Prevalencia de subtipos de cáncer de mama y su asociación con factores reproductivos / Prevalence of breast cancer subtypes and their association with reproductive factors

Introducción: Los factores reproductivos se asocian con cáncer de mama. Actualmente se estudia el comportamiento según subtipos moleculares. Objetivo: Establecer la prevalencia de estos subtipos y su asociación con factores reproductivos en mujeres atendidas en centros del nororiente colombiano. Método: Estudio observacional de corte transversal, en mujeres con cáncer de mama subtipos luminales y HER2 durante 2012-2021. Se indagaron variables sociodemográficas, factores reproductivos y estadio tumoral. Resultados: En total, 347 pacientes cumplieron criterios de elegibilidad, correspondiendo a luminal A el 49,8% (intervalo de confianza del 95% [IC95%]: 44,5-55,1), a luminal B el 29,1% (IC95%: 24,3-33,9) y a HER2 el 15,5% (IC95%: 11,7-19,4). Las mujeres con tumores de mama luminal B tenían más riesgo de tener estadios localmente avanzados (odds ratio [OR]: 1,83; IC95%: 1,11-3,01; p = 0,02). Agrupando los subtipos luminales frente a HER2 se encontró que el 40,72% de las pacientes con subtipos luminales no habían lactado, frente al 69,71% con HER2 (diferencia estadísticamente significativa a favor de luminal A; OR: 1,91; IC95%: 1,02-3,53; p = 0,041). Conclusiones: La prevalencia de tumores luminales es del 84,5%. Existe asociación diferencial entre el antecedente de lactancia materna y la aparición de subtipos luminales, es decir, las mujeres que no lactaron se corresponden con mayor frecuencia con HER2. No se estableció asociación con otros factores estudiados.

Introduction: Stimulus-estrogenic factors are associated with breast cancer. Currently, the behavior according to molecular subtypes is being studied. Objective: To establish the prevalence of these subtypes and their association with reproductive factors in women attended in centers in northeastern Colombia. Method: Observational cross-sectional study in women with breast cancer subtypes luminal and HER2 during 2012 -2021. Sociodemographic variables, stimulus-estrogenic factors and tumor stage were investigated. Results: In total, 347 patients met eligibility criteria, corresponding to luminal A 49.8% (95% confidence interval [95%CI]: 44.5-55.1), luminal B 29.1% (95%CI: 24.3-33.9) and HER2 15.5% (95%CI: 11.7-19.4). Women with luminal B breast tumors were at higher risk of having locally advanced stages (odds ratio [OR]: 1.83; 95%CI: 1.11-3.01; p = 0.02). Grouping the luminal subtypes versus HER2 showed that 40.72% of patients with luminal subtypes had not lactated, compared to 69.71% HER2 (statistically significant difference in favor of luminal A; OR: 1.91; 95%CI: 1.02-3.53; p = 0.041). Conclusions: The prevalence of luminal tumors is 84.5%. There is a differential association between the history of breastfeeding and the appearance of luminal subtypes, i.e., women who did not breastfeed are more likely to have HER2. No association was established with other factors studied.

Birth Preparedness and Complication Readiness among Pregnant and Recently Delivered Women in Gandhinagar District, Gujarat, India: A Community-based Cross-sectional Study

Background: Birth Preparedness and Complication Readiness (BPCR) helps in improving the effective utilization of available maternal and newborn health care services through knowledge of danger sign, identifying birth place and attendant, means of transportation, managing fund for an emergency, birth companion and identification of blood donor. Aim: To find the association between socio-demographic characteristics and BPCR index indicators. Settings and Design: A cross-sectional study was conducted among the recently delivered and pregnant women in urban and rural areas of the Gandhinagar district of Gujarat. Methods and Material: Total 420 pregnant and recently delivered women from urban and rural areas were interviewed for study. A pretested semi-structured questionnaire was used to interview women at household setting. BPCR index is estimated by set of 7 quantifiable indicators and expressed in the percentage of women with specific characteristics. Results: Regarding ANC registration within 12th weeks of pregnancy and skilled birth attendant for delivery. Significant difference was observed with variable like APL/BPL status, education of women and their husband, parity and type of family. Conclusions: Hindu religion, APL economic status, higher education level, joint family, high parity and joint family were found important predictor of better BPCR practice.

Desfechos materno-fetais adversos relacionados a paridade em uma maternidade do sul do Brasil / Adverse maternal-fetal outcomes related to parity in a maternity hospital in Southern Brazil

Avaliar os desfechos adversos perinatais relacionados à primiparidade. Trata-se de um estudo de corte transversal, realizado na Maternidade Darcy Vargas em Joinville­SC, no período de agosto a dezembro de 2020. Dividiu-se as pacientes em 2 grupos, primíparas e multíparas. Através da análise do Prontuário Único do Paciente (PUP), os desfechos perinatais adversos foram avaliados com cálculo de razão de chance ajustado, utilizando intervalo de confiança de 95%. Os fatores de confusão adotados foram: idade, tabagismo, alcoolismo e outras drogas. As puérperas foram divididas em primíparas (n=522/31,2%) e multíparas (n=1148/68,7%). Após o cálculo de razão de chance ajustado, primíparas tiveram aumento da chance de episiotomia (RC=7,069 IC95% 4,275-11,690), prematuridade (RC=1,784 IC95% 1,011-3,148) e redução da chance de recém-nascidos Grandes para a Idade Gestacional (GIG) (RC=0,555 IC95% 0,388-0,793), não interferiu nos demais desfechos. Pacientes primíparas apresentaram maior chance de episiotomia, prematuridade e menor chance de recém-nascidos GIG.

To investigate the effects of perinatal primiparity. This was a cross-sectional cohort study, carried out at the Darcy Vargas Maternity Hospital in Joinville, state of Santa Catarina, from August to December 2020. Patients were assigned to 2 groups, primiparous and multiparous. With the analysis of electronic medical records, perinatal adverse outcomes were evaluated using the adjusted odds ratio, using a 95% confidence interval. Confounding factors adopted were: age, smoking, alcoholism, and other drugs. Postpartum women were divided into primiparous (n=522/31.2%) and multiparous (n=1,148/68.7%) women. After calculating the adjusted odds ratio, primiparous women had an increased chance of having an episiotomy (OR= 7,069 CI95% 4,275-11,690), prematurity (OR=1,784 CI95% 1,011-3,148) and reduced chance of Large for Gestational Age (LAG) newborns (OR=0,555 CI95% 0,388-0,793). Primiparous patients had a higher chance of having an episiotomy, prematurity, and a lower chance of LAG newborns.

