Características sociodemográficas e de assistência à gestação e ao parto no extremo sul do Brasil

Adequacy of Prenatal Care in Northeast Brazil: Pilot Data Comparing Attainment of Standard Care Criteria for First-Time Adolescent and Adult Pregnant Women

Background

Adolescent pregnancy is a public health concern worldwide, particularly in low-income settings. Adolescent mothers face higher risks during pregnancy and delivery compared to adult mothers and yet, may also experience worse quality of obstetrical care. This study evaluates adherence to meeting Brazilian recommendations for prenatal care by comparing first-time adolescent versus adult mothers in a rural, low-income setting.

Methods

Using data from the Adolescence and Motherhood Research (AMOR) project, we evaluated adherence to national recommendations as documented in the prenatal cards of 39 adolescents (13-18 years) and 37 adults (23-28 years) from a low-income area in northeast Brazil. Recommendations included ≥6 prenatal consultations, gestational age ≤12 weeks at the first visit, participation in 3 educational activities, 2 serology for syphilis (VDRL) and HIV, 1 Toxoplasmosis serology, 2 urine tests, 2 blood glucose and 2 hemoglobin/hematocrit (Hb/Ht) exams. Chi-square tests were used to compare the proportions of adolescents and adults with a record of these procedures in the prenatal cards.

Results

Compared to adult women, the adolescent group had lower attainment of almost all recommended components of prenatal care compared to the adult group, with statistically significant differences for 2 blood glucose tests (46.2% vs 78.4%; p=0.004), 2 VDRL tests (30.8% vs 54.1%; p=0.040), 2 Hb/Ht exams (35.9% vs 83.8%; p<0.001), and at least 6 consultations (84.6% vs 100%; p=0.013).

Conclusion

Despite greater health risks of adolescent fertility, the prenatal cards of adolescent mothers presented a poorer record of adherence to recommendations for adequate prenatal care compared to adult mothers from a low-income setting of Brazil. Health policies for both health professionals and the target population are needed to ensure adequacy of prenatal care and appropriate risk reduction for this vulnerable population.

Adolescent pregnancy trends in the last decade

INTRODUCTION

Teenage pregnancy is a universal phenomenon, with higher prevalence in developing countries. Although there has been a reduction in Brasil since the year 2000, the age-specific fertility rate for this age group remains high.

OBJECTIVE

To evaluate the frequency of adolescence pregnancy in in Brasil from 2006 to 2015 and its association with the Human Development Index (HDI).

METHODS

A descriptive epidemiological study, conducted by searching the database of the Department of Informatics of the Unified Health System (DATASUS), using information from the Information System on Live Births (SINASC) for the five Brazilian regions.

RESULTS

There was a reduction in the percentage of live births (LB) from adolescent mothers (10 to 19 years old) in Brasil by 13.0% over the last ten years. This decline was observed in all Brazilian regions among mothers aged 15 to 19 years. The number of LB increased by 5.0% among mothers aged 10 to 14 years in the North and decreased in the other regions, with higher rates in the South (18.0%). The specific fertility rate for the 15-19-year-old group decreased from 70.9/1,000 to 61.8/1,000 in the period. The proportion of LB is inversely associated with the HDI, except in the Northeast (the lowest HDI in the country), where there was a significant reduction (18.0%) among mothers aged 15-19 and 2% among those aged 10-14 years.

CONCLUSION

Teenage pregnancy in Brasil is in slow decline, especially among mothers aged 10-14 years and is inversely associated with the HDI, except in the Northeast.

Evaluation of prenatal care in Primary Health Care in Brazil

Abstract Objectives: to evaluate prenatal care in Primary Care by identifying the aspects that influence structural and operational adequacy. Methods: evaluation research with analysis of 4,059 municipalities that joined the 2nd cycle of the Program for Improving Access and Quality in Primary Care in 2013-2014. The evaluative model composed of 19 indicators grouped in structural aspects and operational aspects dimensions was validated in a consensus conference. Data analysis was descriptive, with the issuance of value judgment. Results: in structural aspects, 32.6% of the municipalities presented adequacy, whilst in operational ones, only 24.1%. In the general prenatal evaluation, less than a quarter (24.6%) of the municipalities was adequate, those with up to 10 thousand inhabitants had a higher percentage of adequacy (41.6%). The South region presented adequacy of 33.8%, considering all sizes. Conclusions: most municipalities presented low adequacy in prenatal care, with better performance of structural aspects. Smaller municipalities presented better results in all analyzed items. Structural aspects and general evaluation of prenatal care are highlighted in the South region. Adequate attention to prenatal care needs to be comprehensive and equitable, with the strengthening of regional networks geared towards social inclusion.

