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1.
Medicine (Baltimore) ; 99(1): e16791, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895764

RESUMO

The present study aimed to investigate the feasibility of vaginal delivery combined with vaginal tightening surgery and perineal body repair.From January 2017 to April 2017, 5 cases underwent vaginal delivery combined with vaginal tightening surgery and perineal body repair. We retrospectively analyzed the clinical data.The incisions of 5 cases were all primary healing; vulva form was improved, and there were no postoperative hematoma, infection or vaginal mucosa prolapse. Sexual function was improved to different degrees. The pelvic muscle force test showed that both the type I and type II myofiber scores were increased.It is feasible to perform vaginal delivery combined with vaginal tightening surgery and perineal body repair, which is a safe and effective method for improving sex life and pelvic floor function.


Assuntos
Parto Obstétrico/efeitos adversos , Vagina/cirurgia , Adulto , Feminino , Humanos , Lacerações/etiologia , Lacerações/cirurgia , Diafragma da Pelve/fisiopatologia , Diafragma da Pelve/cirurgia , Períneo/lesões , Períneo/cirurgia , Gravidez , Qualidade de Vida , Vagina/fisiopatologia , Vulva/cirurgia
2.
BJOG ; 127(3): 397-403, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31749273

RESUMO

OBJECTIVE: To determine whether restrictive or routine episiotomy in term pregnant Southeast Asian women results in fewer complications. DESIGN: A multicentre randomised controlled trial. SETTING: Two tertiary and two general hospitals in Thailand. POPULATION: 3006 singleton pregnant women 18 years or older, ≥37 weeks of gestation, cephalic presentation and planned vaginal delivery. METHODS: This randomised controlled trial compared routine versus restrictive episiotomies in Thai women giving birth vaginally. Participants were singleton, term pregnant women with cephalic presentation. Block randomisation was stratified by study site and parity. Risk ratios (RR) and 95% confidence intervals (CI) were calculated to indicate between-group differences. MAIN OUTCOME MEASURES: Primary outcome was severe perineal laceration. Secondary outcomes included vaginal laceration, cervical laceration, and pregnancy outcomes. RESULTS: 3006 women were randomly assigned to restrictive (1502) and routine (1504) episiotomy. There was no difference in severe perineal laceration between the groups (RR 0.72, 95% CI 0.46-1.12). Restrictive episiotomy resulted in more intact perineums in multiparous women (RR 3.09, 95% CI 2.10-4.56). Restrictive episiotomy increased the risk of vaginal laceration in primiparous (RR 1.96, 95% CI 1.62-2.37) and multiparous women (RR 2.21, 95% CI 1.77-2.75) but did not lead to more suturing. There were comparable risks of cervical laceration, postpartum haemorrhage, wound complication, birth asphyxia, and admission to neonatal intensive care unit. CONCLUSIONS: Restrictive episiotomy results in more intact perineum in multiparous women. Risks of maternal and neonatal outcomes were comparable between the two practices. These results strengthen the certainty of the existing Cochrane review findings in supporting restrictive episiotomy. TWEETABLE ABSTRACT: Restrictive episiotomy results in more intact perineums after vaginal birth in multiparous Southeast Asian women.


Assuntos
Parto Obstétrico , Episiotomia , Complicações Intraoperatórias , Lacerações , Períneo/lesões , Adulto , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Episiotomia/efeitos adversos , Episiotomia/métodos , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/prevenção & controle , Apresentação no Trabalho de Parto , Lacerações/diagnóstico , Lacerações/etiologia , Lacerações/prevenção & controle , Paridade , Gravidez , Resultado da Gravidez/epidemiologia , Risco Ajustado/métodos , Nascimento a Termo , Tailândia
3.
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
5.
J Glob Health ; 9(2): 020432, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31788230

