Obesidad pregestacional y alteraciones del parto

Objetivo . Establecer la asociación entre obesidad pregestacional y el riesgo de alteraciones del parto. Diseño. Estudio de cohortes retrospectivo. Institución. Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Métodos . Resultante obstétrica de pacientes según índice de masa pregestacional -obesidad (grupo A), sobrepeso (grupo B) y peso normal (grupo C)- atendidas entre enero y diciembre de 2021. Principales medidas de estudio. Duración del embarazo y duración, tipo y alteraciones del parto. Resultados . Se atendió 2,250 partos durante el periodo de estudio, de los cuales se seleccionó 226 gestantes para el análisis. La mayoría de gestantes (60,5%) fueron asignadas al grupo A, 47 (20,8%) al grupo B y 41 (17,5%) al grupo C. Las gestantes del grupo A presentaron una mayor probabilidad de cesárea (razón de probabilidad (RP) 1,76; intervalo de confianza del 95% (IC95%), 1,03 a 2,98), de parto prolongado (RP 2,09; IC95%, 1,23 a 3,53) y de embarazo prolongado (RP 2,30; IC95%, 1,32 a 4,01) comparadas con las embarazadas del grupo C. Las gestantes del grupo B no mostraron diferencias estadísticamente significativas en la frecuencia de las variables obstétricas comparado con las gestantes del grupo C (p = ns). Conclusión . Existió asociación significativa entre la obesidad pregestacional y el riesgo de alteraciones del parto.

Objective : To establish the association between pregestational obesity and the risk of birth alterations. Design: Retrospective cohort study. Institution: Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Methods : Obstetric outcome of patients according to pregestational mass index -obese (group A), overweight (group B), and normal weight (group C)- attended between January and December 2021. Main study measures: Duration of pregnancy and duration, type and alterations of delivery. Results : A total of 2,250 deliveries were attended during the study period, of which 226 pregnant women were selected for analysis. The majority of the pregnant women (60.5%) were assigned to group A, 47 (20.8%) to group B, and 41 (17.5%) to group C. Pregnant women in group A had a higher probability of cesarean section (odds ratio (OR) 1.76; 95% confidence interval (95%CI), 1.03 - 2.98), prolonged labor (OR 2.09; 95%CI, 1.23 - 3.53) and prolonged pregnancy (OR 2.30; 95%CI, 1.32 - 4.01) compared to pregnant women in group C. The pregnant women in group B did not show statistically significant differences in the frequency of obstetric variables compared to the pregnant women in group C (p = ns). Conclusion : There was a significant association between pregestational obesity and the risk of birth alterations.

Balões de tamponamento intrauterino na hemorragia pós-parto ­ Atualizações / Uterine balloon tamponade in postpartum hemorrhage ­ Updates

A hemorragia pós-parto continua sendo uma condição relacionada a elevada morbimortalidade materna, sendo essenciais o diagnóstico precoce e o início do tratamento farmacológico. Em caso de falha, os balões de tamponamento uterino são uma alternativa eficiente, com aplicabilidade crescente na prática clínica. Esses dispositivos são seguros, apresentam baixa incidência de eventos adversos e reduzem as taxas de procedimentos cirúrgicos. Existe uma ampla variedade de modelos, tanto industriais quanto artesanais, com acúmulo de relatos na literatura demonstrando sua eficácia. Este artigo descreve os principais balões intrauterinos, com ênfase nos modelos mais novos, aplicabilidade, taxas de sucesso e eventos adversos.(AU)

Postpartum hemorrhage continues to be a condition related to high maternal morbimortality, early diagnosis and initiation of pharmacological treatment are essential. In case of failure, uterine balloon tamponade is an efficient alternative, with increasing applicability in clinical practice. These devices are safe, have a low incidence of adverse events and reduce the overall rates of surgical procedures. There is a wide variety of models, both industrial and artisanal, with an accumulation of reports in the literature demonstrating their effectiveness. This article describes the main intrauterine balloons, with an emphasis on newer models, applicability, success rates and adverse events.(AU)

Efficacy of Doula delivery combined with painless delivery and its effects on pregnancy outcome / 中国基层医药

Objective:To investigate the efficacy of Doula delivery combined with painless delivery and its effects on pregnancy outcome.Methods:A total of 150 parturient women who underwent delivery in the First People's Hospital of Yongkang from June 2019 to June 2020 were included in this study. They were randomly assigned to undergo either conventional delivery (control group, n = 75) or Doula delivery combined with painless delivery (observation group, n = 75). Analgesic effect, mode of delivery, duration of labor and pregnancy outcome as well as mood score before and after intervention were compared between the two groups. Results:Total analgesia-effective rate in the observation group was significantly higher than that in the control group [100.00% (75/75) vs. 65.33% (49/75), χ2 = 31.45, P < 0.05]. Vaginal delivery rate in the observation group was significantly higher than that in the control group [84.00% (63/75) vs. 66.67% (50/75), χ2 = 6.60, P < 0.05]. The length of the first stage of labor, the second stage of labor, the third stage of labor and total labor length in the observation group were (398.42 ± 35.41) minutes, (43.65 ± 5.78) minutes, (8.36 ± 1.08) minutes and (450.87 ± 37.98) minutes, which were significantly shorter than those in the control group [(543.21 ± 47.87) minutes, (76.73 ± 16.56) minutes, (9.76 ± 1.23) minutes, (629.34 ± 45.26) minutes, t = 21.05, 16.33, 7.40, 26.15, all P < 0.05]. The incidence of neonatal asphyxia, fetal distress and postpartum hemorrhage in the observation group were [1.33% (1/75), 2.67% (2/75) and 2.67% (2/75), respectively, which were significantly lower than those in the control group [13.33% (10/75), 17.33% (13/75), 18.67% (14/75), χ2 = 7.94, 8.96, 10.07, all P < 0.05]. Self-rating Anxiety Scale score and Self-Rating Depression Scale score in the observation group were (43.25 ± 4.28) points and (40.28 ± 3.45) points, which were significantly lower than those in the control group [(52.12 ± 3.95) points, (47.79 ± 3.72) points, t = 13.18, 12.81, both P < 0.05). Conclusion:Doula delivery combined with painless delivery can relieve women's emotional changes, alleviate pain, shorten labor duration, and improve pregnancy outcomes.

