Processo assistencial das mulheres com morbidade materna grave: um estudo misto

• Ano de defesa: 2019
• Autor(a) principal: Villalba, Jessica Paola Garcia
• Orientador(a): Pereira, Adriana Lenho de Figueiredo
• Banca de defesa: Vargens, Octavio Muniz da Costa , Queiroz, Ana Beatriz Azevedo
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade do Estado do Rio de Janeiro
• Programa de Pós-Graduação: Programa de Pós-Graduação em Enfermagem
• Departamento: Centro Biomédico::Faculdade de Enfermagem
• País: BR
• Palavras-chave em Português: Complicações na gravidez; Morbidade; Qualidade de assistência à saúde; Saúde da mulher; Enfermagem obstétrica
• Palavras-chave em Inglês: Complications in pregnancy; Morbidity; Quality of health care; Obstetric nursing
• Área do conhecimento CNPq: CNPQ::CIENCIAS DA SAUDE::ENFERMAGEM
• Link de acesso: http://www.bdtd.uerj.br/handle/1/11198

The object of this dissertation is to research the care process of women with risk pregnancy and severe maternal morbidity. General objective: to analyze the factors of the care process to women with risk pregnancy and severe maternal morbidity. Specific objectives: to identify maternal and obstetric factors associated with severe maternal morbidities during hospital care and to understand the factors of the care process related to the occurrence of these morbidities. Explanatory sequential mixed study conducted in a tertiary maternity hospital, linked to a teaching hospital in the city of Rio de Janeiro from February to July 2019. Quantitative phase conducted through a cross-sectional study, based on the pregnant women's medical records with maternal morbidity attended in 2017. For data collection, a form based on the notification form proposed by WHO was used. The qualitative phase corresponded to a qualitative and descriptive study, which the the nurses and doctors who take care of these women were interviewed. Quantitative data were analyzed by the classic chi-square (χ2) statistical tests, with significance level of p <0.05, Bonferroni post hoc test and Fi or Phi (&#981;) and Cramer V tests, which measured the strength. between categorical variables and the severity outcome, as well as the Prevalence Ratio. Qualitative data were analyzed based on the thematic content analysis framework. In the quantitative phase, the sample consisted of 66 (100%) women with risk pregnancy and severe maternal morbidity, and 12 (18.2%) cases of maternal near miss were identified. Severe preeclampsia (77.3%), postpartum hemorrhage (18.2%) and sepsis (10.6%) were more prevalent. The likelihood of severe outcome decreases when the woman has had severe preeclampsia, while this probability increases for sepsis, postpartum hemorrhage, ICU admission, exploratory laparotomy and blood transfusions. In the qualitative phase, 13 professionals participated, being nurses and doctors, who consider that the occurrence of severe maternal morbidity is related to deficiencies in the organization and resources of the health system; poor quality of primary and hospital care; inadequate professional training; limited maternal socioeconomic conditions and limited access to care. There are also delays involved in making a decision to seek care; access to health services and quality of care received. Systemic infection, postpartum hemorrhage, and ICU admission were factors of care most associated with severe / near miss maternal morbidity in the study sample. Improvements in the social conditions of the female population, timely access to maternal care and the organization of the primary and hospital health care network are necessary to qualify the process of assisting women with risky pregnancies and severe maternal morbidity.