Assistência obstétrica nos municípios de São Paulo e Santos: análise secundária dos dados do estudo Nascer Saudável
Data
2022
Autores
Timoteo, Alessandra Costa 
Orientadores
Barbieri, Márcia
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Analisar a assistência obstétrica na rede suplementar de saúde de cinco hospitais dos municípios de São Paulo e um de Santos de acordo com as recomendações da Organização Mundial da Saúde e do Ministério da Saúde. Método: Trata-se de estudo epidemiológico, descritivo e transversal. Foi realizado em seis hospitais da rede suplementar de saúde que participaram do Projeto Parto Adequado da região Sudeste do país. Fizeram parte deste estudo 2.435 mulheres admitidas nas maternidades selecionadas por ocasião da realização da assistência ao parto e seus conceptos vivos com qualquer idade gestacional, peso ao nascer ou mortos com idade gestacional ≥ 20 semanas e/ou peso ao nascer ≥ 500g no período de março a agosto de 2017. Resultados: das 976 puérperas que entraram em trabalho de parto, 75,7% caminharam, 61,0% realizaram medidas não farmacológicas para alívio da dor, 58,0% tinham o partograma, 20,7% não tiveram amniotomia artificial, 47,1% consumiram líquido ou alimento, receberam analgesia farmacológica, hidratação venosa e ocitocina (46,1%, 43,8% e 47,1%), respectivamente. Destas, apenas 58,3% das puérperas tiveram parto vaginal, 81,0% pariram em posição litotômica, 53,0% não apresentaram laceração ou trauma perineal, 39,7% foram submetidas a episiotomia e 23,5% à manobra de Kristeller. O acompanhante esteve presente em (81,9%) do trabalho de parto e (97,1%) no parto. No pós-parto imediato 54,0% dos recém-nascidos de parto vaginal fizeram contato pele a pele e foram amamentados na primeira hora de vida, enquanto dos nascidos de parto cesáreo, somente 26,9% realizaram o contato pele a pele e 30% foram amamentados na primeira hora de vida. Encontrou-se que a enfermeira participou da assistência no trabalho de parto em conjunto com o médico (52,3%) e no parto, quase a totalidade foi assistida por médico (99,3%). Conclusão: Ao analisar as boas práticas obstétricas durante o trabalho de parto, parto e no pós-parto imediato, observa-se que a qualidade da assistência não está adequada as recomendações da OMS e do MS. O estudo revela participação da enfermeira obstétrica no trabalho de parto, a escassez dessa profissional no momento do parto e a ausência da obstetriz o que mostra a necessidade de mobilizações para que as práticas consideradas úteis e benéficas para a mãe e bebê sejam mais estimuladas dentre os hospitais participantes.
Objective: The analysis of obstetric care in the supplementary health network of five hospitals in the cities of São Paulo and one Santos according to the recommendations of the World Health Organization and the Brazilian Ministry of Health. Method: This is an epidemiological, descriptive, and cross-sectional study. It was carried out in six hospitals of the supplementary health network that participated in the Adequate Childbirth Project in the Southeast region. 2,435 women who took part in this study have been admitted to the selected maternity hospitals at the time of delivery care and their live fetuses with any gestational age, birth weight or stillbirth with gestational age ≥ 20 weeks and/or birth weight ≥ 500g from March to August 2017. Results: of the 976 postpartum women who went into labour, 75,7% walked, 61.0% performed non-pharmacological measures for pain relief, 58.0% had a partogram, 20.7% did not have artificial amniotomy, 47.1% consumed liquid or food, received pharmacological analgesia, intravenous hydration and oxytocin (46.1%, 43.8% and 47.1%), respectively. Only 58.4% of the puerperal women had a vaginal delivery, 81.0% gave birth in the lithotomic position, 53.0% did not have perineal laceration or trauma, 39.7% underwent episiotomy and 23.5% underwent the Kristeller manoeuvre. The companion was present (81,9%) during labour and (97.1%) during delivery. In the immediate postpartum period, 54.0% of newborns delivered vaginally made skin-to-skin contact and were breastfed in the first hour of life, while among those born by cesarean section, only 26.9% had skin-to-skin contact and 30 % were breastfed in the first hour of life. It was found that the nurse participated in the assistance in labour together with the doctor (52,3%) and in the delivery, almost all were assisted by a doctor (99.3%). Conclusion: When analyzing good obstetric practices during labour, delivery and in the immediate postpartum period, it is observed that the quality of care is not adequate to the WHO and MS recommendations. The study reveals the participation of the obstetric nurse in labour, the scarcity of this professional at the time of delivery and the absence of the midwife, which shows the need for mobilization so that the practices are considered useful and beneficial for the mother and baby are more stimulated among the participating hospitals.
Objective: The analysis of obstetric care in the supplementary health network of five hospitals in the cities of São Paulo and one Santos according to the recommendations of the World Health Organization and the Brazilian Ministry of Health. Method: This is an epidemiological, descriptive, and cross-sectional study. It was carried out in six hospitals of the supplementary health network that participated in the Adequate Childbirth Project in the Southeast region. 2,435 women who took part in this study have been admitted to the selected maternity hospitals at the time of delivery care and their live fetuses with any gestational age, birth weight or stillbirth with gestational age ≥ 20 weeks and/or birth weight ≥ 500g from March to August 2017. Results: of the 976 postpartum women who went into labour, 75,7% walked, 61.0% performed non-pharmacological measures for pain relief, 58.0% had a partogram, 20.7% did not have artificial amniotomy, 47.1% consumed liquid or food, received pharmacological analgesia, intravenous hydration and oxytocin (46.1%, 43.8% and 47.1%), respectively. Only 58.4% of the puerperal women had a vaginal delivery, 81.0% gave birth in the lithotomic position, 53.0% did not have perineal laceration or trauma, 39.7% underwent episiotomy and 23.5% underwent the Kristeller manoeuvre. The companion was present (81,9%) during labour and (97.1%) during delivery. In the immediate postpartum period, 54.0% of newborns delivered vaginally made skin-to-skin contact and were breastfed in the first hour of life, while among those born by cesarean section, only 26.9% had skin-to-skin contact and 30 % were breastfed in the first hour of life. It was found that the nurse participated in the assistance in labour together with the doctor (52,3%) and in the delivery, almost all were assisted by a doctor (99.3%). Conclusion: When analyzing good obstetric practices during labour, delivery and in the immediate postpartum period, it is observed that the quality of care is not adequate to the WHO and MS recommendations. The study reveals the participation of the obstetric nurse in labour, the scarcity of this professional at the time of delivery and the absence of the midwife, which shows the need for mobilization so that the practices are considered useful and beneficial for the mother and baby are more stimulated among the participating hospitals.