Application of unprotected perineum delivery technique for natural childbirth in primiparas / 中国基层医药

Objective:To investigate the application effects of unprotected perineum delivery technique for normal vaginal delivery in primiparas.Methods:A total of 260 primiparas who underwent natural childbirth in Tengzhou Central People's Hospital between January 2019 and September 2020 were included in this study. They were randomly assigned to undergo childbirth either with an unprotected perineum delivery technique (study group, n = 130) or the conventional delivery technique (control group, n = 130). Delivery-related indicators were compared between the two groups. Results:The rate of first-degree perineal tear in the study and control groups was 71.52% and 29.23%, respectively, the rate of second-degree perineal tear were 7.16% and 3.16%, respectively, and the episiotomy rate in the two groups were 21.32% and 67.51%, respectively. There were significant differences in rate of first-degree perineal tear, rate of second-degree perineal tear and episiotomy rate between the two groups ( χ2 = 7.19, 7.03, 8.35, all P < 0.05). The length of hospital stay in the study and control group was 3.27 ± 5.79 days and 5.18 ± 7.26 days, respectively. The numerical rating scale score of postpartum perineal pain in the two groups was 1.23 ± 2.51 points and 3.24 ± 2.79 points, respectively. The incidence of postpartum complications was 3.33% and 11.67%, respectively. There were significant differences in length of hospital stay, numerical rating scale score of postpartum perineal pain and incidence of postpartum complications between the two groups ( t = 2.23, 2.06, χ2 = 2.52, all P < 0.05). There were no significant differences in length of second stage of labor and Apgar score in new born infants between the study and control groups (all P > 0.05). Conclusion:Unprotected perineum delivery technique can greatly decrease episiotomy rate, alleviate perineal tear, reduce pain, reduce complications, shorten length of hospital stay, and improve quality of obstetric care.

Combined application of intraspinal analgesia, bilateral pudendal nerve block anesthesia and modified perineal protection in midwifery / 中国基层医药

Objective:To investigate the clinical efficacy of intraspinal analgesia, pudendal nerve block anesthesia and modified perineal protection in combination in midwifery.Methods:A total of 160 primiparous women who were subjected to full-term vaginal delivery in Suqian Hospital of Nanjing Drum Tower Hospital Group between January 2019 and January 2021 were included in this study. They were randomly assigned to undergo either bilateral pudendal nerve block combined with modified perineal protection (control group, n = 80) or intraspinal analgesia, pudendal nerve block anesthesia and modified perineal protection in combination (observation group, n = 80). Each clinical index was compared between the control and observation groups. Results:Duration of labor in the observation group was significantly shorter than that in the control group [(7.23 ± 2.11) hours vs. (9.35 ± 3.79) hours, t = 4.27, P < 0.05). Cesarean section rate in the observation group was significantly lower than that in the control group [8.7% (7/80) vs. 52.5% (42/80), χ 2 = 17.18, P < 0.05]. Incidence of perineal tears in the observation group was significantly lower than that in the control group [8.7% (7/80) vs. 32.5% (26/80), χ 2 = 15.48, P < 0.05]. Third-degree perineal tears occurred in neither group. Time of postpartum off-bed ambulation and length of postpartum hospital stay in the observation group were (1.37 ± 0.13) days and (3.22 ± 0.31) days, respectively, which were significantly shorter than those in the control group [(2.52 ± 0.22) days, (5.23 ± 0.62) days, t = 25.90, 25.94, both P < 0.05). The incidence of complications in the observation group was significantly lower than that in the control group [7.5% (6/80) vs. 23.7% (19/80), χ 2 = 8.01, P < 0.05]. There were no significant differences in incidence of neonatal asphayxia, 2-hour postpartum hemorrhage and postpartum hemorrhage between the two groups (all P > 0.05). Conclusion:During midwifery of full-term vaginal delivery, combined application of intraspinal analgesia, bilateral pudendal nerve block anesthesia and modified perineal protection can shorten duration of labor and decrease cesarean section rate.

