Avaliação de boas práticas obstétricas e desfechos maternos em maternidade de referência

Abstract

The objective was to adopt good practices of attention to childbirth and birth and how they affect the maternal and neonatal outcomes in reference maternity in Ceará. This is an observational study, with descriptive and analytical components, cross-section and quantitative analysis carried out at Assis Chateaubriand Maternity School. The population was the full-term pregnant women who experienced labor in Maternity in the year 2017. Data collection was performed in the second half of 2018, through the spreadsheets fed on the basis of the Maternity Care and Birth of the institution. The maternal outcomes evaluated were type of delivery and laceration, while the neonates were vitality of the NB (Apgar in the fifth minute) and place of admission of the newborn (joint housing or hospitalization unit). The independent variables were the practices of attention to childbirth. And finally, the control variables were those referring to the origin, gestational history and current gestation. To assess the role of some variables as predictors for the occurrence of maternal and neonatal outcomes, oddis ratio (OR) and its 95% CI confidence intervals adjusted for the outcome effect were calculated. It was considered statistically significant that p-value <0.05. The project was approved by the Ethics and Research Committee of the institution under opinion 2,855,683. The use of the partograph, non-pharmacological methods of pain relief, form of labor (spontaneous or induced), fasting, venoclysis, oxytocin use, oxytocin use, amniotomy, and amniotomy dilatation were the practices that influenced the way of birth in the present study. Regarding the existence of laceration, there was a statistical difference between the presence of the companion and the practice of episiotomy. Regarding the neonatal outcomes, the partograph and the Kristeller maneuver showed association with the apgar in the fifth minute. Partogram, fasting, presence of the companion and type of delivery were associated with the place of hospitalization of the newborn in the maternity ward. It was concluded that there was a prevalence of good obstetrical practices. The rate of venoclysis was high. It is suggested to stimulate the variation of vertical delivery positions, skin-to-skin contact and adoption of good practices also in the surgical center. The limitations were the underreporting and the impossibility of analyzing the duration of labor and hospital stay and the intercurrences during the delivery.