Nonpharmacological Methods to Reduce Pain During Active Labor in A Real-life Setting / Métodos não farmacológicos para reduzir a dor durante o trabalho de parto ativo em um cenário da vida real

Abstract Objective To evaluate the association between pain intensity in the active phase of the first stage of labor with the use or not of nonpharmacological methods for pain relief in a real-life scenario. Methods This was an observational cross-sectional study. The variables analyzed were obtained by a questionnaire with the mothers (up to 48 hours postpartum) to investigate the intensity of pain during labor using the visual analog scale (VAS). The nonpharmacological pain relief methods routinely used in obstetric practice were evaluated by consulting medical records. The patients were separated into two groups: Group I - patients who did not use nonpharmacological methods for pain relief and Group II -patients who used these methods. Results A total of 439 women who underwent vaginal delivery were included; 386 (87.9%) used at least 1 nonpharmacological method and 53 (12.1%) did not. The women who did not use nonpharmacological methods had significantly lower gestational age (37.2 versus 39.6 weeks, p < 0.001) and shorter duration of labor (24 versus 114 min, p < 0.001) than those who used the methods. There was no statistically significant difference in the pain scale score using the VAS between the group that used nonpharmacological methods and the group that did not (median 10 [minimum 2- maximum 10] versus 10 [minimum 6-maximum 10] p = 0.334). Conclusion In a real-life setting, there was no difference in labor pain intensity between the patients who used nonpharmacological methods and those who did not use them during the active phase of labor.

Resumo Objetivo Avaliar a associação da intensidade da dor na fase ativa da dilatação do parto em mulheres de acordo com a utilização ou não de métodos não farmacológicos para alívio da dor em cenário de vida real. Métodos Trata-se de um estudo observacional de corte transversal. As variáveis analisadas foram obtidas através de questionário com as puérperas (até 48 horas pós-parto) investigando a intensidade da dor no parto pela escala visual analógica (EVA). As medidas não farmacológicas de alívio da dor, utilizadas rotineiramente na prática obstétrica, foram avaliadas pela consulta aos prontuários. As pacientes foram separadas em dois grupos: Grupo I - pacientes que não utilizaram medidas não farmacológicas para alívio da dor e Grupo II - pacientes que utilizaram estas medidas. Resultados Foram incluídas 439 mulheres que tiveram parto vaginal, sendo que 386 (87,9%) utilizaram, pelo menos, uma medida não farmacológica e 53 (12,1%) não utilizaram. As mulheres que não utilizaram as medidas não farmacológicas apresentaram idade gestacional significativamente menor (37,2 versus 39,6 semanas, p < 0,001) e menor duração do trabalho de parto (24 versus 114 minutos, p < 0,001) quando comparadas às que utilizaram as medidas. Não houve diferença estatisticamente significativa na pontuação da escala da dor pela EVA de acordo com a categorização pelo uso ou não de métodos não farmacológicos (mediana 10 [mínimo 2-máximo 10] versus 10 (mínimo 6-máximo 10), p = 0,334]. Conclusão Em cenário de vida real, as pacientes submetidas aos métodos não farmacológicos não apresentaram diferença em relação à intensidade da dor quando comparadas às que não os utilizaram durante a fase ativa do trabalho de parto.

Labor interventions in low- and high-risk parturients in a university hospital

SUMMARY OBJECTIVE: The main aim of this study was to evaluate the impact of using interventions in low- and high-risk parturients on maternal and perinatal adverse outcomes during labor. METHODS: This is a prospective study. The analyzed variables were obtained through a questionnaire with puerperal women (between 1- and 48-h postpartum) and through medical record searches. The study population was divided into two groups as follows: Group I included parturients who underwent at least one type of obstetric intervention and Group II included parturients who did not undergo any type of obstetric intervention. RESULTS: Most parturients (75.3%) underwent at least one type of intervention, with oxytocin being the most prevalent intervention (49.5%), followed by misoprostol use (28.7%), elective cesarean section at the request of the patient (23.0%), amniotomy (21.2%), and episiotomy (21.0%). Regarding the adverse perinatal outcomes related to low-risk pregnancies, the prevalence of the second- or third-degree perineal tears (17.8% vs. 36.7%, p=0.001) was lower in Group I than in Group II. Moreover, in high-risk pregnancies, the prevalence of hospitalization in the neonatal intensive care unit (2.8% vs. 16.7%, p<0.001), adult intensive care unit admission (0.8% vs. 3.9%, p=0.004), and the need for oxygen therapy (26.8% vs. 40.4%, p<0.001) was lower in Group I than in Group II. CONCLUSIONS: In low-risk parturients, the interventions performed were associated with lower prevalence of second- or third-degree perineal tears. There was a lower prevalence of neonatal and adult intensive care unit admissions, the need for oxygen therapy, intracranial hemorrhage, and neonatal infection among high-risk parturients.

