Evaluation of the quality of prenatal care based on the recommendations Prenatal and Birth Humanization Program

Mendes, Rosemar Barbosa; Santos, José Marcos de Jesus; Prado, Daniela Siqueira; Gurgel, Rosana Queiroz; Bezerra, Felipa Daiana; Gurgel, Ricardo Queiroz

doi:10.1590/1413-81232020253.13182018

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ARTICLE • Ciênc. saúde coletiva 25 (3) • Mar 2020 • https://doi.org/10.1590/1413-81232020253.13182018 copy

Evaluation of the quality of prenatal care based on the recommendations Prenatal and Birth Humanization Program

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The Prenatal Care and Birth Humanization Program (PHPN) establishes a minimum number of procedures to be provided to all pregnant women during prenatal care. This study aimed to analyze the quality of prenatal care in Sergipe based on the PHPN recommendations. This is a cross-sectional study, with a descriptive and analytic approach, using survey data from the Birth in Sergipe research, conducted from June 2015 to April 2016 with 768 puerperae proportionally distributed among all state maternity hospitals (n = 11). Data were collected from face-to-face interviews and patients’ prenatal care cards. The results showed a high coverage of prenatal care (99.3%; n =763), but little more than half of these women started their prenatal care within 16 weeks of gestation (57%; n =435), and 74.7% (n = 570) had six or more visits. We noted that 16.6% (n = 127) of pregnant women were at high risk for complications and almost half continued monitoring prenatal care with professional nurses. Around 61.3% were advised about the maternity care service of reference for delivery, and 29.4% sought more than one health service for childbirth. We concluded that there was a high prenatal care coverage in Sergipe, however, with issues concerning its adaptation to the PHPN.

Key words
Pregnant Women; Prenatal care; Women’s Health

Exposure/Outcome	Prenatal care	p	Early onset	p	Received prenatal care card	p	Number of prenatal care visits			P
Exposure/Outcome	Prenatal care	p	Early onset	p	Received prenatal care card	p	1-3	4-5	≥ 6	P
Municipality	%		%		%		%	%	%
Aracaju	99.1		54.3		93.7		4.5	15.3	80.2
Capela	100		51.7		100		3.4	13.8	82.8
Estância	100		66.1		100		9.7	27.4	62.9
Glória	100		45.5		100		9.1	18.2	72.7
Itabaiana	98.8	0.939	69.8	0.085	97.7	0.265	4.7	12.8	82.6	0.058
Lagarto	100		50		100		3	15.2	81.8
Propriá	100		62.9		100		2.9	25.7	71.4
Socorro	100		54.2		95.8		16.7	25	58.3
Age (years)
10 - 14	92.9		42.9		92.9		0	7.1	92.9
15 - 19	99.3		55.3		98.7		8	20.7	71.3
20 - 34	99.4	0.022	57.1	0.723	95.5	0.020	5.3	16.5	78.2	0.068
35 or more	100		58.3		94.4		0	12.8	87.5
Ethnicity/skin color	100		58,9		98,2		7,1	10,7	82,1
White	100		60		95.4		4.6	13.8	81.7
Black	100		58.9		98.2		7.1	10.7	82.1
Brown	99.3	0.201	56.9	0.894	95.8	0.458	5.2	17.9	76.9	0.253
Yellow	95.7		47.8		95.7		0	17.4	82.6
Indigenous	100		66.7		100		33.3	33.3	33.3
Maternal schooling
None	100		40		100		30	10	60
Primary School	99.1		55.8		98.8		7.5	21.1	71.4
Secondary School	99.4	0.912	61.9	0.025	97.4	˂0.001	3.2	16.5	80.3	˂0.001
Higher Education	100		45.5		81.2		1	4	95
Marital Status
Without a partner	99.5		52		96.2		12.7	14.1	73.1
With a partner	99.4	0.630	58.6	0.016	97.9	0.009	5.6	18.1	76.3	0.691
Number of previous pregnancies
None	99		59.1		95.5		2.7	15.5	81.8
1	100		58.8		96		6	13.1	80.9
2	100	0.256	50.9	0.282	94.6	0.124	8	17	75	0.004
3 or more	98.3		52		98.4		7.9	26	66.1
Wished to get pregnant
Wanted to get pregnant	100		61.1		96.5		1.6	12	86.4
Wanted to wait more	100	0.023	52.5	0.032	95.6	0.099	8.8	18.2	72.9	˂0.001
Did not want to get pregnant	98.1		53.4		95.5		7.1	20.7	72.2
Feelings about pregnancy
Satisfied	100		60.4		96.1		3.7	13.8	82.5
More or less satisfied	98	0.026	52	0.021	95.1	0.104	9.8	23.5	66.7	˂0.001
Unsatisfied	98.6		45.1		97.2		2.8	18.3	78.9
Attempted to interrupt pregnancy
No	99.7		57.9		96.2		4.9	16.3	78.7
Yes	92.1	˂0.001	34.2	0.008	92.1	˂0.001	10.5	26.3	62.2	0.221
Total	99.3		57		96.6		^* * Participants who did not fully answer the questions were excluded from the analysis. 5.2	^* * Participants who did not fully answer the questions were excluded from the analysis. 16.9	^* * Participants who did not fully answer the questions were excluded from the analysis. 74.7

