Encontro com Especialistas - Projetos arquitetônicos da Rede Cegonha: ambientes de atenção ao parto

Encontro com os Especialistas Dianne Soares, arquiteta do Ministério da Saúde, e Adalberto Aguemi, médico tocoginecologista pela FEBRASGO e Coordenador da Saúde da Mulher da SMS-SP.

Barriers to attendance at a tertiary hospital's perinatal mortality meeting.

BACKGROUND: Perinatal mortality multi-disciplinary team meetings (PM-MDTMs) offer a forum for multi-disciplinary discussion of poor perinatal outcomes. They ensure a thorough understanding of individual cases and present an important learning opportunity for healthcare professionals (HCPs). Attendance at PM-MDTMs in this tertiary maternity hospital has been low. AIMS: We aimed to identify barriers which may be targeted to improve attendance and engagement. METHODS: An anonymous questionnaire was developed, and all HCPs invited to participate. Demographic data on respondents was collected, as was knowledge of PM-MDTMs, their purpose and relevance to clinical practice, and barriers to attendance at meetings. A total of 78 responses were obtained and analysed. RESULTS: Self-reported understanding of the purpose and format PM-MDTMs was high (84.6% (66/78) and 65.4% (51/78), respectively), while only 50% (39/78) of respondents provided an accurate description of either. Only 50% (39/78) reported having attended a meeting in the hospital, of whom 61.5% (24/39) described the correct meeting. Of these, 37.5% (9/24) reported attending regularly and 70.8% (17/24) found the meeting relevant to their clinical practice. Of the 33.33% (26/78) who reported attending a PM-MDTM in another hospital, 73.1% (19/26) accurately described the meeting, 63.1% (12/19) of these attended regularly, and 100% (19/19) found it relevant. Three main qualitative themes emerged as barriers to attendance and were areas for suggested improvements: workload and staffing levels, meeting logistics, and lack of communication and education regarding PM-MDTMs. CONCLUSIONS: Communication regarding PM-MDTMs and their learning opportunities needs to improve. Lack of engagement is likely compounded by high workloads and staffing levels, but these issues should be surmountable.

Analysis of the structural adequacy of maternity hospitals in Piauí, Brazil, 2018-2019 / Análise da adequação estrutural das maternidades do Piauí, Brasil, 2018-2019

Abstract Objectives: to evaluate the structure and adequacy of maternal healthcare facilities in Piauí. Methods: cross-sectional study in 26 hospitals with more than 200 births/year between 2018-2019. The structure was assessed by direct observation and interview with manager, in four domains: physical aspects, human resources, equipment, and drugs. Fisher's chi-square/exact tests were used to assess differences in adequacy of structure. Results: only 46.2% of the maternal healthcare facilities had pre-delivery, parturition and immediate post-partum room. Pediatricians (73.1%) and anesthesiologists (61.5%) were the least present professionals on-duty regime. Regarding drugs, magnesium sulfate and oxytocin were observed in 76.9% of hospitals. Overall adequacy was 23.1%, being higher in maternal healthcare facilities in the capital (p=0.034) and in private ones (p=0.031). Conclusions: Data show inequalities in the structure of maternity hospitals of the state. The absence of health professionals, essential drugs, and appropriate physical structure can expose women and newborns to unnecessary and avoidable risks.

Resumo Objetivos: avaliar a estrutura e adequação das maternidades do Piauí. Métodos: estudo transversal em 26 hospitais com mais de 200 partos/ano entre 2018 e 2019. A estrutura foi avaliada por observação direta e entrevista com gestor, em quatro domínios: aspectos físicos, recursos humanos, equipamentos e medicamentos. Foram empregados os testes do quiquadrado/exato de Fisher para avaliar diferenças na adequação da estrutura. Resultados: apenas 46,2% das maternidades tinham quarto pré-parto, parto e puerpério. Pediatras (73,1%) e anestesistas (61,5%) foram os profissionais menos presentes em regime de plantão. Dos medicamentes, sulfato de magnésio e ocitocina foram observados em 76,9% dos hospitais. A adequação global foi de 23,1%, sendo maior em maternidades da capital (p=0,034) e privadas (p=0,031) Conclusões: os dados exibem desigualdades na estrutura das maternidades do estado. A ausência de profissionais de saúde, medicamentos essenciais e estrutura física apropriada pode expor mulheres e recém-nascidos a riscos desnecessários e evitáveis.

