Tendencia temporal y factores asociados al parto prematuro en Chile, 1992-2018 / Temporal trends and factors associated with preterm birth in Chile, 1992-2018

RESUMEN Se realizó un estudio analítico con base en los registros poblacionales de nacimientos en Chile, obtenidos del Departamento de Estadística e Información en Salud (DEIS), con el objetivo de evaluar la tendencia temporal de los partos prematuros en Chile en el periodo 1990-2018, asociado a la edad de la madre. Los resultados muestran que, para el año 1992, la tasa de parto prematuro fue del 5,0%, aumentando a 7,2% en 2018. El promedio del porcentaje del cambio anual (PPCA) fue de 1,44. Los grupos etarios extremos -menor o igual de 19 años y 35 y más años- fueron los que presentaron las tasas de parto prematuro más altas, tanto al inicio y como al término del periodo, siendo este último grupo el que mostró una menor disminución al inicio del periodo (1992-1995), con porcentaje de cambio anual (PCA) de -3,00. Para ambos grupos, la probabilidad de un parto prematuro fue mayor respecto del grupo de 20 a 34 años. Chile, presenta uno de los mejores indicadores de salud materna e infantil para la región; no obstante, dada la actual postergación de la maternidad, deben vigilarse las repercusiones asociadas, dentro de ellas un nacimiento prematuro.

ABSTRACT An analytical study based on Chilean birth records obtained from the Department of Statistics and Health Information (DEIS) was conducted. This study aimed to evaluate temporal trends in preterm births by maternal age in Chile from 1990 to 2018. Results show that the preterm birth rate in 1992 was 5.0% and increased to 7.2% in 2018. The average annual percent change (AAPC) was 1.44. Age groups at the extremes (19 and under and 35 and over) presented the highest rates of preterm birth, both at the beginning and at the end of the study period. The latter group showed a smaller decrease at the beginning (1992 to 1995), with an annual percentage change (APC) of -3.00. The probability of preterm birth in both groups was higher compared to the 20-34 year old group. Although Chile boasts some of the best maternal and child health indicators in the region, repercussions associated with the current postponement of maternity - including preterm birth - must be monitored.

Impacto da pandemia por COVID-19 na prevalência de casos de prematuridade / Impacto de la pandemia de COVID-19 en la prevalencia de casos de prematuridad / Impact of the COVID-19 pandemic on the prevalence of prematurity cases

Objetivo: analisar a prevalência da prematuridade no contexto da pandemia. Método: estudo transversal, retrospectivo e descritivo, desenvolvido na maternidade de referência do estado do Piauí. Resultados: 46,7% dos prontuários foram do ano de 2020 e 53,3% do ano de 2021. Houve 79% para gravidez única, parto cesáreo 59,1% e líquido amniótico claro 53%. O perfil clínico do RN em relação ao sexo, 47% eram do sexo feminino e 35 % do masculino. Médias: peso de 2462g, perímetro cefálico 34.36cm, torácico 32.58 cm, e comprimento de 48.02 cm. Considerando essa análise no ano de 2020 e 2021 foram contabilizados 21,1% RN com idade gestacional identificando uma prematuridade ao nascer e, 78,9% com idade gestacional dentro dos valores para pós termo. Conclusão: Os índices de prematuridade estão acima do esperado (21,1%), novas pesquisas com amostras mais importantes e melhor delineamento de métodos são necessárias para ampliar o escopo da discussão.(AU)

Objective: to analyze the prevalence of prematurity in the context of the pandemic. Method: a cross-sectional, retrospective and descriptive study, carried out at a reference maternity hospital in the state of Piauí. Results: 46.7% of the medical records were from 2020 and 53.3% from 2021. There were 79% for singleton pregnancy, cesarean delivery 59.1% and clear amniotic fluid 53%. The clinical profile of the NB in relation to sex, 47% were female and 35% male. Averages: weight of 2462g, head circumference 34.36cm, thoracic circumference 32.58cm, and length of 48.02cm. Considering this analysis, in 2020 and 2021, 21.1% of newborns with gestational age were identified as prematurity at birth, and 78.9% with gestational age within the values for post-term. Conclusion: Prematurity rates are higher than expected (21.1%), new research with more important samples and better method design are necessary to broaden the scope of the discussion (AU)

Objetivo: analizar la prevalencia de la prematuridad en el contexto de la pandemia. Método: estudio transversal, retrospectivo y descriptivo, desarrollado en la maternidad de referencia del estado de Piauí. Resultados: El 46,7% de los registros fueron del año 2020 y el 53,3% del año 2021. Hubo un 79% por embarazo único, parto por cesárea un 59,1% y líquido amniótico claro un 53%. El perfil clínico del RN en relación al sexo, el 47% eran del sexo femenino y el 35% del masculino. Promedios: peso de 2462 g, perímetro cefálico 34,36 cm, perímetro torácico 32,58 cm y longitud de 48,02 cm. Considerando este análisis, en 2020 y 2021, el 21,1% de los recién nacidos con edad gestacional fueron identificados como prematuros al nacer, y el 78,9% con edad gestacional dentro de los valores para postérmino. Conclusión: Las tasas de prematuridad son más altas de lo esperado (21,1 %), se necesitan nuevas investigaciones con muestras más importantes y un mejor diseño de métodos para ampliar el alcance de la discusión(AU)

