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1.
Medicine (Baltimore) ; 99(23): e20626, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502041

RESUMO

The World Health Organization recommended that the oral intake of low-risk pregnant women during labor should not be restricted. Hospitals in different countries take different measures to manage the intake during labor, but it is not clear about the current situation of oral intake management measures in the hospital during labor in China. Thus, the objective of this study was to investigate the current situation of oral intake management measures during labor in China, so as not only provide references for developing appropriate midwifery technology training and formulating relevant policies, but also provide a basis for exploring and implementing better oral intake management measures in the future.A cross-sectional survey was conducted. From December 2017 to November 2018, the oral intake management measures of 1213 hospitals in 22 provinces, cities, and autonomous regions in China were investigated by a self-designed questionnaire. χ test was used for statistical analysis.Different hospitals in China have adopted different oral intake management measures. Among the 1213 hospitals, 939(77.4%) hospitals took measures to allow pregnant women to bring the easily digestible food, 813(67.0%) hospitals took measures to allow pregnant women to eat what she wanted to eat. Few hospitals provide pregnant women with oral nutrition solution or provide a suitable diet for pregnant women. Thirty-four (2.8%) hospitals still restrict pregnant women's fluid intake.Oral intake management measures that are more suitable for Chinese pregnant women should be explored to better ensure the women energy needs and they safely go through childbirth.


Assuntos
Comportamento Alimentar , Alimentos , Trabalho de Parto , China , Estudos Transversais , Feminino , Hospitais/estatística & dados numéricos , Humanos , Gravidez , Inquéritos e Questionários
2.
PLoS One ; 15(5): e0230704, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32357152

RESUMO

BACKGROUND: Cortisol has been used to capture psychophysiological stress during childbirth and postpartum wellbeing. We explored the effect of a brief antenatal training course in self-hypnosis on salivary cortisol during childbirth and 6 weeks postpartum. METHODS: In a randomized, controlled trial conducted at Aarhus University Hospital Skejby Denmark during the period January 2010 until October 2010, a total of 349 healthy nulliparous women were included. They were randomly allocated to a hypnosis group (n = 136) receiving three one-hour lessons in self-hypnosis with additional audio-recordings, a relaxation group (n = 134) receiving three one-hour lessons in various relaxation methods with audio-recordings for additional training, and a usual care group (n = 79) receiving ordinary antenatal care only. Salivary cortisol samples were collected during childbirth (at the beginning of the pushing state, 30 minutes, and 2 hours after childbirth), and 6 weeks postpartum (at wake up, 30 minutes after wake up, and evening). Cortisol concentrations were compared using a linear mixed-effects model. Correlations between cortisol concentrations and length of birth, experienced pain and calmness during birth were examined by a Spearman rank correlation test. FINDINGS: During childbirth, week correlations were found between cortisol concentrations 30 minutes after childbirth and length of birth. In the beginning of the pushing state and 2 hours after childbirth, we found a tendency towards higher cortisol concentrations in the hypnosis group compared to the other two groups (hypnosis versus relaxation p = 0.02 and 0.03, hypnosis versus usual care p = 0.08 and 0.05). No differences were observed in cortisol concentrations between the groups 30 minutes after childbirth (hypnosis versus relaxation p = 0.08, hypnosis versus usual care 0.10) or 6 weeks postpartum (hypnosis versus relaxation: p = 0.85, 0.51, and 0.68, hypnosis versus usual care: p = 0.85, 0.93, and 0.96). CONCLUSION: Antenatal hypnosis training may increase the release of cortisol during childbirth with no long-term consequences. Further research is needed to help interpret these findings.


Assuntos
Hipnose/métodos , Dor do Parto/terapia , Parto/metabolismo , Terapia de Relaxamento , Adulto , Analgesia Obstétrica/efeitos adversos , Parto Obstétrico , Feminino , Humanos , Hidrocortisona/metabolismo , Dor do Parto/metabolismo , Dor do Parto/fisiopatologia , Trabalho de Parto/fisiologia , Parto/fisiologia , Satisfação do Paciente , Período Pós-Parto/metabolismo , Período Pós-Parto/fisiologia , Gravidez , Cuidado Pré-Natal , Saliva/metabolismo
3.
Sante Publique ; HS1(S1): 93-104, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32374099

