Connaissances, attitudes et perceptions de la césarienne chez les gestantes suivies en CPN dans 6 maternités de Kinshasa / NA

Objectifs: Evaluer le niveau de connaissances, décrire les attitudes ainsi que les perceptions des gestantes sur la césarienne. MéthodesIl s'agissait d'une étude descriptive transversale qui s'est déroulée durant la période allant du 01 Février au 30Avril 2023 (soit 3mois) dans les services des consultations prénatales (CPN) des 6 6 structures de la Ville Province de Kinshasa ; les Cliniques Universitaires de Kinshasa (CUK), le Centre Hospitalier Roi Baudoin 1, l'Hôpital Saint Joseph(HSJ), les Maternités de Kintambo, de Binza et de Kingasani. Un total de 481 gestantes était interrogé dans l'ensemble des formations sanitaires sélectionnées. Les données sociodémographiques et celles relatives à la connaissance, attitude et perception sur la césarienne ont été récoltées par interview et analysées à l'aide des statistiques descriptives. L'évaluation de connaissances était faite selon la cotation suivante; moins de 50% de bonnes réponses (MAUVAISES) ;entre 50% et 70% de bonnes réponses (MOYENNES) et plus de 70% de bonnes réponses ( BONNES ). L'échelle de Likert a servi à l'évaluation des attitudes et perceptions sur la césarienne. Résultats Sur les 481 gestantes interviewées, seulement 16,1% avaient un antécédent personnel de Césarienne, l'âge de moyen de gestantes était de 29 ans, mariées pour la plupart (87,9%), employée (56,4%) avec un niveau d'étude secondaire (49,3%) et un niveau socio-économique moyen (53,8%). La source d'information sur cette intervention était diversifiée chez 39,8% de gestantes et les CPN n'ont contribué que dans 22,4%. Le niveau de connaissance était satisfaisant chez 73, 3% de gestantes. L'attitude des gestantes était négative chez 70,1% la perception par contre était positive à 64,4 %. Conclusion: La majorité de gestantes avait un niveau suffisant de connaissances sur la césarienne et une perception positive alors qu'elle garde une attitude négative face à cette intervention.

Objectives: Evaluate the level of knowledge, describe the attitudes and perceptions of pregnant women about cesarean section. Methods This was a cross-sectional descriptive study which took place during the period from February 1 to April 30, 2023 (i.e. 3 months) in the prenatal consultation services (PCS) of the 6 health structures in the City Province of Kinshasa; the University Clinics of Kinshasa (UCK), Roi Baudoin 1 Hospital Center, Saint Joseph Hospital (SJH), Kintambo, Binza and Kingasani maternity wards. A total of 481 pregnant women were interviewed in all the selected health facilities.ResultsAmong the 481 pregnant women interviewed, only 16.1% had a personal history of Caesarean section, the average age of pregnant women was 29 years, most of them married (87.9%), employed (56.4%) with a secondary education level (49.3%) and a socio-economic level. average economic (53.8%). The source of information on this intervention was diversified among 39.8% of pregnant women and antenatal cares only contributed to 22.4%. The level of knowledge was satisfactory in 73.3% of pregnant women. The attitude of the pregnant women was negative at 70.1%, the perception on the other hand was positive at 64.4%.Conclusion:The majority of pregnant women had a sufficient level of knowledge about caesarean section and a positive perception while they maintain a negative attitude towards this intervention

El enigma del coronavirus - La variante BA.2.86 del SARS-CoV-2 - Lo nuevo sobre el COVID prolongado - Vacunas - Premios Nobel

El coronavirus ha continuado paseándose por el mundo con nuevas variantes, algunas consideradas de preocupación. Las hospitalizaciones aumentaron en algunas partes con la variante BA.2.86, especialmente en personas mayores obesas o con morbilidad, pero han disminuido, así como los fallecimientos. Las mujeres que gestaron mediante técnicas de reproducción asistida tuvieron similar morbilidad que quienes gestaron espontáneamente, pero con más resultados maternoperinatales adversos en aquellas de mayor edad, con embarazos múltiples, nuliparidad, índice de masa corporal >30. Los niños que nacieron al inicio de la pandemia mostraron un microbioma de diferente composición que quienes nacieron antes de la pandemia, lo que pudiera afectar su salud más adelante en la vida. Las personas que presentan COVID prolongado, un cuarto de ellas sufre secuelas en órganos y sistemas, con limitación y años perdidos de actividades, así como posibilidad de muerte prematura. El COVID prolongado ocurre más en mujeres entre 35 y 49 años y en quienes tienen menos ingresos económicos. Podrían desarrollar diabetes tipo 2. Habría interacciones directas entre el SARS-CoV-2 y proteínas mitocondriales esenciales en la producción de energía. El ARN viral ha sido detectado en lesiones ateroescleróticas coronarias y la espiga ha sido hallada en huesos del cráneo, meninges y cerebro. Las vacunas contra el coronavirus protegen a las gestantes y sus recién nacidos a través de transferencia placentaria y la lactancia. En la población, la inmunidad protectora de la infección y de las vacunas declina con el tiempo y se requerirá nueva vacunación con una regularidad aún no determinada.

The coronavirus has continued to move around the world with new variants, some of which are of concern. Hospitalizations increased in some places with the BA.2.86 variant, especially in obese or morbid elderly people, but have decreased, as have deaths. Women who gestated by assisted reproductive techniques had similar morbidity as those who gestated spontaneously, but with more adverse maternal-perinatal outcomes in those older, with multiple pregnancies, nulliparity, body mass index >30. Children born at the beginning of the pandemic showed a different microbiome composition than those born before the pandemic, which could affect their health later in life. Among people with long COVID, a quarter of them suffer organ and system sequelae, with limitation and lost years of activity, as well as the possibility of premature death. Long COVID occurs more in women between 35-49 years of age and in those with lower income. They could develop type 2 diabetes. There would be direct interactions between SARS-CoV-2 and mitochondrial proteins essential in energy production. Viral RNA has been detected in coronary atherosclerotic lesions and the spike has been found in skull bones, meninges and brain. Coronavirus vaccines protect pregnant women and their newborns through placental transfer and lactation. In the population, protective immunity from infection and vaccines declines over time and new vaccination will be required at an as yet undetermined regularity.

El enigma del coronavirus - Consecuencias de la infección por el SARS-CoV-2 en el ser humano El cerebro - Gestante y recién nacido

El virus SARS-CoV-2 sigue replicándose. Sus nuevas variantes no estarían causando las muertes y hospitalizaciones graves de los años 2020 a 2022, por lo que la Organización Mundial de la Salud (OMS) ha declarado el final del estado de emergencia sanitaria. Hasta el 24 de mayo de 2023, el tablero de coronavirus de la OMS señala más de 766 millones de casos confirmados, y cerca de 7 millones de muertes en el mundo, con mayor concentración en Europa, Pacífico Occidental y América (especialmente en los E.E. U.U. y Brasil). Europa y China se preparan para los nuevos avances del virus. Por ello se recomienda precaución sanitaria y cumplir con la vacunación y refuerzos, así como elaborar nuevas vacunas. Se comenta sobre la fragilidad de los ensayos aleatorios publicados en los primeros dos años de la pandemia, así como los recientes hallazgos de cuáles enfermos con COVID podrían desarrollar COVID prolongado. Es de importancia conocer los nuevos alcances sobre la afectación del coronavirus sobre la gestante, el feto y neonato y el seguimiento inicial de los últimos.

