Quality Of Prenatal Care Research Articles

Multiparous Black and Latinx Women Face More Barriers to Prenatal Care than White Women.

Women who are late to prenatal care miss opportunities for health interventions and are at increased risk for pregnancy-related complications. Black women have the lowest rates of first trimester care compared with White or Latinx women. We sought to describe barriers to prenatal care experienced by race/ethnicity in a multi-site, prospective cohort. We performed a secondary analysis of the Community Child Health Research Network Study, a multi-site prospective cohort study of pregnant women from 2008 to 2012. Women were recruited at the time of delivery and followed prospectively for 2years. Participants who experienced a repeat pregnancy in the 2-year follow-up period had a prospective assessment of prenatal care barriers. A multilevel mixed effects Poisson regression was performed to evaluate the association between race/ethnicity and number of prenatal barriers. Of the 298 participants in the sample, 43% of Black, 35% of Latinx, and 23% of White participants reported barriers to prenatal care. After adjustment for confounders, Black and Latinx women reported almost twice as many barriers to prenatal care as White women (adjusted rate ratio 1.89 [1.2, 3.0]; 2.00 [1.1, 3.8], respectively). In our analysis, multiparous Black and Latinx women reported encountering more barriers to prenatal care than White women. Additional reforms and policy change are needed at the clinic, local, and state levels to support women in accessing early quality prenatal care to achieve racial equity in prenatal care.

The Relationship between Maternal Health Literacy and Pregnancy Status in New Mothers who Referred to Health Centers of Yazd

Introduction: Health literacy includes special knowledge and social skills in pregnant women to diagnose prenatal risk factors, healthy lifestyle, and proper nutrition during pregnancy. Health literacy affects the outcome of pregnancy by improving the quality of prenatal health care. The aim of this study was to investigate the health literacy in women referring to health centers in Yazd City of Iran in 2017. Methods: This cross-sectional study was conducted on 390 new mothers who referred to health centers of Yazd City selected by multistage cluster sampling. Data were collected by Maternal Health Literacy. Validity and reliability of the questionnaire were confirmed in previous studies. Data were analyzed by SPSS21 software using T-test and ANOVA. Results: The results showed that the mean score of health literacy was 54.67±9.85. The results also indicated that maternal health literacy had a significant relationship with educational level, knowledge of pre-pregnancy weight, and history of disease during pregnancy. Discussion: The health literacy of new mothers was fairly favorable in this study. Health policymakers should simplify the required training for pregnant and lactating women to minimize the various factors that affect their health literacy.

Evaluation of the quality of prenatal care based on the recommendations Prenatal and Birth Humanization Program.

The Prenatal Care and Birth Humanization Program (PHPN) establishes a minimum number of procedures to be provided to all pregnant women during prenatal care. This study aimed to analyze the quality of prenatal care in Sergipe based on the PHPN recommendations. This is a cross-sectional study, with a descriptive and analytic approach, using survey data from the Birth in Sergipe research, conducted from June 2015 to April 2016 with 768 puerperae proportionally distributed among all state maternity hospitals (n = 11). Data were collected from face-to-face interviews and patients' prenatal care cards. The results showed a high coverage of prenatal care (99.3%; n =763), but little more than half of these women started their prenatal care within 16 weeks of gestation (57%; n =435), and 74.7% (n = 570) had six or more visits. We noted that 16.6% (n = 127) of pregnant women were at high risk for complications and almost half continued monitoring prenatal care with professional nurses. Around 61.3% were advised about the maternity care service of reference for delivery, and 29.4% sought more than one health service for childbirth. We concluded that there was a high prenatal care coverage in Sergipe, however, with issues concerning its adaptation to the PHPN.

A review of the quality of midwifery care in Iran

Introduction: About half a million women worldwide die annually from complications of pregnancy or lack of midwifery care, 99% of which occur in developing countries. High-quality service often leads to customer satisfaction. Staff play a significant role in improving the quality of care. Given the importance of this issue in improving macroeconomic and international indicators, we decided to review the quality of midwifery care in Iran. Materials and Methods: After searching 950 articles with these keywords: quality, care, midwifery and satisfaction in the search engines of Sciencedirect, Iranmedex, SID, Magiran, Google Scholar, Pubmed and IranDoc, about 28 articles were finally selected and the results were filmed. Results: Studies reported the quality of prenatal care, pregnancy, postpartum and family planning at a moderate level, so that the weakest quality was observed in the fourth stage of labor. Satisfaction of pre-natal services, labor and childbirth, post-partum and family planning was stated at a high and very high level, and the satisfaction with the pre-natal period was higher than the labor. Conclusion: The quality of midwifery care was at a moderate level and its satisfaction was high. Therefore, high satisfaction does not always mean high quality of service, as mothers' satisfaction may be due to their low expectation. Therefore, in order to evaluate the quality of midwifery services, in addition to obtaining satisfaction, international standards must always be considered.

Maternal factors associated with prematurity in public maternity hospitals at the Brazilian Western Amazon

ObjectiveTo analyse maternal factors associated with prematurity in public maternity hospitals. DesignRetrospective unmatched case-control study on two public maternity hospitals in the State of Acre, Brazil. Setting and ParticipantsA sample of 341 newborn infants of premature birth (< 37 weeks; case group) and 388 newborn infants of term delivery (≥ 37 weeks; control group). MethodsA validated instrument was used for interviews, and information was collected from hospital records. The variables were divided into five blocks: (1) maternal sociodemographic and economic characteristics, (2) maternal biological and reproductive characteristics, (3) maternal habits, (4) pregnancy complications, and (5) neonatal characteristics. The hierarchical analysis was performed using multiple logistic regression. ResultsThe risk factors associated with premature birth were as follows: newborn infants of mothers who were born premature (p = 0.005), with low BMI (p = 0.006), history of a previous preterm child (p<0.003), who had stress (p = 0.020) and physical injury during pregnancy (p = 0.025), with quality of prenatal care classified as inadequate II (p = 0.001), which presented abnormal amniotic fluid volume (p<0.001), pre-eclampsia/eclampsia (p<0.001), bleeding (p = 0.013) and hospitalization during pregnancy (p = 0.001). ConclusionThe variables that were associated with premature birth were mother born preterm, low BMI, previous premature child, stress and physical injury during pregnancy, prenatal care inadequate II, bleeding, abnormal amniotic fluid volume, pre-eclampsia/eclampsia and hospitalization during pregnancy. It is important to properly perform prenatal care, having a multidisciplinary approach as support, with the objective of keep up with changes in nutritional classification and monitoring of adverse clinical conditions.

Using Text Messaging to Improve Access to Prenatal Health Information in Urban African American and Afro-Caribbean Immigrant Pregnant Women: Mixed Methods Analysis of Text4baby Usage.

BackgroundThe Text4baby (T4B) mobile health (mHealth) program is acclaimed to provide pregnant women with greater access to prenatal health care, resources, and information. However, little is known about whether urban African American and Afro-Caribbean immigrant pregnant women in the United States are receptive users of innovative health communication methods or of the cultural and systematic barriers that inhibit their behavioral intent to use T4B.ObjectiveThis study aimed to understand the lived experiences of urban African American and Afro-Caribbean immigrant pregnant women with accessing quality prenatal health care and health information; to assess usage of mHealth for seeking prenatal health information; and to measure changes in participants’ knowledge, perceptions, and behavioral intent to use the T4B mHealth educational intervention.MethodsAn exploratory sequential mixed methods study was conducted among pregnant women and clinical professionals for a phenomenological exploration with focus groups, key informants, interviews, and observations. Qualitative themes were aligned with behavioral and information technology communications theoretical constructs to develop a survey instrument used. repeated-measures pre- and post-test design to evaluate changes in participants’ knowledge, attitudes, and beliefs, of mHealth and T4B after a minimum of 4 weeks’ exposure to the text message–based intervention. Triangulation and mixing of both qualitative and quantitative data occurred primarily during the survey development and also during final analysis.ResultsA total of 9 women participated in phase 1, and 49 patients signed up for T4B and completed a 31-item survey at baseline and again during follow-up. Three themes were identified: (1) patient-provider engagement, (2) social support, and (3) acculturation. With time as a barrier to quality care, inadequate patient-provider engagement left participants feeling indifferent about the prenatal care and information they received in the clinical setting. Of 49 survey participants, 63% (31/49) strongly agreed that T4B would provide them with extra support during their pregnancy. On a Likert scale of 1 to 5, participants’ perception of the usefulness of T4B ranked at 4.26, and their perception of the compatibility and relative advantage of using T4B ranked at 4.41 and 4.15, respectively. At follow-up, there was a 14% increase in participants reporting their intent to use T4B and a 28% increase from pretest and posttest in pregnant women strongly agreeing to speak more with their doctor about the information learned through T4B.ConclusionsUrban African American and Afro-Caribbean immigrant pregnant women in Brooklyn endure a number of social and ecological determinants like low health literacy, income, and language that serve as barriers to accessing quality prenatal health care and information, which negatively impacts prenatal health behaviors and outcomes. Our study indicates a number of systematic, political, and other microsystem-level factors that perpetuate health inequities in our study population.

