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1.
Cambios rev. méd ; 22 (2), 2023;22(2): 928, 16 octubre 2023. ilus, tabs
Article in Spanish | LILACS | ID: biblio-1516529

ABSTRACT

El procedimiento quirúrgico cesárea con miras a la historia es considerada como un avance de suma importancia en la dismi-nución del riesgo de mortalidad materna y perinatal1.Es la intervención más realizada a nivel de especialidad lo que conlleva riesgos inherentes, quirúrgicos y anestésicos2,3.En el año 2015 la incidencia en el Ecuador de terminación del embarazo por cesárea es del 29,3% en el sector público, 49,9% en Seguridad Social y 69,9% en clínicas privadas4. Para la Or-ganización Mundial de la Salud (OMS) en el mismo año refiere que "En ninguna región del mundo se justifica la incidencia de cesárea superior al 10- 15%"5. La variabilidad de indicación de cesárea, hace que sea necesaria la creación de guías y protocolos, para de esta manera unificar los criterios médicos, de acuerdo a la mejor evidencia científica disponible.


The cesarean section surgical procedure is historically considered a very important advance in reducing the risk of maternal and perinatal mortality1.It is the most frequently performed intervention at the specialty level, which entails inherent surgical and anesthetic risks2,3.In 2015, the incidence in Ecuador of termination of pregnancy by cesarean section is 29,3% in the public sector, 49,9% in Social Security and 69,9% in private clinics4. For the World Health Or-ganization (WHO) in the same year, it states that "In no region of the world is the incidence of cesarean section higher than 10-15% justified" 5.The variability of the indication for cesarean section makes it ne-cessary to create guidelines and protocols, in order to unify me-dical criteria, according to the best scientific evidence available.


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications , Obstetric Surgical Procedures , Pregnancy , Cesarean Section , Parturition , Emergencies , Risk Management , Maternal Mortality , Pregnancy, High-Risk , Ecuador , Perinatal Mortality , Obstetric Labor Complications
2.
Psicol. ciênc. prof ; 43: e264324, 2023. tab
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1529206

ABSTRACT

O estudo teve como objetivo identificar os argumentos da estratégia de persuasão dos discursos apresentados na audiência pública sobre a Arguição de Descumprimento de Preceito Fundamental-ADPF 442, realizada em 2018, cujo propósito era discutir sobre a interrupção voluntária da gravidez até a 12ª semana. Para tal, foi realizada uma pesquisa de abordagem qualitativa, analítico-descritiva e documental. O objeto de análise foi o registro da audiência, apresentado em vídeo, disponibilizado na plataforma digital YouTube, e em ata lavrada pelo STF, ambos de acesso público. A partir de uma análise do discurso, identificou-se os argumentos utilizados na estratégia de persuasão, que foram sistematizados em quatro categorias de argumentos para cada um dos dois grupos identificados: o grupo pró e o grupo contra a descriminalização do aborto. As três primeiras categorias, Saúde mental, Direito e Saúde pública, mesmo com diferenças na forma de apresentar o argumento, se repetem nos dois grupos. Todavia, a quarta categoria, Pressupostos, se diferenciou. No grupo pró descriminalização do aborto, apresentou-se como Pressupostos filosóficos e científicos, e no grupo contra, como Pressupostos morais. Por fim, a defesa da saúde mental das mulheres foi o principal argumento numa forma de humanizar o sofrimento vivido pelas que desejam abortar e não encontram o suporte do Estado para assegurar sua dignidade, cidadania e efetiva igualdade, garantidas constitucionalmente.(AU)


The study aimed to identify the arguments of the persuasion strategy of the speeches presented at the public hearing on the Action Against the Violation of Constitutional Fundamental Rights -ADPF 442, held in 2018, whose purpose was to discuss the voluntary interruption of pregnancy until the 12th week. To this end, a qualitative, analytical-descriptive, and documentary research was carried out. The object of analysis was the video recording of the hearing available on the YouTube platform, and in minutes drawn up by the STF, both of which are public. Based on a discourse analysis, the arguments used in the persuasion strategy were identified, which were systematized into four categories of arguments for each of the two identified groups: the group for and the group against the decriminalization of abortion. The first three categories, Mental Health, Law and Public Health, even with differences in the way of presenting the argument, are repeated in both groups. However, the fourth category, Assumptions, differed. In the group for the decriminalization of abortion, it was presented as Philosophical and Scientific Assumptions, whereas the group against, as Moral Assumptions. Finally, the defense of women's mental health was the main argument in a way of humanizing the suffering experienced by those who wish to have an abortion and do not find the support of the State to guarantee their dignity, citizenship, and effective equality, constitutionally guaranteed.(AU)


El estudio tuvo como objetivo identificar los argumentos de la estrategia de persuasión de los discursos presentados en la audiencia pública sobre el Argumento por Incumplimiento de un Percepto Fundamental -ADPF 442, realizada en 2018, con el objetivo de discutir la interrupción voluntaria del embarazo hasta la 12.ª semana. Para ello, se llevó a cabo una investigación cualitativa, analítico-descriptiva y documental. El objeto de análisis fue la grabación de la audiencia, que está disponible en la plataforma digital YouTube, y actas levantadas por el Supremo Tribunal Federal -STF, ambas de acceso público. A partir de un análisis del discurso se identificaron los argumentos utilizados en la estrategia de persuasión, los cuales se sistematizaron en cuatro categorías de argumentos para cada uno de los dos grupos identificados: el grupo pro y el grupo en contra de la despenalización del aborto. Las tres primeras categorías ("salud mental", "derecho" y "salud pública") aún con diferencias en la forma de presentar el argumento se repiten en ambos grupos. Pero difiere la cuarta categoría "supuestos". En el grupo a favor de la despenalización del aborto se presentó como "supuestos filosóficos y científicos", y en el grupo en contra, como "supuestos morales". Finalmente, la defensa de la salud mental de las mujeres fue el principal argumento en un intento por humanizar el sufrimiento que viven aquellas que desean abortar y no encuentran el apoyo del Estado para garantizar su dignidad, ciudadanía e igualdad efectiva, preconizadas por la Constitución.(AU)


