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1.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47926

RESUMO

A Sociedade Brasileira de Pediatria (SBP), a Sociedade Brasileira de Imunizações (SBIm) e a Federação Brasileira de Ginecologia e Obstetrícia (Febrasgo) divulgaram o documento técnico “Imunização na gestação: pré-concepção e puerpério” com o objetivo de orientar profissionais de saúde sobre a importância da vacinação durante a gestação.


Assuntos
Período Pós-Parto , Gravidez/imunologia , Imunização , Cuidado Pré-Concepcional
2.
Oral Health Prev Dent ; 18(1): 855-864, 2020 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-33028053

RESUMO

PURPOSE: This study examines the difference in the oral microbiome during pregnancy and the postpartum period of a Chinese population, with the focus on P. gingivalis, P. intermedia and P. nigrescens and their shift during pregnancy, in order to understand the host-microbe relationship in maintaining homeostasis during pregnancy. MATERIALS AND METHODS: This cross-sectional study was carried out in a total of 117 women who underwent prenatal or regular examinations at four public hospitals, including 84 pregnant and 33 postpartum women. Women in the postpartum group were examined within 0.5-1 year after delivery, while the pregnant group was divided into early pregnancy (0-13 weeks), middle pregnancy (14-27 weeks), and late pregnancy (28-39 weeks) according to gestational age. Sociodemographic parameters were self-reported by recruited women. The study required evaluations of probing depth (PD), bleeding index (BI), clinical attachment loss (CAL), and plaque index (PlI). Unstimulated whole saliva samples were collected for the detection of P. gingivalis, P. intermedia, and P. nigrescens. Bacterial populations were evaluated using 16S rRNA-based polymerase chain reaction. RESULTS: P. nigrescens exhibited higher prevalence in the pregnant group compared to the postpartum group (45.67% vs 12.10%, p < 0.01). P. nigrescens was more frequently detected in late than in early pregnancy (57.7% vs 48.3%, p < 0.05) and middle pregnancy (57.7% vs 31.0%, p < 0.01). Initially high prevalence of P. gingivalis in early pregnancy wanes in middle and late pregnancy (69.0%, 44.8%, 38.5%). However, the prevalence of P. gingivalis in the postpartum group (81.8%) exceeds all of the pregnant groups (p < 0.01). The change in the prevalence of P. intermedia among different groups was not statistically significant. The percentages of bleeding on probing (BOP%) sites and PD ≥4 mm sites in the postpartum group were statistically significantly higher when compared with each of the pregnant groups (p < 0.01). During pregnancy, women experienced elevated PlI, BI, PD, and BOP% (p < 0.05). The proportions of subjects in the pregnant group who agreed with the statements 'Gingival bleeding is normal', 'Can't brush teeth within 1st month postpartum', 'It's unnecessary to see a dentist if not uncomfortable' were 39.3%, 28.6%, and 35.7%, respectively. CONCLUSIONS: P. nigrescens is more related than P. gingivalis to pregnancy status. The periodontal status of Chinese women progressively deteriorates during pregnancy and persists into the postpartum period, which may result from lack of dental care knowledge.


Assuntos
Microbiota , Doenças Periodontais , Estudos Transversais , Feminino , Humanos , Doenças Periodontais/epidemiologia , Período Pós-Parto , Gravidez , RNA Ribossômico 16S
3.
Rev Lat Am Enfermagem ; 28: e3335, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33027400

RESUMO

OBJECTIVE: to assess the effect of a breastfeeding educational intervention on the counseling provided to postpartum women. METHOD: this is a randomized controlled trial including 104 postpartum women (intervention group = 52 and control group = 52) from a private hospital, whose educational intervention was based on the pragmatic theory and on the use of a soft-hard technology called Breastfeeding Educational Kit (Kit Educativo para Aleitamento Materno, KEAM). Women were followed-up for up to 60 days after childbirth. Chi-Squared Test, Fischer's Exact Test, and Generalized Estimating Equation were used, with a significance level of 5% (p-value <0.05). The analyses were performed using the Statistical Package for the Social Sciences, version 24. RESULTS: the postpartum women in the intervention group had fewer breastfeeding difficulties and a higher percentage of exclusive breastfeeding at all time points compared with those in the control group. CONCLUSION: the educational intervention based on active methodologies and stimulating instructional resources was effective in developing greater practical mastery among postpartum women with regard to adherence and maintenance of exclusive breastfeeding. Registry REBEC RBR - 8p9v7v.


