Adequate surveillance in Maternal Health in Primary Care - Quality improvement work

Elisa Martins, Inês Sampaio Lima, Raquel Plácido, Filipe Prazeres

Keywords: Maternal Health, Pregnancy, Primary Care

Background:
Surveillance of low-risk pregnancy has key periods and parameters to assess maternal-fetal well-being. This work aimed to evaluate and promote continuous quality improvement in this field.

Research questions:
How adequate is the surveillance of low-risk pregnancies?

Method:
A retrospective evaluation was done using fifteen parameters. The audit was carried out in two stages. In the first stage, pregnancies corresponding to births between May and October 2019 were evaluated. The most frequent non-compliances were identified and presented at a team meeting, and improvement strategies were defined. In a second step, pregnancies corresponding to births between July and September 2021 were evaluated. Regarding the parameters that correspond to an indicator of the Primary Health Care Identity Card, in the first phase, the objective was to reach the “minimum accepted” value defined. In the second phase, in the parameters whose percentage was initially lower than the “minimum accepted”, the goal was this value; In those whose percentage was initially higher than the “minimum accepted”, the goal was the “minimum expected”; in the parameters not included in the Identity Card, the goal was 70%.

Results:
In the first stage, 32 pregnant women were included. There were three parameters whose percentage of compliance was lower than the “minimum accepted”: registration of the 2nd trimester ultrasound and laboratory tests of the 2nd and 3rd trimesters. Record of 1st trimester laboratory tests was between the “minimum accepted” and the “minimum expected“. Regarding the parameters that do not have any established indicator, all reached the target. In the second stage, 17 pregnant women were included. We reached the goal of recording results from the 2nd trimester obstetric ultrasound and 3rd trimester laboratory tests. The improvement in 1st and 2nd laboratory tests was not sufficient to achieve the objectives.

Conclusions:
Although there is room for improvement, we consider this intervention to be positive.

Points for discussion: