Percepciones sobre la aplicación de principios bioéticos en mujeres puérperas en un Hospital público del Ecuador

Fundamento: El puerperio es el periodo de tiempo que comienza en la finalización del parto hasta las seis semanas posparto; durante el cual, es necesario brindar atención conforme a los principios bioéticos inscritos en la normativa de salud vigente en el Ecuador. Objetivo: Analizar las percepciones que tienen las mujeres puérperas sobre la aplicación de los 4 principios bioéticos durante la atención en salud. Metodología: El estudio es de tipo descriptivo con enfoque cualitativo. Los datos corresponden a 10 mujeres puérperas mayores de edad, atendidas en el Hospital Gineco Obstétrico Pediátrico de Nueva Aurora "Luz Elena Arizmendi" de la ciudad de Quito, que respondieron a una entrevista sobre los principios bioéticos aplicados en la atención recibida. Se realizaron análisis de contenido a través del software ATLAS TI versión 23. Resultados: Se obtuvo una percepción positiva de las mujeres puérperas acerca de la aplicación del principio de justicia. Por otra parte, se evidencian dificultades en el de autonomía, sobre todo en la comprensión de la información brindada a la paciente acerca de los procedimientos durante el parto y puerperio, además de coacciones por parte del personal sanitario. Se percibe el consentimiento informado como un mero trámite administrativo. El principio de beneficencia se lo asume como parte de la vocación del personal y la no maleficencia genera malestar si no va acompañado de información clara y oportuna. Conclusiones: Los principios bioéticos son transversales en la normativa de salud vigente, pero sobresale el de justicia en la atención a mujeres puérperas.

Background: The puerperium is the period of time beginning at the end of labor until six postpartum weeks; during which it is necessary to provide attention in accordance with the bioethical principles included in the current health guidelines in Ecuador. Objective: To analyze the perceptions that postpartum women have about the 4 bioethical principles application during health care. Methodology: The study type is descriptive with a qualitative approach. The data correspond to 10 adult postpartum women assisted at the Nueva Aurora "Luz Elena Arizmendi" Pediatric Obstetric and Gynecological Pediatric Hospital in the Quito city, who responded to an interview about the bioethical principles applied in the received care. Content analysis was conducted through ATLAS TI version 23 software. Results: A positive perception was obtained from postpartum women concerning the application of the Justice principle. Furthermore, difficulties are evident in the Autonomy section, mainly in the comprehension of the information provided to the patient about the procedures during the labor and puerperium, as well as coercion by health personnel. Informed consent is perceived as a mere administrative formality. The Beneficence principle is assumed as part of the vocation of the personnel and Non-maleficence generates discomfort if it is not accompanied by clear and opportune information. Conclusions: Bioethical principles are transversal in current health guidelines, but that of Justice stands out in the care of postpartum women.

Evidence-based practice in the management of maternal discharge preparation services / 中国实用护理杂志

Objective:To implement evidence-based practice of discharge preparation service in maternal and to explore the clinical effect.Methods:Based on the evidence-based continuous quality improvement framework, apply the evidence on the clinical through evidence acquisition, baseline evaluation, evidence introduction, and after-effect evaluation. Sixty women hospitalized in the obstetrics department of the Affiliated Hospital of Chengde Medical College from January to March 2021 were selected as the baseline group, and 60 women hospitalized in the obstetrics department of the hospital from April to July 2021 were selected as the evidence application group, to evaluate and compare the quality of discharge guidance for practitioners, discharge readiness level, maternal and newborn management knowledge level, incidence of maternal and newborn complications and the compliance of practitioners to evidence.Results:Finally, 10 pieces of evidence applied to clinical practice were included and 15 review indicators were translated. After the application of evidence, the quality of discharge guidance of practitioners increases from (141.83±24.66) to (166.13±10.30), the maternal discharge readiness increased from (127.12 ± 26.29) to (137.63 ± 22.59) , the score of maternal knowledge level increased from (164.58 ± 20.10) to (176.08 ± 24.25) , t values were -7.04, -2.39 and -2.83, all P<0.05. The incidence of postpartum women breast disease, postnatal constipation and newborn eczema, newborn red buttocks, newborn diarrhea, newborn jaundice decreased significantly, the difference were statistically significant, χ2 values were 5.21-7.50, all P<0.05. After the application of evidence, the implementation rate of the review indicators increased from ≤31.67% to ≥86.66%. Conclusions:The evidence-based practice of discharge preparation service in postpartum women improve the quality of discharge guidance for practitioners and compliance with evidence, promote clinical quality improvement, can be used for clinical reference.

