LEVEL OF PAIN AND ANALGESICS TAKEN AFTER CESAREAN SECTION AND DIFFERENCES ACCORDING TO TYPE OF ANESTHESIA AND DEMOGRAPHIC FACTORS.

The aim of this study was to investigate the level of pain and analgesic consumption in puerperas after cesarean section according to the type of anesthesia administered. This was a prospective study conducted at the Department of Obstetrics and Gynecology, Mostar University Hospital, in the period from September 2015 to June 2016. The study included 111 puerperas. Experimental group included 54 puerperas operated on under spinal anesthesia, while comparative group included 57 puerperas operated on under general anesthesia. Primary endpoints of the study were pain score and dose number of analgesics used. Input parameters of the study were age, gestational age, education, and place of residence. To determine the level of pain, visual analog scale for pain was used. Results showed that puerperas operated on under spinal anesthesia had significantly lower pain sensation (p=0.031) and less need for analgesic consumption in the postoperative period as compared to those operated on under general anesthesia (p=0.024). Increased age was associated with lower pain sensation (p=0.014) and need for analgesics (p<0.05). Higher level of education was associated with greater need for analgesics (p=0.016). Living in urban area was associated with greater pain sensation (p=0.023) and less need for analgesics (p<0.17). Spinal anesthesia for cesarean section resulted in less pain and less need for analgesics in the postoperative period compared to general anesthesia.

Risk Factors of Perinatal Negative Mood and Its Influence on Prognosis: A Retrospective Cohort Study.

Background: Maternal anxiety or depression in the perinatal period has a high prevalence. The negative emotion during the puerpera is unfavorable to the process of childbirth and also affects the recovery and the quality of life in postpartum patients significantly. The present study aimed to elucidate the risk factors of negative emotion in perinatal women and its influence on prognosis to provide a reference for improving maternal prognosis. Methods: Initially, 350 expectant mothers were randomly enrolled in the present study between August 2021 and August 2022. Among these, after applying the established inclusion and exclusion criteria, 314 patients were eventually selected. The independent risk factors of negative emotion and poor prognosis were analyzed through binary logistics regression and multiple linear regression. Follow-up was conducted via telephone, email, and a follow-up visit one month after discharge. Results: Among the included patients, 18 (5.7%) had prenatal anxiety, 16 (5.1%) had prenatal depression, 31 (9.9%) had postnatal anxiety, and 28 (8.9%) had postnatal depression. Perinatal negative emotional risk factors include age, marital relationship, regular prenatal examination, E2 level, 5-HT level before and after delivery, family monthly income, neonatal health, breastfeeding time, intrapartum hemorrhage, constipation and other complications. The development of postpartum negative emotions is a risk factor for maternal prognosis. Conclusion: The results showed that the risk factors of perinatal depression and anxiety were complex. In order to improve the quality of life of pregnant women, maintain their long-term emotional stability, and promote their postpartum recovery, it may be considered to promote the use of screening tools to identify women at risk of anxiety and depression before and after delivery, and timely psychological counseling for patients with high risk factors to promote their mental health.

Postpartum depression and partner support during the period of lactation: Correlation research and its influencing factors.

BACKGROUND: Postpartum depression (PPD) not only affects the psychological and physiological aspects of maternal health but can also affect neonatal growth and development. Partners who are in close contact with parturient women play a key role in communication and emotional support. This study explores the PPD support relationship with partners and its influencing factors, which is believed to establish psychological well-being and improve maternal partner support. AIM: To explore the correlation between PPD and partner support during breastfeeding and its influencing factors. METHODS: Convenience sampling was used to select lactating women (200 women) who underwent postpartum examinations at the Huzhou Maternity and Child Health Care Hospital from July 2022 to December 2022. A cross-sectional survey was conducted on the basic information (general information questionnaire), depression level [edinburgh postnatal depression scale (EPDS)], and partner support score [dyadic coping inventory (DCI)] of the selected subjects. Pearson's correlation analysis was used to analyze the correlation between PPD and DCI in lactating women. Factors affecting PPD levels during lactation were analyzed using multiple linear regression. RESULTS: The total average score of EPDS in 200 lactating women was (9.52 ± 1.53), and the total average score of DCI was (115.78 ± 14.90). Dividing the EPDS, the dimension scores were: emotional loss (1.91 ± 0.52), anxiety (3.84 ± 1.05), and depression (3.76 ± 0.96). Each dimension of the DCI was subdivided into: Pressure communication (26.79±6.71), mutual support (39.76 ± 9.63), negative support (24.97 ± 6.68), agent support (6.87 ± 1.92), and joint support (17.39 ± 4.19). Pearson's correlation analysis demonstrated that the total mean score and individual dimension scores of EPDS during breastfeeding were inversely correlated with the total score of partner support, stress communication, mutual support, and co-support (P < 0.05). The total mean score of the EPDS and its dimensions were positively correlated with negative support (P < 0.05). Multiple linear regression analysis showed that the main factors affecting PPD during breastfeeding were marital harmony, newborn health, stress communication, mutual support, negative support, co-support, and the total score of partner support (P < 0.05). CONCLUSION: PPD during breastfeeding was associated with marital harmony, newborn health, stress communication, mutual support, negative support, joint support, and the total DCI score.

