A new effect of intravenous iron treatment in pregnancy: contraction in nonstress test and timing of labor.

OBJECTIVE: The aim of this study was to elucidate the cause and results of contractions occurring in term pregnant women receiving intravenous iron therapy. METHODS: During 2019-2020, 136 pregnant women beyond 35 weeks of gestation, who received intravenous iron treatment due to iron deficiency anemia, were included through retrospective screening. Iron deficiency anemia was defined as having hemoglobin levels <10 g/dL and ferritin levels <15 ng/mL, and the pregnant women underwent nonstress test before and after treatment. RESULTS: The average treatment week for the pregnant women was 36.82±0.74, and the presence of regular contractions in post-treatment follow-up nonstress tests was 72.1% (n=98). The average week of birth was 38.48±1.60. Pregnant women with contractions who had previous cesarean were found to have a mean delivery week of 36.82±0.67, which was statistically significant earlier than for nulliparous and multiparous women (p<0.001). CONCLUSION: In pregnant women with iron deficiency anemia who were beyond 35 weeks, temporary regular contractions may be observed in the nonstress test following intravenous iron replacement. We think that this effect may lead to early term birth in pregnant women with a history of cesarean section. It needs to be confirmed by further prospective studies and animal studies.

Influence of non-pharmacological methods on duration of labor: a systematic review.

The article aims to verify the influence of MNFs on the duration of the birth process. A systematic review was carried out in the MEDLINE, Web of Science and LILACS databases, through a combination of terms that cover the topic addressed, from 1996 to 2021/April. The Excel spreadsheet was used to collect data to extract information regarding each selected article, in turn, data analysis included the evaluation and classification of quality, reliability and risk of bias, thus, the following tools were used: Cochrane RoB 2, Checklist and Newcastle-Ottawa Scale. Warm bath, walking, exercises with a birthing ball, breathing techniques, supine position, acupuncture, acupressure and water birth reduced labor time. While spontaneous pushing, massage and immersion baths prolonged labor. Non-pharmacological methods capable of reducing the duration of labor were hot/warm shower, walking, birth ball exercises, breathing techniques, maternal mobility, dorsal position, acupuncture, acupressure and water birth, as well. associated applied techniques such as hot/warm bath, ball exercises and lumbosacral massage, as well as immersion bath, ball exercises, aromatherapy, vertical postures and maternal mobility with alternating vertical postures, shortened the birth time.

Maternal and perinatal effects with the use of floral therapy in childbirth: randomized clinical trial.

OBJECTIVE: To evaluate the clinical, obstetric, maternal and perinatal effects of the use of flower essences in labor, against factors that enhance it. METHOD: Clinical trial, randomized, controlled, in 164 parturients divided into two groups, flower essences and placebo, respectively, evaluated before and after the intervention. Carried out in a vaginal delivery center, in the city of São Paulo, from May to October 2018. Data were analyzed using descriptive statistics, Student's t test, bilateral hypothesis, negative and positive observed critical t, Pearson's chi-square, exact test. Fisher. RESULTS: It was observed in the Experimental Group, moderate increase in systolic blood pressure (p=0.046), frequency (p=0.055) and intensity of contractions (p=0.031), as well as a reduction in time to birth (194 minutes), higher number of vaginal deliveries (p=0.038) and better pattern of fetal vitality. CONCLUSION: There was evidence of a positive action of the Floral Essence on the potentiating factors of labor, being effective in maternal clinical and obstetrical repercussions, as well as perinatal ones.

Experiencias de puérperas sobre violencia obstétrica en la perspectiva fenomenológica / Experiences of puerperas on obstetric violence in the phenomenological perspective

Introducción: La violencia obstétrica caracteriza un tipo específico de violencia de género, perpetrada contra mujeres en trabajo de parto, parto y posparto en instituciones de salud. Objetivo: Entender la experiencia de las mujeres posparto sobre violencia obstétrica en un hospital público de maternidad. Métodos: Investigación fenomenológica realizada con 17 parturientas en 2017, a través de entrevistas guiadas por un cuestionario semiestructurado. Los discursos fueron analizados y organizados a partir de la Fenomenología de la percepción de Merleau-Ponty. Resultados: Se identificaron tres categorías: El deseo de parto normal y la barrera de resolución profesional; La deshumanización de las actitudes profesionales y la conciencia del mejor logro; El compañero presente y el acompañamiento resistente. Se identificaron ambigüedades en las percepciones experimentadas por las mujeres, con sentimientos de inseguridad a satisfacción con el servicio recibido de los profesionales de la salud. Conclusiones: Hay significados perceptivos de violencia obstétrica en los informes de parturientas, y existe la necesidad de cambios en las prácticas profesionales para calificar la atención obstétrica de una manera humana(AU)

Introduction: Obstetric violence is a specific type of gender violence, perpetrated against women in labor, delivery and postpartum in health institutions. Objective: To understand the experience of postpartum women concerning obstetric violence in a public maternity hospital. Methods: Phenomenological research carried out with seventeen parturients in 2017, through interviews guided by a semistructured questionnaire. Their discourses were organized and analyzed based on Merleau-Ponty's phenomenology of perception. Results: Three categories were identified: desire for vaginal delivery versus professional decision-making, dehumanization of professional attitudes and awareness of best achievements, partner presence and enduring companion. Ambiguities were identified in the perceptions experienced by women, with feelings from insecurity to satisfaction concerning the service received from health professionals. Conclusions: There are perceptual meanings regarding obstetric violence in the reports of women in labor. There is a need for changes in professional practices to qualify obstetric care in a humane way(AU)

Assessment of fetal lung maturity using analysis of amniotic fluid from ewes that gave birth prematurely and at term / Avaliação da maturidade pulmonar fetal utilizando a análise de líquido amniótico de ovelhas que deram à luz prematuramente e a termo

