A vivência do pai no nascimento por cesariana no centro obstétrico: contribuições para a assistência / The father's experience in cesarean birth at the obstetric center: contributions to care / La experiencia del padre al nacimento por cesárea en el centro obstétrico: contribuciones a la asistencia

Objective: the study's goal has been to describe the experience of the accompanying father in the birth process by caesarean section at the Obstetric Center and point out the favorable and unfavorable conditions that influence this process.Methods: qualitative research, carried out at a University Hospital from august to september 2016 with 10 accompanying parents. The data collection was established by a semi-structured interview, submitted to Bardin's content analysis. Results: through the analysis, two categories emerged: possibilities and limitations in the experience of accompanying parents and emotional aspects in the birth process, which include the physical aspects of the operating room, the welcoming and guidance of the multidisciplinary team and the feelings presented by the parents. Conclusion: the father's participation in the cesarean delivery provides positive impacts for the mother-child-family trinomial, making crucial his presence since prenatal care and the physical adequacy of the cesarean environment

Objetivo: descrever a vivência do pai acompanhante no processo de nascimento por cesariana no Centro Obstétrico e apontar as condições favoráveis e desfavoráveis que influenciaram neste processo. Métodos: pesquisa qualitativa, realizada em um Hospital Universitário de agosto a setembro de 2016 com 10 pais acompanhantes. A coleta de dados se estabeleceu por meio de uma entrevista semiestruturada, submetida à análise de conteúdo de Bardin. Resultados: pela análise, emergiram duas categorias: possibilidades e limitações na vivência do pai acompanhante e aspectos emocionais no processo de nascimento, que compreenderam: os aspectos físicos da sala de cirurgia, o acolhimento e orientação da equipe multiprofissional e os sentimentos apresentados pelos pais. Conclusão: a participação do pai no parto cesárea proporciona impactos positivos ao trinômio mãe-filho-família, tornando cruciais a sua presença desde o pré-natal e a adequação física do ambiente da cesárea

Objetivo: describir la experiencia del padre acompañante en el proceso de parto por cesárea en el Centro de Obstetricia y señalar las condiciones favorables y desfavorables que influyeron en este proceso. Métodos: investigación cualitativa realizada en un Hospital Universitario de agosto a septiembre de 2016 con 10 padres acompañantes. La recopilación de datos se estableció mediante una entrevista semiestructurada, sometida al análisis del contenido de Bardin. Resultados: por análisis, surgieron dos categorías: posibilidades y limitaciones en la experiencia del padre acompañante y aspectos emocionales en el proceso del parto, que incluyeron los aspectos físicos de la sala de operaciones, la bienvenida y la orientación del equipo multidisciplinario y los sentimientos presentados por los padres. Conclusión: la participación del padre en la cesárea proporciona impactos positivos para el trinomio madre-hijo-familia, lo que hace que su presencia desde la atención prenatal y la adecuación física del entorno de la cesárea sean cruciales

Boas práticas no cuidado ao recém-nascido com boa vitalidade na sala de parto: revisão integrativa / Good practices in caring for a newborn with good vitality in the delivery room: integrative review / Buenas prácticas en el cuidado de un recién nacido con buena vitalidad en la sala de entrega: revisión integrativa

Objetivo: analisar a produção científica brasileira sobre boas práticas relacionadas ao cuidado do recém-nascido com boa vitalidade na sala de parto. Métodos: revisão integrativa realizada em cinco recursos informacionais, mediante associação dos descritores: recém-nascido; assistência perinatal; e, parto humanizado, em português, inglês e espanhol. Resultados: 12 publicações compuseram a análise interpretativa, nas quais contato pele a pele imediato mãe-bebê, aleitamento materno precoce e clampeamento oportuno do cordão umbilical são reconhecidos como boas práticas ao recém-nascido na sala de parto. A adesão ou não a essas condutas associam-se a fatores como tipo de parto, presença de acompanhante, vínculo com a equipe de saúde, infraestrutura, disponibilidade de recursos e hospital intitulado Amigo da Criança. Conclusão: é necessária uma mudança de paradigma vislumbrando o fortalecimento do vínculo entre mãe e bebê, logo, são necessários profissionais capacitados e sensibilizados para a humanização das condutas na sala de parto