RESUMO

Background: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, but it mainly affects women from low- and middle-income countries. Despite being a treatable condition, the high number of maternal deaths resulting from PPH is outstanding for at least 25 years. Late diagnosis and difficulties in identifying women who will develop severe postpartum bleeding can, in part, explain the high incidence of PPH. Over the past few years, researchers have focused on identifying a simple, accessible and low-cost diagnostic tool that could be applied to avoid maternal deaths. In particular, it has been suggested that vital signs and shock index (SI) could be useful. The objective of this study was to evaluate whether vital signs are correlated with the percentage of body blood volume (BBVp) lost after vaginal delivery. Methods: A prospective cohort study was performed at the Women's Hospital of UNICAMP, Brazil. The inclusion criteria were women delivering vaginally who did not suffer from hypertension, hyper- or hypothyroidism, cardiac disease, infections or coagulopathy. Blood loss was measured over 24 hours using a calibrated drape and by weighing compresses, gauzes and pads. Vital signs were measured up to 24 hours after delivery. We evaluated the BBVp lost, and generated a Receiver operating characteristics (ROC) curve with area under the curve (AUC) analysis to determine the cut-off values for vital signs to determine the likelihood of postpartum bleeding above the 90th percentile within 24 hours of delivery. Results: A total of 270 women were included. The mean blood loss within 24 hours of vaginal delivery was 570.66 ± 360.04 mL. In the first 40 minutes, 73% of the total blood loss over the 24-hour period had occurred, and within 2 hours, 91% of women had bled 90% of the total blood loss. Changes in SI and heart rate (HR) were statistically significant in predicting postpartum bleeding (P ≤ 0.05). Higher values for likelihood ratio (LR) to identify BBVp loss above the 90th percentile within 2 hours were a SI above 1.04 at 41-60 minutes after birth (LR = +11.84) and a HR above 105.2 bpm at 21-40 minutes after birth (LR = +4.96). Both measures showed high specificity but low sensitivity. Conclusion: Values of SI and HR are statistically significant in predicting postpartum bleeding with high specificity but low sensitivity. The cut-off points were 1.04 for SI and 105 bpm for HR.


Assuntos
Perda Sanguínea Cirúrgica/fisiopatologia , Parto Obstétrico/efeitos adversos , Frequência Cardíaca/fisiologia , Hemorragia Pós-Parto/epidemiologia , Índices de Gravidade do Trauma , Adulto , Volume Sanguíneo , Brasil/epidemiologia , Feminino , Humanos , Incidência , Mortalidade Materna , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Índice de Gravidade de Doença , Sinais Vitais
6.
Zhonghua Fu Chan Ke Za Zhi ; 54(11): 751-755, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31752458

RESUMO

Objective: To study and analyze the incidence of pelvic organ prolapse (POP) in women who underwent cesarean section. Methods: A cross-sectional study was conducted. The clinical data of the women who underwent regular antepartum examination and cesarean delivery in Peking University People's Hospital from January 2019 to June 2019 were collected, including the cervical dilatation. The incidence of POP was analyzed. Results: (1) A total of 345 women met the inclusion criteria, with cervical dilatation of 0-10 cm before cesarean section, the cervix was not dilatated in 58.6% (202/345) of the women, and the cervix was fully dilatated in 2.9% (10/345) of the women. There were 109 cases of POP stage Ⅰ or above, 13 cases of POP stage Ⅱ, and no stage Ⅲ or Ⅳ. The incidence of POP was 31.6% (109/345). (2) Statistical analysis showed that the cervical dilatation of the POP group was significantly larger than that of the non-prolapse group (median: 1.0 vs 0 cm;Z=-2.227, P=0.026). The risk of POP of vaginal trial-birth transfer to cesarean section was higher than that of elective cesarean section [42.4% (36/85) vs 28.1% (73/260), P=0.014]. However, the further analysis of Spearman correlation between cervical dilatation, elective cesarean section and POP, as well as the receiver operating characteristic curve showed that the correlation and prediction value were poor. Conclusion: Elective cesarean section has a certain protective effect on postpartum prolapse, but the protective effect of vaginal trial-birth transfer to cesarean section on pelvic floor is weakened.


Assuntos
Cesárea/efeitos adversos , Parto Obstétrico/efeitos adversos , Prolapso de Órgão Pélvico/etiologia , Período Pós-Parto , Estudos Transversais , Feminino , Humanos , Prolapso de Órgão Pélvico/epidemiologia , Gravidez
7.
BJOG ; 126(13): 1577-1586, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31483935

