Quality Of Prenatal Care Research Articles

570 Maternal education disparities among prenatal care trends in a national sample

Prior studies have noted inverse relationships between maternal education and adverse outcomes. Adequate prenatal care (PNC) has been shown to improve pregnancy outcomes, however the relationship with maternal education and PNC is not well understood. A population-based retrospective analysis of nulliparous, term, singleton, vertex (NTSV) deliveries using the National Center for Health Statistics’ birth certificate data. We examined the association of maternal education (some high school education, high school graduate, some college education, college graduate, post-college graduate) with PNC adequacy, defined as no PNC, 2nd/3rd trimester initiation, and at or above the median number of PNC visits. Log linear models adjusting for demographic and comorbidity factors were fit for each outcome. Interaction terms with education maternal race were assessed a priori given their close relationship and stratified models were fit. From 2016-2018, we identified 3.7 million NTSV deliveries with the plurality of patients having some college education (27.7%) followed by 23.6% graduating high school. Higher education level was associated with PNC adequacy with post college educated patients having 11% initiating PNC in the 2nd/3rd trimester, 63% less than the median PNC visits, and 0% having no PNC compared to less educated patients (Table 1). Adjusted analysis noted an inverse relationship between education and risk of no PNC, noting patients some high school education at highest risk (adjusted risk ratio (aRR) 2.88, 95% CI: 2.69-2.91). A similar trend was seen for attending less than the median number of PNC visits (aRR 1.13, 95% CI: 1.13-1.14) and 2nd/3rd trimester PNC initiation (aRR=1.60, 1.58-1.61) (Table 2). Stratified models by maternal race noted similar education findings. Lower levels of maternal education were associated with a significantly higher risk of receiving inadequate PNC, even after stratification for maternal race. Targeted efforts aimed at increasing access to high quality PNC may require screening for education and should be a public health priority.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Antenatal care in Southern Brazil: Coverage, trends and inequalities

We described prenatal care quality for four indicators over a 12-years period among puerperae living in Southern Brazil. Five surveys including all women giving birth between 01/01 to 31/12 in 2007, 2010, 2013, 2016, and 2019 were conducted in Rio Grande, Rio Grande do Sul state, Brazil. A single standardized questionnaire was applied within 48 h after delivery in all the city's maternity hospitals. Outcomes included the followings proportion of pregnant women who started prenatal care in the first trimester and performed at least six medical visits, completed at least two HIV, two syphilis and two qualitative urine tests. These indicators were stratified according to quartiles of household income. Absolute and relative measures of inequalities were calculated. A total of 12,645 (98% of the total) of the 12,914 mothers eligible in the five surveys were successfully interviewed. Coverage for all indicators increased substantially, especially in the poorest quartile for six prenatal care visits starting in the first trimester, and for HIV and qualitative urine tests. The slope index (SII) and the concentration index (CIX) of inequality showed clear disadvantage among the poorest for prenatal visits starting in the first trimester and performing two or more urine tests. There was a substantial increase in coverage for all variables studied in the period. The reduced inequity, mainly for the beginning of the first trimester and for visits and urine tests, was due to the higher coverage achieved in the poorest quartile.

Identifying Barriers and Facilitators to Prenatal Care for Spanish-Speaking Women.

BACKGROUND Early access to quality prenatal care is an essential component of improving maternal and neonatal outcomes as it allows for early intervention and risk stratification. Women who receive late or infrequent prenatal care are at high risk for complications including preterm birth, infant death, and stillbirth. We sought to better understand the barriers Spanish-speaking women face in accessing quality prenatal care and to identify facilitators in obtaining timely quality prenatal care.METHODS We recruited a homogeneous group of 11 women with Spanish as their primary language who were pregnant or had given birth within the last six months. We then conducted two focus groups in Spanish. The focus groups were recorded, translated, and transcribed, and then coded using grounded theory.RESULTS In our cohort of participants, the three major themes included desire for psychosocial support, health care system logistics, and barriers due to Latinx ethnicity.LIMITATIONS Our study has several limitations, including a small sample size and single site design.CONCLUSION Latinx women experience unique barriers to care including language barriers, a lack of cultural competency on the part of health care personnel, and ethnic discrimination. Additional research is needed to develop patient-centered interventions to address these barriers.

