ABSTRACT Background: Perinatally HIV-infected children are surviving into adulthood, and getting pregnant. There is a scarcity of information on health and pregnancy outcomes in these women. Aim: To evaluate characteristics related to HIV disease and pregnancy outcomes in perinatally infected women, and to compare these women with a group of youth with behaviorally acquired HIV-infection, at a reference hospital in Rio de Janeiro, Brazil. Methods: A cohort study. Epidemiological, clinical, and laboratory data were compared between perinatally (PHIV) and behaviorally HIV-infected (BHIV) pregnant youth with the primary aim to study pregnancy outcomes in the PHIV group and compare with outcomes to BHIV group. Results: Thirty-two pregnancies occurred in PHIV group, and 595 in BHIV group. A total of seven (22%) PHIV women and 64 (11%) BHIV women had a premature delivery (p = 0.04), however, when adjusting for younger age at pregnancy, and antiretroviral therapy initiation in 1st trimester of pregnancy (OR = 18.66, 95%CI = 5.52–63.14), the difference was no longer significant. No cases of mother-to-child HIV transmission (MTCT) were observed in the PHIV group while there was a 2% MTCT rate in BHIV group. Conclusion: Pregnancy among PHIV was as safe as among BHIV. The differences between those groups were probably related to treatment and prolonged care in the first group.

OBJECTIVES: To determine the HIV vertical transmission rate (VTR) and associated risk factors by use of zidovudine and infant care education in Brazil. METHODS: Since 1995, a prospective cohort of HIV infected pregnant women has been followed at the Federal University of Rio de Janeiro. A multidisciplinary team was established to implement the best available strategy to prevent maternal-infant HIV transmission. Patients with AIDS or low CD4 and high viral load received anti-retroviral drugs in addition to zidovudine. Children were considered infected if they had 2 positive PCR-RNA tests between 1 and 4 months of age, or were HIV antibody positive after 18 months. Education regarding infant treatment and use of formula instead of breast feeding was provided. RESULTS: Between 1995 and August, 2000, HIV status was determined for 145 infants. Compliance with intra-partum treatment, infant treatment and use of formula was 88.2%. Intra-partum zidovudine treatment was completed in 134/145 (92.6%) of patients; 88.1% had rupture of membranes < 4 hours; 85.4% of mothers were asymptomatic. The mean CD4 count was 428.4 cells and mean viral load 39,050 copies. HIV vertical transmission rate was 4/145 (2.75%; CI: 0.1%-5.4%). The only risk factor significantly associated with transmission was a failure to use zidovudine intra-partum in 2 of the 4 mothers (50% versus 6.4% in non-transmitting mothers). A trend toward low CD4 and high viral load at entry, and rupture of membranes > 4 hours were associated with increased HIV transmission. CONCLUSION: HIV vertical transmission in Brazil was reduced to a level similar to other countries with the most effective prevention programs using a multidisciplinary team approach. A high level of compliance for use of anti-retroviral drugs, the provision of health education to mothers, and use of formula for all exposed infants.

O objetivo do estudo foi avaliar a qualidade da assistência ao trabalho de parto prematuro, utilizando referentes, indicadores e padrões derivados de evidências científicas - ensaios clínicos controlados e meta-análises -, tomando como caso a corticoterapia anteparto. Foram analisados dados de sumários de alta relativos a sete maternidades públicas do Rio de Janeiro. O padrão utilizado para a análise de processo foi de 100%. Não foi possível estimar padrões de resultado - incidência esperada de síndrome de angústia respiratória e mortalidade neonatal - para os referentes previstos, em razão da impossibilidade de ajustar os resultados para idade gestacional, poderoso fator interveniente. A utilização da corticoterapia antenatal pelos serviços analisados foi irrisória, cerca de 4% e 2%, para os referentes relativos a pacientes com menos de 34 semanas e com até 36 semanas de idade gestacional, respectivamente. A falha no uso da corticoterapia antenatal quando indicada merece a atenção de planejadores e gestores do setor, tendo em vista a fácil incorporação de tal tecnologia, bem como os benefícios e os custos desta, em comparação com aqueles associados à assistência neonatal a bebês prematuros.

This study aimed to assess quality of obstetric care for preterm labor patients, using referents, indicators, and standards derived from scientific evidence, focusing on antenatal corticotherapy. Available metanalyses and randomized controlled trials were examined to establish referents, defining indicators and estimating process and outcome standards for the present study. Data from hospital discharge summaries of seven public maternity hospitals in Rio de Janeiro were analyzed. The standard of process used was 100%. It was not possible to estimate outcome standards, since the necessary adjustment for gestational age was not feasible. Utilization of antenatal corticotherapy in the present study was very low, about 4% and 2%, considering patients up to 33 weeks and 6 days and 36 weeks and 6 days, respectively. Failure to use antenatal corticotherapy when formally indicated deserves attention by health planners and managers, considering: a) the ease in incorporating such a technology, in contrast to the adequate incorporation of special/intensive neonatal care; b) benefits and costs associated with this technology compared to those of delivering neonatal care to premature babies.

O objetivo do estudo foi avaliar a qualidade da assistência ao trabalho de parto prematuro, utilizando referentes, indicadores e padrões derivados de evidências científicas - ensaios clínicos controlados e meta-análises -, tomando como caso a corticoterapia anteparto. Foram analisados dados de sumários de alta relativos a sete maternidades públicas do Rio de Janeiro. O padrão utilizado para a análise de processo foi de 100%. Não foi possível estimar padrões de resultado - incidência esperada de síndrome de angústia respiratória e mortalidade neonatal - para os referentes previstos, em razão da impossibilidade de ajustar os resultados para idade gestacional, poderoso fator interveniente. A utilização da corticoterapia antenatal pelos serviços analisados foi irrisória, cerca de 4% e 2%, para os referentes relativos a pacientes com menos de 34 semanas e com até 36 semanas de idade gestacional, respectivamente. A falha no uso da corticoterapia antenatal quando indicada merece a atenção de planejadores e gestores do setor, tendo em vista a fácil incorporação de tal tecnologia, bem como os benefícios e os custos desta, em comparação com aqueles associados à assistência neonatal a bebês prematuros.

