Análise de indicadores demográficos e assistenciais das gestantes atendidas na rede pública de saúde e seu impacto no resultado materno e perinatal

Abstract

The quality prenatal assistance and the reduction of the indicators of morbidity and maternal and perinatal mortality in the country constitutes an essential goal for the improvement of the woman and child health. Objective: verify the importance of indicators of quality of the prenatalappointment, associated with socioeconomic vulnerability and to the patterns of geographic displacement of the pregnant women on the public health services network, as determinants of the iniquity of the obstetric assistance. Methodology: was analyzed the base of the Sisprenatal of Belo Horizonte, in the year of 2012, with 18.133 pregnant women. The cases of gestational losses that had not surpassed 20 gestational weeks were excluded, totalizing 16.710 pregnant women, the spatial distribution of the residential places of the pregnant women, the location and the offer of health services that provide obstetric assistance, combined with aggregated and individual data were processed through statistic methods, to analyze profiles and patterns that influenced the obstetric results. Techniques of univariate and multivariate association evaluated the impact of the woman age, schooling, social vulnerability, prenatal appointments, premature identification, minimum prenatal exams, and distance to the basic health unit (UBS) over obstetric outcomes. As outcome was used the interference over the baby getting born alive, based on the occurrence of the puerperium appointment, the occurrence of at least six prenatal appointments and the estimated length of the gestation. Through analysis techniques of survival, the premature end of pregnancy was evaluated to the outcome of the puerperal appointment associated with the same predictors; the length of the gestation was estimated for the time between the date of the last menstruation and the puerperium appointment. The results:the analysis indicated that do six or more appointments increased the chance of being born alive (2,2 IC95%: 2,0 to 2,3) if compared to whom did less than six appointments. The pregnant women with a number of appointments lower than six showed a bigger chance of prematureend of gestation than the women that did six or more appointments (1,22 IC95%: 1,16 to 1.28). In the spatial analysis of the displacement of the pregnant women, the women that resided more than two km of the UBS off the first appointment decreased the chance of doing six or moreappointments (0,86 IC95%: 0,76 to 0,97) in relation to those that resided within 500 m. Conclusion: the realization of the adequate prenatal, with six or more appointments, exams an recommended vaccines. Among others, increases the chance of being born alive and the longerduration of pregnancy. The need of big displacements for prenatal appointments affects negatively in the realization of the minimal number of six appointments. The results may subside proposals of adjustment to the profile and the needs of the population to be attended.