Os Programas de Saúde e o Sistema de Saúde da Marinha: a importância e aplicabilidade da ecocardiografia fetal como exame de rotina do pré-natal das gestantes no Sistema de Saúde da Marinha

Abstract

The Women's Health Program of the Navy Health Directorate (DSM) seeks to address the assistance to women in all phases of life to adapt the actions to be performed. Among the objectives, we can mention prenatal care, whose actions are aimed at providing the patient with a healthy pregnancy and reduce the risk of complicatio ns that could compromise the health of the pregnant woman or the fetus. Based on this assumption and on the importance of the early diagnosis of congenital heart diseases, which correspond to approximately 40% of all congenital fetal malformations with hig h morbidity and mortality, present today an approximate incidence of 1 in every 100 live births in national and international statistics. The benefits of prenatal diagnosis, especially in the more complex heart diseases, allow the delivery site to be progr ammed with the hospital structure necessary to receive the newborn cardiac disease and that enables the specialists to assist in a timely manner to stabilize the patient and preparation for future surgical and hemodynamic procedures as necessary. Thus, gre atly reducing the complications and injuries to these newborns, related to the transportation of these patients to other reference units and delayed therapeutic procedures, which may influence the morbidity and mortality of these small patients. The resear ch will have as theoretical support the academic production based on the national and international scientific publications regarding the subject, mainly with respect to the best routines of indication of the imaging exams for the evaluation of fetal cardi ac screening during prenatal follow - up. In the same way, it compares the methods and techniques of obstetrical ultrasound and the precise indications of fetal echocardiography in the early diagnosis of congenital heart diseases and the possible reduction o f health costs in patients with prenatal diagnosis. Most of the studies concluded that the use of obstetrical ultrasound for the fetal morphological evaluation performed in the extended cardiopulmonary mode in the screening of congenital heart defects duri ng the prenatal period can raise the sensitivity of the exam to 83%, leaving Fetal Echocardiography, performed by the pediatric cardiologist, to be indicated in cases in which the screening method raised some suspicion of a certain congenital heart defect, serving as a ratifying or verifying examination of congenital fetal heart malformation. There are reports in the literature of reduction of health costs in obtaining an early diagnosis, considering the previous planning and positive results in relation to the reduction of pre and postoperative morbidity that could influence the length of hospitalization due to better clinical conditions. A field survey was conducted by means of a questionnaire to the specialists who work in the assistance to the SSM pregna nt women, including the professionals who perform the obstetrical ultrasound, in the Naval Hospitals and Naval Polyclinics, concluding that there is a deficit of professionals in the specialty, especially in the OM, but follow the protocols of conduct reco mmended by the current Guidelines that do not recommend the universal indication of Fetal Echocardiography. We also studied the positive and intangible psychosocial impacts produced by the early diagnosis of congenital heart diseases and the multidisciplin ary action, influencing the maintenance of a greater family balance, while preparing to receive a child with heart disease.