A birth population-based survey of preterm morbidity and mortality by gestational age.

BACKGROUND: Despite 15-17 millions of annual births in China, there is a paucity of information on prevalence and outcome of preterm birth. We characterized the outcome of preterm births and hospitalized preterm infants by gestational age (GA) in Huai'an in 2015, an emerging prefectural region of China. METHODS: Of 59,245 regional total births, clinical data on 2651 preterm births and 1941 hospitalized preterm neonates were extracted from Huai'an Women and Children's Hospital (HWCH) and non-HWCH hospitals in 2018-2020. Preterm prevalence, morbidity and mortality rates were characterized and compared by hospital categories and GA spectra. Death risks of preterm births and hospitalized preterm infants in the whole region were analyzed with multivariable Poisson regression. RESULTS: The prevalence of extreme, very, moderate, late and total preterm of the regional total births were 0.14, 0.53, 0.72, 3.08 and 4.47%, with GA-specific neonatal mortality rates being 44.4, 15.8, 3.7, 1.5 and 4.3%, respectively. There were 1025 (52.8% of whole region) preterm admissions in HWCH, with significantly lower in-hospital death rate of inborn (33 of 802, 4.1%) than out-born (23 of 223, 10.3%) infants. Compared to non-HWCH, three-fold more neonates in HWCH were under critical care with higher death rate, including most extremely preterm infants. Significantly all-death risks were found for the total preterm births in birth weight <  1000 g, GA < 32 weeks, amniotic fluid contamination, Apgar-5 min < 7, and birth defects. For the hospitalized preterm infants, significantly in-hospital death risks were found in out-born of HWCH, GA < 32 weeks, birth weight <  1000 g, Apgar-5 min < 7, birth defects, respiratory distress syndrome, necrotizing enterocolitis and ventilation, whereas born in HWCH, antenatal glucocorticoids, cesarean delivery and surfactant use decreased the death risks. CONCLUSIONS: The integrated data revealed the prevalence, GA-specific morbidity and mortality rate of total preterm births and their hospitalization, demonstrating the efficiency of leading referral center and whole regional perinatal-neonatal network in China. The concept and protocol should be validated in further studies for prevention of preterm birth.

Experiences of intergenerational co-parenting during the postpartum period in modern China: A qualitative exploratory study.

Most studies conducted in the West on the role played by intergenerational families in co-parenting have focused mostly on families with a single mother or those in difficult circumstances, while little is known about the experiences of members of intergenerational intact families during the early postpartum period. This study aimed to explore the intergenerational co-parenting experiences of young parents and grandmothers in China, focusing on how they shared the responsibility of caring for the new mother and infant during the postpartum period. A total of 16 eligible intergenerational intact families, including 16 mothers, 15 fathers and 12 grandmothers, were interviewed. The data set was analysed using the approach of directed content analysis guided by Feinberg's Ecological Model of Co-parenting. The data were categorized into four themes: 'division of labour', 'postpartum and infant care agreement', 'support-undermining' and 'joint family management'. An additional theme, 'expressed a need for family support', emerged from the data on these intergenerational families. The findings emphasize the importance of intergenerational co-parenting relationships in families where two generations co-parent the newborn together.

Postnatal care education in health facilities in Accra, Ghana: perspectives of mothers and providers.

