摘要：General Objective: to evaluate the influence of the Delivery and Newborn Assistance Hierarchyzation Program on maternal and perinatal results in the DIR XI –SP region, from 1995 to 2002. Specific Objectives: to calculate the number of deliveries, Caesarean rates, the cause of hospitalar maternal mortality (HMMC) and precocious perinatal mortality rates (PPMR), in maternity hospitals of low risk (Hospital Regional-Associação Beneficente dos Hospitais Sorocabana – HR-ABHS) and high risk (Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP – HC-FMB). Methodology: descriptive and prospective study of hierarchyzation in delivery and newborn assistance, during eight years (1995-2002), in low risk (HR-ABHS) and high risk (HC-FMB) hospitals in the DIR XI region. The study included all the patients attended at these Services with daily record of standardized clinical protocol containing the following information: number of deliveries, Caesareans, maternal deaths, liveborns, stillborns and precocious neoborns (up to 7 days of age). The ?2 test and the calculus of simple linear correlation coefficient were used to assess the results. Results: the total of assisted deliveries in that period was 17748, being that, at the program settlement time, 410 deliveries/year at HR-ABHS and 1076/year at HC-FMB were performed. There was an increase of 2.5 times in the number of deliveries in low risk hospitals and, in high risk hospitals, that number was maintained. The number of deliveries in 2002 was similar for both Services. Caesarean rate decreased in both places, however, it was more accentuated in the low risk (HR-ABHS from 46.6% to 26.9%; ? < 0.0001) than in the high risk hospital (HC-FMB from 49.2% to 40.1%; ? < 0.0001). HMMC was lower at HR-ABHS (26.3 vs 128.7 / 100,000 liveborns; ? < 0.02). PPMR decreased in both Services, with more accentuated fall in the high risk hospital (HC-FMB from 60.8‰ to 26.2‰; ? < 0.00001) than in the low risk one (HR-ABHS from 9.7‰ to 6.7‰; ? < 0.04). Conclusions: The Delivery and Newborn Assistance Hierarchyzation Program improved the obstetric and perinatal assistance quality in the DIR XI – SP region: there was a decrease in Caesarean and perinatal mortality rates in both hospitals. Maternal mortality was higher in the high risk hospital, however, during two years, no death occurred in the tertiary hospital. There was no maternal mortality in the secondary hospital during six years. The importance of delivery and newborn hierarchyzation levels was proved by the decrease of Caesarean rates associated to diminished perinatal I mortality rate.
关键词：Hierarchyzation. Delivery assistance. Maternal and perinatal results.;Hierarquização. Assistência ao parto. Resultados maternos e perinatais.
