Mortalidade materna no estado da Paraíba, 2000 a 2004

Esta tese articulou as áreas do conhecimento da Epidemiologia, Saúde Pública, Demografia e Estatística. Para esta investigação, traçaram-se duas estratégias: por um lado, buscou-se relatar a trajetória dos direitos femininos em saúde no Brasil a partir do período pós-guerra até os dias atuais; por outro lado, objetivou-se analisar diferenciais da morte materna e suas associações com variáveis sociodemográficas das mulheres residentes no estado da Paraíba no período de 2000 a 2004. As explorações decorrentes destes objetivos resultaram na produção de três abordagens. Na primeira, procedeu-se a um olhar retrospectivo sobre as políticas de saúde da mulher no país e seus desdobramentos regionais, enfocando a saúde materna. A análise permitiu reconhecer que, apesar de todas as conquistas adquiridas pelas mulheres desde os anos 80, a população feminina brasileira, em particular a paraibana, ainda carece de melhorias nas condições de saúde, sendo esta situação retratada pelo elevado número de mortes maternas ocorridas nos últimos anos. Também se buscou retratar os esforços dos sistemas oficiais na luta pela melhoria da qualidade dos dados reconhecida, na agenda nacional, como sendo ainda uma grande preocupação atual. Na segunda, o objetivo foi identificar o poder associativo entre a raça das mulheres residentes no estado da Paraíba e algumas variáveis sociodemográficas. Os resultados mostraram que houve indícios significativos de que as mulheres não brancas da Paraíba tiveram maiores chances de morrer que as brancas com baixa escolaridade e por morte obstétrica direta. Na terceira, centrou-se no tipo de óbito materno, cujo objetivo consistiu em analisar associações entre o tipo de óbito materno das mulheres paraibanas e as variáveis: grupo etário, escolaridade e raça, no período de 2000 a 2004. Os testes estatísticos realizados apontaram que a mulher paraibana teve cinco vezes mais chances de morrer por morte obstétrica direta ou indireta na faixa etária abaixo dos 20 anos e acima dos 34 em relação a faixa etária entre 20-34 anos

Prevalência e fatores associados à morbidade materna: inquérito populacional em Natal/RN

INTRODUCTION: Severe maternal morbidity , also known as maternal near miss , has been used as an alternative to the study of maternal mortality , since being more frequent shares the same determinants and enables the implementati on of epidem iological surveillance of cases . Since then, hospital audits ha ve been carried out to determine the rates of maternal near miss, its mai n causes and associated factors . More recently, population surveys based on self - reported morbidity have als o been presented as vi able in identifying these cases . OBJECTIVE: The aim of this study was to determine the prevalence and associated factors of maternal near miss and complications during pregnancy and puerperal period in Natal/RN. METHODS: A cross - secti onal population - based study was conducted in Natal /RN , Brazil, which has as its target population women aged 15 to 49 years who were pregnant in the last five years. It was carried out a probabilistic sam pling design based on a multi - stage complex sample , in which 60 census tracts were selected from three strata (north , south - east and west). Afterwards, domiciles were visited in order to obtain a sample of the 908 eligible women in whom a questionnaire was applied. The descriptive analyzes and bivariate ass ociations were performed using the Chi - square test and the estimate of the prevalence ratio (PR ) with 95% confidence interval (CI) and considering the weights and design effects . The Poisson regression analysis , also with 5% significance and 95% CI, was us ed for analyzes of associated factors. RESULTS: 848 women were identified and interviewed after visits in 8.227 households corresponding to a response rate of 93 . 4 %. The prevalence of maternal near miss was 41 . 1 /1 000NV, being the Intensive Care Unity stay i ng (19 . 1 /1 000 LB ) and eclampsia (13 . 5/1000LB) the most important marker s . The prevalence of complications in the puerperal peri od was 21 . 2 %, and hemorrhage (10 . 7%) and urinary tract infection (10 . 7%) the most frequently reported clinical conditions and rema in ing in the hospital for over a week after delivery the mo st frequent intervention (5.4%) . Regarding associated factors , the bivariate analysis showed an association between the increased number of complications in women of black/brown race ( PR= 1 . 23; CI95 % : 1 . 04 - 1 . 46) and lower socioeconomic status ( PR= 1 . 33; CI95%: 1 . 12 - 1 . 58) in women who had pre natal care in public service ( PR= 1 . 42; CI95%: 1 . 16 to 1 . 72 ) and that were not advised during prenatal about where they should do the d elivery (PR= 1 . 24; CI95%: 1 . 05 - 1 . 46), made the del ivery in the public service (PR= 1 . 63; CI95%: 1 . 30 - 2 . 03), had to search for more than one hospital for delivery (PR=1 . 22; CI95%: 1 . 03 - 1 . 45) and had no companion during childbirth ( PR =1 . 19; CI95%: 1 . 01 - 1 . 41) or at all times of childbirth c are - before, during and after childbirth - ( PR= 1 . 25, CI95%: 1 . 05 - 1 . 48) . Moreover, the number of days postpartum hospitalization was higher in women who had more complications (P R= 1 . 59 ; CI95%: 1 . 36 - 1 . 86). In the final regression model for both birth place (P R= 1 . 21 ; CI 95% : 1 . 02 to 1 . 44 ) and socioeconomic status (PR = 1.54 ; CI95%: 1 . 25 - 1 . 90 ) the association remained. CONCLUSION : Conducting population surveys using the pragmatic definition of near miss is feasible and may add importa nt information about this ev ent . It was possible to find the expression of health inequalities related to maternal health in the analysis of both socioeconomic conditions and on the utilization of health services.

