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1.
Rev. inf. cient ; 99(1): 20-29, ene.-feb. 2020. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-1093926

RESUMO

RESUMEN Introducción: La mortalidad materna ha sido utilizada como un indicador del desarrollo socioeconómico de un país y de la calidad de los servicios médicos en la Salud Pública. La morbilidad materna extremadamente grave (near miss) constituye el escenario necesario para entender las condiciones y hechos prevenibles que determinan la muerte materna. Objetivo: Caracterizar la morbilidad materna en la Unidad de Cuidados Intensivos del Hospital General Docente "Orlando Pantoja Tamayo" de la provincia Santiago de Cuba durante los años 2014-2019. Método: Se realizó un estudio observacional, que incluyó a 223 pacientes atendidas en la Unidad de Cuidados Intensivos por complicaciones relacionadas con el embarazo-parto-puerperio, en el periodo de tiempo comprendido desde enero de 2014 a diciembre de 2019. Se realizó un análisis descriptivo de las variables: edad, servicio de procedencia, diagnóstico, estadía y complicaciones. Resultados: El 56 % de pacientes admitidas estuvo dentro de 20 y 29 años de edad, siendo los trastornos hipertensivos asociados al embarazo con un 65,4 % y la hemorragia obstétrica para un 22,0 % las principales causas de ingresos. La estadía promedio de las pacientes fue de 3,6 días y durante la misma, la diabetes insípida fue la principal complicación. Conclusiones: La morbilidad materna se caracterizó por presentarse en edades adecuadas para el desarrollo del embarazo, con una estadía en Unidades de Cuidados Intensivos por debajo de lo reportado en la literatura, y existe relación estadística entre los diagnósticos de ingreso y la aparición de complicaciones.


ABSTRACT Introduction: Maternal mortality has been used as an indicator of the socioeconomic development of a country and the quality of medical services in Public Health. Extremely severe maternal morbidity (near miss) is the necessary scenario to understand the preventable conditions and facts that determine maternal death. Objective: To characterize maternal morbidity in the Intensive Care Unit of the General Teaching Hospital "Orlando Pantoja Tamayo" of the Santiago de Cuba province during the years 2014-2019. Method: An observational study was conducted, which included 223 patients treated in the Intensive Care Unit for complications related to pregnancy-childbirth-puerperium, in the period of time from January 2014 to December 2019. A descriptive analysis of the variables was performed: age, service of origin, diagnosis, stay and complications. Results: 56% of admitted patients were within 20 and 29 years of age, with hypertensive disorders associated with pregnancy with 65.4% and obstetric hemorrhage for 22.0% the main causes of income. The average stay of the patients was 3.6 days and during it, diabetes insipidus was the main complication. Conclusions: Maternal morbidity was characterized by presenting at adequate ages for the development of pregnancy, with a stay in Intensive Care Units below what was reported in the literature, and there is a statistical relationship between the diagnosis of admission and the appearance of complications.


RESUMO Introdução: A mortalidade materna tem sido utilizada como um indicador do desenvolvimento socioeconômico de um país e da qualidade dos serviços médicos em Saúde Pública. A morbidade materna extremamente grave (near miss) é o cenário necessário para entender as condições evitáveis e os fatos que determinam a morte materna. Objetivo: Caracterizar a morbidade materna na Unidade de Terapia Intensiva do Hospital Geral de Ensino "Orlando Pantoja Tamayo" da província de Santiago de Cuba nos anos 2014-2019. Método: Foi realizado um estudo observacional, que incluiu 223 pacientes atendidos na Unidade de Terapia Intensiva por complicações relacionadas à gravidez-parto-puerpério, no período de janeiro de 2014 a dezembro de 2019. Foi realizada uma análise descritivo das variáveis: idade, serviço de origem, diagnóstico, permanência e complicações. Resultados: 56% das pacientes admitidas tinham entre 20 e 29 anos de idade, com distúrbios hipertensivos associados à gravidez com 65,4% e hemorragia obstétrica por 22,0%, as principais causas de renda. A permanência média dos pacientes foi de 3,6 dias e, durante o mesmo, o diabetes insipidus foi a principal complicação. Conclusões: A morbidade materna foi caracterizada por apresentar-se em idades adequadas para o desenvolvimento da gravidez, com permanência em Unidades de Terapia Intensiva abaixo do relatado na literatura, e existe relação estatística entre o diagnóstico de admissão e o aparecimento de complicações.