Macrosomía fetal y factores de riesgo asociados en la provincia Camagüey

Introducción: La macrosomía fetal, de manera tradicional, ha sido definida por un peso arbitrario al nacer; la misma, ya sea definida por un límite de peso o grande para la edad gestacional, se asocia con numerosas complicaciones perinatales y maternas. Objetivo: Describir los factores de riesgo asociados a la macrosomía fetal en los partos del Hospital Universitario Ginecobstétrico Provincial Ana Betancourt de Mora durante el año 2019. Métodos: Se realizó un estudio observacional descriptivo de corte transversal. El universo quedó constituido por la totalidad de gestantes que tuvieron recién nacidos con peso al nacimiento mayor o igual a 4 000 gramos, el cual ascendió a 526 gestantes. Se utilizó estadística descriptiva. Se calculó media y desviación estándar a las variables cuantitativas. Resultados: Las gestantes estudiadas tenían una media de edad de 27,86 años y un IMC a la captación como promedio de 26,77 con un valor medio de ganancia de peso de 13,68 Kg. Entre los 26 y 35 años hubo 290 gestantes con recién nacidos macrosómicos, respecto a la paridad las que paren sin experiencia de este reunió a 222 grávidas. En las embarazadas catalogadas de sobrepeso con ganancia de 10 a 15 kg se reúnen 104 de los recién nacidos macrosómicos. Respecto al tipo de parto la cesárea representó el 61,4 %. Se observó en 40 gestantes la presencia de diabetes gestacional o pregestacional y preeclampsia respectivamente. Conclusiones: La ganancia excesiva de peso en gestantes con evaluación nutricional de sobrepeso u obesas tuvo la mayor incidencia en la génesis de la macrosomía en los recién nacidos.

Introduction: Fetal macrosomia has traditionally been defined by an arbitrary birth weight. Fetal macrosomia, whether defined by borderline weight or large for gestational age, is associated with numerous perinatal and maternal complications. Objective: To describe the risk factors associated with fetal macrosomia in deliveries at Ana Betancourt de Mora Provincial Gyneco-Obstetric University Hospital during 2019. Methods: A cross-sectional descriptive observational study was carried out. The study universe was made up of all pregnant women who had newborns with a birth weight greater than or equal to 4 000 grams, which amounted to 526 pregnant women. Descriptive statistics were used. Average and standard deviation were calculated for the quantitative variables. Results: The studied pregnant women had an average age of 27.86 years and an average BMI at uptake of 26.77 with an average value of weight gain of 13.68 Kg. Between 26 and 35 years there were 290 pregnant women with newborn macrosomic births, with respect to parity those who give birth without experience of this brought together 222 gravid women. In pregnant women classified as overweight with a gain of 10 to 15 kg, 104 of the macrosomic newborns are gathered. Regarding the type of delivery, cesarean section represented 61.4%. The presence of gestational or pregestational diabetes and preeclampsia, respectively, was observed in 40 pregnant women. Conclusions: The excessive weight gain in pregnant women with nutritional evaluation of overweight or obese were those that had the highest incidence in the genesis of macrosomia in newborns.

Variables clínicas del parto en posición vertical y horizontal: revisión exhaustiva de literatura / Clinical Behavior of Vertical and Horizontal Deliveries: Exhaustive Literature Review / Variáveis clínicas do parto em posição vertical e horizontal: revisão abrangente de literatura

Introducción: El trabajo de parto representa el acontecimiento más importante durante la culminación del periodo de gestación y, por lo tanto, la adecuada elección de su posición, ya sea vertical u horizontal, resulta indispensable para minimizar las complicaciones maternas y neonatales. Objetivo: Llevar a cabo una revisión de la literatura sobre el comportamiento clínico del parto vertical y horizontal, describiendo los principales resultados en diferentes países del mundo. Método: Revisión documental mediante la búsqueda de la literatura entre 2009 y 2020 en bases de datos especializadas. Resultados: La posición vertical se asoció con una menor duración del trabajo de parto, dolor referido y necesidad de episiotomía; no obstante, esta posición puede incrementar el riesgo de hemorragia posparto y daño perineal. Conclusión: La variedad de desenlaces obstétricos y neonatales asociados a las posiciones de parto vertical y horizontal hacen complejo definir una posición de parto óptima; por lo tanto, se recomienda la libre elección de acuerdo con las características que presente cada paciente

Introduction: Parturition represents the most important event during the culmination of the gestation period and, therefore, the appropriate choice of its position, whether vertical or horizontal, it is essential to minimize maternal and neonatal complications. Objective: To carry out a review of the literature on the clinical behavior of vertical and horizontal delivery, describing the main results in different countries of the world. Method: Document review by searching the literature between the years 2009 and 2020, available in Specialized Databases. Results: The vertical position was associated with a shorter duration of labor obstetric, referred pain, and episiotomy; however, this position may increase the risk of postpartum hemorrhage and perineal damage. Conclusion: The variety of obstetric and neonatal outcomes associated with vertical and horizontal delivery positions make it difficult to define an optimal delivery position and, therefore, free choice is recommended according to the characteristics of each patient

Introdução: O trabalho de parto representa o acontecimento mais importante no final do período gestacional e, portanto, a escolha apropriada da posição, seja vertical ou horizontal, é indispensável para minimizar as complicações maternas e neonatais. Objetivo: Realizar uma revisão bibliográfica sobre o comportamento clínico do parto vertical e hori-zontal, descrevendo os principais resultados em diferentes países do mundo. Método: Revisão documental através de pesquisa da literatura em bases de dados especializadas entre os anos 2009 e 2020. Resultados: A posição vertical foi associada a uma duração mais curta do parto, dor referida e ne-cessidade de episiotomía; contudo, esta posição pode aumentar o risco de hemorragia pós-parto e dano perineal. Conclusão: A variedade de resultados obstétricos e neonatais associados às posições de parto vertical e horizontal torna complexa a escolha de uma posição de parto ótima; por conseguinte, recomen-da-se a livre escolha de acordo com as caraterísticas de cada paciente