Prevalência, padrões e fatores associados à contracepção no Brasil e meta-análise da descontinuidade contraceptiva no cenário mundial / Prevalence, patterns and factors associated with contraception in Brazil and meta-analysis of contraceptive discontinuation on the global stage

Introdução: O Brasil tem uma elevada prevalência de uso de contraceptivos entre mulheres em idade reprodutiva. No entanto, observa-se que persistem desigualdades, tanto no acesso quanto em relação ao tipo de método usado, o que pode contribuir para as altas taxas de gestações não planejadas e abortos induzidos no país. Outro fator que contribui para esses desfechos é a descontinuidade contraceptiva, porém este indicador não é monitorado no país desde 1996, dificultando dimensionar a magnitude do problema. Objetivos: Estimar fatores individuais e contextuais associados ao uso de contraceptivos de acordo com a paridade das mulheres brasileiras em idade reprodutiva; estimar os fatores associados ao tipo de método contraceptivo usado pelas brasileiras; e estimar a magnitude da descontinuidade contraceptiva na literatura mundial a partir de uma meta-análise. Métodos: Foram utilizados dados da Pesquisa Nacional de Saúde de 2013 e 2019 para responder aos dois primeiros objetivos da tese. Os desfechos principais foram o uso de métodos contraceptivos (MC) e o tipo de método classificado quanto ao tempo de ação: contraceptivos reversíveis de curta duração (SARCs) e contraceptivos reversíveis de longa duração (LARCs), e MC permanentes. Os fatores individuais foram características da história reprodutiva, do acesso aos serviços de saúde e sociodemográficas; e os contextuais: Índice de Desenvolvimento Humano (IDH), Índice Sociodemográfico (SDI), Rendimento Mensal Médio e Cobertura da Atenção Primária (APS). Primeiramente, utilizou-se modelos de regressão logística multinível para estimar os fatores individuais e contextuais associados ao uso de MC, estratificados por paridade. Em seguida, para estimar os fatores associados ao tipo de MC usado pelas mulheres foram utilizados modelos de regressão logística multinomial, cuja categoria de referência foram as usuárias de SARC. Por último, foi conduzida uma revisão sistemática com meta-análise para estimar a magnitude da descontinuidade contraceptiva (abandono e troca) na literatura mundial, que também considerou a classificação dos métodos em SARCs e LARCs. Resultados: A prevalência do uso de MC foi superior a 80% em 2013 e 2019, e menor entre nulíparas. Entre 2013 e 2019, observou-se uma redução da variabilidade da chance de usar MC entre as Unidades Federativas (UFs) para nulíparas. Mesmo assim, nulíparas que residiam em UFs com melhores indicadores socioeconômicos, tais como maior IDH e SDI, tinham mais chance de uso de MC. Por outro lado, a cobertura da APS foi a única variável que permaneceu associada a maior probabilidade de uso de MC em 2019 entre primíparas/multíparas. Quanto ao tipo de MC, mais de 70% das mulheres usavam SARCs. Mulheres com melhores condições socioeconômicas tinham mais chance de usar LARCs e menos chance de usar métodos permanentes quando comparados aos SARCs. Por outro lado, mulheres com maior idade, paridade e que viviam com companheiro tinham maior chance de usar métodos permanentes em relação aos SARCs. Ao realizar a meta-análise dos dados identificou-se que a taxa de descontinuidade de SARCs foi de 56,8%, enquanto para LARCs foi de 17,8%. Para as usuárias de SARCs, a chance de abandono foi quase 7 vezes maior que a de troca. Das mulheres que descontinuaram, a maioria abandonou o uso de MC devido a efeitos colaterais. Conclusão: Existem desigualdades individuais e contextuais em relação ao acesso à contracepção no país, segundo a paridade das mulheres. Além disso, mulheres com melhores condições socioeconômicas têm mais acesso aos MC mais eficazes, como os LARCs. Destaca-se ainda as elevadas taxas de descontinuidade encontradas na meta-análise, principalmente para os SARCs, MC mais usados pelas brasileiras. Nossos achados indicam a necessidade de retomar a discussão da contracepção no país com políticas e programas voltados ao enfrentamento das iniquidades, à qualificação do acesso, à promoção da equidade, tendo em vista grupos mais alijados, bem como retomar o monitoramento da descontinuidade contraceptiva em âmbito nacional, além de incluir aspectos assistenciais que deem conta de manejar melhor esse fenômeno.

Brazil has a high prevalence of contraceptive use among women of reproductive age. However, it is observed that inequalities persist, both in access and in relation to the type of method used, which may contribute to the high rates of unplanned pregnancies and induced abortions in the country. Another factor that contributes to these outcomes is contraceptive discontinuity, but this indicator has not been monitored in the country since 1996, making it difficult to measure the magnitude of the problem. Objectives: To estimate individual and contextual factors associated with the use of contraceptives according to the parity of Brazilian women of reproductive age; to estimate the factors associated with the type of contraceptive method used by Brazilian women; and to estimate the magnitude of contraceptive discontinuity in the world literature based on a meta-analysis. Methods: Data from the National Health Survey of 2013 and 2019 were used to answer the first two objectives of the thesis. The main outcomes were the use of contraceptive methods (CM) and the type of method classified according to the time of action: short-acting reversible contraceptives (SARCs) and long-acting reversible contraceptives (LARCs), and permanent CM. Individual factors were reproductive history, access to health services and sociodemographic characteristics; and the contextual ones: Human Development Index (HDI), Sociodemographic Index (SDI), Average Monthly Income and Primary Care Coverage (PHC). First, multilevel logistic regression models were used to estimate the individual and contextual factors associated with CM use, stratified by parity. Then, to estimate the factors associated with the type of CM used by women, multinomial logistic regression models were used, whose reference category was users of SARCs. Finally, a systematic review was conducted with meta-analysis to estimate the magnitude of contraceptive discontinuity (abandonment and switch) in the world literature, which also considered the classification of methods in SARCs and LARCs. Results: The prevalence of MC use was greater than 80% in 2013 and 2019, being lower among nulliparous women. Between 2013 and 2019, there was a reduction in the variability of the chance of using CM between the Federative Units (FUs) for nulliparous women. Even so, nulliparous women residing in FUs with better socioeconomic indicators, such as higher HDI and SDI, were more likely to use MC. On the other hand, PHC coverage was the only variable that remained associated with a greater chance of CM use in 2019 among primiparous/multiparous women. As for the type of CM, more than 70% of the women used SARCs. Women with better socioeconomic conditions were more likely to use LARCs and less likely to use permanent methods when compared to SARCs. On the other hand, women of greater age, parity and who lived with a partner were more likely to use permanent methods in relation to SARCs. When performing a meta-analysis of the data, it was identified that the discontinuity rate for SARCs was 56.8%, while for LARCs it was 17.8%. For users of SARCs, the chance of dropping out was almost 7 times greater than switching. Of the women who discontinued, most discontinued MC use due to side effects. Conclusion: There are individual and contextual inequalities regarding access to contraception in the country, according to women's parity. In addition, women with better socioeconomic conditions have more access to the most effective CM, such as LARCs. Also noteworthy are the high rates of discontinuity found in the meta-analysis, especially for SARCs, the MC most used by Brazilian women. Our findings indicate the need to resume the discussion of contraception in the country with policies and programs aimed at confronting inequities, qualifying access, promoting equity, with a view to more marginalized groups, as well as resuming the monitoring of contraceptive discontinuity in nationwide, in addition to including assistance aspects that manage this phenomenon better.

