Qualidade do processo da assistência pré-natal: unidades básicas de saúde e unidades de Estratégia Saúde da Família em município no Sul do Brasil

Abstract

O processo da atenção pré-natal em unidades básicas de saúde tradicionais (UBS) e unidades de Estratégia Saúde da Família (ESF) foi avaliado em Santa Maria, Rio Grande do Sul, Brasil. Foram entrevistadas 795 puérperas que realizaram pré-natal nas UBS ou ESF. Utilizou-se quatro níveis de qualidade: nível 1 (índice de Kessner modificado por Takeda); nível 2, que adiciona ao nível 1 procedimentos clinico-obstétricos; nível 3, que acrescenta ao nível 1 exames laboratoriais; e nível 4, que considera todos os parâmetros anteriores. A atenção pré-natal realizada na ESF foi superior a das UBS em todos os níveis, com diferenças estatisticamente significativas nos níveis 1 e 2. As gestantes da ESF receberam mais orientações. A atenção pré-natal foi favorável à ESF, devendo ser melhorada em relação aos procedimentos e exames, a fim de aprimorar a assistência pré-natal e fortalecer a atenção primária à saúde.

Evaluation of prenatal care in unit with family health strategy

“…The proportion of records of tests found in this study was higher than or similar to other studies (1,7,8) , with a decline between the first consultation and the 30th week. This result is disturbing, as the tests provide information about the health status of pregnant women; they are also important in screening for diseases that could have negative consequences for mothers and fetuses, for example, sexually transmitted diseases such as syphilis, hepatitis B and AIDS, as well as anemia, gestational diabetes, maternal-fetal blood incompatibility, asymptomatic bacteriuria of pregnancy and toxoplasmosis.…”

“…Also, there is a possibility of error in the execution of the tests, due to lack of specific materials, damaged equipment, delay in returning the results and loss of samples, among others. In a study conducted in the metropolitan region of São Paulo, among the hypotheses put forward to explain the low coverage of examinations in the third trimester, it is highlighted that professionals do not request the tests because they are out of the habit, and that some pregnant women fail to take tests even when they have been ordered (22) .The proportion of records of tests found in this study was higher than or similar to other studies (1,7,8) , with a decline between the first consultation and the 30th week. This result is disturbing, as the tests provide information about the health status of pregnant women; they are also important in screening for diseases that could have negative consequences for mothers and fetuses, for example, sexually transmitted diseases such as syphilis, hepatitis B and AIDS, as well as anemia, gestational diabetes, maternal-fetal blood incompatibility, asymptomatic bacteriuria of pregnancy and toxoplasmosis.…”

“…Thus, health care for women during pregnancy should only be considered complete after puerperal consultation (19) . The National Survey on Demography and Health (2006) (20) showed that women attend a postpartum consultation in only 29% of births, emphasizing that this important stage of care has been neglected.Despite the higher or similar percentage of puerperal consultation compared to that found in other studies (7,13,21) , we emphasize the need for attention from staff in order to increase the number of women with puerperal consultations, given the importance of healthcare provided in this period to decreasing maternal and perinatal morbidity and mortality.A limitation of the present study is that the data were obtained from the medical records of pregnant women, because some actions may have been carried out and not recorded, and this aspect should be considered when interpreting the results.It is considered, therefore, that errors in the medical records regarding testing and tetanus immunizations may have affected the final outcome of the adequacy of prenatal care. Also, there is a possibility of error in the execution of the tests, due to lack of specific materials, damaged equipment, delay in returning the results and loss of samples, among others.…”

“…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) .…”

“…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. …”