Women's satisfaction with childbirth in a public hospital in Brazil.

OBJECTIVE: The purpose of this study was to evaluate women's satisfaction with vaginal birth in a public hospital in São Paulo, Brazil. METHODS: A total of 372 low-risk postpartum women were interviewed. Maternal satisfaction was measured by the Mackey Childbirth Satisfaction Rating Scale (MCSRS), validated to Brazilian Portuguese. The scale is divided into six subscales: self-evaluation, partner, baby, nursing, physicians, and overall satisfaction. Childbirth care data were related to maternal mobility, shower bath, birth ball exercises, manual massage, and the health care providers assisting delivery. RESULTS: The MCSRS total score was significantly higher in women living with their partners than those not living with a partner (median 145.5 vs 133.0; P = 0.019), in women with a companion during childbirth than those with no labor support (146.0 vs 136.5; P = 0.047), and in women who early breastfed within the first hour compared with those who did not (146.0 vs 137.0; P = 0.001). Multiple regression identified 'living with partner' (coefficient 6.205; P = 0.043) and 'breastfeeding within the first hour' (coefficient 7.856; P = 0.005) as independent variables that determine the total score of MCSRS. CONCLUSIONS: Our findings indicate that living with one's partner and early initiation of breastfeeding are key factors enhancing satisfaction with vaginal birth in women who received care at a public Brazilian hospital.

Dealing with female sexuality: training, attitude, and practice of obstetrics and gynecology residents from a developing country.

INTRODUCTION: There is little research on how obstetrics and gynecology (Ob/Gyn) residents deal with female sexuality, especially during pregnancy. AIM: The aim of this study was to assess the training, attitude, and practice of Ob/Gyn residents about sexuality. METHODS: A cross-sectional survey of Brazilian Ob/Gyn residents enrolling in an online sexology course was conducted. A questionnaire assessed their training in sexuality during medical school and residency and their attitude and practice on sexual issues during pregnancy. MAIN OUTCOME MEASURES: Training, attitude, and practice of Ob/Gyn residents regarding sexuality were the main outcome measures. RESULTS: A total of 197 residents, from 21 different programs, answered the online questionnaire. Mean age was 27.9 ± 2.2, most were female (87%), single (79%), and had graduated in the last 5 years (91%). Almost two-thirds (63%) stated that they did not receive any training at all and 28% reported having only up to 6 hours of training about sexuality in medical school. Approximately half of the respondents (49%) stated that they had received no formal training about sexuality during their residency up to that moment and 29% had received ≤6 hours of training. Over half (56%) never or rarely took a sexual history, 51% stated that they did not feel competent or confident to answer their pregnant patients' questions about sexuality, and 84% attributed their difficulties in dealing with sexual complaints to their lack of specific knowledge on the topic. CONCLUSION: The vast majority of Brazilian Ob/Gyn residents enrolling in a sexuality course had little previous formal training on this topic in medical school and during their residency programs. Most residents do not take sexual histories of pregnant patients, do not feel confident in answering questions about sexuality in pregnancy, and attribute these difficulties to lack of knowledge. These findings point to a clear need for additional training in sexuality among Brazilian Ob/Gyn residents.

Ultra-processed foods and the nutritional quality of the diet of Brazilian pregnant women.

OBJECTIVE: The aim of this study was to evaluate the consumption of ultra-processed foods by Brazilian pregnant women and its association with the nutritional quality of the diet. METHODS: This is a prospective and cross-sectional study with food consumption data of Brazilian pregnant women from the 2017 to 2018 Family Budgets Survey (Pesquisa de Orçamentos Familiares). Food consumption was measured using two 24-h food recalls, and the foods were categorized according to the NOVA classification. The averages of absolute and relative energy consumption for each of the NOVA groups and subgroups were estimated. The sociodemographic characteristics described the diet's caloric contribution of ultra-processed and non-ultra-processed food fractions. Linear regression models were used to describe the association between quintiles of the caloric contribution of ultra-processed foods and the average content of nutrients in the diet. RESULTS: Consumption of ultra-processed foods represented 20.9% of the total calories in the diet of Brazilian pregnant women. There was a higher energy contribution of ultra-processed foods in the diet of pregnant women living in urban areas (22%), with higher per capita income (23.7%), and in the south region of the country (26.9%). In addition, the data showed an association between higher consumption of ultra-processed foods with reduced intake of protein, carbohydrate, fiber, potassium, iron, zinc, and folate and increased intake of total fat, saturated fat, trans fat, and free sugar. CONCLUSION: Results show that higher consumption of ultra-processed foods is associated with a reduction in the nutritional quality of the diet of Brazilian pregnant women.

