Avaliando diagnósticos e intervenções de enfermagem no trabalho de parto e na gestação de risco / Evaluar diagnóstico y la intervención de enfermería en trabajo y riesgo durante el embarazo / Assessing nursing diagnoses and interventions in labour and high-risk pregnancies

RESUMO Objetivo Avaliar o uso de diagnósticos e intervenções de enfermagem propostos para mulheres em trabalho de parto e gestantes de alto risco. Método Estudo descritivo, documental e retrospectivo realizado com 1000 prontuários, através de checklist, durante julho a setembro de 2014, em uma maternidade da Paraíba. Analisaram-se as medidas descritivas e a relação comparativa entre os diagnósticos e as intervenções de enfermagem utilizadas no serviço por meio da NANDA-Internacional e da Classificação das Intervenções de Enfermagem. Resultados Os diagnósticos mais evidenciados no trabalho de parto: dor aguda (62%), fadiga (24,7%) e ansiedade (22%). Para as gestantes de alto risco: sono e repouso prejudicados (100%), risco de infecção (81,8) e ansiedade (77,2%). As intervenções foram: lavar as mãos (80,8%), identificar e acomodar no leito (78%). Conclusão Os diagnósticos expressam as necessidades na parturição e nas alterações psicobiológicas na gestação de risco. As intervenções estão desarticuladas dos diagnósticos, necessitando de revisões e mudanças.

RESUMEN Objetivo Evaluar el uso de intervenciones de enfermería de diagnóstico y propuestas para mujeres en trabajo de parto y embarazadas de alto riesgo. Método Estudio descriptivo, documental y retrospectivo con 1.000 registros a través de lista de verificación durante julio a septiembre de 2014, en una maternidad de Paraíba. Se analizaron las medidas descriptivas y la relación comparativa entre los diagnósticos y las intervenciones de enfermería utilizados en el servicio con la NANDA-Internacional y la Clasificación de Intervenciones de enfermería. Resultados Los diagnósticos más evidentes en el trabajo de parto: el dolor agudo (62%), fatiga (24,7%) y ansiedad (22%). Para las mujeres embarazadas de alto riesgo: sueño y reposo perjudicados (100%), riesgo de infección (81,8) y ansiedad (77,2%). Las intervenciones fueron: lavarse las manos (80,8%), identificar y acomodarse en la cama (78%). Conclusión Las necesidades expresas de diagnóstico durante el parto y los cambios psicobiológicos en el embarazo de riesgo. Las intervenciones son diagnósticos inconexos que requieren revisiones y cambios.

ABSTRACT Objective To evaluate the use of nursing diagnoses and interventions proposed for women in labour and high-risk pregnancies. Method This is a descriptive, retrospective study with documentary analysis of 1000 medical records and a checklist conducted from July to September 2014, at a maternity hospital in Paraiba, Brazil. It consisted of analysing descriptive measures and comparing the relationship between nursing diagnoses and interventions using NANDA - International and the Nursing Interventions Classification. Results The most common diagnoses in labour were acute pain (62%), fatigue (24.7%), and anxiety (22%). For high-risk pregnant women they were impaired sleep and rest (100%), risk of infection (81.8%), and anxiety (77.2%). The interventions were hand washing (80.8%) and identify and accommodate patient in the bed (78%). Conclusion The diagnoses express needs during parturition and the psychobiological changes in high-risk pregnancy. The interventions are disconnected from the diagnoses and should therefore be reviewed and altered.

Embarazo adolescente como factor de riesgo para complicaciones obstétricas y perinatales en un hospital de Lima, Perú / Teenage pregnancy as a risk factor for obstetric and perinatal complications at a hospital in Lima, Peru

