Mortalidad materna y atención del parto bajo el modelo centinela. Estudio de caso / Maternal mortality and delivery care under the sentinel model. Case study

Resumen: Objetivo: Evaluar la cobertura de atención del parto eutócico en Unidad Centinela (UC), de primer nivel de atención. Verificar el cumplimento de lo establecido en el modelo e identificar los factores que impiden o favorecen su uso, desde la perspectiva de los prestadores de salud y de las usuarias. Materiales y métodos: Estudio con un componente cuantitativo y uno cualitativo, retrospectivo, con información de bases primarias y secundarias. Variable principal: Atención del parto eutócico, Análisis: Descriptivo, porcentajes para variables categóricas y promedios δ para variables continuas, diferencias estadísticas entre dos variables categóricas, Chi2 de Pearson. Multivariado: Regresión logística de factores asociados a la atención del parto. Se realizaron 12 entrevistas semiestructuradas a usuarias y 8 prestadores de servicios, el análisis se realizó con base en la Teoría Fundamentada a través de Ethnograph v.5. Resultados: Muestra: 218 usuarias, edad promedio fue 24.7 años. La UC proporcionó control prenatal, el 61% más de 5 consultas; sin embargo, la atención de partos eutócicos solamente fue de 17 partos (33.4%). Las barreras más importantes referidas por las usuarias y prestadores de salud fueron: falta de personal, capacitación, insumos, apoyo insuficiente y protección legal institucional en caso de complicaciones. Conclusiones: La UC es una estrategia para regresar la atención de partos al primer nivel de atención, pero es necesario implementar un plan de mejora y fortalecimiento de los proveedores.

Abstract: Objective: Evaluate the coverage of eutocic delivery care in the Sentinel Unit (UC), of the first level of care, verify compliance with what is established in the model and identify the factors that prevent or favor its use, from the perspective of the providers of health and users. Materials and methods: Qualitative and quantitative study, retrospective with information on the primary and secondary bases. Main variable: care of eutocic delivery. Analysis: Descriptive, percentages for categorical variables and δ means for continuous variables, statistical differences between two categorical variables, Pearson Chi2. Multivariate: logistic regression of factors associated with delivery care. Twelve semi-structured interviews were conducted with users and 8 service providers, the analysis was carried out based on Grounded Theory through Ethnograph v.5. Results: Sample: 218 users, average age was 24.7 years. The UC provided prenatal control, 61% more than 5 consultations; however, the care of eutocic deliveries was only 17 deliveries (33.4%). The most important barriers referred to by the users and health providers were: lack of personnel, training, supplies and insufficient support and institutional legal protection in case of complications. Conclusions: UC is a strategy to return delivery care to the first level of care, but it is necessary to implement a plan to improve and strengthen providers.

Evolución de la cesárea en Colombia y su asociación con la naturaleza jurídica de la institución donde se atiende el parto / Evolution of cesarean sections in Colombia and its association with the legal standing of the institutions where deliveries take place

RESUMEN Objetivos: Describir la evolución de la frecuencia de la cesárea en Colombia a partir de 1998, tanto global como discriminada según la naturaleza jurídica de las instituciones prestadoras de salud (IPS) donde se atienden los partos, y calcular la magnitud de la asociación entre la naturaleza jurídica de la IPS y la realización de cesáreas entre 2015 y 2017. Materiales y métodos: Estudio de corte transversal que describe la frecuencia de partos por cesárea entre los años 1998 y 2020, y un componente analítico para estimar la asociación entre la naturaleza jurídica y la vía del parto entre los años 2015 y 2017, a partir de las bases de registros de nacimientos del Departamento Administrativo Nacional de Estadística (DANE) de Colombia. Se presentan las proporciones de cesárea por año y el incremento en la proporción de cesárea por tipo de institución; como estimador de esta asociación se utilizó la razón de prevalencia. Resultados: En 1998, la proporción de cesárea fue 25,7 %, incrementó hasta 46,4 % en 2015 y descendió a 44,6 % para 2020. A partir de 1998, la proporción de cesárea en las IPS públicas pasó de 26,2 a 42,9 % para el año 2014 y en las privadas de 45,0 a 57,7 % para el año 2013. La razón de prevalencia de la cesárea de las instituciones privadas con respecto a las públicas fue 1,57 (IC 95 %: 1,56-1,57). Conclusiones: Después de un periodo largo de incremento sostenido, se está presentando una disminución en la proporción de cesáreas en el país; las IPS públicas incrementaron estos procedimientos en mayor proporción durante la mayor parte del tiempo estudiado y en las IPS privadas se realizan con mayor frecuencia a todos los subgrupos de mujeres. Se deberá evaluar en el futuro, mediante metodologías más robustas, si el descenso en la frecuencia de cesárea es una tendencia real o secular.

