Atenção pré-natal em casos de fendas orais no Sistema Único de Saúde

Abstract

Oral clefts are defects with high prevalence in low- and middle-income countries (1:730 newborns) and significant morpho-functional impairment. Prenatal diagnosis allows health interventions to minimize complications associated with low weight gain and increased neonatal morbidity and mortality. Aiming to assess prenatal care in cases of oral clefts this was a cross-sectional and descriptive study. The sample comprised 86 mother-child dyads with oral clefts registered in the Brazilian Database on Craniofacial Anomalies (BDCA) by Brazil’s Craniofacial Project participating services, between January/2019 and April/2020. Sociodemographic, clinical, and genetic data were extracted from the BDCA, while face-to-face or phone interviews to obtain prenatal information. Prenatal diagnosis occurred in 26 (30.2%) dyads. Higher maternal education (p=0.009), prenatal care in capitals (p=0.001) and ≥3 ultrasounds (p=0.005) predominated in this group. Familial history of oral clefts was the most frequent risk indicator, with no differences between the groups (p=0.194). Only 17 pregnant women received counseling during prenatal, three of who were referred to a specialized service. Prenatal risk classification, type of delivery, prematurity and child's birth weight, and age at the first visit to the specialized service did not differ between groups. The last was later for 50% of children. The diagnosis during prenatal did not change the care provided. Results showed failures in identifying oral cleft-related risk indicators during prenatal. Almost a third of mothers had a prenatal diagnosis. However, it did not produce changes in the way prenatal teams manage their healthcare. Globally, results showed that primary health teams are not skilled in dealing with oral cleft diagnosis, sheltering pregnant women, and managing the situation. These failures have delayed the referring and binding of the dyads to an oral cleft specialized service which impacts treatment and prognosis. Through this study, it was possible to identify needs and opportunities for increasing oral cleft health care.