RESUMO
BACKGROUND: To compare two care models of high-risk pregnant women--a House for Pregnant Women, staffed by nurse-midwives, versus a traditional care model in a hospital maternity ward. DESIGN: This was across-sectional study conducted in two reference maternity hospitals for high-risk pregnancies, in Belo Horizonte, Minas Gerais, Brazil. The sample consisted of 312 high-risk pregnant women consecutively admitted from January 1st to December 31st, 2010, either to the House for Pregnant Women (n=247), or the hospital maternity ward (n=65). Gestational ages varied from 22 weeks to 36 weeks and six days. We measured individual, demographic, obstetric, labour and delivery variables, and newborn characteristics. For data analysis, we used descriptive, bivariate and multivariate statistics using Poisson regression, with a 5% significance level. FINDINGS: At the conventional hospital maternity ward, more women had six or more antenatal exams, greater frequencies of diagnosis related to blood pressure, and a greater number of women underwent either a C-section or a vaginal delivery with an episiotomy and analgesia. At the House for Pregnant Women, the majority of the hospitalizations were related to preterm labour and premature rupture of membranes. There were no statistical differences in the newborn characteristics. KEY CONCLUSIONS: The House for Pregnant Women care model, utilizing midwives was less interventionist, yet with results as favorable as in a conventional maternity hospital setting.
Assuntos
Mortalidade Infantil/tendências , Serviços de Saúde Materna/normas , Gravidez de Alto Risco , Adolescente , Adulto , Brasil , Criança , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Mortalidade Materna , Tocologia/métodos , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/normas , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normasRESUMO
PURPOSES: To identify and to analyze maternal mortality causes, according to hospital complexity levels. METHODS: A descriptive-quantitative cross-sectional study of maternal deaths that occurred in hospitals in Paraná, Brazil, during the periods from 2005 to 2007 and from 2008 to 2010. Data from case studies of maternal mortality, obtained by the State Committee for Maternal Mortality Prevention, were utilized. The study focused on variables such as site and causes of death, hospital transfer, and avoidability. Maternal mortality rate, proportions, and hospital lethality ratio were calculated according to subgroups of low and high-risk pregnancy reference hospitals. RESULTS: Maternal mortality rate, including late maternal deaths, was 65.9 per 100.000 live-borns (from 2008 to 2010). Almost 90% of all maternal deaths occurred in the hospital environment, in both periods. The hospital lethality ratio at the high-risk pregnancy reference hospital was 158.4 deaths per 100,000 deliveries during the first period and 132.5/100,000 during the second, and the main causes were pre-eclampsia/eclampsia, puerperal infection, urinary tract infection, and indirect causes. At the low-risk pregnancy reference hospitals, the hospital lethality ratios were 76.2/100,000 and 80.0/100,000, and the main causes of death were hemorrhage, embolism, and anesthesia complications. In 64 (2005 - 2007) and in 71% (2008 - 2010) of the cases, the patients died in the same hospital of admission. During the second period, 90% of the casualties were avoidable. CONCLUSIONS: Hospitals of both levels of complexity are having difficulties in treating obstetric complications. Professional training for obstetric emergency assistance and the monitoring of protocols at all hospital levels should be considered by the managers as a priority strategy to reduce avoidable maternal deaths.
Assuntos
Hospitais , Mortalidade Materna , Complicações na Gravidez/mortalidade , Brasil , Causas de Morte , Estudos Transversais , Feminino , Humanos , Gravidez , Gravidez de Alto Risco , Encaminhamento e ConsultaRESUMO
PURPOSE: to identify the profile, tendency and causes of maternal death by pre-eclampsia/eclampsia in Paraná. METHODS: descriptive, transversal cohort study on maternal death by pre-eclampsia/eclampsia from 1997 to 2005. Data were obtained from case studies prepared by Maternal Death Committees that employ the Reproductive Age Mortality Survey Method to examine all the cases of death among women in fertile age. The general and specific maternal death rate (MDR) by pre-eclampsia/eclampsia were considered. To evaluate the tendency, triennial periods have been compared, two by two, taking into consideration the MDR of each period (p<0.05). In the triennial period from 2003 to 2005, 56 deaths by pre-eclampsia/eclampsia were analyzed. The variables focused were: age, income, schooling, gestation number and complications, pre-natal conditions, signs and symptoms related to the condition, delivery route, the time gestation was interrupted, the newborn conditions, access and treatment, ability to avoid and prevention measures. RESULTS: the general triennial MDR has presented significant decline, with 64.3/100,000 born-alive babies. There has been stability along the period for MDR by hypertensive disorder, with MDR of 11.8/100,000 born-alive. Primiparous women, women over 40 and with low socio-economical status have presented higher risks. In relation to the treatment, there has been underuse or inadequate use of conventional medicines for severe pre-eclampsia and eclampsia. The committees' analysis indicated that all the maternal death due to these conditions could have been avoided. CONCLUSIONS: actions aiming at minimizing the set of causes that lead to death by pre-eclampsia in Paraná should be enforced, including the training and monitoring of health professionals in order to apply the treatment protocols, besides the formalization of a reference net of clinics and hospitals, qualified for the care of high risk pregnancy and its intercurrences, to which pre-natal pregnant women are enrolled.
Assuntos
Eclampsia/mortalidade , Pré-Eclâmpsia/mortalidade , Adolescente , Adulto , Brasil/epidemiologia , Causas de Morte , Criança , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Adulto JovemRESUMO
Postpartum appointments are essential in women health care. This study aimed at identifying the social health needs of women during postpartum. A survey was conducted with 50 puerperal women of the Curitiba Mother Program receiving care at basic health units of a health district of the city of Curitiba, Paraná, southern Brazil. An instrument with objective questions was applied in February and March, 2007, to collect the data. Descriptive statistics was used to analyze the data. The most frequently mentioned set of needs was "to be someone with the right to be different", whereas the least mentioned was "link with health professional and team". The latter appears as a positive aspect of the nurse's (and health team) work, whereas the first shows the need to build practices to strengthen the autonomy and the self-reliance of women in health care.
Assuntos
Cuidado Pós-Natal , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , SociologiaRESUMO
Enough scientific evidences exist for the recommendation of the abolition of the used episiotomia in a liberal way. With objective of identifying the vision of a group of post-partum women in relation to the episiotomy it was done a study of qualitative approach, with the participation of 20 women, in the postpartumn period. It was used for data collection a semi-structured tool applied from April to June, 2004. The results were analyzed based in thematic analysis. The women's ignorance was verified in relation to the episiotomy and on their own body; although, they did not receive information, in any moment that this is a selective intervention, indicating the need of knowledge amplification and of the ransom of the woman's autonomy in the childbirth process and birth.
Assuntos
Episiotomia , Episiotomia/psicologia , Feminino , Humanos , Entrevistas como Assunto , Direitos do PacienteRESUMO
This study is about a part of Alice Michaud's biography, the first nurse in Parana and the first ABEn-PR's president, majored in 1948, being the third group of the Nursing School in São Paulo-USP The facts stated here were obtained from periodicals, recorded interviews with the honored nurse and after her death by documents given by the family. The data permitted to identify the source, the formation, the main work developed, the homages and the public acknowledgment of this nurse. This is the first, out of a series of registers, to be done standing out the life and work of Alice Michaud.