Coexistence and prevalence of obstetric interventions: an analysis based on the grade of membership.

BACKGROUND: Obstetric interventions performed during delivery do not reflect improvements in obstetric care. Several practices routinely performed during childbirth, without any scientific evidence or basis - such as Kristeller maneuver, routine episiotomy, and movement or feeding restriction - reflect a disrespectful assistance reality that, unfortunately, remains in place in Brazil. The aims of the current study are to assess the coexistence and prevalence of obstetric interventions in maternity hospitals in Belo Horizonte City, based on the Grade of Membership (GoM) method, as well as to investigate sociodemographic and obstetric factors associated with coexistence profiles generated by it. METHODS: Observational study, based on a cross-sectional design, carried out with data deriving from the study "Nascer em Belo Horizonte: Inquérito sobre o Parto e Nascimento" (Born in Belo Horizonte: Survey on Childbirth and Birth). The herein investigated interventions comprised practices that are clearly useful and should be encouraged; practices that are clearly harmful or ineffective and should be eliminated; and practices that are inappropriately used, in contrast to the ones recommended by the World Health Organization. The analyzed interventions comprised: providing food to parturient women, allowing them to have freedom to move, use of partogram, adopting non-pharmacological methods for pain relief, enema, perineal shaving, lying patients down for delivery, Kristeller maneuver, amniotomy, oxytocin infusion, analgesia and episiotomy. The current study has used GoM to identify the coexistence of the adopted obstetric interventions. Variables such as age, schooling, skin color, primigravida, place-of-delivery financing, number of prenatal consultations, gestational age at delivery, presence of obstetric nurse at delivery time, paid work and presence of companion during delivery were taken into consideration at the time to build patients' profile. RESULTS: Results have highlighted two antagonistic obstetric profiles, namely: profile 1 comprised parturient women who were offered diet, freedom to move, use of partogram, using non-pharmacological methods for pain relief, giving birth in lying position, patients who were not subjected to Kristeller maneuver, episiotomy or amniotomy, women did not receive oxytocin infusion, and analgesia using. Profile 2, in its turn, comprised parturient women who were not offered diet, who were not allowed to have freedom to move, as well as who did not use the partograph or who were subjected to non-pharmacological methods for pain relief. They were subjected to enema, perineal shaving, Kristeller maneuver, amniotomy and oxytocin infusion. In addition, they underwent analgesia and episiotomy. This outcome emphasizes the persistence of an obstetric care model that is not based on scientific evidence. Based on the analysis of factors that influenced the coexistence of obstetric interventions, the presence of obstetric nurses in the healthcare practice has reduced the likelihood of parturient women to belong to profile 2. In addition, childbirth events that took place in public institutions have reduced the likelihood of parturient women to belong to profile 2. CONCLUSION(S): Based on the analysis of factors that influenced the coexistence of obstetric interventions, financing the hospital for childbirth has increased the likelihood of parturient women to belong to profile 2. However, the likelihood of parturient women to belong to profile 2 has decreased when hospitals had an active obstetric nurse at the delivery room. The current study has contributed to discussions about obstetric interventions, as well as to improve childbirth assistance models. In addition, it has emphasized the need of developing strategies focused on adherence to, and implementation of, assistance models based on scientific evidence.

[Intimate partner violence against pregnant women: the environment according to Levine's nursing theory]. / Violência perpetrada por parceiro íntimo à gestante: o ambiente à luz da teoria de Levine.

OBJECTIVE: Analyzing the elements that compose the environment of pregnant women who have experienced intimate partner violence in the light of Levine's Nursing Theory. METHOD: A qualitative, descriptive study conducted from September to January 2012, with nine pregnant women in a Municipal Health Center in Rio de Janeiro. The interviews were semi-structured and individual. The theoretical framework was based on Levine's Nursing Theory. RESULTS: Thematic analysis evidenced the elements that composed the external environment, such as violence perpetrated by intimate partners before and during pregnancy, violence in childhood and adolescence, alcohol consumption and drug use by the partner, unemployment, low education and economic dependency, which affected health and posed risks to the pregnancy. CONCLUSION: Violence perpetrated by an intimate partner was the main external factor that influenced the internal environment with repercussions on health. This theory represents a tool in nursing care which will aid in detecting cases and the fight against violence.

Time series analysis: trend in late maternal mortality in Brazil, 2010-2019.