Analizar el riesgo de complicaciones obstétricas y perinatales en adolescentes embarazadas en un hospital de Lima, Perú. Métodos: estudio de cohorte retrospectiva de 67.693 gestantes atendidas en el período 2000-2010. Se evaluó complicaciones obstétricas y perinatales. Las adolescentes se clasificaron en tardías (15-19 años) y tempranas (< 15 años) y se compararon con las adultas (20-35 años). Se calculó OR ajustados por educación, estado civil, control prenatal, gestaciones previas, paridad e IMC pregestacional. Resultados: se encontró mayor riesgo de cesárea (OR=1,28; IC95 por ciento=1,07-1,53) e infección puerperal (OR=1,72; IC95 por ciento=1,17-2,53) en las adolescentes menores de 15 años, así como mayor riesgo (OR=1,34; IC95 por ciento=1,29-1,40)de episiotomía en las adolescentes tardías. Asimismo, se identificó un menor riesgo del embarazo adolescente para preeclampsia (OR=0,90; IC95 por ciento=0,85-0,97), hemorragia de la 2da mitad del embarazo (OR=0,80; IC95 por ciento=0,71-0,92), ruptura prematura de membranas (OR=0,83; IC95 por ciento=0,79-0,87), amenaza de parto pretérmino (OR=0,87; IC95 por ciento=0,80-0,94) y desgarro vaginal (OR= 0,86; IC95 por ciento=0,79-0,93). Conclusión: el embarazo se comporta como factor de riesgo para ciertas complicaciones obstétricas en la población adolescente, especialmente en las adolescentes tempranas. Existen además otros factores, que sumados a la edad materna, constituyen la necesidad de formar equipos multidis-ciplinarios para reducir complicaciones obstétricas en esta población...

To evaluate the risk of obstetric and perinatal outcomes in teenage pregnancy in comparison with adult pregnancy. Methods: retrospective cohort study of 67.693 pregnant women attended in a public hospital in Lima between 2000 and 2010. Obstetric and perinatal outcomes were evaluated. The adolescent group was divided in late adolescents (15-20 years), and early adolescents (<15 years) and was compared among the adult group (20-35 years). Adjusted odds ratios were calculated by education, civil status, prenatal care, previous pregnancies, parity, and pre-gesta-tional BMI. Results: higher risk of cesarean (OR=1,28; CI95 percent=1,07-1,53) and puerperal infection (OR=1,72; CI95 percent=1,17-2,53) was found in teenager under 15 years old; as well as higher risk of episiotomy (OR=1,34; CI95 percent=1,29-1,40) in late teenagers. In addition, this study identified a lower risk of teenage pregnancy for preeclampsia (OR=0,90; CI95 percent=0,85-0,97), 2nd half-pregnancy bleeding (OR=0,80; CI95 percent=0,71-0,92), premature rupture of membranes(OR=0,83; CI95 percent=0,79-0,87), preterm labor (OR=0,87; CI95 percent=0,80-0,94) and vaginal tearing (OR=0,86; CI95 percent=0,79-0,93). Conclusion: pregnancy behaves as a risk factor for some obstetric outcomes in the adolescent group, especially in the youngest ones. In addition to maternal age, there are other factors that constitute the need to form multidisciplinary teams to reduce obstetric outcomes in this population...

Knowledge and utilization of the partograph among obstetric care givers in South West Nigeria

This cross-sectional study assessed knowledge and utilization of the partograph among health care workers in southwestern Nigeria. Respondents were selected by multi-stage sampling method from primary; secondary and tertiary level care. 719 respondents comprising of CHEWS - 110 (15.3); Auxiliary Nurses - 148 (20.6); Nurse/Midwives - 365 (50.6); Physicians - 96 (13.4) were selected from primary (38.2); secondary (39.1) and tertiary levels (22.7). Only 32.3used the partograph to monitor women in labour. Partograph use was reported significantly more frequently by respondents in tertiary level compared with respondents from primary/secondary levels of care (82.4vs. 19.3; X2 = 214.6; p 0.0001). Only 37.3of respondents who were predominantly from the tertiary level of care could correctly mention at least one component of the partograph (X2 = 139.1; p 0.0001). The partograph is utilized mainly in tertiary health facilities; knowledge about the partograph is poor. Though affordable; the partograph is commonly not used to monitor the Nigerian woman in labour

Evaluación nutricional durante el embarazo: Nuevo estándar / Nutrition assessment during pregnancy: A new weight chart