Acquired methemoglobinemia in a third trimester puerpera and her premature infant with sodium nitrite poisoning: A case report.

BACKGROUND: The common cause of sodium nitrite poisoning has shifted from previous accidental intoxication by exposure or ingestion of contaminated water and food to recent alarming intentional intoxication as an employed method of suicide/exit. The subsequent formation of methemoglobin (MetHb) restricts oxygen transport and utilization in the body, resulting in functional hypoxia at the tissue level. In clinical practice, a mismatch of cyanotic appearance and oxygen partial pressure usually contributes to the identification of methemoglobinemia. Prompt recognition of characteristic mismatch and accurate diagnosis of sodium nitrite poisoning are prerequisites for the implementation of standardized systemic interventions. CASE SUMMARY: A pregnant woman was admitted to the Department of Critical Care Medicine at the First Affiliated Hospital of Harbin Medical University due to consciousness disorders and drowsiness 2 h before admission. Subsequently, she developed vomiting and cyanotic skin. The woman underwent orotracheal intubation, invasive mechanical ventilation (IMV), and correction of internal environment disturbance in the ICU. Her premature infant was born with a higher-than-normal MetHb level of 3.3%, and received detoxification with methylene blue and vitamin C, supplemental vitamin K1, an infusion of fresh frozen plasma, as well as respiratory support via orotracheal intubation and IMV. On day 3 after admission, the puerpera regained consciousness, evacuated the IMV, and resumed enteral nutrition. She was then transferred to the maternity ward 24 h later. On day 7 after admission, the woman recovered and was discharged without any sequelae. CONCLUSION: MetHb can cross through the placental barrier. Level of MetHb both reflects severity of the sodium nitrite poisoning and serves as feedback on therapeutic effectiveness.

Postdischarge coping difficulties and influencing factors of pregnant women with gestational diabetes mellitus: A cross-sectional study.

AIMS AND OBJECTIVES: To identify coping difficulties after discharge and influencing factors of pregnant women with gestational diabetes mellitus. DESIGN: A cross-sectional descriptive survey was conducted with gestational diabetes mellitus women from four tertiary hospitals in the Shandong Peninsula in China. METHODS: The study consists of 252 gestational diabetes mellitus women. Survey measures included demographic information, quality of discharge teaching scale, readiness for hospital discharge scale and postdischarge coping difficulty scale. Multiple linear regression analysis was used to explore the factors of coping difficulties after discharge. RESULTS: The situation of coping difficulties in pregnant women with gestational diabetes mellitus after discharge is not optimistic. Age, education level, type of birth, parity, quality of discharge teaching and discharge readiness are six factors that significantly influence postdischarge coping difficulties.

Sirolimus combined with oseltamivir and corticosteroid treatment for a puerpera with severe pneumonia caused by 2009 pandemic H1N1: A case report.

Severe pneumonia in patients infected with the 2009 pandemic H1N1 (pH1N1) virus was partially attributed to excessive immune response. Anti-virus treatment for these patients was insufficient. Here we reported the therapy effect of sirolimus, an immunosuppressor, combined with oseltamivir and corticosteroid for a puerpera with severe pneumonia caused by pH1N1 virus. This patient has infected with the pH1N1 virus in late pregnancy, and antiviral therapy was not implemented timely. She developed severe pneumonia and ARDS rapidly and need receive a cesarean section on the 39th week after pregnancy. After giving birth to a healthy baby, she received a combination of oseltamivir, sirolimus and corticosteroid, and improved in the following days. Moreover, the cytokines in serum and viral loads in BALF decreased significantly. She recovered without infectious symptoms and was discharged. Sirolimus combined with oseltamivir and corticosteroid is likely responsible for lowering the viral loads, reducing the patient's cytokine level, and further improving her clinical outcomes. It provides evidence that adjuvant treatment was beneficial to patients with severe pneumonia induced by the pH1N1 virus.