To analyze the temporal trend of the late maternal mortality ratio (LMMR) in Brazil and its geographic regions in the period from 2010 to 2019, an ecological time series study was conducted. Data related to late maternal mortality from information systems of the Brazilian Ministry of Health were used. Statistical analysis used Prais-Winsten autoregressive models. A total of 1,470 late maternal deaths were reported in Brazil, resulting in an LMMR of 5 deaths per 100,000 live births. The late maternal mortality records revealed regional disparities, with the lowest index in the North (3.5/100,000 live births) and the highest in the South (8.3/100,000 live births). The LMMR showed an increasing trend in the country, with a general increase in the LMMR in the period and a mean annual percentage variation of 9.79% (95%CI: 4.32; 15.54). The Central-West region led this increase, with a mean annual percentage change of 26.06% (95%CI: 16.36; 36.56), followed by the North and Northeast regions, with 23.5% (95%CI: 13.93; 33.88). About 83% of the reported late maternal deaths were investigated, and 65.6% were corrected by the Maternal Mortality Committees. These findings highlight the relevance of late maternal mortality as an important indicator for maternal health, which is often invisible. The increase in the LMMR result from the improvement in the quality of the registration of these deaths in recent years in Brazil, and especially from the work of investigating deaths. The fragility of reporting with regional disparities points to the need for a more comprehensive approach that promotes equity and prevention of avoidable late maternal mortality.

Repercussions of SARS-CoV-2 infection and the pandemic on birth routes: a cross-sectional study.

OBJECTIVE: To assess the repercussions of SARS-CoV-2 infection (suspected or confirmed) and the context of the pandemic on the birth route and humanized assistance during childbirth. METHOD: Cross-sectional epidemiological study, nested within a cohort and comparative with the research "Birth in Belo Horizonte: Survey on Childbirth and Delivery".The medical records of three reference maternity hospitals in Belo Horizonte were assessed, with a final sample of 1,682 pregnant women, in the months of May, June and July 2020. A descriptive analysis was carried out, with absolute and relative frequency, and a comparative one, with a Pearson's chi-square test. RESULTS: It was observed that 2.02% of pregnant women were infected with SARS-CoV-2.Before the pandemic, out of a total of 390 pregnant women, 74.10% gave birth vaginally.During a pandemic, among infected women, 51.61% gave birth via cesarean section and 48,39% via vaginal delivery;among uninfected, 26.99% cesarean sections and 73.01% vaginaldeliveries. CONCLUSION: There was an increase in the percentage of cesarean sections and a possible influence of the pandemic on the rates of indication of cesarean sections at the time of admission to the maternity ward.

Rede Cegonha network and the methodological challenges of implementing networks in the SUS. / Rede Cegonha e desafios metodológicos de implementação de redes no SUS.

This paper addresses strategies employed in the implementation of the Rede Cegonha ("Stork Network") (RC), considering its contribution to change the delivery and birth care model in the Brazilian Unified Health System (SUS). It contextualizes RC as a project signed by SUS management interagency bodies and the importance of implementing the services' strategies. In this sense, it points out two essential axes supporting the RC, which are strategic to promote the intervention-analysis in obstetric-neonatal care, namely, institutional support (IS) and teamwork training. The IS enables the RC to become a collective construction assumed by teams in their action spaces and is pointed out as an innovative way of implementing health-related projects. The intervention-training methodology innovates training to intervene in work. These experiences are affirmed as potentiators of the RC in creating the conditions to change the technocratic rationale of management and care throughout labor and birth.

O artigo aborda estratégias usadas na implementação da Rede Cegonha (RC), considerando sua finalidade de contribuir para uma mudança de modelo de atenção ao parto e nascimento nos serviços do SUS. Contextualiza a RC como projeto firmado interinstâncias gestoras do SUS e a importância de estratégias de sua execução junto aos serviços. Nesse sentido aponta dois eixos essenciais na sustentação da RC, considerados estratégicos para promover a análise-intervenção na atenção obstétrico-neonatal: o apoio institucional (AI) e a formação para o trabalho em equipe. O AI possibilita que a RC se efetive como uma construção coletiva assumida pelas equipes nos seus espaços de ação; é apontado como inovação no modo de implementar projetos de saúde. A metodologia da formação-intervenção inova no modo de formar para intervir no trabalho. Essas experiências são afirmadas como potencializadoras da RC na criação de condições para mudar a lógica tecnocrática de gestão e atenção ao parto e nascimento.

Association between early pregnant hospitalization and use of obstetric interventions and cesarean: a cross-sectional study.

OBJECTIVE: Evaluate the association between early pregnant hospitalization and the use of obstetric interventions and cesarean delivery route. METHODS: Cross-sectional study, with 758 women selected at the time of childbirth. It was assumed as early hospitalization when the woman was admitted to the hospital having less than 6 cm of cervical dilation. Logistic regression models were constructed in order to estimate the odds ratio for each obstetric intervention, adjusted by sociodemographic and obstetric variables. RESULTS: 73.22% of women were early hospitalized. On average, they had 1.97 times the chance to undergo Kristeller's maneuver, 2.59 and 1.80 times the chance to receive oxytocin infusion and analgesia, respectively, and 8 times more chances to having their children by cesarean delivery when compared to women that had timely hospitalization. CONCLUSION: Early hospitalized women were submitted to a higher number of obstetric intervention and had increased chances of undergoing cesarean sections.

Methodology to articulate the process of training-intervention-evaluation in the professional education in nursing. / Metodologia para articular processos de formação-intervenção-avaliação na educação profissional em enfermagem.

