Absence of Trichinella spp. larvae in carcasses of road-killed wild animals in Paraná state, Brazil.

Trichinella spp. are zoonotic parasites that are widely distributed in warm-blooded carnivores and omnivores, including humans. Until the present moment, Brazil has been considered by World Animal Health Organization free from the domestic cycle of trichinellosis, whereas the parasite's sylvatic cycle has the status of infection in limited zones. However, neighboring countries such as Argentina have reports of parasite larvae in the wild fauna. The present study aimed to determine the occurrence of Trichinella spp. in road-killed wild animals in Paraná, Brazil. Biological samples from 71 wild animals-29 Didelphis albiventris, 11 Nasua nasua, ten Cerdocyon thous, seven Dasypus novemcinctus, six Leopardus guttulus, six Sphiggurus spinosus and two Puma concolor-collected from November 2016 to November 2021 were subjected to artificial digestion, following the methodology described in the REGULATION (EC) No. 2075/2005. No Trichinella spp. larvae were detected in the carcasses of the road-killed wild animals. However, considering the wide spectrum of possible reservoirs that could act as a link between the sylvatic and domestic cycles and considering the current Brazilian status of sylvatic trichinellosis in limited zones, frequent monitoring of wild fauna remains necessary.

Prevalence and risk factors of Eimeria spp. natural infection in sheep from northern Paraná, Brazil.

The present study aimed to perform an epidemiological and morphological identification of Eimeria infection in sheep in Brazil. Fecal samples from sheep were collected from 20 farms in northern Paraná, Brazil. An epidemiological questionnaire was used to evaluate the risk factors. Fecal samples containing oocysts per gram of feces (OoPG) ≥1000 were subjected to the modified Willis-Mollay method to perform oocyst identification. Sporulated oocysts were observed microscopically for morphological identification. A total of 807 fecal samples were collected. Based on the morphological characteristics of the sporulated oocysts, 10 species of Eimeria were identified, with main species observed: Eimeira ovinoidalis (98.1%), Eimeria crandallis (87.6%), Eimeria parva (79.1%), and Eimeria bakuensis (60.8%). Only 2.6% (7/268) of the sheep were infected with a single species, 4.8% (13/268) contained two different species, and 92.5% (248/268) were infected with three or more species. The analysis of risk factors showed that an intensive rearing, no rotation of pasture, dirt, and slatted floors, and age up to 12 months were associated with infection. This study showed a high prevalence of Eimeria natural infection in sheep from northern Paraná, Brazil. Furthermore, based on the risk factors, good management and hygiene practices must be employed to avoid infection.

Evaluation of implementation of the primary, secondary and tertiary prevention measures of the Surveillance Program of Gestational and Congenital Toxoplasmosis in the city of Londrina-PR.

Toxoplasmosis acquired during pregnancy is one that can lead to death or malformations of the foetus, and it is a complex disease to diagnose. The objective of the study was to evaluate the Surveillance Program of Gestational and Congenital Toxoplasmosis. To assess primary prevention, 424 pregnant women were interviewed regarding their knowledge of prevention measures in 2019. Secondary prevention measures were assessed, and the results of anti-Toxoplasma gondii serological tests were collected from pregnant women, from 2015 to 2018. In tertiary prevention measures, babies of mothers with a recent suspicion of T. gondii infection were screened to verify forwarding to the reference service. As a result, 45.5% (192/424) reported that they had received guidance from health professionals; 35.4% (68/192) changed their risk habits. The variables of schooling and age, having received prior guidance from health professionals and feline possession, proved to be significant when associated with the notions of preventive measures. 90.2% (17,423/19,319) of pregnant women had undergone serological tests to detect anti-T. gondii antibodies, but there was an excess in requests for tests and medication and only 40.6% (26/64) of the children were referred to the reference hospital. The Program presents positive results about the performance of serological screening in prenatal care; however, the dissemination of knowledge as for the prevention of toxoplasmosis and the request for tests need to be improved.