Spatio-temporal trends in the risk of adolescent pregnancy in Minas Gerais, Brazil, 2000-2015

PURPOSE

To investigate, through a spatio-temporal analysis, the association between the percentages of live births of adolescent mothers (LBAM) and the human development index (HDI), including the three components: income, education and longevity.

METHODS

The percentage of LBAM was obtained from the Brazilian Live Births Information System for the state of Minas Gerais, Brazil in the period 2000-2015 and the HDI data and its components were obtained from United Nations Development Program's (UNDP) Human Development Reports. A generalized additive model (GAM) was used to estimate the relative risk of LBAM in relation to the HDI and to identify spatial clusters of the geographical distribution of LBAM, the Moran global and local index was used.

RESULTS

There is an association between the HDI and its components with LBAM. The high values of relative risk are spatially concentrated in the northern part of the state of Minas Gerais. The graphs indicated a nonlinear relationship between LBAM over the years.

CONCLUSIONS

There is a strong spatial dependence of LBAM in Minas Gerais, which suggests that a geographical location plays a fundamental role in understanding it. The regional disparity confirmed in this study is inherent in the process of human development, it is important for planning actions aimed at the development of these regions in order to minimize existing disparities.

GESTAÇÃO, PARTO, NASCIMENTO E INTERNAÇÃO DE RECÉM-NASCIDOS EM TERAPIA INTENSIVA NEONATAL: RELATO DE MÃES

RESUMO Objetivo: descrever a trajetória do parto, nascimento e internação do recém-nascido em unidade de terapia intensiva neonatal. Método: pesquisa qualitativa desenvolvida com 25 mães de recém-nascidos internados na terapia intensiva neonatal. A coleta de dados ocorreu nos meses de agosto a outubro de 2014, por meio de entrevista semiestruturada, abordando questões do pré-natal à internação do bebê. Os dados foram submetidos à análise de conteúdo temática. Resultados: a trajetória apontou complicações na gravidez, gestação não-planejada e a não vinculação com o profissional com quem estava realizando o pré-natal; necessidade de deslocamento para o parto e condições do nascimento revelaram importante impacto na vivencial das mães. Conclusões: Foram características da trajetória destas mulheres o início tardio do pré-natal e a fragilidade de vínculo com o profissional que realizou o pré-natal. Além disso, a dificuldade de acesso aos serviços de saúde para o parto culminou com o impacto de um nascimento de risco e internação na terapia intensiva.

História gestacional e características da assistência pré-natal de puérperas adolescentes e adultas em uma maternidade do interior de Minas Gerais, Brasil

Resumo O objetivo desta pesquisa foi analisar a história gestacional e as características da assistência pré-natal de puérperas adolescentes e adultas em uma maternidade localizada em uma cidade de Minas Gerais, referência para a macrorregião de saúde do Jequitinhonha. Trata-se de um estudo transversal descritivo. Entrevistou-se 327 puérperas, entre maio de 2013 a março de 2014, utilizando um instrumento semiestruturado. Predominou o número de puérperas adultas com uma amostra de 255. Com relação ao pré-natal, 324 puérperas realizaram as consultas. Quanto ao local de realização do pré-natal, 79,2% das adolescentes, realizaram no serviço público de saúde, enquanto entre as adultas essa porcentagem foi de 60,4%. Quanto ao tipo de parto, 54,7% das puérperas o tiveram normal e 45% cesárea. Entre as adolescentes, houve uma maior porcentagem de parto normal comparado às adultas, e esse dado teve relação estatisticamente significativa com a idade da puérpera. Com relação à idade gestacional no momento do parto, 85,9% tiveram seus partos a termo; 13,5% pré-termo e 0,6% pós-termo. Evidenciou-se que as puérperas adolescentes estiveram em desvantagem em relação às demais mães no que diz respeito tanto às características socioeconômicas quanto na assistência recebida no pré-natal.