Utilización de tromboprofilaxis en el período grávido - puerperal por Ginecólogos y Residentes de Ginecología del Uruguay

Resumen: Introducción: La enfermedad tromboembólica venosa en el período grávido - puerperal es una de las primeras causas de morbi-mortalidad materna. No existe un consenso acerca de las directivas para su abordaje, por lo que el objetivo de esta investigación fue conocer cómo se desempeñan los Ginecólogos y Residentes de Ginecología del Uruguay, con respecto a distintos factores de riesgo, la indicación de tromboprofilaxis y las herramientas disponibles. Metodología: Se realizó de julio a octubre del 2020, un estudio observacional, descriptivo, transversal donde se incluyeron a Ginecólogos y Residentes de Ginecología del Uruguay, mediante una encuesta electrónica anónima a través de la plataforma Survey Monkey. Resultados: Se obtuvo un n de 159 encuestados. El 57,3% refirió pensar sistemáticamente en factores de riesgo para enfermedad tromboembólica venosa. Las guías más utilizadas para la clasificación del riesgo e indicación de tromboprofilaxis fueron la American College of Obstestricians and Gynecologists con un 81,0% y la Royal College of Obstestricians and Gynaecologists con un 13,0%. La herramienta terapéutica con mayor disponibilidad es la heparina de bajo peso molecular y la menos utilizada es la compresión neumática intermitente. Conclusiones: Existen inconsistencias entre la clasificación de riesgo e indicación de tromboprofilaxis en diferentes situaciones clínicas. Existe un porcentaje no despreciable de profesiones que no piensan sistemáticamente en factores de riesgo para eventos tromboembólicos durante el período grávido - puerperal.

Abstract: Introduction: One of the main causes of maternal morbity and mortality in the pregnant - puerperal period is venous thromboembolic disease. There is no consensus on the guidelines to address this illness. The main objective of this research was to know how Gynecologists and Gynecology Residents of Uruguay perform, in reference to considering potential risk factors, indication for thromboprophylaxis and the tools available. Methodology: An observational, descriptive, cross-sectional study carried out from July to October 2020, including Gynecologists and Gynecology Residents of Uruguay, through an anonymous online survey using the Survey Monkey platform. Results: A final n of 159 respondents was obtained. 57.3% of which referred to think systematically about risk factors for venous thromboembolic disease. The most popular guidelines for risk classification and indication of thromboprophylaxis were the American College of Obstestricians and Gynaecologists with 81.0% and the Royal College of Obstestricians and Gynaecologists with 13.0%. The most chosen therapeutic tool was low molecular weight heparin, and the least preferred one was intermittent pneumatic compression. Conclusions: There are incoherences between the risk classification and the actual indication of thromboprophylaxis in different clinical situations. There´s still a non-negligible percentage of professionals that do not systematically consider risk factors for thromboembolic events during the pregnant-puerperal period.

Resumo: Introdução: A doença tromboembólica venosa no período gestação - puerpério é uma das principais causasde morbidadee mortalidade materna. Nãohá consenso sobre as diretrizes para o seu abordagem, por issoo objetivo desta pesquisa foi saber como encarao os ginecologistas e os residentes em ginecologia do Uruguai, no que dizrespeito à fatores de risco, indicação de tromboprofilaxia e as ferramentas disponíveis. Metodologia: Estudo observacional, descritivo e transveral realizado de julho a outubro de 2020, que incluiu ginecologistas e residentes em ginecologia do Uruguai. Um levantamento eletrônico anónimo foi desenvuelto através da plataforma SurveyMonkey. Resultados: Foram estudados 159 entrevistados. 57,3% relataram pensarsobre fatores de risco para doença tromboembólica venosa. As diretrizesmais utilizadas para classificação de risco e indicação de tromboprofilaxia foram o American College of Obstestricians and Gynecologists com 81,0% e o Royal College of Obstestricians and Gynaecologists com 13,0%. A ferramenta mais selecionada é heparina de baixo peso molecular e a menos utilizada é a compressão pneumática intermitente. Conclusões: Há inconsistências entre a classificação de risco e a indicação de tromboprofilaxia em diferentes situações clínicas. Ainda há um numero consideravel de profisionais que não pensam sistematicamente em fatores de risco para eventos tromboembólicos durante o período gravidez - puerperal.

A assistência do enfermeiro à parturiente no contexto hospitalar: um olhar sobre a violência obstétrica / The nursing care to the parturient in the hospital context: a look at obstetric violence / El cuidado de enfermería a la parturienta en el contexto hospitalario: una mirada a la violencia obstétrica

Objetivo: Analisar a recorrência da violência obstétrica, elucidar a heterogeneidade deste tema, compreender o tratamento recebido pelas pacientes, e discorrer a visão da enfermagem frente à Violência obstétrica. Método: Metodologia descritiva; revisão bibliográfica a partir da plataforma Google Acadêmico, embasada em artigos publicados em bases científicas como SciELO, PubMed, Lilacs, etc., com abordagem qualitativa. Resultados: Trata-se de qualquer ato exercido por profissionais da saúde no que cerne ao corpo, aos processos reprodutivos e ao psicológico das mulheres, exprimido através de uma atenção desumanizada, abuso de ações intervencionistas, medicalização e a transformação patológica dos processos de parturição fisiológicos. Conclusão: Foi possível compreender que há necessidade da criação de leis rigorosas que concretizem o conceito de Violência obstétrica e puna os responsáveis por praticála, mais pesquisas e debates envolvendo este tema, orientações a respeito dos direitos das grávidas, parturientes e puérperas, fiscalização rotineira das instituições e a busca pela educação continuada.

