Effect of low-level laser therapy on pain and perineal healing after episiotomy: A triple-blind randomized controlled trial.

BACKGROUND AND OBJECTIVE: Episiotomy is associated with perineal pain and healing complications. The low-level laser therapy (LLLT) reduces pain and inflammation and stimulates the healing process. This study aimed to assess the effect of LLLT on pain and perineal healing after an episiotomy. DESIGN/MATERIALS AND METHODS: A randomized, triple-blind, parallel clinical trial with 54 postpartum women who had a spontaneous birth with a right mediolateral episiotomy. The women were randomized into two groups: the experimental group (applications of LLLT n = 29) or the placebo group (simulated LLLT applications n = 25). Three sessions of real or sham irradiation were performed at 6-10 hours after normal birth, and the 2nd and 3rd applications were performed at 20-24 hours and 40-48 hours after the first session, respectively. Perineal pain was recorded using a Numeric Scale ranging from 0 to 10 (0 = absence and 10 = worst pain). Perineal healing was assessed using the redness, oedema, ecchymosis, discharge, and approximation (REEDA) scale. Both groups were assessed four times: in each of the three LLLT sessions and at 7-10 days after normal birth. The groups were compared using the Student's t, Mann-Whitney, and Chi-square tests. RESULTS: There was no significant difference between the groups regarding perineal healing after LLLT. The perineal pain scores were statistically higher in the experimental group in the first assessment and after the third LLLT. There was no significant difference between the groups related to the perineal pain scores 7-10 days after normal birth. CONCLUSION: The use of LLLT does not provide any benefit for treating postpartum perineal trauma using these specific protocol and parameters. Lasers Surg. Med. 49:181-188, 2017. © 2016 Wiley Periodicals, Inc.

[Implementation methodology of practices based on scientific evidence for assistance in natural delivery: a pilot study]. / Metodologia de implementação de práticas baseadas em evidências científicas na assistência ao parto normal: estudo piloto.

OBJECTIVE: Presenting methodology for transferring knowledge to improve maternal outcomes in natural delivery based on scientific evidence. METHOD: An intervention study conducted in the maternity hospital of Itapecerica da Serra, SP, with 50 puerperal women and 102 medical records from July to November 2014. The PACES tool from Joanna Briggs Institute, consisting of pre-clinical audit (phase 1), implementation of best practice (phase 2) and Follow-up Clinical Audit (phase 3) was used. Data were analyzed by comparing results of phases 1 and 3 with Fisher's exact test and a significance level of 5%. RESULTS: The vertical position was adopted by the majority of puerperal women with statistical difference between phases 1 and 3. A significant increase in bathing/showering, walking and massages for pain relief was found from the medical records. No statistical difference was found in other practices and outcomes. Barriers and difficulties in the implementation of evidence-based practices have been identified. Variables were refined, techniques and data collection instruments were verified, and an intervention proposal was made. CONCLUSION: The study found possibilities for implementing a methodology of practices based on scientific evidence for assistance in natural delivery.

Identification of selection signatures in livestock species.

The identification of regions that have undergone selection is one of the principal goals of theoretical and applied evolutionary genetics. Such studies can also provide information about the evolutionary processes involved in shaping genomes, as well as physical and functional information about genes/genomic regions. Domestication followed by breed formation and selection schemes has allowed the formation of very diverse livestock breeds adapted to a wide variety of environments and with special characteristics. The advances in genomics in the last five years have enabled the development of several methods to detect selection signatures and have resulted in the publication of a considerable number of studies involving livestock species. The aims of this review are to describe the principal effects of natural/artificial selection on livestock genomes, to present the main methods used to detect selection signatures and to discuss some recent results in this area. This review should be useful also to research scientists working with wild animals/non-domesticated species and plant biologists working with breeding and evolutionary biology.

Association between perineal trauma and pain in primiparous women.