BACKGROUND: The recent use of antenatal care (ANC) has steadily improved in low- and middle-income countries (LMIC), but postnatal care (PNC) has been widely underutilized. Most maternal and newborn deaths occur during the critical postnatal period, but PNC does not receive adequate attention or support, particularly in Sub-Saharan Africa. In Ghana, the majority of mothers attend four ANC assessments, but far fewer receive the four recommended PNC visits. This study sought to understand perceptions toward PNC counselling administered prior to discharge among both mothers and healthcare providers in the Greater Accra Region of Ghana. METHODS: Facility assessments were conducted among 13 health facilities to determine the number and type of deliveries, staffing, timing of discharge following delivery and the PNC schedule. Structured interviews were conducted for 172 mothers over four-months in facilities, which included one regional hospital, four district hospitals, and eight sub-district level hospitals. Additionally, healthcare providers from 12 of the 13 facilities were interviewed. Data were analyzed with Chi-square or students t-test, as appropriate, with p < 0.05 considered statistically significant. RESULTS: Ninety-nine percent of mothers received PNC instructions prior to hospital discharge, the majority of which were given in a group format. Mothers in the regional hospital were significantly more likely to have been informed about maternal danger signs but were less likely to know the PNC schedule than were mothers in district and sub-district facilities. No mother recalled more than four maternal or five newborn danger signs. Thirty-eight percent of facilities did not have PNC guidelines. Most patient and providers reported positive attitudes toward the level of PNC education, however, knowledge was inconsistent regarding the number and timing of PNC visits as well as other critical information. Only 23% of patients reported having a contact number to call for concerns. CONCLUSIONS: Despite overall positive feelings toward PNC among Ghanaian mothers and providers, there are significant gaps in PNC education that must be addressed in order to recognize problems and to prevent serious complications. Improvements in pre-discharge PNC counseling should be provided in Ghana to give mothers and babies a better chance at survival in the critical postnatal period.

Cultura de seguridad del paciente en la perspectiva del equipo de enfermería en una maternidad pública / Cultura de segurança do paciente na perspectiva da equipe de enfermagem em uma maternidade pública / Patient safety culture from the perspective of the nursing team in a public maternity hospital

OBJETIVO: Evaluar las dimensiones de la cultura de seguridad del paciente desde la perspectiva del equipo de enfermería en un hospital público de maternidad. MÉTODO: Estudio transversal realizado en un hospital público de maternidad con 69 profesionales de enfermería, de junio a agosto de 2017, aplicando el cuestionario de la Encuesta hospitalaria sobre cultura de seguridad del paciente. RESULTADOS: El promedio de puntajes positivos varió de 33.0% a 69.6%, y las mejores evaluaciones fueron en las dimensiones: aprendizaje organizacional, trabajo en equipo entre unidades y respuestas no punitivas al error. Las evaluaciones más frágiles incluyen: transferencias internas y cambio de turno, además de la frecuencia de los eventos informados. CONCLUSIÓN: El estudio señaló una cultura de seguridad débil en todas las áreas. Por lo tanto, destaca la importancia de planificar estrategias específicas para lograr una cultura de seguridad de calidad para el binomio madre / hijo

OBJETIVO: Avaliar as dimensões da cultura de segurança do paciente na perspectiva da equipe de Enfermagem, em uma maternidade pública. MÉTODO: Estudo transversal realizado em uma maternidade pública, com 69 profissionais de Enfermagem, no período de junho a agosto de 2017, mediante aplicação do questionário Hospital Survey on Patient Safety Culture. RESULTADOS: A média dos escores positivos variou de 33,0 % a 69,6%, sendo que as melhores avaliações foram nas dimensões: aprendizado organizacional, trabalho em equipe entre as unidades e respostas não punitivas ao erro. Das avaliações com maiores fragilidades, destacam-se: transferências internas e passagem de plantão, além da frequência de eventos relatados. CONCLUSÃO: O estudo apontou para a cultura de segurança sem nenhuma área de força em todas as áreas. Assim, evidencia a importância do planejamento de estratégias direcionadas, a fim de alcançar a cultura de segurança com qualidade para o binômio mãe/filho

OBJECTIVE: To evaluate the dimensions of patient safety culture from the perspective of the nursing team in a public maternity hospital. METHOD: Cross-sectional study conducted in a public maternity hospital with 69 nursing professionals, from June to August 2017, through the application of the Hospital Survey on Patient Safety Culture. RESULTS: The average of positive scores ranged from 33.0% to 69.6%, and the best evaluations were made in the following dimensions: organizational learning, teamwork between units, and non-punitive responses to the error. The most fragile evaluations were made in: internal transfers and shift reports, in addition to the frequency of reported events. CONCLUSION: The study pointed to a weak safety culture in all areas, and indicated that planning targeted strategies in order to achieve quality safety culture for the mother/child binomial is important

Cost-Utility of Intermediate Obstetric Critical Care in a Resource-Limited Setting: A Value-Based Analysis.