Optimizing mother-baby wellness during the 2019 coronavirus disease pandemic: A case for telemedicine.

Background:The 2019 coronavirus disease pandemic poses unique challenges to healthcare delivery. To limit the exposure of providers and patients to severe acute respiratory syndrome coronavirus 2, the Centers for Disease Control and Prevention encourages providers to use telehealth platforms whenever possible. Given the maternal mortality crisis in the United States and the compounding 2019 coronavirus disease public health emergency, continued access to quality preconception, prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby.Objective:This commentary explores unique opportunities to optimize virtual obstetric care for low-risk and high-risk mothers at each stage of pregnancy.Methods:In this review paper, we present evidence-based literature and tools from first-hand experience implementing telemedicine in obstetric care clinics during the pandemic.Results:Using the best evidence-based practices with telemedicine, health care providers can deliver care in the safest, most respectful, and appropriate way possible while providing the critical support necessary in pregnancy. In reviewing the literature, several studies endorse the implementation of specific tools outlined in this article, to facilitate the implementation of telemedicine. From a quality improvement standpoint, evidence-based telemedicine provides a solution for overburdened healthcare systems, greater confidentiality for obstetric services, and a personalized avenue for health care providers to meet maternal health needs in the pandemic.Conclusion:During the COVID-19 pandemic, continued access to quality prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby.

Improving Spoken Language Interpreter Services for Birthing People

Health disparities for perinatal people in North Carolina (NC) with limited English proficiency (LEP) are widening, including decreased access to quality prenatal care, higher-risk deliveries, disproportionate obstetric trauma, and increased postpartum depression. Several obstacles exist related to utilization and availability of medical interpreters, and without swift policy action to address these barriers to linguistically accessible care, health disparities will continue to widen. The aim of this commentary is to assist NC in developing policy that increases health equity for perinatal people with LEP. Through utilization of a socioecologic framework and SWOT analysis, we proposed four different policies related to medical interpreter services. Proposed policies were: 1) to improve the quality of training for medical interpreters by requiring that all interpreters be board certified, 2) to provide Medicaid reimbursement to hospitals and providers for interpreter services, 3) to mandate culturally-sensitive curricula in medical schools, and 4) to allocate funding for language concordant statewide perinatal education that includes information about navigating healthcare systems with LEP, patients’ rights, and patient advocacy. Current policies are insufficient to address the widening health disparities that are occurring for perinatal people with LEP. The proposed policies are worthy of consideration for implementation to further address reducing health disparities for birthing people with LEP at patient, provider, and structural levels.

Clinical Effects of the COVID-19 Pandemic Among the Uninfected Pregnant Women - 6 PLADs, China, 2019-2020.

Summary What is already known about this topic? The coronavirus disease 2019 (COVID-19) pandemic potentially affected prenatal care quality and maternal and fetal outcomes globally. What is added by this report? During COVID-19 pandemic period, the rates of caesarean sections (CS) and preterm birth for uninfected pregnant women increased slightly in areas that were relatively severely impacted by the pandemic in China. The overall number of prenatal examinations did not dramatically decrease, while the eligible examinations significantly decreased in Hubei Province. What are the implications for public health practice? Routine prenatal examinations had been well maintained during the pandemic period in China. In the future, in-time prenatal examinations should be provided to improve the quality of screening and management of high-risk pregnancy under pandemic-affected circumstances. Psychological counseling and transfer treatment channels should be strengthened for pregnant women during lockdown period.