Análise do perfil de encaminhamento da atenção primária para pré-natal de alto risco: desafios para o ensino de competências em saúde materno-infantil

OBJECTIVE: to identify a profile of the main causes of inappropriate referrals from primary care to specialized services, as strategy for the curriculum development of core competencies related to maternal health. METHODS: a cross-sectional study was performed using document analysis of all referrals of pregnant women from primary care to the high-risk pregnancy service, state of Rio Grande do Norte, Brazil. All pregnant women referred from June to December 2014 (n = 771) were included. According to their causes the referrals were categorized as adequate, inadequate or inconclusive. RESULTS: a total of 188 referrals were classified as inadequate (24.4%) and 93 inconclusive (12.1%) totalizing 36.5% of inappropriate referrals. The main causes identified in these inappropriate referrals were: low-risk pregnancy (12.8%), unconfirmed hypertension (12.1%), risk of abortion (8.9%), teenage pregnancy (7.1%) , toxoplasmosis (5.3%), Rh incompatibility (4.6%) and urinary tract infection (4.3%). These data contributed to the formulation of the following products: 1) a continuing education program for health professionals working in primary care, undergraduate students and residents; and 2) development of a virtual platform to support professionals who need to refer patients to high-risk pregnancy service. CONCLUSION: the results of this study are relevant in the current context of education of health professionals, with potential for positively impact not only in the development of skills related to maternal health in undergraduate and graduate education, as well as contributing for improvement of the health care of the population.

Construção e validação do instrumento de investigação do conhecimento de gestantes sobre sua saúde bucal e a do seu bebê: perspectiva do cuidado em saúde

