Avaliação da qualidade da assistência perinatal : um exercício

Abstract

The connection between the quality of health care practice and its outcomes has been a controversial matter in many different fields. Chiefly in the perinatal area, where at the end of a pregnancy without risk factors being monitored in accordance with valid obstetric standards, the birth of healthy babies is expected. The objective of this study has been to assess the relationship among the quality of obstetrical care in pregnancies free of risk factors during the intrapartum death, neonatal death and evidences of adverse clinical signs at an early neonatal period, with high predictive values for later neurological disability such as seizures and other signs of asphyxia constitute the neonatal adverse outcomes. The quality of obstetrical practice during the intrapartum period was gauged by the duration of labour, the observation of abnormalities during labour, the time elapsed between observation and intervention, the number of examinations performed and the time between the last obstetric visit and labour. Concerned with perinatal care in public maternities in the State of Rio de Janeiro, this study presumed that under the quality assessment view the selected factors, as components of the process of labour care, should be associated with their outcomes. This study was aimed at developing such comprehension, through epidemiological methodology, adopting a case referent or a case-control study with primary definition of the base where the above mentioned factors were determinant of neonatal adverse outcome occurrence and the odds ratio (OR) was the parameter of interest. A labour duration which exceeded 12 hours has been associated to a crude OR of 3.48 (CI: 1.28-9.43) for neonatal adverse outcome. The mother s age, the degree of cervical dilation admission and the birth weight modified the effect of such association which was expressed by an OR of 14.73 (CI; 4.23-54.27). As the time of intervention grew larger, the risk increased, following a linear tendency. Some studied factors could supply indicators for further investigations of the relationship between the quality of intrapartum care and neonatal adverse outcomes.