ABSTRACT Objectives: To describe how the frequency of cesarean section has evolved in Colombia since 1998, both in overall terms as well as discriminated according to the legal standing of the healthcare providers (IPSs) where delivery takes place, and to estimate the size of the association between the legal standing of the institutions and the performance of cesarean sections between 2015 and 2017. Material and methods: A cross-sectional cohort study that describes the frequency of cesarean deliveries between 1998 and 2020, plus an analytical component to estimate the association between the legal nature and the route of delivery between 2015 and 2017, based on the birth records of the Colombian National Statistics Administrative Department (DANE). Proportions of cesarean sections and their increase by institution type are presented. The prevalence ratio was used as an estimator of this association. Results: In 1998, the proportion of cesarean deliveries was 25.7 %; it increased to 46.4 % by 2015 and then dropped to 44.6 % by 2020. After 1998, the proportion of cesarean sections in public hospitals increased from 26.2 % to 42.9 % by 2014, while in private providers it increased from 45.0 % to 57.7 % by 2013. The prevalence ratio of cesarean sections in private versus public institutions was 1.57 (95 % CI: 1.56-1.57). Conclusions: After a long period of sustained growth, there is now a reduction in the proportion of cesarean sections in the country. In public health care institutions, these procedures increased in greater proportion during most of the study period, while in private healthcare providers they are carried out at a higher frequency in all subgroups of women. It will be necessary to evaluate in the future, using more robust methodologies, whether the decrease in the frequency of cesarean section is a real or secular trend.

Profile on childbirth care at a public maternity hospital / Perfil da assistência ao parto em uma maternidade pública

Abstract Objectives: to describe the profile on childbirth care at a reference maternity hospital in the State of Piauí based on the 2018 World Health Organization Recommendations. Methods: retrospective cross-sectional quantitative study, descriptive documentary, population census, containing vaginal deliveries performed in 2017. The data was entered in Microsoft Excel for simple statistical analysis. Results: the percentages registered at the Centro Obstétrico Superior (Superior Obstetric Center) and Centro de Parto Normal (Normal Delivery Center) were, respectively, 85.5% and 98% with the presence of a companion, 34.2% and 94% used the partogram, 63.8% and 98% took non-pharmacological methods for pain relief, 74.8% and 98.7% received fluids during labor. Amniotomy at 15.2% and 17.2%, oxytocin was administered at 26.5% and 14.6% in the 1st and 2nd periods, non-lithotomic position at 39.7% and 93.4%, episiotomy 9.9% and 6.6%. After birth, 85.5% and 96% of newborns had skin-to-skin contact and, in 65.5% and 94% there were maternal breastfeeding promotion. Conclusions: this study comprehended the indicators on childbirth care service, which are, in general, better than the national and the northeast region ones. The importance of registering indicators to evaluate care is emphasized.

Resumo Objetivos: descrever o perfil da assistência ao parto em uma maternidade de referência do estado do Piauí, a partir das Recomendações da Organização Mundial da Saúde de 2018. Métodos: estudo quantitativo transversal retrospectivo, descritivo documental, população censitária, contendo os partos vaginais realizados em 2017. Os dados foram inseridos no Microsoft Excel para análise estatística simples. Resultados: os percentuais registrados no Centro Obstétrico e Centro de Parto Normal foram, respectivamente, 85,5% e 98% da presença de acompanhante, 34,2% e 94% utilizaram partograma, 63,8% e 98% métodos não-farmacológicos para alívio da dor, 74,8% e 98,7% receberam líquidos durante o trabalho de parto. Amniotomia em 15,2% e 17,2%, ocitocina foi administrada em 26,5% e 14,6% no 1° e 2a períodos, posição não-litotômica em 39,7% e 93, 4%, episiotomia 9,9% e 6,6%. Após o nascimento, 85, 5% e 96% dos recém-nascidos em contato pele a pele e, em 65,5% e 94% houve promoção do aleitamento materno. Conclusões: este estudo permitiu conhecer os indicadores de assistência ao parto do serviço, que de maneira geral estão melhores que os indicadores nacionais e da região nordeste. Ressalta-se a importância do registro de indicadores para a avaliação da assistência.

