The association between victim-offender relationship and the age of children and adolescents who suffer sexual violence: a cross-sectional study

Abstract Objectives: Sexual violence is a problem that affects children and adolescents regardless of social class, age, origin, religion, education level, marital status, race, or sexual orientation. This study aimed to analyze the associations between victim-offender relationships and the victim's age in cases of sexual violence involving female victims. Methods: This cross-sectional, retrospective observational study used data from the Brazilian Ministry of Health's Department of Public Health Surveillance in Brasília regarding the reportable crime of rape as informed by female victims in the Federal District between January 1, 2012, and December 31, 2018. The age of the victim was classified as <15 years or 15-19 years. The offenders were classified into eight different categories according to their relationship with the victim: father, stepfather, brother, husband, boyfriend, friend, stranger, and others. The association between the victim-offender relationship and the victim's age was assessed. Results: Overall, there were 4,617 reported cases of sexual violence, with 78.3% of these (n = 3614) corresponding to children under 15 and 21.7% to adolescents 15-19 years old (n = 1003). Close relatives, including brothers, and friends were the main perpetrators in cases of girls < 15 years old. Strangers and friends were the principal perpetrators in the group of girls 15-19 years old. Conclusions: Children under 15 are the group most affected by sexual violence. Strategies must be developed to prevent the sexual abuse of children and adolescents and to facilitate the rehabilitation of victimized children.

Gravidez na adolescência: determinantepara prematuridade e baixo peso / Teenage pregnancy: determinant of prematurity and low-birth weight

A prematuridade e o baixo peso ao nascer são problemas de saúde pública.Este trabalho objetivou relacionar a ocorrência de partos prematurose de baixo peso ao nascer com a gravidez em adolescentes e foirealizada uma revisão bibliográfica sobre as suas condições socioeconômicas e culturais da gravidez na adolescência e os resultados perinatais.Utilizando o levantamento bibliográfico foram identificados artigos observacionaise de revisão sistemática que abordam o assunto. A análiseda literatura permite concluir que as gestações na adolescência bemcomo o ambiente socioeconômico e cultural em que está inserida a jovemmãe estão associadas ao aumento da freqüência de recém-nascidosde baixo peso e de prematuros. O desenvolvimento e a implantação depolíticas públicas efetivas direcionadas a essa população são necessáriaspara uma melhor abordagem do problema.

Prematurity and low birth weight are public health problems. This paperaims to relate the occurrence of premature labors and low birth weightwith adolescent pregnancy. We performed a literature review aboutthe socioeconomic and cultural conditions of adolescent pregnancy andperinatal results. Through bibliographical data, we identified observationaland systematic review articles that deal with the subject. The literatureanalysis permits us to conclude that adolescent pregnancies as well as the socioeconomic and cultural environment in which the young mother is inserted are associated with the increased frequency of prematures and low birth weight babies. The development and the implementation of effective public policies directed to that population arenecessary to a better approach of the problem.

Extração de feto grande pela manobra all-fours / Extration of large fetus through the all-fours maneuver

Introdução. A distocia de ombro é situação grave e imprevisível nos partos vaginais. Pode ser definida como impactação do ombro anterior contra o púbis materno que ocorre logo após a exteriorização da cabeça fetal. A manobra all-fours consiste em posicionar a parturiente de quatro, ou seja, movendo-a da sua posição litotômica dorsal para a posição de mãos-e-joelhos. Objetivo. Relatar experiência acerca do uso da manobra all-fours em feto grande, durante o parto, com intuito de oferecer aos profissionais de saúde maior compreensão e melhores condições de assistência às parturientes em situações de distocia de ombro. Caso. Parturiente, 32 anos, secundigesta, primípara, admitida no Hospital Regional da Asa Sul, com queixa de bolsa rota havia três horas e idade gestacional de quarenta semanas. História de parto normal na gestação anterior. Durante o período expulsivo, do segundo parto, tentou-se extrair o feto com manobras comuns, sem êxito. Diagnosticada, então, distocia de ombro grave. Foi decidido pela equipe executar a manobra all-fours, extraindo, em seguida, um feto vivo do sexo feminino, a termo, com Apgar 5-9, peso de 5.420 g. Conclusão. A manobra all-fours é segura, útil e eficaz quando realizada com técnica e, por ser relativamente nova na prática obstétrica, toda a equipe que atua em centros obstétricos deve conhecer sua indicação e seu manejo, para incrementar sua prática e evitar danos maternos e fetais nos casos de distocia de ombro.

Introduction. Shoulder dystocia is a serious, unexpected situation during the vaginal delivery. It can be defined as when the baby’s anterior shoulder gets stuck behind the mother’s pubic bone, after delivery of the fetal head. The all-fours maneuver consists of placing the expecting mother on her hands and knees, that is, moving from its dorsal lithotomy position for the hands-and-knees position. Objective. This work aims to report an experience of using the all-fours maneuver in large fetus during labor, in order to offer the health workers a better understanding and a better assistance to pregnant women presenting shoulder dystocia. Case. Woman in labor, 2nd gestation, 1 vaginal delivery, 32 years, admitted at Hospital Regional da Asa Sul referring fluid loss for three hours and with 40 weeks of gestation. During the delivery stage, we attempted to extract the fetus through the routine maneuvers without success. Then, it was diagnosed with severe shoulder dystocia. We were determined to perform the all-fours maneuver with the support of the team. Then, we extracted a live female fetus, at term, presenting Apgar 5-9, and weighing 5,420 g. Conclusion. The all-fours maneuver is safe, useful and effective when performed according to technique and, for being relatively new in the obstetric practice, the professionals who work at labor centers should be aware of the indications and the use of the maneuver, in order to improve the practice and prevent maternal and fetal injuries in cases of shoulder dystocia.