Prognosis of the glucose metabolism and its impacting factors at 6-12 weeks postpartum in women with abnormal blood glucose during pregnancy / 中华健康管理学杂志

Objective:To analyze the prognosis of glucose metabolism and its impacting factors at 6-12 weeks postpartum in patients with abnormal blood glucose during pregnancy.Methods:In this cross-sectional study, a total of 192 patients with abnormal blood glucose during pregnancy enrolled and delivered in the maternity clinic of Daxing Teaching Hospital of Capital Medical University from December 1, 2019 to December 31, 2020 were collected. The 75 g oral glucose tolerance test (OGTT) was applied for diabetes screening at 6-12 weeks after delivery. According to the results of postpartum blood glucose, the patients were divided into two groups: postpartum normal blood glucose group (148 cases) and abnormal blood glucose group (44 cases). Hypothesis testing was used to compare the clinical data before, during and after the pregnancy between the two groups. Multi-factor logistic regression was performed to analyze the influencing factors of postpartum abnormal blood glucose in patients with abnormal blood glucose during pregnancy.Results:Among the 192 patients with abnormal blood glucose during pregnancy, the incidence of postpartum abnormal blood glucose was 22.92% (44/192), including 6 cases of diabetes mellitus (DM) (13.64%), 38 cases of impaired glucose tolerance (IGT) (86.36%). Neck circumference, waist circumference, multiparous women and insulin use during pregnancy in postpartum abnormal blood glucose group were all significantly higher than those in postpartum normal blood glucose group [34.25(33.00, 36.00) vs 33.55 (32.00, 35.00) cm, 87.00 (82.00, 93.00) vs 84.00 (78.00, 90.00) cm, 54.55% vs 37.16%, 18.18% vs 6.76%] (all P<0.05). Neck circumference ( OR=1.315, 95% CI: 1.026-1.685), multiparous women ( OR=2.261, 95% CI: 1.057-4.836), insulin use during pregnancy ( OR=3.767, 95% CI: 1.236-11.478) were positively correlated with the occurrence of postpartum abnormal blood glucose (all P<0.05). Conclusions:The incidence of postpartum abnormal blood glucose is high at 6-12 weeks postpartum in patients with abnormal blood glucose during pregnancy. Neck circumference, waist circumference, parity and insulin use during pregnancy are important impacting factors of postpartum abnormal blood glucose.

Is there a precise correlation between the lengths of the peritoneal reflection and the middle rectal valve?

Introduction: Pelvic anatomy remains a challenge, and thorough knowledge of its intricate landmarks has major clinical and surgical implications in several medical specialties. The peritoneal reflection is an important landmark in intraluminal surgery, rectal trauma, impalement, and rectal adenocarcinoma. Objectives: To investigate the correlation between the lengths of the middle rectal valve and of the peritoneal reflection determined with rigid sigmoidoscopy and to determine whether there are any differences in the location of the peritoneal reflection between the genders and in relation to body mass index (BMI) and parity. Design: We prospectively investigated the location of the middle rectal valve and of the peritoneal reflection via intraoperative rigid sigmoidoscopy in colorectal cancer patients undergoing elective colorectal surgery. Results: We evaluated 38 patients with a mean age of 55.5 years old (57.5% males) who underwent colorectal surgery at the coloproctology service of the Hospital Santa Marcelina, São Paulo, state of São Paulo, Brazil. There was substantial agreement between the lengths of the middle rectal valve and of the peritoneal reflection (Kappa = 0.66). In addition, the peritoneal reflection was significantly lower in overweight patients (p = 0.013 for women and p < 0.005 for men) and in women with > 2 vaginal deliveries (p = 0.009), but there was no significant difference in the length of the peritoneal reflection between genders (p = 0.32). Conclusion: There was substantial agreement between the lengths of the peritoneal reflection and of the middle rectal valve, and the peritoneal reflection was significantly lower in overweight patients and in women with more than two vaginal deliveries. (AU)

Intervalo intergestacional e desfechos desfavoráveis para a gestante e o recém-nascido / Interpregnancy interval and unfavorable outcomes for the mother and newborn

Introdução: O Ministério da Saúde recomenda o intervalo mínimo de dois anos entre as gestações. Intervalos fora do recomendado têm sido associados à mortalidade neonatal, trabalho de parto prematuro e baixo peso ao nascer, além de dificultar a amamentação nos primeiros 12 meses de vida. O objetivo do estudo foi identificar os fatores relacionados ao intervalo intergestacional que influenciam na gestação, no neonato e no processo do aleitamento materno. Métodos: Estudo observacional transversal realizado no Hospital Nossa Senhora da Conceição em Tubarão/SC, no período de maio a junho de 2019. Resultados: O estudo foi composto por 206 puérperas multíparas e seus respectivos recém-nascidos vivos. O intervalo inferior a dois anos esteve presente em 24,3% das puérperas. A mediana do intervalo intergestacional foi de 50 meses. Apenas 28,6% receberam orientação médica sobre anticoncepção. Do total, 49,5% das participantes deixaram de amamentar exclusivamente antes dos seis meses na gestação anterior, e apenas 33,2% amamentaram até dois anos ou mais. Houve associação entre idade materna e intervalo intergestacional (p<0,001). Trabalho de parto prematuro apresentou associação com intervalo acima do recomendado (p=0,039). Intervalos curtos apresentaram menor número de consultas pré-natais (p=0,020). Conclusão: Intervalos curtos foram associados à menor idade materna, e longos, à maior idade. Entretanto, não houve associação entre intervalo e tempo de aleitamento materno ou idade e tempo de aleitamento materno. Foram observadas altas taxas de desmame precoce, independentemente da idade materna e do intervalo intergestacional.

Introduction: The Ministry of Health recommends a minimum of two years between pregnancies. Shorter or longer intervals have been associated with neonatal mortality, preterm labor, and low birth weight, in addition breastfeeding difficulties in the first 12 months of life. The objective of this study was to identify factors related to interpregnancy interval that influenced the pregnancy, the newborn, and the breastfeeding process. Methods: This cross-sectional observational study was conducted at Hospital Nossa Senhora da Conceição in Tubarão, SC, Brazil between May and June 2019. Results: A total of 206 multiparous postpartum women and their newborns were included. An interpregnancy interval < 48 months occurred in 24.3% of the women. The median interval was 50 months. Only 28.6% received medical advice about contraception. A total of 49.5% of the mothers stopped breastfeeding < 6 months after the previous pregnancy and only 33.2% breastfed ≥ 48 months in the previous pregnancy. There was an association between maternal age and interpregnancy interval (p<0.001). Preterm labor was associated with intervals > 48 months (p=0.039). Intervals < 48 months involved fewer prenatal consultations (p=0.020). Conclusions: Shorter intervals were associated with lower maternal age, and longer intervals were associated with higher age. However, there was no association between interval length and breastfeeding duration or between age and breastfeeding duration. High rates of early weaning were observed regardless of maternal age and interpregnancy interval.