Assuntos
Humanos , Feminino , Gravidez , Adulto , Complicações na Gravidez , Gravidez de Alto Risco , Complicações do Trabalho de Parto , Epidemiologia Descritiva , Estudos Transversais
2.
Nursing (Säo Paulo) ; 23(261): 3607-3615, fev.2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1095669

RESUMO

Objetivou-se identificar o conhecimento das parturientes sobre violência obstétrica, levantar se conseguem identificar as principais ações presentes na violência obstétrica, detectar os impactos físicos e psicológicos da violência obstétrica. Os sujeitos desse estudo foram 14 puérperas residentes do estado do Rio de Janeiro. Foi realizado um estudo do tipo descritivo, exploratório com abordagem quali-quantitativa. A coleta de dados foi realizada por meio de um formulário eletrônico online, na qual foi viabilizado um formulário individual composto de perguntas relacionadas ao objetivo da pesquisa sendo de fácil e rápido acesso ao sujeito participante. Concluiu-se através dos resultados desta pesquisa que as mulheres possuem um conhecimento limitado acerca da violência obstétrica, podendo estar relacionado à falta de informação durante o pré-natal.(AU)


The aim was to identify the parturients' knowledge about obstetric violence, to get up if they can identify the main actions present in obstetric violence, to detect the physical and psychological impacts of obstetric violence. The subjects of this study were 14 puerperal women living in the state of Rio de Janeiro. A descriptive, exploratory study with a qualitative and quantitative approach was carried out. Data collection was performed using an online electronic form, in which an individual form was made available, consisting of questions related to the research objective, being easily and quickly accessed by the participating subject. It was concluded through the results of this research that women have limited knowledge about obstetric violence, which may be related to the lack of information during prenatal care.(AU)


El objetivo era identificar el conocimiento de las parturientas sobre la violencia obstétrica, levantarse si pueden identificar las principales acciones presentes en la violencia obstétrica, detectar los impactos físicos y psicológicos de la violencia obstétrica. Los sujetos de este estudio fueron 14 mujeres puerperales que viven en el estado de Rio de Janeiro. Se realizó un estudio exploratorio descriptivo con enfoque cualitativo y cuantitativo. La recopilación de datos se realizó mediante un formulario electrónico en línea, en el que se puso a disposición un formulario individual, que consta de preguntas relacionadas con el objetivo de la investigación, de fácil y rápido acceso por parte del sujeto participante. A través de los resultados de esta investigación, se concluyó que las mujeres tienen un conocimiento limitado sobre la violencia obstétrica, que puede estar relacionada con la falta de información durante la atención prenatal.(AU)


Assuntos
Humanos , Feminino , Gravidez , Parto Obstétrico/instrumentação , Dor do Parto , Saúde Materna , Complicações do Trabalho de Parto , Enfermagem Obstétrica
3.
West Afr J Med ; 37(1): 74-78, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030716

RESUMO

PURPOSE: Identification of health problems of women of reproductive age, using a reliable mortality data, is essential in evading preventable female deaths. This study aimed at investigating mortality profile of women of reproductive age group in Nigeria. MATERIALS AND METHODS: This is a descriptive, retrospective study involving women of reproductive age group of 15-49 years that died at DELSUTH from 1st January 2016 to 31st December 2018. The age, date of death and cause of death were retrieved from the hospital records and subsequently analyzed using SPSS version 21. RESULTS: One hundred and eighty-seven eligible deaths were encountered in this study, constituting 17.5% of all deaths in the hospital. Twenty four (12.8%) cases were of maternal etiology while 163 (87.2%) were of non-maternal causes. Non-communicable disease, communicable disease and external injuries accounted for 100 (53.5%), 44 (23.5%) and 19 (10.2%) deaths among the non-maternal causes. The mean age and the peak age group are 34.4 years and the 4th decade respectively. The leading specified non-maternal causes of death (in descending order) are AIDS/TB, cerebrovascular accidents (CVA), breast cancer, road traffic accident (RTA), diabetes, perioperative death and sepsis while the leading maternal causes of death are abortion, postpartum hemorrhage, eclampsia and puerperal sepsis. CONCLUSION: Most deaths affecting WRAG are preventable, with non-maternal causes in excess of maternal causes. There is need for holistic life-long interventional policies and strategies that will address the health need of these women, using evidence-based research findings.


Assuntos
Mortalidade Hospitalar , Hospitais/estatística & dados numéricos , Mortalidade Materna , Aborto Induzido/mortalidade , Adolescente , Adulto , Neoplasias da Mama/mortalidade , Causas de Morte/tendências , Eclampsia/mortalidade , Feminino , Infecções por HIV/mortalidade , Humanos , Mortalidade Materna/tendências , Pessoa de Meia-Idade , Nigéria/epidemiologia , Complicações do Trabalho de Parto/mortalidade , Hemorragia Pós-Parto/mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Infecção Puerperal/mortalidade , Estudos Retrospectivos , Sepse/mortalidade , Acidente Vascular Cerebral , Tuberculose/mortalidade , Adulto Jovem
4.
Nat Rev Neurol ; 16(3): 154-170, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32080393

RESUMO

Neuromyelitis optica spectrum disorders (NMOSD) are a type of neurological autoimmune disease characterized by attacks of CNS inflammation that are often severe and predominantly affect the spinal cord and optic nerve. The majority of individuals with NMOSD are women, many of whom are of childbearing age. Although NMOSD are rare, several small retrospective studies and case reports have indicated that pregnancy can worsen disease activity and might contribute to disease onset. NMOSD disease activity seems to negatively affect pregnancy outcomes. Moreover, some of the current NMOSD treatments are known to pose risks to the developing fetus and only limited safety data are available for others. Here, we review published studies regarding the relationship between pregnancy outcomes and NMOSD disease activity. We also assess the risks associated with using disease-modifying therapies for NMOSD during the course of pregnancy and breastfeeding. On the basis of the available evidence, we offer recommendations regarding the use of these therapies in the course of pregnancy planning in individuals with NMOSD.


