Programa de humanização do parto e nascimento: aspectos instituicionais na qualidade da assistência / Humanization of labor and birth program: institutional aspects in the quality of assistance

Objetivo: discutir os aspectos institucionais, a partir de uma perspectiva dinâmica e interrelacional, nos limites e possibilidades para a operacionalização da Proposta de Humanização da Atenção ao Parto e Nascimento. Método: estudo descritivo, de abordagem qualitativa, que utilizou a observação participante em uma maternidade do Nordeste do Brasil. A Etnografia Institucional (EI) foi considerada a perspectiva metodológica adequada, por investigar o universo das ações em ato, e a sua forma de coordenação articulada ao espaço do trabalho que modela esta dinâmica. Resultados: observou-se que os aspectos institucionais analisados não possibilitam a operacionalização na qualidade da assistência a partir da PHPN. Conclusão: as condições estruturais das maternidades se fazem necessárias e ainda se constituem como desafio, cabendo aos gestores e às equipes dos serviços de saúde desenvolver mecanismos que ampliem sua comunicação visando a contribuir na prestação do cuidado de qualidade e consolidação do PHPN.

Selection and concentration of obstetric facilities in Japan: Longitudinal study based on national census data.

AIM: A shortage of obstetricians with increased workload is a social problem in Japan. In response, the government and professional bodies have accelerated the 'selection and concentration' of obstetric facilities. The aim of this study was to evaluate the recent trend of selection and concentration. METHODS: We used data on the number of deliveries and of obstetricians in each hospital and clinic in Japan, according to the Static Survey of Medical Institutions in 2005, 2008 and 2011. To evaluate the inter-facility equality of distribution of the number of deliveries, number of obstetricians and number of deliveries per obstetrician, Gini coefficients were calculated. RESULTS: The number of obstetric hospitals decreased by 20% and the number of deliveries per hospital increased by 26% between 2005 and 2011. Hospital obstetricians increased by 16% and the average number of obstetricians per hospital increased by 19% between 2008 and 2011. Gini coefficient of deliveries has significantly decreased. In contrast, Gini coefficient of deliveries per obstetrician has significantly increased. The degree of increase in obstetricians and of decrease in deliveries per obstetrician was largest at the hospitals with the highest proportion of cesarean sections. The proportion of obstetric hospitals with the optimal volume of deliveries and obstetricians, as defined by Japan Society of Obstetrics and Gynecology, was 4% in 2008, and it had doubled to 8.1% 3 years later. CONCLUSION: The selection and concentration of obstetric facilities is progressing rapidly and effectively in Japan.

Emprego de tecnologias não invasivas de cuidado de enfermagem nos partos acompanhados por enfermeiras obstétricas em maternidade filantrópica do Médio-Paraíba/RJ / The use of non-invasive technologies for nursing care in births attend by nurse-midwives in a philanthropic maternity of the region of Middle-Paraiba/RJ

A presente pesquisa aborda a temática da assistência ao parto hospitalar na Região Médio-Paraíba, considerando a política pública de humanização do parto e nascimento A medicalização do parto e nascimento vem ocorrendo em todo o mundo. Mesmo em países desenvolvidos, a grande maioria dos partos vaginais e de baixo risco ainda é conduzida com práticas intervencionistas sem evidências científicas de sua eficácia. Em contraposição a este modelo assistencial implantou-se a política de humanização do parto e nascimento. A enfermeira obstétrica tem sido elemento importante para a consolidação do uso de práticas consideradas humanizadas na assistência ao parto de baixo risco em ambiente hospitalar. O objeto deste estudo foi o emprego de tecnologias não invasivas de cuidado de enfermagem em partos acompanhados por enfermeiras obstétricas na Associação de Proteção a Maternidade e à Infância de Resende/RJ (APMIR). Os objetivos foram: identificar as tecnologias não invasivas de cuidado de enfermagem obstétrica (TNICE) usualmente empregadas por enfermeiras obstétricas no cuidado a parturientes; discutir o emprego dessas TNICE por enfermeiras obstétricas no cuidado a parturientes sob a perspectiva da humanização do parto e nascimento; caracterizar o processo de implementação das TNICE na assistência ao parto na maternidade. Trata-se de pesquisa descritiva, quantitativa desenvolvida em uma maternidade filantrópica da região sul-fluminense que pertence ao Médio-Paraíba, na qual enfermeiras obstétricas estão incluídas na equipe de acompanhamento do parto. Foram analisados os registros correspondentes aos partos acompanhados por enfermeiras obstétricas compreendendo o período de Novembro de 2012 à Julho de 2013. Houve registro de 84 partos neste período. Os dados foram obtidos através de Livro de Registros de Parto do serviço. Os registros foram feitos em formulário próprio implantado a partir da pesquisa...