Estudio de caso control en amenaza de parto pretermino y sus factores de riesgo en gestantes en un hospital de referencia del Peru durante la pandemia COVID-19

RESUMEN El objetivo del presente estudio fue determinar la relación entre la amenaza de parto pretermino y sus factores de riesgo en gestantes atendidas en un hospital de referencia del Perú durante la pandemia covid-19, con énfasis en la infección de tracto urinario. Se realizó un diseño de tipo casos y controles no emparejado, con una muestra representativa, con un tamaño muestral de 92 casos y 92 controles por muestreo probabilístico aleatorio simple, se realizó un modelo de regresión logística para la infección de tracto urinario y la amenaza de parto pretermino para el cálculo del Odds Ratio e intervalos de confianza al 95%. Se reportó una asociación para la amenaza de parto pretermino con las variables gestante añosa 3.159 (IC95% 1.66 - 6.02), menos de seis controles prenatales 3.9 (IC95% 2.084 - 7.298), paridad 0.353 (IC95% 0.180 - 0.691), antecedente de parto pretermino 2.843 (IC95% 1.253 - 5.639) e infección de tracto urinario 2.843 (IC95% 1.253 - 5.639). Se concluye que la infección de tracto urinario se asocia a la amenaza de parto pretermino en gestantes atendidas en un hospital de referencia peruano.

ABSTRACT The objective of the present study was to determine the relationship between the threat of preterm birth and its risk factors in pregnant women treated at a referral hospital in Peru during the covid-19 pandemic, with emphasis on urinary tract infection. An unpaired case-control type design was carried out, with a representative sample including 92 cases and 92 controls selected by simple random probabilistic sampling. A logistic regression model was carried out for urinary tract infection and threat of preterm birth for calculating the Odds Ratio and 95% confidence intervals. An association was reported for the threat of preterm birth with the variables: elderly pregnant woman 3.159 (95% CI 1.66 - 6.02), less than six prenatal controls 3.9 (95% CI 2.084 - 7.298), parity 0.353 (95% CI 0.180 - 0.691), history of preterm birth 2843 (95% CI 1253-5639) and urinary tract infection 2843 (95% CI 1253-5639). It is concluded that urinary tract infection is associated with the threat of preterm birth in pregnant women treated in a Peruvian reference hospital.

Vivências de mães de bebês prematuros: da gestação aos cuidados no domicílio / Experiences of mothers of untimely babies: from pregnancy to home care / Experiencias de madres de bebés prematuros: desde el embarazo hasta la atención domiciliaria

Objetivo: conhecer as vivências de mães de bebês prematuros da gestação até o domicílio, após a alta hospitalar. Método: estudo qualitativo, descritivo e exploratório, desenvolvido com 16 puérperas em uma Policlínica Infantil, em dezembro de 2020, por meio de entrevistas semiestruturadas, submetidas à análise de conteúdo temática. Resultados: as vivências da gestação envolveram tanto a ausência como a presença de fatores de risco. No nascimento, observou-se a separação da mãe e do bebê, com poucas orientações sobre as razões da permanência deste na Unidade de Terapia Intensiva Neonatal. Na internação, as mães demonstraram desgaste emocional e físico diante das mudanças na rotina. Já no domicílio, elas buscaram a manutenção dos cuidados desenvolvidos no ambiente hospitalar. Conclusão: é fundamental o olhar sensível e atento dos profissionais de saúde quanto às orientações fornecidas à mulher e sua família, permitindo maior compreensão sobre as questões ligadas à prematuridade.

Objective: recognizing the experiences of mothers of untimely babies from pregnancy to home, after hospital discharge. Method: a qualitative, descriptive and exploratory study developed with 16 puerperal women in a Children's Polyclinic, in December 2020, through semi-structured interviews, submitted to Thematic Content Analysis. Results: the experiences of pregnancy involved both the absence and the presence of risk factors. At birth, it was observed the separation of the mother and the baby, with few orientations on the reasons for their stay in the Neonatal Intensive Care Unit. In hospitalization, the mothers showed emotional and physical exhaustion in the face of changes in routine. At home, they sought to keep the care developed in the hospital environment. Conclusion: it is fundamental the sensitive and attentive look of health professionals regarding the orientations provided to women and their families, allowing greater understanding of issues related to prematurity.

Objetivo: conocer las experiencias de las madres de bebés prematuros desde el embarazo hasta el domicilio, tras el alta hospitalaria. Método: un estudio cualitativo, descriptivo y exploratorio desarrollado con 16 mujeres puerperales en un Policlínico Child, en diciembre de 2020, a través de entrevistas semiestructuradas, sometido a análisis de contenido temático. Resultados: las experiencias de embarazo implicaron tanto la ausencia como la presencia de factores de riesgo. Al nacer, se observó la separación de la madre y el bebé, con pocas orientaciones acerca de los motivos de su estancia en la Unidad de Cuidados Intensivos Neonatales. En la hospitalización, las madres mostraron agotamiento emocional y físico ante los cambios en la rutina. En casa, buscaban mantener la atención desarrollada en el ámbito hospitalario. Conclusión: es fundamental la mirada sensible y atenta de los profesionales de la salud en respecto a las orientaciones brindadas a las mujeres y sus familias, permitiendo una mayor comprensión de los temas relacionados con la prematuridad.