The SARS-CoV-2 virus continues to replicate. Its new variants would not be causing the deaths and serious hospitalizations of the years 2020-2022, so the World Health Organization (WHO) has declared the end of the state of health emergency. Until May 24, 2023, the WHO coronavirus dashboard shows more than 766 million confirmed cases, and about 7 million deaths in the world, with greater concentration in Europe, Western Pacific, and America (especially the U.S.A. and Brazil). Europe and China prepare for new virus breakthroughs. Therefore, health precaution is recommended, as well as compliance with vaccination and boosters, and the development of new vaccines. We comment on the fragility of randomized trials published in the first two years of the pandemic, as well as recent findings of which patients with COVID could develop long COVID. It is important to know the new scopes on the affectation of the coronavirus on the pregnant woman, the fetus and the neonate and the initial follow-up of the latter.

Vozes silenciadas: vivências de pessoas que convivem com HIV na província de Gaza, Moçambique / Silenced voices: experiences of people living with HIV in the province of Gaza, Mozambique / Voces silenciadas: experiencias de personas que viven con el VIH en la provincia de Gaza, Mozambique

OBJETIVO: No mundo, cerca de 16 milhões de mulheres vivem com HIV, muitas delas em idade reprodutiva. Esses níveis de infecção e as taxas de transmissão vertical ainda trazem grandes preocupações, devido à pouca intervenção terapêutica precoce em muitos países africanos. Em Moçambique, país da África Subsaariana, os índices de prevalência do HIV são de 13,2%, colocando o país em segundo lugar na conta de novas infecções, atrás apenas da África do Sul. OBJETIVO: Conhecer as experiências e as principais dificuldades vivenciadas pelas gestantes ou lactantes soropositivas e seus parceiros sexuais no contexto específico. METODOLOGIA: Estudo qualitativo realizado em Chókwè na província de Gaza- Moçambique. Foram realizadas entrevistas semiestruturadas com mulheres gestantes ou lactantes que vivem com HIV, com seus parceiros sexuais e com profissionais de saúde. Foram realizados grupos focais com mães mentoras e entrevista em grupo com pais mentores, as quais ocorreram no segundo semestre de 2021. As entrevistas e os encontros foram gravados com gravador de voz e transcritas na íntegra. As informações passaram pelo processo de análise temática. RESULTADOS: Participaram do estudo dez mulheres gestantes ou lactantes soropositivas e um parceiro sexual; treze mães mentoras e dois pais mentores; duas enfermeiras de Saúde Materno Infantil e uma psicóloga. Os achados revelam que as participantes associam o diagnóstico do HIV ao teste de gravidez ou ao parto, e o período da gestação e da amamentação é marcado pelo medo de infectar o filho com o vírus. As mulheres escondem seu estado sorológico do marido, da família e da comunidade por medo das consequências relacionadas com normas sociais rígidas e interferência de fatores culturais. Os resultados dos profissionais de saúde trouxeram aspectos similares aos das mulheres vivendo com HIV, entretanto, ressaltam a falta de profissionais para oferecer atendimento de qualidade. Constatou-se que na unidade de saúde e na comunidade utilizam palestras como única estratégia de educação em saúde, apesar da pouca eficácia. CONCLUSÕES: Observou-se que ainda existem muitas barreiras para prevenção da transmissão vertical em Moçambique, em especial, a qualidade do aconselhamento e dificuldades de acesso ao serviço, seja por falta de recursos ou pelas normas sociais e familiares que não reconhecem a autonomia da mulher. É necessario apoiar as mães que não desejam amamentar e aquelas que tem maior vulnerabilidade socioeconômica. Recomenda-se maior investimento nas estratégias de apoio psicossocial e envolvimento comunitário, utilizando alternativas como a Terapia Comunitária Integrativa (TCI) e Educação Popular. Sugere-se o envolvimento de lideranças comunitárias no processo de desenvolvimento de um programa de intervenção e promoção de saúde mental para mulheres gestantes ou lactantes soropositivas.

OBJECTIVE: In the world, about 16 million women are living with HIV, many of them in reproductive age. These levels of infection and vertical transmission rates are still of great concern, due to the lack of early therapeutic intervention in many African countries. In Mozambique, a country in sub-Saharan Africa, HIV prevalence rates are 13.2%, placing the country in second place in terms of new infections, behind only South Africa. OBJECTIVE: To know the experiences and the main difficulties experienced by HIV-positive pregnant or lactating women and their sexual partners in the specific context. METHODOLOGY: Qualitative study carried out in Chókwè in the province of Gaza - Mozambique. Semi-structured interviews were conducted with pregnant or lactating women living with HIV, with their sexual partners and with health professionals. Focus groups were held with mentor mothers and group interviews with mentor fathers, which took place in the second half of 2021. The interviews and meetings were recorded with a voice recorder and transcribed in full. The information went through the thematic analysis process. RESULTS: Ten seropositive pregnant or lactating women and one sexual partner participated in the study; thirteen mentor mothers and two mentor fathers; two Maternal and Child Health nurses and a psychologist. The findings reveal that the participants associate the HIV diagnosis with the pregnancy test or childbirth, and the period of pregnancy and breastfeeding is marked by the fear of infecting the child with the virus. Women hide their serological status from their husband, family and community for fear of consequences related to rigid social norms and interference of cultural factors. The results of health professionals brought similar aspects to those of women living with HIV, however, they highlight the lack of professionals to offer quality care. It was found that the health unit and the community use lectures as the only health education strategy, despite its low effectiveness. CONCLUSIONS: It was observed that there are still many barriers to preventing mother-to-child transmission in Mozambique, in particular, the quality of counseling and difficulties in accessing the service, whether due to lack of resources or social and family norms that do not recognize women's autonomy. . It is necessary to support mothers who do not wish to breastfeed and those who are more socioeconomically vulnerable. Greater investment in psychosocial support and community involvement strategies is recommended, using alternatives such as Integrative Community Therapy (ICT) and Popular Education. It is suggested the involvement of community leaders in the process of developing a program of intervention and promotion of mental health for seropositive pregnant or lactating women.

