How to Reach the Best Ultrasound Performance in the Delivery Room / Como obter o melhor desempenho do ultrassom na sala de parto

Abstract Ultrasonography is an instrument that is present in the maternal-fetal assessment throughout pregnancy and with widely documented benefits, but its use in intrapartum is becoming increasingly relevant. From the assessment of labor progression to the assessment of placental disorders, ultrasound can be used to correlate with physiological findings and physical examination, as its benefit in the delivery room cannot yet be proven. There are still few professionals with adequate training for its use in the delivery room and for the correct interpretation of data. Thus, this article aims to present a review of the entire applicability of ultrasound in the delivery room, considering the main stages of labor. There is still limited research in evidence-based medicine of its various possible uses in intrapartum, but it is expected that further studies can bring improvements in the quality of maternal and neonatal health during labor.

Resumo A ultrassonografia é um instrumento que está presente na avaliação materno-fetal durante toda a gestação e com benefícios largamente documentados, porém sua utilização no intraparto vem sendo cada vez mais pertinente. Desde a avaliação de progressão de trabalho de parto a avaliação das desordens placentárias, a ultrassonografia pode ser empregada correlacionando com os achados fisiológicos e do exame físico, pois o seu benefício na sala de parto ainda não pode ser comprovado. Há ainda poucos profissionais com treinamento adequado para seu uso na sala de parto e para interpretação correta dos dados. Dessa forma, este artigo tem como finalidade apresentar uma revisão de toda a aplicabilidade do ultrassom na sala de parto, considerando as principais etapas do trabalho de parto. Ainda são limitadas as pesquisas em medicina baseada em evidências sobre os diversos usos possíveis no intraparto, mas espera-se que novos estudos possam trazer melhorias na qualidade da saúde materno-neonatal durante o 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.

Assessment of embryo/fetus during pregnancy by threedimensional ultrasonography using the HD live software: iconographic essay / Avaliação do embrião/feto ao longo da gestação por meio da ultrassonografia tridimensional com o software HD live: ensaio iconográfico

Fetal development is studied since the advent of two-dimensional ultrasonography. However, a detailed assessment of structures and surfaces improved with three-dimensional ultrasonography. Currently, it is possible to identify embryonic components and fetal parts with greater detail, at all pregnancy trimesters, using the HD live software, where the images gain realistic features by means of appropriate control of lighting and shadowing effects. In the present study, the authors utilized this resource to follow-up, by means of images, the development of a normal pregnancy along all trimesters.

O desenvolvimento fetal é estudado desde o advento da ultrassonografia bidimensional. Entretanto, a avaliação pormenorizada de estruturas e superfícies ganhou maior qualidade com a ultrassonografia tridimensional. Atualmente, é possível identificar componentes embrionários e partes do feto com maior riqueza de detalhes, em todos os trimestres da gestação, utilizando o software HD live, no qual a imagem ganha características realísticas mediante controle adequado de luz e sombreamento. Neste estudo utilizamos este recurso, por meio de imagens, para acompanhar a evolução de uma gestação normal em todos os seus trimestres.