Insucesso de indução por misoprostol em gestantes: revisão integrativa / Fracaso de la inducción por misoprostol en mujeres embarazadas: revisión integradora / Unsuccessful misoprostol induction in pregnant women: an integrative review

Resumo Objetivo Analisar as evidências disponíveis na literatura acerca do insucesso da indução do trabalho de parto com misoprostol em gestações a termo. Métodos Revisão integrativa, realizada entre janeiro e novembro de 2022, cuja pergunta de pesquisa e descritores foram delineados por meio da estratégia PECO. As buscas foram realizadas nas bases de dados MEDLINE; Web of Science; CINAHL; EMBASE e Scopus por duas pesquisadoras de forma independente, assim como a avaliação. Para a fase de seleção e identificação dos estudos foi utilizado o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A avaliação do risco de viés dos artigos incluídos foi realizada através do questionário Newcastle Ottawa Scale. Resultados Foram identificados 3.674 artigos, 84 foram lidos na íntegra, dos quais 11 compuseram a revisão (n=9.010 gestantes), com publicação entre os anos de 2005 a 2021, sendo a maioria nos Estados Unidos. Quanto ao nível de evidência, todos os artigos foram classificados como 2b, avaliada coforme o delineamento de cada investigação. O estudo apontou evidências quanto aos seguintes fatores: IMC elevado (maior igual a 30kg/m2), nuliparidade, bishop imaturo, comprimento cervical (maior igual a 30mm), estatura, etnia (não caucasianas do sul da Europa) e peso fetal (maior igual a 4kg). Conclusão Alcançou-se o objetivo do estudo tendo sido demonstrado seis fatores maternos e um fetal que podem levar ao insucesso da indução. Vale ressaltar a necessidade de evidências que incorporem a individualidade de cada característica e destaca-se a contribuição desse estudo para embasar a escolha da melhor conduta para cada gestação de forma individualizada.

Resumen Objetivo Analizar las evidencias disponibles en la literatura acerca del fracaso de la inducción del trabajo de parto con misoprostol en gestaciones a término. Métodos Revisión integradora, realizada entre enero y noviembre de 2022, cuya pregunta de investigación y descriptores fueron definidos mediante la estrategia PECO. Las búsquedas fueron realizadas en las bases de datos MEDLINE, Web of Science, CINAHL, EMBASE y Scopus por dos investigadoras de forma independiente, al igual que la evaluación. Para la fase de selección e identificación de los estudios se utilizó el Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). La evaluación del riesgo de sesgo de los artículos incluidos se realizó a través del cuestionario Newcastle Ottawa Scale. Resultados Se identificaron 3.674 artículos, 84 se leyeron en su totalidad, de los cuales 11 conformaron la revisión (n=9.010 mujeres embarazadas), publicados entre los años 2005 y 2021, la mayoría en Estados Unidos. Respecto al nivel de evidencia, todos los artículos fueron clasificados como 2b, evaluada de acuerdo con el diseño de cada investigación. El estudio indicó evidencias respecto a los siguientes factores: IMC elevado (mayor igual a 30 kg/m2), nuliparidad, bishop bajo, longitud cervical (mayor o igual a 30 mm), estatura, etnia (no caucasoide del sur de Europa) y peso fetal (mayor igual a 4 kg). Conclusión Se alcanzó el objetivo del estudio y se demostraron seis factores maternos y uno fetal que pueden llevar al fracaso de la inducción. Cabe resaltar la necesidad de evidencias que incorporen la individualidad de cada característica y se destaca la contribución de este estudio para fundamentar la elección de la mejor conducta en cada gestación de forma individualizada.

Abstract Objective To analyze the evidence available in literature regarding unsuccessful labor induction with misoprostol in full-term pregnancies. Methods This is an integrative review, carried out between January and November 2022, whose research question and descriptors were outlined using the PECO strategy. The searches were carried out in the MEDLINE, Web of Science, CINAHL, EMBASE and Scopus databases by two researchers independently as well as assessment. For the study selection and identification phase, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. The risk of bias assessment of included articles was carried out using the Newcastle-Ottawa Scale. Results A total of 3,674 articles were identified, and 84 were read in full, of which 11 comprised the review (n=9,010 pregnant women), published between 2005 and 2021, with the majority in the United States. Regarding the level of evidence, all articles were classified as 2b, assessed according to the design of each study. The study showed evidence regarding the following factors: High BMI (greater than 30 kg/m2), nulliparity, immature bishop, cervical length (greater than 30 mm), height, ethnicity (non-Caucasians from southern Europe) and fetal weight (greater equal to 4 kg). Conclusion The objective study was achieved, having demonstrated six maternal factors and one fetal factor that can lead to unsuccessful induction. It is worth highlighting the need for evidence that incorporates the individuality of each characteristic and the contribution of this study to support the choice of the best conduct for each pregnancy on an individual basis stands out.

Effect of mode of delivery on postpartum health-related quality of life

SUMMARY OBJECTIVE: The aim of the study was to explore the impact of mode of delivery on health-related quality of life in mothers. METHODS: This cross-sectional study was conducted between May and August 2022 on healthy singleton pregnant women aged between 18 and 45 years. Data on socio-demographic variables, clinic features, pregnancy and birth characteristics, and neonatal outcomes were collected. Health-related quality of life was assessed by using EQ-5D-5L questionnaire. RESULTS: A total of 1,015 healthy pregnant women were included. The EQ-5D-5L index score was higher in those with regular sleep patterns (p<0.001), those who did physical activity (PA) during pregnancy (p<0.001), those who received spousal support (p<0.001), and those with very good and good perceived health (p<0.001). EQ-5D-5L index and EQ-5D-5L-VAS scores were lower in those with unplanned pregnancy, those who preferred cesarean section, those who had cesarean section, those who underwent episiotomy, and those who admitted to the intensive care unit (p<0.001). Emergency cesarean section and elective cesarean section had the lowest and second lowest health-related quality of life mean scores, while normal vaginal deliveries had the highest health-related quality of life mean scores, respectively (p<0.001). CONCLUSION: This study showed that health-related quality of life was higher after vaginal delivery than after cesarean section. In addition, spousal support, regular sleep pattern, and PA during pregnancy play an important role in maternal health-related quality of life.

Conduta obstétrica em caso de hipoplasia materna da veia cava inferior / Obstetric management in case of the maternal inferior vena cava hypoplasia

A hipoplasia da veia cava inferior é uma patologia rara que integra o conjunto de anomalias do desenvolvimento da veia cava inferior. A sua incidência situa-se entre 0,3%-0,5% na população saudável e 5% nos adultos jovens sem fatores de risco para trombose venosa profunda, sendo considerada um importante fator de risco para o desenvolvimento de trombose dos membros inferiores. O principal objetivo deste trabalho é reportar a conduta obstétrica de um caso clínico de uma grávida diagnosticada com hipoplasia da veia cava inferior, prévia à gravidez. Trata-se de um caso clínico, de uma grávida, primigesta, com 37 anos, com hipoplasia da veia cava inferior e heterozigotia para o gene MTHFR677 diagnosticadas, na sequência de uma trombose venosa bilateral dos membros inferiores e do segmento infrarrenal da veia cava inferior. A gravidez foi seguida em consulta hospitalar na nossa instituição, tendo a grávida sido medicada com enoxaparina em dose profilática e ácido acetilsalicílico, com um período pré natal que decorreu sem intercorrências. Às 37 semanas e 6 dias de gestação, deu entrada no Serviço de Urgência de Obstetrícia por rotura prematura de membranas. Intraparto foram utilizadas meias de compressão pneumática intermitente, tendo o parto ocorrido às 38 semanas de gestação por via vaginal (parto eutócico), do qual nasceu um recém-nascido do sexo feminino, com 2620g e índice de Apgar 9/10/10. O presente caso clínico demonstra que em situações de hipoplasia da veia cava inferior com um seguimento obstétrico adequado é possível a realização de um parto vaginal, possibilitando um desfecho obstétrico favorável (AU).

Hypoplasia of the inferior vena cava is a rare condition that belongs to the group of developmental anomalies of the inferior vena cava. It has an incidence between 0.3% and 0.5% in the healthy population and 5% in young adults without risk factors for deep venous thrombosis, being considered an important risk factor for the development of lower limb thrombosis. This study aims to report the obstetric conduct of a clinical case of a pregnant woman diagnosed with hypoplasia of the inferior vena cava prior to pregnancy. This is a clinical case of a pregnant woman, primigravid 37 years old, with hypoplasia of the inferior vena cava and heterozygosity for MTHFR677, diagnosed following a bilateral venous thrombosis of the lower limbs and the infrarenal segment of the inferior vena cava. The pregnancy was followed up in our institution. The pregnant woman was medicated with a prophylatic dose of low molecular weight heparin and acetylsalicylic acid with an uneventful prenatal period. At 37 weeks and 6 days of gestation, she was admitted to the Obstetrics Emergency Service due to premature rupture of membranes. Intermittent pneumatic compression sockings were used intrapartum, and at 38 weeks of gestation, a female newborn was vaginally delivered (eutocic delivery) with 2620g and an Apgar score of 9/10/10. The present clinical case demonstrates that in situations of hypoplasia of the inferior vena cava with an adequate obstetric follow-up, it is possible to perform a vaginal delivery, enabling a favourable obstetric outcome (AU).

Assessment of responsiveness and minimum important difference of the Maternal perception of Childbirth Fatigue Questionnaire (MCFQ) / Avaliação da responsividade e diferença mínima importante do Questionário de percepção Materna de Fadiga no trabalho de Parto (QMFP)

INTRODUCTION: The assessment of responsiveness and the Minimum Clinically Important Difference (MCID) is the basis for validating the Maternal perception of Childbirth Fatigue Questionnaire (MCFQ). OBJECTIVE: To assess the responsiveness and determine the value of the MCID for the MCFQ. METHODS: This is an observational study, conducted at HC-UFPE with 50 parturients in active labor. The MCFQ was applied in two moments: in the initial evaluation (EV1), performed at the beginning of labor between 4-6 cm of uterine dilation, and final (EV2), six hours after the first evaluation. Responsiveness was determined by calculating the effect size (ES), and standardized response mean (SRM), considering that values of 0.2, 0.5, and 0.8 points represent respectively small, moderate, or large values of responsiveness. The ability to detect change through the questionnaire was also assessed by the t-test. The level of significance adopted for this analysis was p less than 0.05. The MCID was verified based on the calculation of the standard error of measurement (SEM) index. RESULTS: The MCFQ showed values of 0.4 and 0.6 for ES and SEM respectively and a p-value <0.001, thus showing a good capacity for change. The value of the MCID for this population was seven points. CONCLUSION: MCFQ presents a potentially significant change with a value of the MCID of seven points after six hours of active labor.

INTRODUÇÃO: A avaliação da responsividade e da Diferença Mínima Importante (DMI) é fundamentação para validação do Questionário de percepção Materna de Fadiga no Trabalho de Parto (QMFP). OBJETIVO: Avaliar a responsividade e determinar o valor da DMI para o QMFP. MÉTODOS: Trata-se de um estudo observacional, realizado no HC-UFPE com 50 parturientes em fase ativa do trabalho de parto. O QMFP foi aplicado em dois momentos: na avaliação inicial (AV1), realizada no início do trabalho de parto entre 4-6 centímetro de dilatação uterina, e final (AV2), após seis horas da primeira avaliação. A responsividade foi determinada pelo cálculo do effect size (ES), standardized response mean (SRM), considerando que valores de 0,2, 0,5 e 0,8 pontos representam respectivamente um pequeno, moderado ou grande valor de responsividade. A capacidade de detectar mudança pelo questionário também foi avaliada pelo test t. O nível de significância adotado para essa análise foi p menor que 0,05. A DMI foi verificada com base no cálculo do índice standard error of measurement (SEM). RESULTADOS: O QMFP apresentou valores de 0,4 e 0,6 de ES e SEM respectivamente e valor de p<0,001, logo apresenta uma boa capacidade de mudança. O valor da DMI para esta população foi de sete pontos. CONCLUSÃO: O QMFP apresenta uma mudança potencialmente significativa com um valor da DMI de sete pontos após seis horas de trabalho de parto ativo.