Minireview: Utilidad de las pruebas predictivas para parto pretérmino utilizadas en la práctica clínica / Minireview: Utility of predictive tests for preterm birth used in clinical practice

El parto prematuro, definido como el parto que ocurre antes de las 37 semanas de gestación, es una condición obstétrica grave que representa el 11% de los embarazos en todo el mundo. Las pruebas predictivas para parto prematuro son importantes, dado el impacto personal, económico y de salud del parto prematuro. Esta revisión explora la utilidad tanto de las pruebas predictivas actuales utilizadas en la práctica clínica (características maternas, longitud cervical y marcadores bioquímicos), así como nuevas pruebas emergentes. Se realizó una búsqueda electrónica en las bases de datos científicas en salud: PUBMED, COCHRANE, SCIELO, revisión de repositorios virtuales de universidades nacionales utilizando los siguientes ítems de búsqueda y sus combinaciones: parto pretérmino, longitud cervical, acortamiento cervical, cervicometría, fibronectina fetal, factores de riesgo, características maternas. Se incluyeron trabajos publicados en inglés y español, desde el año 2006 hasta el año 2020, que respondían al objetivo de la revisión: La utilidad de los diferentes predictores para parto pretérmino. En total se incluyeron 30 artículos en la presente revisión bibliográfica. Existen múltiples criterios científicos sobres las diferentes técnicas actuales para identificar pacientes de riesgo y lograr una prevención adecuada del parto pretérmino. La medición de la longitud cervical por ecografía transvaginal es el método más rentable en mujeres con historia de parto prematuro o síntomas de amenaza de parto prematuro; la evidencia actual permite sostener que también es indispensable realizar cervicometría de rutina a todas las pacientes, aún de bajo riesgo. Existen métodos ecográficos de predicción como la elastografía cervical y el índice de consistencia cervical que son prometedores, pero existen limitaciones en su implementación técnica y se propone que podrían ser una posible alternativa en el futuro, que puede combinarse con la longitud cervical. También, la adición de la medición de la longitud cervical a las pruebas bioquímicas parece mejorar la precisión predictiva(au)

Preterm labor, defined as delivery before 37 weeks of gestation, is a serious obstetric condition that accounts for 11% of pregnancies worldwide. Predictive tests for preterm birth are important, given the personal, economic, and health impact of preterm birth. This review explores the utility of both, the current predictive tests used in clinical practice (maternal characteristics, cervical length and biochemical markers), as well as the new emerging tests. An electronic search was carried out in the scientific health databases: PUBMED, COCHRANE, SCIELO, national universities virtual repositories were also reviewed, using the following search items and their combinations: preterm delivery, cervical length, cervical shortening, cervicometry, fetal fibronectin, risk factors, and maternal characteristics. We included papers in English and Spanish published from 2006 to 2020, which responded to the aim of the review: the utility of predictive test for preterm delivery. A total of 30 articles were included in this review. There are multiple scientific criteria on the different current techniques to identify patients at risk and achieve adequate prevention of preterm birth. Measurement of cervical length by transvaginal ultrasound is the most cost-effective method in women with a history of preterm labor or symptoms of preterm labor; the current evidence allows us to affirm that it is also essential to perform routine cervicometry in all patients, even with low risk. There are promising ultrasound predictive methods such as cervical elastography and cervical consistency index, but there are limitations in their technical implementation, it is proposed that they could be a possible alternative in the future, that can be combined with cervical length measurement. Also, adding cervical length easurement to biochemical tests appears to improve predictive accuracy.(au)

Maternal and fetal parameters in pregnant woman undergoing tocolysis with nifedipine / Parâmetros maternos e fetais em gestante submetida a tocólise com nifedipina

Abstract Objectives: to evaluate the effects of nifedipine with tocolysis under maternal and fetal parameters. Methods: a cohort study with 40 pregnant women admitted at a high-risk pregnancy ward to inhibit premature labor between September/2010 to May/2012. Nifedipine was used as a 20mg sublingual attack dose and maintained 20mg every six and eight hours orally. The variables of the analysis were fetal heart rate (FHR), maternal heart rate (MHR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), and amniotic fluid index (AFI). All the variables were evaluated prior to administrating nifedipine and approximately after 6 hours and every 24 hours, until hospital discharge. Results: there were no modification of the FHR (p=0.48) and the SBP (p=0.29). The MHR increased after 24 hours, but with no statistical difference (p=0.08), returning to similar levels as at admission within 48 hours. The DBP decreased at 6 (p=0.04) to 72 hours, being stable afterwards. The AFI decreased significantly at 24, 48 and 72 hours. Conclusions: the use of high doses of nifedipine with tocolysis causes a decrease of the maternal's diastolic blood pressure and consequently decreases the amniotic fluid index, but probably without any clinical repercussions.