Relationship between the number of prenatal care visits and the occurrence of adverse perinatal outcomes

SUMMARY OBJECTIVE: The objective of this study was to analyze the relationship between the number of prenatal care visits and the occurrence of adverse perinatal outcomes in an average city in the state of Minas Gerais, Brazil. METHODS: This was a prospective and observational study. The variables analyzed were obtained through a questionnaire administered to postpartum women (between 1 and 48 h postpartum) and information contained in prenatal cards. The pregnant women were classified into three groups: Group I, <3 prenatal care visits; Group II, 3-5 prenatal care visits; and Group III, ≥6 prenatal care visits. RESULTS: Group I had a lower median weight (57.0 vs. 64.0 kg, p<0.001), body mass index (22.1 vs. 24.3 kg/m2, p<0.001), and weight gain (9.0 vs. 12 kg, p=0.002) than Group III. The prevalence of admission to the neonatal intensive care unit (11.6 vs. 4.2%, p=0.02) and the newborn mortality rate within the first 72 h of life (2.3 vs. 0%, p<0.001) were higher in Group I than in Group III. Group II had a higher prevalence of admission to the adult intensive care unit (5.7 vs. 0.6%, p<0.001) and a higher newborn mortality rate within the first 72 h of life (1.6% vs. 0%, p<0.001) than Group III. CONCLUSIONS: Having ≥6 prenatal care visits was associated with lower rates of admission to the neonatal and adult intensive care unit, as well as a lower newborn mortality rate within the first 72 h of life.

Cuidados paliativos e espiritualidade no câncer: um estudo bibliométrico / Palliative care and cancer spirituality: a bibliometric study / Atención paliativa y espiritualidad del cáncer: un estudio bibliométrico

O objetivo foi realizar um estudo bibliométrico sobre cuidados paliativos e espiritualidade buscando saber o que tem sido produzido em artigos nacionais e internacionais. Foram selecionados estudos nas bases de dados LILACS, SciELO e MEDLINE, sendo encontrados 728 estudos, desses selecionados 95 atenderam aos critérios de inclusão. Entre esses critérios estão estudos publicados em português, espanhol ou inglês, entre 2008 e 2018, classificados como artigo empírico, artigo teórico, revisão sistemática ou teórica, ter acesso livre, e ter como temas centrais tanto a espiritualidade como o cuidado paliativo. A busca foi realizada com os descritores "palliative care" e "spirituality". Os indicadores bibliométricos apontaram um aumento de publicações sobre espiritualidade e cuidados paliativos de 2008 a 2018, especialmente em 2012. Além disso, há um aumento sobre a abordagem sobre o assunto como um maior enfoque dos profissionais de saúde para abordar a espiritualidade como parte do cuidado de pacientes em cuidados paliativos.(AU)

The aim was to conduct a bibliometric study on palliative care and spirituality seeking to know what has been produced in national and international articles. Studies were selected from the LILACS, SciELO and MEDLINE databases, and 728 studies were found, of which 95 met the inclusion criteria. Among these criteria are studies published in Portuguese, Spanish or English, between 2008 and 2018, classified as empirical article, theoretical article, systematic or theoretical review, having free access, and having as central themes both spirituality and palliative care. The search was performed using the keywords "palliative care" and "spirituality". Bibliometric indicators pointed to an increase in publications on spirituality and palliative care from 2008 to 2018, especially in 2012. In addition, there is an increase in approaching the subject as a greater focus of health professionals to address spirituality as part of care. of patients in palliative care.(AU)

El objetivo fue realizar un estudio bibliométrico sobre cuidados paliativos y espiritualidad buscando conocer lo que se ha producido en artículos nacionales e internacionales. Se seleccionaron estudios de las bases de datos LILACS, SciELO y MEDLINE, y se encontraron 728 estudios, de los cuales 95 cumplieron los criterios de inclusión. Entre estos criterios se encuentran los estudios publicados en portugués, español o inglés, entre 2008 y 2018, clasificados como artículo empírico, artículo teórico, revisión sistemática o teórica, que tienen acceso libre y tienen como temas centrales tanto la espiritualidad como los cuidados paliativos. La búsqueda se realizó utilizando las palabras clave cuidados paliativos y espiritualidad. Los indicadores bibliométricos señalaron un aumento en las publicaciones sobre espiritualidad y cuidados paliativos entre 2008 y 2018, especialmente en 2012. Además, hay un aumento en el enfoque del tema como un mayor enfoque de los profesionales de la salud para abordar la espiritualidad como parte de la atención. de pacientes en cuidados paliativos.(AU)