Implantação do protocolo nascer maduro referência em incompetência istmo-cervical do estado do Amazonas

Abstract

The care during prenatal, childbirth and postpartum has undergone important advances in recent years. We follow the improvement in care coverage, implantation of humanized, awareness and guidance on obstetric violence, allowing the Pregnant women and their families actively participate in the entire process of pregnancy, childbirth and puerperium. There was an important improvement, but much has to be done because the coverage still is far from ideal, being insufficient in many respects. Many pregnant women find the pregnancy without being able to achieve the minimum of recommended consultations and without screening important during pregnancy due to system inoperability. The lack of access to treatment of Isthmus-Cervical incompetence is also a very frequent problem faced by the users of SUS in Manaus. They end up not being able to procedure at the right time, evolving to late abortions, often impacting because they eliminate their live and morphologically perfect fetuses, which die soon after birth due to extreme prematurity. The "lucky ones" who can achieve 26th week, or a little more, also go through disorders ranging from hospitalizations prolonged in neonatal UTI until the consequences of premature birth, which causes long-term follow-up by a multidisciplinary team (physiotherapy, phonoaudiology, pneumologist, neurologist, endocrinology, among other specialists) extremely exhausting for the child and their families. The work tries to prove that the implementation of a reference protocol in the SUS Manaus with care focused on diagnosis and treatment of the pathology will be a gateway for users who will have the right to prophylactic cerclage at the right time. It will have the support of the preceptors and residents of the Ana Braga Maternity Hospital who will be responsible for carrying out the procedure and filling in the annex (Informed Consent) and appendix (Specific Record of the Mature Birth Protocol) of the Intervention Project. The social and financial impact of this project for SUS Manaus will be extremely important because we will avoid countless admissions to neonatal ICUs and, consequently, chronic use of the system with a multidisciplinary team. We will demonstrate that with an organized Protocol of low complexity and low cost inserted into the structure already set up at the Public Maternity it will be a source of savings for the Managers, learning for the residents, welcoming for the users and research for science.