Fatores clínicos do bem-estar de mulheres em parturição: perspectivas deontológicas e da bioética principialista / Clinical factors of women in labor well-being: deontological and bioethical principlism perspectives / Factores clínicos del bienestar de la mujer en trabajo de parto: perspectivas deontológicas y de la bioética principialista

Objetivo: avaliar os fatores clínicos associados ao bem-estar das mulheres durante o trabalho de parto e parto à luz da bioética principialista e da deontologia. Método: estudo transversal com abordagem quantitativa. Participaram 396 puérperas internadas em um hospital municipal do sudoeste da Bahia, e os dados foram coletados no período de janeiro a maio de 2023, após aprovação do comitê de ética em pesquisa. Os dados foram organizados no software Excel e analisados via SPSS v.25. a partir da regressão logística multinomial. Resultados: a maior parte da amostra apresentou bem-estar com assistência em saúde, mulheres que tiveram parto realizado por profissionais não médicos apresentaram mais chances de níveis de bem-estar "adequado". E mulheres que não tiveram a via de parto cesárea apresentaram aumento de chances de bem-estar. Conclusão: é necessário que os profissionais reflitam sobre suas ações, condicionando-as à humanização no parto, em observância aos princípios bioéticos.

Objective: to evaluate the clinical factors associated with women's well-being during labor and delivery in the light of bioethics principlism and deontology. Method: a cross-sectional study with a quantitative approach was conducted. It involved 396 postpartum women admitted to a municipal hospital in the southwest of Bahia. Data were collected from January to May 2023, after approval from the research ethics committee. The data were tabulated using Excel software and analyzed using SPSS v.25 through Multinomial Logistic Regression. Results: majority of the sample exhibited well-being with health care assistance. Women who underwent delivery performed by non-medical professionals showed higher chances of "adequate" levels of well-being. Additionally, women who did not undergo cesarean delivery showed increased chances of well-being. Conclusion: It is necessary for professionals to reflect on their actions, conditioning them to the humanization of childbirth, according to bioethical principles.

Objetivo: evaluar los factores clínicos asociados al bienestar de la mujer durante el trabajo de parto y parto a la luz de la bioética y la deontología principialista. Método: estudio transversal con enfoque cuantitativo. Incluyó 396 puérperas ingresadas en un hospital municipal del suroeste de Bahía. Recolección de datos de enero a mayo de 2023, con aprobación del comité de ética en investigación. Los datos se tabularon en el software Excel y se analizaron mediante SPSS v.25. utilizando regresión logística multinomial. Resultados: la mayoría de las participantes de la muestra presentó bienestar con la atención para la salud; las que tuvieron partos realizados por profesionales no médicos tenían más probabilidades de tener niveles "adecuados" de bienestar; las que no tuvieron parto por cesárea tenían mayores probabilidades de tener bienestar. Conclusión: es necesario que los profesionales reflexionen sobre sus acciones y las adecuen para humanizar el parto, respetando los principios bioéticos.

Desfechos obstétricos adversos durante a COVID-19: uma série de casos retrospectiva / Adverse obstetric outcomes during COVID-19: a retrospective case series / Resultados obstétricos adversos durante el COVID-19: serie de casos retrospectiva

Objetivo: analisar as características e os desfechos obstétricos adversos em gestantes/puérperas infectadas pelo SARS-CoV-2 em serviço de referência. Método: série de casos retrospectiva entre gestantes com Covid-19 em um hospital universitário em Minas Gerais, Brasil, atendidas no serviço de 2020 a 2021, coletados em abril de 2022, empregando-se estatística descritiva para análise dos dados através do Statistical Package for the Social Science. Resultados: incluídas 26 gestantes, em sua maioria brancas, que tiveram como principais desfechos obstétricos adversos a internação em UTI (43,5%), parto prematuro (34,6%), dado reestratificado de semanas para dias para investigar o encurtamento da gestação, onde constatou-se média de 38,6 dias potenciais de gravidez perdidos dos 280 dias ideais, e ainda 15,4% evoluíram para óbito materno. Conclusão: o estudo proporcionou evidenciar a necessidade de vigilância e atenção às gestantes com foco nos principais desfechos adversos, podendo-se intervir em tempo oportuno para diminuir adversidades.

Objective: to analyze the characteristics and adverse obstetric outcomes in pregnant/puerperal women infected by SARS-CoV-2 at a reference service. Method: a retrospective case series conducted among pregnant women with Covid-19 in a university hospital from Minas Gerais, Brazil, treated at the service from 2020 to 2021. The cases were collected in April 2022 employing descriptive statistics for data analysis in the Statistical Package for the Social Science. Results: a total of 26 pregnant women were included, mostly white-skinned, whose main adverse obstetric outcomes were admission to the ICU (43.5%), premature birth (34.6%) and data restratified from weeks to days to investigate shortening of pregnancy, where a mean of 38.6 potential days of pregnancy were lost out of the ideal 280 days, and 15.4% resulted in maternal death. Conclusion: the study provided evidence of the need for surveillance and care for pregnant women with a focus on the main adverse outcomes, enabling timely intervention to reduce adversities.

Objetivo: analizar las características y resultados obstétricos adversos en gestantes/puérperas infectadas por SARS-CoV-2 en un servicio de referencia. Método: serie de casos retrospectiva entre gestantes con Covid-19 en un hospital universitario de Minas Gerais, Brasil, atendidas en el servicio de 2020 a 2021. Los datos se recolectaron en abril de 2022, se utilizó estadística descriptiva para analizar los datos mediante el Statistical Package for the Social Science. Resultados: se incluyeron 26 gestantes, la mayoría de raza blanca, cuyos principales resultados obstétricos adversos fueron ingreso a UCI (43,5%), parto prematuro (34,6%), dato reestratificado de semanas a días para investigar el acortamiento de la gestación, que arrojó como resultado un promedio de 38,6. Se comprobó que se perdieron en promedio 38,6 días potenciales de embarazo de los 280 días ideales, y muerte materna (15,4%). Conclusión: la evidencia que proporcionó el estudio indica que es necesario vigilar y atender a las gestantes enfocándose en los principales resultados adversos, lo que permite intervenir de forma oportuna para reducir adversidades.

Tecnologias eHealth nos cuidados parentais aos bebês nascidos prematuros: revisão integrativa / EHealth technologies in parental care for preterm infants: an integrative review

Resumo As tecnologias eHealth contribuem na promoção das práticas parentais de cuidado para bebês pré-termo. Não obstante, é notável a abundância de informações e aplicativos disponíveis, a disparidade na qualidade, facilidade de uso e confiabilidade desses recursos. Este artigo objetiva examinar as tecnologias eHealth direcionadas aos pais para o cuidado de bebês pré-termo. Realizou-se uma revisão integrativa nas principais bases de dados da área da saúde (Capes, EBSCO, BVS, PubMed, Scholar e SciELO), com a seleção de publicações de 2011 a 2022, em português e inglês, sobre a utilização de tecnologias eHealth voltadas aos cuidados de bebês pré-termo. Identificaram-se 13 artigos com temáticas sobre: as tecnologias da informação e comunicação nas estratégias de educação e a promoção da saúde de bebês pré-termo e seus pais; e importância da avaliação e validação das tecnologias eHealth na promoção da saúde materno-infantil. Tecnologias eHealth validadas adequadamente podem desempenhar um papel fundamental em apoiar os pais na promoção da saúde e na prestação de cuidados ao bebê pré-termo após a alta hospitalar. Isso, por sua vez, tem o potencial de impulsionar a evolução dos sistemas de saúde e a melhoria das práticas clínicas.

