RESUMO
Este artigo analisou a percepção e os sentimentos de casais sobre o atendimento recebido nos serviços de saúde acessados em função de perda gestacional (óbito fetal ante e intraparto). O convite para a pesquisa foi divulgado em mídias sociais (Instagram e Facebook). Dos 66 casais que contataram a equipe, 12 participaram do estudo, cuja coleta de dados ocorreu em 2018. Os casais responderam conjuntamente a uma ficha de dados sociodemográficos e uma entrevista semiestruturada, realizada presencialmente (n=4) ou por videochamada (n=8). Os dados foram gravados em áudio e posteriormente transcritos. A Análise Temática indutiva das entrevistas identificou cinco temas: sentimento de impotência, iatrogenia vivida nos serviços, falta de cuidado em saúde mental, não reconhecimento da perda como evento com consequências emocionais negativas, e características do bom atendimento. Os achados demonstraram situações de violência, comunicação deficitária, desvalorização das perdas precoces, falta de suporte para contato com o bebê falecido e rotinas pouco humanizadas, especialmente durante a internação após a perda. Para aprimorar a assistência às famílias enlutadas, sugere-se qualificação profissional, ampliação da visibilidade do tema entre diferentes atores e reorganização dos serviços, considerando uma diretriz clínica para atenção ao luto perinatal, com destaque para o fortalecimento da inserção de equipes de saúde mental no contexto hospitalar.(AU)
This study analyzed couples' perceptions and feelings about pregnancy loss care (ante and intrapartum fetal death). A research invitation was published on social media (Instagram and Facebook) and data collection took place in 2018. Of the 66 couples who contacted the research team, 12 participated in the study by filling a sociodemographic questionnaire and answering a semi-structured interview in person (n=04) or by video call (n=08). All interviews were audio recorded, transcribed, and examined by Inductive Thematic Analysis, which identified five themes: feelings of impotence, iatrogenic experiences in health services, lack of mental health care, not recognizing pregnancy loss as an emotionally overwhelming event, and aspects of good healthcare. Analysis showed experiences of violence, poor communication, devaluation of early losses, lack of support for contact with the deceased baby, and dehumanizing routines, especially during hospitalization after loss. Professional qualification, extended pregnancy loss visibility among different stakeholders, and reorganization of health services are needed to improve the care offered to grieving families, considering a clinical guideline for perinatal grief care with emphasis on strengthening the insertion of mental health teams in the hospital context.(AU)
Este estudio analizó las percepciones y sentimientos de parejas sobre la atención recibida en los servicios de salud a los que accedieron debido a la pérdida del embarazo (muerte fetal ante e intraparto). La invitación al estudio se publicó en las redes sociales (Instagram y Facebook). De las 66 parejas que se contactaron con el equipo, 12 participaron en el estudio, cuya recolección de datos se realizó en 2018. Las parejas respondieron un formulario de datos sociodemográficos y realizaron una entrevista semiestructurada presencialmente (n=4) o por videollamada (n=08). Los datos se grabaron en audio para su posterior transcripción. El análisis temático inductivo identificó cinco temas: Sentimiento de impotencia, experiencias iatrogénicas en los servicios, falta de atención a la salud mental, falta de reconocimiento de la pérdida como un evento con consecuencias emocionales negativas y características de buena atención. Los hallazgos evidenciaron situaciones de violencia, comunicación deficiente, desvalorización de las pérdidas tempranas, falta de apoyo para el contacto con el bebé fallecido y rutinas poco humanizadas, especialmente durante la hospitalización tras la pérdida. Para mejorar la atención a las familias en duelo, se sugiere capacitación profesional, ampliación de la visibilidad del tema entre los diferentes actores y reorganización de los servicios, teniendo en cuenta una guía clínica para la atención del duelo perinatal, enfocada en fortalecer la inserción de los equipos de salud mental en el contexto hospitalario.(AU)
Assuntos
