Resultado materno e perinatal de gestações de alto risco acompanhadas por enfermeiras obstetras, 2014-2015

Abstract

This research aimed to evaluate the maternal and perinatal results of a high-risk antenatal care (ANC) with the participation of the obstetrical nurse as a member of the multidisciplinary team. It is an observational, descriptive and retrospective study, with a quantitative approach, based on a non-concurrent cohort study. The research was developed at the Hospital Sofia Feldman located in the city of Belo Horizonte / MG. The medical records of high-risk prenatal pregnant women were used in the study, which were attended by the obstetrical nurse for at least 03 consultations, in the period from January 1, 2014 to December 31, 2015, with the outcome of gestation in the research scenario. After the approval of the Research Ethics Committee, the data were obtained by means of an instrument prepared to analyze the medical records containing the variables to be studied, which was adapted in a Microsoft Excel spreadsheet. Quantitative variables were described as the median, the 1st quartile (Q1) and the 3rd quartile (Q3), the minimum value and the maximum value; And the qualitative variables, by the absolute frequency (n) and the relative frequency (%). To test the relationship between the qualitative variables, the chi-square test (X2) was used, and the odds ratio (OR) with a 95% confidence interval (95% CI) was calculated. The size of the effect was evaluated by Cramer's V, when the scale Cohen is using. The results showed that the pregnant women had a mean age of 32 years old, most of them declared themselves to be pardo, single and with complete or incomplete secondary education. They started the High-risk ANC on average at 16 weeks and three days of gestation, 62.2% were submitted to more than seven prenatal visits, the median was eight visits, the first half performed by the obstetrical nurse and the other half by the doctor. The main reasons for the referral to the High-risk ANC were hypertension (31%) and diabetes (19%). Intercurrences were observed in 25% of the pregnant women that resulted in hospital admission; the most frequent being preeclampsia (20.4%) and glycemic control (14.8%). The intercurrences in the puerperium occurred in 30 puerperae (14.2%), with hemorrhage accounting for 36.6% of the cases. The most frequent type of delivery was normal delivery (54.6%), in the semi-sitting position in 59% of the cases, and the presence of an accompanying person was guaranteed in 97.2% of the deliveries. There was 3.5% of episiotomy and 60% of 1st degree tears. 50% of the deliveries were performed exclusively by the obstetrician and a significant association between the type of delivery and the professional who performed the delivery (X2 = 174,102; gl = 2; p <0,0001), in 100% of the cases in which the delivery care is shared with the obstetrician the birth route is the normal delivery. The mean gestational age at delivery was 39 weeks and three days; prematurity occurred in 10% of live births, 20% presented low birth weight and 3% Apgar <7 at the 5th minute. 82.3% of the newborns were placed skin to skin with their mother and 64.7% started breastfeeding in the delivery room. It has been observed that for the twin pregnancies, less than seven prenatal consultations and intercurrences during pregnancy increase the chance of prematurity with a moderate magnitude effect. There was no maternal mortality in this study. The neonatal mortality rate was 9 per thousand live births and the fetal deaths 13/1000 live births. It was possible to conclude on the efficacy of prenatal coverage of pregnant women with higher reproductive risk when the onset of follow-up occurred in the first trimester of pregnancy. The average number of prenatal visits was eight and the obstetrician nurse attended half of them. There were 54.6% of normal deliveries and a correlation between the delivery route and the attending professional. The present research provides support for the formulation of health policies, for decision making by managers and reflections on the work of the obstetrician / obstetrician nurse in the Pnar and the delivery assistance in Brazil.