Fluxo para encaminhamento inter-hospitalar da gestante na rede de atenção à saúde

Abstract

Introduction: Brazil faces challenges in ensuring quality care for pregnant women and fetuses, and therefore in guaranteeing a healthy delivery and postpartum period. The structuring of healthcare services for maternal and neonatal care remains precarious in small cities, necessitating the implementation of an effective maternal transport system that is well-coordinated across care points. For this reason, it is necessary to create a flow of care, with criteria subsidized by protocols, to guide the referral of obstetric patients, guaranteeing continuity and quality in the care provided. Objective: To develop a flow for the inter-hospital referral of obstetric patients treated in the Health Care Network (RAS) of Santa Inês Regional Office, in the Vale do Pindaré region of Maranhão. Method: This methodological study was conducted in three stages: (1) a documentary study to analyze current Brazilian legislation, guidelines, and care protocols, seeking recommendations to support the development of the flow for obstetric patient referrals; (2) a descriptive study aimed at mapping and describing the RAS services in Santa Inês region that attend obstetric patients, assessing their installed capacity, and identifying available and necessary human resources to ensure appropriate obstetric referrals in the regional health system; 3) construction of the inter-hospital Referral Flow for Obstetric Patients, taking into account the results of the previous stages. Results: Results: It was mapped and described the services and human resources that care for pregnant women in Santa Inês-MA region, highlighting that there are 13 municipalities and that none of them has the appropriate structure for caring for pregnant women. The 13 municipalities have 14 hospitals, two of which are state-run and 12 municipal, most equipped for low-risk care, with only one hospital handling high-risk pregnancies. In terms of professionals, there are 929, the majority of whom are generalist nurses (596). An analysis was made of the active regulations in Brazil in relation to the flow of inter-hospital care, evaluating care for pregnant women, structure and human resources for inter-hospital obstetric referral and risk classification. After these analysis, it is presented: the Description of the factors and criteria for scoring the Pregnant Woman's Risk Classification; the Flow for inter-hospital obstetric referral in Santa Inês Regional Health Care Network, in the Vale do Pindaré region of Maranhão; and the Form for inter-hospital obstetric referral in this RAS. Conclusion: By adopting this referral flow, healthcare institutions can standardize the inter-hospital referral process, ensuring that pregnant women are directed to the most appropriate service according to their risk classification. This contributes to more efficient resource management and improved healthcare system organization, promoting continuous and quality care for all pregnant women.