Los límites para el aumento de peso ideal de una mujer embarazada y el patrón de ganancia de peso han sido poco estudiados en nuestra región. Los objetivos fueron: 1) construir una nueva curva de distancia del índice de masa corporal (IMC) para evaluación nutricional de la embarazada; 2) calcular la ganancia media de peso semanal y total por trimestres, y 3) comparar la nueva curva con un estándar propuesto como referente. Se incluyeron 326 embarazadas antes de la 16ª semana en el Hospital Sardá (Buenos Aires) entre 2001 y 2002. Se midieron peso, talla, perímetro braquial y pliegue tricipital. Se calcularon media, desviación estándar y coeficiente de variación (CV). Los percentilos reales 3 al 97 del peso y del IMC materno para la edad gestacional entre la 12ª y 42ª semana se calcularon mediante interpolación polinómica. El CV alcanzó un valor máximo del 18.4% después de la 28ª semana. El promedio del IMC preconcepcional fue de 24.2 kg/m² ± 4.5 y el 96% de los recién nacidos fueron de término con un índice ponderal de 2.7 ± 0.2 g/cm³. Los incrementos de peso fueron 0.600 kg ± 0.473, 6.476 kg ± 3.739 y 5.388kg ± 4.233 para el 1°, 2° y 3° trimestres respectivamente. Se observó concordancia entre la media de la nueva curva y el límite superior de la categoría "normal" de la curva actualmente recomendada. Los nuevos estándares de la ganancia de peso según peso e IMC permitirán lograr un adecuado control del incremento de peso gestacional.

Weight charts and patterns of weight gain for pregnant women in Argentina are scarce. The aims of the study were:1) to design a new reference weight gain chart to asses the nutritional status of pregnant women using the body mass index (BMI); 2) to estimate weight gain patterns, and 3) to compare it with a proposed reference chart. In 326 pregnant women before 16th week gestation at enrollment during 2001-2002 at the Sarda' Maternity Hospital (Buenos Aires), weight, height, mid arm circumference and skinfold were measured and body mass index was calculated. Mean, standard deviation, coefficient of variation and polynomial percentiles 3rd through 97th were generated for each gestational age between 12th to 42nd weeks. Maximum variability was 18.4% after 28th week, mean preconcepcional BMI was 24.2 ± 4.5 kg/m² and 96% of newborns were at term with a mean Ponderal Index of 2.7 ± 0.2 g/cm³. Trimesters weight increments were 0.600 kg ± 0.473, 6.476 kg ± 3.739 and 5.388kg ± 4.233 for the 1st, 2nd and 3rd, respectively. Total weight gain achieved was 12.46 Kg ± 3.13. Compared with the reference curve, the new one showed concordance at the 50th percentile with the upper limit of the normal range. The new reference charts of weight gain for pregnant women using maternal weight and BMI may be useful in prenatal care to asses nutritional status during pregnancy.

Risk factors related to group B streptococcal colonization in pregnant women in labor.

OBJECTIVE: To determine the risk factors related to group B streptococcal (GBS) colonization in pregnant women on admission in labor MATERIAL AND METHOD: From the 1st-30th October 2004, at the Rajavithi Hospital, 320 pregnant women, who fulfilled the specified criteria, were selected for a cross-sectional descriptive study. Swabs were cultured from the lower vagina and anorectum for GBS using Todd-Hewitt broth with nalidixic acid 15 microg/ml and gentamicin 8 microg/ml only. RESULTS: Colonization was present in 58 cases (18.12%). The risk factor for GBS colonization was an older mean maternal age and a lower mean gestational age. No mothers or neonates during the study period developed a clinical infection from GBS. CONCLUSION: The risk factors for GBS colonization in pregnant women were older maternal age and lower gestational age.

Normas y protocolos para la atención de las complicaciones obstétricas / Standards and protocol for the care of obstetric complications

El Ministerio de Salud de Nicaragua presenta la Normas y Protocolo de las Complicaciones Obstétricas dedicadas a la atención de los profesionales de la salud para a la atención de la mujer durante su embarazo, parto y puerperio, son el esfuerzo de un grupo de profesionales del Ministerio de Salud, de la Sociedad de Gineco-obstétricia, OPS/UNICEF entre otros. Este documento deberá contribuir a la actualización de los conocimientos científicos y la homogenización del manejo de las complicaciones obstétricas con el fin de impactar radicalmente en la reducción de la Mortalidad Materna en el país y brindar una atención digna a las mujeres en esta etapa de su vida...

Novos aspectos da vácuo-extração fetal / New aspects of vaccum-extracted deliveries

Apresentamos um dispositivo descartável de manejo simples (Mityvac - Prism Healthcare, San Antonio, Texas) que, embora pouco difundido, já está disponível em alguns hospitais brasileiros e é devidamente licenciado pela Agência Nacional de Vigilância Sanitária (ANVISA). Sua aceitação na Inglaterra e Estados Unidos tem sido grande nos últimos 10 anos. Os principais tempos e cuidados no manuseio do equipamento são expostos

Complications of home delivery: a retrospective analysis.