Assuntos
Aleitamento Materno , Período Pós-Parto , Distribuição de Qui-Quadrado , Parto Obstétrico , Feminino , Humanos , Parto , Educação de Pacientes como Assunto , Gravidez
4.
Rev Lat Am Enfermagem ; 28: e3364, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33027402

RESUMO

OBJECTIVE: to analyze the relationship between maternal self-efficacy to breastfeed and sociodemographic, obstetric, and neonatal variables; between the duration of exclusive breastfeeding and sociodemographic variables; and between the breastfeeding self-efficacy and the duration of exclusive breastfeeding at the intervals of 30, 60, and 180 days postpartum. METHOD: a longitudinal and prospective study conducted with 224 women. A sociodemographic questionnaire, the Breastfeeding Self-Efficacy Scale - Short Form, and a questionnaire on breastfeeding and child feeding were used for collecting the data. Fisher's exact test and Pearson's correlation coefficient test were used for analysis. RESULTS: there was no association between breastfeeding self-efficacy and the duration of exclusive breastfeeding identified at 30, 60, and 180 days. Self-efficacy was associated with the type of delivery and complications in the postpartum period. There was also an association between religion and exclusive breastfeeding 30 and 60 days postpartum, and assistance with baby care and exclusive breastfeeding at 60 days. CONCLUSION: It was identified that the type of delivery, complications in the postpartum period, religion, and assistance with baby care corroborate to increase maternal confidence in the ability to breastfeed.


Assuntos
Aleitamento Materno , Autoeficácia , Adulto , Criança , Feminino , Humanos , Mães , Período Pós-Parto , Gravidez , Estudos Prospectivos
5.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47870

RESUMO

Publicação integra Plano de Apoio à Gestação e Puerpério para garantir cuidado adequado, incentivar testagem e ampliar acompanhamento pré-natal e pós-parto.


Assuntos
Gravidez , Período Pós-Parto , Cuidado Pré-Natal
8.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(4): 456-461, 2020 Apr 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32879072

RESUMO

Postpartum depression is a kind of mental disorder caused by the comprehensive effects of economics, psychosociology, biology, obstetrics and other characteristic factors in the process of female pregnancy. The pathogenesis of postpartum depression is complicated and has not been clarified. With the process pregnancy, the influence of psychosocial and biology factors are also in dynamic change. The postpartum depression predictor among psychosocial factors are antenatal depression, life events and social supports. Among biological factors, the predictors are hypothalamic-pituitary-thyroid axis and serum lipids. Timely and effective prediction can identify the high-risk population and risk factors for postpartum depression.


Assuntos
Depressão Pós-Parto , Complicações na Gravidez , Depressão , Feminino , Humanos , Período Pós-Parto , Gravidez , Fatores de Risco
9.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(3): 118-127, jul.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-191031

RESUMO

La infección causada por el nuevo coronavirus SARS-CoV-2 (COVID-19) representa actualmente una de las mayores emergencias sanitarias a nivel mundial. La aparición de una nueva infección potencialmente grave y la situación de pandemia actual ha implicado importantes ajustes en la práctica clínica en medicina materno-fetal. Aunque no parece existir una mayor afectación o susceptibilidad al virus de las mujeres embarazadas respecto la población general, existen aspectos específicos ligados a la gestación que deben tenerse en cuenta de cara al diagnóstico y manejo de la COVID-19 en pacientes embarazadas. En el siguiente documento se exponen las recomendaciones y el protocolo de actuación ante la infección por COVID-19 durante el embarazo desarrollado en nuestro centro, basado en la evidencia científica disponible hasta la fecha y las principales recomendaciones internacionales


The severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) disease (COVID-19) has caused a large global outbreak and has had a major impact on health systems and societies worldwide. The generation of knowledge about the disease has occurred almost as fast as its global expansion. Very few studies have reported on the effects of the infection on maternal health, since its onset. The mother and foetus do not seem to be at particularly high risk. Nevertheless, obstetrics and maternal-foetal medicine practice have made profound changes in order to adapt to the pandemic. In addition, there are aspects specific to COVID-19 and gestation that should be known by specialists. In this review an evidenced-based protocol is presented for the management of COVID-19 in pregnancy


Assuntos
Humanos , Masculino , Feminino , Gravidez , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Pneumonia Viral/virologia , Complicações Infecciosas na Gravidez/virologia , Espanha , Escores de Disfunção Orgânica , Obstetrícia/métodos , Período Pós-Parto
10.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47803

RESUMO

Divulgação do podcast da dra. Rossiclei Pinheiro, do Departamento Científico de Aleitamento Materno da Sociedade Brasileira de Pediatria (SBP), no quinto programa da série “RP Convida – especial Agosto Dourado” da revista Residência Pediátrica (RP). Na edição, a especialista ressalta a adoção de boas práticas segundo as evidências mais atuais da literatura médica.