Prevalence and risk factors of Eimeria spp. natural infection in sheep from northern Paraná, Brazil / Prevalência e fatores de risco da infecção natural por Eimeira spp. em ovinos na região norte do Paraná, Brasil

Abstract The present study aimed to perform an epidemiological and morphological identification of Eimeria infection in sheep in Brazil. Fecal samples from sheep were collected from 20 farms in northern Paraná, Brazil. An epidemiological questionnaire was used to evaluate the risk factors. Fecal samples containing oocysts per gram of feces (OoPG) ≥1000 were subjected to the modified Willis-Mollay method to perform oocyst identification. Sporulated oocysts were observed microscopically for morphological identification. A total of 807 fecal samples were collected. Based on the morphological characteristics of the sporulated oocysts, 10 species of Eimeria were identified, with main species observed: Eimeira ovinoidalis (98.1%), Eimeria crandallis (87.6%), Eimeria parva (79.1%), and Eimeria bakuensis (60.8%). Only 2.6% (7/268) of the sheep were infected with a single species, 4.8% (13/268) contained two different species, and 92.5% (248/268) were infected with three or more species. The analysis of risk factors showed that an intensive rearing, no rotation of pasture, dirt, and slatted floors, and age up to 12 months were associated with infection. This study showed a high prevalence of Eimeria natural infection in sheep from northern Paraná, Brazil. Furthermore, based on the risk factors, good management and hygiene practices must be employed to avoid infection.

Resumo O presente estudo teve como objetivo realizar uma avaliação epidemiológica e morfométrica da infecção por Eimeria em ovinos no Brasil. Amostras fecais de ovinos foram coletadas em 20 fazendas no sul do Brasil. Um questionário epidemiológico foi utilizado para avaliar os fatores de risco. Amostras fecais, contendo oocistos por grama de fezes (OoPG) ≥1000, foram submetidas ao método de Willis-Mollay modificado para realizar a identificação de oocistos. Oocistos esporulados foram observados microscopicamente para identificação morfológica. Foram coletadas 807 amostras fecais. Com base nas características morfológicas e morfométricas dos oocistos esporulados, foram identificadas 10 espécies de Eimeria, com as principais espécies observadas: Eimeria ovinoidalis (98,1%), Eimeria crandallis (87,6%), Eimeria parva (79,1%) e Eimeria bakuensis (60,8%). Apenas 2,6% (7/268) dos ovinos estavam infectados com uma única espécie, 4,8% (13/268) continham duas espécies diferentes e 92,5% (248/268) estavam infectados com três ou mais espécies. A análise dos fatores de risco mostrou que uma criação intensiva, sem rotação de pasto, terra, piso de ripa e idade até 12 meses foram associadas à infecção. Este estudo mostrou uma alta prevalência de infecção natural por Eimeria em ovinos do norte do Paraná, Brasil. Além disso, com base nos fatores de risco, boas práticas de manejo e higiene devem ser empregadas para evitar infecções.

Factors influencing the response of spermatozoa to agitation stress: Implications for transport of extended boar semen.

The shipping of liquid preserved semen is common practice in animal breeding and prior to cryopreservation for gene banking. Vibration emissions during transport may be harmful to spermatozoa. Therefore, strategies to minimize agitation-induced sperm injury are needed. The aim was to examine whether the type of semen extender, time after semen processing and the temperature in simulated transport conditions influence the response of boar spermatozoa to agitation stress. In Experiment 1, boar semen samples (n = 16) extended in Beltsville Thawing Solution (BTS) or Androstar Plus (APL) medium were filled in 90 mL tubes and shaken for 4 h at 200 rpm either at 22 °C or 17 °C. Samples were then stored at 17 °C for 144 h. In Experiment 2, semen samples (n = 11) extended in Androstar Premium were shaken either directly after filling at 22 °C or 20 h later after cooling to 5 °C. Samples were stored at 5 °C for 144 h. In Experiment 1, sperm motility and viability were lower (p < 0.05) in the shaken samples compared to the controls. The temperature, extender and the storage length had no effect on the agitation-induced loss of sperm quality. Sperm quality traits were higher in samples stored in APL compared to BTS. In Experiment 2, sperm motility at 24 h was reduced (p < 0.05) in those samples shaken at 22 °C but not at 5 °C. Sperm viability, membrane fluidity and mitochondrial membrane potential were not affected in either of the treatment groups. Extended boar semen designed for 17 °C storage and shipped on the day of collection is sensitive to agitation stress. In contrast, spermatozoa slowly cooled to 5 °C and shaken 20 h after processing are more resistant to agitation-induced shear forces and interfacial phenomena.

Techniques for inactivating Toxoplasma gondii oocysts: a systematic review.