Assuntos
Anormalidades Induzidas por Medicamentos , Aborto Espontâneo/induzido quimicamente , Fatores Imunológicos/efeitos adversos , Neuromielite Óptica/tratamento farmacológico , Neuromielite Óptica/imunologia , Complicações do Trabalho de Parto/induzido quimicamente , Pré-Eclâmpsia/induzido quimicamente , Adulto , Feminino , Humanos , Gravidez
5.
Nursing (Säo Paulo) ; 23(260): 3529-3532, jan.2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1095543

RESUMO

Objetivo: Conhecer, através da revisão integrativa de literatura, a produção científica sobre violência obstétrica. Método: Trata-se de uma revisão integrativa de literatura, método que tem como finalidade sintetizar as pesquisas publicadas, para obter novas conclusões a partir de um tema de interesse. Foi realizado um levantamento nas bases de dados da Biblioteca Virtual em Saúde, a saber: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Base de Dados em Enfermagem (BDENF). Resultado: Evidenciou-se como fator predominante a formação dos profissionais de saúde e a negligência como parte estruturante no desenho atual da assistência. Destacando em alguns artigos que a prática da violência institucional obstétrica ocorre por negligência, pela violência verbal, e a violência física. Conclusão: A pesquisa revelou que, para a melhoria da violência obstétrica, serão necessárias adequações no serviço de saúde. Para que as mudanças aconteçam o processo de formação dos profissionais de saúde são fundamentais deverão ser modificados.(AU)


Objective: To know, through an integrative literature review, the production of knowledge about obstetric violence. Method: This is an integrative review, a method whose purpose is to synthesize the published researches, to obtain new conclusions from a topic of interest. Through a bibliographical survey, in the databases of the Virtual Health Library, as of August 2017, namely: Latin American and Caribbean Literature in Health Sciences (LILACS) and Nursing Database (BDENF). Outcome: The training of health professionals and neglect as a structuring part of the current assistance design was evidenced as a predominant factor. Emphasizing in some articles that the practice of institutional obstetric violence occurs through neglect, verbal violence, and physical violence. Conclusion: The research revealed that, for the improvement of obstetric violence, adjustments will be necessary in the health service. For changes to occur the process of training of health professionals are fundamental must be modified.(AU)


Objetivo: Conocer, a través de la revisión integrativa de literatura, la producción científica sobre violencia obstétrica. Método: Se trata de una revisión integrativa de literatura, método que tiene como finalidad sintetizar las investigaciones publicadas, para obtener nuevas conclusiones a partir de un tema de interés. Se realizó un levantamiento en las bases de datos de la Biblioteca Virtual en Salud, a saber: Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) y Base de Datos en Enfermería (BDENF). Resultado: Se evidenció como factor predominante la formación de los profesionales de salud y la negligencia como parte estructurante en el diseño actual de la asistencia. Destacando en algunos artículos que la práctica de la violencia institucional obstétrica ocurre por negligencia, por la violencia verbal, y la violencia física. Conclusión: La investigación reveló que, para la mejora de la violencia obstétrica, serán necesarias adecuaciones en el servicio de salud. Para que los cambios ocurran el proceso de formación de los profesionales de salud son fundamentales deben ser modificados.(AU)


Assuntos
Humanos , Feminino , Gravidez , Parto Obstétrico , Complicações do Trabalho de Parto , Serviços de Saúde Materna , Enfermagem Obstétrica , Saúde Materno-Infantil
6.
Int J Gynaecol Obstet ; 148 Suppl 1: 16-21, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31943183

RESUMO

OBJECTIVE: To determine obstetric fistula knowledge among prenatal attendees and midwives in Mfantsiman municipality, Ghana. METHODS: An analytical cross-sectional study was conducted among prenatal clinic attendees and midwives in Mfantsiman municipality from March to April, 2016. Women were selected by systematic sampling and consenting midwives were recruited. Respondents were interviewed using a pretested structured questionnaire. Data were analyzed using the χ2 test and Poisson regression with a robust error variance to generate relative risks (RRs) with 95% confidence intervals (CIs). P<0.05 was considered statistically significant. RESULTS: Altogether, 393 prenatal attendees and 45 midwives were studied. Mean age of attendees was 28.1 ± 7.1 years. About 29% of prenatal attendees knew of, 37.2% had poor knowledge of, and 56.6% had some misconceptions about obstetric fistula. Women who had attained some level of education (P trend=0.001), were employed (adjusted RR 4.92; 95% CI, 1.98-12.21), or had given birth before (P trend=0.01) were more likely to have heard of obstetric fistula. All midwives knew of obstetric fistula and its preventive measures; however, up to 73.3% had some misconceptions about it. CONCLUSION: Educating prenatal attendees and organizing regular refresher courses on obstetric fistula for midwives should be a priority in the municipality.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Tocologia/educação , Fístula Vesicovaginal/prevenção & controle , Adolescente , Adulto , Estudos Transversais , Feminino , Gana , Humanos , Complicações do Trabalho de Parto/terapia , Gravidez , Cuidado Pré-Natal/normas , Inquéritos e Questionários , Adulto Jovem
7.
Int J Gynaecol Obstet ; 148 Suppl 1: 6-8, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31943187

RESUMO

Thirteen years after the last supplement on obstetric fistula, the authors challenge the progress achieved. Citing the ongoing need for a standardized classification system, uniform surgical training and certification, evaluation, follow-up, and research, we emphasize the need for improved communication and coordination between government and nongovernment entities invested in ending obstetric fistula. Struck by the call by the United Nations to end obstetric fistula by 2030, we stress the need for increased and targeted funding of programs that are of the highest quality and impact.


Assuntos
Obstetrícia/normas , Fístula Vesicovaginal/cirurgia , Competência Clínica , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Cooperação Internacional , Complicações do Trabalho de Parto , Obstetrícia/educação , Gravidez , Fístula Vesicovaginal/prevenção & controle
8.
BJOG ; 127(3): 405-413, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31762140

RESUMO

OBJECTIVE: To determine variations in cord blood gas (CBG) parameters after 3-minute delayed cord clamping (DCC) in vaginal deliveries (VDs) and caesarean deliveries (CDs) at term without fetal distress. DESIGN: Prospective observational study. SETTING: University hospital. SAMPLE: CBG from 97 VDs and 124 CDs without fetal distress. METHODS: Comparison of paired arterial-venous CBG parameters drawn at birth from the unclamped cord and after 3-minutes DCC for VDs and CDs. MAIN OUTCOME MEASURES: Base excess, bicarbonate, haematocrit and haemoglobin from both arterial and venous cord blood, lactate, neonatal outcomes, partial pressure of oxygen (pO2 ), partial pressure of carbon dioxide (pCO2 ), pH, and postpartum haemorrhage. RESULTS: Arterial cord blood pH, bicarbonate ( HCO 3 - , mmol/l), and base excess (BE, mmol/l) decreased significantly after 3-minute DCC both in VDs (pH = 7.23 versus 7.27; P < 0.001; HCO 3 -  = 23.3 versus 24.3; P = 0.004; BE = -5.1 versus -2.9; P < 0.001) and CDs (pH = 7.28 versus 7.34; P < 0.001; HCO 3 -  = 26.2 versus 27.2; P < 0.001; BE = -1.5 versus 0.7; P < 0.001). After 3-minute DCC, pCO2 increased in CDs only (57 versus 51; P < 0.001), whereas lactate increased more in CDs compared with VDs (lactate, +1.1 [0.9, 1.45] versus +0.5 [-0.65, 2.35]; P = 0.01). Postpartum maternal haemorrhage, neonatal maximum bilirubin concentration, and need for phototherapy were similar between the two groups. Newborns born by CD more frequently required postnatal clinical monitoring or admission to a neonatal intensive care unit. CONCLUSIONS: After 3-minute DCC, the acid-base status shifted towards mixed acidosis in CDs and prevalent metabolic acidosis in VDs. CDs were associated with a more pronounced increase in arterial lactate, compared with VDs. TWEETABLE ABSTRACT: By 3-minute DCC, acid-base status shifts towards mixed and metabolic acidosis in caesarean and vaginal delivery, respectively.


Assuntos
Acidose , Cesárea , Parto Obstétrico , Sangue Fetal/metabolismo , Complicações do Trabalho de Parto , Cordão Umbilical/cirurgia , Acidose/sangue , Acidose/diagnóstico , Acidose/etiologia , Gasometria/métodos , Cesárea/efeitos adversos , Cesárea/métodos , Cesárea/estatística & dados numéricos , Constrição , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Itália/epidemiologia , Masculino , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etiologia , Gravidez , Resultado da Gravidez/epidemiologia , Tempo para o Tratamento
10.
Chemosphere ; 240: 124904, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31550593

RESUMO

BACKGROUND: Prenatal exposure to ambient levels of air pollution has been reported to adversely affect birth outcomes, yet few studies have investigated refined susceptible windows for adverse birth outcomes. OBJECTIVES: The study aimed at estimating associations between maternal exposure to ambient fine particulate matter (PM2.5; particles with an aerodynamic diameter ≤ 2.5 µm) and birth outcomes, including birth weight, low birth weight (LBW) and preterm birth (PTB), and identify specific susceptible windows. METHODS: A total of 3692 singleton live births were enrolled between 2013 and 2016 in Shanghai Birth Cohort, China. Based on mothers' residential addresses, weekly mean concentrations of PM2.5 over gestation were estimated based on an incorporated evaluating approach combining satellite-based estimates and ground-level measurements. Distributed lag non-liner models (DLNMs) were fitted by incorporating with multiple liner models and Cox proportional hazard models to evaluate weekly-as well as trimester-exposure-lag-response associations between average PM2.5 level and birth weight, LBW and PTB, and to identify critical windows. RESULTS: In this study, gestational exposure to PM2.5 was associated with adverse birth outcomes in infants, and critical windows were identified as 31st-34th gestational weeks for reduced birth weight, 38th-42 nd weeks for LBW and 27th-30th weeks for PTB, respectively. Trimester-specific associations were found for all birth outcomes during the third trimester. CONCLUSIONS: Ambient PM2.5 exposure exhibited adverse impacts on multiple outcomes including reduced birth weight, LBW and PTB in the late pregnancy. The study provides further evidence supporting harmful effects of maternal PM2.5 exposure on birth outcomes and identifying critical windows.


Assuntos
Exposição Materna/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Material Particulado/análise , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Peso ao Nascer , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Exposição Materna/efeitos adversos , Gravidez , Terceiro Trimestre da Gravidez , Nascimento Prematuro/induzido quimicamente
12.
BJOG ; 127(6): 702-707, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31846206

RESUMO

OBJECTIVE: To evaluate the mode of delivery and stillbirth rates over time among women with obstetric fistula. DESIGN: Retrospective record review. SETTING: Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia and Ethiopia. POPULATION: A total of 4396 women presenting with obstetric fistulas for repair who delivered previously in facilities between 1990 and 2014. METHODS: Retrospective review of trends and associations between mode of delivery and stillbirth, focusing on caesarean section (CS), assisted vaginal deliveries and spontaneous vaginal deliveries. MAIN OUTCOME MEASURES: Mode of delivery, stillbirth. RESULTS: Out of 4396 women with fistula, 3695 (84.1%) delivered a stillborn baby. Among mothers with fistula giving birth to a stillborn baby, the CS rate (overall 54.8%, 2027/3695) rose from 45% (162/361) in 1990-94 to 64% (331/514) in 2010-14. This increase occurred at the expense of assisted vaginal delivery (overall 18.3%, 676/3695), which declined from 32% (115/361) to 6% (31/514). CONCLUSIONS: In Eastern and Central Africa, CS is increasingly performed on women with obstructed labour whose babies have already died in utero. Contrary to international recommendations, alternatives such as vacuum extraction, forceps and destructive delivery are decreasingly used. Unless uterine rupture is suspected, CS should be avoided in obstructed labour with intrauterine fetal death to avoid complications related to CS scars in subsequent pregnancies. Increasingly, women with obstetric fistula add a history of unnecessary CS to their already grim experiences of prolonged, obstructed labour and stillbirth. TWEETABLE ABSTRACT: Caesarean section is increasingly performed in African women with stillbirth treated for obstetric fistula.


Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Complicações do Trabalho de Parto/terapia , Fístula Retovaginal/terapia , Fístula Vesicovaginal/terapia , Adulto , África Central/epidemiologia , África Oriental/epidemiologia , Feminino , Morte Fetal , Humanos , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Resultado da Gravidez , Fístula Retovaginal/epidemiologia , Estudos Retrospectivos , Natimorto , Vácuo-Extração , Fístula Vesicovaginal/epidemiologia
13.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 17(3): 5-9, dic.2019. tab
Artigo em Espanhol | LILACS, BDNPAR | ID: biblio-1021561

RESUMO

La hemorragia postparto es una de las complicaciones obstétricas más temidas por los obstetras a nivel mundial, pudiendo causar la muerte de las puérperas. El objetivo de este estudio fue determinar las causas de las hemorragias y las patologías asociadas a estas en las pacientes atendidas en el Hospital Gineco-Obstétrico Enrique C. Sotomayor de Guayaquil, Ecuador en el periodo 2016­2018 y que estaban en su puerperio inmediato. Las mujeres atendidas en ese periodo en dicha institución fueron 528, de las cuales 160 presentaron hemorragias en el puerperio inmediato. Las hemorragias por desgarro del suelo pélvico representaron un 48,75% y se asociaron en un 35% a hematomas en las paredes del suelo, las causadas por retención de restos placentarios, constituyeron un 26,25% y el 20% presentó acretismo placentario y finalmente las ocasionadas por atonía uterina fueron de un 25%, correspondiendo un 25% a coagulopatías. Se concluyó que las hemorragias postparto por desgarro del suelo pélvico son la causa con mayor porcentaje en contraposición con otros estudios que indican que la atonía uterina es la causa más frecuente de hemorragias postparto inmediato(AU)


Postpartum hemorrhage is one of the obstetric complications most feared by obstetricians worldwide, and may cause the death of puerperal women. The objective of this study was to determine the causes of hemorrhages and the pathologies associated with these in the patients treated at the Enrique C. Sotomayor Obstetric Hospital of Guayaquil, Ecuador in the period 2016 - 2018 and that were in their immediate puerperium. The women who attended in that period were 528 women, 160 of them presented hemorrhages in the immediate puerperium. Hemorrhages by pelvic floor tearing represented 48.75% and 35% were associated to bruises in the floor walls, those caused by retention of placental remains constituted 26.25% and 20% presented accretism and finally those caused by uterine atony were 25% while 25% corresponded to coagulopathies. We concluded that the postpartum hemorrhages by tearing of the pelvic floor are the cause with the highest percentage; in contrast to other studies, which indicate that uterine aton is the most frequent cause of immediate postpartum hemorrhage(AU)


Assuntos
Humanos , Feminino , Gravidez , Período Pós-Parto , Hemorragia Pós-Parto/etiologia , Complicações do Trabalho de Parto/etiologia , Placenta Acreta , Transtornos da Coagulação Sanguínea/etiologia , Estudos Retrospectivos , Hematoma/etiologia
14.
Rev. colomb. obstet. ginecol ; 70(4): 253-265, oct.-dic. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1093048

RESUMO

RESUMEN Objetivo: revisar los conceptos que subyacen al trabajo de parto con feto en presentación pelviana, su semiología y las maniobras obstétricas que facilitan un resultado materno perinatal exitoso. Materiales y métodos: a partir de un caso hipotético que ambienta de manera práctica el tema, se crea un documento explicativo construido a partir de una revisión narrativa, en donde se examinan los preceptos relacionados con el diagnóstico, el mecanismo del parto en presentación pelviana y el manejo intraparto de la gestante, con énfasis en la adecuada ejecución de las maniobras que facilitan la extracción fetal. Resultados: el parto en presentación pelviana debe ser atendido por vía vaginal cuando se encuentra en periodo expulsivo con encajamiento cumplido. Para su diagnóstico y atención es esencial hacer una adecuada identificación de la presentación, así como conocer su fisiología, la indicación y adecuada ejecución de las maniobras obstétricas que facilitan un parto sin complicaciones. Conclusiones: el mecanismo del parto en presentación pelviana es complejo y requiere, cuando no hay otra alternativa para la atención, que tanto el obstetra como el médico general conozcan su fisiología y las múltiples maniobras obstétricas que facilitan obtener buen resultado materno perinatal.


ABSTRACT Objective: To review the concepts underlying breech presentation delivery as well as the semiology and the obstetric maneuvers contributing to a successful perinatal maternal outcome. Materials and methods: Based on a hypothetical scenario to set the stage for a practical approach to the topic, an explanatory paper built on a narrative review is created in order to examine the principles related to diagnosis, mechanism of delivery and maternal care, emphasizing maneuvers to ease fetal extraction. Results: Breech presentation delivery must be managed through the vaginal canal when already in the expulsion phase with fetal engagement. For diagnosis and care, it is essential to know the unique semiology and physiology of this condition as well as the obstetric maneuvers to facilitate an uncomplicated delivery. Conclusions: The mechanism of childbirth in breech presentation is complex and requires knowledge of its physiology and multiple obstetric maneuvers on the part of the obstetrician as well as the general practitioner, in order to ensure adequate care when there is no other option.


Assuntos
Humanos , Gravidez , Recém-Nascido , Complicações do Trabalho de Parto , Apresentação Pélvica , Distocia , Educação Médica Continuada
16.
An. pediatr. (2003. Ed. impr.) ; 91(6): 378-385, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186785

RESUMO

Introducción: El objetivo fue comparar la morbimortalidad neonatal de los partos vaginales por ventosa con los restantes partos vaginales e identificar los factores de riesgo. Material y métodos: Realizamos un estudio caso-control, retrospectivo, en un hospital con servicios de neonatología y cuidados intensivos neonatales, entre 2012 y 2016, con inclusión de 1.802 partos vaginales con ventosa, 1.802 partos eutócicos y 909 partos con fórceps. Se consideraron complicaciones menores (traumatismo de tejidos blandos, cefalohematoma, ictericia, fototerapia doble, lesión transitoria del plexo braquial) y mayores (encefalopatía hipóxico-isquémica, hemorragia intracraneal y subgaleal, convulsión, fractura craneal, lesión permanente del plexo braquial), ingreso en la Unidad de Cuidados Intensivos Neonatales y fallecimiento. Resultados: El riesgo de traumatismo de los tejidos blandos (ORa 2,4; p < 0,001), cefalohematoma (ORa 5,5; p < 0,001), ictericia (ORa 4,4; p < 0,001), fototerapia doble (ORa 2,1; p < 0,001) y lesión transitoria del plexo braquial (ORa 2,1; p = 0,006) fue mayor en los partos con ventosa en comparación con los eutócicos. El ingreso en la Unidad de Cuidados Intensivos Neonatales también fue mayor en los partos con ventosa que en los eutócicos (OR 1,9; p = 0,001). En comparación con los partos con fórceps, también se ha comprobado un mayor riesgo de traumatismo de los tejidos blandos (OR 2,1; p = 0,004), cefalohematoma (OR 2,2; p = 0,046) e ictericia (OR 1,4; p = 0,012) en los partos con ventosa. Los partos con ventosa presentaron mayor incidencia de complicaciones mayores que los restantes partos vaginales, pero la diferencia no fue significativa. Las 2 muertes ocurrieron en partos con ventosa (1,1 por 1.000). Conclusión: Las tasas de complicaciones neonatales menores fueron más altas en el parto con ventosa. Aunque las complicaciones mayores y la muerte también fueron más frecuentes, fueron poco comunes y no mostraron diferencias significativas. El parto con ventosa es una técnica con indicación obstétrica, pero que debe alertar sobre la necesidad de vigilancia de posibles complicaciones neonatales