Mídias sociais como fonte de conhecimento para o processo de parto normal / Los medios sociales como fuente de conocimientos para el proceso de parto normal / Social media as a source of knowledge for the process of normal delivery

RESUMO Objetivo: verificar o conhecimento adquirido pelas gestantes para o processo de parto normal através das mídias sociais e a influência sobre a experiência do parto. Metodologia: estudo qualitativo com 12 puérperas de um hospital filantrópico, na cidade de Recife-PE. Foram realizadas entrevistas individuais, entre dezembro de 2018 e fevereiro de 2019, e foi utilizada a metodologia de análise de conteúdo. Resultados: após análise, emergiram duas categorias: Uso da mídia social como suporte de informações durante a gestação, e Expectativa para o parto vaginal através do conhecimento adquirido versus a realidade da experiência do parto vaginal. Conclusão: em resposta ao déficit de educação em saúde, as mídias sociais ganharam espaço como principal fonte de informações e esclarecimento de dúvidas a respeito do parto. Os profissionais da saúde, conhecendo as fontes de informação utilizadas pelas gestantes, podem contribuir com as orientações e indicação de fontes seguras e com conteúdo de qualidade.

RESUMEN: Objetivo: verificar los conocimientos adquiridos por las embarazadas para el proceso de parto normal a través de los medios sociales y la influencia sobre la experiencia del parto. Metodología: estudio cualitativo realizado con 12 puérperas de un hospital filantrópico en la ciudad de Recife-PE. Se realizaron entrevistas individuales entre diciembre de 2018 y febrero de 2019 y se utilizó la metodología del análisis de contenido. Resultados: luego del análisis surgieron dos categorías: Uso de los medios sociales como soporte de información durante el embarazo, y Expectativa con respecto al parto vaginal a través del conocimiento adquirido versus la realidad de la experiencia del parto vaginal. Conclusión: en respuesta al déficit de educación en salud, los medios sociales ganaron espacio como fuente principal de información y aclaración de dudas con respecto al parto. Al conocer qué fuentes de información emplearon las embarazadas, los profesionales de la salud pueden contribuir con pautas orientadoras y con la indicación de fuentes seguras y que aporten contenido de calidad.

ABSTRACT Objective: To check the knowledge acquired by pregnant women through social media about the normal delivery process and the influence on the delivery experience. Method: A qualitative study with 12 puerperal women from a philanthropic hospital, in the city of Recife-PE. Individual interviews were conducted between December 2018 and February 2019, and the methodology of content analysis was used. Results: Two categories emerged after analysis: The use of social media as information sources during pregnancy, and Expectation towards vaginal delivery with the acquired knowledge versus the reality of the vaginal delivery experience. Conclusion: In response to the health education deficit, social media gained ground as the main source of information and clarification of pieces of doubt about childbirth. Health professionals, knowing the sources of information used by pregnant women, can contribute with the guidance and indication of safe sources with quality content.

Four Cases of Patients with Skin Disorders (Atopic Dermatitis, Prurigo Gestationis, Acne Vulgaris) During Pregnancy Responded well to Tokishakuyakusan / 日本東洋医学雑誌

When female patients with skin disorders become pregnant, the treatments with the previously used antiallergic oral drugs are preferred to be switched to the treatments with external medicines alone, which often make patients experience unbearable itching and exacerbation of rashes. The use of tokishakuyakusan is known to be safe and improve various symptoms in the pregnancy period. In this report, the treatment of 4 patients with skin disorders were successfully switched to tokishakuyakusan alone from previously used antiallergic internal medicines and other traditional Japanese herbal medicines after pregnancy. Case 1 and 2 were patients with atopic dermatitis who had been treated only with the external medicine during a previous pregnancy but without amelioration. Case 3 was a patient with prurigo gestations who had rashes on the upper body trunk and complained of a strong itching sensation. Case 4 was a patient with acne vulgaris. In all cases, the rashes and itching sensation improved promptly with oral administration of tokishakuyakusan, followed by successful delivery. No side effects of gastrointestinal disorders were observed in any cases. Their skin disorders were speculated to be caused by the blood deficiency and stasis. Qi deficiency and fluid disturbance developed in association with pregnancy, which led to Yin deficiency and abundance of moisture. The positive responses of these conditions indicated that tokishakuyakusan was effective in the cases reported herein.

