Knowledge, attitudes, and awareness towards newborn screening in association with received prenatal care: A survey of primiparous postpartum mothers at the Philippine General Hospital

@#<p style="text-align: justify;"><strong>Background.</strong> Newborn screening (NBS) is a procedure for the immediate detection of genetic, metabolic, and endocrine disorders in neonates and is crucial for prompt treatment should such disorders be identified. In the Philippines, Republic Act 9288 requires health workers to properly inform mothers regarding NBS and its importance before the procedure.</p><p style="text-align: justify;"><strong>Objective.</strong> To determine the knowledge, attitude, and awareness of primiparous postpartum mothers towards NBS Methods: A survey questionnaire was administered to primiparous mothers from Wards 15 and 16 of the Philippine General Hospital from April 11 through May 14, 2017. Results of primiparous postpartum mothers with or without previous prenatal check-ups were then compared.</p><p style="text-align: justify;"><strong>Results.</strong> We surveyed 160 mothers, with half (56.3%) aged between 20 and 29 years. There were 149 mothers with and 11 without prenatal checkups. Mothers with previous prenatal checkups were more likely to be aware of NBS than those without prenatal checkups. Knowledge on NBS of mothers with previous prenatal checkups was higher on average compared to those without previous prenatal checkups. There was no significant difference in attitude between mothers with or without prenatal checkups.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Prenatal checkups increased the awareness and knowledge of primiparous mothers' towards NBS, and thus can be a potent vehicle where healthcare providers may inform the mother on the process and purpose of this procedure.</p>

A Influência do Exercício Físico no Desfecho Materno Fetal / The Influence of Physical Exercise in the Fetal Maternal Outcome

RESUMO O objetivo do artigo foi analisar a influência do exercício físico durante a gestação, correlacionando a sua prática com o desfecho materno fetal. O estudo realizado foi de caráter observacional, descritivo, quantitativo e retrospectivo, com entrevistas realizadas com as puérperas primigestas internadas no serviço de pós-parto em uma maternidade pública de Joinville, SC. Os questionários perguntavam sobre informações prévias da puérpera, condições da gestação, exercícios físicos realizados durante a gestação e dados acerca do recém-nascido (RN). As puérperas foram divididas em dois grupos: ativo (n=110) e inativo (n=122), possibilitando, desta maneira, a análise dos diferentes desfechos entre os grupos. Evidenciou-se que o grupo ativo apresentou maiores chances de obter ganho de peso adequado durante a gestação (RC 1,556) e de realização de parto normal (RC 1,899). Em contrapartida, apresentou maiores chances de o RN ser pequeno para a idade gestacional (PIG) (RC 2,436), considerando o intervalo de confiança de 95%. Os dados do presente estudo sugerem que a atividade física durante o período gestacional traz benefícios tanto para a saúde materna quanto para o recém-nascido, desde que realizado de maneira programada, bem orientada e dentro de um limite de intensidade e duração.

ABSTRACT The aim of the article was to analyze the influence of physical exercise during pregnancy, correlating its practice with the fetal maternal outcome. The study was observational, descriptive, quantitative and retrospective, with interviews conducted with primiparous mothers who were in the postpartum service in a public maternity hospital in Joinville, SC. The questionnaires asked about previous information on the postpartum women, pregnancy conditions, physical exercises performed during pregnancy and data about the newborn (NB). The postpartum women were divided into two groups: active (n = 110) and inactive (n = 122), allowing the analysis of the different outcomes between the groups. It was shown that the active group was more likely to obtain adequate weight gain during pregnancy (OR 1,556) and normal delivery (OR 1,899). On the other hand, it was more likely that the newborn was small for gestational age (SGA) (OR 2,436), considering the 95% confidence interval. The data from the present study suggest that physical activity during pregnancy brings benefits to both maternal and newborn health, provided that it is performed in a regular, well-oriented manner and within a limit of intensity and duration.

Comparison of pelvic floor dysfunction in primiparous and nulliparous women and its relation to pelvic floor muscle strength

Background: The pelvic floor muscles (PFM) play an important role in supporting the pelvic and abdominal organs and controlling urinary and fecal continence, in addition to their role in the sexual function. The objective of this study was to compare pelvic floor muscle strength in primiparous 6 months after delivery and nulliparous women, to evaluate pelvic floor dysfunction (PFD) in these women and to find the association of PFD with pelvic floor muscle strength (PFMS).Methods: A total of 100 women were recruited in the cross-sectional study which included 28 nulliparous and 72 primiparous women 6 months after delivery. The assessment included general physical examination (GPE), POP-Q and assessment of pelvic floor muscle strength by modified oxford score and perineometer.Results: Endurance of PFMS measured by duration of contraction and number of contractions/min was higher in nulliparous. Mean of the duration of contraction was significantly higher in nulliparous group as compared to primipara i.e., 28.61 seconds and 23.9 seconds in nulliparous and primiparous group respectively (p=0.005). Mean of the number of contractions performed in one minute was significantly higher in nulliparous group as compared to primipara i.e., 31.04 and 19.97 in nulliparous and primiparous group respectively (p<0.0001). None of the nulliparous women had any PFD symptoms, while 4.17% of the primiparous patients had PFD in the form of bladder symptoms and 1.39% of them had PFD in the form bowel symptoms. Vaginal squeeze pressure was found to be affected by mode of delivery. It was lowest in instrumental delivery. It was 39.78±13.33 cmH20 in vaginal delivery, 51.42±12.88 cmH2O in Caesarean section and 31.67±14.36 cmH2O in instrumental delivery (p-0.039).Conclusions: Endurance of PFMS measured by duration of contraction and number of contractions/min was higher in nulliparous. Vaginal squeeze pressure was found to be affected by mode of delivery. It was lowest in instrumental delivery.

