Sentidos do Nascer: exposição interativa para a mudança de cultura sobre o parto e nascimento no Brasil / Sentidos del Nacer - exposición interactiva para el cambio de cultura sobre el parto y el nacimiento en Brasil / Senses of Birth: An interactive and provocative exhibition to change the culture about childbirth in Brazil

A exposição Sentidos do Nascer (SDN) é uma ação de educomunicação inovadora que visa contribuir para mudança de cultura sobre o parto e nascimento no Brasil, incentivar o parto normal e apoiar a redução das elevadas taxas de cesarianas desnecessárias. Trata-se de uma exposição imersiva e interativa que articula linguagens e técnicas para sensibilizar o grande público e instigá-lo, de forma lúdica, a conhecer mais e se posicionar criticamente sobre a temática. Este artigo descreve as estratégias e dispositivos desenvolvidos para sensibilização e envolvimento do público no debate sobre o modelo assistencial ao parto e nascimento, bem como a metodologia utilizada para avaliar os efeitos e mudanças no conhecimento e percepção dos visitantes. Houve considerável mudança de opinião e percepção e ampliação do conhecimento sobre o parto e nascimento, revelando o potencial dessa estratégia em saúde.(AU)

La exposición "Sentidos del nacer" es una acción de educomunicación innovadora cuyo objetivo es contribuir con el cambio de cultura sobre el parto y el nacimiento en Brasil, incentivar el parto normal y dar apoyo a la reducción de los elevados índices de cesárea innecesarias. Se trata de una exposición de inmersión e interactiva que articula lenguajes y técnicas para sensibilizar al gran público e instigarlo, de forma lúdica, para que conozca más y se posicione críticamente sobre la temática. Este artículo describe las estrategias y dispositivos desarrollados para la sensibilización y el envolvimiento del público en el debate sobre el modelo asistencial al parto y al nacimiento, así como la metodología utilizada para evaluar los efectos y cambios en el conocimiento y percepción de los visitantes. Hubo un considerable cambio de opinión, percepción y ampliación del conocimiento sobre el parto y el nacimiento, revelando el potencial de esta estrategia de salud.(AU)

The Senses of Birth exhibit is an innovative educommunication action that seeks to contribute to a change in culture regarding childbirth in Brazil, giving incentive to normal childbirth and making a case for the reduction of unnecessary cesarean (C-section) rates. It is an immersive and interactive exhibition that articulates languages and techniques to raise awareness and instigate the general public, in a playful manner, to increase knowledge and promote a critical position on the subject. The article describes the strategies and devices used to raise the public´s awareness and involvement in the debate concerning childbirth care, as well as analyzes the effects and changes in the visitor´s knowledge and perception about childbirth. The results show considerable changes in opinion and perception favoring normal childbirth and an increase in knowledge related to forms of childbirth care and best practices, revealing the potential of this educational health strategy.(AU)

Laceração palpebral e canalicular neonatal em parto cesárea / Neonatal eyelid and canalicular laceration in cesarean delivery

Resumo Na medicina moderna, lesões traumáticas neonatais durante o parto são raras. Mais raras ainda são as relatadas por ocasião de um parto cesárea. Reporta-se o primeiro caso descrito de laceração palpebral e canicular neonatal em parto cesáreo. Descreve-se o trabalho conjunto de diagnóstico oportuno por parte da equipe de pediatria e a pronta intervenção cirúrgica oftalmológica num caso bem conduzido de laceração palpebral e canalicular à direita. O lactente apresenta-se sem prejuízo funcional permanente durante seguimento pós-operatório.

Abstract In modern medicine, neonatal traumatic injuries during childbirth are rare. More rarely are those during a cesarean birth. That is the first reported case of palpebral laceration and neonatal canicular cesarean section. We describe the joint work of early diagnosis by the pediatric team and the prompt ophthalmologic surgical intervention in a well-conducted case of right palpebral and canalicular laceration. The infant presents without permanent functional impairment during postoperative follow-up.

Representações sociais do processo de parturição de mulheres que vivenciaram a gravidez na adolescência / Social representations of the parturition process of women who experienced teenage pregnancy / Representaciones sociales del proceso del parto de las mujeres que experimentaron el embarazo adolescente

Objetivos: Conhecer as representações sociais do processo de parturição de mulheres que vivenciaram partos recorrentes na adolescência. Métodos: Trata-se de um estudo descritivo com abordagem qualitativa, fundamentado na Teoria das Representações Sociais proposta por Serge Moscovici. Fizeram parte desta pesquisa 30 mulheres que vivenciaram o parto recorrente na adolescência. Os dados foram coletados no período de maio a agosto de 2015, por meio de entrevista semiestruturada. Os dados foram analisados por meio da análise textual discursiva e do referencial teórico da Teoria das Representações Sociais. Resultados: Foi constatada a presença de representações sociais positivas e negativas de ambas as vias de parto. É possível perceber que as mulheres compreendem os benefícios do parto normal, bem como as indicações do parto cesariano. Conclusão: O conhecimento das mulheres está atrelado ao universo consensual; desta forma, constroem representações sociais negativas do processo de parturição que vão perpassando as gerações

Objectives: To know the social representations of women in parturition process that experienced recurring deliveries in adolescence. Methods: This is a descriptive study with a qualitative approach based on the theory of Social Representations proposed by Serge Moscovici. They were part of this study 30 women who experienced recurrent birth in adolescence. Data were collected from May to August 2015 through semi-structured interview. Data were analyzed using the Text Analysis Discourse and the theoretical framework of the Theory of Social Representations. Results: it was found the presence of positive and negative social representations of both delivery routes. You can see that women understand the benefits of normal birth, and the indications of cesarean section. Conclusion: Knowledge of women is linked to the consensual universe, thus build negative social representations of the parturition process that will permeating generations

Objetivos: Conocer lãs representaciones sociales de las mujeres em proceso de parto que experimentaron las entregas recurrentes em la adolescencia. Métodos: Se realizo um estúdio descriptivo com enfoque cualitativo basado en la teoría de las representaciones sociales propuesto por Serge Moscovici. Eran parte de este estudio 30 mujeres que experimentaron el nacimiento recurrente em la adolescencia. Los datos fueron recolectados entre mayo y agosto 2015 mediante entrevista semiestructurada. Los datos fueron analizados mediante e la nálisis del discurso de texto y el marco teórico de la Teoría de las Representaciones Sociales. Resultados: Se encontro la presencia de las representaciones sociales positivos y negativos de las entrega. Se puede ver que las mujeres entiendan los beneficios de un parto normal, y indicaciones de cesárea. Conclusion: El conocimiento de las mujeres está vinculada al universo consensual, así, construir representaciones sociales negativas del proceso de parto que impregna generaciones

Satisfação e percepção de dor em puérperas: um estudo comparativo após parto vaginal e cesariana em maternidades públicas de Aracaju / Pain perception and satisfaction of postpartum women: a comparative study after vaginal and caesarean birth in Aracaju public hospitals

INTRODUÇÃO: Além da qualidade do cuidado, estrutura física e acesso ao serviço de saúde, a assistência humanizada no processo de nascimento deve refletir sobre a experiência de dor e satisfação da mulher. OBJETIVO: Comparar a satisfação e a percepção de dor vivenciada pela mulher no parto vaginal e na cesariana. MÉTODOS: Estudo descritivo de corte transversal envolvendo puérperas. Foram aplicados: "Questionário de Experiência e Satisfação com o Parto" (QESP) modificado, versão curta do "questionário de dor McGill" e "esquema de representação corporal feminino". RESULTADOS: Foram entrevistadas 150 puérperas. Após a cesariana, demonstraram maior satisfação quanto à forma que decorreu o trabalho de parto (TP) (p=0,01) e menos satisfação em relação à dor no pós-parto (PP) (p=0,04). As de parto vaginal estavam mais satisfeitas sobre como decorreu o PP (p=0,02) e menos satisfeitas com a intensidade de dor no TP (p=0,03) e no parto (P) (p=0,01). As características dolorosas durante o TP e P foram aguda e cruel-punitiva. Em relação ao PP, a dor em baixo ventre foi mais relatada após a cesariana. A intensidade dolorosa no TP foi significativamente maior no parto vaginal (7,30 (±2,82) versus 5,86 (±3,51), (p=0,007). CONCLUSÃO: As que realizaram cesariana estavam mais satisfeitas como decorreu o TP e menos satisfeitas em relação à dor no PP. As de parto vaginal estavam mais satisfeitas com a forma que decorreu o PP e menos satisfeitas com a intensidade de dor no TP e P.