Newborn Care Practices and Associated Factors Among Lactating Mothers at Home in the Rural Districts of Gedeo Zone, Southern Ethiopia.

IntroductionGlobally, approximately three million neonates die in the first month of life. Neonatal mortality is a public problem in low and middle-income counties. Home-based good newborn care practice by lactating mothers is vital to improve newborns' health. In Ethiopia, home-based cultural newborn care practice among lactating mothers is very common, in contrast to standard essential newborn care practice. Thus, this study aimed to assess home-based newborn care practices among lactating mothers and associated factors in rural districts of Gedeo Zone, Southern Ethiopia, in 2018.MethodsA community-based cross-sectional study was conducted in the rural districts of Gedeo Zone, Southern Ethiopia. A single population formula was used to determine the sample size, and 834 lactating mothers were enrolled in the study. Multistage sampling techniques were used to select study participants. Data were collected using a pre-tested interviewer-administered structured questionnaire and analyzed by SPSS version 22 software (IBM Corporation, Armonk, NY, USA). To determine associated factors with good newborn care practice among lactating mothers, the odds ratio with 95% confidence interval was used.ResultsThe level of good newborn care practice among lactating mothers at home was 24.1% with 95% CI: 2.5–9.7. The factors significantly associated were maternal education (adjusted OR=2.6; 95% CI: 1.8–3.9), maternal employment (adjusted OR=2.1; 95% CI: 1.4–3.1), pregnancy intention (adjusted OR=1.7, 95% CI: 1.2–2.2), antenatal care visit (adjusted OR=5.7, 95% CI 3.9–7.9), and birth interval (adjusted OR=1.9, 95% CI: 1.3–2.8).ConclusionThe level of good newborn care practices among lactating mothers at home was found to be low. Thus, advancing women's education and employment in the community, and providing quality prenatal care are suggested to scale up good newborn care practice among lactating mothers at home. Additionally, an observational study might be needed to identify further associated factors.

Fatores de risco associados à prematuridade e baixo peso ao nascer nos extremos da vida reprodutiva em uma maternidade privada

Objetivo: A presente pesquisa objetivou avaliar os fatores de risco associados à prematuridade e baixo peso ao nascer dos recém-nascidos das parturientes nos extremos da vida reprodutiva. Métodos: Participaram do estudo 1.117 prontuários de gestantes. Utilizou-se um protocolo de pesquisa previamente formulado pelos pesquisadores para registro das características sociodemográficas maternas, bem como dados sobre: paridade; idade gestacional; realização de pré-natal; intercorrências; via de parto; e outros. Resultados: Os achados evidenciaram que no grupo de mães acima de 34 anos a ocorrência de menos de seis consultas no pré-natal e o índice de Apgar no quinto minuto menor que sete predizem maiores chances de prematuridade e baixo peso ao nascer. Conclusão: Conclui-se que a idade materna influencia significativamente na ocorrência de parto prematuro e baixo peso ao nascimento, sendo justificado essencial políticas de saúde estaduais mais operante em relação ao pré-natal de qualidade.

