Caracterização da assistência pré-natal em uma maternidade pública de referência em Goiânia-Goiás

Abstract

The prenatal assistance for its relevance and impact, has been receiving great prominence in relation to maternal and child health, remaining as the concern focus on the history of public health in Brazil. The aim of this study was to characterize the pre-natal assistance provided to users of the Unified Health System in a reference public maternity hospital in Goiânia, Goiás and to describe the perception of managers of sanitary districts (DS) of Goiânia on prenatal assistance provided by their teams, to pregnant women. A standardized questionnaire was applied and with it was obtained data on demographic, socioeconomic and prenatal characteristics. Secondary data were collected through analysis of the pregnant woman's card and hospital records for childbirth. The outcome was analyzed in progressive levels of prenatal adequacy, according to the PHPN / 2000 and the modified Kessner index criteria, being level 1 evaluated by the number of consultations and the beginning of prenatal, at level 2 was added the analysis of laboratory tests records and at level 3 the reports of clinical-obstetric data. To verify the perception of DS managers was applied a semi-structured questionnaire to DS general directors and technical supervisors in September of 2015. The data were analyzed by content analysis, according to Bardin (2011). Regarding the adequacy of prenatal, it was found that 71.4% of participants had adequate prenatal profile at level 1. However, at level 2, when added the analysis of performed tests, there was an adequacy reduction for 5.4% and 4.3% at level 3, when added the analysis of clinical-obstetric data. As for the perception of DS managers, the main ideas presented in the questionnaires were systematized in four categories: human resources (RH); access to the system; physical structure; and adhesion of pregnant women. The central idea of these categories is consistent with the responses from parturients with regard to the difficulties encountered during prenatal. Among them, 67 (36.2%) suggested more professionals to health units, 61 (33.0%) recommended to improve access for examinations and consultations, 33 (17.8%) suggested a physical restructuring of the health units and 24 (13%) participants recommended improving access to emergency services for pregnant women. The criteria used in this study were the minimum requirements for prenatal care of low complexity and yet, the adequacy of care was unsatisfactory. Possibly the low adequacy to the PHPN criteria is due to a practice-oriented activities that are not carried out routinely in SUS, the absence of registration of information on the pregnant women´s cards, a lack of compliance of protocols by health professionals and a lack of organization of health services. Furthermore, bureaucratization of the system as a whole commits both the user access to the system and the quality of service provided by professionals.