Prophylactic antibiotics in patients with episiotomy following normal vaginal delivery: a randomised clinical trial

Background: Postpartum  infectious  complications  following  normal  vaginal delivery  remains  a  cause  of   major  concern for  the  health  care professionals  due  to  higher  morbidity  and  mortality  and  prolonged hospital  stays  and  increased  healthcare  costs which makes us consider prophylactic use of antibiotics after normal vaginal delivery. On the other hand unjudicious use of antibiotics has led to widespread antibiotic resistance. Therefore this study was carried out to validate the use of prophylactic antibiotics in these patients and their role in prevention of puerperial pyrexia, wound infections and prolonged hospital stay.Methods: This Randomised clinical trial was conducted at KCHC-Kerala Co-operative Hospital Complex, Pariyaram, Kannur District, Kerala from 1st March 2012 to 30th April 2013. Eligible women were randomly assigned to group which does not receive prophylactic antibiotics (Group A) and group receiving prophylactic antibiotics (Group B). Patients in both the groups were examined every day till the patient was discharged from the hospital and observed for signs and symptoms of infected episiotomy wound, puerperial pyrexia and duration of hospital stay was noted.Results: Mean age in years was 25.6 for Group A and 26.2 for Group B. Mean gestational age in both the groups was 37.6 weeks. Mean duration of labour was 6.62 and 6.22 hours for Group A and B respectively. 6 subjects in Group A and 5 subjects in Group B had puerperial pyrexia. 3 Subjects in Group A and 2 subjects in Group B had wound infection. The mean duration of hospital stay for Group A was 4.18 with SD of 1.0 while mean hospital stay for Group B was 4.01 with SD of 1.1.Conclusions: By comparing subjects in both the groups with respect to puerperial pyrexia, wound infection and duration of hospital stay there was no statistical difference in any of the above criteria in both groups. Hence, in view of the risk of allergic reactions, toxicity and the selection of resistant strains the prophylactic administration of antibiotics does not seem to be justified in patients with episiotomy following vaginal delivery as per this study.

Autonomia da gestante na escolha do tipo de parto / Autonomy of the pregnant woman in the selection of the type of childbirth / Autonomía de la gestante en la selección del tipo de parto

Introdução: inúmeros fatores estão envolvidos na tomada de decisão da mulher pelo tipo de parto a ser escolhido. Quando se trata da mulher primigesta, as experiências prévias não se fazem presentes, porém, outros fatores podem então influenciá-la na escolha pelo modo de parir. Objetivo: identificar a preferência da gestante primigesta quanto à via de parto, conhecer os fatores que influenciam a sua tomada de decisão nessa escolha, e as suas expectativas em relação ao parto mediante a via escolhida. Método: estudo descritivo com abordagem quantitativa realizado com 35 primigestas em acompanhamento pré-natal nas unidades públicas de saúde em um município do Sul de Minas Gerais, Brasil. A coleta de dados ocorreu em agosto e setembro de 2015 e utilizou um formulário semiestruturado. Resultados: predominou a escolha pela via de parto vaginal, a presença de expectativas positivas em relação a via escolhida e a não influência de terceiros sobre a tomada de decisão. Conclusão: a decisão da mulher na escolha da via de parto está se transformando em uma preferência e não apenas em uma indicação profissional, o que ressalta a importância da educação em saúde na consulta pré-natal.

Introduction: Innumerable factors are considered in the decision-making when choosing the type of childbirth. When it is a first-time woman, there are not previous experiences, so other factors can influence her in the selection of how to give birth. Objective: to identify the preference of the first-time pregnant woman in terms of the type of childbirth, to know the factors that influence her decision-making in that selection and her expectations in relation to childbirth through the chosen type of birth-delivery. Method: A descriptive study with a quantitative approach carried out with 35 first-timers in prenatal care in public health units in a municipality in the south of Minas Gerais, Brazil. Data collection was conducted in August and September 2015 and a semi-structured interview was used. Results: the selection of the vaginal delivery, the presence of positive expectations in relation to the chosen way of birth-giving and the lack of influence of third parties on the decision-making process prevailed. Conclusions: The decision of the women in selecting the way of birth- delivery is turning in a preference, but a simply a professional indication, which highlights the importance of health education in prenatal consultation.

Introducción: Innumerables factores están involucrados en la toma de decisiones de la mujer por el tipo de parto a ser escogido. Cuando se trata de una mujer primeriza, las experiencias previas no se hacen presentes, por tanto, otros factores pueden influenciarla en la selección del modo de dar a luz. Objetivo: identificar la preferencia de la gestante primeriza en cuanto a la forma de parto, conocer los factores que influencian su toma de decisión en esa selección y sus expectativas en relación al parto mediante la vía escogida. Método: estudio descriptivo con abordaje cuantitativo realizado con 35 primerizas en acompañamiento prenatal en las unidades públicas de salud en un municipio del Sur de Minas Gerais, Brasil. La recolección de datos se realizó en agosto y septiembre de 2015 y utilizó una entrevista semiestructurada. Resultados: predominó la selección de la vía de parto vaginal, la presencia de expectativas positivas en relación a la vía escogida y la no influencia de terceros sobre la toma de la decisión. Conclusiones: la decisión de las mujeres en la selección de la vía del parto se está transformando en una preferencia y no simplemente en una indicación profesional, lo que resalta la importancia de la educación en salud en la consulta prenatal.