Subject(s)
Humans , Female , Pregnancy , Abortion, Criminal , Mental Health , Abortion , Anxiety , Pain , Parity , Pregnancy, Unwanted , Prejudice , Psychology , Public Policy , Rape , Religion , Reproduction , Safety , Audiovisual Aids , Sex , Sex Education , Sex Offenses , Social Behavior , Suicide , Obstetric Surgical Procedures , Torture , Violence , Public Administration , Unified Health System , Brazil , Pregnancy , Bereavement , Pharmaceutical Preparations , Abortion, Eugenic , Christianity , Women's Health , Patient Compliance , Civil Rights , Negotiating , Abortion, Induced , Condoms , Abortion, Legal , Communications Media , Pregnancy, High-Risk , Pregnancy Reduction, Multifetal , Contraceptive Devices , Contraceptive Devices, Male , Feminism , Life , Advertising , Crime , Personal Autonomy , Patient Rights , Legal Intervention , Death , Information Dissemination , Prenatal Nutritional Physiological Phenomena , Wedge Argument , Beginning of Human Life , Sexology , Depression , Reproductive Rights , Disease Prevention , Family Development Planning , Health of Specific Groups , Violence Against Women , Control and Sanitary Supervision of Equipment and Supplies , Cerebrum , Family Planning Services , Fertilization , Fetal Distress , Health Communication , Fetus , Social Networking , Reproductive Health , Sexual Health , Sexism , Social Discrimination , Help-Seeking Behavior , Public Service Announcements as Topic , Political Activism , Freedom , Sadness , Psychological Distress , Internet Use , Gender Equity , Citizenship , Document Analysis , Guilt , Human Rights , Anencephaly , Love , Mental Disorders , Morale
3.
Psicol. ciênc. prof ; 43: e263877, 2023.
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1529224

ABSTRACT

A violência sexual e o aborto legal são temas tabus em nossa sociedade. No campo da saúde, a(o) psicóloga(o) atua em fases distintas, seja na avaliação psicológica do pedido pelo aborto legal, que culminará ou não em sua aquiescência; seja no momento posterior à solicitação, no atendimento em enfermarias ou ambulatorial. Partindo de relato de experiência, este artigo tem como objetivo refletir sobre as possibilidades e desafios da atuação psicológica no atendimento em saúde para pessoas em situação de gestação decorrente de violência sexual e que buscam pelo aborto legal. Para tanto, dividimos o artigo em três momentos. No primeiro deles, será possível encontrar dados conceituais, estatísticos e históricos sobre ambos os temas, trazendo recortes nacionais e internacionais. No segundo, trazemos apontamentos sobre o que chamamos de "eixos norteadores", ou seja, dialogamos com aspectos fundamentais para o trabalho nesta seara, sendo eles gênero, família, sexualidade e trauma. Por fim, no terceiro, aprofundamos a reflexão sobre o atendimento psicológico atrelado aos conceitos já discutidos, analisando de forma crítica principalmente um dos pontos mais espinhosos da atuação: a avaliação para aprovação (ou recusa) do pedido pelo aborto. Apoiamo-nos no referencial psicanalítico e defendemos que esta atuação psicológica é primordialmente uma oferta de cuidado, comprometido com as demandas das pessoas atendidas e com a promoção de saúde mental, e consideramos que o papel da psicologia é essencial para o reconhecimento do sofrimento e dos efeitos do abandono socioinstitucional na vida do público atendido.(AU)


Sexual abuse and legal abortion are taboo subjects in our society. On the health area, the psychologist works on different fields, such as psychological evaluation from the request of legal abortion, that will end or not on its approval, and also in a further moment, either the care on wards or ambulatorial treatment. Relying on a case report, this article aims to contemplate the possibilities and challenges from psychological work on healthcare to pregnant women from sexual violence and seek legal abortion. For this purpose, we divide this article in three moments. On the first, it will find definitions, statistics, and historical data about both issues, including national and international information. On the second, we bring notes called 'guiding pillar,' that is, we interact with fundamental aspects from this area, such as gender, family, sexuality, and trauma. On the third one, in-depth discussions we dwell on psychological care tied to the concepts previously addressed, critically analyzing one of the hardest moments of working in this area: the evaluation to approve (or refuse) the request for abortion. We lean over psychoanalytic thoughts and argue that this psychological work is primarily an offer of care, committed to the needs from those who seek us and to promoting good mental health and, also, we consider that psychology is essential to acknowledge the suffering and the effects of social and institutional neglect on the lives of the people seen.(AU)


La violencia sexual y el aborto son temas tabús en nuestra sociedad. En el campo de la salud, el(la) psicólogo(a) actúa en diferentes fases: en la evaluación psicológica de la solicitud del aborto legal, que culminará o no en su obtención, y/o en el momento posterior a la solicitud en la atención en enfermería o ambulatorio. Desde un reporte de experiencia, este artículo pretende reflexionar sobre las posibilidades y los desafíos de la Psicología en la atención en salud para personas en estado de embarazo producto de violencia sexual y que buscan un aborto legal. Para ello, este artículo está dividido en tres momentos. En el primer, presenta datos conceptuales, estadísticos e históricos sobre los dos temas, trayendo recortes nacionales e internacionales. En el segundo, comenta los llamados "ejes temáticos", es decir, se establece un diálogo con aspectos fundamentales para el trabajo en este ámbito, como género, familia, sexualidad y trauma. Por último, en el tercer, profundiza en la reflexión sobre la atención psicológica asociada a los conceptos discutidos, analizando de forma crítica uno de los puntos más espinosos de la actuación: la evaluación para la aprobación (o negativa) de la solicitud de aborto. Se utilizó el referencial psicoanalítico y se argumenta que esta atención psicológica es sobre todo una forma de cuidado, comprometida con las demandas de las personas atendidas y la promoción de la salud mental, y el papel de la Psicología es esencial para reconocer el sufrimiento y los efectos del abandono socioinstitucional en la vida del público atendido.(AU)


Subject(s)
Humans , Female , Pregnancy , Psychology , Sex Offenses , Health , Abortion, Legal , Patient Care Team , Pedophilia , Pleasure-Pain Principle , Poverty , Pregnancy Maintenance , Prejudice , Prisons , Psychoanalysis , Public Policy , Punishment , Rape , Rehabilitation , Religion , Reproduction , Safety , Sexual Behavior , Sex Education , Social Class , Social Environment , Social Identification , Social Problems , Social Sciences , Stress Disorders, Post-Traumatic , Obstetric Surgical Procedures , Surgical Procedures, Operative , Taboo , Violence , Unified Health System , Risk Groups , Brazil , Pregnancy , Sex Counseling , Sexually Transmitted Diseases , Abortion, Criminal , Residence Characteristics , Maternal Mortality , Mental Health , Health Education , Vital Statistics , Women's Health , Acquired Immunodeficiency Syndrome , Gestational Age , HIV , Intersectoral Collaboration , Practice Guideline , Coronavirus , Battered Women , Confidentiality , Sexuality , Feminism , Crime Victims , Crime , Criminology , Hazards , Disaster Vulnerability , Cultural Characteristics , Personal Autonomy , Dangerous Behavior , Judiciary , Criminal Liability , Public Defender Legal Services , Public Attorneys , Death , Stress Disorders, Traumatic, Acute , Prenatal Nutritional Physiological Phenomena , Parturition , Vulnerable Populations , Aggression , Sexology , Human Rights Abuses , Racial Groups , Fetal Mortality , Pregnancy, Unplanned , Reproductive Rights , Erotica , PAHO Ethics Review Committee , Violence Against Women , Fear , Pleasure , Embryonic and Fetal Development , Human Trafficking , Psychological Trauma , Psychosocial Support Systems , Social Construction of Ethnic Identity , Social Construction of Gender , Androcentrism , Embarrassment , Sexual Trauma , Developmental Disability Nursing , Emotional Abuse , Gender Equity , Homicide , Interpersonal Relations , Anencephaly , Jurisprudence , Life Change Events , Men , Age Groups
4.
Rev. cuba. reumatol ; 24(3)sept. 2022.
Article in Spanish | LILACS, CUMED | ID: biblio-1530161

