à saúde da mulher e da criança foram evidenciadas nas regiões Leste, Campos Gerais e Sul. Esses resultados permitem a avaliação e o planejamento dos serviços de saúde.

Objective To analyze the occurrence, profile and main causes of hospitalization during pregnancy according to the type of childbirth financial coverage. Method A cross-sectional population-based study carried out with puerperal women through a stratified sample, calculated according to the hospital and the type of childbirth financial coverage source: public sector (SUS) or private (not SUS). The sociodemographic profile, the rate of obstetric complications and the causes of hospitalization were analyzed, coded according to International Classification of Diseases. Results A total of 928 postpartum women were interviewed, of whom 32.2% reported at least one hospitalization during pregnancy. Those with childbirth covered by SUS were less favored because they were the majority among hospitalized women (57.2%), with a higher percentage of adolescents (18.1%), lower education level (91.8%), low family income (39.3%) and fewer prenatal consultations (25.3%). The most frequent causes of hospitalization were "other maternal diseases that complicate pregnancy" (24.6%) (with emphasis on anemia and influenza), urinary tract infection (13.1%), preterm labor (8.7%) and hypertension (7.2%). Conclusion Anemia, influenza, urinary tract infection, preterm labor and hypertension should especially be prevented and treated to avoid hospital admissions during pregnancy, especially among pregnant women covered by SUS.

Foram analisadas características dos nascidos vivos e mães residentes em municípios-sede de Regionais deSaúde no Paraná, em 2006, a partir do Sistema de Informações de Nascidos Vivos, segundo variáveis que podem representardesvantagem em saúde. Nos municípios-sede, em média, 19,4% das mães eram adolescentes, 35,9% tinham baixaescolaridade, 26,4% tiveram número insuficiente de consultas de pré-natal e 55% dos partos foram por cesariana. Existeheterogeneidade entre os municípios no Paraná, destacando-se Guarapuava, Paranaguá e Umuarama com elevadospercentuais indicativos de risco à mãe e ao bebê. Estes resultados evidenciam municípios que necessitam de maioresrecursos e políticas públicas específicas, descentralizadas e integralizadas, envolvendo gestores, profissionais de saúdee movimentos sociais organizados, no intuito de minimizar as desigualdades na saúde da população, em especial dapopulação materno-infantil.