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BackgroundIn Brazil, hospital childbirth care is available to all, but differences in access and quality of care result in inequalities of maternal health. The objective of this study is to assess the infrastructure and staffing of publicly financed labor and birth care in Brazil and its adequacy according to clinical and obstetric conditions potentially associated with obstetric emergencies.MethodsNationwide cross-sectional hospital-based study “Birth in Brazil: national survey into labor and birth” conducted in 2011–2012. Data from 209 hospitals classified as public (public funding and management) or mixed (public or private funding and private management) that generate estimates for 1148 Brazilian hospitals. Interview with hospital managers provided data for the structure adequacy assessment covering four domains: human resources, medications, equipment for women emergency care and support services. We conducted analysis of the structure adequacy rate according to type of hospital (public or mixed), availability of ICU and the woman obstetric risk using the X 2 test to detect differences in categorical variables with the level of statistical significance set at p <0.05.ResultsGlobal rate of adequacy of 34.8 %: 42.2 % in public hospitals and 29.0 % in mixed hospitals (p < 0.001). Public and mixed hospitals with ICU had higher scores of adequacy than hospitals without ICU (73.3 % × 24.4 % public hospitals; 40.3 % × 10.6 % mixed hospitals). At a national level, 32.8 % of women with obstetric risk were cared for in hospitals without ICU and 29.5 % of women without risk were cared for in hospitals with ICU. Inequalities were observed with the North, Northeast and non-capital regions having the lower rates of hospitals with ICU.ConclusionsThe majority of maternity wards across the country have a low rate of adequacy that can affect the quality of labor and birth care. This holds true for women at high obstetric risk, who suffer the possibility of having their care compromised by failures of hospital infrastructure, and for women at low obstetric risk, who may not receive the appropriate care to support the natural evolution of their labor when in a technological hospital environment.

(18) Fluorodeoxyglucose (FDG)-PET and PET-CT are highly accurate diagnostics tools for DTC recurrence in patients who present a negative whole-body scintigraphy and could impact the clinical and therapeutic management of DTC.

A mortalidade materna é uma questão complexa e permanece sendo um grave problema de saúde pública. Este artigo se propõe a olhar esse fenômeno sob a ótica do direito à saúde, destacando que a opção por trazer a discussão para o campo dos direitos humanos proporcionou a ampliação de sua explicação e uma apresentação mais clara à sociedade. É apresentada breve trajetória da inserção desse tema na agenda política global, explorando algumas iniciativas internacionais e nacionais. O quadro atual da mortalidade materna no Brasil é apenas a face mais visível da precariedade da atenção à saúde das mulheres. A situação se agrava quando são considerados os casos de morbidade materna grave, que afeta um expressivo número de mulheres. Apesar das iniciativas para a efetivação do direito à maternidade segura, ainda são poucos os avanços, e a sociedade deve exigir que o Estado reverta o quadro de injustiça contra as mulheres.

The results from implementing a strategy for monitoring adverse effects from drugs in a public hospital in the municipality of Rio de Janeiro, Southeastern Brazil, in 2007, were analyzed. Based on retrospective analysis of 32 medical files, adverse effects were found in 16%. To identify these effects, 38 tracking criteria were needed. Among these, the main ones were the use of antiemetics, abrupt cessation of medication and oversedation. Despite the difficulties, especially in relation to access to information and the record quality, application of these tracking criteria seems to be viable. To improve the implementation of the method, it is suggested that the data collection should be computerized and risk adjustment indicators should be sought.

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BackgroundMaternal morbidity and mortality are still serious public health concerns in Brazil, and access to quality obstetric care is one critical point of this problem. Despite efforts, obstetric care quality problems and sub-optimal/poor outcomes persist. The study aimed to identify contextual elements that would potentially affect the implementation of an obstetric care quality improvement intervention.MethodsA qualitative study was conducted in three public maternity hospitals of a large Brazilian city, with high annual volume of births and buy-in from high-level managers. Individual interviews with doctors and nurses were conducted from July to October 2015. Semi-structured interviews sought to explore teamwork, coordination and communication, and leadership, being open to capture other contextual elements that could emerge. Interviews were recorded and transcribed, and the categories of analysis were identified and updated based on the constant comparative method.ResultsTwenty-seven interviews were carried out. Extra-organizational context concerning the dependence of the maternity hospitals on primary care units, responsible for antenatal care, and on other healthcare organizations’ services emerged from interviews, but the main findings of the study centered on intra-organizational context with potential to affect healthcare quality and actions for its improvement, including material resources, work organization design, teamwork, coordination and communication, professional responsibility vis-à-vis the patient, and leadership. A major issue was the divergence of physicians' and nurses' perspectives on care quality, which in turn negatively affected their capacity to work together.ConclusionOverall, the findings suggest that care on the maternity hospitals was fragmented and lacked continuity, putting at risk the quality. Redesigning work organization, promoting conditions for multi-professional teamwork, better communication and coordination, improving more systemic accountability/lines of authority, and investing in team members’ technical competence, and fitness of organizational structures and processes are all imbricated actions that may contribute to obstetric care quality improvement.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2088-3) contains supplementary material, which is available to authorized users.

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