Objective: Analyze the recurrence of Obstetric Violence, elucidate the heterogeneity of this theme, understand the treatment received by patients, and discuss the view of nursing in relation to Obstetric Violence. Method: Descriptive methodology; bibliographical review using the Google Academic platform, based on articles published in scientific databases such as SciELO, PubMed, Lilacs, etc., with a qualitative approach. Results: It is any act performed by health professionals regarding the body, reproductive and psychological processes of women, expressed through dehumanized care, abuse of interventionist actions, medicalization and the pathological transformation of physiological parturition processes. Conclusion: It was possible to understand that there is a need to create strict laws that implement the concept of Obstetric Violence and punish those responsible for practicing it, more research and debates involving this topic, guidance on the rights of pregnant women, parturients and postpartum women, inspection routine of institutions and the search for continuing education.

Objetivo: Analizar la recurrencia de la violencia obstétrica, dilucidar la heterogeneidad de este tema, comprender el trato recibido por los pacientes y discutir la visión de la enfermería en relación a la Violencia Obstétrica. Método: Metodología descriptiva; Revisión bibliográfica mediante la plataforma Google Academic, basada en artículos publicados en bases de datos científicos como SciELO, PubMed, Lilacs, etc., con un enfoque cualitativo. Resultados: Es todo acto realizado por profesionales de la salud en relación con los procesos corporales, reproductivos y psicológicos de la mujer, expresado a través de cuidados deshumanizados, abuso de acciones intervencionistas, medicalización y transformación patológica de los procesos fisiológicos del parto. Conclusión: Se pudo entender que existe la necesidad de crear leyes estrictas que implementen el concepto de violencia obstétrica y sancionen a los responsables de practicarlo, más investigaciones y debates en torno a este tema, orientaciones sobre los derechos de las mujeres embarazadas, parturientas y posparto. la mujer, la rutina de inspección de las instituciones y la búsqueda de la educación continua.

Analysis on the level of knowledge, attitude and practice of rehabilitationfor postpartum diastasis recti abdominisinpuerperaeand the influencing factors of behavior / 中国实用护理杂志

Objective:To explore the current level of knowledge, attitude and practice of rehabilitation for postpartum diastasis recti abdominis inpuerperae, and analysis the influencing factors of behavior, in order to provide a reference frame for nursing staff to formulate effective health education programs.Methods:From November 2020 to April 2021, a self-designed questionnaire was used to investigate 522 puerperae from 4 tertiary hospitals in Guangdong province, Jiangsu province and Zhejiang province, to explore their level of knowledge, attitude and behavior of rehabilitation for postpartum diastasis recti abdominis. Mann-Whitney Utest or Kruskal-Wallis Htest was used for univariate analysis, Binary Logistic regression analysis was used to analysis the influencing factors of rehabilitative behavior.Results:The median score of knowledgedimension, attitude dimension and behavior dimension of rehabilitation for postpartum diastaisis recti abdominis in puerperae respectively were 47.0 (36.0, 55.0), 26.0 (24.0, 31.0), 15.0 (10.0, 18.0) points. The results show that the main factors influencing of rehabilitation behaviorfor postpartum diastaisis recti abdominis in puerperae were knowledge ( χ2 = 87.78, P<0.05), attitude ( χ2 = 4.77, P<0.05), number of deliveries ( χ2 = 3.94, P<0.05) and family personal monthly income ( χ2 = 4.88, P<0.05). Conclusions:At present, puerperae have a positive attitude towards rehabilitation for postpartum diastasis recti abdominis, but the level of knowledge and practice of rehabilitation for postpartum diastasis recti abdominisneed to be improved.Nursing staff should focus on puerperae with incomplete knowledge, negative attitude, multiple deliveries and low family personal monthly income.

Research on postpartum physical activities based on the best evidence / 中国康复理论与实践

ObjectiveTo summarize and evaluate the best evidence for postpartum physical activity and exercise regimens. MethodsLiteratures of postpartum sports and exercise programs were searched from JBI, UpToDate, Cochrane Library, International Federation of Gynecology and Obstetrics (FIGO), The Agency for Healthcare Research and Quality(AHRQ), Royal College of Obstetricians and Gynaecologists (RCOG), American Collage of Obstetricians and Gynecologists (ACOG), Registered Nurses' Association of Ontario (RNAO), World Health Organization (WHO), Fitness Australia (FA), National Institute for Health and Care Excellence (NICE), Web of Science, PubMed, CINAHL, Medlive, CNKI, and Wanfang Data, from database inception to October, 2021. Two researchers independently evaluated the literature quality according to the tool of the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE Ⅱ), A Measurement Tool to Assess Systematic Reviews (AMSTAR), and Joanna Briggs Institute Critical Appraisal Checklist. ResultsA total of 15 articles were selected, including four randomized controlled trials, four systematic reviews, one cross-sectional study, one evidence summary, four guidelines, and one expert consensus. A total of 28 pieces of evidence were summarized, including the significance of postpartum physical activity and exercise, obstacle factors, assessment, exercise style, intensity and timing, and precautions. ConclusionKnowledge of exercise after delivery is important to promote women's health and quality of life. It is recommended that the evidence be screened on a case-by-case basis and that an individualized programme of physical activity and exercise be developed.