This study aimed to assess quality of obstetric care for preterm labor patients, using referents, indicators, and standards derived from scientific evidence, focusing on antenatal corticotherapy. Available metanalyses and randomized controlled trials were examined to establish referents, defining indicators and estimating process and outcome standards for the present study. Data from hospital discharge summaries of seven public maternity hospitals in Rio de Janeiro were analyzed. The standard of process used was 100%. It was not possible to estimate outcome standards, since the necessary adjustment for gestational age was not feasible. Utilization of antenatal corticotherapy in the present study was very low, about 4% and 2%, considering patients up to 33 weeks and 6 days and 36 weeks and 6 days, respectively. Failure to use antenatal corticotherapy when formally indicated deserves attention by health planners and managers, considering: a) the ease in incorporating such a technology, in contrast to the adequate incorporation of special/intensive neonatal care; b) benefits and costs associated with this technology compared to those of delivering neonatal care to premature babies.

O objetivo do presente trabalho foi avaliar a qualidade do atendimento ao trabalho de parto prematuro em maternidades públicas do Rio de Janeiro, utilizando referentes, indicadores e padrões de processo e de resultado derivados de evidências científicas. Na análise de processo, o padrão utilizado para o uso de tocolíticos betamiméticos foi de 100%, considerando os referentes derivados. Na análise de resultados, o padrão foi a ocorrência de parto prematuro em 11% das pacientes dentro de 24 h e em 24% dentro de 48 h da admissão hospitalar. O uso de tocolíticos ocorreu em 18,7% das pacientes admitidas em trabalho de parto prematuro. Na faixa de idade gestacional de 28 a 33 semanas e seis dias, especialmente importante para a sobrevivência neonatal, o uso de tocolíticos foi feito em 32,6% das pacientes. Parto prematuro ocorreu em 59% das pacientes dentro de 24 h e em 64% das pacientes dentro de 48 h da admissão, resultados consistentes com o baixo uso de tocolíticos observado. A efetividade da assistência ao trabalho de parto prematuro, medida pela taxa de nascimentos prematuros, foi baixa. Os achados das correspondentes análises de processo e resultado foram consistentes.

The objective of this study was to assess quality of care for premature labor at public maternity facilities in Rio de Janeiro, Brazil, using referents, indicators, and standards of care derived from scientific evidence. The standard utilized in the process analysis for use of betamimetic tocolytics was 100%, considering the related referents. For outcome analysis, the standard applied was the occurrence of premature delivery in 11% of patients within 24 h and in 24% of patients (referent) within 48 h of hospital admission. Use of tocolytics was observed in 18.7% of patients admitted in premature labor. At gestational age from 28 weeks to 33 weeks and 6 days, especially critical for neonatal survival, tocolytics were used in 32.6% of patients. Premature birth occurred in 59% of patients within 24 h and in 64% within 48 h. These outcomes were consistent with the low rate of utilization of tocolytics. Effectiveness of care for preterm labor measured by rate of premature birth was low. Results of the corresponding process and outcomes analysis were consistent.

O objetivo do presente trabalho foi avaliar a qualidade do atendimento ao trabalho de parto prematuro em maternidades públicas do Rio de Janeiro, utilizando referentes, indicadores e padrões de processo e de resultado derivados de evidências científicas. Na análise de processo, o padrão utilizado para o uso de tocolíticos betamiméticos foi de 100%, considerando os referentes derivados. Na análise de resultados, o padrão foi a ocorrência de parto prematuro em 11% das pacientes dentro de 24 h e em 24% dentro de 48 h da admissão hospitalar. O uso de tocolíticos ocorreu em 18,7% das pacientes admitidas em trabalho de parto prematuro. Na faixa de idade gestacional de 28 a 33 semanas e seis dias, especialmente importante para a sobrevivência neonatal, o uso de tocolíticos foi feito em 32,6% das pacientes. Parto prematuro ocorreu em 59% das pacientes dentro de 24 h e em 64% das pacientes dentro de 48 h da admissão, resultados consistentes com o baixo uso de tocolíticos observado. A efetividade da assistência ao trabalho de parto prematuro, medida pela taxa de nascimentos prematuros, foi baixa. Os achados das correspondentes análises de processo e resultado foram consistentes.

The objective of this study was to assess quality of care for premature labor at public maternity facilities in Rio de Janeiro, Brazil, using referents, indicators, and standards of care derived from scientific evidence. The standard utilized in the process analysis for use of betamimetic tocolytics was 100%, considering the related referents. For outcome analysis, the standard applied was the occurrence of premature delivery in 11% of patients within 24 h and in 24% of patients (referent) within 48 h of hospital admission. Use of tocolytics was observed in 18.7% of patients admitted in premature labor. At gestational age from 28 weeks to 33 weeks and 6 days, especially critical for neonatal survival, tocolytics were used in 32.6% of patients. Premature birth occurred in 59% of patients within 24 h and in 64% within 48 h. These outcomes were consistent with the low rate of utilization of tocolytics. Effectiveness of care for preterm labor measured by rate of premature birth was low. Results of the corresponding process and outcomes analysis were consistent.