OBJETIVO: En el mundo, alrededor de 16 millones de mujeres viven con el VIH, muchas de ellas en edad reproductiva. Estos niveles de infección y tasas de transmisión vertical siguen siendo motivo de gran preocupación, debido a la falta de una intervención terapéutica temprana en muchos países africanos. En Mozambique, un país del África subsahariana, las tasas de prevalencia del VIH son del 13,2%, lo que coloca al país en el segundo lugar en términos de nuevas infecciones, solo por detrás de Sudáfrica. OBJETIVO: Conocer las vivencias y las principales dificultades vividas por mujeres embarazadas o lactantes seropositivas y sus parejas sexuales en el contexto específico. METODOLOGÍA: Estudio cualitativo realizado en Chókwè en la provincia de Gaza-Mozambique. Se realizaron entrevistas semiestructuradas con mujeres embarazadas o lactantes que viven con el VIH, con sus parejas sexuales y con profesionales de la salud. Se realizaron grupos focales con madres mentoras y entrevistas grupales con padres mentores, que se realizaron en el segundo semestre de 2021. Las entrevistas y encuentros fueron grabados con una grabadora de voz y transcritas en su totalidad. La información pasó por el proceso de análisis temático. RESULTADOS: Participaron del estudio diez mujeres embarazadas o lactantes seropositivas y una pareja sexual; trece madres mentoras y dos padres mentores; dos enfermeras de Salud Materno Infantil y una psicóloga. Los hallazgos revelan que las participantes asocian el diagnóstico de VIH con la prueba de embarazo o el parto, y el período de embarazo y lactancia está marcado por el miedo a contagiar al niño con el virus. Las mujeres ocultan su estado serológico a su esposo, familia y comunidad por temor a las consecuencias relacionadas con las normas sociales rígidas y la interferencia de factores culturales. Los resultados de los profesionales de la salud trajeron aspectos similares a los de las mujeres que viven con el VIH, sin embargo, destacan la falta de profesionales para ofrecer una atención de calidad. Se constató que la unidad de salud y la comunidad utilizan las charlas como única estrategia de educación en salud, a pesar de su baja efectividad. CONCLUSIONES: Se observó que todavía existen muchas barreras para prevenir la transmisión maternoinfantil en Mozambique, en particular, la calidad de la consejería y las dificultades para acceder al servicio, ya sea por falta de recursos o por normas sociales y familiares que no reconocer la autonomía de la mujer. Es necesario apoyar a las madres que no desean amamantar ya aquellas que son más vulnerables socioeconómicamente. Se recomienda una mayor inversión en estrategias de apoyo psicosocial y participación comunitaria, utilizando alternativas como la Terapia Comunitaria Integrativa (TIC) y la Educación Popular. Se sugiere involucrar a los líderes comunitarios en el proceso de desarrollo de un programa de intervención y promoción de la salud mental para mujeres embarazadas o lactantes seropositivas.

O papel do enfermeiro no parto humanizado: A visão das parturientes / El papel de la enfermera en el parto humanizado: La visión de las parturistas / The role of the nurse in humanized birth: The view of pregnant women

Objetivo: Identificar e conhecer a visão das parturientes em relação ao papel do enfermeiro no parto humanizado. Método:Pesquisa de campo qualiquantitativo de um município do interior do estado de São Paulo. Os dados quantitativos foram tabulados no Excel, e os qualitativos analisados pela temática de Minayo. Resultado: De acordo com os dados obtidos na pesquisa14,28% das participantes reportaram que houve ameaça, foram impossibilitadas de caminhar, procurar posições mais confortáveis e aplicação de episiotomia, a presença do acompanhante foi impossibilitada em 28,6% das participantes. Os toques vaginais por diferentes pessoas aconteceram em 57,14% das participantes, 35,71% relataram o encaminhamento do bebê para sala de procedimentos sem nenhuma justificativa considerável. Conclusão: O papel do enfermeiro é de grande importância para preparar a mulher antes, durante e após o trabalho de parto com orientações sobre os seus direitos,o enfermeiro deve estar preparado constantemente para atender a sua comunidade.(AU)

Objective: To identify and understand the view of parturients in relation to the role of nurses in humanized childbirth. Method: Qualitative field research in a city in the interior of the state of São Paulo. Quantitative data were tabulated in Excel, and qualitative data analyzed by Minayo's theme. Result: According to the data obtained in the survey, 14.28% of the participants reported that there was a threat, they were unable to walk, look for more comfortable positions and apply an episiotomy, the presence of a companion was impossible in 28.6% of the participants. Vaginal touches by different people happened in 57.14% of the participants, 35.71% reported the baby being sent to the procedure room without any considerable justification. Conclusion: The role of nurses is of great importance to prepare women before, during and after labor with guidelines on their rights, nurses must be constantly prepared to serve their community.(AU)

Objetivo: Identificar y comprender la visión de las parturientas en relación al papel del enfermero en el parto humanizado. Método: Investigación cualitativa de campo en una ciudad del interior del estado de São Paulo. Los datos cuantitativos fueron tabulados en Excel y los datos cualitativos analizados por el tema de Minayo. Resultado: De acuerdo con los datos obtenidos en la encuesta, el 14,28% de los participantes reportaron que había amenaza, no podían caminar, buscar posiciones más cómodas y aplicar una episiotomía, la presencia de un acompañante era imposible en el 28,6% de los participantes. Los toques vaginales por diferentes personas ocurrieron en el 57,14% de las participantes, el 35,71% relató que el bebé fue enviado a la sala de procedimientos sin ninguna justificación considerable. Conclusión: El papel de las enfermeras es de gran importancia para preparar a las mujeres antes, durante y después del parto con lineamientos sobre sus derechos, las enfermeras deben estar constantemente preparadas para servir a su comunidad.(AU)

O papel do enfermeiro no parto humanizado: A visão das parturientes / The role of the nurse in humanized birth: The view of pregnant women

Objetivo: Identificar e conhecer a visão das parturientes em relação ao papel do enfermeiro no parto humanizado. Método:Pesquisa de campo qualiquantitativo de um município do interior do estado de São Paulo. Os dados quantitativos foram tabulados no Excel, e os qualitativos analisados pela temática de Minayo. Resultado: De acordo com os dados obtidos na pesquisa14,28% das participantes reportaram que houve ameaça, foram impossibilitadas de caminhar, procurar posições mais confortáveis e aplicação de episiotomia, a presença do acompanhante foi impossibilitada em 28,6% das participantes. Os toques vaginais por diferentes pessoas aconteceram em 57,14% das participantes, 35,71% relataram o encaminhamento do bebê para sala de procedimentos sem nenhuma justificativa considerável. Conclusão: O papel do enfermeiro é de grande importância para preparar a mulher antes, durante e após o trabalho de parto com orientações sobre os seus direitos,o enfermeiro deve estar preparado constantemente para atender a sua comunidade(AU)

Objective: To identify and understand the view of parturients in relation to the role of nurses in humanized childbirth. Method: Qualitative field research in a city in the interior of the state of São Paulo. Quantitative data were tabulated in Excel, and qualitative data analyzed by Minayo's theme. Result: According to the data obtained in the survey, 14.28% of the participants reported that there was a threat, they were unable to walk, look for more comfortable positions and apply an episiotomy, the presence of a companion was impossible in 28.6% of the participants. Vaginal touches by different people happened in 57.14% of the participants, 35.71% reported the baby being sent to the procedure room without any considerable justification. Conclusion: The role of nurses is of great importance to prepare women before, during and after labor with guidelines on their rights, nurses must be constantly prepared to serve their community.(AU)