A comparative study of prevalence of postnatal depression among subjects with normal and cesarean deliveries

Background: Postpartum depression (PPD) is a type of clinical depression which can affect woman after childbirth. PPD is very common among women and is a major public health problem. It is estimated that overall 10 to 15% women experience PND while it ranges from 3.5 to 63.3% in Asian countries. But it is one of the most underdiagnosed conditions due to lack of adequate number of studies on the subject. Hence the current study was conducted with an objective of assessing the prevalence of postnatal depression among subjects with normal and cesarean deliveries and to compare the socio-demographic profile between normal and cesarean deliveries. Materials and methods: The study was a cross sectional study, conducted in the Department of Pediatrics, Apollo institute of medical sciences and research (AIMSR), Chittor. The data collection for the study was done between January 2015 to November 2015. The study population included people who were undergoing normal and cesarean deliveries. Post natal depression was assessed by EPDS score. Results: The highest proportion of patients belonged to 21-25 years and 26-30 years age groups in both the study groups Normal delivery and Caesarean delivery, the association of age groups between the study groups was statistically significant (P value<0.001). The maximum proportion of patients were housewives in both the study groups. The rural area patients were more in normal and caesarean deliveries as 44% and 39% respectively, the locality showed statistically significant association with the study groups (P value<0.05). All the individual EPDS scores mean values were high in cesarean group when compared to normal delivery group. The mean Total EPDS score mean in normal Dinesh P, Swetha Raghavan. A comparative study of prevalence of postnatal depression among subjects with normal and cesarean deliveries. IAIM, 2018; 5(2): 6-11. Page 7 delivery patients was 8.85 and in cesarean delivery patients 10.85 with t value=-4.766. The proportion of patients with postnatal depression prevalence was high (30%) in cesarean group where as it was only 15% in normal delivery group. The t value was 6.452. Conclusions: Prevalence of postnatal depression was comparably high in caesarean sections compared to normal deliveries with clear statistics about the same, EPDS scores also reflected the higher risk of depression in caesarean section when compare with normal deliveries knocking the alarm to concentrate on the patients more with caesarean sections by providing good counselling, better medication and positive environment in each stage during and after pregnancy from both the patient’s family side and medical staff side.

Análise comparativa da força muscular respiratória de primigestas no puerpério imediato de parto normal e de nuligestas / Comparative analysis of respiratory muscle strength in the immediate puerperium of first pregnancy of natural childbirth and nulliparous

Este artigo visa analisar a força muscular respiratória (FMR) de puérperas primíparas de parto normal e nulíparas. Trata-se de estudo do tipo caso-controle que avaliou 59 mulheres alocadas no grupo puérperas (GP) (primigestas, n=29) e no grupo controle (GC) (nuligestas, n=30). Foram avaliadas características antropométricas e FMR (PImax e PEmax) por meio da manovacuometria digital. O teste t Student comparou dados antropométricos e da FMR entre os grupos. A correlação de Pearson (p<0,05) avaliou a associação entre idade, índice de massa corporal (IMC) e FMR. Houve diferença significante na PImax (p<0,001) e na PEmax (p<0,001) entre GC e GP. A média da PImax (%predito) no GP e GC foi 39,1 ± 16,2 cmH2O e 82,3 ± 23,9 cmH2O e a da PEmax (%predito) foi 34,7 ± 14,6 cmH2O e 80,4 ± 18,4 cmH2O, respectivamente. Houve correlação negativa entre idade e PEmax no GP (r= -0,378; p= 0,043). Evidenciou-se, sem distinção entre grupos, uma correlação negativa de pequena a moderada entre IMC e PImax (r=-0,380; p=0,003) e PEmax (r= -0,525; p<0,001). Foi evidenciada uma FMR menor que pode estar relacionada às alterações decorrentes da gestação na configuração da parede torácica.

