Avaliação da qualidade da assistência hospitalar obstétrica: uso de corticóides no trabalho de parto prematuro

Abstract

This study aimed to assess quality of obstetric care for preterm labor patients, using referents, indicators, and standards derived from scientific evidence, focusing on antenatal corticotherapy. Available meta-analyses and randomized controlled trials were examined to establish referents, defining indicators and estimating process and outcome standards for the present study. Data from hospital discharge summaries of seven public maternity hospitals in Rio de Janeiro were analyzed. The standard of process used was 100%. It was not possible to estimate outcome standards, since the necessary adjustment for gestational age was not feasible. Utilization of antenatal corticotherapy in the present study was very low, about 4% and 2%, considering patients up to 33 weeks and 6 days and 36 weeks and 6 days, respectively. Failure to use antenatal corticotherapy when formally indicated deserves attention by health planners and managers, considering: a) the ease in incorporating such a technology, in contrast to the adequate incorporation of special/intensive neonatal care; b) benefits and costs associated with this technology compared to those of delivering neonatal care to premature babies.

A population-based, multifaceted strategy to implement antenatal corticosteroid treatment versus standard care for the reduction of neonatal mortality due to preterm birth in low-income and middle-income countries: the ACT cluster-randomised trial

“…6,9–12 An important determinant is that less than half of births in low-income countries occur in hospitals with antenatal corticosteroids available. 13,14 Although institutional delivery is increasing, access to tertiary care similar to that in hospitals in middle-income or high-income countries is poor for most women in low-income countries.…”

Antenatal treatment with corticosteroids for preterm neonates: impact on the incidence of respiratory distress syndrome and intra-hospital mortality

“…The use of antenatal corticosteroids for fetal maturation is one of these procedures. 2 The initial studies on antenatal corticosteroids had their scientific grounding in investigations on animals done in the 1960s. In these, it was noted that glucocorticoids were capable of accelerating the development process of organs and systems, especially for the lungs.…”

“…In a study covering seven public maternity hospitals in Rio de Janeiro, the antenatal corticosteroid utilization was 4% and 2% for patients with gestational ages of under 34 and up to 36 weeks, respectively. 2 Another survey was done on premature infants with birth weights of under 1,500 g, born in eight neonatal intensive care units at university hospital referral facilities in various Brazilian states, during the period from March 1998 to December 1999. This showed an average utilization rate for antenatal corticosteroids of 29%, varying between 10% and 39% across the eight facilities.…”

Neonatal mortality: description and effect of hospital of birth after risk adjustment

“…Previous studies in Brazil showed evidence of structural defi ciencies in hospitals and professional skill-related problems which contributed to low quality care during labor and delivery. 5,6,9 In addition, some studies also showed low rates of prenatal corticosteroid therapy utilization in preterm labor, 12,15 even though scientifi c evidence has proven that prenatal corticosteroids reduce the incidence of respiratory distress syndrome by more than 50% in babies born before 34 weeks gestation, thus reducing morbidity and mortality. 7,16 The present study fi ndings suggest that hospital procedures towards delivery should be carefully investigated as an important source of variability between hospitals with a good prospect of reducing infant mortality.…”