Abstract The eHealth technologies promote parental care practices for preterm infants. Nonetheless, we should underscore the abundant information and available apps and disparities in these resources' quality, usability, and reliability. This article examines eHealth technologies directed at parents to care for preterm infants. An integrative review was conducted across the principal health databases (Capes, EBSCO, BVS, PubMed, Scholar, and SciELO), selecting works published from 2011 to 2022 in Portuguese and English, focusing on the use of eHealth technologies for the care of preterm infants. We identified 13 articles related to information and communication technologies in strategies for educating and promoting the health of preterm infants and their parents and the importance of evaluating and validating eHealth technologies in maternal and child health promotion. Properly validated eHealth technologies can be crucial in supporting parents in promoting health and providing care for preterm infants after hospital discharge, which, in turn, can drive the evolution of healthcare systems and improve clinical practices.

Situacion de la sifilis congénita en Paraguay utilizando datos del sistema de informacion perinatal (sip plus)

Introducción : Se promueven iniciativas para mejorar la salud de las mujeres y niños siendo el denominador común disponer de un sistema de información con repercusión en la salud de esta población. En Paraguay el SIP PLUS es utilizado con diferente grado de cobertura en los servicios maternoinfantiles. Objetivo: analizar la calidad de los datos generados para la construcción de los indicadores de Eliminación de la Sífilis Congénita (SC). Metodología: Estudio nacionalmente representativo utilizando datos generados por el SIP PLUS. Resultados: 32.479 historias perinatales cargadas desde el 2018 a julio del 2021. La representación de la muestra 1,5% en 2018 al 23% en 2021. Mayores pérdidas de información en el 2020. Para las variables de contexto con menos pérdidas de información en comparación a las de prevención primaria, secundaria y salud reproductiva. La pérdida de datos para: porcentaje de mujeres embarazadas con cuidado prenatal (4 o más) en un promedio de 64,4%; porcentaje de mujeres embarazadas tamizadas 43,1 % en el 2020 y 33,4% en 2019; positividad de la prueba de sífilis 49% en el 2020. Lo que también se observa en el indicador de tratamiento. Se registraron 506 casos de SC. Tasa de SCx1000 nacidos vivos ( 10 x1000 nacidos vivos en los 4 años analizados. Edad adolescente (p: 0,040) como factor de riesgo para SC. Conclusiones: Pérdida de registros en lo referente a ETMI, por falta de carga de datos. Alta incidencia de SC en los años analizados. Adolescentes como factor de riesgo para SC.

Introduction: Initiatives are promoted to improve the health of women and children, the common denominator being having an information system with an impact on the health of this population. In Paraguay, the SIP PLUS is used with different degrees of coverage in maternal and child services. Objective: analyze the quality of the data generated for the construction of the indicators for the Elimination of Congenital Syphilis (CS). Methodology: Nationally representative study using data generated by the SIP PLUS. Results: 32,479 perinatal histories uploaded from 2018 to July 2021. The representation of the sample went from 1.5% in 2018 to 23% in 2021. Greater information losses in 2020. For the context variables with fewer information losses in comparison to those of primary, secondary prevention and reproductive health. Loss of data for: percentage of pregnant women with prenatal care (4 or more) averaged 64.4%; percentage of pregnant women screened 43.1% in 2020 and 33.4% in 2019; syphilis test positivity 49% in 2020. This is also observed in the treatment indicator. 506 cases of CS were recorded. Rate of SCx1000 live births  10 x1000 live births in the 4 years analyzed. Adolescent age (p: 0.040) as a risk factor for CS. Conclusions: Loss of records regarding ETMI, due to lack of data loading. High incidence of CS in the years analyzed. Adolescents as a risk factor for CS.

Factores asociados a cesárea en usuarias de una clínica privada en Chile, años 2018 a 2022

Introducción: De acuerdo con lo reportado por la Organización para la Cooperación y el Desarrollo Económico, Chile posee una de las tasas más altas de cesárea para el continente, llegando a un 44,7% en 2013 y un 47,7% en 2017, ubicándose en tercer lugar, solo precedido por Turquía y México. Objetivo: Analizar los factores relacionados a intervención de cesárea en las mujeres que atendieron su parto en una clínica privada de la Quinta Región de Chile entre los años 2018 y 2022. Método: Estudio transversal analítico en 9041 usuarias. Se utilizó un modelo de regresión logística con odds ratio y sus intervalos de confianza del 95% para evaluar la asociación con variables sociodemográficas y obstétricas. Resultados: La prevalencia de cesárea fue del 85,1% en el periodo estudiado. La condición de gestante primípara, la cesárea previa, la presencia de patología materna o fetal, la ausencia de trabajo de parto y la esterilización quirúrgica presentaron mayor probabilidad de cesárea, mientras que para la edad gestacional, menor o igual a 36 semanas, ésta fue menor. Conclusiones: Destaca un alta prevalencia de cesáreas para el periodo de estudio, superior a lo reportado en la literatura.

Introduction: According to the Organisation for Economic Co-operation and Development, Chile has one of the highest caesarean section rates on the continent, reaching 44.7% in 20132 and 47.7% in 20173 , ranking third only to Turkey and Mexico. Objective: Analyze the factors related to cesarean section intervention in women who delivered in a private clinic in the Fifth Region of Chile, from 2018 to 2022. Method: Cross-sectional study involving 9,041 users. A logistic regression model with odds ratio and its 95% confidence intervals was used to assess associations with sociodemographic and obstetric factors. Results: The prevalence of cesarean section during the study period was 85.1%. Primiparous status, previous cesarean section, presence of maternal and fetal pathology, absence of labor and surgical sterilization were associated with an increased likelihood of cesarean section, while gestational age 36 and under weeks showed a decreased chance. Conclusions: A high prevalence of cesarean sections stands out for the study period, higher than that reported in the literature.