Humanos , Masculino , Feminino , Gravidez , Adulto , Pessoa de Meia-Idade , Serviços de Saúde da Criança , Saúde Mental , Humanização da Assistência , Morte Fetal , Dor , Pais , Pediatria , Perinatologia , Doenças Placentárias , Preconceito , Cuidado Pré-Natal , Psicologia , Psicologia Médica , Política Pública , Qualidade da Assistência à Saúde , Reprodução , Síndrome , Anormalidades Congênitas , Tortura , Contração Uterina , Traumatismos do Nascimento , Auxílio-Maternidade , Trabalho de Parto , Prova de Trabalho de Parto , Adaptação Psicológica , Aborto Espontâneo , Cuidado da Criança , Enfermagem Materno-Infantil , Recusa em Tratar , Saúde da Mulher , Satisfação do Paciente , Poder Familiar , Licença Parental , Qualidade, Acesso e Avaliação da Assistência à Saúde , Privacidade , Depressão Pós-Parto , Credenciamento , Afeto , Choro , Curetagem , Técnicas de Reprodução Assistida , Acesso à Informação , Ética Clínica , Parto Humanizado , Ameaça de Aborto , Negação em Psicologia , Fenômenos Fisiológicos da Nutrição Pré-Natal , Parto , Dor do Parto , Nascimento Prematuro , Lesões Pré-Natais , Mortalidade Fetal , Descolamento Prematuro da Placenta , Violência contra a Mulher , Aborto , Acolhimento , Ética Profissional , Natimorto , Estudos de Avaliação como Assunto , Cordão Nucal , Resiliência Psicológica , Fenômenos Reprodutivos Fisiológicos , Medo , Doenças Urogenitais Femininas e Complicações na Gravidez , Fertilidade , Doenças Fetais , Uso Indevido de Medicamentos sob Prescrição , Esperança , Educação Pré-Natal , Coragem , Trauma Psicológico , Profissionalismo , Sistemas de Apoio Psicossocial , Frustração , Tristeza , Respeito , Angústia Psicológica , Violência Obstétrica , Apoio Familiar , Obstetra , Culpa , Acessibilidade aos Serviços de Saúde , Maternidades , Complicações do Trabalho de Parto , Trabalho de Parto Induzido , Ira , Solidão , Amor , Tocologia , Mães , Cuidados de EnfermagemRESUMO
Objectives: To determine the proportion of successful vaginal deliveries in women with prior cesarean section; to describe maternal and perinatal complications; and to examine the factors associated with vaginal delivery. Materials and methods: Descriptive cross-sectional study of women with a history of cesarean delivery, gestational age of more than 24 weeks, singleton live fetuses, with prior vaginal delivery who received care in a high complexity public institution in 2019. Patients with a history of more than one cesarean section or myomectomy were excluded. Consecutive sampling was used. Sociodemographic and obstetric variables, delivery route and maternal and perinatal complications were measured. A descriptive analysis as well as a multivariate exploratory analysis of the factors associated with successful vaginal delivery were carried out. Results: Among 286 pregnant women included, the percentage of successful vaginal deliveries was 74.5 %. Maternal complications were identified in 3.2 % of vaginal delivery cases and in 6.8 % of cesarean births. Complications occurred in 1.3 % of all live neonates; there were 2 perinatal deaths. An association was found between successful vaginal delivery and a history of prior vaginal delivery (OR: 2.7; 95 % CI: 1.15-6.29); a Bishop score greater than 6 (OR: 2.2; 95 % CI: 1.03-4.56); spontaneous labor initiation (OR: 4.5; IC 95 % CI: 2.07-9.6); and maternal age under 30 years (OR:2.28; 95 % CI: 1.2-4.2). Conclusions: Vaginal delivery is a safe option to consider in patients with prior cesarean section, in particular in cases of spontaneous labor initiation or prior vaginal delivery. Prospective cohorts are needed in order to confirm these findings.
Objetivos: determinar la proporción de parto vaginal exitoso en mujeres con cesárea previa, describir las complicaciones maternas y perinatales, y realizar una aproximación a los factores asociados al parto vaginal. Materiales y métodos: estudio de corte transversal descriptivo. Se incluyeron mujeres con antecedente de un parto por cesárea, con edad gestacional mayor a 24 semanas y fetos únicos vivos que tuvieron prueba de parto vaginal, atendidas en una institución pública de alta complejidad en 2019. Se excluyeron aquellas pacientes con antecedente de más de una cesárea o miomectomía. Muestreo consecutivo. Se midieron variables sociodemográficas, obstétricas, vía del parto y complicaciones maternas y perinatales. Se hace análisis descriptivo y un análisis exploratorio multivariado de los factores asociados al parto vaginal exitoso. Resultados: de 286 gestantes incluidas, el porcentaje de éxito de parto vaginal fue del 74,5 %. Se identificaron complicaciones maternas en el 3,2 % de los partos vaginales y en el 6,8 % de las cesáreas. El 1,3 % de los recién nacidos tuvo alguna complicación. Hubo 2 muertes perinatales. Se encontró asociación entre parto vaginal exitoso y tener antecedente de parto vaginal (OR: 2,7; IC 95 %: 1,15-6,29); puntaje de Bishop mayor de 6 (OR: 2,2; IC 95 %: 1,03-4,56); inicio de trabajo de parto espontáneo (OR: 4,5; IC 95 %: 2,07-9,6); y edad materna menor de 30 años (OR: 2,28; IC 95 %: 1,2-4,2). Conclusiones: el parto vaginal es una opción segura para considerar en pacientes con cesárea anterior, especialmente si inician trabajo de parto espontáneo o han tenido un parto vaginal previamente. Se requieren cohortes prospectivas para confirmar estos hallazgos.