Female sexual function and gestational diabetes.

INTRODUCTION: The number of women with gestational diabetes mellitus (GDM) is growing worldwide in parallel with the obesity epidemic. The diagnosis of GDM leads to substantial modifications in the daily routine of these women, and these adjustments could potentially affect their sexual function. There are no previous studies on the sexual function of patients with GDM. AIM: The aim of this study was to investigate the sexual function of patients with GDM in comparison with healthy pregnant women at the same gestational age. METHODS: Brazilian women in the third trimester of pregnancy with and without GDM were invited to participate in this cross-sectional study while waiting for their antenatal care visits at a single public tertiary teaching institution between March and December 2010. The Brazilian version of the Female Sexual Function Index (FSFI) questionnaire was used to assess sexual function. MAIN OUTCOME MEASURES: Desire, arousal, lubrication, orgasm, sexual satisfaction, and pain during and after coitus in the last 4 weeks, measured according to a standardized and validated questionnaire. RESULTS: A total of 87 participants were enrolled (43 healthy women and 44 with GDM). There were no significant differences in the sociodemographic characteristics of both groups. The total FSFI scores of GDM patients was 21.0±9.59 compared with 22.3±9.17 for healthy women (P=0.523). Difficulty in desire was the most common sexual dysfunction symptom in both groups, being reported by 42% and 50% of GDM and healthy women, respectively (P=0.585). CONCLUSION: The sexual function of Brazilian patients with GDM does not differ significantly from that of healthy pregnant women at the same gestational age.

Electromyographic evaluation of pelvic floor muscles in pregnant and nonpregnant women.

INTRODUCTION AND HYPOTHESIS: We compared the maximal voluntary contraction (MVC) and strength of pelvic floor muscles (PFM) of pregnant and nonpregnant women using surface electromyography (SEMG). METHODS: Fifteen pregnant primiparous women and 15 nulliparous nonpregnant women were evaluated. The healthy pregnant women were in the third trimester of pregnancy with a single fetus and did not have any neuromuscular alterations. The nonpregnant women did not present with PF dysfunctions and, as with the pregnant women, did not have any previous gynecological surgeries or degenerative neuromuscular alterations. The evaluation methods used were digital palpation (Oxford Grading Scale, which ranges from 0 to 5) and SEMG. In the EMG exam, MVC activity was evaluated, and the better of two contractions was chosen. Before the evaluation, all women received information about PFM localization and function and how to correctly contract PFM. RESULTS: In the EMG evaluation, MVC was significantly greater in the nonpregnant group (90.7 µv) than in the pregnant group (30 µv), with p < 0.001. The same results were observed after vaginal palpation, measured by the Oxford scale, which presented an average of 2.1 in the pregnant group and 4.5 in the nonpregnant group (p = 0.005). CONCLUSION: In comparison to nulliparous women, pregnant women demonstrated worse PFM function with decreased strength and electrical activity.

Effects of Bryophyllum pinnatum Administration on Wistar Rat Pregnancy: Biochemical and Histological Aspects.

