Fatores periparto associados a necessidade de reanimação em sala de parto de RN de peso ≥ 2.500g em maternidades públicas de nível terciário do Ceará, Brasil
Data
2014
Autores
Sousa, Jose Roberto Pereira 
Orientadores
Guinsburg, Ruth
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar os fatores periparto associados a necessidade de reanimacao neonatal em sala de parto em recem-nascidos com peso ao nascer ≥2.500g sem malformacoes congenitas, em maternidades publicas de referencia do estado do Ceara. Metodos: Caso-controle retrospectivo de base hospitalar e multicentrico. Os casos foram recem-nascidos com peso ao nascer ≥2500g sem malformacoes que necessitaram de ventilacao com pressao positiva em sala de parto e/ou apresentaram Boletim de Apgar de 5º minuto inferior a sete, nascidos nas maternidades publicas de referencia do Estado do Ceara-Brasil, no periodo de Marco/2009 a Marco/2010. O grupo controle foi selecionado entre os nascidos vivos no mesmo periodo com Apgar no 1º minuto ≥ 8 e que nao realizaram qualquer manobra de reanimacao, pareado com o caso por sexo, peso ao nascer (mais ou menos 100g), idade gestacional (mais ou menos 7 dias) e epoca de nascimento (a mais proxima). Foram estudadas as caracteristicas demograficas maternas e a morbidade materna antenatal, as caracteristicas do parto e a morbidade intraparto e as caracteristicas do atendimento obstetrico ao trabalho de parto e parto. As variaveis associadas a necessidade de reanimacao neonatal em sala de parto e/ou a apresentacao de Boletim de Apgar de 5º minuto inferior a sete foram determinadas pela regressao logistica multivariada condicional, com os resultados expressos por odds ratio (OR) e IC95%. Resultados: Dos 2.233 nascidos vivos com peso ≥ 2.500g com Apgar ≤ 7 no 1º minuto e/ou <7 no 5º minuto e sem malformacao congenita, 399 receberam ventilacao com pressao positiva, 8 foram submetidos a ventilacao e massagem cardiaca e/ou medicacoes e, em 33, nao havia anotacao de manobras de reanimacao, mas o Apgar de 5º minuto permaneceu menor do que sete. Assim, 435 casos e a mesma quantidade de controles foram analisados. A regressao logistica condicional para o uso de ventilacao com pressao positiva em sala de parto e/ou Boletim de Apgar de 5º minuto inferior a sete mostrou sua associacao com idade gestacional <37 semanas (OR 4,35; IC95%: 1,44-13,20), liquido amniotico meconial (8,54; 4,18-17,43), gestante transferida de outro hospital (1,68; 1,00-2,81), realizacao de exame de avaliacao da dilatacao cervical na admissao (0,59; 0,40-0,86) e realizacao de partograma (0,70; 0,48-1,00). Conclusao: Os resultados revelam falhas importantes na assistencia obstetrica associadas a organizacao do sistema de referencia, efetivacao de protocolos de assistencia obstetrica ao parto e intraparto
Objective: To evaluate peripartum variables associated to the need for resuscitation in the delivery room of neonates weighing ≥2,500g without malformations. Methods: Case control retrospective study. Cases: neonates from single gestations, with birth weight ≥2,500g, without malformations, requiring positive pressure ventilation in the delivery room and/or with a 5thminute Apgar scores <7, born in the 4 public reference maternities in Ceará, Northeast Brazil, between March/2009 and March/2010. Controls: neonates from single gestations, with 1minute Apgar scores ≥8, that did not receive resuscitation procedures, paired according to gender, birth weight (±100g), gestational age (±7 days) and date of birth (the nearest). Demographic characteristics, maternal morbidity and obstetrical care characteristics were studied. Variables associated to the outcome were determined by conditional multivariate logistic regression, expressed as odds ratio (OR) and a 95% confidence interval (CI). Results: Among 2,233 live births with weight ≥2,500g, 1 st minute Apgar score ≤7 and without malformations, 435 cases met inclusion criteria. Therefore, the studied population comprised 435 pairs of cases and controls. Conditional logistic regression for the use of positive pressure ventilation in delivery room and/or 5minute Apgar score <7 showed association with: gestational age <37 weeks (OR 4.35; 95% CI: 1.4413.20), meconium stained amniotic fluid (8.54; 4.1817.43), pregnant woman transferred from another hospital (1.68; 1.002.81), undergoing cervical dilation exam on admission (0.59; 0.400.86) and use of partograph (0.70; 0.481.00). Conclusion: There are important flaws in obstetrical care associated to the organization of the reference system, and in the completion of obstetrical care protocols concerning delivery and intrapartum care
Objective: To evaluate peripartum variables associated to the need for resuscitation in the delivery room of neonates weighing ≥2,500g without malformations. Methods: Case control retrospective study. Cases: neonates from single gestations, with birth weight ≥2,500g, without malformations, requiring positive pressure ventilation in the delivery room and/or with a 5thminute Apgar scores <7, born in the 4 public reference maternities in Ceará, Northeast Brazil, between March/2009 and March/2010. Controls: neonates from single gestations, with 1minute Apgar scores ≥8, that did not receive resuscitation procedures, paired according to gender, birth weight (±100g), gestational age (±7 days) and date of birth (the nearest). Demographic characteristics, maternal morbidity and obstetrical care characteristics were studied. Variables associated to the outcome were determined by conditional multivariate logistic regression, expressed as odds ratio (OR) and a 95% confidence interval (CI). Results: Among 2,233 live births with weight ≥2,500g, 1 st minute Apgar score ≤7 and without malformations, 435 cases met inclusion criteria. Therefore, the studied population comprised 435 pairs of cases and controls. Conditional logistic regression for the use of positive pressure ventilation in delivery room and/or 5minute Apgar score <7 showed association with: gestational age <37 weeks (OR 4.35; 95% CI: 1.4413.20), meconium stained amniotic fluid (8.54; 4.1817.43), pregnant woman transferred from another hospital (1.68; 1.002.81), undergoing cervical dilation exam on admission (0.59; 0.400.86) and use of partograph (0.70; 0.481.00). Conclusion: There are important flaws in obstetrical care associated to the organization of the reference system, and in the completion of obstetrical care protocols concerning delivery and intrapartum care
Descrição
Citação
SOUSA, José Roberto Pereira. Fatores periparto associados à necessidade de reanimação em sala de parto de RN de peso ≥ 2.500g em maternidades públicas de nível terciário do Ceará, Brasil. 2014. 92 f. Tese (Doutorado em Ciências) – Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2014.