Impact of day care services on physical and cognitive functions in old people with dementia in a medical center in central Taiwan.

BACKGROUND: Day care service (DCS) provides various activities in a professional environment to meet the old people with functional limitations. However, relatively little is known about the effects of DCS on physical and mental functions. METHODS: This was a retrospective study that we used a comprehensive geriatric assessment to evaluate the changes before and after DCS among participants in a hospital-affiliated geriatric day care center in Taiwan. The burden of the participants' families was also assessed. RESULTS: The 18 participants with a median age of 80.9 (interquartile range (IQR) 75.2-86.6 y/o) were enrolled and followed up for 6 months. Based on the clinical dementia rating (CDR), disease stage was very mild in 3 participants, mild in 10, moderate in 3, and severe in 2. The activities of daily living (ADL) scores of the participants improved significantly from 75 (IQR 60.0-80.0) at baseline to 77.5 (IQR 65.0-90.0) at the 6 month (p < 0.001), and mini-mental state examination (MMSE) scores from 15 (IQR 11.5-20.0) to 18 (IQR 15.8-24.0) (p = 0.026). There was a positive correlation of baseline mini-nutritional assessment-short form score and the 3-level version of the European Quality of Life-5 dimensions utility index with both ADL and MMSE scores at the 6-month follow-up. In addition, the family burden scale was reduced from 22 to 15 (p = 0.002). CONCLUSIONS: The physical and cognitive functions in old people with dementia who received DCS were maintained or partially improved, and their families' stress burden was alleviated.

Predictors of affect following discharge from partial hospitalization: a two-week ecological momentary assessment study.

BACKGROUND: Little is known about the everyday experiences of individuals transitioning from acute to outpatient psychiatric care, an important period of risk for mood symptom relapse. This study used ecological momentary assessment (EMA) to examine whether specific daily experiences were related to momentary affective states following discharge from a partial hospitalization program (PHP). METHODS: A sample of 114 adults (Mage = 36 years old, 52% female, 83% White) completed four brief EMA surveys every day for 2 weeks assessing intensity/type of stressful events and social contact, as well as positive/negative affect (PA/NA). Half of participants reported therapeutic skills use. RESULTS: Stress severity ratings prospectively predicted increased NA. NA predicted spending less time with close relationships. However, interacting with close relationships predicted increased positive affect (PA). Finally, PA predicted spending time with more people. The use of two skills (behavioral activation and interpersonal effectiveness) was concurrently, but not prospectively, associated with improved affect. CONCLUSIONS: Examining daily experiences of individuals discharging from partial hospitalization provides important information about factors that may influence affective states during the transition from acute to outpatient care. Findings from this study can be used to help prepare patients for discharge and develop interventions for the post-acute period.

People with dementia attending farm-based day care in Norway - Individual and farm characteristics associated with participants' quality of life.

Farm-based day care for people with dementia is supposed to improve the participants quality of life by using activities and resources of the farm environment to promote mental and physical health. In this paper, we describe the characteristics of those attending farm-based day care services in Norway and explore the association between individual and farm characteristics and the quality of life. A sample of 94 people with dementia who attended farm-based day care was recruited from 25 farms between January 2017 and January 2018. The data collection was performed using standardized instruments. Information about the farms was retrieved from a former study. The association between the participants' quality of life and their individual and/or farm characteristics was examined with a linear multilevel regression model. The participants had a mean age of 76 years, 62% were men, and 68% had additional education after primary school. Most of them had mild (54.3%) or questionable dementia (18.3%). A few participants used antipsychotics (3.7%), tranquilizers (9.9%) and painkillers (13.6%), while a higher number used antidepressants (30.9%). Quality of life was associated with the experience of having social support (p = .023), a low score on depressive symptoms (p < .001), and spending time outdoors at the farm (p < .001). The variation between the farm-based day care services in the participants' reported quality of life was related to time spent outdoors at the farm. In light of the present study, it seems as farm-based day care is addressing people with dementia in an early stage, dominated by men, with quite good physical and medical condition. The strong association between quality of life and spending time outdoors underscores that facilitation for outdoor activity should be prioritized in all types of dementia care.

[Differential Reflection of the Relationship between Therapeutic Alliance and Outcome in a Day Treatment Hospital Setting]. / Differentielle Betrachtung des Zusammenhangs von therapeutischer Beziehung und Therapieerfolg in einem tagesklinischen Versorgungssetting.

