Proposta de implantação do comitê de prevenção de mortalidade infantil e fetal Gramado-RS

Abstract

Fetal and infant mortality, although it has declined in recent decades, remains a major challenge for Brazilian Public Health. Studies regarding the subject point out that most of the occurrences are classified as preventable, which result from biological, social, cultural factors and the health system failures. This analysis is a powerful indicator for the qualification of obstetric and neonatal care, especially in relation to preventable causes. The investigation of the occurrences is the responsibility of the municipal Epidemiological Surveillance, which takes place with the assistance of the regional health coordinators. Although mandatory, the proportion of infant and fetal deaths investigated in the country is still low, especially in the states of the North and Northeast regions. In line with this perspective, aiming to induce these analytical processes in the daily routine of services, the Ministry of Health, in 2004, proposed to the federated entities the institution of the Fetal and Infant Mortality Prevention Committees, which should offer visibility, follow and monitor infant and fetal deaths, while proposing interventions to reduce mortality at the local level. Within this, an attempt was made to carry out an analysis of fetal and neonatal mortality in the period from 2017 to 2019 in the municipality of Gramado/RS and to propose the implementation of the Prevention Committee in the Municipality. This is a qualitative and quantitative research, with a retrospective design, based on documents supported by direct research in the investigation records of fetal and neonatal deaths in the municipal epidemiological surveillance sector. Data analysis was based on descriptive statistics, presenting as result in the period of this study, 56% (n: 10) of neonatal deaths, followed by 44% (n: 8) of fetal deaths, of which 61% (n: 11) were extremely premature, 22% (n: 4) were within the regular gestational period and 17% (n: 3) were premature. From the neonatal deaths, 50% (n: 5) occurred within 24 hours of life. Regarding the birth weight, 30% (n: 3) weighed more than 2,500g, 10% (n: 1) weight 2,500g to 1500g and 60% (n: 6) weight less than 1,500g. From the fetal deaths, 37.5% (n: 3) weighed more than 2,500g and 62,5% (n: 5) weighed less than 1500g. There was a predominance of white women (72%, n: 13), with complete high school education (44%, n: 8), aged between 20-34 years (62%, n: 13) and with partner (61%, n: 11). Multiparity was predominant (67%, n: 12). 56% (n: 10) did not have history of abortion and 94% (n: 17) were single pregnancies. In relation to the gestational risk previously estimated, the low risk prevailed, at 66.6% (n: 12). The access to prenatal care of 67% (n: 12) occurred in the first trimester of pregnancy. 65% (n: 11) performed prenatal care in the public network and 35% (n: 6) in the private network. 95% (n: 15) had some gestational risk factor. The product generated from this study was the proposal for implantation by the Municipal Health Secretariat of the Child and Fetal Mortality Committee in the municipality of Gramado, constituting the presentation of the documents: Construction of the proposal for the implementation of the child and fetal mortality prevention committee Gramado-RS ; Results of the characterization of fetal and neonatal mortality in the municipality; Contextualization of records related to pregnancy risks and delivery outcome; Committee Charter.