This paper aims to analyze the respiratory muscle strength (RMS) of primiparous women of normal delivery and nulliparous. It is a case-control study that assess 59 women allocated to the Puerperal Group (PG) (primiparous, n= 29) and Control Group (CG) (niligestas, n= 30). Anthropometric and RMS characteristics were assessed (MIP and MEP) through digital manovacuometer. The Student's t-test compared anthropometric and RMS data between groups. The Pearson correlation (p<0.05) assessed the association between age, body mass index (BMI) and RMS. There was a significant difference in the MIP (p <0.001) and the MEP (p <0.001) between CG and PG.. The average MIP (predicted%) in PG and CG was 39.1 ± 16.2 cmH2O and 82.3±23.9 cmH2O and the MEP (% predicted) was 34.7±14.6 cmH2O and 80,4±18.4 cmH2O, respectively. There was a negative correlation between age and MEP in PG (r = -0.378; p = 0.043). It was evidenced, without distinction between groups, a small to moderate negative correlation between BMI and MIP (r = -0.380, p = 0.003) and MEP (r = -0.525, p<0.001). A lower FMR was evidenced, which may be related to changes in the chest wall configuration due to gestation.

Vantagens e desvantagens do parto normal e cesariano: opinião de puérperas / Ventajas y desventajas de un parto normal y cesárea: opinión de puerperal / Advantages and disadvantages of labour and normal cesarean: view puerperal

Objective: to identify the opinion of postpartum women about the advantages and disadvantages of normal and caesarean delivery. Method: qualitative research conducted in rooming-in in a public maternity hospitalin Natal/RN, with 21 postpartum women over 20 years old after 12 hours postpartum, which had before both normal as cesarean delivery. For data collection a semi-structured interview was used in March 2012,analyzed by content analysis technique. The ethical aspect of the study was approved and CAAE0295.0.051.000-11 opinion. Results: after analysis two categories for the advantage and disadvantage of normal delivery were identified: fast recovery and strong contractions; in cesarean section, the advantage to not feel pain and disadvantage of a delayed recovery. Conclusion: it is important that health professionals guide women, especially to pregnant woman for the first time, clarifying questions about the two types of delivery.

Objetivo: identificar a opinião de puérperas quanto às vantagens e desvantagens do parto normal e cesariano. Método: pesquisa qualitativa desenvolvida no alojamento conjunto de uma maternidade pública de Natal/RN com 21 puérperas acima de 20 anos após 12 horas de puerpério, as quais já tinham passado anteriormente tanto por parto normal quanto cesariano. Para coleta dos dados, utilizou-se uma entrevista semiestruturada no mês de março de 2012, os quais foram analisados mediante técnica de análise de conteúdo. O aspecto ético da pesquisa teve parecer favorável e CAAE nº 0295.0.051.000-11. Resultados: após análise, foi possível identificar duas categorias para vantagem e desvantagem do parto normal:recuperação rápida e fortes contrações; na cesariana, como vantagem, não sentirem dor e, como desvantagem, recuperação tardia. Conclusão: é importante que os profissionais da saúde orientem as mulheres, principalmente, as primigestas, esclarecendo dúvidas sobre os dois tipos de parto.

Objetivo: identificar la opinión de las mujeres después del parto sobre las ventajas y desventajas de un parto normal y cesáreo. Método: investigación cualitativa realizada en alojamiento conjunto en una maternidad pública de Natal/RN con 21 mujeres en el posparto mayores de 20 años después de 12 horas del parto, que había pasado antes por tanto partos normales como por cesáreas. Para la recolección de datos se utilizó una entrevista semi-estructurada en marzo de 2012 analizados por la técnica de análisis de contenido. El aspecto ético del estudio fue favorable y con CAAE 0295.0.051.000-11. Resultados: tras el análisis identificaron dos categorías para la ventaja y la desventaja de parto normal: una recuperación rápida y contracciones fuertes; en la cesárea, la ventaja y que no se siente dolor y la desventaja de la recuperación demorada. Conclusión: es importante que los profesionales de la salud guíen a las mujeres, especialmente las primíparas con preguntas aclaratorias sobre los dos tipos de parto.

Percepção de puérperas quanto ao procedimento da episiotomia / Perception of mothers regarding episiotomy procedure

Objetivo ­ Identificar a percepção de puérperas quanto ao procedimento da episiotomia. Métodos ­ Trata-se de um estudo descritivo, observacional, com abordagem qualitativa. A amostra foi constituída por 20 puérperas internadas em uma Maternidade de Minas Gerais durante agosto de 2009 na qual haviam passado pela episiotomia em partos anteriores. Para a coleta de dados utilizou-se informações do prontuário e um formulário semiestruturado. Os depoimentos foram gravados e transcritos na íntegra. O tratamento dos dados se deu por meio da Análise de Conteúdo. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa, protocolo 1395/2009. Resultados ­ Foi possível observar que elas compreenderam a episiotomia como uma forma de alívio a dor, como uma possibilidade de diminuir o tempo de expulsão do feto ou como uma forma de evitar problemas no órgão genital feminino. Conclusão ­ De forma a violar os direitos sexuais e reprodutivos da mulher, os profissionais de saúde tomam a decisão pela episiotomia de forma a negar as parturientes o direito de optarem pela realização ou não do procedimento. A utilização da episiotomia deve ser de forma seletiva, priorizar um atendimento mais humanizado, condutas individualizadas e práticas de valorização e garantia dos direitos femininos.