Assuntos
Aleitamento Materno , Período Pós-Parto , Promoção da Saúde
11.
Adv Exp Med Biol ; 1252: 199-207, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816283

RESUMO

Young breast cancer patients face numerous challenges during the cancer trajectory. As in the last decade, women tend to delay pregnancies to a later time in life, and clinicians are often faced with young breast cancer patients who want to start a family or complete it. Becoming a mother is a delicate developmental process in which the woman redefines and restructures her identity as she gets prepared for her new role and responsibilities. When there is a history of cancer or cancer diagnosis is communicated during the pregnancy, fears, worries, and concerns emerge and specific support may be necessary. Follow-ups during the post-partum period are also recommended as lactation issues should not be overlooked. In this chapter, we analyze the psychological aspects of cancer survivors and women with pregnancy-associated breast cancer, and the management of these issues.


Assuntos
Neoplasias da Mama/psicologia , Lactação/psicologia , Complicações Neoplásicas na Gravidez/psicologia , Ansiedade , Aleitamento Materno , Feminino , Humanos , Período Pós-Parto/psicologia , Gravidez
12.
Rev Med Liege ; 75(7-8): 529-531, 2020 Jul.
Artigo em Francês | MEDLINE | ID: mdl-32779905

RESUMO

Cerebral thrombophlebitis is a rare but serious complication of pregnancy and postpartum. This condition is characterized by a misleading symptomatology. It must be systematically discussed in case of the persistence of a headache in the aftermath of childbirth and the diagnosis must be confirmed early with the help of computed tomography and cerebral magnetic resonance. NMR is the reference examination. The treatment is essentially based on anticoagulants. The functional prognosis remains good if the diagnosis is made in time and the treatment is initiated early. We report the case of a young 25-year-old woman who presented postpartum cerebral thrombophlebitis with a late diagnosis. The evolution was marked by severe neurological sequelae. This is why we emphasize the interest of imaging in the early diagnosis of this pathology.


Assuntos
Transtornos Puerperais , Tromboflebite , Adulto , Anticoagulantes , Feminino , Humanos , Imagem por Ressonância Magnética , Período Pós-Parto , Gravidez
13.
PLoS One ; 15(8): e0237609, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833975

RESUMO

BACKGROUND: The role of maternal personality and perceived social support for peripartum changes in psychopathological symptoms remains unresolved. METHODS: In a regional-epidemiological sample of 306 women, depressive, anxiety, and stress symptoms were assessed three times during pregnancy and three times after delivery with the 21-item version of the Depression Anxiety Stress Scale. In pregnancy, the Big Five personality traits and perceived social support were assessed with the short version of the Big Five Inventory and the Social Support Questionnaire. RESULTS: Multilevel analyses revealed that depressive (b = -0.055) and stress (b = -0.047) symptoms decreased from early to late pregnancy. After delivery, anxiety symptoms were lower (two months postpartum: b = -0.193; four/ 16 months postpartum: b = -0.274), but stress symptoms were higher (two months postpartum: b = 0.468; four/ 16 months postpartum: b = 0.320) than during pregnancy. Across the peripartum period, more conscientious and more extraverted women experienced lower depressive and stress symptoms (b = -0.147 to -0.177), and more emotionally stable women experienced lower depressive, anxiety, and stress symptoms (b = -0.294 to -0.415). More emotionally stable women more strongly increased in anxiety during pregnancy (b = 0.019), and more extraverted women less strongly increased in depression after delivery (b = -0.010). Moreover, peripartum depressive, anxiety, and stress symptoms were lower in women with higher perceived social support (b = -0.225 to -0.308). CONCLUSIONS: Less emotionally stable, less conscientious, and less extraverted women and women with lower perceived social support seem to be at increased risk for peripartum psychopathological symptoms and might thus particularly profit from targeted prevention.


Assuntos
Transtornos de Ansiedade/epidemiologia , Depressão/epidemiologia , Mães/psicologia , Transtornos da Personalidade/epidemiologia , Período Pós-Parto/psicologia , Apoio Social , Estresse Psicológico/epidemiologia , Adolescente , Adulto , Transtornos de Ansiedade/psicologia , Depressão/psicologia , Feminino , Alemanha/epidemiologia , Humanos , Estudos Longitudinais , Transtornos da Personalidade/psicologia , Gravidez , Estudos Prospectivos , Estresse Psicológico/psicologia , Inquéritos e Questionários , Adulto Jovem
14.
PLoS One ; 15(8): e0237510, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810155