RESUMO

INTRODUCTION: The latest global reports show that in 2016, 2.6 million children died worldwide during their first month of birth. Also, the proportion of neonatal deaths among the deaths of children under 5 increased between 1990 and 2015: from 26% in 1990 to 35% in 2015 [1]. METHOD: An anthropological study in public health and home-based structures in north Togo (Savanes region) allowed us to observe and perform a clinical ethnography of different perinatal death situations. RESULTS: The nursing staff, consider the mother as responsible: She didn't come to the hospital early; she was ill but did not get treated or she was late for the expulsion leaving the newborn suffocating. The health care staff is rarely called into question in the face of such a situation. In addition to the guilt of grieving mothers, these tragic situations are in most cases erased as having never occurred by the nursing staff and also by the family: silence and many things left unsaid surround these deaths. CONCLUSION: This study shows that we need to initiate death audits in the maternity wards in order to improve care for mothers and newborns.


Assuntos
Atitude do Pessoal de Saúde/etnologia , Trabalho de Parto , Tocologia , Mães/psicologia , Morte Perinatal , Antropologia Cultural , Criança , Feminino , Morte Fetal , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Togo
4.
Am J Obstet Gynecol ; 223(1): 66-74.e3, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32283073

RESUMO

Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2, has been declared a pandemic by the World Health Organization. As the pandemic evolves rapidly, there are data emerging to suggest that pregnant women diagnosed as having coronavirus disease 2019 can have severe morbidities (up to 9%). This is in contrast to earlier data that showed good maternal and neonatal outcomes. Clinical manifestations of coronavirus disease 2019 include features of acute respiratory illnesses. Typical radiologic findings consists of patchy infiltrates on chest radiograph and ground glass opacities on computed tomography scan of the chest. Patients who are pregnant may present with atypical features such as the absence of fever as well as leukocytosis. Confirmation of coronavirus disease 2019 is by reverse transcriptase-polymerized chain reaction from upper airway swabs. When the reverse transcriptase-polymerized chain reaction test result is negative in suspect cases, chest imaging should be considered. A pregnant woman with coronavirus disease 2019 is at the greatest risk when she is in labor, especially if she is acutely ill. We present an algorithm of care for the acutely ill parturient and guidelines for the protection of the healthcare team who is caring for the patient. Key decisions are made based on the presence of maternal and/or fetal compromise, adequacy of maternal oxygenation (SpO2 >93%) and stability of maternal blood pressure. Although vertical transmission is unlikely, there must be measures in place to prevent neonatal infections. Routine birth processes such as delayed cord clamping and skin-to-skin bonding between mother and newborn need to be revised. Considerations can be made to allow the use of screened donated breast milk from mothers who are free of coronavirus disease 2019. We present management strategies derived from best available evidence to provide guidance in caring for the high-risk and acutely ill parturient. These include protection of the healthcare workers caring for the coronavirus disease 2019 gravida, establishing a diagnosis in symptomatic cases, deciding between reverse transcriptase-polymerized chain reaction and chest imaging, and management of the unwell parturient.


Assuntos
Infecções por Coronavirus/diagnóstico , Obstetrícia/métodos , Pneumonia Viral/diagnóstico , Complicações Infecciosas na Gravidez/virologia , Doença Aguda , Algoritmos , Anestesia , Betacoronavirus , Cesárea , Infecções por Coronavirus/prevenção & controle , Diagnóstico Diferencial , Feminino , Pessoal de Saúde , Humanos , Recém-Nascido , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Trabalho de Parto , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Gravidez , Radiografia Torácica
6.
PLoS One ; 15(4): e0231461, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298307

RESUMO

Although being the golden standard for intrapartum fetal surveillance, cardiotocography (CTG) has been shown to have poor specificity for detecting fetal acidosis. Non-invasive near-infrared-spectroscopy (NIRS) monitoring of placental oxygenation during labour has not been studied yet. The objective of the study was to determine whether changes in placental NIRS values during labour could identify intrapartum fetal hypoxia and resulting acidosis. We included 43 healthy women in active stage of labour at term. CTG and NIRS parameters in groups with vs. without neonatal umbilical artery pH ≤ 7.20 were compared using Mann-Whitney-U. Receiver-operating-characteristics (ROC) curves were used to estimate predictive value of CTG and NIRS parameters for neonatal pH ≤ 7.20. A computer-based statistical classification was also performed to further evaluate predictive values of CTG and NIRS for neonatal acidosis. Ten (23%) neonates were born with umbilical artery pH ≤ 7.20. Compared to group with pH > 7.20, fetal acidosis was associated with more episodes of placental NIRS deoxygenation (9 (range 2-37) vs. 2 (range 0-65); p<0.001), higher velocity of placental NIRS deoxygenation (2.31 (range 0-22) vs. 1 (range 0-49) %/s; p = 0.03), more decelerations on CTG (25 (range 3-91) vs. 10 (range 10-60); p = 0.02), and more prolonged decelerations on CTG (2 (range 0-4) vs. 1 (range 0-3); p = 0.04). Number of placental deoxygenations had the highest prognostic value for fetal/neonatal acidosis (area under the ROC curve 0.85 (95% confidence interval 0.70-0.99). Computer-based classification also identified number of placental deoxygenations as the most accurate classifier, with 25% false positive and 93% true positive rate in the training dataset, with 100% accuracy when applied to the testing dataset. Placental deoxygenations during labour measured by NIRS are associated with fetal/neonatal acidosis. Predictive value of placental NIRS for neonatal acidosis was superior to that of CTG.


