Partner profile of pregnant women who have obstetric prenatal high risk in a university hospital south of Brazil

doi:10.4236/ojog.2013.39A005

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Open Journal of Obstetrics and Gynecology, 2013, 3, 35-40 OJOG

http://dx.doi.org/10.4236/ojog.2013.39A005 Published Online November 2013 (http://www.scirp.org/journal/ojog/)

Partner profile of pregnant women who have obstetric

prenatal high risk in a university hospital south of Brazil

Gisele Perin Guimarães1,2, Jussara Gue Martini3,4,5

1Clinical Nurse Neonatology Service of the Regional Hospital of St. Joseph, São José, Brazil

2Internment Facility Screening Obstetrical and Gynecological Hospital of the Federal University of Santa Catarina, Florianópolis,

Brazil

3Department of Nu r sing and the Graduate Program in Nursing at UFSC, Florianópolis, Brazil

4Graduate Program in Respiratory Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

5Center for Health Research, Researcher Group Research in Nursing and Health Education and IEG, Florianópolis, Brazil

Email: [email protected], [email protected]

Received 23 September 2013; revised 20 October 2013; accepted 27 October 2013

mons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work

is properly cited.

ABSTRACT

This study aimed to relate the social and obstetric

risk factors presented by pregnant women who un-

derwent high risk prenatal in a southern Brazil hos-

pital unit. This is a quantitative research. The data

collection was conducted from January to September

2012, where 12 high-risk pregnancies and nine com-

panions with diversified social and obstetric condi-

tions were seen. The analysis was by simple statistics.

Pregnant women social profile results indicated that

predominant age group was 31 to 40 years old; all

had some degree of education; 84% Catholic; 75% of

pregnant women were accompanied by someone of

their choice during high risk prenatal care; and 50%

of the choices were for her spouse; half of these preg-

nant women have a professional occupation. Obstet-

rics findings demonstrated that the majority of women

were not planning on the pregnancy, only 17% started

prenatal care in the first trimester, 42% had already

presented risk in previous pregnancy, 58% of women

were classified as high risk due to fetal abnormalities.

Given these findings, it is clear that high-risk preg-

nancy as a period involving several factors, including

social and obstetric that, when connected, can com-

promise the process of gestating for both the mother

and the fetus.

Keywords: Pregnancy; Prenatal Care; High Risk;

Nursing

1. INTRODUCTION

Pregnancy is considered as a physiological event in a

couple’s life, with a period of evolution, mostly un-

eventful, surrounded by sensations that generate pleasure

and expectation s in the months that follow until the end-

ing weeks of gestation. However, this period considered

physiologic in women’s lives, it is often modified as a

result of certain conditions, which triggers specific char-

acteristics that may evolve unfavorably, representing

both maternal and fetal risks, with the possibility to ad-

mission at a hospital.

Women who experience a pregnancy outside the nor-

mal range and that are perceived in a health-disease

process are called “high risk pregnancies” [1].

The maternal and fetal risks are not only related to ob-

stetric factors of the current pregnancy, but also external

factors that aggregate unfavorable situations to a favor-

able evolution of the pregnancy, those directly related to

social conditi on s, an d hi st o ry of previous pregnancies.

Another factor that must be taken into consideration is

the high number of pregnant teens in our midst, and that

has been associated with an increased frequency of ad-

verse obstetric outcomes such as low birth weight, pre-

mature delivery, maternal death and perinatal mortality,

preeclampsia and cesarean birth, among others. Not that

these are classified as high risk, but the possibility of be-

coming in the course of pregnancy is higher when com-

pared wit h pregnant women of ot he r a ge groups [2].

Therefore, this article aims to understand the social

and obstetric profile of pregnant women who underwent

prenatal high risk in a hospital in southern Brazil.