Quality of Prenatal Care and Associated Factors among Pregnant Women at Public Health Facilities of Wogera District, Northwest Ethiopia

Background Prenatal care refers to services a pregnant woman receives during pregnancy to ensure a healthy outcome for herself and her newborn. However, only limited studies have so far been done to assess the quality of prenatal care in the study area. Thus, this study is aimed at assessing the quality of prenatal care and associated factors at public health facilities in Wogera district, northwest Ethiopia. Methods An institution-based cross-sectional study was conducted in Wogera district from March to April 2019. A total of 465 pregnant women were interviewed using a semi-structured interviewer-administered questionnaire; consecutive sampling was used to select the participants. The binary logistic regression analysis model was fitted to identify the potential predictor variables. Variables with <0.2 p values were fitted into the multivariable logistic regression analysis model; <0.05 p values and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) were used to declare factors associated with the quality of prenatal care. Results The overall quality of prenatal care was 32.7% (95% CI: 28.1, 37.2). Four or more prenatal care visits (AOR = 2.3; 95% CI: 1.2, 4.7), high maternal education (AOR = 2.9; 95% CI: 1.03, 7.93), over USD 175.5 monthly household income (AOR = 2.8; 95% CI: 1.1, 7.8), and the availability of maternity waiting areas (AOR = 2.4; 95% CI: 1.2, 5.0) were positively associated with the quality of the care. Conclusion The overall quality of prenatal care in this study was low. Therefore, promoting focused prenatal care and increasing infrastructure, encouraging maternal education, and compensating for the healthcare costs for women with low household income might enhance the quality of the care.

Does Universal Coverage Mitigate Racial Disparities in Potentially Avoidable Maternal Complications?

Potentially avoidable maternity complications (PAMCs) have been validated as an indicator of access to quality prenatal care. African-American mothers have exhibited a higher incidence of PAMCs, which has been attributed to unequal health coverage. The objective of this study was to assess if racial disparities in the incidence of PAMCs exist in a universally insured population. PAMCs in each racial group were compared relative to White mothers using multivariate logistic regression. Stratified subanalyses assessed for adjusted differences in the odds of PAMCs for each racial group within direct versus purchased care. A total of 675,553 deliveries were included. Among them, 428,320 (63%) mothers were White, 112,170 (17%) African-American, 37,151 (6%) Asian/Pacific Islanders, and 97,912 (15%) others. African-American women (adjusted odds ratio [aOR]: 1.05, 95% CI: 1.02-1.08) were more likely to have PAMCs compared with White women, and Asian women (aOR: 0.92, 95% CI: 0.89-0.95) were significantly less likely to have PAMCs compared with White women. On stratified analysis according to the system of care, equal odds of PAMCs among African-American women compared with White women were realized within direct care (aOR: 1.03, 95% CI: 1.00-1.07), whereas slightly higher odds among African-American persisted in purchased (aOR: 1.05, 95% CI: 1.01-1.10). Higher occurrence of PAMCs among minority women sponsored by a universal health coverage was mitigated compared with White women. Protocol-based care as in the direct care system may help overcome health disparities.

Prenatal care in the Brazilian public health services.

ABSTRACTOBJECTIVE To verify regional inequalities regarding access and quality of prenatal and birth care in Brazilian public health services and associated perinatal outcomesMETHODS Birth in Brazil was a national hospital-based survey conducted between 2011 and 2012, which included 19,117 women with public-funded births. Regional differences in socio-demographic and obstetric characteristics, as well as differences in access and quality of prenatal and birth care were tested by the χ2 test. The following outcomes were assessed: spontaneous preterm birth, provider-initiated preterm birth, low birth weight, intrauterine growth restriction, Apgar in the 5th min < 8, neonatal and maternal near miss. Multiple and non-conditional logistic regressions were used for the analysis of the associated perinatal outcomes, with the results expressed in adjusted odds ratio and 95% confidence interval.RESULTS Regional inequalities regarding access and quality of prenatal and birth care among users of public services are still evident in Brazil. Pilgrimage for birth associated with all perinatal outcomes studied, except for intrauterine growth restriction. The odds ratios ranged between 1.48 (95%CI 1.23–1.78) for neonatal near miss and 1.62 (95%CI 1.27–2.06) for provider-initiated preterm birth. Among women with clinical or obstetric complications, pilgrimage for birth associated with provider-initiated preterm birth and with Apgar in the 5th min < 8, odds ratio of 1.98 (95%CI 1.49–2.65) and 2.19 (95%CI 1.31–3.68), respectively. Inadequacy of prenatal care associated with spontaneous preterm birth in both groups of women, with or without clinical or obstetric complications.CONCLUSION Improvements in the quality of prenatal care, appropriate coordination and comprehensive care at the time of birth have a potential to reduce prematurity rates and, consequently, infant morbidity and mortality rates in the country.