Objetivo: Identificar y comprender la visión de las parturientas en relación al papel del enfermero en el parto humanizado. Método: Investigación cualitativa de campo en una ciudad del interior del estado de São Paulo. Los datos cuantitativos fueron tabulados en Excel y los datos cualitativos analizados por el tema de Minayo. Resultado: De acuerdo con los datos obtenidos en la encuesta, el 14,28% de los participantes reportaron que había amenaza, no podían caminar, buscar posiciones más cómodas y aplicar una episiotomía, la presencia de un acompañante era imposible en el 28,6% de los participantes. Los toques vaginales por diferentes personas ocurrieron en el 57,14% de las participantes, el 35,71% relató que el bebé fue enviado a la sala de procedimientos sin ninguna justificación considerable. Conclusión: El papel de las enfermeras es de gran importancia para preparar a las mujeres antes, durante y después del parto con lineamientos sobre sus derechos, las enfermeras deben estar constantemente preparadas para servir a su comunidad(AU)

Construction of predictive model for pregnancy-related anxiety risk in pregnant women based on LASSO regression / 环境与职业医学

Background Pregnancy-related anxiety has a negative impact on the physical and mental health of pregnant women and the normal growth and development of the fetus. Establishing prediction models for pregnancy-related anxiety to screen associated predictive factors may provide important opportunities for prenatal intervention. Objective To establish a prediction model of pregnancy-related anxiety risk of pregnant women. Methods From January to July 2021, a questionnaire survey on pregnancy-related anxiety and predictors was conducted among pregnant women having routine prenatal check-ups provided by an obstetrics clinic of a tertiary grade A hospital in Ningxia. The socio-demographic characteristics of the subjects were collected, and the pregnant women were evaluated by the Life Event Scale (LES), Perceived Social Support Scale (PSSS), Family APGAR Index (APGAR), and Pregnancy-related Anxiety Questionnaire (PAQ). R 4.2.0 software was used to fit all selected variables by least absolute shrinkage and selection operator (LASSO) regression to identify predictors of pregnancy-related anxiety in the second and third trimesters. On the basis of logistic regression analysis, prediction models of pregnancy-related anxiety in the second and third trimesters were constructed, and the model nomogram and receiver operating characteristic curve (ROC) were drawn. The prediction effect of the model was evaluated by area under the curve (AUC). A calibration chart was drawn to evaluate the calibration of the model. Results A total of 1500 questionnaires were distributed, and 1448 valid questionnaires were recovered, with an effective rate of 96.53%. Among the 1448 pregnant women, the overall positive rate of pregnancy-related anxiety was 28.80% (417/1448), and the positive rates in the second and third trimesters were 29.21% (276/935) and 27.49% (141/513), respectively. The predictors entering the the second trimester model were age of marriage, family care, social support, family expectations for the fetus, physical condition during pregnancy, and whether experiencing life stressful events during pregnancy. The predictors entering the the third trimester model were pregnancy intention, physical discomfort, and whether experiencing life stress during pregnancy. A risk prediction model of pregnancy-related anxiety for the second trimester was established: risk of pregnancy-related anxiety=−0.07× marriage age +0.12× family care −0.03× social support −0.65× family expectation of fetal sex +0.42× physical condition during pregnancy +0.47× whether experiencing life stressful events during pregnancy. A risk prediction model of pregnancy-related anxiety for the third trimester was established: risk of pregnancy-related anxiety=−5.69+0.82× pregnancy intention +1.06× physical discomfort +0.94× whether experiencing life stressful events during pregnancy. The ROC curves of the two models were drawn. The AUC of the second trimester model was 0.71, and the AUC of related validation model was 0.68. The AUC of the third trimester model was 0.72, and the AUC of related validation model was 0.66. Conclusion The risk prediction models of pregnancy-related anxiety constructed based on LASSO regression and logistic regression have good prediction ability, and they suggest that pregnant women in the second trimester with short marriage age, high family care, low social support, family expectations for fetal sex, average physical condition, and experiencing life stress during pregnancy, and pregnant women in the third trimester with spontaneous pregnant intention, unintended pregnancy, physical discomfort, and experiencing life stress during pregnancy are high-risk groups for pregnancy-related anxiety.

Iodine nutritional status of children and pregnant women in 37 coastal counties (cities and districts) of Shandong Province in 2021 / 中华地方病学杂志

Objective:To learn about the prevalence of iodized salt in coastal counties (cities and districts, hereinafter referred to as counties) of Shandong Province, evaluate the iodine nutritional status of children and pregnant women, so as to provide data support for timely targeted prevention and control measures and scientific adjustment of intervention strategies.Methods:In 2021, in 37 coastal counties of Shandong Province, one township was selected from each of the five directions of the east, west, south, north, and middle of each county, one primary school was selected from each township, 40 non-boarding students aged 6 - 12 years old were selected from each primary school. In addition, 20 pregnant women were selected from each township. Children's and pregnant women's household salt samples and urine samples were collected to detect salt iodine and urinary iodine contents. The children from 19 counties selected from the 37 coastal counties of Shandong Province were examined by B-mode ultrasound, and the goiter rate of children was calculated.Results:Totally 7 736 household edible salt samples from the children were tested, and the coverage rate of iodized salt, iodized salt qualified rate and qualified iodized salt consumption rate was 74.3% (5 746/7 736), 74.3% (4 267/5 746) and 55.2% (4 267/7 736), respectively. A total of 7 740 urine samples were collected from the children, the median urinary iodine was 174.0 μg/L. A total of 4 344 children were selected for thyroid examination, and the goiter rate was 3.0% (131/4 344). Totally 4 513 household edible salt samples from the pregnant women were tested, and the coverage rate of iodized salt, iodized salt qualified rate and qualified iodized salt consumption rate was 83.7% (3 779/4 513), 77.6% (2 933/3 779) and 65.0% (2 933/4 513), respectively. A total of 7 740 urine samples were collected from the pregnant women, the median urinary iodine was 133.5 μg/L.Conclusions:Children in 37 coastal counties of Shandong Province are generally at the appropriate level of iodine, but pregnant women still have the risk of iodine deficiency. Comprehensive prevention and control measures for iodine deficiency disorders need to be continuously implemented to consolidate and deepen the achievements of iodine deficiency prevention and control.

Analysis of iodine nutrition status of children and pregnant women in Henan Province in 2020 / 中华地方病学杂志

Objective:To investigate the iodine nutritional status of children aged 8-10 years old and pregnant women in Henan Province.Methods:From March to September 2020, a cross-sectional survey was conducted in 18 provincial-level cities and 9 directly administered counties (collectively referred to as provincial-level cities) and 155 counties (cities, districts) in Henan Province. One township was selected from each county (city, district) in five directions: east, west, south, north, and central. One primary school was selected from each township, and 40 non boarding children aged 8-10 years old (half male and half female) were selected from each primary school; 20 pregnant women were selected from each township. Home edible salt samples and once urine samples from children and pregnant women were collected, to detect salt iodine and urinary iodine levels. Thyroid volume of children in 1/3 of the monitored counties (cities, districts) under the jurisdiction of each provincial-level city was examined.Results:A total of 31 645 home edible salt samples were collected from children aged 8-10 years old, with a median salt iodine of 25.8 mg/kg, the iodine salt coverage rate was 97.8% (30 941/31 645) and qualified iodine salt consumption rate was 93.4% (29 545/31 645). A total of 15 234 home edible salt samples were collected from pregnant women, with a median salt iodine of 25.7 mg/kg, the iodized salt coverage rate was 98.1% (14 937/15 234), and the qualified iodized salt consumption rate was 92.2% (14 040/15 234). A total of 31 642 urine samples from children aged 8-10 years old were tested, with a median urine iodine of 235.0 μg/L; 15 234 urine samples from pregnant women were tested, with a median urinary iodine of 196.5 μg/L. The thyroid volume of 13 792 children was examined, and the rate of goiter was 1.2% (165/13 792).Conclusions:Iodine nutrition of 8-10 years old children in Henan Province is at an over appropriate iodine level, and the prevalence of goiter is less than 5%. Pregnant women's iodine nutrition is at an appropriate iodine level.