RESUMO

Periodontitis is a highly prevalent condition leading to a continuous destruction of tooth-supporting tissues. It increases the risk for various systemic diseases and adverse pregnancy outcomes. Therefore, screening for periodontitis is important. Screening measures can range from self-reported symptoms to clinical full-mouth periodontal examination. The hypothesis of our study was that self-reported parameters and clinical definition perform equally well in identifying periodontitis patients. The aim of this study was to develop, validate its internal consistency, and evaluate a self-reported instrument against periodontal clinical evaluation for diagnosis of periodontitis in a group of postpartum women, as well as to describe their periodontal status and the risk factors associated with periodontal disease. A cross-sectional study on postpartum women was conducted in a tertiary university hospital, from April 2018 to March 2019. Sociodemographic and behavioral data, periodontal clinical parameters, and self-reported periodontal perception were collected. A 16-item questionnaire was developed to obtain information about perceived periodontal alterations and oral hygiene habits. The utility of the questionnaire was tested against a periodontal diagnosis based on a full-mouth periodontal examination. The questionnaire was applied in 215 postpartum women aged 29.16±5.54 years (mean age (y) ± standard deviation) having the following periodontal status: 16 individuals without periodontal disease (7.44%), 32 individuals with gingivitis (14.88%), 19 individuals with mild periodontitis (8.84%), 132 individuals with moderate periodontitis (61.39%), and 16 individuals with severe periodontitis (7.44%). A significant association was observed between oral hygiene score, smoking status, and periodontal conditions (p<0.05). A significant association between the self-reported items related to "gum swelling", "halitosis", "previous periodontal diagnosis" and "previous periodontal treatment" with clinical periodontitis have been identified (p<0.05). Using self-reported questionnaires for detection of periodontal disease was ineffective in our studied population, since self-reported parameters and clinical definition do not appear to perform equally in identifying periodontitis cases. Clinical periodontal examination remains the gold standard for screening. Periodontitis was frequent in our group and the severity was significantly associated with the oral hygiene score and smoking. These results underline the necessity for periodontal clinical examination during pregnancy.


Assuntos
Doenças Periodontais/epidemiologia , Doenças Periodontais/etiologia , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/etiologia , Autorrelato , Adolescente , Adulto , Estudos Transversais , Europa Oriental/epidemiologia , Feminino , Gengivite/epidemiologia , Gengivite/etiologia , Halitose/epidemiologia , Halitose/etiologia , Humanos , Higiene Bucal/estatística & dados numéricos , Periodontite/epidemiologia , Periodontite/etiologia , Período Pós-Parto , Gravidez , Prevalência , Fatores de Risco , Romênia/epidemiologia , Autorrelato/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
15.
PLoS One ; 15(8): e0237852, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853242

RESUMO

Although improving postpartum and neonatal health is a key element of the Ethiopian health extension program, the burdens of postpartum and neonatal illnesses and healthcare-seeking in rural communities in Ethiopia are poorly characterized. Therefore, we aimed to assess the incidence and risk factors for these illnesses and measure the utilization of healthcare services. We conducted a prospective cohort study of 784 postpartum women and their 772 neonates in three randomly selected kebeles in rural southern Ethiopia. Eight home follow-up visits were conducted during the first 42 postpartum days, and six neonate follow-ups were conducted at the same home over the first 28 days of life. The Prentice, Williams, and Peterson's total time Cox-type survival model was used for analysis. We recorded 31 episodes of postpartum illness per 100 women-weeks (95% confidence interval [CI]: 30%, 32%) and 48 episodes of neonatal illness per 100 neonate-weeks (95% CI: 46%, 50%). Anemia occurred in 19% of women (95% CI: 17%, 22%) and low birth weight (<2,500g) in 15% of neonates (95% CI: 13%, 18%). However, only 5% of postpartum women (95% CI: 4%, 7%) and 4% of neonate (95% CI: 3%, 5%) reported utilizing healthcare services. Walking over 60 minutes to access healthcare was a factor of both postpartum illnesses (AHR = 2.61; 95% CI: 1.98, 3.43) and neonatal illnesses (AHR = 2.66; 95% CI: 2.12, 3.35)). Birth weight ≥2500g was identified factor of neonatal illnesses (AHR = 0.39; 95% CI: 0.33, 0.46). Compared with younger mothers, older mothers with sick newborns (AHR = 1.22; 95% CI: 1.00, 1.50) or postpartum illnesses (AHR = 1.40; 95% CI: 1.03, 1.89) were more likely to seek healthcare. Reasons for not utilizing healthcare services included a belief that the illnesses were not serious or would resolve on their own, little confidence in the healthcare institutions, and the inability to afford the cost. The burden of postpartum and neonatal illnesses in rural communities of southern Ethiopia remains high. Unfortunately, few participants utilized healthcare services. We recommend strengthening the health system that enables identifying, managing, treating, and referring maternal and neonatal illnesses and provide reasonable healthcare at the community level.