This research addresses the issue of assisted birth in a hospital in the Middle Paraíba region, considering the public policy of humanization of childbirth. The medicalization of childbirth is occurring worldwide. Even in developed countries, the vast majority of low-risk vaginal deliveries are still conducted with interventionist practices, some of them without scientific evidence of its effectiveness. In opposition to this care model, it was implemented the policy of humanization of childbirth. The midwife has been an important element in the consolidation of using practices considered humanized in the low-risk delivery care in the hospital environment. The object of this research was the use of non - invasive technologies for nursing care in childbirth attended by nurse-midwives in the Association for the Protection of Motherhood and Childhood Resende / RJ (APMIR). The objectives were: to identify the non invasive technologies of midwifery care (TNICE) usually employed by nurse-midwives in the care of mothers, to discuss the use of these TNICE by nurse-midwives in the care of mothers from the perspective of humanization of childbirth, and to characterize the process of implementing TNICE in childbirth at the hospital. It is descriptive, quantitative study, carried out in a philanthropic maternity the South Region of Rio de Janeiro State, mainly in the region of the Middle Paraíba, in which nurse-midwives are participants of the team of delivery attendance. The records included the childbirths attended by nurse-midwives covering the period from .November 2012 to July 2013. 84 childbirths were recorded in this period. Data were obtained from the Book of Registers from the institution. The recordings were made in a form especially made for the study...

A importância da participação cidadã nas políticas de saúde: o caso da reestruturação dos serviços de saúde materno-infantil em Portugal / Citizen Participation relevance in health policies: the case of the maternal and child health services restructuring in Portugal

As questões em torno da participação cidadã tornaram-se indiscutivelmente centrais na análise dos processos públicos de decisão das sociedades ditas democráticas. Uma das maiores dificuldades tem, no entanto, residido na ampla definição das modalidades participativas a considerar neste domínio. Neste trabalho assume-se que as ações de protesto são uma modalidade legítima de participar nos processos públicos de decisão. Analisa-se, para tal, o processo de encerramento de blocos de parto em Portugal, uma das medidas da recente reestruturação dos serviços de saúde materno-infantil, executada entre Maio de 2006 e Dezembro de 2007, e as consequentes ações de protesto encetadas pelas populações das localidades afetadas pela medida. Avalia-se a forma como a implementação não informada e participada de uma medida focada em critérios como segurança e qualidade da prestação de cuidados de saúde pode, mesmo assim, desencadear movimentos de contestação, sobretudo enquanto estratégia dos cidadãos para participar na (re)formulação de uma política pública.

UK childbirth delivery options in 2001-2002: alternatives to consultant unit booking and delivery.

BACKGROUND: Government policy advocates maternal choice in pregnancy care. Two key issues are place of birth and type of lead professional. Anecdotal evidence suggests there is variation in both these issues across the UK, but there has been no recent national assessment of whether maternal options are in line with government policy. AIM: To establish the range of women's childbirth delivery options, degree of midwife autonomy, and supporting training and governance mechanisms. DESIGN: Two postal questionnaires. SETTING: UK maternity units. METHOD: Questionnaires were sent to maternity services managers. MAIN OUTCOME MEASURES: number and type of units and births, transfers and care types; midwifery procedures; clinical governance and training activities. RESULTS: Completed questionnaires were received from 301 out of 308 (97.7%) units in 2002 and from 258 out of 309 (83.5%) units in 2001. Midwife-led care is available in 186 English (76.9%), 15 Welsh (78.9%), 18 Scottish (48.6%) and three Northern Ireland (30.0%) units. There are 73 (24.3%) stand-alone, 22 (7.3%) alongside, 127 (42.2%) integrated and 79 (26.2%) consultant units (for definitions of unit types, see main text), with a median 2215 hospital, 25 home and 210 midwife-led births. The median antenatal and labour transfers from midwife-led units are 25.5% (interquartile range [IQR] = 18.5-36.5%) and 18.0% (IQR = 13.4-24.8%) respectively; transfers are independent of distance to nearest consultant unit, country and unit type. CONCLUSIONS: Despite government policy promoting greater parental choice, this is not in evidence in many parts of the UK. The wide variations in home birth, midwife-led care and maternity-unit types merit further exploration. If more midwife-led units are to be established as a way of promoting parental choice and dealing with junior doctor rota problems, then such units must have adequate governance and training activities in place.

[Development and utilization of the integral system of computer monitoring in anesthesiology in clinical obstetrics and gynecology]. / Opyt razrabotki i ispol'zovaniia integrirovannoi sistemy komp'iuternogo monitoringa v anesteziologicheskoi praktike kliniki akusherstva i ginekologii.

