[Evaluation of the prenatal care program in Curitiba, Paraná, Brazil: a cohort study of primigravidae].

A prenatal care program was evaluated to measure its effectiveness and impact. In 1999 a new prenatal care program was introduced in Curitiba, Paraná State, Brazil, in health services under the Unified National Health System, introducing organizational changes in order to enhance accessibility, increase the number and distribution of prenatal visits, and ensure minimum necessary procedures. To evaluate how these changes were assimilated in routine practice, a cohort study was proposed in a sample of 660 primigravidae randomly selected among women enrolled in the program before the 20th week of gestation, from March to August, 2000. Two home visits and consultation of maternity cards or patient records during prenatal and hospital care were performed. The results indicate good accessibility and professional adherence to the protocol, but problems still remain with initiating care before the end of the first trimester and adequate distribution of consultations. According to the study criteria, adequate care was found for only 38.6% of the women, pointing to the complexity of factors that influence adequate prenatal care.