Fascitis necrosante genital posterior a parto instrumentado: reporte de un caso / Genital necrotizing fasciitis after operative vaginal delivery: A case report

Resumen ANTECEDENTES: La fascitis necrosante es una infección rara del tejido subcutáneo y la fascia que rápidamente puede complicarse y poner en riesgo la vida; por esto siempre debe tenerse en mente la posibilidad de este diagnóstico. OBJETIVO: Describir un caso raro de fascitis necrosante genital aparecida luego de un parto instrumentado. CASO CLÍNICO: Paciente primigesta, de 30 años, con antecedente de infección vaginal por Ureaplasma. El parto instrumentado tuvo lugar a las 39 semanas; se reparó la episiotomía medio-lateral derecha, sin complicaciones, y se dio de alta del hospital a las 48 horas. Al quinto día de puerperio acudió a Urgencias por dolor perineal intenso y fiebre. Durante la auscultación se encontró un hematoma perineal y glúteo derecho, con eritema alrededor, indurado y con crepitación vaginal, con secreción hematopurulenta fétida. Reportes de laboratorio: leucocitosis y anemia. Los cultivos de la herida reportaron infección polimicrobiana. El ultrasonido pélvico evidenció dos colecciones debidamente delimitadas en planos dérmicos y musculares. Se indicó tratamiento con antibióticos de amplio espectro, lavado quirúrgico y desbridamiento quirúrgico diario durante 5 días. Después, se inició la terapia de cierre asistido por vacío (VAC) durante 7 días hasta lograr la granulación. Se continuó con lavados quirúrgicos durante 5 días más. El día 18 posparto se cerró la herida sin complicaciones. A la sexta semana de seguimiento la herida había cicatrizado, sin dolor, ni incontinencia fecal o urinaria: solo hipoestesia de la cicatriz, pero con evolución satisfactoria. CONCLUSIÓN: Lo ideal es establecer el diagnóstico lo más temprano posible para disminuir la morbilidad y mortalidad, ofrecer inmediatamente atención multidisciplanaria que permita conseguir los mejores desenlaces quirúrgicos e incrementar la supervivencia.

Abstract BACKGROUND: Necrotizing fasciitis is a rare infection of the subcutaneous tissue and the fascia that is rapidly progressive and deadly, requiring early and aggressive surgical debridement to decrease mortality. The objective of this study was to describe a rare case of genital necrotizing fasciitis after operative vaginal delivery. CLINICAL CASE: A 30 years old primiparous woman with a history of vaginal infection by Ureaplasma. Instrumented delivery was attended at 39 weeks, repairing right mid-lateral episiotomy without complications and discharge after 48 hours. On the fifth day of the puerperium she went to the emergency department for severe perineal pain and fever, finding perineal hematoma and right gluteus with erythema around, indurated and with vaginal crepitation with fetid hemato-purulent secretion. The laboratories reported leukocytosis and anemia, wound cultures showed polymicrobial infection and pelvic ultrasound diagnosed 2 well-defined collections in dermal and muscular planes. Management was initiated with broad-spectrum antibiotics plus washing and daily surgical debridement for 5 days. Subsequently, it was placed with VAC therapy for 7 days until granulation was achieved; and then, surgical washes were continued for 5 more days. On the 18th day, the wound was closed without complications. In her sixth week of follow-up she has a scarred wound, without pain or fecal or urinary incontinence; only refers to hypoesthesia of the scar, but with satisfactory evolution. CONCLUSION: The ideal is to establish the diagnosis as early as possible to decrease morbidity and mortality, immediately offer multidisciplinary care that allows the best surgical outcomes to be achieved, and increases survival.

Impact of birth weight and daily weight gain during suckling on the weight gain of weaning piglets / Impacto do peso ao nascimento e ganho de peso na maternidade sobre o ganho de peso dos leitões na creche

This study evaluated the effect of birth weight and weight gain during the suckling phase on the piglet daily weight gain during the nursery phase (21-61 days of age). Piglets (n= 534) derived from 55 first-parity sows were weighed at birth, weaning, and end of the nursery phase. The data were analyzed according to a completely randomized experimental design, with three classes of birth weight (BW) and two classes of weight gain during the suckling phase (SDWG). High BW and low SDWG piglets were 0.2kg lighter at weaning than low BW and high SDWG animals (P< 0.05). However, at the end of the nursery phase, this situation was inverted, with high BW and low SDWG piglets 2.20kg heavier (P< 0.05). Low BW and high SDWG piglets were heavier at weaning and at the end of the nursery phase than low BW and low SDWG piglets (P< 0.05). At the same time, intermediate and high BW and low and high SDWG piglets presented body weight differences at weaning (P< 0.05), but not at the end of the nursery phase (P< 0.05). Piglets with 1.25 to 2.30kg BW and low weight gain during suckling presented a partial compensatory growth during the nursery phase.(AU)

Objetivou-se avaliar o efeito do peso dos leitões ao nascimento e do seu ganho de peso na maternidade sobre seu desempenho na fase de creche (21-61 dias de idade). Quinhentos e trinta e quatro leitões, provenientes de 55 primíparas, foram pesados ao nascimento, no desmame e na saída da creche. Os animais foram distribuídos em um delineamento inteiramente ao acaso, em três classes de peso ao nascimento (PN) e duas classes de ganho de peso diário (GPD) na maternidade. Os animais com alto PN e baixo GPD na maternidade desmamaram 0,2kg mais leves que os animais com baixo PN e alto GPD na maternidade (P<0,05). Porém, os animais com alto PN e baixo GPD na maternidade saíram da creche 2,10kg mais pesados (P<0,05). A diferença aos 21 dias entre os dois tratamentos (alto e baixo GPD) com animais de baixo PN foi de 1,18kg e passou para 2,20kg ao final da creche (P<0,05). No caso dos animais com médio e alto PN, a diferença ao desmame era de 1,14 e 1,26kg e passou para 0,90 e 0,70kg na saída da creche (P<0,05), respectivamente. Leitões com peso ao nascimento entre 1,25 e 2,30kg, com baixo ganho de peso diário na maternidade, apresentaram efeito compensatório parcial no ganho de peso diário durante a creche.(AU)