INTRODUCTION: Bryophyllum pinnatum is widely used in folk medicine. It has neuropharmacological, anti-inflammatory, immunomodulatory, antidiabetic, hepatoprotective, and nephroprotective effects, among others. It also acts on uterine contractility. It is prescribed by practitioners of anthroposophic medicine for preterm labor, insomnia, and emotional disorders, and has other potential uses in obstetrics. As all drugs currently used in preterm labor have side effects, new tocolytic agents remain an area of active research. OBJECTIVE: To evaluate the effect of B. pinnatum mother tincture (MT) on albino rats and their offspring throughout pregnancy from a biochemical and histological standpoint. METHODS: Longitudinal, prospective, randomized controlled bioassay. This is the second stage of a trial that investigated 60 animals distributed across six equal groups: controls C1 and C2, which received 1 and 25 times the vehicle dose (30% ethanol), B1 and B2 (1- and 25-fold doses of B. pinnatum MT), and B3 and B4 (which received 50- and 100-fold doses of B. pinnatum concentrate). At this stage, blood chemistry parameters (glucose, alanine aminotransferase [ALT], aspartate aminotransferase [AST], creatinine, and blood urea nitrogen) were measured in dams, as well as histological aspects of dam liver, kidney, placenta, and uterine tissue and fetal liver, kidney, heart, and brain. RESULTS: No differences were found between group B1 (therapeutic dose) and its control C1 in relation to glucose, AST, ALT, and creatinine. Group B2 exhibited lower glucose levels than groups C1, B3, and B4. There was no difference in AST across groups. Groups B3 and B4 exhibited higher ALT levels than groups C1 and B1. Groups B1-B4 exhibited higher urea nitrogen levels than group C1. Creatinine levels were higher in groups B2 and B3 than group C1. On morphological evaluation, fatty infiltration of the liver was observed in the alcoholic vehicle control groups (C1 and C2). CONCLUSIONS: Daily administration of B. pinnatum at therapeutic doses (group B1) to pregnant albino rats appears to be safe, with reduced glucose at dose B2, elevated ALT at doses B3 and B4, and increased urea at doses B1 to B4 and creatinine at B2 and B3, but never exceeding the normal reference range. It was not associated with histological changes in specimens of the maternal or fetal structures of interest.

Pelvic floor muscle and transversus abdominis activation in abdominal hypopressive technique through surface electromyography.

AIMS: The abdominal hypopressive technique (AHT) is performed mainly via transversus abdominis (TrA) activation and has been indicated for pelvic floor muscle (PFM) disorders. In some European countries, this technique has become widely used. This study aimed to investigate PFM and TrA activation during the AHT through surface electromyography. METHODS: Thirty-four nulliparous physical therapists in good general health were asked to participate in the trial. To ascertain a correct PFM contraction, each of the participants was assessed by inspection and digital palpation. Ability to contract the TrA was assessed by surface electromyography and AHT training was given before analysis. TrA and PFM activity was recorded using surface electromyography. RESULTS: The mean age of the volunteers was 28.1 (±6.0) years and the mean body mass index was 23.7 (±3.3) kg/m(2) . More than half of the volunteers were physically active (61.3%) and regularly performed PFM training (52.9%) but not TrA exercises (58.8%). Although the AHT activates the PFM when compared to resting tone (P < 0.001), this method is significantly less effective than PFM alone (P < 0.001). Additionally, the combination of the two techniques (AHT + PFM) was similarly effective as isolated PFM contraction (P = 0.586). Although the AHT activated the TrA significantly more than did PFM alone (P = 0.002), the addition of PFM contraction to the AHT significantly increased the amount of TrA activation (P < 0.001). CONCLUSIONS: Based on our results, the AHT is less effective than PFM contraction alone, and adding PFM contraction to AHT also improves the TrA contraction.

Chronic use of indinavir in albino rat pregnancy (Rattus norvegicus albinus, Rodentia, Mammalia): biological assay.

AIM: Assess possible adverse effects of the chronic use of indinavir during pregnancy in a rat model. METHODS: 40 pregnant EOM-1 albino rats were randomly allocated into four groups of 10 animals each: a control (Ctr) group (without any handling) and three experimental groups (Exp 1, Exp 2 e Exp 3) which received indinavir 9, 27 e 81 mg/kg, respectively). Rats were treated by gavage once daily. The treatment period extended from day 0 until the 20th day of pregnancy. Body weights were recorded on days 0, 7, 14 and 20. At term, the rats were sacrificed, and the implantation sites, number of live and dead fetuses and placentas, resorptions, fetal and placental weights were recorded. The fetuses were evaluated for external abnormalities under a stereomicroscope. RESULTS: Weight gain during pregnancy did not differ significantly between the groups. Average weight gains between the 7th and 20th day were 7.95-42.70 g; 7.22-45.27 g; 7.12-46.26 g and 8.05-42.29 g in groups Ctr, Exp 1, Exp 2 and Exp 3, respectively. All other parameters assessed did not differ significantly between groups. CONCLUSIONS: Chronic use of various dosages of indinavir during pregnancy was not associated significant adverse outcomes.

Psychometric properties of the Mackey Childbirth Satisfaction Rating Scale cross-culturally adapted to Brazilian Portuguese.