[Quality of prenatal services in primary healthcare in Brazil: indicators and social inequalities]

The aim of this study was to describe quality indicators for prenatal care in Brazil as part of the Program for the Improvement of Access and Quality (PMAQ-AB). The study analyzed number of prenatal visits, vaccination status, prescription of ferrous sulfate, physical examination, orientation, and laboratory tests, based on which a summary quality indicator was constructed. Data were collected in 2012-2013 during interviews conducted by External Evaluators of the PMAQ-AB, with 6,125 users who had done their last prenatal follow-up in Family Health units. During prenatal follow-up, 89% reported six or more visits, more than 95% received a tetanus booster and prescription of ferrous sulfate, 24% reported having received all the procedures in the physical examination, 60% received all the orientation, and 69% had all the recommended laboratory tests. Only 15% of interviewees had received adequate prenatal care, including all the recommended measures, and there was a significantly higher proportion of "complete" care in pregnant women that were older, with higher income, in the Southeast region of Brazil, in municipalities with more than 300,000 inhabitants, and in those with (HDI) in the upper quartile. There are persist social and individual inequalities that can be targeted by measures to upgrade the teams' work processes.

Access to childbirth care by adolescents and young people in the Northeastern region of Brazil

OBJECTIVE

To identify the factors that interfere with the access of adolescents and young people to childbirth care for in the Northeast region of Brazil.

METHODS

Cross-sectional study with 3,014 adolescents and young people admitted to the selected maternity wards to give birth in the Northeast region of Brazil. The sample design was probabilistic, in two stages: the first corresponded to the health establishments and the second to women who had recently given birth and their babies. The data was collected by means of interviews and consulting the hospital records, from pre-tested electronic form. Descriptive statistics were used for the univariate analysis, Pearson's Chi-square test for the bivariate analysis and multiple logistic regressions for the multivariate analysis. Sociodemographic variables, obstetrical history, and birth care were analyzed.

RESULTS

Half of the adolescents and young people interviewed had not been given guidance on the location that they should go to when in labor, and among those who had, 23.5% did not give birth in the indicated health service. Furthermore, one third (33.3%) had to travel in search of assisted birth, and the majority (66.7%) of the postpartum women came to maternity by their own means. In the bivariate analysis, the variables marital status, paid work, health insurance, number of previous pregnancies, parity, city location, and type of health establishment showed a significant association (p < 0.20) with inadequate access to childbirth care. The multivariate analysis showed that married adolescents and young people (p < 0.015), with no health insurance (p < 0.002) and from the countryside (p < 0.001) were more likely to have inadequate access to childbirth care.

CONCLUSIONS

Adolescents and young women, married, without health insurance, and from the countryside are more likely to have inadequate access to birth care. The articulation between outpatient care and birth care can improve this access and, consequently, minimize the maternal and fetal risks that arise from a lack of systematic hospitalization planning.

Obstetric profile of pregnant adolescents in a public hospital: risk at beginning of labor, at delivery, postpartum, and in puerperium

Objective:

describe the obstetric profile of adolescents at beginning of labor, at delivery, postpartum, and in puerperium.

Method:

Cross-sectional descriptive study with 85 pregnant adolescents, selected by convenience, referred by health centers to a public hospital in Mexico City. Risks were evaluated before, during and after delivery and in puerperium, and measured respectively with the "Previgenes" that compose the Reproductive and Perinatal Risk Assessment System.

Results:

socioeconomic status, occupation and education level had influence on the emotionality of adolescents in relation to labor, whose obstetric risk was low for 55%, medium for 35%, and high for 10%. Risk in labor was low for 55%, medium for 18%, and high for 27%. Risk postpartum was low for 50%, medium for 25%, and high for 25%. In puerperium, most adolescents (90%) had low risk.

Conclusion:

most adolescents had low risk in the stages evaluated. The study contributed to identify strategies to approach risk considering the vulnerability inherent in this type of population and favored the conduct of appropriate interventions for the respective needs.