OBJECTIVE: The therapeutic alliance is considered to be a significant and empirically well-documented determinant of therapeutical success. The aim of the present study was to replicate this effect using a large daily clinical sample and to consider different aspects of the therapeutic relationship in an extreme group of particularly low relationship satisfaction separately. METHOD: A longitudinal examination of a sample of n=809 patients (M=34,32; SD=10,7; 72,6% female) in a day care hospital setting was carried out. Using multiple regression analysis, the link between therapeutic alliance (Helping Alliance Questionnaire; HAQ-S) in the third week and therapeutic outcome (Brief Symptom Inventory-18; BSI-18) was investigated. Analyses have been conducted for the overall sample as well as for the extreme group representing the lowest decile regarding relationship satisfaction and the remaining 90%. A distinction was also made between the 2 subscales of the HAQ, satisfaction with the relationship and satisfaction with the outcome. RESULTS: The therapeutic alliance after 3 weeks was a significant predictor for therapeutic outcome. Within the extreme group with initially low relationship satisfaction, relationship satisfaction proved to be a significant and strong predictor for therapeutic outcome, but was not useable for the prediction of individual cases due to wide confidence interval (ß=0,622; 95% CI [0,051; 1,095]). In contrast, the relationship satisfaction in the remaining 90 percent explained no additional variance of therapeutic outcome beyond the explanation by satisfaction with the outcome (ß=0,244; 95% CI [0,176; 0,391]). DISCUSSION: The results emphasize the importance of therapeutic alliance also in a day care hospital setting. Relationship satisfaction plays a central, other factors exceeding role in the prediction of therapeutic outcome only in the extreme group of particularly dissatisfied patients. CONCLUSION: Ensuring at least a sufficiently good therapeutic relationship is of great importance and therefore requires early identification and, if necessary, intervention.

[Revive the life pulsion: the geriatric psychiatry day care hospital]. / Relancer la pulsion de vie: l'hôpital de jour de psychiatrie gériatrique.

Old age with its succession of losses is a vulnerable phase in life for developing or exacerbating mental illnesses. Pragmatically, we can identify three types of senior patients: patients presenting behavioral and psychological symptoms of dementia, patients affected by a chronic mental illness, patients experiencing a first major psychiatric syndrome in later life. The purpose of this article is to describe the specific programs developed by the day care hospital of the Geriatric Psychiatry Service, Geneva University Hospitals, to respond to the need of these groups of patients as well as their relatives. This community psychiatric care intends to provide a better psychological adaption in order to support functional and social recovery.

L'âge avancé, avec son lot de pertes potentielles, favorise l'apparition ou l'exacerbation de troubles psychiatriques. On peut identifier trois types de patients âgés avec troubles psychiatriques: ceux présentant des symptômes psycho-comportementaux qui apparaissent en lien avec l'évolution d'un trouble neurocognitif, ceux avec une maladie psychique chronique et ceux vivant une première manifestation d'un syndrome psychiatrique à l'âge avancé. Cet article vise à décrire les programmes spécifiques que l'hôpital de jour du Service de psychiatrie gériatrique, HUG, a développés pour répondre aux besoins de ces trois types de patients ainsi qu'à ceux de leurs proches. Ces soins de psychiatrie communautaire visent à apporter aux patients un meilleur équilibre psychologique en vue de leur rétablissement fonctionnel et social.

Can brief telephone interventions reduce caregiver burden and depression in caregivers of people with cognitive impairment? - long-term results of the German day-care study (RCT).