Background: Sierra Leone faces among the highest maternal mortality rates worldwide. Despite this burden, the role of life-saving critical care interventions in low-resource settings remains scarcely explored. A value-based approach may be used to question whether it is sustainable and useful to start and run an obstetric intermediate critical care facility in a resource-poor referral hospital. We also aimed to investigate whether patient outcomes in terms of quality of life justified the allocated resources. Objective: To explore the value-based dimension performing a cost-utility analysis with regard to the implementation and one-year operation of the HDU. The primary endopoint was the quality-adjusted life-years (QALYs) of patients admitted to the HDU, against direct and indirect costs. Secondary endpoints included key procedures or treatments performed during the HDU stay. Methods: The study was conducted from October 2, 2017 to October 1, 2018 in the obstetric high dependency unit (HDU) of Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone. Findings: 523 patients (median age 25 years, IQR 21-30) were admitted to HDU. The total 1 year investment and operation costs for the HDU amounted to €120,082 - resulting in €230 of extra cost per admitted patient. The overall cost per QALY gained was of €10; this value is much lower than the WHO threshold defining high cost effectiveness of an intervention, i.e. three times the current Sierra Leone annual per capita GDP of €1416. Conclusion: With an additional cost per QALY of only €10.0, the implementation and one-year running of the case studied obstetric HDU can be considered a highly cost-effective frugal innovation in limited resource contexts. The evidences provided by this study allow a precise and novel insight to policy makers and clinicians useful to prioritize interventions in critical care and thus address maternal mortality in a high burden scenario.

Clinical nursing and midwifery education in the pandemic age.

The COVID-19 pandemic has disrupted clinical nursing and midwifery education. This disruption has long-term implications for the nursing and midwifery workforce and for future healthcare responses to pandemics. Solutions may include enhanced partnerships between schools of nursing and midwifery and health service providers and including schools of nursing and midwifery in preparedness planning. These suggestions notwithstanding, we call upon national and international nursing and midwifery bodies to study how to further the clinical education of nurses and midwives during pandemics and other times of crisis.

Reducing caesarean rates in a public maternity hospital by implementing a plan of action: a quality improvement report.

BACKGROUND: Caesarean rates increased in different parts of the world, rising from 20% to 33% in the USA and from 40% to 55% in Brazil between 1996 and 2011; however, there was no reduction in morbimortality rates. Several factors have been suggested as responsible for this increase, such as health judicialisation, fear of the painful process on the patients' part and reduction of medical training in vaginal delivery and labour complications. It is urgent to reverse this process and, therefore, a model of actions was created with the intention of engaging the team in order to reduce caesarean rates in a Brazilian hospital. METHODOLOGY: The model was based on the following actions: encouragement of labour analgesia; execution of written reports of any cardiotocographic examination; plan-do-study-act cycles for nursing orientations about the positions that favour pregnant women during labour; creation of a birth induction form; monthly feedback with physicians and nurses on caesarean rates achieved; verification of the caesarean rate by medical staff with individual feedback; daily round of medical coordination for case discussions; disclosure of caesarean rates on hospital posters; and constant dissemination of literature with strategies to reduce caesarean delivery. This plan of action started in January 2016. The mean caesarean section rate in the 31 months preceding the interventions (period A) was then compared with the 31 subsequent months (period B). RESULTS: Both periods presented caesarean rates with normal distribution. The mean caesarean rate was 29.24% (range: 38.69%-23.89%, SD 3.24%) vs 25.84% (range: 17.96%-34.97%, SD 3.92%, p<0.05), respectively, for periods A and B. CONCLUSION: After the implementation of the plan of action, there was a reduction in caesarean rates in this hospital.

COVID-19 Obstetrics Task Force, Lombardy, Italy: Executive management summary and short report of outcome.

From February 24, 2020, a COVID-19 obstetric task force was structured to deliver management recommendations for obstetric care. From March 1, 2020, six COVID-19 hubs and their spokes were designated. An interim analysis of cases occurring in or transferred to these hubs was performed on March 20, 2020 and recommendations were released on March 24, 2020. The vision of this strict organization was to centralize patients in high-risk maternity centers in order to concentrate human resources and personal protective equipment (PPE), dedicate protected areas of these major hospitals, and centralize clinical multidisciplinary experience with this disease. All maternity hospitals were informed to provide a protected labor and delivery room for nontransferable patients in advanced labor. A pre-triage based on temperature and 14 other items was developed in order to screen suspected patients in all hospitals to be tested with nasopharyngeal swabs. Obstetric outpatient facilities were instructed to maintain scheduled pregnancy screening as per Italian guidelines, and to provide pre-triage screening and surgical masks for personnel and patients for pre-triage-negative patients. Forty-two cases were recorded in the first 20 days of hub and spoke organization. The clinical presentation was interstitial pneumonia in 20 women. Of these, seven required respiratory support and eventually recovered. Two premature labors occurred.

