Maternal health in Brazil: priorities and challenges

1256125

Mortality among childbearing-age women in Campinas, São Paulo (1985-1994)

To provide a profile of the main health problems in childbearing-age women, we studied all 3,086 death certificates from the SEADE Foundation for women from 10 to 49 years of age and residing in the municipality of Campinas, from January 1, 1985, to December 31, 1994. The primary cause of death was identified and classified according to the 10th review of the ICD. Population data were obtained from the Laboratory for Epidemiological Analyses and Research, UNICAMP. One-fourth of the deaths were cardiovascular in origin, one-fifth were from external causes, and almost 20% were due to neoplasms. Maternal mortality was the ninth cause of death. External causes predominated in the 10-to-34-year age group, as compared to cardiovascular diseases and neoplasms in the 35-to-49-year group. Most alarming were the predominance of traffic accidents among causes of death in women up to age 34 (greater than AIDS during the study period) and the high mortality rate from homicides.Com o fim de obter um perfil das principais doenças que afetam as mulheres em idade fértil, estudaram-se todas as 3.086 declarações de óbito de mulheres de 10 a 49 anos, residentes no Município de Campinas, Estado de São Paulo. Óbitos ocorridos entre primeiro de janeiro de 1985 e 31 de dezembro de 1994, fornecidos pela Fundação SEADE. A causa básica desencadeante do óbito foi identificada e classificada segundo a CID 10ª revisão. Os dados populacionais para o períodos foram obtidos do Laboratório de Análises e Pesquisas Epidemiológicas da UNICAMP. Um quarto dos óbitos foram por doenças cardiovasculares e um quinto por causas externas. A terceira causa, próxima a 20% do total, foi neoplasia. A mortalidade materna constituiu a nona causa de morte. As causas externas foram as principais causas de morte entre 10 e 34 anos. A partir dos 35 anos, predominaram as causas cardiovasculares e neoplasias. Chama a atenção o predomínio dos acidentes de trânsito como primeira causa de morte ate os 34 anos de idade, superando a AIDS durante o período estudado, assim como a alta mortalidade por homicídio.67167

Applying the new concept of maternal near-miss in an intensive care unit

OBJECTIVES: The World Health Organization has recommended investigating near-misses as a benchmark practice for monitoring maternal healthcare and has standardized the criteria for diagnosis. We aimed to study maternal morbidity and mortality among women admitted to a general intensive care unit during pregnancy or in the postpartum period, using the new World Health Organization criteria. METHODS: In a cross-sectional study, 158 cases of severe maternal morbidity were classified according to their outcomes: death, maternal near-miss, and potentially life-threatening conditions. The health indicators for obstetrical care were calculated. A bivariate analysis was performed using the Chi-square test with Yate's correction or Fisher's exact test. A multiple regression analysis was used to calculate the crude and adjusted odds ratios, together with their respective 95% confidence intervals. RESULTS: Among the 158 admissions, 5 deaths, 43 cases of maternal near-miss, and 110 cases of potentially lifethreatening conditions occurred. The near-miss rate was 4.4 cases per 1,000 live births. The near-miss/death ratio was 8.6 near-misses for each maternal death, and the overall mortality index was 10.4%. Hypertensive syndromes were the main cause of admission (67.7% of the cases, 107/158); however, hemorrhage, mainly due to uterine atony and ectopic pregnancy complications, was the main cause of maternal near-misses and deaths (17/43 cases of near-miss and 2/5 deaths). CONCLUSIONS: Hypertension was the main cause of admission and of potentially life-threatening conditions; however, hemorrhage was the main cause of maternal near-misses and deaths at this institution, suggesting that delays may occur in implementing appropriate obstetrical care

Support during childbirth: perception of health care providers and companions chosen by women