Clinical characteristics of nucleic acid negative neonates delivered by pregnant women infected with SARS-CoV-2 in Sanya, Hainan / 中国热带医学

@#Abstract: Objective　To explore the clinical characteristics of nucleic acid negative newborns delivered by pregnant women infected with SARS-CoV-2 (Omicron variant BA. 5.1.3) in Sanya area, and to provide evidence for understanding its clinical characteristics. Methods　A retrospective analysis was performed on 14 neonates with negative nucleic acid delivered by pregnant women who tested positive for SARS-CoV-2 (Omicron variant BA.5.1.3) in Sanya Central Hospital (the Third People's Hospital of Hainan Province) from June 2022 to September 2022 (observation group, n=14). The corresponding nucleic acid-negative newborns delivered by pregnant women detected negative with SARS-CoV-2 (Omicronon variant strain BA.5.1.3) were set as the control group (n=56), and the general data and clinical characteristics of neonates in the two groups were compared. Results　There was no significant difference between the observation group and the control group in pregnancy diabetes, pregnancy induced hypertension, gestational pre-eclampsia, fetal intrauterine distress, premature rupture of membranes (P>0.05); there was no significant difference between the observation group and the control group in terms of sex, gestational age, birth weight, age, mode of delivery, birth Apgar score, heart screening, pulmonary disease, glucose 6-phosphate dehydrogenase (G6PD) deficiency, thalassemia, breast milk jaundice, hemolytic jaundice (P>0.05). The bilirubin level, blue light irradiation cases and the duration of blue light irradiation of the newborns in the observation group at 7 days after birth were higher than those in the control group (P<0.05); the ratio of blood oxygen saturation ≥ 90% in the observation group was lower than that in the control group (21.43% vs 89.29%, P<0.05), and the ratio of blood oxygen saturation occasionally<90% was higher than that in the control group (57.14% vs 10.71%, P<0.05). The ratio of blood oxygen saturation<90% had no significant difference compared with that in the control group (7.14% vs 0, P>0.05), and the ratio of blood oxygen saturation reduced to the required oxygen uptake was higher than that in the control group (14.29% vs 0, P<0.05). Conclusions　The jaundice manifestation of the nucleic acid-negative newborns delivered by pregnant women infected with SARS-CoV-2 (Omicronon variant strain BA.5.1.3) in Sanya area is relatively obvious, with blood oxygen saturation easily lower than 90% and even requiring oxygen inhalation in severe cases.

Dietary exposure level of to perfluorinated compounds and its relationship with perinatal adverse events in pregnant women in Xuhui District of Shanghai / 环境与职业医学

Background Perfluorinated compounds (PFCs) are persistent organic pollutants. Dietary exposure to PFCs among pregnant women may lead to elevated risks of adverse events during pregnancy and postpartum depression. Objective To estimate potential risk of dietary exposure to PFCs among pregnant women in Xuhui District, Shanghai, and the relationship between dietary PFCs exposure and risks of adverse events during pregnancy and postpartum depression. Methods This study was a small cohort study which recruited women residing in Xuhui District from July 2017 to September 2018. All information was collected through questionnaires by trained investigators. Basic information and dietary information were collected at the time of inclusion, where the dietary information was obtained through the Food Frequency Questionnaire (FFQ). A follow-up visit was conducted within 42 d after delivery to collect the occurrence of adverse events during pregnancy and postpartum depression. According to the results of dietary survey, sampling and PFCs level testing were conducted on commercially available staple foods, poultry and livestock meat, aquatic products, vegetables, milk and dairy products, eggs, etc. The food sampling points covered all subdistricts in Xuhui District, including farmers' markets, supermarkets, convenience stores, and shops. Daily exposure level and hazard ratio (HR) of PFCs per capita were calculated according to the dietary survey and laboratory testing. Logistic regression was used to estimate the relationship between PFCs exposure and the risks of adverse events during pregnancy and postpartum depression. The levels of PFCs exposure were further divided into 4 groups according to interquartile range, and OR and Ptrend value were calculated respectively. Results A total of 345 pregnant women were recruited in this study, whose average age was (29.61±4.92) years. Among them, 26.37% subjects reported at least one adverse event during pregnancy, and 30.14% subjects reported an Edinburgh Postnatal Depression Scale (EPDS) score ≥12. A total of 132 food samples were collected and tested, and PFCs were positive mainly in milk and dairy products, poultry meat, livestock meat, eggs, fresh water products, and sea water products. The PFCs positive rate in fresh water products was the highest, reaching 100%. The average concentration of PFCs in the positive samples was 0.018-2.10 μg·kg−1. The HR of PFCs was 4.44. A higher risk of postpartum depression was found along with a higher perfluorooctane sulfonate (PFOS) exposure level (Ptrend=0.02). Conclusion Dietary PFCs exposure may pose a health risk to pregnant women. The study findings suggest that decreasing the intake of freshwater products might help reduce the risk of PFCs exposure among pregnant women in Xuhui district, Shanghai.

Association between perfluoroalkyl and polyfluoroalkyl substances and maternal thyroid-related hormones in pregnant women / 环境与职业医学

Background Exposure to perfluoroalkyl and polyfluoroalkyl substances (PFAS) during pregnancy might affect thyroid-related hormone levels in pregnant women. However, most previous studies focused on the effects of PFAS containing 8-10 carbon atoms, and few studies have estimated the associations between PFAS with longer carbon chain and thyroid-related hormone levels. Objective To examine the associations between PFAS exposure and thyroid-related hormones in pregnant women. Methods The present study was based on the Jiashan Birth Cohort from September 2016 to April 2018. We analyzed 13 PFAS in maternal blood samples (n=781) by high-performance liquid chromatography-tandem mass spectrometry, as well as total triiodothyronine (T3), total thyroxine (T4), free T3 (FT3), free T4 (FT4), thyroid stimulating hormone (TSH), thyroglobulin antibody (TG-Ab), and thyroid peroxidase antibody (TPOAb) by electrochemiluminescence immunoassay. PFAS were divided into three groups:low concentration, medium concentration and high concentration according to the tertile of their concentrations. We estimated the associations between PFAS concentrations and thyroid-related hormones in pregnant women by multiple linear regression. Results In the multiple linear regression models, a change in perfluorododecanoic acid (PFDoA) concentrations from the low concentration group to the high concentration group was associated with a −0.10 (95%CI: −0.20, 0) nmol·L−1 change in T3, −0.15 (95%CI: −0.28, −0.02) pmol·L−1 change in FT3, and −3.02 (95%CI: −5.66, −0.39) pmol·L−1 change in FT4, respectively. A change in perfluorotridecanoic acid (PFTrDA) concentrations from the low concentration group to the high concentration group was associated with a −0.10 (95%CI: −0.20, 0) nmol·L−1 change in T3. Compared with the low concentration group, the concentration of T4 in the medium concentration group of perfluorohexane sulfonate (PFHxS) increased by 6.10 (95%CI: 0.44, 11.75) nmol·L−1. No statistically significant associations were found between PFAS and TSH concentration. The negative associations of PFAS with thyroid-related hormones were more pronounced in pregnant women with positive TG-Ab and/or TPOAb. Conclusion Exposure to PFAS during pregnancy may affect thyroid-related hormone homeostasis in pregnant women, and the effect is stronger in TG-Ab and/or TPOAb-positive pregnant women.

