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Previous issue date: 2016-07-28 === Introdu??o: A infec??o urin?ria na gesta??o ? um agravo importante que pode prejudicar a
sa?de do bin?mio m?e-filho e aumentar a morbimortalidade materna e neonatal. Desfechos
desfavor?veis da gesta??o relacionam-se ?s falhas na capacidade preven??o e resposta diante
de intercorr?ncias do pr?-natal, parto e puerp?rio. Atualmente, carecem estudos sobre
estrat?gias que fomentem a melhoria da qualidade do pr?-natal e fortale?am estrat?gias de
gest?o p?blica para otimizar os processos de trabalho, melhorar a acessibilidade das mulheres
aos servi?os que realizam pr?-natal e, principalmente, qualificar a assist?ncia no per?odo
gestacional. Objetivo: Avaliar os efeitos de um ciclo de melhoria da qualidade em preven??o
e manejo das ITUs no pr?-natal. Metodologia: Trata-se de um estudo de natureza
quantitativa, com delineamento quase-experimental, tipo antes e depois, sem grupo controle,
realizado em Cacoal/RO, entre 2015 e 2016. Aplicou-se um ciclo externo de melhoria da
qualidade, com avalia??es de cinco crit?rios de qualidade e dois indicadores sentinela. Foram
realizadas duas avalia??es, com temporalidade de tr?s meses entre elas, e, entre elas, dois
monitoramentos tipo Lot Quality Acceptance Sampling ? LQAS. Entre a primeira e a segunda
avalia??o, aplicou-se uma interven??o participativa, planejada e norteada pelos resultados da
primeira avalia??o. As amostras foram aleat?rias, constitu?das por 120 cart?es de gestantes
compreendidas entre a 36? e 42? semana de gesta??o para avalia??o dos crit?rios 1, 2, 3 e 4,
al?m dos dados de mortalidade perinatal, que foram coletados do Relat?rio de Gest?o
Municipal. Com intuito de identificar o n?vel de qualidade, foi empregada a estimativa
pontual e intervalo de confian?a (95%) do cumprimento dos crit?rios. E, visando a
comprova??o da efetividade da interven??o, foram calculadas as melhorias absoluta e relativa
entre a primeira e a segunda avalia??o, assim como a sua significa??o estat?stica com teste z
unilateral. Resultados: Na an?lise da melhoria da qualidade, observou-se que a maioria dos
crit?rios apresentaram signific?ncia estat?stica (p<0,001), entre a 1? e 2? avalia??o, exceto o
crit?rio 1 que apresentou um p acima do esperado. J? os crit?rios 1, 2 e 4 alcan?aram um
percentual acima de 65% de cumprimento em ambas ?s amostras analisadas. Com rela??o ao
crit?rio 5, pode-se inferir que em 10,8% da amostra analisada, constava registro de resultados
de exames qualitativo de urina e/ou urocultura alterados, e destas, 53% tinham registro de
tratamento adequado. A taxa mortalidade perinatal teve um decl?nio de 4,7% entre os anos de
2014 e 2015, e a taxa de mortalidade neonatal precoce diminuiu 3,23% entre os anos de 2013
e 2015. Conclus?es: A metodologia empregada com o ciclo externo da melhoria da qualidade
colaborou no remodelamento dos processos assistenciais do pr?-natal e, principalmente, na
integra??o entre as equipes assistenciais e as gestoras dos diferentes n?veis de complexidade
trabalhadas, fortalecendo a cogest?o e a coparticipa??o dos trabalhadores envolvidos
diretamente no cuidado ?s usu?rias, nos processos de gerenciamento da sa?de municipal.
Possibilitou, tamb?m, reflex?es acerca dos fluxogramas vigentes, proporcionando seu
redesenho, o que refletiu na melhoria do acesso das gestantes aos servi?os de sa?de e ?
qualidade assistencial. === Introduction: Urinary tract infection in pregnancy is an important condition that can harm
the health of both, the mother and child and increase maternal and neonatal mortality.
Adverse pregnancy outcomes are related to failures in prevention and response capacity
before prenatal complications, childbirth and postpartum. Currently, the lack of studies on
strategies that promote improved quality of prenatal care and strengthen public management
strategies to optimize work processes, improve access of women to services that perform
prenatal and especially qualify the assistance during pregnancy. Objective: To evaluate the
effects of a quality improvement cycle in the prevention and management of UTI during
prenatal. Methodology: This is a quantitative study with partly completed experimental
design type before and after, no control group. An external cycle of quality improvement,
with evaluation of five criteria of quality and two sentinel indicators were applied. Two
evaluations were carried out, considering the time of three months between them, and two
monitoring type Lot Quality Acceptance Sampling - LQAS. Between the first and the second
evaluation, a participatory intervention, planned and guided by the first evaluation was
applied. Samples were random, consisting of 120 cards pregnant women between 36 and 42
for the assessment of the criteria 1, 2, 3 and 4, besides the perinatal mortality data were
collected from the Municipal Management Report. In order to identify the level of quality, it
was used the point estimate and confidence interval (95%) of compliance with the criteria.
Aiming to prove the effectiveness of the intervention, the Absolute and Relative
improvements were calculated between the first and second evaluation, as well as its
statistical significance with one-sided z test. Results: Multivariate analysis of quality
improvement, it was observed that most of the criteria of statistical significance (p<0.001),
except criterion 1 which showed a p above than expected. The criteria 1, 2 and 4 achieved a
percentage above 65% compliance in both the samples. With respect to criterion 5, it can be
inferred that 10.8% of the analyzed sample contained record examination results EQU and / or
altered urine culture, and of these 53% had adequate treatment record. Perinatal mortality rate
had a significant decline of 4.7% between 2014 and 2015, and early neonatal mortality rate
decreased by 3.23% between 2013 and 2015. Conclusion: The methodology used to improve
the quality of the external cycle collaborated in the remodeling of the care processes of
prenatal and especially in the integration between care teams and managers of different levels
of complexity worked, strengthening co-management and co-participation of workers
involved directly in care for users in the municipal health management processes. It has also
enabled reflections on the existing flowcharts, providing the redesign of the same as reflected
in improving access of pregnant women to health services and quality care.
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