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1.
Rev Bras Ginecol Obstet ; 42(4): 181-187, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32330959

RESUMO

OBJECTIVE: To evaluate the ability of the pubic arch angle (PAA) as measured by transperineal ultrasonography during labor to predict the delivery type and cephalic pole disengagement mode. METHODS: The present prospective cross-sectional study included 221 women in singleton-gestational labor ≥ 37 weeks with cephalic fetuses who underwent PAA measurement using transperineal ultrasonography. These measurements were correlated with the delivery type, cephalic pole disengagement mode, and fetal and maternal characteristics. RESULTS: Out of the subjects, 153 (69.2%) had spontaneous vaginal delivery, 7 (3.2%) gave birth by forceps, and 61 (27.6%) delivered by cesarean section. For the analysis, deliveries were divided into two groups: vaginal and surgical (forceps and cesarean). The mean PAA was 102 ± 7.5° (range, 79.3-117.7°). No statistically significant difference was observed in delivery type (102.6 ± 7.2° versus 100.8 ± 7.9°, p = 0.105). The occipitoanterior position was seen in 94.1% of the fetuses and the occipitoposterior position in 5.8%. A narrower PAA was found in the group of surgical deliveries (97.9 ± 9.6° versus 102.6 ± 7.3°, p = 0.049). Multivariate regression analysis showed that PAA was a predictive variable for the occurrence of head disengagement in occipital varieties after birth (odds ratio, 0.9; 95% confidence interval, 0.82-0.99; p = 0.026). CONCLUSION: Ultrasonographic measurement of the PAA was not a predictor of delivery type, but was associated with the persistence of occipital varieties after birth.

2.
Rev Bras Ginecol Obstet ; 42(2): 74-80, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32227322

RESUMO

PURPOSE: To evaluate the impact of the presence of criteria for severe maternal morbidity and maternal near miss associated with hypertensive disorders on maternal and perinatal outcomes in a maternity school. METHODS: The present is a sub-analysis of a larger study involving 27 centers in Brazil that estimated the prevalence of serious maternal morbidity and near miss. It is an analytical and cross-sectional study with a quantitative approach, involving 928 women who were cared for at Maternidade Escola Assis Chateaubriand (MEAC, in Portuguese), Universidade Federal do Ceará (UFC, in Portuguese), from July 2009 to June 2010. The women were diagnosed with near miss according to the World Health Organization (WHO) criteria. The sample was divided into 2 groups: patients with (n = 827) and without hypertension (n = 101). The results were considered statistically significant when p < 0.05. The Pearson chi-squared and Fisher Exact tests were used for the categorical variables, and the Mann-Whitney U test was used for the continuous variables. RESULTS: In total, 51 participants with maternal near miss criteria were identified, and 36 of them had hypertensive disorders. Of these, 5 died and were obviously excluded from the near miss final group. In contrast, we observed 867 cases with non-near miss maternal morbidity criteria. During this period, there were 4,617 live births (LBs) in the institution that was studied. CONCLUSION: In the severe morbidity/maternal near miss population, the presence of hypertensive complications was prevalent, constituting a risk factor for both the mother and the fetus.

3.
J Matern Fetal Neonatal Med ; : 1-9, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31505974

RESUMO

Objective: To evaluate the relevance of the angle of progression (AOP) and head-perineum distance (HPD) for predicting the type of delivery and duration of the second stage of labor using intrapartum ultrasonography. Methods: In total, 221 women in labor with a single gestational sac at ≥37 weeks of gestation and fetuses in cephalic presentation underwent two-dimensional ultrasonography by transperineal route for measurements of AOP and HPD. Correlations between the type of delivery (vaginal or surgical (cesarean section and forceps)), duration of the second stage of labor, and fetal and maternal characteristics were assessed. AOP and HPD variables were separately studied in the first and second stages of labor. Multivariate logistic regression was followed in stages to identify the predictors for the surgical delivery outcome - stepwise forward method. Results: In total, 153 (69.2%) women underwent vaginal deliveries, 7 (3.2%) underwent forceps deliveries, and 61 (27.6%) underwent cesarean deliveries. AOP was a statistically significant parameter in first and second stages of labor (107.8 ± 12.1° versus 100.8 ± 13.7°; p = .017), with an inverse correlation with the occurrence of vaginal delivery. HPD was a statistically significant parameter in the second stage of labor (3.42 ± 0.84 cm versus 4.17 ± 0.54 cm; p < .003), with a direct correlation with the occurrence of surgical delivery. The value of AOP that optimized the curve was 129.9° with 85% specificity and 63% sensitivity for the vaginal delivery endpoint. The value of HPD that optimized the curve was 4.3 cm with 69% specificity and 89% sensitivity for the surgical delivery endpoint. In the first phase, the variables defining the type of delivery were the following: height, body mass index, and AOP. In the second phase, the variables defining were the following: height, labor analgesia, HPD, and position of the fetal occiput. Conclusion: AOP and HPD determined by intrapartum ultrasonography were associated with duration of labor, which may aid in predicting the type of delivery in association with clinical parameters.

4.
PLoS One ; 14(4): e0216037, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31034500

RESUMO

The objective of this study was identify the association between delays in the care provided to pregnant women and the fetal death outcome, in a tertiary reference maternity hospital in the Northeastern Brazil. A case-control study, with 72 cases of fetal death and 144 controls (live births) in women admitted to the Obstetrics Service of the Assis Chateaubriand Teaching Maternity Hospital, in Fortaleza, Ceará. Controls were matched (2:1) by the approximate gestational age of the case. The groups were compared using the three delays model of obstetric care. The Pearson's Chi-square test and the Fisher's exact test were used to compare the groups. P <0.05 was considered statistically significant. The Group with fetal death had a smaller number of prenatal consultations (> 6 consultations: 27.8% in cases, 40.3% in controls, p = 0.003), less risk classification of pregnancy (41.7% vs 55.9%, p = 0.048), less guidance about the health facility for delivery (44.5% vs 64%, p = 0.009), lower frequency of cesarean sections (25.4% vs 65.7%) and higher frequency of hemorrhagic syndromes (33.3% vs 19.4%, p = 0.024) and syphilis (15.3% vs 4.2%, p = 0·004). Variables that persisted significantly associated with fetal death in the logistic regression were: Refusal of assistance (OR = 4.07, IC 95%: 1.08-15.3), Absence or inadequacy of prenatal care (OR = 2.69, IC 95%: 1.07-6.75), Delay in diagnosis (OR = 10.3, IC 95%: 2.58-41.4) and Inadequate patient conduct (OR = 4.88; IC 95%: 1.43-16.6). Despite of having a higher frequency of obstetric complications, gestations with fetal death are more prone to delays in obstetric care.


Assuntos
Morte Fetal/etiologia , Obstetrícia , Resultado da Gravidez , Adolescente , Adulto , Brasil , Estudos de Casos e Controles , Criança , Feminino , Humanos , Modelos Logísticos , Gravidez , Adulto Jovem
5.
Rev. bras. ginecol. obstet ; 41(1): 17-23, Jan. 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1003519

RESUMO

Abstract Objective To assess and compare the sensitivity and specificity of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta in patients with placenta previa. Methods This retrospective cohort study included 37 women, and was conducted between January 2013 and October 2015; 16 out of the 37 women suffered from placenta accreta. Histopathology was considered the gold standard for the diagnosis of placenta accreta; in its absence, a description of the intraoperative findings was used. The associations among the variables were investigated using the Pearson chi-squared test and the Mann-Whitney U-test. Results The mean age of the patients was 31.8 ± 7.3 years, the mean number of pregnancies was 2.8 ± 1.1, the mean number of births was 1.4 ± 0.7, and the mean number of previous cesarean sections was 1.2 ± 0.8. Patients with placenta accreta had a higher frequency of history of cesarean section than those without it (63.6% versus 36.4% respectively; p < 0.001). The mean gestational age at birth among women diagnosed with placenta previa accreta was 35.4 ± 1.1 weeks. The mean birth weight was 2,635.9 ± 374.1 g. The sensitivity of the ultrasound was 87.5%, with a positive predictive value (PPV) of 65.1%, and a negative predictive value (NPV) of 75.0%. The sensitivity of the magnetic resonance imaging was 92.9%, with a PPV of Conclusion The ultrasound and the magnetic resonance imaging showed similar sensitivity and specificity for the diagnosis of placenta accreta.


Resumo Objetivo Avaliar e comparar a sensibilidade e especificidade da ultrassonografia e da ressonância magnética no diagnóstico do acretismo placentário em pacientes com placenta prévia. Métodos Estudo de coorte retrospectivo com 37 mulheres, sendo 16 com acretismo placentário, realizado de janeiro de 2013 a outubro de 2015. Considerou-se padrãoouro para o diagnóstico de acretismo placentário o exame anatomopatológico, sendo que, na sua ausência, a descrição do achado intraoperatório. As associações entre variáveis foram investigadas utilizando o teste qui-quadrado de Pearson e o teste U de Mann-Whitney. Resultados A idade média foi de 31,8 ± 7,3 anos, o número médio de gestações foi de 2,8 ± 1,1, o número médio da quantidade de partos foi de 1,4 ± 0,7, e o número médio de cesáreas prévias foi de 1,2 ± 0,8. O grupo do acretismo placentário apresentou antecedente de cesariana mais frequentemente do que o grupo sem acretismo (63,6% versus 36,4%, respectivamente; p < 0,001). A idade gestacional no parto em mulheres com diagnóstico de placenta prévia com acretismo foi de 35,4 ± 1,1 semanas. O peso ao nascer médio foi de 2.635,9 ± 374,1 g. A sensibilidade do ultrassom foi de 87,5%, comvalor preditivo positivo (VPP) de 65,1%, e valor preditivo negativo (VPN) de 75,0%. Para a ressonância magnética, a sensibilidade foi de 92,9%, com VPP de 76,5% e VPN de 75,0%. O índice kappa para concordância entre os dois testes foi de 0,69 (intervalo de confiança de 95% [IC95%]: 0,26-1,00). Conclusão O ultrassom e a ressonância magnética apresentaram sensibilidade e especificidade semelhantes no diagnóstico do acretismo placentário.