Introduction: The purpose of this study was to assess the neonatal morbidity and mortality associated with vacuum-assisted vaginal deliveries compared to all other vaginal deliveries, and to identify the associated risk factors. Material and methods: We conducted a retrospective case-control study in a level iii maternity hospital between 2012 and 2016, including 1,802 vacuum-assisted vaginal deliveries and 2 control groups: 1802 spontaneous deliveries and 909 forceps-assisted deliveries. We considered minor complications (soft tissue trauma, cephalohaematoma, jaundice, intensive phototherapy, transient brachial plexus injury) and major complications (hypoxic-ischaemic encephalopathy, intracranial and subgaleal haemorrhage, seizures, cranial fracture, permanent brachial plexus injury), admission to the neonatal intensive care unit and death. Results: The risk of soft tissue trauma (aOR, 2.4; P < .001), cephalohaematoma (aOR, 5.5; P < .001), jaundice (aOR, 4.4; P < .001), intensive phototherapy (aOR, 2.1; P < .001) and transient brachial plexus injury (aOR; 2.1, P = .006) was higher in vacuum deliveries compared to spontaneous deliveries. Admission to the neonatal intensive care unit was also higher in vacuum deliveries compared to spontaneous deliveries (OR, 1.9; P = .001). When we compared vacuum with forceps deliveries, we found a higher risk of soft tissue trauma (OR, 2.1; P=.004), cephalohaematoma (OR, 2.2, P = .046) and jaundice (OR, 1.4; P = .012). Major complications were more frequent in the vacuum group comparing with the control groups, but the difference was not significant. The 2deaths occurred in vacuum deliveries (1.1 per 1000). Conclusion: The proportion of minor neonatal complications was higher in the vacuum-assisted delivery group. Although major complications and death were also more frequent, they were uncommon, with no significant differences compared to the other groups. There are obstetrical indications for vacuum delivery, but it should alert to the need to watch for potential neonatal complications


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Complicações do Trabalho de Parto/epidemiologia , Vácuo-Extração/tendências , Mortalidade Infantil , Vácuo-Extração/efeitos adversos , Estudos de Casos e Controles , Fatores de Risco , Indicadores de Morbimortalidade
17.
PLoS One ; 14(12): e0226891, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31860643

RESUMO

BACKGROUND: Birth asphyxia is a leading cause of infant morbidity and mortality in developing nations, such as Ethiopia. Though Ethiopia has made considerable achievement in the reduction of under-five mortality rate, the neonatal mortality burden has not experienced the same reduction, which may be attributed to birth asphyxia. Thus, this study attempts to assess the prevalence and associated factors of birth asphyxia among newborns in public hospitals in the northeastern Amhara region, Ethiopia. METHODS: An institution-based cross-sectional study was conducted on 357 births from 1st April to 2nd May 2018. The sample size was proportionally allocated to randomly selected three public hospitals namely, Dessie referral hospital, Debre Berhan referral hospital, and Woldia general hospital. The allocation was made by taking the average number of deliveries given in each hospital six months before the data collection period. Using the delivery registration of hospitals a systematic random sampling technique was used to get all study participants. The diagnosis of birth asphyxia was confirmed based on the physician's diagnosis of an APGAR score < 7 in the 1st and 5th minutes of birth. A pretested and structured questionnaire was used to collect data. Variables with p-values < 0.25 in the bivariable analysis were entered into a multivariable logistic regression analysis. A statistical significant level was declared at a p-value of <0.05. RESULTS: The prevalence of birth asphyxia was found to occur 22.6% of the time [95% CI 19.2% - 26.4%] in the first minute of birth. In the multivariable logistic regression being primipara [AOR = 3.77: 95% CI 1.86, 7.65], presented with complicated labor [AOR = 3.45: 95% CI 1.58, 7.49], premature rupture of membrane [AOR = 3.85: 95% CI 1.76, 8.44) and having blood-stained amniotic fluid at birth [AOR = 5.02: 95% CI 1.69, 14.87] were the independent predictors of birth asphyxia. CONCLUSION: The study revealed that birth asphyxia is a common newborn complication in the Amhara region. Integrated mitigation measure to reduce neonatal mortality in the Amahar region should give due attention to primipara women and for these high-risk pregnancies in order for the region to achieve national and global commitment to have sustainable change in women and neonatal health.


