(OR = 1.9; hemorrhage (OR = 2.2; hypertension (OR = 3.0; syphilis (OR = 3.3; lack of prenatal care (OR = 5.6;, cesarean section and hospital, were associated with near miss; while hemorrhage (OR = 4.6; 95%CI: 1,, lack of prenatal care (OR = 17.4;

OBJECTIVETo compare collaborative and traditional childbirth care models.METHODSCross-sectional study with 655 primiparous women in four public health system hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for the collaborative model and 322 for the traditional model, including those with induced or premature labor). Data were collected using interviews and medical records. The Chi-square test was used to compare the outcomes and multivariate logistic regression to determine the association between the model and the interventions used.RESULTSPaid work and schooling showed significant differences in distribution between the models. Oxytocin (50.2% collaborative model and 65.5% traditional model; p < 0.001), amniotomy (54.3% collaborative model and 65.9% traditional model; p = 0.012) and episiotomy (collaborative model 16.1% and traditional model 85.2%; p < 0.001) were less used in the collaborative model with increased application of non-pharmacological pain relief (85.0% collaborative model and 78.9% traditional model; p = 0.042). The association between the collaborative model and the reduction in the use of oxytocin, artificial rupture of membranes and episiotomy remained after adjustment for confounding. The care model was not associated with complications in newborns or mothers neither with the use of spinal or epidural analgesia.CONCLUSIONSThe results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes.

Risco reprodutivo e renda familiar: análise do perfil de gestantesReproductive risk and family income: analysis of the profile of pregnant women

This cross-sectional study of 831 low-risk pregnancies compared the management of labor and delivery in a birthing center, a hospital that had previously won the "Galba de Araújo" Award (for excellence in obstetric and neonatal care), and a standard-protocol maternity facility. The rates for use of ocytocin during labor were 27. 9%, 59.5%, and 40.1%, while amniotomy was performed in 67.6%, 73.6%, and 82.2% IntroduçãoA assistência obstétrica no Brasil é caracterizada pelo emprego inapropriado de intervenções no processo fisiológico do trabalho de parto, cujo uso abusivo pode levar a efeitos danosos para mãe e filho 1,2,3 . Além de desconfortos físicos para a mulher e dos riscos associados às altas taxas de partos cirúrgicos, de episiotomias e do uso rotineiro da ocitocina e da amniotomia, acumulamse evidências sobre uma epidemia de prematuridade tardia causada pela interrupção eletiva e sem indicação clínica precisa da gravidez 4,5 .A taxa de cesárea, indicador importante do modelo de atenção chamado de "tecnicista" que está em vigor no Brasil 1,2,6 , alcançou em 2006 uma média nacional de 43,8% 7 . Essa tendência foi concomitante ao aumento da prematuridade que variou entre 3,4% e 15% em diferentes regiões do país 4 . A episiotomia, outro indicador importante, apresenta média nacional de 71,6% 7 , e estudos no Rio de Janeiro mostraram uso de ocitocina entre 39,3% e 64,4% 8,9 .Apesar do acesso praticamente universal ao pré-natal e ao parto hospitalar em todo país e dos avanços importantes no conhecimento científico, observa-se um paradoxo na assistência obstétri-ca brasileira: as mulheres e seus recém-nascidos adoecem e morrem tanto pela falta quanto pelo uso inapropriado e inseguro da tecnologia 2 .Entendendo-se como modelo de atenção a forma de organização das práticas assistenciais, ARTIGO ARTICLE Vogt SE et al.

OBJECTIVE The objective of this study was to test the validity of the pragmatic criteria of the definitions of neonatal near miss, extending them throughout the infant period, and to estimate the indicators of perinatal care in public maternity hospitals.METHODS A cohort of live births from six maternity hospitals in the municipalities of São Paulo, Niterói, and Rio de Janeiro, Brazil, was carried out in 2011. We carried out interviews and checked prenatal cards and medical records. We compared the pragmatic criteria (birth weight, gestational age, and 5’ Apgar score) of the definitions of near miss of Pileggi et al., Pileggi-Castro et al., Souza et al., and Silva et al. We calculated sensitivity, specificity (gold standard: infant mortality), percentage of deaths among newborns with life-threatening conditions, and rates of near miss, mortality, and severe outcomes per 1,000 live births.RESULTS A total 7,315 newborns were analyzed (completeness of information > 99%). The sensitivity of the definition of Pileggi-Castro et al. was higher, resulting in a higher number of cases of near miss, Souza et al. presented lower value, and Pileggi et al. and de Silva et al. presented intermediate values. There is an increase in sensitivity when the period goes from 0–6 to 0–27 days, and there is a decrease when it goes to 0–364 days. Specificities were high (≥ 97%) and above sensitivities (54% to 77%). One maternity hospital in São Paulo and one in Niterói presented, respectively, the lowest and highest rates of infant mortality, near miss, and frequency of births with life-threatening conditions, regardless of the definition.CONCLUSIONS The definitions of near miss based exclusively on pragmatic criteria are valid and can be used for monitoring purposes. Based on the perinatal literature, the cutoff points adopted by Silva et al. were more appropriate. Periodic studies could apply a more complete definition, incorporating clinical, laboratory, and management criteria, including congenital anomalies predictive of infant mortality.