The oocyst, a resistant form of Toxoplasma gondii, plays an important role in the transmission of this protozoan. The objective of this review was to report the methods capable of inactivating oocysts through a systematic review of the literature carried out in the Scientific Electronic Library Online, Web of Science, Science Direct, PubMed and Scopus databases. The keywords searched were (((effects OR infectivity OR resistance) AND Toxoplasma) AND oocyst). We selected 16 articles that described 309 different treatments. Among all the protocols evaluated, 35.60% (110/309) were effective in inactivating oocysts. Physical methods were more effective than other methods (p <0.05). Sporulated oocysts and the T. gondii VEG strain were more resistant (p <0.05) to treatments. Although it is effective against viruses and bacteria, the use of disinfectants in water has little or no effect on T. gondii oocysts. The use of radiation and pressure were effective in inactivating oocysts, as these treatments do not include changes in temperature, they can be used in foods for raw consumption, such as vegetables, as it will not cause substantially changes in their physical and chemical characteristics. Therefore, these methods can be viable alternatives for the control of T. gondii.

Adjusted method of penis fixation during boar semi-automatic semen collection aiming to reduce bacterial contamination.

Semen collection has an essential role in the initial bacterial load in boar ejaculates and extended semen. The study aimed to explore the efficacy of an adjusted penis fixation in a semi-automatic collection system on reducing bacterial contamination of ejaculates in two-boar studs with different scenarios. Historically, stud A had low levels of bacterial load in raw semen, while stud B had a high level of contamination. A total of 56 mature boars had their semen collected using two methods of penis fixation: (a) Traditional: The penis was fixed directly with the artificial cervix and transferred to the adjustable clamp; (b) Adjusted: The fixation was performed with one gloved-hand, and after exteriorization, the penis was gripped using the artificial cervix with the other gloved-hand and transferred to the adjustable clamp. The bacterial load (p = .0045) and the occurrence of ejaculates >231 CFU/ml (p = .0101) were reduced in the Adjusted compared to the Traditional method. Bacterial load was reduced when using the Adjusted method in stud B (p = .0011), which showed a greater occurrence of critical factors for bacterial contamination (p ≤ .0034). The Adjusted method reduced the occurrence of ejaculates >231 CFU/ml when the preputial ostium was dirty (p = .016) and the duration of semen collection was >7 min (p = .022) compared to the Traditional method. In conclusion, the Adjusted penis fixation was efficient in reducing bacterial load of ejaculates, mainly in boar stud B, which had high contamination challenges.

Parasites in road-killed wild felines from North of Paraná state, Brazil.

This study aimed to identify the intestinal parasites of road-killed wild felines in the North Central and North, Paraná state, southern Brazil. The animals were monitored by sampling previously established transects. The places where the felines were run over were mapped, the animals were identified, and the gastrointestinal tract was evaluated. The feces were submitted to coproparasitological techniques of spontaneous sedimentation, floating in hypersaturated NaCl solution and centrifugal floating in zinc sulfate. All the parasitic structures detected were photomicrographed. In the coproparasitological analyses were identified oocysts of Cystoisospora spp., eggs of Ancylostomatidae, and Capillaria spp.; eggs of Aelurostrongylus spp., Toxocara spp., Physaloptera spp., Taenia spp., and Spirometra spp.; Aelurostrongylus abstrusus larvae; and eggs and adults of Ancylostoma cati and Taenia spp. One of the cats was parasitized by a flea of Ctenocephalides felis felis. Based on these results, the animals analyzed in this study supplied important samples for the evaluation of parasitic diversity of North of Paraná and suggested that this region may have conditions that allow the maintenance of these parasites life cycles in the environment and among wildlife.

Device to predict pelvic floor integrity during vaginal delivery: an intra- and interrater reliability study of the Epi-no distensibility measurement.