Resumo Objetivos: avaliar os efeitos da nifedipina utilizada na tocólise sobre os parâmetros maternos e fetais. Métodos: estudo de coorte incluindo 40 gestantes admitidas na enfermaria de alto risco para inibição do trabalho de parto prematuro entre setembro/2010 a maio/2012. Utilizou-se a nifedipina sublingual na dose de ataque de 20mg e uma manutenção de 20mg por via oral a cada seis e oito horas. As variáveis avaliadas foram os batimentos cardio-fetais (BCF), frequência cardíaca materna (FCM), pressão arterial sistólica (PAS) e diastólica (PAD) e índice de líquido amniótico (ILA). Todas as variáveis foram avaliadas antes da administração da nifedipina e aproximadamente após 6h e cada 24h até alta hospitalar. Resultados: não houve modificação dos BCF (p=0,48) e da PAS (p=0,29). A FCM aumentou após 24h, mas sem significância estatística (p=0,08) retornando a níveis similares ao da admissão com 48h. A PAD diminuiua partir de 6h (p = 0,04)até 72h, mantendo-se constante. O ILA diminuiu significativamente em 24h, 48h e 72h. Conclusão: a utilização de altas doses de nifedipina para tocóliseocasio na diminuição dos níveis pressóricos diastólicos maternos e consequentemente diminuição do ILA, mas provavelmente sem repercussões clínicas.

A retrospective study on the relationship between LMR and preterm delivery in pregnant women / 中国实用妇科与产科杂志

OBJECTIVE: To study a potential relationship between preterm labor and lymphocyte to monocyte ratio(LMR).METHODS: This retrospective cohort study was conducted in Second Affiliated Hospital of Chongqing Medical University from August 2016 to November 2017. Totally 100 pregnant women who delivered between 28 th to 37 th gestational week were included as the study group,and 116 pregnant women who delivered after 37 th gestational week were as the control group. The data of routine blood test from 11 th to 13 th gestational week and 28 th to 30 th gestational week were observed and compared.RESULTS: The LMR value of preterm women was significantly higher than that of those who delivered at term(early pregnancy 4.90±1.40 vs. 4.31±1.30,P<0.01;middle and advanced stage of pregnancy 3.54±0.93 vs. 2.95±0.64,P<0.01). A negative correlation was observed between the level of LMR and the gestational weeks of termination of pregnancy(r=-0.350,P<0.01).CONCLUSION: The value of LMR in pregnancy is associated with the occurrence of preterm labor. Therefore,it is necessary to make further study.

Factores maternos que inciden en amenaza de parto pretérmino en adolescentesgestantes del cantón San Jacinto de Yaguachi / Maternal factors that affect thethreat of preterm delivery in pregnantadolescents of San Jacinto deYaguachi canton

Introducción:La amenaza de parto pre término consiste en la presencia de contracciones regulares después de las 20 y antes de las 37 semanas de gestación Objetivo: Determinar los factores maternos que inciden la amenaza de parto pretérmino en las mujeres gestantes que acuden al Hospital Básico de Yaguachi.Métodos:Sé realizo un Estudio cuantitativo, descriptivo, y transversal en el Hospital Básico "Dr. José Cevallos Ruiz", con una muestra de 20 adolescentes de sexo femenino, con el diagnostico amenaza de parto pretérmino, a las que se les aplicó una encuesta que constó con 5 preguntas entre ellas: Edad, educación, domicilio, controles prenatales y patología asociada a su embarazo.Resultados:Predominó el grupo de adolescentes correspondiente a los 17-19 años con un65%, instrucción secundaria el 55%, el 80% de las gestantes residía en la zona rural. En cuanto a los controles prenatales el 60% de las adolescentes asistieron de 1 a 4 controles, y el 50% de las adolescentes presentaron como factor de riesgo para la amenaza de parto pretérmino, la rotura prematura de membranas como patología asociada a su embarazo. Conclusiones:El factor materno que predominó fue la rotura prematura de membranas, sin embargo la infección de vías urinarias y los trastornos hipertensivosdel embarazo, también se encontraron presentes y por ello, la educación prenatal debe ser tomada en gran consideración

Introduction:The threat of preterm birth consists in the presence of regular contractions after 20 and before 37 weeks of gestation. Objective: To determine the maternal factors that affect the threat of preterm delivery in pregnant women who come to the Basic Hospital of YaguachiMethods:Aquantitative, descriptive, and transversal study in the Basic Hospital "Dr. José Cevallos Ruiz ", with a sample of 20 female adolescents, with the diagnostic threat of preterm delivery, to which a survey was applied that consisted of 5 questions including: Age, education, home, prenatal check-ups and associated pathology to your pregnancy.Results:The group of adolescents corresponding to 17-19 years old predominated with 65%, secondary instruction 55%, 80% of pregnant women resided in the rural area. Regarding the prenatal controls, 60% of the adolescents attended from 1 to 4 controls, and 50% of the adolescents presented as a risk factor for the threat of preterm delivery, the premature rupture of the membranes as a pathology associated with their pregnancy.Conclusions:The maternal factor that predominated was the premature rupture of membranes, nevertheless the infection of urinary tract and the hypertensive disorders of pregnancy, were also present and therefore, prenatal education should be taken into great consideration

Effect of ritodrine hydrochloride on peripheral blood and tocolysis rate of patients with threatened premature labor / 中国生化药物杂志

Objective To observe the effect of ritodrine hydrochloride on peripheral blood and tocolysis rate of patients with threatened premature labor.Methods89 cases of patients with threatened premature labor were selected from October 2015 to September 2016 and randomly divided into two groups, research group with 45 cases treated with ritodrine hydrochloride and control group with 44 cases treated with epsom salt.The peripheral blood, extinction time of uterine contraction, extended days of pregnancy, postpartum hemorrhage, neonatal birth weight and tocolysis rate were compared between two groups.ResultsAfter treatment, CRH, NO, PGE2 and IL-8 of control group were obviously higher than research group, the difference was statistically significant (t=10.826,3.839,7.534,8.075,P0.05).The overall efficacy of tocolysis in control group was 70.5%, while that in research group was 86.7%, which was obviously higher than the control group, the difference was statistically significant (χ2=7.801,P<0.05).ConclusionRitodrine hydrochloride can effectively control uterine contraction factor in peripheral blood and extend gestational days of patients with threatened premature labor, so as to improve tocolysis rate and birth quality.