Factors associated with lack of prenatal care in a large municipality

OBJECTIVE To analyze the factors associated with a lack of prenatal care in a large municipality in southern Brazil. METHODS In this case-control age-matched study, 716 women were evaluated; of these, 179 did not receive prenatal care and 537 received prenatal care (controls). These women were identified using the Sistema Nacional de Informação sobre Nascidos Vivos (Live Birth Information System) of Pelotas, RS, Southern Brazil, between 2009 and 2010. Multivariate analysis was performed using conditional logistic regression to estimate the odds ratios (OR). RESULTS In the final model, the variables associated with a lack of prenatal care were the level of education, particularly when it was lesser than four years [OR 4.46; 95% confidence interval (CI) 1.92;10.36], being single (OR 3.61; 95%CI 1.85;7.04), and multiparity (OR 2.89; 95%CI 1.72;4.85). The prevalence of a lack of prenatal care among administrative regions varied between 0.7% and 3.9%. CONCLUSIONS The risk factors identified must be considered when planning actions for the inclusion of women in prenatal care by both the central management and healthcare teams. These indicated the municipal areas with greater deficits in prenatal care. The reorganization of the actions to identify women with risk factors in the community can be considered to be a starting point of this process. In addition, the integration of the activities of local programs that target the mother and child is essential to constantly identify pregnant women without prenatal care.

Baixo peso ao nascer em adolescentes e adultas jovens na Região Nordeste do Brasil

Objetivos: avaliar a associação entre as características sociodemográficas, do pré-natal e do parto de mães adolescentes e adultas jovens com o baixo peso ao nascer, em capitais e outros municípios da Região Nordeste do Brasil, no período de 2011 e 2012. Métodos: estudo transversal, de base hospitalar e nível regional, realizado em 2011 e 2012. As informações foram obtidas por meio de entrevista com a puérpera no pós-parto imediato e coletados dados dos prontuários maternos e dos recém-nascidos. Um modelo teórico conceitual foi estabelecido com três níveis de hierarquia e a variável dependente foi o baixo peso ao nascer (BPN). Resultados: do total de 3009 puérperas entrevistadas, 9,7% apresentaram conceptos com baixo peso. As puérperas que realizaram menos que seis consultas no pré-natal apresentaram uma chance 1,7 vezes maior de ter RN com baixo peso; ser primigesta aumentou a chance da ocorrência do BPN em 1,5 vezes; assim como a prematuridade que representou o principal fator de exposição, elevando em 21 vezes a chance desse desfecho. Conclusões: o estudo demonstrou alta frequência de baixo peso ao nascer entre mães adolescentes e adultas jovens, tendo como principais fatores associados o número insuficiente de consultas pré-natal, primigestação e prematuridade.

Desigualdades no pré-natal em cidade do Sudeste do Brasil

O artigo tem por objetivo avaliar a associação de variáveis demográficas e sociais com o pré-natal adequado na cidade de Niterói, RJ. Estudo transversal, realizado de 2000 a 2009. Foram estudados 62.449 nascidos vivos, por meio do Sistema de Informação sobre Nascidos Vivos (SINASC). A análise multivariada por regressão logística considerou como variável dependente o pré-natal quantitativamente adequado - sete ou mais consultas - e como variáveis independentes: idade, escolaridade materna, cor da pele. Também foi analisada a tendência temporal de idade e escolaridade maternas, número de consultas de pré-natal. O nível de significância foi 5%. Houve aumento da escolaridade, redução de gravidez na adolescência e aumento de mães com mais de 35 anos em Niterói. O percentual de mulheres com sete ou mais consultas se manteve acima de 80%, com diferenças de acordo com idade, escolaridade e cor da pele. Tiveram mais chances de pré-natal adequado: adultas (OR=1,4; IC95% 1,39-1,56); com oito anos ou mais de estudo (OR=2,5; IC95% 2,45-2,70); e brancas (OR=2,4; IC95% 2,30-2,53). Identificamos desigualdades na atenção à saúde materna oferecida em Niterói, apesar da melhora temporal dos indicadores sociais e demográficos na cidade.