OBJECTIVE: To analyze the psychometric properties of the Brazilian version of Mackey Childbirth Satisfaction Rating Scale (MCSRS). METHODS: The MCSRS questionnaire was applied to postpartum mothers before discharge at low-risk maternity hospital in Brazil. The inclusion criteria were maternal age between 18 and 34 years, delivery of a live infant, and gestational age at birth over 36 weeks. In analyzing psychometric properties, dimensionality was evaluated by exploratory factor analysis and reliability by Cronbach's alpha and McDonald's omega. RESULTS: Fifty-three questionnaires were filled out by the postpartum mothers for an analysis of psychometric properties. Of the participants, 84.9% had vaginal deliveries; and 58.5% had deliveries by obstetricians and 41.5% by midwives. Two latent dimensions model was significantly better than those obtained with the single-factor model (Dc233 = 145.9, p < .001). The first dimension explains 35% of the variance related to the items covering care giving, and the second explains 17% of the variance related to self-satisfaction and satisfaction with the partner. High communality was found for factor 1 (0.36-0.71) and factor 2 (0.28-0.50). For factors 1 and 2, Cronbach's alpha was 0.96 and 0.92, and McDonalds' omega was 0.96 and 0.89, respectively. The reliability coefficient omega for the overall reliability of the questionnaire was 0.97. CONCLUSION: The psychometric properties of the Brazilian version of the MCSRS yielded two dimensions related to professional care giving and family. This version demonstrated good reliability and is thus a potential instrument to promote improvement of childbirth care in the country. Nonetheless, confirmation of the structural model of the tool should be sought.

Usual-Risk Pregnant Women's Health-Related Quality of Life through Pregnancy and Puerperium with Anthroposophical Prenatal Care: A Retrospective Study.

INTRODUCTION: Pregnancy is a physiological event that can lead to a decrease in quality of life. Symptoms within this period lack riskless treatment options. However, the anthroposophical integrative view points out the stimulation of vital energy recuperation as a possible inducer of changes in health perception for pregnant women. OBJECTIVE: The aim was to observe the health-related quality of life variation in women during pregnancy and puerperium. The evaluation was based on the Medical Outcomes Study 36-Item Short-Form (SF-36). METHOD: This is a retrospective longitudinal study of SF-36 questionnaires administered at 3 different time points: at the first appointment, at an appointment between the 36th ± 1 week of pregnancy and at another appointment within the puerperium period. RESULTS: Sixty-five patients completed the 3 questionnaires within the period of the study. The 8 domains of SF-36 and women's behaviors throughout the prenatal and puerperal care period were analyzed. Quality of life decreased by the third trimester, with recuperation in the puerperium. Physical components were reduced significantly, while emotional and social components did not change significantly. Scores in mental health and vitality, as well as general health status, were higher in puerperium. CONCLUSION: Multiprofessional intervention broadened by the anthroposophical perspective fosters the health-related quality of life of women through gestation and puerperium.

Type of Childbirth and its Association with the Maternal-Filial Interaction.

OBJECTIVE: The purpose of the present study was to evaluate the quality of mother-child bonding in three different contexts related to the labor, that is, vaginal delivery, elective cesarean section, and intrapartum cesarean section. METHODS: This was an observational, cross-sectional clinical study conducted in two cities within the state of São Paulo, Brazil. The study sample consisted of 81 babies born without any major complications during pregnancy and labor, aged 3 to 4 months, and their respective mothers, aged between 20 and 35 years old, primiparous, living in the cities of Palmital and Ourinhos, state of São Paulo, Brazil. The evaluation of the quality of the maternal-filial interaction was performed through video-image analysis, using the Mother-baby Interaction Observation Protocol from 0 to 6 months (POIMB 0-6, in the Portuguese acronym). RESULTS: Mothers who had vaginal delivery had higher amount of visual contact or attempted visual contact (p = 0.034), better response to the social behavior of the child (p = 0.001) and greater sensitivity (p = 0.007) than the others. Their children also showed more interaction with them, as they looked more frequently at the mother's face (p ≤ 0.008) and responded more frequently to the mother's communicative stimulus (p < 0.001). CONCLUSION: Considering the occurrence of vaginal delivery, it is concluded that the interaction between the mother-child dyad is quantitatively larger and qualitatively better when compared with intrapartum or elective cesarean section.