Assuntos
Cesárea , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Estudos Transversais , Parto Obstétrico , Estudos Prospectivos , Trabalho de Parto , Resultado da GravidezRESUMO
AIM: There is much discussion about the advantages and disadvantages of a trial of labor after cesarean (TOLAC). Some data suggest the greater the likelihood of success, the lower the risks of TOLAC. Our goal was to identify clinical and demographic variables associated with a failed TOLAC, available at admission for spontaneous labor and until 3 h later, with the aim of building two scores for risk of failed TOLAC. METHODS: This is a nested case-control study with live births to women with one previous cesarean, in a public Brazilian teaching hospital. Preterm, induction, noncephalic presentations, twins, fetal malformations were excluded. Cases were failed TOLAC, and controls, the successful TOLAC. It was accessed the association of the cases with 20 variables (P < 0.05). Associated variables were tested in multivariate analysis to build the scores, which were internally validated. RESULTS: We included 260 TOLAC, 42 cases and 218 controls. We found 11 variables associated with failed TOLAC. In the score to be applied at admission, we included hypertension, fundal height, previous vaginal birth and dilatation at admission. In the second score hypertension, fundal height at admission, membrane status and difference in dilatation 3 h after admission. Both scores presented good performance in the receiver-operator curve (areas under curve: 0.73 and 0.84, respectively). Both scores were translated into nomograms for clinical use. CONCLUSION: Two scores were built for risk of failed TOLAC, to be applied at admission and 3 h later. We believe that choosing the more favorable cases makes risks of TOLAC lower.
Assuntos
Complicações do Trabalho de Parto/etiologia , Admissão do Paciente/estatística & dados numéricos , Medição de Risco/métodos , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea/efeitos adversos , Adulto , Brasil , Estudos de Casos e Controles , Recesariana/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Análise Multivariada , Gravidez , Gravidez de Alto Risco , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To assess the hospital, maternal, and obstetric characteristics associated with elective repeat cesarean delivery (ERCD) among women eligible for trial of labor after cesarean (TOLAC) delivery in Brazil. METHODS: The present data were retrieved from the Birth in Brazil study, a national hospital-based cohort study conducted during 2011-2012. Data were collected from medical records and by interview. Univariate and hierarchical multiple logistic regression analyses were performed to analyze factors associated with ERCD among women with a previous cesarean delivery who were eligible for TOLAC. RESULTS: Among 2295 women considered eligible for TOLAC, 1516 (66.1%) had an ERCD; the overall cesarean delivery rate was 79.4%. In the private sector, almost all deliveries (95.3%) were performed by ERCD. In the public sector, ERCD was associated with socioeconomic (more years of schooling), obstetric (women's preference, no previous vaginal delivery, macrosomia), and hospital (mixed hospital, location in noncapital city, fewer than 1500 deliveries per year) characteristics. CONCLUSION: The ERCD rate in Brazil was high even in a low-risk group, indicating that nonclinical factors may be driving the decision for cesarean delivery. Efforts aiming to reduce cesarean deliveries in Brazil should target women with a previous cesarean delivery.
Assuntos
Recesariana/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Prova de Trabalho de Parto , Adulto , Brasil , Tomada de Decisão Clínica , Estudos de Coortes , Escolaridade , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Macrossomia Fetal/cirurgia , Humanos , Preferência do Paciente , Gravidez , Fatores de Risco , Nascimento Vaginal Após Cesárea/estatística & dados numéricos , Adulto JovemAssuntos
Cesárea/estatística & dados numéricos , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea/estatística & dados numéricos , Adolescente , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária , Nascimento Vaginal Após Cesárea/classificação , Adulto JovemRESUMO
OBJECTIVE: To determine whether obesity is an independent risk factor for cesarean delivery in Martinique. METHODS: A retrospective study was performed using data for deliveries that occurred at the University Hospital of Fort de France between January and September 2010. Women were divided into four groups on the basis of body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters; < 25 [group 1], 25-29 [group 2], 30-39 [group 3], and ≥ 40 [group 4]). Independent risk factors for cesarean delivery were identified through multivariate analysis. RESULTS: Overall, 1286 women were included. Mean weight gain was lower in groups 2 (9.9 kg, 95% CI 9.2-10.7), 3 (5.7 kg, 4.7-6.7), and 4 (1.0 kg,-1.5 to 3.5), than in group 1 (12.3 kg, 11.9-12.7; P < 0.001 for all). In univariate analysis, cesarean deliveries were more frequent among nulliparous women in group 2 (P = 0.007) and group 3 (P = 0.053) than among those in group 1. In multivariate analysis, BMI was not associated with cesarean delivery (BMI 25-29: adjusted odds ratio 0.64, 95% CI 0.33-1.25; BMI ≥ 30: 0.61, 0.29-1.39). CONCLUSION: Obesity was not an independent risk factor for cesarean delivery. Weight control and a positive attitude towards trial of labor in obese women could have led to the findings.
Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/métodos , Obesidade/complicações , Complicações do Trabalho de Parto/etiologia , Complicações na Gravidez/etiologia , Adulto , População Negra , Índice de Massa Corporal , Feminino , Humanos , Martinica , Análise Multivariada , Razão de Chances , Paridade , Gravidez , Estudos Retrospectivos , Fatores de Risco , Prova de Trabalho de Parto , Aumento de PesoRESUMO
Objective. To describe trends, geographic distribution, and risk factors for cesarean deliveries in Brazil in 2000–2011, and to determine if efforts to curtail rates have had a measurable impact. Methods. This was an observational study using nationwide information from the Department of Informatics of the Unified Health System (DATASUS). Individual level analyses were based on data regarding maternal education, age, parity, and skin color. Ecological analyses at the level of 431 health districts investigated the relationships with health facility density and poverty level. Results. Cesarean rates increased markedly, from 37.9% in 2000 to 53.9% in 2011. Preliminary results from 2012 showed a rate of 55.8%, with the richest geographic areas showing the highest rates. Rates at the municipal level varied from 9%–96%. Cesareans were more common in women with higher education, white skin color, older age, and in primiparas. In the ecological analyses, the number of health facilities per 1 000 population was strongly and positively correlated with cesarean rates, with an increase of 16.1 percentage points (95% Confidence Interval [95%CI] = 4.3–17.8) for each facility. An increase of 1 percentage point in the poverty rate was associated with a decline of 0.5 percentage point in cesarean rates (95%CI = 0.5–0.6). Conclusions. The strong associations with maternal education and health facility density suggest that the vast majority of cesareans are not medically indicated. A number of policies and programs have been launched to counteract this trend, but have had virtually no impact.
Objetivo. Describir las tendencias, la distribución geográfica, y los factores de riesgo de parto por cesárea en el Brasil durante el período del 2000 al 2011, y determinar si las iniciativas dirigidas a reducir las tasas de cesáreas han tenido una repercusión cuantificable. Métodos. Se trata de un estudio de observación que utilizó información a escala nacional del Departamento de Informática del Sistema Unificado de Salud (DATASUS). Los análisis a nivel individual se basaron en datos sobre el nivel de formación materna, la edad, la paridad y el color de la piel. Se investigaron las relaciones con la densidad de establecimientos de salud y el nivel de pobreza mediante análisis ecológicos a nivel de 431 distritos de salud. Resultados. Las tasas de cesáreas aumentaron notablemente, de 37,9% en el 2000 a 53,9% en el 2011. Los resultados preliminares del 2012 mostraron una tasa de 55,8%, con tasas más elevadas en las zonas geográficas más ricas. Las tasas a escala municipal variaron de 9 a 96%. Los partos por cesárea fueron más frecuentes en las mujeres blancas, en las que tenían un mayor nivel de formación, en las de mayor edad y en las primíparas. En los análisis ecológicos, el número de establecimientos de salud por 1 000 habitantes se correlacionó intensa y positivamente con la tasa de cesáreas, con un incremento de 16,1 puntos porcentuales (intervalo de confianza (IC) de 95% = 4,3–17,8) para cada establecimiento. Un aumento de un punto porcentual en la tasa de pobreza se asociaba con una disminución de medio punto porcentual en la tasa de cesáreas (IC de 95% = 0,5–0,6). Conclusiones. Las intensas asociaciones con el nivel de formación materna y la densidad de establecimientos de salud indican que la mayor parte de las cesáreas no están indicadas médicamente. Se han puesto en marcha diversos programas y políticas dirigidos a contrarrestar esta tendencia, pero prácticamente no han tenido ninguna repercusión.