Association between postpartum neurological complications and epidural analgesia in labor / 中华围产医学杂志

As one of the most effective and commonly used analgesic methods during labor and delivery,epidural analgesia has been widely accepted in terms of its safety.Neurological complications following childbirth,which are most related to pregnancy and childbirth factors rather than labor analgesia,has not been well studied or recognized in China.Therefore,there are some confusions and misunderstandings of reasons for these neurological complications,and,to a certain extent,have affected the clinical implementation of epidural labor analgesia.This review analyzed the etiology and prognosis of this problem in order to help the clinicians in identifying the risk factors and causes and also to improve clinical awareness,prevention,and management for these conditions.

Inevitable mother-baby separation in the immediate postpartum from a maternal perspective / Separação inevitável do binômio mãe-bebê no pós-parto imediato na perspectiva materna

Abstract Objectives: to understand the process of inevitable mother-baby separation in the immediate postpartum from a maternal perspective. Methods: this is a qualitative approach research study developed by interviewing 15 mothers who were separated from their children in the postpartum at a public maternity hospital in Belo Horizonte, Minas Gerais, Brazil. The analysis content was used for data interpretation. Results: the categories were evidenced through "Maternal feelings and perceptions regarding to the child's separation in the postpartum period" and "Women's perception about health professionals' performance at the time of the separation and the presence of their companions", the contradictions offeelings and challenges experienced by the mothers due to the separation as for, the happiness of her child's birth followed by the anguish of being separated and the fear of losing her child..The healthcare team plays a relevant role regarding the difficulties and helps to overcome these challenges. Conclusions: advances in healthcare actions are needed in order to offer directed care to the real necessities of these mothers and decrease the negative impacts caused by this separation.

Resumo Objetivos: compreender o processo de separação inevitável da mãe e o bebê no pós-parto imediato na perspectiva materna. Métodos: trata-se de uma pesquisa de abordagem qualitativa, desenvolvido por meio de entrevista com 15 mães que foram separadas de seus filhos no pós-parto, em uma maternidade pública em Belo Horizonte, Minas Gerais, Brasil. Foi usada a análise de conteúdo para interpretação dos dados. Resultados: evidenciou-se por meio das categorias "Sentimentos e percepções maternas frente à separação do filho no pós parto" e "Percepção das mulheres sobre a atuação dos profissionais de saúde no momento da separação e a presença de seus acompanhantes" as contradições de sentimentos e desafios vivenciados pelas mães diante da separação, como a alegria pelo nascimento do filho seguido da angústia por ter que se separar desse e o medo de perde-lo. O trabalho da equipe de saúde assume um papel relevante para o enfrentamento das dificuldades e superação desses desafios. Conclusão: percebe-se a necessidade de avançar na dimensão cuidadora das ações em saúde, a fim de oferecer um atendimento direcionado às reais necessidades dessas mães e minorar impactos negativos dessa separação.

Amenazas a la seguridad de la paciente por la conducción del parto con oxitocina. Experiencia en un hospital público de Lima, Perú / Threats to the safety of the patient due to the delivery management with oxytocin. Experience in a public hospital in Lima, Peru

Resumen OBJETIVO Identificar las amenazas a la seguridad de la paciente en la práctica de la conducción del trabajo de parto con oxitocina y las repercusiones maternas y perinatales en un hospital público de tercer nivel de Lima, Perú. MATERIALES Y MÉTODOS Estudio cuantitativo, descriptivo, retrospectivo y transversal efectuado en pacientes embarazadas atendidas en un hospital público, de tercer nivel, de Lima, Perú, a quienes se indicó conducción del parto con oxitocina. Los datos se tabularon en Excel y SPSS v21. El análisis univariado incluyó frecuencia y porcentaje para las variables cualitativas; se emplearon medidas de tendencia central, dispersión y desviación estándar para variables cuantitativas. RESULTADOS Se revisaron 112 historias clínicas de pacientes sin alteraciones en el trabajo de parto a quienes se indicó conducción con oxitocina (29.5%; n = 33). La principal vía de término fue el parto vaginal (73.2%; n = 82) y del grupo con cesárea el motivo más común fue la desproporción céfalo pélvica (56.7%; n = 17). Se observaron complicaciones obstétricas en 25% (n = 28), de este grupo la principal fue la hemorragia posparto (46.4%; n = 13). El peso de los recién nacidos fue 3401 ± 394 gramos, 93.7 y 96.4% obtuvieron un Apgar entre 10 a 7 al primero y quinto minutos, respectivamente. CONCLUSIONES Las amenazas identificadas a la seguridad de la paciente fueron: conducción del parto con oxitocina en quienes no tenían alteraciones en el trabajo de parto y en quienes tuvieron desproporción céfalo-pélvica, a pesar de que es una contraindicación para el procedimiento.