Factors associated with early initiation of breastfeeding / Fatores associados ao aleitamento materno na primeira hora de vida

INTRODUCTION: Early initiation of breastfeeding (EIBF) is still little stimulated in several hospitals in Brazil. Objective: To estimate the prevalence and factors associated with Early initiation of breastfeeding (EIBF). METHODS: Cross-sectional, quantitative study with retrospective secondary data collection in hospital records of 250 full-term newborns, regardless of the type of delivery, with no history of maternal gestational risk, seen in the last six months. Data collection period in a public maternity hospital in Greater São Paulo. Data collection was performed between November 2018 and January 2019, with approval from the hospital and the FMABC Research Ethics Committee under register n. 2,924,393. RESULTS: The prevalence of EIBF was 66%. BFH is associated with anesthesia at childbirth (p<0,001), APGAR less than or equal to 8 in the 1st and 5th minutes (p<0,001), and with c-section (p<0,001), which represented 29.2% of deliveries in the sample. Respiratory distress (38.82%), hypotonia (24.70%), followed by unfavorable maternal conditions (18.82%), were shown to be impeding factors for EIBF, although 90% of newborns received Apgar 9 /10 in the 5th minute. CONCLUSION: The prevalence of early breastfeeding is lower than recommended, but compatible with the most recent national frequency proportions.

INTRODUÇÃO: O aleitamento materno na primeira hora de vida ainda é pouco estimulado em vários hospitais do Brasil. OBJETIVO: Analisar a prevalência e os fatores associados ao aleitamento materno na primeira hora de vida (AMP) entre recém-nascidos a termo. MÉTODOS: Estudo transversal, de natureza quantitativa, com coleta de dados secundários retrospectivos em prontuários hospitalares de 250 recém-nascidos a termo, independentemente do tipo de parto, com histórico de gestacional de risco habitual, atendidos nos últimos seis meses anteriores ao período de coleta de dados, em uma maternidade pública da Grande São Paulo. Os dados foram coletados entre novembro de 2018 e janeiro de 2019, por meio de roteiro estruturado, mediante aprovação do hospital e do Comitê de Ética em Pesquisa da FMABC (Parecer n.º 2.924.393). O banco de dados e o tratamento estatístico foram realizados através do programa STATA®. Para a análise, utilizou-se proporções e teste qui-quadrado, adotando-se um nível de significância de 5% e 95% o intervalo de confiança. RESULTADOS: A prevalência de AMP foi de 66%. O AMP está associado a anestesia no parto (p<0,001), APGAR menor ou igual a 8 no 1º e 5º minutos (p<0,001) e ao parto cesárea (p<0,001), cuja proporção na amostra foi de 29,2%. Desconforto respiratório (38,82%), hipotonia (24,70%), seguido de condições maternas desfavoráveis (18,82%), mostraram-se como fatores impeditivos para o AMP, embora 90% dos recém-nascidos tenham recebido Apgar 9/10 no 5º minuto. CONCLUSÃO: A prevalência do aleitamento materno precoce é inferior ao recomendado, porém compatível com as proporções de frequência nacional mais recentes.

Partos y cesáreas en edad de riesgo en hospitales del Maule desde 2017 a 2021 / Births and cesarean sections at risk age in Maule hospitals from 2017 to 2021

Pregnancy, despite being a physiological process, can lead to morbidity and mortality, which is increased at risk ages, defined as younger or equal to15 years and older or equal to 35 years. For an adequate approach it is necessary to know the local reality of the population, therefore, the objective of this study is to describe and analyze the discharges of births and cesarean sections at risk age in the Maule Region from 2017 to 2021 using the database collected from the Biostatistics Unit of the Maule Health Service, which includes the hospitals of the region. Within the observed period, a total of 30,599 deliveries and cesarean sections were studied, being these a total of 5,581 at risk age, of which 0.65% corresponds to women younger or equal to 15 years and 17.57% to women older or equal to 35 years. There is a downward tendency in births in general, mostly evidenced in less or equal to 15 years, and on the contrary, a rise in births and cesarean sections of more or equal to 35 years, differing with the statistics at the country level. The tendency of increasing maternal age of pregnancies in the Maule region and its consequences are a fundamental factor when planning new public policies, so we consider it of vital importance to promote research and update the evidence, with a focus on the local population.

El embarazo a pesar de ser un proceso fisiológico puede conllevar morbimortalidad, la cual se acrecienta en edades de riesgo, definida como menor o igual a 15 años y mayor o igual a 35 años. Para el adecuado enfrentamiento se necesita conocer la realidad local, por ello, el objetivo de este estudio es describir y analizar los egresos de partos y cesáreas en edad de riesgo en la Región del Maule desde el año 2017 a 2021 utilizando la base de datos recogida desde la Unidad de Bioestadística del Servicio de Salud Maule, la cual incluye los hospitales de la región. Dentro del periodo observado se estudió un total de 30.599 partos y cesáreas, siendo estos un total de 5.581 en edad de riesgo, de los cuales 0.65% corresponde a mujeres menores o igual a 15 años y 17.57% a mujeres mayores o igual a 35 años. Existe una tendencia a la baja de los nacimientos en general, mayormente evidenciado en menores o igual a 15 años, y por el contrario, un alza en los partos y cesáreas de mayores o igual a 35 años, difiriendo con las estadísticas a nivel país. El aumento de la edad materna de los embarazos en la región del Maule y sus consecuencias son un factor fundamental a la hora de planificar nuevas políticas públicas, por lo que consideramos de vital importancia promover la realización de investigaciones y actualización de la evidencia sobre el tema, con un enfoque en la población local.

Fatores associados à deficiência de vitamina D em mulheres gestantes e lactantes / Factores asociados a la deficiencia de vitamina D en mujeres embarazadas y lactantes / Factors associated with vitamin d deficiency in pregnant and lactatingwomen

Introdução: A deficiência de vitamina D durante a gestação e a lactação pode repercutir negativamente no desenvolvimento fetal e infantil, devido seu papel fundamental nos sistemas imunológico, cardíaco, ósseo, muscular e neural. Objetivo: Realizar uma revisão de literatura para integrar estudos que evidenciam a deficiência de vitamina D em gestantes e lactantes, e os fatores de risco associados a essa carência. Metodologia: Foi realizado um levantamento bibliográfico entre agosto e outubro de 2021, com atualização entre outubro e novembro de 2022 através de pesquisas às bases Pubmed e Scielo, bem como às listas de referências dos artigos selecionados. Foram empregados os descritores consumo alimentar, vitamina D, deficiência de vitamina D, gestantes e lactantes, usando-se o operador booleano AND para a associação entre eles. Como critérios de inclusão foram adotados o tipo de estudo (epidemiológicos, ensaios clínicos e revisões integrativa e sistemática), o idioma (espanhol, inglês e português) e o período de publicação (2010 a 2022). Resultados: Evidenciou-se que existem vários fatores de riscos para a inadequação do status de vitamina D em gestantes e lactantes como a baixa exposição da pele à luz solar e fatores relacionados (uso excessivo de protetor solar, menor tempo de atividades ao ar livre, clima, religião e hábitos culturais, maior escolaridade);a pigmentação mais escura da pele; o baixo consumo alimentar de vitamina D e variáveis associadas; a menor idade materna; o primeiro trimestre gestacional; a primiparidade e o excesso de tecido adiposo. Conclusões: Em gestantes e lactantes, a carência de vitamina D associa-se a distintos fatores, com destaque principalmente para a baixa exposição à luz solar, a pigmentação mais escura da pele e o excesso de tecido adiposo, sendo de extrema importância que sejam abordados com cautela, visando ações voltadas a variáveis modificáveis, de modo a auxiliar na redução da hipovitaminose D nestes grupos (AU).

