Clinical and obstetric situation of pregnant women who require prehospital emergency care

Freitas, Vívien Cunha Alves de; Quirino, Glauberto da Silva; Giesta, Rogério Pinto; Pinheiro, Ana Karina Bezerra

doi:10.1590/0034-7167-2019-0058

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Revista Brasileira de Enfermagem

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Sumário

ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (suppl 4) • 2020 • https://doi.org/10.1590/0034-7167-2019-0058 copy

Clinical and obstetric situation of pregnant women who require prehospital emergency care

Situación clínica y obstétrica de gestantes que solicitan el servicio médico de urgencia prehospitalaria

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to identify the clinical and obstetric situation of pregnant women who required emergency care, considering the adequacy of their requirement.

Methods:

this is a cross-sectional study, developed in the headquarters of the Mobile Emergency Care Services from a state in the Brazilian Northeast, through the analysis of 558 reports of obstetric patients attended in 2016. The magnitude of the associations was expressed by odds ratio and confidence intervals, considering a 5% significance level.

Results:

more than half (50.9%) requirements for emergency care were from women who went into labor (non-expulsive), especially among third trimester pregnant women (p < 0.000). Most clinical and obstetric parameters were normal.

Conclusions:

the inadequate demands for emergency care services reflect the excessive medicalization of the gestational process and shows how important it is to discuss the physiological symptoms that involve pregnancy, so that a more egalitarian and efficient urgency service can be offered.

Descriptors:
Pregnant Women; Emergencies; Emergency Medical Services; Prehospital Emergency Care; Pregnancy Complications

Variables (n = 558)	N	%
Airways
Opened	399	71.6
Obstructed	4	0.7
Orotracheal intubation	4	0.7
Not answered	151	27
Respiration
Eupneic	528	94.6
Tachypneic (> 20irpm)	20	3.6
Not answered	10	1.8
Circulation - cardiac frequency
Normocardiac	450	80.6
Tachycardiac	102	18.4
Not answered	6	1
O₂ saturation
≥ 95%	499	89.5
< 95%	16	2.9
Not answered	43	7.6
Blood pressure levels
Up to 139×89 mmHg	411	73.7
≥ 140×90 and < 160×110 mmHg	84	15
≥ 160×110 mmHg	41	7.4
Not answered	22	3.9
Neurological - Glasgow Coma Scale
Mild injury (score from 13 to 15)	496	88.9
Moderate injury (score from 9 to 12)	6	1
Severe injury (score from 3 to 8)	5	0.9
Not answered	51	9.2
Exposure - lesions in the body
No	548	98.2
Yes	7	1.2
Not answered	3	0.6

Variables (n = 558)	N	%
Age group
< 18 years old	90	16.2
18-35 years old	423	75.8
> 35 years old	37	6.6
Not answered	8	1.4
Pregnancy trimester
First (<14 weeks)	26	4.6
Second (from 14 to 27 weeks)	57	10.2
Third (> 28 weeks)	282	50.5
Not answered	193	34.7
Number of previous pregnancies
One	99	17.7
Two	93	16.6
≥ three	139	25
Not answered	227	40.7
Number of previous births
Zero	109	19.6
From one to two	137	24.5
≥ three	47	8.4
Not answered	265	47.5
Number of previous abortions
Zero	243	43.5
From one to two	4	0.7
≥ three	1	0.3
Not answered	310	55.5
Prenatal consultations
Yes	21	3.8
No	6	1
Not answered	531	95.2
If yes, how many prenatal consultations?
Up to six	10	1.8
More than six	2	0.3
Does not apply	6	1
Not answered	540	96.9

Cause of the incident (n = 558)	N	%
Women went into labor¹ (not in the expulsive stage)	284	50.9
Other^* * Other: pain in the lower abdomen and lumbar areas, sick feeling, nausea, vomit, among other physiological symptoms characteristic of a pregnancy;	79	14.2
Abortion	34	6.1
Pre-eclampsia	33	5.9
Transvaginal bleeding	32	5.7
Eclampsia	26	4.7
Unspecified injury	18	3.2
Ectopic pregnancy	17	3
Not registered in the records^ The record was characterized as obstetric and the health workers attended the patient; however, they did not describe the reason for the occurrence.	35	6.3

	Going into labor (n = 284)		Other causes (n = 274)		p value	OR (IC95%)
	N	%	N	%	p value	OR (IC95%)
Gestational age per trimester					0.000	1.9 (1.1 -3.3)
1º	0	0	25	9.1
2º	12	4.2	46	16.8
3º	155	54.6	127	46.3
Not answered	117	41.2	76	27.8
Gravidity					0.730	1.1 (0.7-2.1)
Primigravida	45	15.8	49	17.9
Multigravida	126	44.4	88	32.1
Not answered	113	39.8	137	50
Parity					0.5	1.2 (0.7-2.1)
Primiparous	49	17.2	55	20.1
Multiparous	99	34.9	68	24.8
Not answered	136	47.9	151	55.1
Previous abortions					0.542	1.4 (0.5-4.9)
None	121	42.6	104	38
One or more	27	9.5	19	6.9
Not answered	136	47.9	151	55.1

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[1] Corresponding author: Vívien Cunha Alves de Freitas E-mail: vivien-alves@hotmail.com