Assuntos
Utilização de Instalações e Serviços , Serviços de Saúde , Doenças do Recém-Nascido/epidemiologia , Período Pós-Parto/fisiologia , Transtornos Puerperais/epidemiologia , População Rural , Adolescente , Adulto , Peso ao Nascer , Estudos de Coortes , Etiópia/epidemiologia , Feminino , Humanos , Incidência , Recém-Nascido , Masculino , Modelos de Riscos Proporcionais , Adulto Jovem
16.
Cochrane Database Syst Rev ; 8: CD011625, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32761813

RESUMO

BACKGROUND: Postpartum constipation, with symptoms, such as pain or discomfort, straining, and hard stool, is a common condition affecting mothers. Haemorrhoids, pain at the episiotomy site, effects of pregnancy hormones, and haematinics used in pregnancy can increase the risk of postpartum constipation. Eating a high-fibre diet and increasing fluid intake are usually encouraged. Although laxatives are commonly used in relieving constipation, the effectiveness and safety of available interventions for preventing postpartum constipation should be ascertained. This is an update of a review first published in 2015. OBJECTIVES: To evaluate the effectiveness and safety of interventions for preventing postpartum constipation. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, and two trials registers ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (7 October 2019), and screened reference lists of retrieved trials. SELECTION CRITERIA: We considered all randomised controlled trials (RCTs) comparing any intervention for preventing postpartum constipation versus another intervention, placebo, or no intervention in postpartum women. Interventions could include pharmacological (e.g. laxatives) and non-pharmacological interventions (e.g. acupuncture, educational and behavioural interventions). Quasi-randomised trials and cluster-RCTs were eligible for inclusion; none were identified. Trials using a cross-over design were not eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the results of the search to select potentially relevant trials, extracted data, assessed risk of bias, and the certainty of the evidence, using the GRADE approach. We did not pool results in a meta-analysis, but reported them per study. MAIN RESULTS: We included five trials (1208 postpartum mothers); three RCTs and two quasi-RCTs. Four trials compared a laxative with placebo; one compared a laxative plus a bulking agent versus the same laxative alone, in women who underwent surgical repair of third degree perineal tears. Trials were poorly reported, and four of the five trials were published over 40 years ago. We judged the risk of bias to be unclear for most domains. Overall, we found a high risk of selection and attrition bias. Laxative versus placebo We included four trials in this comparison. Two of the trials examined the effects of laxatives that are no longer used; one has been found to have carcinogenic properties (Danthron), and the other is not recommended for lactating women (Bisoxatin acetate); therefore, we did not include their results in our main findings. None of the trials included in this comparison assessed our primary outcomes: pain or straining on defecation, incidence of postpartum constipation, or quality of life; or many of our secondary outcomes. A laxative (senna) may increase the number of women having their first bowel movement within 24 hours after delivery (risk ratio (RR) 2.90, 95% confidence interval (CI) 2.24 to 3.75; 1 trial, 471 women; low-certainty evidence); may have little or no effect on the number of women having their first bowel movement on day one after delivery (RR 0.94, 95% CI 0.72 to 1.22; 1 trial, 471 women; very low-certainty evidence); may reduce the number of women having their first bowel movement on day two (RR 0.23, 95% CI 0.11 to 0.45; 1 trial, 471 women; low-certainty evidence); and day three (RR 0.05, 95% CI 0.00 to 0.89; 1 trial, 471 women; low-certainty evidence); and may have little or no effect on the number of women having their first bowel movement on day four after delivery (RR 0.22, 95% CI 0.03 to 1.87; 1 trial, 471 women; very low-certainty evidence), but some of the evidence is very uncertain. Adverse effects were poorly reported. Low-certainty evidence suggests that the laxative (senna) may increase the number of women experiencing abdominal cramps (RR 4.23, 95% CI 1.75 to 10.19; 1 trial, 471 women). Very low-certainty evidence suggests that laxatives taken by the mother may have little or no effect on loose stools in the baby (RR 0.62, 95% CI 0.16 to 2.41; 1 trial, 281 babies); or diarrhoea (RR 2.46, 95% CI 0.23 to 26.82; 1 trial, 281 babies). Laxative plus bulking agent versus laxative only Very low-certainty evidence from one trial (147 women) suggests no evidence of a difference between these two groups of women who underwent surgical repair of third degree perineal tears; only median and range data were reported. The trial also reported no evidence of a difference in the incidence of postpartum constipation (data not reported), but did not report on quality of life. Time to first bowel movement was reported as a median (range); very low-certainty evidence suggests little or no difference between the two groups. A laxative plus bulking agent may increase the number of women having any episode of faecal incontinence during the first 10 days postpartum (RR 1.81, 95% CI 1.01 to 3.23; 1 trial, 147 women; very low-certainty evidence). The trial did not report on adverse effects of the intervention on babies, or many of our secondary outcomes. AUTHORS' CONCLUSIONS: There is insufficient evidence to make general conclusions about the effectiveness and safety of laxatives for preventing postpartum constipation. The evidence in this review was assessed as low to very low-certainty evidence, with downgrading decisions based on limitations in study design, indirectness and imprecision. We did not identify any trials assessing educational or behavioural interventions. We identified four trials that examined laxatives versus placebo, and one that examined laxatives versus laxatives plus stool bulking agents. Further, rigorous trials are needed to assess the effectiveness and safety of laxatives during the postpartum period for preventing constipation. Trials should assess educational and behavioural interventions, and positions that enhance defecation. They should report on the primary outcomes from this review: pain or straining on defecation, incidence of postpartum constipation, quality of life, time to first bowel movement after delivery, and adverse effects caused by the intervention, such as: nausea or vomiting, pain, and flatus.


