Análise da percepção de puérperas sobre a assistência ao parto em uma maternidade do Tocantins / Analysis of the perception of puerperal women about maternity care assistance in a maternity of Tocantins

Objetivo: No decorrer dos séculos, o parto migrou do ambiente domiciliar para o hospitalar, sendo então repleto de procedimentos que, embora tenham o intuito de ajudar, nem sempre são adequados ou baseados em evidências. Por isso, o objetivo deste estudo é identificar os procedimentos realizados com parturientes durante o parto em uma maternidade do Tocantins, além de caracterizar o perfil dessas pacientes. Método: Foi aplicado um questionário a 70 puérperas de parto normal, maiores e menores de idade, durante quatro meses. O questionário de referência foi o utilizado do estudo Nascer no Brasil. Resultados: A maioria das pacientes se autodeclarou parda, tinha ao menos o ensino médio completo e era maior de 18 anos. Mais da metade delas tiveram alguma alteração no períneo, 25% sofreram manobra de Kristeller e 88% submeteram-se à litotomia. Além disso, a grande maioria avaliou o serviço da maternidade como bom/ótimo/excelente. Conclusão: A assistência ao parto no Tocantins ainda se divide em práticas adequadas e técnicas ultrapassadas. Trata-se de um estudo original e um dos primeiros nesse sentido realizado no estado mais novo do Brasil.(AU)

Objective: Throughout the centuries, childbirth has migrated from the home environment to the hospital, being then full of procedures that although they are intended to help, are not always adequate or based on evidence. Therefore, the objective of this study is to identify the procedures performed with parturients during childbirth in a maternity hospital in Tocantins, in addition to characterizing the profile of these patients. Method: A questionnaire was applied to 70 mothers of normal birth, older and younger, for four months. The reference questionnaire was used in the Nascer no Brasil study. Results: Most patients declared themselves to be brown, had at least completed high school, and were over 18 years old. More than half of them had some alteration in the perineum, 25% underwent a Kristeller maneuver and 88% underwent lithotomy. In addition, the vast majority rated the maternity service as good/excellent/excellent. Conclusion: Assistance to childbirth in Tocantins is still divided into outdated technical and appropriate practices. This is an original study and one of the first in this sense carried out in the newest state of Brazil.(AU)

Clinical analysis of extraperitoneal cesarean section plus forceps in repeated cesarean section / 中国基层医药

Objective To observe the clinical application of extraperitoneal cesarean section(ECS) plus forceps vs transperitoneal cesarean sections(TCS) in repeated cesarean section.Methods 98 multiparous women with scar uterus for elective repeated cesarean sections were recruited retrospectively,47 cases for ECS plus forceps(group A),and 51 cases for TCS(group B).The multiparous women with hyperglycemia not controlled,severe preeclampsia,heart disease,placenta previa,premature rupture of membrane,a history of ＞ 1 cesarean section,myoma and/or ovarian neoplasm were excluded.Results Skin incision to baby delivery time and total operation time of group A were (7.7 ± 2.8) min and (42.8 ± 9.7) min,respectively,which were significantly shorter than (9.3 ± 3.2) min and (47.6 ± 9.4) min of group B,(t =2.700,2.497,P =0.008,0.014).There was significant difference in blood loss volume during the operation and postoperative 2 hours,which was (310.4 ± 106.3) mL,(365.3 ± 142.8) mL respectively(t =2.142,P =0.035).The Visual Analog Scale for pain (VAS pain) was (2.8 ± 1.8) in group A and (4.1 ± 1.9) in group B,respectively (t =3.252,P =0.002).The gastrointestinal function recovery mean time of group A was significantly shorter than that of group B (12.5 h versus 16.0h,t =2.771,P =0.007).And the postoperative febrile morbidity was significantly lower in group A than in group B(8.5％ versus 25.5％ ;x2 =4.918,P =0.033).The patients with chronic pelvic pain followed up after operation was 3 versus 12,and the difference was significant (x2 =5.143,P =0.026).There were no differences in neonatal Apgar score at 1 minute,birth asphyxia and wound healing rates.Conclusion ECS plus forceps can be safely used for repeated cesarean section,with the advantages of less operation time,less bleeding volume,lower postoperative morbidity,and fewer complications than TCS.

Embarazo, trauma obstétrico y sus efectos sobre el piso pélvico. Revisión de la literatura / Pregnancy, obstetric trauma and their effects on the pelvic floor. Literature review / Gravidez, trauma obstétrico e seus efeitos sobre o piso pélvico. Revisão da literatura

Los trastornos del piso pélvico son una condición que afecta al 30% de las mujeres de todas las edades, e incluyen un abanico de patologías anatómicas y funcionales que, aunque no alteran la supervivencia de las pacientes, sí afectan en gran medida su calidad de vida. Dentro de estas patologías encontramos la incontinencia urinaria y fecal, el prolapso de órganos pélvicos y la disfunción sexual. La importancia del tema radica en que los trastornos del piso pélvico son más frecuentes después del embarazo y el parto por los cambios inherentes al embarazo mismo y por el trauma obstétrico que son factores de riesgo conocidos y que pueden estar asociados con secuelas graves del piso pélvico. Es por ello que se deben prever posibles complicaciones en el trabajo de parto que puedan aumentar el riesgo de trastornos del piso pélvico e implementar ciertas estrategias de prevención y de intervenciones seguras, que minimicen los daños y las secuelas que se producen en el largo plazo. A continuación haremos una revisión de la literatura sobre los cambios fisiológicos del embarazo en el piso pélvico, los trastornos disfuncionales más frecuentes, el papel del parto intervenido en la aparición de estos trastornos y las estrategias de prevención que pueden implementarse para disminuir los efectos sobre el piso pélvico.