BACKGROUND: Day-care and telephone counseling have been discussed as effective support measures for caregivers of people with cognitive impairment. METHODS: In a two-arm cluster-randomized trial involving multicomponent therapy for cognitively impaired persons in day-care centers and telephone counseling for their caregivers versus treatment as usual (TAU), we investigated long-term effects on caregivers' burden and depressiveness. Person-caregiver dyads involving home-dwelling persons with MCI, mild dementia, or moderate dementia were eligible. Day-care centers were randomized into an intervention group (IG) or a control group (CG). Outcome assessors were blinded. Out of 359 caregivers who had completed a 6-month intervention phase (nIG = 205, nCG = 154), a total of 304 of them were available at the 12-month follow-up (nIG = 173, nCG = 131). Instruments for assessing were the Burden Scale for Family Caregivers - short version (BSFC-s) (caregiver burden) and the Well-Being Index Score (WHO-5) (depressiveness). Mixed ANOVAs were used for the main analyses; descriptive statistics and subgroup analyses were additionally performed; secondary analyses involved multiple linear regressions for the main outcomes that were significant in the unadjusted main analysis. RESULTS: At follow-up, crude mean differences showed a nonsignificant advantage for the IG in caregiver burden [IG: -.20 (SD = 5.39) vs. CG: .76 (SD = 5.49), p = .126, d = .177] and depressiveness (reverse scored) [IG: -.05 (SD = 5.17) vs. CG: -.98 (SD = 5.65), p = .136, d = .173]. For caregiver burden, a mixed ANOVA resulted in significant main effects of group (F (1, 302) = 4.40; p = .037) and time (F (1.88, 568.96) = 3.56; p = .032) but not a significant interaction. The largest effects were found for the "mild dementia" subgroup (d = .443 for caregiver burden and d = .520 for depressiveness). DISCUSSION: Positive long-term effects of a combined intervention involving telephone counseling for caregivers and multicomponent activation for patients were observed especially for mild dementia. However, the treatment effects washed out after the intervention ended. TRIAL REGISTRATION: ISRCTN16412551 (date: 30 July 2014, retrospectively).

Desired weight and treatment outcome among adolescents in a novel family-based partial hospitalization program.

The purpose of the current study was to investigate desired weight percentage and weight difference percentage and their association with treatment outcome in a novel family-based partial hospitalization program. Twenty-six adolescents with anorexia nervosa or subthreshold anorexia nervosa between the ages of 12 and 19 completed the Eating Disorder Examination (EDE) at intake and upon completion from a partial hospitalization program in which parents played a large role in the recovery process, consistent with family-based treatment principles. Lower desired weight percentage at baseline was associated with higher scores on the restraint subscale of the EDE at end of treatment. Higher weight difference percentage (greater desire to lose weight) at baseline was associated with higher scores on all EDE subscales and global score at end of treatment. Neither desired weight percentage nor weight difference percentage at baseline were associated with treatment dropout or percent expected body weight at end of treatment. In a family-based program, participants' desired weight may be related to eating disorder thoughts (for example, shape or weight concerns) but not to behavioral outcomes such as weight gain or treatment dropout, which may be more directly under the influence of the parents.

Day Care for People with Dementia: A Qualitative Study Comparing Experiences from Norway and Scotland.

Potential benefits from day care attendance are reported in the literature for both people with dementia and caregivers, although the evidence-base is limited. The study aimed to explore and compare experiences of day care services for people with dementia as described by day care attendees and their caregivers in Norway and Scotland. Whereas day care receives prominence in Norway's national dementia plan, Scotland does not highlight day care in its national dementia strategy. A qualitative cross-national comparative study was undertaken. Semi-structured interviews were conducted with 17 people with dementia and 17 caregivers in Norway, and 19 people with dementia and 15 caregivers in Scotland. Data were analyzed thematically and comparatively to explore the experiences and outcomes of the participants. Findings indicate positive outcomes from day care for both people with dementia and caregivers. Satisfaction with services related to meaningful activities, getting out of the home, strengthening social connections and careful staff facilitation to create a positive and welcoming atmosphere. There were strong similarities in the content of services and experiences reported in the two countries. Some minor differences were noted, with caregiver support being an area of notable divergence in experiences. Specialist day care for people with dementia seems to provide important support and positive outcomes for people with dementia, and respite and reassurance for their caregivers. More research is needed to further explore the effect of day care designed for people with dementia both on the attendees and their caregivers.

Advancing Care Within an Adult Mental Health Day Hospital: Program Re-Design and Evaluation.

Day hospital mental health programs provide alternate care to individuals of high acuity that do not require an inpatient psychiatric stay. Ensuring provision of best practice within these programs is essential for patient stabilization and recovery. However, there is scant literature to review when creating such a program. This paper provides an overview of the steps an acute care hospital took when designing and implementing new programming within a day hospital program. Qualitative data was collected following initial program rollout. This data helped to inform the ongoing modification of groups offered, group scheduling and content, as well as ensuring patient satisfaction and adequate skill delivery during the rollout period and beyond. The goal of this paper is to inform health service delivery for other programs when attempting to build or re-design a day hospital program.

