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2.
Rinsho Ketsueki ; 60(8): 924-928, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31484891

RESUMO

A 32-year-old woman was diagnosed with autoimmune hemolytic anemia (AIHA) at 12 weeks of a pregnancy examination and followed up closely without treatment. At 40 weeks of gestation, she underwent emergency caesarean section because of premature rupture. On postoperative day one, the patient exhibited worsening hemolysis and tachycardia and developed high-output heart failure; she was diagnosed with Basedow disease based on the tachycardia pattern and thyroid storm based on the presence of hyperthyroidism, fever, tachycardia, and heart failure. She was administered thiamazole and potassium iodide, which improved her thyroid function, hemolytic anemia, and heart failure. AIHA is rarely associated with Basedow disease, and hemolytic anemia can be aggravated by hyperthyroidism. In pregnant women with AIHA, management of hyperthyroidism is crucial as delivery can lead to thyroid storm.


Assuntos
Anemia Hemolítica Autoimune , Insuficiência Cardíaca , Crise Tireóidea , Adulto , Cesárea , Feminino , Humanos , Parto , Gravidez
3.
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
4.
Science ; 365(6452): 444-445, 2019 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-31371599
5.
Rev. enferm. UFSM ; 9: 2, jul. 15, 2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1009315

RESUMO

"\"\\\"[{\\\\\\\"text\\\\\\\": \\\\\\\"Objetivo: analisar a assistência ao parto e nascimento, sob a ótica de puérperas atendidas em uma\\\\\\\\r\\\\\\\\nmaternidade pública. Método: estudo de natureza qualitativa, descritivo, realizado com dez puérperas no centro\\\\\\\\r\\\\\\\\nobstétrico de uma instituição pública da cidade de Russas, Ceará, Brasil. Os dados foram coletados a partir de\\\\\\\\r\\\\\\\\nentrevistas gravadas, transcritas e analisadas mediante a técnica do discurso do sujeito coletivo. Resultados: da\\\\\\\\r\\\\\\\\nanálise emergiram três ideias centrais: falta de assistência humanizada e suas limitações; insatisfação com o\\\\\\\\r\\\\\\\\natendimento prestado; e informação dos benefícios do parto normal. Considerações finais: essa investigação\\\\\\\\r\\\\\\\\naponta a necessidade de refletir acerca das políticas e práticas em saúde direcionadas para a assistência ao parto e\\\\\\\\r\\\\\\\\nnascimento e a forma como os diferentes atores se inserem nesta dinâmica, entendendo os limites e as\\\\\\\\r\\\\\\\\npotencialidades da atenção em saúde a esse grupo em destaque.\\\\\\\", \\\\\\\"_i\\\\\\\": \\\\\\\"pt\\\\\\\"}, {\\\\\\\"text\\\\\\\": \\\\\\\"Aim: to analyze delivery and birth care, from the point of view of puerperal women cared for at a\\\\\\\\r\\\\\\\\npublic maternity hospital. Method: a qualitative, descriptive study performed with ten puerperae at the obstetric\\\\\\\\r\\\\\\\\ncenter of a public institution in the city of Russas, Ceará, Brazil. Data were collected from recorded interviews,\\\\\\\\r\\\\\\\\ntranscribed and analyzed using the collective subject discourse technique. Results: three main ideas emerged from\\\\\\\\r\\\\\\\\nthe analysis: lack of humanized assistance and its limitations; dissatisfaction with the offered service; and\\\\\\\\r\\\\\\\\ninformation on the benefits of normal birth. Conclusion: this research points to the need to reflect on the health\\\\\\\\r\\\\\\\\npolicies and practices directed to the delivery and birth care and how the different actors are inserted in this\\\\\\\\r\\\\\\\\ndynamic, understanding the limits and potentialities of health care to the highlighted group.\\\\\\\", \\\\\\\"_i\\\\\\\": \\\\\\\"en\\\\\\\"}, {\\\\\\\"text\\\\\\\": \\\\\\\"Objetivo: analizar la asistencia al parto y al nacimiento, a partir del punto de vista de las puérperas\\\\\\\\r\\\\\\\\natendidas en una maternidad pública. Método: estudio de naturaleza cualitativa, descriptiva, realizado con diez\\\\\\\\r\\\\\\\\npuérperas, en el centro obstétrico de una institución pública, de la ciudad de Russas, Ceará, Brasil. Los datos fueron\\\\\\\\r\\\\\\\\nrecolectados a partir de entrevistas grabadas y transcritas y analizadas por la técnica del discurso del sujeto\\\\\\\\r\\\\\\\\ncolectivo. Resultados: del análisis surgieron tres ideas centrales: falta de asistencia humanizada y sus limitaciones;\\\\\\\\r\\\\\\\\ninsatisfacción con la atención prestada; e información sobre los beneficios del parto normal. Conclusión: esta\\\\\\\\r\\\\\\\\ninvestigación resalta la necesidad de reflexionar sobre las políticas y prácticas en salud direccionadas a la asistencia\\\\\\\\r\\\\\\\\nal parto y al nacimiento y a la forma como los diferentes actores se insertan en esa dinámica, entendiendo los\\\\\\\\r\\\\\\\\nlímites y las potencialidades de la atención en salud a ese grupo destacado.\\\\\\\", \\\\\\\"_i\\\\\\\": \\\\\\\"es\\\\\\\"}]\\\"\""