OBJECTIVE: To understand health care providers' perception on managing laboring women in the presence of a labor companion of their choice, and the labor companion's perception of this experience. METHODS: A qualitative study was conducted based on a controlled randomized clinical trial. Sampling was intentional and determined through information saturation. Semi-structured interviews were carried out with 11 health care providers and 16 laboring companions in the obstetric unit of a maternity facility at the hospital complex, in Campinas, Southern Brazil, between October 2004 and March 2005. The thematic analysis of discourse was applied using the following methodological figures: central idea, key expressions and discourse of the collective subject. RESULTS: The most remarkable central ideas of health care providers were: no difference was observed in managing laboring women with a labor companion; positive changes were noted in labor management when a labor companion was present; the companion provided emotional support to laboring women who were more pleased, and felt safer and peaceful; many positive aspects were seen in the behavior and involvement of laboring women with a labor companion; the companion caused no problems and encouraged health providers to engage in a more humane and less routine attitude. The main central ideas of labor companions were: positive feelings, emotions, a sense of satisfaction with the experience; being with the laboring woman was a great opportunity to provide her emotional support; and they felt welcome by health care providers. CONCLUSIONS: Health providers considered positive the support provided by a labor companion and had no problems in managing laboring women in the presence of their companions. Labor companions were pleased and happy with this experience. There was no conflicting opinions.OBJETIVO: Descrever a percepção de profissionais da saúde sobre prestar assistência à parturiente na presença do acompanhante por ela escolhido, e a percepção dos acompanhantes sobre essa experiência. MÉTODOS: Realizou-se estudo qualitativo, a partir de ensaio clínico randomizado controlado. A amostra estudada foi intencional e definida por saturação de informação. Foram entrevistados 11 profissionais da saúde e 16 acompanhantes no centro obstétrico de uma maternidade em Campinas, SP, de outubro de 2004 a março de 2005. Empregou-se a técnica de análise temática de discurso, utilizando-se as figuras metodológicas: idéia central, expressões-chave e o discurso do sujeito coletivo. RESULTADOS: Entre as idéias centrais dos profissionais destacaram-se: não houve diferença em prestar assistência com acompanhante durante o trabalho de parto e parto; com o acompanhante ocorreram mudanças positivas na assistência; o acompanhante dá apoio emocional à parturiente, que fica mais satisfeita, segura e tranqüila; existem muitos aspectos positivos no comportamento e participação das parturientes com acompanhante; o acompanhante não causou problema e fez o profissional ter atitude mais humana e menos rotineira. As principais idéias centrais dos acompanhantes foram: sentimentos positivos, emoção, satisfação com a experiência; poder ajudar ao dar apoio emocional; sentir-se bem recebido pelos profissionais. CONCLUSÕES: Os profissionais da saúde consideraram importante o apoio do acompanhante não tendo sido observado problema em prestar assistência na sua presença. Os acompanhantes se sentiram satisfeitos e recompensados com a experiência. Não foram detectados conflitos de opinião entre os envolvidos

[evidence On Support During Labor And Delivery: A Literature Review].

The effects of support for women during labor and delivery provided by health professionals, lay women, and doulas on the maternal and neonatal outcomes have been evaluated through randomized clinical trials, meta-analyses, and systematic reviews. This article presents a review of these studies, focusing on the principal characteristics, support provider, simultaneous presence of the woman's spouse and/or family members during labor and delivery and the outcomes. The analysis included studies published from 1980 to 2004 which explicitly approached these aspects. In general, the results of such support were favorable, highlighting a reduction in the cesarean rate, analgesia/ medication for pain relief, duration of labor, and utilization of oxytocin and an increase in maternal satisfaction with the experience. The benefits were greater when the support provider was not a health professional. The available studies did not evaluate the specific companion chosen by the woman as a support provider, which constitutes a gap in the knowledge that should be filled by future research.211316-2

Support during childbirth: perception of health care providers and companions chosen by women

