Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil.
Faculdade de Medicina de Jundiaí HU/FMJ, Jundiaí/SP, Brazil.
PLoS One. 2021 Jul 23;16(7):e0254977. doi: 10.1371/journal.pone.0254977. eCollection 2021.
COVID-19 pandemic posed major challenges in obstetric health care services. Preparedness, development, and implementation of new protocols were part of the needed response. This study aims to describe the strategies implemented and the perspectives of health managers on the challenges to face the pandemic in 16 different maternity hospitals that comprise a multicenter study in Brazil, called REBRACO (Brazilian network of COVID-19 during pregnancy).
Mixed-method study, with quantitative and qualitative approaches. Quantitative data on the infrastructure of the units, maternal and perinatal health indicators, modifications on staff and human resources, from January to July/2020. Also, information on total number of cases, and availability for COVID-19 testing. A qualitative study by purposeful and saturation sampling was undertaken with healthcare managers, to understand perspectives on local challenges in facing the pandemic.
Most maternities early implemented their contingency plan. REBRACO centers reported 338 confirmed COVID-19 cases among pregnant and post-partum women up to July 2020. There were 29 maternal deaths and 15 (51.8%) attributed to COVID-19. All maternities performed relocation of beds designated to labor ward, most (75%) acquired mechanical ventilators, only the minority (25%) installed new negative air pressure rooms. Considering human resources, around 40% hired extra health professionals and increased weekly workload and the majority (68.7%) also suspended annual leaves. Only one center implemented universal screening for childbirth and 6 (37.5%) implemented COVID-19 testing for all suspected cases, while around 60% of the centers only tested moderate/severe cases with hospital admission. Qualitative results showed that main challenges experienced were related to the fear of the virus, concerns about reliability of evidence and lack of resources, with a clear need for mental health support among health professionals.
Study findings suggest that maternities of the REBRACO initiative underwent major changes in facing the pandemic, with limitations on testing, difficulties in infrastructure and human resources. Leadership, continuous training, implementation of evidence-based protocols and collaborative initiatives are key to transpose the fear of the virus and ascertain adequate healthcare inside maternities, especially in low and middle-income settings. Policy makers need to address the specificities in considering reproductive health and childbirth during the COVID-19 pandemic and prioritize research and timely testing availability.
COVID-19 大流行给产科保健服务带来了重大挑战。准备、制定和实施新方案是应对挑战的必要措施。本研究旨在描述在巴西一个名为 REBRACO（COVID-19 期间妊娠巴西网络）的多中心研究中的 16 家不同产科医院中实施的策略以及卫生管理人员对面临大流行挑战的看法。
混合方法研究，包括定量和定性方法。2020 年 1 月至 7 月期间，收集单位基础设施、孕产妇和围产儿健康指标、工作人员和人力资源变化、总病例数以及 COVID-19 检测可用性的定量数据。还通过有针对性和饱和抽样进行了定性研究，以了解卫生管理人员对当地应对大流行挑战的看法。
大多数产科医院提前实施了应急计划。截至 2020 年 7 月，REBRACO 中心报告了 338 例确诊的 COVID-19 孕妇和产后妇女病例。有 29 例孕产妇死亡，其中 15 例（51.8%）归因于 COVID-19。所有产科医院都对专门用于分娩的病床进行了重新安置，大多数（75%）获得了机械呼吸机，只有少数（25%）安装了新的负压室。考虑到人力资源，大约有 40%雇用了额外的卫生专业人员，每周工作量增加，大多数（68.7%）还暂停了年假。只有一个中心对分娩实施了普遍筛查，6 个中心（37.5%）对所有疑似病例进行了 COVID-19 检测，而大约 60%的中心只对有住院的中度/重度病例进行了检测。定性结果表明，所经历的主要挑战与对病毒的恐惧、对证据可靠性的担忧以及资源匮乏有关，卫生专业人员明显需要心理健康支持。
研究结果表明，REBRACO 倡议的产科医院在应对大流行时经历了重大变化，检测受限，基础设施和人力资源困难。领导力、持续培训、实施基于证据的方案以及协作举措是克服对病毒的恐惧并确保在产科医院提供适当保健的关键，特别是在中低收入环境中。政策制定者需要解决在 COVID-19 大流行期间考虑生殖健康和分娩的特殊性，并优先进行研究和及时提供检测。