Serum proteinogram and biochemistry of Holstein cows in the peripartum period / Proteinograma e bioquímica séricas de vacas da raça Holandesa no período periparto

In face of the few reports found in national literature analyzing the potential influence of parturition number in serum proteinogram and biochemical profile in the peripartum period of high yielding dairy cows, the aim of the present study was to comparatively evaluate the dynamics of these serum constituents' concentrations in blood samples obtained from primiparous and multiparous Holstein cows, 60 and 30 days prepartum and in the day of parturition. Data were analyzed by repeated measures variance analysis (ANOVA) and differences between groups and moments were analyzed by Tukey's test. Results were considered significant when P<0.05. Parity influenced levels of total protein, albumin, globulins, magnesium, cholesterol, which were higher in multiparous cows, as well as concentrations of ceruloplasmin, total calcium, chloride and alkaline phosphatase activity, which were higher in primiparous cows. Parturition influenced serum concentrations of ceruloplasmin (+58%), transferrin (-25%), haptoglobin (+33%), total protein (-17%), globulins (-25%), immunoglobulin A (-43%), immunoglobulin G (-24%), total calcium (-12%), inorganic phosphorus (-10%), chloride (+5%), sodium (+4%), cholesterol (-23%), triglycerides (-38.6%), as well as activities of aspartate aminotransferase (+14%) and alkaline phosphatase (+28%). A decrease in serum levels of total calcium, inorganic phosphorus, cholesterol and triglycerides was more pronounced in multiparous than in primiparous cows. These results demonstrate that the interpretation of proteinogram and serum constituents should take into consideration lactation number and the moment of parturition as relevant factors in high yielding dairy cows in the transition period.(AU)

Diante da escassez de relatos encontrados na literatura nacional quanto à potencial influência do número de parições sobre o proteinograma sérico e perfil bioquímico no período periparto de vacas leiteiras de alta produção, o objetivo do presente estudo foi avaliar comparativamente a dinâmica de constituintes séricos em amostras de sangue obtidas de vacas da raça Holandesa primíparas e pluríparas, 60 e 30 dias pré-parto e no dia do parto. Os resultados foram avaliados por análise de variância (ANOVA) com medidas repetidas no tempo e as diferenças entre grupos e entre momentos foram analisadas pelo teste de Tukey, sendo os resultados considerados significativos quando P<0,05. O número de parições influenciou os teores de proteína total, albumina, globulinas, magnésio e colesterol, que foram maiores em vacas pluríparas, bem como as concentrações de ceruloplasmina, cálcio total, cloreto e atividade de fosfatase alcalina, que foram maiores em vacas primíparas. O número de parições influenciou as concentrações séricas de ceruloplasmina (+58%), transferrina (-25%), haptoglobina (+33%), proteína total (-17%), globulinas (-25%), imunoglobulina A (-43%), imunoglobulina G (-24%), cálcio total (-12%), fósforo (-10%), cloretos (+5%), sódio (+4%), colesterol (-23%), triglicérides (-38.6%), bem como as atividades de aspartato aminotransferase (+14%) e fosfatase alcalina (+28%). A diminuição do teor sérico de cálcio total, fósforo, colesterol e triglicérides foi mais acentuada em vacas pluríparas do que em vacas primíparas. Esses resultados mostram que a interpretação do proteinograma e dos constituintes séricos deve levar em consideração o número de lactações e a ocorrência do parto como fatores relevantes em vacas leiteiras de alta produção no período de transição.(AU)

Maternal outcomes of the childbirth among primiparous teenagers in South Kivu, RD Congo

Background: Adolescent births remain at high risk. The aim of this study was to determine the maternal prognosis of births among primiparous teenagers in South Kivu.Methods: A case-control study of 250 primiparous teenagers (cases) and another group of 500 primiparous adults aged 20-34 years (control) was performed in 4 General Reference Hospitals of South Kivu in Republic Democratic Congo. The study period was from January to December 2017. A survey sheet was used to collect the data. The analysis were performed using SPSS 22.0 and EPIINFO version 7.2.2.6.Results: Out of a total of 8490 deliveries recorded at the 4 General Reference Hospitals in South Kivu in 2017, authors recorded 250 deliveries of primiparous teenagers, or 2.9%. The maternal prognosis of adolescent deliveries was more marked by a high rate of caesarean section (OR=13.5), the presence of complications (OR=7.37), prolonged labor (OR=4.51), lesions soft tissues (OR=3.92), intraoperative bleeding (OR=3.26) and fever by puerperal infection (OR=2.13).Conclusions: The frequency of childbirth among primiparous teenagers and maternal-neonatal prognosis has been determined and is of concern. The prevention of adolescent obstetric complications includes the respect for the legal age of marriage, adequate antenatal care and childbirth in a specialized hospital setting.

Comparison of Low Urinary Tract Symptoms during Pregnancy between Primiparous and Multiparous Women

Low urinary tract symptoms (LUTS) are a common problem during pregnancy. This study aimed to compare changes in the prevalence of LUTS during pregnancy between primiparous and multiparous women. A chart review of consecutive pregnant women who attended our antenatal clinic from August 2015 to December 2016 was performed. All of the women were asked to respond to a LUTS questionnaire in either of the three trimesters. Of the 270 women included, 164 were nullipara and 106 were multipara. The most common LUTS during pregnancy were frequency (77%), followed by nocturia (75.6%), stress urinary incontinence (SUI) (51.1%), incomplete emptying (43.7%), dysuria (17.8%), and urgency incontinence (10.4%). There was a significantly higher prevalence of SUI (P < 0.001) and urgency incontinence (P= 0.005) in the multiparous compared to the nulliparous women. Increasing prevalence rates of frequency, nocturia, SUI, and incomplete emptying were reported with gestational age in both the nulliparous and multiparous women. Frequency and nocturia were the two most common LUTS during pregnancy. The prevalence rates of all LUTS increased with increasing gestational age except for frequency in the nulliparous women during the second trimester. In addition, multipara was a predictor of SUI during Pregnancy.

