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1.
Rev Bras Ginecol Obstet ; 42(3): 124-132, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32232819

RESUMO

OBJECTIVE: To assess the use of the intensive care unit (ICU) and its effect on maternal mortality (MM) among women with severe maternal morbidity (SMM). MATERIALS AND METHODS: A secondary analysis of a cross-sectional study on surveillance of SMM in 27 Brazilian obstetric referral centers. The analysis focused on the association between ICU use and maternal death according to individual characteristics and disease severity. Two multivariate regressions considering use of the ICU, age, ethnicity, adequacy of care and the human development index were performed to identify the factors associated to maternal death and maternal near-miss. RESULTS: Out of 82,388 deliveries during the period, there were 9,555 (11.6%) women with SMM, and the MM ratio was of 170.4/100 thousand live births. In total, 8,135 (85.1%) patients were managed in facilities in which ICUs were available; however, only 2,059 (25.3%) had been admitted to the ICU. On the multivariate analysis, when the severity of the maternal disease was measured by the maternal severity score (MMS), the strength of the association between the use of the ICU and maternal death was greatly reduced, along with inadequate care and non-availability of the ICU at the facility. On the assessment of only the more critical cases (SMO, severe maternal outcome), the same pattern of association between ICU and MM was observed. In the models used, only inadequate care and MSS were significantly associated with MM. CONCLUSION: The current study indicates that the main variables associated with maternal death are the severity and adequacy of the case management, which is more frequent in ICU admissions. The use of the ICU without the stratification of the patients by severity may not produce the expected benefits for part of the women.

2.
Rev. bras. ginecol. obstet ; 42(3): 124-132, Mar. 2020. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1098861

RESUMO

Abstract Objective To assess the use of the intensive care unit (ICU) and its effect on maternal mortality (MM) among women with severe maternal morbidity (SMM). Materials and Methods A secondary analysis of a cross-sectional study on surveillance of SMM in 27 Brazilian obstetric referral centers. The analysis focused on the association between ICU use and maternal death according to individual characteristics and disease severity. Two multivariate regressions considering use of the ICU, age, ethnicity, adequacy of care and the human development index were performed to identify the factors associated to maternal death and maternal near-miss. Results Out of 82,388 deliveries during the period, there were 9,555 (11.6%) women with SMM, and the MM ratio was of 170.4/100 thousand live births. In total, 8,135 (85.1%) patients were managed in facilities in which ICUs were available; however, only 2,059 (25.3%) had been admitted to the ICU. On the multivariate analysis, when the severity of the maternal disease was measured by the maternal severity score (MMS), the strength of the association between the use of the ICU and maternal death was greatly reduced, along with inadequate care and non-availability of the ICU at the facility. On the assessment of only the more critical cases (SMO, severe maternal outcome), the same pattern of association between ICU and MM was observed. In the models used, only inadequate care and MSS were significantly associated with MM. Conclusion The current study indicates that the main variables associated with maternal death are the severity and adequacy of the case management, which is more frequent in ICU admissions. The use of the ICU without the stratification of the patients by severity may not produce the expected benefits for part of the women.


Resumo Objetivo Avaliar o efeito da utilização de unidades de terapia intensiva (UTIs) na mortalidade materna (MM) entre mulheres com morbidade materna grave (MMG). Materiais e Métodos Foi realizada uma análise secundária de um estudo transversal de vigilância de morbidade materna grave em 27 centros de referência obstétrica no Brasil. O foco desta análise foi a associação entre a utilização de UTI e morte materna segundo características individuais e condições de gravidade. Análises múltiplas considerando as variáveis uso de UTI, idade, etnia, adequação do cuidado e índice de desenvolvimento humano foram realizadas para identificar os fatores associados à morte materna e near-miss materno. Resultados Dos 82.388 partos ocorridos durante o período de estudo, 9.555 (11,6%) mulheres apresentaram MMG, e a razão de MM foi de 170,4/100 mil nascidos vivos. Neste grupo, 8.135 (85,1%) pacientes foram atendidas em instituições com disponibilidade de leitos de UTI, mas apenas 2.059 (25,3%) foram de fato admitidas em leitos de UTI. Na análise de regressão multivariada, quando se considerou a gravidade do caso pelo maternal severity score (pontuação de severidade materna, MMS, na sigla em inglês), houve uma grande redução da força de associação entre utilização de UTI e morte materna, além da inadequação do cuidado e não disponibilidade de UTI na instituição. Na avaliação considerando apenas os casos de maior gravidade (desfecho materno grave, DMG), observou-se o mesmo padrão de associação entre UTI e MM. Nos modelos utilizados, apenas a inadequação do cuidado e o MSS apresentam associação significativa com a MM. Conclusão O presente estudo aponta que as principais variáveis associadas à morte materna são a gravidade e a adequação do manejo do caso, mais frequentes nas internações em UTI. A utilização dos leitos de UTI sem a estratificação da gravidade da paciente pode não trazer benefícios esperados para uma parte das mulheres.