Assuntos
Humanos , Parto , Período Pós-Parto , Humanização da Assistência
6.
Rev. Ciênc. Plur ; 5(1): 18-33, jun. 2019. tab
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1007335

RESUMO

Introdução:A qualidade da assistência do parto indica um importante fator nas taxas de mortalidade infantil, pois os problemas decorrentes deste, quando realizado de forma inadequada, pode ter repercussão sobre o recém-nascido durante os primeiros dias de vida.Objetivo:Avaliar a qualidade da assistência do parto e a correlação comos indicadores de saúde da criança.Método:Trata-se de um estudo quantitativo e avaliativo dos indicadores de morbidade e mortalidade materno e infantil realizado nas Unidades Básicas de Saúde que integram a rede da Atenção Primária à Saúde (APS), do município de Santa Cruz, Rio Grande do Norte, Brasil. Com uma amostra de 200 mulheres mães de crianças menores de dois anos. Resultados:Foram entrevistadas mães com média de idade de 28,17 anos, com bebês com em média 10,42 meses de idade. 95,5% das mães afirmaram ter realizado o acompanhamento pré-natal. A maioria (60,5%) das mulheres classificou a assistência recebida no parto como boa; 74,5 % afirmaram que a criança foi colocada no peito após o parto; 90% dos binômios mãe-bebê estiverem juntos no quarto após o parto.Conclusões:Pode-se perceber que a assistência ao parto acontece de forma adequada e satisfatória, atendendo necessidades da maioria das entrevistadas. Porém ainda há uma necessidade de conscientização e qualificação dos profissionais de saúde, para que não ocorram situações indesejáveis na saúde materno-infantil e diminua as taxas de morbidade e mortalidade materna e neonatal (AU).


Introduction:The quality of delivery care indicates an important factor in the infant mortality rates, since the problems arising from it, when performed in an inappropriate way, can have repercussion on the newborn during the first days of life. Objective:To evaluate the quality of childbirth care and the correlation with child health indicators.Methods:This is a quantitative and evaluative study of the indicators of maternal and infant morbidity and mortality carried out at the Basic Health Units that integrate the Primary Health Care (PHC) network of the municipality of Santa Cruz, Rio Grande do Norte, Brazil. With a sample of 200 women mothers of children under two years.Results:Mothers with a mean age of 28.17 years were interviewed, with infants with a mean of 10.42 months of age. 95.5% of the mothers reported having had prenatal care. The majority (60.5%) of the women classified care received at delivery as good; 74.5% stated that the child was placed in the breast after delivery; 90% of the mother-baby binomials are together in the fourth postpartum.Conclusions:It can be noticed that the delivery assistance takes place adequately and satisfactorily, meeting the needs of the majority of the interviewees. However, there is still a need for awareness and qualification of health professionals, so that undesirable situations in maternal and child health do not occur and the rates of maternal and neonatal morbidity and mortality decrease (AU).


Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Cuidado Pré-Natal/métodos , Atenção Primária à Saúde , Avaliação em Saúde/métodos , Criança , Saúde Materno-Infantil , Parto , Brasil , Inquéritos e Questionários , Interpretação Estatística de Dados , Indicadores de Qualidade em Assistência à Saúde
7.
Women Birth ; 32(5): 383-390, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31257181

RESUMO

BACKGROUND: This case study explores the four pregnancy and birthing journeys of Wiradjuri & Ngemba-Wayilwan woman, Fleur Magick Dennis. Fleur provides a personal account of her journeys and relates them to socio-cultural issues surrounding her life during these times. Fleur experienced her first birth in hospital and her three next births at different locations out of hospital on Wiradjuri Country. Fleur is able to show that her personal wellbeing & healing and that of her family & community is linked to her having been able to birth according to her spiritual & cultural beliefs. The midwife for Fleur's third and fourth pregnancy, Hazel Keedle, then provides a brief account of her experiences supporting Fleur in her choices and explores the impact of these births on her midwifery and personal life.


Assuntos
Continuidade da Assistência ao Paciente , Parto Domiciliar , Tocologia , Mães/psicologia , Grupo com Ancestrais Oceânicos/psicologia , Parto/psicologia , Satisfação Pessoal , Austrália , Centros de Assistência à Gravidez e ao Parto , Feminino , Hospitais , Humanos , Gravidez
8.
Women Birth ; 32(5): 412-426, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31262706

RESUMO

BACKGROUND: Culturally secure care is considered foundational for good perinatal outcomes for Indigenous women. It is unknown what literature reports on whether Indigenous women giving birth in urban areas receives appropriate cultural care. The aim of this scoping review was to examine and summarise relevant evidence which reports on culturally secure care for Indigenous women using urban maternity services at any time during the perinatal period. METHODS: Ten journal databases plus grey literature and theses databases were searched for relevant material dated 1986-2018. Articles were included if they were about Indigenous women from Australia, New Zealand, Canada or the USA; care was provided anytime during the perinatal period, in an urban area; and cultural security (or variations of this term) were used. RESULTS: 6856 titles and abstracts were screened, of these: 25 studies, 15 grey literature documents and 9 theses matched the search criteria. Studies were mostly qualitative (13/25) and from Australia (18/25). Studies showed women's access to and experiences of culturally secure maternity care in urban areas as variable. The grey literature originated from Australia (8/15); New Zealand (4/15); and Canada (3/15); while theses were from Canada (7/9) and Australia (2/9). CONCLUSION: The scoping review results showed substantial qualitative evidence on Indigenous women's experience during the perinatal period in urban areas. In-depth analysis of these studies is required to inform future practice and policy on what works and what needs improvement. Culturally secure midwifery care shows promising results.


Assuntos
Assistência à Saúde Culturalmente Competente , Assistência à Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Tocologia/métodos , Assistência Perinatal , Austrália , Canadá , Competência Cultural , Assistência à Saúde/métodos , Feminino , Humanos , Nova Zelândia , Parto , Gravidez , População Urbana
9.
Women Birth ; 32(5): 427-436, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31326382

RESUMO

BACKGROUND: The urban-based Malabar Community Midwifery Link Service integrates multidisciplinary wrap-around services along-side continuity of midwifery care for Aboriginal and Torres Strait Islander mothers and babies. AIM: To evaluate the Malabar Service from 1 January 2007 to 31 December 2014. METHODS: A mixed method design. Outcomes for mothers of Aboriginal and/or Torres Strait Islander babies cared for at an urban Australian referral hospital by the Malabar Service were compared to mainstream. Primary outcomes are rates of low birth weight; smoking >20 weeks gestation; preterm birth; and breastfeeding at discharge. Malabar outcomes are also compared to national and state perinatal outcomes. RESULTS: The Malabar Service (n = 505) demonstrated similar rates of preterm birth (aOR 2.2, 95% CI 0.96-4.97); breastfeeding at discharge (aOR 1.1, 95% CI 0.61-1.86); and a higher rate of low birth weight babies (aOR 3.6, 95% CI 1.02-12.9) than the comparison group (n = 201). There was a 25% reduction in smoking rates from 38.9% to 29.1%. Compared to national and state populations, Malabar outcomes were better. Women experienced greater psychosocial complexity but were well supported. Malabar Mothers (n = 9) experienced: accessibility, preparedness for birth and cultural safety. Staff (n = 13) identified going 'above and beyond' and teamwork to provide culturally safe care counterbalanced with concerns around funding and cultural support. CONCLUSIONS: Dedicated integrated continuity of midwifery care with wrap-around services for Aboriginal and/or Torres Strait Islander mothers is highly valued and is culturally safe. The service is as safe as main stream services and promotes better clinical outcomes compared to national and state outcomes.


