Résumé
Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)
Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)
Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)
Sujets)
Humains , Femelle , Grossesse , Prise en charge prénatale , Grossesse à haut risque , Intervention psychosociale , Cardiopathies congénitales , Anxiété , Orientation , Douleur , Relations parent-enfant , Parents , Paternité , Équipe soignante , Patients , Pédiatrie , Placenta , Placentation , Complications de la grossesse , Maintien de la grossesse , Pronostic , Théorie psychanalytique , Psychologie , Troubles du postpartum , Qualité de vie , Rayonnement , Religion , Reproduction , Phénomènes physiologiques des appareils urinaire et reproducteur , Chirurgie générale , Syndrome , Malformations , Modération , Thérapeutique , Appareil urogénital , Bioéthique , Cabinets médicaux , Prématuré , Travail obstétrical , Grossesse , Gestation animale , Issue de la grossesse , Adaptation psychologique , Préparations pharmaceutiques , Échocardiographie , Spectroscopie par résonance magnétique , Famille , Avortement spontané , Éducation de l'enfant , Protection de l'enfance , Santé mentale , Santé de la famille , Taux de survie , Espérance de vie , Cause de décès , Échographie prénatale , Cartographie chromosomique , Congé parental , Capacité mentale , Polykystose rénale autosomique récessive , Syndrome de Down , Soins périnatals , Services de santé polyvalents , Composés Chimiques , Dépression du postpartum , Manifestations neurocomportementales , Enfants handicapés , Techniques et procédures diagnostiques , Gravidité , Intervention de crise , Affect , Analyse cytogénétique , Spiritualité , Complicité , Valeur de la vie , Accouchement Humanisé , Mort , Prise de décision , Mécanismes de défense , Menace d'avortement , Prestations des soins de santé , Démence , Incertitude , Organogenèse , Recherche qualitative , Femmes enceintes , Diagnostic précoce , Naissance prématurée , Mesure de la clarté nucale , Mortalité de l'enfant , Dépression , Trouble dépressif , Période du postpartum , Diagnostic , Techniques de diagnostic gynécologique et obstétrique , Éthanol , Moi , Émotions , Empathie , Environnement , Humanisation de l'Assistance , Adoption par l'Utilisateur , Déontologie , Forme du noyau cellulaire , Nutrition Prénatale , Mesure de la longueur du col utérin , Conflit familial , Thérapie familiale , Résilience psychologique , Phénomènes physiologiques de la reproduction , Maladies de l'appareil urogénital féminin et complications de la grossesse , Sac gestationnel , Bref incident résolu inexpliqué , Mort foetale , Développement embryonnaire et foetal , Imagerie multimodale , Mortalité prématurée , Prise de décision clinique , Médecine d'urgence pédiatrique , Enfant placé en famille d'accueil , Liberté , Épuisement psychologique , Environnement de la naissance , Frustration , Tristesse , Respect , Détresse psychologique , Génétique , Bien-être psychologique , Obstétriciens , Culpabilité , Bonheur , Professions de santé , Hospitalisation , Maternités (hôpital) , Hôpitaux universitaires , Développement humain , Droits de l'homme , Imagination , Infections , Infertilité , Anencéphalie , Jurisprudence , Complications du travail obstétrical , Autorisation d'exercer , Événements de vie , Soins de maintien des fonctions vitales , Solitude , Amour , Personnel médical hospitalier , Déficience intellectuelle , Sens moral , Mères , Narcissisme , Malformations et maladies congénitales, héréditaires et néonatales , Néonatologie , Malformations du système nerveux , Attachement à l'objetRésumé
Resumo Malformação congênita, segunda maior causa de mortalidade infantil, constitui condição de vulnerabilidade importante na gravidez, que repercute desfavoravelmente na saúde mental da gestante. Objetivou-se estudar o impacto do momento do diagnóstico de malformação congênita sobre a saúde mental de 66 gestantes em atendimento pré-natal. Para isso, as participantes responderam ao Questionário "Momento da notícia", o qual identifica variáveis psicossociais relativas ao momento do diagnóstico da deficiência, e as Escalas Beck, para avaliar sinais e sintomas de ansiedade (Beck Anxiety Inventory) e depressão (Beck Depression Inventory). Todas receberam a notícia através de um médico, sendo 19 no segundo trimestre gestacional. Quatorze consideraram a transmissão do diagnóstico apropriada. No entanto, quando a notícia ocorreu no primeiro trimestre, tanto indicadores de ansiedade (p = 0,0009) quanto de depressão (p = 0,000004) se associaram ao momento da comunicação do diagnóstico; diferente de quando a gestante era comunicada no segundo trimestre, ao qual esteve associado somente os indicadores de depressão (p = 0,0462). Discute-se indicadores de ansiedade e depressão na gestação relacionados ao diagnóstico de malformação congênita como agravantes da vulnerabilidade física e psíquica durante a gestação.
