Analysis of obstetric care provided by the Mobile Emergency Care Service

retrospective and analytical research. All records of prehospital obstetric care delivered by the SAMU 192 in 2012 were analyzed. To be considered responsive, calls should lead to referral to a reference obstetric hospital or be classified with the colors red, orange and yellow, according to risk criteria defined by the Ministry of Health.

Results:

considering the two outcomes evaluated: referral to a reference hospital and risk criteria defined by the Ministry of Health, 6.7% and 75.6% of the calls were not pertinent, respectively. There was no matching between outcomes, neither variation between primiparas and multiparas as regards the call pertinence.

Conclusion:

this study ratifies the need for implementing a risk classification protocol in obstetrics, and support managers in the organization, qualification and effective implementation of the Rede Cegonha.

Descriptors:
Emergence Medical Services; Emergency Nursing; Prehospital Services; Pregnant Women; Obstetric Nursing

Characteristics	n (%)	Total of records^* * Total records filled in the SAMU cards.
Mean age in years (minimum - maximum)	22 (14–43)	358
Parity		304
Multipara	165 (54.3)
Primipara	137 (45.7)
Region of origin in the municipality		350
Center	77 (22.0)
South	76 (21.7)
East	68 (19.4)
North	67 (19.2)
West	62 (17.7)
Care vehicle		358
Basic Support Unit	275 (76.8)
Advanced Support Unit	77 (21.5)
White Ambulance	6 (1.7)

Variables	Mean (minimum - maximum)	n (%)	Total of records^* * Total records filled in the SAMU cards.
Systolic blood pressure (mmHg)	90 (80–220)	–	346
Diastolic blood pressure (mmHg)	50 (40–90)	–	346
Heart rate (heartbeats/minute)	90 (56–147)	–	345
Respiratory rate (breathings/minute)	20 (14–60)	–	284
Temperature (oC)	36 (35–39)	–	20
Oxygen saturation (%)	98 (87–100)	–	348
Blood glucose dosing (mg/dl)	98 (72–193)	–	24
Glasgow coma scale	15 (14–15)	–	300
Fetal heart rate (heartbeats/minute)	140 (90–188)	–	243
Conscious	–	299 (99.0)	302
Eupneic	–	283 (95.3)	297
Capillary refill time < 2 seconds	–	199 (99.0)	201

Complaints	Primiparas n (%)	Multiparas n (%)
Uterine contraction	103 (41.0)	99 (34.8)
Loss of the mucus plug / vaginal content	39 (15.5)	38 (13.4)
Loss of amniotic liquid	36 (14.3)	38 (13.4)
Vaginal bleeding	33 (13.2)	35 (12.3)
Low abdomen / suprapubic pain	16 (6.4)	20 (7.0)
Nausea / vomiting	6 (2.4)	5 (1.7)
Crisis of anxiety / syncope	4 (1.6)	13 (4.6)
General malaise (dizziness, weakness and headache)	3 (1.2)	14 (5.0)
Signs and symptoms of urinary tract infection	2 (0.8)	8 (2.8)
Others	9 (3.6)	14 (5.0)
Total^* * The same woman could make more than one complaint.	251 (100.0)	284 (100.0)

Main findings recorded	Primiparas n (%)	Multiparas n (%)
Cervical dilation of 1 to 4 cm	15 (40.6)	12 (16.2)
Blood pressure ≥ 140×90 mmHg	5 (13.5)	11 (14.9)
Reduced fetal movements	4 (10.8)	8 (10.8)
Cervical dilation of 5 to 8 cm	3 (8.1)	6 (8.1)
Request from basic unit for transfer to the obstetric reference service	3 (8.1)	5 (6.8)
No prenatal	2 (5.4)	9 (12.1)
Cervical dilation of 9 to 10 cm	2 (5.4)	5 (6.8)
Increased fetal movements	2 (5.4)	0 (0.0)
Cessation of prescribed medications	1 (2.7)	4 (5.4)
User of alcohol / other drugs	0 (0.0)	10 (13.5)
Others	0 (0.0)	4 (5.4)
Total	37 (100.0)	74 (100.0)

Demand	Primiparas		Multiparas		p value^* * Chi-square test.
Demand	n	%	n	%	p value^* * Chi-square test.
Referral to a hospital
Non-pertinent	7	5.1	13	8.0	0.3147
Pertinent	130	94.9	149	92.0	0.3147
Ministry of Health risk criteria
Non-pertinent	111	80.4	115	71.4	0.0707
Pertinent	27	19.6	46	28.6	0.0707

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] CORRESPONDING AUTHOR: Cristina Maria Garcia de Lima Parada. E-mail: cparada@fmb.unesp.br