Premature childbirth: pregnant women's characteristics of a population in the South area of São Paulo / Parto prematuro: características das gestantes de uma população da zona sul de São Paulo

Abstract Objectives: to identify the characteristics of pregnant women who had premature child-birth (PPT) in the South region of São Paulo city. Methods: a cross-sectional observational study with a data collection of 122 medical files on pregnant women who had PPT in 2013. The collected data were analyzed by a statistical package, Graphpad Prism 6. As for the variables that were shown to be significant in the multivariate regression, an analysis was performed in a dichotomous form by odds ratio. Results: the mean age of the pregnant women was 24.9 years old. Of the 122 pregnant women, 34.4% were included in the age group considered to be at risk by the Ministry of Health. The predominant race was mixed (46.2%). 41.8% were high school graduates. Regarding to personal background, the history on urinary infection was mostly mentioned (37.5%). In relation to family history regarding clinical conditions, 43% had diabetes history and 61% had hypertension. As for gynecological history, 37.5% reported having dysmenorrhea during menstrual cycles. Multivariate analysis was performed and found that particularly hypertension and dysmenorrhea were the most significant. Conclusions: Regarding to women´s risk factors for premature childbirth, the most determining factor was dysmenorrhea, followed by hypertension.

Resumo Objetivos: identificar as características das gestantes que tiveram parto prematuro (PPT) na região sul da cidade de São Paulo. Métodos: estudo observacional transversal com coleta de dados de 122 prontuários de gestantes que tiveram PPT em 2013. Os dados coletados foram analisados pelo pacote estatístico Graphpad Prism 6. Para as variáveis que se mostraram significantes dentro da regressão multivariada foi feita análise de forma dicotômica por meio odds ratio. Resultados: a média de idade das gestantes foi de 24,9 anos. Das 122 gestantes, 34,4% estavam na faixa etária considerada de risco pelo Ministério da Saúde. A raça predominante foi parda (46,2%). 41,8% finalizaram o ensino médio. Em relação aos antecedentes pessoais, o que mais se destacou foi o histórico de infecção urinária (37,5%) . Em relação aos antecedentes familiares em relação à condições clínicas, 43% possuíam antecedentes com diabetes e 61% com hipertensão arterial. Quanto aos antecedentes ginecológicos, 37,5% relataram apresentar dismenorreia durante os ciclos menstruais. Ao ser realizada análise multivariada, foi verificado que a hipertensão arterial e principalmente a dismenorreia foram as mais significantes. Conclusões: em relação aos fatores de risco das mulheres para parto prematuro das mulheres, a dismenorreia foi o fator mais determinante, seguido de hipertensão arterial.

Predição de parto prematuro pela biometria e dopplervelocimetria da glândula adrenal fetal empacientes com sintomas de trabalho de parto prematuro

OBJETIVOS: O objetivo do presente estudo foi avaliar a capacidade de predição do partoprematuro através da biometria e da dopplervelocimetria da glândula adrenal fetal empacientes com sintomas de trabalho de parto prematuro e membranas íntegras e compará-loscom o poder de predição da medida do comprimento do colo uterino. Metodologia: O estudodo tipo transversal, prospectivo, foi realizado na Maternidade-Escola Assis ChateaubriandUFCde abril de 2014 a março de 2015 com cinquenta e sete pacientes consecutivamenteinternadas no setor de obstetrícia com idades gestacionais entre 24 e 36 semanas. Foramexcluídas as pacientes com diabetes, hipertensão, malformações ou restrição do crescimentofetais. Ultrassom foi realizada no primeiro dia da admissão para a medida do comprimento docolo uterino (transvaginal), biometria e dopplervelocimetria da glândula adrenal fetal. Avariável desfecho foi o tempo decorrido até o parto com subclassificação em dois grupos:aquelas que tiveram o parto em até sete dias ou depois do sétimo dia. Considerou-se nível designificância de p<0,05. Utilizou-se o teste Exato de Fisher para variáveis nominais o teste tStudentou de Mann-Whitney para as variáveis contínuas. Foi realizado curva ROC paradefinir pontos de corte...

OBJECTIVES: The purpose of this study is to evaluate the predicting capacity of the biometry offetal adrenal gland in patients who are undergoing symptoms of premature labor anduntouched membranes, and compare it with uterine collum measurement regarding suchprediction. Methodology: A transverse kind of study was accomplished at the “AssisChateubriand” Maternity School at the Federal University of Ceará from April 2014 to March2015 on fifty-seven (57) patients consecutively hospitalized at the obstetrics section atpregnant age ranged from 24 to 36 weeks. Patients suffering from diabetes, hypertension,malformations or fetal-development restriction were excluded. Ultrasound was carried out onthe first day of their hospitalization to measure the length of their uterine collum(transvaginal) as well as the biometry of their fetal adrenal gland. The main outcome variablewas the time elapsed until the delivery itself, with a subclassification into two groups: theones who had their delivery up to seven days or after the seventhy day. The significance levelconsidered was p< 0,05. The Fisher – Exact test was used for nominal variables and the Tstudentor the Mann-Whitney Test for continuous variables. The ‘ROC’ curve was carried outto define cutoffs...