Drug use according to risk classification and associated factors among pregnant women: results from NISAMI cohort

This study aimed to investigate the factors associated with drug use in pregnancy by risk categories in pregnant women from Santo Antônio de Jesus, Bahia. It is a cross-sectional cohort study with 1,091 pregnant women attended in primary health care between 2012 and 2014. Drug use during pregnancy was classified according to the FDA’s pregnancy risk classification. Prevalence ratios and respective 95% confidence intervals were adjusted by Poisson regression with robust error variance. The prevalence of drug use was more pronounced in risk categories A, B, C, D, and X, respectively. The use of safe medication was associated with education, number of prenatal consultations, and health problems after data adjustment. Age greater than 24 years, onset of prenatal care during the first trimester, and have any health problem were factors associated with the use of risk medication. Quality prenatal care is important to ensure the safe and conscious use of drugs. Furthermore, investments in continuing vocational education that promote rational antenatal drug use are needed.

Timing of Prenatal Care Initiation in the Health Resources and Services Administration Health Center Program in 2017

Early prenatal care is vital for improving maternal health outcomes and health behaviors, but medically vulnerable and underserved populations are less likely to begin prenatal care in the first trimester. In 2017, the Health Center Program provided safety-net care to more than 27 million persons, including 573026 prenatal patients, at approximately 12000 sites across the United States and U.S. jurisdictions. As part of a mandatory reporting requirement, health centers tracked whether patients initiated prenatal care in their first trimester of pregnancy. To identify health center characteristics associated with the initiation of prenatal care in the first trimester, as well as actionable steps policymakers, providers, and health centers can take to promote early initiation of prenatal care. Secondary analysis of cross-sectional data from the 2017 Uniform Data System. The United States and 8 U.S. jurisdictions. Health center grantees with prenatal patients (n= 1281). Multinomial logistic regression (adjusted for state or jurisdiction clustering) was used to identify health center characteristics associated with achievement of the Healthy People 2020 baseline (77.1%) and target (84.8%) for women receiving prenatal care in the first trimester (Maternal, Infant, and Child Health Objective 10.1). Overall, 57.4% of health centers met the Healthy People 2020 baseline (mean, 78%; median, 81%), and 37.9% met the Healthy People 2020 target. Several characteristics were positively associated with meeting the baseline (larger proportion of prenatal patients aged 20 to 24 years) and target (more total patients, prenatal care by referral only, a larger proportion of prenatal patients aged 25 to 44 or ≥45 years, and a larger proportion of White or privately insured patients). Other characteristics were negatively associated with the baseline (location outside New England, location in a rural area, and a large proportion of prenatal patients aged <15 years) and target (more prenatal patients, location outside New England, provision of prenatal care to women living with HIV, and more uninsured patients or patients eligible for both Medicare and Medicaid). The data set is at the health center grantee level and does not contain information on timing or quality of follow-up prenatal care. Most health centers met the Healthy People 2020 baseline, but opportunities for improvement remain and the Healthy People 2020 target is still a challenge for many health centers. Policymakers, providers, and health centers can learn from high-achieving centers to promote early initiation of prenatal care among medically vulnerable and underserved populations. Health Resources and Services Administration.

Mortalidade infantil em uma capital do norte do Brasil: estudo de série temporal

Objetivo: caracterizar e identificar causas de mortalidade infantil em Porto Velho, Rondônia de 2012 a 2017. Métodos: série temporal com dados do Sistema de Informação sobre Mortalidade e Sistema de Informações sobre Nascidos Vivos. As frequências e o coeficiente foram realizadas pelo software SPSS Statistics, versão 17. Resultados: Dos 53.321 nascidos vivos, 1,31% vieram a óbitos antes de completar um ano de vida. Destes, 48,93% ocorreram no período neonatal precoce e 56,78% foram por causas não claramente evitáveis. As maiores causas de óbitos foram associadas às ações com adequada atenção ao feto e recém-nascido (46,50%) e à mulher na gestação (32,87%). A principal causa de óbitos neonatais foi por septicemia bacteriana não especificada no recém-nascido (57,73%). O maior coeficiente de mortalidade Infantil foi em 2016 (14,82 óbitos/1.000 nascidos vivos). Conclusão: O óbito infantil no período neonatal precoce ocorreu por causas evitáveis ligadas à atenção ao feto/recém-nascido e à gestante. A mortalidade neonatal por septicemia bacteriana não especificada reflete falhas no pré-natal/parto/pós-nascimento. É imprescindível qualificar profissionais que atuam no ciclo gravídico-puerperal, sobretudo médicos responsáveis pelas notificações para melhorar a vigilância do óbito infantil. Sugere-se avaliar fatores que interferem na qualidade do pré-natal e na assistência realizada no momento do parto.