Infection of AIDS ， syphilis and hepatitis B in 24 546 pregnant women in Yueyang City， Hunan Province / 上海预防医学

ObjectiveTo investigate the infection situation of AIDS， syphilis and hepatitis B among pregnant women in Yueyang City， to provide formulated treatment and intervention measures to reduce mother-to-child transmission， and to improve the quality of birth population. MethodsA total of 24 546 pregnant women who agreed to take the tests of AIDS， syphilis and hepatitis B from January 2018 to December 2021 in our hospital were retrospectively analyzed. ResultsThe positive rate of human immunodeficiency virus antibody （anti-HIV） was 0.045%； positive rates of syphilis antibody （anti-TP） and HBsAg were 4.64% and 0.64%， respectively. The positive rates of anti-HIV， anti-TP and HBsAg varied from 2018 to 2021， but the differences were not statistically significant （P>0.05）. The positive rate of HBsAg increased gradually with the increase of maternal age， and the difference was statistically significant （P<0.01）. There were 16 mixed infections among 1 309 positive cases， 15 of which were hepatitis B and syphilis mixed infections. ConclusionThe infection of AIDS， syphilis and hepatitis B in pregnant women in Yueyang City is relatively high. The screening of AIDS， syphilis and hepatitis B before pregnancy is helpful to prevent and reduce the risk of mother-to-child transmission of infectious diseases in time， which is of great significance to eugenic and eugenic education.

Association between dietary patterns during pregnancy and gestational diabetes mellitus / 预防医学

Objective@#To explore the association between dietary patterns during pregnancy and the development of gestational diabetes mellitus (GDM), so as to provide the guidance of diet balance and GDM prevention for pregnant women.@*Methods@#Pregnant women who underwent prenatal examination at the First Affiliated Hospital of Xinjiang Medical University from December 2021 to July 2022 were selected as the subjects. The oral glucose tolerance test (OGTT) was employed at 24 to 28 weeks of gestation to diagnose GDM. The questionnaire of "The Survey on Nutrition and Health of Pregnant Women in China" was used to collect general information, food intake frequency and amount during a month before OGTT. Dietary patterns were determined by factor analysis, and the association between dietary patterns and the development of GDM was identified using a multivariable logistic regression model. @*Results@#Totally 449 pregnant women were included, with a median (interquartile range) age of 31.00 (5.00) years and a median (interquartile range) gestational age of 35.00 (3.00) weeks. There were 7 dietary patterns named potato-cereal pattern, poultry-meat-dessert pattern, milk-egg-aquatic product pattern, mushroom-vegetable-offal pattern, fruit-bean pattern, pickle-wheaten food pattern, and beverage-nut pattern according to the food types with high factor loads. There were 89 cases diagnosed as GDM, with a prevalence rate of 19.82%. Multivariable logistic regression analysis showed that the development of GDM was associated with the poultry-meat-dessert pattern (OR=0.242, 95%CI: 0.086-0.678) and the fruit-bean pattern (OR=0.093, 95%CI: 0.025-0.342), compared with the potato-cereal pattern. @*Conclusion@#Compared to the potato-cereal pattern, the poultry-meat-dessert pattern and the fruit-bean pattern may reduce the risk of GDM. Key words： gestational diabetes mellitus dietary pattern pregnant woman low carbohydrate diet

Evaluation on the information about absolute and relative indications of cesarean sections available on popular websites / Avaliação das informações sobre indicações absolutas e relativas de cesarianas disponíveis em sites populares

Abstract Objectives: to evaluate the reliability of information available on popular websites, in other words, websites aimed lay pregnant women, about absolute and relative indications for cesarean sections. Methods: this was a descriptive/comparative study based on the popular websites most likely to be visited by lay pregnant women and that contained information about indications for absolute and relative cesarean sections. Cohen's Kappa index of agreement was used to analyze the reliability degree on the indications for cesarean sections presented on the websites and the scientific evidence. Results: there was a higher prevalence (62.63%) of information on the indications for cesarean sections that did not mention whether the indication was absolute or relative, and of these indications, 40.74% were not indications for cesarean sections. Low agreement was also observed among websites and the scientific evidence when the website mentioned the indication for cesarean section was absolute or relative. Conclusion: this study showed that the reliability of the information on absolute and relative indications for cesarean sections available in popular websites is questionable.

Resumo Objetivos: avaliar a confiabilidade das informações disponíveis em sites populares, ou seja, sites voltados para gestantes leigas, sobre indicações absolutas e relativas de cesarianas. Métodos: estudo descritivo/comparativo, baseado nos sites populares mais prováveis de serem visitados por gestantes leigas e que traziam informações sobre as indicações de cesarianas absolutas e relativas. Para analisar o grau de confiabilidade das indicações de cesarianas apresentadas pelos sites e a evidência cientifica, foi realizado o índice de concordância de Kappa de Cohen. Resultados: houve maior prevalência (62,63%) de informações de indicações de cesarianas que não mencionavam se a indicação apresentada era absoluta ou relativa, sendo que destas, 40,74% não eram indicações de cesarianas. Observou-se, concordância baixa entre os sites e a evidência cientifica quando o site mencionava que a indicação de cesariana era absoluta ou relativa. Conclusão: este estudo demonstrou que a confiabilidade das informações acerca das indicações absolutas e relativas de cesarianas disponíveis em sites populares é questionável

Fatores associados ao ganho de peso gestacional acima do recomendado: revisão sistemática / Factors associated with gestational weight gain above recommended: systematic review / Factores asociados con el aumento de peso gestacional arriba recomendado: revisión sistemática

Objetivo: estimar os fatores que estão relacionados ao ganho de peso gestacional acima do recomendado. Método: a busca foi realizada em maio de 2021 nas bases de dados: LILACS, PubMed e COCHRANE, com os descritores: "Pregnant women"; "Gestational weight gain"; "Pregnancy"; "Gestation"; "Risk Factors"; "Socioeconomic Factors". O protocolo do estudo foi registrado na PROSPERO sob o nº CRD42021258655. A seleção dos artigos foi realizada com foco na pergunta norteadora "Quais fatores estão associados ao ganho de peso gestacional acima do recomendado?". Artigos selecionados foram analisados pelos sistemas "JBI Critical Appraisal Checklist" e Grading of Recommendations Assessment, Development and Evaluation. Resultados: foram selecionados 15 artigos. Os fatores mais prevalentes, foram: peso pré-gestacional, uso de tabaco, paridade e renda familiar. Conclusão: estimar esses fatores contribui para a obtenção de um melhor período gestacional, parto e período pós-parto.