Objective To identify the association between perineal trauma and pain in 473 primiparous women. Method Cross-sectional study in which pain was measured by the numerical pain scale (0 to 10 - 0 being no pain and 10 maximal pain). Results The prevalence and mean intensity of pain were 33.0% and 4.7 points (standard deviation = 2.0) in the numeric scale, respectively. Episiotomy represented the most frequent trauma (46.7%). The occurrence and intensity of the pain were associated with perineal trauma and postpartum time. Having perineal trauma tripled the chance of pain. Each hour elapsed following the birth reduced the chance of pain by 4.8%. Conclusion Primiparous women are subject to a high frequency of perineal trauma, with episiotomy being the most prominent. Perineal pain affects approximately one-third of primiparous women and is associated with the postpartum time and perineal traumas.

[Cryotherapy after childbirth: the length of application and changes in perineal temperature]. / Crioterapia no pós-parto: tempo de aplicação e mudanças na temperatura perineal.

We present a descriptive study based on the data from two clinical trials conducted at a maternity hospital in São Paulo, Brazil, in 2008 and 2009. This study aimed to describe perineal temperature after the application of an ice pack during the postpartum period. Three groups of 38 postpartum women (n=114 total) received an ice pack between 2 and 48 h after delivery. The results showed that after 10 minutes of cryotherapy, the mean perineal temperature varied between 13.3 degreeCand 15.3 degree"C, with a small reduction at the end of the 15- and 20-minute applications (2.4 degreeC and 2.7"C, respectively). Women who received cryotherapy for 10 minutes reported a cool sensation and pain relief; after a session of 15 or 20 minutes, the women reported anesthesia and numbness. In conclusion, an ice pack applied for 10 minutes reduced the perineal temperature to the recommended levels for analgesia (10-15 degreeC).

[Reliability of an instrument to classify newborns according to care complexity]. / Confiabilidade de um instrumento para classificar o recém-nascido segundo a complexidade assistencial.

In most maternity units, the physician classifies, evaluates, and determines which unit will receive the newborn (NB) after birth. Evaluation occurs in the delivery room, taking into consideration the following factors: birth weight, gestational age, and behaviors that define the clinical picture and disease. This observational study evaluates the reliability of an NB classification instrument. The study was conducted at the nursery of a public hospital in São Paulo. Nine nurses applied the instrument to 63 NB, with two of the nurses working simultaneously in each of the nursery's five sectors. The Kappa level of agreement among the nurses was found to be excellent for most care areas (69.0%). It was concluded that there was a consensus and agreement among the nurses that the instrument was complete, easy to understand and applicable, but was very time consuming. The nurses recognize the instrument's importance for the allocation of professionals, organization, and care planning.

[Care in a birth center according to the recommendations of the World Health Organization]. / Assistência em um centro de parto segundo as recomendações da Organização Mundial da Saúde.

Birth centers are maternal care models that use appropriate technology when providing care to birthing women. This descriptive study aimed to characterize intrapartum care in a freestanding birth center, in light of the practices recommended by the World Health Organization (WHO), with 1,079 assisted births from 2006 to 2009 in the Sapopemba Birth Center, São Paulo, Brazil. Results included the use of intermittent auscultation (mean=7 controls); maternal positions during delivery: semi-sitting (82.3%), side-lying (16.0%), other positions (1.7%), oral intake (95.6%); companionship (93.3%); exposure to up to three vaginal examinations (85.4%), shower bathing (84.0%), walking (68.0%), massage (60.1%), exercising with a Swiss ball (51.7%); amniotomy (53.4%), oxytocin use during the first (31.0%) and second stages of labor (25.8%), bath immersion (29.3%) and episiotomy (14.1%). In this birth center, care providers used practices recommended by the WHO, although some practices might have been applied less frequently.

[Transferring mothers from a free-standing birth center to a reference hospital]. / Remoções maternas da Casa do Parto de Sapopemba para hospital de referência.