INTRODUCTION: Humanized and quality prenatal and post-partum care is critical to maternal and newborn health, as well as oral health care. Currently, the National Oral Health Policy is aiming at expanding dental care for pregnant women. Thus, the promotion of oral health and attention to prenatal care policies should be integrated; however, there is still limited participation of pregnant women. Thus, it is necessary to verify the knowledge of pregnant women related to oral health, seeking to estimate the quality of dental care provided during prenatal care, being essential for the Family Health strategy to organize personnel, plan costs and to ensure the quality standard of care. OBJECTIVE: To develop and validate a research instrument on the knowledge of pregnant women about their oral health and of their baby. METHOD: This is a construction and validation study with 93 pregnant women in Family Health Units and specialized private clinics in Obstetrics, in the city of Natal / RN. It was authorized by the Onofre Lopes University Hospital Ethics Committee of the Universidade Federal do Rio Grande do Norte (UFRN) under the registration number 421.163/13. The construction of the instrument followed steps so that it was valid, reliable and sensitive: creation and reduction of the items (drafting of the instrument), content validity and testing of the instrument, and hypotheses validation. Once constructed, the instrument was evaluated by experts who suggested modifications. There was consultation with the target population about the new version of the created instrument, which had the instrument validation verified by internal consistency through intra and inter-calibration and test-retest. Next, the hypotheses were validated. A database was built in the Statistical Package for Social Sciences (SPSS), version 22.0. After creating the hypotheses, an association was found for validating the criteria between each of the specific issues for each established criteria, considering a 5% significance level. Data analysis was carried out by describing the absolute and relative frequencies of the variables pertaining to issues relating to their pregnancy knowledge about their oral health and their baby. The Kappa coefficient was used for the calibration process (Inter and Intra-examiner calibration) and Cronbach's alpha coefficient was used to analyze instrument reproducibility (test-retest). In addition, the chi-square test was used to cross the dependent variable with the (dichotomized) independent variables. RESULTS: The intra and inter agreement analysis presented a Kappa coefficient between 0.400 and 1.000. Internal consistency through the analysis showed that 90% of the instrument's questions showed great reliability in the answers (Cronbach α ˃ 0.7). In the investigation of the relationship between the dependent variable (knowledge about oral health) and the independent variables (trimester of pregnancy, education, income and multiparous), it was found that none of these independent variables were significantly associated. All hypotheses had their Ho confirmed. CONCLUSION: The constructed instrument was validated, considering that it showed to be sensitive with good reliability and good accuracy, and therefore can be used to assess pregnant women’s knowledge about their oral health and the oral health of their baby.

Construção e validação do instrumento de investigação do conhecimento de gestantes sobre sua saúde bucal e a do seu bebê: perspectiva do cuidado em saúde

INTRODUCTION: Humanized and quality prenatal and post-partum care is critical to maternal and newborn health, as well as oral health care. Currently, the National Oral Health Policy is aiming at expanding dental care for pregnant women. Thus, the promotion of oral health and attention to prenatal care policies should be integrated; however, there is still limited participation of pregnant women. Thus, it is necessary to verify the knowledge of pregnant women related to oral health, seeking to estimate the quality of dental care provided during prenatal care, being essential for the Family Health strategy to organize personnel, plan costs and to ensure the quality standard of care. OBJECTIVE: To develop and validate a research instrument on the knowledge of pregnant women about their oral health and of their baby. METHOD: This is a construction and validation study with 93 pregnant women in Family Health Units and specialized private clinics in Obstetrics, in the city of Natal / RN. It was authorized by the Onofre Lopes University Hospital Ethics Committee of the Universidade Federal do Rio Grande do Norte (UFRN) under the registration number 421.163/13. The construction of the instrument followed steps so that it was valid, reliable and sensitive: creation and reduction of the items (drafting of the instrument), content validity and testing of the instrument, and hypotheses validation. Once constructed, the instrument was evaluated by experts who suggested modifications. There was consultation with the target population about the new version of the created instrument, which had the instrument validation verified by internal consistency through intra and inter-calibration and test-retest. Next, the hypotheses were validated. A database was built in the Statistical Package for Social Sciences (SPSS), version 22.0. After creating the hypotheses, an association was found for validating the criteria between each of the specific issues for each established criteria, considering a 5% significance level. Data analysis was carried out by describing the absolute and relative frequencies of the variables pertaining to issues relating to their pregnancy knowledge about their oral health and their baby. The Kappa coefficient was used for the calibration process (Inter and Intra-examiner calibration) and Cronbach's alpha coefficient was used to analyze instrument reproducibility (test-retest). In addition, the chi-square test was used to cross the dependent variable with the (dichotomized) independent variables. RESULTS: The intra and inter agreement analysis presented a Kappa coefficient between 0.400 and 1.000. Internal consistency through the analysis showed that 90% of the instrument's questions showed great reliability in the answers (Cronbach α ˃ 0.7). In the investigation of the relationship between the dependent variable (knowledge about oral health) and the independent variables (trimester of pregnancy, education, income and multiparous), it was found that none of these independent variables were significantly associated. All hypotheses had their Ho confirmed. CONCLUSION: The constructed instrument was validated, considering that it showed to be sensitive with good reliability and good accuracy, and therefore can be used to assess pregnant women’s knowledge about their oral health and the oral health of their baby.