The importance of identifying the social and obstetric

profile of pregnant women helps promote a deeper un-

derstanding of the family contexts advantages and diffi-

culties and its relationship, as well as, the risk that rated

OPEN ACCESS

G. P. Guimarães, J. G. Martini / Open Journal of Obstetrics and Gynecology 3 (2013) 35-40

the mother as high risk. Through this social and obstetric

information the relationship between subject and re-

searcher get s closer.

2. METHODOLOGY

It is a quantitative research carried out in public training

hospital in southern Brazil, where the study subjects, 12

high-risk pregnancies and nine companions, were un-

dergoing prenatal care. Data collection began after the

subjects were aware of the objectives, intentions and

modes of participation, and agreed to participate in the

study.

It was not determined a minimum number of partici-

pants. The only stipu lation was related to a timeframe of

six months, which determined that the period to accept

new mothers would be from January through June 2012,

being this, the exclusion criterion. After ending these

months, prenatal care resumed for those who were al-

ready in the process of health education, lasting until

September when all had finished the reflective processes.

Thus, the sample size (n = 12) was set intentionally

selecting the elements that compose the inclusion and

exclusion criteria, i.e. be high risk pregnancies and inter-

est in participating in th e study.

When performing Nursing Consultation (NC), it was

necessary to have a better understanding of the social and

obstetric’ s situation of every high risk pregnant woman

accompanied by their companions during their prenatal

care. This process proportionated us a better visualization

of the main factors related in such special moment of the

pregnancy.

At the first stage of the NC, which was carried out in-

dividually with the high-risk pregnant women and their

companions, is the time when initial dialog ue was estab-

lished in search of validation of the social and obstetric

data obtained from their medical records.

Social data collected was: age, education, religion,

profession/occupation, marital status and companion of

choice. Whereas the obstetric approached parity, for ex-

ample, the number of pregnancies experienced, whether

or not that’s a planned pregnancy, risk classification,

diagnosis and if there was the need for hospitalizatio n in

the current pregnancy.

After being extracted information from medical re-

cords, the registry of this data was entered in a field diary

and later transferred to an Excel spreadsheet, for simpli-

fied tabulation. Data analysis was done using on simple

statistics method, enabling a reduction in terms of the

sample, representatively without loss characteristics.

Ethical principles established by Resolution 196/96 of

the National Health Coun cil [3] and the principles of the

Code of Professional Ethics to standardize the investiga-

tive activities were respected. Project was submitted to

UFSC’s (Universidad Federal de Santa Catarina) Ethics

Committee on Human Research, with assent under No.

2257/11, Certificate of Appreciation for Ethics Presenta-

tion No. 448412.

3. RESULTS

Social and obstetric conditions were varied, thus to better

understand the findings of this study, data will be pre-

sented separately. First will be social findings and later

obstetric events.

Age range of women who experienced high-risk preg-

nancy (n = 12) ranged between 13 and 40 years (n = 5,

42%), of age with predominance (Ta b l e 1) for pregnant

women between 31 and 40 years old. These assertions is

Table 1. Social profile of pregnant women who received pre-

natal care in high-risk HU/UFSC-2012.

Profile n %

Ages

13 - 19 years 3 25

20 - 30 years 4 33

31 - 40 years 5 42

Total 12 100

Schooling

High school graduate 06 50

Incomplete secondary education06 50

Total 12 100

Religion

Catholic 10 84

Spiritualist 01 8

No religion 01 8

Total 12 100

Companion

Partner 06 50

Other 03 25

Unaccompanied 03 25

Total 12 100

Marital status

Stable Unio n 07 58

Maiden 04 34

Separate 01 8

Total 12 100

Occupation/profession

Unemployed 06 50

With occupancy 06 50

Total 12 100

G. P. Guimarães, J. G. Martini / Open Journal of Obstetrics and Gynecology 3 (2013) 35-40 37

in line with results presented by the Min istry of Health [4]

highlighting Southern Brazil as the largest proportion of

births alive in this age group, whereas the Northern re-

gion presents the highest rates of high-risk pregnancies

in teens.

The lower age group of women who underwent high

risk prenatal in this study was adolescents (n = 3, 25%).