The association between Toxoplasma gondii infection and postpartum blues.

INTRODUCTION AND AIM: Toxoplasma gondii is an intracellular protozoan parasite infecting approximately 30% of the global human population. It has often been suggested that chronic infection with T. gondii is related to personality changes and various mental disorders including depression. It is not known whether this includes post-partum blues or depression. In this study, we test the hypothesis that there is a relationship between T. gondii infection and post-partum blues by measuring the association between infection and postpartum blues. METHODS: A total of 475 Chinese women who have just given birth were detected serology for Toxoplasma IgG and IgM antibodies, and evaluated the degree of depression by Hamilton Depression Scale (HAMD) score. Data were analyzed by Chi-square or Fisher's Exact tests using SPSS software. RESULTS: We found an overall Toxoplasma seroprevalence of 5.68% (27/475; 95% CI: 3.59-7.77) which was broken down into a prevalence of 6.60% (7/106; 95% CI: 1.80-11.41) in mothers with post-partum blues and 5.42% (20/369; 95% CI: 3.10-7.74) in non-affected mothers. There was no significant association between infection and post-partum blues (p = 0.64). CONCLUSION: The results suggest that there is no relationship between T. gondii infection and postpartum blues, at least in this sample of patients from China.

Delivery-associated presence of supramolecular fibronectin-fibrin complexes in puerperal and cord plasma.

Objective: The variable fibronectin (FN) molecular forms are known to be engaged in coagulation and fibrinolysis pathways as well as tissue remodeling and repair processes. Some of them seem to be indispensable molecules within intensive biological processes associated with delivery. The aim of the study was to evaluate the FN molecular status in maternal and cord plasma after vaginal birth and cesarean section (C-section). Materials and methods: The study included nonpregnant women's plasma samples (n = 31) and puerperal and cord plasma samples collected from 49 mothers who delivered healthy newborns at term by vaginal birth (n = 25) and C-section (n = 24). The maternal and cord plasma FN concentrations and presence and relative ratios of different FN-fibrin complexes were determined by ELISA and sodium dodecyl sulfate (SDS) -agarose immunoblotting, respectively. Results: FN concentration in puerperal plasma after vaginal birth (232.08 ± 71.8 mg/L) and C-section (228.17 ± 71.2 mg/L) was significantly higher than in the plasma of nonpregnant women (190.00 ± 48.75 mg/L). In contrast, FN concentration in cord plasma of the C-section group (101.95 ± 30.3 mg/L) was significantly lower than that of the vaginal birth group (121.80 ± 22.2 mg/L). Immunoblotting of puerperal and cord plasma distinguished the most abundant dimeric plasma FN form, the 220-280-kDa FN degradation products and 750-1900-kDa FN-fibrin complexes, which occurred more frequently and in higher amounts in puerperal and cord plasma groups than the nonpregnant women group, although independently of the mode of delivery. Conclusions: Occurrence and relative amount of delivery-associated FN-fibrin complexes in both puerperal and cord plasmas might be bound with the physiological adaptive mechanisms reducing the risk of hemorrhage and intensive remodeling and repair processes after delivery.

Percepciones sobre la aplicación de principios bioéticos en mujeres puérperas en un Hospital público del Ecuador

Fundamento: El puerperio es el periodo de tiempo que comienza en la finalización del parto hasta las seis semanas posparto; durante el cual, es necesario brindar atención conforme a los principios bioéticos inscritos en la normativa de salud vigente en el Ecuador. Objetivo: Analizar las percepciones que tienen las mujeres puérperas sobre la aplicación de los 4 principios bioéticos durante la atención en salud. Metodología: El estudio es de tipo descriptivo con enfoque cualitativo. Los datos corresponden a 10 mujeres puérperas mayores de edad, atendidas en el Hospital Gineco Obstétrico Pediátrico de Nueva Aurora "Luz Elena Arizmendi" de la ciudad de Quito, que respondieron a una entrevista sobre los principios bioéticos aplicados en la atención recibida. Se realizaron análisis de contenido a través del software ATLAS TI versión 23. Resultados: Se obtuvo una percepción positiva de las mujeres puérperas acerca de la aplicación del principio de justicia. Por otra parte, se evidencian dificultades en el de autonomía, sobre todo en la comprensión de la información brindada a la paciente acerca de los procedimientos durante el parto y puerperio, además de coacciones por parte del personal sanitario. Se percibe el consentimiento informado como un mero trámite administrativo. El principio de beneficencia se lo asume como parte de la vocación del personal y la no maleficencia genera malestar si no va acompañado de información clara y oportuna. Conclusiones: Los principios bioéticos son transversales en la normativa de salud vigente, pero sobresale el de justicia en la atención a mujeres puérperas.