Curative effect between ritodrine hydrochloride and magnesium sulfate treated with threatened premature labor and its effect to fetal fibronectin / 中国基层医药

Objective To discuss curative effect between ritodrine hydrochloride and magnesium sulfate treated with threatened premature labor and its effect to fetal fibronectin .Methods 368 cases threatened premature labor puerperants were selected and randomly divided into the ritodrine hydrochloride treatment group ( short for obser-vation group) and magnesium sulfate treatment group (short for control group),The two group puerperants′curative effect,changes of fetal fibronectin positive rate and safety evaluation were observed .Results Compared with the con-trol group,the observation group′s medicine effect time ,treatment failure proportion obviously decreased;prolongation pregnancy days,treatment success proportion obviously increased ,the differences all had statistical significances (t=103.4,9.6,χ2 =12.0,all P0.05);after the treatment,the observation group′s fFN positive rates was 28.26%,wich of the control group was 42.39%,compared the two groups′fFN positive rates,the observa-tion group obviously decreased ,the differences had statistical significances (χ2 =8.0,P <0.05).The observation group′s untoward effect rate was 1 9 .5 7%, which was lower than that of the control group (χ2 =4 .8 , P<0 .0 5 ) .Conclusion Ritodrine hydrochloride treated with threatened premature labor not only can get good treatment effect , shorten medicine effect time ,prolong pregnancy days;but also can obviously decrease fetal fibronectin positive rate , which has good safety ,and is suitable for clinical application .

Rehabilitation for Patients Recovering from Threatened Abortion and Premature Labor : During Pregnancy and the Postpartum Period / The Japanese Journal of Rehabilitation Medicine

Bed rest for pregnant women recovering from threatened abortion and premature labor to prevent abortion can cause deconditioning syndrome, but it is not clear what kind of physical exercise should be provided for these patients. To better provide appropriate rehabilitation for threatened abortion and premature labor patients, we investigated patient clinical records retrospectively. In 11 patients who were provided rehabilitation within the past three years, eight delivered during hospitalization and three became independent in ADLs and were discharged while still pregnant. All patients who delivered during their hospitalization became independent in ADLs immediately after delivery, and as a result, the maternal prognosis was good. Choosing an appropriate rehabilitation approach for patients with threatened premature labor may help alleviate their deconditioning during pregnancy without any adverse impact.

Sulfato de magnesio y protección neuronal prenatal / Magnesium sulfate for prenatal neuroprotection

Antecedentes: la prematuridad es importante factor de riesgo para el desarrollo de parálisis cerebral (PC). El Sulfato de Magnesio (MgSO4) se ha planteado como una estrategia para reducir el riesgo de PC en recién nacidos por debajo de las 34 semanas de gestación. Objetivo: precisar con la evidencia disponible, la validez del uso del MgSO4 para protección neuronal prenatal en embarazadas en riesgo de parto pretér-mino (PP) inminente. Método: se revisaron las bases de datos PubMed, ScienceDirect, EBSCOhost, Scielo y OvidSP en búsqueda de estudios clínicos y epidemiológicos, revisiones sistemáticas, consensos y meta análisis. Se realizó revisión temática de los artículos que cumplieron los criterios de selección. Resultados: experimentos en modelos animales mostraron la posibilidad que el MgSO4 fuese protector neuronal. Estudios observacionales señalaron la posible asociación entre la exposición fetal al MgS04 y reducción en morbilidad neurológica en nacidos pretérmino (NP). Cinco ensayos clínicos entre 2002-2008, individualmente no mostraron datos concluyentes. En el 2009 se publicaron tres metaanálisis, basados en esos mismos ensayos y mostraron significativa reducción de PC en NP expuestos prenatalmente al MgSO4. Conclusión: existe evidencia para recomendar MgSO4 para protección neuronal prenatal antes de las 34 semanas de embarazo y con riesgo inminente de PP, aunque no está definida la dosis óptima. Se recomienda aplicar hasta el parto o por 12-24 horas.

Background: prematurity is a leading risk factor for development of cerebral palsy (CP). The use of Magnesium sulphate (MgSO4) has been proposed as a strategy to reduce the risk of cerebral palsy in preterm infants less than 34 weeks of gestation. Aims: to assess the best available evidence in order to validate the use of MgSO4 for prenatal neuroprotection in pregnant women at risk of imminent preterm delivery. Methods: we searched the PubMed, ScienceDirect, EBSCOhost, Scielo and OvidSP databases for clinical and epidemiological studies, systematic reviews, consensus and meta-analysis about the use of Magnesium sulphate to prevent cerebral palsy. Thematic review was conducted of articles that met the selection criteria. Results: experiments in animal models showed properties of MgSO4 for neuroprotection. Observational studies indicated the possible association between fetal exposures to MgS04 and reduced neurological morbidity in PP. Five clinical trials between 2002 and 2008 showed no conclusive data individually. In 2009, three meta-analysis showed significant reduction of cerebral palsy in MgSO4 exposed preterm infants. Conclusion: there is evidence to recommend the use of MgSO4 for prenatal neuroprotection before 34 weeks of pregnancy and imminent risk of preterm birth. It is unclear the optimal dose of MgSO4; is recommended until delivery or by 12-24 hours.