Assuntos
Continuidade da Assistência ao Paciente , Serviços de Saúde do Indígena , Serviços de Saúde Materna/organização & administração , Bem-Estar Materno/etnologia , Tocologia/organização & administração , Grupo com Ancestrais Oceânicos/psicologia , Parto/etnologia , Adulto , Austrália , Características Culturais , Feminino , Humanos , Obstetrícia , Gravidez , Fumar
10.
Women Birth ; 32(5): 437-448, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31326383

RESUMO

BACKGROUND: Good quality antenatal care is essential to improve the perinatal outcomes of Aboriginal and Torres Strait Islander women in Australia. Group antenatal care (GAC) is an innovative model which places clinical assessment, education and social support into a group setting. Previous studies have found GAC to be associated with improved perinatal outcomes, particularly for vulnerable populations, and high satisfaction levels among group members. No implementations of GAC, or evaluations of its acceptability, for an Indigenous population in Australia have been previously conducted. AIM: To explore the perceptions of a group of Indigenous health workers (n=5) in a health service in Far North Queensland, Australia, towards the prospective acceptability of GAC as an additional choice of model of care for their Indigenous women clients. METHODS: This qualitative acceptability study employed a descriptive/exploratory methodology. Data collection was by semi structured interview. Data analysis was guided by a theoretical framework of acceptability and conducted following a process of iterative categorisation. FINDINGS: No overall precluding factors were identified to render the model unacceptable for Indigenous women in this locality. Some features of the model would not suit all women. Indigenous health workers were interested in increased involvement with antenatal care and participation in a GAC model. CONCLUSION: A foundation of acceptability exists upon which the implementation of a GAC model could offer benefits to Indigenous women in this health service. The positive response of the Indigenous health workers to the concept of GAC endorsed the potential of this model to contribute to the provision of culturally appropriate and effective antenatal care within mainstream services.


Assuntos
Assistência à Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Serviços de Saúde Materna/organização & administração , Bem-Estar Materno/etnologia , Grupo com Ancestrais Oceânicos/etnologia , Cuidado Pré-Natal/métodos , Adulto , Austrália , Feminino , Pessoal de Saúde , Disparidades em Assistência à Saúde , Humanos , Grupo com Ancestrais Oceânicos/psicologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Parto , Gravidez , Pesquisa Qualitativa , Qualidade da Assistência à Saúde
11.
Women Birth ; 32(5): 391-403, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31345660

RESUMO

BACKGROUND: Birth on Country is often assumed as relevant to Aboriginal women in rural/remote locations and not usually associated with urban environments. In Western Australia, one third of the Aboriginal population live in the greater metropolitan area. We wanted to know Aboriginal women's experiences of on Country urban births. METHODS: Indigenous qualitative data collection and analysis methods were used to learn about Aboriginal women's stories of contemporary and past experiences of maternity care and cultural practices associated with Birth on Country. RESULTS: Aboriginal Birthing, Senior and Elder women consistently reported ongoing cultural practices associated with childbirth including knowledge sharing across generations and family support, observance of extended family present at the time of or shortly after birth, and how their cultural security was improved when Aboriginal staff were present. Also noted, were the inflexibility of health systems to meet their needs and midwives lack of cultural awareness and understanding of the importance of Aboriginal kinship. CONCLUSION: The Birthing on Noongar Boodjar project Aboriginal women's data represents four generations of women's stories, experiences and expressions of childbearing, which highlighted that maternity care changes across time have failed to acknowledge and support Aboriginal women's cultural needs during childbearing. In terms of on Country urban birth, the women collectively expressed a strong desire to maintain cultural practices associated with childbirth, including birthing close to home (on Country); having family acknowledged and included throughout the perinatal period; and, having access to Aboriginal midwives, nurses, doctors, and other health care workers to support their cultural security.