The aim of this study was to evaluate the lung maturity of premature and full-term lambs by analyzing amniotic fluid using the following methods: Clements test, Nile blue cytology test, hematoxylin-Shorr stain, lamellar body count, and radiographic tests. The use of these methods is intended to identify high-risk newborns and provide immediate clinical intervention after birth. Altogether, 56 animals (24 ewes and 32 lambs) were included in the study and divided into 3 groups. Group I consisted of 8 ewes that were at approximately 145 days of gestation; this group delivered 10 lambs naturally. Group II consisted of 8 ewes that were at 138 days' gestation; this group delivered 11 lambs by cesarean section. Group III consisted of 8 ewes at 138 days' gestation; this group was administered intramuscular dexamethasone (16mg/animal) 36 hours prior to a cesarean section. Group III delivered11 lambs. Cytological tests were performed using a microscope with a maximum magnification of 1000x, while the Clements test was visually observed by one of the researchers. Amnioticfluid lamellar body counts were measured using transmission electron microscopy. Among the staining methods, hematoxylin-Shorr was reliable, and Group III had a greater number of orangeophilic cells when compared to Group II, probably due to corticoid administration. The Clements test showed pulmonary maturity in approximately 20% of Group I lambs and Group II showed 9.1% of bubbles; however, Group III had the highest pulmonary maturity percentage (36.4%). The lamellar bodies were measured, and all groups had sizes between 0.019 and 0.590μm. Radiographic evaluation revealed that the majority of lambs presented some level of pulmonary radiodensity, indicating an acinar pattern at birth. These results are in line with the expectations of each group. We found that the normal group showed greater pulmonary maturity, whereas Group II presented pulmonary immaturity, which is expected because this group comprised lambs born prematurely and Group III showed pulmonary maturity almost comparable to the normal delivery group (Group I). This is due to the fact that although these animals are premature, the use of dexamethasone helped in pulmonary maturation. Therefore, these pulmonary maturity tests are considered effective when more than one technique is used and can be used routinely in the care of a pregnant ewe in labor, where a simple collection of amniotic fluid can predict a high-risk pregnancy and alert the veterinarian if the newborn needs intensive supportive treatment.(AU)

O objetivo deste estudo foi avaliar a maturidade pulmonar de cordeiros prematuros e a termo por meio da análise do líquido amniótico utilizando os seguintes métodos: teste de Clements, teste de citologia do azul do Nilo, coloração de hematoxilina-Shorr, contagem de corpos lamelares e testes radiográficos. Um desses métodos tem por objetivo identificar recém-nascidos de alto risco e fornecer intervenção clínica imediata após o nascimento. Ao todo, 56 animais (24 ovelhas e 32 cordeiros) foram incluídos no estudo e divididos em 3 grupos. O grupo I foi composto por 8 ovelhas com aproximadamente 145 dias de gestação; este grupo deu à luz 10 cordeiros naturalmente. O Grupo II foi composto por 8 ovelhas com 138 dias de gestação; este grupo deu à luz 11 cordeiros por cesariana. Grupo III consistiu de 8 ovelhas com 138 dias de gestação; este grupo recebeu dexametasona intramuscular (16 mg / animal) 36 horas antes de uma cesariana. O Grupo III entregou 11 cordeiros. Os testes citológicos foram realizados em microscópio com aumento máximo de 1000x, enquanto o teste de Clements foi observado visualmente por um dos pesquisadores. A contagem de corpos lamelares de líquido amniótico foi medida usando microscopia eletrônica de transmissão. Dentre os métodos de coloração, o hematoxilina-Shorr foi confiável, sendo que o Grupo III apresentou maior número de células orangeofílicas quando comparado ao grupo II, provavelmente devido à administração de corticóide. O teste de Clements mostrou maturidade pulmonar em aproximadamente 20% dos cordeiros do Grupo I e o Grupo II apresentou 9,1% de bolhas; entretanto, o Grupo III apresentou o maior percentual de maturidade pulmonar (36,4%). Os corpos lamelares foram medidos e todos os grupos apresentaram tamanhos entre 0,019 e 0,590μm. A avaliação radiográfica revelou que a maioria dos cordeiros apresentava algum grau de radiodensidade pulmonar, indicando padrão acinar ao nascimento. Esses resultados estão alinhados com as expectativas de cada grupo. Verificamos que o grupo normal apresentou maior maturidade pulmonar, enquanto o Grupo II apresentou imaturidade pulmonar, o que é esperado por se tratar de cordeiros nascidos prematuramente e o Grupo III apresentou maturidade pulmonar quase comparável ao grupo de parto normal (Grupo I). Isso se deve ao fato de que, embora esses animais sejam prematuros, o uso da dexametasona auxiliou na maturação pulmonar. Portanto, esses testes de maturidade pulmonar são considerados eficazes quando mais de uma técnica são utilizadas e podem ser usadas rotineiramente no cuidado de uma ovelha gestante em trabalho de parto, onde uma simples coleta de líquido amniótico pode prever uma gravidez de alto risco e alertar o veterinário se o recém-nascido precisa de tratamento de suporte intensivo.(AU)

Assessment of fetal lung maturity using analysis of amniotic fluid from ewes that gave birth prematurely and at term / Avaliação da maturidade pulmonar fetal utilizando a análise de líquido amniótico de ovelhas que deram à luz prematuramente e a termo

