Prenatal care Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):717-724
DOI 10.1590/S0100-72032003001000004
PURPOSE: to evaluate the adequacy of the prenatal care process offered to users of the Unified Health Care System (SUS) in Juiz de Fora-MG and to compare the municipal services. METHODS: a transversal study with auditing was carried out on the records of 370 pregnant women, selected by systematic sampling among women who carried their pregnancies to term and gave birth using SUS services in the first semester of 2002, with prenatal care given in Juiz de Fora. For statistical analysis the c² test was used to compare the municipal services (level of significance: 5%). The evaluation followed a three-tiered complementary sequence, using: the utilization of prenatal care (Kessner index: beginning and frequency of care) at level 1; the utilization of prenatal care and basic laboratory tests, according to the Humanization Program of Prenatal Care and Birth (ABO-Rh, hemoglobin/hematocrit, VDRL, glycemia and urinalysis), at level 2; and the utilization of prenatal care, the basic laboratory tests and the obligatory clinical-obstetric procedures during a prenatal visit (assessment of blood pressure, weight, edema, uterine fundal height, gestational age, fetal heart rate and fetal presentation), at level 3. RESULTS: the observed adequacy of the process was only 26.7% (level 1), 1.9% (level 2) and 1.1% (level 3). We also observed a prenatal coverage of 99.04%, an average of 6.4 visits per pregnant woman, and an average gestational age of 17.4 weeks at the time of the first prenatal visit. There were no significant differences between the municipal services. CONCLUSIONS: prenatal care offered to SUS users in Juiz de Fora should be reviewed from a qualitative standpoint, and periodic evaluations as necessary instruments of improvement are recommendable. Managers and professionals should undertake actions aimed at increasing compliance with norms/routines of the program - principally the request/recording of basic complementary tests - and which guarantee increased utilization of prenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):717-724
DOI 10.1590/S0100-72032003001000004
PURPOSE: to evaluate the adequacy of the prenatal care process offered to users of the Unified Health Care System (SUS) in Juiz de Fora-MG and to compare the municipal services. METHODS: a transversal study with auditing was carried out on the records of 370 pregnant women, selected by systematic sampling among women who carried their pregnancies to term and gave birth using SUS services in the first semester of 2002, with prenatal care given in Juiz de Fora. For statistical analysis the c² test was used to compare the municipal services (level of significance: 5%). The evaluation followed a three-tiered complementary sequence, using: the utilization of prenatal care (Kessner index: beginning and frequency of care) at level 1; the utilization of prenatal care and basic laboratory tests, according to the Humanization Program of Prenatal Care and Birth (ABO-Rh, hemoglobin/hematocrit, VDRL, glycemia and urinalysis), at level 2; and the utilization of prenatal care, the basic laboratory tests and the obligatory clinical-obstetric procedures during a prenatal visit (assessment of blood pressure, weight, edema, uterine fundal height, gestational age, fetal heart rate and fetal presentation), at level 3. RESULTS: the observed adequacy of the process was only 26.7% (level 1), 1.9% (level 2) and 1.1% (level 3). We also observed a prenatal coverage of 99.04%, an average of 6.4 visits per pregnant woman, and an average gestational age of 17.4 weeks at the time of the first prenatal visit. There were no significant differences between the municipal services. CONCLUSIONS: prenatal care offered to SUS users in Juiz de Fora should be reviewed from a qualitative standpoint, and periodic evaluations as necessary instruments of improvement are recommendable. Managers and professionals should undertake actions aimed at increasing compliance with norms/routines of the program - principally the request/recording of basic complementary tests - and which guarantee increased utilization of prenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):391-396
DOI 10.1590/S0100-72032001000600008
