Adequação da assistência pré-natal no estado do Rio Grande do Sul: estudo transversal

Abstract

Prenatal care (PNC) presents the ideal timeframe for health interventions to be carried out. In addition, a prenatal care with early onset and intervention of risk situations is essential for prevention of negative maternal-fetal outcomes, such as of sexually transmitted diseases, for instance. The state of Rio Grande do Sul (RS) is historically one of the states with the highest rates of HIV infection in Brazil. Moreover, in recent years, it has figured among the states with the highest detection rates of syphilis and congenital syphilis in the country. These data suggest inadequacy in PNC. Therefore, it is important to obtain data regarding the adequacy of PNC, as well as, on the profile of women receiving care in maternity hospitals of the Unified Health System (SUS) and private associated facilities in RS to assess the quality of PNC offered to and to improve public health policies targeted at women receiving care in this setting. This dissertation presents the results obtained from the evaluation of the PNC adequacy in RS using survey data from "Projeto Parturientes RS", which was carried out from 2017 to 2019. This is a cross-sectional study, with a probabilistic sample of childbearing women, from 66 maternity hospitals of the SUS and private associated facilities, from the 19 Regional Health Coordinations, belonging to the seven health macro-regions of the state.Secondary data (from the prenatal cards, hospital records and medical reports) of 13,432 childbearing women were collected from September 26th,2017 to October 21st, 2019. The results showed high PNC coverage (98.4%), but only 57.5% of the participants initiated PNC until the 12th gestational week and attended at least 6 appointments. The variables age, race/ethnicity, educational level, mode of delivery, number of deliveries and region of residence were associated with PNC adequacy. The multivariate analysis showed that for each 1-year increase in the age of the childbearing woman, there was a 4% increase in the chance of having an adequate PNC. White women, with higher education and with fewer deliveries, residing in the macro-region of Valleys are more likely to have adequate PNC when compared to non-white women, illiterate and/or with incomplete elementary school, with 3 or more deliveries and who reside in the other macro-regions of RS. At Delivery, 98.% of the participants performed at least one anti-HIV test and 96.9% a rapid test for syphilis. The cesarean rate was 57.2%. In the population of parturients residing in RS, assisted by the SUS, PNC reached practically universal coverage, however is more than adequate for just over half of the population. White parturients, with a lower number of previous deliveries and with a higher education level present better PNC adequacy. Screening for HIV and syphilis covered almost all pregnant women and percentages of cesarean delivery were far above those recommended by the WHO. In order to obtain a more detailed analysis of the quality of prenatal care in RS, it is necessary to consider all aspects of prenatal care with indicators on the structure, process (interventions performed) and pregnancy outcomes. [resumo fornecido pelo autor]