Effect of Positive Psychology Interventions on the Quality of Prenatal Care Offered by Midwives: A Field Trial.

Background:The quality of prenatal care has been recognized as critical to the effectiveness of care in optimizing maternal and child health outcomes. This study examined the effect of positive psychology interventions on the quality of prenatal care offered by midwives.Materials and Methods:This field trial was conducted on 60 midwives working in community health centers in Mashhad, Iran, from September 23, 2015 to March 20, 2016. Initially, centers No. 1 and No. 3 were selected via cluster sampling from among the five healthcare centers of Mashhad. Then, all subsidiaries of these centers were listed and assigned to intervention and control groups through simple random sampling. Thus, 60 midwives were randomly assigned to two equal intervention and control groups. The intervention, based on Seligman's Well-Being Theory, was presented weekly with homework in eight 2-h sessions. Before the interventions and immediately after the intervention, the Oxford Happiness Questionnaire (OHQ) and Ryff's Scales of Psychological Well-Being (SPWB) were completed by the midwives, and the Quality of Prenatal Care Questionnaire (QPCQ) was completed by two pregnant women for each midwife.Results:After the intervention, the mean [Standard Deviation (SD)] score of the overall quality of prenatal care in the intervention group was significantly higher than that of the control group [mean (SD) = 1.51 (0.49) vs. 0.05 (0.21); t43,12= 18.7, p < 0.001].Conclusions:It seems that improving the well-being of midwives through positive psychology interventions is effective on the quality of prenatal care provided by them.

The relationship between hope and happiness with prenatal care.

INTRODUCTION:Prenatal care refers to proper and principled implementation aimed at maintaining a healthy pregnancy in terms of physical health and favorable psychological outcomes for the mother, infant, and family. The adequacy of prenatal care is an important indicator in predicting infant and maternal mortality. Mental health components such as hope and happiness can influence the quality of prenatal care. The aim of this study was to determine the relationship between hope and happiness with prenatal care.METHODS:This is a cross-sectional study that was performed on 200 pregnant mothers referred to Isfahan, Iran, comprehensive health centers in 2018 using an available sampling method. The research instrument was a questionnaire of hope, happiness, and quality of prenatal care that was completed by qualified people. The data were analyzed by descriptive and analytical statistical methods (Pearson correlation).RESULTS:The results of this study showed that there is a significant relationship between the adequacy of care and overall hope score (P = 0.032). There was also a positive and significant relationship between the adequacy of care and the subscales of hope (thinking [P = 0.002] and path [P = 0.004]). There was a positive and significant relationship between the adequacy of prenatal care and overall happiness score (P = 0.03). Positive emotion subscale (P = 0.033) had a significant positive correlation and negative emotion subscale (P = 0.001) had a significant negative relationship with the adequacy of prenatal care.CONCLUSION:According to the results, mental health can affect the quality of prenatal care. As a result, health providers to pregnant mothers can improve the adequacy of prenatal care by examining pregnant women in terms of these two issues, thereby improving the health of themselves and their children, and ultimately, community health.

Congenital syphilis in Brazil: distribution of cases notified from 2009 to 2016.

