Síntese e adaptação de recomendações de diretrizes clínicas para cuidados na gestação e no puerpério
Arquivos
Data
2020-09-30
Autores
Brito, Patrícia Cristine Mandú de 
Orientadores
Melo, Daniela Oliveira de
Tipo
Trabalho de conclusão de curso
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Tanto a gravidez quanto o puerpério são processos marcados por
intensas alterações físicas e psicoemocionais que podem favorecer o surgimento
de doenças ou agravar condições pré-existentes, aumentando os riscos de
mortalidade materna. É fundamental que as mulheres recebam uma assistência
médica de qualidade para proporcionar bons resultados durante e após a
gravidez, e nesse contexto de melhoria as diretrizes clínicas (DC) baseadas em
evidência mostram-se uma importante ferramenta para o cuidado das gestantes
e puérperas. Considerando que são necessários recursos humanos, técnicos e
financeiros para a elaboração de DC, uma alternativa assertiva para viabilizar a
aplicação no cenário brasileiro é a adaptação de DC de boa qualidade já
existentes considerando o contexto e realidade local. O objetivo deste trabalho
foi sintetizar e adaptar recomendações sobre cuidados na gestação e puerpério
obtidas a partir de DC elaboradas por instituições reconhecidas por produzirem
DC de boa qualidade metodológica. As instituições foram descritas em estudos
prévios e utilizou-se adicionalmente a plataforma de busca ECRI para elencar as
DC a serem utilizadas. Também foi feita uma busca por documentos nacionais
para respaldo das informações contidas nas DC elencadas. A maioria das
recomendações das DC internacionais e documentos nacionais concordavam ou
se complementavam, entretanto, especialmente quando o assunto estava
relacionado às opções terapêuticas, dosagens e utilização de medicamentos
e/ou suplementos e métodos diagnósticos, houve certas divergências. A
recomendação de 5mg/dia de ácido fólico sugerida por documentos nacionais
contradizendo às 0,4mg/dia indicada nas DC internacionais; a ausência do
medicamento Labetalol para tratamento de distúrbios hipertensivos nos
documentos nacionais; a não recomendação dos hipoglicemiantes orais para
tratamento do diabetes Mellitus (DM) durante a gestação nos documentos
nacionais enquanto estes apresentavam-se como opção terapêutica nas DC
internacionais, são exemplos de recomendações conflitantes encontradas.
Como resultado, 199 recomendações foram sintetizadas e adaptadas para uso
local e benefício de mulheres grávidas e puérperas brasileiras.
Pregnancy and the puerperium are processes marked by intense physical and psycho-emotional changes that may contribute to the onset of diseases or aggravate pre-existing conditions, increasing the risks of maternal mortality. It is essential that women receive qualified medical care to provide them good results during and after pregnancy, and in this context of improvement, evidence-based clinical practice guidelines (CPG) are an important tool to ensure pregnant and puerperal women care implementation. However, considering that human, technical and financial resources can be expensive for the elaboration of a new CPG, an assertive alternative to enable the application of essential CPG for pregnant and puerperal women in the Brazilian scenario is using good quality guidelines already existing for the adaptation to context and local reality. Thereby, the main goal of this work was to synthesize and adapt recommendations on care during pregnancy and the puerperium obtained from CPG elaborated by institutions recognized for producing high quality methodological CPG. The institutions were described in a previous study and the ECRI search platform was additionally used to list the CPG to be used. The CPG recommendations were extracted, organized, compared and synthesized. A search was also made for national documents to support the information contained in high quality CPG. Most of the recommendations of the international CPG and national documents agreed or complemented each other, but especially when the central issue was related to therapeutic options, dosages and use of medications and/or supplements and diagnostic methods, there were certain divergences. The recommendation of 5mg/day of folic acid suggested by national documents contradicting the 0.4mg/day indicated in international CPG; the absence of the Labetalol drug for treatment of hypertensive disorders in national documents; the non-recommendation of oral hypoglycemic agents for the treatment of diabetes mellitus (DM) during pregnancy in national documents while they were a therapeutic option in international CPG are examples of conflicting recommendations found. As a result, 199 recommendations were synthesized and adapted for local use and benefit of Brazilian pregnant and puerperal women.
Pregnancy and the puerperium are processes marked by intense physical and psycho-emotional changes that may contribute to the onset of diseases or aggravate pre-existing conditions, increasing the risks of maternal mortality. It is essential that women receive qualified medical care to provide them good results during and after pregnancy, and in this context of improvement, evidence-based clinical practice guidelines (CPG) are an important tool to ensure pregnant and puerperal women care implementation. However, considering that human, technical and financial resources can be expensive for the elaboration of a new CPG, an assertive alternative to enable the application of essential CPG for pregnant and puerperal women in the Brazilian scenario is using good quality guidelines already existing for the adaptation to context and local reality. Thereby, the main goal of this work was to synthesize and adapt recommendations on care during pregnancy and the puerperium obtained from CPG elaborated by institutions recognized for producing high quality methodological CPG. The institutions were described in a previous study and the ECRI search platform was additionally used to list the CPG to be used. The CPG recommendations were extracted, organized, compared and synthesized. A search was also made for national documents to support the information contained in high quality CPG. Most of the recommendations of the international CPG and national documents agreed or complemented each other, but especially when the central issue was related to therapeutic options, dosages and use of medications and/or supplements and diagnostic methods, there were certain divergences. The recommendation of 5mg/day of folic acid suggested by national documents contradicting the 0.4mg/day indicated in international CPG; the absence of the Labetalol drug for treatment of hypertensive disorders in national documents; the non-recommendation of oral hypoglycemic agents for the treatment of diabetes mellitus (DM) during pregnancy in national documents while they were a therapeutic option in international CPG are examples of conflicting recommendations found. As a result, 199 recommendations were synthesized and adapted for local use and benefit of Brazilian pregnant and puerperal women.