OBJETIVO: O objetivo do presente estudo foi avaliar a qualidade do vínculo mãe-filho em três contextos diferentes relacionados ao trabalho de parto, ou seja, parto vaginal, cesariana eletiva e cesariana intraparto. MéTODOS: Estudo clínico observacional, transversal, realizado em duas cidades do estado de São Paulo, Brasil. A amostra do estudo foi composta por 81 recém-nascidos sem maiores complicações durante a gravidez e o parto, com idades entre 3 e 4 meses, e suas respectivas mães, com idades entre 20 e 35 anos, primíparas, residentes nas cidades de Palmital e Ourinhos, estado de São Paulo, Brasil. A avaliação da qualidade da interação materno-filial foi realizada por meio de análise de vídeo-imagem, utilizando o Protocolo de Observação da Interação Mãe-Bebê de 0 a 6 meses (POIMB 0­6). RESULTADOS: Mães que tiveram parto vaginal tiveram maior quantidade de contato visual ou tentativa de contato visual (p = 0,034), melhor resposta ao comportamento social da criança (p = 0,001) e maior sensibilidade (p = 0,007) que as demais. Os filhos também mostraram maior interação com elas, pois olhavam com mais frequência para o rosto da mãe (p < 0,008) e respondiam com mais frequência ao estímulo comunicativo da mãe (p < 0,001). CONCLUSãO: Considerando a ocorrência do parto vaginal, conclui-se que a interação entre a díade mãe-filho é quantitativamente maior e qualitativamente melhor quando comparada à cesariana intraparto ou eletiva.

Quantitative assessment of pelvic floor muscle extensibility in pregnant women with a perineal elasticity meter.

Objective: The objective of this study was to compare measurements of pelvic floor muscle extensibility in pregnant women obtained through the Epi-no® and perineal elasticity meter (PEM) devices.Methods: This was an observational, cross-sectional study with a consecutive sample, conducted in a prenatal care outpatient clinic. The pelvic floors of 62 healthy pregnant women with gestational ages between 35 and 40 weeks were assessed. Perineal extensibility was measured using the Epi-no® and PEM devices. Through the linear regression method, a formula was created to calculate the Epi-no® values from the PEM values. To determine the degree of relationship between both variables, Pearson's correlation coefficient was used.Results: In the comparison of the results for 62 pregnant women using the two perineal extensibility assessment methods, the value obtained in the Pearson correlation coefficient analysis (0.621) indicated a moderate relationship between the variables. This finding was not confirmed by the Kappa correlation test. When the measurements were classified into three groups, a slight correlation was identified (perineum with restrictions, moderate extensibility, and good extensibility).Conclusion: There was a relationship between Epi-no® and PEM from slight to moderate agreement.

Content and Face Validity of the Mackey Childbirth Satisfaction Rating Scale Questionnaire Cross-culturally Adapted to Brazilian Portuguese.

OBJECTIVE: The aim of this study was to determine the content and face validity of the Mackey Childbirth Satisfaction Rating Scale (MCSRS) questionnaire cross-culturally adapted to Brazilian Portuguese. METHODS: The MCSRS is a questionnaire with 34 items related to childbirth satisfaction. The forward- and back-translated versions were compared with the original material, and 10 experts analyzed each item according to the following criteria: clarity, semantic equivalence, appropriateness, and cultural relevance. The final version was presented to 10 mothers for face validation to ensure the questionnaire would suit the target population. RESULTS: The total of 34 items assessed by experts for clarity, semantic equivalence, appropriateness, and relevance showed positive agreement of 0.85, 0.92, 0.97 and 0.97; negative agreement of 0.13, 0.09, 0.04 and 0.04; and total agreement of 0.75; 0.85, 0.94 and 0.94, respectively. Multilevel linear modeling was applied with crossed random effects and with nested random effects for each judge. The intercept of each criterion was as follows: clarity, 0.87; semantic equivalence, 0.92; appropriateness, 0.96; and cultural relevance, 0.96. The overall mean of agreement was 92.8%. The face validity measurement yielded 80% of agreement on the items, all of them clearly understood. CONCLUSION: The final version of the Brazilian Portuguese MCSRS questionnaire had face and content validity confirmed. This instrument of evaluation of maternal satisfaction during childbirth was validated to be applied in the Brazilian female population.