Objective ­ To identify the perceptions of mothers regarding episiotomy procedure. Methods ­ It is descriptive study, observational, with a qualitative approach. The sample was composed of 20 women interned in a maternity Minas Gerais during August 2009 in which they had passed through episiotomy in previous deliveries. For data collection was used information from medical records and a semi-structured form. The interviews were recorded and transcribed in full. Data analysis was done through the Content Analysis. The research project was approved by the Research Ethics Committee, protocol 1395/2009. Results ­ It was observed that they understood the episiotomy as a form of pain relief, as a possibility to shorten the expulsion of the fetus or as a way to avoid problems in the female genital organ. Conclusion ­ In order to violate sexual and reproductive rights of women, healthcare professionals make the decision for episiotomy in order to deny mothers the right to opt for performance or nonperformance of the procedure. The use of episiotomy should be selectively prioritize a more humanized care, individualized procedures and valuation practices and guarantee women's rights.

Methods and Estimates of the Reimbursement for the Nurse Midwifery Center in the National Health Insurance / 여성건강간호학회지

PURPOSE: The purpose of this study is to develop the optimal nursing fee for nurse-midwifery center (MC) in the national health insurance system. METHODS: The three methodologies used to calculate the conversion factors for the MCs in the national health insurance include cost accounting method, sustainable growth rate (SGR) model, and index model. In this study, the macro-economic indicators and the national statistics were used to estimate the conversion factors for the MCs. RESULTS: The optimal nursing fee for the MCs in 2011 was estimated to be an increase of 57.7% by cost accounting analysis, a decrease of 17.1% by SGR model, and a decrease of 16.1% by index model. The results from SGR model and index model could had been biased due to the upswing of medical spendings in the short-term period (2008~2009). A sensitivity analysis of pre-delivery subsidy program for OB & GYN hospitals and clinics showed that the program has substantially diminished the demand for the MC services. CONCLUSION: More reliable methodologies to estimate nursing fees precisely are required to prove the value of nurses' services and a government subsidy program for the MC services should be followed from a social perspective.

Resultados perinatais e maternos de gestantes adolescentes / Perinatal and maternal results of adolescent pregnant girls

Objetivo: Análise retrospectiva dos achados clínicos de gestantes adolescentes e adultas (grupo-controle) atendidas em um centro de atendimento terciário em Ribeirão Preto, no período de um ano. Métodos: Foram analisados os prontuários médicos de 438 pacientes de um centro de atendimento terciário em Ribeirão Preto, sendo que a população estudada foi dividida em Grupos I, II e III, segundo a faixa etária materna: 10 a 14, 15 a 19 e 20 a 35 anos, respectivamente. As variáveis analisadas foram: idade materna no parto, tipo de parto, patologias maternas, duração da gestação, peso ao nascer e índice de Apgar. A análise estatística foi realizada para variáveis qualitativas por meio do teste X2 e para variáveis quantitativas por meio dos testes ?t de Student? e análise de variância para medidas repetidas. Resultados: Analisando-se o total dos partos nos dois hospitais, a taxa de cesariana foi maior nos grupos I (28,9%) e II (37%) em relação ao grupo III (19,5%) (p=0,0008). Evidenciamos uma maior incidência de trabalho de parto pré-termo no grupo I (57,1%) em relação ao grupo III (26%) (p=0,022). O peso fetal ao nascer foi significantemente mais baixo entre pacientes do grupo I (23,1%) em relação ao grupo III (5,5%) (p=0,002). Conclusão: O presente estudo demonstrou que a gestação na adolescência se associou a maior freqüência de parto pré-termo, baixo peso ao nascer e parto cesárea desta forma se justificam estudos que visem reduzir as complicações maternas e perinatais.