Effect of parity segregation on Mycoplasma hyopneumoniae infection dynamics and pneumonic lesions in pigs / Efeito da ordem de parto segregada sobre a dinâmica de infecção de Mycoplasma hyopneumoniae e lesões pulmonares ao abate

Gilts represent a group risk for Mycoplasma hyopneumoniae vertical transmission in swine herds. Therefore, parity segregation can be an alternative to control M. hyopneumoniae infections. The study evaluated the effect of parity segregation on M. hyopneumoniae infection dynamics and occurrence and severity of lung lesions at slaughter. For that, three multiple site herds were included in the study. Herd A consisted of the farm where gilts would have their first farrowing (parity order (PO) 1). After the first farrowing PO 1 sows were transferred to herd B (PO2-6). Herd C was a conventional herd with gilt replacement (PO1-6). Piglets born in each herd were raised in separated nursery and finishing units. Sows (n = 33 (A), 37 (B), 34 (C)) in all herds were sampled prior to farrowing and piglets (n = 54 (A), 71 (B), 66 (C)) were sampled longitudinally at 21, 63, 100, 140 days of age and at slaughter for M. hyopneumoniae detection by PCR and lung lesions scoring. M. hyopneumoniae prevalence in sows did not differ among herds. Prevalence of positive piglets was higher at weaning in the PO1 herd (A) (P < 0.05). However, prevalence of positive pigs from 100 days of age to slaughter age was higher in the PO2-6 herd (B) (P < 0.05). Lung lesion occurrence and severity were higher in herd B. The authors suggested that the lack of a proper gilt acclimation might have influenced the results, leading to sows being detected positive at farrowing, regardless of the parity.

As leitoas consistem em um grupo de risco na transmissão vertical de Mycoplasma hyopneumoniae dentro do sistema de produção de suínos. Dessa forma, a segregação de partos poderia ser utilizada como alternativa para controlar as infecções por M. hyopneumoniae. O objetivo deste estudo foi avaliar o efeito da segregação de partos sobre a dinâmica de infecção de M. hyopneumoniae e a ocorrência e severidade das lesões pulmonares ao abate. Para isso três sistemas de produção de suínos com três sítios cada foram incluídos no estudo. A granja A consistia da unidade onde as leitoas tem o primeiro parto, ou seja, alojava somente de fêmeas de ordem de parto 1 (Granja OP1). Após o primeiro parto as fêmeas OP1 foram transferidas para a granja B (Granja OP2-6), ou seja, consistia de fêmeas de ordem de parto 2 a 6, e a granja C consistiu em uma granja convencional com reposição de leitoas (Granja OP1-6), com fêmeas de ordem de parto 1 a 6. Os leitões nascidos de cada granja foram transferidos e criados em creches e terminações segregadas. As matrizes (n = 33 (A), 37 (B), 34 (C)) de todas as granjas do estudo foram amostradas previamente ao parto e os leitões (n = 54 (A), 71 (B), 66 (C)) foram amostrados longitudinalmente aos 21, 63, 100 e 140 dias de idade e ao abate. Em todos os momentos de coleta, as amostras foram avaliadas por PCR para detecção de M. hyopneumoniae. As lesões pulmonares foram avaliadas e escores de lesão foram atribuídos ao abate. A prevalência de matrizes positivas para M. hyopneumoniae não diferiu entre as granjas (P > 0,05). A prevalência ao desmame foi maior na granja A (OP1) (P < 0,05). No entanto, dos 100 dias de idade até o abate a prevalência de leitões positivos para M. hyopneumoniae foi maior na granja B (OP2-6) (P < 0,05). A ocorrência e severidade de lesões pulmonares foram maiores na granja B. Os autores sugerem que a falta de uma aclimatação adequada das leitoas pode ter influenciado nos resultados, levando à detecção de matrizes positivas ao parto, independente da ordem de parto.

Correlates of exclusive breast feeding among nursing mothers attending child health clinic at a general hospital in Rivers State Nigeria

Background: Early initiation of breast feeding and feeding exclusively for six months have great implication for the survival, well-being and growth of new borne. Factors such as maternal age, occupation, religion, spouse age, spouse occupation, parity, antenatal care (ANC) attendance, mode of delivery (MOD) and birth order are significantly associated with exclusive breast feeding (EBF) Methodology: The study is a descriptive cross-sectional study conducted among nursing mothers attending child health clinic in General Hospital Bonny, in Bonny Island, Rivers State, Nigeria. All eligible nursing mother who presented at the clinic were enlisted for the study. Enlistment of eligible participants was done on every child welfare clinic day. Data was collected using a pretested, interviewer administered, structured questionnaire which was adapted and prepared in English Language. Categorical data was analyzed using multinomial logistic regression model with statistical significance set at 0.05. Result: Results from this study identified significant association between EBF and some maternal variables such as age, occupation and religion. Spouse age and occupation were significantly associated with EBF. ANC attendance, gestational age, MOD, parity and birth order were also significant variables associated with EBF. Conclusion: Maternal variables such as age, occupation, religion, parity, MOD, ANC attendance including spouse age and occupation significantly influence EBF of new borne.

Maternal age and miscarriage: A unique association curve in Sudan

This study's aim was to estimate the prevalence and maternal age and other risk factors of miscarriage among Sudanese women. Across-sectional study was conducted at the Saad Abuelela Tertiary Hospital in Khartoum, Sudan, from February to December 2019. Sociodemographic, obstetric and clinical data were collected. A multivariate logistic regression analysis was performed. Four hundred thirteen (20.5%) women reported experiencing a miscarriage. Risk factors included older age, high parity, histories of caesarean delivery, and obesity. Logistic regression showed that the lowest risk for women aged less than 20 years (adjusted odds ratio [AOR], 0.33) or 20 to 24 years (AOR, 0.57), primiparas (AOR, 0.42) and women educated below the secondary level (AOR, 0.78). Unlike the global age-associated risk of miscarriage, the risk of miscarriage among Sudanese women follows a unique curve in relation to maternal age. Interestingly, the curve showed a lower risk for women less than 20 years and at 40 years. (Afr J Reprod Health 2022; 26 [7]: 15-21).

Learning curve for ultrasound-guided external cephalic version without anesthesia in full-term and near-term pregnancies / 中华围产医学杂志

Objective:To evaluate the effects of physician skills on the success rate of the external cephalic version (ECV) and investigate the learning curve for ECV.Methods:A retrospective study of 97 pregnant women who underwent ECV at the First Affiliated Hospital of Nanjing Medical University from March 2019 to August 2021 was performed. Patients were divided into multipara and primipara groups. The success rate of ECV and morbidity were compared between the two groups, and the learning curve for ECV was evaluated using cumulative sum analysis (CUSUM).Results:(1) Patients in the multipara group were older than those in the primipara group [(33.0±3.4) vs (29.2±3.0) years, t=－5.57, P<0.001]. No significant difference was found in other baseline data between the two groups. (2) The overall ECV success rate was 61.9% (60/97), and a higher success rate was observed in the multipara group [93.3% (28/30) vs 47.8% (32/67), χ 2=18.24, P<0.001]. Fetal heart rate deceleration (5.2%, 5/97), vaginal bleeding (1.0%, 1/97), premature rupture of membranes (1.0%, 1/97), and fetal distress (1.0%, 1/97) were the main complications. (3) The CUSUM analysis showed that it needed 53 primiparas for a physician to obtain a 50% consistent success rate ( R2=0.91, H=－3.27, Y=52.16) and seven multiparas to achieve a 70% consistent success rate ( R2=0.99, H=－1.635, Y=6.60). Conclusions:Parity and operator skills have a significant influence on the success of ECV. A physician with standardized training will manage non-anesthesia ECV skillfully in full-term and near-term pregnancies after practice on 50 primiparae or approximately ten multiparae. It is recommended to start with the multiparae for learning ECV to build up confidence and promote the implementation of ECV.