RESUMO

OBJECTIVE: To estimate incidence, trends over time, and risk factors for massive blood transfusions in obstetric patients. A secondary aim was to evaluate transfusion ratios in relation to massive transfusion. DESIGN: Population-based cohort. SETTING: Five hospitals, in the Stockholm County, Sweden, from 1990 to 2011. POPULATION: All women that gave birth in Stockholm county, Sweden, and who received blood transfusions postpartum between 1990 and 2011. METHODS: Data on pregnancies and deliveries from the Swedish National Medical Birth Registry was cross-linked to the Stockholm transfusion database. Massive blood transfusion was defined as the transfusion of ≥10 units of red blood cells from partus through the next day. MAIN OUTCOME MEASURES: Main primary outcome was massive blood transfusion postpartum. RESULTS: Our cohort comprised 517 874 deliveries. Massive blood transfusion occurred in 277 women, for an incidence of 5.3 per 10 000 deliveries, and increased by 30% (P < 0.001) between the first and the second half of the study period. Major risk factors apparent before delivery were abnormal placentation (odds ratio [OR] 41; 95% CI 29.3-58.1), pre-eclampsia/placental abruption (OR 4; 95% CI 2.8-5.6), and previous caesarean delivery (OR 4; 95% CI 3.1-6.0). Risk factors at time of delivery were uterine rupture, atonic uterus, and caesarean delivery (OR 38, 17, and 3, respectively). CONCLUSION: We found an increasing trend in the postpartum rate of massive transfusion. Women with abnormal placentation were found to have the highest increased risk. Improved antenatal awareness of these women at risk might improve management and reduce the rate of massive transfusion. TWEETABLE ABSTRACT: Risk of massive blood transfusion in obstetric patients increases with placental complications and prior caesarean section.


Assuntos
Transfusão de Sangue , Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Hemorragia Pós-Parto/epidemiologia , Descolamento Prematuro da Placenta/epidemiologia , Adulto , Transfusão de Sangue/estatística & dados numéricos , Cesárea/efeitos adversos , Parto Obstétrico/efeitos adversos , Feminino , Inquéritos Epidemiológicos , Humanos , Histerectomia/estatística & dados numéricos , Incidência , Placenta Acreta/epidemiologia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/terapia , Gravidez , Fatores de Risco , Suécia/epidemiologia , Inércia Uterina/epidemiologia , Inércia Uterina/terapia
8.
BMC Res Notes ; 12(1): 482, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382987

RESUMO

OBJECTIVE: The study aimed to determine proportion and risk factors for maternal complication related to forceps and vacuum delivery among mother who gave birth at Felege Hiwot Comprehensive Specialized Hospital (FHCSH). RESULTS: Records of 406 mothers managed with instrumental vaginal delivery were reviewed and 97% of the reviewed card had complete documentation. The proportion of maternal complications related to instrumental delivery was 12.1%. A major complication of forceps assisted delivery was 2nd-degree perineal tear (7.4%), 3rd-degree perineal tear (1.5%), cervical tear (1.5%) and episiotomy extension (1%). However, the complication of vacuum-assisted vaginal delivery was only cervical tear (0.5%) and episiotomy extension (0.5%). Episiotomy during instrumental delivery reduce maternal complication by 86% [AOR = 0.14, 95% CI 0.07-0.3]. Forceps assisted vaginal delivery had 3.4 times more risk for maternal complication compared to vacuum-assisted vaginal delivery [AOR = 3.4, 95% CI 1.08-10.67] and the same is true for primiparity that primipara women who gave birth by the help of instrument had 3.5 times more risk for maternal complication compared to a multipara women [AOR = 3.5, 95% CI 1.26-9.98].


Assuntos
Parto Obstétrico/métodos , Hospitais Especializados , Complicações do Trabalho de Parto/diagnóstico , Parto , Vácuo-Extração/métodos , Adulto , Estudos Transversais , Parto Obstétrico/efeitos adversos , Etiópia/epidemiologia , Feminino , Humanos , Recém-Nascido , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Vácuo-Extração/efeitos adversos , Adulto Jovem
9.
J Dermatol ; 46(10): 849-852, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31418467

RESUMO

Infantile hemangioma is one of the most common tumors in infancy. Delivery may be a clue for the trigger of infantile hemangioma formation in the head and face areas. In this study, we tried to plot localization of infantile hemangioma as well as capillary malformation on the head and face, and compared them to identify their characteristics and risk factors. The distribution of 104 lesions in 100 patients with infantile hemangioma was as follows: 32 lesions on the head, 12 on the forehead, 57 on the cheek and three in the jaw area. We could not find a statistically significant correlation of the distribution with three clinical subtypes (superficial, deep and mixed), sex or size of the lesions. However, the lesions in the jaw or chin areas were significantly less frequent than other areas (P = 0.0008 or 0.03, respectively). This tendency was not found in 40 patients with capillary malformation. Mechanical stress to jaw or chin areas may be less than other areas in normal cephalic delivery. Considering the emergence after birth and age-dependent involution of infantile hemangioma, we speculate that physiological events including perinatal hypoxia or mechanical stress during delivery as the trigger of hemangioma formation. Taken together, our results may reveal the contribution of mechanical stress to the trigger of infantile hemangioma, not capillary malformation, and may facilitate clinical differentiation between the two diseases by their localization. Further studies with an increased number of patients will be necessary to validate the finding.


Assuntos
Capilares/anormalidades , Hemangioma/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Análise Espacial , Malformações Vasculares/diagnóstico por imagem , Capilares/diagnóstico por imagem , Parto Obstétrico/efeitos adversos , Face , Feminino , Hipóxia Fetal/complicações , Cabeça , Hemangioma/etiologia , Humanos , Lactente , Japão , Masculino , Fotografação , Pele/diagnóstico por imagem , Neoplasias Cutâneas/etiologia , Distribuições Estatísticas , Estresse Mecânico
10.
Artigo em Inglês | MEDLINE | ID: mdl-31426304

RESUMO

Perinatal distress and depression can have significant impacts on both the mother and baby. The present study investigated psychosocial and obstetric factors associated with perinatal distress and depressive symptoms among culturally and linguistically diverse (CALD) Australian women in Sydney, New South Wales. The study used retrospectively linked maternal and child health data from two Local Health Districts in Australia (N = 25,407). Perinatal distress was measured using the Edinburgh Postnatal Depression Scale (EPDS, scores of 10-12) and depressive symptoms, with EPDS scores of 13 or more. Multivariate multinomial logistic regression models were used to investigate the association between psychosocial and obstetric factors with perinatal distress and depressive symptoms. The prevalence of perinatal distress and depressive symptoms among CALD Australian women was 10.1% for antenatal distress; 7.3% for antenatal depressive symptoms; 6.2% for postnatal distress and 3.7% for postnatal depressive symptoms. Antenatal distress and depressive symptoms were associated with a lack of partner support, intimate partner violence, maternal history of childhood abuse and being known to child protection services. Antenatal distress and depressive symptoms were strongly associated with postnatal distress and depressive symptoms. Higher socioeconomic status had a protective effect on antenatal and postnatal depressive symptoms. Our study suggests that current perinatal mental health screening and referral for clinical assessment is essential, and also supports a re-examination of perinatal mental health policy to ensure access to culturally responsive mental health care that meets patients' needs.


Assuntos
Depressão Pós-Parto/epidemiologia , Violência por Parceiro Íntimo/psicologia , Adulto , Austrália/epidemiologia , Grupos de Populações Continentais , Parto Obstétrico/efeitos adversos , Depressão , Depressão Pós-Parto/etiologia , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Violência por Parceiro Íntimo/estatística & dados numéricos , Programas de Rastreamento , Mães/psicologia , New South Wales/epidemiologia , Assistência Perinatal , Gravidez , Complicações na Gravidez/epidemiologia , Prevalência , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Fatores de Risco , Parceiros Sexuais , Adulto Jovem
11.
Biomed Res Int ; 2019: 9180314, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467919

RESUMO

Background: The first 28 days of life (the neonatal period) constitute the most vulnerable time for a child's survival. Overall 2.7 million neonatal deaths were stated by the 2015 global report of neonatal mortality and they account for 45% of under-five deaths. Sub-Saharan Africa remains the region with the highest risk of death in the first month of life and is among the regions showing the least progress in reducing neonatal mortality in the world. Ethiopia, as part of sub-Saharan Africa, also shares the greatest risk of neonatal death. A recent report in Ethiopia showed that neonatal mortality was 29 deaths per 1,000 live births. Therefore, the signs that suggest the onset of severe illness which leads to death and their contributing factors should be identified. The aim of the study was to assess knowledge about neonatal danger signs and associated factors among mothers attending immunization clinic at Arba Minch General Hospital. Method: Institution-based cross-sectional study design was employed from Feb to April 2018. Systematic sampling technique was used to select a total of 345 mother-child pairs. A pretested, structured, and interviewer-administered questionnaire was used to collect data. Data were entered using Epidata version 3.1 and analyzed using SPSS version 20. Bivariate and multivariable analysis were carried out using binary logistic regression to check and test the association between dependent and explanatory variables. Model fitness was checked by Hosmer-Lemeshow goodness of fit test. Result: Nearly two-fifths (40.9%) of all mothers had good knowledge about neonatal danger signs (95% CI; 35.7, 46.4). Close to thirty-three percent of mothers identified child's body hotness (fever) as a neonatal danger sign. Maternal educational status (AOR: 5.64; 95% CI: 1.68, 18.95) and attendance of postnatal care (AOR: 2.64; 95% CI: 1.36, 5.15) were significantly associated with maternal knowledge about neonatal danger signs in multivariable analysis. Conclusion: Even though considerable improvement has been achieved over the past decades as a result of expanded coverage of maternal and childcare services, still there are a significant number of mothers who have limited knowledge about neonatal danger signs. Therefore, interventional strategies that stress strengthening maternal education and ANC follow-up should be extended.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Imunização , Adulto , Parto Obstétrico/efeitos adversos , Etiópia/epidemiologia , Feminino , Hospitais Gerais , Humanos , Mães , Morte Perinatal/prevenção & controle , Gravidez , Inquéritos e Questionários
12.
Zhonghua Fu Chan Ke Za Zhi ; 54(8): 512-515, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31461806

RESUMO

Objective: To investigate the ratio of transfer cesarean section after trial of labor and maternal-fetal outcomes based on Robson classifications. Methods: The delivery data by cesarean section in Third Affiliated Hospital of Guangzhou Medical University from January 1st, 2009 to December 31st, 2015 (gestational age ≥28 weeks and newborn birth weight >1 000 g) were retrospectively collected. The ratio of transfer cesarean section after trial of labor and maternal-fetal adverse outcomes were analyzed by weighted adverse outcome score in different Robson classifications. Results: (1) The highest ratio of transfer cesarean section after trial of labor was classification 9 (all abnormal lies, including previous cesarean section and breech were excluded) reached 47.31% (431/911) , followed by classification 2 (nulliparous women with a single cephalic pregnancy, ≥37 weeks gestation who had labour induced) accounted for 44.90%(409/911). (2)The tops of weighted adverse outcome score of transfer cesarean section after trial of labor were classification 10 (single cephalic pregnancy at <37 weeks gestation, including women with previous cesarean delivery) 24.55, classification 5 (single cephalic pregnancy multiparous women, with at least one previous cesarean delivery, ≥37weeks gestation) 3.64. Conclusion: Carefully evaluating the delivery mode and emphasizing the intrapartum management in nulliparous women with a single cephalic pregnancy, at ≥37 weeks gestation who had labour induced and trial of labor after cesarean section is essential to reduce the risk of adverse outcomes in transfer cesarean section after trial of labor.


Assuntos
Cesárea/classificação , Cesárea/estatística & dados numéricos , Parto Obstétrico/classificação , Parto Obstétrico/estatística & dados numéricos , Prova de Trabalho de Parto , Adulto , Cesárea/efeitos adversos , Parto Obstétrico/efeitos adversos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Apresentação no Trabalho de Parto , Parto , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
13.
Medicine (Baltimore) ; 98(35): e16907, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464923

RESUMO

This study was to investigate the incidence and the risk factors of postpartum stress urinary incontinence (SUI), and the effect of comprehensive care and rehabilitation program (CCRP) on preventing postpartum SUI.In stage I, 479 puerperae were recruited within 1 week postpartum, then the postpartum SUI incidence at 8th week and its risk factors were investigated. In stage II, 240 vaginal delivery puerperae were enrolled within 1 week postpartum and randomly assigned to CCRP group or control group as 1:1 ratio. The postpartum SUI incidence and pelvic floor muscle function indexes were evaluated at 8th week.In stage I, the postpartum SUI incidence was 25.7%, and SUI puerperae presented with higher body mass index (BMI), vaginal delivery rate, newborn weight, and larger newborn head diameter compared with non-SUI puerperae. Besides, the vaginal delivery, the elevated age and BMI were independent risk factors for postpartum SUI. In stage II, the postpartum SUI incidence in CCRP group was decreased compared with control group, and the vaginal resting pressure, vaginal squeezing pressure, and vaginal contraction duration were increased in CCRP group compared to control group at 8th week postpartum.The incidence of postpartum SUI is 25.7%, and the vaginal delivery, increased age, and BMI are independent risk factors for postpartum SUI. More importantly, CCRP strengthens pelvic floor muscle functions and decreases postpartum SUI incidence in puerperae.


Assuntos
Assistência Integral à Saúde/métodos , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/reabilitação , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/reabilitação , Adulto , Índice de Massa Corporal , Cesárea/efeitos adversos , Parto Obstétrico/efeitos adversos , Feminino , Educação em Saúde/métodos , Humanos , Incidência , Idade Materna , Diafragma da Pelve/fisiopatologia , Período Pós-Parto , Gravidez , Distribuição Aleatória , Incontinência Urinária por Estresse/etiologia
14.
Taiwan J Obstet Gynecol ; 58(4): 492-496, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307739

RESUMO

OBJECTIVES: Antenatal classes are a common method of preparation for birth with proven efficiency in improving perinatal outcomes. Yet, their impact on fear perception during labour has not been identified. The aim of the study was to analyse whether preparation for labour by means of antenatal classes attendance could be associated with decrease in level of experienced fear and pain during birth. MATERIALS AND METHODS: It was a cross-sectional study of 147 women who had given vaginal births. Data was collected from mothers between 24 and 72 h postpartum. Patients answered self-reported questionnaires concerning subjective perception of birth including Delivery Fear Scale (DFS) and Numeric Rating Scale (NRS) for fear and pain assessment. The study group was divided into subgroups depending on parity and antenatal classes attendance. RESULTS: Patients in the primiparas subgroup who attended antenatal classes scored lower in the DFS (48.7 ± 23.5 vs. 60.2 ± 16.5, p < .03). There was no difference in the DFS score in the multiparas subgroup (p < .90). No significant differences in the NRS score depending on antenatal classes attendance in any subgroup were observed. CONCLUSION: Participation in antenatal classes should be advised to every pregnant primiparous woman as this type of non-invasive preparation lowers level of fear experienced during childbirth.


Assuntos
Parto Obstétrico/efeitos adversos , Medição da Dor , Dor/etiologia , Dor/prevenção & controle , Cuidado Pré-Natal/métodos , Educação Pré-Natal/métodos , Adulto , Estudos Transversais , Parto Obstétrico/métodos , Feminino , Humanos , Satisfação do Paciente , Polônia , Cuidado Pós-Natal/métodos , Gravidez , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto Jovem
15.
BMC Pregnancy Childbirth ; 19(1): 225, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272413

RESUMO

BACKGROUND: Most women choose to have another vaginal delivery following one complicated by an obstetrical anal sphincter injury (OASIS). However, little is known about patient satisfaction or regret with this decision. Therefore, our objective was to assess decisional regret with subsequent route of delivery following one affected by an OASIS. METHODS: A survey study was conducted among women seen in a specialty postpartum perineal clinic at a tertiary teaching hospital following a vaginal delivery with an OASIS between March 2012 and December 2016 who also had a subsequent delivery during that time period. Women were mailed a 13-item questionnaire between June and October 2017 that addressed pelvic floor symptoms and regret with their decision regarding mode of subsequent delivery. Regret was assessed with a modified Decision Regret Scale. Bivariate analyses were used to compare women with no, mild, or moderate/severe regret. RESULTS: Among 115 eligible women, 50 completed the survey. The majority (82%, n = 41) had a subsequent vaginal delivery and 18% (n = 9) had a subsequent cesarean delivery. Over one-third (34.9%, n = 15) reported the counseling they received after the OASIS influenced their decision regarding route of subsequent delivery. Fifty-four percent (n = 27) had no regret regarding their decision about subsequent delivery route, while 18 (36%) had mild, and five (10%) had moderate/severe regret. Regret was associated with older age (none: 36.8 ± 3.6 vs mild: 37.3 ± 3.4 vs moderate/severe: 41.7 ± 3.8 years, p = .03) and prevalence of fecal incontinence after delivery with OASIS (none: 15% vs mild: 17% vs moderate/severe: 80%, p = .01). CONCLUSIONS: Most women with an OASIS and a subsequent pregnancy will choose a repeat vaginal delivery, and over half have no regret about this decision. Older age and fecal incontinence following the incident delivery with OASIS were associated with regret regarding subsequent delivery mode.


Assuntos
Canal Anal/lesões , Parto Obstétrico/efeitos adversos , Satisfação do Paciente/estatística & dados numéricos , Períneo/lesões , Adulto , Fatores Etários , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Emoções , Incontinência Fecal/etiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Gravidez , Estudos Retrospectivos
16.
Int J Evid Based Healthc ; 17 Suppl 1: S34-S37, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283578