Efeito da idade materna sobre os resultados perinatais

Objetivo: analisar a relação entre a idade materna e a ocorrência de resultados perinatais adversos na população do Rio Grande do Norte. Métodos: foram analisados os registros oficiais de 57.088 nascidos vivos no Estado do Rio Grande do Norte no ano de 1997. Os dados foram obtidos do Sistema de Informação sobre Nascidos Vivos do Ministério da Saúde. A população estudada foi dividida em Grupos I, II e III, segundo a faixa etária materna: 10 a 19, 20 a 34 e 35 anos ou mais, respectivamente. As variáveis analisadas foram: duração da gestação, peso ao nascer e tipo de parto. A análise estatística foi realizada utilizando-se o teste c2. Resultados: observamos uma maior incidência de parto pré-termo no Grupo I (4,3 %), em comparação ao Grupo II (3,7%) (p = 0,0028). A taxa de cesariana foi menor nos Grupos I e III, em comparação ao Grupo II (p<0,0001). Evidenciamos freqüência significativamente maior de recém-nascidos de baixo peso nos Grupos I (8,4%) e III (8,3%), quando comparados ao Grupo II (6,5%) (p<0,0001). Conclusões: a gravidez nos extremos da vida reprodutiva esteve associada com maior freqüência de parto pré-termo e baixo peso ao nascer, entretanto, com relação ao tipo de parto, foi observada maior freqüência de parto normal do que no grupo de gestantes com idade entre 20 e 34 anos

Lactação materna: a contribuição do pai

BRITO, Rosineide Santana de; ENDERS, Bertha Cruz; SOARES, Verônica Guedes. Lactação materna: a contribuição do pai. Revista Baiana de Enfermagem, Salvador, v.19/20,n.1-3, p.105-112, jan./dez. 2004,jan./dez. 2005.

Efeito Da Suplementação Materna Com Palmitato De Retinila Sobre A Concentração De Retinol No Colostro Em Condições De Jejum E Pós-Prandial.

Vitamin A is important in many essential body processes and its deficiency results in serious consequences for human health. Breast milk is the only source of this vitamin for children that are exclusively breastfed. Analysis of vitamin A in mother s milk is important because its concentration is related to maternal vitamin A status and to its ingestion by the mother during pregnancy. The aim of the present study was to assess the effect of maternal supplementation with retynil palmitate on the concentration of colostrum retinol under fasting and postprandial conditions. A total of 149 nursing mothers were recruited at the Januário Cicco Maternity School (Natal, Brazil) and allocated to two groups: Comparison (n = 69) and Test (n = 80). Blood and colostrum (in fasting and postprandial conditions) samples were collected up to 24hs after delivery. Serum retinol and colostrum levels were analyzed by high-performance liquid chromatography. The serum retinol level of 41.6 ± 12.7μg/dL (mean ± standard deviation) indicates adequate biochemical nutritional status. Colostrum retinol level was not influenced by serum retinol levels under any of the conditions established. In the colostrum, the retinol concentration in the unsupplemented test group was 67.3 ± 37.7 μg/dL under fasting and 80.3 ± 35.1 μg/dL under postprandial conditions (p<0.05), showing an increase of 19.3%. In the supplemented test group the values were 102.6 ± 57.3 μg/dL and 133.4 ± 78.3 μg/dL under fasting and postprandial, respectively (p<0.05), representing an increase of 30%. Considering that under fasting conditions most of the vitamin A transported to the milk originates in the retinol binding protein (RBP), the postprandial increase in colostrum retinol suggests a different transport mechanism of retinol to maternal milk from that performed by RBP. This situation becomes more evident under supplementation conditions.