Pelvic floor disorders are a medical condition that affects 30% of women of all ages, and include a plethora of anatomical and functional pathologies that, though they do not alter patient survival, do affect their well-being to a large extent. Urinary and fecal incontinence, pelvic organ prolapse and sexual dysfunction are among these pathologies. The importance of the subject rests on the fact that pelvic floor disorders are more frequent after pregnancy and birth as a result of inherent changes to pregnancy itself and obstetric injuries that are widely known risk factors, which may be associated to severe damage to the pelvic floor. Therefore, possible labor complications that may increase the risk of pelvic floor disorders must be prevented, along with the implementation of certain preventive strategies and safe interventions that reduce damage and possible long-term consequences. Here, we present a literature review about the physiological changes in the pelvic floor during pregnancy, the most frequent dysfunctional disorders, the role of forceps delivery in the appearance of different conditions, and preventive strategies that may be implemented to reduce the effects on the pelvic floor.

Os transtornos do piso pélvico são uma condição que afeta a 30% das mulheres de todas as idades, e incluem um leque de patologias anatómicas e funcionais que, embora não alteram a supervivência das pacientes, sim afetam em grande medida sua qualidade de vida. Dentro destas patologias encontramos a incontinência urinaria e fecal, o prolapso de órgãos pélvicos e a disfunção sexual. A importância do tema radica em que os transtornos do piso pélvico são mais frequentes depois da gravidez e do parto pelas mudanças inerentes à gravidez em si e pelo trauma obstétrico que são fatores de risco conhecidos e que podem estar associados com sequelas graves do piso pélvico. É por isso que se devem prever possíveis complicações no trabalho de parto que possam aumentar o risco de transtornos do piso pélvico e implementar certas estratégias de prevenção e de intervenções seguras, que minimizem os danos e as sequelas que se produzem em longo prazo. A continuação faremos uma revisão da literatura sobre as mudanças fisiológicas da gravidez no piso pélvico, os transtornos disfuncionais mais frequentes, o papel do parto intervindo na aparição destes transtornos e as estratégias de prevenção que podem implementar-se para diminuir os efeitos sobre o piso pélvico.

Perineal trauma after vaginal delivery in healthy pregnant women / Trauma perineal após parto vaginal em parturientes saudáveis

CONTEXT AND OBJECTIVE: Despite all the medical care provided during delivery labor, perineal injury is still prevalent and may lead to diverse pelvic floor disorders. The aim here was to investigate the prevalence of obstetric and anal sphincter injuries (OASIS) in healthy pregnant women after vaginal delivery. DESIGN AND SETTING: Cross-sectional study involving 3,034 patients with singletons in a secondary hospital for low-risk cases. METHODS: A standardized questionnaire was prepared and applied to medical files that had been completely filled out (classification of the Royal College of Obstetricians and Gynecologists, RCOG) in order to identify OASIS and analyze risk factors associated with mild and severe perineal lacerations. RESULTS: The women's mean age was 25 years; more than half (54.4%) were primiparae. Almost 38% of the participants had perineal lacerations; these were severe in 0.9% of the cases. Previous vaginal delivery (odds ratio, OR: 1.64 [1.33-2.04]) and forceps delivery (OR: 2.04 [1.39-2.97]) were risk factors associated with mild perineal injuries (1st and 2nd OASIS classifications). Only remaining standing for prolonged periods during professional activity (OR: 2.85 [1.34-6.09]) was associated with severe perineal injuries. CONCLUSION: The prevalence of severe perineal injuries was concordant with data in the literature. The variable of standing position was considered to be a risk factor for severe perineal injury and should be further investigated. .