Establishment and validation of nomogram for postpartum stress urinary incontinence / 中华泌尿外科杂志

Objective:To analyze the predictive factors of postpartum SUI, and establish and validate nomogram model.Methods:A total of 272 patient from Affiliated Jinhua Hospital, Zhejiang University School of Medicine were reviewed, and the general clinical data and ultrasound parameters were analyzed. The median age (range) was 32 (28-38) years. Vaginal delivery was recorded in 191(70.0%), while cesarean section was performed in 81(30.0%) cases. The average body mass index (BMI) was (23.0±2.9) kg/m 2. The median bladder neck mobility was 2.5cm and rate of bladder neck funnel was 25%. Patients were divided into two groups: Group SUI(n=98) and Group NSUI (without SUI, n=174). The independent predicting SUI were analyzed by univariate and multivariate logistic regression analysis. Two predictive models were constructed with the important general clinical data and ultrasound parameters, then receiver operating characteristic (ROC) curve analyses were conducted to evaluate the predictive power of two models. At last, the nomogram was established for the better model. Results:The results of multivariate analysis showed that age( OR=1.08, P=0.011), delivery method( OR=9.26, P<0.01), body mass index( OR=1.15, P=0.023), bladder neck distance ( OR=1.73, P=0.047) and bladder neck funneling( OR=18.44, P<0.01) were independent predictors for SUI. Two predictive models were used with independent predictors of SUI. The area under the receiver operating characteristic(ROC)curve of validation group was 0.88. The area under the ROC curve of general clinic factors was 0.77. The difference between the two model and other indicators was statistically significant( P<0.001). The nomogram model was well calibrated, with the mean absolute error of 1.9%. Conclusions:Age, delivery method, BMI, bladder neck mobility and bladder neck funneling were independent predictors for SUI. The nomogram model for predicting SUI has a good statistical significance.

Research on the mediation effect of expectation gap of postpartum support between perceived stress and postpartum depression / 中国实用护理杂志

Objective:To investigate the relationships of expectation gap of postpartum support with perceived stress and postpartum depression, and the mediating role of the former in the association between the latter two.Methods:A total of 278 convenient sample of puerperas at 6-8 weeks after delivery from June to August in 2019 in Shenzhen Hospital of Southern Medical University were investigated with the Perceived Stress Scale, the Chinese version of the Postpartum Social Support Questionnaire, and the Edinburgh Postnatal Depression Scale. Structure equation model was established and Bootstrap method was used to explore the direct and indirect effects of these variables.Results:The perceived stress score, and expectation gap of postpartum support score were (26.50±2.50), (25.30±5.79), respectively; and the postpartum depression score was (14.60±2.10). The incidence of postpartum depression(defined as postpartum depression score ≥10) was 37.4%(104/278). Path analysis showed that the model was well fitted (χ 2/ df was 0.265, Tucker-Lewis index was 1.0, comparative fit index was 1.0,root mean square of approximate error was 0, root mean square of standard deviation and residual error was 0.04). Perceived stress positively correlated with expectation gap of postpartum support, and postpartum depression ( P<0.05). Expectation gap of postpartum support positively correlated with postpartum depression ( P<0.05). The effect of perceived stress on postpartum depression was partially mediated by expectation gap of postpartum support (Estimate was 0.285, 95% CI 0.197-0.352). Conclusions:Perceived stress had direct or indirect effect via expectation gap of postpartum support on postpartum depression. This indicated that the medical staff can build a comprehensive support system, reduce the experience of perceived stress among puerperas, improve social support satisfaction, and thus reduce the incidence of postpartum depression.

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

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

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

Masa pélvica en la mujer puérpera. Presentación de caso / Pelvic mass in puerperal woman. Case presentation

El término infección puerperal se utiliza para describir cualquier infección bacteriana del aparato genital después del parto. Durante gran parte del siglo XX las infecciones puerperales, la preeclampsia y la hemorragia obstétrica formaron parte de la tríada letal de mortalidad materna. La ecografía, la resonancia magnética y la tomografía axial computarizada son la triada de elección para el diagnóstico del abdomen agudo en el puerperio. El mismo resulta difícil debido a factores intrínsecos y es entonces, cuando el radiólogo adquiere un papel crucial. Se presentó un caso de una mujer de 30 años, con 8 días de habérsele practicado una cesárea con un puerperio inmediato normal. Posteriormente presentó dolor abdominal, fiebre, escalofríos y masa palpable en fosa iliaca izquierda. Se practicaron técnicas de imágenes se plantea una masa ovárica izquierda, se realizó laparotomía exploradora y se concluyó como absceso ovárico (AU).

The term puerperal infection is used to describe any bacterial infection of the genital tract after delivery. During much of the twentieth century puerperal infections, preeclampsia and obstetric hemorrhage were part of the lethal triad of maternal mortality. Ultrasonography, magnetic resonance imaging and computed tomography are the triad of choice for the diagnosis of acute abdomen in the puerperium, which is difficult due to intrinsic factors and it is when radiologist plays a vital role. The authors present the case of a woman, aged 30 years, at the 8th day after undergoing a cesarean section with a normal immediate puerperium, who later presented abdominal pain (AU).