This study was conducted to analyze the cases who had attended Nepal Medical College Teaching Hospital (NMCTH) after home delivery in order to broadly review the complications. This is a retrospective descriptive study. The number of total deliveries during the study period of two years (April, 2002- April, 2004) was 1619, among which 88 (5.4%) were cases who attended after home delivery. Majority of women (35.2%) were primi, 57.9% belonged to 20-25 year age group, 17% were young primi, and 85.2% were full term deliveries whereas 9.1% were preterm. More than half of them (57.9%) had regular antenatal check up. Most of them came from within 1-2 km distance of NMCTH. 51.1% were brought only after 2 hrs of delivery. The most common reason for attending hospital was retained placenta (84.1%-74 cases) among whom 51 (68.9%) needed controlled cord traction, 8 cases (10.8%) needed manual removal, rest of the cases had placenta lying in the vagina. Fifteen (17%) cases had post partum hemorrhage, 9 cases (10.2%) were brought in a state of shock. 71.6% were anemic, 11 (12.5%) had Hb <7 gm%. Other complications included cervical, third degree perineal tear. Blood transfusion was needed in 19 (21.6%) cases. All cases improved with proper resuscitation, use of antibiotics and definitive management of complications. Most of them were discharged within 4 days of admission. Perinatal mortality rate was 65.9/1000 births. This study showed that home deliveries were associated with increased maternal morbidity especially the third stage complications. Studies done in developed countries have shown that home birth is safe for normal, low risk women, with adequate infrastructure and support i.e. given a well trained midwife and facilities to transfer to hospital if necessary. In our context, a community based obstetric service must be developed with emphasis on regular and quality antenatal care, health education to women and proper training of birth attendants.

Labour admission test--an effective risk screening tool.

Recording of foetal heart tracing on cardiotocogram for 30 minutes was done in 500 women on admission in labour and contraction mediated responses were recorded as labour admission test (LAT). Subjects were also stratified into high or low risk groups based on antenatal factors. Seventy-seven out of 500 labour cases (36 out of 433 cases with reactive, 16 out of 37 with suspicious and 25 out of 30 cases with ominous LATs) manifested foetal distress. Eighty-two per cent of antenatal high risk and 89% of low risk pregnancies showed reactive LATs. The LAT was found to have high specificity (93%) and negative predictive value (91%). However, the sensitivity and positive predictive values were lower (53% and 61% respectively). Patients with pre-existing risk factors showed intrapartum foetal distress by 3 hours of reactive LAT, whereas the ones with no antenatal risk factors did not develop foetal distress till 6 hours after reactive LAT. Reactive LAT tracing is of some predictive value; at least for the first few hours after admission in labour.

Desprendimiento prematuro de placenta en la maternidad del Hospital Dr. Adolfo Prince Lara, Puerto Cabello / Placental abruption in the Maternity of the \"Dr. Adolfo Prince Lara\" Hospital, Puerto Cabello

Analizar la incidencia, características maternas, obstétricas, complicaciones más frecuentes y determinar la asociación entre desprendimiento prematuro de placenta y factores de riesgo como hipertensión asociada al embarazo. Estudio retrospectivo y descriptivo de 224 casos atendidos desde 1984 hasta 1993 en 38.747 nacimientos. Maternidad del Hospital "Dr. Adolfo Prince Lara", Puerto Cabello, Estado Carabobo, Venezuela. La incidencia fue de 0.57 por ciento, 1 caso por cada 175 partos. Predominó el grupo etáreo de 27 a 32 años (31,25 por ciento). El 62,06 por ciento fueron multíparas; 55,56 por ciento presentaron embarazos menores de 37 semanas. El 92,41 por ciento fue de cesárea y 7,59 por ciento parto espontáneo. En el 49,03 por ciento el grado de desprendimiento fue grave, 29,61 por ciento moderado y 21,36 por ciento leve. Las complicaciones maternas fueron anemia 57,72 por ciento, coagulación intravascular diseminada 17,45 por ciento, shock hemorrrágico 14,19 por ciento, útero couvelaire 8,72 por ciento y 2,01 por ciento falla renal. El bajo peso al nacer representó el 43,56 por ciento. La tasa de mortalidad fetal fue de 506x1000. Hubo 4 muertes maternas. El desprendimiento prematuro de placenta ha presentado un leve incremento en el período de estudio, amerita establecer un programa preventivo y de educación actualizada para el pronóstico y manejo adecuado

Vasa previa in Ramathibodi Hospital: a 10 years review.