Avaliação do desenvolvimento neuropsicomotor em crianças na rede básica de saúde utilizando o teste de Denver II: identificação de fatores de risco materno

Alterations in the neuropsychomotor development of children are not rare and can manifest themselves with varying intensity at different stages of their development. In this context, maternal risk factors may contribute to the appearance of these alterations. A number of studies have reported that neuropsychomotor development diagnosis is not an easy task, especially in the basic public health network. Diagnosis requires effective, low-cost, and easy - to-apply procedures. The Denver Developmental Screening Test, first published in 1967, is currently used in several countries. It has been revised and renamed as the Denver II Test and meets the aforementioned criteria. Accordingly, the aim of this study was to apply the Denver II Test in order to verify the prevalence of suspected neuropsychomotor development delay in children between the ages of 0 and 12 months and correlate it with the following maternal risk factors: family income, schooling, age at pregnancy, drug use during pregnancy, gestational age, gestational problems, type of delivery and the desire to have children. For data collection, performed during the first 6 months of 2004, a clinical assessment was made of 398 children selected by pediatricians and the nursing team of each public health unit. Later, the parents or guardians were asked to complete a structured questionnaire to determine possible risk indicators of neuropsychomotor development delay. Finally the Denver II Developmental Screening Test (DDST) was applied. The data were analyzed together, using Statistical Package for Social Science (SPSS) software, version 6.1. The confidence interval was set at 95%. The Denver II Test yielded normal and questionable results. This suggests compromised neuropsychomotor development in the children examined and deserves further investigation. The correlation of the results with preestablished maternal risk variables (family income, mother s schooling, age at pregnancy, drug use during the pregnancy and gestational age) was strongly significant. The other maternal risk variables (gestational problems, type of delivery and desire to have children) were not significant. Using an adjusted logistic regression model, we obtained the estimate of the greater likelihood of a child having suspected neuropsychomotor development delay: a mother with _75 4 years of schooling, chronological age less than 20 years and a drug user during pregnancy. This study produced two manuscripts, one published in Acta Cirúrgica Brasileira , in which an analysis was performed of children with suspected neuropsychomotor development delay in the city of Natal, Brazil. The other paper (to be published) analyzed the magnitude of the independent variable maternal schooling associated to neuropsychomotor development delay, every 3 months during the first twelve months of life of the children selected.. The results of the present study reinforce the multifactorial characteristic of development and the cumulative effect of maternal risk factors, and show the need for a regional policy that promotes low-cost programs for the community, involving children at risk of neuropsychomotor development delay. Moreover, they suggest the need for better qualified health professionals in terms of monitoring child development. This was an inter- and multidisciplinary study with the integrated participation of doctors, nurses, nursing assistants and professionals from other areas, such as statisticians and information technology professionals, who met all the requirements of the Postgraduate Program in Health Sciences of the Federal University of Rio Grande do Norte

Fatores determinantes da near miss materna em uma unidade de terapia intensiva obstétrica: avaliação das competências profissionais da área médica

Objective: Evaluate the determinants of morbidity and mortality in an obstetric intensive care unit and professional medical skills of students/residents at a university hospital. Methods: observational cross - sectional with 492 pregnant/pue rperal women and 261 students/residents. Patients were admitted to the obstetric intensive care unit during a year, being informed about the proposals of the study and a questionnaire was applied. The analysis was performed using Microsoft Excel 2013 and G raphPad6. Chi - square tests were used to evaluate risk factors and student t test evaluates resident/students' skills concerning the cognitive test and the Mini - Cex. Results: the main risk factors to near miss were: non - white race (OR = 2.527; RR = 2.342) ; marital status(married women) (OR = 7.968; RR = 7.113) , schooling (primary) (OR = 3.177 ; RR = 2.829) , from country town (OR = 4.643 ; RR = 4.087), low income (OR = 7014 ; RR = 5.554) , gestational hypertensive disorders (OR = 16.35 ; RR = 13.27) , re alization of pre - natal (OR = 5.023 ; RR = 4.254) and C - section before labor(OR = 39.21 ; RR = 31.25). In cognitive/Mini - cex analysis were noted significant difference in the performance of students on the subject (3.75 ± 0.93, 4.03 ± 0.94 and 4.88 ± 0.35). We still observed the best performance of residents, when compared to graduation students (p < 0.01). Conclusions: the prevalence of near miss was associated with socioeconomic/clinics factors and care issues, revealing the importance of interventions to improve these indicators. In addition, we suggest a better curriculum insertion of this subject in the medical Course disciplines due the importance to avoid the near miss through of adequacy of medical education.

