Evaluation of prenatal care in unit with family health strategy

Abstract

INTRODUCTIONPrenatal care (PN) may contribute to more favorable maternal and perinatal outcomes by enabling early detection and timely treatment of various diseases; in addition to the control of some risk factors that cause complications to women's health and that of newborns (1) .In Brazil, although infant mortality rates have decreased in recent decades, this decline has been uneven across states and municipalities, as well as between areas of a specific municipality (2,3) . To improve national rates and decrease these regional differences, the Brazilian government has taken several measures to increase women's access to prenatal care, in order to qualify the actions developed within it and to modify the model of health care for deliveries.For pregnant women of normal risk, the Program for Humanization of Prenatal and Birth (PHPB) established basic rules for qualified and humanized care, recommending a first prenatal care consultation before the fourth month of pregnancy, at least six prenatal visits (one in the first trimester of pregnancy, two in the second and three in the third), and puerperal consultation until 42 days after birth (4) .Furthermore, in the city of São Paulo, with the goal of improving the quality of maternal-infant care, the Network for the Protection of the Paulistana Mother (Rede de Proteção à Mãe Paulistana) was created in 2006 (5) , which works by way of articulation, integration and monitoring of ambulatory healthcare services as well as municipal and state hospitals. This program aims to ensure: registration and connection of pregnant women to primary healthcare units (PHU) near their homes; inclusion of pregnant women exclusively in the primary healthcare network, regulating the entry point into the healthcare system; linking of pregnant women to reference hospitals in their region and means of transport.Despite the expansion of teams in the Family Health Strategy Service (FHSS) in the municipal healthcare system in São Paulo, the most recent study that evaluated the quality of the prenatal care network occurred in the mid-2000s (6) , and did not specifically focus on primary care. Therefore, there is a knowledge gap, especially in the regions of greatest vulnerability in São Paulo. Recent studies indicate that prenatal care offered by FHSS teams is more in line with the regulations of the PHPB than in the PHU, which has a more traditional organization (7,8) .The objectives of this study were therefore constituted as follows: to analyze the healthcare process of PN in a unit of the FHSS, in accordance with the indicators of the PHPB, and compare the adequacy of the PN with sociodemographic variables, clinical procedures and obstetrics, examinations and maternal and perinatal outcomes. METHODThis study is part of the project Prenatal assessment in a region of the southern area of São Paulo, funded by the National Council for Scientific and Technological Development -CNPq (Case No. 485.264/2011-0), approved by the Research Ethics Committee of the sponsoring institution and the co-par...

Satisfaction Level of New Mothers with Prenatal Care and the Healthcare Professionals Who Provide It

“…She was the one that most often listened to their worries during the pregnancy and who gave them security and peace of mind. In line with our results, Corrêa et al (23) found that women placed a high value on the preparation and competence of midwives who helped them to cope with their psychological and emotional needs as well as with those of their partner. They wanted the midwives to listen to them and to treat them as individuals.…”

Assistência de enfermagem no pré-natal de baixo risco na atenção primária

“…O empreendimento de aferir o perfil e os aspectos dos enfermeiros no processo assistencial da atenção pré-natal transita pela precisão em ponderar e avaliar o panorama e as qualidades das atividades executadas, mediante a tomada de novas decisões. 7,8 Os O cuidado integral e humanizado, oferta de insumos necessários e a intervenção precoce diante certos sinais e sintomas realizados pela enfermagem devem contribuir de maneira significativa para que haja efetividade nos modelos preconizados pelo MS, propendendo à melhoria nos indicadores de morbi-mortalidade. 15 Por sua vez, auxiliando tais indicadores, as ações educativas no decorrer do ciclo gravídico-puerperal, torna-se ferramenta importante, particularmente, no pré-natal, por orientar a mulher na futura vivência do parto de forma positiva, com menor risco de complicações no puerpério, desencadeando maior sucesso no cuidado com o bebê.…”

“…O que podem interferir no acompanhamento é a não adesão ao uso da medicação prescrita para o período gestacional de acordo com a necessidade, e as dificuldades em agendar/realizar os exames solicitados. 7,8 As consultas do pré-natal de baixo risco devem ser realizadas mensalmente e apesar da gestação ser entendida como um processo fisiológico e que na grande maioria das vezes transcorre sem complicações, são preconizadas pelo Ministério da Saúde -MS, no mínimo seis consultas. 9 Assim, as mulheres que não apresentam complicações no decorrer da gravidez são classificadas como grupo de gestantes de baixo risco e as que desenvolvem problemas durante o período gestacional ou evoluem com potenciais complicações para a mãe e feto compõe o grupo de gestantes de alto risco.…”

Mortality among children under the age of one: analysis of cases after discharge from maternity *

“…The improvement of prenatal care quality in Brazil could prevent those maternal and infant deaths considered to be preventable. This demands evaluating health services in order to qualify that care (19) . Most of the women in this study had no addiction; however, among those with some addiction the risk of death of the child has clearly doubled.…”