Assuntos
Parto Obstétrico/métodos , Grupo com Ancestrais Oceânicos/psicologia , Parto/psicologia , Adulto , Idoso , Parto Obstétrico/estatística & dados numéricos , Feminino , Grupos Focais , Pessoal de Saúde , Humanos , Tocologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Parto/etnologia , Gravidez , Pesquisa Qualitativa , População Rural , Austrália Ocidental
12.
Medicine (Baltimore) ; 98(28): e16056, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305391

RESUMO

RATIONALE: Giant uterine myomas may be life-threatening due to pressure effects on the lungs and other contiguous organs. PATIENT CONCERNS: A 32-year-old pregnant Asian woman was admitted to our hospital early in her pregnancy with a pre-pregnancy history of multiple uterine myomas. DIAGNOSIS: She was diagnosed with multiple giant uterine myomas in pregnancy. INTERVENTIONS: No intervention was performed on the woman. OUTCOMES: A reduction in tumor size and disappearance of tumor blood supply were seen on conventional and contrast-enhanced ultrasounds (CEUS) on postpartum day 34. Mass volume gradually decreased and no blood flow signals were seen on CEUS during postpartum follow-up. LESSONS: Childbirth can block the blood supply of giant uterine myomas and reduce mass size. In such cases, childbirth may be considered therapeutic.


Assuntos
Mioma/irrigação sanguínea , Parto/fisiologia , Complicações Neoplásicas na Gravidez/fisiopatologia , Neoplasias Uterinas/irrigação sanguínea , Adulto , Feminino , Humanos , Mioma/complicações , Mioma/diagnóstico por imagem , Gravidez , Carga Tumoral , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico por imagem
15.
Rev. urug. enferm ; 14(1): 19-27, jun 2019.
Artigo em Espanhol | LILACS, InstitutionalDB | ID: biblio-1009317

RESUMO

En la investigación desarrollada en el salón de Partos del hospital Docente "Eusebio Hernández", se pudo constatar que para el personal de enfermería el cuidado de la mujer en trabajo de parto es un elemento importante para el progreso de la perinatología. El presente trabajo es una investiga-ción de desarrollo tecnológico con el objetivo de identifi car las competencias específi cas del enfer-mero que labora en el salón de partos. Se trabajó con: análisis documental, encuestas a expertos y entrevistas a profesionales de enfermería que laboran en el salón de partos. Se elaboró, a partir de la identifi cación de competencias específi cas para el personal de enfermería que labora en el salón de parto, un mapa para el desarrollo del currículo laboral (mapa DACUM) donde se incluyen las tareas y funciones que debe realizar el personal de enfermería


In the investigation developed in the living room of Childbirths of the Educational hospital Eu-sebio Hernández Pérez, could ascertain that for the personnel of infi rmary the care of the woman in work of childbirth. " e present work is an investigation of technological development with the aim to identify thespecifi c competitions of infi rmary. We worked with: documentary analysis, expert surveys and interviews with nursing professionals who work in the delivery room. It was elaborated, from the identifi cation of specifi c competencies for the nursing staff that works in the delivery room, a map for the development of the labor curriculum (DACUM map) which includes the tasks and func-tions that the nursing staff must perform


Na pesquisa realizada na sala de parto do Hospital Universitário "Eusebio Hernández", consta-tou-se que para a equipe de enfermagem o cuidado da mulher em trabalho de parto é um elemento importante para o progresso da perinatologia. O presente trabalho é uma pesquisa de desenvol-vimento tecnológico com o objetivo de identifi car as competências específi cas do enfermeiro que trabalha na sala de parto. Trabalhamos com: análise documental, pesquisas de especialistas e en-trevistas com profi ssionais de enfermagem que atuam na sala de parto. Foi elaborado, a partir da identifi cação de competências específi cas para a equipe de enfermagem que trabalha na sala de parto, um mapa para o desenvolvimento do currículo de trabalho (mapa DACUM) que inclui as tarefas e funções que a equipe de enfermagem deve realizar.


Assuntos
Humanos , Competência Profissional , Parto , Enfermagem Obstétrica , Prática Profissional , Educação em Enfermagem , Cuidados de Enfermagem
16.
Rev. méd. Urug ; 35(2): 113-116, jun. 2019. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-999563