Near miss materno e iniquidades em saúde: análise de determinantes contextuais no Rio Grande do Norte, Brasil

The scope of this study was to identify socioeconomic contextual and health care factors in primary care associated with maternal near misses and their marker conditions. This is an ecological study that used aggregated data of 63 clusters formed by the municipalities of State of Rio Grande do Norte, Brazil, using the Skater method of area regionalization, as the unit of analysis. The ratio of maternal near misses and their marker conditions were obtained from the Hospital Information System of the Brazilian Unified Health System. In multiple linear regression analysis, there was a significant association between maternal near misses and variables of poverty and poor primary health care. Hypertensive disorders were also associated with poverty and poor primary care and the occurrence of hemorrhaging was associated with infant mortality. It was observed that the occurrence of maternal near misses is linked to unfavorable socioeconomic conditions and poor quality health care that are a reflection of public policies that accentuate health inequalities.

Near miss materno e iniquidades em saúde: análise de determinantes contextuais no Rio Grande do Norte, Brasil

The scope of this study was to identify socioeconomic contextual and health care factors in primary care associated with maternal near misses and their marker conditions. This is an ecological study that used aggregated data of 63 clusters formed by the municipalities of State of Rio Grande do Norte, Brazil, using the Skater method of area regionalization, as the unit of analysis. The ratio of maternal near misses and their marker conditions were obtained from the Hospital Information System of the Brazilian Unified Health System. In multiple linear regression analysis, there was a significant association between maternal near misses and variables of poverty and poor primary health care. Hypertensive disorders were also associated with poverty and poor primary care and the occurrence of hemorrhaging was associated with infant mortality. It was observed that the occurrence of maternal near misses is linked to unfavorable socioeconomic conditions and poor quality health care that are a reflection of public policies that accentuate health inequalities.

A produção do cuidado no período gravídico-puerperal: experiência de mulheres usuárias de serviços públicos de saúde

Despite numerous government projects aimed at reorganizing and qualifying obstetric and neonatal care in Brazil, it remains problematic, with repercussions for maternal and newborn mortality and humanized care of both the mother and child. The objective of this study was to analyze the care provided to women during the pregnancy-puerperium cycle, based on reports of public health service users regarding their pregnancy and delivery experiences, using comprehensiveness and humanization as reference. The study applied a qualitative approach and the methodological strategy consisted of listening to the women, in order to identify, based on the meanings of their discourse concerning their experiences with health services, continuities and discontinuities of care during the pregnancy-puerperium cycle. Study participants were women who gave birth at a municipal public maternity, residents of Natal, Brazil, who at the time of the interviews, were between 10 and 42 days postpartum. Seven women reported their pregnancy and delivery experiences at public services. As interviews and observation took place, the material produced was also analyzed, in order to achieve simultaneous production and data analysis. Using systematization, a dialogue was established between the women’s discourses and production in the field of Collective Health, with respect to concepts and discussion about obstetric and neonatal care as well as the Comprehensiveness and Humanization of such care. Participant discourses underscored aspects related to prenatal care starting at pregnancy and its repercussions as well as prenatal monitoring by health services; aspects associated with care during labor and delivery, as well as those involved in postpartum in the maternity, both with respect to newborn and maternal careç and lastly, puerperium care after discharge from the maternity. Analysis of results sought to identify lines of continuity and discontinuity in the comprehensiveness and humanization of care. Based on these lines and as final contributions of the study, the following paths were proposed to achieve comprehensive and humanized production of health care for women during the pregnancy-puerperium cycle: Path 1- Reassess care in the maternal and newborn health network, aimed at comprehensiveness in terms of guaranteeing access to the various services and technological resources available to enhance health and life. Path 2- Reorganize work processes in order to attain comprehensive and humanized care for women in the pregnancy-puerperium cycle. Path 3 – Qualify the professional-user relationship in care management during the pregnancy-puerperium cycle. Path 4 – Invest in the qualification of communication processes in the different dimensions of care during the pregnancy-puerperium cycle.