Assuntos
Cesárea , Parto Obstétrico , Prova de Trabalho de Parto , Fatores Socioeconômicos , Saúde da Criança , Saúde Materna , Cesárea , Parto Obstétrico , Prova de Trabalho de Parto , Fatores Socioeconômicos , Saúde Materno-Infantil , Brasil , BrasilAssuntos
Cesárea/métodos , Medicina Baseada em Evidências , Cesárea/efeitos adversos , Cesárea/mortalidade , Recesariana/estatística & dados numéricos , Ensaios Clínicos Controlados como Assunto , Feminino , Humanos , Recém-Nascido , Estudos Observacionais como Assunto , Gravidez , Resultado da Gravidez , Medição de Risco , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea/estatística & dados numéricosRESUMO
UNLABELLED: BAKCGROUND: Caesarean section is the main proceedings for ending of pregnancy in the world, and currently represents a public health problem. Some factors that benefit the likelihood of vaginal birth after a previous C-section have been described in literature, with scoring tools designed to predict success for trial of labor after a previous cesarean. There are few studies that identify predictors of success for vaginal delivery in Latin-American patients. OBJECTIVE: To identify predictive factors associated to vaginal delivery success in patients with a prior cesarean delivery. MATERIAL AND METHOD: Case-control study. We included patients with one previous cesarean delivery admitted at our hospital. The variables analyzed with a logistic regression system to predict vaginal delivery success probabilities. RESULTS: A total of 11 60 patients were included, 668 underwent C-section (considered control group), and 492 patients had a vaginal delivery (considered study group). The Factors associated to vaginal birth after cesarean delivery were maternal age (25.1±5.4 vs 24.7±5.5 years old, OR 0.967, p<0.05), fetal weight (3,253±389 vs 3,383±452 g, OR 0.99, p<0.05), previous vaginal delivery (49 vs 1 8.4%, OR 2.97, p<0.05) and spontaneous labor (90.8 vs 74.1%, OR 3.68, p<0.05, respectively). CONCLUSION: Maternal age, fetal weight, previous vaginal delivery and spontaneous labor were associated with vaginal delivery success in patients with a previous cesarean delivery.
Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/métodos , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea/estatística & dados numéricos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Trabalho de Parto , Modelos Logísticos , Idade Materna , Gravidez , Fatores de RiscoRESUMO
To explore attitudes of physicians attending births in the public and private sectors and at the managerial level toward cesarean birth in Nicaragua. A qualitative study was conducted consisting of four focus groups with 17 physicians and nine in-depth interviews with decision-makers. Although study participants listed many advantages of vaginal birth and disadvantages of cesarean birth, they perceived that the increase in the cesarean birth rate in Nicaragua has resulted in a reduction in perinatal morbidity and mortality. They ascribed high cesarean birth rates to a web of interrelated provider, patient, and health system factors. They identified five actions that would facilitate a reduction in the number of unnecessary cesarean operations: establishing standards and protocols; preparing women and their families for labor and childbirth; incorporating cesarean birth rate monitoring and audit systems into quality assurance activities at the facility level; strengthening the movement to humanize birth; and promoting community-based interventions to educate women and families about the benefits of vaginal birth. Study participants believe that by performing cesarean operations they are providing the best quality of care feasible within their context. They do not perceive problems with their current practice. The identified causes of unnecessary cesarean operations in Nicaragua are multifactorial, so it appears that a multi-layered strategy is needed to safely reduce cesarean birth rates. The recent Nicaraguan Ministry of Health guidance to promote parto humanizado ("humanization of childbirth") could serve as the basis for a collaborative effort among health care professionals, government, and consumer advocates to reduce the number of unnecessary cesarean births in Nicaragua.