OBJECTIVE: To understand health care providers' perception on managing laboring women in the presence of a labor companion of their choice, and the labor companion's perception of this experience. METHODS: A qualitative study was conducted based on a controlled randomized clinical trial. Sampling was intentional and determined through information saturation. Semi-structured interviews were carried out with 11 health care providers and 16 laboring companions in the obstetric unit of a maternity facility at the hospital complex, in Campinas, Southern Brazil, between October 2004 and March 2005. The thematic analysis of discourse was applied using the following methodological figures: central idea, key expressions and discourse of the collective subject. RESULTS: The most remarkable central ideas of health care providers were: no difference was observed in managing laboring women with a labor companion; positive changes were noted in labor management when a labor companion was present; the companion provided emotional support to laboring women who were more pleased, and felt safer and peaceful; many positive aspects were seen in the behavior and involvement of laboring women with a labor companion; the companion caused no problems and encouraged health providers to engage in a more humane and less routine attitude. The main central ideas of labor companions were: positive feelings, emotions, a sense of satisfaction with the experience; being with the laboring woman was a great opportunity to provide her emotional support; and they felt welcome by health care providers. CONCLUSIONS: Health providers considered positive the support provided by a labor companion and had no problems in managing laboring women in the presence of their companions. Labor companions were pleased and happy with this experience. There was no conflicting opinions.OBJETIVO: Descrever a percepção de profissionais da saúde sobre prestar assistência à parturiente na presença do acompanhante por ela escolhido, e a percepção dos acompanhantes sobre essa experiência. MÉTODOS: Realizou-se estudo qualitativo, a partir de ensaio clínico randomizado controlado. A amostra estudada foi intencional e definida por saturação de informação. Foram entrevistados 11 profissionais da saúde e 16 acompanhantes no centro obstétrico de uma maternidade em Campinas, SP, de outubro de 2004 a março de 2005. Empregou-se a técnica de análise temática de discurso, utilizando-se as figuras metodológicas: idéia central, expressões-chave e o discurso do sujeito coletivo. RESULTADOS: Entre as idéias centrais dos profissionais destacaram-se: não houve diferença em prestar assistência com acompanhante durante o trabalho de parto e parto; com o acompanhante ocorreram mudanças positivas na assistência; o acompanhante dá apoio emocional à parturiente, que fica mais satisfeita, segura e tranqüila; existem muitos aspectos positivos no comportamento e participação das parturientes com acompanhante; o acompanhante não causou problema e fez o profissional ter atitude mais humana e menos rotineira. As principais idéias centrais dos acompanhantes foram: sentimentos positivos, emoção, satisfação com a experiência; poder ajudar ao dar apoio emocional; sentir-se bem recebido pelos profissionais. CONCLUSÕES: Os profissionais da saúde consideraram importante o apoio do acompanhante não tendo sido observado problema em prestar assistência na sua presença. Os acompanhantes se sentiram satisfeitos e recompensados com a experiência. Não foram detectados conflitos de opinião entre os envolvidos.445

Systemic Lupus Erythematosus And Pregnancy: Clinical Evolution, Maternal And Perinatal Outcomes And Placental Findings.

Systemic lupus erythematosus is a chronic disease that is more frequent in women of reproductive age. The relationship between lupus and pregnancy is problematic: maternal and fetal outcomes are worse than in the general population, and the management of flare-ups is difficult during this period. The aim here was to compare the outcomes of 76 pregnancies in 67 women with lupus, according to the occurrence or absence of flare-ups. An observational cohort clinical study evaluating the evolution of pregnant women with lupus who were receiving care at the prenatal outpatient clinic, Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas (CAISM/Unicamp), between 1995 and 2002. Data were collected on a precoded form. The women were divided into two groups according to the occurrence or absence of flare-ups, as defined by the systemic lupus erythematosus disease activity index (SLEDAI). The presence or absence of flare-ups and renal involvement was considered to be the independent variable and the other results were dependent variables. Flare-ups occurred in 85.3% of cases, and were most significant when there was renal involvement. This was related to greater numbers of women with preeclampsia and poor perinatal outcome. Intrauterine growth restriction was more common in the women with active disease. Placental weight was significantly lower in the women with renal involvement. Flare-ups and renal involvement in lupus patients during pregnancy are associated with increased maternal and perinatal complications.12591-

Situational analysis of facilitators and barriers to availability and utilization of magnesium sulfate for eclampsia and severe preeclampsia in the public health system in Brazil

Background: Eclampsia 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. Method: A 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. Results: 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. Magnesium sulfate is currently only administered in referral maternity hospitals. Conclusion: The 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 rates16sem informaçã

Computer-assisted Telephone Interviewing (cati): Using The Telephone For Obtaining Information On Reproductive Health.

The objective of this study was to evaluate the feasibility of using computer assisted telephone interviewing (CATI) as a method for obtaining information on reproductive health in Brazil. A total of 998 eligible women for the study were selected to answer a questionnaire through computer- assisted telephone interviewing undertaken by trained interviewers. The outcomes of each telephone contact attempt were described. Differences between groups were assessed using the χ(2) test. Phone contact was made in 60.3% of the attempts and 57.5% of the interviews were completed. The success rate improved with the decrease in time from hospitalization to interview and with the higher numbers of telephones available. A total of 2,170 calls were made, comprising of one to sixteen attempts per woman. The majority of situations where extra calls were necessary were due to the number being busy or to the fact that the woman was not available at the time of the call. CATI can prove be a valuable procedure for obtaining information on reproductive health among Brazilian women, particularly for relatively recent events and when more than one alternative telephone number is available.271801-