Introduction: Vitamin D deficiency during pregnancy and breastfeeding can have a negative impact on fetal and infant development due to its fundamental role in the immune, cardiac, bone, muscular and neural systems. Objective: To conduct a literature review to integrate studies which show the Vitamin D deficiency in pregnant andlactating women, and the risk factors associated with this deficiency. Methodology: A bibliographic survey was carried out between August and October 2021, with an update between October and November 2022 through searches in the Pubmed and Scielo databases, as well as the reference lists of the selected articles. The descriptors food consumption, vitamin D, vitamin D deficiency, pregnant and lactating women were used, using the Boolean operator AND for the association between them. The type of study (epidemiological, clinical trials and integrative and systematic reviews), language (Spanish, English and Portuguese) and publication period (2010 to 2022) was adopted as inclusion criteria.Results:It was shown that there are several risk factors for inadequate vitamin D status in pregnant and lactating women, such as low skin exposure to sunlight and related factors (excessive use of sunscreen, less time spent outdoors, climate, religion and cultural habits, higher education); darker skin pigmentation; low dietary intake of vitamin D and associated variables; the lowest maternal age; the first gestational trimester; primiparity and excess adipose tissue.Conclusions: Vitamin D deficiency in pregnant and lactating women is associated with different factors, witha main emphasis on low exposure to sunlight, darker skin pigmentation and excess adipose tissue. Furthermore, it is extremely important that these factors are approached with caution, implementing actions aimed at modifiable variables in order to help reduce hypovitaminosis D in these groups (AU).

Introducción: La deficiencia de vitamina D durante el embarazo y la lactancia puede tener un impacto negativo en el desarrollo fetal e infantil, por su papel fundamental en los sistemas inmunológico, cardíaco, óseo, muscular y neural. Objetivo: Realizar una revisión bibliográfica para integrar estudios que evidencien la deficiencia de vitamina D en mujeres embarazadas y lactantes, y los factores de riesgo asociados. Metodología:Se realizó un levantamiento bibliográfico entre agosto y octubre de 2021, con actualizaciones entre octubre y noviembre de 2022 mediante búsquedas en las bases de datos Pubmed y Scielo, así como en las listas de referencias de los artículos seleccionados. Se utilizaron los descriptores consumo de alimentos, vitamina D, deficiencia de vitamina D, gestantes y lactantes, utilizándose el operador booleano AND para la asociación entre ellos. Se adoptaron como criterios de inclusión el tipo de estudio (epidemiológicos, clínicos, revisiones integradoras y sistemáticas), idioma (español, inglés y portugués) y período de publicación (2010 a 2022).Resultados: Existen varios factores de riesgo para un estado inadecuado de vitamina D en mujeres embarazadas y lactantes, como la baja exposición de la piel a la luz solar y factores relacionados (uso excesivo de protector solar, menor tiempo al aire libre, clima, religión y hábitos culturales, educación más alta); pigmentación de la piel más oscura; baja ingesta dietética de vitamina D y variables asociadas; la edad materna más baja; el primer trimestre gestacional; Primiparidad y exceso de tejido adiposo. Conclusiones:En mujeres embarazadas y lactantes, el déficit de vitamina D se asocia a diferentes factores, especialmente la baja exposición solar, la pigmentación de la piel más oscura y el exceso de tejido adiposo, y es de suma importancia abordarlos con precaución, apuntando a acciones dirigidas a variables modificables, con el fin de ayudar a reducir la hipovitaminosis D en estos grupos (AU).

Transição para a maternidade não planejada após os 35 anos: teoria de situação específica / Transition to unplanned motherhood after age 35: situation-specific theory

Resumo: A saúde sexual e reprodutiva é um pilar fundamental do sistema de saúde brasileiro, assinalando a importância das políticas públicas e programas voltados para a promoção dos direitos sexuais e reprodutivos. Nessas políticas, mulheres com 35 anos ou mais recebem pouca ou nenhuma atenção em relação a esse tema, pois as políticas estão voltadas para prevenção de doenças. Há uma crescente prevalência de gravidezes não planejadas nessa faixa etária e estudos não têm conseguido apreender conhecimentos acerca das experiências de mulheres que vivenciam a transição para a maternidade não planejada em idade avançada, a fim de aprimorar o cuidado a essas e promover uma transição bem-sucedida. Assim, o objetivo deste estudo foi desenvolver uma Teoria de Situação Específica para o cuidado de Enfermagem à mulher com 35 anos ou mais em transição para a maternidade de uma gestação não planejada, a partir da Teoria das Transições. O estudo caracteriza-se como teórico-exploratório de natureza qualitativa, que utilizou a Abordagem Integrativa para o desenvolvimento de Teorias de Situação Específica em enfermagem, guiada pela estratégia teoria-pesquisa-teoria, de Afaf Meleis. O processo metodológico envolveu um exercício reflexivo dedutivo, iniciando com a derivação dos conceitos centrais da Teoria das Transições. Seguiu-se a indução por meio de pesquisa de campo qualitativa, com entrevistas semiestruturadas de seis gestantes que não planejaram a gestação, com média de idade de 41 anos, ocorridas entre julho de 2022 a julho de 2023 no prénatal de alto risco de um hospital universitário do Sul do Brasil. Ainda indutivamente, produziuse dados a partir da reanálise de uma dissertação de Mestrado do grupo de pesquisa, bem como de revisão integrativa da literatura e da experiência com pesquisas prévias no tema, a fim de fundamentar o desenvolvimento da Teoria de Situação Específica. Foram desenvolvidas a partir disso declarações do metaparadigma, pressupostos e proposições. A teoria desenvolvida explica a transição para a maternidade não planejada em mulheres com 35 anos ou mais, contextualizando-a como um fenômeno social complexo, influenciado por fatores socioeconômicos, culturais, individuais e coletivos. A teoria explica como a maternidade tardia, especialmente quando não planejada, emerge como um papel em constante transformação, permeado por percepções diversas sobre o significado de ser mãe nessa fase da vida, desafiando frequentemente expectativas e crenças prévias. À medida que a experiência se amplia, concepções anteriores sobre a maternidade são questionadas, e novas são formadas, conduzindo a um processo de empoderamento e redefinição pessoal. Esta transição para a maternidade, marcada pela pluralidade de perspectivas e experiências, destaca a complexidade e a individualidade de cada mulher. Foi desenvolvida uma representação gráfica com as relações entre as declarações do metaparadigma., assim como nove proposições e cinco pressupostos. Esta teoria se baseia em vertentes do conhecimento científico atual para justificar sua construção, ressaltando a importância de compreender as experiências humanas e os contextos sociais onde ocorrem. A Teoria de Situação Específica atingiu o objetivo na medida em que propõe uma estrutura teórica em que o cuidado de enfermagem facilita os processos de transição e promove a interação entre cliente, ambiente, saúde e enfermagem. Além disso, possibilita que o enfermeiro provoque e estimule mudanças significativas nos resultados das transições por meio das terapêuticas de cuidado de enfermagem, evidenciando a necessidade de um cuidado personalizado e contextualizado, que leve em consideração a complexidade das experiências de maternidade tardia não planejada.

