Dimensiones emocionales y sociales de la gestación de alto riesgo en la atención especializada
una investigación cualitativa*
Palabras clave:
Embarazo de alto riesgo, Atención prenatal, Enfermería obstétrica, Atención Integral de Salud.Resumen
Objetivo: Analizar las experiencias emocionales y sociales de gestantes de alto riesgo en seguimiento en un centro de referencia, a la luz de la Teoría del Alcance de Metas de Imogene King.
Método: Estudio cualitativo, realizado con 20 gestantes de Três Rios, Rio de Janeiro, entre noviembre y diciembre de 2024, mediante entrevistas semiestructuradas. Los datos fueron analizados mediante análisis léxico, con el auxilio del software IRaMuTeQ, y sometidos al Análisis de Contenido temático.
Resultados: Las participantes eran, en su mayoría, mujeres con educación secundaria completa, de bajos ingresos familiares y autodeclaradas pardas. Los hallazgos se organizaron en dos ejes centrales: Vivencias emocionales frente a la gestación de alto riesgo y Percepciones sobre el seguimiento en el Centro Especializado en Salud de la Mujer. Las narrativas revelaron miedo, susto y preocupación, que fueron resignificados a partir de la interacción con el equipo multiprofesional.
Consideraciones finales: La gestación demanda cuidado integral que trasciende la dimensión clínica. La interacción terapéutica y la negociación de metas contribuyen a la autonomía y al fortalecimiento del vínculo.
Citas
1. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Gestação de alto risco: manual técnico [Internet]. Brasília (DF): Ministério da Saúde; 2012 [cited 2025 Jul 14]. 302 p. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/manual_tecnico_gestacao_alto_risco.pdf
2. Pacagnella RC, Nakamura-Pereira M, Gomes-Sponholz F, de Aguiar RALP, Guerra GVQL, Diniz CSG, et al. Maternal mortality in Brazil: proposals and strategies for its reduction. Rev Bras Ginecol Obstet [Internet]. 2018 [cited 2025 Jul 14];40(9):501-6. Available from: https://doi.org/10.1055/s-0038-1672181
3. Say L, Souza JP, Pattinson RC. Maternal near miss: towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol [Internet]. 2009 [cited 2025 Jul 16];23(3):287-96. Available from: https://doi.org/10.1016/j.bpobgyn.2009.01.007
4. Tuyishime E, Ingabire H, Mvukiyehe JP, Durieux M, Twagirumugabe T. Implementing the Risk Identification (RI) and Modified Early Obstetric Warning Signs (MEOWS) tool in district hospitals in Rwanda: a cross-sectional study. BMC Pregnancy Childbirth [Internet]. 2020 [cited 2025 Jul 14];20:568. Available from: https://doi.org/10.1186/s12884-020-03187-1
5. Carle C, Alexander P, Columb M, Johal J. Design and internal validation of an obstetric early warning score: secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database. Anaesthesia [Internet]. 2013 [cited 2025 Jul 14];68(4):354-67. Available from: https://doi.org/10.1111/anae.12180
6. Diguisto C, Saucedo M, Kallianidis A, Bloemenkamp K, Bødker B, Buoncristiano M, et al. Maternal mortality in eight European countries with enhanced surveillance systems: descriptive population-based study. BMJ [Internet]. 2022 [cited 2025 Jul 14];379:e070621. Available from: https://doi.org/10.1136/bmj-2022-070621