RESUMO

Antecedentes: en Uruguay, el Ministerio de Salud ha seleccionado la disminución de las cesáreas innecesarias como uno de los objetivos sanitarios nacionales por considerarlo un problema de salud pública. Objetivos: analizar las tasas de cesáreas por sector asistencial: público versus privado y Montevideo versus interior, usando la clasificación de Robson como insumo para su disminución. Material y método: estudio descriptivo de corte transversal que categoriza cada nacimiento ocurrido en Uruguay en 2017 en uno de los diez grupos de Robson, según el sector de asistencia y el lugar geográfico donde ocurrió, informando el tamaño relativo, la tasa de cesáreas y las contribuciones absolutas y relativas hechas por cada grupo a la tasa global de cesáreas. Resultados: la tasa de cesáreas en 2017 fue de 44%. Los grupos que más contribuyeron a la tasa global de cesáreas (70% de las cesáreas practicadas en el país) fueron: mujeres con una o más cesáreas previas, cesáreas electivas o inducciones fallidas en nulíparas y el grupo de nulíparas de término con inicio espontáneo. Luego de ajustar por las variables pronósticas, la probabilidad de terminar en cesáreas en el sector privado fue 18% mayor que en el sector público, sin mostrar diferencias en los resultados perinatales. Las tasas de cesáreas por grupos de Robson en Montevideo y en el interior se muestran muy similares. Conclusiones: fomentar el parto vaginal después de una cesáreas, evitar cesáreas electivas e inducciones innecesarias y disminuir la primera cesáreas son las medidas propuestas para bajar las tasas de cesáreas innecesarias. Guías clínicas basadas en la mejor evidencia científica que sistematicen estas intervenciones ayudarán a implementar los cambios.


Background: in Uruguay, the Ministry of Public Health has set the reduction of unnecessary C-sections as one of the "National Health Goals", as it considers this a public health issue. Objectives: to analyse the C-section rates by health sector: the private sector versus the public sector and Montevideo versus the rest of the country, using the Robson classification and an input to be used to reduce the rate. Method: transversal descriptive study that categorizes every birth in Uruguay during 2017 according to the Robson criterion in one of the 10 groups, depending on the healthcare center and the geographical place of birth, reporting the relative size, the C-section rate and the absolute and relative contributions of each group to the global CS rate. Results: in 2017 the CS rare was 44%. The groups that contributed the most to the global CS rate (70% of the CS in the country) were the following: women with previous CS, elective CS or failed induced labor in nulliparous women and the term nulliparous women with spontaneous initiation of labor group. After adjusting the prognostic variables, the possibility of ending up in CS in the private sector was 18% higher than in the public sector, without there being any differences in terms of the perinatal results. CS rates by Robson group in Montevideo and the rest of the country are very similar. Conclusions: vaginal birth must be encouraged after a CS, elective CS and unnecessary induction of labor must be avoided, and the number of first CS needs to be reduced. These are the measures proposed to reduce the unnecessary CS rates. Clinical guidelines based on the best scientific evidence that systematize these interventions will contribute to the implementation of changes.


Antecedentes: o Ministério da Saúde do Uruguai (MS) definiu como um dos "Objetivos sanitários nacionais" a redução do número de cesáreas (CS) necessárias por considerar que este é um problema de saúde pública. Objetivos: analisar as taxas de CS por setor assistencial: público vs privado e geográfico: Montevideo vs Interior usando a classificação de Robson, como insumo para sua redução. Material e métodos: estudo descritivo transversal que classifica cada nascimento ocorrido no Uruguai em 2017, em um dos 10 grupos de Robson de acordo com o setor de assistência e o lugar onde aconteceu, informando tamanho relativo, taxa de CS e as contribuições absolutas e relativas de cada grupo à taxa global de CS. Resultados: a taxa de CS em 2017, foi de 44%. Os grupos que mais contribuíram para a taxa global de CS (70% das CSs realizadas no país) foram: as cesareadas previas, as cesáreas eletivas ou induções falidas em nulíparas e o grupo de nulíparas a termo com início espontâneo. Depois de ajustar pelas variáveis prognósticas, a probabilidade de terminar em CS no setor privado foi 18% maior que no setor público, sem diferenças nos resultados perinatais. As taxas de CS por grupos de Robson em Montevideo e no Interior foram similares. Conclusões: fomentar o parto vaginal depois de uma CS, evitar CS eletivas e induções desnecessárias e diminuir a quantidade de primeira CS, são las medidas propostas para reduzir as taxas de cesáreas desnecessárias. Pautas clínicas baseadas na melhor evidência científica que sistematizem estas intervenções ajudarão a implementar as mudanças propostas.


