Prenatal assessment of high-risk pregnancies in primary and specialized outpatient care: a mixed study.
Fabiana Fontana Medeiros, Izabel Dayana de Lemos Santos, Juliana Vicente de Oliveira Franchi and 5 others
PMID 37970965WHAT IT FOUND
High-risk prenatal care was classified inadequate for 157 of 319 women for nutrition, 227 for maternal and fetal assessment, and 284 for prevention.
Shared primary and specialist care had better documentation, but 139 of 223 waited more than 15 days for follow-up.
Key findings
01The adequacy table reported inadequate high-risk prenatal care for 157 of 319 women for nutritional interventions, 227 for maternal and fetal assessment, 284 for preventive measures, 213 for improvements in utilization and quality of care, and 247 for care markers.
02Shared care had higher adequacy rates for maternal and fetal assessment, improvements in utilization and quality of care, and care markers, but 139 of 223 women in shared care waited more than 15 days to start outpatient follow-up.
03Managers said incomplete prenatal booklet records weakened communication between services and suggested better referral and counter-referral, electronic unified records, staff, and clear guidelines.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done in one public maternity hospital and several local services in southern Brazil, so its records and referral problems may not match other places. The quantitative part looked at care after childbirth using records and interviews, and 19 women could not be contacted after discharge, so some prenatal details may be incomplete. The adequacy categories were adapted from guidelines by the researchers, so classification depends on their chosen cut-offs. Shared care was linked with better documentation, but the study did not test shared care as an intervention, so it cannot show that shared care caused better care. The qualitative part included 13 managers, not pregnant women, so it describes management views rather than patient experience.
The easy way to misread this
Do not read shared care as a proven way to improve maternal or baby outcomes. The study measured how well care was recorded and coordinated, not health outcomes, and it did not test shared care as an intervention.