Age range considered for teenagers in this study was 13

through 19 years old. This is taking into account the

minimum age advocated by Law 8069 of July 13, 1990,

which is provided for in the Child and Ad olescent Statute.

Teen is a person who is between the age of twelve and

eighteen years of age. World Health Organization (WHO)

adopts the rage between 15 and 19 years [5] for teens.

It was observed that the pregnant women in this study

were all literate (n = 12, 100%), varying only in the level

of education, being 50% high school graduate, and 50%

incomplete secondary education. The fact that these

women had a certain degree of education that provided

not only practical, visual and life knowledge, but also

written words and knowledge exchange during the proc-

ess of reflection-action-reflection. Some even had read

about the risk they were experiencing, and sought for

information in the virtual universe of the internet or

through people who reported their personal experiences

of pregnancy on their blogs, a space on the internet or-

ganized in reverse chronological order, focusing on a

particular theme, which can be written by a variable

number of people who share their personal experiences

and can post pictures, text, etc.

However, despite early adoption by the pregnant

women of electronic media search for knowledge related

to their situation, many readings came distorted, gener-

ating higher anxiety levels in them and their companions

and increasing emotional instability, requiring constant

back and forth to bring them to th eir reality and closer to

the context in which they were living .

Religion, predominating Catholicism (84%), was some-

thing strongly emphasized by the pregnant women,

which in conjunction with prenatal care provided com-

fort, motivation and strength to continue the journey of

risky pregnancy. Having faith was the base to keeping

them strong and to facing obstacles, besides the strong

presence of their companion, which provided greater

security in times of difficulty, o f expectations and also of

happiness.

The choice of companions by the pregnant women

during prenatal care was varied. M ost women 50% (n = 6)

were accompanied by their partners. Other choices of

companions were the mother and sister-in-law/God-

mother. It stood up the fact that some women 25% did

not have a companion, having to face the difficulties of

the high-risk pregnancy without any support, whether

from family, friends or someone who they could share

their feelings with and encourage a dialogic relationship

during the prenatal care assistance meetings.

An important fact that should be noted is the marital

status of the 12 pregnant women being followed. Most

women had a companion through a domestic union (sta-

ble union—Brazilian regulation) 58% (n = 7), allowing

for the sharing of moments experienced during the preg-

nancy. This study had a significant number of unmar-

ried pregnant women, a total of 34% (n = 4).

The constitution of the family income is exercised

with balance by the companion, considering that 50% of

pregnant women did not any realize profit-making ac-

tivities, devoting most of their time to domestic activities.

On the other hand, the other 50% of women from this

study had a professional occupation, such as: cleaning

ladies; maid; beautician; seamstress, bartender and op-

erator. Beside these activities, they still took care of their

home by performing domestic activities and, some, also

adopted the role of br eadwinner, denoting multiple work-

ing shifts.

The results presented so far allowed for a view of the

pregnant women’s social profile, focus of this study;

however, this is not enough to glimpse, in a global scale,

the high-risk pregnancy. For that, we present the obstet-

ric profile, trying to correlate the social and obstetric fac-

tors that pregnant women underwent during the high-risk

prenatal care which allows us to do broader and more

appropriate critical analysis.

Obstetric findings reflect the women’s profile since the

first moment, being that most of these women said they

had not planned for the pregnancy. Only some had

planned with their companions when to get pregnant.

The fact majority had not planned for the pregnancy may

justify the beginning of their prenatal care assistance

only in the second or third trimester of the pregnancy.

With respect to the parity of the women (Table 2),

there was a certain proximity between first pregnancy,

those who a generating their first child and second preg-

nancy. In greater number (n = 5, 42%) it was the group

of women that had had three or more pregnancies, which

are classified as multigravida.

Previous history of the studied pregnant women shows

that the minority of these women had risk situations in

some of their previous pregnancies, corresponding to

17%. Most women received low-risk prenatal care at

their local Basic Health Units—BHU, in contrast with

the current pregnancy where they were classified as

high-risk pregnancies and requiring to perform prenatal

at hospital of reference for such assistance.