Efficiency of health resource utilisation in primary-level maternal and child health hospitals in Shanxi Province, China: a bootstrapping data envelopment analysis and truncated regression approach.

BACKGROUND: District- and county-level maternal and child health hospitals (MCHHs) are positioned to provide primary maternal and child healthcare in rural and urban areas of China. Their efficiencies and productivity largely affect the equity and accessibility of maternal and child health care. This study aimed to assess the efficiency of district- and county-level MCHHs in China and identify their associated factors. METHODS: Thirty-three district- and 84 county-level MCHHs were selected from Shanxi Province in 2017. At the first stage, bootstrapping data envelopment analysis (DEA) models were established to calculate the technical efficiency (TE), pure technical efficiency (PTE) and scale efficiency (SE) of district- and county-level hospitals. At the second stage, the estimated efficiency scores were regressed against external and internal hospital environmental factors by using bootstrap truncated regression to identify their determinants. RESULTS: The average TE, PTE and SE scores for district-level MCHHs were 0.7433, 0.8633 and 0.9335, respectively. All hospitals were found to be weakly efficient, although more than 50% of the hospitals performed with efficient SE (SE scores≥100%). As for county-level MCHHs, their average TE, PTE and SE scores were 0.5483, 0.6081 and 0.9329, respectively. The hospitals with TE and PTE scores less than 0.7 accounted for more than 60%, and no hospital was observed to operate effectively. Truncated regressions suggested that the proportion of health professionals, including doctors, nurses, pharmacists, inspection technician and image technician (district level: ß = 0.57, 95% CI = 0.30-0.85; county level: ß = 0.33, 95% CI = 0.15-0.52), and the number of health workers who received job training (district level: ß = 0.67, 95% CI = 0.26-1.08; county level: ß = 0.34, 95% CI = 0.14-0.54) had a positive association with efficiency scores. The amount of financial subsidy (ß = 0.07, 95% CI = 0.05-0.09) was found to be directly proportional to the productive efficiency of the county-level MCHHs. CONCLUSION: The operational inefficiency of district- and county-level MCHHs in Shanxi Province is severe and needs to be substantially improved, especially in terms of TE and PTE. Hiring additional medical personnel and ensuring the stability of the workforce should be prioritised. The Chinese government must provide sufficient financial subsidy to compensate for service costs.

Maternal factors associated with prematurity in public maternity hospitals at the Brazilian Western Amazon.

OBJECTIVE: To analyse maternal factors associated with prematurity in public maternity hospitals. DESIGN: Retrospective unmatched case-control study on two public maternity hospitals in the State of Acre, Brazil. SETTING AND PARTICIPANTS: A sample of 341 newborn infants of premature birth (< 37 weeks; case group) and 388 newborn infants of term delivery (≥ 37 weeks; control group). METHODS: A validated instrument was used for interviews, and information was collected from hospital records. The variables were divided into five blocks: (1) maternal sociodemographic and economic characteristics, (2) maternal biological and reproductive characteristics, (3) maternal habits, (4) pregnancy complications, and (5) neonatal characteristics. The hierarchical analysis was performed using multiple logistic regression. RESULTS: The risk factors associated with premature birth were as follows: newborn infants of mothers who were born premature (p = 0.005), with low BMI (p = 0.006), history of a previous preterm child (p<0.003), who had stress (p = 0.020) and physical injury during pregnancy (p = 0.025), with quality of prenatal care classified as inadequate II (p = 0.001), which presented abnormal amniotic fluid volume (p<0.001), pre-eclampsia/eclampsia (p<0.001), bleeding (p = 0.013) and hospitalization during pregnancy (p = 0.001). CONCLUSION: The variables that were associated with premature birth were mother born preterm, low BMI, previous premature child, stress and physical injury during pregnancy, prenatal care inadequate II, bleeding, abnormal amniotic fluid volume, pre-eclampsia/eclampsia and hospitalization during pregnancy. It is important to properly perform prenatal care, having a multidisciplinary approach as support, with the objective of keep up with changes in nutritional classification and monitoring of adverse clinical conditions.