The effect of an occupational therapy mental health day treatment centre on the use of inpatient services in the Western Cape, South Africa.

Purpose: The aim of this study was to determine whether attendance at an occupational therapy-led day treatment centre for mental health care users affects the use of inpatient services in South Africa. Methods: A retrospective pre-test/post-test quasi-experimental study design was used to compare admissions and days spent in hospital during the 24 months before and after attendance at the centre, using the hospital's electronic records. Total population sampling yielded data for 44 mental health care users who made first contact with the service between July 2009 and June 2010. Data were compared using the Kruskal-Wallis test, Wilcoxon Signed Ranks test and Mann-Whitney U test. Results: There was a significant decrease in the number of admissions (z = -4.093, p = 0.00) and the number of days spent in hospital (z = -4.730, p = 0.00). Participants were admitted to psychiatric care 33 times less in the 24 months' post-intervention, indicating a medium effect (r = 0.436). They also spend 2569 days less in hospital, indicating a large effect (r = 0.504). Conclusion: The findings suggest that an occupational therapy-led day treatment centre could be effective in reducing the use of inpatient mental health services in South Africa. Implications for Rehabilitation Attendance at an occupational therapy-led community day treatment centre decreases the number of admissions and number of days spent in hospital and is therefore beneficial to mental health care users and service providers. The study indicates that the successful implementation of a community day treatment centre for mental health care users on the grounds of a tertiary hospital by utilising existing resources is possible.

Characterizing gender differences in nonsuicidal self-injury: Evidence from a large clinical sample of adolescents and adults.

While nonsuicidal self-injury (NSSI) is common in both men and women, research exploring the intersection of NSSI and gender has been limited by the use of small samples of males drawn primarily from non-clinical populations. To address these limitations, we analyzed data from a large sample of patients enrolled in an NSSI partial hospitalization program (PHP) to compare males and females across several variables, including NSSI characteristics, correlates, and pre-post treatment outcomes. Results indicated similar NSSI characteristics and treatment outcomes for males and females, with few exceptions. Males notably reported lower severity levels for most NSSI correlates (e.g., psychopathology, suicidality), highlighting the need to screen males for NSSI even when reporting comparatively less impairment. Finally, our results also suggest that PHP treatment for NSSI can be beneficial for both males and females. These findings have implications for the assessment, diagnosis, conceptualization, and treatment of NSSI in males and females.

Experiences of attending day care services designed for people with dementia - a qualitative study with individual interviews.

OBJECTIVES: Day care is assumed to promote independence in home-dwelling people with dementia, increase well-being and enhance social stimulation. Few studies have directly engaged people with dementia to better understand the benefits and impacts of such services. The aim of this study was to explore attendees' experiences with day care designed for people with dementia. METHOD: This study had a qualitative descriptive design and included individual interviews with 17 users attending day care. The analysis was undertaken using content analyses. RESULTS: The participants reported that day care had a positive influence on their physical functioning, cognition, well-being, and situation at home because they were provided with social stimulation, meals, and activities. Day care contributed to the maintenance of a rhythm and structure in everyday life. Furthermore, the staff contributed to making the day care a safe place to be and enhanced a sense of belonging. CONCLUSION: This study reveals the positive impact of day care on the daily lives of people with dementia because this service contributes to the enhancement of activities and social support, prevents isolation, and enhances practical and cognitive functioning as experienced by the users. The staff has a major impact on the experience of the participants in the day care.

Exploring the experiences of patients attending day hospitals in the rural Scotland: capturing the patient's voice.

AIMS AND OBJECTIVES: To understand the meaning of person-centred compassionate care for people attending day hospitals in rural Scotland. BACKGROUND: Increasing numbers of older people are living with chronic conditions and require support to live at home. Intermediate care services such as day hospitals can enable this. Much previous research about day hospitals focused on organisational aspects of care. This study set out to capture the voice of the patient using this service. DESIGN: A descriptive qualitative study. METHODS: Individual interviews were undertaken in participant's homes using emotional touchpoints as prompts to help patients discuss their experience of care within a day hospital (n = 15). Data were analysed using thematic analysis. RESULTS: Four main themes were identified from the data: Relationships, Feeling Valued, Expectations and Perceived Benefits. The findings showed that relationships with staff and other patients were important. The patients also wanted to feel valued, and helping others was part of this. The patients had clear expectations of the service but had an acute awareness of the benefits of attending the day hospital such as coordination of their care. Overall, the patients were highly satisfied, felt that care was person-centred and recognised the advantages of remaining close to home. CONCLUSIONS: At a time when enabling health and social care integration is a priority, this study provides insight into the patient perspective of intermediate care. The findings reveal what matters to patients cared for in the community and how this service can respond to this. RELEVANCE TO CLINICAL PRACTICE: This study provides insight for healthcare practitioners caring for patients in the community and those responsible for planning and resourcing this service. It should also start a dialogue about how these services could be used more.

