Este artigo avaliou o uso das boas práticas (alimentação, deambulação, uso de métodos não farmacológicos para alívio da dor e de partograma) e de intervenções obstétricas na assistência ao trabalho de parto e parto de mulheres de risco obstétrico habitual. Foram utilizados dados da pesquisa Nascer no Brasil, estudo de base hospitalar realizada em 2011/2012, com entrevistas de 23.894 mulheres. As boas práticas durante o trabalho de parto ocorreram em menos de 50% das mulheres, sendo menos frequentes nas regiões Norte, Nordeste e Centro-oeste. O uso de ocitocina e amniotomia foi de 40%, sendo maior no setor público e nas mulheres com menor escolaridade. A manobra de Kristeller, episiotomia e litotomia foram utilizada, em 37%, 56% e 92% das mulheres, respectivamente. A cesariana foi menos frequente nas usuárias do setor público, não brancas, com menor escolaridade e multíparas. Para melhorar a saúde de mães e crianças e promover a qualidade de vida, o Sistema Único de Saúde (SUS) e, sobretudo o setor privado, necessitam mudar o modelo de atenção obstétrica promovendo um cuidado baseado em evidências científicas.

This study aims to describe prenatal care provided

BackgroundThe rate of preterm birth has been increasing worldwide, including in Brazil. This constitutes a significant public health challenge because of the higher levels of morbidity and mortality and long-term health effects associated with preterm birth. This study describes and quantifies factors affecting spontaneous and provider-initiated preterm birth in Brazil.MethodsData are from the 2011–2012 “Birth in Brazil” study, which used a national population-based sample of 23,940 women. We analyzed the variables following a three-level hierarchical methodology. For each level, we performed non-conditional multiple logistic regression for both spontaneous and provider-initiated preterm birth.ResultsThe rate of preterm birth was 11.5 %, (95 % confidence 10.3 % to 12.9 %) 60.7 % spontaneous - with spontaneous onset of labor or premature preterm rupture of membranes - and 39.3 % provider-initiated, with more than 90 % of the last group being pre-labor cesarean deliveries. Socio-demographic factors associated with spontaneous preterm birth were adolescent pregnancy, low total years of schooling, and inadequate prenatal care. Other risk factors were previous preterm birth (OR 3.74; 95 % CI 2.92–4.79), multiple pregnancy (OR 16.42; 95 % CI 10.56–25.53), abruptio placentae (OR 2.38; 95 % CI 1.27–4.47) and infections (OR 4.89; 95 % CI 1.72–13.88). In contrast, provider-initiated preterm birth was associated with private childbirth healthcare (OR 1.47; 95 % CI 1.09–1.97), advanced-age pregnancy (OR 1.27; 95 % CI 1.01–1.59), two or more prior cesarean deliveries (OR 1.64; 95 % CI 1.19–2.26), multiple pregnancy (OR 20.29; 95 % CI 12.58–32.72) and any maternal or fetal pathology (OR 6.84; 95 % CI 5.56–8.42).ConclusionThe high proportion of provider-initiated preterm birth and its association with prior cesarean deliveries and all of the studied maternal/fetal pathologies suggest that a reduction of this type of prematurity may be possible. The association of spontaneous preterm birth with socially-disadvantaged groups reaffirms that the reduction of social and health inequalities should continue to be a national priority.

BackgroundCaesarean section rates in Brazil have been steadily increasing. In 2009, for the first time, the number of children born by this type of procedure was greater than the number of vaginal births. Caesarean section is associated with a series of adverse effects on the women and newborn, and recent evidence suggests that the increasing rates of prematurity and low birth weight in Brazil are associated to the increasing rates of Caesarean section and labour induction.MethodsNationwide hospital-based cohort study of postnatal women and their offspring with follow-up at 45 to 60 days after birth. The sample was stratified by geographic macro-region, type of the municipality and by type of hospital governance. The number of postnatal women sampled was 23,940, distributed in 191 municipalities throughout Brazil. Two electronic questionnaires were applied to the postnatal women, one baseline face-to-face and one follow-up telephone interview. Two other questionnaires were filled with information on patients’ medical records and to assess hospital facilities. The primary outcome was the percentage of Caesarean sections (total, elective and according to Robson’s groups). Secondary outcomes were: post-partum pain; breastfeeding initiation; severe/near miss maternal morbidity; reasons for maternal mortality; prematurity; low birth weight; use of oxygen use after birth and mechanical ventilation; admission to neonatal ICU; stillbirths; neonatal mortality; readmission in hospital; use of surfactant; asphyxia; severe/near miss neonatal morbidity. The association between variables were investigated using bivariate, stratified and multivariate model analyses. Statistical tests were applied according to data distribution and homogeneity of variances of groups to be compared. All analyses were taken into consideration for the complex sample design.DiscussionThis study, for the first time, depicts a national panorama of labour and birth outcomes in Brazil. Regardless of the socioeconomic level, demand for Caesarean section appears to be based on the belief that the quality of obstetric care is closely associated to the technology used in labour and birth. Within this context, it was justified to conduct a nationwide study to understand the reasons that lead pregnant women to submit to Caesarean sections and to verify any association between this type of birth and it’s consequences on postnatal health.

