Page 25 - IJPS-10-3

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

the 1 week, puerperal women admitted to the maternity prenatal care, especially regarding breastfeeding,
st
ward on Monday, Wednesday, Friday, and Sunday were physiological and pathological signs and symptoms of
contacted, while in the 2 week, those admitted on Tuesday, pregnancy and childbirth, newborn care, healthy habits,
nd
Thursday, and Saturday were approached. This alternation iron and folic acid supplementation, and participation in
was maintained throughout the duration of the study. pregnancy support groups with health-care professionals

Women were approached at their puerperium beds in to gain information about pregnancy and newborn care,
the HRSJ ward at least 6 h post-delivery, at an appropriate were collected through questionnaire responses from the
time determined by them and according to the evaluation patients.
of the medical and investigation team. After receiving 2.3.1. The normative criteria of prenatal care
information about the survey, patients signed the free and
informed consent form and/or the free and clarified assent The quality of prenatal care was assessed based on
form for minors. the Kessner index modified by Takeda (1993), the
adapted adequacy of prenatal care utilization (APNCU)
2.3. Measuring instruments index (Kotelchuck, 1994), the Anversa et al. (2012)
We employed two instruments for data collection. The classification, as well as the review of compliance with
first instrument was for the collection of secondary data, essential recommendations from both the MoH and the
either from the prenatal booklet or from the medical municipality of São José. The adequacy categories (adequate
records, while the second one consisted of a questionnaire and very adequate) and non-adequacy (intermediate and
administered to the patients. inadequate) were grouped to assess the relationship with
the sociodemographic, behavioral, and gestational data.
Initially, the records in the prenatal booklet were
verified, followed by the review of data entered in the For the Kessner index modified by Takeda (1993),
medical records of puerperal women. The secondary data prenatal care was considered inadequate if it began after
were transcribed into the data collection instrument. 28 weeks of gestational age or <3 physician office visits.
Subsequently, the patients responded to a questionnaire Adequacy was defined as the beginning of prenatal care
comprising 16 multiple-choice questions about prenatal before 20 weeks and six or more physician office visits.
care and their socioeconomic conditions. If a participant Intermediate status encompassed all other situations.
was unable to respond at the time of approach, the As for the adapted APNCU index (Kotelchuck, 1994),
questionnaire was left with them and collected later, before prenatal care was considered inadequate if there were no
hospital discharge. visits at the beginning of prenatal care, visits after 15 weeks
The date and time of delivery, along with gestational of gestational age, and fewer than 50% of expected visits
age, were extracted from the medical records of each to the physician’s office. It is intermediate if the expectant
puerperal woman based on the list of deliveries during mother visited the physician’s office for 50 – 79% of
the data collection period. Socioeconomic information expected visits, adequate if she performed 80 – 109% of
was drawn from the prenatal booklet, including age group, expected visits, and very adequate if she performed 110%
self-reported skin color, education level, marital status, and or more expected visits.
lifestyle habits such as smoking history, as well as alcohol The Anversa classification is divided into four levels
and drug use. Obstetric clinical history and records of (Anversa et al., 2012). Level 1 is the same as the Kessner
the current pregnancy, including whether the pregnancy index modified by Takeda. In Level 2, prenatal care was
was planned, laboratory and ultrasound examinations considered adequate if it began before 20 weeks and included
performed each trimester, identification of any pathologies six or more physician office visits, along with five or more
during pregnancy, and referral to high-risk prenatal care recordings of blood pressure (BP), weight, gestational age,
(HRPN), were also documented. Any variables not recorded uterine fundal height, and four or more recordings of fetal
in the prenatal booklet were considered procedures not heart rate and fetal movement. Inadequacy was determined
performed. According to the municipal protocol, patients by the beginning of prenatal care after 28 weeks and <3
are referred to the HRPN in the municipality of São physician office visits, two or fewer records of BP, weight,
José if they have comorbidities that require specialized gestational age, uterine fundal height, fetal heart rate, and
monitoring by an obstetrician, in addition to the assistance fetal movement. Intermediate status was applied to the
provided by the nursing and medical staff at the Primary remaining situations. Level 3’s adequacy was the beginning
Health Unit (UBS) (São José, 2015). of prenatal care before 20 weeks and six or more physician
Data concerning women’s socioeconomic conditions office visits. It included records of the examinations of
and verbal guidance/recommendations received during blood type and Rh factor, hemoglobin and hematocrit,

Volume 10 Issue 3 (2024) 19 https://doi.org/10.36922/ijps.1422