Assuntos
Tomada de Decisões , Parto Obstétrico/estatística & dados numéricos , Médicos , Adulto , Atitude do Pessoal de Saúde , Coeficiente de Natalidade , Cesárea/estatística & dados numéricos , Cesárea/tendências , Parto Obstétrico/métodos , Feminino , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Nicarágua , Parto , Gravidez , Pesquisa Qualitativa , Prova de Trabalho de Parto , Nascimento Vaginal Após CesáreaRESUMO
Objetivo: caracterizar los casos de Hemorragia Post-Parto (HPP) que ocurren por etiologías diferentes a la hemorragia por atonía uterina en el Hospital Escuela de Tegucigalpa. Material y métodos: se realizó un estudio descriptivo-transversal, se tomó como población a todas las pacientes que ingresaron al Hospital Escuela por atención de parto vía vaginal, cesárea o ingresadas en el puerperio inmediato durante los meses de junio a diciembre del año 2011. La muestra se tomó de las pacientes complicadas con hemorragia postparto diagnosticadas clínicamente según la clasificación de Benedetti. Se consideró la presencia de factores de riesgo asociados al manejo y complicaciones. Resultados: ocurrieron 10,701 nacimientos y 56 casos de hemorragia postparto poratonía grado I, trauma del canal del parto, retención de tejido o trastornos de la coagulación, con una frecuencia de 0.5% de casos, las causas de hemorragia fueron: 22(39%) casos por trauma del canal del parto, de estos, 17(77%) fueron nacimientos por cesárea; ocurrieron 19(34%) por retención de tejido. Se clasificó la gravedad de la hemorragia que presentaron las pacientes al momento del ingreso en grado III y grado IV, resultando 9 (16%) casos de cada uno. Las complicaciones fueron: coagulopatía, falla renal, sepsis y Síndrome Anémico. La mayoría de las pacientes 45 (80%) presentó gestaciones a término; los factores de riesgo fueron: 13(23%) enfermedad hipertensiva, en 4 (7%) se aumentó la labor del parto con fármacos, la mayoría 30 (54%) no tuvieron factores asociados. El manejo inicial se realizó con reanimación con cristaloides, el uterotónico más utilizado fue la combinación de oxitocina y prostaglandinas en 20 (36%) pacientes, se realizó manejo quirúrgico en 14 (25%) y ocurrieron 3(5%) muertes por complicaciones asociadas a hemorragia. Conclusiones: La causa más frecuente de hemorragia postparto encontrada en la población de estudio fue el trauma del canal del parto; en su mayoría...
Assuntos
Humanos , Feminino , Hemorragia Pós-Parto/diagnóstico , Inércia Uterina/diagnóstico , Complicações do Trabalho de Parto , Prova de Trabalho de Parto , Traumatismos do Nascimento/complicaçõesRESUMO
OBJECTIVE: To examine the availability of trial of labor after cesarean delivery (TOLAC) in New Mexico from 1998 to 2012 and maternity care providers' perception of barriers to TOLAC. METHODS: Hospital maternity unit directors were surveyed regarding TOLAC availability from 1998 to 2012. Maternity care providers (obstetrician-gynecologists, certified nurse-midwives, and family medicine physicians) were surveyed in 2008 regarding resources and barriers to providing TOLAC and emergency cesarean delivery. RESULTS: Trial of labor after cesarean delivery was available in 100% of counties with maternity care units in 1998 (22/22); by 2008, availability decreased to 32% (7/22). After changes in national guidelines, availability increased slightly to 9 of 22 (41%) in 2012. Barriers to TOLAC included anesthesia availability (88%), hospital and medical malpractice policies (80%), malpractice cost (69%), and obstetric surgeon availability (59%). In hospitals without TOLAC services, 73% of maternity care providers indicated a surgeon could be present in the hospital within 20 minutes of the emergency delivery decision; only 43% indicated obstetric anesthesia personnel could be present within 20 minutes (P<.001). CONCLUSIONS: Availability of TOLAC in New Mexico has decreased dramatically. Policy changes are needed to support TOLAC access in rural and community hospitals. LEVEL OF EVIDENCE: III.
Assuntos
Acessibilidade aos Serviços de Saúde , Hospitais Rurais/estatística & dados numéricos , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea/estatística & dados numéricos , Feminino , Humanos , New Mexico , Guias de Prática Clínica como Assunto , GravidezRESUMO
OBJECTIVE: To identify factors associated with cesarean section in women with only one previous delivery by cesarean section and undergoing a trial of labor. METHODS: A retrospective cross sectional study was performed from 1986 to 1998 including a total of 1746 women with one prior cesarean section and delivering after a trial of labor. Cases with a current twin pregnancy or with malformation incompatible with life were excluded. Women were divided in two groups according to the mode of the second delivery: Cesarean (n=731) or Vaginal Birth After Cesarean (VBAC, n=1015). To identify factors associated to the mode of delivery, the prevalence ratios (PR) and the 95%CI for each isolated factor, adjusted according to age, were assessed. In each analysis, cases with missing information were excluded. RESULTS: The total rate of Vaginal Birth After Cesarean was 58.1%. The factors significantly associated with cesarean section were: higher maternal age, greater fundal height (PR 1.5; 95%CI 1.19-1.88), premature rupture of membranes (1.3; 1.08-1.54), amniotic fluid with an altered aspect (1.22; 1.04-1.43) or volume (1.32; 1.01-1.73), altered fetal heart rate (1.96; 1.68-2.28), non cephalic presentation (2.03; 1.54-2.66), induction of labor (1.74; 1.42-2.11) and no labor analgesia (2.57; 2.11-3.11). CONCLUSION: The factors associated with cesarean section were older age, non-cephalic presentation, premature rupture of membranes, signs of large fetus, the need of induction of labor and signs of compromised fetal wellbeing.