This article presents a methodology for professional training in obstetrics nursing (ON) that goes beyond teaching specific competencies and contributes to the change in the model of childbirth care as proposed by Brazilian Unified Health System. This methodology addresses gaps and challenges in the current ON model and it builds on existing initiatives for the inclusion of ON in the teamwork environment. The training-intervention-evaluation method proposes the inclusion of evaluation as part of the training, which is in line with methods for intervention research. A triangulation of strategies, techniques, and instruments is conducted articulated to analytical dimensions of obstetric and neonatal care. This methodology was implemented in multicentric ON courses coordinated by the Federal University of Minas Gerais (UFMG) between 2016 and 2018. A total of 20 ON courses across states, 1,150 professionals (students, faculty, coordinators, preceptors, and supervisors), and 400 health services (internship fields and teaching hospitals) participated in the process. In conclusion, based on the experiences of those participating in this project, the implementation of this methodology produced nurses more qualified and better prepared for practice and for adapting the model of childbirth care.

O artigo apresenta uma metodologia de formação profissional em enfermagem obstétrica (EO) na perspectiva de avançar para além da apropriação de competências específicas e contribuir com a mudança de modelo de atenção ao parto e nascimento, conforme proposto pelo Sistema Único de Saúde. Estudo que parte das lacunas do modelo atual e de cursos recentes para incentivo à inserção da EO na ótica do trabalho em equipe. Nesse contexto apresenta um caminho metodológico de formação-intervenção-avaliação, com eixos diretivos de uma prática avaliativa indissociada da formação, alinhando conceitos que sustentam a proposta nos moldes de pesquisa-intervenção. Nesse caminho triangulam-se estratégias, técnicas e instrumentos, articulados a dimensões de análise do trabalho na atenção obstetriconeonatal. A metodologia foi desenvolvida tendo por campo cursos multicêntricos de EO coordenados pela UFMG entre 2016 e 2018, abrangendo: 20 cursos descentralizados nos estados, 1.150 profissionais (alunos e agentes envolvidos na condução), 400 serviços (campos de práticas). Conclui-se a apresentação metodológica com os principais rumos de efeitos das experiências, afirmando-se a produção e qualificação de redes de enfermeiros para a assistência e interferência no modelo de cuidado ao parto e nascimento.

Factors associated with the performance of episiotomy.

OBJECTIVE: To analyze the factors associated with the performance of episiotomy. METHODS: Cross-sectional study, developed with data from the research "Born in Belo Horizonte: Labor and birth survey, "conducted with 577 women who had their children via vaginal birth. In order to verify the magnitude of the association between episiotomy and its possible determinants, logistic regression models were constructed to estimate the odds ratio. RESULTS: Episiotomy was performed in 26.34% of women, and 59.21% knew they had been subjected to it. We observed that younger women, primiparous women, women assisted by a professional other than the obstetric nurse and women who had their babies in a private hospital have an increased chance of being submitted to this procedure. CONCLUSION: Considering the rates of episiotomy, this study highlights the need for the absolute contraindication to indiscriminate performing it.

Culture of patient safety in hospital units of gynecology and obstetrics: a cross-sectional study.

OBJECTIVES: to assess the patient safety culture of the health team working in three maternity hospitals. METHODS: observational, cross-sectional, comparative study. 301 professionals participated in the study. The Hospital Survey on Patient Safety Culture questionnaire validated in Brazil was used. For data analysis, it was considered a strong area in the patient safety culture when positive responses reached over 75%; and areas that need improvement when positive responses have reached less than 50%. To compare the results, standard deviation and thumb rule were used. RESULTS: of the 12 dimensions of patient safety culture, none obtained a score above 75%, with nine dimensions scoring between 19% and 43% and three dimensions between 55% and 57%. CONCLUSIONS: no strong dimensions for safety culture were identified in the three maternity hospitals. It is believed that these results may contribute to the development of policies that promote a culture of safety in institutions.

Factors associated with normal and cesarean delivery in public and private maternity hospitals: a cross-sectional study.

OBJECTIVES: to investigate the factors associated with the mode of delivery in pregnant women in the city of Belo Horizonte. METHODS: cross-sectional study developed with data from the study "Being born in Belo Horizonte: survey on childbirth and birth" carried out in seven maternity hospitals in Belo Horizonte - Minas Gerais. The final sample consisted of 1088 pregnant/postpartum women. In this study, to verify the magnitude of the association between the outcome variable and its possible determinants (exposure variables) logistic regression models were constructed to estimate the Odds Ratio. RESULTS: increasing age, the lack of companionship, the hospital's private financing for performing delivery and being a first-time pregnant woman increased the chance of delivery by cesarean section. Final Considerations: the knowledge of factors associated with the prevalence of cesarean sections can support reflections among health professionals about this surgical procedure in certain situations, especially when there are no precise clinical indications.

[Meanings of the childbirth plan for women that participated in the Meanings of Childbirth Exhibit]. / Os significados e sentidos do plano de parto para as mulheres que participaram da Exposição Sentidos do Nascer.