Research of the effects for the hepatitis B virus puerpera′s breastfeeding by pluralistic management in hospital / 中国实用护理杂志

Objective@#To discuss the impact and practicability of pluralistic management when puerpera with hepatitis B virus (HBV) in hospital.@*Methods@#By review researching and convenient sampling, two groups of puerpera with HBV were studied comparatively by the index of the time of breast milk, the breastfeeding rate and the satisfaction rate in hospital.The control group (411 cases, January to December, 2017) carried on the normal regulations nursing and the observation group (411 cases, January to October, 2018) carried on the pluralistic management in the Obstetrics and Gynecology Department of the Fifth Medical Center of PLA General Hospital.@*Results@#The rate of the starting time of milk secretion (<24, 24-48, 49-72, >72 h) was 29.4%(121/411), 36.0%(148/411), 24.6%(101/411), 1.0%(41/411) in the observation group, and 13.6%(56/411), 21.7%(89/411), 33.3%(137/411), 31.4%(129/411) in the control group. The differences between the two groups were significant (χ2 value was 7.66-57.43, all P<0.01). Postpartum hospital stay in 3 days and 6 days, the breastfeeding rate and average rate was 90.4%(198/219), 95.3%(183/192), 92.7%(381/411) in the observation group, and 79.0%(180/228), 84.2%(154/183), 81.3%(334/411) in the control group, the differences between the two groups were significant (χ2 value was 11.13, 12.7, 23.61, all P<0.01). The total satisfaction rate in hospital was 99.5%(409/411) in the observation group, and 91.2%(375/411) in the control group, the difference between the two groups was significant (χ2 value was 31.93, P<0.01).@*Conclusions@#Pluralistic management can raise the rate of breastfeeding of puerpera with HBV and the satisfaction of puerpera with HBV and her family.

Factores de riesgo asociados al bajo peso al nacer en un área de salud de Santiago de Cuba / Risk factors associated with low birth weight in an health area from Santiago de Cuba

Introducción: El bajo peso al nacer constituye en todo el mundo y grupos de poblaciones el índice más importante para determinar las posibilidades que tiene el recién nacido de sobrevivir y tener un crecimiento sano. Objetivo: Identificar algunos factores de riesgo sociobiológicos asociados al bajo peso al nacer en el área de salud del Policlínico Docente 30 de Noviembre de Santiago de Cuba durante el 2016. Métodos: Se realizó un estudio analítico, de casos y controles. Se escogieron como controles a las 8 puérperas que aportaron igual cantidad de recién nacidos con bajo peso y como controles a 16 de las madres cuyo producto de la concepción tuvo un peso normal en igual período. Entre las variables analizadas figuraron: edad materna, antecedentes obstétricos desfavorables, enfermedades previas asociadas y propias del embarazo, edad gestacional en el momento del parto y estado nutricional. Resultados: En la serie predominaron las enfermedades previas y propias del embarazo, fundamentalmente la anemia y la infección vaginal; mientras que el parto pretérmino tuvo alta significación estadística. Conclusiones: Los factores de riesgos biológicos con mayor fuerza de asociación fueron la malnutrición por defecto durante la captación, las enfermedades previas y asociadas al embarazo; en tanto, entre los factores con significación estadística predominaron la prematuridad y el período intergenésico corto, no así los antecedentes obstétricos desfavorables. Existió correlación entre la edad gestacional, el bajo peso al nacer, la presencia de partos pretérminos y el crecimiento intrauterino retardado.

Introduction: Low birth weight constitutes in the entire world and populational groups the most important index to determine the possibilities that the newborn has to survive and to have a healthy growth. Objective: To identify some social and biological risk factors associated with low birth weight in the health area from 30 de Noviembre Teaching Polyclinic in Santiago de Cuba during 2016. Methods: An analytic study of cases and controls was carried out. The 8 postpartum women who contributed with the same quantity of underweight newborns and as controls 16 of the mothers whose product of the conception had a normal weight in same period were chosen. Among the analyzed variables there were: maternal age, unfavorable obstetric history, associated previous diseases and diseases characterizing pregnancy, gestational age at childbirth and nutritional state. Results: Previous diseases and diseases characterizing pregnancy, fundamentally anemia and vaginal infection prevailed in the series; while preterm childbirth had a high statistical significance. Conclusions: Biological risk factors with greater association force were malnutrition defect during registration, the previous diseases and those associated with pregnancy; as long as, among the factors with statistical significance prematurity and the short intergenesis prevailed, what did not occur with the unfavorable obstetric history. Correlation existed between gestational age, low birth weight, the presence of preterm childbirths and the slowed intra-uterine growth.

Óbito por leishmaniose visceral em puérpera no município de Palmas, Tocantins, Brasil / Death due to visceral leishmaniasis in puerperium in the municipality of Palmas, Tocantins, Brazil

Relato de caso: neste estudo, foi relatado um óbito por LV, ocorrido em uma puérpera, no município de Palmas, Tocantins, cuja enfermidade não foi identificada durante a gestação, tampouco no período em que permaneceu hospitalizada; evidenciados os fatores que contribuíram para a letalidade do caso; e discutidas as formas adequadas de manejo. Conclusão: por meio de investigação rigorosa nos registros clínicos, laboratoriais e informações junto à família, foi detectada ausência de informações nos prontuários médicos, falhas no monitoramento da paciente, dificuldades de reconhecer um quadro grave de LV em puérpera e, com isso, a necessidade de atualização dos profissionais de saúde com relação à análise clínica e laboratorial, a fim de que haja uma avaliação mais apurada dos sintomas, detecção precoce das complicações, diagnóstico rápido, tratamento adequado e evitar a ocorrência de óbitos.