Avaliação da qualidade da assistência pré-natal prestada pelo enfermeiro

Objetivos: avaliar a atenção no pré-natal pelo enfermeiro; analisar a consulta de enfermagem na percepção da gestante. Metodologia: pesquisa exploratória, descritiva, qualitativa, desenvolvida em uma Clínica de Saúde da Família do Município do Rio de Janeiro. A população do estudo consistiu em 15 gestantes, usando referencial avaliativo proposto por Avedis Donabedian. Resultados: o estudo apontou gestantes jovens, casadas, sem incentivo do enfermeiro na participação do parceiro, porém classificando positivamente a consulta pré-natal. A sala de pré-natal possui equipamentos necessários, mas o registro no cartão da gestante foi inadequado. Conclusão: necessário maior incentivo da presença paterna nas consultas e uniformidade nos registros do cartão da gestante com qualificação do enfermeiro na assistência prestada.

The prenatal triad: The importance of provider-patient communication with expectant fathers throughout the prenatal care process

Previous research has primarily focused on the relationship between providers and expectant mothers as a key element of quality prenatal care. Significantly less attention has been directed toward expectant fathers and the importance of their communication with prenatal care providers and involvement in the prenatal care process. Much of this limited existing literature emphasizes the health benefits including fathers would bring for mom and baby, but rarely is the potential benefit to fathers’ health included in the conversation. This discussion aims to highlight the value of this line of research for both communication and medical researchers and consider potential avenues for studying and promoting father engagement in prenatal care.

Toxoplasmosis in pregnancy: a clinical, diagnostic, and epidemiological study in a referral hospital in Rio de Janeiro, Brazil

Toxoplasmosis in pregnant women can cause significant morbidity and mortality in the fetus, which may be mitigated by early diagnosis and treatment. Social factors have also been related to the risk of developing the congenital form of toxoplasmosis, since some of these factors interfere directly in the quality of prenatal care. This study aimed to describe the clinical, laboratory, and epidemiological data of pregnant women diagnosed with toxoplasmosis and their newborns followed up at a referral hospital in Rio de Janeiro, Brazil. This was descriptive cohort study of 334 pregnant women with toxoplasmosis followed from May 2014 to December 2017. We conducted interviews to assess knowledge about the disease and its preventive measures, analyzed clinical and laboratory data during antenatal visits, and collected data from the newborns’ medical charts. ResultsThis was a predominantly low-income women cohort study, with little schooling, mainly referred from public health services late in pregnancy (178; 53.3%), in the second and third trimesters (286; 85.6%). Diagnosis of acute toxoplasmosis had not been confirmed in 171 cases (51.2%). Out of 183 (54.9%) women who had initiated treatment at the original health services, 45 (24.6%) received an incorrect prescription. Seventy-two amniocenteses were performed, with positive real-time polymerase chain reaction (qPCR) in the amniotic fluid in two cases (2.8%). Congenital toxoplasmosis at birth was identified in eight newborns (5.4%). ConclusionLate referral to specialized medical services, inadequate toxoplasmosis management at the original prenatal care services, and social vulnerabilities are contributing factors to the persistent occurrence of congenital toxoplasmosis cases.