6.
Rev Bras Ginecol Obstet ; 41(1): 17-23, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30428490

RESUMO

OBJECTIVE: To assess and compare the sensitivity and specificity of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta in patients with placenta previa. METHODS: This retrospective cohort study included 37 women, and was conducted between January 2013 and October 2015; 16 out of the 37 women suffered from placenta accreta. Histopathology was considered the gold standard for the diagnosis of placenta accreta; in its absence, a description of the intraoperative findings was used. The associations among the variables were investigated using the Pearson chi-squared test and the Mann-Whitney U-test. RESULTS: The mean age of the patients was 31.8 ± 7.3 years, the mean number of pregnancies was 2.8 ± 1.1, the mean number of births was 1.4 ± 0.7, and the mean number of previous cesarean sections was 1.2 ± 0.8. Patients with placenta accreta had a higher frequency of history of cesarean section than those without it (63.6% versus 36.4% respectively; p < 0.001). The mean gestational age at birth among women diagnosed with placenta previa accreta was 35.4 ± 1.1 weeks. The mean birth weight was 2,635.9 ± 374.1 g. The sensitivity of the ultrasound was 87.5%, with a positive predictive value (PPV) of 65.1%, and a negative predictive value (NPV) of 75.0%. The sensitivity of the magnetic resonance imaging was 92.9%, with a PPV of 76.5%, and a NPV of 75.0%. The kappa coefficient of agreement between the 2 tests was 0.69 (95% confidence interval [95%CI]: (0.26-1.00). CONCLUSION: The ultrasound and the magnetic resonance imaging showed similar sensitivity and specificity for the diagnosis of placenta accreta.


Assuntos
Imagem por Ressonância Magnética , Placenta Acreta/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Estudos de Coortes , Feminino , Humanos , Gravidez , Diagnóstico Pré-Natal/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade
7.
J Matern Fetal Neonatal Med ; 32(22): 3824-3829, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29732948

RESUMO

Objective: To verify the relationship between the time of clamping of the umbilical cord and the development of neonatal jaundice, the dosage of bilirubin and the need for phototherapy. Methods: Cross-sectional, retrospective study with 398 parturients at normal risk (single term gestation, no complications during gestation or delivery, birth weight between 2500 and 4499 g). The population was divided into three groups regarding the time of cord clamping: <1 min(117, 29.4%), between 1 and 3 min(228, 57.3%) and >3 min(53, 13.3%). Sociodemographic, clinical and obstetric characteristics, birth and delivery data, and maternal and perinatal outcomes were evaluated. Pearson's chi-square test, Fisher's exact test and the Kruskal-Wallis test were used for comparison between the groups. Statistical significance was considered p < .05. Results: The groups were similar in the development of jaundice (p = .370), bilirubin dosage (p = .342) and need for phototherapy (p = .515). Late clamping was more prevalent in vaginal deliveries when compared to cesarean sections (1-3 min: 64 versus 21.4%, >3 min: 16.6 versus 1%) (p < .001). There was no difference in other maternal or perinatal variables. Conclusion: The clamping time of the umbilical cord showed no association with jaundice, bilirubin dosage, or phototherapy needs in neonates at normal risk. The adoption of late clamping was more prevalent in vaginal deliveries.


Assuntos
Parto Obstétrico , Icterícia Neonatal/epidemiologia , Icterícia Neonatal/terapia , Fototerapia/estatística & dados numéricos , Instrumentos Cirúrgicos , Cordão Umbilical/cirurgia , Adolescente , Adulto , Constrição , Estudos Transversais , Parto Obstétrico/efeitos adversos , Parto Obstétrico/instrumentação , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Icterícia Neonatal/etiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Instrumentos Cirúrgicos/efeitos adversos , Instrumentos Cirúrgicos/estatística & dados numéricos , Cordão Umbilical/patologia , Adulto Jovem
8.
Rev Esc Enferm USP ; 52: e03404, 2018 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-30517294

RESUMO

OBJECTIVE: The aim of this study was to compare the incidence of different criteria of maternal near miss in women admitted to an obstetric intensive care unit and their sensitivity and specificity in identifying cases that have evolved to morbidity. METHOD: A cross-sectional analytical epidemiological study was conducted with women admitted to the intensive care unit of the Maternity School Assis Chateaubriand in Ceará, Brazil. The Chi-square test and odds ratio were used. RESULTS: 560 records were analyzed. The incidence of maternal near miss ranged from 20.7 in the Waterstone criteria to 12.4 in the Geller criteria. The maternal near-miss mortality ratio varied from 4.6:1 to 7.1:1, showing better index in the Waterstone criteria, which encompasses a greater spectrum of severity. The Geller and Mantel criteria, however, presented high sensitivity and low specificity. Except for the Waterstone criteria, there was an association between the three other criteria and maternal death. CONCLUSION: The high specificity of Geller and Mantel criteria in identifying maternal near miss considering the World Health Organization criteria as a gold standard and a lack of association between the criteria of Waterstone with maternal death.