OBJECTIVE: To determine the test-retest reliability of the pelvic floor distensibility evaluation with Epi-no® device. METHODS: Prospective, blinded observational study with 32 women pregnant from 35 gestational weeks. An Epi-no® balloon was inflated within the pregnant woman's vagina and the maximum circumference achieved was measured using a standard metric measuring tape. Measurements were performed twice in a day by two physiotherapists in a randomized order. Intraobserver reproducibility was obtained with another evaluation 7-14 d after the initial examination. The intraclass correlation coefficient (ICC) was used to determine the intra and interrater reliability and the respective 95% confidence intervals with an alpha level of 0.05. RESULTS: From a total of 32 included pregnant women, 28 were analyzed; they were 29.3 (±5.97) years old, were at 37 (±1.3) weeks' gestation and presented a mean Epi-no® circumference of 20.4 (±2.4) cm. Regarding the intraobserver analysis, examiner 1 observed a maximum circumference of 20.6 (±2.6) cm in the first evaluation and 20.2 (±2.4) cm in the second evaluation, with good reliability (ICC = 0.85). Examiner 2 observed 19.7 (±2.4) cm in the first evaluation and 21.0 (±2.0) cm in the second one, with moderate reliability (ICC = 0.58). Regarding the interobserver analysis, there was good reliability on two evaluation days, with an ICC of 0.76 and 0.82, respectively. CONCLUSIONS: Epi-no® device is a reliable device for physiotherapists to measure pelvic floor distention during pregnancy.

Techniques for inactivating Toxoplasma gondii oocysts: a systematic review / Técnicas para inativar oocistos de Toxoplasma gondii: uma revisão sistemática

Abstract The oocyst, a resistant form of Toxoplasma gondii, plays an important role in the transmission of this protozoan. The objective of this review was to report the methods capable of inactivating oocysts through a systematic review of the literature carried out in the Scientific Electronic Library Online, Web of Science, Science Direct, PubMed and Scopus databases. The keywords searched were (((effects OR infectivity OR resistance) AND Toxoplasma) AND oocyst). We selected 16 articles that described 309 different treatments. Among all the protocols evaluated, 35.60% (110/309) were effective in inactivating oocysts. Physical methods were more effective than other methods (p <0.05). Sporulated oocysts and the T. gondii VEG strain were more resistant (p <0.05) to treatments. Although it is effective against viruses and bacteria, the use of disinfectants in water has little or no effect on T. gondii oocysts. The use of radiation and pressure were effective in inactivating oocysts, as these treatments do not include changes in temperature, they can be used in foods for raw consumption, such as vegetables, as it will not cause substantially changes in their physical and chemical characteristics. Therefore, these methods can be viable alternatives for the control of T. gondii.

Resumo O oocisto, forma resistente do Toxoplasma gondii, desempenha um papel importante na transmissão desse protozoário. O objetivo desta revisão foi relatar os métodos capazes de inativar oocistos por meio de uma revisão sistemática da literatura realizada nas bases de dados Scientific Electronic Library Online, Web of Science, Science Direct, PubMed e Scopus. As palavras-chave pesquisadas foram (((efeitos OR infectividade OR resistência) AND Toxoplasma) AND oocyst). Foram selecionados 16 artigos que descreveram 309 tratamentos diferentes. Dentre todos os protocolos avaliados, 35,60% (110/309) foram eficazes na inativação de oocistos. Os métodos físicos foram mais eficazes do que outros métodos (p <0,05). Oocistos esporulados e a cepa VEG de T. gondii foram mais resistentes (p <0,05) aos tratamentos. Embora seja eficaz contra vírus e bactérias, o uso de desinfetantes na água tem pouco ou nenhum efeito sobre os oocistos de T. gondii. O uso de radiação e pressão foram eficazes na inativação de oocistos. Como esses tratamentos não incluem mudança de temperatura, podem ser utilizados em alimentos de consumo cru, tais como vegetais, pois não acarretarão substancialmente alterações nas suas características físico-químicas. Portanto, esses métodos podem ser alternativas viáveis ​​para o controle de T. gondii.

Molecular diagnosis of the curly lettuce parasitic contamination from hydroponic cultivation from supermarkets.

The consumption of vegetables has increased in recent years due to the search for a healthier diet that is rich in fiber and has fewer calories. To assess the parasitic contamination of lettuce sold in markets, a survey of parasites was carried out from a supermarket chain in the city of Londrina, Paraná. A total of thirty samples of lettuce were purchased in the ten markets visited, three in each, of which ten were conventionally cultivated, ten were hydroponically cultivated, and ten were organically cultivated. All samples were analyzed using the sedimentation methods of Hoffman, Pons and Janer and the fluctuation method of Faust and colleagues and Willis with adaptations. In addition, the samples were subjected to DNA extraction by a commercial kit and polymerase chain reaction to detect Toxoplasma gondii, Cryptosporidium spp. and Giardia spp., which are protozoa that cause food and waterborne parasitic outbreaks. All samples were negative for sedimentation and flotation techniques. One of the hydroponically cultivated samples was positive for T. gondii. The results demonstrate the risk of curly lettuce contamination from hydroponic cultivation and the need for proper cleaning of these foods before consumption.