Characteristics of women who underwent one or more previous cesarean sections according to Nascer no Brasil / Características de mulheres com uma ou mais cesáreas anteriores no nascer no Brasil

ABSTRACT OBJECTIVE To descriptively analyze Brazilian parturient women who underwent previous cesarean section and point out the factors associated with Vaginal Birth After Cesarean (VBAC) in Brazil. METHODS The study used data from women with one, two, or three or more cesarean sections from the survey Nascer no Brasil (Birth in Brazil). Differences between categories were assessed through the chi-square test (χ2). Variables with significant differences (p < 0.05) were incorporated into logistic regression. FINDINGS Out of the total of 23,894 women, 20.9% had undergone a previous cesarean section. The majority (85.1%) underwent another cesarean section, with 75.5% occurring before the onset of labor. The rate of Vaginal Birth After Cesarean (VBAC) was 14.9%, with a success rate of 60.8%. Women who underwent three or more cesarean sections displayed greater social vulnerability. The chances of VBAC were higher among those who opted for a vaginal birth towards the end of gestation, had a prior vaginal birth, underwent labor induction, were admitted with over 4 centimeters of dilation, and without partner. Receiving care from the private health care system, having two or more prior cesarean sections, obstetric complications, and deciding on cesarean delivery late in gestation reduced the chances of VBAC. Age group, educational background, prenatal care adequacy, and the reason for the previous cesarean section did not result in significant differences. CONCLUSION The majority of women who underwent a previous cesarean section in Brazil are directed towards another surgery, and a higher number of cesarean sections is linked to greater social inequality. Factors associated with VBAC included choosing vaginal birth towards the end of gestation, having had a previous vaginal birth, higher cervical dilation upon admission, induction, assistance from the public health care system, absence of obstetric complications, and without a partner. Efforts to promote VBAC are necessary to reduce overall cesarean rates and their repercussions on maternal and child health.

RESUMO OBJETIVO Analisar descritivamente as parturientes brasileiras com cesariana anterior e apontar os fatores associados ao parto vaginal após cesárea (Vaginal Birht After Cesarean- VBAC) no Brasil. MÉTODOS Foram utilizados dados de mulheres com uma, duas ou três e mais cesáreas da pesquisa Nascer no Brasil. As diferenças entre categorias foram avaliadas pelo teste de qui-quadrado (χ2). As variáveis que apresentaram diferença significativa (< 0,05) foram incluídas em regressão logística. RESULTADOS Do total de 23.894 mulheres, 20,9% tinham cesárea anterior. A maior parte (85,1%) foi submetida a outra cesárea, 75,5% antes do início do trabalho de parto. A porcentagem de VBAC foi de 14,9%, uma taxa de sucesso de 60,8%. Mulheres com três cesáreas ou mais apresentaram maior vulnerabilidade social. As chances de VBAC foram maiores entre aquelas decididas pelo parto vaginal no fim da gestação, com parto vaginal anterior, indução de parto, admitidas com mais de 4 centímetros de dilatação e sem companheiro. Assistência no sistema privado, ter duas cesáreas ou mais, complicações obstétricas e decisão por cesariana no final da gestação diminuíram as chances de VBAC. Faixa etária, escolaridade, adequação do pré-natal e razão da cesárea anterior não apresentaram diferença significativa. CONCLUSÃO A maior parte das mulheres com cesárea anterior no Brasil é encaminhada para uma nova cirurgia, e o maior número de cesáreas está associado à maior iniquidade social. Os fatores associados ao VBAC foram decisão pelo parto vaginal no fim da gestação, parto vaginal anterior, maior dilatação cervical na internação, indução, atendimento no sistema público de saúde, ausência de complicações obstétricas e ausência de companheiro. São necessárias ações de estímulo ao VBAC, visando reduzir taxas globais de cesarianas e suas consequências para a saúde materno-infantil.

Adequacy of prenatal care and associated factors in the State of Rio Grande do Sul, Brazil

ABSTRACT OBJECTIVE This study aims to assess the degree of adequacy of prenatal care (PNC) in the state of Rio Grande do Sul (RS) and in its 7 macro-regions considering the time of PNC initiation and the number of appointments attended. It also aims to verify the mode of delivery prevalence and the factors associated with PNC adequacy by mode of delivery. METHODS Sub analysis from a cross-sectional study conducted among 13,432 childbearing women aged 15-49 years assisted in 66 maternity hospitals of the Unified Health System (SUS) and private associated facilities from September 2017 to October 2019. A standardized form was used to collect sociodemographic data, and information about PNC and delivery from the childbearing women's prenatal cards, hospital records, and medical reports. RESULTS The PNC coverage was (98.4%), but only 57.5% of the participants had an adequate PNC defined as the one initiated until the 12th gestational week, with attendance of at least 6 appointments. The cesarean rate was 57.2%. Among women who performed vaginal delivery, multivariate analysis showed that for each 1-year increase in the age of the parturient, the chance of having an adequate PNC increased by 5%. White parturients with higher education and fewer deliveries residing in the macro-region of Valleys were more likely to have an adequate PNC when compared with non-white parturients, who were illiterate and/or had incomplete elementary school, with 3 or more deliveries and who resided in other macro-regions. During pregnancy, 96.0% of the women performed at least one anti-HIV test, 55.8% a rapid test for syphilis, and 75.0% a Venereal Disease Research Laboratory test (VDRL). CONCLUSIONS Despite the almost universal PNC coverage in RS, the PNC offered by the SUS was adequate for just half of the population, therefore public health policies targeted at women receiving care in this setting shall be revisited.

Fatores sociodemográficos e via de parto: revisão sistemática / Sociodemographic factors and type of delivery: systematic review / Factores sociodemográficos y tipo de parto: revisión sistemática

Objetivo: identificar os fatores sociodemográficos associados à via de parto. Método: trata-se de revisão sistemática com busca nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, PubMed e Cochrane em maio de 2021. O protocolo do estudo foi registrado na PROSPERO sob o nº CRD42021257340. Os artigos selecionados foram posteriormente analisados pelos sistemas Joanna Briggs Institute e Sistema Grading of Recommendations Assessment, Development and Evaluation. Resultados: mulheres com maior nível socioeconômico, maior nível de escolaridade, com idade acima de 35 anos e parto em instituições privadas possuem maior chance de realizar cesariana comparado ao parto vaginal. A qualidade da evidência para variável de prestador hospitalar foi baixa, para idade e escolaridade materna a qualidade é moderada e classe econômica a qualidade é alta. Conclusões: os fatores sociodemográficos contribuem para o aumento da taxa de cesárea e reforçam o cenário encontrado na literatura.

Objective: to identify the sociodemographic factors associated with the mode of delivery. Method: this is a systematic review with a search in the Latin American and Caribbean Literature on Health Sciences, PubMed and Cochrane databases in May 2021. The study protocol was registered with PROSPERO under number CRD42021257340. The selected articles were analyzed by the Joanna Briggs Institute and the Grading System of Recommendations Assessment, Development and Evaluation systems. Results:women with a higher socioeconomic level, higher education, aged over 35 years and private institutions have a greater chance of having a cesarean section compared to the vaginal level. The quality of quality of quality for the service provider variable was low and the quality of maternal schooling is low and the quality of economic class is high. Conclusion: Sociodemographic conclusions in the literature.