The aim of this study was to evaluate the lung maturity of premature and full-term lambs by analyzing amniotic fluid using the following methods: Clements test, Nile blue cytology test, hematoxylin-Shorr stain, lamellar body count, and radiographic tests. The use of these methods is intended to identify high-risk newborns and provide immediate clinical intervention after birth. Altogether, 56 animals (24 ewes and 32 lambs) were included in the study and divided into 3 groups. Group I consisted of 8 ewes that were at approximately 145 days of gestation; this group delivered 10 lambs naturally. Group II consisted of 8 ewes that were at 138 days' gestation; this group delivered 11 lambs by cesarean section. Group III consisted of 8 ewes at 138 days' gestation; this group was administered intramuscular dexamethasone (16mg/animal) 36 hours prior to a cesarean section. Group III delivered11 lambs. Cytological tests were performed using a microscope with a maximum magnification of 1000x, while the Clements test was visually observed by one of the researchers. Amnioticfluid lamellar body counts were measured using transmission electron microscopy. Among the staining methods, hematoxylin-Shorr was reliable, and Group III had a greater number of orangeophilic cells when compared to Group II, probably due to corticoid administration. The Clements test showed pulmonary maturity in approximately 20% of Group I lambs and Group II showed 9.1% of bubbles; however, Group III had the highest pulmonary maturity percentage (36.4%). The lamellar bodies were measured, and all groups had sizes between 0.019 and 0.590μm. Radiographic evaluation revealed that the majority of lambs presented some level of pulmonary radiodensity, indicating an acinar pattern at birth. These results are in line with the expectations of each group. We found that the normal group showed greater pulmonary maturity, whereas Group II presented pulmonary immaturity, which is expected because this group comprised lambs born prematurely and Group III showed pulmonary maturity almost comparable to the normal delivery group (Group I). This is due to the fact that although these animals are premature, the use of dexamethasone helped in pulmonary maturation. Therefore, these pulmonary maturity tests are considered effective when more than one technique is used and can be used routinely in the care of a pregnant ewe in labor, where a simple collection of amniotic fluid can predict a high-risk pregnancy and alert the veterinarian if the newborn needs intensive supportive treatment.(AU)

O objetivo deste estudo foi avaliar a maturidade pulmonar de cordeiros prematuros e a termo por meio da análise do líquido amniótico utilizando os seguintes métodos: teste de Clements, teste de citologia do azul do Nilo, coloração de hematoxilina-Shorr, contagem de corpos lamelares e testes radiográficos. Um desses métodos tem por objetivo identificar recém-nascidos de alto risco e fornecer intervenção clínica imediata após o nascimento. Ao todo, 56 animais (24 ovelhas e 32 cordeiros) foram incluídos no estudo e divididos em 3 grupos. O grupo I foi composto por 8 ovelhas com aproximadamente 145 dias de gestação; este grupo deu à luz 10 cordeiros naturalmente. O Grupo II foi composto por 8 ovelhas com 138 dias de gestação; este grupo deu à luz 11 cordeiros por cesariana. Grupo III consistiu de 8 ovelhas com 138 dias de gestação; este grupo recebeu dexametasona intramuscular (16 mg / animal) 36 horas antes de uma cesariana. O Grupo III entregou 11 cordeiros. Os testes citológicos foram realizados em microscópio com aumento máximo de 1000x, enquanto o teste de Clements foi observado visualmente por um dos pesquisadores. A contagem de corpos lamelares de líquido amniótico foi medida usando microscopia eletrônica de transmissão. Dentre os métodos de coloração, o hematoxilina-Shorr foi confiável, sendo que o Grupo III apresentou maior número de células orangeofílicas quando comparado ao grupo II, provavelmente devido à administração de corticóide. O teste de Clements mostrou maturidade pulmonar em aproximadamente 20% dos cordeiros do Grupo I e o Grupo II apresentou 9,1% de bolhas; entretanto, o Grupo III apresentou o maior percentual de maturidade pulmonar (36,4%). Os corpos lamelares foram medidos e todos os grupos apresentaram tamanhos entre 0,019 e 0,590μm. A avaliação radiográfica revelou que a maioria dos cordeiros apresentava algum grau de radiodensidade pulmonar, indicando padrão acinar ao nascimento. Esses resultados estão alinhados com as expectativas de cada grupo. Verificamos que o grupo normal apresentou maior maturidade pulmonar, enquanto o Grupo II apresentou imaturidade pulmonar, o que é esperado por se tratar de cordeiros nascidos prematuramente e o Grupo III apresentou maturidade pulmonar quase comparável ao grupo de parto normal (Grupo I). Isso se deve ao fato de que, embora esses animais sejam prematuros, o uso da dexametasona auxiliou na maturação pulmonar. Portanto, esses testes de maturidade pulmonar são considerados eficazes quando mais de uma técnica são utilizadas e podem ser usadas rotineiramente no cuidado de uma ovelha gestante em trabalho de parto, onde uma simples coleta de líquido amniótico pode prever uma gravidez de alto risco e alertar o veterinário se o recém-nascido precisa de tratamento de suporte intensivo.(AU)

Practices During Preparturition and Normal Delivery Care in a Maternity Hospital in Southern Brazil

Abstract This study aimed to evaluate the practices of hospital care during pré parturition and normal delivery in a maternity hospital in Southern Brazil. A cross-sectional and quantitative study performed with 82 postpartum women. Results were evaluated for the total number of postpartum women and in two groups according to hospital delivery time (≤ 8 and > 8 hours). Chi-square and Fisher Exact tests were used. with a significance level of 5%. Percentages of useful practices were: oral diet (23.2%), freedom of position and movement (90.2%), non-pharmacological methods to alleviate pain (64.6%), companion in prepartum (62.1%) and parturition (42.5%) and partogram (62.2%). Harmful practices: enema (3.7%), trichotomy (3.7%), lithotomy position (92.7%) and Kristeller maneuver (20.7%). Practices used inappropriately: amniotomy (4.9%), oxytocin (41.5%), analgesia (1.2%) and episiotomy (36.6%). The hospital labor time above 8 hours was associated with offering oral diet (p < 0.001), use of non-pharmacological methods for pain relief (p < 0.01), oxytocin infusion (p = 0.01) and episiotomy (p < 0.01). The delivery care with minimum intervention compatible with the recommendations is still a challenge.