Determination of a cooling-rate frame for antibiotic-free preservation of boar semen at 5°C.

Hypothermic storage of boar semen provides the possibility to omit antibiotics from semen extenders so long as sperm quality is maintained and bacterial growth prevented. The objective of this study was to determine an optimal cooling-rate frame for boar semen preserved at 5°C in an antibiotic-free extender. Semen from eight boars extended in AndroStar® Premium was cooled from 30°C to 5°C using seven different cooling rates, ranging initially from 0.01 to 0.36°C min-1 and reaching 5°C between 2 h and 24 h after dilution. Sperm motility, membrane integrity, membrane fluidity, mitochondrial membrane potential and the response to the capacitation stimulus bicarbonate remained at a high level for 144 h at 5°C when the semen was initially cooled in a cooling-rate frame ranging from 0.01 to 0.09°C min­1 in the temperature zone from 30 to 25°C, followed by 0.02 to 0.06°C min-1 to 10°C and 0.01 to 0.02°C min­1 to the final storage temperature. A cooling rate of 0.07°C min-1 in the temperature zone from 30 to 10°C led to a reduced response to bicarbonate (P < 0.01) and fast cooling to 5°C within 1 h with a cooling rate of 0.31°C min-1 resulted in lower values (P > 0.05) of all sperm parameters. In a further experiment, slow cooling with a holding time of 6 h at 22°C induced after 6 h storage a temporary increase in Escherichia coli of 0.5 × 103 to 2.4 × 103 CFU mL-1 in the sperm-free inoculated extender. Overall, the load of mesophilic bacteria in the stored semen was below 6 × 103 CFU mL-1, a level that is not regarded as critical for sperm quality. In conclusion, appropriate cooling protocols were established for the antibiotic-free storage of boar semen at 5°C, allowing the application of hypothermic preservation in research and in artificial insemination.

Differential seminal plasma proteome signatures of boars with high and low resistance to hypothermic semen preservation at 5°C.

BACKGROUND: Hypothermic storage at 5°C has been investigated as an alternative to promote the prudent use of antibiotics for boar artificial insemination doses. However, this temperature is challenging for some ejaculates or boars. OBJECTIVE: The present study aimed to identify putative biomarkers for semen resistance to hypothermic storage at 5°C by comparing the seminal plasma proteomes of boars with high and low seminal resistance to preservation at 5°C. MATERIALS AND METHODS: From an initial group of 34 boars, 15 were selected based on the following criteria: ejaculate with ≤20% abnormal spermatozoa and at least 70% progressive motility at 120 hours of storage at 17°C. Then, based on the response to semen hypothermic storage at 5°C, boars were classified into two categories: high resistance-progressive motility of >75% in the three collections (n = 3); and low resistance-progressive motility of <75% in the three collections (n = 3). Seminal plasma proteins were analyzed in pools, and differential proteomics was performed using Multidimensional Protein Identification Technology. RESULTS: Progressive motility was lower at 120 hours of storage in low resistance, compared to high resistance boars (P < .05). Acrosome and plasma membrane integrity were not affected by the boar category, storage time, or their interaction (P ≥ .104). Sixty-five proteins were considered for differential proteomics. Among the differentially expressed and exclusive proteins, the identification of proteins such cathepsin B, legumain, and cystatin B suggests significant changes in key enzymes (eg, metalloproteinases) involved in spermatogenesis, sperm integrity, and fertilizing potential. DISCUSSION AND CONCLUSION: Differences in the seminal plasma suggest that proteins involved in the proteolytic activation of metalloproteinases and proteins related to immune response modulation could disrupt key cellular pathways during spermatogenesis and epididymal maturation, resulting in altered resistance to chilling injury. Further in vivo studies focusing on the immunological crosstalk between epithelial cells and gametes might explain how the immune regulators influence sperm resistance to hipothermic storage.

Quantitative assessment of pelvic floor muscle extensibility in pregnant women with a perineal elasticity meter.