Pré-natal na atenção primária do município de João Pessoa-PB: caracterização de serviços e usuárias

OBJETIVOS: caracterizar a assistência pré-natal em Unidades básicas de Saúde envolvendo profissionais e usuárias do município de João Pessoa-PB. MÉTODOS: estudo do tipo transversal e analítico-descritivo. A fim de caracterizar o pré-natal, um instrumento específico foi elaborado com base nas diretrizes do Programa de Humanização do Pré-natal e Nascimento reunindo questões distribuídas e analisadas segundo a tríade avaliativa: estrutura, processo e resultados. RESULTADOS: observou-se boa infra-estrutura em maior parte dos serviços; quanto ao processo, identificou-se baixa adesão aos requisitos mínimos do Programa de Humanização do Pré-natal e Nascimento (39,9%), além de baixo percentual de serviços com atividades de educação em saúde (45,5%) e avaliação interna (47,7%). Para os resultados da assistência, altos percentuais de gestantes com intercorrências clínicas (60,9%), inadequada situação nutricional (56,3% sobrepeso e obesidade) e baixa prevalência de aleitamento materno exclusivo (58,05 ± 34,19 dias) foram observados. CONCLUSÕES: aspectos de processo referentes à adesão ao pré-natal, presença de serviços com atividades de educação em saúde e indicadores de avaliação interna além de questões de resultados envolvendo intercorrências clínicas, inadequada situação nutricional na gestação e baixa prevalência de aleitamento materno exclusivo são barreiras à qualidade das ações de pré-natal no âmbito da atenção primária à saúde.

Risk factors for birth-related perineal trauma: a cross-sectional study in a birth centre

AIM AND OBJECTIVES

To identify maternal, newborn and obstetric factors associated with birth-related perineal trauma in one independent birth centre.

BACKGROUND

Risk factors for birth-related perineal trauma include episiotomy, maternal age, ethnicity, parity and interventions during labour including use of oxytocin, maternal position at time of birth and infant birth weight. Understanding more about these factors could support the management of vaginal birth to prevent spontaneous perineal trauma, in line with initiatives to reduce routine use of episiotomy.

DESIGN

Cross-sectional study.

METHODS

Data were retrospectively collected from one independent birth centre in Brazil, during 2006-2009. The dependent variable (perineal trauma) was classified as: (1) intact perineum or first-degree laceration, (2) second-degree laceration and (3) episiotomy (right mediolateral or median).

RESULTS

There were 1079 births during the study period. Parity, use of oxytocin during labour, position at time of giving birth and infant birth weight were associated with second-degree lacerations and episiotomies. After adjusting for parity, oxytocin, maternal position at the expulsive stage of labour and infant birth weight influenced perineal outcomes among primiparae only.

CONCLUSIONS

Although the overall rate of episiotomies in this study was low compared with national data, it was observed that younger women were most vulnerable to this intervention. In this age group in particular, the use of oxytocin as well as semi-upright positions at the time of birth was associated with second-degree lacerations and episiotomies.

RELEVANCE TO CLINICAL PRACTICE

The use of upright alternative positions for birth and avoidance of use of oxytocin could reduce the risk of perineal trauma from lacerations and need to perform episiotomy.

Self-care behaviors among Thai primigravida teenagers

The purpose of this study was to investigate predictive factors of the self-care behaviors among Thai teenagers with primigravida. The samples of 206 primigravida teenagers attending ANC clinics of six hospitals in the North-Eastern region of Thailand were included. Data collection was done through self administered-questionnaire. Scales of the questionnaire had reliability coefficients ranging from 0.72 – 0.92. The data were analyzed by using descriptive and inferential statistics. The results revealed that the percentage-mean score of overall self-care behavior was 76.91. The percentage-mean scores of self-care behaviors in specific trimester were found that the score in the second trimester was lower than the scores in the first and third trimesters (57.58, 60.45, and 64.65, respectively). Factors associated with overall self-care behavior were perceived self-efficacy, perceived social support from family, knowledge on self-care during pregnancy, accessibility to health services, self-esteem and age (r = 0.47, 0.34, 0.28, 0.24, 0.19, and 0.15, respectively). Perceived self-efficacy and knowledge on self-care during pregnancy were the two considerable predictors accounted for 25% of the variance in the self-care behaviors of Thai teenagers with primigravida.