Objective: to estimate the factors that are related to gestational weight gain above the recommended level. Method: the search was carried out in May 2021 in the following databases: LILACS, PubMed and COCHRANE, with the descriptors: "Pregnant women"; "Gestational weight gain"; "Pregnancy"; "Gestation"; "Risk Factors"; "Socioeconomic Factors". The study protocol was registered at PROSPERO under number CRD42021258655. The selection of articles was carried out with a focus on the guiding question "Which factors are associated with gestational weight gain above the recommended?". Selected articles were analyzed using the "JBI Critical Appraisal Checklist" and "Grading of Recommendations Assessment, Development and Evaluation" systems. Results: 15 articles were selected. The most prevalent factors were: pre-pregnancy weight, tobacco use, parity and family income. Conclusion:estimating these factors contributes to obtaining a better gestational period, childbirth and postpartum period.

Objetivo: estimar los factores que se relacionan con el aumento de peso gestacional por encima del nivel recomendado. Método:la búsqueda se realizó en mayo de 2021 en las siguientes bases de datos: LILACS, PubMed y COCHRANE, con los descriptores: "Mujeres embarazadas"; "Aumento de peso gestacional"; "El embarazo"; "Gestación"; "Factores de riesgo"; "Factores socioeconómicos". El protocolo del estudio fue registrado en PROSPERO con el número CRD42021258655. La selección de artículos se realizó con un enfoque en la pregunta orientadora "¿Qué factores se asocian con un aumento de peso gestacional superior al recomendado?". Los artículos seleccionados se analizaron mediante los sistemas "JBI Critical Appraisal Checklist" y "Grading of Recomendaciones Assessment, Development and Evaluation". Resultados: se seleccionaron 15 artículos. Los factores más prevalentes fueron: peso previo al embarazo, tabaquismo, paridad e ingresos familiares Conclusión: estimar estos factores contribuye a obtener un mejor período gestacional, parto y puerperio.

Prospective cohort study of pre-pregnancy sugar-sweetened beverage consumption and risk of gestational diabetes mellitus / 环境与职业医学

Background There is a lack of research evidence on the association between sugar-sweetened beverage (SSB) consumption and gestational diabetes mellitus (GDM) in China. Objective To explore the association between frequency of SSB consumption before pregnancy and risk of GDM in pregnant women in Shaanxi Province, and to provide a scientific basis for targeted interventions to control maternal blood glucose. Methods The recruitment to the China Birth Cohort study started in October 2020. Pregnant women at 6-16 weeks who had their first prenatal examination at five hospitals in Shaanxi Province were recruited. A maternal health questionnaire was used to collect basic information about pregnant women. A semi-quantitative food frequency questionnaire was used to collect the consumption of carbonated beverages, fruit and vegetable juice beverages, coffee beverages, and milk tea beverages in one year before pregnancy, which were summed to obtain the SSB consumption. Pregnant women were divided into three groups according to SSB consumption, namely <1 serving·week−1, 1-4 servings·week−1, and ≥5 servings·week−1. GDM was confirmed by oral glucose tolerance test (OGTT) between 24-28 weeks of gestation. A binary logistic regression model was applied to explore the association between SSB consumption and risk of GDM. Multiple linear regression was applied to investigate the associations between SSB consumption (per 1-serving·d−1 increase) and OGTT fasting plasma glucose, 1-hour glucose, and 2-hour glucose. Results A total of 3811 pregnant women were finally enrolled in this study, of which 752 developed GDM, with an incidence rate of 19.7%. The incidence rates of GDM in pregnant women with SSB consumption frequency of <1 serving·week−1, 1-4 servings·week−1, and ≥5 servings·week−1 were 18.0%, 21.1%, and 26.8%, respectively. After adjusting for maternal age, pre-pregnancy body mass index (BMI), education, number of children born, family history of diabetes, smoking, alcohol consumption, physical activity level, and total energy intake, the risk of GDM increased by 26% (OR=1.26, 95%CI: 1.05, 1.50) in the 1-4 servings·week−1 group and by 76% (OR=1.76, 95%CI: 1.31, 2.38) in the ≥5 servings·week−1 group compared to the <1 serving·week−1 SSB consumption group, respectively. Further stratified analysis revealed no interaction effect (Pinteraction>0.05) between SSB consumption and maternal age, pre-pregnancy BMI, or first labor or not. For each additional SSB consumption per day, the risk of GDM increased by 94% (OR=1.94, 95%CI: 1.37, 2.75); and the maternal OGTT 1-hour glucose and 2-hour glucose increased by 0.33 mmol·L−1 and 0.18 mmol·L−1, respectively (P<0.05), and no significant increase in fasting plasma glucose was found (P>0.05). Conclusion Higher SSB consumption before pregnancy increases the risk of GDM in pregnant women.

Satisfação de gestantes atendidas na atenção primária à saúde / Satisfaction of pregnant women attended in primary health care / Satisfacción de gestantes atendidas en atención primaria de salud

Objetivo: Analisar produção científica sobre satisfação de gestantes atendidas na Atenção Primária à Saúde. Métodos: Revisão integrativa, realizada em setembro de 2020, na Biblioteca Virtual em Saúde, Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature e Excerpta Medica Database, cruzando descritores com operadores booleanos. Foram incluídos estudos primários, excluídos estudos realizados em hospitais, mulheres não gestantes, resumos de congresso, teses e artigos duplicados. Não houve delimitação temporal ou de idioma. A busca gerou 355 artigos. Após leitura de títulos e resumos, exclusão dos duplicados e leitura completa, incluiuse 20 artigos. Os dados foram discutidos com bibliografias atualizadas. Por se tratar de revisão, não houve necessidade de parecer em Comitê de Ética. Resultados: A maioria dos artigos foi publicada em 2012 e realizada fora do Brasil. Os resultados indicam satisfação das gestantes pela assistência recebida na Atenção Primária à Saúde, considerando algumas lacunas: continuidade do cuidado após o parto, acolhimento e aspectos da estrutura física das unidades. Conclusão: As pesquisadas apresentaram satisfação pela assistência, atestando a qualidade do atendimento. (AU)

Objective: To analyze scientific production on satisfaction of pregnant women attended in Primary Health Care. Methods: Integrative review, carried out in September 2020, at the Virtual Health Library, Online Medical Literature Analysis and Retrieval System, Cumulative Index to Nursing and Allied Health Literature and Excerpta Medica Database, crossing descriptors with Boolean operators. Primary studies were included, studies performed in hospitals, non-pregnant women, congress abstracts, theses and duplicate articles were excluded. There was no temporal or language delimitation. The search generated 355 articles. After reading the titles and abstracts, excluding duplicates and completely reading, 20 articles were included. Data were discussed with updated bibliographies. As this is a review, there was no need for an opinion from the Ethics Committee. Results: Most articles were published in 2012 and carried out outside Brazil. The results indicate the satisfaction of pregnant women with the assistance received in Primary Health Care, considering some gaps: continuity of care after childbirth, reception and aspects of the physical structure of the units. Conclusion: The respondents were satisfied with the care, attesting to the quality of care. (AU)