Assuntos
Cardiotocografia/métodos , Feto/irrigação sanguínea , Trabalho de Parto , Placenta/fisiologia , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Adolescente , Adulto , Feminino , Humanos , Trabalho de Parto/fisiologia , Pessoa de Meia-Idade , Oxigênio/metabolismo , Placenta/metabolismo , Gravidez , Adulto Jovem
7.
Curr Opin Anaesthesiol ; 33(3): 299-304, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32324661

RESUMO

PURPOSE OF REVIEW: The prevalence of cesarean delivery is increasing worldwide despite the advance of Trial of Labor After Cesarean section. In many countries, a history of previous cesarean section is an almost absolute indication for a repeat cesarean section. The purpose of this review was to examine if the perioperative anesthetic management of patients with repeat cesarean section is different from the anesthetic management of patients with primary cesarean section. RECENT FINDINGS: This review discusses important topics, such as early diagnosis of cases with a potentially high risk for complications; the need for assessment of patients diagnosed with abnormal placentation; the importance of a multidisciplinary approach that includes interaction of the anesthesiologist, gynaecologist, and invasive radiologist; emphasizing the need for reinforcement of new methods of invasive procedures; management of massive bleeding, use of new technologies, and development of an institutional protocol for management of patients with abnormal placentation. SUMMARY: According to this review, we show that the management of patients with repeat cesarean section without abnormal placentation is almost the same as the management of patients for primary cesarean section. Timely diagnosis of patient with abnormal placentation and multidisciplinary approach is crucial for prevention of morbidity or even mortality.


Assuntos
Anestesia Obstétrica , Anestésicos/administração & dosagem , Recesariana/estatística & dados numéricos , Complicações do Trabalho de Parto/prevenção & controle , Cesárea , Feminino , Humanos , Trabalho de Parto , Gravidez , Prevalência
8.
Zhen Ci Yan Jiu ; 45(4): 325-9, 2020 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-32333540

RESUMO

OBJECTIVE: To investigate the effect of electroacupuncture (EA) analgesia at the latent stage of labor on epidural analgesia, labor outcome and neonatal score so as to provide the reference to the clinical labor analgesia. METHODS: According to the random number table, 104 primipara of vaginal delivery were divided into three groups, named an EA group (37 cases), a sham-EA group (36 cases) and an epidural block group (31 cases). In the EA group, when the cervix opened up by 1 cm, Han's acupoint nerve stimulation apparatus was attached to bilateral Hegu (LI4) and bilateral Sanyinjiao (SP6) to achieve EA analgesia till the active stage (the cervix up 3 cm). In the sham-EA group, the procedure was same as the EA group, but with the sham-stimulation. In the epidural block, EA was not used in intervention. When the cervix opened up 3 cm, the epidural block and the patient-controlled epidural analgesia were all adopted in each group. The score of visual analogue scale (VAS) and the dosage of Sufentanil and Ropivacaine in patient-controlled analgesia pump at the different time points were compared among the groups. Respectively, in 1 h of EA stimulation (T1), 2 h of EA stimulation (T2), at the moment of epidural block (T3) and the complete open of the cervix (T6), the venous blood sample was collected to determine the concentration of beta-endorphin (beta-EP), and the use time of oxytocin, the bleeding amount and the state of newborn were recorded. RESULTS: There was no statistical difference in immediate of EA stimulation (T0) among the groups in VAS score (P>0.05). But, in T1 to T6, VAS score in the EA group was reduced obviously as compared with the sham-EA group and the epidural block group separately (P<0.05). There was no statistical difference in the use time of oxytocin among the three groups (P>0.05). In the sham-EA group and the epidural block group, bleeding amount during labor and in 24 h after labor was all higher than that of the EA group (P<0.05). In each group, the concentration of beta-EP in T3 and T6 was increased obviously as compared with that in T1 and T2 respectively (P<0.05). In the EA group, the concentration of beta-EP in T1 to T3 and in T6 was higher than that in sham-EA group and the epidural block group respectively (P<0.05). The dosage of Ropivacaine and Sufentanil in the EA group was less than that in either the sham-EA group or the epidural block group (P<0.05). There was no significant difference in amniotic fluid turbidity rate and Apgar score among the three groups (P>0.05). CONCLUSION: Electroacupuncture analgesia at the latent stage of labor effectively relieves labor pain of primipara, increases the concentration of beta-EP, enhances the effect of epidural block analgesia, reduces labor bleeding and has no side effect on newborn. The combination of electroacupuncture analgesia and the epidural anesthesia in the latent stage is applicable in the whole process of labor.