7. World Health Organization (WHO). Maternal mortality [Internet]. Geneva: WHO; 2023 [cited 2025 Sep 5]. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
8. United Nations. Department of Economic and Social Affairs. The Sustainable Development Goals report 2025 [Internet]. New York: United Nations; 2025 [cited 2025 Sep 5]. Available from: https://unstats.un.org/sdgs/report/2025/
9. Chirowa F, Atwood S, Van der Putten M. Gender inequality, health expenditure and maternal mortality in sub-Saharan Africa: a secondary data analysis. Afr J Prim Health Care Fam Med [Internet]. 2013 [cited 2025 Sep 5];5(1):471. Available from: https://doi.org/10.4102/phcfm.v5i1.471
10. Brasil. Ministério da Saúde. Rede Alyne: saúde reforça ações para reduzir a mortalidade materna de mulheres negras [Internet]. Brasília (DF): Ministério da Saúde; 2024 [cited 2025 Sep 5]. Available from: https://www.gov.br/saude/pt-br/assuntos/noticias/2024/dezembro/rede-alyne-saude-reforca-acoes-para-reduzir-a-mortalidade-materna-de-mulheres-negras
11. Cecatti JG, Souza RT, Pacagnella RC, Leal MC, Moura EC, Santos LMP. Maternal near miss among women using the public health system in the Amazon and Northeast regions of Brazil. Rev Panam Salud Publica [Internet]. 2015 [cited 2025 Sep 5];37(4-5):232-8. Available from: https://pubmed.ncbi.nlm.nih.gov/26208190/
12. Leal MC, Esteves-Pereira AP, Nakamura-Pereira M, Torres JA, Theme-Filha M, Domingues RMSM, et al. Prevalence and risk factors related to preterm birth in Brazil. Reprod Health [Internet]. 2016 [cited 2025 Sep 5];13(Suppl 3):127. Available from: https://doi.org/10.1186/s12978-016-0230-0
13. King IM. A theory for nursing: systems, concepts, process. Albany (NY): Delmar; 1981. Cap. 4, p. 61.
14. King IM. King's conceptual system, theory of goal attainment, and transaction process in the 21st century. Nurs Sci Q [Internet]. 2007 [cited 2025 Sep 5];20(2):109-11. Available from: https://doi.org/10.1177/0894318407299846
15. Påfs J, Musafili A, Binder-Finnema P, Klingberg-Allvin M, Rulisa S, Essén B. Beyond the numbers of maternal near-miss in Rwanda: a qualitative study on women's perspectives on access and experiences of care in early and late stage of pregnancy. BMC Pregnancy Childbirth [Internet]. 2016 [cited 2025 Sep 5];16:257. Available from: https://doi.org/10.1186/s12884-016-1051-4
16. World Health Organization (WHO). WHO recommendations on antenatal care for a positive pregnancy experience [Internet]. Geneva: WHO; 2016 [cited 2025 Sep 5]. Available from: https://www.who.int/publications/i/item/9789241549912
17. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care [Internet]. 2007 [cited 2026 Jan 18];19(6):349-57. Available from: https://doi.org/10.1093/intqhc/mzm042
18. de Souza MAR, Wall ML, Thuler ACMC, Lowen IMV, Peres AM. The use of IRAMUTEQ software for data analysis in qualitative research. Rev Esc Enferm USP [Internet]. 2018 [cited 2025 Sep 5];52:e03353. Available from: https://doi.org/10.1590/S1980-220X2017015003353
