RESUMO
Objective: The aim of this study was to assess the influence of the cesarean section scars on the mean pulsatility index (PI) of the uterine artery Doppler between 20 and 34 weeks of gestation. A secondary objective was to assess the association between previous cesarean section and adverse maternal/perinatal outcomes. Methods: A retrospective cohort study was conducted with pregnant women who had their deliveries between March 2014 and February 2023. PI of the uterine arteries Doppler was performed transvaginally between 20-24 weeks and transabdominally between 28-34 weeks. The following variables were considered adverse perinatal outcomes: birth weight < 10th percentile for gestational age, preeclampsia, premature birth, placental abruption, perinatal death, postpartum hemorrhage, neonatal intensive care unit (NICU) admission. Results: A total of 479 pregnant women were included in the final statistical analysis, being that 70.6% (338/479) had no (Group I) and 29.4% (141/479) had at least one previous cesarean section (Group II). Pregnant women with a previous cesarean had higher median of mean PI (1.06 vs. 0.97, p = 0.044) and median MoM of mean PI uterine arteries Doppler (1.06 vs. 0.98, p = 0.037) than pregnant women without previous cesarean section at ultrasound 20-24 weeks. Pregnant women with a previous cesarean section had higher median of mean PI (0.77 vs. 0.70, p < 0.001) and mean MoM PI uterine arteries Doppler (1.08 vs. 0.99, p < 0.001) than pregnant women without previous cesarean section at ultrasound 28-34 weeks. Pregnant women with ≥ 2 previous cesarean sections had a higher median of mean PI uterine arteries Doppler than those with no previous cesarean sections (1.19 vs. 0.97, p = 0.036). Group II had a lower risk of postpartum hemorrhage (aPR 0.31, 95% CI 0.13-0.75, p = 0.009) and composite neonatal outcome (aPR 0.66, 95% CI 0.49-0.88, p = 0.006). Group II had a higher risk of APGAR score at the 5th minute < 7 (aPR 0.75, 95% CI 1.49-51.29, p = 0.016). Conclusion: The number of previous cesarean sections had a significant influence on the mean PI uterine arteries Doppler between 20-24 and 28-34 weeks of gestation. Previous cesarean section was an independent predictor of postpartum hemorrhage and APGAR score at the 5th minute < 7. Pregnancy-associated arterial hypertension and number of previous deliveries influenced the risk of composite neonatal outcome, but not the presence of previous cesarean section alone.
RESUMO
Antes del surgimiento de la psiquiatría, oír voces que otras personas no oyen era considerado una experiencia común. Sin embargo, a partir del siglo XIX, la psiquiatría trajo un nuevo signifi cado para esa experiencia, clasifi cándola como un síntoma característico de diversos trastornos mentales. Sin embargo, en la década de 1980 surge en Holanda el Movimiento Internacional de Oyentes de Voces, que propone la elaboración de nueva interpretación para esa experiencia, permitiendo al (la) oyente nuevas estrategias para comprender y convivir con las voces sin, necesariamente, recurrir a psiquia-tría, pues entiende las voces como parte de la subjetividad humana. Este estudio analizó el registro al respecto de la audición de voces hecho por trabajadores de un servicio de atención psicosocial. La colecta de datos ocurrió entre setiembre de 2017 y mayo de 2018. Fueron analizados 389 prontuarios de usuarios activos en el servicio, de los cuales 181 presentaron registro de audición de voces. Para análisis e interpretación de los datos fue realizada la lectura exhaustiva del material, a partir de la cual emergieron de los temas: a) audición de voces descripta a partir del conocimiento psiquiátrico; b) audición de voces descripta mientras experiencia humana. Los registros de los trabajadores de CAPS evidenciaron que hay una predominancia del conocimiento biomédico, por medio de diferen-tes formas de control del discurso de los usuarios. En ese sentido, es fundamental que el trabajador (a) de la salud mental se movilice en el sentido de promover abordajes terapéuticos que permitan un diálogo emancipatorio, en el sentido de no cronifi car el relato de oír voces en las primeras ex-presiones traídas por los (as) oyentes (as). Cuando bien registrado, el prontuario puede ser utilizado como un instrumento de comunicación entre los integrantes del equipo de salud, y también valorar la experiencia de los usuarios.
Listening to voices that other people do not hear was considered a common experience before the onset of psychiatry. However, from the nineteenth century, psychiatry brought a new meaning to this experience, classifying it as a characteristic symptom of several mental disorders. In the 1980s, however, the International Movement of Voice-hearers was created in the Netherlands, which pro-poses the elaboration of a new interpretation for this experience, allowing the hearer new strategies to understand and coexist with voices without necessarily resorting psychiatry, since it understands voices as part of human subjectivity. ! is study analyzed the record regarding hearing of voices made by the workers of a psychosocial care service. Data collection occurred between September 2017 and May 2018. A total of 389 medical records of active users in the service were analyzed, of which 181 presented voiced hearing records. In order to analyze and interpret the data, a thorough reading of the material was carried out, from which two themes emerged: a) hearing of voices described from psychiatric knowledge; b) hearing of voices described as human experience. ! e records of psychosocial care service workers showed that there is a predominance of biomedical knowledge, through diff erent forms of user discourse control. In this sense, it is fundamental that the mental he-alth worker operate to promote therapeutic approaches that allow an emancipatory dialogue, in the sense of not chronifying the report of hearing voices in the fi rst expressions brought by the hearers. When well recorded, the medical record can be used as an instrument of communication among the members of the health team, and also value the experience of the service users.
Antes do surgimento da psiquiatria, ouvir vozes que outras pessoas não ouvem era considerado uma experiência comum. Porém, a partir do século XIX, a psiquiatria trouxe um novo signifi cado para essa experiência, classifi cando-a como um sintoma característico de diversos transtornos men-tais. No entanto, na década de 1980 surge na Holanda o Movimento Internacional de Ouvidores de Vozes, que propõe a elaboração de uma nova interpretação para essa experiência, permitindo ao (a)ouvinte novas estratégias para compreender e conviver com as vozes sem, necessariamente, recorrer a psiquiatria, pois compreende as vozes como parte da subjetividade humana. Este estudo analisou o registro a respeito da audição de vozes feito pelos trabalhadores de um serviço de atenção psi-cossocial. A coleta de dados ocorreu entre setembro de 2017 e maio de 2018. Foram analisados 389 prontuários de usuários ativos no serviço, dos quais 181 apresentaram registro de audição de vozes. Para análise e interpretação dos dados foi realizada a leitura exaustiva do material, a partir da qual emergiram dois temas: a) audição de vozes descrita a partir do saber psiquiátrico; b) audição de vozes descrita enquanto experiência humana. Os registros dos trabalhadores do CAPS evidenciaram que há uma predominância do saber biomédico, por meio de diferentes formas de controle do discurso dos usuários. Nesse sentido, é fundamental que o trabalhador (a) da saúde mental movimente-se no sentido de promover abordagens terapêuticas que permitam um diálogo emancipatório, no sentido de não cronifi car o relato de ouvir vozes nas primeiras expressões trazidas pelos (as) ouvidores (as). Quando bem registrado, o prontuário pode ser utilizado como um instrumento de comunicação entre os integrantes da equipe de saúde, e também valorizar a experiência dos usuários.