Parto normal X parto cesáreo: análise epidemiológica em duas maternidades no sul do Brasil / Normal delivery X caesarian delivery: epidemilogic analysis in two maternities in the south of Brazil

Introdução: Os índices de cesariana vêm aumentando consideravelmente nos últimos anos, mesmo com o conhecimento prévio de que o parto normal é mais seguro, tanto para a mãe, quanto para o bebê. Métodos: Em um estudo retrospectivo, foram analisados 1.479 partos ocorridos na Maternidade da Santa Casa de Misericórdia de Pelotas (SCMP) e 1.522 partos na Maternidade do Hospital São Francisco de Paula (HUFSP), no período de 01/01/2007 a 31/12/2007 e comparados com os dados obtidos em estudo anterior com o mesmo objetivo no período de 01/07/1993 a 30/06/1994. Resultados: Foi observado um incremento dos partos cesáreos nas duas instituições, com 41,1% dos partos da SCMP e 40,7% no HUSFP realizados por via alta. Houve similaridade com relação ao peso dos recém-nascidos de gestantes submetidas à via alta de parto, encontrando-se a maioria com peso entre 2.501g e 3.500g, o que foge ao preconizado pela indicação obstétrica que recomenda tal via em fetos macrossômicos diante do maior risco de desproporção cefalopélvica. Também foi observado que a maioria dos partos cesáreos foram realizados em mulheres entre 21 e 30 anos. Em comparação com os dados de 1994, observou-se que houve aumento na proporção de cesarianas em todas as categorias de peso do recém-nascido e idade materna, mas com maior prevalência nos fetos macrossômicos. Conclusão: Este estudo constatou uma incidência aumentada de partos cesáreos nas maternidades estudadas em relação ao preconizado pelo Ministério da Saúde (AU)

Introduction: The rates of caesarian surgeries have been increasing considerably in recent years, despite the awareness that normal delivery is safer both for the mother and for the infant. Methods: In a retrospective study, we evaluated 1,479 deliveries in the Santa Casa de Misericórdia of Pelotas, RS (SCMP) and 1,522 deliveries in the Hospital São Francisco de Paula, RS (HUFSP) from January 1, 2007 to December 31, 2007, which were compared to the data obtained in a previous study carried out for the same purpose from July 1, 1993 to June 30, 1994. Results: An increase in the number of caesarian sections was observed, accounting for 41.1% of the deliveries in the SCMP and for 40.7% in the HUSFP. There was similarity concerning birth weight of pregnant women submitted to caesarian sections, most of them weighing from 2,501g to 3,500g, which is out of the obstetrical recommendation of using such route for macrosomic fetuses because of the greater risk of cephalo-pelvic disproportion. Most of the caesarian deliveries were performed in women between 21 and 30 years of age. As compared to 1994 data, there was an increase in the percentage of caesarian sections in all categories of birth weight and maternal age, but with a greater prevalence in macrosomic fetuses. Conclusions: This study has found an increased incidence of caesarian surgeries in the studied hospitals as compared to what is recommended by the Ministry of Health (AU)

A Case of Valsalva Retinopathy following Normal Delivery

PURPOSE: We report a case of Valsalva retinopathy following normal delivery. METHODS: A 32-year-old woman presented with visual blurring in her right eye which had developed on the previous day. At the first visit, visual acuity was 0.02 with correction. Anterior segment examination was unremarkable and dilated fundus examination revealed a dumbbell-shaped preretinal hemorrhage in the macula. Preretinal hemorrhage was a well-demarcated, red-colored subinternal limiting membrane hemorrhage. Fluorescein angiography demonstrated blocked fluorescence due to hemorrhage. The patient was followed up for two years. RESULTS: Two weeks after the first visit, the size of the preretinal hemorrhage decreased. Three weeks after the first visit, there was marked resolution of the hemorrhage with yellowish degeneration, but visual acuity did not improve. Six weeks after the first visit, the preretinal hemorrhage was resolved completely and visual acuity returned to normal with no specific treatment.

A Case of Normal Full Term Delivery after Afrenalectomy for Cushing's Syndrome in a Pregnant Patient / 대한내분비학회지

We experienced a case of Cushings syndrome due to adrenal adenoma associated with pregnancy 23th week in a 26 year old female patient. On physical findings, hypertension, moon face, hirsutism, abdominal striae and buffalo hump were noticed. Laboratory findings showed increased serum cortisol, increased 24 hours-urinary cortisol, and decreased plasma ACTH. Abdominal MRI demonstrated 4 cm sized in long diameter, well marginated, and ovoid-shape right adrenal mass. Unilateral total adrenalectomy was performed at the 23th week of pregnancy and the mass it was confirmed to benign adrenal adenoma. Steroid replacement therapy was continued with 7.5 mg prednisolone during remaining pregnancy. At the 38th week of pregnancy, labor was developed and she delivered healthy female weighing 2.5 kg through normal vaginal delivery without complication. Pregnancy rarely occurs in patients with Cushings syndrome. We think she was the first case in Korea who had normal 38th week transvaginal delivery after adrenalectomy in adrenal Cushings syndrome during pregnancy.