Assuntos
Unidades de Terapia Intensiva , Mortalidade Materna , Near Miss/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Incidência , Morte Materna/estatística & dados numéricos , Gravidez , Sensibilidade e Especificidade , Adulto Jovem
9.
Artigo em Inglês | MEDLINE | ID: mdl-30177912

RESUMO

Background: Dunnigan-type familial partial lipodystrophy (FPLD2) is a rare autosomal dominant disease caused by heterozygous mutations in the LMNA gene that results in regional loss of subcutaneous adipose tissue with onset in puberty. However, a generalized lipodystrophy phenotype has also been associated with heterozygous mutations in this gene, demonstrating the noticeable phenotypic heterogeneity of this disease. Methods: We report and describe clinical and metabolic features of four patients from the same family with the p.R582C LMNA mutation, three homozygous and one in the heterozygous state that present with three distinct lipodystrophic phenotypes. Results: Case description: The proband was a 12-year-old girl who developed severe subcutaneous fat atrophy in limbs and abdomen followed by a remarkable dorsocervical fat accumulation in adulthood along with diabetes at age 23. The proband's sister was a phenotypically normal girl who developed hypertriglyceridemia at age 8, progressive features of partial lipodystrophy at age 11, and diabetes at age 22. The proband's mother was first examined at age 32, presenting diabetes and a severe generalized lipodystrophic phenotype; she developed kidney failure at age 41 and died due to diabetic complications. The proband's father was a 50-year-old man with abdominal fat concentration that was initially considered phenotypically normal. Massively parallel sequencing using a platform of genes related to genetic lipodystrophies, followed by Sanger sequencing, revealed the transversion c.1744C>T at exon 11 of the LMNA gene (p.R582C) in the homozygous (mother and daughters) and heterozygous (father) states. Conclusion: We documented three distinct phenotypes of the homozygous and heterozygous p. R582C LMNA mutation in the same kindred, illustrating that FPLD2 linked to mutations in this gene is a disease of great clinical heterogeneity, possibly due to associated environmental or genetic factors.

10.
Health Qual Life Outcomes ; 16(1): 109, 2018 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-29855338

RESUMO

BACKGROUND: Gestation is a period that can positively or negatively influence the life of a woman in the pregnancy-puerperal cycle. Thus, evaluating the quality of life of this population can redirect the implementation of innovative practices, with the goal of making them more effective and practical or the promotion of humanized care. The present study aimed to evaluate the predictors that influence the health-related quality of life of low-risk pregnant women, as well as to describe the main areas affected in the quality of life of pregnant women. METHODS: A correlational, quantitative and cross-sectional study was carried out in two public units that provide prenatal care services and a private unit in the city of Fortaleza, a municipality in the Northeast of Brazil. The sample consisted of 261 pregnant women who were interviewed from September to November 2014. The collection instruments were a questionnaire covering sociodemographic, obstetric and quality of life variables, in addition to the Brazilian version of the Mother-Generated Index (MGI). The data were compiled and analyzed through the Statistical Package for the Social Sciences (SPSS) software, version 20.0. A descriptive analysis was performed through the application of Pearson's chi-square test, Fisher's exact test and one-way ANOVA. Maternal predictors for the quality of life of pregnant woman were identified through a multivariate analysis/multiple regression. RESULTS: The response rate was 100%, corresponding to 261 respondents. Occupation, parity, partner support, marital status and persons with whom the women live were the predictors that positively interfered in the quality of life of pregnant women. In contrast, gestational age, type of housing, occupation, use of illicit drugs, non-receipt of partner support and maternal age were the predictors that negatively influenced quality of life. CONCLUSION: Our results indicate that happiness to become a mother and body image were areas with the greatest positive and negative influence on health-related quality of life, which suggests being relevant aspects in the planning and implementation of actions aimed at its improvement.