This study aimed to analyze the perspective of women who used the childbirth plan on their childbirth experience, the meanings of the childbirth plan and its components, and the relationship between the childbirth plan and labor and delivery. A qualitative descriptive study was performed. Data were collected with the questionnaire Meanings of Birth - Postpartum Contacts, applied via telephone contact. The study included women from the city and greater metropolitan area of Belo Horizonte, Minas Gerais, Brazil, that participated in the Meanings of Childbirth Exhibit in May-June 2015 and March 2016, when they were pregnant, with date of previous childbirth having occurred at least a year previously and without having experienced abortion. The questions were analyzed with content analysis. Data analysis revealed the following categories related to the childbirth plan: "presence of an accompanying person", "information on procedures", "use of pain relief methods", "use of anesthesia to continue with normal delivery", "eating during labor", "presence of a doula", "no unnecessary intervention", "normal delivery", "umbilical cord cut after pulsation", "presence of postpartum breastfeeding", and "respect/treatment". There was a direct relationship between performing the childbirth plan and a positive childbirth experience. This highlights the importance of using the childbirth plan as a technique that favors a positive childbirth experience. Women's development of the plan during prenatal care and its use by the attending healthcare team contributes to favorable labor.

O objetivo foi analisar a percepção das mulheres que realizaram o plano de parto sobre a experiência de parto, os significados do plano de parto, seus elementos constituintes e a relação do plano de parto com o trabalho de parto e parto. Um estudo descritivo qualitativo foi realizado. Os dados foram coletados por meio do questionário Sentidos do Nascer - Contatos Pós-parto, aplicado via contato telefônico. Incluiu mulheres de Belo Horizonte, Minas Gerais, Brasil, e região metropolitana que participaram da Exposição Sentidos do Nascer, no período de maio a junho de 2015 e março de 2016, quando estavam grávidas, com data do parto anterior ocorrida há mais de um ano e não ter tido abortamento. O tratamento analítico empregado foi a análise de conteúdo das questões. A partir da análise dos dados, emergiram as seguintes categorias referentes ao plano de parto: "presença de acompanhante", "informações sobre os procedimentos", "uso de métodos de alívio de dor", "o uso de anestesia para a continuação do parto normal", "alimentação durante o trabalho de parto", "presença da doula", "não haver intervenção desnecessária", "realização do parto normal", "corte do cordão umbilical após cessar pulsação", "presença e amamentação de recém-nascido pós-parto" e "respeito/tratamento". Observou-se relação direta com a realização do plano de parto e a experiência do parto positiva. Destaca-se a importância da utilização do plano de parto como uma tecnologia que favorece a experiência positiva do parto. A construção do plano pelas mulheres durante o pré-natal e a realização dele por parte da equipe de saúde contribuíram para o desenvolvimento favorável do trabalho de parto.

El objetivo fue analizar la percepción de las mujeres que participaron en el plan de parto sobre su experiencia durante el mismo, los significados del plan de parto, sus elementos constituyentes y la relación del plan de parto con el trabajo de parto y el parto en sí. Se realizó un estudio descriptivo cualitativo. Los datos se recogieron mediante el cuestionario Sentidos de Nacer - Contactos Posparto, aplicado por contacto telefónico. Incluyó a mujeres de Belo Horizonte, Minas Gerais, Brasil, y región metropolitana que participaron en la Exposición Sentidos de Nacer, durante el período de mayo a junio de 2015 y marzo de 2016, cuando estaban embarazadas, con un parto anterior con fecha de hacía más de un año y no haber sufrido un aborto. El tratamiento analítico empleado fue el análisis de contenido de las cuestiones. A partir del análisis de los datos, surgieron las siguientes categorías referentes al plan de parto: "presencia de acompañante", "información sobre los procedimientos", "uso de métodos para aliviar el dolor", "uso de anestesia para continuar con el parto normal", "alimentación durante el trabajo de parto", "presencia de una partera", "inexistencia de intervención innecesaria", "realización de parto normal", "corte del cordón umbilical tras cesar la pulsación", "presencia y lactancia de recién nacido posparto" y "respeto/tratamiento". Se observó la relación directa con la realización del plan de parto y la experiencia de parto positiva. Se destaca la importancia de la utilización del plan de parto como una tecnología que favorece la experiencia positiva del parto. La construcción del plan por parte de las mujeres durante el período prenatal y la realización del mismo, por parte del equipo de salud, contribuyen al desarrollo favorable del trabajo de parto.

Obstetric violence: influences of the Senses of Birth exhibition in pregnant women childbirth experience. / Violência obstétrica: influência da Exposição Sentidos do Nascer na vivência das gestantes.