Objetivo: identificar los factores sociodemográficos asociados a la modalidad de parto. Método: se trata de una revisión sistemática con búsqueda en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud, PubMed y Cochrane en mayo de 2021. El protocolo de estudio fue registrado en PROSPERO con el número CRD42021257340. Los artículos seleccionados fueron analizados por el Instituto Joanna Briggs y los sistemas Grading System of Recommendations Assessment, Development and Evaluation. Resultados: las mujeres con mayor nivel socioeconómico, educación superior, mayores de 35 años e instituciones privadas tienen mayor probabilidad de tener una cesárea en comparación con el nivel vaginal. La calidad de calidad de calidad para la variable proveedor de servicios fue baja y la calidad de escolaridad materna es baja y la calidad de clase económica es alta.

Tipos de partos y niveles de oxitocina, cortisol y hormonas tiroideas en plasma del cordón umbilical / Types of deliveries and levels of oxytocin, cortisol and thyroid hormones in umbilical cord plasma

Introducción: La placenta sintetiza y secreta varias hormonas que permiten la regulación del embarazo, el trabajo de parto y la adaptación metabólica materno-fetal. Su comportamiento asociado al tipo de parto puede dar información relevante sobre efectos epigenéticos. Objetivo: Describir el tipo de parto con los niveles de oxitocina, cortisol y hormonas tiroideas en plasma de cordón umbilical al nacer. Método: A 50 mujeres con embarazos principalmente normales se les cuantificaron los niveles neurohormonales en plasma de cordón umbilical, obtenido inmediatamente tras el periodo expulsivo. Los resultados se incorporaron a la base de datos clínicos de cada participante y se analizaron con Stata v.14.0. El protocolo fue aprobado por el comité de ética. Resultados: Hubo 33 partos vaginales (12 espontáneos, 13 acelerados y 8 inducidos) y 17 cesáreas (7 electivas y 10 de urgencia). Se observaron mayores niveles de cortisol en los partos vaginales acelerados; las cesáreas tuvieron menores niveles de cortisol y hormona estimulante de la tiroides. Las intervenciones clínicas, con altos o bajos niveles hormonales, están en directa relación con el tipo de parto. Conclusiones: El cortisol y la hormona estimulante de la tiroides medidos en plasma de cordón umbilical variaron según el tipo de parto. Esto es una primera cuantificación de hormonas en plasma de cordón umbilical y su posible regulación placentaria a propósito del tipo de parto.

Introduction: The placenta synthesizes and secretes several hormones allowing the regulation of pregnancy, labor and maternal-fetal metabolic adaptation. Their behavior associated with the type of delivery, may provide relevant information on epigenetic effects. Objective: To describe the type of delivery with the levels of oxytocin, cortisol and thyroid hormones in umbilical cord plasma at birth. Method: Neurohormonal levels from umbilical cord plasma obtained immediately post expulsion, were quantified in 50 women with mainly normal pregnancies. Results incorporated into the clinical database of each participant, statistically analyzed in Stata v.14.0. Protocol approved by ethics committee. Results: 33 were vaginal deliveries (12 spontaneous, 13 accelerated, 8 induced) and 17 cesarean sections (7 elective and 10 emergency). Higher cortisol levels were observed in accelerated vaginal deliveries, cesarean sections had lower cortisol and thyroid stimulating hormone levels. While clinical interventions, with high or low hormone levels, were related to the type of delivery. Conclusions: Cortisol and thyroid stimulating hormone measured in umbilical cord plasma varied according to the type of delivery. This is a first quantification of hormones in umbilical cord plasma and their possible placental regulation in relation to the type of delivery.

Association between autism spectrum disorder and peripartum events: a case-control study / Associação entre o transtorno do espectro do autismo e eventos periparto: estudo de caso-controle

Abstract Objective: To assess the association between peripartum events and autism spectrum disorder (ASD) development in children and adolescents. Methods: The current research is a case-control study in northern Minas Gerais state, Brazil. The inclusion criteria in the case group included individuals whose medical records reported an autistic disorder diagnosis, individuals had this diagnosis further confirmed by Northern Minas Autistic Support Association and specialized clinics, and their mothers had to answer positively to the question: "Was your child diagnosed with autism spectrum disorder?" in the data collection instrument. Thus, the case group included 253 mothers of children/adolescents of 2-15 years old diagnosed with autism. The inclusion criteria in the control group included 852 individuals belonging to the same age group and enrolled in the same schools as the case group. A semi-structured questionnaire was applied for mothers of children/adolescents, and the multiple logistic regression model was adopted for data analysis. Gross and adjusted Odds Ratios (ORa) were used to estimate the magnitude of the associations. Results: Autistic disorder was associated with the presence of meconium in amniotic fluid (AF) (ORa 1.67; 95% confidence interval [95%CI] 1.06-2.65) and cesarean delivery type (ORa 1.65; 95%CI 1.17-2.32). Emergency cesarean section increased autistic disorder development likelihood (ORa 2.38; 95%CI 1.61-3.51). Children and adolescents with ASD were more likely to have been exposed to two or more unfavorable peripartum events and obstetric complications than control groups (ORa 1.59; 95%CI 1.01-2.51). Conclusions: Meconium stained amniotic fluid, delivery by cesarean, and two or more unfavorable peripartum events are variables that should be considered in studies about ASD etiology.

RESUMO Objetivo: Avaliar a associação entre os eventos periparto e o desenvolvimento do transtorno do espectro autista (TEA) em crianças/adolescentes. Métodos: Trata-se de um estudo de caso-controle desenvolvido no norte de Minas Gerais, Brasil. Os critérios de inclusão do grupo caso foram indivíduos com diagnóstico de TEA por laudo médico, confirmado pela Associação Norte Mineira de Apoio ao Autista ou por clínicas especializadas, e as mães que responderam positivamente a: "Seu filho foi diagnosticado com TEA?". Assim, o grupo caso incluiu 253 mães de crianças/adolescentes com 2-15 anos diagnosticadas com autismo. O critério de inclusão no grupo controle abrangeu 852 indivíduos pertencentes à mesma faixa etária e matriculados nas mesmas escolas que o grupo caso. Um questionário semiestruturado foi aplicado às mães e o modelo de regressão logística múltipla foi adotado para a análise de dados. Para estimar a magnitude das associações, utilizou-se Odds Ratio (OR) bruta e ajustada. Resultados: O TEA foi associado à presença de mecônio no líquido amniótico (ORa 1,67; intervalo de confiança [IC95%] 1,06-2,65) e ao parto cesáreo (ORa 1,65; IC95% 1,17-2,32). A cesárea de emergência aumentou a chance de desenvolvimento do autismo (ORa 2,38; IC95% 1,61-3,51). Crianças/adolescentes com autismo apresentaram maior chance de exposição a dois ou mais eventos desfavoráveis de parto (ORa 1,59; IC95% 1,01-2,51). Conclusões: A presença de mecônio no líquido amniótico, cesárea de emergência e mais de um evento de parto desfavorável são fatores que devem ser considerados nos estudos sobre a etiologia do transtorno autístico.