Abstract: Sexual and reproductive health is a fundamental pillar of the Brazilian healthcare system, highlighting the importance of public policies and programs aimed at promoting sexual and reproductive rights. In these policies, women aged 35 and older receive little or no attention regarding this issue, as the policies are focused on disease prevention. There is an increasing prevalence of unplanned pregnancies in this age group, and studies have not been able to capture knowledge about the experiences of women undergoing the transition to unplanned motherhood at an older age, in order to improve care for these women and promote a successful transition. Therefore, the aim of this study was to develop a Specific Situation Theory for nursing care of women aged 35 and older transitioning to motherhood from an unplanned pregnancy, based on the Transition Theory. The study is characterized as theoretical-exploratory with a qualitative nature, using the Integrative Approach for the development of Specific Situation Theories in nursing, guided by Afaf Meleis's theory-research-theory strategy. The methodological process involved a deductive reflective exercise, starting with the derivation of the central concepts of the Transition Theory. This was followed by induction through qualitative field research, with semi-structured interviews of six pregnant women who had unplanned pregnancies, with an average age of 41 years, conducted between July 2022 and July 2023 in the high-risk prenatal care of a university hospital in Southern Brazil. Inductively, data was also generated from the reanalysis of a master's thesis from the research group, as well as from an integrative literature review and experience with previous research on the topic, to support the development of the theory. From this, metaparadigm statements, assumptions, and propositions were developed. The developed theory explains the transition to unplanned motherhood in women aged 35 and over, contextualizing it as a complex social phenomenon, influenced by socioeconomic, cultural, individual, and collective factors. The theory elucidates how late motherhood, especially when unplanned, emerges as a role in constant transformation, permeated by diverse perceptions about the meaning of being a mother at this stage of life, often challenging previous expectations and beliefs. As the experience broadens, previous conceptions about motherhood are questioned, and new ones are formed, leading to a process of empowerment and personal redefinition. This transition to motherhood, marked by a plurality of perspectives and experiences, highlights the complexity and individuality of each woman. A graphic representation of the relationships between the metaparadigm statements was developed, along with nine propositions and five assumptions. This theory is based on strands of current scientific knowledge to justify its construction, emphasizing the importance of understanding human experiences and the social contexts in which they occur. The Specific Situation Theories achieved its objective insofar as it proposes a theoretical framework in which nursing care facilitates transition processes and promotes the interaction between client, environment, health, and nursing. Moreover, it enables the nurse to provoke and stimulate significant changes in transition outcomes through nursing care therapeutics, highlighting the need for personalized and contextualized care that considers the complexity of the experiences of unplanned late motherhood.

Características de recién nacidos hijos de madre con IgM positiva para el Virus Herpes Simplex

Introducción: El herpes connatal es una entidad infrecuente asociada a elevada morbimortalidad. La probabilidad de transmisión al recién nacido va de 5% al 85%. El diagnóstico se dificulta por falta de clínica, serología no confiable y por la no disponibilidad de PCR en los servicios públicos de países en vías de desarrollo. La IgM en gestantes podría ser utilizada como un marcador de sospecha para evaluar al neonato. Objetivo: Caracterizar a los recién nacidos, hijos de gestantes con IgM positiva para HVS 1-2 y la frecuencia de encefalitis en los infantes. Materiales y métodos : Estudio observacional, descriptivo, prospectivo, realizado de mayo de 2020 a octubre de 2021. Se incluyeron recién nacidos (RN) de madres con IgM positiva para Herpes Virus Simplex (HVS) a partir de la segunda mitad del embarazo. En el RN se realizó serología IgG e IgM, y además, PCR- RT para HVS 1-2 en sangre y/o LCR, excluyéndose los nacidos en otras maternidades y/o sin datos de serología materna. Resultados: 36 pacientes. Edad materna 28 años (DS + 4), 5% con antecedentes de HVS, 61% cesárea. 36% prematuros, 13% RCIU. Síntomas agudos en el RN 22%. De ellos, 19% plaquetopenia, 44% alteración de GOT. 63% PCR HVS en sangre y 44% en LCR. Se encontró hemorragia, hidrocefalia, leucomalacia en 27%. No se encontró diferencias en la expresión clínica por tipo de parto. Conclusiones: Los RN hijos de gestantes con IgM positiva para VHS desde la segunda mitad del embarazo o periparto, presentaron infección por VHS determinada por PCR en sangre o LCR, independiente de la vía del parto. El diagnóstico serológico en embarazadas permite la pesquisa, diagnóstico y tratamiento temprano del RN.

Introduction: neonatal herpes is a rare entity associated with high morbidity and mortality. The probability of transmission to the newborn ranges from 5% to 85%. The diagnosis is difficult due to the lack of clinical signs, unreliable serology and the non-availability of PCR in public services in developing countries. IgM in pregnant women could be used as a suspected marker to evaluate the neonate. Objective: To characterize newborn children of pregnant women with positive IgM for HSV 1-2 and the prevalence of encephalitis in infants. Materials and methods: Observational, descriptive, prospective study, carried out from May 2020 to October 2021. Newborns (NB) of mothers with positive IgM for Herpes Virus Simplex (HSV) from the second half of pregnancy were included. In newborns, IgG and IgM were performed, and in addition, PCR-RT for HSV 1-2 in blood and/or CSF, excluding those born in other hospitales and/or without maternal serology data. Results: We included 36 patients. Maternal age was 28 years (DS + 4), 5% with a history of HSV. 61% were delivered via cesarean section, 36% were premature, 13% had IUGR. 22% of the newborns had acute symptoms. 19% had thrombocytopenia, 44% had GOT alteration. 63% were PCR positive for HSV in serum and 44% were CSF-positive. Hemorrhage, hydrocephalus and leukomalacia were found in 27%. No differences were found in clinical expression by type of delivery. Conclusions: Newborns born to pregnant women with positive IgM for HSV from the second half of pregnancy or peripartum, presented HSV infection as determined by PCR in blood or CSF, regardless of the route of delivery. Serological diagnosis in pregnant women allows early screening, diagnosis and treatment of the NB.