Abstract OBJECTIVE Identify the threats to the safety of the patient in the practice of conducting labor with oxytocin and maternal and perinatal outcomes in a public tertiary hospital in Lima, during 2016. MATERIALS AND METHODS Quantitative, descriptive, retrospective and cross-sectional. A total 112 pregnants' medical histories were review who underwent augmentation of labour with oxytocin. Inclusion criteria's: term gestation, hospitalization with a 4 cm dilatation, fetuses in cephalic presentation. Exclusion criteria's: patients with previous or intercurrent pathologies to pregnancy. RESULT The augmentation with oxytocin made in pregnant women without alterations in labor (29.5%; n = 33). The main type childbirth was vaginal delivery (73.2%; n = 82) and of the group that underwent cesarean section, the most usual reason was cephalopelvic disproportion (56.7%; n = 17). Obstetric complications were observed (25%; n = 28), of this group the main was postpartum hemorrhage (46.4%; n = 13). The weight of the newborns oscillated between 3401 ± 394 g, 93.7% and 96.4% obtained an Apgar 10 to 7 at the 1st and 5th minute respectively. CONCLUSIONS The threats to the safety of the patient identified were the practice of augmentation of labor with oxytocin in pregnant women without alterations in labor and in pregnant women with cephalopelvic disproportion, although it is a contraindication to the procedure.

Excesso de peso materno e início da amamentação ­ revisão analítica de estudos observacionais / Maternal overweight and breastfeeding initiation ­ an analytic review of observational studies

Este artigo tem o objetivo de realizar uma revisão analítica de estudos observacionais que avaliaram a relação entre o excesso de peso materno e o tempo de início do aleitamento materno, com enfoque nos fatores que podem atuar como mediadores da associação. Extensa revisão foi realizada nas bases de dados PubMed/MEDLINE, Google Acadêmico e Bireme/Lilacs utilizando um conjunto de termos relacionados ao início do aleitamento materno e ao excesso de peso materno. As referências dos artigos incluídos foram manualmente revisadas para identificar artigos não revelados anteriormente. Os critérios de seleção foram: idioma português, inglês ou espanhol; estudos originais, e estudo realizado em humanos. Vinte e nove artigos, provenientes de 24 diferentes estudos foram incluídos nas análises. A avaliação desses estudos indica que o excesso de peso materno atua como fator de risco importante para o não início do aleitamento materno e que esse risco se acentua com o aumento no grau de excesso de peso materno. Fatores psicológicos, raça, formas corporais e complicações gestacionais/obstétricas são variáveis maternas que parecem interagir com o excesso de peso, influenciando o início da amamentação. (AU)

This paper aims to propose an analytic review of observational studies that addressed the influence of maternal overweight on breastfeeding initiation, with emphasis on the factors that can act as mediators on this association. A search on PubMed/MEDLINE, Google Scholar and Bireme/Lilacs databases was conducted applying a number of descriptors related to breastfeeding and maternal body mass index. The reference lists of included articles were handsearched to identify further relevant studies. Selection criteria were: original articles, with human subjects, published in Portuguese, English or Spanish. A total of 29 papers from 24 different studies were included in the analysis. Maternal overweight was an important risk factor for failure to initiate breastfeeding. The risk was accentuated by the increase in maternal body mass index. Psychological factors, ethnicity, body shape and obstetric complications seem to interact with maternal overweight to interfere in breastfeeding initiation. (AU)

Status and Analysis of the Accidental Out-of-Hospital Deliveries Transferred by Emergency Medical Service Providers

PURPOSE: Accidental out-of-hospital deliveries are generally associated with high rates of perinatal morbidity and mortality. To determine the status of accidental out-of-hospital deliveries transferred by emergency medical services (EMS), we analyzed the records of EMS runsheets in two South Korean provinces, Gyeonggi and Gangwon. METHODS: The EMS runsheets of patients who were more than 20 weeks pregnant and had delivery-related symptoms between January 2012 and December 2013 in Gyeonggi and Gangwon province were reviewed retrospectively. We analyzed the characteristics of accidental out-of-hospital deliveries by comparing these with those non out-of-hospital deliveries. RESULTS: There were 1,426 urgent dispatches during the study period. In 137 (9.6%) out-of-hospital deliveries, which took place prior to arriving at the hospital, and 48 of these were attended by EMS providers. The accidental out-of-hospital deliveries were more frequent during night time and more common among multiparous and younger age women; however, these observation was without any significance with respect to premature birth. The rate of the accidental out-of-hospital deliveries was not significantly different between rural and urban areas. Twenty cases of complication, including 10 arrests of neonates and EMS providers managed them by the following intervention: reduction of nuchal cord, umbilical cord clamping and cut, warming-up of and stimulating the neonates warms, using oropharyngeal suction, O₂ supplication, and neonatal cardiopulmonary resuscitation. CONCLUSION: As the rate of accidental out-of-hospital deliveries in patients who were transferred by EMS is higher than the rate of out-of-hospital deliveries in general, EMS providers should be fully trained. Moreover, there is the need for more completive records and continuous education.