Assuntos
Analgesia Epidural , Eletroacupuntura , Dor do Parto , Trabalho de Parto , Feminino , Humanos , Recém-Nascido , Manejo da Dor , Gravidez
9.
Am J Perinatol ; 37(8): 829-836, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32344441

RESUMO

Novel coronavirus disease 2019 (COVID-19) is a respiratory tract infection that was first identified in China. Since its emergence in December 2019, the virus has rapidly spread, transcending geographic barriers. The World Health Organization and the Centers for Disease Control and Prevention have declared COVID-19 as a public health crisis. Data regarding COVID-19 in pregnancy is limited, consisting of case reports and small cohort studies. However, obstetric patients are not immune from the current COVID-19 pandemic, and obstetric care will inevitably be impacted by the current epidemic. As such, clinical protocols and practice on labor and delivery units must adapt to optimize the safety of patients and health care workers and to better conserve health care resources. In this commentary, we provide suggestions to meet these goals without impacting maternal or neonatal outcomes. KEY POINTS: • Novel coronavirus disease 2019 (COVID-19) is a pandemic.• COVID-19 impacts care of obstetric patients.• Health care should be adapted for the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Parto Obstétrico/métodos , Controle de Infecções , Trabalho de Parto , Pandemias , Assistência Perinatal , Pneumonia Viral , Gestão de Riscos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Assistência Perinatal/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Gestão de Riscos/métodos , Gestão de Riscos/organização & administração
13.
Am J Obstet Gynecol ; 223(1): 140-141, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32184148
15.
Arch Gynecol Obstet ; 301(3): 693-698, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32125522

RESUMO

BACKGROUND: Women's experience of pain during labor varies greatly, and pain control is a major concern for obstetricians. Several methods have been studied for pain management for women in labor, including drug and non-drug interventions. OBJECTIVE: To test the hypothesis that in nulliparous women with singleton pregnancies at term, listening to music would reduce the pain level during labor. METHODS: Parallel group non-blinded randomized clinical trial conducted at a single center in Italy. Nulliparous women in spontaneous labor with singleton pregnancies and vertex presentation admitted in labor and delivery room between 37 0/7 and 42 0/7 weeks of gestation for active phase of labor were eligible, and were randomized in a 1:1 ratio to receive music during labor or no music during labor. Music in labor was defined listening to music from the randomization until the delivery of the baby. The primary endpoint was the pain level during the active phase of labor, recorded using the visual analogue scale (VAS) for pain, ranging from 0 (no pain) to 10 (unbearable pain). The effect of music use during labor on each outcome was quantified as the mean difference (MD) with 95% confidence interval (CI). RESULTS: During the study period, 30 women agree to take part in the study, underwent randomization, and were enrolled and followed up. 15 women were randomized in the music group, and 15 in the control group. No patients were lost to follow up for the primary outcome. Pain level during the active phase of labor was scored 8.8 ± 0.9 in the music group, and 9.8 ± 0.3 in the control group (MD - 1.00 point, 95% CI - 1.48 to - 0.52; P < 0.01). Music during labor and delivery was also associated with a decreased pain at 1 h postpartum (MD - 2.40 points, 95% CI - 4.30 to - 0.50), and decreased anxiety level during active phase of labor (MD - 19.90 points, 95% CI - 38.72 to - 1.08), second stage of labor (MD - 49.40 points, 95% CI - 69.44 to - 29.36), and at 1 h postpartum (MD - 27.00 points, 95% CI - 47.37 to - 6.63). CONCLUSION: In nulliparous women with singleton pregnancies at term, listening to music reduces the pain level, and the anxiety level during labor. TRIAL REGISTRATION: Clinicaltrials.gov NCT03779386.