Violencia obstétrica: percepción de las mujeres durante la atención de parto en dos hospitales rurales de la zona Nahua-Mixteca / Obstetric violence: women perception during labor in two hospitals in Nahua-Mixteca zone

Resumen Antecedentes: Múltiples estudios en Latinoamérica revelan que un gran número de pacientes ginecológicas sufren de violencia obstétrica en la atención institucional, la cual es definida como la apropiación del cuerpo de las mujeres por parte del personal de salud, aumentando las cifras de morbimortalidad. Objetivo: Determinar la frecuencia de acciones indirectas que representan violencia obstétrica, en un grupo de pacientes en el puerperio inmediato en hospitales rurales de la zona Nahua-Mixteca de los Estados de Puebla y Guerrero. Método: Estudio prospectivo y descriptivo realizado del 1 de enero al 30 de agosto del 2019 en el que se investigó la ocurrencia de violencia obstétrica en 296 pacientes atendidas durante el puerperio inmediato. Las variables sociodemográficas, procedimientos médicos durante el trabajo de parto, iniciativa de parto amigable y el alumbramiento fueron investigados en el expediente clínico. Resultados: La agresión verbal fue documentada en el 14.1% del grupo, siendo el médico el agresor más frecuente, seguido del personal de enfermería, sin embargo se documentó también la agresión por parte de otro tipo de personal. En un 13.5% no hubo evidencia de empatía con las emociones del trabajo de parto. Conclusiones: Se demostró una frecuencia elevada de violencia obstétrica, una mejora parcial en la iniciativa de parto amigable y un elevado porcentaje de procedimientos obstétricos que conllevan riesgos para la mujer y el recién nacido.

Abstract Background: Multiple studies in Latin America reveal that a large number of gynecological patients suffer a kind of obstetric violence in institutional care, which is defined as the appropriation of women's bodies by health personnel, increasing morbidity and mortality rates. Objective: To determine the frequency of indirect actions that represent obstetric violence, in a group of patients in the immediate puerperium in rural hospitals in the Nahua-Mixtec area of the States of Puebla and Guerrero. Method: Prospective and descriptive study carried out from January 1 to August 30, 2019, in which the occurrence of obstetric violence was investigated in 296 patients treated during the immediate postpartum period. Sociodemographic variables, medical procedures during labor, friendly labor initiative, and delivery were investigated in the clinical record. Results: Verbal aggression was documented in 14.1% of the group, with the doctor being the most frequent aggressor, followed by nursing staff; however, aggression by other types of personnel was also documented. In 13.5% there was no evidence of empathy with the emotions of labor. Conclusions: A high frequency of obstetric violence was demonstrated, a partial improvement in the friendly delivery initiative and a high percentage of obstetric procedures that carry risks for the woman and the newborn.

Postpartum depression in adolescent mothers before and during COVID-19 and the role of self-esteem, maternal self-efficacy, and social support / Depresión posparto en madres adolescentes antes y durante la pandemia por COVID-19 el papel de la autoestima, la autoeficacia materna y el apoyo social

Abstract Introduction Although the COVID-19 pandemic negatively impacted the mental health of vulnerable populations, such as adolescent mothers, very few studies have documented the prevalence of postpartum depression (PPD) in this population. Objective a) Determine the frequency of PPD (Edinburgh Postnatal Depression Scale [EPDS] ≥ 9) in adolescent mothers before (AM-BP) and during (AM-DP) the pandemic, b) Examine psychosocial factors (self-esteem, maternal efficacy, social support, depression and anxiety in pregnancy, planned and wanted pregnancy) in AM-BP and AM-DP, and c) Determine whether being an AM-DP was a significant factor for experiencing PPD (EPDS ≥ 9). Method Cross sectional study. Subjects: Forty-one AM-BP recruited at Health Centers and interviewed face to face and forty-one AM-DP surveyed online. Results PPD (EPDS ≥ 9) was 42% (p = .001) more frequent in AM-DP. The groups differed significantly in all psychosocial factors, with AM-DP faring worse. Unadjusted regressions showed that being an AM-DP, having lower maternal efficacy and self-esteem, greater dissatisfaction with social support, and depression and/or anxiety in pregnancy increased PPD (EPDS ≥ 9). Adjusted multiple analysis indicated that lower self-esteem was the only factor to maintain its association with PPD (EPDS ≥ 9; p = .017). Discussion and conclusion The pandemic negatively affected PPD (EPDS ≥ 9) and psychosocial factors in AM-DP, as compared to AM-BP, with self-esteem being the main factor associated with PPD (EPDS ≥ 9). In situations of extreme stress as happened in the pandemic, the mental health of adolescent mothers should be prioritized to prevent negative effects such as PPD. PPD preventive and treatment interventions should consider strengthening self-esteem.

Resumen Introducción La pandemia por COVID-19 tuvo un impacto negativo en la salud mental de poblaciones vulnerables, como las madres adolescentes, no obstante, escasos estudios documentaron la prevalencia de depresión posparto (DPP) en esta población. Objetivo a) Conocer la frecuencia de DPP (Escala Edinburgh para la Depresión Postnatal [EPDS] ≥ 9) en madres adolescentes antes de la pandemia (MA-AP) y durante la pandemia (MA-DP), b) Examinar algunos factores psicosociales (autoestima, eficacia materna, apoyo social, depresión y ansiedad en el embarazo, embarazo planeado y deseado) en MA-AP y MA-DP, y, c) Analizar si ser MA-DP, fue un factor significativo para experimentar DPP (EPDS ≥ 9). Método Estudio transversal. Participantes: 41 MA-AP captadas en Centros de Salud y 41 MA-DP encuestadas en línea. Resultados La DPP (EPDS ≥ 9) fue 42% (p = .001) más frecuente en las MA-DP. Los grupos difirieron significativamente en todos los factores psicosociales, en detrimento de las MA-DP. Las regresiones no ajustadas mostraron que ser MA-DP, tener menor eficacia materna y autoestima, mayor insatisfacción con el apoyo social, y depresión y/o ansiedad en el embarazo incrementaron la DPP (EPDS ≥ 9). El análisis múltiple ajustado indicó que una menor autoestima fue el único factor que mantuvo su asociación con DPP (EPDS ≥ 9; p = .017). Discusión y conclusión La pandemia tuvo un efecto negativo en la DPP (EPDS ≥ 9) y en factores psicosociales en MA-DP; la autoestima fue el principal factor asociado a la misma. Ante situaciones de estrés extremo, la salud mental de madres adolescentes debería ser prioritaria para prevenir efectos negativos como la DPP. Intervenciones preventivas y de tratamiento de DPP deben fortalecer la autoestima.

Diabetes mellitus e saúde materna durante a pandemia de covid-19 no Brasil / Diabetes mellitus and maternal health during the COVID-19 pandemic in Brazil / Diabetes mellitus y salud materna durante la pandemia de la COVID-19 en Brasil

A pandemia do novo coronavírus (covid-19) é um grave problema de saúde pública. Adicionalmente, a hiperglicemia na gestação (diabetes preexistente, diabetes diagnosticado pela primeira vez na gestação e diabetes mellitus gestacional) é uma das complicações maternas mais frequentes na população obstétrica. A sobreposição desses problemas pode refletir na saúde materna e fetal. Desse modo, o objetivo deste estudo é reunir evidências acerca da saúde materna de mulheres com hiperglicemia na gestação durante a pandemia de covid-19 no Brasil. Trata-se de uma revisão narrativa, em que a fonte de dados compreendeu artigos publicados até maio de 2023 nas bases de dados Medline, via PubMed, Lilacs e WHO COVID-19 Research Database. Foram listados 167 artigos e, após a aplicação dos critérios de elegibilidade, cinco estudos foram incluídos, compreendendo 1.469 gestantes e puérperas com diabetes mellitus gestacional ou diabetes preexistente. Quanto à saúde materna, os principais desfechos foram relacionados à infecção por covid-19, como gravidade da doença e risco de morte. Além disso, foi observada maior prevalência de transtornos mentais comuns, como ansiedade e depressão. Portanto, a saúde materna de mulheres com hiperglicemia na gestação foi impactada negativamente durante a pandemia de covid-19 no país.