Assuntos
Constipação Intestinal/prevenção & controle , Fibras na Dieta/uso terapêutico , Laxantes/uso terapêutico , Transtornos Puerperais/prevenção & controle , Adulto , Defecação , Fibras na Dieta/efeitos adversos , Feminino , Humanos , Laxantes/efeitos adversos , Períneo/lesões , Período Pós-Parto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
17.
Cochrane Database Syst Rev ; 8: CD013679, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32813276

RESUMO

BACKGROUND: The global burden of poor maternal, neonatal, and child health (MNCH) accounts for more than a quarter of healthy years of life lost worldwide. Targeted client communication (TCC) via mobile devices (MD) (TCCMD) may be a useful strategy to improve MNCH. OBJECTIVES: To assess the effects of TCC via MD on health behaviour, service use, health, and well-being for MNCH. SEARCH METHODS: In July/August 2017, we searched five databases including The Cochrane Central Register of Controlled Trials, MEDLINE and Embase. We also searched two trial registries. A search update was carried out in July 2019 and potentially relevant studies are awaiting classification. SELECTION CRITERIA: We included randomised controlled trials that assessed TCC via MD to improve MNCH behaviour, service use, health, and well-being. Eligible comparators were usual care/no intervention, non-digital TCC, and digital non-targeted client communication. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane, although data extraction and risk of bias assessments were carried out by one person only and cross-checked by a second. MAIN RESULTS: We included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low-, middle- or high-income countries (LMHIC); pregnant and postpartum women living with HIV (three trials carried out in one lower middle-income country); and parents of children under the age of five years (13 trials conducted in LMHIC). Most interventions (18) were delivered via text messages alone, one was delivered through voice calls only, and the rest were delivered through combinations of different communication channels, such as multimedia messages and voice calls. Pregnant and postpartum women TCCMD versus standard care For behaviours, TCCMD may increase exclusive breastfeeding in settings where rates of exclusive breastfeeding are less common (risk ratio (RR) 1.30, 95% confidence intervals (CI) 1.06 to 1.59; low-certainty evidence), but have little or no effect in settings where almost all women breastfeed (low-certainty evidence). For use of health services, TCCMD may increase antenatal appointment attendance (odds ratio (OR) 1.54, 95% CI 0.80 to 2.96; low-certainty evidence); however, the CI encompasses both benefit and harm. The intervention may increase skilled attendants at birth in settings where a lack of skilled attendants at birth is common (though this differed by urban/rural residence), but may make no difference in settings where almost all women already have a skilled attendant at birth (OR 1.00, 95% CI 0.34 to 2.94; low-certainty evidence). There were uncertain effects on maternal and neonatal mortality and morbidity because the certainty of the evidence was assessed as very low. TCCMD versus non-digital TCC (e.g. pamphlets) TCCMD may have little or no effect on exclusive breastfeeding (RR 0.92, 95% CI 0.79 to 1.07; low-certainty evidence). TCCMD may reduce 'any maternal health problem' (RR 0.19, 95% CI 0.04 to 0.79) and 'any newborn health problem' (RR 0.52, 95% CI 0.25 to 1.06) reported up to 10 days postpartum (low-certainty evidence), though the CI for the latter includes benefit and harm. The effect on health service use is unknown due to a lack of studies. TCCMD versus digital non-targeted communication No studies reported behavioural, health, or well-being outcomes for this comparison. For use of health services, there are uncertain effects for the presence of a skilled attendant at birth due to very low-certainty evidence, and the intervention may make little or no difference to attendance for antenatal influenza vaccination (RR 1.05, 95% CI 0.71 to 1.58), though the CI encompasses both benefit and harm (low-certainty evidence). Pregnant and postpartum women living with HIV TCCMD versus standard care For behaviours, TCCMD may make little or no difference to maternal and infant adherence to antiretroviral (ARV) therapy (low-certainty evidence). For health service use, TCC mobile telephone reminders may increase use of antenatal care slightly (mean difference (MD) 1.5, 95% CI -0.36 to 3.36; low-certainty evidence). The effect on the proportion of births occurring in a health facility is uncertain due to very low-certainty evidence. For health and well-being outcomes, there was an uncertain intervention effect on neonatal death or stillbirth, and infant HIV due to very low-certainty evidence. No studies reported on maternal mortality or morbidity. TCCMD versus non-digital TCC The effect is unknown due to lack of studies reporting this comparison. TCCMD versus digital non-targeted communication TCCMD may increase infant ARV/prevention of mother-to-child transmission treatment adherence (RR 1.26, 95% CI 1.07 to 1.48; low-certainty evidence). The effect on other outcomes is unknown due to lack of studies. Parents of children aged less than five years No studies reported on correct treatment, nutritional, or health outcomes. TCCMD versus standard care Based on 10 trials, TCCMD may modestly increase health service use (vaccinations and HIV care) (RR 1.21, 95% CI 1.08 to 1.34; low-certainty evidence); however, the effect estimates varied widely between studies. TCCMD versus non-digital TCC TCCMD may increase attendance for vaccinations (RR 1.13, 95% CI 1.00 to 1.28; low-certainty evidence), and may make little or no difference to oral hygiene practices (low-certainty evidence). TCCMD versus digital non-targeted communication TCCMD may reduce attendance for vaccinations, but the CI encompasses both benefit and harm (RR 0.63, 95% CI 0.33 to 1.20; low-certainty evidence). No trials in any population reported data on unintended consequences. AUTHORS' CONCLUSIONS: The effect of TCCMD for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. High-quality, adequately powered trials and cost-effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality.


