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...

Objectives: to analyze prenatal care process in primary health care units and compare the prenatal adequacy in the third trimester with maternal and perinatal outcomes. Methods: a cross-sectional study of 2,404 pregnant women assisted in 2011in twelve primary health care units in the South region of São Paulo city. The data was collected through medical records. The assessment was based on the indicators process of the Programa de Humanização do Pré-natal e Nascimento (PHPN) (Prenatal and Birth Humanization Program). The prenatal adequacy in the third trimester was analyzed according to three criteria (early-onset, minimum of six consultations and puerperal consultation); and the compared maternal and perinatal outcomes were: type of childbirth, gestational age, birth weight and breastfeeding. The analysis was descriptive for the PHPN indicators and comparative for the prenatal adequacy by the chi-square test. Results: early prenatal (82.9%), minimum of six consultations (73.0%) and puerperal consultation (77.9%). In the overall of the PHPN indicators, there was an expressive decrease in the medical records (10.2%). Prenatal care was adequate for 63.6% with a significant difference in relation to gestational age (p=0.037) and birth weight (p=0.001). Conclusions: There were deficiencies in prenatal care. The difference between the groups in the perinatal outcomes reinforcing the need for prenatal care according to national indicators.

Este estudo buscou analisar a assistência pré-natal oferecida às gestantes matriculadas no Programa de Pré-Natal (PN) em uma Unidade Básica de Saúde (UBS) da zona sul do Município de São Paulo. Os objetivos foram: descrever a organização e a estrutura da UBS; caracterizar as gestantes, conforme dados sociodemográficos e clínico-obstétricos; analisar o processo da assistência PN, conforme os indicadores de processo do Programa de Humanização do Pré-Natal e Nascimento (PHPN) ampliado, os critérios de adequação do pré-natal e o Índice de Kessner modificado por Takeda. Trata-se de um estudo transversal com coleta de dados por meio de entrevista com o responsável pela unidade e consulta aos dados de prontuários de gestantes matriculadas em 2011. A amostra compôs-se de 308 prontuários. A coleta de dados foi realizada entre dezembro de 2012 e março de 2013. O estudo integra o projeto "Assistência pré-natal em uma região da zona sul do Município de São Paulo" financiado pelo CNPq (Processo n o. 485264/2011-0), realizado em 12 UBS do Distrito de Capão Redondo em São Paulo que prestam atendimento às gestantes, pelo Programa Mãe Paulistana, no âmbito da Estratégia Saúde da Família (ESF). O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem da USP-Parecer nº. 145.651 e pelo Comitê de Ética em Pesquisa da Secretaria Municipal de Saúde de São Paulo-Parecer nº. 156.805. Os resultados mostraram que a estrutura do serviço atende aos requisitos para o desenvolvimento de ações preconizadas para a atenção PN, apesar da insuficiência de médicos. As gestantes eram jovens, média da idade 24 anos; 52,3% da raça parda; 58,2% com 8 a 11 anos de estudo; 43,6% com companheiro e filhos; 87,9'% casadas ou solteiras com união estável; 40,0% primigestas. Observou-se que: 82,1% da amostra iniciaram o PN até 16 semanas de gestação; 84,1% fizeram o número mínimo de seis consultas; 63,6% tiveram, pelo menos, uma consulta no primeiro trimestre, duas no segundo e três no terceiro; 16,2% iniciaram o PN até 16 semanas de gestação, realizaram o mínimo de seis consultas e todos os exames básicos; 13,3% iniciaram o PN até 16 semanas de gestação, fizeram o mínimo de seis consultas, os exames básicos e a consulta de puerpério (CP); 9,7% iniciaram o PN até 16 semanas de gestação, realizaram o mínimo de seis consultas, os exames básicos, a CP e a dose imunizante da vacina antitetânica; 67,5% eram imunes ou receberam a imunização antitetânica e 89,0% realizaram a CP. Pelo Índice de Kessner modificado por Takeda, 79,2% gestantes tiveram o PN adequado; 5,9% inadequado e 14,9% intermediário. Não foram encontradas diferenças entre os grupos PN adequado e inadequado em quase a totalidade das variáveis estudadas. Concluiu-se que a assistência pré-natal da ESF vem se mostrando como um modelo de atenção com bons resultados de adequação pré-natal aos critérios do PHPN e do Índice de Kessner modificado por Takeda. Não obstante, os registros mostraram falhas no atendimento à realização de exames básicos, imunizações e participação em grupos edu...