Association between delivery mode and exclusive breastfeeding during hospitalization and within six months after birth: a meta-analysis / 中华围产医学杂志

Objective:To systematically review the association between delivery mode and exclusive breastfeeding rate during hospitalization and within the first six months of life.Methods:Observational studies on the association between delivery mode and feeding pattern were searched from PubMed, Web of Science, Cochrane Library, EBSCO, China Biomedical Literature Database, CNKI, Wanfang Database, and VIP Database from inception to October 2022. Two independent reviewers screened the literature, extracted data, and assessed the quality of included studies using Critical Appraisal Tools published by Joanna Briggs Institute or Newcastle-Ottawa Quality Scale (NOS). This meta-analysis was performed using R 4.1.0 software. Fixed-effect or random-effect models were used to pool data. Egger test and funnel plot were used to assess publication bias.Results:A total of 34 studies involving 597 203 subjects were included, including 22 cross-sectional studies and 12 cohort studies. All of the 22 cross-sectional studies were B-level quality, and eleven out of the 12 included cohort studies scored 7 points or above on the NOS scale with high quality. The results of meta-analysis showed that the likelihood of exclusive breastfeeding during hospitalization of women who had cesarean section was lower than those who delivered vaginally ( OR=0.33, 95% CI: 0.22-0.50, P<0.001); and so was the likelihood of exclusive breastfeeding at six months postpartum ( OR=0.61, 95% CI: 0.47-0.79, P<0.001). Conclusion:Current evidence suggests that cesarean section is a disadvantage to exclusive breastfeeding during hospitalization and within six months after delivery.

Robson Classification for cesarean section in a Public Hospital in Distrito Federal / Classificação de Robson para cesárea em um Hospital Público do Distrito Federal

Abstract Objectives: to evaluate cesarean taxes by looking at Robson classification on 10 groups (G) and the principal indications at the prevalent groups and at G10. Methods: cross-sectional, observational, retrospective study, including all deliveries performed in a public hospital in Distrito Federal in 2019. Data were collected from medical records and pregnant women were classified in 10 groups. Pearson's chi-squared test was used to calculate the p-value. The risk estimate for cesarean was defined by common odds ratio of Mantel-Haenszel, with calculation of odds ratio (OR) and 95% confidence interval (CI95%). Results: there were 2,205 deliveries, 1,084 (49.1%) of which were cesarean and 1,121 (50.9%) vaginal deliveries. The principal factors for cesarean were G5 (39.3%), G2 (21.2%) and G1 (13.6%). At G10, cesarean had 51.5% of births, not differing statistically from the other groups (p>0.05). Considering all preterm births, G6 to G10 and the other groups, there is a bigger chance of cesarean happening in relation to normal labor (OR=1.4; CI95%= 1.011-2.094; p=0.042). Dystocia remained at G1 and G2, previous cesarean at G5 and hypertensive syndrome at G10. Conclusion: cesarean was most prevalent delivery route, showing elevated rates even in primiparous and preterm births. Preponderance of dystocia and acute fetal distress suggests better evaluation of the diagnostic criteria, mainly in G1, G2 and G10.

Resumo Objetivos: avaliar as taxas de cesárea pela classificação de Robson em 10 grupos (G) e as principais indicações nos grupos prevalentes e no G10. Métodos: estudo transversal, observacional, retrospectivo, incluindo todos os nascimentos em um hospital público do Distrito Federal em 2019. Dados coletados de prontuários eletrônicos e as parturientes categorizadas em dez grupos. Teste qui-quadrado de Pearson para o valor de p e razão de chances comum de Mantel-Haenszel para estimativa de risco, com OR e IC95%. Resultados: ocorreram 2.205 nascimentos, 1.084 (49,1%) cesáreas e 1.121 (50,9%) partos normais. Os principais contribuintes para a cesárea foram G5 (39,3%), G2 (21,2%) e G1 (13,6%). No G10, cesárea teve 51,5% dos nascimentos, não diferindo estatisticamente dos demais grupos (p>0,05). Considerando todos os prematuros, G6 ao G10 e demais grupos, há maior chance de cesárea em relação ao parto normal (OR=1,4; IC95%= 1.011-2.094; p=0,042). Distócia prevaleceu nos G1 e G2, Cesárea prévia no G5 e Síndromes hipertensivas no G10. Conclusão: a cesárea mostrou taxas elevadas inclusive nas primíparas e nos prematuros. Predomínio de Distócia e Sofrimento fetal sugerem melhor avaliação destes critérios diagnósticos, principalmente em G1, G2 e G10.

Concepção de puérperas sobre violência obstétrica: Revisão integrativa / Concepción de puérperas sobre la violencia obstétrica: Revisión integradora / Conception of puerperal women about obstetric violence: Integrative review

Objetivo: Descrever a concepção de puérperas sobre violência obstétrica. Método: Trata-se de revisão integrativa da literatura que utilizou a estratégia PICo. A busca ocorreu entre novembro e dezembro de 2020 na Biblioteca Virtual da Saúde, Medline e SciELO com recorte temporal de artigos publicados de 2010 a 2020. Resultado: Foram analisados 12 artigos que se adequaram aos critérios de inclusão e responderam à questão norteadora da pesquisa. A análise do corpus proporcionou identificar que a maioria das puérperas desconhecem o termo violência obstétrica fato que obscurece a identificação que determinadas práticas realizadas em unidades hospitalares não condizem com as evidências científicas podendo ser consideradas como maus-tratos. Conclusão: Dentre os fatores que aumentam a vulnerabilidade para a ocorrência da violência obstétrica pode-se considerar a escassez de ações de educação em saúde durante o período pré-natal que viabilizem o reconhecimento dos direitos sexuais e reprodutivos das mulheres.(AU)

Objective: To describe the conception of puerperal women about obstetric violence. Method: This is an integrative literature review that used the PICo strategy. The search took place between November and December 2020 in the Virtual Health Library, Medline and SciELO, with a temporal cut of articles published from 2010 to 2020. Result: 12 articles were analyzed that met the inclusion criteria and answered the guiding question of the research. The analysis of the corpus made it possible to identify that most of the puerperal women are unaware of the term obstetric violence, a fact that obscures the identification that certain practices carried out in hospital units do not match the scientific evidence and can be considered as maltreatment. Conclusion: Among the factors that increase vulnerability to the occurrence of obstetric violence, one can consider the scarcity of health education actions during the prenatal period that enable the recognition of women's sexual and reproductive rights.(AU)

