Influências da transgeracionalidade em gestantes primigestas / Influences of transgenerationality on primigravidae pregnant women

Neste trabalho, a transgeracionalidade pode ser vista como essencial na formação da identidade materna e em toda sua carga psíquica, como costumes, ideias, valores, traumas, fardos e segredos que envolvem a gestante e que terão influências na construção de sua identidade. Assim, busca-se constatar e determinar as influências da transgeracionalidade nas mães primigestas, por meio de uma entrevista semidirigida, sendo feita, posteriormente, sua análise de conteúdo. A gestante selecionada tem as avós da criança vivas e presentes, tanto materna quanto paterna, o que permite diferenciar a influência que cada família exerce. A partir da entrevista, foi possível notar que a gestante sofre muita influência maternal e, realmente, a presença, as ideias e os costumes fazem-na abdicar com frequência dos seus conceitos para seguir os da família, muitas vezes trazendo frustração à nova mãe, que não se sente livre para exercer seu papel materno em seu modelo ideal.

In this work, transgenerationality can be seen as essential in the formation of the maternal identity and in all its psychic load, such as customs, ideas, values, traumas, bundles and secrets that involve the pregnant woman and that will have influences in the construction of this identity in constitution. Therefore, this work seeks to establish and determine the influences of transgenerationality in primigravidae mothers, by a semi-directed interview, which the content analysis was done. The selected pregnant woman has the grandparents of the child alive and present, both maternal and paternal, in order to differentiate the influence that each family has on this pregnant woman. From the interview, it is noticed that the pregnant woman suffers a lot of maternal influence, and indeed the presence, ideas and customs make the pregnant woman frequently abdicate her concepts to follow those of the family, which often brings frustration to the new mother, for not feeling free to play their maternal role in their ideal model.

Comparison of analgesic efficacy of intramuscular tramadol and pethidine in labour

Background: Labour pain is among the most severe pain experienced by women. It is unpleasant and distressing to the parturient. The objective of the study was to evaluate and compare the analgesic efficacy and adverse effects of intramuscular tramadol and pethidine in labour. Methods: The prospective study conducted in SDM College of Medical Sciences and Hospital, Department of OBG, from December 2013 to November 2014. The study was a study of the parturients admitted in the labour theatre. Written and informed consent was taken from all the patients enrolled in the study. One hundred parturient at term in active labour were randomly assigned to one of the two groups to receive intramuscularly either tramadol 100 mg or pethidine 75 mg. Results: Results were comparable in terms of maternal age, maternal weight and neonatal weight. Proportion of cases with satisfactory to good pain relief was 74% in the tramadol group and 78% in the pethidine group. Nausea and/or vomiting (12% versus 8%), fatigue (6% versus 4%) and drowsiness (8% versus 4%) were significantly high in the pethidine group than the tramadol group(p<0.05). The drugs used did not appear to influence the mode of delivery. Proportion of cases with non-reassuring foetal heart rate was high in the pethidine group. Meconium stained liquor was equally seen in both the groups and there were no incidence of neonatal respiratory depression in any of the groups.Conclusion: Tramadol is an equally effective labour analgesic as pethidine with less maternal and perinatal side effects.

An interesting case report of ruptured pyogenic liver abscess with 40 weeks gestation in labour

Pyogenic liver abscess during pregnancy is an extremely rare condition. Although rare, in situations of sepsis or septic shock in pregnancy, as well as the common sources of infection, a possibility of a liver abscess should be considered. We present a case report of 32-year-old primigravida 37.3 weeks by date, 37 weeks by scan with breech presentation with premature rupture of membranes and pain in abdomen since 12 hours with breathlessness, fever and diarrhoea since 2 days came in emergency to study hospital. General condition of the patient on arrival was pulse-140 beats per minute, blood pressure was 90/60 mmHg, respiratory rate was 40/min, on per abdominal examination, breech presentation with fetal heart rate of 150 beats per minute on doppler was noted. Per vaginal examination revealed cervical os 5 cm dilated, 40% effacement, breech presentation, absent membranes. With urgent report of complete hemogram and acid blood gas analysis, metabolic acidosis was noted which was corrected and patient was taken for emergency lower segment caesarean section. Intra-operative, 250 ml greenish pus flakes fluid was noted inside the abdominal cavity. Fluid was drained and sent for culture sensitivity with maximum aseptic precautions, uterus was opened, baby was delivered followed by uterus closure. Ruptured liver abscess 6×4×2 cm in 2nd and 3rd segment of liver was noted, abdominal wash with antibiotics and NS was given, drain was kept. Appropriate antibiotics were started and was discharged on day 14 after suture removal.

Pattern of maternal weight gain among primigravidae in tertiary care hospital and urban health centre

Background: The appropriate amount of weight gain during pregnancy has been a topic of interest and debate over a century. A low body mass index (BMI) and suboptimal weight gain during pregnancy are long recognised risk factors for delivery of infants too small for gestational age.Methods: The present study was observational prospective study conducted among primigravidae in two groups with sample size 197 in tertiary care hospital antenatal clinic and 97 in urban health centre antenatal clinic for the period of 1year and 6 months.Results: In tertiary care hospital average weight gain was 10.04 kg with 33 (16.75%) women gained less than or equal to 8 kg weight gain, 148 (75.13%) gained weight in range of 8.1 to 16 kg while 16 (8.12) gained more than 15 kg weight during pregnancy while In urban health centre average weight gain was 8.96 kg with 46 (47.42%) women gained less than or equal to 8 kg weight gain, 45 (46.39%) gained weight in range of 8.1 to 16 kg while 6 (6.19%) gained more than 16 kg weight during pregnancy. Women with lower BMI found to gain lesser weight compared to normal body mass women.Conclusions: Presence of low BMI was an add on social risk factor which may adversely impact the weight gain in the mother and expected child.

Retrospective analysis of indications of primary caesarean sections done at a tertiary care hospital

Background: Caesarean section rates have globally risen above the levels that can be considered medically necessary. The aim of the study is to analyze the rate and indications of caesarean sections for primigravidae in the period 2016 to 2018 at a tertiary care hospital in Delhi.Methods: It is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology at PGIMER and Dr RML Hospital, New Delhi. A total of 552 caesarean deliveries in primigravidae were studied.Results: The total deliveries during the study period were 3346 and the total caesarean section rate observed was 30.66%. The caesarean section rate among primigravidae was 29.1%. The rate of caesarean section in primigravidae rose from 22.7% in 2016 to 39.3% in 2018 with 17% increase. Majority of them belonged to the age group 20-30 years (79.34%) and 2.53% were elderly primigravidae. Out of the total number of primigravidae caesarean deliveries, 67.2% were performed in emergency and 32.7% were performed electively. Among the emergency caesarean sections performed, 64% of patients had induced labor and 22% had spontaneous labor. The most common indication of caesarean section was fetal distress (19.77%) followed by arrest of labor (17.87%) and malpresentations (8.9%). The short-term caesarean morbidity rate was 25.4% including one mortality. Wound infection was the most common complication.Conclusions: Various reasons like changing maternal risk profile increased IVF pregnancies, scientific advances, personal choice and medico legal considerations have been cited for increased caesarean rate. Following evidence-based labor protocols, judicious use of cardiotocography, proper patient selection for labor induction and patient education will contribute in reduction of caesarean sections and related complications.

Episiotomía estado del arte. Una muestra conductual en los partos del Hospital Universitario Hernando Moncaleano Perdomo / Episiotomy state of the art. A sample in the deliveries of the Hernando Moncaleano Perdomo Hospital Universitario