Análise dos óbitos fetais ocorridos em uma maternidade de referência

Objetivo: Analisar os óbitos fetais, segundo características sócio-demográficas, clínicas e critérios de evitabilidade, ocorridos em uma maternidade. Métodos: Estudo retrospectivo dos óbitos fetais ocorridos no período de 2014 a 2017. Elaborou-se uma planilha no Excel 2010, com as variáveis contidas na ficha de investigação de óbitos fetais. Realizaram-se análises descritivas e classificaram-se as causas dos óbitos, conforme critério de evitabilidade, por faixa de peso (1500g-2500g; &gt;2500g). Resultados: Ocorreram 1029 óbitos no período. A taxa de mortalidade fetal foi de 25,1/1000 nascidos vivos (NV) em 2013 e 26,1/1000 NV em 2017. 39,9% das mães tinham entre 20 a 40 anos e 39,9% possuíam mais 8 anos de estudo. As patologias mais citadas durante a gravidez foram: hipertensão arterial/DHEG (33,1%), hemorragia/ DPP/ placenta prévia (31,1%) e infecção urinária (20,1%). No momento da internação, 38,4% apresentavam amniorrexe prematura sem trabalho de parto, 9,7% pré-eclampsia grave e 9,1% apresentaram descolamento prematuro da placenta. As principais intercorrências durante o parto foram: eclampsia / hipertensão (25,6%), hemorragia (20,2%). Dos 570 óbitos fetais (acima de 1500g) analisados, 84,9% ocorreram por causas evitáveis, 4,9% por causas não claramente evitáveis e 10,2% por causas mal definidas. As principais causas dos óbitos fetais evitáveis (n=484) foram classificadas como: reduzíveis por adequada atenção à mulher na gestação (56,6%) e adequada atenção à mulher no parto (36,4%) e adequada atenção ao recém-nascido (7,0%). Conclusão: os achados revelam uma proporção alta de óbitos fetais que poderiam ser evitados com ações voltadas a melhoria na qualidade da assistência ao pré-natal e ao parto.

Assistência de enfermagem a mulheres com ansiedade e depressão na gravidez: uma revisão integrativa

Objetivo: Demonstrar a importância do conhecimento sobre ansiedade e depressão durante a gestação para a melhoria da qualidade na assistência ao pré-natal no âmbito da Atenção Básica em Saúde. Metodologia: Trata-se de uma revisão integrativa da literatura realizada com artigos publicados e indexados na Biblioteca Virtual em Saúde (BVS) e nos bancos de dados LILACS e MEDLINE. Resultados e discussão: Dos 34 artigos encontrados, após aplicação dos critérios de inclusão, exclusão e da análise dos seus conteúdos, 09 foram selecionados para a análise do estudo. Foram identificadas características que mais se destacaram na ocorrência de problemas para harmonizar o psicológico durante e depois do período gravídico. Conclusão: Ansiedade e depressão estão presentes, principalmente em mães adolescentes, mães com baixa escolaridade, sem apoio familiar e solteiras, assim a influência de fatores socioeconômicos como fatores de risco para esses distúrbios na gestação. Como estratégia para uma assistência de qualidade a gestantes com depressão e ansiedade o Pré-natal Psicológico aliado com acompanhamento multiprofissional se revelou essencial.

Cesarean Law: a turning point in the fight against the Brazilian epidemic of cesarean section?

Abstract In the opposite direction to the process that had been gradually changing birth forms and indicators in Brazil, in 2019 the State of São Paulo (located in southeastern Brazil) enacted Law 17. 137, which guarantees all pregnant women the choice of a cesarean section from the 39 weeks of pregnancy, regardless of the obstetric indication. That is a preliminary qualitative analysis of a doctoral investigation, we are looking for show some points of inflection of this law to combat the cesarean epidemic. Affiliated to the theoretical-methodological approach of discursive practices and the production of meanings in daily, it investigates the discourses that support the current policies to encourage humanized obstetric care based on scientific evidence, built over the last 20 years, and those who supported the approval of this legal norm, known as the Cesarean Law. One of the inflection points of Law concerns the quality of prenatal care and the way that women receive information about childbirth during pregnancy. Because lack of information and insecurity are important factors in the choice of women by the type of delivery. Iatrogenic prematurity is one of the biggest problems of Brazilian cesarean section epidemic. Thus, even after 39 weeks of pregnancy, there is no guarantee of baby's maturity. Since the 90's, the Brazilian government had been encouraging the insertion of midwives and nurse midwives in the childbirth care of all women at regular risk and encouraged the creating of childbirth centers as well an adequate classification of gestational risk. At this point, the law affronts the current organization of the system, as it prioritizes attendance by doctors over professional midwives. The cesarean rates and other health indicators are not available yet after the approval of the law in São Paulo state. However, we can postulate that it will mean a setback in the fight against the epidemic of cesarean sections in Brazil. Key messages The Cesarean law approved in the state of São Paulo / BR presents inflection points in the fight against the cesarean section epidemic. The Cesarean law approved in the state of São Paulo / BR ignores important issues in the Brazilian obstetric scenario.