Assuntos
Gestantes/psicologia , Qualidade de Vida , Adulto , Fatores Etários , Imagem Corporal/psicologia , Brasil/epidemiologia , Estudos Transversais , Feminino , Felicidade , Humanos , Estado Civil , Gravidez , Cuidado Pré-Natal/psicologia , Inquéritos e Questionários , Adulto Jovem
11.
Rev Rene (Online) ; 19: e3182, jan. - dez. 2018.
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-883231

RESUMO

Objetivo: analisar as evidências científicas acerca dos fatores que influenciam os casos de near miss materno e possíveis direcionamentos para redução da morbidade e mortalidade materna. Métodos: revisão integrativa com 2.895 artigos encontrados e 17 selecionados. Resultados: os fatores que influenciam nos casos de near miss foram: atrasos nos cuidados obstétricos; despreparo da equipe de saúde; condições precárias dos serviços; disponibilidade limitada de derivados de sangue; e deficiência no pré-natal, no uso de Práticas Baseadas em Evidências e nas auditorias. Como principais direcionamentos para minimizar esses eventos, evidenciaram-se: fortalecer a rede de referência e contrarreferência; realizar capacitação profissional; melhorar a cobertura do pré-natal; e investir na infraestrutura, na gestão de processos e em auditorias clínicas. Conclusão: os fatores que influenciam os casos de near miss materno englobam desde o atraso nos cuidados até a não realização do pré-natal, cuja melhoria na gestão constitui o principal direcionamento. (AU)


Assuntos
Humanos , Feminino , Saúde Materna , Mortalidade Materna , Morbidade , Near Miss , Enfermagem
12.
Rev. Esc. Enferm. USP ; 52: e03404, 2018. tab. ilus
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-985063

RESUMO

ABSTRACT Objective: The aim of this study was to compare the incidence of different criteria of maternal near miss in women admitted to an obstetric intensive care unit and their sensitivity and specificity in identifying cases that have evolved to morbidity. Method: A cross-sectional analytical epidemiological study was conducted with women admitted to the intensive care unit of the Maternity School Assis Chateaubriand in Ceará, Brazil. The Chi-square test and odds ratio were used. Results: 560 records were analyzed. The incidence of maternal near miss ranged from 20.7 in the Waterstone criteria to 12.4 in the Geller criteria. The maternal near-miss mortality ratio varied from 4.6:1 to 7.1:1, showing better index in the Waterstone criteria, which encompasses a greater spectrum of severity. The Geller and Mantel criteria, however, presented high sensitivity and low specificity. Except for the Waterstone criteria, there was an association between the three other criteria and maternal death. Conclusion: The high specificity of Geller and Mantel criteria in identifying maternal near miss considering the World Health Organization criteria as a gold standard and a lack of association between the criteria of Waterstone with maternal death.


RESUMO Objetivo: O estudo tem o objetivo de comparar a incidência de critérios diferentes de near miss materno em mulheres admitidas em uma UTI obstétrica e a sensibilidade e especificidade de identificação dos casos que evoluíram para morbidade. Método: Estudo transversal epidemiológico-analítico, composto por mulheres admitidas em UTI da Maternidade Escola Assis Chateaubriand no Ceará, Brasil. Os testes qui-quadrado e Odds Ratio foram utilizados. Resultados: 560 registros foram analisados. A incidência de near miss materno variou de 20,7 nos critérios de Waterstone a 12,4 nos critérios de Geller. A proporção de mortalidade near miss erro materno variou de 4,6:1 a 7,1:1, demonstrando melhor índice nos critérios de Waterstone, o que abrange um maior espectro de gravidade. Os critérios de Geller e Mantel, contudo, apresentaram alta sensibilidade e baixa especificidade. Exceto pelos critérios de Waterstone, houve uma associação entre os três outros critérios e morte materna. Conclusão: Foi encontrada alta especificidade de critérios de Geller e Mantel na identificação do near miss materno considerando os critérios da Organização Mundial da Saúde como padrão-ouro e uma falta de associação entre os critérios de Waterstone com a morte materna.


RESUMEN Objetivo: El estudio tiene el fin de comparar la incidencia de criterios distintos de near miss materno en mujeres ingresadas en una UCI obstétrica y la sensibilidad y especificidad de identificación de los casos que evolucionaron a morbilidad. Método: Estudio transversal epidemiológico analítico, compuesto de mujeres ingresadas en UCI de la Maternidad Escuela Assis Chateaubriand en Ceará, Brasil. Las pruebas de chi-cuadrado y Odds Ratio fueron utilizadas. Resultados: 560 registros fueron analizados. La incidencia de near miss materno varió de 20,7 en los criterios de Waterstone a 12,4 en los criterios de Geller. La proporción de mortalidad por near miss materno varió de 4,6:1 a 7,1:1, demostrando mejor índice en los criterios de Waterstone, lo que abarca un mayor espectro de gravedad. Sin embargo, los criterios de Geller y Mantel presentaron alta sensibilidad y baja especificidad. Excepto por los criterios de Waterstone, hubo una asociación entre los tres otros criterios y muerte materna. Conclusión: Fue encontrada alta especificidad de criterios de Geller y Mantel en la identificación del near miss materno considerando los criterios de la Organización Mundial de la Salud como regla de oro y una ausencia de asociación entre los criterios de Waterstone con la muerte materna.


