Abstract
BackgroundEclampsia is the main cause of maternal death in Brazil. Magnesium sulfate is the drug of choice for seizure prevention and control in the management of severe preeclampsia and eclampsia. Despite scientific evidence demonstrating its effectiveness and safety, there have been delays in managing hypertensive disorders, including timely access to magnesium sulfate. To conduct a general situational analysis on availability and use of magnesium sulfate for severe preeclampsia and eclampsia in the public health system.MethodA situational analysis was conducted with two components: a documental analysis on information available at the official websites on the policy, regulation and availability of the medication, plus a cross sectional study with field analysis and interviews with local managers of public obstetric health services in Campinas, in the southeast of Brazil. We used the fishbone cause and effect diagram to organize study components. Interviews with managers were held during field observations using specific questionnaires.ResultsThere was no access to magnesium sulfate in primary care facilities, obstetric care was excluded from urgency services and clinical protocols for professional guidance on the adequate use of magnesium sulfate were lacking in the emergency mobile care service. Magnesium sulfate is currently only administered in referral maternity hospitals.ConclusionThe lack of processes that promote the integration between urgency/emergency care and specialized obstetric care possibly favors the untimely use of magnesium sulfate and contributes to the high maternal morbidity/mortality rates.
Highlights
Eclampsia is the main cause of maternal death in Brazil
There was no access to magnesium sulfate in primary care facilities, obstetric care was excluded from urgency services and clinical protocols for professional guidance on the adequate use of magnesium sulfate were lacking in the emergency mobile care service
Our results are presented according to the four components of the fishbone diagram and are available in the summary table (Table 1): Regulatory/governmental component This component corresponds to the documental analysis as planned
Summary
Eclampsia is the main cause of maternal death in Brazil. To conduct a general situational analysis on availability and use of magnesium sulfate for severe preeclampsia and eclampsia in the public health system. In a recent multicenter study conducted in Brazil, during a one-year period, 82,388 hospitalized women were monitored for any pregnancy-related complication in 27 referral maternity hospitals. These maternity hospitals represented the five regions of the country. Among the 9,555 women identified with severe maternal complications, hypertensive disorders was the main cause of hospital admission (73 %), and eclampsia was the major cause of death in the country [3, 4]
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