Objective: to analyze the Brazilian scientific production on good practices related to the care of newborns with good vitality in the delivery room. Method: integrative review carried out on five information resources, using the association of descriptors: newborn; perinatal care; and humanized birth, in Portuguese, English and Spanish. Results: 12 publications comprised the interpretative analysis, in which mother-infant immediate skin-to-skin contact, early breastfeeding, and timely umbilical cord clamping are recognized as good practices for the newborn in the delivery room. Adherence or not to these behaviors is associated with factors such as type of delivery, presence of companion, bond with the health team, infrastructure, availability of resources and hospital called Child Friendly

Objetivo: analizar la producción científica brasileña sobre buenas prácticas relacionadas con el cuidado de recién nacidos con buena vitalidad en la sala de partos. Método: revisión integradora en cinco recursos de información, utilizando la asociación de descriptores: recién nacido; cuidado perinatal; y nacimiento humanizado, en portugués, inglés y español. Resultados: 12 publicaciones comprendieron el análisis interpretativo, en el cual el contacto inmediato piel a piel de la madre y el bebé, la lactancia temprana y el pinzamiento oportuno del cordón umbilical se reconocen como buenas prácticas. El cumplimiento de estas se asocia a tipo de parto, presencia de acompañante, vínculo con equipo de salud, infraestructura, disponibilidad de recursos y hospital llamado Child Friendly. Conclusión: se necesita un cambio de paradigma para prever el fortalecimiento del vínculo entre la madre y el bebé, por lo tanto, se necesitan profesionales capacitados y sensibilizados para humanizar la conducta en la sala de partos

Delivery room interventions to prevent bronchopulmonary dysplasia in preterm infants: a protocol for a systematic review and network meta-analysis.

INTRODUCTION: As gestational age decreases, incidence of bronchopulmonary dysplasia (BPD) and chronic lung disease increases. There are many interventions used in the delivery room to prevent acute lung injury and consequently BPD in these patients. The availability of different treatment options often poses a practical challenge to the practicing neonatologist when it comes to making an evidence-based choice as the multitude of pairwise systematic reviews including Cochrane reviews that are currently available only provide a narrow perspective through head-to-head comparisons. METHODS AND ANALYSIS: We will conduct a systematic review of all randomised controlled trials evaluating delivery room interventions within the first golden hour after birth for prevention of BPD. The primary outcome includes BPD. Secondary outcomes include death at 36 weeks of postmenstrual age or before discharge; severe intraventricular haemorrhage (grade 3 or 4 based on the Papile criteria); any air leak syndromes (including pneumothorax or pulmonary interstitial emphysema); retinopathy of prematurity (any stage) and neurodevelopmental impairment at 18-24 months. We will search from their inception to August 2018, the following databases: Medline, EMBASE and Cochrane Central Register of Controlled Trials as well as grey literature resources. Two reviewers will independently screen titles and abstracts, review full texts, extract information and assess the risk of bias and the confidence in the estimate (with Grading of Recommendations Assessment, Development and Evaluation approach). This review will use Bayesian network meta-analysis approach which allows the comparison of the multiple delivery room interventions for prevention of BPD. We will perform a Bayesian network meta-analysis to combine the pooled direct and indirect treatment effect estimates for each outcome, effectiveness and safety of delivery room interventions for prevention of BPD. ETHICS AND DISSEMINATION: The proposed protocol is a network meta-analysis, which has been registered on PROSPERO International prospective register of systematic reviews (CRD42018078648). The results will provide an evidence-based guide to choosing the right sequence of early postnatal interventions that will be associated with the least likelihood of inducing lung injury and BPD in preterm infants. Furthermore, we will identify knowledge gaps and will encourage further research for other therapeutic options. Therefore, its results will be disseminated through peer-reviewed publications and conference presentations. Due to the nature of the design, no ethics approval is necessary.