RESUMO

Caesarean section is currently the most frequently performed intervention after episiotomy in obstetrics and one of the most common abdominal operations overall. Rates of caesarean section have been rising globally. Given the increasing rate worldwide it is therefore necessary and important to understand how caesarean section affects child development. Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioural disorder in children. ADHD is characterized by a combination of symptoms including inattention, impulsivity and hyperactivity. Caesarean section may affect psychological development through changes in microbiota or stress response, and birth by caesarean section can be associated with a small increased risk of ADHD. In the current literature, there is no systematic review or protocol of the systematic review answering the question of whether the mode of delivery has influence on the risk of ADHD development.The objective of this review is to synthesize the best available evidence regarding the epidemiological association between the mode of delivery (caesarean section versus vaginal delivery) as exposure and ADHD as the outcome.A three-step strategy will be utilized in this review, aiming to find both published and unpublished studies. The initial search will be conducted using the MEDLINE, CINAHL and EMBASE. The second search will involve 21 databases and sources. Following the Preferred Reporting Items for Systematic Review and Meta-analysis statement analysis of title, abstracts and full texts, critical appraisal and data extraction will be carried out on selected studies using standardized instruments developed by Joanna Briggs Institute. All steps will be performed by two independent reviewers. If possible, statistical meta-analysis using Joanna Briggs Institute within the System for the Unified Management, Assessment and Review of Information will be pooled. Statistical heterogeneity will be assessed.The results will be disseminated by publishing in a peer-reviewed journal. Ethical assessment is not needed - we will search/evaluate the existing sources of literature.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Parto Obstétrico/métodos , Criança , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Gravidez , Projetos de Pesquisa , Revisão Sistemática como Assunto
17.
Eur J Obstet Gynecol Reprod Biol ; 239: 35-38, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31163355

RESUMO

OBJECTIVES: Patients who sustain an Obstetric Anal Sphincter Injury (OASI) have the opportunity to select an elective caesarean section over a vaginal delivery in subsequent pregnancies. It remains unclear whether there are identifiable factors which predict expectant mothers' choices. The primary aim of our study was to explore this issue further in a consecutive group of patients who had suffered OASI. STUDY DESIGN: Data were retrospectively collected for patients attending a specialist OASIS clinic between July 2016 and February 2018. Information routinely collected in clinical practice was considered including mode of previous delivery, severity of OASI, combined with anal incontinence symptoms and endoanal ultrasound results. Logistic regression analysis was used to explore the relationship between these variables and the preferred mode of delivery. RESULTS: A total of 188 patients were identified of whom 153 had complete data for analysis. Approximately 30% (n = 45) of patients preferred to have a caesarean section in their subsequent pregnancy. Bivariate analysis revealed significant associations between choosing a caesarean section in subsequent pregnancy and individuals with major tears (p = 0.001), high anal incontinence scores (p = 0.001) and defects on endoanal ultrasound (p < 0.001). Logistic regression analysis showed statistically significant associations between Caucasian ethnicity (Odds ratio (OR) 12.6, 95% CI 2.4-69.9) and endoanal ultrasound results (OR 2.3, 95% CI 1.7-3.2) with preference for caesarean section. CONCLUSION: Our data suggests that emphasis is placed by patients on endoanal ultrasound results when making their decision about mode of delivery in a subsequent pregnancy, suggesting a useful application of this tool. Ethnicity is a strong predictor of choice of delivery after OASI and may be potentially useful in forecasting maternity unit services.


Assuntos
Canal Anal/lesões , Parto Obstétrico/efeitos adversos , Parto Obstétrico/psicologia , Preferência do Paciente/estatística & dados numéricos , Adulto , Canal Anal/diagnóstico por imagem , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Ultrassonografia
18.
Ceska Gynekol ; 84(2): 111-114, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31238680

RESUMO

OBJECTIVE: To compare diagnostic possibilities of endoanal (EAUS) and transperineal (TPUS) ultrasound during anal sphincter examination and patients preferences. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague. METHODS: Patients involved had EAUS and TPUS of anal sphincter. First group were patients scheduled for control check after vaginal delivery complicated with anal sphincter injury (post OASI) and adequate suture. Second (control) group contained new patients coming for urogynecological examination with some symptoms of anal incontinence. Refusal were noted and after completing both ultrasounds patients marked on visual analog scale (VAS) the level of dyscomfort and answered few simple questions about their preference of exam in future. RESULTS: This study contains twenty-nine patients (fifteen post OASI and fourteen in control group). Two patients (post OASI) refused EAUS and one patient from control group did not mark the level of dyscomfort. In post OASI group eleven patients (84.6%) considered EAUS as botherless or slighly bothering (VAS 3). The average dyscomfort for EAUS was 1.92 and for TPUS 1.08. Five patients marked EAUS more dyscomfortable as TPUS and this difference is significant (p < 0.05). In control group eleven patients (84.6%) marked EAUS as botherless or slightly bothering (VAS 3). There was no difference between post OASI and control group. We have not found by any exam residual anal sphincter defect in any patient post OASI. For this reason we could not decide about efectivity. In matter of future preference patients would prefer TPUS to EAUS in case of similar effectivity. However, in case of different effectivity patients would prefer the more effective. CONCLUSION: Our patients prefer less dyscomfortable TPUS. The pilot study did not display higher effectivity of EAUS in diagnostics of residual anal sphincter defect.