A randomised trial of Acceptance and Commitment Therapy for Anorexia Nervosa after daycare treatment, including five-year follow-up.

BACKGROUND: No specific psychotherapy for adult anorexia nervosa (AN) has shown superior effect. Maintenance factors in AN (over-evaluation of control over eating, weight and shape) were addressed via Acceptance and Commitment Therapy (ACT). The study aimed to compare 19 sessions of ACT with treatment as usual (TAU), after 9 to 12 weeks of daycare, regarding recovery and risk of relapse up to five years. METHODS: Patients with a full, sub-threshold or partial AN diagnosis from an adult eating disorder unit at a hospital were randomized to ACT (n = 24) and TAU (n = 19). The staff at the hospital, as well as the participants, were unaware of the allocation until the last week of daycare. Primary outcome measures were body mass index (BMI) and specific eating psychopathology. Analyses included mixed model repeated measures and odds ratios. RESULTS: Groups did not differ regarding recovery and relapse using a metric of BMI and the Eating Disorder Examination Questionnaire (EDE-Q). There were only significant time effects. However, odds ratio indicated that ACT participants were more likely to reach good outcome. The study was underpowered due to unexpected low inflow of patients and high attrition. CONCLUSION: Longer treatment, more focus on established perpetuating factors and weight restoration integrated with ACT might improve outcome. Potential pitfalls regarding future trials on AN are discussed. Trial registration number ISRCTN 12106530. Retrospectively registered 08/06/2016.

Implementation of Choice from Participants' Perspectives: A Study of Community Mental Healthcare Reform in Sweden.

The aim of this study was to explore participants' experiences and opinions about a free-choice system in relation to policy objectives articulated by the national government and local authorities. A case study was conducted. Thirty-five informants participated. Qualitative interviews were undertaken. Results are discussed on how to address different dimensions of choice, not only where, but also what, by whom, how much, and when. They also concern how to design systems that in some ways ensure predictability and continuity to avoid unwanted harm caused by the unpredictability embedded in competitive choice systems. Finally, different aspects of quality need to be addressed.

Effectiveness of a day care program in supporting patients on peritoneal dialysis and their caregivers.

PURPOSE: Physical inactivity and social isolation are major problems faced by peritoneal dialysis (PD) patients. Respite care is also an unmet need for their caregivers. The study aimed to evaluate the benefits of day care service for PD patients. METHOD: Khoo Teck Puat Hospital collaborated with St Luke's Eldercare (SLEC) to provide day care services for PD patients. The day care provided assistance with two PD exchanges and activities for patients to maintain health and improve social interaction. Outcome indicators included: (1) enrollment status, length of stay and peritonitis rate; (2) quality of life and mental status evaluations on patients and caregivers with the 12-item Short-Form Health Survey, Hospital Anxiety and Depression Scale and Zarit Burden Interview Short-Form 12; and (3) qualitative data collected via interviews with patients, caregivers, healthcare providers and SLEC staff. RESULTS: Sixty-four patients were referred, and 16 eventually participated. Mean age of participants was 67.2 (range 54-85) years. For patients who stayed >1 month (n = 9), length of stay was 205.0 days (58-428) and frequency of attendance was 2.9 (0.6-4.8) times/week. There were no peritonitis episodes while patients were in the program. Mental improvement was noticed for most patients and caregivers, but physical improvement was less obvious. Caregivers also felt less burden. CONCLUSIONS: Day care service is effective in alleviating the burden of caregivers and beneficial to patients with relatively good functional status. However, persuading patients and their caregivers to take up the program was a challenge.

Community day care with carer support versus usual nursing home-based day care: effects on needs, behavior, mood, and quality of life of people with dementia.