Quality Improvement Project to Decrease Delivery Room Intubations in Preterm Infants.

BACKGROUND AND OBJECTIVES: Avoidance of delivery room intubation (DRI) reduces death or bronchopulmonary dysplasia (BPD) in preterm neonates. Our objective with this quality improvement project was to decrease DRI rates by improving face mask positive pressure ventilation (Fm-PPV) among infants born ≤29 weeks' gestation. METHODS: Key drivers of change were identified from a retrospective review of resuscitation records. A resuscitation bundle to optimize Fm-PPV including the use of a small round mask and end-tidal CO2 detectors, increasing peak inspiratory pressure when indicated, and debriefing after each intubation were implemented in consecutive plan-do-study-act cycles. The DRI rate was tracked by using a control chart. Resuscitation practice and outcomes of pre-quality improvement cohort (QIC) (January 2014-September 2015) were compared with post-QIC (October 2015-December 2016). RESULTS: Of the 314 infants who were resuscitated, 180 belonged to the pre-QIC and 134 to the post-QIC. The antenatal steroid administration rate was higher in the post-QIC (54% vs 88%). More infants in the post-QIC had resolution of bradycardia after Fm-PPV (56% vs 77%, P = .02). Infants in the post-QIC had lower DRI rates (58% vs 37%, P < .01), lower need for mechanical ventilation (85% vs 70%, P < .01), lower rates of BPD (26% vs 13%, P < .01), and severe retinopathy of prematurity (14% vs 5%, P = .01). Rates of DRI, BPD, and severe retinopathy of prematurity remained lower even after controlling for the potential confounders. CONCLUSIONS: Implementation of a resuscitation bundle decreased the DRI rate and improved outcomes of preterm infants.

UK neonatal resuscitation survey.

BACKGROUND: Previous surveys have demonstrated that neonatal resuscitation practices on the delivery suite vary between UK units, particularly according to the hospital's neonatal unit's level. Our aim was to determine if recent changes to the Resuscitation Council guidelines had influenced clinical practice. METHODS: Surveys of resuscitation practices at UK delivery units carried out in 2012 and 2017 were compared. RESULTS: Comparing 2017 with 2012, initial resuscitation using air was more commonly used in both term (98% vs 75%, p<0.001) and preterm (84% vs 34%, p<0.001) born infants. Exhaled carbon dioxide monitoring was more frequently employed in 2017 (84% vs 19%, p<0.001). There were no statistically significant differences in practices according to the level of neonatal care provided by the hospital. CONCLUSION: There have been significant changes in neonatal resuscitation practices in the delivery suite since 2012 regardless of the different levels of neonatal care offered.

Percepções do acompanhante de escolha da mulher acerca da organização e ambiência do centro obstétrico / La percepción del acompañante de elección de la mujer acerca de laorganización y el ambiente del centro obstétrico / Perceptions from the delivering women’s chosen companion concerning the obstetrics ward organization and ambience

Objective: Descriptive research, with a qualitative approach, aiming to know the companion’s perceptions about the organization and ambience of the obstetrical center, and to identify which aspects facilitate and make difficult their stay. Method: Data was collected through semi-structured interviews with 16 companions chosen by delivering women from November 2010 to May 2011, in a public maternity in Santa Catarina, Brazil. Results: Using Collective Subject Discourse in analyzing the data, the following four themes emerged: orientation about norms and routines supplied to the companion before entering the obstetrics ward; obstetrics ward ambience; aspects which facilitate staying; and difficulties surrounding staying in the obstetrics ward. Conclusion: although some difficulties were faced, especially resulting from the lack of orientation and inappropriate accommodation of the companion, they were not obstacles to their permanence by the delivering woman’s side.