After these pregnant women were considered of high-

risk and being monitored by the specialized prenatal care,

it was observed that the majority o f these high risk preg-

nant women 92% (n = 11) displayed a serene and un-

eventful pregnancy, with no need for hospitalization for

G. P. Guimarães, J. G. Martini / Open Journal of Obstetrics and Gynecology 3 (2013) 35-40

Table 2. Profile of women who underwent obstetric prenatal

care for high-risk HU/UFSC-2012.

n %

Home assistance prenatal

1˚ trimester 02 17

2˚ trimester 06 50

3˚ trimester 04 33

Total 12 100

Parity

First pregnancy 03 25

Second pregnancy 04 33

Three or more pregnancies 05 42

Total 12 100

Risk situation in previous pregnancy

Yes 02 17

No 07 58

Not applicable (first pregnancy) 03 25

Total 12 100

Hospitalization this pregnancy

Yes 01 8

No 11 92

Total 12 100

reasons related to the pregnancy. However, it is note-

worthy that three pregnant women were first pregnancy

and not considered in relation to the experience of pre-

vious pregnancies.

Women studied, in addition to being classified as high

risk within the prenatal care assistance, were also di-

rected based on the risk type (Table 3). This could be

maternal risk, fetal risk and maternal-fetal risk. When

relating the type of risk, we’ve realized that most of the

women 58% were performing prenatal risk due to fetal

risk, and a smaller propor tion (n = 5, 42%) was related to

maternal-fetal risk. None of the studied women presented

maternal risk exclusively.

Such risk ratings were determined from the clinical

diagnoses (Table 4) collected during prenatal care, which

guided the approach and dialogic processes during all

interactions, favoring the overco ming of needs presented

by each of the women and their companions.

The way pregnant women faced these situations of

risk and their unborn was favored not only by specialized

prenatal care, which targeted their needs, but also, and

with the same value, by the possibility of having along

this journey of choosing the companion who was sig-

nificant and who could support, encourage, understand

their feelings and share the whole process of reflection-

Table 3. Risk of obstetric pregnant women who underwent

prenatal high risk in HU/UFSC-2012.

Risks obstetric n %

Fetal 07 58

Maternal - fetal 05 42

Maternal 00 -

Total 12 100

Table 4. Diagnostic risk of pregnant women who received pre-

natal care in high-risk HU/UFSC-2012.

Diagnostic risk obstetric

Maternalfetal Fetal

Sickle cell anemiaDiaphra gmatic hernia

Adolescence Dextropositioncardiac/cardiacmalformation

HPV Oligoamnion

Depression Skeletaldys plasia

Vascular disease Dandy Walker

- Cerebellar agenesis

- Down syndrome

- Twin-twin transfusion

- Congenital malformation

(clubfoot, syndactyly, etc.)

action-reflection, encouraging them to overcome the dif-

ficulties and enabling the empowerment of being a high

risk pregnant wom a n .

4. DISCUSSION

During pregnancy a woman goes through many situa-

tions and many of these lead pregnant women to be con-

sidered as being of greater or lesser risks, which may be

exacerbated by social and obstetric factors. Factors iden-

tified in this study denote a pregnant woman profile that

goes against institutional reality, focus of this study,

where women have some level of education, are mostly

in the company of someone of their choice, where they

already had a previous pregnancy and possessed a belief

that helps them during their journey, among others, fa-

voring reflective moments and promoting better out-

comes for the pregnant women.

To counter these moments of weakness are other no-

ticeable changes in the profile of these women, who are

increasingly seeking their independence, by becoming

pregnant over the age of 30, studying longer, with a level

of education that promotes sharing of knowledge, be-

sides having a professional occupation, showing greater

maturity in their behavior and decisions making. This

new way of seeing the future, promotes a more secure

G. P. Guimarães, J. G. Martini / Open Journal of Obstetrics and Gynecology 3 (2013) 35-40 39

and determined acting.