Assuntos
Canal Anal/diagnóstico por imagem , Canal Anal/lesões , Incontinência Fecal/diagnóstico por imagem , Incontinência Fecal/etiologia , Ultrassonografia/métodos , Adulto , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Projetos Piloto , Gravidez , Estudos Prospectivos
19.
J Forensic Leg Med ; 66: 44-49, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31220788

RESUMO

BACKGROUND: Today even low incidence of complications for mothers or neonates during pregnancy, delivery or postpartum is unacceptable to the public and can result in claims because of greater expectation from patients and an increase in media coverage. The present study was conducted to investigate the reasons for medical malpractice claims on maternal and neonatal impairment, which are achieved in Iranian Legal Medicine Organization councils. MATERIALS AND METHODS: The present cross-sectional and retrospective study used convenience sampling to collect data of total claims from 31 provinces archived in the supreme council of the ILMO in 2 years. In this article, the medical malpractice claims on maternal and neonatal impairment during pregnancy, labour, delivery and early postpartum were reported. The data were collected through a validated researcher-made checklist and were analyzed in SPSS 16. RESULTS: Among total of 299 cases of impairment, cerebral palsy (33.34%), Erb's palsy due to shoulder dystocia (24.24%) and Down Syndrome (24.24%) were the main confirmed causes of malpractice for neonatal impairment and Retained Surgical Mass (20.5%), Salpingectomy and/or Oophorectomy Related to EP (17.2%), Hysterectomy (17.2%) and Episiotomy Related complication (17.2%) were the main confirmed causes of malpractice for maternal impairment. CONCLUSION: Considering this fact that medical malpractice was confirmed in a large proportion of some preventable and important complications, therefore, results of this study can be used for developing educational programs for related healthcare providers to prevent those complications.


Assuntos
Parto Obstétrico/efeitos adversos , Imperícia/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Adulto , Neuropatias do Plexo Braquial/epidemiologia , Paralisia Cerebral/epidemiologia , Estudos Transversais , Síndrome de Down/epidemiologia , Distocia/epidemiologia , Feminino , Corpos Estranhos/epidemiologia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Recém-Nascido , Irã (Geográfico)/epidemiologia , Enfermeiras Obstétricas/estatística & dados numéricos , Obstetrícia , Gravidez , Estudos Retrospectivos , Amostragem
20.
BMC Pregnancy Childbirth ; 19(1): 180, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31117972

RESUMO

BACKGROUND: Worldwide, around 289,000 maternal mortalities occur each year from complications related to pregnancy and childbirth. In Ethiopia, the maternal mortality rate is among the highest in the world. This is mainly contributed by the three delays. Husbands' involvement in birth preparedness and complication readiness can significantly reduce these delays. Therefore, it is important to know what, currently, is the husbands view regarding knowledge of key danger sign and involvement about birth preparedness and complication readiness. The investigation of husband's involvement in birth preparedness and complication readiness was sounded throughout much of the developed world. However, despite the putative assumption that the problem exists in Ethiopia at large and Axum in particular, there is no article related to the problem as yet. For this reason, the study intended to assess husband's involvement in birth preparedness and complication readiness. METHOD: A community based cross-sectional study was conducted in Axum Town from September-June 2017. Data were collected from a randomly selected sample of 406 husbands using the lottery method and interviewer administered structured questionnaires. Data were entered into Epi info version 7 and analyzed using SPSS version 20. The statistical analysis was made at the 95% confidence level. The data were summarized and described using descriptive statistics. RESULT: Four hundred six husbands were participating in the study with a response rate of 98%. Out of total respondents 258(64.7%) were in the age range of '18 - 39' years and the mean age was 36.55 years. Three hundred forty-three (86%) of the respondents has attended primary education or above and 187(46.9%) fulfilled five or more variables of parameter for husband's involvement in birth preparedness and complication readiness and leveled as having good involvement. One hundred sixteen (29.1%) respondents had gotten health service problems that prohibited from going to the health facility. CONCLUSION: Based on the findings, the overall involvements by husbands in birth preparedness and complication readiness were low. Most of the respondents have low knowledge. Knowledge of husbands, health service issues, facility and quality of care are reported factors that affect husband's involvement in birth preparedness and complication readiness.


Assuntos
Parto Obstétrico/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Parto/psicologia , Cuidado Pré-Natal/psicologia , Cônjuges/psicologia , Adulto , Estudos Transversais , Parto Obstétrico/efeitos adversos , Etiópia , Feminino , Humanos , Masculino , Gravidez , Inquéritos e Questionários , Adulto Jovem
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