Objetivo: Pesquisa descritiva, com abordagem qualitativa, que objetivou conhecer as percepções do acompanhante sobre a organização e a ambiência do centro obstétrico, e identificar quais aspectos facilitam e dificultam sua permanência. Método: Os dados foram coletados por meio de entrevistas semiestruturadas, realizadas de novembro de 2010 a maio de 2011, em uma maternidade pública de Santa Catarina, com 16 acompanhantes de escolha da mulher. Resultados: A partir da análise dos dados, utilizando-se o Discurso do Sujeito Coletivo, emergiram quatro temas: orientações sobre as normas e rotinas recebidas pelo acompanhante antes de entrar no centro obstétrico; ambiência do centro obstétrico; aspectos que facilitaram a permanência do acompanhante no centro obstétrico; e aspectos que dificultaram. Conclusão: Apesar de algumas dificuldades enfrentadas, especialmente decorrentes da falta de orientação e da acomodação inapropriada para o acompanhante, de maneira geral, elas não se tornaram obstáculos para a permanência junto à parturiente.

Objetivo: Investigación descriptiva y cualitativa para conocer las percepciones de los acompañantes sobre la organización y ambiente del centro de obstetricia, determinar qué aspectos facilitan/dificultan su permanencia. Método: La recolección de datos se hizo por medio de entrevistas semiestructuradas con dieciséis acompañantes elegidos por la mujer, de noviembre de 2010 a mayo de 2011, en una maternidad pública de Santa Catarina. Resultados: El análisis de datos, por medio del Discurso del Sujeto Colectivo, llevó a cuatro temas: orientaciones sobre las reglas y rutinas recibidas por el acompañante antes de entrar al centro obstétrico; el ambiente del centro obstétrico; los factores que facilitaron la permanencia del acompañante en ese centro; y factores que obstaculizaron la permanencia del acompañante en ese centro. Conclusión: A pesar de las dificultades enfrentadas, debido la falta de orientación y el alojamiento inadecuado para el acompañante, esas dificultades no se convirtieron en obstáculos para su permanencia con la parturienta.

Meconium "aspiration" (or respiratory distress associated with meconium-stained amniotic fluid?).

The designation meconium aspiration syndrome (MAS) reflects a spectrum of disorders in infants born with meconium-stained amniotic fluid, ranging from mild tachypnea to severe respiratory distress and significant mortality. The frequency of MAS is highest among infants with post-term gestation, thick meconium, and birth asphyxia. Pulmonary hypertension is an important component in severe cases. Prenatal hypopharyngeal suctioning and postnatal endotracheal intubation and suctioning of vigorous infants are not effective. Intubation and suctioning of non-breathing infants is controversial and needs more investigation. Oxygen, mechanical ventilation, and inhaled nitric oxide are the mainstays of treatment. Surfactant is often used in infants with severe parenchymal involvement. High-frequency ventilation and extracorporeal membrane oxygenation are usually considered rescue therapies.

Implementation methods for delivery room management: a quality improvement comparison study.

BACKGROUND: There is little evidence to compare the effectiveness of large collaborative quality improvement versus individual local projects. METHODS: This was a prospective pre-post intervention study of neonatal resuscitation practice, comparing 3 groups of nonrandomized hospitals in the California Perinatal Quality Care Collaborative: (1) collaborative, hospitals working together through face-to-face meetings, webcasts, electronic mailing list, and data sharing; (2) individual, hospitals working independently; and (3) nonparticipant hospitals. The collaborative and individual arms participated in improvement activities, focusing on reducing hypothermia and invasive ventilatory support. RESULTS: There were 20 collaborative, 31 individual, and 44 nonparticipant hospitals caring for 12,528 eligible infants. Each group had reduced hypothermia from baseline to postintervention. The collaborative group had the most significant decrease in hypothermia, from 39% to 21%, compared with individual hospital efforts of 38% to 33%, and nonparticipants of 42% to 34%. After risk adjustment, the collaborative group had twice the magnitude of decrease in rates of newborns with hypothermia compared with the other groups. Collaborative improvement also led to greater decreases in delivery room intubation (53% to 40%) and surfactant administration (37% to 20%). CONCLUSIONS: Collaborative efforts resulted in larger improvements in delivery room outcomes and processes than individual efforts or nonparticipation. These findings have implications for planning quality improvement projects for implementation of evidence-based practices.