3.
PLoS One ; 15(3): e0230530, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32163501

RESUMO

[This corrects the article DOI: 10.1371/journal.pone.0217907.].

4.
Artigo em Inglês | MEDLINE | ID: mdl-31345740

RESUMO

The major cause of maternal death worldwide is postpartum hemorrhage (PPH). Early identification is the basis for adequate treatment. In addition to the visual estimation of blood loss, clinical signs could offer a more reliable representation of the cardiovascular system of the bleeding woman. However, in postpartum women, recognition of hypovolemic shock through vital signs is impaired owing to physiological cardiovascular changes in pregnancy. The Shock Index [SI] is one composite vital sign that may help in the identification of women with hypovolemic shock. Values of SI ≥ 1 in the first hour postpartum indicate cardiac decompensation, and treatment should be implemented immediately. From the diagnosis of PPH, first-line measures should ensure coordinated care actions including the availability of blood derivatives, the establishment of conditions for volume replacement, oxygen therapy, and identification and timely treatment causes of bleeding. Individualized fluid resuscitation should start with warmed crystalloids and be limited to 3.5 L.


Assuntos
Hipovolemia , Hemorragia Pós-Parto , Choque , Feminino , Humanos , Hipovolemia/etiologia , Hipovolemia/terapia , Mortalidade Materna , Período Pós-Parto , Gravidez , Choque/etiologia , Choque/terapia
5.
PLoS One ; 14(6): e0217907, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31185036

RESUMO

OBJECTIVE: To determine Shock Index (SI) reference values in the first two hours of the postpartum period after objectively measuring postpartum bleeding. MATERIALS AND METHODS: A complementary analysis using data from a prospective cohort study at Women's Hospital of the University of Campinas, Brazil, between 1 February 2015 and 31 March 2016. It included women giving birth vaginally unless they had one of these conditions: gestational age below 34 weeks, hypertension, hypo- or hyperthyroidism without treatment, any cardiac disease, infections with fever or sepsis, history of coagulopathy or delivery by C-section. Blood loss was measured by adding the blood volume collected in the drape placed under the women's buttocks and the weight of gauzes and compresses used (excluding the dry weight). Vital signs were measured every 5-15 min after delivery. Exploratory data analysis was performed to assess the mean, standard deviation, median, and percentiles (5th, 10th, 25th, 50th, 75th, 90th, 95th). To identify variation among the periods after delivery, the mean SI and heart rate (HR) values observed for the following intervals were used in the analysis: 0-20 min, 21-40 min, 41-60 min, 61-90 min and 91-120 min. RESULTS: One hundred eighty-six women were included. The mean age ± SD was 24.9 ± 6.1 years and the mean gestational age at birth was 39.2 ± 1.8 weeks. At the puerperal period, the mean SI values ranged from 0.68 ± 0.14 to 0.74 ± 0.15. The percentile distribution ranged from 0.46 (5th percentile) to 1.05 (95th percentile). The mean HR values ranged from 80.8 ± 12.7 bpm to 92.3 ± 14.4 bpm. The percentile distribution ranged from 62.0 bpm (5th percentile) to 117 bpm (95th percentile). CONCLUSION: Reference ranges were established for SI and HR values which showed small variations throughout the postpartum period.