ABSTRACT

El lupus eritematoso sistémico es una enfermedad autoinmune que se caracteriza por un proceso inflamatorio crónico y el aumento de la producción de autoanticuerpos como mecanismos patogénicos. Se presenta con mayor frecuencia en pacientes femeninas y en edad fértil. La gestación en pacientes con esta enfermedad se considera como una condición de extrema precaución, ya que existe influencia de la gestación en la actividad clínica del lupus y del lupus en la evolución de la gestación. Las complicaciones quirúrgicas, como es el caso de una apendicitis aguda, aportan mayor riesgo al binomio madre-feto. El objetivo del presente trabajo es comunicar la experiencia de tratamiento de una paciente de 31 años de edad, con diagnóstico de lupus eritematoso sistémico y a quien a las 35,6 semanas de gestación se le presentó un cuadro de apendicitis aguda que no solo provocó la actividad de la enfermedad, sino que causó la interrupción de la gestación. La paciente y el recién nacido presentaron una evolución favorable sin complicaciones posteriores.


Systemic lupus erythematosus is an autoimmune disease that includes the presence of a chronic inflammatory process and increased production of autoantibodies as etiopathogenic mechanisms. As a disease, it occurs more frequently in female patients and those of childbearing age. Pregnancy in patients with this disease is considered an element of extreme caution since there is an influence of pregnancy on the clinical activity of lupus and lupus on the evolution of pregnancy. The presence of surgical complications, as is the case of acute appendicitis, brings greater risk to the mother-fetus binomial. The objective of this report is to communicate the treatment experience of a 31-year-old patient, diagnosed with systemic lupus erythematosus and who at 35.6 weeks of gestation presented acute appendicitis that not only causes disease activity, but it generates the need to interrupt the pregnancy. The patient and the newborn had a favorable evolution, with no subsequent complications.


Subject(s)
Humans , Female , Adult , Appendicitis/complications , Pregnancy Complications/surgery , Autoimmune Diseases/prevention & control , Lupus Erythematosus, Systemic/complications , Obstetric Surgical Procedures/methods
5.
Afr. J. reprod. Health (online) ; 26(4): 1-12, 2022-06-03. Figures, Tables
Article in English | AIM | ID: biblio-1381556

ABSTRACT

Episiotomy is one of the most common obstetric procedures done by health providers putting the client at high risk of developing complications and lacerations. These days, episiotomy has been done at an alarming rate in Ethiopia as compared to the slant set by World Health Organization. Be that as it may, there is a need for nationally representative data. This study aimed to determine the pooled prevalence of episiotomy practice among women who gave birth at public health institutions in Ethiopia. We accessed PubMed, Web of Science, Google Scholar, EMBASE, and manual search was used to retrieve articles. The extractions of the data were done by using Microsoft Excel and analyzed by STATA version 11 statistical software. The publication bias was checked by funnel plot visually and Egger's test and Begg's test, with P < 0.05 considered indicating potential publication bias. I2 was used to check the presence of heterogeneity of the studies. Overall estimated analysis was done. Subgroup analysis was done by region. We carried out a leave-one-out sensitivity analysis. The Joanna Briggs Institute risk of bias assessment tool was used. Out of 254 articles retrieved, 9 studies met the eligibility criteria and are thus included in this study. The overall episiotomy practice in Ethiopia was 45.01% (95% CI: 36.288, 53.741). Based on the sub-group analysis, prevalence of episiotomy practice was 49.32% (95%CI: 12.67, 85.97), 46.92% (95%CI: 29.47, 64.37), 44.23 (95%CI: 37.77, 50.99) and 38.29 (95%CI: 32.38, 44.20) among South region, Addis Ababa, Amhara region and Tigray region respectively. The findings revealed that the prevalence of episiotomy practice in Ethiopia was high (45.01%). Therefore, it is better to have periodic training for birth attendants on the indication of episiotomy and the appropriate use of guidelines to reduce the rate of episiotomy. (Afr J Reprod Health 2022; 26[4]: 98-109).


Subject(s)
Public Health , Prevalence , Health Personnel , Parturition , Episiotomy , Pregnancy Complications , Obstetric Surgical Procedures , Women , Lacerations
6.
Rev. chil. obstet. ginecol. (En línea) ; 86(1): 42-51, feb. 2021. graf, tab
Article in Spanish | LILACS | ID: biblio-1388629

ABSTRACT

OBJETIVO: Identificar la presencia de infección de sitio quirúrgico y factores de riesgo en pacientes sometidas a cirugías Gineco-Obstétricas de forma programada o de urgencia en un hospital de II nivel de atención en Honduras. METODOLOGÍA: Estudio observacional, descriptivo, retrospectivo; recopilando 226 fichas del registro de infección de sitio quirúrgico recuperadas de los expedientes clínicos brindados por el servicio de estadística del Hospital Mario Catarino Rivas. Captando pacientes sometidas a cirugías Gineco-Obstétricas, durante el 2017 y 2018. RESULTADOS: 99 fichas cumplieron los criterios de inclusión, reportando una edad de 24 años [RIQ, 19,0 - 30,0], peso 82,0 kg [RIQ, 51,7 - 98,25], talla 154 cm [150,0 - 158,0] y el IMC de 25,8 ± 3,6 kg/m2. Un 9,1% presento antecedentes de inmunosupresión. 5,1% presento ISQ. El 55.6% de las cirugías se realizó el mismo día de ingreso del paciente. El tiempo entre la profilaxis antibiótica y el comienzo de la intervención quirúrgica es de 60 minutos [RIQ, 40,0 - 160,0]. La duración de los procedimientos quirúrgicos son de 45 minutos [RIQ, 35,0 - 55,0]. Los microrganismos aislados en los cultivos fueron Cocos gram positivos (2/5), Enterococcus faecalis (1/5), Klebsiella pneumoniae (2/5). CONCLUSIÓN: La presencia de ISQ en cirugías Gineco-Obstétricas del HMCR es del 5.1%, identificando los siguientes factores de riesgo: edad extrema, obesidad, diabetes mellitus, estado inmunitario (VIH), profilaxis antibiótica (temprana); por último, la técnica y el tiempo quirúrgico.