Assuntos
Humanos , Cesárea/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Prevalência , Parto
17.
Rev. Univ. Ind. Santander, Salud ; 51(2): 135-146, abr.-jun. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1003164

RESUMO

Resumen Introducción: La violencia obstétrica ha sido tipificada como una modalidad de violencia de género, que hace referencia a las conductas de acción u omisión; puede ser institucional, psicológica, simbólica o sexual. Objetivo: Caracterizar las diferentes modalidades de violencia obstétrica. Metodología: Estudio cualitativo con enfoque fenomenológico; conformado por 16 mujeres con experiencias obstétricas menores de dos años que asistieron a los hogares de Familia, Mujer e Infancia (FAMI) del Instituto Colombiano de bienestar familiar en la ciudad de Popayán (Colombia) durante el 2016. Se realizaron entrevistas estructuradas y a profundidad sobre sus experiencias en la atención institucional del parto, en términos de toma de decisiones e información sobre procedimientos, posición para el parto, presencia de acompañante, derecho a la intimidad, percepciones sobre maltrato físico y psicológico. Resultados: El 69% de las entrevistadas reportaron alguna forma de violencia obstétrica. La violencia institucional se registró en la mayoría de los relatos y estuvo asociada a políticas institucionales que no satisfacen las expectativas de las gestantes en el proceso de parto e inconformidad con la atención en salud recibida durante el trabajo de parto; la violencia psicológica, fue percibida como falta de información y de autonomía en la toma de decisiones en el proceso de atención, malos tratos e impedimento a las gestantes para expresar sus sentimientos y emociones. Conclusiones: La mayoría de mujeres desconocen sus derechos y/o naturalizan los actos de violencia obstétrica. Los profesionales de salud deben reconocer en su formación y en los campos de práctica, los distintos tipos de violencia obstétrica con el fin de diseñar mecanismos para su prevención y abolición. Se hace necesario explorar la ocurrencia de eventos asociados a violencia sexual en el marco de la atención obstétrica.


Abstract Introduction: Obstetric violence has been typified as a form of gender violence, which refers to the behaviors of action or omission; It can be institutional, psychological, symbolic or sexual. Objective: To characterize the different modalities of obstetric violence. Methodology: Qualitative study with a phenomenological approach; conformed by 16 women with obstetric experiences under two years who attended the homes of Family, Women and Children (FAMI) of the Colombian Institute of Family Welfare in the city from Popayán (Colombia) during the 2016. Structured interviews were conducted and in depth about their experiences in the institutional care of childbirth, in terms of decision making and information about procedures, position for childbirth, presence of companion, right to privacy, perceptions about physical and psychological abuse. Results: 69% of the interviewed women reported some form of obstetric violence. Institutional violence was recorded in most of the reports and was associated with institutional policies that do not meet the expectations of pregnant women in the birth process and nonconformity with health care received during labor; Psychological violence was perceived as a lack of information and autonomy in decision-making in the process of care, mistreatment and impediment to pregnant women to express their feelings and emotions. Conclusions: The majority of women are unaware of their rights and / or naturalize acts of obstetric violence. Health professionals must recognize in their training and in the fields of practice, the different types of obstetric violence in order to design mechanisms for their prevention and abolition. It is necessary to explore the occurrence of events associated with sexual violence within the framework of obstetric care.


Assuntos
Humanos , Violência , Parto , Direitos Sexuais e Reprodutivos
18.
Soins Pediatr Pueric ; 40(308): 20-23, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31171294

RESUMO

In the Maghreb, rites of protection are performed to prevent or compensate for any threats to which newborns are exposed as a result of their birth. The passage from one world to another is therefore accompanied by rituals, real vectors of socialisation, values and knowledge. They are important therapeutic levers in the context of transcultural psychotherapy, in order to reappropriate a containing and mixed cultural sheath.


Assuntos
Comportamento Ritualístico , Parto , África do Norte , Feminino , Humanos , Recém-Nascido , Gravidez , Psicoterapia
19.
J Anim Sci ; 97(7): 2927-2939, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31150088