Analgesia subaracnoidea en el trabajo de parto: bupivacaína/fentanilo vs. petidina / Subarachnoid analgesia in labor: bupivacaine/fentanyl vs pethidine

Introducción: La analgesia subaracnoidea es una alternativa para el trabajo de parto por su seguridad y adecuada relación riesgo/beneficio. Objetivo: Evaluar la efectividad de la analgesia durante el trabajo de parto con la comparación de dos métodos analgésicos. Método: Se realizó un estudio cuasiexperimental, longitudinal y prospectivo en 92 gestantes que se atendieron en el Hospital General Docente Abel Santamaría Cuadrado durante el período entre enero de 2014 y enero de 2017. Las pacientes se dividieron en dos grupos de 46 cada uno, al azar, por orden de llegada a la unidad quirúrgica. El grupo A, bupivacaína al 0,5 por ciento, en dosis de 2 mg y fentanilo en dosis de 25 mcg; y grupo B en el que se utilizó petidina en dosis de 25 mg, en todos los casos por vía intratecal. Las variables analizadas fueron: tensión arterial media, frecuencia cardíaca media, saturación parcial de oxígeno, tiempo de inicio de la analgesia, calidad analgésica, efectos adversos y nivel de satisfacción de las pacientes. Se empleó el análisis descriptivo y la diferencia de proporciones. Resultados: El grupo A mantuvo una TAM entre 84 y 88 mmHg, (Z= 6,0 significativa); FC media entre 80 y 88 lat/min, (Z= 1,94 no significativa); SpO2 con una media de 99,2 por ciento. En 46,74 por ciento (43 casos) el tiempo de inicio de la analgesia fue corto (Z= 8,47), siendo Buena en 100 por ciento de los casos (Z= 6,89 significativa), con recién nacido vigoroso en 100 por ciento (Z= 10,25 significativa). La evolución fue satisfactoria en 48,19 por ciento de las pacientes. Presentaron prurito 8,69 por ciento. En el grupo B hubo hipertensión arterial en 2,17 por ciento de los casos, con menos estabilidad de la FC, tiempos mayores de inicio de trabajo de parto en 12,96 por ciento y fue Buena en 40,22 por ciento. Estas pacientes mostraron menos satisfacción (41,30 por ciento). Conclusiones: La administración subaracnoidea de fentanilo/bupivacaína fue más efectiva que la petidina para la analgesia durante el trabajo de parto(AU)

Introduction: Subarachnoid analgesia is an alternative for labor due to its safety and suitable risk-benefit relationship. Objective: To evaluate the effectiveness of analgesia during labor with the comparison of two analgesic methods. Method: A quasiexperimental, longitudinal and prospective study was carried out in 92 pregnant women who attended Abel Santamaría Cuadrado General Teaching Hospital during the period between January 2014 and January 2017. The patients were divided into two groups of 46 each, randomly assigned, in order of arrival to the surgical unit. Group A was treated with intrathecal administration of bupivacaine 0.5 percent, in a dose of 2 mg, and fentanyl in a dose of 25 mcg; and group B was treated with intrathecal administration of pethidine, in a dose of 25 mg. The variables analyzed were mean arterial blood pressure, mean heart rate, partial oxygen saturation, time of onset of analgesia, analgesic quality, adverse effects and level of patient satisfaction. The descriptive analysis and the difference in proportions were used. Results: Group A maintained a mean arterial blood pressure between 84 and 88 mmHg, (Z=6.0 significant); heart rate averages between 80 and 88 beats per minute, (Z=1.94 not significant); partial oxygen saturation with an average of 99.2 percent. In 46.74 percent (43 cases) the time of onset of analgesia was short (Z=8.47), being good in 100 percent of the cases (Z=6.89 significant), with vigorous newborn in 100 percent (Z=10.25 significant). The evolution was satisfactory in 48.19 percent of the patients. They presented pruritus 8.69 percent. In group B, there was arterial hypertension in 2.17 percent of the cases, with less stability of the heart rate, greater times of labor beginning in 12.96 percent and it was good in 40.22 percent. These patients showed less satisfaction (41.30 percent). Conclusions: Subarachnoid administration of fentanyl/bupivacaine was more effective than pethidine for analgesia during labor(AU)

INADEQUATE ADHERENCE TO THE RECOMMENDATIONS REGARDING LABOR INDUCTION AS A TRIGGER OF CESAREAN SECTION IN WOMEN WITH SINGLE, TERM PREGNANCY. A DESCRIPTIVE STUDY.

OBJECTIVE: To describe the characteristics of the labor induction process associated with the excess number of cesarean sections in women subjected to this intervention. METHODS: Descriptive historical. cohort that included pregnant women without a history of previous cesarean section, with single term pregnancy and cephalic presentation who were subjected to labor induction in a Level III com- plexity hospital in Medellín, Colombia, during the time period between May 2015 and October 2016. Consecutive sampling was used. Measured variables were maternal age, parity, gestational age, indica- tion for labor induction, cervical favorability, time of induction, quality of uterine activity achieved, type of delivery, and time point during induction when the decision of cesarean section was made. The clinical practice guidelines of international organizations of the specialty and the new guides arising from the 2012 proposal of limiting the first cesarean section were used in order to define ad- herence to the recommendations for induction. RESULTS: Of the 2402 births, 289 which met the inclusion criteria were selected. Cesarean section was performed in 48% of the women subjected to induction, 60.8% nulliparous and 32.1% multiparous. Of those with unfavorable cervix, 72.2% received oxytocin for cervical maturation. Of the women subjected to delivery induction, 108 (37%) underwent cesarean section due to a diagnosis of failed induction. This was considered inadequate in all of them, considering that the diagnosis was made before reaching a dilatation of 6 cm in 88 (81.5%), with intact membranes in 67 (62%), with no uterine activity in 42 (38.9%), with poor quality uterine activity in 23 (21.3%) and in 55 (61%) who did not have at least 24 hours of latent phase before undergoing cesarean section. CONCLUSIONS: Failure to adhere to the recommendations for adequate induction was found, added to a mistaken diagnosis of failed induction.

