Ramos Valdete Maria, Figueiredo Elisabeth Niglio de, Succi Regina Célia de Menezes
Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Rev Bras Epidemiol. 2014 Dec;17(4):887-98. doi: 10.1590/1809-4503201400040008.
The objective of this study was to identify possible barriers to control vertical transmission of syphilis and HIV through the analysis of the orientation process of pregnant women from prenatal care to the obstetric center at an university hospital in Sao Paulo (Reference) and their return (with their exposed babies) for follow-up after hospital discharge (counter-reference).
It is a retrospective cross-sectional study including interviews with healthcare personnel. Pregnant women with syphilis and/or HIV-infection admitted for labor or miscarriage were identified from August 2006 to August 2007. Routine care for mothers and babies were analyzed.
56 pregnant women were identified: 43 were HIV-infected, 11 had syphilis and two were coinfected (syphilis/HIV); 22 health care professionals were interviewed. Prenatal care was identified in 91.1% of these women: 7/11 (63.6%) with syphilis; 44/45 (97.8%) HIV-infected or coinfected. The reference for delivery was satisfactory for 57.7% of the syphilis-infected women and 97.7% of the HIV-infected ones. The counter-reference was satisfactory for all babies and mothers at hospital discharge, besides the non-adherence to this recommendation. Interviews with health care professionals showed there are better routines for assisting and following-up pregnant women, puerperal women and HIV-infected or exposed babies than for those infected with syphilis. The epidemiological report and surveillance system are also better for HIV-infected patients.
The difficulties in the reference and counter-reference system of these women and their babies are evident barriers to control the vertical transmission of these infectious diseases.
本研究的目的是通过分析圣保罗一所大学医院（参照组）从产前护理到产科中心的孕妇转诊过程以及她们出院后（带着受感染婴儿）回来进行随访（反参照组）的过程，确定控制梅毒和艾滋病毒垂直传播的可能障碍。
这是一项回顾性横断面研究，包括对医护人员的访谈。确定了2006年8月至2007年8月期间因分娩或流产入院的梅毒和/或艾滋病毒感染孕妇。分析了对母亲和婴儿的常规护理情况。
确定了56名孕妇：43名感染艾滋病毒，11名感染梅毒，2名合并感染（梅毒/艾滋病毒）；对22名医护人员进行了访谈。这些妇女中有91.1%接受了产前护理：11名梅毒感染孕妇中有7名（63.6%）；45名艾滋病毒感染或合并感染孕妇中有44名（97.8%）。57.7%的梅毒感染妇女和97.7%的艾滋病毒感染妇女分娩转诊情况令人满意。除了未遵守这一建议外，反参照组在出院时对所有婴儿和母亲来说都令人满意。对医护人员的访谈显示，与梅毒感染孕妇相比，在协助和随访孕妇、产后妇女以及艾滋病毒感染或暴露婴儿方面有更好的常规做法。艾滋病毒感染患者的流行病学报告和监测系统也更好。
这些妇女及其婴儿的转诊和反转诊系统中的困难显然是控制这些传染病垂直传播的障碍。