Evaluation of Pregnancy Outcomes in Iranian Women with Uterine Myomas

Background: To investigate the impacts of myomas on the outcomes of pregnancy in Iranian pregnant women with uterine fibroids. Materials and Methods: In this retrospective cohort study, the consequences of myomas on pregnancy were investigated in Iranian pregnant women referred to the perinatology clinic of Mahdieh Hospital (Tehran, Iran). One-hundred and sixty pregnant women diagnosed with uterine myoma were enrolled in the study as the case group. The control group consisted of 160 pregnant women without fibroma. The characteristics of the myomas and their relationships with pregnancy outcomes were surveyed. Results: Non-cephalic presentation, preterm labor, and Cesarean delivery were significantly higher in the case group in comparison with the control group. 106 patients (66.7%) had myomas larger than 5 cm in diameter. Intramural fibroids were seen in 132 (83%) patients. In addition, 133 (83.6%) patients had myomas in the body (corpus) of the uterus. Considering the number of myomas, 124 (78%) patients revealed one myoma in uterus. Uterine myomas during pregnancy rendered an important risk factor for cesarean delivery, breech presentation, and preterm delivery. However, there were no significant correlations between uterine myomas and IUGR, premature membranes rupture, either abortion or bleeding in the first trimester, low birth weight, and severe postpartum bleeding. Conclusion: Our results showed that the presence of myoma could modulate pregnancy outcomes. Our results can be useful in improving the quality of prenatal care and education.

Determinants of the use of nonpharmacological analgesia for labor pain management: a national population-based study.

Besides neuraxial analgesia, nonpharmacological methods are also proposed to help women coping with pain during labor. We aimed to identify the individual and organizational factors associated with the use of nonpharmacological analgesia for labor pain management. Women who attempted vaginal delivery with labor analgesia were selected among participants included in the 2016 National Perinatal Survey, a population-based cross-sectional study. Labor analgesia was studied as neuraxial analgesia alone, nonpharmacological analgesia alone, and neuraxial and nonpharmacological analgesia combined. The associations were studied using multilevel multinomial logistic regression. Among the 9231 women included, 62.4% had neuraxial analgesia alone, 6.4% had nonpharmacological analgesia alone, and 31.2% had both. Nonpharmacological analgesia alone or combined with neuraxial analgesia were both associated with high educational level (adjusted odds ratio 1.55; 95% confidence interval [CI], 1.08-2.23 and 1.39; 95% CI, 1.18-1.63), antenatal preference to deliver without neuraxial analgesia, and public maternity unit status. Nonpharmacological analgesia alone was more frequent among multiparous women, and in maternity units with an anesthesiologist not dedicated to delivery unit (1.57; 95% CI, 1.16-2.12) and with the lowest midwife workload (2.15; 95% CI, 1.43-3.22). Neuraxial and nonpharmacological analgesia combined was negatively associated with inadequate prenatal care (0.70; 95% CI, 0.53-0.94). In France, most women who had nonpharmacological analgesia during labor used it as a complementary method to neuraxial analgesia. The use of nonpharmacological analgesia combined with neuraxial analgesia mainly depends on the woman's preference, but also on socioeconomic factors, quality of prenatal care, and care organization.