Purpose: to evaluate the prescription of prenatal fluoride supplements by gynecologists and obstetricians in Curitiba and metropolitan region. Methods: two hundred and twenty-three (223) questionnaires were distributed to gynecologist-obstetricians. Questions were about the use of fluoride during pregnancy, time since graduation, workplace, among other parameters. Statistical analyses were carried out using Student's t-test, variance analysis (ANOVA), chi² test or Fisher exact test. Results: only 137 questionnaires were returned, which corresponds to 30% (137/441) of the professionals in the studied area and 61.4% (137/223) of the distributed questionnaires. Of the professionals, 47.5% prescribe fluoride as a supplement during pregnancy. Sixty percent of professionals who prescribe fluoride believe that this procedure leads to a better dental formation and caries prevention in the baby. The professionals who do not prescribe prenatal fluoride graduated more recently than the professionals who prescribe it (t=2.27, p<0.05). Moreover, the professionals who work exclusively in the public service prescribe less than those who work only in the private sector (Fisher exact test, p<0.05). Conclusion: there is a large percentage of gynecologist-obstetricians who still prescribe fluoride in the prenatal period, in spite of the recent studies that have not observed any benefit to the child. Therefore, there is a need to update these professionals about the mechanism of action, indication and clinical use of fluoride.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):391-396
DOI 10.1590/S0100-72032001000600008
Purpose: to evaluate the prescription of prenatal fluoride supplements by gynecologists and obstetricians in Curitiba and metropolitan region. Methods: two hundred and twenty-three (223) questionnaires were distributed to gynecologist-obstetricians. Questions were about the use of fluoride during pregnancy, time since graduation, workplace, among other parameters. Statistical analyses were carried out using Student's t-test, variance analysis (ANOVA), chi² test or Fisher exact test. Results: only 137 questionnaires were returned, which corresponds to 30% (137/441) of the professionals in the studied area and 61.4% (137/223) of the distributed questionnaires. Of the professionals, 47.5% prescribe fluoride as a supplement during pregnancy. Sixty percent of professionals who prescribe fluoride believe that this procedure leads to a better dental formation and caries prevention in the baby. The professionals who do not prescribe prenatal fluoride graduated more recently than the professionals who prescribe it (t=2.27, p<0.05). Moreover, the professionals who work exclusively in the public service prescribe less than those who work only in the private sector (Fisher exact test, p<0.05). Conclusion: there is a large percentage of gynecologist-obstetricians who still prescribe fluoride in the prenatal period, in spite of the recent studies that have not observed any benefit to the child. Therefore, there is a need to update these professionals about the mechanism of action, indication and clinical use of fluoride.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(9):575-580
DOI 10.1590/S0100-72032001000900005
Purpose: to check alcohol consumption during pregnancy regarding type of drink, amount ingested, awareness of alcohol consumption risk, and tracking its consumption during prenatal care. Methods: interview of 445 women who had just given birth in a maternity hospital from January to May, 1999. The data analysis was performed using Student's t test and Kruskal-Wallis nonparametric test. Results: of the women interviewed, 66.3% did not consume alcohol, 17.8% consumed it throughout pregnancy and 15.9% consumed it until pregnancy was confirmed, which occurred when they were 9.6 weeks pregnant on average; 98.7% of the women consumed it on weekends or at parties, and 1.3% daily. The mean ingestion was 14.74 grams/occasion for those who consumed alcohol throughout pregnancy and 25.83% grams/occasion for those who consumed it until pregnancy was confirmed. There were statistical differences between the mean rates in both groups. The mean intake per occasion was classified as moderate. The most ingested alcoholic beverage was beer (64.0%). Regarding awareness of the risk of alcohol intake, 71.5% believe that it is not good for the fetus health, 15.5% believe that it is not good for their own health. Alcohol consumption tracking was referred to by 48.8% of the women. Conclusion: a great number of women consumed alcoholic drinks at some time during pregnancy, despite being aware of the risks to their fetus. Prenatal care is not used as a favorable occasion for alcohol consumption tracking as well as for discontinuing its intake.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(9):575-580
DOI 10.1590/S0100-72032001000900005
