Casa da gestante e enfermaria hospitalar na atenção ao alto risco: repercussões em indicadores de saúde maternos e perinatais

Abstract

The high-risk pregnancies represents 15% of pregnant women, so it is essential that the health professionals are trained to recognize risk and refer them effectively to the service of greater complexity. Although the existence of encouragement and ministerial programs, such as the House of Pregnancy, doesnt have studies which proves the effectiveness and rationale for their implementation for the health of high-risk pregnancies. The objective of this study was to analyze the association of models of care for pregnant women at high risk (House of Pregnant versus ward hospital) and indicators of maternal and perinatal health. This is an epidemiological study of a retrospective cohort conducted in two hospitals in reference to the pregnant woman at high risk from Minas Gerais, and one of them is developed in the program House Pregnant and other admissions are made exclusively in ward hospital. The sample consisted of 312 pregnant women at risk hospitalized, 65 in Ward and 247 in the House of Pregnancy, in 2010, with a gestational age between 22 and 36.6 weeks and who met the inclusion criteria of the study. The variables analyzed were: maternal age, parity, color, education, marital status, maternal origin, personal history of disease, number of prenatal consultations, beginning of labor, type of parturition, episiotomy, oxytocin in labor analgesia for vaginal parturition, gestational age at admission, admission date, variables related to the conditions of the newborn (sex, gestational age at birth, sector sent the newborn after parturition, birth weight and Apgar score at 5 minutes, resuscitation in the delivery room, death in the delivery room). Data were analyzed using descriptive statistics, bivariate and multivariate analyzes a significance level of 5% (p < 0,05). The results showed that pregnant women admitted to the traditional model showed: high prevalence of diagnosis related to blood pressure on admission, regardless of history of chronic hypertension (PR: 1.45, 95% CI: 1.10 to 1.90) and more than 6 appointments prenatal hospitalization, independent of the merits or admission diagnosis (PR: 1.58, 95% CI: 1.21 to 2.07), higher incidence of cesarean section, regardless of admission diagnosis ( HR: 1.73, 95% CI: 1.19 to 2.52), high number of vaginal deliveries with episiotomy and analgesia. In House of Pregnancy prevailed the hospitalizations related to preterm labor and premature rupture of membranes preterm, with mothers coming from outside. There was not statistical difference in the referral of newborns to neonatal care in the models studied. The care model of the House of Pregnant has a less interventionist, compared to traditional hospital ward. The assistance in the House of Pregnant can be considered effective, because it showed maternal and perinatal outcomes as favorable as the traditional nursing care model.