Qualidade de assistência ao parto em Goiânia, 2007

Abstract

OBJECTIVE: To evaluate the quality of the attendance to the childbirth in the public hospitals and hospitals private contracted out by SUS in Goiânia, in the year of 2007. METHODOLOGY: I study descriptive analytical, where were appraised thirteen hospitals of Goiânia (10 private contracted out by SUS and 3 publics) and studied a sample of 404 normal childbirths accomplished at those hospitals. The data were obtained through questionnaires and interviews accomplished with directors of the hospitals, it looks for in handbooks, interviews with the puérperas and observation of the service to the childbirth in thosehospitals. Variables demographic, obstetric, structural were investigated and related to the process and results of the attendance to the childbirth. It took place comparative analysis of the quality of attendance among the categories of hospitals, with statistical validation given by the test qui squared with p <0,05 and analysis of the risk factors for the quality of attendance being used the index Bologna (indicator of the World Organization of Health), with calculation of Odds Ratio with intervals of trust of 95% and p <0,05, for the found associations.RESULTS: Most of the childbirths (61,6%) it was accomplished at the hospitals private contracted out by SUS (HPS). The taxes of elective cesarians were of 34,1% and 21.9% in HPS and public hospitals (HP), respectively. However, in HPS the taxes of cesarians were differentiated to depend on the agent backer, with taxes of elective Cesarians of 25,4% for users of SUS and of 93,9% for pregnant women of agreements or matters. In spite of 95,8% of the childbirths they have been accomplished by the obstetrician, only 30,8% of those they had pediatrician in delivery room. The percentage of urgency cesarians was of 11,4% in HPSand 19,4% in HP. Important differences in the hospital organization in relation to the attendance to the childbirth were observed among the categories of hospitals, with the pediatrician's absence in most of the childbirths accomplished in HPS and doctors persons on duty absence for attendance to patient of agreements or matters in those hospitals. The labor percentage and childbirth attended by professional of health was of 100%, most of the time for obstetrician. The partogram presence and of annotations of the evolutions of the labor they were extremely low in the two categories of hospitals, although a little better in HP, in the same way that the frequency of evaluations of the fundamental parameters for appropriate attendance to the childbirth. It auscultates her of BCF was not accomplished in 33% and 23% of the cases in HPS and HP, respectively. In the two categories of hospitals it was also high the use of practices considered harmful, as routine use of ocitócicos in the labor, and low theuse of practices considered beneficial, as the family companion's presence in the childbirth. 9 The index Bologna of the normal childbirths was very low in the two hospital categories, with average of 1 for HPP and 2 for HP. The hospital category was the factor of independent risk that more he/she associated to the childbirth quality measured by the index Bologna, and the pregnant women chance assisted in HP receive better quality of attendance was 9,1 times larger in relation to HPS.CONCLUSION: The results showed low quality of attendance to the childbirth in the public hospitals and private contracted out by SUS in Goiânia, in the year of 2007, although a little better in the first hospitals. On the other hand, the hospital category was the risk factor with larger association with the quality of the attendance to the childbirth measured by the index Bologna