Abstract Congenital malformation, the second largest cause of infant mortality, is an important cause of vulnerability during pregnancy, and it has an unfavorable effect on the mental health of pregnant woman. The objective of this study was to investigate the impact of the moment of diagnosis of congenital malformation on the mental health of 66 pregnant women receiving prenatal care. The participants answered the questionnaire "Momento da notícia" (Moment of diagnosis), which identifies psychosocial variables related to the moment of diagnosis. The Beck Scales were also used to assess signs and symptoms of anxiety (Beck Anxiety Inventory) and depression (Beck Depression Inventory). All participants were given the diagnosis by a physician, and 19 were notified during the second trimester of pregnancy. The diagnosis communication was considered adequate by fourteen participants. However, when the diagnosis was notified during the first trimester of pregnancy it was associated with indicators of anxiety (p = 0.0009) and depression (p = 0.000004). Different results were found when the mother was notified during the second trimester, when only the indicators of depression were associated to the diagnosis received (p = 0.0462). The present study addressed the indicators of anxiety and depression during pregnancy associated to the diagnosis of congenital malformation as risk factors for the physical and psychological vulnerability during this period.
Sujets)
Humains , Grossesse , Malformations , Diagnostic , Santé mentale , Femmes enceintesRésumé
Background: The Chilean Ministry of Health has reported a meaningful increase of births from teenager mothers (aged less than 20 years) in the period 1990-2008. On the contrary, there was a decrease of births from teenage mothers at The University of Chile Clinical Hospital (HCUCH). Aim: To compare the prevalence rates at birth of congenital malformations (CMF) in newborns from mothers younger than 20 with those of mothers between 20 and 34 years old. Patients and Methods: The Latin American Collaborative Study of Congenital Malformations (ECLAMC) data base of the HCUCH, since 1969 was analyzed. The last ten years (2002-2011) were studied. Results: There were 15,636 births in the period studied, 153 of them were stillbirths (0.97%). There were 1174 newborns from teenage mothers, 82 of them had one or more congenital malformations (7%). We found an association between smoking and drug consumption in mothers and CMF in their newborns. Conclusions: The rate of congenital malformations among offspring of teenage mothers is lower than the rate for mothers between 20 and 34 years old.
Sujets)
Adolescent , Adulte , Femelle , Humains , Nouveau-né , Grossesse , Jeune adulte , Malformations/épidémiologie , Grossesse de l'adolescente/statistiques et données numériques , Taux de natalité , Chili/épidémiologie , Niveau d'instruction , Âge maternel , Prévalence , Facteurs de risqueRésumé
Objective To investigate the value of spiral CT for the diagnosis and treatment of congenital anorectal malformations (CARM). Methods Thirty children with CARM underwent lateral upside-down plain film in abdomen and spiral CT scanning in pelvic cavity before surgical operation. The distance between rectal blind end and anal fossa in two imaging modalities was measured. The correlation between the measurement results in two imaging modalities was compared with operational results. Sacral deformation was diagnosed according to 3D reconstruction of CT images. Results The measurement results obtained from CT were correlated positively with those of operation (r=0.99, P0.05). Conclusion Spiral CT scanning can accurately describe the atresic level of rectum and malformation of sacrum. It can provide reliable evidence for surgeon to choose the best surgical method and to judge prognosis.