Assuntos
Idade Gestacional , Parto , Hemorragia Pós-Parto , Período Pós-Parto , Choque , Adulto , Brasil , Feminino , Humanos , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/fisiopatologia , Gravidez , Estudos Prospectivos , Choque/diagnóstico , Choque/fisiopatologia
9.
Rev. bras. ginecol. obstet ; 40(9): 518-526, Sept. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-977824

RESUMO

Abstract Objective To assess the relationship between the use of psychoactive substances during pregnancy and the occurrence of severe maternal morbidity (SMM), perinatal outcomes and repercussions on the neuropsychomotor development of exposed children. Methods A case-control study nested within a cohort of severe maternal morbidity (COMMAG) was performed. Women with SMM were considered cases. Controls were thosewith low-risk pregnancy,without SMMand admitted during the same time period as the cases. Cohort data were collected retrospectively in hospital records for childbirth. A face-to-face interview was also performed with 638 women (323 without SMM and 315 with SMM) and their children of the index pregnancy between 6 months and 5 years after childbirth. During the interview, substance abuse during pregnancy was assessed by a modified question from the Alcohol, Smoking and Substance Involvement Screening Test 2.0 (ASSIST) and the neuropsychomotor development in the children was assessed by the Denver Developmental Screening Test, 2nd edition. Results The prevalence of licit or illicit drug use during pregnancy was ~ 17%. Among drug users, 63.9% used alcohol, 58.3% used tobacco, 9.2% used cocaine/crack and 4.6% used marijuana. There was no association between drug use during pregnancy and SMM, although tobacco use during pregnancy was associated with bleeding, presence of near-miss clinical criteria (NMCC) and alteration in infant development; alcohol use was associated with neonatal asphyxia; and cocaine/crack use was associated with the occurrence of some clinical complications during pregnancy. Conclusion The use of psychoactive substances during pregnancy is frequent and associated with worse maternal, perinatal and child development outcomes.


Resumo Objetivo Avaliar a relação entre o uso de substâncias psicoativas na gestação e a ocorrência de morbidade materna grave (MMG), resultados perinatais e repercussões no desenvolvimento neuropsicomotor das crianças expostas. Métodos Estudo de caso-controle a partir de uma coorte de morbidade materna grave (COMMAG). Mulheres com MMG foram consideradas casos. Controles foram mulheres com gestação de baixo risco, admitidas no mesmo período que os casos. Os dados da coorte foram coletados retrospectivamente em prontuários de internação para o parto e entrevistas presenciais conduzidas com 638 mulheres e seus filhos da gestação-índice, entre 6 meses e 5 anos após o parto. Na entrevista, o uso de substâncias na gestação foi avaliado com uma pergunta modificada introduzida no questionário para triagem do uso de álcool, tabaco e outras substâncias 2.0 (ASSIST, na sigla em inglês) e o desenvolvimento neuropsicomotor das crianças foi avaliado pelo teste de triagem do desenvolvimento Denver II. Resultados A prevalência do uso de drogas lícitas ou ilícitas na gestação foi de cerca de 17%. Das usuárias, 63,9% usaram álcool, 58,3% usaram tabaco, 9,2% usaram cocaína/crack e 4,6% usaram maconha. Não houve associação entre o uso de drogas na gestação eMMG. Contudo, o uso de tabaco foi associado a hemorragia, presença de critérios clínicos de near miss e alteração no desenvolvimento infantil. O uso de álcool foi associado à asfixia neonatal e o uso de cocaína/crack à ocorrência de alguma complicação clínica na gestação. Conclusão O abuso de substâncias lícitas ou ilícitas na gestação é frequente e associado a piores desfechos maternos, perinatais e do desenvolvimento infantil.