Guidance provided to women during prenatal care	Number of visits		p	Total N (%)
	≤ 5 (n= 169)	≥ 6 (n= 566)
	N (%)	N (%)
Activities to facilitate delivery
No	116 (25.2)	345 (74.8)	0.051	461 (62.6)
Yes	52 (18.9)	223 (81.1)	0.051	275 (37.4)
Signs of onset of labor
No	115 (27.7)	300 (72.3)	0.001	415 (56.5)
Yes	54 (16.9)	266 (83.1)	0.001	320 (43.5)
Clinical alterations that would indicate pregnancy risk
No	92 (29)	225 (71)	0.001	317 (43.10
Yes	77 (18.4)	342 (81.6)	0.001	419 (56.9)
Importance of breastfeeding in the first hour of life
No	82 (27.5)	216 (72.5)	0.012	298 (40.4)
Yes	86 (19.6)	353 (80.4)	0.012	439 (59.6)

Exposure/Outcome	Payment source		p	Type of health facility		p	Professional category		p	Monitoring by the same professional	p
	Public	Private		Primary Care	Hospital outpatient clinic		Doctor	Nurse		%
Municipality	%	%		%	%		%	%
Aracaju	65.3	33.6		61.7	38.3		59	41		83.5
Capela	86.2	13.7		65.5	34.5		44.8	55.2		86.2
Estância	93.5	6.4		75.8	24.2		22.6	77.4		98.4
Glória	90.9	9		81.8	18.2		9.1	90.9		86.4
Itabaiana	52.3	47.3	˂0.001	59.3	40.7	0.001	45.3	54.7	˂0.001	93	˂0.001
Lagarto	80.3	19.7		50	50		47	53		87.9
Propriá	91.4	8.6		97.1	2.9		14.3	85.7		97.1
Socorro	95.8	4.2		79.2	20.8		45.8	54.2		100
Age (years)
10 - 14	78.6	21.4		71.4	28.6		50	50		71.5
15 - 19	84	16		68.6	31.4		38	62		85.4
20 - 34	68.8	31.2	0.001	63.7	36.3	0.050	50.4	49.6	0.010	89.1	0.029
35 or more	59.7	40.3		59.7	40.3		62.5	37.5		83.3
Ethnicity/skin color
White	59.6	40.4		62.4	37.6		52.3	47.7		87.2
Black	71.4	28.6		71.4	28.6		46.4	53.6		83.9
Brown	73.1	26.9	0.273	63.5	36.5	0.159	48.8	51.2	0.979	87.7	0.124
Yellow	73.9	26.1		78.3	21.7		47.8	52.2		91.3
Indigenous	100	0		100	0		33.3	66.7		100
Maternal schooling
None	80	20		90	10		30	70		80
Primary School	88.2	11.8		75.1	24.9		35	65		88.5
Secondary School	67.7	32.2	˂0.001	62.9	37.1	˂0.001	54.5	45.5	˂0.001	86.1	0.899
Higher Education	21.8	78.2		29.7	70.3		83.2	16.8		89.1
Marital Status
Without a partner	60.9	39.1		47.5	52.5		64.2	35.8		83.4
With a partner	77.1	22.9	˂0.001	70.1	29.9	˂0.001	42.9	57.1	0.018	87.4	0.650
Number of previous pregnancies
None	68.2	31.8		61.8	38.2		51.5	48.5		86.6
1	66.3	33.7		62.3	37.7		52.3	47.7		89.4
2	75.9	24.1	0.053	67.9	32.1	0.154	49.1	50.9	0.050	87.5	0.412
3 or more	81.9	18.1		71.7	28.3		37.8	62.2		86.6
Total	^* * Participants who did not fully answer the questions were excluded from the analysis. 71.6	^* * Participants who did not fully answer the questions were excluded from the analysis. 22		64.9	35.1		^* * Participants who did not fully answer the questions were excluded from the analysis. 49.4	^* * Participants who did not fully answer the questions were excluded from the analysis. 48		88.1

