Use of prenatal care and hospital structure according to obstetric risk in Rio de Janeiro, Brazil

To estimate the use and adequacy of prenatal care services and to verify the structure of the maternity hospital to meet the needs of health care during childbirth in the Brazilian Unified Health System.

This is a cross-sectional, hospital-based study conducted in the state of Rio de Janeiro, Brazil. 1,073 puerperae were eligible, whose delivery took place in public and mixed hospitals. The interviews were conducted in the hospital, and data were extracted from the prenatal card and maternal medical records. To evaluate the hospital structure, managers were interviewed. Sociodemographic, obstetric and prenatal care characteristics of the puerperae were described according to obstetric risk. The evaluation of the structure of the maternity hospital included: human resources, medicines, emergency equipment, and support services, according to the complexity level. Moreover, the distribution of puerperae classified as at obstetric risk was analyzed according to the complexity of the hospital structure.

The highest prevalence of high obstetric risk was observed in hospitals located in small cities, among white women, aged 35 years or over, with up to 11 years of formal study, multiparous, and obese. Prenatal care adequacy, control of hypertension, diabetes, and nutritional evaluation were low, and traveling for delivery was significant. Hospitals with ICU/NICU presented better levels of adequacy in all structure dimensions evaluated. At the state level, 30.5% of women at high obstetric risk were seen in maternity hospitals without ICU/NICU; and 40.4% women at normal risk, in maternity hospitals with ICU/NICU.

We highlight the need to improve prenatal care and the implementation of an articulated network of services that integrate the Brazilian Unified Health System (SUS), centered on maternity hospitals that guarantee the structure conditions for quality and safety in obstetric and neonatal care, both in good practices at normal risk and in the management of complications at high obstetric risk, in such a way to impact the considerable outcomes of maternal and neonatal morbidity and mortality.