Resumen La episiotomía es una intervención común usada en las salas de partos. Se define como la realización un tipo de intervención quirúrgica en el periné́ que pretende facilitar la expulsión del producto ampliando el canal blando del parto. Este tiene unas indicaciones para su realización. El objetivo de nuestro estudio fue evaluar las razones para la realización de episiotomía en el HUHMP, analizar si esta se realiza según las indicaciones maternas-fetales, evaluar cuanto la implementación de una episiotomía selectiva puede proteger contra las laceraciones perineales y realizar una revisión de la literatura relevante y actual en este tema. El total de pacientes fue 214 en el periodo de Agosto, Septiembre y Octubre DEL 2016. De las cuales 103 (48.13%) fueron primigestantes, y las no primigestantes fueron 111(51.86%). En cuanto a la presencia de desgarros en las primigestantes se encontró desgarro grado 1 (17.51%), desgarro grado 2 ( 21.63%) desgarro grado 3 (0%) y desgarro grado 4 ( 1.03%), sin desgarro (39.14%),a este grupo de pacientes se les realizo episiotomía a (25.75%). En las no primigestantes fue desgarro grado 1 (32.19%), desgarro grado 2 ( 14.43%) desgarro grado 3 (0%) y desgarro grado 4 ( 0%), sin desgarro (68.82%),a este grupo de pacientes se les realizo episiotomía a (7.77%) Cuando se realizaron episiotomías se tuvieron como indicación periné corto y poca distensibilidad con un 19.3%, acortamiento del periodo expulsivo 16%, prevención de desgarro y acortamiento de trabajo de parto 6.4%, primigestante 3.2% Y en el 58% de las pacientes en quienes se realizó episiotomía no tenían indicación descrita.

Abstract Episiotomy is a common intervention used in maternity ward. It is defined as a type of surgery in the perineum intended to facilitate the expulsion of the product extending the birth canal. This has some indications for its realization. The objetive of our study was to evaluate the episiotomy reasons in HUHMP, analyze whether this is done by maternal-fetal indications, the assess the implementation of a selective episiotomy may protect against lacerations and a review of the relevant and current literature on this subject. The total was of 214 patients in the period of August, September and October 2016. Of which 103 (48.13%) were primigravidae, and non primigravidae were 111 (51.86%). In the primigravidae group the tearing grade 1 (17.51%), tearing grade 2 (21.63%) tearing Grade 3 (0%) and tear Grade 4 (1.03%), without tearing (39.14%); this group of Patients underwent episiotomy (25.75%). In non primigravidae I was tear grade 1 (32.19%), tear grade 2 (14.43%) tearing Grade 3 (0%) and tear Grade 4 (0%), without tearing (68.82%), this group of Patients Were episiotomy Performed (7.77%) When episiotomies were performed were taken as indication Short perineum and poorly compliant con un 19,3%, shortening the period expulsive 16%, prevention tear and shortening of Labor 6.4%, 3.2% primiparousAnd in 58% of Patients Who episiotomy was performed in they had no indication described

Variáveis Associadas à Ansiedade Gestacional em Primigestas e Multigestas / Las Variables Asociadas con la Ansiedad Gestacional en el Primigestas y Multigestas / Variables Associated with Gestational Anxiety in Primigravidas and Multigravidas

Resumo Este estudo teve por objetivo descrever e comparar a ansiedade de primigestas e multigestas, no terceiro trimestre gestacional, bem como identificar, dentre as variáveis sociodemográficas e de gestação, as que se associaram para alta ansiedade. Participaram 479 gestantes que responderam a um instrumento de ansiedade (IDATE) e um questionário sobre variáveis sociodemográficas e da gestação. Compararam-se os grupos estatisticamente e montou-se um modelo de regressão logística para avaliar o peso das associações (p<0,05). Os resultados indicaram que 36% das gestantes apresentaram sintomas de alta ansiedade no terceiro trimestre gestacional, com um predomínio das multigestas em relação às primigestas. Para as multigestas, a maior chance para alta ansiedade esteve associada à baixa renda e, para as primigestas, à ameaça de aborto no início da gestação. Tanto para primigestas como para multigestas, desejar o bebê apareceu como fator de proteção para alta ansiedade. A expressiva porcentagem de gestantes com sintomas de ansiedade justifica o oferecimento de serviços voltados à prevenção e promoção de saúde mental das gestantes, com atenção diferenciada às primigestas e multigestas.

