To explore attitudes of physicians attending births in the public and private sectors and at the managerial level toward cesarean birth in Nicaragua. A qualitative study was conducted consisting of four focus groups with 17 physicians and nine in-depth interviews with decision-makers. Although study participants listed many advantages of vaginal birth and disadvantages of cesarean birth, they perceived that the increase in the cesarean birth rate in Nicaragua has resulted in a reduction in perinatal morbidity and mortality. They ascribed high cesarean birth rates to a web of interrelated provider, patient, and health system factors. They identified five actions that would facilitate a reduction in the number of unnecessary cesarean operations: establishing standards and protocols; preparing women and their families for labor and childbirth; incorporating cesarean birth rate monitoring and audit systems into quality assurance activities at the facility level; strengthening the movement to humanize birth; and promoting community-based interventions to educate women and families about the benefits of vaginal birth. Study participants believe that by performing cesarean operations they are providing the best quality of care feasible within their context. They do not perceive problems with their current practice. The identified causes of unnecessary cesarean operations in Nicaragua are multifactorial, so it appears that a multi-layered strategy is needed to safely reduce cesarean birth rates. The recent Nicaraguan Ministry of Health guidance to promote parto humanizado ("humanization of childbirth") could serve as the basis for a collaborative effort among health care professionals, government, and consumer advocates to reduce the number of unnecessary cesarean births in Nicaragua.

Background The incidence of placenta accreta has increased in recent years and it has been suggested that the rising trend in cesarean delivery and other uterine surgery is the underlying cause. Objective To explore the magnitude of the effect of performing single and repeat cesarean deliveries or other uterine surgery on the incidence of placenta accreta. Search strategy Relevant databases were searched for papers published before August 1, 2018, using terms including “accreta” and “cesarean.” Selection criteria Cohort studies assessing the risk of placenta accreta according to women's history of uterine surgery. Data collection and analysis Meta‐analyses were performed to assess the risks associated between uterine surgery and placenta accreta, hysterectomy, and uterine rupture. The I2 statistic was used to examine between‐study heterogeneity. Main results The risk of placenta accreta in a second pregnancy increased for women who had undergone a cesarean in their first pregnancy compared with vaginal delivery (OR 3.02; 95% CI, 1.50–6.08). Absolute risk of placenta accreta increased with the number of previous cesareans. The risk of uterine rupture and hysterectomy was also associated with the number of cesareans. Conclusions Risk of placenta accreta, hysterectomy, and uterine rupture increases with the number of previous cesarean deliveries. PROSPERO: CRD42016050646.

Este artículo presenta una sistematización del Proyecto Redes, Salud y Alimentos llevado adelante por un equipo interdisciplinario de docentes de la Universidad de la República (Udelar) en 2018 en la localidad de San Antonio, Departamento de Canelones, Uruguay. El proyecto tuvo como objetivo promover la creación de un espacio para la promoción integral de la salud y la agroecología desde el enfoque de la Ecosalud. A nivel académico el proyecto se propuso promover la producción de conocimiento interdisciplinario en torno a los ejes de salud humana, construcción social de la salud y producción agroecológica de alimentos. Material y métodos. En el territorio, desde un enfoque de Ecosalud, se generaron acciones de prevención y promoción de la salud a partir de una concepción holística y sistémica de las relaciones ambientales y humanas. Se incorporó la perspectiva agroecológica, considerando a los alimentos y su sistema de producción como determinantes de la sustentabilidad ambiental y de la seguridad y soberanía alimentaria. Resultados. Como resultados destacamos el logro de los objetivos de promover la participación e integración del saber comunitario y haber creado un espacio de promoción de la salud integral, en sintonía con los pilares de la Carta de Shangai, “Promoción de la salud en la Agenda 2030 para el desarrollo sostenible”. Discusión. Esta experiencia es una respuesta a los desafíos que enfrenta la academia, en su afán de aportar al desarrollo de la sociedad. Sus desarrollos pueden verse también son pilares teóricos y ejes de acción de una nueva Salud Pública.