Background: The puerperium is the period of time beginning at the end of labor until six postpartum weeks; during which it is necessary to provide attention in accordance with the bioethical principles included in the current health guidelines in Ecuador. Objective: To analyze the perceptions that postpartum women have about the 4 bioethical principles application during health care. Methodology: The study type is descriptive with a qualitative approach. The data correspond to 10 adult postpartum women assisted at the Nueva Aurora "Luz Elena Arizmendi" Pediatric Obstetric and Gynecological Pediatric Hospital in the Quito city, who responded to an interview about the bioethical principles applied in the received care. Content analysis was conducted through ATLAS TI version 23 software. Results: A positive perception was obtained from postpartum women concerning the application of the Justice principle. Furthermore, difficulties are evident in the Autonomy section, mainly in the comprehension of the information provided to the patient about the procedures during the labor and puerperium, as well as coercion by health personnel. Informed consent is perceived as a mere administrative formality. The Beneficence principle is assumed as part of the vocation of the personnel and Non-maleficence generates discomfort if it is not accompanied by clear and opportune information. Conclusions: Bioethical principles are transversal in current health guidelines, but that of Justice stands out in the care of postpartum women.

A assistência do enfermeiro à parturiente no contexto hospitalar: um olhar sobre a violência obstétrica / The nursing care to the parturient in the hospital context: a look at obstetric violence / El cuidado de enfermería a la parturienta en el contexto hospitalario: una mirada a la violencia obstétrica

Objetivo: Analisar a recorrência da violência obstétrica, elucidar a heterogeneidade deste tema, compreender o tratamento recebido pelas pacientes, e discorrer a visão da enfermagem frente à Violência obstétrica. Método: Metodologia descritiva; revisão bibliográfica a partir da plataforma Google Acadêmico, embasada em artigos publicados em bases científicas como SciELO, PubMed, Lilacs, etc., com abordagem qualitativa. Resultados: Trata-se de qualquer ato exercido por profissionais da saúde no que cerne ao corpo, aos processos reprodutivos e ao psicológico das mulheres, exprimido através de uma atenção desumanizada, abuso de ações intervencionistas, medicalização e a transformação patológica dos processos de parturição fisiológicos. Conclusão: Foi possível compreender que há necessidade da criação de leis rigorosas que concretizem o conceito de Violência obstétrica e puna os responsáveis por praticála, mais pesquisas e debates envolvendo este tema, orientações a respeito dos direitos das grávidas, parturientes e puérperas, fiscalização rotineira das instituições e a busca pela educação continuada.

Objective: Analyze the recurrence of Obstetric Violence, elucidate the heterogeneity of this theme, understand the treatment received by patients, and discuss the view of nursing in relation to Obstetric Violence. Method: Descriptive methodology; bibliographical review using the Google Academic platform, based on articles published in scientific databases such as SciELO, PubMed, Lilacs, etc., with a qualitative approach. Results: It is any act performed by health professionals regarding the body, reproductive and psychological processes of women, expressed through dehumanized care, abuse of interventionist actions, medicalization and the pathological transformation of physiological parturition processes. Conclusion: It was possible to understand that there is a need to create strict laws that implement the concept of Obstetric Violence and punish those responsible for practicing it, more research and debates involving this topic, guidance on the rights of pregnant women, parturients and postpartum women, inspection routine of institutions and the search for continuing education.

Objetivo: Analizar la recurrencia de la violencia obstétrica, dilucidar la heterogeneidad de este tema, comprender el trato recibido por los pacientes y discutir la visión de la enfermería en relación a la Violencia Obstétrica. Método: Metodología descriptiva; Revisión bibliográfica mediante la plataforma Google Academic, basada en artículos publicados en bases de datos científicos como SciELO, PubMed, Lilacs, etc., con un enfoque cualitativo. Resultados: Es todo acto realizado por profesionales de la salud en relación con los procesos corporales, reproductivos y psicológicos de la mujer, expresado a través de cuidados deshumanizados, abuso de acciones intervencionistas, medicalización y transformación patológica de los procesos fisiológicos del parto. Conclusión: Se pudo entender que existe la necesidad de crear leyes estrictas que implementen el concepto de violencia obstétrica y sancionen a los responsables de practicarlo, más investigaciones y debates en torno a este tema, orientaciones sobre los derechos de las mujeres embarazadas, parturientas y posparto. la mujer, la rutina de inspección de las instituciones y la búsqueda de la educación continua.