Excessive interventions during labor in Brazil have been reported as disrespect and abuse and contribute to neonatal and maternal morbidity and mortality. The Senses of Birth exhibition aims to encourage normal birth to promote health and improve the experience of childbirth in the country. This article describes the characteristics of 555 women who visited the exhibition during pregnancy and their perception of obstetric violence in childbirth. Obstetric violence was reported by 12.6% of the women, mostly low-income and unmarried. It was associated to lithotomic position and Kristeller maneuver during childbirth and non-immediate skin-to-skin contact with the baby. The main categories of obstetric violence reported were: not accepted interventions /accepted interventions on the basis of partial information (36.9%), undignified care / verbal abuse (33.0%); physical abuse (13.6%); non-confidential / non-privative care (2.9%) and discrimination (2.9%). Visiting the exhibition significantly increased pregnant women's knowledge about obstetric violence. However, recognition of obsolete or harmful practices as obstetric violence was still low. Initiatives such as Senses of Birth may contribute to increase knowledge and social mobilization to disseminate good practices in childbirth care.

O excesso de intervenções no parto no Brasil tem sido reportado como violência obstétrica e contribui para os índices elevados morbi-mortalidade materna e neonatal. A exposição Sentidos do Nascer busca incentivar o parto normal para promover a saúde e melhorar a experiência de parir e nascer no País. Este artigo analisa o perfil e a experiência de parto de 555 mulheres que visitaram a exposição durante a gestação, com enfoque na percepção sobre violência obstétrica. A violência obstétrica foi reportada por 12,6% das mulheres e associada ao estado civil, à menor renda, à ausência de companheiro, ao parto em posição litotômica, à realização da manobra de Kristeller e à separação precoce do bebê após o parto. Predominaram nos relatos de violência obstétrica: intervenção não consentida/aceita com informações parciais, cuidado indigno/abuso verbal; abuso físico; cuidado não confidencial/privativo e discriminação. A visita à exposição aumentou o conhecimento das gestantes sobre violência obstétrica. Entretanto, o reconhecimento de procedimentos obsoletos ou danosos na assistência ao parto como violência obstétrica foi ainda baixo. Iniciativas como esta podem contribuir para ampliar o conhecimento e a mobilização social sobre as práticas na assistência ao parto e nascimento.

Obstetric Nursing in best practices of labor and delivery care.

OBJECTIVE: to evaluate the association of Obstetric Nursing in the best practices of delivery and birth care in maternity hospitals. METHOD: a cross-sectional study, with 666 women selected for delivery. Parturition obstetric practices performed by professionals were categorized into: clearly useful practices that should be encouraged, practices that are clearly harmful or ineffective and that should be eliminated and practices used inappropriately at the time of parturition. RESULTS: clearly useful practices were used in greater proportions in the hospitals that had Obstetric Nursing working, while clearly harmful practices and those used inappropriately were practiced in smaller proportions in hospitals that had Obstetric Nursing, both with statistical difference. CONCLUSION: institutions with Obstetric Nursing adopt better practices of delivery and birth care, based on scientific evidence, when compared to those that do not act.

Time series analysis: trend in late maternal mortality in Brazil, 2010-2019 / Análisis de serie temporal: tendencia de la mortalidad materna tardía en Brasil, 2010-2019 / Análise de série temporal: tendência da mortalidade materna tardia no Brasil, 2010-2019

Abstract: To analyze the temporal trend of the late maternal mortality ratio (LMMR) in Brazil and its geographic regions in the period from 2010 to 2019, an ecological time series study was conducted. Data related to late maternal mortality from information systems of the Brazilian Ministry of Health were used. Statistical analysis used Prais-Winsten autoregressive models. A total of 1,470 late maternal deaths were reported in Brazil, resulting in an LMMR of 5 deaths per 100,000 live births. The late maternal mortality records revealed regional disparities, with the lowest index in the North (3.5/100,000 live births) and the highest in the South (8.3/100,000 live births). The LMMR showed an increasing trend in the country, with a general increase in the LMMR in the period and a mean annual percentage variation of 9.79% (95%CI: 4.32; 15.54). The Central-West region led this increase, with a mean annual percentage change of 26.06% (95%CI: 16.36; 36.56), followed by the North and Northeast regions, with 23.5% (95%CI: 13.93; 33.88). About 83% of the reported late maternal deaths were investigated, and 65.6% were corrected by the Maternal Mortality Committees. These findings highlight the relevance of late maternal mortality as an important indicator for maternal health, which is often invisible. The increase in the LMMR result from the improvement in the quality of the registration of these deaths in recent years in Brazil, and especially from the work of investigating deaths. The fragility of reporting with regional disparities points to the need for a more comprehensive approach that promotes equity and prevention of avoidable late maternal mortality.