An original computer monitoring system for preoperative monitoring was developed at the department of anesthesiology and intensive care of the Research Center for Obstetrics and Gynecology of the Russian Academy of Medical Sciences. The system includes a bedside monitor Athena (S&W + Artema, Denmark) and two special monitors ABM-100 (Datex, Finland) and NCCOM (Bomed, USA). The potentialities of the system are discussed; physiological parameters were monitored and estimated in the real time mode. Variants of graphic interface of the system are presented, including an original multisystem integral nomogram. Utilization of the system demonstrated the advantages of objective physiological information recorded by the system, a high informative values of integral estimated parameters in the real time mode. The use of the multisystem integral nomogram helps the anesthesiologist rapidly and unambiguously to interpret the clinical situation and essentially accelerates the decision-making on further treatment strategy. The work with the system does not require any special knowledge and skills, the system is simple and easy in use.

Proximity to maternity services and stillbirth risk.

A study of all 77 995 live births and 1234 stillbirths to mothers living in West Cumbria from 1950 to 1989 found no significant increase in stillbirth risk with distance of mother's residence from the first or second nearest maternity services, after allowing for year of birth, father's social class, and birth order.

[Uterine rupture at the Niamey Central Maternity Reference Center, Nigeria. Epidemiologic features and prevention strategies]. / La rupture utérine à la Maternité Centrale de Référence de Niamey (Niger). Aspects épidémiologiques et stratégies de prévention.

The authors have documented 50 cases of U.R., out 2,151 normal deliveries. During the same period, 614 surgeries for caesarean sections were performed. The U.R. frequency has been estimated at 1.80%. 98% of the U.R. were referred to us from outside in the vicinity maternities of Niamey. The maximum number of frequencies occurs between the ages of 15-42 years, and in decreasing order, among multiparas (with a parity of 5 and above). Uterine scars are among the principal causing factors. Sub total hysterectomy was the most widely used surgical method (60%). Among the 50 cases, 8 maternal deaths (16%) and 48 fatal deaths were reported (96%). The average length of stay in hospital was between 4 and 7 days. The shortest was 5 day and the longest 17 days. In order to alleviate this dramatic situation, the authors suggest the following measures: the implementation of a family planning programme (to discourage multiparity) a wide information campaign of the population, the insurance of a better treatment of uterus scars, the building of surgical units closer to rural areas, the provision of a better equipment to medical centres, the retraining of medical personnel.

Comparación de factores de riesgo en dos poblaciones de embarazadas adolescentes nulíparas / Risk factors comparison in 2 populations of pregnant nulliparous adolescents

Se realizó un estudio retrospectivo, observacional, descriptivo y analítico sobre adolescentes embarazadas nulíparas asistidas en dos instituciones diferentes, el Hospital Durand de Buenos Aires y el Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes de Tucumán. Se analizaron historias clínicas perinatales archivadas a través del Sistema Informático Perinatal (CLAP-OPS-OMS) en ambos centros, en un total de 1069 para el primero, y 9002 para el segundo, desde el 1 de enero de 1993 al 31 de diciembre de 1995. El criterio de inclusión adoptado fue la pertenencia a adolescencia temprana (10 a 13 años), mediana (14 a 16 años) y tardía (17 a 19 años) para los casos, y adultez (20 a 49 años) para los controles. Los factores de riesgo considerados fueron: soltera, analfabetismo funcional, analfabetismo absoluto, control prenatal insuficiente y cesárea. Los puntos finales fueron: mortalidad perinatal I, bajo peso al nacer, prematurez y depresión al nacer. En el aspecto analítico se observó asociación entre el hecho de ser madre soltera y analfabeta con el daño depresión del recién nacido en el Hospital Durand. En cambio en el Instituto de Maternidad se registró mayor asociación para los factores de riesgo, soltera y control prenatal insuficiente con bajo peso al nacer y prematurez. Para la prevalencia de factores de riesgo y resultados adversos se vió que el mayor índice de madres solteras corresponde a la Maternidad de Tucumán, mientras que en el Hospital Durand se registró mayor índice de analfabetismo. El control prenatal insuficiente fue notablemente mayor en Tucumán, siendo que las cesáreas fueron más frecuentes en el Hospital Durand. La mortalidad perinatal I, el bajo peso al nacer y la prematurez revelaron cifras mayores en la institución tucumana, con diferencia significativa sólo para el primero. La depresión al nacer al 1' presentó un porcentaje más importante (4,7 por ciento) en el Hospital Durand, con respecto a la Maternidad de Tucumán (3,35 por ciento), mientras que para la depresión a los 5' se observó una inversión de los valores, en la Capital Federal 1,40 por ciento y en Tucumán 3,25 por ciento. Comparando ambas instituciones se vió que los resultados adversos podrían obedecer a diferencias de estructuras y de tecnologías disponibles en ambos centros.