Avaliação da adequação da assistência pré-natal na rede SUS do Município do Rio de Janeiro, Brasil

Abstract

<jats:p>A persistência de desfechos perinatais negativos no Município do Rio de Janeiro, Brasil, sugere problemas na qualidade da assistência pré-natal. A última investigação realizada nessa cidade mostrou adequação de apenas 38% dessa assistência. O objetivo deste estudo é avaliar a adequação da assistência pré-natal na rede do SUS do Município do Rio de Janeiro. Foi realizado um estudo transversal, em 2007-2008, por meio de entrevistas com 2.422 gestantes em atendimento nos serviços de pré-natal de baixo risco. Para avaliação da adequação da assistência, foi utilizado o índice PHPN, com as recomendações do Programa de Humanização do Pré-natal e Nascimento, do Ministério da Saúde, e um índice PHPN ampliado, em que foram acrescentados procedimentos clinico-obstétricos, prescrição de sulfato ferroso suplementar e ações educativas. Foi encontrada adequação de 38,5% para o PHPN e 33,3% para o PHPN ampliado. Estratégias de ampliação da captação precoce das gestantes e melhor utilização dos contatos com os serviços para a realização de ações de atenção à saúde são prioritárias para a reversão desse quadro.</jats:p>

Evaluation of prenatal care in unit with family health strategy

“…However, it was lower than Botucatu, which ranged from 86.0% to 93.0%, (13) and Araguari, with 91.7% (14) . The number of six or more visits during PN was superior to several recent studies, which found 79.2% (1) 80.0 to 74.0% (15) , 80.0% (13) and 80.4% (16) , but lower than that of João Pessoa, with 89.9% (12) and Botucatu, with 94.0% in the FHSS and 97.0% in the traditional PHU (13) . Also, the combination of an early start of PN and conducting six consultations was higher than that found in two studies, one in São Paulo, at 63.1% (17) and another in Recife, at 38.0% (18) .…”

“…In this study, we found that the proportion of pregnant women enrolled in SISPRENATAL who adhered to this recommendation was higher than that found in a study in Rio de Janeiro and similar to that of a study from João Pessoa -74.4% to 83.6 % (1,12) . However, it was lower than Botucatu, which ranged from 86.0% to 93.0%, (13) and Araguari, with 91.7% (14) .…”

“…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.…”

“…Prenatal 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) .…”

“…

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.

…”