Utilización de tromboprofilaxis en el período grávido - puerperal por Ginecólogos y Residentes de Ginecología del Uruguay

Resumen: Introducción: La enfermedad tromboembólica venosa en el período grávido - puerperal es una de las primeras causas de morbi-mortalidad materna. No existe un consenso acerca de las directivas para su abordaje, por lo que el objetivo de esta investigación fue conocer cómo se desempeñan los Ginecólogos y Residentes de Ginecología del Uruguay, con respecto a distintos factores de riesgo, la indicación de tromboprofilaxis y las herramientas disponibles. Metodología: Se realizó de julio a octubre del 2020, un estudio observacional, descriptivo, transversal donde se incluyeron a Ginecólogos y Residentes de Ginecología del Uruguay, mediante una encuesta electrónica anónima a través de la plataforma Survey Monkey. Resultados: Se obtuvo un n de 159 encuestados. El 57,3% refirió pensar sistemáticamente en factores de riesgo para enfermedad tromboembólica venosa. Las guías más utilizadas para la clasificación del riesgo e indicación de tromboprofilaxis fueron la American College of Obstestricians and Gynecologists con un 81,0% y la Royal College of Obstestricians and Gynaecologists con un 13,0%. La herramienta terapéutica con mayor disponibilidad es la heparina de bajo peso molecular y la menos utilizada es la compresión neumática intermitente. Conclusiones: Existen inconsistencias entre la clasificación de riesgo e indicación de tromboprofilaxis en diferentes situaciones clínicas. Existe un porcentaje no despreciable de profesiones que no piensan sistemáticamente en factores de riesgo para eventos tromboembólicos durante el período grávido - puerperal.

Abstract: Introduction: One of the main causes of maternal morbity and mortality in the pregnant - puerperal period is venous thromboembolic disease. There is no consensus on the guidelines to address this illness. The main objective of this research was to know how Gynecologists and Gynecology Residents of Uruguay perform, in reference to considering potential risk factors, indication for thromboprophylaxis and the tools available. Methodology: An observational, descriptive, cross-sectional study carried out from July to October 2020, including Gynecologists and Gynecology Residents of Uruguay, through an anonymous online survey using the Survey Monkey platform. Results: A final n of 159 respondents was obtained. 57.3% of which referred to think systematically about risk factors for venous thromboembolic disease. The most popular guidelines for risk classification and indication of thromboprophylaxis were the American College of Obstestricians and Gynaecologists with 81.0% and the Royal College of Obstestricians and Gynaecologists with 13.0%. The most chosen therapeutic tool was low molecular weight heparin, and the least preferred one was intermittent pneumatic compression. Conclusions: There are incoherences between the risk classification and the actual indication of thromboprophylaxis in different clinical situations. There´s still a non-negligible percentage of professionals that do not systematically consider risk factors for thromboembolic events during the pregnant-puerperal period.

Resumo: Introdução: A doença tromboembólica venosa no período gestação - puerpério é uma das principais causasde morbidadee mortalidade materna. Nãohá consenso sobre as diretrizes para o seu abordagem, por issoo objetivo desta pesquisa foi saber como encarao os ginecologistas e os residentes em ginecologia do Uruguai, no que dizrespeito à fatores de risco, indicação de tromboprofilaxia e as ferramentas disponíveis. Metodologia: Estudo observacional, descritivo e transveral realizado de julho a outubro de 2020, que incluiu ginecologistas e residentes em ginecologia do Uruguai. Um levantamento eletrônico anónimo foi desenvuelto através da plataforma SurveyMonkey. Resultados: Foram estudados 159 entrevistados. 57,3% relataram pensarsobre fatores de risco para doença tromboembólica venosa. As diretrizesmais utilizadas para classificação de risco e indicação de tromboprofilaxia foram o American College of Obstestricians and Gynecologists com 81,0% e o Royal College of Obstestricians and Gynaecologists com 13,0%. A ferramenta mais selecionada é heparina de baixo peso molecular e a menos utilizada é a compressão pneumática intermitente. Conclusões: Há inconsistências entre a classificação de risco e a indicação de tromboprofilaxia em diferentes situações clínicas. Ainda há um numero consideravel de profisionais que não pensam sistematicamente em fatores de risco para eventos tromboembólicos durante o período gravidez - puerperal.

Ovarian vein thrombosis--a case report.