OBJECTIVE: To identify the presence of surgical site infection and risk factors in patients undergoing Gynecological-Obstetric surgeries on a scheduled or emergency basis in a 2nd level of care hospital in Honduras. METHODOLOGY: Observational, descriptive, retrospective study, compiling 226 data sheets of the surgical site infection record recovered from the clinical records provided by the statistics service of the "Hospital Mario Catarino Rivas". Recruiting patients undergoing Gynecological-Obstetric surgeries, during 2017 and 2018. RESULTS: 99 tabs met the inclusion criteria, reporting an age of 24 [RIQ, 19.0 - 30.0], weight 82.0 kg [RIQ, 51.7 - 98.25], size 154 cm [150.0 - 158.0] and BMI of 25.8 ± 3.6 kg/m2. 9.1% have a history of immunosuppression. 5.1% present ISQ. 55.6% of surgeries were performed on the same day as the patient's admission. The time between antibiotic prophylaxis and the onset of surgery 60 minutes [RIQ, 40.0 - 160.0]. Duration of surgical procedures 45 minutes [RIQ, 35.0 - 55.0]. Isolated micro-morphisms in crops were Cocos gram positives (2/5), Enterococcus faecalis (1/5), Klebsiella pneumoniae (2/5). CONCLUSION: The presence of ISQ in HMCR Gynecological-Obstetric surgeries is 5.1%, identifying the following risk factors: extreme age, obesity, diabetes mellitus, immune status (HIV), early antibiotic prophylaxis; finally, technique and surgical time.


Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Gynecologic Surgical Procedures/adverse effects , Obstetric Surgical Procedures/adverse effects , Surgical Wound Infection/epidemiology , Cesarean Section/adverse effects , Cross Infection/epidemiology , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Gram-Positive Cocci/isolation & purification , Enterococcus faecalis/isolation & purification , Surgical Wound/microbiology , Abdomen/surgery , Honduras , Hospitals, Public/statistics & numerical data , Klebsiella pneumoniae/isolation & purification , Laparotomy/adverse effects
7.
Article in English | WPRIM | ID: wpr-964842

ABSTRACT

Background@#Surgical site infection (SSI) is a common complication among all surgical cases. It is the most common nosocomial infection identified in the developing world with pooled incidence of 11.8 per 100 surgical procedures. In our institution, the SSI rate in major obstetric and gynecologic cases in years 2000–2013 is 12.68%. @*Objective@#To compare the efficacy of a single-dose cefazolin versus a single dose cefazolin plus 7-day mupirocin ointment wound application in preventing SSI among women undergoing major obstetric and gynecologic abdominal surgical procedures.@*Materials and Methods@#The study included are 164 female participants, aged 18–65 years old who underwent major obstetric and gynecologic surgical procedures. Participants were randomly assigned to Groups A and B, wherein all participants were given single dose of 2 g cefazolin, intravenous, 30 min before skin incision. For the participants in Group B, an additional 7-day application of mupirocin ointment on incisional wound during the postoperative period was given. Assessment for occurrence of SSI and healing time using a standardized collection tool and Southampton wound scoring system, respectively, was done on the 8th, 15th, and 30th postoperative days. @*Results@#The incidence of SSI is 2.45% (4 out of 164 participants). It was slightly higher in the Cefazolin only arm having three cases, while only one case in the Cefazolin plus mupirocin group. However, the difference of SSI occurrence between the two groups is not statistically significant. Wound healing time was also evaluated which was comparable between treatment groups.@*Conclusion@#Single dose Cefazolin plus 7-day once daily Mupirocin ointment application is comparable to single dose of cefazolin in preventing SSI in patients undergoing major low-risk obstetric and gynecologic surgeries. Therefore, the addition of mupirocin in uncomplicated major obstetric and gynecologic surgical cases is not cost-beneficial.


Subject(s)
Cefazolin , Gynecologic Surgical Procedures , Mupirocin , Obstetric Surgical Procedures , Surgical Wound Infection
8.
Nursing (Ed. bras., Impr.) ; 23(271): 5013-5024, dez.2020.
Article in Portuguese | BDENF, LILACS | ID: biblio-1147016

ABSTRACT

Objetivo: investigar o conhecimento de enfermeiros da atenção primária à saúde acerca da violência obstétrica. Método: estudo de caráter descritivo-exploratório com abordagem qualitativa, desenvolvido com sete enfermeiros de duas unidades básicas de saúde do Distrito Federal, Brasil. Os dados foram coletados a partir de entrevistas gravadas, transcritas e analisadas mediante a análise de conteúdo. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da Universidade Paulista sob o parecer nº 3.604.615 (CAAE 19781019.0.0000.5512). Resultados: a abordagem do tema acontece de forma incipiente e muitas vezes sem a qualidade esperada. Identificou-se ainda que existe despreparo dos profissionais sobre o assunto para que haja uma boa fonte de informações para as gestantes durante o acompanhamento pré-natal. Conclusão: torna-se necessário incorporar a temática no curso de graduação em Enfermagem, além de uma melhor capacitação dos profissionais para uma abordagem satisfatória acerca da temática no contexto da atenção primária à saúde.(AU)


Objective: to investigate the knowledge of nurses in primary health care about obstetric violence. Method: a descriptive-exploratory study with a qualitative approach, developed with seven nurses from two basic health units in the Federal District, Brazil. The data were collected from recorded interviews, transcribed and analyzed through content analysis. The research was approved by the Research Ethics Committee of University Paulista under opinion nº 3.604.615 (CAAE 19781019.0.0000.5512). Results: the topic is approached incipiently and often without the expected quality. It was also identified that professionals are unprepared on the subject so that there is a good source of information for pregnant women during prenatal care. Conclusion: it becomes necessary to incorporate the theme in the undergraduate nursing course, in addition to better training of professionals for a satisfactory approach to the theme in the context of primary health care.(AU)


Objetivo: investigar el conocimiento de las enfermeras en atención primaria de salud sobre violencia obstétrica. Método: estudio descriptivo-exploratorio con enfoque cualitativo, desarrollado con siete enfermeras de dos unidades básicas de salud en el Distrito Federal, Brasil. Los datos fueron recolectados de entrevistas grabadas, transcritas y analizadas a través del análisis de contenido. La investigación fue aprobada por el Comité de Ética en Investigación de la Universidad Paulista con el dictamen nº 3.604.615 (CAAE 19781019.0.0000.5512) Resultados: el enfoque del tema es incipiente y, a menudo, sin la calidad esperada. También se identificó que los profesionales no están preparados sobre el tema, por lo que existe una buena fuente de información para las mujeres embarazadas durante la atención prenatal. Conclusión: se hace necesario incorporar el tema en el curso de pregrado en enfermería, además de una mejor capacitación de profesionales para un enfoque satisfactorio del tema en el contexto de la atención primaria de salud.(AU)


