Box. Classification of prenatal care by IPR/Prenatal. João Pessoa, state of Paraíba, Brasil, 2016.
| Aspect | Evaluation criteria | Description of the criteria | Grade | Collection form |
|---|---|---|---|---|
| Infrastructure (services) | Construction in own building | Unit built with physical plant to be health service | 1 (Yes) = adequate; 2 (No) = inadequate | Interview |
| Exposure of health unit operation to users | Present in a visible place the days, shifts and prenatal professionals | 1 (Yes) = adequate; 2 (No) = inadequate | Direct observation | |
| Equipment for prenatal use in operationa | To have at least six: clinical and Pinard stethoscope, sphygmomanometer, inelastic tape measure, glucometer, clinic table and chairs, stretcher, two-step iron ladder, scale, doppler fetal monitor/sonar, obstetric disk and exclusive cabinet for storage of medicines | 1 (Yes) = adequate; 2 (No) = inadequate | Interview and direct observation | |
| Prenatal routine procedure materials | To have at least seven: exam request card, pregnant woman’s card, daily record map, referral form, medication prescription, follow-up form/handbook, disposable gloves, clean sheets for gynecological tables, materials for cytological collection, garbage basket, soap for personal hygiene, paper towel, gel alcohol, sink and toilet inside the office | 1 (Yes) = adequate; 2 (No) = inadequate | Interview and direct observation | |
| Therapeutic supplies (medicines, quick tests, supplements, vaccines for prenatal use) b | To have at least eight: ferrous sulfate, folic acid, hepatitis B vaccine, diphtheria and tetanus (dT), diphtheria, tetanus and pertussis (dTpa) vaccine, influenza vaccine, antacids, antibiotics, antipyretics, anthelmintics, complex B, vitamin C, hypotensives, antiemetics, anti-inflammatories and quick tests (HIV, syphilis and pregnancy) | 1 (Yes) = adequate; 2 (No) = inadequate | Interview and direct observation | |
| Laboratory Support | Guarantee of laboratory support to perform the recommended examinationsc | 1 (Yes) = adequate; 2 (No) = inadequate | Interview | |
| Human Resources | Have the minimum team of primary health cared | 1 (Yes) = adequate; 2 (No) = inadequate | Interview | |
| Process (services) | Coverage of pregnant women followed up | Provide coverage of 100% of the pregnant women monitored in relation to the total area covered in the month prior to the visit | 1 (Yes) = adequate; 2 (No) = inadequate | Note on documents in the units |
| Coverage of pregnant women who met the goals of the Ministry of Health | To present coverage of 100% of the pregnant women who performed at least seven visits beginning in the first trimester and all the exams in the month prior to the visit in relation to the total number of pregnant women followed up (including immunization) | 1 (Yes) = adequate; 2 (No) = inadequate | Note on documents in the units | |
| Multiprofessional service | Performing prenatal care with the presence of more than one senior professional | 1 (Yes) = adequate; 2 (No) = inadequate | Interview | |
| Clinical-obstetric procedures | Team performs all the recommended procedurese | 1 (Yes) = adequate; 2 (No) = inadequate | Interview | |
| Presence of clinical information on the follow-up of pregnant women | Team presents the same records on the pregnant woman’s card for the individual monitoring of users | 1 (Yes) = adequate; 2 (No) = inadequate | Note on documents in the units | |
| Prescription of clinical exams | Prescription of recommended exams by professionalsc | 1 (Yes) = adequate; 2 (No) = inadequate | Interview | |
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| Box. Classification of prenatal care by IPR/Prenatal. João Pessoa, state of Paraíba, Brasil, 2016. Continuation | ||||
| Results (users) | Orientação sobre aleitamento materno e sinais e sintomas do parto | To have received guidance on management, duration, possible breastfeeding problems, complementary feeding and birth | 1 (Yes) = adequate; 2 (No) = inadequate | Interview |
| Health Education | To have participated in prenatal health education activities | 1 (Yes) = adequate; 2 (No) = inadequate | Interview | |
| Supplementation | Use of iron and folic acid during gestation | 1 (Yes) = adequate; 2 (No) = inadequate | Interview | |
| Onset of prenatal care | To start prenatal care until the 12th gestational week | 1 (Yes) = adequate; 2 (No) = inadequate | Pregnant woman’s card | |
| Number of medical consultations | To have had at least seven prenatal visits | 1 (Yes) = adequate; 2 (No) = inadequate | Pregnant woman’s card | |
| Perform laboratory exams | To have performed the exams according to the Ministry of Healthc | 1 (Yes) = adequate; 2 (No) = inadequate | Pregnant woman’s card | |
| Immunizationf | To have taken hepatitis B, tetanus, and influenza vaccines | 1 (Yes) = adequate; 2 (No) = inadequate | Pregnant woman’s card | |
| Referral to maternity | To have received the referral to maternity hospital from primary care | 1 (Yes) = adequate; 2 (No) = inadequate | Interview | |
a Units where there was not doppler fetal monitor or sonar, or it was not functioning, were considered inadequate in the equipment aspect.
b The isolated absence of ferrous sulfate, folic acid or vaccines recommended for gestation was considered inadequate.
c Recommended exams: blood count (at least 2, fasting blood glucose: 2, blood typing: 1, Venereal Disease Research Laboratory (VDRL/Syphilis): 2, anti-HIV test: 2, toxoplasmosis: 1, hepatitis B and C: 2, urine summary: 2, ultrasonography: 1, electrophoresis: 1, Oral Glucose Tolerance Test (OGTT) and preventive cervical cancer if necessary.
d Physician, nurse, nursing technicians, community health agents, dentist and auxiliary or oral health technician.
e Registry of fetal movements, calculation of the probable date of birth, obstetric palpation, preventive cervical cancer test if necessary, assessment of nutritional status, measurement of uterine height, auscultation of the fetal heart rate, verification of blood pressure and edema, request of the exams and analysis of the breasts.
f Specifically in relation to tetanus and hepatitis B, it was considered appropriate when the woman had the complete vaccination schedule, even if immunization occurred prior to gestation.