Factors associated with the need for ventilation at birth of neonates weighing >/=; 2, 500 g

OBJECTIVES: Approximately 20-40% of annual global neonatal deaths occur among infants with birthweights ≥2,500 g, and most of these deaths are associated with intrapartum asphyxia in low- and middle-income countries. This study aims to evaluate the peripartum variables associated with the need for resuscitation at birth of neonates weighing ≥2,500 g. METHOD: This case-control retrospective study was performed on data from all public reference maternity units in the state of Ceará, Northeast Brazil, between March 2009 and March 2010. The subjects were singleton neonates without malformations weighing ≥2,500 g, who required positive-pressure ventilation in the delivery room. The controls had a 1-minute Apgar score of ≥8 and did not undergo resuscitation. Variables associated with positive-pressure ventilation in the delivery room were evaluated via conditional multivariate logistic regression. RESULTS: Of the 2,233 live births with birth weights ≥2,500 g, 1-minute Apgar scores ≤7, and no malformations, 402 patients met the inclusion criteria, and they were paired with 402 controls. Risk variables for positive-pressure ventilation at birth were a gestational age <37 weeks (OR: 3.54; 95% CI: 1.14-10.92) and meconium-stained amniotic fluid (8.53; 4.17-17.47). Cervical examination at maternal admission (0.57; 0.38-0.84) and a written follow-up of the labor (0.68; 0.46-0.98) were identified as protective variables. CONCLUSIONS: Significant flaws in obstetric care are associated with the need for positive-pressure ventilation at birth for neonates weighing ≥2,500 g.

Indications and pregnancy outcomes of intrapartum cesarean section after the new partogram applied / 中华妇产科杂志

Objective To study the changes of intrapartum cesarean rate, cesarean indications and pregnancy outcomes after the new partogram applied. Methods Totally 3 290 pregnant women trying to vaginal delivery which were managed according to the new partogram in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from August to October in 2014 (new partogram group) were involved;2 987 pregnancy women trying to vaginal delivery from May to July in 2014 which were managed according to the old partogram (old partogram group) were involved as control. The intrapartum cesarean rate, cesarean indications and the pregnancy outcomes between the two groups were analyzed. Results The rate of intrapartum cesarean delivery was 8.50%(254/2 987) in old partogram group, and was significantly higher than that in new partogram group (6.2%, 204/3 290;P0.05), but the incidence of postpartum hemorrhage in new partogram group was higher than the old partogram group [6.9% (14/204) versus 1.6% (4/254), P<0.05]. Conclusion After the new partogram applied, the rate of intrapartum cesarean delivery is significantly decreased, but the incidence of postpartum hemorrhage is increased.

Maternal near miss among women using the public health system in the Amazon and Northeast regions of Brazil / Morbilidad materna extremadamente grave entre las usuarias del sistema de salud pública en las regiones amazónica y noreste del Brasil

OBJECTIVE: To assess the prevalence of pregnancy complications identified as maternal near miss (MNM) and associated factors among women using the public health care system in the Amazon and Northeast regions of Brazil. METHODS: A secondary analysis of a population-based survey conducted in 2010 was performed focusing on women self-reporting maternal complications. The main outcome was MNM, pragmatically defined as intensive care unit admission, eclampsia, hysterectomy, or blood transfusion. In addition, the risk of MNM was estimated for certain sociodemographics and characteristics of care received. Poisson regression was performed, generating adjusted prevalence ratios (PRadj) with 95% confidence intervals (95%CI). RESULTS: A total of 13 044 women (77%) who had given birth during the prior year using the public health system were interviewed. At least one complication was reported by 37.5%, with hemorrhage (28.4%) and infection (8.3%) being the most frequent. The overall MNM ratio was 31.5 per 1 000 live births, higher for the Amazon region than for the Northeast. Factors with a higher risk for developing MNM were: indigenous ethnicity (PRadj 2.77; 95% CI: 1.50-5.14), more than one hour to reach the hospital (PRadj 1.55; 95%CI: 1.06-2.25), being refused by a full hospital and having to find another one (PRadj 1.49; 95%CI: 1.03-2.16), cesarean section (PRadj 2.56; 95%CI: 1.90-3.44), and public prenatal care (PRadj 1.95; 95%CI: 1.06-3.61). CONCLUSIONS: Users of public health system in the Amazon and Northeast regions of Brazil have high MNM rates. Some characteristics of the women and of the care they received represent inequalities associated with higher risk for MNM. Specific actions are required to improve maternal health programs in these expansive areas of the country.

OBJETIVO: Evaluar la prevalencia de las complicaciones del embarazo establecidas como morbilidad materna extremadamente grave (MMEG), y los factores asociados, entre las usuarias del sistema de atención de salud pública en las zonas amazónica y noreste del Brasil. MÉTODOS:Se realizó un análisis secundario de una encuesta poblacional llevada a cabo en el 2010 y centrado en las mujeres que autonotificaban complicaciones obstétricas. El principal resultado fue la MMEG, definida a efectos prácticos como ingreso en una unidad de cuidados intensivos, eclampsia, histerectomía o transfusión de sangre. Se calculó además el riesgo de MMEG para determinadas características sociodemográficas y de la atención recibida. Se llevó a cabo una regresión de Poisson y se generaron las razones de prevalencia ajustadas (RPa) con intervalos de confianza de 95% (IC 95%). RESULTADOS:Se entrevistó a un total de 13 044 mujeres (77%) que habían dado a luz durante el año previo en el sistema de salud pública. Un 37,5% notificó como mínimo una complicación; la hemorragia (28,4%) y la infección (8,3%) fueron las más frecuentes. El índice general de MMEG fue de 31,5 por 1 000 nacidos vivos, más elevado en la región amazónica que en la noreste. Los factores que comportaron un riesgo mayor de MMEG fueron la etnicidad autóctona (RPa 2,77; IC 95% = 1,50-5,14), precisar más de una hora para llegar al hospital (RPa 1,55; IC 95% = 1,06-2,25), no ser admitida en un hospital por estar completo y tener que encontrar otro (RPa 1,49; IC 95% = 1,03-2,16), la cesárea (RPa 2,56; IC 95% = 1,90-3,44), y la asistencia prenatal pública (RPa 1,95; IC 95% = 1,06-3,61). CONCLUSIONES: Las usuarias del sistema de salud pública en las regiones amazónica y noreste del Brasil muestran tasas elevadas de morbilidad materna extremadamente grave. Algunas características de las mujeres y de la atención recibida comportan desigualdades asociadas con un riesgo mayor de morbilidad materna extremadamente grave. Se requieren acciones específicas que mejoren los programas de salud materna en estas amplias zonas del país.