Subject(s)
Humans , Female , Pregnancy , Primary Health Care , Obstetric Surgical Procedures , Obstetric Nursing , Prenatal Care , Violence , Maternal Health
10.
Nursing (Ed. bras., Impr.) ; 23(264): 4008-4012, maio.2020.
Article in Portuguese | LILACS, BDENF | ID: biblio-1102869

ABSTRACT

Objetivo: analizar los resultados maternos y perinatales en mujeres embarazadas después de la cirugía bariátrica y clasificarlos como de alto riesgo. Método: Este es un estudio epidemiológico, observacional y retrospectivo, con un enfoque cuantitativo, basado en datos secundarios de 4,293 mujeres embarazadas de alto riesgo en una clínica ambulatoria especializada en el sur de Brasil. De este total, 50 mujeres embarazadas se sometieron a cirugía bariátrica como una condición preexistente (grupo de casos), y dadas las características de edad, estado civil y educación, el grupo de control se homogeneizó para comparación en el estudio, lo que resultó en 150 mujeres embarazadas. La variable independiente será la condición clínica preexistente de la cirugía bariátrica. Las variables de resultado serán: prematuridad, bajo peso al nacer, Apgar <7 en el primer y quinto minutos, muerte fetal, muerte neonatal y tipo de parto. Resultados: Al comparar el grupo de control con mujeres embarazadas que se sometieron a cirugía bariátrica previa, hubo un mayor riesgo relativo de puntaje Apgar por debajo de 7 en el primer minuto. Conclusión: Con base en el análisis de los datos obtenidos, se concluye que la cirugía bariátrica como una condición clínica preexistente en mujeres embarazadas de alto riesgo no influye negativamente en los resultados perinatales. Sin embargo, el seguimiento prenatal y puerperio debe ser realizado por un equipo multidisciplinario y capacitado que reconozca cualquier posible complicación temprana.(AU)


Objective: To analyze maternal and perinatal outcomes in pregnant women after bariatric surgery and classified as high risk. Method: This is an epidemiological, observational, and retrospective study, with a quantitative approach, based on secondary data from 4,293 high-risk pregnant women at a specialized outpatient clinic in southern Brazil. Of this total, 50 pregnant women had bariatric surgery as a pre-existing condition (case group), and given the characteristics of age, marital status and schooling, the control group was homogenized for comparison in the study, resulting in 150 pregnant women. The independent variable will be the pre-existing clinical condition of bariatric surgery. The outcome variables will be prematurity, low birth weight, Apgar <7 in the 1st and 5th minutes, fetal death, neonatal death and type of delivery. Results: When comparing the control group with pregnant women who had previous bariatric surgery, there was an increased relative risk for Apgar score below 7 in the 1st minute. Conclusion: Based on the analysis of the data obtained, it is concluded that bariatric surgery as a pre-existing clinical condition in high-risk pregnant women does not negatively influence perinatal results. However, prenatal and puerperium follow-up must be carried out by a multidisciplinary and trained team that recognizes any possible complications early.(AU)


Objetivo: Analisar os desfechos maternos e perinatais em gestantes pós cirurgia bariátrica e classificadas como alto risco. Método: Trata-se de um estudo epidemiológico, observacional e retrospectivo, com abordagem quantitativa, realizado a partir de dados secundários de 4.293 gestantes de alto risco de um ambulatório especializado do sul do Brasil. Desse total, 50 gestantes tinham como condição clínica pré-existente a cirurgia bariátrica (grupo caso), e diante das características de idade, situação conjugal e escolaridades homogeneizou-se o grupo controle para comparação no estudo, obtendo-se 150 gestantes. A variável independente será a condição clínica pré-existente de cirurgia bariátrica. As variáveis desfechos serão: prematuridade, baixo peso ao nascer, Apgar <7 no 1º e 5º minutos, óbito fetal, óbito neonatal e tipo de parto. Resultados: Ao comparar o grupo controle com gestantes que possuem cirurgia bariátrica previa, notou-se um risco relativo aumentado para índice de Apgar abaixo de 7 no 1º minuto. Conclusão: Com base na análise dos dados obtidos, conclui-se que a cirurgia bariátrica como condição clínica pré-existente em gestantes de alto risco não influencia negativamente os resultados perinatais. Todavia o acompanhamento durante pré-natal e puerpério devem ser realizados por uma equipe multidisciplinar e capacitada, que reconheça precocemente qualquer possível complicação.(AU)


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications , Obstetric Surgical Procedures , Risk Factors , Bariatric Surgery , Maternal and Child Health , Pregnancy, High-Risk
11.
Rev. baiana enferm ; 34: e35874, 2020. tab
Article in Portuguese | BDENF, LILACS | ID: biblio-1137062

ABSTRACT

Objetivo: analisar o perfil de pacientes obstétricas admitidas na Unidade de Terapia Intensiva Adulto. Método: estudo quantitativo, descritivo-retrospectivo, desenvolvido por meio da busca e obtenção dos dados referentes ao perfil socioeconômico e clínico dos prontuários das pacientes gestantes ou puérperas internadas por causa obstétrica, entre janeiro 2017 e dezembro de 2018, na Unidade de Terapia Intensiva de um hospital público de Pernambuco, Brasil. Os resultados foram analisados pelo programa Statistical Package for the Social Science. Resultados: as mulheres tinham, em sua maioria, idade entre 19 e 29 anos (56,1%), e cor parda (88,6%). A maioria foi internada no pós-parto (75,6%), o tipo de parto mais prevalente foi o cesáreo (87,2%), as síndromes hipertensivas foram a maior causa do internamento (61,8%). O principal distúrbio hipertensivo apresentado é pré-eclâmpsia (39,8%). Conclusão: as pacientes adultas jovens, puérperas de parto cesáreo, com síndromes hipertensivas são internadas com mais frequência na Unidade de Terapia Intensiva.


Objetivo: analizar el perfil de las pacientes obstétricas ingresadas en la Unidad de Cuidados Intensivos. Método: estudio cuantitativo, descriptivo y retrospectivo, desarrollado por medio de la búsqueda y la recuperación de los datos del perfil socioeconómico y clínico del registro médico de pacientes embarazadas o en posparto ingresadas por causa obstétrica, entre enero de 2017 y diciembre de 2018, en la Unidad de Cuidados Intensivos de un hospital público en el estado de Pernambuco, Brasil. Los resultados fueron analizados mediante el Statistical Package for the Social Sciences. Resultados: las mujeres tenían, en su mayoría, edades comprendidas entre los 19 y 29 años (56,1%), y pardas (88,6%). La mayoría fue hospitalizada en el posparto (75,6%), el tipo de parto por cesárea fue el más frecuente (87,2%), síndromes hipertensivos fueron la principal causa de hospitalización (61,8%). El principal trastorno hipertensivo presentado es la pre-eclampsia (39,8%). Conclusión: las pacientes adultas jóvenes, puérperas, cuyo parto fue cesárea, con síndromes hipertensivos son hospitalizadas con mayor frecuencia en las Unidades de Cuidados Intensivos.