The objective of this descriptive study was to characterize the transfers of mothers from the Sapopemba Birth Center to reference hospitals in São Paulo, from September 1998 to July 2008. The studied population was 229 cases of mother transfers. Data were obtained from medical records and record books of the transferred women. Descriptive analysis was performed. The transfer rate was 5.8% (5.5% in the intrapartum period and 0.3% in the postpartum period). Most women who were transferred to the hospital were nulliparous (78.6%). The most common reason for intrapartum transfers was fetal or pelvis abnormalities (22.6%), and abnormal placental detachment (50%) for women in the postpartum period. Some conditions such as nulliparity, cervical dilation at admission, rupture of the membranes and gestational age over 40 weeks were highlighted as important variables for studying the risk factors for mothers being transferred.

Pelvic floor dysfunction in primiparous women up to 6 months after delivery: cohort study.

OBJECTIVE: To analyze pelvic floor muscular strength (PFMS), urinary (UI) and anal (AI) incontinence and dyspareunia in primiparous women up to 6 months after normal or cesarean delivery. METHODS: this is a prospective cohort with 169 women (128 normal births, 41 cesarean sections), followed between 50-70 and 170-190 days postpartum, when PFMS was measured using perineometry, and UI and AI and dyspareunia, through interview. RESULTS: PFMS, UI and dyspareunia were similar between types of delivery. The difference was significant only for the time elapsed, with improvement in the studied period (2 and 6 months postpartum). Regarding AI, there was a significant difference between 2 and 6 months postpartum, with an interaction between type of delivery and time (p=0.022). CONCLUSION: the type of delivery did not show any influence on pelvic floor dysfunctions, except for AI. For all outcomes, there was an improvement in the period studied.

Perineal muscle strength during pregnancy and postpartum: the correlation between perineometry and digital vaginal palpation.

Digital vaginal palpation performed during clinical practice can help diagnose urinary, intestinal and sexual disorders, while perineometry is more useful for performing perineal exercises with biofeedback. This study verifies whether there is a correlation between values of Pelvic Floor Muscle Strength (PFMS) obtained through perineometry performed with an electronic perineometer and through digital vaginal palpation using the Oxford scale. This is a prospective cohort study with 330 measurements carried out in 110 women. Data were collected from 2007 to 2008 in the health service system in Itapecerica da Serra, São Paulo, Brazil. Evaluations were carried out at three points in time: up to 12 weeks of pregnancy; between 36-40 weeks; and between 42-60 days postpartum. The Spearman coefficient indicated a strong positive correlation between the two evaluation methods for the three evaluations (p<0.0001). The conclusion is that both methods are valid for measuring PFMS during pregnancy and after delivery.

[Clinical trial comparing three types of cryotherapy in nonpregnant women]. / Ensaio clcnico comparando três modalidades de crioterapia em mulheres não gravidas.

The objective of the present study was to compare three methods of cryotherapy in healthy non-pregnant women. This is a randomized controlled clinical trial that was conducted by 32 undergraduates of a private nursing college in the city of Sao Paulo, divided into three groups (iced water, soft ice, ice gel). The temperatures were verified (axillary, thigh, of the three ice packs) between zero and twenty minutes. The temperatures of the packs were the following: soft ice, from negative 9 degrees C to 2 degrees C; iced water, from 0 degrees C to 8 degrees C; and ice gel from negative 11 degrees C to 2 degrees C. There was a significant difference between the average thigh temperature values at 10 minutes (p = 0.007), 15 minutes (p = 0.003) and 20 minutes (p = 0.005). The gel was the most efficient cooling method. The three cryotherapy methods achieved the recommended temperature for analgesia and may be tested in women with perineal pain after childbirth.

[Maternal and perinatal outcomes of an alongside hospital birth center in the city of São Paulo, Brazil]. / Resultados maternos e neonatais em centro de Parto Normal peri-hospitalar na cidade de São Paulo, Brasil.