Role of nitric oxide in the pathophysiology of pregnancy-induced hypertension

Background: Pregnancy-induced hypertension (PIH) is a major cause of morbidity and mortality during pregnancy. Previous research suggests that endothelial dysfunction is important in the pathogenesis of PIH and may lead to alterations in nitric oxide (NO) synthesis. As endothelial cell damage is considered pivotal in the pathogenesis of pre-eclampsia, this study was initiated to determine whether NO production is decreased in patients with PIH. Objective: The objectives of this study were to determine the role of NO levels on the increased vascular resistance in the pathophysiology of PIH. Materials and methods: A case–control study was conducted. A total of 60 women in the second trimester of pregnancy with PIH and 60 healthy, normotensive women in second trimester matched with respect to maternal age, gestational age, and body mass index were selected. The resting blood pressure of the subjects was recorded on 2 consecutive days, and the average of the two values was recorded. Fasting blood samples of the subjects was obtained for the estimation of NO levels. Results: The mean serum NO levels of both the groups were compared. A decrease was observed in the mean serum NO levels (μM) in subjects with PIH (18.5 ± 5.8) compared with the controls (36.9 ± 3.9). The difference was statistically significant at P < 0.05. Conclusion: The present study shows a significantly less level of serum NO in women in their second trimester of pregnancy with PIH compared to the controls. This finding may be one of the major clues in unravelling the role of endothelial dysfunction in the pathophysiology of PIH and hence aid in its management.

Effect of problem-oriented health education on postpartum depression and hormone levels in primipara / 中国实用护理杂志

Objective@#To explore the effect of problem-based learning (PBL) health education and nursing mode on the occurrence of depression after primiparous women and its hormone levels.@*Methods@#A total of 468 primiparas who were delivered were selected. The number of singular numbers in the order of hospitalization was the control group, and the double number was the experimental group, 234 cases each. The control group used the traditional obstetric care model, and the experimental group used PBL health education model. The Edinburgh Postnatal Depression Scale (EPDS) and Self-rating Anxiety Scale (SAS) scores were compared between the two groups of prenatal women, 7 days, 42 days, and 3 months postpartum. Estrogen, progesterone, and 5-e were also tested. Serotonin levels. Postpartum depression rates were compared between the two groups according to EPDS and SAS scores. At the same time, the satisfaction rate of women on the quality of care in the two groups was investigated.@*Results@#The EPDS scores (8.3 ± 2.5), (9.0 ± 3.8), and (8.1 ± 2.2) points at 7 days, 42 days, and 3 months after birth were significantly lower in the experimental group than in the control group (9.8 ± 2.5), (11.1 ± 3.7), and (9.2 ± 2.1) points. The difference between the two groups was statistically significant (t =2.35, 1.76, 0.26, P < 0.01). The SAS scores (45.44±4.48), (49.28±3.59), and (38.16±4.45) points at 7 days, 42 days, and 3 months after birth were significantly lower in the experimental group than in the control group (51.69±4.93), (55.79±5.72), and (44.81±3.69) points. The difference was statistically significant (t =2.51, 3.65, 9.91, P < 0.01). There were 41 patients with post-production depression at 42 days postpartum, which was significantly higher than 13 patients in the experimental group. The difference was statistically significant (χ2=1.58, P<0.01). Maternal satisfaction in the experimental group was 96.15%(233/234), and in the control group was 89.32%(228/234), the difference was statistically significant (χ2=14.13, P<0.01). Estradiol levels (14 192.26±3 187.41), (2 954.44±326.16), (702.34±46.41) pmol/L at 7 days, 42 days and 3 months after birth were significantly higher in the experimental group than those in the control group (13 694.45±3 212.18), (2 316.16±391.22), (669.47 ± 53.25) pmol/L. The difference was statistically significant (t =5.16, 1.69, 4.26, P < 0.05). The serotonin levels (434.25±8.41), (315.05±12.35) ng/L at 42 days and 3 months after delivery were significantly higher in the experimental group than those in the control group (415.96±12.35), (308.15±11.35) ng/L. The difference was statistically significant (t=1.58, 3.25, P < 0.05). Progesterone levels (28.19±2.36), (8.25±0.98) µg/L at 42 days and 3 months after delivery were significantly lower in the experimental group than those in the control group (34.25±2.44), (9.69±1.25) µg/L. The difference was statistically significant (t =2.24, 5.16, P < 0.05).@*Conclusions@#PBL health education model can significantly reduce the risk of postpartum depression in primipara, regulate estrogen, progesterone and serotonin levels, and can be applied in obstetrics.