OBJECTIVE AND IMPORTANCE: Ovarian vein thrombosis is a rare condition usually seen in the puerperium. The incidence is 0.05-0.18% of pregnancies. Possible complications of ovarian vein thrombosis are sepsis, thrombus extension into the inferior vena cava or renal veins and pulmonary embolism. CLINICAL PRESENTATION: A 31-year-old puerpera complained about abdominal pain in the right lower quadrant and right inguinal region. INTERVENTION: Ultrasonographic examination and multislice computed tomography (MSCT) revealed the right ovarian vein thrombosis. Patient was treated with low-molecular weight heparin and antibiotics for 2  weeks. She was discharged with oral anticoagulants for 6  months. CONCLUSION: Ovarian vein thrombosis should be taken under consideration in the post-partum period.

Masa pélvica en la mujer puérpera. Presentación de caso / Pelvic mass in puerperal woman. Case presentation

El término infección puerperal se utiliza para describir cualquier infección bacteriana del aparato genital después del parto. Durante gran parte del siglo XX las infecciones puerperales, la preeclampsia y la hemorragia obstétrica formaron parte de la tríada letal de mortalidad materna. La ecografía, la resonancia magnética y la tomografía axial computarizada son la triada de elección para el diagnóstico del abdomen agudo en el puerperio. El mismo resulta difícil debido a factores intrínsecos y es entonces, cuando el radiólogo adquiere un papel crucial. Se presentó un caso de una mujer de 30 años, con 8 días de habérsele practicado una cesárea con un puerperio inmediato normal. Posteriormente presentó dolor abdominal, fiebre, escalofríos y masa palpable en fosa iliaca izquierda. Se practicaron técnicas de imágenes se plantea una masa ovárica izquierda, se realizó laparotomía exploradora y se concluyó como absceso ovárico (AU).

The term puerperal infection is used to describe any bacterial infection of the genital tract after delivery. During much of the twentieth century puerperal infections, preeclampsia and obstetric hemorrhage were part of the lethal triad of maternal mortality. Ultrasonography, magnetic resonance imaging and computed tomography are the triad of choice for the diagnosis of acute abdomen in the puerperium, which is difficult due to intrinsic factors and it is when radiologist plays a vital role. The authors present the case of a woman, aged 30 years, at the 8th day after undergoing a cesarean section with a normal immediate puerperium, who later presented abdominal pain (AU).

Fascitis necrotizante en puérpera de once días / Necrotizing Fasciitis in Eleven-Day Postpartum

Introducción: La fascitis necrotizante es una infección progresiva poco común, con alta letalidad que puede afectar a cualquier parte del cuerpo, pero es más frecuente en las extremidades, en especial en las piernas, causada en su mayoría por una infección polimicrobiana y se caracteriza por afectar la fascia superficial, tejido subcutáneo, grasa subcutánea con nervios, arterias, venas y fascia profunda. Objetivo: Reportar el caso de una puérpera diagnosticada de fascitis necrotizante. Presentación de caso: Puérpera de 28 años de edad con antecedentes de obesidad e infección por VIH, ingresada en el Servicio de Obstetricia en un hospital de la República Sudafricana, por presentar fiebre, escalofríos y dolor en el abdomen. Se utilizó tratamiento endovenoso con antibióticos y tratamiento quirúrgico. Resultados: Evolución satisfactoria de la paciente sin secuelas. Conclusiones: El diagnóstico oportuno de esta patología permite un accionar temprano, con la consecuente sobrevida de los pacientes(AU)

Introduction: Necrotizing fasciitis is a very lethal uncommon progressive infection that can affect any part of the body, however it is more frequent in the limbs, especially the legs, caused mostly by a polymicrobial infection. It affects the superficial fascia, subcutaneous tissue, subcutaneous fat with nerves, arteries, veins and deep fascia. Objective: To report the case of a puerpera diagnosed with necrotizing fasciitis. Case presentation: A 28-year-old woman with a history of obesity and HIV infection, was admitted to the Obstetrics Service at a hospital in the Republic of South Africa. She had fever, chills and pain in the abdomen. Intravenous treatment with antibiotics and surgical treatment was used. Results: Satisfactory evolution of the patient with no sequelae. Conclusions: The opportune diagnosis of this pathology allows acting early, with the consequent survival of the patients(AU)

Óbito por leishmaniose visceral em puérpera no município de Palmas, Tocantins, Brasil / Death due to visceral leishmaniasis in puerperium in the municipality of Palmas, Tocantins, Brazil