INTRODUCTION: Congenital syphilis is considered a severe public health problem because it accounts for approximately 40% of the perinatal mortality rates, 25% of stillbirths, and 14% of neonatal deaths, in addition to causing severe consequences for the fetus. This study aimed to describe the rates of congenital syphilis in children under one year of age in Brazilian capitals from 2009 to 2016. METHODS: Ecological time series study, using rates of congenital syphilis in children under one year of age and living in Brazilian capitals. The Prais-Winsten regression model was used to assess the trend.RESULTS: A total of 44,056 cases of congenital syphilis in children under one year of age were reported in Brazilian capitals between 2009 and 2016. The highest rate of congenital syphilis in children under one year of age occurred in 2016 in Porto Alegre (31.07/1,000 live births). The Northeastern capitals showed high rates, particularly the capital Recife (23.67/1,000 live births). CONCLUSIONS: Congenital syphilis represents a major challenge for public policies. The need for improvements in the quality of prenatal care is highlighted, as it is essential to reduce the alarming rates.

Infant deaths due to preventable causes in the Far West Health Region of Santa Catarina

The discussion and scientific production on preventable infant deaths has attracted attention due to the intrinsicassociation with the quality of health services and social determinants. Its analysis, within the scope of SUS, supportsthe management and planning of health promotion and prevention interventions aimed at children. Thus, the presentstudy aimed to analyze the occurrence of infant deaths from preventable causes in the Health Region of the Far West ofSanta Catarina. Data collection was carried out between the months of July and December 2019, in secondary sources,in the death certificates, live birth certificates, and infant death investigation forms for the period from 01/01/2018to 12/31/2018. The information obtained was analyzed using descriptive statistics. The instrument for the analysis ofpreventability was the Brazilian List of causes of preventable deaths by interventions of the Unified Health System. Froma total of 3,046 births, verified in the analyzed period, there were 62 deaths, among which were 25 fetal deaths (40.32%) and 37 infant deaths (59.67%). With an Infant Mortality Rate estimated at 12.14%, there was a predominance of fetal(40.32%) and early neonatal (29.03%) deaths. As for preventability, 40 (64%) deaths were classified as preventable, 14(23%) were not preventable, and 8 (13%) had ill-defined causes. The causes that can be reduced by adequate care forwomen during pregnancy stood out as the main component in infant mortality. Our results demonstrate that there isa compromise in the quality of prenatal and neonatal care and demonstrate the importance of directing attention andinvestments to improve this care.

Non-performance of serological tests for syphilis during prenatal care: prevalence and associated factors.

Syphilis is a sexually transmitted disease, easy to diagnose and treat, but whose incidence is increasing in Brazil. This study estimated the prevalence of the non-performance of serological tests for syphilis during prenatal care, in addition to evaluating its trend and identifying its associated factors in the municipality of Rio Grande, Rio Grande do Sul, Southern Brazil. This is a cross-sectional survey that included all pregnant women living in this municipality who gave birth between January 1 and December 31, 2007, 2010, and 2013. A single standardized questionnaire was administered to the mothers within 48 hours of delivery, while they were still in the maternity ward. We used the χ2 test for proportions and linear trend, and Poisson regression with robust adjustment in the multivariate analysis. The effect measure adopted was prevalence ratio (PR). Among the 7,351 mothers who had at least one prenatal visit, the prevalence of non-performance of serological tests for syphilis in the three years studied was 2.9% (95% confidence interval - 95%CI 2.56 - 3.33), with 3.3% (95%CI 2.56 - 3.97) in 2007, 2.8% (95%CI 2.20 - 3.52) in 2010, and 2.7% (95%CI 2.12 - 3.38) in 2013. Black mothers, those with low household income and schooling, and who had few prenatal visits showed higher PR of non-performance of this test. The prevalence of non-performance has virtually not changed in the period, and women with high-risk pregnancy showed a greater probability of not undergoing the test. This municipality needs to reach mothers with lower socioeconomic status, restructure the local health services, and enhance their operationalization to improve the quality of prenatal care.