Assuntos
Humanos , Mortalidade Materna , Morbidade , Near Miss , Unidades de Terapia Intensiva , Enfermagem Obstétrica
13.
Rev Lat Am Enfermagem ; 25: e2948, 2017 Dec 04.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-29211194

RESUMO

OBJECTIVE: to test the efficacy of the behavioral and educational interventions undertaken by telephone, for women's attendance at the consultation to receive the Pap test report. METHOD: a randomized clinical trial, with a sample randomized in three groups: telephone call - educational (n=171), telephone call - reminder (n=171) and comparison (n=169). The inclusion criteria were to be of legal age, to have become sexually active, to undertake the preventive examination during the study and to have a mobile or fixed telephone. The educational group received a telephone call involving a script based in the motivational interview and in the Brazilian guidelines. The behavioral group received a telephone call involving a reminder about the consultation. The comparison group received a card with details of when to return for a consultation regarding the results. RESULTS: the women who received one of the interventions had a non-return rate of 7.3% and an increase of 39% (RR CI95%: 1.24-1.55) in the protection against this outcome. In the individual analysis of the interventions, it was evidenced that both are efficacious, as the telephone call - reminder reduces the woman's failure to return to the service by 40% (RR CI95%: 1.25-1.57), while the telephone call - educational does so by 37% (RR CI95%: 1.22-1.54). The rates of non-return were of 6.5% and 8.2%, respectively, as against 33.1% in the comparison group. CONCLUSION: the interventions tested showed greater efficacy in the educational and behavioral contexts, in relation to the normal attendance, as they motivated the women to return to the service to receive the Pap test report. Clinical trial register: RBR-w3vnc.


Assuntos
Teste de Papanicolaou , Cooperação do Paciente/estatística & dados numéricos , Telefone , Esfregaço Vaginal , Adulto , Feminino , Educação em Saúde , Humanos
14.
Arq Neuropsiquiatr ; 75(10): 703-710, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29166461

RESUMO

OBJECTIVE: The new epidemic of Zika virus infection raises grave concerns, especially with the increasingly-recognized link between emerging cases of microcephaly and this infectious disease. Besides small cranial dimensions, there are striking morphologic anomalies in the fetal brain. Key anomalies include cortical developmental malformations and a peculiar distribution of pathologic calcifications. These potentially indicate a new pattern of congenital central nervous system infection. METHODS: Eight women underwent fetal MRI. Four infants also underwent postnatal CT. Five of the women underwent amniocentesis. RESULTS: All neonates were born with microcephaly. On fetal MRI, ventriculomegaly, marked reduction of white matter thickness, severe sylvian fissure simplification, abnormal sulcation, and diffuse volumetric loss of cerebellar hemispheres were consistently seen. On postnatal CT, diffuse subcortical and basal ganglia calcifications were observed. The Zika virus was detected in two amniocenteses by polymerase chain reaction assays. CONCLUSION: We hope to assist the medical community in recognizing the spectrum of encephalic changes related to congenital Zika virus infection.


Assuntos
Feto/diagnóstico por imagem , Microcefalia/diagnóstico por imagem , Infecção por Zika virus/diagnóstico por imagem , Adulto , Feminino , Humanos , Recém-Nascido , Imagem por Ressonância Magnética , Microcefalia/virologia , Gravidez , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Infecção por Zika virus/complicações
15.
Arq. neuropsiquiatr ; 75(10): 703-710, Oct. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-888253

RESUMO

ABSTRACT The new epidemic of Zika virus infection raises grave concerns, especially with the increasingly-recognized link between emerging cases of microcephaly and this infectious disease. Besides small cranial dimensions, there are striking morphologic anomalies in the fetal brain. Key anomalies include cortical developmental malformations and a peculiar distribution of pathologic calcifications. These potentially indicate a new pattern of congenital central nervous system infection. Methods: Eight women underwent fetal MRI. Four infants also underwent postnatal CT. Five of the women underwent amniocentesis. Results: All neonates were born with microcephaly. On fetal MRI, ventriculomegaly, marked reduction of white matter thickness, severe sylvian fissure simplification, abnormal sulcation, and diffuse volumetric loss of cerebellar hemispheres were consistently seen. On postnatal CT, diffuse subcortical and basal ganglia calcifications were observed. The Zika virus was detected in two amniocenteses by polymerase chain reaction assays. Conclusion: We hope to assist the medical community in recognizing the spectrum of encephalic changes related to congenital Zika virus infection.