Assuntos
Ansiedade/terapia , Dor do Parto/terapia , Trabalho de Parto , Musicoterapia , Música , Adulto , Feminino , Humanos , Itália , Trabalho de Parto/psicologia , Manejo da Dor/métodos , Paridade , Período Pós-Parto , Gravidez , Resultado da Gravidez , Resultado do Tratamento , Escala Visual Analógica , Saúde da Mulher
19.
PLoS One ; 15(3): e0230063, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32142545

RESUMO

BACKGROUND: Women-held maternity documents are well established for enabling continuity of maternity care worldwide, with the World Health Organisation (WHO) recommending their use in effective decision-making. We aimed to assess the presence, content and completeness of women-held maternity documents at admission to hospitals in The Gambia, and investigate barriers and facilitators to their completion. METHODS: We interviewed 250 women on maternity wards of all 3 Banjul hospitals and conducted content analysis of documentation brought by women on admission for their completeness against WHO referrals criteria. Logistic regression models were used to estimate the odds of the minimum criteria being met. Two focus groups and 21 semi-structured interviews (8 doctors, 8 midwives and 5 nurses) were conducted with healthcare practitioners to explore barriers and facilitators to documented clinical information availability on admission. FINDINGS: Of the women admitted, all but 10/250 (4%) brought either a maternity card or a structured referral sheet. Of all forms of documentation, women most frequently brought the government-issued maternity card (235/250, 94%); 16% of cards had all 9 minimum criteria completed. Of the 79 referred women, 60% carried standardised referral forms. Only 30% of 97 high-risk women had risk-status recorded. Women were less likely to have documents complete if they were illiterate, had not attended three maternity appointments, or lived more than one hour from hospital. During qualitative interviews, three themes were identified: women as agents for transporting information and documents (e.g. remembering to bring maternity cards); role of individual healthcare professionals' actions (e.g. legibility of handwriting); system and organisational culture (e.g. standardised referral guidelines). CONCLUSION: Women rarely forgot their maternity card, but documents brought at admission were frequently incomplete. This is a missed opportunity to enhance handover and quality of care, especially for high-risk women. National guidelines were recognised by providers as needed for good document keeping and would enhance the women-held maternity documents' contribution to improving both safety and continuity of care.


Assuntos
Trabalho de Parto , Registros Médicos/normas , Adulto , Feminino , Grupos Focais , Gâmbia , Pessoal de Saúde/psicologia , Humanos , Entrevistas como Assunto , Alfabetização , Modelos Logísticos , Gravidez , Cuidado Pré-Natal , Encaminhamento e Consulta/normas , Ultrassonografia , Adulto Jovem
20.
PLoS One ; 15(3): e0229941, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150593

RESUMO

The adoption of respectful maternity care during labor and birth is a complex process which needs both scientific and interpersonal skills of providers. In this regard, identifying the potential barriers and applying effective strategies for implementing respectful maternity care are essential. This study aimed to explore the perceptions of Iranian midwives regarding respectful maternity care during labor and childbirth. This was a qualitative study which was conducted from September-December 2018 in two non-teaching public hospitals in Tehran, Iran. Twenty-four semi-structured interviews were conducted with midwives, who had more than one year work experience in labor and childbirth units, through a purposive sampling method. A content analysis approach was used to analyze the data and identify themes. Three themes were extracted including "showing empathy", "women-centered care" and "protecting rights". Showing empathy reflects that "establishing a friendly relationship" and "being with women". Women-centered care encompassed "keeping women safe" and "participating in decision making". Protecting rights reflected a need for "safeguarding dignity" as well as "giving equal care" and "preparing appropriate environment". Iranian midwives considered respectful maternity care a broader concept than just preventing mistreatment. Providing supportive care through friendly interaction with women was the first step for providing respectful maternity care. Respectful care is also promoted by providing safe care, implementing evidence-based care and involving women in their care as well as by providing an appropriate environment for women, families and caregivers.


Assuntos
Serviços de Saúde Materna , Tocologia , Relações Enfermeiro-Paciente , Adulto , Empatia , Feminino , Humanos , Irã (Geográfico) , Trabalho de Parto , Pessoa de Meia-Idade , Parto , Gravidez , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Respeito , Adulto Jovem
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