Objective: to analyze the profile of obstetric patients admitted to the Intensive Care Unit. Method: quantitative, descriptive and retrospective study, developed through searches and retrieval of data referring to socioeconomic and clinical profile of pregnant or postpartum patients' records admitted for obstetric cause, between January 2017 and December 2018, in the Intensive Care Unit of a public hospital in Pernambuco, Brazil. The results were analyzed using the Statistical Package for the Social Sciences. Results: most women were between 19 and 29 years (56.1%), and pardas (88.6%). The majority was hospitalized in the postpartum (75.6%), the most prevalent delivery type was cesarean section (87.2%), hypertensive syndromes were the major cause of hospitalization (61.8%). The main hypertensive disorder was pre-eclampsia (39.8%). Conclusion: the young adult puerperal patients, whose delivery route was cesarean section, with hypertensive syndromes are hospitalized more frequently in the Intensive Care Unit.


Subject(s)
Humans , Female , Pregnancy , Obstetric Surgical Procedures , Maternal and Child Health , Pregnancy, High-Risk , Obstetric Nursing , Health Profile , Hospitals, Public , Intensive Care Units
12.
Article in English | WPRIM | ID: wpr-764566

ABSTRACT

OBJECTIVE: To investigate the relationship between the precursors of high grade serous ovarian cancer (HGSOC) and the characteristics of patients with a low HGSOC risk in terms of the effects of pregnancy. METHODS: We prospectively examined consecutive cases in which the bilateral fallopian tubes were removed during benign gynecological or obstetric surgery and assessed the relationship between the patient characteristics, including parity and pregnancy, and the incidence of HGSOC precursors. All the fallopian tubes were examined by applying the Sectioning and Extensively Examining the Fimbriated End (SEE-FIM) Protocol. RESULTS: Of the 113 patients enrolled, 67 were gynecological and 46 were obstetric. The p53 signature was identified in 21 patients. No other precursors were identified. In a comparison of the p53 signature-positive and negative groups, parous women and pregnant women were significantly fewer in the p53 signature-positive group (53% vs. 86%, p=0.002, 10% vs. 47%, p=0.001, respectively). Current pregnancy was also associated with a significantly lower incidence of the p53 signature after multivariate adjustment (odds ratio [OR]=0.112; 95% confidence interval [95% CI]=0.017–0.731; p=0.022). Among gynecological patients, parous women were fewer in the p53 signature-positive group on univariate (47% vs. 73%, p=0.047) and multivariate analysis (OR=0.252; 95% CI=0.069–0.911; p=0.036). No other characteristics were associated with p53 signature positivity. CONCLUSIONS: The incidence of the p53 signature was significantly lower in parous women and pregnant women. This decreased incidence of early phase serous carcinogenesis may be one of the possible mechanisms underlying HGSOC risk reduction among parous women.


Subject(s)
Female , Humans , Pregnancy , Carcinogenesis , Cystadenocarcinoma, Serous , Fallopian Tube Neoplasms , Fallopian Tubes , Incidence , Multivariate Analysis , Obstetric Surgical Procedures , Ovarian Neoplasms , Parity , Pregnant Women , Prospective Studies , Risk Reduction Behavior , Tumor Suppressor Protein p53
13.
Article in English | WPRIM | ID: wpr-760666

ABSTRACT

Placental abruption is a condition that should be carefully considered in perinatal management because it is associated with serious events in both the mother and neonate, such as intrauterine fetal death, cerebral palsy, obstetric critical bleeding, and uncontrollable bleeding. The concomitant presence of disseminated intravascular coagulation (DIC) more easily causes critical bleeding that may necessitate hysterectomy or multi-organ failure resulting in maternal death. Therefore, early management should be provided to prevent progression to serious conditions by performing both hemostatic procedures and DIC treatment. To take measures to improve the outcomes in both the mother and neonate, health guidance for pregnant women, early diagnosis, early treatment, development of the emergency care system, and provision of a system for transport to higher-level medical institutions should be implemented.


Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Abruptio Placentae , Cerebral Palsy , Dacarbazine , Disseminated Intravascular Coagulation , Early Diagnosis , Emergency Medical Services , Fetal Death , Fibrinogen , Hemorrhage , Hysterectomy , Maternal Death , Mothers , Obstetric Surgical Procedures , Pregnant Women
14.
São Paulo; Instituto de Saúde São Paulo; 2019.
Non-conventional in Portuguese | PIE, LILACS | ID: biblio-1292793

ABSTRACT

O problema: O Brasil é o segundo país com as taxas mais elevadas de cirurgia cesariana no mundo, muito além da recomendação de 10 a 15% da Organização Mundial da Saúde (WHO et al., 2015). O uso excessivo e desnecessário de tecnologias na atenção ao parto e nascimento tem contribuído para aumentar os riscos à saúde de mães e recém-nascidos. Opções para enfrentar o problema: Nesta Síntese são apresentadas cinco propostas de intervenções para reduzir as taxas de cirurgia cesariana, todas de caráter não clínico, selecionadas a partir de revisões sistemáticas. Sistemas públicos e privados podem se beneficiar com a implementação dessas ações, cada qual com suas possibilidades e limitações. Opção 1 ­ Incentivar o uso de intervenções combinadas para redução de cesarianas, com foco em profissionais de saúde e na gestão dos serviços e sistemas de saúde Intervenções múltiplas em diversos contextos da assistência obstétrica, com foco em profissionais de saúde e na gestão dos serviços de saúde, podem reduzir em até 27% as taxas de cirurgia cesariana. Elas incluem estratégias baseadas em auditoria e feedback, educação profissional e uso de protocolos clínicos. Opção 2 ­ Promover, durante o pré-natal, o preparo da mulher para o parto normal Atenção pré-natal em grupo, programas de preparo para o parto normal para mulheres e casais, continuidade do cuidado desde o pré-natal até o parto, e incentivo ao exercício físico são medidas com potencial para reduzir em até 78% as taxas de cesariana. Opção 3 ­ Fornecer apoio contínuo às mulheres durante o trabalho de parto e parto O apoio contínuo às mulheres durante o trabalho de parto até o nascimento pode reduzir as taxas de cirurgia cesariana em até 51%. Esse tipo de apoio pode ser prestado por um profissional (doula, enfermeira, obstetriz), ou membros da família com alguma ou nenhuma formação especial. Opção 4 ­ Estruturar e facilitar o acesso a diferentes ambientes para o parto promover nascimentos em centros de parto normal, casas de parto e domicílio pode reduzir em até 58% as taxas de cesariana. Além disso, contribui para a redução de analgesia, episiotomia, sangramento e infecção nas mulheres, prematuridade e baixo peso ao nascer. Opção 5 ­ Implementar estratégias de apoio ao parto vaginal após cesárea prévia (VBAC -Vaginal Birth After Cesarean) Aconselhamento pré-natal, cuidado por equipe multiprofissional, uso de protocolos clínicos, auditoria e feedback, que contemplem a temática do VBAC, podem aumentar as tentativas e os partos normais de mulheres com cesárea prévia, em até 28% e 41% respectivamente.