Case report: In this study, a death due to LV occurred in a puerpera, in the municipality of Palmas, Tocantins, whose disease was not identified during pregnancy, nor during the period in which she was hospitalized evidenced the factors that contributed to the lethality of the case; and discussed the appropriate forms of management. Conclusion: A rigorous investigation in the clinical, laboratorial and family records revealed a lack of information in the medical records, failure to monitor the patient, difficulties in recognizing a severe VL in the puerperium, and with this, the need for updating of health professionals with respect to clinical and laboratory analysis, in order to have a more accurate evaluation of symptoms, early detection of complications, rapid diagnosis, adequate treatment and avoiding the occurrence of deaths.

Fascitis necrotizante en puérpera de once días / Necrotizing Fasciitis in Eleven-Day Postpartum

Introducción: La fascitis necrotizante es una infección progresiva poco común, con alta letalidad que puede afectar a cualquier parte del cuerpo, pero es más frecuente en las extremidades, en especial en las piernas, causada en su mayoría por una infección polimicrobiana y se caracteriza por afectar la fascia superficial, tejido subcutáneo, grasa subcutánea con nervios, arterias, venas y fascia profunda. Objetivo: Reportar el caso de una puérpera diagnosticada de fascitis necrotizante. Presentación de caso: Puérpera de 28 años de edad con antecedentes de obesidad e infección por VIH, ingresada en el Servicio de Obstetricia en un hospital de la República Sudafricana, por presentar fiebre, escalofríos y dolor en el abdomen. Se utilizó tratamiento endovenoso con antibióticos y tratamiento quirúrgico. Resultados: Evolución satisfactoria de la paciente sin secuelas. Conclusiones: El diagnóstico oportuno de esta patología permite un accionar temprano, con la consecuente sobrevida de los pacientes(AU)

Introduction: Necrotizing fasciitis is a very lethal uncommon progressive infection that can affect any part of the body, however it is more frequent in the limbs, especially the legs, caused mostly by a polymicrobial infection. It affects the superficial fascia, subcutaneous tissue, subcutaneous fat with nerves, arteries, veins and deep fascia. Objective: To report the case of a puerpera diagnosed with necrotizing fasciitis. Case presentation: A 28-year-old woman with a history of obesity and HIV infection, was admitted to the Obstetrics Service at a hospital in the Republic of South Africa. She had fever, chills and pain in the abdomen. Intravenous treatment with antibiotics and surgical treatment was used. Results: Satisfactory evolution of the patient with no sequelae. Conclusions: The opportune diagnosis of this pathology allows acting early, with the consequent survival of the patients(AU)

Prevention effect of collaborative care model-based continuous nursing on the postpartum posttraumatic stress disorder / 中国实用护理杂志

Objective@#To explore the effectiveness of collaborative care model-based continuous nursing on the postpartum posttraumatic stress disorder(PPTSD), to provide reference for postpartum clinical nursing.@*Methods@#A total of 100 cases of postpartum puerpera in Beijing Luhe Hospital of Capital Medical University were assigned to the intervention group and the control group according to the random number table method with 50 cases each. In the control group, patients received continuous nursing, however, collaboration care model-based continuous nursing care was carried out in the intervention group. The PPTSD status and psychological resilience between the two groups was assessed by Posttraumatic stress Checklist-Civilian version (PCL-C) and Connor-Davidson Resilience Scale (CD-RISC), respevtively.@*Results@#Before intervention, symptoms scores and total scores of PCL-C and CD-RISC between the two group was no statistical difference (P>0.05). After intervention, the scores of increased arousal symptoms (7.22±1.09), avoidance/numbing (9.77±2.41), re-experiencing symptoms (5.66±1.17) and PCL-C total scores (22.64±3.02) were significantly decreased in the intervention group compared to the control group (8.32 ± 1.05), (11.46 ± 2.87), (6.36 ± 1.25), (26.14 ± 3.27), and there were significant differences between the two groups (t=2.899-5.559, all P<0.01). However, the scores of tenacity (24.90 ± 4.83), strength (14.91 ± 2.25), optimism (7.18 ± 1.61) symptoms and CD-RISC total scores (46.99 ± 6.30) were remakedly increased in the intervention group compared to the control group (23.22 ± 2.69), (13.61 ± 1.75), (6.14 ± 0.91), (42.97 ± 3.30), there were significant differences between the two groups (t=2.154-4.011, P<0.05 or 0.01).@*Conclusions@#Collaboration care model-based continuous nursing care can promote the psychological resilience and alliviate PPTSD.

