Melhoria da qualidade da atenção obstétrica e neonatal em maternidade de risco habitual no Rio Grande do Norte

Abstract

INTRODUCTION: maternal and neonatal morbidity and mortality can be prevented with quality and safe care. Measures are needed to ensure the improvement of the quality of care in labor and birth. OBJECTIVE: to increase adherence to good practices in childbirth in a public maternity hospital in the State of Rio Grande do Norte. METHOD: This is a quasi-experimental study with a cycle of improvement with data analysis before and after the intervention. A retrospective review of medical records of 108 deliveries (baseline) and 102 deliveries (post-intervention) was performed, totaling 420 individuals (mothers and newborns), selected by systematic random sampling. The intervention was planned with the service team and consisted of changes in the medical records, training on good practices, reactivation of the managing collegiate, among others. The study's variables of interest include simple and composite indicators of good practices and adverse events. A descriptive analysis was performed with absolute and relative frequencies and a confidence interval of 95% (95%CI) and for the analysis of the improvement of post-intervention good practices, the Student's T test was applied, considering a value of p<0.05. RESULTS: It was observed that 89.52% of the mothers were between 14 and 34 years of age, 96.19% of the total births occurred in the term or post-term period (with 37 weeks or more of gestation), 89% of the pregnant women were discharged with up to 03 days of hospitalization and 60.9% of the deliveries were of the normal type. The main causes of the low performance of good practices are related to the work process and continuing education according to the Ishikawa diagram. After the intervention, there was an increase in good practices: filling in the partogram (p=0.031), presence of a companion (p=0.002), breastfeeding in the 1st hour postpartum (p<0.001), skinto-skin contact between mother and baby (p<0.001), administration of vitamin k (p<0.001) and newborn identification with a bracelet (p<0.001). The proportion of deliveries with at least one adverse event in relation to the total deliveries considering the two periods was 9.5%. CONCLUSIONS: it is possible to induce an increase in the implementation of good practices in childbirth care in health services through multifaceted interventions. It is necessary to invest in strategies for the sustainability of this improvement.