10.
Rev Bras Ginecol Obstet ; 40(9): 518-526, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30064145

RESUMO

OBJECTIVE: To assess the relationship between the use of psychoactive substances during pregnancy and the occurrence of severe maternal morbidity (SMM), perinatal outcomes and repercussions on the neuropsychomotor development of exposed children. METHODS: A case-control study nested within a cohort of severe maternal morbidity (COMMAG) was performed. Women with SMM were considered cases. Controls were those with low-risk pregnancy, without SMM and admitted during the same time period as the cases. Cohort data were collected retrospectively in hospital records for childbirth. A face-to-face interview was also performed with 638 women (323 without SMM and 315 with SMM) and their children of the index pregnancy between 6 months and 5 years after childbirth. During the interview, substance abuse during pregnancy was assessed by a modified question from the Alcohol, Smoking and Substance Involvement Screening Test 2.0 (ASSIST) and the neuropsychomotor development in the children was assessed by the Denver Developmental Screening Test, 2nd edition. RESULTS: The prevalence of licit or illicit drug use during pregnancy was ∼ 17%. Among drug users, 63.9% used alcohol, 58.3% used tobacco, 9.2% used cocaine/crack and 4.6% used marijuana. There was no association between drug use during pregnancy and SMM, although tobacco use during pregnancy was associated with bleeding, presence of near-miss clinical criteria (NMCC) and alteration in infant development; alcohol use was associated with neonatal asphyxia; and cocaine/crack use was associated with the occurrence of some clinical complications during pregnancy. CONCLUSION: The use of psychoactive substances during pregnancy is frequent and associated with worse maternal, perinatal and child development outcomes.


Assuntos
Transtornos do Neurodesenvolvimento/induzido quimicamente , Complicações na Gravidez/induzido quimicamente , Psicotrópicos/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/complicações , Estudos de Casos e Controles , Pré-Escolar , Feminino , Humanos , Lactente , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Índice de Gravidade de Doença
11.
Rev. bras. ginecol. obstet ; 39(9): 443-452, Sept. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-898895

RESUMO

Abstract Objective To define transvaginal ultrasound reference ranges for uterine cervix measurements according to gestational age (GA) in low-risk pregnancies. Methods Cohort of low-risk pregnantwomen undergoing transvaginal ultrasound exams every 4 weeks, comprisingmeasurements of the cervical length and volume, the transverse and anteroposterior diameters of the cervix, and distance fromthe entrance of the uterine artery into the cervix until the internal os. The inter- and intraobserver variabilities were assessed with the linear correlation coefficient and the Student t-test. Within each period of GA, 2.5, 10, 50, 90 and 97.5 percentiles were estimated, and the variation by GA was assessed with analysis of variance for dependent samples. Mean values and Student t-test were used to compare the values stratified by control variables. Results After confirming the high reproducibility of the method, 172 women followed in this cohort presented a reduction in cervical length, with an increase in volume and in the anteroposterior and transverse diameters during pregnancy. Smaller cervical lengths were associated with younger age, lower parity, and absence of previous cesarean section (C-section). Conclusion In the studied population, we observed cervical length shortening throughout pregnancy, suggesting a physiological reduction mainly in the vaginal portion of the cervix. In order to better predict pretermbirth, cervical insufficiency and premature rupture of membranes, reference curves and specific cut-off values need to be validated.


Resumo Objetivo Elaborar curvas de referências de medidas ultrassonográficas de colo uterino por idade gestacional (IG) em gestações de baixo risco. Métodos Coorte de gestantes de baixo risco, submetidas a ultrassom transvaginal repetido a cada 4 semanas, com medida do comprimento, dos diâmetros anteroposterior e transverso, da distância entre a entrada da artéria uterina no colo e o orifício interno, e do volume do colo. Foi avaliada a variabilidade inter e intraobservador entre as medidas com o coeficiente de correlação linear e teste t de Student. Para cada faixa de IG, estimaram-se os percentis 2,5, 10, 50, 90 e 97,5 dos valores das medidas, com a variação por IG avaliada por análise de variância para amostras dependentes. As comparações dos valores por variáveis de controle foram feitas por meio dos cálculos de médias e teste t de Student. Resultados Assegurada a alta reprodutibilidade do método, as 172 mulheres acompanhadas na coorte apresentaram redução das medidas de comprimento de colo com o decorrer da gestação, com aumento de volume e dos diâmetros anteroposterior e transverso. O menor comprimento cervical foi associado à menor idade materna, menor paridade, e ausência de cesárea prévia. Conclusão Na população estudada foi observada redução no comprimento cervical com o decorrer da gestação, sugerindo encurtamento fisiológico principalmente à custa da porção vaginal do colo. Há a necessidade de validar tais curvas de referência e pontos de corte específicos para uma melhor predição de risco de parto pré-termo, insuficiência cervical, e amniorrexe prematura.