Effect of lactation confirmation on breastfeeding behavior and confidence in maternal breastfeeding nursing / 现代临床护理

Objective To investigate the effect of lactation confirmationon breastfeeding behavior and confidence in maternal breastfeeding nursing. Methods 63 puerperas admitted and treated from June 2015 to June 2016 in our hospital was assigned as control group, and another 63 ones from July 2016 to July 2017 in our hospital as observation group. The control group was treated with routine postpartum care and the latter with lactation confirmation. The two groups were compared in terms of breastfeeding behavior, confidence and lactation volume. Results The breastfeeding rates of the observation group at 24h, 48h, 72h after delivery were significantly higher than those of the control group (all P＜0.05). The confidence scores of the observation group at 24h, 48h, 72h after delivery weresignificantly higher than those of the control group (all P＜0.05).The amount of milk produced by the observation group at 24h, 48h, 72h after delivery was significantly higher than that of the control group (all P＜0.05). Conclusion Lactation confirmation used in puerperal breastfeeding can effectively improve the rate of breastfeeding, increase their confidence in breastfeeding and improve milk yield, worthy of clinical promotion.

Survey on knowledge of stress urinary incontinence in postpartum women in Shanghai Meilong district / 中华全科医师杂志

Objective To survey the prevalence of stress urinary incontinence(SUI)and related knowledge among postpartum women in Shanghai Melong district.Methods A questionnaire survey on the knowledge of stress urinary incontinence was conducted among 317 postpartum women who were home visited by Meilong Community Health Service Center between March 2017 and June 2017.The self-designed questionnaire included the general situation(age, height, weight, occupation, menstrual history), pregnancy and childbirth, and knowledge of SUI; the International Consultation on Incontinence Questionnaire Short form(ICIQ-SF)was also used.Total 317 questionnaires were distributed and 313 valid ones were retrieved(98.73%).Results The prevalence of SUI in the participants was 26.84%(84/313).Multivariate logistic regression showed that BMI≥24 kg/m2(OR=6.24, 95% CI: 3.41 -11.41), complicated metabolic syndrome(OR=9.84, 95% CI: 2.77 -34.96)and birth weight of previous child ≥4 kg(OR=0.09,95%CI:0.04-0.19)is independent risk factors for the development of SUI.The average SUI knowledge score was(10.39 +8.65)points, only 26.20%(82/313)of the participants knew Kegel training(score 5.99 ±1.60).The SUI knowledge level of postpartum women was associated with educational level(F=12.41),occupation(F=9.06), income(F=4.05), reproductive history(F=10.98)and presence of urinary incontinence symptom(F=22.31)(all P<0.05). Conclusion The knowledge level of maternal stress urinary incontinence in Meilong district is relatively low,and the publicity of SUI and pelvic floor rehabilitation knowledge should be enhanced for the pregnant women.

Knowledge and attitudes of puerperal women relating to breastfeeding in a university hospital / Saberes e atitudes de puérperas sobre o aleitamento materno em um hospital universitário

Breastfeeding (BF) has presented, among other benefits, a reduction in infant mortality, a prevention of respiratory infections and a reduction in the risks of developing diseases. Therefore, the objectives of this study were to evaluate the knowledge and attitudes of puerperal in relation to BF in a university hospital, as well as the sources from which this information was obtained and the professional categories responsible for same. The work was carried out at the Hospital das Clinicas, Federal University of Uberlândia (HC-UFU). Structured interviews were conducted to obtain data for the evaluation of information and exercise of the BF practice with puerperal hospitalized in the accommodation complex, for mother and child, from July 1st to December 31st, 2010. Of the total of 907 women interviewed, 617 (68.0%) intended to BF for 12 months or more, 566 (62.4%) performed the BF within the first hour of birth, in 551 cases (60.8%) the decision to BF was taken by the woman before the current pregnancy and 828 (91.3%) received help in BF. Of the women who received help, 788 (95.1%) were assisted by professionals from the nursing team. It was shown that the majority of the puerperal intended to breast-feed for 12 months or more, considering that they also carried out BF in the first hour after child birth. The study also noted the importance of the nursing staff in taking care of the mother/child pair, promoting better interaction and acceptance of BF.

O aleitamento materno tem, dentre outros benefícios, a diminuição da morbimortalidade infantil, a prevenção de infecções respiratórias e a redução dos riscos de desenvolvimento de doenças, portanto, os objetivos deste estudo foram avaliar os saberes e atitudes de puérperas sobre aleitamento materno em um hospital universitário, bem como as fontes de obtenção e as categorias profissionais responsáveis por essas informações. O trabalho foi realizado no Hospital das Clínicas da Universidade Federal de Uberlândia (HC-UFU). Foram realizadas entrevistas estruturadas para obtenção de dados para avaliação de informações e exercício da prática do AM com puérperas internadas no alojamento conjunto, entre 1º de julho a 31 de dezembro de 2010. Do total de 907 entrevistadas, 617 (68,0%) das mulheres pretendiam amamentar por 12 meses ou mais, 566 (62,4%) das mulheres realizaram o AM já na primeira hora do nascimento, em 551 (60,8%) a decisão de amamentar foi tomada pela mulher antes da gravidez atual e 828 (91,3%) receberam ajuda no processo de amamentação. Das mulheres que receberam ajuda, 788 (95,1%) foram auxiliadas por profissionais da equipe de enfermagem. Foi demonstrado que a maioria das puérperas pretendia amamentar por 12 meses ou mais, tendo em vista que também realizaram o AM na primeira hora. Observou-se também a importância da equipe de enfermagem para com o cuidado do binômio mãe/filho, fazendo com que houvesse melhor interação e aceitação do AM