La asistencia al parto: del hogar al hospital / Assistência de parto: de casa para o hospital / Assistance for childbirth: home to hospital

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Improving delivery room management for very preterm infants.

BACKGROUND AND OBJECTIVES: Events in the delivery room significantly impact the outcomes of preterm infants. We developed evidence-based guidelines to prevent heat loss, reduce exposure to supplemental oxygen, and increase use of noninvasive respiratory support to improve the care and outcomes of infants with birth weight ≤1250 g at our institution. METHODS: The guidelines were implemented through multidisciplinary conferences, routine use of a checklist, appointment of a dedicated resuscitation nurse, and frequent feedback to clinicians. This cohort study compares a historical group (n = 80) to a prospective group (n = 80, after guidelines were implemented). Primary outcome was axillary temperature at admission to the intensive care nursery. Secondary outcomes measured adherence to the guidelines and changes in clinically relevant patient outcomes. RESULTS: Baseline characteristics of the groups were similar. After introduction of the guidelines, average admission temperatures increased (36.4°C vs 36.7°C, P < .001) and the proportion of infants admitted with moderate/severe hypothermia fell (14% vs 1%, P = .003). Infants were exposed to less oxygen during the first 10 minutes (P < .001), with similar oxygen saturations. Although more patients were tried on continuous positive airway pressure (40% vs 61%, P = .007), the intubation rate was not significantly different (64% vs 54%, P = .20). Median durations of invasive ventilation and hospitalization decreased after the quality initiative (5 vs 1 days [P = .008] and 80 vs 60 days [P = .02], respectively). CONCLUSIONS: We have demonstrated significantly improved quality of delivery room care for very preterm infants after introduction of evidence-based delivery room guidelines. Multidisciplinary involvement and continuous education and reinforcement of the guidelines permitted sustained change.

A retrospective study of the performance of video laryngoscopy in an obstetric unit.

We evaluated the performance of tracheal intubation using video laryngoscopy in an obstetric unit. We analyzed airway management details during a 3-year period, and observed 180 intubations. All cases were managed with direct or video laryngoscopy. Direct laryngoscopy resulted in 157 out of 163 (95% confidence interval [CI], 92%-99%) first attempt successful intubations and failed once. Video laryngoscopy resulted in 18 of 18 (95% CI, 81%-100%) successful intubations on first attempt. The failed direct laryngoscopy was rescued with video laryngoscopy. The patients managed with video laryngoscopy frequently required urgent or emergency surgery and had predictors of difficult direct laryngoscopy in 16 of 18 cases. Video laryngoscopy may be a useful adjunct for obstetric airway management, and its role in this difficult airway scenario should be further studied.

Testing the Birth Unit Design Spatial Evaluation Tool (BUDSET) in Australia: a pilot study.

OBJECTIVE: To pilot test the Birth Unit Design Spatial Evaluation Tool (BUDSET) in an Australian maternity care setting to determine whether such an instrument can measure the optimality of different birth settings. BACKGROUND: Optimally designed spaces to give birth are likely to influence a woman's ability to experience physiologically normal labor and birth. This is important in the current industrialized environment, where increased caesarean section rates are causing concerns. The measurement of an optimal birth space is currently impossible, because there are limited tools available. METHODS: A quantitative study was undertaken to pilot test the discriminant ability of the BUDSET in eight maternity units in New South Wales, Australia. Five auditors trained in the use of the BUDSET assessed the birth units using the BUDSET, which is based on 18 design principles and is divided into four domains (Fear Cascade, Facility, Aesthetics, and Support) with three to eight assessable items in each. Data were independently collected in eight birth units. Values for each of the domains were aggregated to provide an overall Optimality Score for each birth unit. RESULTS: A range of Optimality Scores was derived for each of the birth units (from 51 to 77 out of a possible 100 points). The BUDSET identified units with low-scoring domains. Essentially these were older units and conventional labor ward settings. CONCLUSION: The BUDSET provides a way to assess the optimality of birth units and determine which domain areas may need improvement. There is potential for improvements to existing birth spaces, and considerable improvement can be made with simple low-cost modifications. Further research is needed to validate the tool.