Influence of lactation number and parity on milk yield of Saanen goat's breed / [Influência do número de lactação e paridade na produção de leite da raça de cabras Saanen]

The aim of this research was to determine the influence of lactation number and parity on milk yield of Saanen goat's breed. It has been concluded that milk yield was higher for goats that had given birth to twins and three kids than for goats that had given birth to a single kid (P<0.05). The longevity has a great positive impact on production, given that goats in the fifth lactation produced more milk than goats in first or second lactation (P<0.05), while goats in the sixth lactation still produced more milk than goats in first lactation (P<0.05). During the period from 2014- 2019, the research was conducted on a farm of multiparous Saanen goats in Vojvodina (northern part of Serbia). In the observed period, the farm had between 350 and 400 goats per milking, and the research included a total of 1,628 concluded lactations, within which the first lactations were the most 484, then the second 381. According to the number of lactations, goats were grouped into classes from one to seven and from one to three for parity. By comparing each individual lactation, it was determined that in first lactation goats produced significantly lower milk than goats in the rest lactations(P<0.05), except the seventh. Research has shown that lactation number has a significant influence on milk yield (P=0.00). Increasing the fertility of goats significantly affects the production capacity of dairy goats, since does with a larger number of kids in the litter had a significantly higher milk production (P<0.05). Due to the larger number of kids in the litter, milk production also increases. Likewise, it is assumed that the increase in milk yield of goats with two and three kids is a consequence of a larger placenta, i.e. stronger lactogenic activity during pregnancy.(AU)

O objetivo desta pesquisa foi determinar a influência do número de lactações e da paridade na produção de leite da raça de cabras Saanen. Concluiu-se que a produção de leite era maior para caprinos que haviam dado à luz gêmeos e três cordeiros do que para caprinos que haviam dado à luz um único cordeiro (P<0,05). A longevidade tem um grande impacto positivo na produção, dado que as cabras na quinta lactação produziram mais leite do que as cabras na primeira ou segunda lactação (P<0,05), enquanto as cabras na sexta lactação ainda produziram mais leite do que as cabras na primeira lactação (P<0,05). Durante o período de 2014- 2019, a pesquisa foi realizada numa fazenda de cabras Saanen multipares em Voivodina (parte norte da Sérvia). No período observado, a fazenda tinha entre 350 e 400 cabras por ordenha, e a pesquisa incluiu um total de 1.628 lactações concluídas, dentro das quais as primeiras lactações foram as mais 484, depois as segundas 381. De acordo com o número de lactações, as cabras foram agrupadas em classes de um a sete e de um a três para paridade. Comparando cada lactação individual, determinou-se que na primeira lactação as cabras produziram leite significativamente menor do que as cabras nas demais lactações (P<0,05), exceto a sétima. Pesquisas mostraram que o número de lactações tem uma influência significativa na produção de leite (P=0,00). O aumento da fertilidade das cabras afeta significativamente a capacidade de produção de caprinos leiteiros, já que com um número maior de cabritos na ninhada a produção de leite foi significativamente maior (P<0,05). Devido ao maior número de cabritos na ninhada, a produção de leite também aumenta. Da mesma forma, assume-se que o aumento na produção de leite de cabras com dois e três cabritos é uma consequência de uma placenta maior, ou seja, de uma atividade lactogênica mais forte durante a gestação.(AU)

Effects of risk factors in the likelihood of breast cancer subtypes in Brazilian women / Efeitos de fatores de risco na probabilidade de subtipos do câncer de mama em mulheres brasileiras

INTRODUCTION: Breast cancer is a heterogenous disease with multiple causes and it lacks more investigation related to its risk factors. OBJECTIVE: To evaluate the likelihood of breast cancer subtypes according to the positivity to estrogen and progesterone receptors (ER+ and PR+ respectively), with or without the expression HER2, related to the following risk factors: age, parity, diabetes mellitus, arterial hypertension, occurrence of familiar cancer case and body mass index (BMI). METHODS: The sample with 79 individuals was divided into three subtypes 1 (ER+/PR-), 2 (ER+/PR+) and 3 (RE+/RP+/HER+) and then analyzed by quantitative methods using Ordinal Generalized Linear Models (OGLM) for estimating the marginal effects of risk factors for the studied subtypes, and modeling the heteroscedasticity in terms of error. RESULTS: It were observed the following statistically significant positive effects: (1) age for the tumoral subtype 1 (ER+/PR-) and (2) parity for the subtype 2 (ER+/PR+); while the significant negative effects were: (1) age for subtype 3 (ER+/PR+/HER2+); (2) parity for both 1 (ER+/PR-) and 3 (ER+/PR+/HER2+) subtypes; and arterial hypertension for subtype 1 (ER+/PR-). There were no statistically significant effects for BMI, Diabetes mellitus and occurrence of familiar cancer variables on the studied tumoral subtypes. CONCLUSION: The risk factos age and parity demonstrated varied effects for the breast cancer subtypes according the expression of estrogen, progesterone and HER2 receptors.

INTRODUÇÃO: O câncer de mama é uma doença heterogênea, multifatorial e que necessita de mais estudos relacionados aos fatores de riscos. OBJETIVO: Analisar a probabilidade dos subtipos tumorais do câncer de mama receptores de estrogênio (RE) ou progesterona (RP) positivos, com ou sem expressão de HER2, em relação aos fatores de risco: idade, parto, diabetes mellitus, hipertensão arterial, ocorrência de câncer de mama familiar e índice de massa corporal (IMC). MÉTODOS: A análise da amostra de 79 pacientes dividida nos subtipos 1 (RE+/RP-), 2 (RE+/RP+) e 3 (RE+/RP+/HER+), foi feita por meio de métodos quantitativos usando o Modelo Linear Generalizado Ordinal (MLGO) para estimar os efeitos marginais dos fatores de risco para os subtipos estudados, e ao mesmo tempo modelando a heterocedasticidade do termo de erro. RESULTADOS: Nos resultados foram observados os seguintes efeitos positivos estatisticamente significantes: (1) da idade para o subtipo tumoral 1 (RE+/RP-) e (2) do número de partos para o subtipo 2 (RE+/RP+); enquanto os efeitos negativos significativos foram os seguintes: (1) da idade para o subtipo 3 (RE+/RP+/HER2+); (2) do número de partos para o sutipos 1 (RE+/RP) e 3 (RE+/RP+/HER2+); e da hipertensão arterial para o o subtipo 1 (RE+/RP-). Não foram observados efeitos estatisticamente significativos das variáveis IMC, Diabetes mellitus e ocorrência de câncer de mama familiar sobre os subtipos tumorais estudados. CONCLUSÃO: Os fatores de risco idade e número de partos têm efeitos variados para os subtipos do câncer de mama segundo a expressão de receptores para estrogênio, progesterona e HER2.