Assuntos
Asfixia Neonatal/epidemiologia , Hospitais Públicos , Parto , Adulto , Líquido Amniótico , Asfixia Neonatal/mortalidade , Estudos Transversais , Países em Desenvolvimento , Etiópia/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais , Humanos , Recém-Nascido , Modelos Logísticos , Complicações do Trabalho de Parto , Paridade , Gravidez , Prevalência , Fatores de Risco , Adulto Jovem
18.
BMC Pregnancy Childbirth ; 19(1): 499, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842788

RESUMO

BACKGROUND: The technique used in the repair of a perineal injury resulting from childbirth could avoid discomfort and morbidity during the postpartum period. Recent studies show inconsistent results and support the need for new research with the inclusion of new health parameters not yet studied. Therefore, this study aims to evaluate if the suture technique (continuous or interrupted) has an effect on pain and other postpartum problems, incidence of incontinence (urinary and/or fecal), and the restart of sexual relations. METHODS: A single-blind randomized clinical trial was conducted in five hospitals in south-east Spain. The participants were primiparous women who had experienced a perineal injury during delivery (second-degree tear or episiotomy). Data was collected on sociodemographic variables, variables associated with pregnancy, labor and delivery, and the postpartum period, and outcomes during the 3 months after delivery: pain, incontinence, and restart of sexual relations. Odds ratios (OR) were calculated by binary logistic regression to assess the influence of the suture type on binary outcomes and t-test used for comparing continuous outcomes. Multivariate analyses (using logistic regression -adjusted (aOR)- and analysis of covariance) were carried out to adjust for unbalanced variables after randomization. RESULTS: A total of 70 women were included in the intervention group (continuous suture) and 64 in the reference group (interrupted sutures). A negative association was observed (aOR = 0.39; 95% CI = 0.18-0.86) between a continuous suture and the need for analgesia at 24 h postpartum. Pain experienced by the women at 24 h postpartum was assessed as 4.4 ± 0.3 compared with a score of 3.4 ± 0.3 in the group with continuous sutures (p = 0.011). At 15 days postpartum, women in the intervention group experienced less pain (aOR = 0.38; 95% CI = 0.18-0.80) (p = 0.019). Urinary sphincter incontinence was also evaluated at 15 days, with 4.3% (n = 3) of the women in the intervention group presenting with urinary incontinence compared with 18.8% (n = 12) in the control group (aOR = 0.11; 95% CI = 0.03-0.47) (P = 0.003). CONCLUSIONS: The women who had a continuous suture repair showed lower levels of pain from delivery to 3 months after delivery and had a lower incidence of urinary incontinence at 15 days postpartum. TRIAL REGISTRATION: ClinicalTrials.gov NCT03825211 posted January 31, 2019 (retrospectively registered).


Assuntos
Lacerações/cirurgia , Complicações do Trabalho de Parto/cirurgia , Períneo/lesões , Complicações Pós-Operatórias/etiologia , Técnicas de Sutura/efeitos adversos , Adulto , Parto Obstétrico/efeitos adversos , Episiotomia/efeitos adversos , Feminino , Humanos , Lacerações/etiologia , Períneo/cirurgia , Período Pós-Parto , Gravidez , Método Simples-Cego , Espanha , Resultado do Tratamento , Adulto Jovem
19.
BMC Pregnancy Childbirth ; 19(1): 498, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842795

RESUMO

BACKGROUND: The trial of labor after cesarean section (TOLAC) is a relatively new technique in mainland of China, and epidural analgesia is one of the risk factors for uterine rupture. This study aimed to evaluate the effect of epidural analgesia on primary labor outcome [success rate of vaginal birth after cesarean (VBAC)], parturient complications and neonatal outcomes after TOLAC in Chinese multiparas based on a strictly uniform TOLAC indication, management and epidural protocol. METHODS: A total of 423 multiparas undergoing TOLAC were enrolled in this study from January 2017 to February 2018. Multiparas were divided into two groups according to whether they received epidural analgesia (study group, N = 263) or not (control group, N = 160) during labor. Maternal delivery outcomes and neonatal characteristics were recorded and evaluated using univariate analysis, multivariable logistic regression and propensity score matching (PSM). RESULTS: The success rate of VBAC was remarkably higher (85.55% vs. 69.38%, p < 0.01) in study group. Epidural analgesia significantly shortened initiating lactation period and declined Visual Analogue Score (VAS). It also showed more superiority in neonatal umbilical arterial blood pH value. After matching by PSM, multivariable logistic regression revealed that the correction of confounding factors including epidural analgesia, cervical Bishop score at admission and spontaneous onset of labor were still shown as promotion probability in study group (OR = 4.480, 1.360, and 10.188, respectively; 95%CI = 2.025-10.660, 1.113-1.673, and 2.875-48.418, respectively; p < 0.001, p = 0.003, and p < 0.001, respectively). CONCLUSIONS: Epidural analgesia could reduce labor pain, and no increased risk of postpartum bleeding or uterine rupture, as well as adverse effects in newborns were observed. The labor duration of multiparas was increased, but within acceptable range. In summary, epidural analgesia may be safe for both mother and neonate in the three studied hospitals. TRIAL REGISTRATION: Chineses Clinical Trial Register, ChiCTR-ONC-17010654. Registered February 16th, 2017.


Assuntos
Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Dor do Parto/tratamento farmacológico , Complicações do Trabalho de Parto/epidemiologia , Prova de Trabalho de Parto , Adulto , China/epidemiologia , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Complicações do Trabalho de Parto/induzido quimicamente , Hemorragia Pós-Parto/induzido quimicamente , Hemorragia Pós-Parto/epidemiologia , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Fatores de Risco , Ruptura Uterina/induzido quimicamente , Ruptura Uterina/epidemiologia
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