Resumen: Con el objetivo de evaluar la tendencia temporal de la tasa de mortalidad materna tardía (TMMT) en Brasil y sus regiones geográficas para el período de 2010 a 2019, se realizó un estudio de serie temporal ecológica. Se utilizaron datos relacionados con la mortalidad materna tardía de los sistemas de información del Ministerio de la Salud de Brasil. El análisis estadístico empleó modelos de regresión de Prais-Winsten. Hubo 1.470 muertes maternas tardías en Brasil, lo que resultó en una TMMT de 5 muertes por cada 100.000 nacidos vivos. Los registros de mortalidad materna tardía revelaron disparidades regionales con la tasa más baja en la Región Norte (3,5/100.0000 nacidos vivos) y la más alta en la Región Sur (8,3/100.000 nacidos vivos). Hubo una tendencia a aumento de TMMT en el país, con un incremento general de TMMT para el período y una variación media porcentual anual de un 9,79% (IC95%: 4,32; 15,54). La Región Centro-oeste presentó las tasas más elevadas, con una variación media porcentual anual de un 26,06% (IC95%: 16,6; 36,56), seguida de las regiones Norte y Nordeste, con un 23,5% (IC95%: 13,93; 33,88). Aproximadamente el 83% de las muertes materna tardía reportadas fueron investigadas, y el 65,6% fue corregido por los Comités de Mortalidad Materna. Estos hallazgos muestran la relevancia de la mortalidad materna tardía como un indicador de importancia para la salud materna, muchas veces invisibilizada. El incremento en la TMMT encontrada puede deberse a la mejora en la calidad del registro de estas muertes en los últimos años en Brasil, especialmente de la investigación de las muertes. La debilidad de las notificaciones con disparidades regionales apunta a la necesidad de un enfoque más integral que promueva la equidad y la prevención de la mortalidad materna tardía evitable.

Resumo: Com o propósito de analisar a tendência temporal da razão de mortalidade materna tardia (RMMT) no Brasil e suas regiões geográficas no período de 2010 a 2019, conduziu-se um estudo ecológico de série temporal. Foram utilizados dados relacionados à mortalidade materna tardia, provenientes de sistemas de informação do Ministério da Saúde. A análise estatística empregou modelos autorregressivos de Prais-Winsten. Foram notificados 1.470 óbitos maternos tardios no Brasil, resultando em uma RMMT de 5 óbitos a cada 100 mil nascidos vivos. Os registros de mortalidade materna tardia revelaram disparidades regionais com o menor índice na Região Norte (3,5/100 mil nascidos vivos) e o maior na Região Sul (8,3/100 mil nascidos vivos). Houve tendência crescente da RMMT no país, com aumento geral no período e variação percentual média anual de 9,79% (IC95%: 4,32; 15,54). A Região Centro-oeste liderou esse aumento, com variação percentual média anual de 26,06% (IC95%: 16,36; 36,56), seguida pelas regiões Norte e Nordeste, com 23,5% (IC95%: 13,93; 33,88). Cerca de 83% das mortes maternas tardias declaradas foram investigadas, sendo que 65,6% foram corrigidas pelos Comitês de Mortalidade Materna. Esses achados ressaltam a relevância da mortalidade materna tardia como um indicador de importância para a saúde materna muitas vezes invisibilizado. O aumento da RMMT verificado pode ser resultado da melhoria da qualidade do registro desses óbitos nos últimos anos no Brasil, sobretudo do trabalho de investigação dos óbitos. A fragilidade das notificações com as disparidades regionais aponta a necessidade de uma abordagem abrangente que promova equidade e prevenção de mortalidade materna tardia evitáveis.

[The postpartum appointment: women's needs from the perspective of social needs in health care]. / A consulta puerperal: demandas de mulheres na perspectiva das necessidades sociais em saáde.

Postpartum appointments are essential in women health care. This study aimed at identifying the social health needs of women during postpartum. A survey was conducted with 50 puerperal women of the Curitiba Mother Program receiving care at basic health units of a health district of the city of Curitiba, Paraná, southern Brazil. An instrument with objective questions was applied in February and March, 2007, to collect the data. Descriptive statistics was used to analyze the data. The most frequently mentioned set of needs was "to be someone with the right to be different", whereas the least mentioned was "link with health professional and team". The latter appears as a positive aspect of the nurse's (and health team) work, whereas the first shows the need to build practices to strengthen the autonomy and the self-reliance of women in health care.

Perfil de mulheres atendidas em hospital de alta complexidade devido a agressão por queimadura pelo parceiro / Profile of women attended at a high complexity hospital due to assumption due to burning by the partner / Perfil de mujeres atendidas a un hospital de alta complejidad por asunción por quemaduras por parte de la pareja

Objetivo: Descrever o perfil dos atendimentos a mulheres que foram agredidas pelo parceiro íntimo e sofreram queimaduras em hospital de referência em trauma, urgência e emergência do Estado de Minas Gerais. Método: estudo transversal, que analisou prontuários de 19 mulheres vítimas de agressão por queimadura realizadas pelo parceiro íntimo em um hospital de referência em trauma, urgência e emergência no período de 2016 a 2019. Resultados: A maioria das vítimas era parda, casada, com filhos, trabalhava informalmente e foi agredida na residência. O atendimento incluiu prioridade muito urgente/laranja, queimaduras graves de 2º grau, internação, procedimentos cirúrgicos, complicações e acompanhamento ambulatorial pós-alta. Conclusão: Os resultados indicam atendimentos de alta complexidade, o que implica necessidade de os serviços de saúde estabelecerem mecanismos de rastreamento e investigação da violência contra a mulher, bem como preparo da equipe, prevenindo agravamentos e oferecendo suporte adequado