Beyond coverage: a qualitative study exploring the perceived impact of Gabon\u2019s health insurance plan on access to and quality of prenatal care

BackgroundAccess to affordable and adequate healthcare in a health system determines the universal health coverage achievement for all residents in a country. Achieving access to healthcare requires the availability of a financing system that ensures access to and provision of adequate care, regardless of the ability to pay. In sub-Saharan Africa, accessibility, use and coverage of prenatal visits are very low and poor, which reduces the quality of care. This paper explored the impact of a social health insurance scheme on the quality of antenatal care in Gabon.MethodsThis qualitative study involved the analysis of data collected from semi-structured interviews and non-participant observations to assess the quality of antenatal care. The study elicited perceptions on the demand side (pregnant women) and the supply side (health professionals) in health facilities. Fifteen semi-structured interviews were conducted with pregnant women (aged between 15 and 49) and 5 with health professionals, who each had a seniority of at least 10 years, at different levels of care. Nine non-participant observations were also conducted. Coded transcripts were reviewed and analyzed using the Canadian Institute for Public Administration of Citizen-Centered Services model as an analytical guide.ResultsOn the demand side, women were generally satisfied with the prenatal services they receive in health facilities. However, complaints were made about the rudeness of some nurses, the high price of the delivery kit (50,000 XAF), and the fact that some essential medicines for maternity are not covered. On the supply side, participants agreed that compulsory health insurance is important in providing antenatal care access to those who need it the most. However, some problems remain. The participants outlined some logistical problems and a lack of medical equipment, including the stock of drugs, disinfectants, and the absence of clean water.ConclusionUnderstanding the perceptions of pregnant women and health professionals regarding the quality of antenatal care can help to inform refinements to methods through which the services can be better provided. In addition, the study findings are vital to increasing the use of care, as well as combating high maternal mortality rates. Compulsory health insurance has improved the accessibility and utilization of healthcare services and has contributed to improved quality of care.

Social and geographical inequalities in the performance of prenatal care in a metropolitan area of Brazil.

This study analyzed the social and geographical inequalities in the performance of prenatal medical care in the Unified Health System (SUS) in the Metropolitan Region of Grande Vitória, Espírito Santo, Brazil. A cross-sectional study was carried out with 1,209 puerperae living in this region, admitted for childbirth from 2010 to 2011. Data about prenatal care and contextual, enabling, and social characteristics were collected, following the Andersen's Behavioral Model. The performance of prenatal care was classified into five levels, including information on the number of prenatal visits, initial and repetitive examinations, tetanus vaccination, gestational risk management, and participation in educational activities. The likelihood of different levels of prenatal care performance was analyzed using a multivariate multinomial model, according to maternal social variables. High prenatal coverage (98%) and 4.4% care adequacy were identified. The likelihood of access to prenatal care was increased by enabling, contextual, and social factors. The relationship between prenatal care quality and pregnant women's social and geographical conditions must be considered in the organization of services to achieve equity and reduce maternal and perinatal morbimortality.

Congenital syphilis distribution in the State of Tocantins, Brazil, 2007-2015.

to describe the epidemiological profile of congenital syphilis (CS) in Tocantins, from 2007 to 2015. this was a cross-sectional descriptive study conducted with data from the Notifiable Health Conditions Information System (SINAN) and the Live Birth Information System (SINASC). 1,029 CS cases were reported; mean CS incidence was 4.6/1,000 Live Births (LB), increasing from 3.1/1,000 LB in 2007 to 9.8/1,000 LB in 2015 (increase of 216.1%); municipalities located in the central and northern regions of the state had the highest rates; the majority of mothers of newborn babies were 15-24 years old, had elementary school education, started prenatal care in the third trimester of pregnancy, and received inadequate prenatal care. high occurrence of congenital syphilis in Tocantins requires immediate intensification of CS surveillance and improved prenatal care quality, especially in municipalities with higher incidence.