Resumen Este estudio tuvo como objetivo describir y comparar la ansiedad en el primigestas y multigestas en tercer trimestre, y para identificar, entre las variables sociodemográficas y el embarazo, que se asocian a mayor ansiedad. Participaron en 479 mujeres embarazadas que respondieron a un instrumento de ansiedad (STAI) y un cuestionario sobre variables sociodemográficas y el embarazo. Los investigadores compararon los grupos estadísticamente y montaron un modelo de regresión logística para evaluar las asociaciones. Los resultados indicaron que el 36% de las mujeres embarazadas tenían síntomas altos de ansiedad en tercer trimestre, con un predominio de multigestas en relación con el primigestas. Para multigestas la mayor oportunidad para alta ansiedad se asoció con bajas ingresos y para el primigestas con un aborto involuntario en el embarazo temprano. Ambos primigestas y multigestas quieren el bebé apareció como un factor protector para alta ansiedad. Un porcentaje significativo de mujeres embarazadas con síntomas de ansiedad justifica los servicios dirigidos a la prevención y promoción de la salud mental de las mujeres embarazadas, con una especial atención a las primigestas y multigestas.

Abstract This study aimed to describe and compare anxiety on primigravidae and multiparous in the third quarter, as well as to identify, among sociodemographic variables and of pregnancy, which ones were associated with high anxiety. There were 479 pregnant women participants who responded to an anxiety instrument (STAI) and a questionnaire on sociodemographic variables and about pregnancy. The groups were statistically compared e a logistic regression model was composed to evaluate associations. The results indicated that 36% of pregnant women presented symptoms of high anxiety on third gestational trimester, with a predominance of the multiparous in relation to the primigravidae. For the multiparous, the highest chance for high anxiety was associated with low income and for the primigravidae to the threat of miscarriage in early pregnancy. For both primigravidae and multiparous, wanting the baby appeared as a protective factor for high anxiety. The expressive percentage of pregnant women with anxiety symptoms justifies the offering of prevention services and promotion of mental health for pregnant women, with a differentiated attention to primigravidae and multiparous.

Taxa de cesariana nas primigestas atendidas numa maternidade pública com assistência humanizada no município de Juiz de Fora ­ MG / Rate of caesarean section in the primigravidae attended at a public maternity hospital with humanized assistance in the city of Juiz de Fora - MG

Nos últimos tempos, o Brasil tem vivenciado uma mudança de paradigma na forma de nascer. A elevada taxa de cesarianas tem demonstrado a banalização desse procedimento. Na tentativa de mudar essa realidade, o Ministério da Saúde instituiu em todo o território brasileiro o Programa de Humanização no Pré-natal e Nascimento. Com o objetivo de verificar a frequência de parto cesáreo e as principais indicações de parto operatório no momento da internação nas primigestas atendidas na Maternidade Viva Vida de Juiz de Fora ­ MG, foi realizado um estudo retrospectivo, baseado na análise do prontuário das primigestas internadas para parto na maternidade supracitada, durante o período de janeiro de 2013 a dezembro de 2014, obtendo um total de 811 primigestas. Foram investigados o perfil epidemiológico, risco pré-natal, motivo de internação, tipo de parto e as principais indicações de parto operatório no momento da internação. O parto cesáreo ocorreu em 40,0% das primigestas e os principais motivos que levaram à indicação de parto operatório no momento da internação foram as distócias (37,8%) e os distúrbios hipertensivos maternos (35,0%). O presente estudo concluiu que a taxa de cesariana encontrada foi semelhante à média da rede pública brasileira, sendo que a maioria das indicações de parto operatório no momento da internação permeavam as indicações relativas e absolutas preconizadas pelo Ministério da Saúde.

Lately, Brazil has experienced a switch-over paradigm in the form of birth. The high rate of caesarean sections has shown the trivialization of this procedure. In an attempt to change this reality, the Health Ministry established throughout the Brazilian territory the Program for Humanization of Prenatal and Birth. This study aimed to describe the frequency of caesarean section and the main indications of operative delivery at the moment of hospitalization in the primigravidae at the Maternidade Viva Vida of Juiz de Fora ­ MG. Thus, a retrospective study based on medical primigravidae records admitted to the aforementioned maternity during January 2013 to December 2014 was done, obtaining a total of 811 first pregnancy. It was investigated the epidemiological profile, prenatal risk, the reason for admission, the type of delivery and the main indications of operative delivery at the moment of hospitalization. The caesarean section represented 40% of deliveries and the main indications of operative delivery at the moment of hospitalization were dystocia (37.8%) and hypertensive disorders (35%). The present study concluded that the cesarean rate found was similar to the Brazilian public sector average, with the majority of indications of operative delivery at the moment of hospitalization permeating the relative and absolute indications recommended by the Ministry of Health.

