Acompañamiento prenatal de la gestación de alto riesgo en el servicio público

el estudio transversal analítico, realizado en una maternidad pública en el Sur de Brasil, durante la internación de 319 puérperas, por medio de un instrumento semiestructurado para la transcripción de los registros de la tarjeta prenatal y la entrevista. Se realizó análisis de los datos por medio del Test Qui-Cuadrado (p≤0,05).

Resultados:

la adecuación del prenatal fue alta (74%); 22,6% intermedio; 3,4% ineficiente. El prenatal tuvo alta cobertura (100%), inicio precoz (81,5%) y realización de seis o más consultas (92,4%), pero (77,4%) no recibieron información sobre enfermedad gestacional y resultados de exámenes (69,3%). Se observó una significativa estadística entre la calidad del prenatal y el lugar de la realización del prenatal (p=0,005).

Conclusión:

se evidenció la necesidad de implementación de protocolo específico a la gestación de alto riesgo y educación continuada a los equipos.

Descriptores:
Salud de la Mujer; Atención Prenatal; Embarazo de Alto Riesgo; Educación en Salud; Salud Pública

Variable	n	%
Age (years)
14-19	35	11.0
20-35	225	70.5
36 and over	59	18.5
Race
White	182	57.0
Brown	95	29.8
Black	42	13.2
Marital status
With a partner	277	86.8
Without a partner	42	13.2
Residence place
Rural zone	24	7.5
Urban zone	295	92.5
Origin city
Londrina	190	59.6
Other city	129	40.4
Schooling
Elementary education	91	28.5
High school	178	55.8
Higher education	49	15.4
Work type
Paid	143	44.8
Unpaid	176	55.2
Family income^* * Minimum wage base in 2017 - R$980.00 (R$ (real) - Brazilian currency) (R$980.00 is about 245 US dollars).
Up to 1 minimum wage	49	15.4
From 2 to 3 minimum wages	115	35.3
More than 3 minimum wages	155	49.3
Parity
Primiparous	122	38.2
Secundiparous	105	32.9
Multiparous	92	28.8
Interpregnancy interval
Less than 2 years	39	12.2
More than 2 years	169	53.0
Pregnancy was planned
Yes	140	43.9
No	179	56.1
Total	319	100.0

Variable	n	%
Care
Knowledge on the reason of referral to high-risk pregnancy
Yes	279	87.5
No	12	3.8
Maternity visit
Yes	22	6.9
No	292	91.5
Follow-up at BHU
Yes	259	81.2
No	42	13.2
Guidance
Guidance on maternal breastfeeding
Yes	114	35.7
No	205	64.3
Guidance on fetal development
Yes	86	27.0
No	233	73.0
Guidance on delivery type
Yes	75	23.5
No	244	76.5
Guidance on medication use
Yes	97	30.4
No	222	69.6
Guidance on gestational illness
Yes	72	22.6
No	247	77.4
Guidance on sex education
Yes	41	12.9
No	278	87.1
Guidance on physical activities
Yes	46	14.4
No	273	85.6
Guidance on exams results
Yes	98	30.7
No	221	69.3
Guidance on postpartum follow-up
Yes	38	11.9
No	281	88.1
Guidance on what hospital to go to in case of emergency
Yes	273	85.6
No	25	7.8
Total	319	100.0

Variable	Efficient prenatal quality		Non-efficient prenatal quality		Total		OR	p value^* * Chi-Square test (p<0.05)
Variable	n	%	n	%	n	%	OR	p value^* * Chi-Square test (p<0.05)
Place of prenatal performance
Primary Care	41	17.4	27	32.5	68	21.3	0.436	0.005
Secondary and Primary Care	195	82.6	56	67.5	251	78.7
City of prenatal performance
Londrina		38.6	48	57.8	139	43.6	0.458	0.003
Other municipalities of Paraná State		61.4	35	42.2	180	56.4
Waiting time for high-risk follow-up
Up to 1 week	41	21.1	17	29.8	58	23.1	-	0.210
Above 1 week	153	78.9	40	70.2	193	76.9
Prenatal onset
<14th week	216	92.3	39	49.4	255	81.5
14th - 27th week	18	7.7	36	45.6	54	17.3	-	0.0001
>27th week	-	-	4	5.1	4	1.3
Number of consultations
6 or more	234	99.2	57	72.2	291	92.4
0-2	-	-	1	1.3	1	0.3		0.0001
3-5	2	0.8	21	26.6	23	7.3
Number of ultrasounds in the 1st quarter
1	113	47.9	37	44.6	150	47.0
2 or more	100	42.4	22	26.5	122	38.2	-	0.0001
No records	23	9.7	24	28.9	47	14.7
Gestational age at the first ultrasound
Up to 14th week	193	81.8	47	56.6	240	75.2	-
15ª to 27th week	26	11.0	22	26.5	48	15.0		0.0001
Above the 27th week	-	-	3	3.6	3	0.9
Oncotic cytology collection
Collected in less than 1 year	61	25.8	31	37.8	92	28.9
Collected at prenatal	91	38.6	39	47.6	130	40.9	-	0.0001
Not performed	84	35.6	11	14.6	95	30.2
Participation in pregnant women group
Yes	60	25.4	15	18.1	75	23.5	-
No	176	74.6	68	81.9	244	76.5		0.174
Guidance on what hospital to go to in case of emergency
Yes	185	78.4	56	67.5	241	75.5	1.749	0.046
No	51	21.6	27	32.5	78	24.5
Interval between the first and last consultation and delivery
0-15 days	213	90.3	67	80.7	280	87.8	2.212	0.031
16 days and more	23	9.7	16	19.3	39	12.2
Total	236	100.0	83	100.0	319	100.0

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding Author: Fabiana Fontana Medeiros. E-mail: fontana.fabi@hotmail.com