TITULO: CUMPLIMIENTO INADECUADO DE LAS RECOMENDACIONES PARA EL PROCESO DE LA INDUCCIÓN DEL TRABAJO DE PARTO COMO DESENCADENANTE DE LA CESÁREA EN MUJERES CON EMBARAZO SIMPLE A TÉRMINO. ESTUDIO DESCRIPTIVO. OBJETIVO: describir las características del proceso de inducción del trabajo de parto relacionadas con el exceso de cesáreas en las mujeres a quienes se les realiza este procedimiento. METODOS: cohorte histórica descriptiva en la que se incluyeron las gestantes sin antecedente de cesárea, con embarazo único, a término y presentación cefálica, sometidas a inducción del trabajo de parto en un hospital de tercer nivel de complejidad, en Medellín, Colombia, en el periodo de mayo de 2015 a octubre de 2016. Se excluyeron mujeres con feto muerto antes de la inducción. Muestreo consecutivo. Se midieron: edad materna, paridad, edad gestacional, indicación de la inducción del trabajo de parto, favorabilidad del cérvix, tiempo de la inducción, calidad de la actividad uterina lograda, tipo de parto, momento de la inducción en que se decide la cesárea. Para definir el cumplimiento de las recomendaciones de inducción se tuvieron como referencia las guías de práctica clínica de organizaciones internacionales de la especialidad y las nuevas directrices generadas en la propuesta de reducción de la primera cesárea del año 2012. Se utilizó estadística descriptiva. RESULTADOS: de 2402 nacimientos se seleccionaron 289 que cumplieron con los criterios de inclusión. Se realizó cesárea al 48 % de las gestantes, a 60,8 % de las nulíparas y a 32,1 % de las multíparas sometidas a inducción. El 72,2 % de las que tenían cérvix desfavorable recibieron oxitocina como método de maduración cervical. A 108 (37 %) de las mujeres llevadas a inducción de parto se les realizó cesárea por diagnóstico de inducción fallida que se consideró inadecuado en todas ellas, ya que el diagnóstico se realizó antes de alcanzar 6 cm de dilatación en 88 (81,5 %), con membranas íntegras en 67 (62 %), sin actividad uterina en 42 (38,9 %), con actividad uterina de mala calidad en 23 (21,3 %) y 55 (61 %), no tuvieron al menos 24 horas de fase latente antes de realizar la cesárea. CONCLUSIONES: se encontró falta de cumplimiento de las recomendaciones para una adecuada inducción que lleva a un diagnóstico errado de inducción fallida.

Complementary therapies in labor: randomized clinical trial. / Terapias complementares no trabalho de parto: ensaio clínico randomizado.

OBJECTIVE: To evaluate the effect of isolated and combined warm shower bath and perineal exercise with Swiss ball, on perception of pain, anxiety and labor progression. METHOD: Randomized, controlled clinical trial with 128 patients allocated into three groups of therapies: isolated and combined bath and ball. Pain and anxiety perception was evaluated before and thirty minutes after therapeutic intervention through visual analogic scales (VAS). RESULTS: Pain perception score increased, and anxiety decreased in all groups, mainly when using a shower bath. The cervical dilation increased in all groups (p<.001), as well as the number of uterine contractions increased, mainly in the group that used combined bath and ball and also showed shorter labor time. CONCLUSION: The studied therapies contribute to maternal adaptation and well-being and favor labor's evolution.

Influence of maternal labor time on delta-aminolevulinate dehydratase enzyme activity and markers of oxidative stress in newborns.

The purpose is to determine markers of oxidative stress related to the longer and shorter duration of labor (DOL) of pregnant women in the umbilical cord blood of neonates, not yet studied. Blood samples from the umbilical cord were collected from pregnant women with normal delivery and classified according to DOL in two groups: a group with DOL less than 310 min (n = 33) and a group with DOL greater than or equal to 310 min (n = 35). The oxidative stress parameters were analyzed by the quantification of thiobarbituric acid reactive substances (TBARS), nitrate/nitrite (NOx), protein thiol groups (P-SH) and non-protein (NP-SH), vitamin C and plasma iron reduction capacity (FRAP), in addition to the activity of the enzyme delta-aminolevulinate dehydratase (δ-ALA-D). The activity of the δ-ALA-D enzyme was shown to be decreased in longer DOL, however, the oxidant parameters and antioxidants were higher in the longer DOL, with the exception of NP-SH that was lower. The longer maternal DOL time is related to the alteration of δ-ALA-D enzyme activity and other parameters in neonates, suggesting an increase in the passage of maternal oxidative markers by umbilical cord blood.

Analgesia during Labor and Vaginal Birth among Women with Severe Maternal Morbidity: Secondary Analysis from the WHO Multicountry Survey on Maternal and Newborn Health.

AIM: To evaluate the use of analgesia for vaginal birth, in women with and without severe maternal morbidity (SMM) and to describe sociodemographic, clinical, and obstetric characteristics and maternal and perinatal outcomes associated with labor analgesia. METHODS: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHO-MCS), a global cross-sectional study performed between May 2010 and December 2011 in 29 countries. Women who delivered vaginally and had an SMM were included in this analysis and were then divided into two groups: those who received and those who did not receive analgesia for labor/delivery. We further compared maternal characteristics and maternal and perinatal outcomes between these two groups. RESULTS: From 314,623 women originally included in WHO-MCS, 9,788 developed SMM and delivered vaginally, 601 (6.1%) with analgesia and 9,187 (93.9%) without analgesia. Women with SMM were more likely to receive analgesia than those who did not experience SMM. Global distribution of SMM was similar; however, the use of analgesia was less prevalent in Africa. Higher maternal education, previous cesarean section, and nulliparity were factors associated with analgesia use. Analgesia was not an independent factor associated with an increase of severe maternal outcome (Maternal Near Miss + Maternal Death). CONCLUSIONS: The overall use of analgesia for vaginal delivery is low but women with SMM are more likely to receive analgesia during labor. Social conditions are closely linked with the likelihood of having analgesia during delivery and such a procedure is not associated with increased adverse maternal outcomes. Expanding the availability of analgesia in different levels of care should be a concern worldwide.