Purpose: to check alcohol consumption during pregnancy regarding type of drink, amount ingested, awareness of alcohol consumption risk, and tracking its consumption during prenatal care. Methods: interview of 445 women who had just given birth in a maternity hospital from January to May, 1999. The data analysis was performed using Student's t test and Kruskal-Wallis nonparametric test. Results: of the women interviewed, 66.3% did not consume alcohol, 17.8% consumed it throughout pregnancy and 15.9% consumed it until pregnancy was confirmed, which occurred when they were 9.6 weeks pregnant on average; 98.7% of the women consumed it on weekends or at parties, and 1.3% daily. The mean ingestion was 14.74 grams/occasion for those who consumed alcohol throughout pregnancy and 25.83% grams/occasion for those who consumed it until pregnancy was confirmed. There were statistical differences between the mean rates in both groups. The mean intake per occasion was classified as moderate. The most ingested alcoholic beverage was beer (64.0%). Regarding awareness of the risk of alcohol intake, 71.5% believe that it is not good for the fetus health, 15.5% believe that it is not good for their own health. Alcohol consumption tracking was referred to by 48.8% of the women. Conclusion: a great number of women consumed alcoholic drinks at some time during pregnancy, despite being aware of the risks to their fetus. Prenatal care is not used as a favorable occasion for alcohol consumption tracking as well as for discontinuing its intake.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(9):617-622
DOI 10.1590/S0100-72032002000900008
Purpose: to study the influence of the prenatal care, fetal and maternal factors on the stillbirth rates of a university hospital from the south of Brazil. Methods :a case-control study of the cases of stillbirth occurred before the beginning of labor, from March 1998 to June 2001, at the Hospital Geral of Caxias do Sul University. The controls were selected among live newborns. The analysis of the quality of the prenatal care was based on the criteria established by the Programa de Humanização do Pré-natal e Nascimento of the Brazilian Health Ministry (2000). To evaluate possible risk factors for stillbirth we used the odds ratio (OR). Other confounding factors were evaluated by logistic regression. Results: preterm delivery was more prevalent in the cases of stillbirth (31.7+4.7 vs 38.6+0.9). The average birth weight among the stillborns was 1,705 g (+837 g), while in the controls it was 3,080 g (+576 g). Prenatal care was observed in 81.5% of the stillbirths and in 91.6% of the control group. The initial analysis showed that three factors were associated with stillbirth: inadequate prenatal care (43.6 vs 23.4%), history of previous stillbirth (6.6 vs 0.9%) and maternal age (27+7.9 years vs 24+6.4 years). Nevertheless, after adjustment of these variables through logistic regression, only the maternal age maintained its association with the stillbirth rates. Conclusions: in the present study, the strongest factor associated with the occurrence of stillbirth was the increase in maternal age.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(9):617-622
DOI 10.1590/S0100-72032002000900008
Purpose: to study the influence of the prenatal care, fetal and maternal factors on the stillbirth rates of a university hospital from the south of Brazil. Methods :a case-control study of the cases of stillbirth occurred before the beginning of labor, from March 1998 to June 2001, at the Hospital Geral of Caxias do Sul University. The controls were selected among live newborns. The analysis of the quality of the prenatal care was based on the criteria established by the Programa de Humanização do Pré-natal e Nascimento of the Brazilian Health Ministry (2000). To evaluate possible risk factors for stillbirth we used the odds ratio (OR). Other confounding factors were evaluated by logistic regression. Results: preterm delivery was more prevalent in the cases of stillbirth (31.7+4.7 vs 38.6+0.9). The average birth weight among the stillborns was 1,705 g (+837 g), while in the controls it was 3,080 g (+576 g). Prenatal care was observed in 81.5% of the stillbirths and in 91.6% of the control group. The initial analysis showed that three factors were associated with stillbirth: inadequate prenatal care (43.6 vs 23.4%), history of previous stillbirth (6.6 vs 0.9%) and maternal age (27+7.9 years vs 24+6.4 years). Nevertheless, after adjustment of these variables through logistic regression, only the maternal age maintained its association with the stillbirth rates. Conclusions: in the present study, the strongest factor associated with the occurrence of stillbirth was the increase in maternal age.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):471-477
DOI 10.1590/S0100-72032002000700007