The aim of this study was to describe the maternal and perinatal results of care in the alongside hospital birth center Casa de Maria (CPN-CM), located in the city of São Paulo. The random sample included 991 women and their newborns, attended between 2003 and 2006. The results showed that 92.2% of women had a companion of her choice during childbirth and the practices commonly used were shower or immersion bath (92.9%), amniotomy (62.6%), walking (47.6%), massage comfort (29.8%) and episiotomy (25.7%). Regarding newborns, 99.9% of them had Apgar scores =7 in the fifth minute, 9.3% received aspiration of the upper airway, no one needed to be intubated and 1.4% were removed to the hospital. The model of care in the CPN-CM provides maternal and perinatal outcomes expected for low obstetric risk women, and means a safe option and less interventionist model in normal childbirth.

High-risk Human Papillomavirus Testing for Triage of Women with Previous Cytological Abnormalities from the Vale do Ribeira Region.

OBJECTIVE: To evaluate the performance of the hybrid capture 2 (HC2) high-risk papillomavirus (hrHPV) assay and cytological test in women with previous abnormalities, to detect cervical intraepithelial neoplasia grade 2 or worse (≥ CIN 2). METHODS: A cytological test and HC2 (Qiagen, Gaithersburg, Maryland, EUA) for hrHPV were conducted in 359 liquid-based (Sure Path, Becton Dickinson, TriPath Imaging, Burlington, NC, USA) samples collected from women from the Vale do Ribeira Region, during July 2013 and September 2015 with previous cytology classified as atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (ASC-H), and atypical glandular cells (AGC). The histopathological examination was conducted in 179 women. The performance evaluations were calculated using the "exact" Clopper-Pearson 95% confidence interval (CI) test by MEDCALC (Medcalc Software Ltd, Ostend, Belgium). RESULTS: The ≥ CIN 2 frequency was 11.7% (21/179). The HC2 for hrHPV and repeat cytology to detect ≥ CIN 2 obtained, respectively, a sensitivity of 90.5% (95%CI = 69.6-98.8) and 90.5%, (95%CI = 69.6-98.8), a specificity of 65.8% (95% CI = 57.9-73.2) and 43.7% (95%CI = 35.8-51.8), a positive predictive value of 26.0% (95% CI = 21.4-31.3) and 17.6%, (95%CI = 14.9-20.6), and a negative predictive value of 98.1% (95%CI = 93.3-99.5) and 97.2% (95% CI = 90.1-99.2). CONCLUSION: Hybrid capture 2 for hrHPV improves the performance of the detection of ≥ CIN 2, without compromising sensitivity, and provides a greater safety margin to return to the triennial screening of women undergoing follow-up due to previous abnormalities, without underlying ≥ CIN 2.

OBJETIVO: Avaliar o desempenho da captura híbrida 2 (CH2) para papilomavírus humano de alto risco (HPVar) e repetição do exame citopatológico em mulheres com anormalidades em citologia anterior, para detectar neoplasia intraepitelial cervical grau 2 ou pior (≥ NIC 2). MéTODOS: Foi realizado exame citopatológico e CH2 para HPVar (Qiagen, Gaithersburg, Maryland, EUA) em 359 amostras em meio líquido (Sure Path, Becton Dickinson, TriPath Imaging, Burlington, NC, USA) coletadas de mulheres da região do Vale do Ribeira, durante julho de 2013 e setembro de 2015 com citologia anterior classificada como células escamosas atípicas de significado indeterminado (ASC-US), lesão intraepitelial de baixo grau (LSIL), células escamosas atípicas, não podendo excluir lesão de alto grau (ASC-H) e células glandulares atípicas (AGC). O exame histopatológico foi realizado em 179 mulheres. As avaliações de desempenho foram calculadas usando o teste de intervalo de confiança (IC) "exato" de Clopper-Pearson de 95% pelo software MEDCALC (Medcalc Software Ltd, Ostend, Bélgica). RESULTADOS: A frequência de ≥ NIC 2 foi 11,7% (21/179). A CH2 para o HPVar e a citologia de repetição para a detecção ≥ NIC 2 obteve, respectivamente, sensibilidade de 90.5% (IC 95% = 69,6­98,8) e 90,5% (IC 95% = 69,6­98,8), especificidade de 65,8% (IC 95% = 57,9­73,2) e 43,7%, (IC 95% = 35,8­51,8), valor preditivo positivo de 26,0% (IC 95% = 21,4­31,3) e 17,6%, (IC95% = 14,9­20,6), e valor preditivo negativo de 98,1% (IC 95% = 93,3­99,5) e 97,2%, (IC 95% = 90,1­99,2). CONCLUSãO: No geral, a CH2 para HPVar aprimora o desempenho para detecção de ≥ NIC 2, sem comprometer a sensibilidade e proporciona maior margem de segurança do retorno ao rastreio trienal de mulheres com anormalidades citológicas prévias, sem ≥ NIC 2 subjacente.