Evaluation of the Quality of Prenatal Consultation in Rural Area of Mali, Case of Kadiolo Health District

Every woman has the right to receive satisfactory quality prenatal care in reproductive health. Giving a life while remaining alive and without sequelae must be the slogan of any gynecologist - obstetrician and midwife, as well as any health worker. It was a descriptive cross-sectional study dealing with the evaluation of the quality of prenatal consultations at the Kadiolo referral health center (or RHC). Adevis Donabedian’s model for assessing the quality of care and services served as a benchmark. According to Donabedian quality means good technical care, with good interpersonal relationships, and adequate and comfortable premises. This study took place from April 24 to December 04, 2017 and aimed to assess the current level of the quality of prenatal consultations at the Kadiolo referral health center, to study the structures in place including infrastructure and personnel, to specify the procedures and to determine their results. This work has permitted us to classify the RHC of Kadiolo at level III with 85%, which means that the references evaluated were satisfactory, with the level of 75% to 94%. In terms of structure, a pricing system was deemed affordable by the opinion of pregnant women. The analysis of the level of the human dimension revealed that the health center was level III. The pregnant women were satisfied with the reception which was good in 76% of the cases, as well as with the quality of the respect of the privacy in 96% and confidentiality in 95%. Despite the satisfaction of pregnant women, gaps remain to be filled in concerning the quality of the services received at the Kadiolo referral health center so as to reach level IV.

Implementação da Rede Cegonha em uma Regional de Saúde do estado de Goiás: o que os indicadores de saúde mostram sobre atenção materno-infantil?

Os indicadores de morbidade e de mortalidade materno-infantis são essenciais no contexto da organização da Rede Cegonha, no âmbito do Sistema Único de Saúde (SUS). Esta rede organiza-se para assegurar o acesso, o acolhimento e a resolutividade, por meio de um modelo de atenção voltado para o pré-natal, parto e nascimento, puerpério e sistema logístico. Este artigo apresenta um estudo ecológico desta rede em uma Regional de Saúde, realizado com uso de dados dos Sistemas de Informação de Saúde do Departamento de Informática do SUS. Verificou-se um percentual crescente de gestantes que realizaram sete ou mais consultas pré-natais. No entanto, poucas concluíram a assistência pré-natal, porque não realizaram a consulta de puerpério. Observou-se uma taxa de mortalidade infantil próxima à da meta estipulada pela ONU. Identificou-se um aumento das cesáreas e uma redução de partos normais, além de uma alta mortalidade materna. Esses indicadores apontam para a necessidade de melhoria da qualidade da atenção pré-natal e da assistência ao parto.

Predictors of Women's Satisfaction with Prenatal Care in a Canadian Setting.

Prenatal care is a vital and important part of a healthy pregnancy, providing many maternal and health benefits. Despite Canada's publically funded health care system with universal access, inadequate rates of prenatal care continue to be observed. As a modifiable risk factor, the process variables that influence satisfaction with prenatal care in Canadian settings have received little attention. The objective of this study was to identify the predictors of satisfaction with prenatal care. A cross-sectional, descriptive, correlational design was used to examine the relationships between expectations, interpersonal processes of care, the quality of prenatal care, personal characteristics, and the type of provider with overall satisfaction, and with four dimensions of satisfaction. A convenience sample of 216 pregnant women was surveyed using self-administered questionnaires with women in their third trimester. Multiple linear regression analyses were used to identify predictors of satisfaction. The quality of prenatal care and provider interpersonal style together explained 80% of the variance in overall satisfaction. Patient-centered decision-making was a significant predictor of satisfaction with information, while having a midwife was a predictor of satisfaction with system characteristics. Expectations were not related to satisfaction. Improving quality of care, provider interpersonal style and patient-centered decision making, and improving the structural characteristics of prenatal care may be effective in improving women's satisfaction and utilization of prenatal care.

Prenatal follow-up of high-risk pregnancy in the public service.

to analyze the prenatal follow-up of high-risk pregnancy in the public service. an analytical cross-sectional study carried out in a public maternity hospital in the South of Brazil, during the hospitalization of 319 postpartum women using a semi-structured tool for transcription of the prenatal card records and interview. The data were analyzed using the Chi-Square test (p≤0.05). the adequacy of prenatal care was high (74%); 22.6% intermediate; 3.4% inefficient. Prenatal care had high coverage (100%), early onset (81.5%) and six or more visits (92.4%), but (77.4%) did not receive information about gestational disease and examinations (69.3%). There was statistical significance between the quality of prenatal care and the place of prenatal care (p=0.005). the need to implement a specific protocol for high-risk gestation and continuous education to the teams was evidenced.