Assuntos
Telefone Celular , Saúde da Criança/normas , Comunicação , Necessidades e Demandas de Serviços de Saúde , Saúde do Lactente/normas , Saúde Materna/normas , Aleitamento Materno/estatística & dados numéricos , Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Parto Obstétrico/normas , Feminino , Infecções por HIV/tratamento farmacológico , Comportamentos Relacionados com a Saúde , Nível de Saúde , Humanos , Lactente , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Saúde Materna/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Período Pós-Parto , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Melhoria de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Envio de Mensagens de Texto
18.
PLoS One ; 15(8): e0237225, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817619

RESUMO

Diet is believed to play a major role in maternal recovery, postpartum weight retention (PPWR) is one of the challenges for Chinese women. However, the association between puerperal women's diet and PPWR remained unclear and complicated in China. The study assessed the dietary quality of puerperal women using adjusted Chinese Dietary Balance Index-16 (DBI-16) and explored its associations with PPWR. Participants were enrolled in the Mother-Infant Cohort Study of China. Dietary intake and demographic characteristics were obtained by a semi-quantitative food frequency questionnaire and a self-designed questionnaire at 0-3 months postpartum. PPWR was calculated by the weight difference at 0-3months and 6-8months postpartum minus pre-pregnancy weight. Dietary quality was assessed using adjusted DBI-16. 316 puerperal women were enrolled. According to adjusted DBI-16, 84.8% of participants had an insufficient dietary intake (vegetables 84.8%, fruits 91.8%, dairy 87.3%, soybean 61.4% and aquatic foods 79.4%, respectively), 67.1% had an excessive intake (cereals 60%, meat 57.3% and eggs 64.9%, respectively), 98.4% had an imbalanced diet consumption. PPWR at 0-3, and 6-8 months were 6.0 (±5.1) kg and 5.2 (±7.7) kg, and the percentage of PPWR (≥5kg) were 63.0% and 52.8% respectively. Multivariable linear regression showed the intake of fish and shrimp at 0-3 months postpartum was negatively associated with PPWR at 6-8 months (ß = -0.114, SE = 0.279, p < 0.05). The diet quality of Chinese puerperal women was unreasonable and imbalanced. Fish intake tended to be a favorable factor for postpartum weight loss.