Objective: To describe the epidemiological profile of women who suffered assault due to burns by their intimate partner and were treated at a referral hospital for trauma emergencies in the State of Minas Gerais, Brazil. Method: This cross-sectional study analyzed the medical records of 19 women who were victims of assault due to burns by their intimate partner from 2016 to 2019in a referral hospital for trauma emergencies in Minas Gerais. Results: Most victims were Brown, married, with children, worked informally, and were assaulted at home. Care included very urgent/orange priority treatment, severe second-degree burns, hospitalization, surgical procedures, complications, and post-discharge outpatient follow-up. Conclusion: Health services must establish mechanisms to track and investigate violence against women, preventing the worsening of their condition and offering adequate support. Professionals must be prepared at all levels of care and use surveillance and promotion strategies

Describir el perfil de atención a mujeres que sufrieron agresión por quemaduras por parte de su pareja íntima, atendidas en un hospital de referencia para trauma, urgencia y emergencia en el estado de Minas Gerais (Brasil). Método: estudio transversal, que analizó las historias clínicas de 19 mujeres víctimas de agresión por quemaduras por parte de su pareja íntima atendidas en un hospital de referencia de trauma, urgencia y emergencia en Minas Gerais, en el periodo de 2016 a 2019. Resultados: La mayoría de las víctimas eran pardas, casadas, con hijos, trabajaban informalmente y fueron agredidas en su casa. La atención incluyó prioridad muy urgente/naranja, quemaduras graves de segundo grado, hospitalización, procedimientos quirúrgicos, complicaciones y seguimiento ambulatorio posterior al alta. Conclusión: Los resultados muestran una atención de alta complejidad, lo que requiere que los servicios de salud establezcan mecanismos para el seguimiento e investigación de la violencia contra la mujer, así como una mejor preparación de los profesionales para prevenir los agravamientos y ofrecer una adecuada asistencia

Repercussions of SARS-CoV-2 infection and the pandemic on birth routes: a cross-sectional study / Repercusiones de la infección por SARS-CoV-2y la pandemia en las vías de nacimiento: un estudio transversal / Repercussões da infecção por SARS-CoV-2 e da pandemia nas vias de nascimento: estudo transversal

ABSTRACT Objective: To assess the repercussions of SARS-CoV-2 infection (suspected or confirmed) and the context of the pandemic on the birth route and humanized assistance during childbirth. Method: Cross-sectional epidemiological study, nested within a cohort and comparative with the research "Birth in Belo Horizonte: Survey on Childbirth and Delivery".The medical records of three reference maternity hospitals in Belo Horizonte were assessed, with a final sample of 1,682 pregnant women, in the months of May, June and July 2020. A descriptive analysis was carried out, with absolute and relative frequency, and a comparative one, with a Pearson's chi-square test. Results: It was observed that 2.02% of pregnant women were infected with SARS-CoV-2.Before the pandemic, out of a total of 390 pregnant women, 74.10% gave birth vaginally.During a pandemic, among infected women, 51.61% gave birth via cesarean section and 48,39% via vaginal delivery;among uninfected, 26.99% cesarean sections and 73.01% vaginaldeliveries. Conclusion: There was an increase in the percentage of cesarean sections and a possible influence of the pandemic on the rates of indication of cesarean sections at the time of admission to the maternity ward.

RESUMEN Objetivo: Evaluar las repercusiones de la infección por SARS-CoV-2 (sospechosa o confirmada) y el contexto de la pandemia en la vía del parto y la asistencia humanizada durante el parto. Método: Estudio epidemiológico transversal, anidado en una cohorte y comparativo con la investigación "Nacimiento en Belo Horizonte: Encuesta sobre Parto y Parto".Se enviaron los prontuarios de tres maternidades de referencia en Belo Horizonte, con una muestra final de 1.682 gestantes, en los meses de mayo, junio y julio de 2020. Se realizó un análisis descriptivo, con frecuencia absoluta y relativa, y comparativo. uno, con una prueba de Chi, cuadrado de Pearson. Resultados: Tenga en cuenta que el 2,02% de las mujeres embarazadas estaban infectadas con SARS-CoV-2.Antes de la pandemia, en un total de 390 gestantes, el 74,10% daba a luz por vía vaginal.Durante una pandemia, entre las mujeres infectadas, el 51,61% dio a luz por cesárea y el 48,39% por parto vaginal;en las no infectadas, 26,99% cesáreas y 73,01% vaginales. Conclusión: Hubo un aumento en el porcentaje de cesáreas y una posible influencia de la pandemia en las tasas de indicación de cesáreas al momento del ingreso a la sala de maternidad.