Relato de caso: neste estudo, foi relatado um óbito por LV, ocorrido em uma puérpera, no município de Palmas, Tocantins, cuja enfermidade não foi identificada durante a gestação, tampouco no período em que permaneceu hospitalizada; evidenciados os fatores que contribuíram para a letalidade do caso; e discutidas as formas adequadas de manejo. Conclusão: por meio de investigação rigorosa nos registros clínicos, laboratoriais e informações junto à família, foi detectada ausência de informações nos prontuários médicos, falhas no monitoramento da paciente, dificuldades de reconhecer um quadro grave de LV em puérpera e, com isso, a necessidade de atualização dos profissionais de saúde com relação à análise clínica e laboratorial, a fim de que haja uma avaliação mais apurada dos sintomas, detecção precoce das complicações, diagnóstico rápido, tratamento adequado e evitar a ocorrência de óbitos.

Case report: In this study, a death due to LV occurred in a puerpera, in the municipality of Palmas, Tocantins, whose disease was not identified during pregnancy, nor during the period in which she was hospitalized evidenced the factors that contributed to the lethality of the case; and discussed the appropriate forms of management. Conclusion: A rigorous investigation in the clinical, laboratorial and family records revealed a lack of information in the medical records, failure to monitor the patient, difficulties in recognizing a severe VL in the puerperium, and with this, the need for updating of health professionals with respect to clinical and laboratory analysis, in order to have a more accurate evaluation of symptoms, early detection of complications, rapid diagnosis, adequate treatment and avoiding the occurrence of deaths.

Factores de riesgo asociados al bajo peso al nacer en un área de salud de Santiago de Cuba / Risk factors associated with low birth weight in an health area from Santiago de Cuba

Introducción: El bajo peso al nacer constituye en todo el mundo y grupos de poblaciones el índice más importante para determinar las posibilidades que tiene el recién nacido de sobrevivir y tener un crecimiento sano. Objetivo: Identificar algunos factores de riesgo sociobiológicos asociados al bajo peso al nacer en el área de salud del Policlínico Docente 30 de Noviembre de Santiago de Cuba durante el 2016. Métodos: Se realizó un estudio analítico, de casos y controles. Se escogieron como controles a las 8 puérperas que aportaron igual cantidad de recién nacidos con bajo peso y como controles a 16 de las madres cuyo producto de la concepción tuvo un peso normal en igual período. Entre las variables analizadas figuraron: edad materna, antecedentes obstétricos desfavorables, enfermedades previas asociadas y propias del embarazo, edad gestacional en el momento del parto y estado nutricional. Resultados: En la serie predominaron las enfermedades previas y propias del embarazo, fundamentalmente la anemia y la infección vaginal; mientras que el parto pretérmino tuvo alta significación estadística. Conclusiones: Los factores de riesgos biológicos con mayor fuerza de asociación fueron la malnutrición por defecto durante la captación, las enfermedades previas y asociadas al embarazo; en tanto, entre los factores con significación estadística predominaron la prematuridad y el período intergenésico corto, no así los antecedentes obstétricos desfavorables. Existió correlación entre la edad gestacional, el bajo peso al nacer, la presencia de partos pretérminos y el crecimiento intrauterino retardado.

Introduction: Low birth weight constitutes in the entire world and populational groups the most important index to determine the possibilities that the newborn has to survive and to have a healthy growth. Objective: To identify some social and biological risk factors associated with low birth weight in the health area from 30 de Noviembre Teaching Polyclinic in Santiago de Cuba during 2016. Methods: An analytic study of cases and controls was carried out. The 8 postpartum women who contributed with the same quantity of underweight newborns and as controls 16 of the mothers whose product of the conception had a normal weight in same period were chosen. Among the analyzed variables there were: maternal age, unfavorable obstetric history, associated previous diseases and diseases characterizing pregnancy, gestational age at childbirth and nutritional state. Results: Previous diseases and diseases characterizing pregnancy, fundamentally anemia and vaginal infection prevailed in the series; while preterm childbirth had a high statistical significance. Conclusions: Biological risk factors with greater association force were malnutrition defect during registration, the previous diseases and those associated with pregnancy; as long as, among the factors with statistical significance prematurity and the short intergenesis prevailed, what did not occur with the unfavorable obstetric history. Correlation existed between gestational age, low birth weight, the presence of preterm childbirths and the slowed intra-uterine growth.