Assuntos
Recesariana , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Paridade , Gravidez , Estudos RetrospectivosRESUMO
OBJETIVO: Identificar fatores associados à cesárea em mulheres com um único parto anterior por cesárea e submetidas à prova de trabalho de parto. MÉTODOS: Estudo de corte transversal retrospectivo, incluindo 1746 mulheres com uma cesárea anterior submetidas à prova de trabalho de parto no segundo parto ocorrendo entre 1986 e 1998. Foram excluídos os casos com atual gestação múltipla e/ou com malformações fetais incompatíveis com a vida. Elas foram divididas pelo tipo de parto atual em dois grupos: cesárea (n=731) e parto vaginal após cesárea (PVAC, n=1015). A análise estatística para a identificação de fatores associados ao tipo de parto foi feita por meio do cálculo da razão de prevalência (RP) e IC 95 por cento, sendo feito também o ajuste por idade, excluindo-se os casos com informações ignoradas em cada análise. RESULTADOS: A taxa total de parto vaginal após cesárea foi de 58,1 por cento. Os fatores significativamente associados com parto por cesárea foram: maior idade materna, maior altura uterina (RP 1,5; IC 95 por cento 1,19-1,88), rotura prematura de membranas (1,3; 1,08-1,54), líquido amniótico não claro (1,22; 1,04-1,43) ou com quantidade alterada (1,32; 1,01-1,73), alteração dos batimentos cardíacos fetais (1,96; 1,68-2,28), apresentação não cefálica (2,03; 1,54-2,66), indução do parto (1,74; 1,42-2,11) e ausência de analgesia (2,57; 2,11-3,11). CONCLUSÃO: Os fatores associados ao parto por cesárea foram a maior idade, apresentação não-cefálica, rotura prematura de membranas, fetos grandes, necessidade de indução do trabalho de parto, e sinais de comprometimento da vitalidade fetal.
OBJECTIVE: To identify factors associated with cesarean section in women with only one previous delivery by cesarean section and undergoing a trial of labor. METHODS: A retrospective cross sectional study was performed from 1986 to 1998 including a total of 1746 women with one prior cesarean section and delivering after a trial of labor. Cases with a current twin pregnancy or with malformation incompatible with life were excluded. Women were divided in two groups according to the mode of the second delivery: Cesarean (n=731) or Vaginal Birth After Cesarean (VBAC, n=1015). To identify factors associated to the mode of delivery, the prevalence ratios (PR) and the 95 percentCI for each isolated factor, adjusted according to age, were assessed. In each analysis, cases with missing information were excluded. RESULTS: The total rate of Vaginal Birth After Cesarean was 58.1 percent. The factors significantly associated with cesarean section were: higher maternal age, greater fundal height (PR 1.5; 95 percentCI 1.19-1.88), premature rupture of membranes (1.3; 1.08-1.54), amniotic fluid with an altered aspect (1.22; 1.04-1.43) or volume (1.32; 1.01-1.73), altered fetal heart rate (1.96; 1.68-2.28), non cephalic presentation (2.03; 1.54-2.66), induction of labor (1.74; 1.42-2.11) and no labor analgesia (2.57; 2.11-3.11). CONCLUSION: The factors associated with cesarean section were older age, non-cephalic presentation, premature rupture of membranes, signs of large fetus, the need of induction of labor and signs of compromised fetal wellbeing.
Assuntos
Adulto , Feminino , Humanos , Gravidez , Recesariana , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea , Estudos de Coortes , Estudos Transversais , Paridade , Estudos RetrospectivosRESUMO
El material presentado en este documento está organizado en distintos acápites: en la sección situación se intenta mostrar las distintas barreras culturales y de calidad que dificultan el acceso de las usuarias, particularmente indígenas, al establecimiento de salud; en la sección Algunas experiencias presenta trabajos de equipos de salud en proyetos que buscan soluciones a las problemáticas tratadas; en la sección recomendaciones se detallan una serie de sugerencias operativas que los equipos de salud pueden tomar como guía para la adecuación cultural de los servicios y de programas que responden a la realidad cultual y a las necesidades de la población
Assuntos
Masculino , Feminino , Humanos , Bem-Estar Materno/etnologia , Prova de Trabalho de Parto , Parto , Parto Domiciliar , Apresentação no Trabalho de Parto , Cuidado Pré-Natal , Bolívia , GravidezRESUMO
El prolapso es motivo frecuente de consulta para en Ginecología y la mayoría de las mujeres que lo padecen sobrepasan los 50 años.Se realizó un estudio retrospectivo, descriptivo y longitudinal desde 1995 al 2000 en el hospital Naval de Guayaquil.El objetivo: Conocer los factores causales más comunes.Comprobar la importancia de la relación entre los antecedentes gineco-obstétricos y el desarrollo del prolapso genital.Identificar el tipo de tratamiento quirúrgico y las complicaciones que se presentaron al momento de la resolución en las pacientes internadas en el hospital Naval de Guayaquil (HOSNAV).Se encontraron 65 casos en el estudio de 6 años, la edad media de presentación fue 57 años 8 meses, se demostró que mientras más se acerquen a la etapa del climaterio, la incidencia de prolapso genital aumenta en forma proporcional. El factor causal que se relaciona al desarrollo de prolapsos es la multiparidad y los partos distócicos.