RESUMO Os novos casos epidêmicos de infecção pelo vírus Zika suscitam grande preocupação, sobretudo com o crescente reconhecimento da ligação entre casos emergentes de microcefalia e esta doença infecciosa. Além da cabeça de pequenas dimensões, existem profundas alterações morfológicas no encéfalo fetal. Anomalias mais típicas incluem malformações do desenvolvimento cortical e uma distribuição peculiar de calcificações patológicas. Estes dados potencialmente indicam um novo padrão de infecção congênita do sistema nervoso central. Métodos: Oito mulheres foram submetidas a RM fetal. Quatro crianças também realizaram TC pós-natal. Cinco mulheres foram submetidas a amniocentese. Resultados: Todos os neonatos nasceram com microcefalia. Na RM fetal, ventriculomegalia, acentuada redução da espessura da substância branca, acentuada simplificação da fissura sylviana, sulcação anormal e redução volumétrica difusa dos hemisférios cerebelares foram constantes. Na TC pós-natal, calcificações difusas subcorticais e nos núcleos da base foram observadas. O vírus Zika foi detectado por PCR em duas amniocenteses. Conclusão: Esperamos dar suporte à comunidade médica em reconhecer este padrão de imagem potencialmente específico.

16.
Asian Pac J Cancer Prev ; 18(9): 2513-2518, 2017 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-28952289

RESUMO

Background: Cervical cancer is one of the most serious threats to women's lives. Therefore, the present study aimed to know the dynamics in the collection of cytologic samples during antenatal care as a method of cervical cancer screening and to identify the factors associated with its performance. Material and Methods: Analytical cross-sectional study carried out with pregnant and postpartum women in Fortaleza, Ceará, Northeastern Brazil. Data were collected using a questionnaire addressing sociodemographic variables, antenatal care, pregnancy and cytology-based screening for cervical cancer during antenatal care. Measures of central tendency were calculated and the Chi-squared test and Fisher's exact test were used with a significance level of 5%. Results: Participants were 229 pregnant women and 89 postpartum women. Age ranged 18 to 43 years, with a mean of 27.9 years (SD=6.1). Only 35 (11%) participants had Pap smears during antenatal care. A total of 283 women did not have Pap smears during pregnancy; of these, 229 (80.9%) did not have the test because of lack of clear information from the health professional, 25 (8.8%) for fear of bleeding or abortion, and 29 (10.3%) because they had had the test before pregnancy. Undergoing cytology-based screening for cervical cancer was associated with high-risk pregnancy (p=0.002), antenatal care provided by a physician (p=0.003), knowledge about the possibility of having the test during pregnancy (p<0.001) and paid job (p=0.043). Conclusion: The percentage of cytology-based screening for cervical cancer during antenatal care was low. Therefore, health education is suggested to improve this figure. However, receiving antenatal care at MEAC, having consultations with a physician, and knowing that it is possible to have a Pap smear during pregnancy were significant protective factors for undergoing cytology screening during pregnancy.

17.
Med Ultrason ; 19(3): 295-301, 2017 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-28845496

RESUMO

AIM: To assess the accuracy of delivery date predictions made using fetal adrenal artery Doppler velocimetry in pregnant women with spontaneous preterm birth (PB) and to compare these predictions with cervical length (CL) measurements.Material and methods: A prospective study was performed with 51 pregnant women whose gestational lengths were between 24 and 36 weeks. The main outcome was the time between the Doppler velocimetry examination and delivery, categorized as delivery within 7 days or 7 days later after the examination. A receiver operating characteristics curve was performed to define the cutoffs among deliveries within 7 days for fetal adrenal artery Doppler velocimetry parameters and CL measurements. RESULTS: The incidence of delivery within 7 days was 37.3%, with a statistically significant difference for the pulsatility index (PI; p=0.045) and resistance index (RI; p=0.030) of the fetal adrenal artery. The best cutoff values of PI and RI for predicting deliveries within 7 days were 1.65 and 0.78, respectively. The sensitivity and specificity of PI, RI, and CL (20 mm) were 73.7% (95% CI: 51.9-95.5) and 56.3% (95% CI: 38.1-74.4); 68.4% (95% CI: 45.4-91.4) and 62.5% (95% CI: 44.8-80.2); and 76.5% (95% CI: 54.0-99.0) and 78.1% (95%: CI 71.1-97.7), respectively. CONCLUSION: Fetal adrenal artery Doppler velocimetry can predict delivery within 7 days among pregnant women in cases of spontaneous PB and this prediction is similar to the predictions made using CL measurements.