Knowledge and attitudes of puerperal women relating to breastfeeding in a university hospital / Saberes e atitudes de puérperas sobre o aleitamento materno em um hospital universitário

Breastfeeding (BF) has presented, among other benefits, a reduction in infant mortality, a prevention of respiratory infections and a reduction in the risks of developing diseases. Therefore, the objectives of this study were to evaluate the knowledge and attitudes of puerperal in relation to BF in a university hospital, as well as the sources from which this information was obtained and the professional categories responsible for same. The work was carried out at the Hospital das Clinicas, Federal University of Uberlândia (HC-UFU). Structured interviews were conducted to obtain data for the evaluation of information and exercise of the BF practice with puerperal hospitalized in the accommodation complex, for mother and child, from July 1st to December 31st, 2010. Of the total of 907 women interviewed, 617 (68.0%) intended to BF for 12 months or more, 566 (62.4%) performed the BF within the first hour of birth, in 551 cases (60.8%) the decision to BF was taken by the woman before the current pregnancy and 828 (91.3%) received help in BF. Of the women who received help, 788 (95.1%) were assisted by professionals from the nursing team. It was shown that the majority of the puerperal intended to breast-feed for 12 months or more, considering that they also carried out BF in the first hour after child birth. The study also noted the importance of the nursing staff in taking care of the mother/child pair, promoting better interaction and acceptance of BF.

O aleitamento materno tem, dentre outros benefícios, a diminuição da morbimortalidade infantil, a prevenção de infecções respiratórias e a redução dos riscos de desenvolvimento de doenças, portanto, os objetivos deste estudo foram avaliar os saberes e atitudes de puérperas sobre aleitamento materno em um hospital universitário, bem como as fontes de obtenção e as categorias profissionais responsáveis por essas informações. O trabalho foi realizado no Hospital das Clínicas da Universidade Federal de Uberlândia (HC-UFU). Foram realizadas entrevistas estruturadas para obtenção de dados para avaliação de informações e exercício da prática do AM com puérperas internadas no alojamento conjunto, entre 1º de julho a 31 de dezembro de 2010. Do total de 907 entrevistadas, 617 (68,0%) das mulheres pretendiam amamentar por 12 meses ou mais, 566 (62,4%) das mulheres realizaram o AM já na primeira hora do nascimento, em 551 (60,8%) a decisão de amamentar foi tomada pela mulher antes da gravidez atual e 828 (91,3%) receberam ajuda no processo de amamentação. Das mulheres que receberam ajuda, 788 (95,1%) foram auxiliadas por profissionais da equipe de enfermagem. Foi demonstrado que a maioria das puérperas pretendia amamentar por 12 meses ou mais, tendo em vista que também realizaram o AM na primeira hora. Observou-se também a importância da equipe de enfermagem para com o cuidado do binômio mãe/filho, fazendo com que houvesse melhor interação e aceitação do AM

Diagnóstico de situación del puerperio reciente y la prestación de anticoncepción en pacientes con screening de drogas positivo en un hospital regional, entre junio 2015 a agosto 2016 / Situation diagnosis of recent puerperio and contraception patients with positive drug screening, in a regional hospital, between june 2015 and august 2016

El consumo de sustancias ilícitas y de alcohol durante el embarazo constituye un problema de salud pública grave, que incide en el aumento de la morbi-mortalidad materno-fetal, el síndrome de abstinencia neonatal e institucionalización de los menores. El puerperio de estas mujeres presenta otros desafíos, siendo uno de ellos el control de su fertilidad posterior dado la menor adherencia al uso de métodos de anticoncepción (MAC) versus la población general. OBJETIVO: Conocer sobre la indicación de métodos anticonceptivos en puérperas con consumo problemático de drogas durante el embarazo, atendidas en el Hospital Dr.Gustavo Fricke, de Viña del Mar. MÉTODO: Se realizó un estudio observacional retrospectivo de los registros médicos de todas las pacientes con test de drogas positivo en orina de la Unidad de Puerperio del Servicio de Ginecología y Obstetricia cuyo parto ocurrió entre Junio del 2015 y Agosto del 2016...

The consumption of illicit substances and alcohol during pregnancy is a serious public health problem, given the increase in maternal-fetal morbidity and mortality, neonatal abstinence syndrome and institutionalization of minors. In turn, the postpartum period of these women presents other challenges, one of which is the control of their subsequent fertility given the lower adherence to the use of contraception methods (MAC) versus the general population. OBJECTIVE: Get to know the indication of contraceptive methods in postpartum women with problematic drug use during pregnancy, treated at the Dr. Gustavo Fricke Hospital, in Viña del Mar. METHOD: A retrospective observational study of the medical records of all patients with a positive urine drug test was performed at the Puerperium Unit of the Gynecology and Obstetrics Service whose delivery occurred between June 2015 and August 2016...