Prolapse is frequent reason of consultation to the gynecologist and most common in women over 50 years. We carried out a retrospective, descriptive and longitudinal study between the years of 1995 to 2000 in the Naval Hospital of Guayaquil with the objective of finding out the most common risk factors, to check the importance of the relationship between the Gynecologic clinical history and the development of the genital prolapse, and to identify the type of surgical treatment and the complications that were presented.There were 65 cases in the 6 year-old study, the age of presentation was 57 years 8 months, it was demonstrated that while more they come closer to the stage of the climaterium, the incidence of genital prolapse increased. The risk factor that is related to the development of prolapse is the multiparty and the distosic childbirths.
Assuntos
Feminino , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico , Fatores de Risco , Prolapso Uterino , Cistocele , Parto Normal , Paridade , Prova de Trabalho de PartoRESUMO
Cual es la eficacia del programa Doulado-Uyusuri en la atención del trabajo del parto, en el Hospital del Distrito No 1 de la ciudad de La Paz?. Objetivos. Determinar la eficacia del Doula-Uyusuri en la atención del trabajo de parto, en el Hospital del Distrito No 1 de la ciudad de La Paz. Diseño: Ensayo clínico controlado. Lugar: Hospital La Paz, Garita de Lima, Distrito No 1. Participantes: Mujeres que acuden a los servicios de salud del Hospital del Distrito No1 para ser atendidas en su trabajo de parto, serán elegidas según criterio de inclusion, mujeres con parto eutócico de 18 a 35 años con parto 0, que un acompañante (a) acompañante o colaborador (a) y sin criterios de exclusion referidos a complicaciones finales durante el trabajo de parto, uso de anestesia, uso de inducción, sin acompañante (a) o colaborador (a), que tenga un embarazo de riesgo, indicación de nacimiento por cesárea...
Assuntos
Modalidades de Fisioterapia , Trabalho de Parto/fisiologia , Prova de Trabalho de PartoRESUMO
OBJECTIVE: To reevaluate the average length of each phase/stage of labor for multiparous and primiparous women in North America who received no regional anesthesia or oxytocin augmentation or induction, to describe a range of labor lengths associated with good childbirth outcomes, and to determine if there is a consensus among labor and delivery nurse managers responding to the survey regarding the need to revise Friedman's Labor Curve. DESIGN: This pilot study used a descriptive and anonymous cross-sectional survey design. Surveys were mailed to 500 maternity care agencies in the United States, Canada, and Mexico with a return rate of 17.8% (n = 89). Each participating agency was asked to submit five patient cases to be included in the analysis. SAMPLE AND SETTING: The sample of patient cases (n = 419) was drawn from randomly selected maternity care agencies throughout North America representing all sizes of agencies and geographic locations. The cases submitted for analysis represented women 14 to 44 years of age with varying ethnicities who received no regional anesthesia or oxytocin augmentation or induction. Twenty-three percent of the women in the sample (n = 97) were primigravidas. RESULTS: The average length of labor for primiparous and multiparous women today is similar to the average length of labor described by Friedman in 1954. However, a wider range of "normal" was found in cases included in the current study. Primiparous women remained in the first stage of labor for up to 26 hours and the second stage of labor up to 8 hours with no adverse effects to mother or infant. Multiparous women remained in the first stage of labor for up to 23 hours and the second stage of labor for up to 4.5 hours with good birth outcomes. In addition, 87.6% of nurse managers responding to the survey believed that Friedman's Labor Curve should be revised to meet the needs of current patient populations, technological advances, and nursing responsibilities. CONCLUSIONS: This study suggests that the parameters to determine if a labor is progressing satisfactorily may need to be expanded. With the availability of technology to assess maternal and fetal well-being, labor should be allowed to progress past the rigid 2-hour time limit for the second stage of labor artificially imposed on women in some childbirth settings. More emphasis should be placed on the nursing assessment techniques used to reassure the family and health care practitioners that labor is progressing safely and the nursing interventions that may have an impact on the length of each stage of labor.