OBJECTIVE:To analyze factors associated with failure to breastfeed during the first hour of life, especially the influence of time of delivery of rapid HIV test results. METHODS:Cohort study, beginning with the administration of the rapid test and ending the first time the baby is breastfed. The study population included 944 delivering mothers that received rapid HIV testing with a negative result in five Baby-Friendly hospitals of the High-Risk Pregnancy System in the city of Rio de Janeiro, Southeastern Brazil, in 2006. Trained interviewers obtained data from laboratory and patient charts and interviewed mothers shortly after delivery. The influence of sociodemographic variables and antenatal and delivery care characteristics on failure to breastfeed during the first hour of life was determined through a multilevel model. RESULTS:Among participants, 15.6% received the result of rapid HIV testing before delivery, 30.8% after delivery, and 53. 6% had not yet been informed of their results at the time of the interview. Prevalence of failure to breastfeed in the first hour of life was 52.5% (95% CI: 49.3;55.8). After adjustment, having received the result of rapid testing only after delivery doubled the risk of failing to breastfeed in the first hour (RR=2.06; 95% CI: 1.55;2.75). Other risk factors included nonwhite skin color, maternal income of up to one minimum wage, delivery by C-section, mother's lack of desire to breastfeed at birth, and mother's report that the hospital staff did not listen to her. Lack of knowledge of HIV testing from the mother's part was found to be a protective factor. CONCLUSIONS:The major risk factor for not breastfeeding in the first hour of life was failure to receive the results of rapid HIV testing prior to delivery. HIV testing should be made widely available during antenatal care; rapid testing should be performed upon admission, only when indicated, and with active search and prompt delivery of results to expecting mothers.

A recorrência da gravidez na adolescência é tema pouco estudado no Brasil, sendo necessário o debate dos direitos reprodutivos dessa parcela da população. Realizou-se estudo transversal com dados das Declarações de Nascidos Vivos de mães adolescentes residentes na cidade do Rio de Janeiro (RJ) do ano de 2005, com o objetivo de conhecer a magnitude e as características associadas à gravidez recorrente (GR). Foram estimadas razões de prevalência de GR com intervalos de confiança (IC) de 95% para variáveis selecionadas através de regressão multivariada log-binomial. Entre 12.168 adolescentes, identificou-se prevalência de GR de 29,1%. Os principais fatores associados à GR foram: idade 15-19 anos (RP=5,42 IC95% 3,72-7,81); não realizar pré-natal (RP=2,36 IC95% 2,16-2,58); escolaridade<4anos (RP=1,48 IC95% 1,25-1,76); ocupação dona de casa (RP=1,8 IC 95% 1,57-2,15) ou outra (RP=1,9 IC95% 1,73-2,10). Parto cesáreo e baixo peso foram associados negativamente a GR com RP iguais a 0,94 (IC95% 0,86-0,99) e 0,69 (IC95% 0,62-0,77). As adolescentes com gravidez recorrente tiveram indicadores socioeconômicos e assistenciais piores do que aquelas na primeira gravidez. Políticas sociais específicas para adolescentes mães em situação de vulnerabilidade possibilitariam melhores condições para o exercício de seus direitos reprodutivos.

OBJETIVOS: avaliar a implantação da Iniciativa Hospital Amigo da Criança no Rio de Janeiro. MÉTODOS: pesquisa avaliativa realizada em 2009, com sete hospitais credenciados (HAC) e oito não (HNC), do SUS. Avaliação de estrutura (Passos 1 e 2) realizada por observação e entrevista a 215 profissionais. Avaliações de processo (Passos 3 a 10) e resultado compreenderam entrevista em amostra representativa de 461 gestantes, 687 mães em alojamento conjunto e 148 mães com recém-nascido em unidade neonatal. O grau de implantação foi avaliado segundo o cumprimento de cada passo e de parâmetros compreendidos nestes passos. A correlação entre grau de implantação e desfechos foi analisada por meio de regressão linear: aleitamento materno (AM) na primeira hora, AM exclusivo (AME) e satisfação das mulheres com o apoio recebido. RESULTADOS: os graus de implantação variaram de 9 a 5 passos (90,6% a 70,1% dos parâmetros) cumpridos nos HAC e de 5 a 1 passo (76,1% a 43,9% dos parâmetros) nos HNC. Foi encontrada correlação linear significativa entre o grau de implantação, expresso em passos e parâmetros, respectivamente, e o AM na primeira hora (r=0,78 e r=0,74), o AME (r=0,72 e r=0,69), e a satisfação (r=0,69 e r=0,73). CONCLUSÕES: ambas as formas de avaliação mostraram-se consistentes com os resultados. Os HAC apresentaram um desempenho superior aos HNC, sendo necessário um investimento na sustentabilidade desta iniciativa.