19. Bardin L. Análise de conteúdo. São Paulo: Edições 70; 2015. 288 p.
20. Brasil. Conselho Nacional de Saúde (BR). Resolução nº 466, de 12 de dezembro de 2012. Aprova as seguintes diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos [Internet]. Brasília (DF): Ministério da Saúde; 2012 [cited 2025 Sep 5]. Available from: https://www.gov.br/conselho-nacional-de-saude/pt-br/acesso-a-informacao/atos-normativos/resolucoes/2012/resolucao-no-466.pdf/view
21. Lansky S, Friche AAL, da Silva AAM, Campos D, Bittencourt SDA, de Carvalho ML, et al. Birth in Brazil survey: neonatal mortality, pregnancy and childbirth quality of care. Cad Saude Publica [Internet]. 2014 [cited 2025 Sep 4];30(Suppl 1):S192-S207. Available from: https://pubmed.ncbi.nlm.nih.gov/25167179/
22. de Melo EMOP, Ferreira PL, de Lima RAG, de Mello DF. The involvement of parents in the healthcare provided to hospitalized children. Rev Lat Am Enfermagem [Internet]. 2014 [cited 2025 Sep 5];22(3):432-9. Available from: https://pubmed.ncbi.nlm.nih.gov/25029054/
23. Silva CS, de Souza KV, Alves VH, Cabrita BAC, da Silva LR. Nurse's performance in prenatal consultation: limits and capabilities. Rev Pesqui Cuid Fundam Online [Internet]. 2016 [cited 2025 Sep 5];8(2):4087-98. Available from: https://www.ssoar.info/ssoar/handle/document/53776
24. Brufatto JPT, Dias TM, D'Abreu NB, Rehder PM. Reproductive planning and the choice of long-acting reversible contraceptive in primary health care: a cross-sectional study. Rev Bras Ginecol Obstet [Internet]. 2023 [cited 2025 Sep 5];45(8):e456-e64. Available from: https://doi.org/10.1055/s-0043-1772188
25. da Silva SC, Morais BX, Munhoz OL, Ongaro JD, Urbanetto JS, Magnago TSBS. Patient safety culture and missed nursing care in obstetrics. Rev Lat Am Enfermagem [Internet]. 2021 [cited 2025 Sep 5];29:e3461. Available from: https://doi.org/10.1590/1518-8345.4855.3461
26. Ferreira MBG, Silveira CF, da Silva SR, de Souza DJ, Ruiz MT. Nursing care for women with pre-eclampsia and/or eclampsia: integrative review. Rev Esc Enferm USP [Internet]. 2016 [cited 2025 Sep 4];50(2):320-30. Available from: https://doi.org/10.1590/S0080-623420160000200020
27. Coates D, Thirukumar P, Henry A. Women’s experiences and satisfaction with having a cesarean birth: an integrative review. Birth. [Internet]. 2020 [cited 2026 Abr 26];47(2):169-182. Available from: https://doi.org/10.1111/birt.12478
28. Leal MC, Bittencourt SA, Esteves-Pereira AP, Ayres BVS, Silva LBRAA, Thomaz EBAF, et.al. Progress in childbirth care in Brazil: preliminary results of two evaluation studies. Cad Saúde Pública [Internet]. 2022 [cited 2026 Apr 25];35(7):e00223018. Available from: https://doi.org/10.1590/0102-311X00223018
29. Brasil. Lei nº 9.263, de 12 de janeiro de 1996. Regula o §7º do art. 226 da Constituição Federal, que trata do planejamento familiar, estabelece penalidades e dá outras providências. [Internet]. Brasília (DF): Presidência da República; 1996 [cited 2025 Sep 5]. Available from: https://www.planalto.gov.br/ccivil_03/Leis/L9263.htm
30. Brasil. Lei nº 14.443, de 2 de setembro de 2022. Altera a Lei nº 9.263/1996, para determinar prazo para oferecimento de métodos e técnicas contraceptivas e disciplinar condições para esterilização no âmbito do planejamento familiar. [Internet]. Brasília (DF): Presidência da República; 2022 [cited 2025 Sep 5]. Available from: https://www.planalto.gov.br/ccivil_03/_ato2019-2022/2022/lei/L14443.htm
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2026 Ana Claudia Sierra Martins, Márcia Vieria dos Santos, Stephanie Vanessa Penafort Martins Cavalcante, Raquel Dias Botelho Borborema, Bianca Dargam Gomes Vieira, Diego Pereira Rodrigues, Valdecyr Herdy Alves

Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Cogitare Enfermagem se reserva el derecho de realizar, en el artículo publicado, cambios de orden normativa, ortográfica y gramatical con el fin de mantener el estándar culto del idioma, respetando, sin embargo, el estilo de los autores.
El estudio publicado es de total responsabilidad del(os) autor(es), siendo exclusivamente responsabilidad de Cogitare Enfermagem la evaluación del manuscrito, en calidad de vehículo de publicación científica.
No se permitirá la adición o cambio de autoría durante la etapa de evaluación o después de la aceptación del texto presentado.
Cogitare Enfermagem no se responsabiliza por posibles violaciones a la Ley Nº 9.610/1998, Ley Brasileña de Derechos de Autor. Cogitare Enfermagem permite que el autor retenga los derechos de autor de los artículos aceptados para su publicación, sin restricciones.





















