Elaboração de protocolos assistenciais de medicina fetal e gravidez de alto risco do Hospital de Clínicas de Uberlândia

Abstract

Introduction: The development of strategies for implementing norms and standards of clinical conduct is essential to guarantee quality in healthcare. Clinical protocols are systematically developed to guide health professionals regarding clinical interventions and technological assessment, aiming to guarantee the quality of care. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) is a validated, reliable and internationally used tool that assesses the methodological rigor and transparency with which a protocol is developed. Objective: Develop and implement the Fetal Medicine and High-Risk Pregnancy care protocols of the Hospital de Clínicas de Uberlândia (HCU), ensuring improved care provided to pregnant women being monitored at this institution. Method: The following topics were selected: toxoplasmosis in pregnancy, fetal growth restriction, diabetes mellitus in pregnancy, and hypertensive syndromes in pregnancy. Evaluation, based on the AGREE II instrument, of current care protocols from the main (national and international) gynecology and obstetrics associations. Based on the selected protocols, recommendations were developed to be implemented in the HCU. Results: The application of AGREE II allowed the elaboration of recommendations for qualification, optimization and standardization of care, with some evidence-based recommendations being adapted to the local reality, due to financial, technical and management limitations. Conclusion: The use of AGREE II in the development of health care protocols needs to be disseminated. It is clear that the vast majority still lack greater methodological rigor; better targeting of the target audience; expansion of protocol drafting committees to include non-medical professionals; greater clarity in recommendations; and instructions regarding the applicability of such recommendations. It is essential that the current protocols developed are periodically updated.