Práticas de cuidado no trabalho de parto e parto antes e durante a pandemia da COVID-19: comparação entre dois inquéritos

Abstract

Introduction: It has been hypothesized that the COVID-19 pandemic may have changed the conduct of obstetric practices at the time of labor (TP), delivery, and birth. In Brazil, many practices lacking scientific evidence are implemented in this care, which is charcaterized by excessive use of unnecessary interventions. This scenario may have been worsened by the pandemic. Objective: To analyze the influence of the COVID-19 pandemic on labor and delivery care practices of women who gave birth in public hospitals in Belo Horizonte – Minas Gerais (MG), Brazil, compared to the pre-pandemic scenario, and compare its occurrence between uninfected and infected/suspected SARS-CoV-2 women. Methods: This cross-sectional and comparative study analyzed preliminary data from the research "Delivery and breastfeeding in children of mothers infected with SARS-CoV-2", conducted in three referral public maternity hospitals in Belo Horizonte - MG during the pandemic. These results were compared to those of the study "Born in Belo Horizonte: labor and birth survey", conducted before the pandemic to investigate the changes in practices of labor and delivery care for the mother and her newborn (NB), with or without COVID-19 infection, before and during the pandemic. Comparisons were performed using Pearson's Chi-square test, with a confidence level of 95% using the Stata statistical program. Results: There were no differences in variables related to hospitalization, obstetric history, and type of hospital discharge according to the presence/suspicion of SARS-CoV-2 infection. Regarding personal history, a higher prevalence of asthma and chronic liver disease was identified among parturients with suspected or confirmed SARS-CoV-2 infection compared to those who were not infected. We found a significant increase in practices recommended by the World Health Organization (WHO) during the pandemic, including: offering diet (48.90% versus 98.65%), non-pharmacological methods for pain relief (MNF) (43.84% versus 67.57%), and breastfeeding in the first hour of life of the RN (60.31% versus 77.98%) (p<0.001). We further found a significant reduction of non-recommended interventions, such as the routine use of episiotomy (15.73% to 2.09%), Kristeller maneuver (16.55% to 0.94%), oxytocin infusion (45.55% to 28.07%), amniotomy (30.81% to 15.08%), and lithotomy position during labor (71.23% to 6.54%) (p<0.001). Conclusion: The results of this study show that despite the COVID-19 pandemic, there have been advances in the establishment of practices recommended by the WHO for labor, delivery and birth and a reduction in practices not recommended.