In line with the findings of this study are the notes

made by [6] that highlight the main reasons for an ad-

vanced maternal age pregnancy, among these, the desire

to invest in their academic training/studying and profes-

sional career; a choice for a later stable conjugal rela-

tionship; the formation of new unions; infertility prob-

lems among others.

On the other hand, the age of the women above 30

years is identified as a factor directly related to maternal

mortality, particularly when associated with multigravida

and other risk factors such as, low literacy and the ab-

sence of a companion during pregnancy. Therefore,

women in this age group should be considered as high-

risk pregnancies and will receive qualified prenatal care,

tailored to their needs [7].

Despite their maturity, sentiment of insecurity, uncer-

tainty, anxieties arise and are intensified at all times

when confronted with new scenarios. However, these

feelings are mitigated by faith and the belief of a higher

Being, regardless of religious belief. It is this greater

Being that gives strength and courage to face the diffi-

culties during the course of the high risk prenatal [8].

Factors such as maturity of the studied pregnant

women, linked to the faith that motivates them to keep

going can be associated, in most cases, to the emotional

support received from their companions, as well as their

family, where the latter two, as faith, can provide for

better emotional stability.

Although some pregnant women were not accompa-

nied by their spouses during the high risk prenatal care,

they were able to count on someon e close to them, which

proportionated a participatory presence in moments of

reflection-action-reflection. For these ladies, it is impor-

tant to build, in a collective space, their life stories,

where they can share wishes and desires [9].

Several scientific studies, both domestic and interna-

tional attest to the benefits of having the presence of a

companion. Besides feeling more secure during the

course of pregnancy, these women also demonstrated

more confidence during labo r [10].

However, we must consider that the absence of a sig-

nificant other during the prenatal care is unfavorable to

overcoming difficulties, not only during these times, but

especially regarding the continuation of the dialog and

on the return home, to the workplace and to the family.

Therefore, when the pregnant woman does not have a

person of reference, it is important that the relationship

between mother and nurse be even closer and stronger, as

many of these women consider the nurse as being this

particular provider of security and attention. Regardless

of the situation, in the world of a high risk pregnancy,

nursing consultations should be surrounded by a lot of

dialogue, reflection and action throughout the whole time

information is being shared.

Authors [11] point out to the importance of nurses in

the prenatal care, as besides answering questions to the

pregnant women and their companions during the meet-

ings, this professional class has been contributing for the

strengthening of a relationship of trust and closeness, as

well as, providing comprehensive care with educational

actions to the pregnant women, their unborn baby and

companion.

Perhaps, a strong influence over the lack of compan-

ionship during the prenatal care of high risk in this study

may be related to unplanned pregnancy. This factor also

has strong relationship to the late beginning of prenatal

care, in the second trimester of pregnancy, which is a

period where these women begin to understand the

physical and emotional changes typical of the gestational

developing period, when they seek for health services to

start the prenatal care.

In those situations where there was no planned preg-

nancy, risk factors for recurrence should be considered,

especially when the mother is a teenager [12]. Thus,

preventive care for a new pregnancy should be part of

the educational and reflective actions during the high risk

prenatal care.

For most pregnant women, the experienced risk in the

pregnancy is something unique, not previously lived,

that’s because it is their first pregnancy or for previous

pregnancy being within a favorable development and

classified as low risk.

The experience of the current pregnancy of risk, was

monitored, in almost all pregnant women, as outpatient,

in other words, it was managed to keep the situation of

fetal or maternal-fetal risk adequately controlled an d sta-

ble, with no need for hospitalization at the maternity

ward.

5. FINAL CONSIDERATIONS

In spite of the wide range of diagnoses identified during

the course of pregnancy, we noticed that the most classi-

fication of obstetric risk was related to pathologies such

depressive state and even depression. The latter is con-

sidered as the disease of the century, and when combined

with hormonal and mood changes, it generates instability

and disbelief of a promising future.