[The partogram as an instrument to analyze care during labor and delivery]. / O Partograma como instrumento de análise da assistência ao parto.

Both the World Health Organization and the Brazilian Ministry of Health recommend using the partogram to follow labor. The objective of this study was to analyze the use of obstetrical interventions, the types of delivery, and perinatal outcomes according to zones I, II and III of the partogram. This cross-sectional study was performed with 233 low-risk pregnant women between December 2004 and March 2005 at a public maternity hospital located in the city of Itapecerica da Serra, in the state of São Paulo. Comparative analysis was performed using Chi-square and Fischer exact tests. The practices used in the different partogram zones with statistical significance of (p = 0.05) were: bath, movement and walking (zone-III); artificial rupture of the membranes (zone-II) and oxytocin (zone-I). Caesarean sections were performed on 24% of women in zone-III. The interventions occurred at a timely moment, indicating that the partogram is an instrument that can be used as a guide when adopting interventions during labor.

The use of liquid petroleum jelly in the prevention of perineal lacerations during birth.

Most of vaginal births are accompanied by lacerations in the genital tract. This was a randomized study carried out in a Birth Center located in São Paulo city to evaluate the efficacy of liquid petroleum jelly in reducing perineal laceration. The sample was composed of 38 nulliparous women per group (experimental and control). In the experimental group was used 30 ml of the petroleum jelly in the perineal region during the expulsive period. The parturient were allowed to push spontaneously during the delivery and remained in the left side position. The frequency of perineal laceration was similar in both groups (experimental 63.2% versus control 60.5%). The posterior perineum region presented the highest frequency of trauma (53.2%). Of the total cases of perineal trauma, 72.3% were first-degree lacerations. The use of liquid petroleum jelly of perineal protection does not reduce the frequency neither the degree of lacerations in childbirth.

Ice pack induced perineal analgesia after spontaneous vaginal birth: Randomized controlled trial.

BACKGROUND: Ice-pack is widely used for alleviating postpartum perineal pain sustained after birth related perineal trauma. However, it lacks robust evidence on timing and frequency of applications, to ensure the effective and safe use of this therapy. AIMS: To evaluate if a 10min ice-pack application relieved postpartum perineal pain and if the analgesic effect was maintained for up to 2h. METHODS: A randomised controlled trial conducted from December 2012 to February 2013 with 69 primiparous women ≥18 years old, 6-24h postpartum, with perineal pain ≥3, who had not received anti-inflammatory medication or analgesics after childbirth, who were randomised to a single ice-pack application on the perineum for 10min or standard care. The primary and secondary outcomes were a reduction ≥30% in perineal pain intensity, immediately after the application and the maintenance of the analgesic effect for up to 2h, respectively. FINDINGS: Immediately post-intervention, the proportion of women whose perineal pain decreased ≥30% was significantly higher in the experimental group. Within 2h, there was no significant difference in the pain levels in both groups. Within 2h, for 61.9% and 89.3% of women in the experimental and control group, respectively, the perineal pain levels remained unchanged. For the remaining participants, perineal pain was increasing after an average time of 1h 45min and 1h 56min for the experimental and control groups, respectively. CONCLUSION: By applying an ice-pack for 10min to the perineum, effective pain relief is achieved, that is maintained for between 1h 45min and 2h.

Implementation of evidence-based practices in normal delivery care.

