Avaliação da assistência materna e neonatal em Casa de Parto

• Autor(a) principal: Oliveira, Tamara Cristina da Matta de
• Data de Publicação: 2017
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/11421
• topic: Obstetric Nursing; Birthing Centers; Humanizing Delivery; Prenatal Care; Enfermagem obstétrica; Centros de Assistência à Gravidez e ao Parto; Parto humanizado; Cuidado pré-natal; CNPQ::CIENCIAS DA SAUDE::ENFERMAGEM

This dissertation was intended to evaluate the maternal and neonatal care provided by the obstetric nursing at the Birth Center; check out the adequacy of the care to the prenatal stage and the natural birth; and analyze the maternal and neonatal outcomes of this care. It is a cross-sectional study, with an evaluative perspective, based on the medical charts of mothers and newborns of the David Capistrano Filho Birth Center and complemented by the information of the parturient women transferred to the reference hospital. The research included the records of the cases involving the women who underwent the prenatal care at the Birth Center, from the beginning or referenced from other health services, and were admitted at the moment of labor, whose resolution happened at the Birth Center or at the reference maternity. Data collection took place through a tool drew up from the ministerial recommendations for prenatal care, labor and birth. A judgment matrix was used to evaluate the prevalence of practice records: 100% - superior adequate; &#8805; 75% - adequate; from 74 to 51% - intermediate; &#8804; 50% - inadequate. Six specific parameters were prepared to check out the prenatal adequacy: number of consultations; beginning of prenatal up to 12 weeks; complete exams (1stquarter); complete exams (3rd quarter); educational groups and immunization. The chi-square test χ2 was applied and, subsequently, the determination of the prevalence ratio (PR), with a 95% confidence interval and α-value &#8804; 0.05, in order to determine the variables associated with the transfer of the mother and the admission of the newborn. The prevalence ratio was used to check out the factors associated with the transfer risk. A total of 482 medical charts of mothers and neonates were analyzed. The prenatal care has obtained evaluation between the appropriate level (34.9%) and the intermediate level (34.2%), where the late beginning of prenatal after 12 weeks by pregnant women (87.1%) emerged as the greatest loss factor in this evaluation. The adequacy of the birth care was satisfactory in all categories evaluated at the Birth Center. The majority (62.5%) of the women transferred to the reference hospital had a natural delivery as outcome. The transfers of mothers are associated with the ruptured amniotic pouch (PR=2.09; CI 95% 1.62 - 2.70) and the amniotic fluid with meconium (PR=1.96; CI 95% 1.47 - 2.60). A total of 39 (0.8%) newborns were transferred to the Neonatal Unit. The factors associated with the admission of the newborn in this unit were the meconium amniotic fluid (PR=2.40; CI 95% 1.30 - 4.43), the Apgar score <7 (PR=5.33; CI 95% 2.65 - 10.73) and the ventilatory support at birth (PR=9.41; CI 95% 5.52 - 16.04). There were no maternal deaths. Nevertheless, one neonatal death occurred in the hospital because of malformation in multiple organs, VATER syndrome. The pregnant women who live in the region attached to the Birth Center need to be encouraged to begin the prenatal care early. The majority of the care indicators evaluated at the Birth Center has shown good results and is similar to the findings of the national and international literature in relation to the natural birth centers.