[Quality assessment of labor care provided in the Unified Health System in Rio de Janeiro, Southeastern Brazil, 1999-2001].
OBJECTIVE
Quality of labor care has been recognized as a major factor for prevention of obstetric complications which can lead to maternal, perinatal and neonatal morbidity and mortality. The objective of the study was to assess quality of labor care by gestational risk and type of health provider.


METHODS
Observational, cross-sectional study of labor care provided to 574 pregnant women. Stratified sampling in 20 Unified Health System maternity hospitals in Rio de Janeiro, Brazil, was carried out between 1999 and 2001. Quality of labor care was assessed by gestational risk and type of health provider. Statistical analyses consisted of variance analysis and the analysis of difference between proportions.


RESULTS
Of all women studied, 29.6% were classified at obstetric risk. Although hypertension is the main cause of maternal death in Brazil, 71.6% did not have their prelabor blood pressure measured. Five measures were taken on average per parturient and the lowest rate was found in privately insured hospitals (average of 2.9). As to humanized health care, only 21.4% of the parturients had an accompanying person on their side during labor, 75.7% were submitted to intravenous hydration and 24.3% to amniotomy. The single care-related factor that varied by obstetric risk was frequency of blood pressure measures: high-risk parturients had their blood pressure measured twice as much as those low-risk women (mean 0.36 vs. 0.18 measures/h, p=0.006).


CONCLUSIONS
In general, low-risk parturients were submitted to unnecessary interventions while high-risk women did not receive adequate care. As a result, there are poor perinatal outcomes, high cesarean rates and high maternal mortality rates, which do not reflect health care investments and technology available.
Oliveira
Maria Inês Couto de
MI
Departamento de Epidemiologia e Bioestatística, Instituto de Saúde da Comunidade, Universidade Federal Fluminense, Niterói, RJ, Brasil. marinesco@superig.com.br
Dias
Marcos Augusto Bastos
MA
Cunha
Cynthia B
CB
Leal
Maria do Carmo
Mdo C
D001938:Brazil / Q000453:epidemiology; D002585:Cesarean Section / Q000592:standards / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000379:methods / Q000592:standards*; D005260:Female; D006771:Hospitals, Maternity / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008427:Maternal Health Services; D008428:Maternal Mortality; D008430:Maternal-Child Health Centers; D018743:Perinatal Care / Q000592:standards / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D017149:Private Sector; D017150:Public Sector; D011787:Quality of Health Care; D018570:Risk Assessment