Role of Oral Misoprostol 600 mcg versus Inj. Syntometrinein the Active Management of Third Stage of Labour

Postpartum haemorrhage is the leading cause of direct maternal death in developing countries. The incidence of PPH may vary from less than 5% to more than 10%. About 30% of maternal deaths in India occur due to massive haemorrhage. Normal blood loss in a vaginal delivery may exceed 500 ml and can range from 500 to 1000 ml. A decline in hematocrit is a more reliable estimation of blood loss. Active management had definitely reduced third stage blood loss. World Health Organisation (WHO) recommends Intra muscular oxytocin in the third stage of labour. Misoprostol PGE1 is a potent uterotonic agent. Ergometrine is also an effective oxytocic. This study has been conducted to compare the efficacy and safety of oral misoprostol 600 mcg with parenteral syntometrine in the active management of third stage of labour in 100 pregnant women of low risk pregnancies by objective assessment of the difference in pre-and post-delivery haemoglobin values. This study concludes that misoprostol has the potential of an effective, stable oral oxytocic with rapid onset of action. Though this study was limited to low risk patients, misoprostol has scope for use even in high risk patients of bronchial asthma, gestational hypertension, pre-eclampsia and Rhesus (Rh) negative groups where syntometrine is contraindicated. Thus, misoprostol may be used as an alternative to IM syntometrine in the active treatment of third stage of labour.

Malaria Prevalence, the Use of Intermittent Preventive Therapy and Long Lasting Insecticidal Nets among Pregnant Women in Onitsha, Anambra State, Nigeria.

Malaria prevalence, the use of intermittent preventive therapy (IPT) and long lasting insecticidal nets (LLINs) was studied among pregnant women in Onitsha, Anambra State, Nigeria. Peripheral blood were obtained from 204 pregnant women and examined microscopically for malaria parasites. Structured questionnaire was used to determine the use of IPT and LLIN among the pregnant women. The results showed an overall malaria prevalence of 40.5% (99/204) in pregnant women. Prevalence varied markedly within age groups, with ages 15-19 recording a value of 75%. Prevalence among the primigravidae was 55.1% compared to 39.5% for multigravidae. There was a statistical significance in prevalence by age and by parity (P<0.05). Compliance to the use of IPT was 53.9% (110/204). The result also showed that 79.4% (162/204) sleep under LLIN. Malaria was still a problem among pregnant woman and IPT reduced malaria during pregnancy.

Does utilization pattern of antennal care & early neonatal practices improved by close supervision and support intervention among primigravidae in the tribal area? - Community based interventional study.

Pregnancy related complications are among the leading causes of death and disability for women aged 15-49 in India. The National Rural Health Mission (NRHM) is contributing to the various health needs still the antenatal care utilization and neonatal practices are very poor especially in the tribal pockets of Maharashtra. Our aim was to assess the impact of close supervision and support intervention (CSSI) among primigravidae as compared to non-intervened primigravidae. Community based interventional study done in the tribal rural health training centre (RHTC) which is field practice area of tertiary health care institute.Total of 120 registered primigravidae mothers were enrolled in the study and were divided into two groups interventional group (N=30) and non- interventional group (N= 90).The CSSI was given to interventional group. Only 57 (42.50%) & 59(49.17%) women had taken two doses of TT immunization and ≥100 IFA tablets respectively. Regular CSSI helped to increase the ANC visits 25(83.33%), helped to confine delivery either at the RHTC or private hospital 29(96.70%).Maximum mothers i.e. 17(90%) and 30(100%) initiated breast feeding within 1 hour and fed colostrums to their baby respectively.