Objetivo: Describir la concepción de las puérperas sobre la violencia obstétrica. Método: Se trata de una revisión integrativa de la literatura que utilizó la estrategia PICo. La búsqueda se realizó entre noviembre y diciembre de 2020 en la Biblioteca Virtual en Salud, Medline y SciELO, con corte temporal de artículos publicados de 2010 a 2020. Resultado: se analizaron 12 artículos que cumplieron con los criterios de inclusión y respondieron a la pregunta orientadora de la investigación . El análisis del corpus permitió identificar que la mayoría de las puérperas desconocen el término violencia obstétrica, hecho que oscurece la identificación de que ciertas prácticas realizadas en las unidades hospitalarias no concuerdan con la evidencia científica y pueden ser consideradas como maltrato. Conclusión: Entre los factores que aumentan la vulnerabilidad a la ocurrencia de violencia obstétrica, se puede considerar la escasez de acciones de educación en salud durante el prenatal que posibiliten el reconocimiento de los derechos sexuales y reproductivos de las mujeres.(AU)

Percepción de las vías del parto de mujeres en edad reproductiva: una revisión de la literatura / Perception regarding the delivery routes of women in reproductive age: a literature review

OBJETIVO: Explorar la percepción de mujeres en edad reproductiva con respecto a las vías del parto reportada en la evidencia disponible. MÉTODO: Se llevó a cabo una revisión sistematizada de artículos en las bases de datos PubMed, SciELO, SCOPUS, Web of Science, LILACS, Cochrane Library y Biblioteca Virtual de Salud. La búsqueda se realizó entre agosto y noviembre del año 2020. Los términos MeSH usados fueron "Perception", "Delivery Obstetric", "Cesarean Section" y "Woman", junto con los términos DECS "Percepción", "Parto Obstétrico", "Cesárea" y "Mujeres". Además, se utilizaron los términos libres "Perceptions", "Vaginal Delivery", "Obstetric Deliveries", "Abdominal Deliveries", "Caesarean Section" y "Womens Groups". En la totalidad de las bases de datos utilizadas se aplicaron como límites de búsqueda "Last 5 Years" y "Free Full Text". RESULTADOS: Respecto a la percepción de las vías de parto, se constató la preferencia de la vía vaginal sobre la cesárea. Además, se evidenciaron factores que influyen en el proceso, tales como miedo, experiencia previa, influencia de terceros, religión, cultura, nivel socioeconómico y zona demográfica. CONCLUSIONES: La evidencia revisada sugiere que las mujeres prefieren la vía del parto vaginal sobre la cesárea, siendo el miedo el factor más influyente al momento de su elección, seguido por los factores asociados a experiencias previas, el nivel socioeconómico y las creencias.

OBJECTIVE: To explore the perception of women of reproductive age regarding delivery routes reported in the available evidence. METHOD: A systematized review of articles in PubMed, SciELO, SCOPUS, Web of Science, LILACS, Cochrane Library, Biblioteca Virtual de Salud databases, was carried out. The search was conducted between August and November 2020. MeSH descriptors "Perception", "Delivery Obstetric", "Cesarean Section" and "Woman", along with DECS descriptors "Percepciones", "Parto Obstétrico", "Cesárea" and "Mujeres", were used. Also, free terms "Perceptions", "Vaginal Delivery", "Obstetric Deliveries", "Abdominal Deliveries", "Caesarean Section" and "Womens Groups". In the totality of databases limits of search "Last 5 years" and "Free Full Text", were used. RESULTS: Regarding the perception of the delivery routes, the preference of the vaginal route over caesarean section was verified. In addition, factors that influence the process such as fear, previous experience, influence of third parties, religion, culture, socioeconomic level and demographic area were evidenced. CONCLUSIONS: The reviewed evidence suggests that women prefer the vaginal delivery route over caesarean section with fear being the most influential factor at the time of their choice, and secondly, the factors associated with previous experiences, socioeconomic level and beliefs.

Fatores que influenciam a decisão da via do parto / Factors that influence the decision of the parturition method

Objetivos: Verificar os fatores que influenciam a parturiente na decisão da via de parturição e identificar a preferência da via de parto em uma próxima gestação. Metodologia: Trata-se de uma revisão integrativa da literatura com artigos datados de 2010 a 2020, retirado nas bases da SCIELO (Scientific Electronic Library Online) e LILACS (Literatura Latino-Americana e do Caribe em Ciências e Saúde). Resultados: Sete dimensões refletem os fatores que influenciam a parturiente no momento da decisão da via de parto: dor ou ausência de dor no momento do parto; dor ou ausência de dor no pós-parto; recuperação no pós-parto; risco de infecção e de hemorragia; experiência prévia; influência da família e médicos, e pelo desejo de realizar a laqueadura. As perguntas norteadoras da pesquisa estão expressas em: quais são os fatores que influenciam a parturiente no momento da decisão da via de parto? E, qual é a via de parto em uma nova gestação? Considerações finais: Os fatores que mais influenciam as gestantes na decisão da via de parto são o medo da dor no parto e a recuperação no pós parto. Em uma nova gestação, acabam optando pela mesma via de parto anterior, devido à segurança, por já terem vivenciado a experiência

Objectives: This study aims to verify the factors that influence the decision of the parturition method and identify the preferred route of parturition in the next pregnancy. Methodology: This is an integrative literature review with articles dated from 2010 to 2020, taken from the SCIELO (Scientific Electronic Library Online) and LILACS (Latin American and Caribbean Literature in Science and Health) databases. Results: Seven dimensions reflect the factors that influence the parturient when deciding the parturition method: pain or absence at the time of parturition; postpartum pain or absence; postpartum recovery; risk of infection and bleeding; previous experience; influence of family and doctors and tubal ligation. The guiding questions of this research are expressed in: What are the factors that influence the parturient when deciding the parturition method? And what is the preferred parturition method a new pregnancy? Final considerations: The factors that most influence pregnant women while deciding the mode of parturition are fear of pain during childbirth and postpartum recovery. In a new pregnancy, they end up opting for the same birth route as the previous one due to the safety of having lived through the experience

Cesarean rates according to the Robson classification: analysis in a municipal maternity in São Paulo

ABSTRACT Objective To investigate the distribution of parturients at Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho according to the Robson classification, identify the cesarean rate in each Robson Group, and understand which group contributes more to the prevalence of Cesarean sections. Methods This is a retrospective observational cross-sectional study conducted through the analysis of medical records of parturients admitted to Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho from October 2016 to August 2019. Results A total of 9,794 births were recorded, and 31% were by Cesarean section. The most prevalent Robson Groups were Group 3 (25.7%-2,519), 1 (22.8%-2,234), and 5 (20.5%-2,006). The relative contribution of Cesarean sections was greatest in Groups 5 (39%), 2 (18%), and 1 (12.5%). Conclusion This study demonstrated the Robson classification is useful to lead to a more critical view, identifying the groups that deserve more attention, since they are the major contributors to cesarean rates; hence, the management protocols could be modified aim to reduce cesarean rates.