INTRODUCTION: In addition to the quality of care, physical structure and access to health services, a humanized care during birth process should reflect on the women's experience of pain and satisfaction. OBJECTIVE: To compare the satisfaction and perception of pain experienced by women during vaginal and cesarean delivery processes. METHODS: Descriptive cross-sectional study involving women in the immediate postpartum period. The modified "Experience and Satisfaction with Childbirth Questionnaire" ("Questionário de Experiência e Satisfação com o Parto" ­ QESP), the short version of "McGill pain questionnaire" and the "female body representation scheme" were used. RESULTS: 150 postpartum women were interviewed. After cesarean section demonstrated more satisfaction regarding the way the labor (LB) was carried out (p=0.01) and less satisfaction with pain in the postpartum period (PP) (p=0.04). Those submitted to vaginal delivery were more satisfied with their PP (p=0.02) and less satisfied with the intensity of pain during LB (p=0.03) and at birth (B) (p=0.01). The pain described during LB and B were "acute" and "cruel-punitive". In relation to PP, pain in the lower belly was more often reported after cesarean sections. Pain intensity during LB was significantly higher in vaginal labor (7,30 (±2,82) versus 5,86 (±3,51), (p=0,007). CONCLUSION: The perform cesarean sections were more satisfied with the way LB was carried out and less satisfied in relation to pain in the PP. Women who underwent vaginal labor were more satisfied with the PP and less satisfied with the intensity of pain during LB and at B.

Anaphylaxis after Induction of General Anesthesia for Cesarian Section : A case report

A 35 year old multipara woman was admitted for emergency repeat cesarian section. She had first cesarian section under general anesthesia 3 years ago, and appendectomy under spinal anesthesia 2 years ago. But no uneventful problem developed in two cases of anesthesia. After induction of general anesthesia with propofol and succinylcholine, the patient showed irritability and severe cough, and immediate anaphylactic reaction developed with cardiovascular collapse, bronchospasm, and erythematous skin eruption. We resuscitated the patient with epinephrine and methylprednisolone but cesarian section was performed without delay. Four minutes after the induction of anesthesia female baby was delivered and the patient was recovered without any complication.

Temperature Changes and Shivering during Epidural Anesthesia in Women Undergoing Cesarian Delivery / 대한마취과학회지

BACKGROUND: Epidural anesthesia decreases the core temperature triggering vasoconstriction and shivering, presumably by increasing apparent lower-body temperature. We therefore tested the hypothesis that epidural anesthesia in cesarian delivery patients decrease forearm-fingertip skin-surface temperature gradient and it is cause of shivering. METHODS: Twenty-two healthy pregnant women were studied. Epidural anesthesia was induced by 2% lidocaine and 0.75% ropivacaine 24 ml (T4 level) at 25degrees C ambient temperature. Shivering were evaluated by observation. Core temperature was recorded in the external auditory canal using a compensated infrared thermometer. Arteriovenous shunt tone was evaluated with forearm- fingertip temperature gradients; gradients less than 0 were considered evidence of vasodilation. Skin-surface temperature, skin- temperature gradients (forearm-fingertip, calf-toe) and the presence or absence of shivering were measured. RESULTS: Shivering was observed in seven of twenty two patients. Sixty minutes after induction, Tympanic temperature decreased for 0.8 +/- 0.1degrees C in non-shivering patients and 0.9 +/- 0.1degrees C in shivering patients. Forearm temperature decreased for 0.2 +/- 1.7degrees C in non-shivering patients, but increased for 0.5 +/- 0.6degrees C in shivering patients. Upper limb (Forearm-fingertip) skin Temperature gradients continues the plus in non-shivering patients, but maintain minus (45 minutes after induction) in shivering patients. Low limb skin temperature is increases in both group. CONCLUSION: We failed to confirm our hypothesis, but for an expected reason: shivering was preceded by hypothermia and vasoconstriction in the arm. For prevention of hypothermia in epidural anesthesia, not to be monitored core temperature, but also upper limb skin temperature gradients.

Comparative Study of Immunologic Parameters between Spinal and Epidural Anesthesia for a Cesarean Section / 대한마취과학회지

BACKGROUND: Surgical stress and anesthesia can cause postoperative immunosuppression. T helper lymphocytes play a central role in the immune response. Cytokines secreted from T helper type-1 (Th1) and Th2 influence patients' morbidity. The purpose of the current study was to compare the effect of spinal anesthesia with epidural anesthesia on the T helper cell and cytokine secretions following cesarean section. METHODS: Forty-four patients were randomly divided into two groups. Total lymphocytes, T helper cells, and T helper type-1 and type-2 cytokines, interleukin-2 (IL-2), interferon gamma (IFN-gamma), and IL-4 and IL-10 in the supernatant of CD4 cells stimulated with phytohemagglutinin were identified by using an enzyme-linked immune assay. Blood samples were obtained before surgery, 1, 3, and 24 h after the start of surgery. RESULTS: Significant decreases in lymphocytes and CD4 cells at 3 and 24 h after the start of surgery were seen in epidural anesthesia. The Th1 response, IFN-gamma and IL-2 secretions were detected in 9 patients, in the spinal group, and 9 and 14 patients in the epidural group, respectively. There were no differences in the Th1 responses between the groups as well as within the groups. Th2 cytokine, IL-10 response in the higher concentration group receiving spinal anesthesia decreased significantly over the three time points studied, but decreased only at 24 h in the epidural group. CONCLUSIONS: Our results show a possible different immune response profile between the spinal and epidural group: a decreased CD4 level in the epidural group and decreased IL-10 levels in the spinal group according to the time period after surgery.