RESUMO

A study was conducted to evaluate the effects of feeding an acidogenic diet with a low dietary cation-anion difference (DCAD) on acid-base balance, blood, milk, and urine Ca concentrations of sows during lactation. A total of 30 multiparous sows (parity: 4.5 ± 2.9, Smithfield Premium Genetic, Rose Hill, NC) were allotted to 1 of 2 dietary treatments: CON (control diets were corn-soybean meal based with a calculated DCAD of 170 and 226 mEq/kg during late gestation and lactation, respectively) or ACI (acidogenic diets had a DCAD 100 mEq/kg lower than the control diets). The lower DCAD was achieved by the addition of an acidogenic mineral. The DCAD was calculated as mEq (Na + K - Cl)/kg diet. Sows had a daily access to 2-kg feed from day 94 of gestation to parturition and ad libitum access to feed during lactation. Blood and urine pH and Ca, serum macrominerals, serum biochemistry, Ca-regulating hormones, and milk composition were measured. Sows in ACI had a lower (P < 0.05) blood pH than sows in CON at day 1 of lactation. Sows in ACI had a lower (P < 0.05) urine pH at day 108 of gestation, days 1, 9, and 18 of lactation compared with sows in CON. Sows in ACI had greater (P < 0.05) concentrations of serum total Ca at days 1 and 18 of lactation than sows in CON. There was a greater (P < 0.05) concentration of colostrum Ca in ACI than in CON. There was no difference in urine Ca concentration between treatments during lactation. Concentrations of parathyroid hormone and 1,25-dihydroxycholecalciferol were not different between treatments at either day 1 or 18 of lactation. Sows in ACI tended to have a smaller (P = 0.086) concentration of total alkaline phosphatase in serum at day 18 of lactation compared with sows in CON. At day 1 of lactation, the concentration of serum Cl in ACI was greater (P < 0.05) than that in CON. Feed intake, BW loss, and litter performance were not different between treatments. Collectively, feeding an acidogenic diet with a low DCAD to sows can induce a mild metabolic acidosis at farrowing, reduce the urine pH consistently, and increase serum total Ca and colostrum Ca concentrations during lactation but without altering the parathyroid hormone and 1,25-dihydroxycholecalciferol levels during lactation.


Assuntos
Ração Animal/análise , Cálcio/análise , Colostro/química , Leite/química , Minerais/análise , Suínos/sangue , Equilíbrio Ácido-Base , Animais , Ânions/análise , Cátions/análise , Dieta/veterinária , Feminino , Lactação , Paridade , Parto , Gravidez
20.
J Anim Sci ; 97(7): 2914-2926, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31155652

RESUMO

The objective of this study was to determine the effects of increased AA and energy intake during late gestation on reproductive performance, milk composition, and metabolic and redox status of sows. A total of 118 Yorkshire sows (third through sixth parity) were randomly assigned to dietary treatments from day 90 of gestation until farrowing. Dietary treatments consisted of combinations of 2 standardized ileal digestible (SID) AA levels [14.7 or 20.6 g/d SID Lys, SID Lys and other AA met or exceeded the NRC (2012) recommendations] and 2 energy levels (28.24 or 33.78 MJ/d intake of NE) in a 2 × 2 factorial design. After parturition, all sows were fed a standard lactation diet. Blood samples were collected and analyzed for parameters on metabolism, redox status, and amino acid profile. The data were analyzed using the generalized linear mixed models to reveal the impact of dietary levels of energy, AA, and their interaction. Sows with increased intake of AA had greater BW gain (P < 0.01) during late gestation. Furthermore, the BW loss during lactation was increased in sows with increasing intake of energy (P < 0.05) or AA (P < 0.05). Sows fed high energy had higher total litter birth weights (20.2 kg vs. 18.4 kg, P < 0.05) and shorter duration of farrowing (261 min vs. 215 min, P < 0.05), compared with those fed low energy, which likely was due to higher (P < 0.05) plasma glucose and lower (P < 0.05) plasma lactate prior to parturition. High AA intake in late gestation increased the ADG of piglets during the following lactation (P < 0.05), and increased the concentrations of plasma urea, and the following AA: Lys, Met, Thr, Val, Ile, Leu, Phe, Asp, Ser, and Arg at farrowing (P < 0.05). In conclusion, the increased intake of energy increased total litter weight of newborns and shortened the farrowing duration, which likely was due to improved energy status at farrowing. Furthermore, sows with increased intake of AA led to higher growth rate of piglets during the following lactation, accompanying with the increasing levels of plasma urea and amino acids. Therefore, the higher energy intake in late gestation appeared to improve litter weight and farrowing duration, while higher AA intake may have positive effect on piglets performance in lactation.


Assuntos
Aminoácidos/metabolismo , Ração Animal/análise , Ingestão de Energia , Leite/química , Reprodução/efeitos dos fármacos , Suínos/fisiologia , Animais , Peso ao Nascer/efeitos dos fármacos , Nitrogênio da Ureia Sanguínea , Dieta/veterinária , Feminino , Íleo/metabolismo , Lactação/efeitos dos fármacos , Estado Nutricional , Oxirredução , Paridade , Parto , Gravidez , Distribuição Aleatória , Suínos/microbiologia
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