Objective: The objective of this study was to compare measurements of pelvic floor muscle extensibility in pregnant women obtained through the Epi-no® and perineal elasticity meter (PEM) devices.Methods: This was an observational, cross-sectional study with a consecutive sample, conducted in a prenatal care outpatient clinic. The pelvic floors of 62 healthy pregnant women with gestational ages between 35 and 40 weeks were assessed. Perineal extensibility was measured using the Epi-no® and PEM devices. Through the linear regression method, a formula was created to calculate the Epi-no® values from the PEM values. To determine the degree of relationship between both variables, Pearson's correlation coefficient was used.Results: In the comparison of the results for 62 pregnant women using the two perineal extensibility assessment methods, the value obtained in the Pearson correlation coefficient analysis (0.621) indicated a moderate relationship between the variables. This finding was not confirmed by the Kappa correlation test. When the measurements were classified into three groups, a slight correlation was identified (perineum with restrictions, moderate extensibility, and good extensibility).Conclusion: There was a relationship between Epi-no® and PEM from slight to moderate agreement.

Molecular diagnosis of the curly lettuce parasitic contamination from hydroponic cultivation from supermarkets / Diagnóstico molecular da contaminação parasitária de alface crespa de cultivo hidropônico em supermercados

Abstract The consumption of vegetables has increased in recent years due to the search for a healthier diet that is rich in fiber and has fewer calories. To assess the parasitic contamination of lettuce sold in markets, a survey of parasites was carried out from a supermarket chain in the city of Londrina, Paraná. A total of thirty samples of lettuce were purchased in the ten markets visited, three in each, of which ten were conventionally cultivated, ten were hydroponically cultivated, and ten were organically cultivated. All samples were analyzed using the sedimentation methods of Hoffman, Pons and Janer and the fluctuation method of Faust and colleagues and Willis with adaptations. In addition, the samples were subjected to DNA extraction by a commercial kit and polymerase chain reaction to detect Toxoplasma gondii, Cryptosporidium spp. and Giardia spp., which are protozoa that cause food and waterborne parasitic outbreaks. All samples were negative for sedimentation and flotation techniques. One of the hydroponically cultivated samples was positive for T. gondii. The results demonstrate the risk of curly lettuce contamination from hydroponic cultivation and the need for proper cleaning of these foods before consumption.

Resumo O consumo de vegetais aumentou nos últimos anos devido à busca de uma dieta mais saudável, rica em fibras e com menos calorias. Para avaliar a contaminação parasitária de alface vendida nos mercados, foi realizado um levantamento de parasitas em vegetais folhosos de uma cadeia de supermercados da cidade de Londrina, Paraná. Um total de 30 amostras foram compradas nos dez mercados visitados, três em cada, dos quais dez foram convencionalmente cultivados, dez cultivados hidroponicamente e dez foram cultivados organicamente. Todas as amostras foram analisadas, usando-se os métodos de sedimentação de Hoffman, Pons e Janer e o método de flutuação de Faust e colaboradores e Willis com adaptações. Além disso, as amostras foram submetidas à extração de DNA por um kit comercial e reação em cadeia da polimerase (PCR) para detectar Toxoplasma gondii, Cryptosporidium spp. e Giardia spp., que são protozoários causadores de surtos transmitidos pela água e alimentos. Todas as amostras foram negativas para técnicas de sedimentação e flutuação. Uma das amostras cultivadas hidroponicamente foi positiva para T. gondii. Os resultados demonstram o risco de contaminação por alface crespa do cultivo hidropônico e a necessidade de limpeza adequada desses alimentos antes do consumo.

Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study / Determinação de um valor de ponto de corte para a extensibilidade do assoalho pélvico pelo balão Epi-no para predizer integridade perineal no parto vaginal: análise pela curva ROC. Estudo prospectivo observacional de coorte única