RESUMO Objetivo: Avaliar as repercussões da infecção por SARS-CoV-2 (suspeita ou confirmada) e do contexto da pandemia na via de nascimento e na assistência humanizada ao parto. Método: Estudo epidemiológico transversal, aninhado a uma coorte e comparativo com a pesquisa "Nascer em Belo Horizonte: Inquérito sobre o Parto e Nascimento". Avaliou-se prontuários de três maternidades-referência em Belo Horizonte, com amostra final de 1.682 parturientes, nos meses de maio, junho e julho de 2020. Realizou-se análise descritiva, com frequência absoluta e relativa, e comparativa, com teste Qui-quadrado de Pearson. Resultados: Observou-se que, 2,02% das gestantes estavam infectadas por SARS-CoV-2. Antes da pandemia, em um total de 390 gestantes, 74,10% pariram via vaginal. Durante a pandemia, nas mulheres infectadas, 51,61% pariram pela via cesariana e 48,39% pela vaginal; nas não infectadas, 26,99% cesarianas e 73,01% vaginais. Conclusão: Observou-se aumento percentual de cesarianas e possível influência da pandemia nas taxas de indicação de cesarianas no momento da admissão na maternidade.

[Episiotomy: focusing women's view]. / Episiotomia: em foco a visão das mulheres.

Enough scientific evidences exist for the recommendation of the abolition of the used episiotomia in a liberal way. With objective of identifying the vision of a group of post-partum women in relation to the episiotomy it was done a study of qualitative approach, with the participation of 20 women, in the postpartumn period. It was used for data collection a semi-structured tool applied from April to June, 2004. The results were analyzed based in thematic analysis. The women's ignorance was verified in relation to the episiotomy and on their own body; although, they did not receive information, in any moment that this is a selective intervention, indicating the need of knowledge amplification and of the ransom of the woman's autonomy in the childbirth process and birth.

[Alice Michaud--devotion and glory: the first nurse in Paraná]. / Alice Michaud--dedicação e glória: a primeira enfermeira do Paraná.

This study is about a part of Alice Michaud's biography, the first nurse in Parana and the first ABEn-PR's president, majored in 1948, being the third group of the Nursing School in São Paulo-USP The facts stated here were obtained from periodicals, recorded interviews with the honored nurse and after her death by documents given by the family. The data permitted to identify the source, the formation, the main work developed, the homages and the public acknowledgment of this nurse. This is the first, out of a series of registers, to be done standing out the life and work of Alice Michaud.

Estratégias de mulheres e familiares no enfrentamento da síndrome congênita do zika vírus / Estrategias de las mujeres y los miembros de la familia para hacer frente al síndrome congénito del virus del zika / Strategies of women and family members in coping with congenital zika virus syndrome

Objetivo: conhecer os recursos familiares e as estratégias de enfrentamento utilizadas na situação de cuidar de uma criança com Síndrome Congênita do Zika vírus. Método: pesquisa qualitativa e interpretativa realizada com mulheres acometidas pelo Zika vírus na gestação e filhos com diagnóstico da Síndrome Congênita do Zika vírus, mediante análise temática de conteúdo embasada no modelo de resiliência, estresse, ajustamento e adaptação familiar. Coleta de dados realizada por meio de entrevistas semiestruturadas e construção de genogramas e ecomapas das famílias como suporte. Resultados: contribuíram como recursos para o enfrentamento das mulheres e famílias a própria família, amigos, vizinhos, grupos, pessoas da comunidade, profissionais de saúde, fontes de informação e a fé em Deus. Considerações finais: as estratégias utilizadas pelas mulheres e seus familiares para cuidar de criança com Síndrome Congênita do Zika vírus procuraram encontrar um caminho singular, em busca do equilíbrio no processo de adaptação, conforme cada realidade e necessidade.

Objetivo: conocer los recursos familiares y las estrategias de afrontamiento utilizadas en la situación de cuidado de un niño con Síndrome Congénito del virus del Zika. Método: investigación cualitativa e interpretativa realizada con mujeres afectadas por el virus Zika durante el embarazo y niños diagnosticados con Síndrome Congénito del virus Zika, a través del análisis temático de contenido basado en el modelo de resiliencia, estrés, adaptación y adaptación familiar. La recolección de datos se realizó a través de entrevistas semiestructuradas y la construcción de genogramas y ecomapas de familias como soporte. Resultados: las familias, sus familias, sus propios amigos, vecinos, grupos, personas de la comunidad, profesionales de la salud, fuentes de información y fe en Dios, contribuyeron como recursos a las mujeres y las familias. Consideraciones finales: las estrategias utilizadas por las mujeres y sus familias para cuidar a los niños con Síndrome Congénito del virus del Zika buscaron encontrar un camino singular, buscando el equilibrio en el proceso de adaptación, de acuerdo a cada realidad y necesidad.

Objective: to know the family resources and coping strategies used in the situation of caring for a child with Congenital Zika virus Syndrome. Method: qualitative and interpretative research conducted with women affected by Zika virus during pregnancy and children diagnosed with Congenital Zika virus Syndrome, through thematic analysis of content based on the model of resilience, stress, adjustment and family adaptation. Data collection was performed through semi-structured interviews and the construction of genograms and ecomaps of families as support. Results: the families, their families, their own friends, neighbors, groups, community people, health professionals, sources of information and faith in God, contributed as resources to the women and families. Final considerations: the strategies used by women and their families to care for children with Congenital Zika virus syndrome sought to find a singular path, seeking balance in the adaptation process, according to each reality and need.