12.
Rev Bras Ginecol Obstet ; 39(9): 443-452, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28778109

RESUMO

Objective To define transvaginal ultrasound reference ranges for uterine cervix measurements according to gestational age (GA) in low-risk pregnancies. Methods Cohort of low-risk pregnant women undergoing transvaginal ultrasound exams every 4 weeks, comprising measurements of the cervical length and volume, the transverse and anteroposterior diameters of the cervix, and distance from the entrance of the uterine artery into the cervix until the internal os. The inter- and intraobserver variabilities were assessed with the linear correlation coefficient and the Student t-test. Within each period of GA, 2.5, 10, 50, 90 and 97.5 percentiles were estimated, and the variation by GA was assessed with analysis of variance for dependent samples. Mean values and Student t-test were used to compare the values stratified by control variables. Results After confirming the high reproducibility of the method, 172 women followed in this cohort presented a reduction in cervical length, with an increase in volume and in the anteroposterior and transverse diameters during pregnancy. Smaller cervical lengths were associated with younger age, lower parity, and absence of previous cesarean section (C-section). Conclusion In the studied population, we observed cervical length shortening throughout pregnancy, suggesting a physiological reduction mainly in the vaginal portion of the cervix. In order to better predict preterm birth, cervical insufficiency and premature rupture of membranes, reference curves and specific cut-off values need to be validated.


Assuntos
Colo do Útero/anatomia & histologia , Colo do Útero/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Feminino , Humanos , Gravidez , Trimestres da Gravidez , Estudos Prospectivos , Valores de Referência , Medição de Risco , Ultrassonografia Pré-Natal/métodos , Vagina , Adulto Jovem
13.
Rev Bras Ginecol Obstet ; 39(2): 44-52, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28231600

RESUMO

Objective To validate the translation and adaptation to Brazilian Portuguese of 36 items from the World Health Organizaton Disability Assessment Schedule 2.0 (WHODAS 2.0), regarding their content and structure (construct), in a female population after pregnancy. Methods This is a validation of an instrument for the evaluation of disability and functioning and an assessment of its psychometric properties, performed in a tertiary maternity and a referral center specialized in high-risk pregnancies in Brazil. A sample of 638 women in different postpartum periods who had either a normal or a complicated pregnancy was included. The structure was evaluated by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), while the content and relationships among the domains were assessed through Pearson's correlation coefficient. The sociodemographic characteristics were identified, and the mean scores with their standard deviations for the 36 questions of the WHODAS 2.0 were calculated. The internal consistency was evaluated byCronbach's α. Results Cronbach's α was higher than 0.79 for both sets of questons of the questionnaire. The EFA and CFA for the main 32 questions exhibited a total variance of 54.7% (Kaiser-Meyer-Olkin [KMO] measure of sampling adequacy = 0.934; p < 0.001) and 53.47% (KMO = 0.934; p < 0.001) respectively. There was a significant correlation among the 6 domains (r = 0.571-0.876), and a moderate correlation among all domains (r = 0.476-0.694). Conclusion The version of the WHODAS 2.0 instrument adapted to Brazilian Portuguese showed good psychometric properties in this sample, and therefore could be applied to populations of women regarding their reproductive history.


Assuntos
Avaliação da Deficiência , Complicações na Gravidez/fisiopatologia , Adulto , Estudos de Coortes , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Autorrelato , Organização Mundial da Saúde , Adulto Jovem
14.
Rev. bras. ginecol. obstet ; 39(2): 44-53, Feb. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-843917

RESUMO

Abstract Objective To validate the translation and adaptation to Brazilian Portuguese of 36 items from the World Health Organizaton Disability Assessment Schedule 2.0 (WHODAS 2.0), regarding their content and structure (construct), in a female population after pregnancy. Methods This is a validation of an instrument for the evaluation of disability and functioning and an assessment of its psychometric properties, performed in a tertiary maternity and a referral center specialized in high-risk pregnancies in Brazil. A sample of 638 women in different postpartum periods who had either a normal or a complicated pregnancy was included. The structure was evaluated by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), while the content and relationships among the domains were assessed through Pearson's correlation coefficient. The sociodemographic characteristics were identified, and the mean scores with their standard deviations for the 36 questions of the WHODAS 2.0 were calculated. The internal consistency was evaluated byCronbach's α. Results Cronbach's α was higher than 0.79 for both sets of questons of the questionnaire. The EFA and CFA for the main 32 questions exhibited a total variance of 54.7% (Kaiser-Meyer-Olkin [KMO] measure of sampling adequacy = 0.934; p < 0.001) and 53.47% (KMO = 0.934; p < 0.001) respectively. There was a significant correlation among the 6 domains (r = 0.571-0.876), and a moderate correlation among all domains (r = 0.476-0.694). Conclusion The version of the WHODAS 2.0 instrument adapted to Brazilian Portuguese showed good psychometric properties in this sample, and therefore could be applied to populations of women regarding their reproductive history.