Exposure/Outcome	Risk pregnancy	p	Attendance in a service of reference			p	Oriented on reference maternity	p	Pilgrimage for delivery	p
	%	p	No	Yes, with difficulty	Yes, without difficulty	p	%	p	%	p
Municipality			%	%	%
Aracaju	22.1		9.1	25.5	65.5		66.4		30.6
Capela	17.2		0	33.3	66.7		58.6		41.4
Estância	6.5		0	25	75		38.7		37.1
Glória	9.1	0.001	100	0	0	0.049	45.5	0.070	22.7	0.001
Itabaiana	4.7		0	0	100		61.6		22.1
Lagarto	15.2		0	0	100		59.1		40.9
Propriá	11.4		100	0	0		60		5.7
Socorro	12.5		50	0	50		54.2		8.3
Age (years)
10 - 14	57.1		20	20	60		64.3		35.7
15 - 19	19.3	˂0.001	6.2	31.2	62.5	0.591	51.3	0.003	42	0.001
20 - 34	13.2		16.7	19.4	63.9		61.5		27.1
35 or more	31.9		0	20	80		81.9		19.4
Ethnicity/skin color
White	11		16.7	16.7	66.6		67		26.6
Black	16.1		0	0	100		60.7		17.9
Brown	18.1	0.428	10.5	24.6	64.9	0.489	60.6	0.941	30.6	0.115
Yellow	17.4		33.3	33.3	33.3		60.9		39.1
Indigenous	33.3		0	0	100		33.3		66.7
Maternal schooling
None	30		50	0	50		60		40
Primary School	19.7		10.8	21.6	67.6		53.5		38.7
Secondary School	14.8	0.250	7.7	30.8	61.5	0.370	63.9	˂0.001	25.5	˂0.001
Higher Education	12.9		14.3	0	85.7		82.2		8.9
Marital Status
Without a partner	23.1		6.9	20.2	72.9		67.2		26.5
With a partner	16.9	0.679	12.2	17.1	70.7	0.758	59.2	˂0.001	31.1	0.174
Number of previous pregnancies
None	16.1		13.3	10	76.7		60.6		32.1
1	14.1		5.3	36.8	57.9		61.3		29.1
2	20.5	0.320	20	20	60	0.427	59.8	0.389	23.2	0.346
3 or more	20.5		11.1	27.8	61.1		65.4		28.3
Total	16.6		11.4	21.4	67.2		61.3		29.4

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[1] Collaborations

RB Mendes, JMJ Santos and RQ Gurgel: contributed in the conception and planning, analysis and interpretation of data; drafting and critical review of the content; and participated in the approval of the final version of the manuscript. DS Prado, FD Bezerra and RQ Gurgel: contributed in the drafting and critical review of the content; and participated in the approval of the final version of the manuscript.