The new coronavirus (COVID-19) pandemic is a major public health issue. Hyperglycemia during pregnancy (pre-existing diabetes, diabetes first diagnosed in pregnancy and gestational diabetes mellitus) is a frequent maternal complication in the obstetric population. Their overlap may impact maternal and fetal health. Thus, this narrative review gathered evidence on the maternal health of women with gestational hyperglycemia during the COVID-19 pandemic in Brazil. Articles published until May 2023 in the Medline (via PubMed), Lilacs and WHO COVID-19 Research Database online databases were eligible. Bibliographic search retrieved a total of 167 articles, of which five remained after applying the inclusion criteria, resulting in a sample of 1,469 pregnant and postpartum women with gestational diabetes or pre-existing diabetes. Regarding maternal health, the main outcomes were related to COVID-19 infection, such as disease severity and risk of death. Additionally, results showed a higher prevalence of common mental disorders such as anxiety and depression. In conclusion, the maternal health of women with gestational hyperglycemia was negatively impacted during the COVID-19 pandemic.

La pandemia del nuevo coronavirus (COVID-19) es un grave problema de salud pública. Además, la hiperglucemia durante el embarazo (diabetes preexistente, diabetes diagnosticada por primera vez durante el embarazo y diabetes mellitus gestacional) es una de las complicaciones maternas más frecuentes en la población obstétrica. La superposición de estos problemas puede afectar la salud materna y fetal. Por lo tanto, el objetivo de este estudio es recopilar evidencia sobre la salud materna de las mujeres con hiperglucemia en el embarazo durante la pandemia de la COVID-19 en Brasil. Se trata de una revisión narrativa, y la fuente de datos comprendió artículos publicados hasta mayo de 2023 en las bases de datos MEDLINE vía PubMed, LILACS y WHO COVID-19 Research Database. Se enumeró un total de 167 artículos y, después de aplicar los criterios de elegibilidad, se incluyeron cinco estudios con 1.469 mujeres embarazadas y puérperas con diabetes gestacional o diabetes preexistente. En cuanto a la salud materna, los principales resultados se relacionaron con el contagio por COVID-19, como la gravedad de la enfermedad y el riesgo de muerte. Además, se observó una mayor prevalencia de trastornos mentales comunes, como la ansiedad y la depresión. Por lo tanto, la salud materna de las mujeres con hiperglucemia durante el embarazo se ha visto afectada negativamente durante la pandemia de la COVID-19 en Brasil.

Levels of IL-37 and CCL11 in serum of pregnant women infected with group B streptococcus in late pregnancy and their predictive efficacy for maternal and infant outcomes / 国际检验医学杂志

Objective To explore the levels of interleukin-37(IL-37)and CC type modified chemokine 11(CCL11)in serum of pregnant women infected with group B streptococcus in late pregnancy and their predic-tive efficacy for maternal and infant outcomes.Methods A total of 86 pregnant women with reproductive tract B streptococcus infection in late pregnancy treated in the hospital from December 2020 to December 2022 were selected as the study group,and 76 pregnant women with normal physical examination admitted during the same period were selected as the control group.The levels of IL-37 and CCL11 in serum of all pregnant women were detected by enzyme-linked immunosorbent assay.According to whether the pregnant women with group B streptococcus infection in late pregnancy had adverse maternal and infant outcomes,they were divided into normal pregnancy outcome group(50 cases)and adverse pregnancy outcome group(36 cases).Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of serum IL-37 and CCL11 on maternal and infant outcomes of pregnant women with reproductive group B streptococcus infection in late pregnancy.Multivariate Logistic regression was used to analyze the factors affecting maternal and in-fant outcomes of pregnant women with reproductive group B streptococcus infection in late pregnancy.Results The levels of IL-37 and CCL11 in the study group were higher than those in the control group(P<0.05).The incidence rate of adverse outcomes in the study group was significantly higher than that in the control group(P<0.05).The proportion of abortion history and the proportion of vaginal microecological disorders and levels of IL-37 and CCL11 and in adverse pregnancy outcome group were higher than those in normal pregnancy outcome group(P<0.05).ROC curve results showed that the area under the curve(AUC)of IL-37 and CCL11 for predicting adverse maternal and infant outcomes of pregnant women infected with group B streptococcus in late pregnancy were 0.876(95%CI:0.824-0.920)and 0.788(95%CI:0.748-0.830),re-spectively.The AUC of the combined prediction of adverse maternal and infant outcomes of pregnant women infected with group B streptococcus were 0.927(95%CI:0.889-0.970).Multivariate Logistic regression a-nalysis results showed that serum IL-37(OR=3.604,95%CI:2.106-6.166),CCL11(OR=4.250,95%CI:2.074-8.709),abortion history(OR=2.707,95%CI:1.688-4.342)and vaginal microecological disorders(OR=3.504,95%CI:1.993-6.162)were risk factors for adverse maternal and infant outcomes in pregnant women infected with group B streptococcus in late pregnancy(P<0.05).Conclusion The levels of IL-37 and CCL11 in serum of pregnant women infected with reproductive group B streptococcus in late pregnancy are in-creased,which are related to adverse pregnancy outcomes,and are expected to be effective indicator for predic-ting adverse pregnancy outcomes of pregnant women infected with reproductive group B streptococcus in late pregnancy.

Nursing practice of discharge planning service for primipara separated from their infants during hospitalization: a field research / 中国实用护理杂志

Objective:To understand the current status of discharge planning nursing for primipara who separated from their infants during hospitalization and provide a reference basis for constructing a clinical nursing plan.Methods:From February to June 2023, a field research about situation of nursing practice in discharge planning service among primiparas who separated from their infants was conducted in the Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Tongji University. Data was collected by field observation and informal interviews with 12 nurses and analyzed by three-level coding method of qualitative research.Results:All 12 nurses were female with 24-46 (33.33 ± 1.83) years old. The work content of the observation subjects could be divided into 4 items including providing infants′ health information, breastfeeding, postpartum rehabilitation, psychological care and social support. All the 4 items needed to be improved in providing infants′ health information, evaluating psychological status and social support, and quality of discharge teaching.Conclusions:It still needs further development in discharge planning nursing for primipara separated from their infants during hospitalization. It is urgent to improve the quality of discharge planning nursing for primiparas who have separated from their infants by developing scientific and standardized discharge planning nursing process, conducting standardized training for nurses, improving nurses′ psychosocial assessment ability, homogenizing health education, and improving humanistic care, so as to promote the rehabilitation of primiparas and get used to being a mother.