Exercise in pregnancy: the impact of an intervention program in the duration of labor and mode of delivery / Exercício na gravidez: impacto de um programa de intervenção na duração do trabalho de parto e via de parto

Abstract Objective To access the benefits or harms of an exercise program, based on the current American College of Obstetricians and Gynecologists guidelines, on the mode of delivery, duration and onset of labor. Methods A study performed at the Hospital Senhora da Oliveira between October 2015 and February 2017. This was a quasi-experimental study involving 255 women divided into two groups: an intervention group engaged in a controlled and supervised exercise program during pregnancy (n = 99), and a control group that did not participate in the exercise program (n = 156). Data were collected in two stages: during the 1st trimester biochemical screening (before the beginning of the program), through a written questionnaire, and after delivery, from the medical files of the patients. The significance level in the present study was 5% (p = 0.05). Results The control group had higher odds of induced labor (odds ratio [OR] 2.71; 95% confidence interval [CI]: 1.42-5.17; p = 0.003), when compared with women who underwent the intervention. No differences were found between the groups in instrumental vaginal deliveries, cesarean rate, time until the beginning of the active phase, duration of the active phase, and duration of the second stage of labor. Conclusion The implementation of a controlled and supervised exercise program in pregnancy was associated with significantly lower odds of induced deliveries.

Resumo Objetivo Avaliar o efeito de um programa de exercícios na gravidez (baseado nas recomendações do American College of Obstetricians and Gynecologists) na via, duração e início do trabalho de parto. Métodos Estudo realizado no Hospital Senhora da Oliveira entre outubro de 2015 e fevereiro de 2017. Trata-se de um estudo quasi-experimental com 255 grávidas, divididas em dois grupos: grupo de intervenção, constituído por mulheres que participaram de um programa controlado e supervisionado de exercícios físicos (n = 99), e um grupo de controle, formado por grávidas que não participaram do programa de exercícios (n = 156). Os dados foram colhidos em dois momentos: durante o rastreio bioquímico do primeiro trimestre (antes do início do programa), através de um questionário escrito, e após o parto, através da consulta do processo clínico da paciente. O nível de significância estatística adotado neste projeto foi de 5% (p = 0,05). Resultados O grupo controle apresentou maior probabilidade de indução do trabalho de parto (razão de chances [RC] 2,71; intervalo de confiança [IC] 95%: 1,42-5,17; p = 0,003) quando comparado com o grupo de intervenção. Não foram encontradas diferenças estatisticamente significativas entre os dois grupos em relação à via de parto, tempo até início da fase ativa, duração da fase ativa e duração do segundo estadio do trabalho de parto. Conclusão A implementação de um programa de exercícios controlado e supervisionado na gravidez foi associada a uma probabilidade significativamente menor de indução do trabalho de parto.

Exercise in Pregnancy: The Impact of an Intervention Program in the Duration of Labor and Mode of Delivery.

OBJECTIVE: To access the benefits or harms of an exercise program, based on the current American College of Obstetricians and Gynecologists guidelines, on the mode of delivery, duration and onset of labor. METHODS: A study performed at the Hospital Senhora da Oliveira between October 2015 and February 2017. This was a quasi-experimental study involving 255 women divided into two groups: an intervention group engaged in a controlled and supervised exercise program during pregnancy (n = 99), and a control group that did not participate in the exercise program (n = 156). Data were collected in two stages: during the 1st trimester biochemical screening (before the beginning of the program), through a written questionnaire, and after delivery, from the medical files of the patients. The significance level in the present study was 5% (p = 0.05). RESULTS: The control group had higher odds of induced labor (odds ratio [OR] 2.71; 95% confidence interval [CI]: 1.42-5.17; p = 0.003), when compared with women who underwent the intervention. No differences were found between the groups in instrumental vaginal deliveries, cesarean rate, time until the beginning of the active phase, duration of the active phase, and duration of the second stage of labor. CONCLUSION: The implementation of a controlled and supervised exercise program in pregnancy was associated with significantly lower odds of induced deliveries.

OBJETIVO: Avaliar o efeito de um programa de exercícios na gravidez (baseado nas recomendações do American College of Obstetricians and Gynecologists) na via, duração e início do trabalho de parto. MéTODOS: Estudo realizado no Hospital Senhora da Oliveira entre outubro de 2015 e fevereiro de 2017. Trata-se de um estudo quasi-experimental com 255 grávidas, divididas em dois grupos: grupo de intervenção, constituído por mulheres que participaram de um programa controlado e supervisionado de exercícios físicos (n = 99), e um grupo de controle, formado por grávidas que não participaram do programa de exercícios (n = 156). Os dados foram colhidos em dois momentos: durante o rastreio bioquímico do primeiro trimestre (antes do início do programa), através de um questionário escrito, e após o parto, através da consulta do processo clínico da paciente. O nível de significância estatística adotado neste projeto foi de 5% (p = 0,05). RESULTADOS: O grupo controle apresentou maior probabilidade de indução do trabalho de parto (razão de chances [RC] 2,71; intervalo de confiança [IC] 95%: 1,42­5,17; p = 0,003) quando comparado com o grupo de intervenção. Não foram encontradas diferenças estatisticamente significativas entre os dois grupos em relação à via de parto, tempo até início da fase ativa, duração da fase ativa e duração do segundo estadio do trabalho de parto. CONCLUSãO: A implementação de um programa de exercícios controlado e supervisionado na gravidez foi associada a uma probabilidade significativamente menor de indução do trabalho de parto.