Total perinatally related losses at Tygerberg Hospital - a comparison between 1986, 1993 and 2006.

OBJECTIVE: To determine the leading causes of perinatal deaths and to evaluate any changes, with the inclusion of placental histology. METHOD: At perinatal mortality meetings, primary and final causes of death were assigned for the period 1 July 2006 - 30 June 2007. All singleton babies born to women residing in the metropolitan area serviced by Tygerberg Hospital were included in the prospective descriptive study. RESULTS: The total number of singleton births was 10 396. The total of perinatally related losses (TPRL) rate was 26.2 per 1,000 births. The leading primary obstetric causes of death were: infections (47 - 17.3%), spontaneous preterm labour (PTL) (41 - 15.1%), antepartum haemorrhage (APH) (40 - 14.7%), intra-uterine growth restriction (IUGR) (40 - 14.7%), fetal abnormality (31 - 11.4%), hypertensive disorders (25 - 9.2%), unexplained intra-uterine deaths (IUD) (20 - 7.4%), intrapartum hypoxia (12 - 4.4%) and maternal disease (9 - 3.3%). A total of 162 placentas were sent for histology; 58 reports changed the primary cause of death. CONCLUSION: The TPRL rate for singleton pregnancies was 26.2 per 1,000 births for the study period. The TPRL rates in 1986 and 1993 were 36.7 and 30.5 per 1,000 deliveries. Infection is now the leading primary cause of death, followed by spontaneous PTL, APH and IUGR. During the previous two study periods, APH was the leading primary cause of death, followed by spontaneous PTL. Unexplained IUDs ranked third in 1986, fourth in 1993 and seventh in this study because of the availability of placental histology. Placental histology reports changed 21.3% of the primary causes of death.

Prácticas en la asistencia de niños nacidos con líquido amniótico meconial en la sala de partos: una encuesta nacional / Delivery room practices in infants born through meconium stained amniotic fluid: a national survery

Las guías de las sociedades científcas internacionales para asistencia intraparto y posparto de nacimiento con líquido amniótico meconial (LAM) cambiaron radicalmente en los últimos años en base a dos grandes estudios aleatorizados. En la Argentina no hay información acerca de las prácticas que se realizan en estos nacimientos. Objetivos: 1) Conocer qué prácticas se utilizan en la recepción de recién nacidos con antecedente de LAM. 2) Evaluar el grado de adherencia a las recomendaciones actuales. Material y métodos- Encuesta anónima vía internet a centros del país con mayor o igual 500 nacimientos anuales. Se contactaron 121 instituciones. Resultados: Respondieron 76/121 (63 por ciento) correspondientes a 182540 nacimientos anuales (26 por ciento del total de la Argentina). De las respuestas, 24 por ciento fueron de la Ciudad de Buenos Aires y 72 por ciento de hospitales públicos. Se realizan frecuentemente los siguientes procedimientos no recomendados: 1) aspiración orofaríngea y nasofaríngea antes del desprendimiento de los hombros: en el 50 por ciento a veces y en el 7 por ciento siempre; 2) Aspiración endotraqueal de rutina en niños vigorosos, 30 por ciento de los centros; 3) laringoscopia de rutina para visualizar las cuerdas vocales en el 13 por ciento de LAM fluido y 31 por ciento de LAM espeso. Por el contrario, y a pesar de ser una recomendación formal, la aspiración endotraqueal de niños deprimidos antes de comenzar con la ventilación se realiza sólo en el 69 por ciento de los casos. Un 7 por ciento de los centros encuestados, realiza otros procedimientos no recomendados, como comprensión torácica y presión sobre la laringe para evitar que el niño respire y también el lavado gástrico. Conclusiones: La aspiración orofaríngea y nasofaríngea antes del desprendimiento de los hombros y la intubación y aspiración posnatal de niños vigorosos con LAM se realizan frecuentemente en la Argentina.