Resumo Objetivo Validar a versão adaptada para o português brasileiro do instrumento World Health Organizaton Disability Assessment Schedule 2.0 (WHODAS 2.0), em seu conteúdo e estrutura (construto), em uma população de mulheres após a gravidez. Métodos Trata-se de validação de um instrumento para incapacidade e funcionalidade, incluindo suas propriedades psicométricas, realizada em uma maternidade de referência em gestação de alto risco no Brasil. Incluiu uma amostra de 638mulheres em diferentes períodos pós-parto que tiveram uma gravidez normal ou com complicações. A estrutura foi avaliada por análise fatorial exploratória (AFE) e análise fatorial confirmatória (AFC), enquanto o conteúdo e as associações entre os domínios foram avaliados por meio do coeficiente de correlação de Pearson. Foram identificadas características sociodemográficas, e os escores médios do WHODAS 2.0 para as 36 questões foram calculados. A consistência interna foi avaliada pelo método α de Cronbach. Resultados O α de Cronbach foi maior do que 0,79 para os dois conjuntos de perguntas do questionário. A AFE e a AFC para as 32 questões apresentaram uma variância total de 54,7% (medida de adequação da amostra de Kaiser-Meyer-Olkin [KMO] = 0,934; p < 0,001) e 53,47% (KMO = 0,934; p < 0,001), respectivamente. Houve uma correlação significativa entre os 6 domínios (r = 0,571-0,876), e moderada correlação entre todos os domínios (r = 0,476-0,694). Conclusão O instrumento WHODAS 2.0, adaptado para o português do Brasil, mostrou boas propriedades psicométricas nessa amostra e, portanto, pode ser aplicado a populações de mulheres com relação à sua história reprodutiva.


Assuntos
Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Avaliação da Deficiência , Complicações na Gravidez/fisiopatologia , Estudos de Coortes , Estudos Retrospectivos , Autorrelato , Organização Mundial da Saúde
15.
Biomed Res Int ; 2014: 965724, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24772441

RESUMO

OBJECTIVE: To assess occurrence of severe maternal complications associated with ectopic pregnancy (EP). METHOD: A multicenter cross-sectional study was conducted, with prospective surveillance of potentially life-threatening conditions (PLTC), maternal near miss (MNM), and maternal death (MD). EP complications, patient sociodemographic/obstetric characteristics, and conditions of severity management were assessed, estimating prevalence ratios with respective 95% CI. Factors independently associated with greater severity were identified using multiple regression analysis. RESULTS: Of the 9.555 severe maternal morbidity patients, 312 women (3.3%) had complications after EP: 286 (91.7%) PLTC, 25 (8.0%) MNM, and 1 (0.3%) MD. Severe maternal outcome ratio (SMOR) was 0.3/1000 LB among EP cases and 10.8/1000 LB among other causes. Complicated EP patients faced a higher risk of blood transfusion, laparotomy, and lower risk of ICU admission and prolonged hospitalization than women developing complications resulting from other causes. Substandard care was the most common in more severe maternal morbidity and EP cases (22.7% MNM and MD versus 15% PLTC), although not significant. CONCLUSION: Increased maternal morbidity due to EP raised awareness about the condition and its impact on female reproductive life. No important risk factors for greater severity were identified. Care providers should develop specific guidelines and interventions to prevent severe maternal morbidity.