Assuntos
Dieta , Ganho de Peso na Gestação , Adulto , China , Ingestão de Alimentos , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Período Pós-Parto , Gravidez , Adulto Jovem
19.
PLoS One ; 15(8): e0238232, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853233

RESUMO

INTRODUCTION: Despite the broad success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV care engagement during the pregnancy and postpartum periods is suboptimal. This study explored the perspectives of women who experienced challenges engaging in PMTCT care, in order to better understand factors that contribute to poor retention and to identify opportunities to improve PMTCT services. METHODS: We conducted in-depth interviews with 12 postpartum women to discuss their experiences with PMTCT care. We used data from a larger longitudinal cohort study conducted in five PMTCT clinics in Moshi, Tanzania to identify women with indicators of poor care engagement (i.e., medication non-adherence, inconsistent clinic attendance, or high viral load). Women who met one of these criteria were contacted by telephone and invited to complete an interview. Data were analyzed using applied thematic analysis. RESULTS: We observed a common pathway that fear of stigma contributed to a lack of HIV disclosure and reduced social support for seeking HIV care. Women commonly distrusted the results of their initial HIV test and reported medication side effects after care initiation. Women also reported barriers in the health system, including difficult-to-navigate clinic transfer policies and a lack of privacy and confidentiality in service provision. When asked how care might be improved, women felt that improved counseling and follow-up, affirming patient-provider interactions, and peer treatment supporters would have a positive effect on care engagement. CONCLUSION: In order to improve the impact of PMTCT programs, there is a need to implement active tracking and follow-up of patients, targeting individuals with evidence of poor care engagement. Tailored supportive intervention approaches may help patients to cope with both the perceived and actual impacts of HIV stigma, including navigating disclosures to loved ones and accessing social support. Fostering HIV acceptance is likely to facilitate commitment to long-term treatment.


Assuntos
Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Adulto , Estudos de Coortes , Aconselhamento/métodos , Revelação , Feminino , Humanos , Estudos Longitudinais , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Período Pós-Parto/fisiologia , Período Pós-Parto/psicologia , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/psicologia , Pesquisa Qualitativa , Estigma Social , Apoio Social , Tanzânia , Carga Viral/fisiologia , Adulto Jovem
20.
Am J Perinatol ; 37(12): 1271-1279, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32757185

RESUMO

OBJECTIVE: This study was aimed to describe the hospitalization and early postpartum psychological experience for asymptomatic obstetric patients tested for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) as part of a universal testing program and report the impact of this program on labor and delivery health care workers' job satisfaction and workplace anxiety. STUDY DESIGN: This is a cohort study of asymptomatic pregnant women who underwent SARS-CoV-2 testing between April 13, 2020 and April 26, 2020. Semistructured interviews were conducted via telephone at 1 and 2 weeks posthospitalization to assess maternal mental health. Depression screening was conducted using the patient health questionnaire-2 (PHQ-2). An online survey of labor and delivery health care workers assessed job satisfaction and job-related anxiety before and during the novel coronavirus disease 2019 (COVID-19) pandemic, as well as employees' subjective experience with universal testing. Patient and employee responses were analyzed for recurring themes. RESULTS: A total of 318 asymptomatic women underwent SARS-CoV-2 testing during this 2-week period. Six of the eight women (75%) who tested positive reported negative in-hospital experiences secondary to perceived lack of provider and partner support and neonatal separation after birth. Among the 310 women who tested negative, 34.4% of multiparous women reported increased postpartum anxiety compared with their prior deliveries due to concerns about infectious exposure in the hospital and lack of social support. Only 27.6% of women, tested negative, found their test result to be reassuring. Job satisfaction and job-related anxiety among health care workers were negatively affected. Universal testing was viewed favorably by the majority of health care workers despite concerns about delays or alterations in patient care and maternal and neonatal separation. CONCLUSION: Universal testing for SARS-CoV-2 in obstetric units has mixed effects on maternal mental health but is viewed favorably by labor and delivery employees. Ongoing evaluation of new testing protocols is paramount to balance staff and patient safety with quality and equality of care. KEY POINTS: · Women with SARS-CoV-2 had a negative hospital experience.. · A negative SARS-CoV-2 test was not reassuring for patients.. · COVID-19 negatively impacts healthcare workers' well-being..


Assuntos
Atitude Frente a Saúde , Infecções por Coronavirus/diagnóstico , Pessoal de Saúde/psicologia , Programas de Rastreamento/psicologia , Isolamento de Pacientes/psicologia , Pneumonia Viral/diagnóstico , Período Pós-Parto/psicologia , Gestantes/psicologia , Apoio Social , Adulto , Ansiedade , Infecções Assintomáticas/psicologia , Atitude do Pessoal de Saúde , Betacoronavirus , Técnicas de Laboratório Clínico , Feminino , Hospitalização , Humanos , Recém-Nascido , Satisfação no Emprego , Tocologia , Enfermeiras e Enfermeiros/psicologia , Enfermagem Obstétrica , Estresse Ocupacional/psicologia , Pandemias , Parto , Questionário de Saúde do Paciente , Médicos/psicologia , Gravidez
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