Effect of probLem-oriented heaLth education on postpartum depression and hormone LeveLs in primipara / 中国实用护理杂志

Objective To explore the effect of problem-based learning (PBL) health education and nursing mode on the occurrence of depression after primiparous women and its hormone levels. Methods A total of 468 primiparas who were delivered were selected. The number of singular numbers in the order of hospitalization was the control group, and the double number was the experimental group, 234 cases each. The control group used the traditional obstetric care model, and the experimental group used PBL health education model. The Edinburgh Postnatal Depression Scale (EPDS) and Self-rating Anxiety Scale (SAS) scores were compared between the two groups of prenatal women, 7 days, 42 days, and 3 months postpartum. Estrogen, progesterone, and 5-e were also tested. Serotonin levels. Postpartum depression rates were compared between the two groups according to EPDS and SAS scores. At the same time, the satisfaction rate of women on the quality of care in the two groups was investigated. ResuLts The EPDS scores (8.3 ± 2.5), ( 9.0 ± 3.8), and ( 8.1 ± 2.2) points at 7 days, 42 days, and 3 months after birth were significantly lower in the experimental group than in the control group (9.8 ± 2.5), (11.1 ± 3.7), and (9.2 ± 2.1) points. The difference between the two groups was statistically significant (t=2.35, 1.76, 0.26, P<0.01). The SAS scores (45.44±4.48), (49.28±3.59), and (38.16±4.45) points at 7 days, 42 days, and 3 months after birth were significantly lower in the experimental group than in the control group (51.69±4.93), (55.79±5.72), and (44.81±3.69) points. The difference was statistically significant (t=2.51, 3.65, 9.91, P < 0.01). There were 41 patients with post-production depression at 42 days postpartum, which was significantly higher than 13 patients in the experimental group. The difference was statistically significant (χ2=1.58, P<0.01). Maternal satisfaction in the experimental group was 96.15%(233/234), and in the control group was 89.32%(228/234), the difference was statistically significant (χ2=14.13, P<0.01). Estradiol levels (14 192.26±3 187.41), ( 2 954.44±326.16), ( 702.34±46.41) pmol/L at 7 days, 42 days and 3 months after birth were significantly higher in the experimental group than those in the control group (13 694.45 ± 3 212.18), (2 316.16 ± 391.22), (669.47 ± 53.25) pmol/L. The difference was statistically significant (t=5.16, 1.69, 4.26, P<0.05). The serotonin levels (434.25±8.41), (315.05±12.35) ng/L at 42 days and 3 months after delivery were significantly higher in the experimental group than those in the control group (415.96 ± 12.35), (308.15 ± 11.35) ng/L. The difference was statistically significant (t=1.58, 3.25, P < 0.05). Progesterone levels (28.19 ± 2.36), (8.25 ± 0.98) μg/L at 42 days and 3 months after delivery were significantly lower in the experimental group than those in the control group (34.25±2.44), (9.69 ± 1.25) μg/L. The difference was statistically significant (t =2.24, 5.16, P < 0.05). ConcLusions PBL health education model can significantly reduce the risk of postpartum depression in primipara, regulate estrogen, progesterone and serotonin levels, and can be applied in obstetrics.

Embarazo espontáneo en una paciente con agenesia de cuello uterino / Spontaneous pregnancy in patient with cervical agenesis

Resumen ANTECEDENTES: La incidencia de agenesia cervical con endometrio funcional se desconoce, aunque se calcula menor a 0.1% en la población general. El pronóstico reproductivo de pacientes con malformaciones müllerianas es limitado y requiere múltiples intervenciones quirúrgicas. CASO CLÍNICO: Paciente primigesta de 21 años, con antecedente de agenesia de cuello uterino y dos tercios superiores de la vagina. Acudió a consulta a las 38.1 semanas de embarazo establecido conforme a la fecha de la última menstruación. Refirió haber concebido de forma espontánea y negó complicaciones durante el embarazo. Se programó para finalizar el embarazo mediante cesárea. El periodo trans y posquirúrgico transcurrió sin complicaciones maternas ni fetales. CONCLUSIÓN: El embarazo espontáneo en pacientes con malformaciones müllerianas debe tratarse a tiempo para asegurar que no surjan complicaciones que pongan en riesgo la vida de la madre y su hijo.

Abstract BACKGROUND: The incidence of cervical agenesis with functional endometrium is unknown, but it's estimated to be less than 0.1% in the general population. The reproductive prognosis in Müllerian malformations is limited and, in most cases, requires multiple surgical interventions to be improved. CASE REPORT: A 21-year-old primiparous patient with a history of agenesis of the cervix and two upper thirds of the vagina. Attended a first-time obstetric appointment at 38.1 weeks of gestation. She refers that the pregnancy was conceived spontaneously and denied complications during pregnancy. A cesarean section was scheduled to end the pregnancy, which had no trans or post-operative maternal-fetal morbidity. CONCLUSIONS: Spontaneous pregnancy in patients with congenital agenesis of the cervix should be addressed in time to ensure a favorable obstetric outcome.

The Effectiveness of Breastfeeding Intervention on Breastfeeding Exclusivity and Duration among Primiparous Mothers in Hospital Universiti Sains Malaysia

Background: In Malaysia, the rates of mothers practising breastfeeding exclusively among babies at six months of age still do not achieve the Global Nutritional Targets 2025 which is 50%. Objective: To determine the effectiveness of breastfeeding intervention in improving breastfeeding outcomes. Method: A quasi-experimental design was used involving a purposive sample of 96 primigravidas (intervention group (IG) = 48, control group (CG) = 48) recruited at Hospital USM. Data were collected using the Breastfeeding Assessment Questionnaire. Mothers in IG received the current usual care and two hours of an additional education programme on breastfeeding, breastfeeding booklet, notes from the module, and postnatal breastfeeding support in the first week of postpartum. Mothers in CG received the current usual care only. The mothers were assessed on the first and sixth week and then the fourth and sixth month of postpartum. Results: The results indicated that there was a statistically significant difference between the groups on the fourth month postpartum (X2 = 5.671, P = 0.017) in practicing full breastfeeding. The breastfeeding duration rates of the IG were longer than those of the CG. However, the results showed only two follow-up weeks that were significant (week 6, X2 = 5.414, P = 0.020, month 4, X2 = 7.515, P = 0.006). There was a statistically significant difference between IG and CG as determined by one-way ANCOVA on the breastfeeding duration after controlling age and occupation, F (3, 82) = 6.7, P = 0.011. The test revealed that the breastfeeding duration among IG was significantly higher (20.80 ± 6.31) compared to CG (16.98 ± 8.97). Conclusions: Breastfeeding intervention can effectively increase breastfeeding duration and exclusivity outcomes among primiparous mother