Terapias complementares no trabalho de parto: ensaio clínico randomizado / Terapias complementarias en el trabajo de parto: ensayo clínico randomizado / Complementary therapies in labor: randomized clinical trial

Resumo OBJETIVO: Avaliar o efeito do banho quente de chuveiro e exercício perineal com bola suíça isolados e de forma combinada, sobre a percepção da dor, ansiedade e progressão do trabalho de parto. MÉTODO: Ensaio clínico randomizado e controlado com 128 parturientes alocadas em três grupos de terapias, banho, bola, isolados e combinados. A percepção da dor e ansiedade foi avaliada antes e trinta minutos após a intervenção terapêutica por meio de escala visual analógica (EVA). RESULTADOS: Houve aumento no escore de dor e redução da ansiedade em todos os grupos, sobretudo quando utilizaram banho de chuveiro. A dilatação cervical, aumentou em todos os grupos de intervenção (p<,001) bem como o número de contrações uterinas, principalmente quem utilizou banho e bola associados como também mostrou menor duração do tempo de trabalho de parto. CONCLUSÃO: As terapias estudadas contribuem para adaptação e bem-estar materno e favorecem a evolução do trabalho de parto.

Resumen OBJETIVO: Evaluar el efecto de la ducha caliente y del ejercicio perineal con pelota suiza, separadamente y de forma combinada, sobre la percepción del dolor, la ansiedad y la progresión del trabajo de parto. MÉTODO: Ensayo clínico aleatorizado y controlado junto a 128 parturientes asignadas en tres grupos de terapias, ducha caliente, pelota suiza separadamente y de forma combinada. La percepción de dolor y de ansiedad se evaluó antes y treinta minutos después de la intervención terapéutica por medio de escala visual analógica. RESULTADOS: Hubo un incremento en la puntuación de dolor y una reducción de la ansiedad en todos los grupos, sobre todo cuando se utilizó la ducha. La dilatación cervical aumentó en todos los grupos de intervención (p<,001) así como el número de contracciones uterinas, principalmente en el grupo que utilizó las dos terapias combinadas, ducha caliente con pelota suiza. Asimismo se constató menor duración del tiempo de trabajo de parto. CONCLUSIÓN: Las terapias estudiadas contribuyen a la adaptación y el bienestar materno y favorecen la evolución del trabajo de parto.

Abstract OBJECTIVE: To evaluate the effect of isolated and combined warm shower bath and perineal exercise with Swiss ball, on perception of pain, anxiety and labor progression. METHOD: Randomized, controlled clinical trial with 128 patients allocated into three groups of therapies: isolated and combined bath and ball. Pain and anxiety perception was evaluated before and thirty minutes after therapeutic intervention through visual analogic scales (VAS). RESULTS: Pain perception score increased, and anxiety decreased in all groups, mainly when using a shower bath. The cervical dilation increased in all groups (p<.001), as well as the number of uterine contractions increased, mainly in the group that used combined bath and ball and also showed shorter labor time. CONCLUSION: The studied therapies contribute to maternal adaptation and well-being and favor labor's evolution.

Concepción integral del cuidado humanizado a la mujer durante el trabajo de parto y parto / Comprehensive Perspective about Humanized Care to Women during Labor and Delivery

RESUMEN Introducción: El reto actual de los profesionales de enfermería es valorar la persona no como objeto sino como sujeto de cuidado. El cuidado de enfermería durante el trabajo de parto y parto requiere de consideraciones especiales hacia la mujer al implicar la sensibilidad y la creatividad en la acción de cuidar. Objetivo: Identificar los referentes teóricos y metodológicos que sustentan el cuidado humanizado a la mujer durante el trabajo de parto y parto. Métodos: Revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo del contenido de documentos, artículos originales y de revisión disponible en Internet, así como de tesis de maestrías y doctorado publicados entre 1992 y 2015 en español portugués e inglés. La búsqueda fue realizada en la base de datos Google académico de marzo a mayo de 2016, las palabras clave utilizadas fueron "cuidados"; "cuidados humanizados"; "trabajo de parto y parto"; "profesionales de enfermería". Tras la identificación de los estudios pre-seleccionados se llevó a cabo la lectura de los títulos, resumen y palabras clave, comprobando la pertinencia con el estudio. Conclusiones: Se fundamenta la relevancia del cuidado humanizado que se le brinda a la mujer durante el trabajo de parto y parto pues conlleva a la satisfacción de las necesidades físicas, emocionales y espirituales de la mujer(AU)

ABSTRACT Introduction: The current challenge of nursing professionals is to evaluate the person not as an object but as a subject of care. Nursing care during labor and delivery requires special considerations for women, involving sensitivity and creativity in the act of caring. Objective: To identify the theoretical and methodological references that support humanized care for women during labor and delivery. Methods: Systematic bibliographic review for developing a reflexive-critical analysis of the content of documents, original and review articles available on the Internet, as well as master's degree theses and doctoral dissertations published between 1992 and 2015 in Spanish, Portuguese and English. The search was made in the database Academic Google, from March to May 2016. The keywords used were cuidados [care];cuidados humanizados [humanized care], trabajode parto y parto [labor and delivery],profesionales de enfermería [ nursing professionals]. After the identification of the pre-selected studies, the titles, summary and key words were read, verifying their relevance with the study. Conclusions: The relevance of the humanized care to women during labor and delivery is based on the satisfaction of the physical, emotional and spiritual needs of women(AU)

Clinical application of the Standard Operating Procedure of Positioning with Premature Infants.