Based on our findings, we realized that the high risk

pregnancy as a period that involves many factors, among

them, social and obstetric that when connected, can com-

promise the gestation process for both the mother and the

fetus.

In this sense, it is essential that the nurse, as an active

professional during the prenatal care, promote a space

that allows for dialog among all individuals within the

pregnancy context, who are the pregnant woman, her

companion and healthy professionals, by offering mo-

G. P. Guimarães, J. G. Martini / Open Journal of Obstetrics and Gynecology 3 (2013) 35-40

ments of dialogue, reflections and actions that will pro-

gressively facilitate the overcoming of difficulties ex-

perienced during high risk pregnancies.

OPEN ACCESS

Among the study limitations, we can cite the absence

of a spouse, for we could profile the couple and family

better understand the organization as well as the lack of

studies more specifically for high-risk pregnancies.

We suggest that further studies look in depth to the

pregnant women’s social and obstetric reality in their

institution, and that they understand how to create a dia-

logue channel among professionals, pregnant women and

their companions, so that they can better d eal with issues

that permeate a risky pregnancy, promoting actions to

overcome difficulties experienced during the entire ges-

tational period, that will help these individuals play an

active role in the changes related to their own life story.

Among the recommendations, we believe that there is

a need for a broader look by professionals who assist in

high risk prenatal care, where the nur se should know the

social and obstetric situation of each of the pregnant

women and their companions, allowing them to correlate

the main risk factors in an attempt to minimize them in

the current pregnancy.

REFERENCES

[1] Brazil, Ministry of Health, Department of Health Policy

(2000) Technical Manual of high risk pregnancy. 3rd

Edition, Ministry of Health, Brasilia.

[2] Magalhaes, M.L., et al. (2006) Pregnancy in early and

late adolescence: No difference in obstetric risks? Revista

Brasileira de Ginecologia e Obstetrícia, 28, 446-452.

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S

0100-72032006000800002&lng=pt&nrm=iso

[3] Brazil, the National Health Council (1996) Guidelines

and rules for human research. Resolution No. 196, CNS,

Brasilia.

[4] Brazil, Ministry of Health, Office of Strategic and

Participative Management. Department Articulation Inter

federativa (2012) Guidelines on indicators of agreeing on

guidelines, objectives and goals in 2012. Ministry of

Health, Brasilia.

[5] Walselfisz, J.J. (2012) Map of violence 2012 children and

adolescents in Brazil. Brazil Cebela FLACSO, Rio de

Janeiro.

[6] Gravena, A.A.F., et al. (2012) Perinatal outcome in pre-

gnancies later. Revista da Escola de Enfermagem da USP,

46, 15-21.

[7] Soares, V.M.N., Schor, N. and Tavares, C.M. (2008)

Lives risky: A reflection on the relationship between the

number of pregnancies and maternal mortality. Brazilian

Journal of Human Growth and Development, 18, 254-263.

http://producao.usp.br/handle/BDPI/14320

[8] Baldwin, L.S.C., et al. (2011) Spirituality, coping and

nursing: An integrative literature review.

http://www.revista.ufpe.br/revistaenfermagem/index.php/

revista/article/viewFile/1737/pdf_456

[9] Basso, J.F. and Monticelli, M. (2010) Expectations, preg-

nant women and caregivers for humanized birth. Latin

American Journal of Nursing, 18, 390-397.

[10] Lessa, R. and da Rose, A.H.V. (2010) Nursing and host:

An importance of dialogic interaction in prenatal.

http://dialnet.unirioja.es/servlet/articulo?codigo=3651897

[11] Cunha, M.A., Mamede, M.V.L., Dotto, M.G. and Mam-

ede, F.V. (2009) Prenatal care: Essential skills performed

by nurses. Escola Anna Nery Revista de Enfermagem, 13,

145-153.

[12] Silva, A.A., et al. (2013) Factors associated with recur-

rence of teenage pregnancy in a maternity hospital: Case-

control study. Cad Public Health, Rio de Janeiro, 29,

496-506.