Subcutaneous terbutaline and oral nifedipine for intrapartum fetal resuscitation: a prospective randomized controlled study / 中华围产医学杂志

Objective:To compare the safety and efficacy of terbutaline and nifedipine for acute intrapartum fetal resuscitation (IUFR).Methods:This was a prospective randomized controlled study involving 110 pregnant women with non-reassuring fetal heart rate tracings (NRFHT) during delivery at Guangzhou Women and Children's Medical Center between January and April 2021. These women were randomly allocated to receive subcutaneous terbutaline sulphate (0.25 mg, terbutaline group) or oral nifedipine (10 mg, nifedipine group), with 55 subjects in each group. Hemodynamic parameters including blood pressure, heart rate, and oxygen saturation before and 5, 15 and 30 min after treatment as well as the success rate of intrapartum resuscitation, the onset time of medication, and the incidence of postpartum hemorrhage were analyzed using t test, Chi-square test or Fisher's exact test. Results:Two groups both showed no significant difference in the mean arterial pressure or oxygen saturation before or after treatment (all P>0.05). The heart rate was not affected in nifedipine group at any time points ( P>0.05). While the patients treated with terbutaline showed accelerated maternal heart rate 5, 15 and 30 min after administration as compared with the baseline[(97.0±20.2), (99.2±13.8), (91.8±12.6) vs (81.7±11.3) bpm, all P<0.001], but it began to decrease at 30 min, with a drop of 6.4 bpm compared with that at 15 min (95% CI: 1.5-11.2, P<0.05). None of the pregnant women had adverse reactions requiring medical intervention. The rates of successful acute resuscitation were similar in the two groups [terbutaline: 78.2% (43/55) vs nifedipine: 70.9% (39/55), χ 2= 0.77, P=0.381]. Terbutaline had a shorter onset time than nifedipine in slowing the frequency of contractions and returning fetal heart rate to class Ⅰ category [2(1-6) vs 6(1-10) min, U=2 348.50, P<0.001]. No significant difference was found between the two groups in terms of NRFHT-indicated cesarean section, assisted vaginal delivery, or second dose of tocolysis within 1 h (all P>0.05) nor in blood loss volume, postpartum hemorrhage rate, low Apgar score, low umbilical artery pH value (pH<7.2), neonatal asphyxia rate, or neonatal intensive care admission rate (all P>0.05). Conclusion:Terbutaline spends less time than nifedipine to take effect and may be an alternative for acute IUFR without significant adverse 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.

Women's satisfaction with childbirth and postpartum care and associated variables / Satisfação da gestante com a assistência ao parto e pós-parto e variáveis associadas / Satisfacción de las gestantes con los cuidados en el parto y puerperio y variables asociadas

ABSTRACT Objective: To determine the level of satisfaction with childbirth and the postpartum period. Method: This is a longitudinal, observational study. Clinical variables of the patients and delivery were collected, and a descriptive and inferential analysis was performed. The validated state-trait anxiety inventory (STAI) and the satisfaction survey Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) in Spanish were used. Results: A total of 381 women was included in the study and grouped into satisfied vs. dissatisfied (94.54% vs. 5.46%). Women having given birth by eutocic delivery (p = 0.005), as well as those who had skin-to-skin time with their newborn (p = 0.012) after delivery, report more satisfaction. Mothers who were separated from their babies reported being less satisfied (p = 0.004), as did those who did not meet the expectations raised in the birth plan (p = 0.013). All the women with minimal anxiety are satisfied (p = 0.004), the same happening for those showing postpartum anxiety (p <0.001). Conclusion: The percentage of satisfied women is high; it is necessary to monitor childbirth and postpartum care, promoting good practices in childbirth care, as well as in women's emotional well-being.

RESUMO Objetivo: Determinar o grau de satisfação no parto e puerpério. Método: Estudo observacional longitudinal. Foram coletadas variáveis clínicas das pacientes e do parto, realizando-se análise descritiva e inferencial. Foram utilizados os questionários validados de ansiedade como traço e estado (STAI) e a pesquisa de satisfação da Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) em espanhol. Resultados: 381 mulheres foram incluídas no estudo, agrupadas em satisfeitas vs. não satisfeitas (94,54% vs. 5,46%). Mulheres com parto eutócico relataram estar mais satisfeitas (p = 0,005), assim como aquelas que realizaram contato pele-a-pele com o recém-nascido (p = 0,012). As mães que se separaram de seus bebês relataram estar menos satisfeitas (p = 0,004), assim como aquelas que não tiveram atendidas as expectativas refletidas no plano de parto (p = 0,013). 100% das mulheres com ansiedade mínima estão satisfeitas (p = 0,004), o mesmo ocorre com o grau de ansiedade pós-parto (p <0,001). Conclusão: O percentual de mulheres satisfeitas é alto, é necessário cuidar da assistência ao parto e puerpério, promovendo boas práticas na assistência ao parto, bem como o bem-estar emocional da mulher.

RESUMEN Objetivo: Determinar el grado de satisfacción en el parto y puerperio. Método: Estudio observacional longitudinal. Se recogieron variables clínicas de las pacientes y del parto, realizándose un análisis descriptivo e inferencial. Se utilizaron los cuestionarios validados de ansiedad estado y rasgo (STAI) y la encuesta de satisfacción Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) en Español. Resultados: Se incluyeron en el estudio 381 mujeres que se agruparon en satisfechas vs. no-satisfechas (94,54% vs. 5,46%). Las mujeres con un parto eutócico refieren estar más satisfechas (p=0,005), así como aquellas que realizaron piel con piel con su recién nacido (p=0,012). Las madres que se separaron de sus bebés refieren estar menos satisfechas (p=0,004), al igual que las que no cumplieron las expectativas reflejadas en el plan de nacimiento (p=0,013). El 100% de las mujeres con ansiedad mínima están satisfechas (p=0,004), de igual manera sucede con el grado de ansiedad estado postparto (p<0,001). Conclusión: El porcentaje de mujeres satisfechas es elevado, es necesario cuidar la atención al parto y puerperio, fomentando las buenas prácticas de atención al parto, así como el bienestar emocional de las mujeres.