Assuntos
Conscientização , Gravidez Ectópica/mortalidade , Adulto , Brasil/epidemiologia , Feminino , Humanos , Mortalidade Materna , Gravidez , Estudos Prospectivos , Estudos Retrospectivos
16.
BMC Pregnancy Childbirth ; 14: 77, 2014 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-24555831

RESUMO

BACKGROUND: The aim of this study was to assess severe maternal morbidity (SMM) and near miss (NM) cases among adolescent girls and women over 35 years of age in the Brazilian Network for Surveillance of Severe Maternal Morbidity, using a set of standard criteria, compared to pregnant women aged 20 to 34 years. METHODS: A cross-sectional multicenter study conducted in 27 referral obstetric units in Brazil. All pregnant women admitted to these centers during a one-year period of prospective surveillance were screened to identify cases of maternal death (MD), NM and other SMM. Indicators of maternal morbidity and mortality were evaluated for the three age groups. Sociodemographic, clinical and obstetric characteristics, gestational and perinatal outcomes, main causes of morbidity and delays in care were also compared. Two multiple analysis models were performed, to estimate the adjusted prevalence ratio for identified factors that were independently associated with the occurrence of severe maternal outcome (SMO = MNM + MD). RESULTS: Among SMM and MD cases identified, the proportion of adolescent girls and older women were 17% each. The risk of MNM or death was 25% higher among older women. Maternal near miss ratio and maternal mortality ratios increased with age, but these ratios were also higher among adolescents aged 10 to 14, although the absolute numbers were low. On multivariate analysis, younger age was not identified as an independent risk factor for SMO, while this was true for older age (PR 1.25; 1.07-1.45). CONCLUSIONS: SMO was high among women below 14 years of age and increased with age in Brazilian pregnant women.


Assuntos
Vigilância da População , Complicações na Gravidez/epidemiologia , Reprodução , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Mortalidade Materna/tendências , Pessoa de Meia-Idade , Morbidade/tendências , Gravidez , Complicações na Gravidez/diagnóstico , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
17.
Reprod Health Matters ; 21(42): 165-73, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24315072

RESUMO

Unsafe abortions remain a major public health problem in countries with very restrictive abortion laws. In Brazil, parliamentarians - who have the power to change the law - are influenced by "public opinion", often obtained through surveys and opinion polls. This paper presents the findings from two studies. One was carried out in February-December 2010 among 1,660 public servants and the other in February-July 2011 with 874 medical students from three medical schools, both in São Paulo State, Brazil. Both groups of respondents were asked two sets of questions to obtain their opinion about abortion: 1) under which circumstances abortion should be permitted by law, and 2) whether or not women in general and women they knew who had had an abortion should be punished with prison, as Brazilian law mandates. The differences in their answers were enormous: the majority of respondents were against putting women who have had abortions in prison. Almost 60% of civil servants and 25% of medical students knew at least one woman who had had an illegal abortion; 85% of medical students and 83% of civil servants thought this person(s) should not be jailed. Brazilian parliamentarians who are currently reviewing a reform in the Penal Code need to have this information urgently.


Assuntos
Aborto Criminoso/legislação & jurisprudência , Aborto Legal/legislação & jurisprudência , Direitos Sexuais e Reprodutivos/legislação & jurisprudência , Direitos da Mulher/legislação & jurisprudência , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Masculino , Gravidez , Opinião Pública , Inquéritos e Questionários
18.
Rev. Assoc. Med. Bras. (1992) ; 59(3): 234-240, maio-jun. 2013. ilus
Artigo em Português | LILACS | ID: lil-679494

RESUMO

OBJETIVO: A Escala de Avaliação de Incapacidades da Organização Mundial de Saúde (WHO-DAS 2.0) foi desenhada para avaliar o nível de funcionalidade em seis domínios de vida (cognição, mobilidade, autocuidado, convivência social, atividades de vida e participação na sociedade). Possui diferentes versões, desde as mais simplificadas até as mais completas, apresentações variadas (entrevistas ou autoadministrado) e abrange os domínios da Classificação Internacional de Funcionalidade (CIF). O objetivo do estudo foi realizar a adaptação transcultural da versão completa para a língua portuguesa. MÉTODOS: O processo foi desenvolvido em seis etapas: tradução, retrotradução, equivalência semântica, avaliação de especialistas das etapas anteriores, pré-teste do instrumento e versão final. RESULTADOS: Após o pré-teste, realizou-se adequação para o português mais coloquial, substituindo termos para aproximar a linguagem às expressões do dia a dia. As versões mostraram-se semelhantes em relação ao significado geral e referencial. CONCLUSÃO: O instrumento WHODAS 2.0 mostrou-se de fácil aplicação e compreensão com mulheres no ciclo grávido-puerperal.


