title: [Avoidable perinatal deaths and the environment outside the health care system: a case study in a city in Greater Metropolitan Rio de Janeiro].
abstract: This paper focuses on the role of environmental factors external to the health care system in the occurrence of perinatal deaths in maternity hospitals belonging to the local health system in a city in Greater Metropolitan Rio de Janeiro in 1994. Elements from the political and administrative context that contribute to an understanding of the relationship between failures in health care and structural deficiencies in these maternity hospitals were divided into four groups of variables: distribution of resources, spatial and temporal factors, organizational and managerial features, and action by interest groups. Semi-structured interviews were conducted. The study concluded that poor performance in four groups of variables may have contributed to perinatal mortality: distribution of resources was insufficient to provide quality in health care, especially in private maternity hospitals; there was no formal or informal regional or hierarchical organization of obstetric care in the city; Ministry of Health guidelines were ignored in all four maternity hospitals, while in three of the hospitals there were no admissions procedures and delivery and fetal follow-up listed in their own rules; and the level of actual participation was low.
authors.affiliation: Consórcio de Acreditação de Sistemas e Serviços de Saúde, Rio de Janeiro, RJ, 20559-900, Brasil.
authors.forename: Maria L G
authors.initials: ML
authors.lastname: Rosa
authors.forename: Virginia Alonso
authors.initials: VA
authors.lastname: Hortale
mesh_terms: D001938:Brazil; D017052:Hospital Mortality; D006771:Hospitals, Maternity / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D010043:Outcome and Process Assessment, Health Care; D018743:Perinatal Care / Q000592:standards*; D012307:Risk Factors; D014505:Urban Population
vernacular_title: Obitos perinatais evitáveis e ambiente externo ao sistema de assistência: estudo de caso em município da Região Metropolitana do Rio de Janeiro.