OBJECTIVE: to evaluate the impact of the implementation of evidence-based practices on normal delivery care. METHOD: quasi-experimental, before-and-after intervention study conducted in a public maternity hospital, Amapá. Forty-two professionals and 280 puerperal women were interviewed and data from 555 medical records were analyzed. The study was developed in three phases: baseline audit (phase 1), educational intervention (phase 2) and post-intervention audit (phase 3). RESULTS: after the intervention, there was an increase of 5.3 percentage points (p.p.) in the normal delivery rate. Interviews with the women revealed a significant increase of the presence of companions during labor (10.0 p.p.) and of adoption of the upright or squatting position (31.4 p.p.); significant reduction of amniotomy (16.8 p.p.), lithotomy position (24.3 p.p.), and intravenous oxytocin (17.1 p.p.). From the professionals' perspective, there was a statistical reduction in the prescription/administration of oxytocin (29.6 p.p.). In the analysis of medical records, a significant reduction in the rate of amniotomy (29.5 p.p.) and lithotomy position (1.5 p.p.) was observed; the rate of adoption of the upright or squatting position presented a statistical increase of 2.2 p.p. CONCLUSIONS: there was a positive impact of the educational intervention on the improvement of parturition assistance, but the implementation process was not completely successful in the adoption of scientific evidence in normal delivery care in this institution.

[Postnatal perineal edema assessment: agreement among observers]. / Avaliação do edema perineal no pós-parto: concordância entre observadores.

Perineal trauma produced during vaginal delivery is frequent, and there are no clinically validated evaluation scales available. The aim was to analyze the reliability of a tool to assess the vulvoperineal region during the postnatal period. This is an observational study conducted at the University Hospital of Universidade de São Paulo, Brazil. Thirty women with vaginal delivery were analyzed. The tool was built and evaluated in three stages: admission, 1-2, and 24-36 hours after delivery. Reliability analysis was carried out, and Kappa coefficient presented excellent, good, or marginal agreement to identify, respectively, 13, 20, and 13 parameters related to the pudendal chink, major and minor labia, clitoris, and perineal body. The conclusions were that the tool may be partially validated due to the reliability showed by the results, and that it must be modified, taking into consideration the individual characteristics of each woman, and changes that do not cause morbidity, which clinical evaluation is irrelevant.

[Korotkoff sounds: development of the sphygmomanometry research at the Nursing School of the USP]. / Sons de Korotkoff: desenvolvimento da pesquisa em esfigmomanometria na Escola de Enfermagem da USP.

This article pays homage to Sergei Nicolai Korotkoff, for the centenary of the auscultatory method discovery. It refers to his discover of blood pressure auscultatory method in Russia, in 1905; presents the evidence that resulted in the development of sphygmomanometry studies in Brasil; describes the important contribution of the Nursing School of the University of São Paulo to the development of blood pressure measurement research; and analyses the results of the research field of "Cuff width influence in blood pressure measurement", created at the Nursing School of The University of São Paulo, in 1974. The scientific results of doctoral studies are presented, identifying the research groups that are contributing to defying knowledge in this area. The article demonstrates the consolidation of the results related to the initial doctoral program studies developed in the area. Confirmation of hypothesis in longitudinal studies is emphasized.

[Scientific production of Brazilian nurses on blood pressure measurement]. / Medida da pressão arterial e a produção científica de enfermeiros brasileiros.

In the previous issue of this journal the authors celebrated in an article the discovery of the Korotkoff sounds, in 1905, and presented the historical facts that determined the important role of the University of São Paulo's Nursing School (EEUSP) in the development of the oldest blood pressure research line in Brazilian Nursing: "Cuff Width Influence in Blood Pressure Measurement." This new article presents the scientific production derived from the studies carried out by nurses with a PhD from EEUSP during and after their doctoral programs in the area. The path each researcher followed in his/her group and laboratory is emphasized. The data presented is aimed at offering a number of qualitative and quantitative indicators that make possible to evaluate the impact of the research that they have carried out, as well as the development of knowledge in the area.