CONTEXTO E OBJETIVOS: Apesar do cuidado médico executado durante o trabalho de parto, os traumas perineais ainda são prevalentes e podem levar a várias desordens do assoalho pélvico. O objetivo foi investigar a prevalência de injúrias obstétricas e do esfíncter anal em mulheres saudáveis após parto vaginal. DESENHO E LOCAL DE ESTUDO: Estudo transversal envolvendo 3.034 pacientes com recém-natos únicos de um hospital secundário de baixo risco. MÉTODOS: Um questionário padronizado foi preparado e aplicado aos prontuários completamente preenchidos (classificação do Royal College of Obstetricians and Gynecologists) para identificar as lesões obstétricas e do esfíncter anal e analisar fatores de risco associados com lacerações perineais leves e graves. RESULTADOS: A média de idade das mulheres era 25 anos; mais da metade (54,4%) era primípara. Quase 38% das participantes tiveram lacerações perineais; estas foram graves em 0,9% dos casos. A presença de parto vaginal prévio (odds ratio, OR, 1,64 [1,33-2,04]) e o parto fórceps (OR 2,04 [1,39-2,97]) foram fatores de risco associados às lesões perineais leves (primeira e segunda classificações de lesão esfíncter e anal). Somente a posição em pé prolongada durante a atividade profissional (OR 2,85 [1,34-6,09]) estava associada com lesões perineais graves. CONCLUSÃO: A prevalência de trauma perineal grave concordou com dados da literatura. A variável posição em pé foi considerada fator de risco para trauma perineal grave e necessita ser investigada. .

clinical study of the low forceps in vaginal delivery / 中国基层医药

Objective To study the clinical application value of the low forceps in vaginal delivery. Methods To retrospectively analyze the clinical data of 280 cases of the low forceps in vaginal delivery,and randomly selected 140 cases pregnant women who cesarean section, as the control group. To compare the influence of maternal and neonatal morbidity in the two groups. Results There were no statistically significant differences between the two groups for the incidence of the postdelivery hemorrage,birth trauma infectious, asphyxia neonatorum associated with delivery from low forceps when compared with cesarean section. The incidenc of the postdelivery sick rate was significantly lower in the low forceps group( 3.2% ) than that in the control group ( 10.0% ) ( x2 = 8.30, P ＜ 0.05 ). Conclusion Low forceps may be a valuable instrument and safety or efficacy in vaginal delivery and that it should be more widely used in appropriate clinical situations.

Morbidity in neonates according to the mode of delivery: a comparative study / Morbidade em recém-nascidos de acordo com a via de parto: um estudo comparativo

Objective: The objective of this study was to compare the effects of the modes of delivery on the health of newborns in a private maternity hospital in the city of São Paulo. Methods: Between January 1995 and December 1998, all patients consecutively admitted for deliveries were included in this cross-sectional retrospective study. A total of 8,457 medical records were analyzed, being excluded of the sample 460 multiple pregnancies and 517 pregnant women with obstetric and/or clinical disorders. The incidence of neonatal birth injury, respiratory distress and anoxia was analyzed, as well as birth weight, type of delivery and gestational age (according to Näegele and Capurro). Results: The final sample consisted of 7,480 neonates, and 69.6% were born by cesarean section, 24% vaginally and 6.4% through the vagina with the aid of forceps. A significant association was found between anoxia and the three types of delivery (p < 0.001). Respiratory distress was more frequent in cesarean delivery in newborns with gestational age superior to 37 weeks and in newborns weighing more than or equal to 2,500 g. Respiratory distress was significantly associated with cesarean delivery and/or forceps delivery, as compared with vaginal delivery, in the entire sample. Neonatal birth injury was associated with the use of forceps. In neonates born by cesarean section, anoxia was associated with lower gestational age estimated by the Capurro method and with lower weight. Conclusions: The abdominal approach is associated with greater morbidity of fetuses due to respiratory distress. Vaginal delivery is safer in newborns with more than 37 weeks of gestation and in those weighing more than 2,500 g.

Objetivo: Analisar comparativamente os efeitos dos tipos de parto sobre a saúde do recém-nascido em maternidade privada da cidade de São Paulo. Métodos: Entre janeiro de 1995 e dezembro de 1998, incluíram-se no estudo transversal retrospectivo todas as pacientes consecutivamente internadas para dar à luz. Foram analisados 8.457 prontuários, excluídas 460 gestações múltiplas e 517 gestantes com afecções obstétricas e/ou clínicas. Foram analisadas as incidências de tocotraumatismo, desconforto respiratório e anoxia, avaliando-se o peso ao nascer, o tipo de parto e a idade gestacional (conforme Näegele e Capurro). Resultados: A amostra final constituiu-se de 7.480 recém-nascidos, sendo que 69,6% nasceram por cesárea, 24% por parto normal e 6,4% com auxílio de fórcipe. Houve associação significativa entre anoxia e os três tipos de parto (p < 0,001). O desconforto respiratório foi mais frequente no parto tipo cesárea em recém-nascidos com mais de 37 semanas de idade gestacional e em recém-nascidos com peso maior ou igual a 2.500 g. Essa complicação teve associação significativa com parto cesariano e/ou fórcipe, mas não com parto normal na amostra total. O tocotraumatismo associou-se ao uso do fórcipe. Em recém-nascidos por cesárea, a anoxia associou-se à menor idade gestacional estimada pelo método de Capurro e ao menor peso. Conclusões: A via abdominal incorre em maior morbidade para o feto em termos de desconforto respiratório. O parto vaginal mostrou-se mais seguro para recém-nascidos com idade gestacional superior a 37 semanas e em recém-nascidos com peso maior que 2.500 g.