Preventing vertical HIV virus transmission: hospital care assessment.

OBJECTIVES: assess the implementation of actions to prevent vertical transmission of HIV. METHODS: a retrospective cohort study conducted in two maternity hospitals in the city of Montes Claros, State of Minas Gerais. All women admitted for childbirth diagnosed with HIV and their respective newborns were included from 2014 to 2017. Data were collected from medical records and analyzed descriptively. RESULTS: population consisted of 46 pairs of mothers and newborns. Management was considered inadequate in 30 cases of parturient/postpartum women (65.2%) and 14 cases of newborns (30.4%). The main reasons for inadequate maternal management were lack of pharmacological inhibition of lactation (53.3%) and counseling/consent for HIV testing (43.3%). For newborns, late onsetoffirst dose ofZidovudine (50.0%) and no prescriptionofNevirapine (28.6%). CONCLUSIONS: important prevention opportunities were missed, pointing to the need for improved care.

Preventing vertical HIV virus transmission: hospital care assessment / Prevención de la transmisión vertical del virus del VIH: evaluación de la asistencia hospitalaria / Prevenção da transmissão vertical do vírus HIV: avaliação da assistência hospitalar

ABSTRACT Objectives: assess the implementation of actions to prevent vertical transmission of HIV. Methods: a retrospective cohort study conducted in two maternity hospitals in the city of Montes Claros, State of Minas Gerais. All women admitted for childbirth diagnosed with HIV and their respective newborns were included from 2014 to 2017. Data were collected from medical records and analyzed descriptively. Results: population consisted of 46 pairs of mothers and newborns. Management was considered inadequate in 30 cases of parturient/postpartum women (65.2%) and 14 cases of newborns (30.4%). The main reasons for inadequate maternal management were lack of pharmacological inhibition of lactation (53.3%) and counseling/consent for HIV testing (43.3%). For newborns, late onsetoffirst dose ofZidovudine (50.0%) and no prescriptionofNevirapine (28.6%). Conclusions: important prevention opportunities were missed, pointing to the need for improved care.

RESUMEN Objetivos: evaluar la implementación de acciones para prevenir la transmisión vertical del VIH. Métodos: estudio de cohorte retrospectivo realizado en dos hospitales de maternidad em la ciudad de Montes Claros, estado de Minas Gerais. Todas las mujeres ingresadas para el parto diagnosticadas con VIH y sus respectivos reciénnacidos se incluyeron entre 2014 y 2017. Los datos se recopilaron de los registros médicos y se analizaron descriptivamente. Resultados: la población consistió en 46 pares de madres y reciénnacidos. El manejo se consideró inadecuado en 30 casos de mujeres parturientas/posparto (65,2%) y 14 casos de reciénnacidos(30,4%). Las razones principales para el manejo materno inadecuado fueron: falta de inhibición farmacológica de lalactancia (53.3%) y asesoramiento/consentimiento para la prueba del VIH (43,3%). Para los reciénnacidos, inicio tardío de la primera dosis de zidovudina (50.0%) y sin prescripción de nevirapina (28,6%). Conclusiones: se perdieron importantes oportunidades de prevención, lo que indica la necesidad de una mejor atención.

RESUMO Objetivos: avaliar a implementação das ações de prevenção da transmissão vertical do HIV. Métodos: estudo de coorte retrospectivo, realizado em duas maternidades de Montes Claros, Minas Gerais. Foram incluídas todas as mulheres admitidas para o parto com diagnóstico de HIV e seus respectivos recém-nascidos, nos anos de 2014 a 2017. Os dados foram coletados de prontuários e analisados de forma descritiva. Resultados: a população foi composta por 46 pares de mães e recém-nascidos. O manejo foi considerado inadequado em 30 casos de parturientes/puérperas (65,2 %) e em 14 casos de recém-nascidos (30,4%). Os principais motivos para a inadequação do manejo materno foram: ausência da inibição farmacológica da lactação (53,3%) e do aconselhamento/consentimento na realização do exame anti-HIV (43,3%). Para os recém-nascidos, início tardio da primeira dose daZidovudina (50,0%) e não prescrição da Nevirapina (28,6%). Conclusões: oportunidades importantes de prevenção foram perdidas, apontando para a necessidade de melhoria da assistência.