ObjectiveTo analyze social inequalities and inequalities in access to and utilization of health care services according to skin color in a representative sample of postpartum women receiving hospital childbirth care. Methods A cross-sectional study was carried out in a sample of 9,633 postpartum women, of whom 5,002 were white (51.9%), 2,796 mulatto (29.0%), and 1,835 black skin color (19.0%), seen in public maternity hospitals, hospitals contracted out by the Unified National Health System, and private hospitals in the period 1999-2001. Data were collected from medical records and through interviews with the mothers in the immediate postpartum period using standardized questionnaires. Statistical analyses were performed using χ² tests to assess homogeneity of proportions and Student's t-test for comparison of measures. The analysis was stratified by maternal schooling. Results A persistent unfavorable situation was seen for mulatto and black women as compared to white women. Mulatto and black women had the highest rates of adolescent mothers, low schooling, unpaid occupation, and not having a partner. History of physical violence, smoking, attempts to interrupt pregnancy, and visits to several hospitals before being admitted were more frequent among black women, followed by mulatto and then white women of low schooling. High schooling group of women showed better indicators but the same pattern was seen. This variability is also seen in the opposite direction in terms of the level of satisfaction with prenatal and childbirth care. Conclusions It was distinguished two forms of discrimination, by educational level and skin color, in care delivered by health services to postpartum women in Rio de Janeiro.

Resumo ObjetivoObservar a evolução das taxas de fecundidade e identificar o papel da gravidez na adolescência como fator de risco para o baixo peso ao nascer (BPN). Métodos Em uma amostra de nascimentos provenientes do Sistema de Informações sobre Nascidos Vivos (SINASC/RJ), entre 1996 e 1998, os fatores determinantes do BPN foram analisados em dois grupos de mães, de 15 a 19 anos e de 20 a 24 anos. Foram estimadas as associações entre as variáveis pela razão dos produtos cruzadosOdds Ratio (OR) e respectivos intervalos de confiança. Utilizaram-se também procedimentos de regressão logística. Resultados O BPN foi significativamente maior entre o grupo de mães adolescentes do que no grupo de 20-24 anos. O pré-natal não foi realizado em 13% das adolescentes, enquanto 10% do outro grupo não tiveram atendimento. Quando realizado o pré-natal, as adolescentes tiveram menos consultas. No grupo de adolescentes, o percentual de prematuros foi significativamente maior que no outro grupo. Foram observadas diferenças por tipo de maternidade (públicas/privadas), com predomínio de uso das públicas pelas adolescentes. A análise de regressão logística mostrou que existe um efeito da idade materna na explicação do BPN, mesmo quando controlado por outras variáveis. Conclusões Os achados sugerem que investigações sobre os mecanismos explicativos da associação entre o BPN e a gravidez na adolescência devem ser realizadas, abrangendo fatores socioculturais como pobreza e marginalidade social, assim como os de natureza biológica e de alimentação na gravidez. Abstract Objective To identify the role of pregnancy during adolescence as a risk factor to low birth weight (LBW). Descritores

Resumo OBJETIVO: Avaliar a adequação do processo de assistência pré-natal segundo os parâmetros do Programa de Humanização do Pré-natal e Nascimento (PHPN), acrescido dos procedimentos previstos pela Rede Cegonha, no Sistema Único de Saúde (SUS) de uma microrregião do Espírito Santo, Brasil. MÉTODOS: Foi realizado um estudo transversal, em 2012-2013, por meio de entrevistas e de análise do Cartão da Gestante e do prontuário do recém-nascido, com 742 puérperas em 7 maternidades da região escolhida para a pesquisa. As informações foram coletadas, processadas e submetidas aos testes do χ 2 e exato de Fisher para testar a diferença de proporção entre os critérios adotados pelo PHPN mais a Rede Cegonha e o local de moradia, renda familiar mensal e modalidade de cobertura do serviço pré-natal. Foi considerado um nível de significância de 5%. RESULTADOS: Os parâmetros que apresentaram as menores taxas de adequação foram os testes rápidos e os exames de repetição, com frequências em torno de 10 e 30%, respectivamente, além das atividades educativas (57,9%) e da imunização antitetânica (58,7%). Já os parâmetros manejo do risco (92,6%) e exame de glicemia de jejum (91,3%) apresentaram os melhores resultados. Foi encontrada adequação de 7,4% para o PHPN, de 0,4% para a Rede Cegonha, no que diz respeito aos parâmetros da gravidez de risco habitual, e de 0 para os de alto risco. Houve diferença estatisticamente significante entre as puérperas segundo local de moradia para realização de sorologia para sífilis (VDRL), teste anti-HIV e repetição de glicemia de jejum, e a renda familiar mensal influenciou a realização dos exames tipagem sanguínea/fator Rh, VDRL, hematócrito e teste anti-HIV. CONCLUSÃO: A assistência pré-natal no SUS mostrou-se inadequada, de acordo com os procedimentos previstos pelo PHPN e Rede Cegonha na microrregião de um estado do Sudeste brasileiro, principalmente para as mulheres de menor renda, usuárias do PACS e residentes na zona rural. Abstract PURPOSE:To evaluate the adequacy of the process of prenatal care according to the parameters of the Program for the Humanization of Prenatal Care (PHPN) and of the procedures provided by the Stork Network of Unified Health System (SUS) in the microregion of Espirito Santo state, Brazil. METHODS: A cross-sectional study was conducted in 2012-2013 by interviewing and analyzing the records of 742 women during the postpartum period and of their newborns in 7 hospitals in the region chosen for the research. The information was collected, processed and analyzed by the χ 2 and Fisher's exact test to determine the difference in proportion between the criteria adopted by the PHPN and the Stork Network and the place of residence, family income and type of coverage of prenatal service. The level of significance was set at 5%. RESULTS: The parameters showing the lowest adequacy rate were quick tests and repeated exams, with frequencies around 10 and 30%, respectively, in addition to educational activities (57.9%) and tetanus immunization (58.7%). In contrast, risk managemen...

A cor da dor: iniquidades raciais na atenção pré-natal e ao parto no Brasil El color del dolor: inequidades raciales en la atención pre-natal y partos en Brasil