OBJETIVO: O objetivo deste estudo foi determinar a validação de face e conteúdo da Escala Mackey de Avaliação da Satisfação com o Parto (MCSRS, na sigla em inglês), transculturalmente adaptada para o português brasileiro. MéTODOS: O MCSRS é um questionário com 34 itens relacionados à satisfação com o parto. As versões traduzida e retrotraduzida foram comparadas com o material original, e 10 especialistas analisaram cada item de acordo com os seguintes critérios: clareza, equivalência semântica, pertinência e relevância cultural. A versão final foi apresentada a 10 mães para validação de face, para garantir que o questionário fosse adequado à população-alvo. RESULTADOS: O total de 34 itens avaliados por especialistas para clareza, equivalência semântica, pertinência e relevância apresentou concordância positiva de 0,85, 0,92, 0,97 e 0,97; concordância negativa de 0,13, 0,09, 0,04 e 0,04; e concordância total de 0,75; 0,85, 0,94 e 0,94, respectivamente. A modelagem linear multinível foi aplicada com efeitos aleatórios cruzados e com efeitos aleatórios aninhados para cada juiz. A intercepção de cada critério foi a seguinte: clareza, 0,87; equivalência semântica, 0,92; pertinência, 0,96; e relevância cultural, 0,96. A média geral de concordância foi de 92,8%. A mensuração da validade de face foi 80% de concordância nos itens, todos claramente entendidos. CONCLUSãO: A versão final do questionário MCSRS do português brasileiro teve validade de face e conteúdo confirmada. Este instrumento de avaliação da satisfação materna durante o parto foi validado para ser aplicado na população feminina brasileira.

Translation and validation of Warmometer, a tool for assessing warmth in patient-provider relationships, for use in Brazilian Portuguese.

BACKGROUND: Empathy in the patient-provider relationship is associated with important outcomes in healthcare practice. Our aim was to translate and validate Warmometer, a visual tool for assessing warmth in patient-provider relationships, for use in Brazilian Portuguese. DESIGN AND SETTING: Cross-sectional study conducted at an antenatal clinic of a public university hospital in São Paulo, Brazil. METHODS: The instrument was translated into Brazilian Portuguese and culturally adapted. It was tested for reliability and validity among 32 pregnant women, between June 2015 and January 2016. To assess construct validity, it was correlated with the Consultation and Relational Empathy (CARE) scale (gold standard for patient-provider relationships) and the Interpersonal Reactivity Index (IRI). RESULTS: The translated version of Warmometer had good face and content validity, low intra-observer reproducibility (intraclass correlation coefficient, ICC: 0.224; 95% confidence interval, CI -0.589 to 0.621;P = 0.242) and high inter-observer reproducibility (ICC: 0.952; 95% CI 0.902 to 0.977; P < 0.001). There was a strong correlation between Warmometer and CARE (r = 0.632) and a weak correlation between Warmometer and IRI (r = 0.105). CONCLUSIONS: Warmometer was translated, culturally adapted and validated for use in Brazilian Portuguese. The translated version is a reliable tool for assessing the degree of empathy perceived by the patient in a patient-provider relationship.

Ultra-processed foods and the nutritional quality of the diet of Brazilian pregnant women

SUMMARY OBJECTIVE: The aim of this study was to evaluate the consumption of ultra-processed foods by Brazilian pregnant women and its association with the nutritional quality of the diet. METHODS: This is a prospective and cross-sectional study with food consumption data of Brazilian pregnant women from the 2017 to 2018 Family Budgets Survey (Pesquisa de Orçamentos Familiares). Food consumption was measured using two 24-h food recalls, and the foods were categorized according to the NOVA classification. The averages of absolute and relative energy consumption for each of the NOVA groups and subgroups were estimated. The sociodemographic characteristics described the diet's caloric contribution of ultra-processed and non-ultra-processed food fractions. Linear regression models were used to describe the association between quintiles of the caloric contribution of ultra-processed foods and the average content of nutrients in the diet. RESULTS: Consumption of ultra-processed foods represented 20.9% of the total calories in the diet of Brazilian pregnant women. There was a higher energy contribution of ultra-processed foods in the diet of pregnant women living in urban areas (22%), with higher per capita income (23.7%), and in the south region of the country (26.9%). In addition, the data showed an association between higher consumption of ultra-processed foods with reduced intake of protein, carbohydrate, fiber, potassium, iron, zinc, and folate and increased intake of total fat, saturated fat, trans fat, and free sugar. CONCLUSION: Results show that higher consumption of ultra-processed foods is associated with a reduction in the nutritional quality of the diet of Brazilian pregnant women.

Experience of an online course on sexuality during pregnancy for residents.