A produção do cuidado no período gravídico-puerperal: experiência de mulheres usuárias de serviços públicos de saúde

Despite numerous government projects aimed at reorganizing and qualifying obstetric and neonatal care in Brazil, it remains problematic, with repercussions for maternal and newborn mortality and humanized care of both the mother and child. The objective of this study was to analyze the care provided to women during the pregnancy-puerperium cycle, based on reports of public health service users regarding their pregnancy and delivery experiences, using comprehensiveness and humanization as reference. The study applied a qualitative approach and the methodological strategy consisted of listening to the women, in order to identify, based on the meanings of their discourse concerning their experiences with health services, continuities and discontinuities of care during the pregnancy-puerperium cycle. Study participants were women who gave birth at a municipal public maternity, residents of Natal, Brazil, who at the time of the interviews, were between 10 and 42 days postpartum. Seven women reported their pregnancy and delivery experiences at public services. As interviews and observation took place, the material produced was also analyzed, in order to achieve simultaneous production and data analysis. Using systematization, a dialogue was established between the women’s discourses and production in the field of Collective Health, with respect to concepts and discussion about obstetric and neonatal care as well as the Comprehensiveness and Humanization of such care. Participant discourses underscored aspects related to prenatal care starting at pregnancy and its repercussions as well as prenatal monitoring by health services; aspects associated with care during labor and delivery, as well as those involved in postpartum in the maternity, both with respect to newborn and maternal careç and lastly, puerperium care after discharge from the maternity. Analysis of results sought to identify lines of continuity and discontinuity in the comprehensiveness and humanization of care. Based on these lines and as final contributions of the study, the following paths were proposed to achieve comprehensive and humanized production of health care for women during the pregnancy-puerperium cycle: Path 1- Reassess care in the maternal and newborn health network, aimed at comprehensiveness in terms of guaranteeing access to the various services and technological resources available to enhance health and life. Path 2- Reorganize work processes in order to attain comprehensive and humanized care for women in the pregnancy-puerperium cycle. Path 3 – Qualify the professional-user relationship in care management during the pregnancy-puerperium cycle. Path 4 – Invest in the qualification of communication processes in the different dimensions of care during the pregnancy-puerperium cycle.

Efeito da idade materna sobre os resultados perinatais

Objetivo: analisar a relação entre a idade materna e a ocorrência de resultados perinatais adversos na população do Rio Grande do Norte. Métodos: foram analisados os registros oficiais de 57.088 nascidos vivos no Estado do Rio Grande do Norte no ano de 1997. Os dados foram obtidos do Sistema de Informação sobre Nascidos Vivos do Ministério da Saúde. A população estudada foi dividida em Grupos I, II e III, segundo a faixa etária materna: 10 a 19, 20 a 34 e 35 anos ou mais, respectivamente. As variáveis analisadas foram: duração da gestação, peso ao nascer e tipo de parto. A análise estatística foi realizada utilizando-se o teste c2. Resultados: observamos uma maior incidência de parto pré-termo no Grupo I (4,3 %), em comparação ao Grupo II (3,7%) (p = 0,0028). A taxa de cesariana foi menor nos Grupos I e III, em comparação ao Grupo II (p<0,0001). Evidenciamos freqüência significativamente maior de recém-nascidos de baixo peso nos Grupos I (8,4%) e III (8,3%), quando comparados ao Grupo II (6,5%) (p<0,0001). Conclusões: a gravidez nos extremos da vida reprodutiva esteve associada com maior freqüência de parto pré-termo e baixo peso ao nascer, entretanto, com relação ao tipo de parto, foi observada maior freqüência de parto normal do que no grupo de gestantes com idade entre 20 e 34 anos