[Perinatal and maternal-child care in primary health care Cerro Largo departmento Uruguay]

A program was initiated in 1980 in the department of Cerro Largo Uruguay to improve the perinatal and maternal-child health components of the primary health care program. The 74000 inhabitants of Cerro Largo are served by a hospital an urban health center and several auxiliary health centers in peripheral urban and rural areas. The program to develop appropriate technologies for perinatal assistance in selected zones of Cerro Largo has 4 overlapping components: initial diagnosis planning application and evaluation. The objective of the initial diagnosis is to assess the usual status of perinatal attention in the zone and to identify its deficiencies and strengths with respect to perinatal problems of the local population. The planning component is designed to achieve at least a minimum level of adequate perinatal attention in all facilities. Priority attention in the application component is given to primary level care in rural areas. Part of the application component consists of the detection assistance and referral of high risk patients. The minimum care is provided for patients with low probabilities of death or serious complication. Care consists basically of prevention and early detection of signs of pathology. The intermediate level of care provides prevention diagnosis and treatment. Treatment and rehabilitation are provided for high risk patients. Evaluations of specific techniques and of the entire program are conducted. 90% of births in Cerro Largo are now covered by the system. 10% of births occur at home. The median gestational age at 1st prenatal visit was found to be 24.5 weeks and 12% of cases had no prenatal visits. The median number of prenatal visits was 4.2 but 17.3% of cases had 1 and 13.9% had 2. Perinatal and infant mortality rates in Cerro Largo declined after implementation of the program probably due in part to its efforts.