OBJECTIVE: Many obstetrics and gynecology (Ob/Gyn) residents report insufficient knowledge about female sexuality and this has a negative impact on their capacity to manage their patients. The aim of this study was to describe an online course about sexuality during pregnancy for Brazilian Ob/Gyn residents and evaluate their knowledge acquisition. METHODS: This longitudinal educational intervention study involved 219 Brazilian Ob/Gyn residents. The online course lasted 24h (10 video lectures and discussion chats). Upon enrollment, the participants answered a questionnaire in regard to their training, attitudes and practices about sexuality during pregnancy. Participants' knowledge acquisition was assessed using a pre- and post-course test about sexuality during pregnancy. At the end of the course, participants were asked to evaluate their educational experience. Student's t and chi-square tests were used to analyze the pre- and post-course test scores. P values<0.05 were considered statistically significant. RESULTS: A total of 143 Ob/Gyns (65.3% of those enrolled) completed the course. At baseline, most participants reported that they did not have any sexology classes as undergraduates (62.5%) or in their residency (52.1%), and that they lacked specific knowledge in this area to manage their patients. Mean test scores increased significantly at the end of the course: 4.4 (±1.6) versus 6.0 (±1.3) (out of a maximum score of 10), before and after the course, respectively (p<0.0001). Most of the residents rated the overall quality of the course as "higher than expected". CONCLUSION: An online course for Ob/Gyn residents was associated with a significant increase in knowledge about sexuality during pregnancy.

Distance Education Course about Sexuality for Obstetrics and Gynecology Residents.

Purpose To describe the experience of a distance education course on sexual issues during pregnancy and after birth for residents. Methods This prospective educational intervention study was conducted by investigators from the Universidade Federal de São Paulo, Brazil, between April and September 2014. The participants were 219 physicians (residents from the 1st to the 6th years). The duration of the course was of 24 hours (10 video lectures and online chats). At baseline, the participants answered questions about their training, attitude and experience regarding sexual issues during pregnancy and after birth; before and after the course, they answered questions to assess their knowledge about the topic; at the end of the course, they answered questions on the quality of the course. The Student t-test was used to compare the before and after scores of the knowledge tests; values of p < 0.05 were considered statistically significant. Results A total of 143 residents concluded the course; most were in their 1st (27.2%) or 3rd (29.4%) years of residency. There was a significant increase in the mean scores of the questionnaires that assessed the knowledge of the topic: 4.4 (±1.6) versus 6.0 (±1.3; maximum score: 10), before and after the course respectively (p < 0.0001). Most of the participants (74.1%) declared that the quality of the course as a whole reached their expectations, and 81.1% would recommend the course to a friend. Conclusions The online Sexology course for Obstetrics and Gynecology residents increased their knowledge about the sexual issues during pregnancy and after birth, and fulfilled the participants' expectations. The experience described here may serve as a model for other sexuality courses targeting similar audiences.

Objetivos Relatar a experiência de um curso de educação a distância sobre questões sexuais na gestação e puerpério para médicos residentes. Métodos Estudo prospectivo de intervenção educacional, realizado entre abril e setembro de 2014, por investigadores da Universidade Federal de São Paulo. Os participantes foram 219 médicos (R1 a R6). O curso teve carga horária de 24 horas (10 videoaulas e discussões online). No início do curso, os participantes responderam perguntas sobre treinamento, atitude e prática relativas a questões sexuais na gestação; antes e após o curso, responderam perguntas de conhecimento sobre o tema; ao final, preencheram questionário sobre a qualidade do curso. O teste t de Student foi utilizado para comparar os testes de conhecimento, antes e após o curso; valores de p < 0,05 foram considerados estatisticamente significantes. Resultados Um total de 143 residentes concluiu o curso; a maioria estava no 1° (27,2%) ou 3° (29,4%) anos de residência. Houve aumento significativo nas notas médias dos questionários que avaliavam o conhecimento sobre o tema: 4,4 (±1,6) versus 6,0 (±1,3; nota máxima: 10), no início e final do curso, respectivamente (p < 0,0001). A maioria dos participantes (74,1%) declarou que a qualidade geral do curso atingiu suas expectativas, e 81,1% recomendariam o curso a um amigo. Conclusões O curso de Sexologia online para residentes de Ginecologia e Obstetrícia promoveu o aumento do conhecimento sobre questões sexuais no ciclo gravídico puerperal, e atendeu às expectativas dos participantes. Essa experiência pode servir de modelo para outros cursos de sexualidade voltados para esse público.

Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study.

CONTEXT AND OBJECTIVE: Several risk factors are involved in perineal lacerations during vaginal delivery. However, little is known about the influence of perineal distensibility as a protective factor. The aim here was to determine a cutoff value for pelvic floor distensibility measured using the Epi-no balloon, which could be used as a predictive factor for perineal integrity in vaginal delivery. DESIGN AND SETTING: Prospective observational single cohort study conducted in a maternity hospital. METHODS: A convenience sample of 227 consecutive at-term parturients was used. All women had a single fetus in the vertex presentation, with up to 9.0 cm of dilation. The maximum dilation of the Epi-no balloon was measured using a tape measure after it had been inflated inside the vagina up to the parturients' maximum tolerance. The receiver operating characteristic (ROC) curve was used to obtain the Epi-no circumference measurement with best sensitivity and specificity. RESULTS: Among the 161 patients who were included in the study, 50.9% underwent episiotomy, 21.8% presented lacerations and 27.3% retained an intact perineum. Age > 25.9 years; number of pregnancies > 3.4; number of deliveries > 2.2 and circumference measured by Epi-no > 21.4 cm were all directly correlated with an intact perineum. Circumference measurements using the Epi-no balloon that were greater than 20.8 cm showed sensitivity and specificity of 70.5% and 66.7% (area under curve = 0.713), respectively, as a predictive factor for an intact perineum in vaginal delivery. CONCLUSION: Circumferences greater than 20.8 cm achieved using the Epi-no balloon are a predictive factor for perineal integrity in parturients.

Can Abdominal Hypopressive Technique Change Levator Hiatus Area?: A 3-Dimensional Ultrasound Study.

This study aimed to evaluate the levator hiatus area (LHA) at rest and during the performance of maximal pelvic floor muscle (PFM) contractions, during the abdominal hypopressive technique (AHT), and during the combination of PFM contractions (PFMCs) and the AHT. The study included 17 healthy nulliparous women who had no history of pelvic floor disorders. The LHA was evaluated with the patients in the lithotomy position. After a physiotherapist instructed the patients on the proper performance of the PFM and AHT exercises, 1 gynecologist performed the 3-dimensional translabial ultrasound examinations. The LHA was measured with the patients at rest. The PFMC alone, the AHT alone or the AHT in combination with a PFMC with 30 seconds of rest between the evaluations were performed. Each measurement was performed 2 times, and the mean value was used for statistical analysis. The Wilcoxon test was used to test the differences between the 2 maneuvers. Similar values were observed when comparing the LHA of the PFM at rest (12.2 ± 2.4) cm and during the AHT (11.7 ± 2.6) cm (P = 0.227). The AHT+ PFMC (10.2 ± 1.9) cm demonstrated lower values compared with AHT alone (11.7 ± 2.6) cm (P = 0.002). When comparing the PFMC (10.4 ± 2.1) cm with the AHT + PFMC (10.2 ± 1.9) cm, no significant difference (P = 0.551) was observed. During PFMC, the constriction was 1.8 cm; during the AHT, the constriction was 0.5 cm; and during the AHT + PFMC, it was 2 cm. The LHA assessed by 3-dimensional ultrasound did not significantly change with AHT. These results support the theory that AHT does not strengthen PFM.

Acupuncture for insomnia in pregnancy--a prospective, quasi-randomised, controlled study.

OBJECTIVE: This study was undertaken to test the effects of acupuncture on insomnia in a group of pregnant women under real life conditions, and to compare the results with a group of patients undergoing conventional treatment alone (sleep hygiene). METHODS: A total of 30 conventionally treated pregnant women were allocated at random into groups with or without acupuncture. Seventeen patients formed the study group and 13 the control group. The pregnant women scored the severity of insomnia using a Numerical Rating Scale from 0 to 10. Women were followed up for eight weeks and interviewed five times, at two-week intervals. RESULTS: Eight women dropped out, five in the study group and three in the control group. The study group reported a larger reduction on insomnia rating (5.1) than the control group (0.0), a difference which was statistically significant (P = 0.0028). Average insomnia scores decreased by at least 50% over time in nine (75%) patients in the study group and in three (30%) of the control group. CONCLUSION: The results of this study suggest that acupuncture alleviates insomnia during pregnancy and further research is justified.