Structure and practices in hospitals of the Apice ON Project: a baseline study.

OBJECTIVE: To describe some characteristics of the 97 teaching hospitals participating in the Projeto de Aprimoramento e Inovação no Cuidado e Ensino em Obstetrícia e Neonatologia (Apice ON-Project for Improvement and Innovation in Care and Teaching in Obstetrics and Neonatology). METHODS: The semester prior to the beginning of the program was adopted as the baseline to evaluate the subsequent structural and processes changes of this project. Secondary data from the first half of 2017 were extracted from the National Registry of Health Establishments (NRHE), the Hospital Information System and the Sistema de Informações sobre Nascidos Vivos (SINASC-Live Birth Information System). RESULTS: Before the implementation of the project, only 66% of the hospitals had a Baby-friendly Hospital Initiative, only 3% offered special accommodations for high-risk pregnant women, mothers and their newborns, and 45.4% hospitals adopted the skin-to-skin contact; 97% hospitals had separate rooms for pre-labor and vaginal delivery (93%), not following the recommendations of the Ministry of Health; nine hospitals (9%) had no rooming-in; there were few obstetrics nurses (less than 1% of professionals enrolled in the NRHE), and in only six hospitals the proportion of births assisted by this professional was above 50% of vaginal deliveries, while in eight this percentage ranged between 15% and 50%; the average cesarean section rate was 42%, ranging between 37.6% (Southeast) and 49.1% (Northeast); ten hospitals did not charge for companions according to inpatient hospital authorization. CONCLUSION: The study strengthens the relevance of the Apice ON project as an inducer of change of the care model in teaching hospitals and, therefore, as a strategy for the implementation of the national public policy represented by the Stork Network.

Obstetric care navigation: results of a quality improvement project to provide accompaniment to women for facility-based maternity care in rural Guatemala.

BACKGROUND: Many maternal and perinatal deaths in low-resource settings are preventable. Inadequate access to timely, quality care in maternity facilities drives poor outcomes, especially where women deliver at home with traditional birth attendants (TBA). Yet few solutions exist to support TBA-initiated referrals or address reasons patients frequently refuse facility care, such as disrespectful and abusive treatment. We hypothesised that deploying accompaniers-obstetric care navigators (OCN)-trained to provide integrated patient support would facilitate referrals from TBAs to public hospitals. METHODS: This project built on an existing collaboration with 41 TBAs who serve indigenous Maya villages in Guatemala's Western Highlands, which provided baseline data for comparison. When TBAs detected pregnancy complications, families were offered OCN referral support. Implementation was guided by bimonthly meetings of the interdisciplinary quality improvement team where the OCN role was iteratively tailored. The primary process outcomes were referral volume, proportion of births receiving facility referral, and referral success rate, which were analysed using statistical process control methods. RESULTS: Over the 12-month pilot, TBAs attended 847 births. The median referral volume rose from 14 to 27.5, meeting criteria for special cause variation, without a decline in success rate. The proportion of births receiving facility-level care increased from 24±6% to 62±20% after OCN implementation. Hypertensive disorders of pregnancy and prolonged labour were the most common referral indications. The OCN role evolved to include a number of tasks, such as expediting emergency transportation and providing doula-like labour support. CONCLUSIONS: OCN accompaniment increased the proportion of births under TBA care that received facility-level obstetric care. Results from this of obstetric care navigation suggest it is a feasible, patient-centred intervention to improve maternity care.