Prácticas en la asistencia de niños nacidos con líquido amniótico meconial en la sala de partos: una encuesta nacional / Delivery room practices in infants born through meconium stained amniotic fluid: a national survery

Las guías de las sociedades científcas internacionales para asistencia intraparto y posparto de nacimiento con líquido amniótico meconial (LAM) cambiaron radicalmente en los últimos años en base a dos grandes estudios aleatorizados. En la Argentina no hay información acerca de las prácticas que se realizan en estos nacimientos. Objetivos: 1) Conocer qué prácticas se utilizan en la recepción de recién nacidos con antecedente de LAM. 2) Evaluar el grado de adherencia a las recomendaciones actuales. Material y métodos- Encuesta anónima vía internet a centros del país con mayor o igual 500 nacimientos anuales. Se contactaron 121 instituciones. Resultados: Respondieron 76/121 (63 por ciento) correspondientes a 182540 nacimientos anuales (26 por ciento del total de la Argentina). De las respuestas, 24 por ciento fueron de la Ciudad de Buenos Aires y 72 por ciento de hospitales públicos. Se realizan frecuentemente los siguientes procedimientos no recomendados: 1) aspiración orofaríngea y nasofaríngea antes del desprendimiento de los hombros: en el 50 por ciento a veces y en el 7 por ciento siempre; 2) Aspiración endotraqueal de rutina en niños vigorosos, 30 por ciento de los centros; 3) laringoscopia de rutina para visualizar las cuerdas vocales en el 13 por ciento de LAM fluido y 31 por ciento de LAM espeso. Por el contrario, y a pesar de ser una recomendación formal, la aspiración endotraqueal de niños deprimidos antes de comenzar con la ventilación se realiza sólo en el 69 por ciento de los casos. Un 7 por ciento de los centros encuestados, realiza otros procedimientos no recomendados, como comprensión torácica y presión sobre la laringe para evitar que el niño respire y también el lavado gástrico. Conclusiones: La aspiración orofaríngea y nasofaríngea antes del desprendimiento de los hombros y la intubación y aspiración posnatal de niños vigorosos con LAM se realizan frecuentemente en la Argentina.(AU)

Centro de nacimientos / No disponible

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El renacer de una sala de partos / A labour room is re-born

El Servicio de Urgencias Gineco-Obstétricas, conocido por “Sala de Partos” es un servicio con una actividad asistencial muy marcada por los pacientes obstétricas. También, existe un grupo notable de pacientes ginecológicas, a pesar de que esta última actividad representa un porcentaje mucho menor. El servicio tiene una voluntad universitaria muy acusada, aunque la investigadora se encuentra obstaculizada por la organización actual y por el gran volumen asistencial. La “Sala de Partos” (SP), está muy orientada a la demanda de la puerta de urgencias y a todas las intervenciones que de éstas derivan. La Dirección del Servicio de Obstetricia, se plantea la creación de una SP con mayor autonomía de gestión, orientada a un modelo organizativo basado en el proceso asistencia. En este caso se va analizar la estructura y la actividad e la SP actual y posteriormente se discutirán oportunidades de mejora en la gestión clínica y la eventualidad de la fusión o no con las urgencias ginecológicas (AU)

The obstetrics and gynecology emergency service, Known as the “Labour Ward”, is a service whose nursing care is highly marked by obstetrics patients. The “Labour Ward” is oriented to emergency demands and all the interventions deriving from this. This work analyses the structure and activity of the current Labour Ward and discusses opportunities for improving clinical management and the possibility of its fusion with gynecological emergencies (AU)