Subject(s)
Prenatal Care , Health Services Administration , Cesarean Section/statistics & numerical data , Midwifery , Policy Making , Obstetric Surgical Procedures , Brazil , Birthing Centers
15.
Rev. bras. ginecol. obstet ; 40(8): 494-496, Aug. 2018. graf
Article in English | LILACS | ID: biblio-959018

ABSTRACT

Abstract Placenta accreta syndromes are associated with increased maternal mortality and morbidity. Cesarean hysterectomy is usually performed in cases of placenta accreta syndrome. Fertility sparing methods can be applied. In the present study, we report a successful segmental uterine resection method for placenta accreta in the anterior uterine wall in a cesarean section case. A 39-year-old woman underwent an elective cesarean section at 38 + 2 weeks. A placental tissue with an area of 10 cm was observed extending fromthe anterior uterine wall to the serosa, 2 cm above the uterine incision line. The placental tissue was removed with the help of monopolar electrocautery. The uterine incision was continuously sutured. The patient was discharged on the second postoperative day. The placental pathology was reported as placenta accreta. The American College of Obstetricians and Gynecologists (ACOG) generally recommends cesarean section hysterectomy in cases of placenta accreta because removal of placenta associated with significant hemorrhage. Conservative and fertility sparing methods include placenta left in situ, cervical inversion technique and triple-P procedure. There are several studies reporting that segmental uterine resection is performed with and without balloon placement or artery ligation. Segmental uterine resection may be an alternative to cesarean hysterectomy to preserve fertility or to protect the uterus in cases of placenta accreta when there is no placenta previa. received


Subject(s)
Humans , Female , Pregnancy , Adult , Placenta Accreta/surgery , Obstetric Surgical Procedures/methods , Uterus/surgery , Cesarean Section , Conservative Treatment
16.
Rev. bras. ginecol. obstet ; 40(8): 465-470, Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-959024

ABSTRACT

Abstract Objective To describe and evaluate the use of a simple, low-cost, and reproducible simulator for teaching the repair of obstetric anal sphincter injuries (OASIS). Methods Twenty resident doctors in obstetrics and gynecology and four obstetricians participated in the simulation. A fourth-degree tear model was created using lowcost materials (condom simulating the rectal mucosa, cotton tissue simulating the internal anal sphincter, and bovine meat simulating the external anal sphincter). The simulator was initially assembled with the aid of anatomical photos to study the anatomy and meaning of each component of the model. The laceration was created and repaired, using end-to-end or overlapping application techniques. Results The model cost less than R$ 10.00 and was assembled without difficulty, which improved the knowledge of the participants of anatomy and physiology. The sutures of the layers (rectal mucosa, internal sphincter, and external sphincter) were performed in keeping with the surgical technique. All participants were satisfied with the simulation and felt it improved their knowledge and skills. Between 3 and 6 months after the training, 7 participants witnessed severe lacerations in their practice and reported that the simulation was useful for surgical correction. Conclusion The use of a simulator for repair training in OASIS is affordable (low-cost and easy to perform). The simulation seems to improve the knowledge and surgical skills necessary to repair severe lacerations. Further systematized studies should be performed for evaluation.


Resumo Objetivo Descrever e avaliar a utilização de um simulador simples, de baixo custo e reprodutível para o ensino de sutura de lacerações perineais de 4° grau. Métodos Participaram da simulação 20 residentes de ginecologia e obstetrícia e quatro profissionais especialistas. Um modelo de laceração de 4° grau foi criado com materiais de baixo custo (preservativo simulando a mucosa retal, tecido de algodão simulando o esfíncter anal interno e carne bovina simulando o esfíncter anal externo). O simulador foi inicialmente montado com ajuda de fotos anatômicas, para estudar a anatomia e o significado de cada componente do modelo. A laceração foi criada e suturada, utilizando técnicas de borda a borda e de sobreposição do esfíncter anal. Resultados O modelo custou menos de R$ 10,00 e foi montado sem dificuldade, aprimorando os conhecimentos dos participantes sobre anatomia e fisiologia. As suturas das camadas (mucosa retal, esfíncter interno e esfíncter externo) foram realizadas seguindo a técnica cirúrgica. Todos os participantes ficaram satisfeitos coma simulação e consideraram que estamelhorou seus conhecimentos e habilidades. Entre 3 a 6 meses após o treinamento, 7 participantes presenciaram em sua prática lacerações graves e relataram que a simulação foi útil para a correção cirúrgica. Conclusão A utilização de um simulador para treinamento de sutura de lacerações obstétricas graves é acessível (baixo custo e fácil execução). A simulação parece aprimorar conhecimentos e habilidades cirúrgicas para sutura de lacerações graves. Mais estudos sistematizados devem ser realizados para avaliação.


Subject(s)
Humans , Female , Pregnancy , Anal Canal/surgery , Anal Canal/injuries , Obstetric Surgical Procedures/education , Suture Techniques/education , Costs and Cost Analysis , Lacerations/surgery , Simulation Training/economics , Gynecology/education , Obstetric Labor Complications/surgery , Obstetrics/education , Self Report , Models, Anatomic
17.
Rev. Fac. Cienc. Méd. (Quito) ; 42(2): 86-90, dic.2017.
Article in Spanish | LILACS | ID: biblio-1005230

ABSTRACT

Contexto: la taquipnea transitoria del recién nacido (TTRN) es una entidad frecuente en neonatos nacidos por cesárea. Objetivo: identificar factores de riesgo potencialmente modificables que contribuyan a la disminución de la patología respiratoria neonatal derivada de un parto por cesárea Sujetos y métodos: se presenta un estudio observacional retrospectivo de cohorte analítico que identifico expedientes clínicos de recién nacidos por cesárea, atendidos en el Hospital de la Policía Quito N°1 en el periodo enero de 2001 a diciembre de 2015; el estudio incorporó neonatos entre 35 y 41 semanas de gestación, a quienes se clasificaron en 2 grupos: con y sin labor de parto previo a la cesárea. Resultados: la frecuencia de recién nacidos con taquipnea transitoria que se determinó en el presente estudio fue 25,6%, 29,4% y 44,8% en los respectivos grupos de edad gestacional determinándose una proporción es 5,1:1; 1,9:1 y 0,5:1 para cada grupo por lo que la relación entre un pretérmino leve frente a RN a término es 10 veces mayor para el grupo que desarrolla TTRN. Existe una mayor frecuencia de TTRN en neonatos de cesáreas sin labor de parto previa comparado con el grupo de neonatos nacidos por cesárea con labor de parto previa; esta diferencia es estadísticamente significativa con un OR de 5,8. Conclusión: se determinó que la labor de parto previa a la cesárea, constituyo un factor protector para taquipnea transitoria del recién nacido en neonatos entre 35 y 38 semanas. La labor de parto previa a la cesárea no fue un factor de protección frente al riesgo de desarrollar taquipnea transitoria del recién nacido en neonatos de 39 o más semana de gestación.(AU)