Objetivo: Analizar la producción científica sobre la satisfacción de gestantes atendidas en Atención Primaria de Salud. Métodos: Revisión integradora, realizada en septiembre de 2020, en la Biblioteca Virtual en Salud, Sistema de Análisis y Recuperación de Literatura Médica en Línea, Índice Acumulativo de Enfermería y Literatura en Salud Afín. y Excerpta Medica Database, cruzando descriptores con operadores booleanos. Se incluyeron estudios primarios, se excluyeron estudios realizados en hospitales, mujeres no embarazadas, resúmenes de congresos, tesis y artículos duplicados. No hubo delimitación temporal ni lingüística. La búsqueda generó 355 artículos. Después de leer los títulos y resúmenes, excluyendo duplicados y lectura completa, se incluyeron 20 artículos. Los datos se discutieron con bibliografías actualizadas. Al tratarse de una revisión, no fue necesaria la opinión del Comité de Ética. Resultados: La mayoría de los artículos se publicaron en 2012 y se realizaron fuera de Brasil. Los resultados indican la satisfacción de las gestantes con la atención recibida en Atención Primaria de Salud, considerando algunas brechas: continuidad de la atención posparto, recepción y aspectos de la estructura física de las unidades. Conclusión: Los encuestados se mostraron satisfechos con la atención, lo que da fe de la calidad de la atención. (AU)

Fatores associados ao perfil psicossocial de mulheres durante o pré ­ natal / Factors associated with women's psychosocial profile during prenatal

Objetivo: analisar os fatores associados ao perfil psicossocial de mulheres durante o pré-natal no Hospital Universitário ­ Unidade Materno Infantil da Universidade Federal do Maranhão ­ HUUFMA. Métodos: estudo transversal realizado com 160 gestantes sem limite de faixa etária, atendidas no Ambulatório de Obstetrícia do HUUFMA no período de março a outubro de 2017. A avaliação do perfil psicossocial foi mensurada por meio do Prenatal Psychosocial Profile (PPP-VP). Resultados: a maioria das gestantes, cerca de 41,25% (66), possui somente o Ensino Médio completo, faixa etária de 15 a 35 anos , cerca de 65,66% (105), no último trimestre gestacional 46,25% (74), a maior parte primigesta, 60% (96), com menos de seis consultas pré-natais realizadas, 67,52% (108). Quanto ao trimestre gestacional, não houve significância estatística com os constructos do PPP-VP, relativo à paridade, as multíparas foram as que mais evidenciaram estresse e o teste de Tukey demonstrou que as multíparas tiveram mais estresse quando comparada com as nulíparas. Conclusão: é pertinente inferir que, em relação ao trimestre gestacional, não houve influência relativa aos constructos do perfil psicossocial, porém ao se relacionar paridade, a situação contrária foi observada, principalmente em multíparas, onde o maior número de partos refletia diretamente no nível desajustado do estresse, sendo assim é necessária uma maior atenção a essas questões para uma assistência pré-natal adequada (AU)

Objective: analyze the factors associated with the psychosocial profile of women during prenatal care at the University Hospital ­ Maternal-Child Unit of the Federal University of Maranhão ­ HUUFMA. Methods: a cross-sectional study conducted with 160 pregnant women without age limit assisted at the HUUFMA Obstetrics Outpatient Clinic from March to October 2017. The assessment of the psychosocial profile was measured using the Prenatal Psychosocial Profile (PPP-VP). Results: most pregnant women, about 41.25% (66) had only completed high school; aged from 15 to 35 years old, about 65.66% (105); in the last gestational trimester 46.25% (74); most of them primigravid, 60% (96); with less than six prenatal appointments performed 67.52% (108). As for the gestational trimester, there was no statistical significance with the PPP-VP constructs; concerning parity, multiparas were the ones who showed more stress, and the Tukey test showed that this group had more stress when compared to nulliparas. Conclusion: it is pertinent to infer that about the gestational trimester, there was no influence on the constructs of the psychosocial profile, but when relating parity, the opposite situation was observed, especially in multiparous women, in which the greater number of births directly reflected in the maladjusted level of stress. Greater attention is necessary to these issues for adequate prenatal care

Desenlace fatal en embarazadas contagiadas con la COVID-19 / Fatal outcome wiht pregnant and COVID-19

Introducción: Múltiples han sido las muertes y contagios por el nuevo coronavirus. En medio de este contexto el contagio de la enfermedad en pacientes embarazadas ha sido bien documentado. Objetivo: Presentar los eventos ocurridos en embarazadas para transmitir la experiencia a quienes tratan estas pacientes. Presentación del caso: Se expone el caso de una gestante de 24 años, obesa, con embarazo de 25 semanas. Fue ingresada con neumonía por COVID-19 y evolución hacia la insuficiencia respiratoria grave que fallece durante la cesárea. Se recibió en el quirófano con hipoxemia e hipercapnia, taquicardia, cianosis, oliguria y ventilada a presión positiva con oxígeno al 100 %. Se conduce con ketamina, fentanilo y rocuronio. A los 35 min, y posterior a la histerotomía, presentó bradicardia progresiva, por lo que se inicia compresiones torácicas externas y tratamiento farmacológico. Se recuperó el ritmo sinusal a los 12 min, pero recidiva la parada en asistolia a los 20 min, con cianosis en esclavina. Se implementó compresiones y administración de epinefrina hasta fallecer 30 min después por no recuperación de ritmo y signos ciertos de la muerte. Conclusiones: La atención multidisciplinaria mejora las condiciones de tratamiento en todas las etapas. El manejo anestésico individualizado ofrece una estrategia invaluable en casos como estos, independientemente del resultado. El tromboembolismo pulmonar en la gestante es un riesgo latente y asociado a la COVID-19, incrementa, exponencialmente, su letalidad.

Introduction: Multiple deaths and infections due to the new coronavirus have occurred. In the midst of this context, the spread of the disease in pregnant patients has been well documented. Objective: Present the events that occurred in pregnant women, in order to share the experience with those who treat these patients. Presentation of the case: The case of a 24-year-old pregnant woman, obese, with a pregnancy of 25 weeks is presented. She was admitted with COVID-19 pneumonia and evolution towards severe respiratory failure led to her death during cesarean section. She was received in the operating room with hypoxemia and hypercapnia, tachycardia, cyanosis, oliguria and ventilated at positive pressure with 100% oxygen. She was treated with ketamine, fentanyl and rocuronium. At 35 min, and after hysterotomy, she presented progressive bradycardia, so external chest compressions and pharmacological treatment were initiated. The sinus rhythm was recovered at 12 min, but the asystole stop relapsed at 20 min, with cyanosis. Compressions and administration of epinephrine were implemented until death 30 minutes later due to non-recovery of rhythm and certain signs of death. Conclusions: Multidisciplinary care improves treatment conditions at all stages. Individualized anesthetic management offers an invaluable strategy in cases like these, regardless of the outcome. Pulmonary thromboembolism in pregnant women is a latent risk associated with COVID-19, exponentially increasing its lethality.