Quality of prenatal care for pregnant women at usual risk: limitations and challenges

Responsible researcher: Viviane Pires Ribeiro

Article title: EVALUATION OF THE PROCESS IN PRENATAL CARE FOR PREGNANT WOMEN AT HABITUAL RISK

Authors of the article: Marianne Maia Dutra Balsells, Tyane Mayara Ferreira de Oliveira, Elizian Braga Rodrigues Bernardo, Priscila de Souza Aquino, Ana Kelve de Castro Damasceno, Régia Christina Moura Barbosa Castro, Paula Renata Amorim Lessa and Ana Karina Bezerra Pinheiro

Intervention Location: Fortaleza, Ceará, Brazil

Sample size: 560 medical records

Sector: Healthcare

Type of intervention: Assessment of the quality of care in terms of the process offered to pregnant women at habitual risk
Variable of main interest: Prenatal care

Evaluation method: Evaluative research

Assessment Context

Prenatal monitoring seeks to ensure the development of pregnancy, aiming to promote a healthy birth, with the least possible impact on maternal and fetal health, thus considering psychosocial aspects, educational and preventive activities. In this sense, Brazilian research shows that the health levels of mothers and fetuses are closely interconnected with the quality of prenatal care, thus having a direct correlation between the provision of adequate prenatal care and the reduction in maternal and maternal morbidity and mortality rates. perinatal.

Balsells et al. (2018) emphasize that current studies that cover the quality of health services have been based on one or more categories proposed by Donabedian (1991), in which he defines the quality of these services as the degree of adequacy of them to needs, expectations, as well as the standard of care for the population. Furthermore, the application of quality criteria to evaluate the prenatal care process is seen as one of the conditions to guarantee the effectiveness of care for pregnant women, as it makes it possible to identify the performance of the service and demonstrate the quality of care.

Intervention Details

Balsells et al. (2018) evaluate the quality of care in terms of the process offered to pregnant women at usual risk. To achieve this objective, the authors use an evaluative research, carried out from May 2015 to January 2016, at the Casa de Parto Natural Lígia Barros Costa (CPN) in Fortaleza, Ceará. The data collection instrument included sociodemographic, clinical and obstetric aspects, and prenatal care process indicators.

The evaluation consisted of analyzing all records from January 2011 (the period corresponding to the formulation of the Rede Cegonha Strategy) until June 2015, with 695 records found. However, the records of women who were undergoing prenatal care at the time of collection (56), those who were referred to high-risk prenatal care (21), and those who had only one record were excluded from the sample. query (24). Therefore, the sample totaled 560 medical records.

Methodology Details

To evaluate the process, the authors adopted prenatal indicators, clinical and obstetric assessment indicators and complementary exam indicators. Regarding prenatal care indicators, prenatal care is considered adequate when it starts within 12 weeks of pregnancy and the woman has had seven or more consultations. It is considered inadequate when prenatal care began after the 27th week of pregnancy or the woman had two or fewer consultations. On the other hand, the quality of prenatal care is considered intermediate when it presents situations between adequate and inadequate.

With regard to indicators related to clinical and obstetric procedures, it is considered adequate when there are five or more records of fundal height (AU), gestational age (GA), weight, Blood Pressure (BP) and Body Mass Index (BMI) ; and four or more records of Heartbeats (BCF's); and two or more records of fetal presentation and edema. It is considered inadequate when there were two or fewer notes of UA, GA, BP, edema, weight and BCF's, or no record of fetal presentation. It is considered intermediate when it presents all intermediate situations between adequate and inadequate.

Regarding the indicators of complementary tests, the authors evaluated the toxoplasmosis and HBsAg tests, recommended by the Rede Cegonha Strategy. Therefore, it is considered adequate when the pregnant woman has performed an ABO-Rh typing, two hematocrits, two hemoglobins, two fasting glycemia, two VDRL, two anti-HIV tests, two type I urine tests, one HBsAg and one serology for toxoplasmosis during all prenatal care. It is assessed as inadequate when there was no record of a laboratory test. And finally, classified as intermediate, any basic exams carried out, regardless of the type.

Results

The average number of prenatal consultations carried out from May 2015 to January 2016 at the CPN was 5.83 (median 6.00) and the majority of pregnant women, 73.8% (n=413) started prenatal care after the 12th gestational week, with the start of prenatal care being more prevalent in the 2nd trimester of pregnancy, 52.9% (n=296).

Regarding prenatal quality indicators, the results show that 42.3% (n=237) attended the appropriate number of consultations, carrying out seven or more consultations. Only 26.3% (n=147) started prenatal care early. Regarding the quality indicators of clinical and obstetric procedures, it was found that 55% (n=309) were adequate. When analyzing the quality indicators relating to laboratory tests, only 25.4% (n=142) were adequate.

Public Policy Lessons

The study carried out by Balsells et al. (2018) evidences the low suitability of prenatal care, with regard to the beginning of prenatal care, number of consultations during pregnancy, clinical and obstetric procedures and laboratory tests recommended by the Ministry of Health. Thus, the late start of prenatal care and an inadequate number of consultations contribute, among other factors, to an unfavorable outcome, since carrying out this procedure is essential for the early discovery of situations that put maternal and fetal health at risk.

The quality of prenatal care is adequate in the minority of the population analyzed. Therefore, there is a need to improve assistance regarding process indicators in the service, deserving greater attention from managers and health professionals, with investment in training and action planning in favor of improving indicators related to the number of consultations, early start of pre- -natal, clinical and obstetric procedures and laboratory tests. Furthermore, it is necessary to implement a monitoring program to evaluate prenatal care, in order to guarantee the effectiveness of actions and the quality of care.

Reference
BALSELLS, MMD et al. Assessment of the process in prenatal care for pregnant women at usual risk. Acta Paulista de Enfermagem, v. 31, no. 3, p. 247-254, 2018.