Comparison of childbirth care models in public hospitals, Brazil.

OBJECTIVE: To compare collaborative and traditional childbirth care models. METHODS: Cross-sectional study with 655 primiparous women in four public health system hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for the collaborative model and 322 for the traditional model, including those with induced or premature labor). Data were collected using interviews and medical records. The Chi-square test was used to compare the outcomes and multivariate logistic regression to determine the association between the model and the interventions used. RESULTS: Paid work and schooling showed significant differences in distribution between the models. Oxytocin (50.2% collaborative model and 65.5% traditional model; p < 0.001), amniotomy (54.3% collaborative model and 65.9% traditional model; p = 0.012) and episiotomy (collaborative model 16.1% and traditional model 85.2%; p < 0.001) were less used in the collaborative model with increased application of non-pharmacological pain relief (85.0% collaborative model and 78.9% traditional model; p = 0.042). The association between the collaborative model and the reduction in the use of oxytocin, artificial rupture of membranes and episiotomy remained after adjustment for confounding. The care model was not associated with complications in newborns or mothers neither with the use of spinal or epidural analgesia. CONCLUSIONS: The results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes.

Comparação de modelos de assistência ao parto em hospitais públicos / Comparison of childbirth care models in public hospitals, Brazil

OBJETIVO Comparar os modelos colaborativo e tradicional na assistência ao parto e nascimento. MÉTODOS Estudo transversal realizado com 655 primíparas em quatro hospitais do sistema único de saúde em Belo Horizonte, MG, em 2011 (333 mulheres do modelo colaborativo e 322 do modelo tradicional, incluindo aquelas com trabalho de parto induzido e prematuro). Os dados foram coletados em entrevistas e levantamento de prontuários. Foram aplicados os testes Qui-quadrado para comparação e regressão logística múltipla para determinar associação entre o modelo e os desfechos analisados. RESULTADOS Houve diferenças significativas entre os modelos em relação ao nível de escolaridade e trabalho remunerado. No modelo colaborativo houve menor utilização da ocitocina (50,2% no modelo colaborativo versus 65,5% no modelo tradicional; p < 0,001), da ruptura artificial das membranas (54,3% no modelo colaborativo versus 65,9% no modelo tradicional; p = 0,012) e da taxa de episiotomia (16,1% no modelo colaborativo versus 85,2% no modelo tradicional; p < 0,001), e maior utilização de métodos não farmacológicos para alívio da dor (85,0% no modelo colaborativo versus 78,9% no modelo tradicional; p = 0,042). A associação entre o modelo colaborativo e a redução no uso da ocitocina, da ruptura artificial das membranas e da episiotomia manteve-se após o ajuste para fatores de confundimento. O modelo assistencial não esteve associado a complicações neonatais ou maternas nem à utilização de analgesia de condução. CONCLUSÕES Os resultados sugerem que o modelo colaborativo poderá reduzir as intervenções na assistência ao trabalho de parto e parto com resultados perinatais semelhantes. .

OBJECTIVE To compare collaborative and traditional childbirth care models. METHODS Cross-sectional study with 655 primiparous women in four public health system hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for the collaborative model and 322 for the traditional model, including those with induced or premature labor). Data were collected using interviews and medical records. The Chi-square test was used to compare the outcomes and multivariate logistic regression to determine the association between the model and the interventions used. RESULTS Paid work and schooling showed significant differences in distribution between the models. Oxytocin (50.2% collaborative model and 65.5% traditional model; p < 0.001), amniotomy (54.3% collaborative model and 65.9% traditional model; p = 0.012) and episiotomy (collaborative model 16.1% and traditional model 85.2%; p < 0.001) were less used in the collaborative model with increased application of non-pharmacological pain relief (85.0% collaborative model and 78.9% traditional model; p = 0.042). The association between the collaborative model and the reduction in the use of oxytocin, artificial rupture of membranes and episiotomy remained after adjustment for confounding. The care model was not associated with complications in newborns or mothers neither with the use of spinal or epidural analgesia. CONCLUSIONS The results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes. .