Analysis of the postoperative complications of pregnant women with two caesarean section / 中国基层医药

Objective To investigate the postoperative complications of pregnant women with two cesarean section.Methods Clinical data of 543 cases of pregnant women with two cesarean section (group A) were retrospective analyzed,and at the same period two spontaneous vaginal delivery in 963 cases(group B),225 cases of pregnant women with the first cesarean delivery add second vaginal delivery(group C) were analyed in contrast.The postoperative close,long-term complications of three different delivery way were censused.Results (1) Postoperative complications:141 cases(26％) in group A,29 cases(3％) ingroup B,27 cases (12％)in group C,and three complications occurrence rate had significant difference (x2 =182.711,29.712,43.040,all P ＜ 0.05).(2) The complications of postpartum bleeding,pelvic adhesions in group A were significantly higher than those of C group(all P ＜0.05) ;And the close complications of postpartum hemorrhage,infection of incision,postpartum fever and the long-term complications of chronic pelvic inflammation,pelvic adhesion in group A,C were significantly higher than those in group B (all P ＜ 0.05).Conclusion The cesarean section is traumatic,which can significantly increase maternal intraoperative,postoperative complications.Clinicians should avoid no indications of cesarean section,reduce the cesarean section rate;For secondary pregnancy after cesarean section,vaginal delivery can be given under the strict observation.

Uso de suturas uterinas compressivas na hemorragia pós-parto / Use of uterine compression sutures in postpartum hemorrhage

A hemorragia pós-parto é uma complicação presente em mais de 18% dos nascimentos e é responsável por cerca de 25 a 30% das mortes maternas no mundo. Nas últimas décadas, várias técnicas conservadoras visando o controle hemorrágico no período pós-parto têm sido relatadas, com destaque para as ligaduras vasculares, suturas uterinas compressivas, embolização arterial, balões intrauterinos e a interrupção do ato operatório com laparostomia, empacotamento pélvico e posterior abordagem cirúrgica. O presente artigo apresenta uma revisão das suturas uterinas compressivas, com destaque para a cronologia de criação das técnicas de execução, e as publicações em periódicos. São descritas as suturas de Schnarwyler, B-Lynch, Cho, Hayman, Bhal, Pereira, Ouabha, Hackethal, Meydanli, Marasinghe-Condous, Matsubara-Yano, Zheng e a técnica de Halder. Foram detalhadas também as indicações, as técnicas associadas e as complicações.(AU)

Postpartum hemorrhage is present in over 18% of births and accounts for 25 to 30% of maternal deaths worldwide. In the last decades, several conservative techniques direct at controlling hemorrhage in the postpartum period have been reported, principally vascular ligatures, uterine compression sutures, arterial embolization, intrauterine balloons and surgery interruption with laparostomy, pelvic packing and subsequent surgical intervention. This article presents a review of uterine compression sutures, especially the chronology of creation of the execution techniques and publications in journals. Schnarwyler, B-Lynch, Cho, Hayman, Bhal, Pereira, Ouabha, Hackethal, Meydanli, Marasinghe-Condous, Matsubara-Yano, Zheng and Halder sutures were reviewed. Indications, associated techniques and complications were also detailed.(AU)

Uso de balões intrauterinos em pacientes com hemorragia pós-parto / Use of intrauterine balloons in patients with postpartum haemorrhage

A hemorragia pós-parto é uma complicação presente em mais de 18% dos nascimentos e responsável por cerca de 25 a 30% das mortes maternas no mundo. No Brasil, apesar da ampliação do acesso aos serviços de saúde e da melhoria em praticamente todos os indicadores de saúde materna, esta etiologia continua se apresentando entre os três principais grupos de causas de morte no ciclo grávido-puerperal. Nas últimas décadas, várias técnicas conservadoras visando o controle hemorrágico no período pós-parto têm sido relatadas, com destaque para as técnicas de desvascularização uterina, suturas compressivas, embolização arterial, balões intrauterinos e a interrupção do ato operatório com laparostomia, empacotamento pélvico e posterior reabordagem cirúrgica. O presente artigo apresenta uma revisão do uso de balões intrauterinos no controle hemorrágico com destaque para os tipos, aplicabilidades e cronologia de invenção e publicações. Foram avaliados os balões de Sengstaken-Blakemore, os artesanais, as sondas de Foley, balão de Rusch, de Bakri e o BT-cath. Detalhou-se também o teste do tamponamento e a técnica do "sanduíche uterino".(AU)