Fatores de risco maternos para prematuridade em uma maternidade pública de Imperatriz-MA / Maternal risk factors for premature births in a public maternity hospital in Imperatriz-MA / Los factores maternos de riesgo de parto prematuro en una maternidad pública de Imperatriz-MA

Apesar dos avanços da obstetrícia, a prematuridade ainda se configura como um dos grandes problemas de saúde pública, em virtude da morbidade e da mortalidade neonatal que causa. O objetivo deste estudo foi investigar fatores de risco maternos para nascimentos de prematuros em uma maternidade pública de Imperatriz-MA. Um estudo comparativo transversal foi realizado com 116 puérperas, por meio de entrevistas estruturadas. Os dados coletados foram analisados através do Software Epi-Info, versão 3.5.1. As variáveis que tiveram associação estatisticamente significante com a prematuridade foram: renda mensal inferior a 2 salários mínimos (p=0,046); estresse na gestação (p=0,027); primiparidade (p=0,044); assistência pré-natal ausente ou inadequada (p<0,001); e intercorrências clínicas na gestação (p=0,001). Os resultados apontam que os fatores de risco maternos implicados na prematuridade estão relacionados, sobretudo, com hábitos de vida, assistência pré-natal e condições socioeconômicas e clínicas.

Despite advances in obstetrics, prematurity is still a major public health problem because of the neonatal morbidity and mortality it causes. The objective of this study was to investigate maternal risk factors for premature births in a public maternity in the city of Imperatriz-MA. A cross-sectional comparative study was conducted with 116 mothers, through structured interviews. The data were analyzed using Epi-Info version 3.5.1. The variables that showed statistically significant association with preterm delivery were monthly income below two minimum wages (p = 0.046), stress during pregnancy (p = 0.027), primiparity (p = 0.044), absent or inadequate prenatal care (p <0.001) and clinical complications in pregnancy (p<0.001). The results show that the maternal risk factors implicated in prematurity are related mainly with lifestyle, socioeconomic and clinical variables, and prenatal care.

A pesar de los avances en la obstetricia y la prematuridad sigue siendo un problema importante de salud pública debido a la morbilidad y mortalidad neonatal que causa. El objetivo de este estudio fue investigar los factores de riesgo maternos para los nacimientos prematuros en una maternidad pública en Imperatriz, MA. Un estudio comparativo de la sección transversal se llevó a cabo con 116 madres, a través de entrevistas estructuradas. Estudio caso-control se realizó con 116 mujeres, agrupadas en el caso de (58) y control (58), a través de entrevistas estructuradas. Los datos fueron analizados con Epi-Info versión 3.5.1. Las variables que mostraron una asociación estadísticamente significativa con el parto prematuro fueron ingresos mensuales <2 salarios mínimos (p=0,046), el estrés durante el embarazo (p=0,027), primiparidad (p=0,044), atención prenatal ausente o inadecuada (p<0,001) y complicaciones clínico durante el embarazo (p=0,001). Los resultados muestran que los factores de riesgo implicados en la prematuridad materna están relacionadas principalmente con el estilo de vida, factores socioeconómico y clínico y la atención prenatal.

Elementos da matriz extracelular da cérvice uterina e trabalho de parto prematuro / Elements of extracellular matrix from uterine cervix and premature labor

As taxas de prematuridade não atingem quedas significativas, mesmo em países desenvolvidos, alertando os pesquisadores a buscarem alternativas clínico-farmacológicas na prevenção desta enfermidade obstétrica. A matriz extracelular ocupa espaço relevante na maturação cervical, e seu entendimento é fundamental para possíveis ações preventivas. Destaca-se a provável correlação dos níveis locais de glicosaminoglicanos na prevenção do parto prematuro por inibir processos inflamatórios na cérvice uterina

The preterm delivery rates do not decrease significantly, even in developed countries, prompting researchers to seek pharmacological and clinical alternatives to prevent this obstetrics disorder. The extracellular matrix is important in cervical length, and its understanding is essential for possible preventive actions. We emphasize the probable correlation of the local levels of glycosaminoglycans to prevent premature labor by inhibiting inflammatory processes from uterine cervix

Parto pretérmino y sufrimiento fetal secundarios a peritonitis por apendicitis aguda perforada / Premature labor and fetal distress in a women with perforating acute appendicitis

La apendicitis aguda es la urgencia quirúrgica no obstétrica más frecuente durante el embarazo. Se ha asociado a parto pretérmino y a morbimortalidad fetal y materna, especialmente cuando se complica con peritonitis. Los cambios anatómicos, fisiológicos y bioquímicos que se producen durante la gestación pueden alterar los síntomas y signos típicos asociados a la apendicitis. Esto puede retrasar el diagnóstico y dar lugar a un aumento de la morbimortalidad materna y fetal. Presentamos el caso de una paciente gestante de 35 semanas en que la dificultad en el diagnóstico de apendicitis aguda conllevó a un cuadro de peritonitis, secundario a perforación apendicular, que causó dinámica uterina prematura y sufrimiento fetal.