CONTEXT AND OBJECTIVE: Several risk factors are involved in perineal lacerations during vaginal delivery. However, little is known about the influence of perineal distensibility as a protective factor. The aim here was to determine a cutoff value for pelvic floor distensibility measured using the Epi-no balloon, which could be used as a predictive factor for perineal integrity in vaginal delivery. DESIGN AND SETTING: Prospective observational single cohort study conducted in a maternity hospital. METHODS: A convenience sample of 227 consecutive at-term parturients was used. All women had a single fetus in the vertex presentation, with up to 9.0 cm of dilation. The maximum dilation of the Epi-no balloon was measured using a tape measure after it had been inflated inside the vagina up to the parturients' maximum tolerance. The receiver operating characteristic (ROC) curve was used to obtain the Epi-no circumference measurement with best sensitivity and specificity. RESULTS: Among the 161 patients who were included in the study, 50.9% underwent episiotomy, 21.8% presented lacerations and 27.3% retained an intact perineum. Age > 25.9 years; number of pregnancies > 3.4; number of deliveries > 2.2 and circumference measured by Epi-no > 21.4 cm were all directly correlated with an intact perineum. Circumference measurements using the Epi-no balloon that were greater than 20.8 cm showed sensitivity and specificity of 70.5% and 66.7% (area under curve = 0.713), respectively, as a predictive factor for an intact perineum in vaginal delivery. CONCLUSION: Circumferences greater than 20.8 cm achieved using the Epi-no balloon are a predictive factor for perineal integrity in parturients.

CONTEXTO E OBJETIVO: Diversos fatores de risco estão envolvidos nas lacerações do períneo durante o parto vaginal, contudo, pouco se sabe sobre a influência da extensibilidade perineal como um fator protetor. O objetivo foi avaliar o ponto de corte da extensibilidade do assoalho pélvico medido pelo balão Epi-no, o qual poderia ser usado como fator preditor de integridade perineal no parto vaginal. TIPO DE ESTUDO E LOCAL: Estudo prospectivo observacional de coorte única conduzido em maternidade. MÉTODOS: Uma amostra de conveniência de 277 parturientes consecutivas no termo foi utilizada. Todas as mulheres tinham feto único com apresentação cefálica fletida, com até 9,0 cm de dilatação. A máxima dilatação do balão Epi-no foi medida com fita métrica após a sua insuflação dentro da vagina até a tolerância máxima da parturiente. Uma curva característica de operação do receptor (ROC) foi utilizada para obter a medida da circunferência com a melhor sensibilidade e especificidade. RESULTADOS: Dentre as 161 pacientes que foram incluídas no estudo, 50,9% sofreram episiotomia, 21,8% lacerações e 27,3% tiveram o períneo intacto. Idade > 25,9 anos; número de gestações > 3,4; número de partos > 2,2; e medida do perímetro do Epi-no > 21,4 cm foram todos diretamente correlacionados com períneo intacto. Os valores do perímetro com o balão Epi-no que estavam acima de 20,8 cm mostraram sensibilidade e especificidade de 70,5% e 66,7% (área sob a curva = 0,713), respectivamente, como fator preditor de períneo intacto no parto vaginal. CONCLUSÃO: Circunferência medida pelo balão Epi-no maior que 20,8 cm é fator preditor de integridade perineal em parturientes.

Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study.

CONTEXT AND OBJECTIVE: Several risk factors are involved in perineal lacerations during vaginal delivery. However, little is known about the influence of perineal distensibility as a protective factor. The aim here was to determine a cutoff value for pelvic floor distensibility measured using the Epi-no balloon, which could be used as a predictive factor for perineal integrity in vaginal delivery. DESIGN AND SETTING: Prospective observational single cohort study conducted in a maternity hospital. METHODS: A convenience sample of 227 consecutive at-term parturients was used. All women had a single fetus in the vertex presentation, with up to 9.0 cm of dilation. The maximum dilation of the Epi-no balloon was measured using a tape measure after it had been inflated inside the vagina up to the parturients' maximum tolerance. The receiver operating characteristic (ROC) curve was used to obtain the Epi-no circumference measurement with best sensitivity and specificity. RESULTS: Among the 161 patients who were included in the study, 50.9% underwent episiotomy, 21.8% presented lacerations and 27.3% retained an intact perineum. Age > 25.9 years; number of pregnancies > 3.4; number of deliveries > 2.2 and circumference measured by Epi-no > 21.4 cm were all directly correlated with an intact perineum. Circumference measurements using the Epi-no balloon that were greater than 20.8 cm showed sensitivity and specificity of 70.5% and 66.7% (area under curve = 0.713), respectively, as a predictive factor for an intact perineum in vaginal delivery. CONCLUSION: Circumferences greater than 20.8 cm achieved using the Epi-no balloon are a predictive factor for perineal integrity in parturients.