Sociodemographic profile of primiparous mothers from nine birth cohorts in three Brazilian cities / Perfil sociodemográfico de mulheres primíparas de nove coortes de nascimentos em três cidades brasileiras / Perfil sociodemográfico de mujeres madres primíparas de nueve cohortes de nacimiento en tres ciudades brasileñas

Fertility reduction is a phenomenon observed in demographic transition. The demographic changes noted in female fertility represent a need for adjustment on health services regarding female health and family planning support. Thus, this study aimed to perform a descriptive analysis by tracing the sociodemographic profile of primiparous mothers belonging to nine Brazilian birth cohorts, in three cities from different states. Standardized questionnaires were applied to assess reproductive characteristics and covariables. Primiparous mothers were defined as women whose child included in birth cohorts was their firstborn child. Sample description was performed using analysis of variance (continuous variables) and chi-square (categorical variables). In total, 44,615 women were included in the analyses and 41.8% (95%CI: 41.3; 42.2) were categorized as primiparous. The primiparity rates were the lowest in Ribeirão Preto (São Paulo State) 1978 (32%; 95%CI: 30.9; 33.1) and the highest in most recent cohorts, reaching up to 50% of the participants (São Luís - Maranhão State 2010: 47.2%; 95%CI: 45.8; 48.6; Ribeirão Preto 2010: 50.2%; 95%CI: 49.1; 51.4); Pelotas (Rio Grande do Sul State) 2015: 49.4% (95%CI: 47.9; 50.9). Primiparous mothers' age and schooling increased over the years in all cohorts. Maternal age at the first childbirth behaved similarly in the three studied cities. There was an increase in the proportion of first-time mothers that were older, higher educated and belonged to richer income groups. Also, the proportion of teenage mothers (aged 15 years or younger) increased until the early 2000's and started decreasing around the years 2010, especially among women in the poorer income groups.

A redução na taxa de fertilidade é um fenômeno observado na transição demográfica. As mudanças demográficas na fertilidade feminina criam a necessidade de ajustes nos serviços de saúde em termos de saúde da mulher e planejamento familiar. Assim, o estudo buscou realizar uma análise descritiva, traçando o perfil sociodemográfico de mães primíparas em nove coortes de nascimentos, de três cidades em estados diferentes do Brasil. Foram aplicados questionários padronizados para avaliar as características reprodutivas e covariáveis. As mães primíparas foram definidas como mulheres cujos filhos incluídos nas coortes de nascimentos eram os seus primogênitos. A descrição da amostra foi realizada com a análise de variância (variáveis contínuas) e qui-quadrado (variáveis categóricas). Um total de 44.615 mulheres foram incluídas nas análises, e 41,8% (IC95%: 41,3; 42,2) foram categorizadas como primíparas. As taxas de primiparidade foram mais baixas em Ribeirão Preto (São Paulo) em 1978 (32%; IC95%: 30,9; 33,1), e as mais altas foram nas coortes mais recentes, atingindo 50% das participantes (São Luís - Maranhão, 2010: 47,2%; IC95%: 45,8; 48,6; Ribeirão Preto, 2010: 50,2%; IC95%: 49,1; 51,4); Pelotas (Rio Grande do Sul) 2015: 49,4% (IC95%: 47,9; 50,9). A idade e escolaridade das primíparas aumentaram ao longo dos anos em todas as coortes. A idade materna no primeiro parto mostrou perfil semelhante nas três cidades. Houve um aumento na proporção de primíparas mais velhas, com maior escolaridade e pertencentes aos estratos econômicos mais altos. Além disso, a proporção de mães adolescentes (até 15 anos de idade) aumentou até o início da década de 2000 e começou a diminuir em torno dos anos 2010, especialmente entre mulheres nos grupos de menor renda.

La reducción de la fertilidad es un fenómeno observado en la transición demográfica. Los cambios demográficos observados en la fertilidad femenina representan la necesidad de un ajuste en los servicios de salud, en términos de salud femenina y asistencia a la planificación familiar. Teniendo esto en consideración, este estudio tuvo como objetivo realizar un análisis descriptivo, mediante el seguimiento del perfil sociodemográfico de las madres primíparas, que pertenecen a nueve cohortes de brasileñas nacimiento, en tres ciudades de diferentes estados. Se aplicaron cuestionarios estandarizados para evaluar las características reproductivas y covariables. Las madres primíparas fueron definidas como mujeres cuyos hijos incluidos en las cohortes de nacimiento eran sus primogénitos. La descripción de la muestra se realizó usando un análisis de variancia (variables continuas) y chi-cuadrado (variables categóricas). Un total de 44.615 mujeres estuvieron incluidas en el análisis y un 41,8% (IC95%: 41,3; 42,2) fueron categorizadas como primíparas. La tasas de primiparidad fueron las más bajas en Ribeirão Preto (Estado de São Paulo) 1978 (32%; 95%CI: 30,9; 33,1) y las más altas en las cohortes más recientes, alcanzando hasta a un 50% de los participantes (São Luís - Estado de Maranhão 2010: 47,2%; IC95%: 45,8; 48,6; Ribeirão Preto 2010: 50,2%; IC95%: 49,1; 51,4); Pelotas (Estado de Rio Grande do Sul) 2015: 49,4% (IC95%: 47,9; 50,9). La edad de las madres primíparas y escolaridad se incrementó a lo largo de los años en todas las cohortes. La edad maternal en el momento del nacimiento del primer hijo se comportó de forma similar en las tres ciudades estudiadas. Hubo un incremento en la proporción de las madres por primera vez, que eran más viejas, con más formación educativa, y pertenecientes a los grupos con ingresos más altos. Asimismo, la proporción de las madres adolescentes (15 años o más jóvenes) se incrementó hasta principios del año 2000 y empezó a decrecer a partir del año 2010, especialmente entre mujeres en los grupos con los ingresos más bajos.

Complicaciones maternas durante la cesárea en pacientes con preeclampsia severa / Maternal complications during cesarean section in patients with severe preeclampsia