Preoperative risk factors analysis of pulmonary hypertension crisis during perioperative period for caesarean section of woman with severe pulmonary hypertension / 中华危重病急救医学

Objective To analyze preoperative risk factors of perioperative pulmonary hypertension crisis (PHC) for pregnant woman with severe pulmonary artery hypertension (PAH), and approach its clinical value. Methods A retrospective analysis was conducted. The clinical data from 152 pregnant women with severe PAH underwent cesarean delivery admitted to Beijing Anzhen Hospital from January 1st 2008 to December 31st 2016 was collected. The patients were divided into two groups according to with perioperative PHC or not. Through the case management system, age, height, weight, gestational age, pregnancy time, type of PAH, emergency or selective surgery, New York Heart Association (NYHA) cardiac function classification, and preoperative ultrasound left ventricular ejection fraction (LVEF), left ventricular diastolic final diameter (LVEDD), the pulmonary artery systolic pressure (sPAP) estimated by ultrasonic TI method, radial artery systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), pulse oxygen saturation (SpO2) without oxygen, oral sildenafil ingestion, having Swan-Ganz catheter placement or not, and whether used norepinephrine or not, as well as the occurrence of perioperative PHC and clinical outcomes were collected. Possible preoperative risk factors were compared between the two groups by single factor and multiple factors logistic regression analysis. The receiver-operating characteristic curve (ROC) was plotted to assess the diagnostic value of various risk factors.Results A total of 152 patients were screened. Ten patients got heart surgery under general anesthesia at the same time, and 4 patients experiencing cesarean section with general anesthesia were excluded. 138 patients were enrolled finally, 27 patients underwent perioperative PHC (19.57%), and 17 patients died with a mortality of 62.96%. Compared with non-PHC group, the patients in PHC group were older (years: 25.07±3.55 vs. 27.64±4.82), had a poor cardiac function (NYHA cardiac function classification: 3.22±0.64 vs. 2.85±0.53), a smaller LVEDD (mm: 38.78±4.76 vs. 43.91±9.67), lower SpO2 without oxygen (0.83±0.12 vs. 0.92±0.06) and oral sildenafil ingestion rate (29.63% vs. 56.76%), and higher sPAP estimated by ultrasonic TI method [mmHg (1 mmHg = 0.133 kPa): 113.41±24.73 vs. 99.35±21.10] and DBP (mmHg: 79.63±13.23 vs. 75.23±12.14), more having Swan-Ganz catheter placement (85.19% vs. 57.66%), more Eisenmenger syndrome (70.37% vs. 37.84%), and more emergency operation (48.15% vs. 23.42%, allP ≤ 0.1). The variables with statistically significant differences showed by single factor analysis were collected, and it was shown by multiple factors logistic regression analysis that LVEDD [odds ratio (OR) = 0.878, 95% confidence interval (95%CI) = 0.796-0.968,P = 0.009], whether oral taken sildenafil (OR = 0.161, 95%CI = 0.051-0.515,P = 0.002) or not, SpO2 at room air (OR = 0.882, 95%CI = 0.829-0.938,P = 0.000), Swan-Ganz catheter placement or not (OR = 6.186, 95%CI = 1.533-24.964,P = 0.010) were independent risk factors of perioperative PHC in pregnant women with severe PAH. It was shown by ROC curve analysis that the area under the ROC curve (AUC) of four factors mentioned above combined diagnosis for PHC was 0.878 (P = 0.000) with the sensitivity of 88.89% and specificity of 76.58%.Conclusions PHC is very dangerous for gravida with severe PAH, and the mortality rate is very high. LVEDD, oral sildenafil, SpO2 at room air, Swan-Ganz catheter placement or not were independent risk factors of perioperative PHC for severe PAH maternal. Four preoperative factors of perioperative PHC joint diagnosis accuracy were higher.

The current situation of maternal self-efficacy of breast feeding and its influencing factors / 中国实用护理杂志

Objective To investigate the current situation of maternal self- efficacy of breastfeeding and explore its influencing factors in Zhengzhou. Methods Using the general condition questionnaires, breast feeding self-efficacy scale, perceived social support scale and Edinburgh postnatal depression scale to assess the situation of 180 puerperas by the convenience sampling in one obstetric hospital of Zhengzhou. Results The total score of maternal breast feeding self-efficacy was(114.04 ± 21.57)points.The frequency of delivery, the way of delivery and feeding ways, the average income of family were effected with breastfeeding self-efficacy. The total score of social support was(68.87 ± 10.43) points, the total score of puerperas depression was(7.61 ± 4.25) points.The social support score had positive correlation with breastfeeding self-efficacy(r=0.423, P<0.01). Puerperas depression had negative correlation with breastfeeding self- efficacy(r=- 0.342, P<0.01). Conclusions The maternal breastfeeding level in Zhengzhou was at a lower level. The level of maternal breastfeeding self-efficacy scale was impacted by maternal social support degree, the degree of depression. Measures should be taken to enhance maternal social support degree, reduce the degree of depression, in order to improve the level of maternal breastfeeding self-efficacy.