Effects of high-efficiency centering pregnancy care combined with information-knowledge-attitude-practice health education on cesarean delivery on maternal request rate, maternal and neonatal health status and breastfeeding in primiparas / 中国实用护理杂志

Objective:To explore the effects of high-efficiency centering pregnancy care (CPC) combined with information-knowledge-attitude-practice (IKAP) health education on cesarean delivery on maternal request (CDMR) rate, maternal and neonatal health status so as to provide referential significance for reducing CDMR rate and improving postpartum maternal and neonatal health status and breastfeeding rate.Methods:In the prospective, single-center and controlled study, a total of 82 primiparas undergoing antenatal examination and delivery in South Binhu Hospital of Hefei First People′s Hospital were enrolled as the research objects between January 2020 and December 2021 by convenience sampling method, including 41 cases given routine health care in routine group between January and December 2020 and 41 cases given high-efficiency CPC combined with IKAP health education on basis of routine group in combination group between January and December 2021. The cognition of cesarean section, delivery modes, incidence of postpartum complications, neonatal complications and breastfeeding between the two groups were compared.Results:The age of the routine group was (26.71 ± 2.18) years old, and the age of the combination group was (27.16 ± 1.79) years old. The proportions of correct cognition, partially correct cognition and incorrect cognition to cesarean section in combination group were 73.17% (30/41), 21.95% (9/41), 4.88% (2/41), and 53.66% (22/41), 26.83% (11/41), 19.51% (8/41) in routine group, and the difference between the two groups was statistically significant ( Z = 4.22, P<0.05). The incidence of cesarean section and CDMR in combination group was 24.39% (10/41) and 1/10, lower than that in routine group [46.34% (19/41), 10/19], and the difference between the two groups was statistically significant ( χ2 = 4.32, P<0.05; Fisher′s exact test, P = 0.049 ). The total incidence rates of postpartum complications of primiparas and neonatal complications in the combination group were 4.88%(2/41) and 7.32%(3/41), lower than 12.20%(5/41) and 12.20%(5/41) in the routine group, and the differences between the two groups were not statistically significant (Fisher′s exact test, P = 0.432, 0.712). The scores of functional health literacy, communicative health literacy and critical health literacy in combination group were (85.73 ± 4.09), (51.93 ± 4.72) and (58.63 ± 4.32) points, higher than those in routine group [(80.17 ± 5.26), (46.37 ± 5.11) , (52.71 ± 5.07) points], and the difference between the two groups was statistically significant ( t = 5.34, 5.12, 5.69, all P<0.01). At 3 months after delivery, exclusive breastfeeding rate, milk powder feeding rate and mixed feeding rate in combination group were 58.54% (24/41), 7.32%(3/41), 34.15(14/41), higher than 26.83% (11/41), 29.27(12/41), 43.90%(18/41) in routine group, and the difference between the two groups was statistically significant ( χ2 = 10.73, P<0.05). Conclusions:High-efficiency CPC combined with IKAP health education can reduce incidence of CDMR, decrease maternal and neonatal complications, enhance maternal postpartum health literacy and improve breastfeeding rate in primiparas by improving correct cognition to cesarean section. It is worthy of clinical application.

Strategies for scientific and technological innovations in provincial maternal and child health care insti-tution based on PEST-SWOT model / 现代医院

Objective To investigate the internal and external factors of scientific and technological innovations in pro-vincial maternal and child health care institutions and propose effective strategies for facilitating the innovations.Methods The PEST-SWOT model was used to analyze the internal strengths and weaknesses,external opportunities,and threats of the scientific and technological innovations in a provincial maternal and child health care institution from the perspectives of political,econom-ic,social,and technical environment.Results The institution has advantages and opportunities in policy support,scientific re-search management and investment,and disciplinary characteristics.However,it faces some threats and has disadvantages in tal-ent team,information-oriented level,and industrial competition.Conclusion The development of scientific and technological in-novation in provincial maternal and child health care institutions is affected by internal and external factors.It is necessary to firmly seize opportunities and comprehensively promote scientific and technological innovations from the aspects of medical treat-ment,teaching and research collaboration,discipline layout,talent team,and information-oriented construction.

Study on the application value of four-dimensional ultrasound combined with maternal serological screening in fetal facial deformities / 中国医学装备

Objective:To explore the application value of four-dimensional ultrasound combined with maternal serological screening in fetal facial deformities.Methods:A total of 106 pregnant women at mid pregnancy,whose fetuses with suspected fetal facial deformities and who conducted prenatal screening in Sanya Maternal and Child Health Hospital(Sanya Women and Children's Hospital)from January 2020 to December 2022,were selected.All of them underwent four-dimensional ultrasound and maternal serological screening.The results of delivery or induced labor were used as the gold standard of diagnosis to compare the diagnostic values of single four-dimensional ultrasound,single maternal serological screening and the combination of them for fetal facial deformities.Results:The analysis of the receiver operating characteristic(ROC)curve showed that the area under curve(AUC)values of four-dimensional ultrasound,maternal serological screening and the combination of them were respectively 0.932,0.863 and 0.981 in diagnosing fetal facial deformities.Both the sensitivities and accuracies of four-dimensional ultrasound and maternal serological screening were significantly lower than those of the combined diagnosis of them in diagnosing fetal facial deformities,and the differences of them were statistical significance(x2=11.173,0.064,P<0.05),respectively.Conclusion:Four-dimensional ultrasound combines with maternal serological screening can improve the diagnostic accuracy for fetal facial deformities.

Research on particular standards related to maternal fetal monitor / 中国医学装备

The safe and reliable maternal fetal monitor can provide comprehensive physiological monitoring for pregnant women and fetuses,and effectively reduce maternal and infant mortality.In the current stage,in addition to the general requirements of medical electrical equipment applicable to maternal fetal monitor in China,there is no particular standard for maternal fetal monitor.The common practice in the industry is to refer to and learn from the particular standards of multi-parameter monitor and ultrasonic Doppler fetal monitor.Based on this,the particular standards applicable to the maternal fetal monitor were researched,and the idea of formulating particular standards for the basic safety and essential performance requirements of the maternal fetal monitor were proposed to ensure the safety and effectiveness of the monitor.

Analysis of Health Human Resource Allocation Situation in All Tertiary Maternal and Child Health Hospitals from 2015-2022 / 中国医院管理

Objective To analyse the health human resource allocation of all tertiary maternal and child healthcare(MCH)hospitals from 2015 to 2022 in China,and to propose basis for further strengthening the talent team construction and management of MCH hospitals.Methods Data were collected through the national MCH institution monitoring system to provide a descriptive analysis of the health human resources of all tertiary MCH hospitals in China.Results From 2015 to 2022,the number of health technicians in tertiary MCH hospitals increased with an average annual growth rate of 10.2%;The proportions of highly educated and professional health technicians increased year by year;The proportion of tertiary MCH hospitals with qualified health technicians has increased to 93.8%;The ratio of doctors to nurses has exceeded 1:1.4.Conclusion The allocation of health human resources in the tertiary MCH hospitals in China shows a good upward trend,which lays a foundation for improving the overall service level and service capacity of MHC hospitals.