OBJECTIVE: To compare the physiological and behavioral responses of Premature Infant (PREEMIE) positioned by the Unit Routine Decubitus (URD) and the Standard Operating Procedure (SOP). METHOD: A quasi-experimental comparative study performed at a Neonatal Intensive Care Unit in Southern Brazil. We evaluated 30 PREEMIEs with gestational age ≤32 weeks, randomly assigned to Unit Routine Decubitus (URD) and Intervention Group (IG), subdivided into Right Lateral Decubitus (RLD), Dorsal Decubitus (DD), Left Lateral Decubitus (LLD) and Ventral Decubitus (VD). It was evaluated before, during and after the procedure: Heart Rate (HR); Respiratory Frequency (RF); Peripheral Oxygen Saturation (SpO2); behavior by the Neonatal Behavioral Assessment Scale (NBAS); by NIPS. RESULTS: During the intervention, RR (p = 0.023), indexes in NBAS (p = 0.01) and NIPS (p <0.0001) reduced significantly in SOP. HR and SpO2 did not present a significant difference. CONCLUSION: Positioning according to the SOP shows benefit in relation to the behavioral and physiological status of PREEMIE.

Every birth is a story: process of choosing the route of delivery.

OBJECTIVE: To analyze the discourses on the choice of the route of delivery from the perspective of women and health professionals in a public network. METHOD: The methodological approach is the discourse analysis. The data collection was through interviews and the treatment of the data was based on discourse analysis. RESULTS: The categories were: 1- Between the preference and the decision there is no choice; 2- The complexity of the choice of the route of delivery; 3- It is necessary to legitimize the choice of the woman. FINAL CONSIDERATIONS: From the perspective of women in labor the route of delivery is determined by the physician and women are not proactive. The nurses' performance is timid, although their presence is fundamental for stimulating the physiological delivery and promoting the autonomy of women. It identifies the need for the physician to adopt a welcoming attitude, informing the women about the pros and cons involved in choosing the route of delivery.

Influencia del desempeño de los profesionales de enfermería en la atención humanizada al parto / The Influence of Nursing Professionals' Performance on Humanized Care during birth labor

RESUMEN Introducción: El parto es atendido de forma directa por el personal de salud, según su perfil o especialización, y el personal de enfermería posee la responsabilidad de la calidad y el logro de la excelencia en la prestación de servicios que brinda de forma humanizada, asumido desde la mejora de su desempeño profesional. Objetivo: Precisar la influencia del desempeño de los profesionales de enfermería en la atención humanizada al parto. Métodos: Se realizó una revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo del contenido de documentos, se consideraron tesis de doctorado, maestría, artículos originales y de revisión publicados entre 1992 y 2015 en español e inglés. La búsqueda fue realizada en las bases de datos SciELO y Google académico de enero a marzo de 2016, las palabras clave utilizadas fueron "enfermería obstétrica", "parto", "humanización", "desempeño profesional de enfermería" y "valores éticos y humanos". Tras la identificación de los estudios pre-seleccionados se llevó a cabo la lectura de los títulos, resumen y palabras clave, comprobando la pertinencia con el estudio. Conclusión: La atención humanizada al parto es una interacción entre los conocimientos y sentimientos por cada mujer, que permite establecer una asistencia de calidad con expresión humana durante el cuidado ofrecido por enfermería partiendo de la influencia de su modo de actuación, de su hacer, en el logro de la humanización(AU)

ABSTRACT Introduction: Birth labor is attended directly by the health personnel, according to their profile or specialization, while the nursing staff has the responsibility for quality and the achievement of the excellence in the provision of services offered in a humanized way, assumed from the improvement of their professional performance. Objective: To determine the influence of the performance of the nursing professionals in the humanized attention to birth labor. Methods: A systematic bibliographic review was carried out to develop a reflexive critical analysis of the content of documents, Ph.D. and master's dissertations, and original and review articles published between 1992 and 2015 in Spanish and English. The search was made in the academic databases SciELO and Google, from January to March 2016; the key words used in Spanish were enfermería obstétrica [obstetric nursing], parto [birth labor], humanización [humanization], desempeño profesional de enfermería [nursing professional performance], and valores éticos y humanos [ethical and human values]. After the identification of the pre-selected studies, the titles, summary and the key words were read, verifying the relevance with the study. Conclusion: The humanized attention to birth labor is an interaction between the knowledge and feelings for each woman, which allows to establish a quality assistance with human expression during the care offered by nursing initiated in the influence of their way of acting, of doing, and resulting in the achievement of humanization(AU)

Systematic review of pelvic floor interventions during pregnancy.

BACKGROUND: Pelvic floor interventions during pregnancy could reduce the impact of pregnancy and delivery on the pelvic floor. OBJECTIVE: To determine the effects of pelvic floor interventions during pregnancy on childbirth-related and pelvic floor parameters. SEARCH STRATEGY: PubMed, Embase, and LILACS were searched for reports published during between 1990 and 2016 in English, Spanish, or Portuguese. The search terms were "pregnancy," "pelvic floor muscle training," and related terms. SELECTION CRITERIA: Randomized controlled trials with healthy pregnant women were included. DATA COLLECTION AND ANALYSIS: Baseline and outcome data (childbirth-related parameters, pelvic floor symptoms) were compared for three interventions: EPI-NO (Tecsana, Munich, Germany) perineal dilator, pelvic floor muscle training, and perineal massage. MAIN RESULTS: A total of 22 trials were included. Two of three papers assessing EPI-NO showed no benefit. The largest study investigating pelvic floor muscle training reported a significant reduction in the duration of the second stage of labor (P<0.01), and this intervention also reduced the incidence of urinary incontinence (evaluated in 10 trials). Two of six trials investigating perineal massage reported that a lower rate of perineal pain was associated with this intervention. CONCLUSION: Pelvic floor muscle training and perineal massage improved childbirth-related parameters and pelvic floor symptoms, whereas EPI-NO showed no benefit.