Assuntos
Glândulas Suprarrenais/irrigação sanguínea , Glândulas Suprarrenais/embriologia , Artérias/diagnóstico por imagem , Nascimento Prematuro/diagnóstico , Reologia/métodos , Ultrassonografia Doppler/métodos , Glândulas Suprarrenais/diagnóstico por imagem , Adulto , Artérias/embriologia , Feminino , Idade Gestacional , Humanos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
18.
Invest. educ. enferm ; 35(2): 199-209, June 15, 2017.
Artigo em Inglês | LILACS, COLNAL | ID: biblio-876266

RESUMO

Objective. To understand and to reflect about care based on the experiences of managers, professionals and users of maternal and child health services. Methods. We developed an evaluative research with a qualitative approach in a Northeastern state of Brazil with extensive experience in the regionalization and implementation process of integrated health networks. Semi-structured interviews were carried out with 68 subjects and direct observation of the maternal and child health services. We adopted the theoretical reference framework of Gadamer's hermeneutics to analyze the narratives. Results. Some units of meaning were present, such as: perception and knowledge about oneself; exercise of autonomy; weaknesses in the provision of resources for the materialization of self-care; and difficulties in accessing health services and care practices. We perceive that care is dynamic, comprises various subjective aspects with respect to the singularities of the subjects and is related to the possibility of generating both individual and collective transformation. Conclusion. Care is built based on a movement among the subjects and between them and the social and health services. Thus, when we intend to take care, we need to consider this instead of focusing care solely on the technical support of health professionals. (AU)


Objetivo. Comprender y reflexionar sobre el cuidado a luz de las experiencias de directivos, profesionales y usuarios de los servicios de salud materna e infantil. Métodos. Se desarrolló una investigación de evaluación con enfoque cualitativo en un estado en el noreste de Brasil, con una amplia experiencia en el proceso de regionalización e implementación de redes. Se realizaron entrevistas semiestructuradas a 68 sujetos y la observación directa de los servicios de salud materna e infantil. Se adoptó el referencial teórico de la hermenéutica de Gadamer para el análisis de las narrativas. Resultados. Estuvieron presentes algunas unidades de significado, como la percepción y conocimiento sobre sí, el ejercicio de la autonomía, las debilidades en la oferta de recursos para la materialización del cuidar de sí mismos y dificultades en el acceso a los servicios de salud y a las prácticas de cuidado. Se percibió que el cuidado es dinámico, se compone de aspectos subjetivos diversos en relación con las singularidades de los sujetos y está asociado a la posibilidad de generar transformación individual y colectiva. Conclusión. El cuidado se construye a partir de un movimiento entre los sujetos y entre éstos y los servicios sociales y de salud. De esta forma, cuando pretendemos cuidar, debemos partir de este horizonte y no centrar únicamente el cuidado en el apoyo técnico de los profesionales de la salud. (AU)


Objetivo. Compreender e refletir sobre o cuidado à luz das experiências de gestores, profissionais e usuárias dos serviços de saúde materna e infantil. Métodos. Desenvolvemos uma pesquisa avaliativa com abordagem qualitativa em um estado do nordeste brasileiro com vasta experiência no processo de regionalização e implantação de redes integradas. Foram realizadas entrevistas semiestruturadas com 68 sujeitos e observação direta dos serviços de saúde materna e infantil. Adotamos o referencial teórico da hermenêutica de Gadamer para análise das narrativas. Resultados. Algumas unidades de significado estiveram presentes, como: percepção e o conhecimento sobre si; exercício da autonomia; fragilidades na oferta de recursos para a materialização do cuidar de si; e, dificuldades quanto ao acesso aos serviços de saúde e às práticas de cuidado. Percebemos que o cuidado é dinâmico, compreende aspectos subjetivos diversos em respeito às singularidades dos sujeitos e está relacionado com a possibilidade de gerar transformação tanto individual como coletiva. Conclusão. O cuidado se constrói a partir de um movimento entre os sujeitos e entre eles e os serviços sociais e de saúde. Desta forma, quando pretendemos cuidar, devemos partir deste horizonte e não centrar o cuidado, unicamente, no apoio técnico dos profissionais de saúde. (AU)


Assuntos
Humanos , Assistência Integral à Saúde , Avaliação em Saúde , Hermenêutica , Serviços de Saúde Materno-Infantil
19.
Rev Lat Am Enfermagem ; 25: e2844, 2017 02 06.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-28177055

RESUMO

Objective: to test the effects of behavioral and educational intervention by telephone on adherence of women with inappropriate periodicity to colpocytological examination. Method: quasi-experimental study with a sample of 524 women, selected with the following inclusion criteria: be aged between 25 and 64 years, have initiated sexual activity, have inappropriate periodicity of examination and have mobile or landline phone. The women were divided into two groups for application of behavioral and educational intervention by telephone. It was used an intervention script according to the principles of Motivational Interviewing. Results: on comparing the results before and after the behavioral and educational interventions, it was found that there was a statistically significant change (p = 0.0283) with increase of knowledge of women who participated in the educational intervention. There was no change in the attitude of women of any of the groups and there was an increase of adherence to colpocytological examination in both groups (p < 0.0001), with greater adherence of women participating in the behavioral group (66.8%). Conclusion: the behavioral and educational interventions by phone were effective in the adherence of women to colpocytological examination, representing important strategies for permanent health education and promotion of care for the prevention of cervical cancer.


Assuntos
Cooperação do Paciente , Educação de Pacientes como Assunto , Telefone , Esfregaço Vaginal , Adulto , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/prevenção & controle
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