Structure and practices in hospitals of the apice ON project: a baseline study / Estrutura e práticas de hospitais integrantes do projeto apice ON: estudo de linha de base

ABSTRACT OBJECTIVE To describe some characteristics of the 97 teaching hospitals participating in the Projeto de Aprimoramento e Inovação no Cuidado e Ensino em Obstetrícia e Neonatologia (Apice ON—Project for Improvement and Innovation in Care and Teaching in Obstetrics and Neonatology). METHODS The semester prior to the beginning of the program was adopted as the baseline to evaluate the subsequent structural and processes changes of this project. Secondary data from the first half of 2017 were extracted from the National Registry of Health Establishments (NRHE), the Hospital Information System and the Sistema de Informações sobre Nascidos Vivos (SINASC—Live Birth Information System). RESULTS Before the implementation of the project, only 66% of the hospitals had a Baby-friendly Hospital Initiative, only 3% offered special accommodations for high-risk pregnant women, mothers and their newborns, and 45.4% hospitals adopted the skin-to-skin contact; 97% hospitals had separate rooms for pre-labor and vaginal delivery (93%), not following the recommendations of the Ministry of Health; nine hospitals (9%) had no rooming-in; there were few obstetrics nurses (less than 1% of professionals enrolled in the NRHE), and in only six hospitals the proportion of births assisted by this professional was above 50% of vaginal deliveries, while in eight this percentage ranged between 15% and 50%; the average cesarean section rate was 42%, ranging between 37.6% (Southeast) and 49.1% (Northeast); ten hospitals did not charge for companions according to inpatient hospital authorization. CONCLUSION The study strengthens the relevance of the Apice ON project as an inducer of change of the care model in teaching hospitals and, therefore, as a strategy for the implementation of the national public policy represented by the Stork Network.

RESUMO OBJETIVO Este artigo descreve algumas características dos 97 hospitais de ensino participantes do Projeto de Aprimoramento e Inovação no Cuidado e Ensino em Obstetrícia e Neonatologia (Apice ON). MÉTODOS Foi adotado como linha de base o semestre anterior ao lançamento do programa, para permitir avaliar as mudanças estruturais e processuais decorrentes desse projeto. Utilizaram-se dados secundários referentes ao primeiro semestre de 2017 disponíveis no Cadastro Nacional de Estabelecimentos de Saúde (CNES), no Sistema de Informações Hospitalares e no Sistema de Informações sobre Nascidos Vivos. RESULTADOS Antes da implantação do projeto, apenas 66% dos hospitais apresentaram habilitação de Hospital Amigo da Criança, somente 3% estavam habilitados com Casa da gestante, Bebê e Puérpera e 45,4% adotavam o método canguru; 97% dispunham de sala de pré-parto e 93% de sala de parto normal separadas, sem seguir o preconizado pelo Ministério da Saúde; nove hospitais (9%) não tinham alojamento conjunto; havia poucos enfermeiros obstetras (menos de 1% dos profissionais cadastrados no CNES), e em apenas seis hospitais a proporção de partos assistidos por esse profissional foi superior a 50% dos partos vaginais, enquanto em oito hospitais esta proporção ficou entre 15 e 50%; a taxa média de cesáreas foi de 42%, variando entre 37,6% (Sudeste) e 49,1% (Nordeste); em dez dos hospitais não constava cobrança de diária de acompanhante na autorização de internação hospitalar. CONCLUSÃO O estudo fortalece a pertinência do projeto Apice ON como indutor de mudança do modelo nos hospitais de ensino e, portanto, como estratégico para a efetivação da política pública nacional representada pela Rede Cegonha.

Plano de contingência da epidemia pelo COVID -19: Hospital e Maternidade Dona Regina Siqueira Campos (HMDR) / COVID -19 epidemic contingency plan: Hospital and Maternity Dona Regina Siqueira Campos (HMDR)

Aborda sobre a assistência hospitalar no HMDR dos casos suspeitos de Coronavírus. Apresenta o fluxo de atendimento da demanda espontânea na porta de entrada do HMDR. Traz recomendações de Biossegurança e outras recomendações gerais.

It addresses hospital care in the HMDR of suspected cases of Coronavirus. It presents the flow of service of spontaneous demand at the entrance door of the HMDR. It offers Biosafety recommendations and other general recommendations.

Aborda la atención hospitalaria en el HMDR de casos sospechosos de coronavirus. Presenta el flujo de servicio de demanda espontánea en la puerta de entrada del HMDR. Ofrece recomendaciones de bioseguridad y otras recomendaciones generales.

Il aborde la prise en charge hospitalière dans l'HMDR des cas suspects de Coronavirus. Il présente le flux de service de la demande spontanée à la porte d'entrée du HMDR. Il propose des recommandations de biosécurité et d'autres recommandations générales.