A qualitative study on successful breastfeeding experience of primiparous women with natural childbirth during the first 6 months postpartum / 中国实用护理杂志

Objective To explore the successful breastfeeding experience of primiparous women with natural childbirth during the first 6 months postpartum. Methods A phenomenological methodology was used. Semi-structured in depth interviews were conducted among 11 primiparous women of natural childbirth. The data were transcribed, collated, summarized and analyzed using Colaizzi′s method. Results The primiparous women who sustained exclusive breastfeeding for six months after natural delivery experienced three stages which were:anxiety of breastfeeding,gradual adaption of breastfeeding, and coexistence of puzzles and insistence. The first stage was anxiety of breastfeeding including three themes: lack of experience in breastfeeding, conflict of breastfeeding, and noticeable fatigue during feeding.The second stage was gradual adaption of breastfeeding including four themes:family and social support, presenting regular feeding schedules, identification of mother role, and establishing a good mother-child relationship.The last stage was coexistence of puzzles and insistence which containing three themes: coexistence of confusion and perseverance, fear of returning back to work, suffering of maternal separation,and commitment of breastfeed. Conclusions In order to release the anxiety and improve the confidence of breastfeeding of primiparous women, it is vital to rely on the conjoint efforts of the family members,healthcare institutions,communities,enterprises,society and other aspects to improve the rate and duration of exclusive breastfeeding.

Descripción de la curva de trabajo de parto en un hospital de tercer nivel de atención / Description of the labor curve in a third-level care hospital

Resumen OBJETIVO Describir la curva de trabajo de parto en una muestra de pacientes atendidas en el Hospital de Ginecoobstetricia Luis Castelazo Ayala y sentar las bases para redefinir el trabajo de parto normal en la paciente primigesta y, por ende, sus alteraciones. MATERIALES Y MÉTODOS Estudio retrospectivo y descriptivo efectuado en pacientes primigestas sanas con embarazo entre 37 y 41 semanas atendidas para parto eutócico en el Hospital de Ginecoobstetricia Luis Castelazo Ayala del Instituto Mexicano del Seguro Social. Descripción del patrón de progresión del primer estadio de trabajo de parto y de la relación entre el tiempo y la dilatación cervical. RESULTADOS Se incluyeron 370 pacientes primigestas sanas. El trabajo de parto duró, en promedio, 862 minutos (14 horas y 12 minutos). La curva de trabajo de parto graficada fue una pendiente con curva ascendente, con una fase de aceleración desde el inicio de los 4 centímetros de dilatación; a partir de ese momento la duración promedio del trabajo de parto fue de 234 minutos (3 horas y 54 minutos), con un patrón de dilatación de 0.4-0.7 cm por h. CONCLUSIÓN La curva del primer estadio del trabajo de parto de las pacientes estudiadas tuvo un patrón de pendiente ascendente, con una aceleración mayor a partir de los 4 cm de dilatación. Nuestra curva difiere en su morfología de la clásica curva sigmoide de atención de parto de Friedman; a pesar de ello ambas curvas coinciden en que el trabajo de parto entra en su fase activa a los 4 centímetros de dilatación.

Abstract OBJECTIVE To describe the labor curve and the dilation-time ratio of the first stage of labor in a group of patients of the Hospital de Ginecoobstetricia Luis Castelazo Ayala. MATERIALS AND METHODS A retrospective and descriptive study with 370 healthy pregnancy primiparous patients between 37 and 41 gestation weeks admitted in the Obstetrics & Gynecology Hospital "Luis Castelazo Ayala" of the Mexican Social Security Institute. All patients were attended of eutocic delivery without any complication. We reviewed the partogram and the progression of cervical dilation on the first stage of labor. By observing the relationship between time and cervical dilation we described we elaborate a labor curve. RESULTS Labor in its entirety lasted on average 862 minutes (14 hours and 12 minutes). The delivery labor curve graphed was a slope upward curve, with an acceleration phase from 4 centimeters dilated, from that moment the duration of labor average was 234 minutes (3 hours and 54 minutes), with a dilating pattern of 0.4-0.7 cm / h. CONCLUSION The curve of the first stage of labor we studied has an upslope pattern, with an increased acceleration from 4 centimeters of dilation. Our curve differs from the classical sigmoid curve care delivery Dr. Friedman in their basic morphology, however both curves agree that labor enters its active phase in the 4 centimeters of dilation.

Incidence of the second parity syndrome in sows from a commercial farm / Incidência de síndrome do segundo parto em fêmeas suínas de uma granja comercial