Purpose: to assess the diagnostic and therapeutic aspects and the complications of symptomatic urinary tract infections (UTI) during pregnancy of patients who were hospitalized. Methods: a total of 136 pregnant women with a clinical diagnosis of pyelonephritis were studied. The studied parameters were: age and parity of patients, gestational age of diagnosis, epidemiologic aspects, laboratory evaluation for UTI, treatment and clinic evolution, prophylaxis and complications. Results: pyelonephritis was diagnosed at the same proportions at all gestational ages. The incidence of UTI was higher among primigravidae. Only 29.3% of the pregnant women had a previous history of UTI; 57.0% were anemic and 93.0% had altered urinalysis. Escherichia coli was the most prevalent uropathogen (75.8% of cases), with low percentages of sensitivity to ampicillin (60.6%) and high percentages of sensitivity to cefuroxime (95,5%). The highest rate of clinical improvement was obtained for the pregnant women treated with cefuroxime (95.7%). Prophylaxis was needed in 11.0% of the patients. Preterm labor occurred in 33.3% of the pregnant women who delivered in our service and preterm delivery occurred in 18.9%. Conclusions: the present results support the need for an early diagnosis and effective treatment of UTI in pregnant women in order to prevent the frequent occurrence of perinatal complications such as premature labor and delivery. We emphasize the need of a periodical evaluation of the pattern of sensitivity of the etiologic agents to the antimicrobials allowed for use during pregnancy, with cefuroxime being adopted as the antibiotic of choice for the treatment of UTI during pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):471-477
DOI 10.1590/S0100-72032002000700007
Purpose: to assess the diagnostic and therapeutic aspects and the complications of symptomatic urinary tract infections (UTI) during pregnancy of patients who were hospitalized. Methods: a total of 136 pregnant women with a clinical diagnosis of pyelonephritis were studied. The studied parameters were: age and parity of patients, gestational age of diagnosis, epidemiologic aspects, laboratory evaluation for UTI, treatment and clinic evolution, prophylaxis and complications. Results: pyelonephritis was diagnosed at the same proportions at all gestational ages. The incidence of UTI was higher among primigravidae. Only 29.3% of the pregnant women had a previous history of UTI; 57.0% were anemic and 93.0% had altered urinalysis. Escherichia coli was the most prevalent uropathogen (75.8% of cases), with low percentages of sensitivity to ampicillin (60.6%) and high percentages of sensitivity to cefuroxime (95,5%). The highest rate of clinical improvement was obtained for the pregnant women treated with cefuroxime (95.7%). Prophylaxis was needed in 11.0% of the patients. Preterm labor occurred in 33.3% of the pregnant women who delivered in our service and preterm delivery occurred in 18.9%. Conclusions: the present results support the need for an early diagnosis and effective treatment of UTI in pregnant women in order to prevent the frequent occurrence of perinatal complications such as premature labor and delivery. We emphasize the need of a periodical evaluation of the pattern of sensitivity of the etiologic agents to the antimicrobials allowed for use during pregnancy, with cefuroxime being adopted as the antibiotic of choice for the treatment of UTI during pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):293-299
DOI 10.1590/S0100-72032002000500002
Purpose: to study the prenatal care among Public Health Service ("Sistema Único de Saúde") users from Caxias do Sul - RS. Methods: a transversal study of 702 pregnancies attended at the Hospital Geral -Universidade de Caxias do Sul from March 2000 to March 2001 based on the criteria set by the "Programa Nacional de Humanização do Pré-natal e Nascimento (PNHPN)" of the Brazilian Ministry of Health. Results: the observed prenatal coverage was 95.4%, whereas the average of visits was 6.2. The main reported reason for not following prenatal care was the lack of information about its importance (65.6%). In 51.5% of the cases, prenatal care started in the third month of pregnancy, whereas 44.3% of the pregnant women carried out all the proposed complementary tests. Prenatal care was considered inappropriate in 64.8% and appropriate in 35.2% of the cases. The quality of prenatal attention was significantly associated with the mother's education, as well as with the number of previous deliveries. The higher the educational level, the better the quality of observed prenatal care (p=0.0148). In addition, the higher number of previous deliveries showed to be associated with a later beginning of prenatal care and a lower number of visits (p=0.0008). Conclusions: the prenatal care available at Caxias do Sul in spite of its good coverage, should be reviewed in terms of quality. Special attention should be given to education in health along the prenatal assistance.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):293-299