Percepção dos profissionais de enfermagem sobre a utilização do checklist do parto seguro / Perception of nursing professionals on the use of the safe delivery checklist / Perception of nursing professionals on the use of the safe delivery checklist

RESUMO Objetivo: compreender como a implantação do Checklist do Parto Seguro modificou a prática obstétrica na percepção da equipe de enfermagem. Método: estudo qualitativo, realizado entre outubro de 2018 e junho de 2019, com 36 profissionais de enfermagem de dois hospitais públicos de ensino no Distrito Federal - Brasil. Utilizou-se técnica narrativa e análise de conteúdo. Resultados: os profissionais compreenderam que o instrumento trouxe benefício e contribuiu para maior qualidade e segurança na assistência obstétrica, além do estímulo à cultura de segurança. Relataram que a sua utilização provocou mudanças na rotina, as quais contribuiram para que alguns membros da equipe demonstrassem resistência e dificuldades pós-implantação. Conclusão: as narrativas suscitaram reflexões como o planejamento em saúde, visando maior adesão da equipe de enfermagem às práticas seguras e sensibilização com relaçào à importância da ferramenta do Checklist do Parto Seguro.

RESUMEN Objetivo: comprender cómo la implementación de una Lista de Verificación del Parto Seguro modificó la práctica obstétrica en la percepción del equipo de enfermería. Método: estudio cualitativo, realizado entre octubre de 2018 y junio de 2019, con 36 profesionales de enfermería de dos hospitales públicos de enseñanza del Distrito Federal - Brasil. Se utilizó la técnica narrativa y el análisis de contenido. Resultados: Los profesionales entendieron que el instrumento aportaba beneficios y contribuía a una mayor calidad y seguridad en la atención obstétrica, además de estimular la cultura de la seguridad. Informaron de que su uso provocó cambios en la rutina, lo que contribuyó a que algunos miembros del equipo mostraran resistencia y dificultades posteriores a la implantación. Conclusión: las narrativas suscitan reflexiones como el planeamiento en salud, visando una mayor adhesión del equipo de enfermería a las prácticas seguras y la sensibilización con relación a la importancia de la herramienta de una lista de verificación del Parto Seguro.

ABSTRACT Objective: to understand how the implementation of the Safe Delivery Checklist has changed obstetric practice in the perception of the nursing team. Method: qualitative study, conducted between October 2018 and June 2019, with 36 nursing professionals from two public teaching hospitals in the Federal District - Brazil. Narrative technique and content analysis were used. Results: The professionals understood that the instrument brought benefits and contributed to greater quality and safety in obstetric care, in addition to stimulating a culture of safety. They reported that its use caused changes in routine, which contributed to some team members showing resistance and post-implementation difficulties. Conclusion: the narratives raised reflections such as health planning, aiming at greater adherence of the nursing team to safe practices and sensitization regarding the importance of the Safe Delivery Checklist tool.

Women's satisfaction with childbirth and postpartum care and associated variables / Satisfação da gestante com a assistência ao parto e pós-parto e variáveis associadas / Satisfacción de las gestantes con los cuidados en el parto y puerperio y variables asociadas

ABSTRACT Objective: To determine the level of satisfaction with childbirth and the postpartum period. Method: This is a longitudinal, observational study. Clinical variables of the patients and delivery were collected, and a descriptive and inferential analysis was performed. The validated state-trait anxiety inventory (STAI) and the satisfaction survey Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) in Spanish were used. Results: A total of 381 women was included in the study and grouped into satisfied vs. dissatisfied (94.54% vs. 5.46%). Women having given birth by eutocic delivery (p = 0.005), as well as those who had skin-to-skin time with their newborn (p = 0.012) after delivery, report more satisfaction. Mothers who were separated from their babies reported being less satisfied (p = 0.004), as did those who did not meet the expectations raised in the birth plan (p = 0.013). All the women with minimal anxiety are satisfied (p = 0.004), the same happening for those showing postpartum anxiety (p <0.001). Conclusion: The percentage of satisfied women is high; it is necessary to monitor childbirth and postpartum care, promoting good practices in childbirth care, as well as in women's emotional well-being.

RESUMO Objetivo: Determinar o grau de satisfação no parto e puerpério. Método: Estudo observacional longitudinal. Foram coletadas variáveis clínicas das pacientes e do parto, realizando-se análise descritiva e inferencial. Foram utilizados os questionários validados de ansiedade como traço e estado (STAI) e a pesquisa de satisfação da Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) em espanhol. Resultados: 381 mulheres foram incluídas no estudo, agrupadas em satisfeitas vs. não satisfeitas (94,54% vs. 5,46%). Mulheres com parto eutócico relataram estar mais satisfeitas (p = 0,005), assim como aquelas que realizaram contato pele-a-pele com o recém-nascido (p = 0,012). As mães que se separaram de seus bebês relataram estar menos satisfeitas (p = 0,004), assim como aquelas que não tiveram atendidas as expectativas refletidas no plano de parto (p = 0,013). 100% das mulheres com ansiedade mínima estão satisfeitas (p = 0,004), o mesmo ocorre com o grau de ansiedade pós-parto (p <0,001). Conclusão: O percentual de mulheres satisfeitas é alto, é necessário cuidar da assistência ao parto e puerpério, promovendo boas práticas na assistência ao parto, bem como o bem-estar emocional da mulher.

RESUMEN Objetivo: Determinar el grado de satisfacción en el parto y puerperio. Método: Estudio observacional longitudinal. Se recogieron variables clínicas de las pacientes y del parto, realizándose un análisis descriptivo e inferencial. Se utilizaron los cuestionarios validados de ansiedad estado y rasgo (STAI) y la encuesta de satisfacción Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) en Español. Resultados: Se incluyeron en el estudio 381 mujeres que se agruparon en satisfechas vs. no-satisfechas (94,54% vs. 5,46%). Las mujeres con un parto eutócico refieren estar más satisfechas (p=0,005), así como aquellas que realizaron piel con piel con su recién nacido (p=0,012). Las madres que se separaron de sus bebés refieren estar menos satisfechas (p=0,004), al igual que las que no cumplieron las expectativas reflejadas en el plan de nacimiento (p=0,013). El 100% de las mujeres con ansiedad mínima están satisfechas (p=0,004), de igual manera sucede con el grado de ansiedad estado postparto (p<0,001). Conclusión: El porcentaje de mujeres satisfechas es elevado, es necesario cuidar la atención al parto y puerperio, fomentando las buenas prácticas de atención al parto, así como el bienestar emocional de las mujeres.