Acute appendicitis is the most common non-obstetric surgical emergency in pregnancy. It has been associated with premature labour and fetal and maternal morbidity and mortality, especially when complicated with peritonitis. Anatomical, physiological and biochemical changes during pregnancy may alter typical symptoms and signs associated with appendicitis. This can result in delayed diagnosis and lead to an increase in mother's and fetus morbimortality. We present a case of a pregnant woman at 35 weeks of gestation in whom the difficulty in diagnosis of acute appendicitis resulted in the appearance of peritonitis because of appendix perforation, which was the cause of preterm labour and fetal distress.

Effects of Abdominal Breathing on Preterm Labor Anxiety / 여성건강간호학회지

PURPOSE: The purpose of this study was to explore the effects of abdominal breathing on relieving anxiety in women diagnosed with preterm labor. METHOD: This was a pilot study, which was based on a repeated pre-post experiment design without a control group. Seven patients with preterm labor who were admitted to Y university medical center, Seoul, Korea, participated in the experiment. They were under receiving ritodrine hydrochloride(Yutopa) as tocolytic therapy and did not have any other complications. The patients were taught abdominal breathing, which is a modified version of Mason's breathing technique. The experimental treatments were done 33 times from February 18 to June 19 in 2005. RESULT: After abdominal breathing, the average psychological anxiety level decreased significantly. The physical anxiety levels of preterm labor patients were measured by blood pressure, pulse, and skin temperature. After abdominal breathing, the average systolic and diastolic blood pressure decreased from 117.3mmHg to 107.6 mmHg (z=-3.85, p<.001) and from 67.3mmHg to 62.7 mmHg (z=-3.14, p<.005), respectively. The average pulse rate also decreased from 97.2/min to 89.8/mim (z=-4.76, p<.001). The average skin temperature increased from 94.0 to 94.9(z=-4.80. p<.001). CONCLUSION: Abdominal breathing is effective for relieving anxiety of women diagnosed with preterm labor. This study, however, has been limited to short-term effects, and therefore further studies are required in order to examine the long-term effects of abdominal breathing.

Perfil de gestantes submetidas à inibição de trabalho de parto prematuro / Profile of pregnant women submitted to inhibition of premature bith

Trata-se de um estudo transversal, do tipo descritivo exploratório, com coleta de dados retrospectiva, cuja população foi constituída por gestantes que fizeram tratamento de inibição de trabalho de parto prematuro no Hospital Universitário da Universidade de São Paulo. Teve como objetivos, identificar a prevalência dos partos prematuros e de termos nas gestantes submetidas ao tratamento de inibição, verificar a frequência de internações hospitalares de gestantes com diagnóstico de trabalho de parto prematuro (TPP) e identificar os fatores de risco de prematuridade nas gestantes tratadas para inibir o TPP. Os dados foram coletados de 163 prontuários, no período de 1995 a 2000. A análise da associação entre os fatores de risco e o trabalho de parto prematuro foi feita pelo teste de associação do Qui-quadrado com correção de Yates e a análise conjunta foi feita pelo método de regressão logística múltipla. Apresentaram os seguintes resultados, a idade média das gestantes foi de 23,7 anos; 74,2% forma internadas apenas uma vez; 66,3% tiveram filhos prematuros. O tratamento prorrogou o parto de 1 a 87 dias (média 17,4 dias). Apenas 22,7% dos nascimentos ocorreram antes de 34 semanas. Houve associação estatística significativa entre parto prematuro e a existência de companheiro (p = 0,042), ser nulípara (p = 0,006) e o número de consultas de pré-natal (p = 0,042), ser nulípara (p = 0,006) e o número de consultas de pré-natal (p = 0,028). Na análise múltipla, a variável companheiro deixou de ser fator de risco pois estava associado à nuliparidade. Não apresentaram significância estatística, a idade, a escolaridade, a atividade ocupacional, o antecedente de prematuridade, o antecedente de abortamento, o intervalo interpartal, a presença de patologia e a ocorrência de infecção urinária

It is a transversal, descriptive exploratory study with retrospective data collection, carried out with pregnant women who undertook treatment to inhibit premature labor in the University Hospital of the University of São Paulo. The purposes were to identify the prevalence of premature and term birth in pregnant women submitted to inhibition treatment, to verify the frequency of hospital internation of pregnant women diagnosed with premature labor (TPP) and to identify the risk factors of prematurity in pregnant women treated od inhibit. The data were collected from 163 handbooks, in the period between 1995 and 2000. The analysis of the association between the risk factors and premature labor was performed through Qui-square association test with Yates correction. The combined analysis was performed using the multiple logistic regression method. The results are as folows: The age average of the pregnant women was 23,7 years; 74,2% of them were hospitalized only once; 66,3% had premature delivery. the treatment delayed the delivery from 1 to 87 days (average of 17,4 days). Only 22,7% of the births occured before 34 weeks. There was a significant statistic association between premature delivery and the existence of the companion (p = 0,042), nulipara (p = 0,006) and the number of prenatal consultations (p = 0,028). In multiple analysis, the variable companion ceased to be a risk factor due to its associations with first time pregnancy. the following did not present statistic significancy: age, schooling, occupation, previous case of prematurity, previous abostations, smoking, the period between births, pathology in pregnancy and urinary infection