BACKGROUND: Several studies have shown that the combined community-based Meeting Centres Support Programme (MCSP) for people with mild to moderate dementia and their carers were more effective in reducing behavior and mood problems of people with dementia than traditional nursing home-based (NH) day care. We therefore investigated in this study whether community-based (CO) psychogeriatric day care for people with mild to severe dementia combined with carer support (in accordance with the MCSP), is more effective than regular NH day care. METHODS: A pre-test-post-test control group design was used to compare the effect of CO and NH day care on care needs, behavior and mood problems, and quality of life of people with dementia. 138 dyads of people with mild to severe dementia and family carers participated in the study: 70 from (new and longer existing) CO day cares (experimental group), and 68 from NH day cares (control group). ANCOVAs were performed at post-tests, including baseline data as covariates. RESULTS: After six months, no overall differences on outcome measures were found between CO and NH day cares. However, participants of recently started CO day cares showed fewer neuropsychiatric symptoms, whereas carers in the longer existing CO day cares reported fewer care needs compared to the control group (large effects). Persons with dementia cohabiting with their carer benefitted most from CO day care. CONCLUSIONS: This study shows that combined CO day care has promising added value compared to NH day care, especially for participants with dementia cohabiting with their carer.

[Changing health, activity and mood Department of day care clients comprehensive social service center: training program, methods, results].

The comparative analysis of changes in the self-assessment of health, activity and mood of older clients (men and women) separating the daycare center of the complex of social services. Used psychodiagnostic method of self-assessment of the functional state of the differential «Test SAN¼ (V.A.Doskin, N.A. Lavrentiev, V.B.Sphere, M.P.Miroshnikov). The study of these states conducted before and after the implementation of targeted training programs, simulation and which goal setting made from the standpoint of the system and subject-activity approach.

Inpatient and Day-Clinic Experience Scale (IDES) - a Psychometric Evaluation.

OBJECTIVES: The Inpatient and Day-Clinic Experience Scale (IDES) was developed to assess common factors in a multimodal psychotherapy setting from the patients' perspective. The questionnaire measures different aspects of therapeutic relationships, a positive self-view and a critical attitude towards therapy. METHODS: Three samples (total N = 821) were used to evaluate the psychometric properties and factor structure of the questionnaire. RESULTS: Confirmatory analyses show a good model fit and support the proposed structure with 25 items and seven scales. In addition, reliability indices were stable throughout multiple assessments over time. Concerning validity, early IDES process measures were moderately associated with symptomatic improvement. CONCLUSIONS: The IDES is a psychometrically reliable questionnaire for the evaluation of process factors in inpatient and day-clinic psychotherapy settings.

Anesthesia for EXIT procedure (ex utero intrapartum treatment) in congenital cervical malformation - a challenge to the anesthesiologist / Anestesia para procedimento EXIT (tratamento extraútero intraparto) em malformação congênita cervical - um desafio para o anestesiologista

The ex utero intrapartum treatment (EXIT) procedure consists of partial externalization of the fetus from the uterine cavity during delivery, allowing the maintenance of placental circulation. It is indicated in the presence of congenital malformation when difficulty in fetal airway access is anticipated, allowing it to be ensured by direct laryngoscopy, bronchoscopy, tracheostomy, or surgical intervention. Anesthesia for EXIT procedure has several special features, such as the appropriate uterine relaxation, maintenance of maternal blood pressure, fetal airway establishment, and maintenance of postpartum uterine contraction. The anesthesiologist should be prepared for the anesthetic particularities of this procedure in order to contribute to a favorable outcome for the mother and particularly the fetus.

O procedimento EXIT (tratamento extraútero intraparto) consiste na exteriorização parcial do feto da cavidade uterina durante o parto para permitir a manutenção da circulação fetoplacentária. Está indicado na presença de malformações congênitas em que se antecipa a dificuldade no acesso da via aérea fetal e permite que essa seja assegurada por laringoscopia direta, broncoscopia, traqueostomia ou intervenção cirúrgica. A anestesia para procedimento EXIT apresenta várias particularidades. O relaxamento uterino adequado, a manutenção da pressão arterial materna, o estabelecimento de via aérea fetal e a manutenção da contração uterina pós-parto são alguns exemplos. O anestesiologista deve estar preparado para as particularidades anestésicas desse procedimento, de modo a contribuir para um desfecho favorável para a mãe e particularmente para o feto.