Vasa previa is presented when fetal vessels cross the internal os as a velamentous insertion of the umbilical cord. This retrospective study is to review the diagnosis, the management, and the outcome of this condition over the 10 years period in Ramathibodi Hospital, Bangkok, Thailand. Five cases were diagnosed after the rupture of membranes with only one case diagnosed prior to the rupture of membranes. The fetal mortality was 50 per cent. Despite continued advances in diagnostic procedures, vasa previa still presents considerable risk to the fetus.

Embarazo, parto y puerperio en mujeres de bajo peso / Pregnancy, delivery and puerperium in low weight women

Mediante el diseño de parejas homólogas fueron evaluadas 104 pacientes con bajo peso preconcepcional, con respecto al curso clínico del embarazo, parto y puerperio como al período perinatal de sus productos. Los criterios de inclusión fueron edad, paridad y tamaño corporal. Un peso preconcepcional menor al 78 por ciento, según el índice de Broca, fue utilizado para definir bajo peso. En el grupo de embarazadas de bajo peso se observó de manera estadísticamente significativa con mayor frecuencia hipotensión arterial (p = 0,0001), anemia (p = 0,02), trabajo de parto pretérmino (p = 0,0001) y prematuridad (p = 0,009). Con menor frecuencia hipertensión arterial (p = 0,03), edema (p = 0,0001) y enfermedad varicosa (p = 0,05). Los recién nacidos de madres de bajo peso presentaron con mayor frecuencia distrofia fetal (p = 0,027), ictericia neonatal (p = 0,028) y un mayor índice de traslados a la unidad de cuidados intensivos (p = 0,03). Estos resultados demuestran claramente el efecto negativo del bajo peso preconcepcional materno sobre el curso del embarazo y el estado del recién nacido

Valor predictivo de la pelvimetría clínica para el diagnostico de la desproporción cefalopélvica de causa materna

En las últimas décadas se han visto cómo ha aumentado en forma progresiva el número de cesáreas por desproporción cefalopélvica de causa materna. En este trabajo se pretende rescatar la pelvimetría como medio clínico, auxiliar en el diagnóstico de esta entidad. Se realizaron mediciones de la pelvis en 145 pacientes, de las cuales 115 fueron incluidas en el presente estudio; de ellas 19 fueron llevadas a cesárea por desproporción. A todas las pacientes se les realizó medición de los diámetros biespinosos, bicrestíleo, bitrocantérico, Baudelocque, arcada subpúbica, bituberoso, palpación del promontorio sacro, de las espinas ciáticas, inclinación del sacro y paredes laterales de la pelvis. El promedio obtenido de los diferentes diámetros en la población de estudio fue menor que los valores aceptados en la literatura como normales. De todos los parámetros estudiados, sólo el diámetro bituberoso disminuido (p= 0.04) y las paredes laterales convergentes (P=0.007) tuvieron un valor predictivo. Se concluye que la pelvimetría es una herramienta útil que puede alertar al clínico, pero que a pesar de hallar alteraciones en la pelvimetría, todas las pacientes deben ser sometidas a una prueba de trabajo de parto y que sólo con alteraciones en su dinámica, se puede diagnosticar la desproporción cefalopélvica

Dystocia: a continuing problem

A three year retrospective study was carried out at Sir Ganga Ram Hospital, Lahore, on 491 cases of dystocia, which formed 3.58% of 13,723 deliveries during the period. Of these 491 cases, 287 [58.45%] came with late obstructed labour and 204 [41.55%] with various types of prolonged labour. The commonest causes of dystocia were foetal malpositions and malpresentations in 172 [35.03%] patients and cephalopelvic disproportion in 167 [34.01%] cases. Five were in false labour; of the remaining, a large number of cases i.e., 372 [75.76%] came with abnormal length of labour with ruptured membranes. A total of 282 [58.02%] patients required a Caesarean section, while 83 [17.08%] had instrumental delivery and 55 [11.32%] were delivered normally. Infection was the most frequent maternal complication found in 297 [11.2%] patients. There were 6 maternal deaths [maternal mortality rate 17.04/1000 live births]. A total of 139 babies were stillborn, while 21 of the 352 live born expired within the first week; thus the perinatal loss was 160 or 329.21/1000. Important factors contributing to mortality were extreme age groups and parity, lack of proper antenatal and intrapartum care and mismanagement by traditional birth attandents