OBJECTIVE: The World Health Organization Disability Assessment Schedule (WHODAS 2.0) was designed to assess the functioning level in six life domains (cognition, mobility, selfcare, getting along, life activities, and participation in community activities). There are different versions, from the simplest to the most complete, various presentations (either interviews or self-administered), comprehending the domains of the International Classification of Functioning, Disability and Health (ICF). This study aimed to make a cross-cultural adaptation of the complete version into Portuguese. METHODS: The proceeding was developed over six stages: translation, back-translation, semantic equivalence, evaluation of previous stages by experts, tool pretest, and final version. RESULTS: After the pretest, an adjustment to a more colloquial Portuguese was made. The versions were shown to be similar regarding general and referential meaning. CONCLUSION: WHODAS 2.0 was shown to be easily applied and understood by women in the pregnancy-postpartum cycle.


Assuntos
Feminino , Humanos , Masculino , Gravidez , Comparação Transcultural , Avaliação da Deficiência , Idioma , Traduções , Brasil , Período Pós-Parto , Reprodutibilidade dos Testes , Organização Mundial da Saúde
19.
Rev Assoc Med Bras (1992) ; 59(3): 234-40, 2013.
Artigo em Português | MEDLINE | ID: mdl-23684209

RESUMO

OBJECTIVE: The World Health Organization Disability Assessment Schedule (WHODAS 2.0) was designed to assess the functioning level in six life domains (cognition, mobility, self-care, getting along, life activities, and participation in community activities). There are different versions, from the simplest to the most complete, various presentations (either interviews or self-administered), comprehending the domains of the International Classification of Functioning, Disability and Health (ICF). This study aimed to make a cross-cultural adaptation of the complete version into Portuguese. METHODS: The proceeding was developed over six stages: translation, back-translation, semantic equivalence, evaluation of previous stages by experts, tool pretest, and final version. RESULTS: After the pretest, an adjustment to a more colloquial Portuguese was made. The versions were shown to be similar regarding general and referential meaning. CONCLUSION: WHODAS 2.0 was shown to be easily applied and understood by women in the pregnancy-postpartum cycle.


Assuntos
Comparação Transcultural , Avaliação da Deficiência , Idioma , Traduções , Brasil , Feminino , Humanos , Masculino , Período Pós-Parto , Gravidez , Reprodutibilidade dos Testes , Organização Mundial da Saúde
20.
PLoS One ; 8(3): e57594, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23483915

RESUMO

INTRODUCTION: This systematic review examines the relationship between blood loss and clinical signs and explores its use to trigger clinical interventions in the management of obstetric haemorrhage. METHODS: A systematic review of the literature was carried out using a comprehensive search strategy to identify studies presenting data on the relationship of clinical signs & symptoms and blood loss. Methodological quality was assessed using the STROBE checklist and the general guidelines of MOOSE. RESULTS: 30 studies were included and five were performed in women with pregnancy-related haemorrhage (other studies were carried in non-obstetric populations). Heart rate (HR), systolic blood pressure (SBP) and shock index were the parameters most frequently studied. An association between blood loss and HR changes was observed in 22 out of 24 studies, and between blood loss and SBP was observed in 17 out of 23 studies. An association was found in all papers reporting on the relationship of shock index and blood loss. Seven studies have used Receiver Operating Characteristic Curves to determine the accuracy of clinical signs in predicting blood loss. In those studies the AUC ranged from 0.56 to 0.74 for HR, from 0.56 to 0.79 for SBP and from 0.77 to 0.84 for shock index. In some studies, HR, SBP and shock index were associated with increased mortality. CONCLUSION: We found a substantial variability in the relationship between blood loss and clinical signs, making it difficult to establish specific cut-off points for clinical signs that could be used as triggers for clinical interventions. However, the shock index can be an accurate indicator of compensatory changes in the cardiovascular system due to blood loss. Considering that most of the evidence included in this systematic review is derived from studies in non-obstetric populations, further research on the use of the shock index in obstetric populations is needed.


Assuntos
Hemorragia/patologia , Feminino , Hemorragia/mortalidade , Humanos , Hemorragia Pós-Parto/mortalidade , Hemorragia Pós-Parto/patologia , Gravidez , Sinais Vitais
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