Postpartum hemorrhage is present in over 18% of births and accounts for 25-30% of maternal deaths worldwide. In Brazil, despite the expansion of access to health care and the improvement of virtually all maternal health indicators, such etiology is still present among the three main causes of death during pregnancy and childbirth. In the last decades, several conservative techniques direct at controlling hemorrhage in the postpartum period have been reported, principally techniques of uterine devascularization, compression sutures, arterial embolization, intrauterine balloons and surgery interruption with laparostomy, pelvic packing and subsequent surgical intervention. This article presents a review of the use of intrauterine balloons in controlling hemorrhage especially types, applicability and chronology of invention and publications. Sengstaken-Blakemore balloons, the artisanal, Foley probes, Rusch balloon, Bakri and BT-cath were reviewed. The tamponade test and the "uterine sandwich" technique were also detailed.(AU)

Influencia de la hipertensión originada por el embarazo en el parto y el recién nacido / Influence of hypertension caused by pregnancy in delivery and by the newborn

Introducción: la preeclampsia representa un gran riesgo para la madre y el producto de la concepción. Objetivo: evaluar la repercusión que tiene la hipertensión originada por el embarazo en la gestación, el parto y el recién nacido. Material y método: se realizó una investigación prospectiva, longitudinal y analítica en el Policlínico Universitario "Hermanos Cruz", en el período comprendido entre mayo de 2011 y mayo de 2012; el universo de estudio estuvo conformado por todas las gestantes pertenecientes a dicho policlínico, mientras la muestra se formó con 130 gestantes que se dividieron en dos grupos, el grupo estudio las pacientes a las que se les diagnosticó un preeclampsia (n = 31) y el grupo control gestante sin la enfermedad (n = 93). Se analizaron diferentes variables del parto y el neonato. Los resultados se calcularon a través del test de ji cuadrado con nivel de significación de p < 0,05. Resultados: la prematuridad se presentó en el 22.58 %, la inducción del parto fue utilizada en 19 gestantes, la cesárea se realizó en el 70.97 %, los neonatos con bajo peso se presentaron en el 54.84 % del grupo estudio y el 38.71 % de los recién nacidos tuvieron puntaje de Apgar bajo a los cinco minutos. Todas las variables fueron altamente significativas. Conclusiones: la preeclampsia influye negativamente en el parto y el recién nacido. Además de considerarse como factor de riesgo para que se produzcan eventos nocivos en la madre y el neonato.

Introduction: preeclampsia is a major risk to the mother and her offspring. Objective: to evaluate the impact of hypertension caused by pregnancy in gestation, delivery and by the newborn. Material and methods: it was performed a prospective, longitudinal and analytical research at Hermanos Cruz University Outpatient Clinic in the period between May 2011 and May 2012, the universe consisted of all pregnant women belonging to that clinic, while the sample was made up of 130 pregnant women, and were divided into two groups: the study group of patients who were diagnosed with preeclampsia (n=31) and the control group of pregnant women without the disease (n=93). Different variables of childbirth and the newborn were analyzed. The results were calculated by the chi-square test with a significance level of p < 0.05. Results: prematurity was presented in 22.58%, delivery induction was used in 19 pregnant women, cesarean section was performed in 70.97 %, low-weight neonates presented in 54.84 % of the study group and 38.71 % of newborns had low Apgar score at five minutes of birth. All variables were highly significant. Conclusions: preeclampsia is affecting the delivery and the newborn. It is also considered as a risk factor for adverse events that occur in the mother and the newborn.

Hemorragia postparto por causas diferentes a atonia uterina severa en el Hospital Escuela Universitario de Tegucigalpa / Postpartum hemorrhage due to different causes not owing to severe uterine atony at the Hospital Escuela Universitario in Tegucigalpa

Objetivo: caracterizar los casos de Hemorragia Post-Parto (HPP) que ocurren por etiologías diferentes a la hemorragia por atonía uterina en el Hospital Escuela de Tegucigalpa. Material y métodos: se realizó un estudio descriptivo-transversal, se tomó como población a todas las pacientes que ingresaron al Hospital Escuela por atención de parto vía vaginal, cesárea o ingresadas en el puerperio inmediato durante los meses de junio a diciembre del año 2011. La muestra se tomó de las pacientes complicadas con hemorragia postparto diagnosticadas clínicamente según la clasificación de Benedetti. Se consideró la presencia de factores de riesgo asociados al manejo y complicaciones. Resultados: ocurrieron 10,701 nacimientos y 56 casos de hemorragia postparto poratonía grado I, trauma del canal del parto, retención de tejido o trastornos de la coagulación, con una frecuencia de 0.5% de casos, las causas de hemorragia fueron: 22(39%) casos por trauma del canal del parto, de estos, 17(77%) fueron nacimientos por cesárea; ocurrieron 19(34%) por retención de tejido. Se clasificó la gravedad de la hemorragia que presentaron las pacientes al momento del ingreso en grado III y grado IV, resultando 9 (16%) casos de cada uno. Las complicaciones fueron: coagulopatía, falla renal, sepsis y Síndrome Anémico. La mayoría de las pacientes 45 (80%) presentó gestaciones a término; los factores de riesgo fueron: 13(23%) enfermedad hipertensiva, en 4 (7%) se aumentó la labor del parto con fármacos, la mayoría 30 (54%) no tuvieron factores asociados. El manejo inicial se realizó con reanimación con cristaloides, el uterotónico más utilizado fue la combinación de oxitocina y prostaglandinas en 20 (36%) pacientes, se realizó manejo quirúrgico en 14 (25%) y ocurrieron 3(5%) muertes por complicaciones asociadas a hemorragia. Conclusiones: La causa más frecuente de hemorragia postparto encontrada en la población de estudio fue el trauma del canal del parto; en su mayoría...