O objetivo do presente estudo foi investigar a ocorrência da síndrome do segundo parto em uma granja comercial de suínos e apresentar alternativas para minimizar esse problema reprodutivo. Os dados foram obtidos de 363 fêmeas de genética comercial (DB-30) de primeiro e segundo partos, entre os anos de 2010 e 2011. Os animais pertenciam a uma granja comercial de ciclo completo com 1200 matrizes, cujos índices zootécnicos não permitiam detectar a presença da síndrome do segundo parto. O período de lactação foi de 24,6±3,3 dias. Foram analisados o número de nascidos totais e nascidos vivos, o peso da leitegada ao nascimento, o número de desmamados e o peso ao desmame do lote e também individualmente de cada marrã ao longo do ano. As médias e o desvio-padrão foram calculados, e os dados obtidos no primeiro e no segundo parto foram comparados pelo teste t pareado a 5%. Não houve diferença (P>0,05) no número de nascidos totais e no número de nascidos vivos entre o primeiro e o segundo parto. No entanto, constatou-se que 54% das fêmeas apresentaram igual ou menor número de nascidos no segundo parto, caracterizando a síndrome do segundo parto na maior parte dos animais. Nesse lote, o número de leitões nascidos a menos em relação ao primeiro ciclo reprodutivo foi de 3,6±2,9. Das 363 matrizes avaliadas, 153 (42%) apresentaram 16 ou mais leitões no primeiro parto. Destas, 92 (60%) tiveram menor número de leitões no segundo parto e 41 (27%) apresentaram maior número de leitões. Também se verificou maior incidência (50% ou mais) da síndrome do segundo parto nos meses de janeiro a março e de outubro a dezembro. Conclui-se que a síndrome do segundo parto é um problema que pode afetar 50% ou mais das matrizes, nem sempre detectada por meio dos índices zootécnicos da granja. Medidas como pesagem dos animais na primeira cobertura e logo após o desmame, além de programas de alimentação com dietas balanceadas, principalmente durante os meses mais quentes do ano, são ferramentas importantes para amenizar esse problema.(AU)

Conocimiento sobre los beneficios de la Lactancia Materna en pacientes mujeres embarazadas y/o en post-parto no primigestas en San Juan Sacatepéquez / Knowledge about breastfeeding benefits in pregnant and postpartum female patients from San Juan Sacatepéquez

Introducción. La leche materna es el alimento óptimo para el lactante especialmente en los primeros seis meses de vida. Objetivo: Se realizó este estudio para identificar los conocimientos sobre lactancia materna en mujeres embarazadas y/o en posparto, no primigestas que acuden a la consulta externa del Centro de Salud Bárbara en San Juan Sacatepéquez. Diseño experimental: Se condujo el estudio en SJS, con una población de 100 madres embarazadas, y/ o post parto no primigestas. Métodos: Se utilizó un cuestionario de 23 preguntas, el cual se evaluó sobre 100 puntos, considerándose un conocimiento adecuado cuando se obtenía 60 o más puntos. Resultados: La mayoría de las madres en un rango de edad entre 27 y 31 años demostraron carecer de los conocimientos básicos sobre la lactancia materna. Conclusiones: Aunque la mayoría de mujeres participantes llevaron control prenatal, se concluyó que sus conocimientos básicos sobre la lactancia materna son pobres.

Introduction: It is well known fact that exclusive breastfeeding is the best nutrition for the newborn during the first six months of life. Mothers who are providing this diet need to have the right information in order to achieve best results. Objective: This study was performed to identify the knowledge about breast feeding in non primiparous pregnant women and/or in postpartum from San Juan Sacatepéquez. Experimental design: The study was conducted in San Juan Sacatepéquez´ Health Center Bárbara, in 100 non primiparous pregnant women and/or in postpartum. Method: A questionnaire of 23 questions was used with a total value of 100 points. It was considered a score of 60 points or higher representing an adequate level of knowledge about breastfeeding. Results: Mostly mothers between 27 and 31 years demonstrated a lack in basic knowledge about breastfeeding. Conclusions: Even though most of the participating women received prenatal control, it was concluded that there is a lack of knowledge about maternal breastfeeding in this group.

Avaliação microbiológica uterina durante o puerpério de vacas Nelore primíparas / Evaluación microbiológica uterina durante el puerperio de vacas Nelore primíparas / Uterine microbiological assessment of primiparous nelore cows during puerperium

O objetivo deste estudo foi avaliar a microbiota uterina de vacas primíparas da raça Nelore durante o período puerperal. Foi coletado material do útero de 15 fêmeas recém-paridas, uma vez por semana, durante 60 dias. O material coletado foi inoculado em meio de cultura, e os microrganismos foram identificados por meio de coloração de Gram, coloração Azul de Algodão e testes bioquímicos. As amostras foram isolados Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus, Streptococcus spp., S. intermedius, Bacillus spp., Actinomyces pyogenes, Sporothrix schenckii, Trichophyton verrucosum e Candida albicans, geralmente em associações. Com isso, concluímos que o puerpério é um processo séptico, e os agentes encontrados são os mesmos que provocam a maioria dos casos de infecções uterinas pós-parto. O número e a variação de microrganismos decrescem a cada semana, demonstrando o processo natural de autodefesa do útero que ocorre quando o animal apresenta-se sadio.

El objetivo de este estudio fue evaluar la microbiota uterina de vacas primíparas de la raza Nelore durante el puerperio. El material fue recogido del útero de 15 vacas que habían parido recientemente, una vez a la semana durante 60 días. El material recogido se inoculó en medios de cultivo y los microorganismos fueron identificados mediante las tinciones de Gram, Azul de Algodón, y por pruebas bioquímicas. En los cultivos se aislaron Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus, Streptococcus spp., S. intermedius, Bacillus spp., Actinomyces pyogenes, Sporothrix schenckii, Trichophyton verrucosum y Candida albicans, generalmente con más de un microorganismo por muestra. Se concluyó que el puerperio es un proceso séptico, y que estos agentes son la causa de la mayoría de los casos de infecciones uterinas después del parto. El número y variedad de microorganismos disminuyeron cada semana, lo que demuestra un proceso natural de autodefensa del útero cuando el animal está sano.

It was aimed to evaluate the uterine microbiota of primiparous Nelore cows during the puerperal period. To 15 fifteen females immediately parous, secretions were obtained from the uterus once a week, during sixty days. Material obtained was inoculated in culture media, and microorganism identification was made by smears stained by the Gram method, cotton blue and biochemical tests. Microorganisms recovered were Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus, S. intermedius, Streptococcus spp, Bacillus spp, Actinomyces pyogenes, Sporotrix schenckii, Trichophyton verrucosum and Candida albicans, generally recovering more than one microorganism per culture, demonstrating that the puerperium is a septic process. The number and type of microorganisms decreased every week, demonstrating the natural process of self-defense of the uterus that occurs by the end of puerperium.