Context: transient tachypnea of the newborn (TTRN) is a frequent entity in neonates born by caesarean section, Objective: identify potentially modifiable risk factors that contribute to the reduction of neonatal respiratory pathology derived from a cesarean delivery Subjects and methods: We present a retrospective observational study of an analytical cohort that identified clinical records of newborns by caesarean section, attended at Quito Police Hospital No. 1 in the period January 2001 to December 2015; The study included neonates between 35 and 41 weeks of gestation, who were classified into 2 groups: with and without labor prior to cesarean section. Results: the frequency of newborns with transient tachypnea that was determined in the present study was 25.6%, 29.4% and 44.8% in the respective gestational age groups determining a proportion is 5.1: 1; 1.9: 1 and 0.5: 1 for each group, so that the relationship between a preterm mild versus a term BN is 10 times higher for the group that develops TTRN. There is a greater frequency of TTRN in neonates of caesarean sections without previous labor compared with the group of neonates born by caesarean section with previous labor; this difference is statistically significant with an OR of 5.8. Conclusion: labor prior to caesarean section constitutes a protective factor for transient tachypnea of thnewborn in neonates between 35 and 38 weeks. Labor prior to cesarean section is not a protective factor againsthe risk of developing transient tachypnea of the newborn in infants of 39 or more weeks of gestation.(AU)


Subject(s)
Humans , Female , Infant, Newborn , Adolescent , Adult , Infant, Newborn , Cesarean Section , Transient Tachypnea of the Newborn , Respiratory Distress Syndrome, Newborn , Obstetric Surgical Procedures , Infant
18.
Rev. Fac. Cienc. Méd. (Quito) ; 42(1): 25-35, jun.2017.
Article in Spanish | LILACS | ID: biblio-1004985

ABSTRACT

Antecedentes: la aplicación de estándares e indicadores de atención materno neonatal en unidades que no utilizan parámetros de calidad mejora el cumplimiento de actividades en la atención prenatal, del parto, del posparto, del recién nacido y de las complicaciones perinatales relacionadas a cesárea. Objetivo: implementar y monitorizar la tendencia de cumplimiento trimestral de un sistema de estándares e indicadores de complicaciones obstétricas y neonatales relacionadas a cesárea y su impacto en la morbimortalidad materna ­ neonatal. Metodología: intervención de carácter prospectivo "antes y después", a realizarse en el Servicio de Obstetricia de la Unidad Metropolitana de Salud Sur de Quito durante 15 meses. Se realizó el levantamiento de la línea de base epidemiológica de cesárea; se socializó y capacitó al personal en el uso del "Manual de Estándares, Indicadores e Instrumentos para medir la Calidad de la Atención Materno-Neonatal" del Ministerio de Salud Pública y se realizaron monitoreos trimestrales de cumplimiento. Resultados: se alcanzan niveles de cumplimiento significativos (p≤0,05) hacia el noveno mes de intervención en 11 de los 17 estándares de calidad seleccionados. A corto plazo determina una reducción significativa de la razón de mortalidad neonatal y una estabilización de la mortalidad materna. No se disminuyó la frecuencia de cesáreas ni la estancia hospitalaria. Conclusión: los resultados apoyan el uso permanente de un sistema de monitorización utilizando estándares e indicadores de complicaciones obstétricas y neonatales relacionados a cesárea para mejorar la calidad de atención médica. (AU)


Background: the application of standards and indicators of maternal neonatal care in units that do not use quality parameters improves regulatory compliance activities on prenatal care, childbirth, postpartum, of the newborn and perinatal complications related to caesarean section. Objective: implement and monitor the trend of compliance quarterly of a system of standards and indicators of obstetric and neonatal complications related to caesarean section and its impact on maternal mortality and morbidity. Methodology: intervention prospective "before and after", to be held in the obstetrics service of the health South of Quito Metropolitan unit for 15 months. Was the lifting of the epidemiological baseline of Caesarea; were you socialized and trained staff in the use of the "Manual of standards, indicators and instruments to measure the quality of Maternal-Neonatal care" of the Ministry of public health; and quarterly monitoring of compliance were carried out. Results: significant levels of compliance are achieved (p≤0. 05) to ninth month of intervention in 11 of the 17 selected quality standards. To short term determines a reduction significant of the reason of mortality neonatal and a stabilization of the mortality maternal. Not decreased the frequency of caesarean section or hospital stay. Conclusion: the results support the use of a monitoring system using standards and indicators of obstetric and neonatal complications related to caesarean section to improve the quality of health care.


Subject(s)
Humans , Female , Pregnancy , Obstetric Surgical Procedures , Women's Health , Maternal-Child Health Services , Quality of Health Care , Social Vulnerability Index , Healthcare Models
19.
Rev. Col. Bras. Cir ; 44(1): 94-101, Jan.-Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-842646

ABSTRACT

ABSTRACT The Gestational Trophoblastic Disease includes an interrelated group of diseases originating from placental tissue, with distinct behaviors concerning local invasion and metastasis. The high sensitivity of the serial dosages of human chorionic gonadotrophin, combined with advances in chemotherapy treatment, have made gestational trophoblastic neoplasia curable, most often through chemotherapy. However, surgery remains of major importance in the management of patients with gestational trophoblastic disease, improving their prognosis. Surgery is necessary in the control of the disease's complications, such as hemorrhage, and in cases of resistant/relapsed neoplasia. This review discusses the indications and the role of surgical interventions in the management of women with molar pregnancy and gestational trophoblastic neoplasia.


RESUMO Doença trofoblástica gestacional inclui um grupo interrelacionado de doenças originadas do tecido placentário, com tendências distintas de invasão local e metástase. A alta sensibilidade das dosagens seriadas de gonadotrofina coriônica humana aliada aos avanços do tratamento quimioterápico tornou a neoplasia trofoblástica gestacional, curável, na maioria das vezes, através da quimioterapia. No entanto, a cirurgia permanece ainda, da maior importância na condução de pacientes com doença trofoblástica gestacional, melhorando seu prognóstico. A cirurgia é necessária no controle de complicações da doença, tais como hemorragia, e em casos de neoplasia resistente/recidivada. Esta revisão discute as indicações e o papel das intervenções cirúrgicas durante o manejo de mulheres com gravidez molar e neoplasia trofoblástica gestacional.


Subject(s)
Humans , Female , Pregnancy , Gestational Trophoblastic Disease/surgery , Gynecologic Surgical Procedures/methods , Obstetric Surgical Procedures/methods
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