Resumen OBJETIVO: Identificar las complicaciones maternas durante la cesárea en pacientes con preeclampsia severa. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal y descriptivo efectuado en pacientes embarazadas con preeclampsia severa atendidas en la Unidad Médica de Alta Especialidad del Hospital de Gineco-Obstetricia 3 del Centro Médico Nacional La Raza entre el 1 de septiembre de 2020 y el 31 de mayo del año 2021. Se registraron: la indicación de la cirugía (materna o feto-placentaria), las complicaciones y su desenlace, el tiempo de estancia en la unidad de cuidados intensivos y en hospitalización y la muerte materna. Se utilizó estadística descriptiva con el programa estadístico SPSS v 20. RESULTADOS: Se estudiaron 100 pacientes con media de edad de 30.5 ± 5.85 años (límites 17 y 43), mediana de la paridad 2 (límites 1 y 6), semanas de embarazo 33.08 ± 3.9 (límites 26 y 39.4), peso 77.98 ± 15.87 kg (límites 42 y 120), talla 1.57 ± 0.07 m (límites 1.36 y 1.73) e IMC 31.46 ± 5.54 (límites 22.15 y 48.44). 90 de ellas finalizaron el embarazo por cesárea indicada por: crisis hipertensiva (81%), síndrome HELLP (17%), eclampsia (2%) y feto-placentaria en 10% (estado fetal no confiable 5%, ruptura prematura de las membranas 2%, anhidramnios 2%, restricción del crecimiento 1%). Se registraron 12% de complicaciones (atonía uterina (6%), lesión de una arteria uterina (2%), desgarro de la comisura de la histerorrafia (1%), hematoma de la histerorrafia (1%), hematoma del ligamento ancho (1%) y sangrado en capa (1%). Todas las complicaciones se corrigieron en el mismo tiempo quirúrgico. La media del tiempo entre el ingreso a hospitalización hasta la finalización del embarazo fue de 6.26 ± 2.26 horas, estancia en cuidados intensivos 1.36 ± 0.69 días y muerte materna 0%. CONCLUSIÓN: La frecuencia de complicaciones fue baja, quizá por tratarse de pacientes intervenidas en un hospital de alta especialidad.

Abstract OBJECTIVE: To identify maternal complications during cesarean section in patients with severe preeclampsia. MATERIALS AND METHODS: Retrospective, cross-sectional, descriptive study carried out in pregnant patients with severe preeclampsia attended at the High Specialty Medical Unit of the Obstetrics and Gynecology Hospital 3 of the National Medical Center La Raza between September 1, 2020 and May 31, 2021. The following were recorded: indication for surgery (maternal or feto-placental), complications and their outcome, length of stay in the intensive care unit and hospitalization, and maternal death. Descriptive statistics were used with the statistical program SPSS v 20. RESULTS: 100 patients were studied with mean age 30.5 ± 5.85 years (limits 17 and 43), median parity 2 (limits 1 and 6), weeks of pregnancy 33.08 ± 3.9 (limits 26 and 39.4), weight 77.98 ± 15.87 kg (limits 42 and 120), height 1.57 ± 0.07 m (limits 1.36 and 1.73) and BMI 31.46 ± 5.54 (limits 22.15 and 48.44). Ninety of them terminated the pregnancy by cesarean section indicated by: hypertensive crisis (81%), HELLP syndrome (17%), eclampsia (2%) and feto-placental in 10% (unreliable fetal status 5%, premature rupture of membranes 2%, anhydramnios 2%, growth restriction 1%). There were 12% complications (uterine atony (6%), uterine artery injury (2%), hysterorrhaphy commissure tear (1%), hysterorrhaphy hematoma (1%), broad ligament hematoma (1%) and layer bleeding (1%). All complications were corrected within the same surgical time. The mean time from hospitalization to termination of pregnancy was 6.26 ± 2.26 hours, intensive care stay 1.36 ± 0.69 days and maternal death 0%. CONCLUSION: The frequency of complications was low, perhaps because these patients underwent surgery in a high specialty hospital.

Histórico gestacional de mulheres com incontinência urinária / Historial gestacional de mujeres con incontinencia urinaria / Gestational history of women with urinary incontinence

RESUMO Objetivo: analisar a relação do histórico gestacional com a incontinência urinária em mulheres. Método: estudo exploratório descritivo de corte transversal quantitativo, com 227 mulheres com incontinência urinária atendidas em um ambulatório de referência do sul brasileiro, identificando histórico gestacional e subtipo de incontinência. Para análise de associação, utilizou-se os testes qui-quadrado e V de Cramér, nível de significância de 5%. Resultados: a incontinência urinária mista (87,2%; n=198) foi predominante, com 89% para duas ou mais gestações, e o parto vaginal (dois ou mais) foi mais ocorrente (71,4%) do que a cesariana (14,5%) para dois ou mais, 64,3% receberam episiotomia. Não houve significância estatística entre os subtipos de incontinência e as variáveis de histórico gestacional. Conclusão: a incontinência urinária mista foi o subtipo mais presente. A multiparidade e parto vaginal caracterizaram este grupo. Demonstra-se a importância do preparo do assoalho pélvico no período perigestacional, minimizando o impacto da incontinência nesta população.

RESUMEN Objetivo: analizar la relación entre historia gestacional e incontinencia urinaria en mujeres. Método: estudio descriptivo exploratorio, de corte cuantitativo, con 227 mujeres con incontinencia urinaria atendidas en una clínica de referencia en el sur de Brasil, habiéndose identificado antecedentes gestacionales y subtipo de incontinencia. Para el análisis de asociación se utilizaron las pruebas de Chi-cuadrado y V de Cramer, con un nivel de significancia del 5%. Resultados: predominó la incontinencia urinaria mixta (87,2%; n = 198), con 89% para dos o más embarazos, y el parto vaginal (dos o más) fue más frecuente (71,4%) que la cesárea (14,5%) para dos o más partos, el 64,3% recibió episiotomía. No hubo significación estadística entre los subtipos de incontinencia y las variables del historial gestacional. Conclusión: la incontinencia urinaria mixta fue el subtipo más común. La multiparidad y el parto vaginal caracterizaron a este grupo. Se demuestra la importancia de preparar el suelo pélvico en el período perigestacional para minimizar el impacto de la incontinencia en esta población.

ABSTRACT Objective: to analyze the relationship between gestational history and urinary incontinence in women. Method: an exploratory, descriptive, cross-sectional and quantitative study, conducted with 227 women with urinary incontinence treated in a reference outpatient unit in the South of Brazil, identifying gestational history and incontinence subtype. To analyze the association, the chi-square and Cramér's V tests were used, with a 5% significance level. Results: mixed urinary incontinence (87.2%; n=198) was predominant, with 89% for two or more pregnancies, and vaginal deliveries (two or more) occurred more frequently (71.4%) than cesarean sections (14.5%) for two or more pregnancies; 64.3% underwent episiotomy. There was no statistical significance between the incontinence subtypes and the gestational history variables. Conclusion: mixed urinary incontinence was the most present subtype. Multiparity and vaginal delivery characterize this group. The importance of pelvic floor preparation in the peri-gestational period is shown, minimizing the impact of incontinence in this population.

