RESUMO
OBJECTIVES: To measure the rate of use of selected intrapartum obstetric practices and to explore the factors associated with their use. DESIGN: Prospective quantitative and qualitative study. SETTING: Fifteen public and private hospitals in Cali, Colombia. SAMPLE: Quantitative arm: 1,767 low-risk women delivering a single live baby; qualitative arm: 36 intrapartum care providers. METHODS: Quantitative analysis of women's clinical charts for measuring the rates of obstetric practices. Qualitative analysis of audiotaped semi-structured interviews with intrapartum care providers. MAIN OUTCOME MEASURES: Rates of use of ten intrapartum obstetric practices and associated factors and intrapartum care providers' views on evidence-based obstetric practice. RESULTS: Rates for the ineffective practices of enema use, perineal/pubic shaving, and routine intravenous infusion during labour were around 75%. Episiotomy rates for primiparae and multiparae were 70 and 22%, respectively. Rates for the beneficial practices of active management of the third stage of labour and allowing women's choice of position during the first stage of labour were around 45%. Companionship during labour, external cephalic version for breech presentation at term, and absorbable synthetic sutures for episiotomy showed rates of utilisation lower than 15%. Hospital characteristics, type of intrapartum care provider, and women's medical insurance status were associated with use of selected practices. Barriers and opportunities for implementing evidence-based practices in routine obstetric care were identified. CONCLUSIONS: Intrapartum care in Cali, Colombia, is not guided by the best available evidence. Effective change strategies should be undertaken to encourage the adoption of obstetric practices clearly demonstrated as effective and to discard those that are ineffective.
Assuntos
Cuidado Pré-Natal/normas , Prática Profissional/normas , Adolescente , Adulto , Atitude do Pessoal de Saúde , Cuidadores/psicologia , Colômbia , Medicina Baseada em Evidências , Feminino , Hospitalização , Maternidades , Humanos , Masculino , Política Organizacional , Relações Profissional-Paciente , Estudos Prospectivos , Pesquisa Qualitativa , Adulto JovemRESUMO
OBJECTIVE: To investigate whether the length of the interval between an abortion and the next pregnancy is associated with increased risks of adverse maternal and perinatal outcomes in Latin America. METHOD: Retrospective cross-sectional study using information from 258,108 women delivering singleton infants and whose previous pregnancy resulted in abortion recorded in the Perinatal Information System database of the Latin American Centre for Perinatology and Human Development, Montevideo, Uruguay, between 1985 and 2002. Adjusted odds ratios were obtained through logistic regression analysis. RESULT: Compared with the post-abortion interpregnancy intervals of 18 to 23 months, intervals shorter than 6 months were significantly associated with increased risks of maternal anemia, premature rupture of membranes, low birth weight, very low birth weight, preterm delivery, and very preterm delivery. CONCLUSION: In Latin America, post-abortion interpregnancy intervals shorter than 6 months are independently associated with increased risks of adverse maternal and perinatal outcomes in the next pregnancy. DEFINITION: Post-abortion interpregnancy interval (PAII): the time elapsed between the day of the abortion and the first day of the last menstrual period for the index pregnancy.