The Effect of Anesthetic Technique on White Blood Cell Response to Surgery in Patients Who Underwent Laparoscopic Cholecystectomy and Cesarian Section / 대한마취과학회지

BACKGROUND: Surgical stress causes changes in the composition of white blood cells in peripheral blood. In addition, anesthesia itself has been suggested to have an immunosuppressive effect. Therefore, the aim of the present study was to investigate the effect of anesthetic technique on the changes of postoperative peripheral white blood cell (WBC) subsets in laparoscopic cholecystectomy patients and cesarian section patients. METHODS: We reviewed 100 patients who had laparoscopic cholecystectomy under conventional general anesthesia or propofol infusion. Each group contained 50 patients equally. We also reviewed 100 patients who had cesarian section under spinal and epidural anesthesia, 50 patients in each group, respectively. The changes of total WBC, lymphocytes, neutrophils and monocytes at 24 h and 48 h postoperatively were compared to baseline values within the groups and these values were compared between the groups. RESULTS: There were significant increases in total WBC and neutrophils, decreases in lymphocytes, no changes in monocytes at 24 h after surgery compared to baseline values for the groups receiving laparoscopic cholecystectomy. No differences were found between the two laparoscopic cholecystectomy groups. Cesarian section patients showed significant differences in total WBC, neutrophils, lymphocytes and monocytes at 48 h after surgery compared to baseline values for the groups. There were no significant differences between the groups. CONCLUSIONS: Neither laparoscopic cholecystectomy nor cesarian section showed significant differences in WBC subsets after surgery according to anesthetic technique.

The effect of succinylated gelatin on maternal and fetal plasma endothelin and calcitonin gene-related peptide levels during caesarian section under epidural anesthesia / 中华麻醉学杂志

0 05) The maternal plasma CGRP level was significantly higher(P

The Study of the Effect of Maternal FiO2 on the Umbilical Blood Gas Analysis and Maternal Awareness in Cesarean Section under General Anesthesia / 대한마취과학회지

General anesthesia for cesarean section usually includes 50% oxygen and nitrous oxide, supplemented by a low concentration of a volatile agent. This is based upon data demonstrating that an increase in maternal FiO2(inspired oxygen concentration) to more than 0.6 did not improve fetal oxygenation, But the use of 100% oxygen supplemented only by volatile anesthetics probably is safe in the case of emergency operation or fetal distress and advantageous in prevention of maternal awareness during cesarean section. The present study was designed to compare the effect of increasing FiO2 upon fetal oxygenation. It was also proposed to determine awareness, by questioning patients as well about dreams or other manifestations of inadequate depth of anesthesia. 30 patients undergoing cesarean section under general anesthesia were selected and they were allocated randomly into three groups according to FiO2 as follows; Group 1(n=10): FiO2 0.33 with 0.75 vo1% isoflurane, Group 2(n=10): FiO2 0.66 with 0.75vo1% isoflurane, Group 3(n= 10): FiO2 1.0 with 0.75 vo1% isoflurane. For the induction of anesthesia, thiopental 4 mg/kg was administered, followed by succinylcholine 1.5 mg/kg. After intubation, the lung was ventilated with different FiO2 and maternal arterial blood was sampled just before delivery and umbilical arterial and venous blood were sampled immediately after delivery. Induction to delivery time(IDT), uterine incision to delivery time(IDT), neonatal birth weight and Apgar score were measured. The patient was interviewed to evaluate the incidence of awareness three days after operation. Our results were as follows; There were statistically significant differences between three groups in maternal PaO2, but there were no statistically significant differences between three groups in umbilical arterial and venous oxygenation. Induction to delivery time(IDT) in group 1 was significantly short, compared to group 2 and 3, but uterine incision to delivery time(UDT) was not statistically difference between three groups. The condition of the neonates at birth was generally good except one in group 2. But, this neonate recovered as 5-min Apgar score of 9 after aspiration of amnionic fluid and oxygen administration. Two patients reported dreaming, pain recall or fact recall and one of them refused to be administrated the same anesthesia once again, respectively in three groups. In conclusion, the use of FiO2 0.33 is probably safe in no fetal distress while the use of FiO2 1.0 results in no increase of oxygen partial pressure of umbilical artery and vein, but it guarantees the safe method in the case of suspecting fetal depression. Our anesthetic method was not enough to prevent the awareness. So, further study about not only deep, but also safe anesthetic method is justified.