Experiências de mulheres ao vivenciarem uma gravidez entre 35 e 45 anos de idade / Experiences of women who faced a pregnancy between 35 and 45 years of age / Experiencias de mujeres al enfrentar un embarazo entre 35 y 40 años

Objetivo: identificar a experiência de mulheres ao vivenciarem uma gravidez tardia. Método: estudo descritivo, quantitativo, desenvolvido no município de Ouro Velho-PB, com mulheres na faixa etária entre 35 a 45 anos de idade. A amostra gerou em torno de 19 mulheres que engravidaram nesta faixa etária, cadastradas na Unidade Básica de Saúde da Família do município. Resultados: observou-se que a maioria estava entre 35 a 40 anos (58%), casadas, pardas e ensino superior, entretanto, a gravidez tardia possibilitou significados na vida destas mulheres, permeadas de sentimentos de satisfação pessoal, familiar, possibilitando maior segurança na relação com o companheiro, família e bebê. Conclusão: identificou-se complicações como hipertensão, prematuridade, aborto e pós-datismo, que influenciaram no tipo da via de parto, sendo a cesariana a de maior evidência. O preparo psicológico para a maternidade nessa faixa etária é acompanhado de sentimentos de desejo, alegria, ansiedade e medo do desconhecido

Objetivo: Identificar la experiencia de las mujeres al enfrentar un embarazo tardío. Método: Estudio descriptivo y cuantitativo, desarrollado en la ciudad de Ouro Velho-PB, con mujeres de entre 35 y 45 años. La muestra generó alrededor de 19 mujeres que quedaron embarazadas en esta franja etaria, registradas en la Unidad Básica de Salud Familiar de dicha ciudad. Resultados: Notamos que la mayoría tenían entre 35 y 40 (58%), casadas, de raza mixta y educación superior; sin embargo, el embarazo tardío permitió significados en la vida de estas mujeres, impregnados de sentimientos de satisfacción personal y familiar, lo que permitió una mayor seguridad en la relación con el compañero, la familia y el bebé. Conclusión: Identificamos complicaciones, como hipertensión, prematuridad, aborto y postdatismo, que influyeron en el tipo de vía de parto, siendo la cesárea la más frecuente. La preparación psicológica para la maternidad en esta franja etaria se entrelaza con sentimientos de deseo, alegría, ansiedad y miedo a lo desconocido

Objetivo: Identificar la experiencia de las mujeres al enfrentar un embarazo tardío. Método: Estudio descriptivo y cuantitativo, desarrollado en la ciudad de Ouro Velho-PB, con mujeres de entre 35 y 45 años. La muestra generó alrededor de 19 mujeres que quedaron embarazadas en esta franja etaria, registradas en la Unidad Básica de Salud Familiar de dicha ciudad. Resultados: Notamos que la mayoría tenían entre 35 y 40 (58%), casadas, de raza mixta y educación superior; sin embargo, el embarazo tardío permitió significados en la vida de estas mujeres, impregnados de sentimientos de satisfacción personal y familiar, lo que permitió una mayor seguridad en la relación con el compañero, la familia y el bebé. Conclusión: Identificamos complicaciones, como hipertensión, prematuridad, aborto y postdatismo, que influyeron en el tipo de vía de parto, siendo la cesárea la más frecuente. La preparación psicológica para la maternidad en esta franja etaria se entrelaza con sentimientos de deseo, alegría, ansiedad y miedo a lo desconocido

A paridade pode influenciar na alimentação do lactente nos primeiros seis meses de vida? / Can parity influence infant feeding in the first six months of life?

Resumo O objetivo deste artigo é avaliar a influência da paridade no aleitamento materno e na introdução da alimentação complementar nos primeiros seis meses de vida. Estudo longitudinal com uma amostra de conveniência de pares mães-filhos, selecionados no pós-parto e acompanhados até o sexto mês de vida, de 2011 a 2016, em Porto Alegre, Brasil. Foi analisado o tempo da primeira mamada após o nascimento, a prática e o tempo de aleitamento materno, o consumo de outros leites e a introdução da alimentação complementar. A amostra consistiu de 161 díades, com 74 primíparas e 87 multíparas. As multíparas iniciaram antes o aleitamento materno nas primeiras 24 horas pós-parto (p = 0,019). A oferta de outros leites não mostrou diferença em relação à paridade, assim como o momento da introdução alimentar; ainda que tanto primíparas como multíparas o fizeram antes dos quatro meses de vida. A paridade pareceu influenciar o momento da primeira oferta do aleitamento materno, mas não a introdução da alimentação complementar, apesar de esta ter ocorrido precocemente. Neste sentido, se faz necessária a maior difusão de informações sobre aleitamento materno e alimentação infantil durante a assistência pré-natal e puericultura, para melhoria da saúde materno-infantil.

Abstract This article aims to evaluate the influence of parity on breastfeeding and introduction of complementary feeding in children up to six months after childbirth. Longitudinal study conducted through a convenience sample of mother-child pairs, selected at postpartum and accompanied until the sixth month of infant's life, between 2011 and 2016, in Porto Alegre, Brazil. There was an analysis of the time taken in the first feeding after birth, practice and time of breastfeeding, consumption of other types of milk and introduction of complementary feeding. The sample consisted of 161 dyads, with 74 primiparous and 87 multiparous. Multiparous women breastfed their babies sooner in the first 24 hours post-partum (p = 0.019). The offering of other kinds of milk showed no difference in relation to parity, as the moment of introduction to infant nutrition, although both primiparous and multiparous did it before the age of four months. Parity seemed to influence the timing of first breastfeeding offer, but not the introduction of complementary feeding, although this occurred in an early way. In this sense, it is necessary to disseminate more information about breastfeeding and infant feeding during prenatal and childcare, to improve maternal and child health.

Avaliação da atividade funcional dos neutrófilos sanguíneos em ovelhas primíparas e pluríparas da raça Lacaune / [Functional evaluation of blood neutrophils in primiparous and pluriparous Lacaune ewes]

This study aimed to evaluate the neutrophil oxidative metabolism and phagocytosis of Zymonsan particles of primiparous and pluriparous Lacaune ewes during the first 30 days after lambing. A total of 20 ewes were evaluated, 10 primiparous (GPR) and 10 pluriparous (GPL). Evaluation of basal oxidative metabolism was performed using the nitroblue tetrazolium (NBT) technique, stimulating neutrophil phagocytosis with Zymosan particles. Blood samples were collected at parturition day (M1) and 1, 3, 7, 15 and 30 days after parturition, corresponding to M2, M3, M4, M5 and M6, respectively. In relation to the groups, GPR presented lower oxidative basal metabolism neutrophils in M1 compared to M4, in M3 with M1, M2, M4 and M5. In M4 and M5 differences were found at all times and in M6 with M4 and M5. Higher percentage of neutrophils than phagocytes were found in M4, M5 and M6 than in M1 and M2 in GPL animals. At all times GPR presented a lower percentage of phagocytosis than GPL. Thus it is concluded that the immune response in pluriparous sheep was more efficient than in primiparous sheep.(AU)

Prevalence of gestational choriocarcinoma in a parous population in ten years

Background: Choriocarcinoma is a rare disease with varying incidence in different parts of the world. Asian, American Indian and Africans are quoted to be at a higher risk. There are no epidemiological data from Middle East and hence authors studied the prevalence of choriocarcinoma in Oman, a Middle East nation with a high parity.Methods: This is a retrospective, descriptive, observational study done at tertiary care hospital; Royal Hospital from Jan 2010 to Dec 2019. Since all women are referred to a single center from all over the country, authors believe all cases are included over ten years.Results: There were 22 patients and the prevalence were 1 in 36966 live births. The main presenting symptom was abnormal uterine bleeding and all were gestational type of choriocarcinoma. Median gravidity was 6 and median parity was 5. Almost 80 % received chemo as their risk scoring was more than 7 and one woman died.Conclusions: The prevalence of choriocarcinoma was much similar to Europe and USA though the median gravidity and parity was high. Clinical features were comparable to the literature and management protocols were as per international recommendations.