Page 24 - IJPS-10-3

International Journal of
Population Studies Prenatal care in Santa Catarina, Brazil

The first step in improving prenatal care in Brazil number of visits or the beginning of prenatal care at the
was the development of the Programa de Assistência correct time does not ensure that patients receive all the
Integral à Saúde da Mulher (PAISM, Program for Integral recommended physical and laboratory examinations. In
Assistance to Women’s Health) in the 1980s, which 2012, Anversa et al. grouped the quality of prenatal care
expanded over subsequent years into the Política Nacional into levels based on the fulfillment of other variables,
de Atenção Integral à Saúde da Mulher (PNAISM, providing a more comprehensive classification (Anversa
National Policy for Integral Attention to Women’s Health). et al., 2012).
The Programa de Humanização no Pré-Natal (PHPN, The lack of uniformity in evaluation criteria results
Prenatal Humanization Program), established in 2000 by in large variations in measurements and complicates
the Ministry of Health (MoH), has been guiding health- comparisons of the studied populations. Thus, the
care actions for pregnant women to this day. In 2011, the objective of this study is to evaluate the quality and factors
Cegonha network emerged to ensure the fulfillment of associated with prenatal care for women admitted for
PHPN initiatives while defining new goals and conducts, childbirth at a public reference maternity hospital in greater
which, from 2012 onwards, were updated in the Basic Care Florianópolis. The study considers the various indices
Book for Low-Risk Prenatal Care and in the Technical available and compliance with the current guidelines of
Manual for High-Risk Pregnancy. Recently, GM/MS the MoH (Brasil, 2012b) and the municipality of São José,
Ordinance No. 2228, dated July 1, 2022, updated the Santa Catarina (São José, 2015).
Cegonha Network and provided qualification and funding
for the Rede de Atenção Materna e Infantil (RAMI, Maternal 2. Methods
and Child Care Network). Such initiatives have fostered an
important expansion of prenatal care, reaching a coverage 2.1. Study design and area
of over 90% of all regions in Brazil (Brasil, 2012a; Brasil, This cross-sectional study was carried out on women
2012b; Brasil, 2011; Brasil, 2022; Cruz et al., 2019). who received prenatal care in the municipality of São José
These national recommendations include early through the Sistema Único de Saúde (SUS-Government
prenatal care (starting with up to 12 weeks of gestation), National Health System) and were admitted for delivery at
its periodic and continuous provision, the performance of the maternity hospital of the Hospital Regional de São José
specific examinations, gestational risk classification, and (HRSJ) from November 2021 to April 2022. This reference
documentation in both the pregnant woman’s health record maternity hospital is located in the municipality of São
and pregnancy booklet (Rodrigues et al., 2020). However, José in greater Florianópolis, in the State of Santa Catarina,
the quality of care did not proportionally improve with the Southern Brazil.
increase in coverage (Leal et al., 2020; Esposti et al., 2020), 2.2. Sample design and selection procedures
still falling short of the established recommendations
(Pilau et al., 2014; Martin et al., 2022; Moron-Duarte et al., From an average of 300 monthly deliveries at this maternity
2021). hospital, including deliveries of women with high-risk
and usual-risk pregnancies, an estimated 97 deliveries
Several parameters underlie this evaluation, including
information recorded in the pregnant woman’s booklet, originated from the municipality of São José. With a
total of 582 pregnant women observed over a 6-month
specific indices, and compliance with MoH guidelines. The collection period and considering a prevalence of 50%
Kessner index, developed in 1973, was one of the pioneering (unknown), relative error of 5%, and confidence level of
and widely utilized indices in literature (Kessner et al., 1973). 95%, the minimum calculated sample size was composed
In 1994, Milton Kotelchuck adapted the Kessner index
to facilitate cross-population comparisons (Kotelchuck, of 232 women.
1994). In Brazil, the Kessner index was modified by The study included women admitted for childbirth at
Takeda in 1993 to align with national guidelines (Takeda, the HRSJ maternity hospital; they were on SUS prenatal
1993). However, the Kessner index did not align with the care in the municipality of São José and possessed a
Brazilian guidelines due to the incorporation of additional prenatal booklet. Women who did not attend prenatal
tests beyond those recommended by the original index. All visits and those with a gestational age of <37 weeks at the
three evaluations were carried out quantitatively, utilizing time of delivery were excluded from the study.
variables such as the “beginning of prenatal care” and the Sample selection was conducted consecutively over the
“number of physician office visits” (Cruz et al., 2019). 6-month data collection period, as there were no parameters
Although essential for evaluation, these indices do not indicative of heterogeneity in the population of interest.
precisely define the quality of care since the recommended Considering an average 48-h hospitalization period, in

Volume 10 Issue 3 (2024) 18 https://doi.org/10.36922/ijps.1422