DOI 10.1590/S0100-72032002000500002
Purpose: to study the prenatal care among Public Health Service ("Sistema Único de Saúde") users from Caxias do Sul - RS. Methods: a transversal study of 702 pregnancies attended at the Hospital Geral -Universidade de Caxias do Sul from March 2000 to March 2001 based on the criteria set by the "Programa Nacional de Humanização do Pré-natal e Nascimento (PNHPN)" of the Brazilian Ministry of Health. Results: the observed prenatal coverage was 95.4%, whereas the average of visits was 6.2. The main reported reason for not following prenatal care was the lack of information about its importance (65.6%). In 51.5% of the cases, prenatal care started in the third month of pregnancy, whereas 44.3% of the pregnant women carried out all the proposed complementary tests. Prenatal care was considered inappropriate in 64.8% and appropriate in 35.2% of the cases. The quality of prenatal attention was significantly associated with the mother's education, as well as with the number of previous deliveries. The higher the educational level, the better the quality of observed prenatal care (p=0.0148). In addition, the higher number of previous deliveries showed to be associated with a later beginning of prenatal care and a lower number of visits (p=0.0008). Conclusions: the prenatal care available at Caxias do Sul in spite of its good coverage, should be reviewed in terms of quality. Special attention should be given to education in health along the prenatal assistance.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(4):253-259
DOI 10.1590/S0100-72032002000400007
Purpose: to determine the frequency of enteroparasitoses in a group of pregnant women undergoing low-risk antenatal care and their association with anemia, maternal nutritional status, schooling and the existence of a bathroom in the home. Methods: to a sample of pregnant women who had begun low-risk antenatal care at IMIP's Maternal Health Care Center between May 2000 and July 2001, a cross-sectional design was applied to determine the frequencies of enteroparasitoses (Hoffman method, in a single sample) and anemia (Hb <11.0 g/dL), nutritional status (through BMI standardized for stage of pregnancy) and social indicators (schooling and the existence of a bathroom in the home). Results: in a sample of 316 pregnant women, a rate of 37.4% enteroparasitosis was detected, of which 31.6% was infestation by a single parasite. The most commonly found parasite species were Entamoeba histolytica (13.3%) and Ascaris lumbricoides (12.0%). Anemia was detected in 55.4% of the pregnant women, malnutrition in 25.0% and overweight or obesity in 24.1%. There was a statistically significant association between enteroparasitosis and schooling. However, no association of, enteroparasitosis, anemia, maternal nutritional status with the existence of a bathroom in the home was noted. Conclusions: The prevalence of enteroparasitoses and anemia is high, albeit without any association of the two conditions, while schooling was statistically associated with the presence of intestinal parasites.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(4):253-259
DOI 10.1590/S0100-72032002000400007
Purpose: to determine the frequency of enteroparasitoses in a group of pregnant women undergoing low-risk antenatal care and their association with anemia, maternal nutritional status, schooling and the existence of a bathroom in the home. Methods: to a sample of pregnant women who had begun low-risk antenatal care at IMIP's Maternal Health Care Center between May 2000 and July 2001, a cross-sectional design was applied to determine the frequencies of enteroparasitoses (Hoffman method, in a single sample) and anemia (Hb <11.0 g/dL), nutritional status (through BMI standardized for stage of pregnancy) and social indicators (schooling and the existence of a bathroom in the home). Results: in a sample of 316 pregnant women, a rate of 37.4% enteroparasitosis was detected, of which 31.6% was infestation by a single parasite. The most commonly found parasite species were Entamoeba histolytica (13.3%) and Ascaris lumbricoides (12.0%). Anemia was detected in 55.4% of the pregnant women, malnutrition in 25.0% and overweight or obesity in 24.1%. There was a statistically significant association between enteroparasitosis and schooling. However, no association of, enteroparasitosis, anemia, maternal nutritional status with the existence of a bathroom in the home was noted. Conclusions: The prevalence of enteroparasitoses and anemia is high, albeit without any association of the two conditions, while schooling was statistically associated with the presence of intestinal parasites.