Inseminação artificial em tempo fixo em primíparas Nelore lactantes acíclicas / Fixed-time artificial insemination in primiparous lactating Nelore acyclic cows

Avaliou-se a eficiência de um protocolo de inseminação artificial em tempo fixo (IATF), para melhorar o desempenho reprodutivo de vacas Nelore primíparas, lactantes e acíclicas. Utilizaram-se 350 vacas com escore de condição corporal médio de 2,65±0,01 e média de dias pós-parto de 67,35±1,0 dias. A estação de monta (EM) foi de 180 dias. Os animais foram distribuídos em: G1(n=61) e G3(n=116) - vacas com presença de folículos ovarianos ≤8mm de diâmetro e sem corpo lúteo (CL); G2(n=57) e G4(n=116) - vacas com folículos ≥8mm e sem CL. As vacas do G1 e do G2 permaneceram em monta natural (MN) a partir do dia zero da EM. G3 e G4 foram tratados (dia zero) com 2mg de benzoato de estradiol (BE), IM, e dispositivo com 1,0g de P4 por oito dias. Retirou-se a P4, administraram-se 400UI de eCG e 75µg de cloprostenol, IM, 24h após, e 1mg BE, IM. A IATF foi realizada 51-54h após retirar P4. Aos cinco dias após término da IATF, as vacas do G3 e do G4 também foram mantidas em MN. Avaliou-se, por ultrassonografia, a presença de CL e realizou-se o diagnóstico de gestação, aos 45 e 210 dias após início da EM. Aos 45 dias, mais animais do G3, 42,2%, e do G4, 51,7%, estavam gestantes (P<0,05), em relação aos do G1, 0%, e do G2, 3,5%. A porcentagem de CL foi de 6,6%; 28,1%; 50,9%; 62,9% em G1, G2, G3 e G4, respectivamente. Aos 210 dias, 22,9% do G1; 45,6% do G2; 40,5% do G3 e 65,5% do G4 estavam gestantes. Os períodos de serviço foram: em G1, 134,00±11,70 dias; em G2, 119,65±8,27 dias; em G3, 79,91±5,38 dias; e em G4, 81,40±4,59 dias. A IATF foi eficiente para melhorar o desempenho reprodutivo de vacas Nelore primíparas lactantes acíclicas em relação ao manejo apenas da MN.

The aim of this experiment was to evaluate the efficiency of a fixed-time artificial insemination protocol to improve the reproductive performance of lactating primiparous acyclic Nelore cows. A total of 350 cows with average body condition score of 2.65±0.01 and average postpartum days of 67.35±1.0 were used. The breeding season (MS) was 180 days. The animals were distributed into G1 (n = 61) and G3 (n = 116) - cows with ovarian follicles ≤8mm in diameter and without corpus luteum (CL). G2 (n = 57) and G4 (n = 116) groups - cows with follicles ≥8mm and without CL. Cows in G1 and G2 remained in natural mating (NM) from day 0 of MS. G3 and G4 were treated (Day 0) with 2mg of oestradiol benzoate (EB), IM, and 1.0g P4 device for eight days. The withdrawal of P4 was administered with 400IU of eCG and cloprostenol 75μg, IM, after 24h, and 1mg BE, IM. The artificial insemination was performed at 51-54h after removing the P4 device. Five days after the end of the artificial insemination, cows from G3 and G4 were also held in MN. Ultrasonography was performed to evaluate the presence of CL and the pregnancy diagnosis at days 45 and 210 after the onset of MS. At 45 days more animals in G3, 42.2% and G4, 51.7% were pregnant (P <0.05) than in G1, 0% and G2, 3.5%. The CL percentage was 6.6%, 28.1%, 50.9%, 62.9% in G1, G2, G3 and G4, respectively. At 210 days 22.9% in G1, 45.6% in G2, 40.5% in G3 and 65.5% in G4 were pregnant. The service periods were: G1, 134.00±11.70 days; G2, 119.65±8.27 days, in G3, 79.91±5.38 days, and G4, 81.40±4.59 days. The fixed-time artificial insemination was efficient to improve the reproductive performance of primiparous lactating Nelore acyclic cows compared to animals that remained only with natural mating.

Comparison of pelvic floor muscle strength evaluations in nulliparous and primiparous women: a prospective study

OBJECTIVE: This study aimed to compare the pelvic floor muscle strength of nulliparous and primiparous women. METHODS: A total of 100 women were prospectively distributed into two groups: Group 1 (G1) (n = 50) included healthy nulliparous women, and Group 2 (G2) (n = 50) included healthy primiparous women. Pelvic floor muscle strength was subjectively evaluated using transvaginal digital palpation. Pelvic floor muscle strength was objectively assessed using a portable perineometer. All of the parameters were evaluated simultaneously in G1 and were evaluated in G2 during the 20th and 36th weeks of pregnancy and 45 days after delivery. RESULTS: In G2, 14 women were excluded because they left the study before the follow-up evaluation. The median age was 23 years in G1 and 22 years in G2; there was no significant difference between the groups. The average body mass index was 21.7 kg/m² in G1 and 25.0 kg/m² in G2; there was a significant difference between the groups (p = 0.0004). In G2, transvaginal digital palpation evaluation showed significant impairments of pelvic floor muscle strength at the 36th week of pregnancy (p = 0.0006) and 45 days after vaginal delivery (p = 0.0001) compared to G1. Objective evaluations of pelvic floor muscle strength in G2 revealed a significant decrease 45 days after vaginal delivery compared to nulliparous patients. CONCLUSION: Pregnancy and vaginal delivery may cause weakness of the pelvic floor muscles.