Women's obstetric history and midtrimester cervical length measurements by 2d/3d and doppler ultrasound / História obstétrica e medida do comprimento do colo uterino de mulheres no segundo trimestre gestacional por ultrassonografia bi/tridimensional e Doppler

Abstract Objective The aim of the present study was to compare the obstetric history and both two- and tri-dimensional ultrasound parameters according to different cervical lengths. Methods The present cross-sectional study analyzed 248 midtrimester pregnant women according to cervical length and compared the data with the obstetric history and 2D/3D ultrasound parameters. Patients were divided into 3 groups according to cervical length: The Short Cervix group for cervical lengths ≥ 15mm and< 25mm(n= 68), the Very Short Cervix group for cervical lengths< 15mm (n = 18) and the Control group, composed of 162 pregnant women with uterine cervical lengths ≥ 25mm. Results When analyzing the obstetric history of only non-nulliparous patients, a significant association between the presence of a short cervix in the current pregnancy and at least one previous preterm birth was reported (p = 0.021). Cervical length and volume were positively correlated (Pearson coefficient = 0.587, p < 0.0001). The flow index (FI) parameter of cervical vascularization was significantly different between the Control and Very Short Cervix groups. However, after linear regression, in the presence of volume information, we found no association between the groups and FI. Uterine artery Doppler was also not related to cervical shortening. Conclusion The present study showed a significant association between the presence of a short cervix in the current pregnancy and at least one previous preterm birth. None of the vascularization indexes correlate with cervical length as an independent parameter. Uterine artery Doppler findings do not correlate with cervical length.

Resumo Objetivo O objetivo do presente estudo foi comparar a história obstétrica e os parâmetros bi- e tridimensionais ultrassonográficos de acordo com os diferentes comprimentos cervicais. Métodos O presente estudo transversal analisou 248 gestantes no segundo trimestre de acordo com o comprimento cervical e comparou os dados com a história obstétrica e os parâmetros ultrassonográficos 2D/3D. As pacientes foram divididas em 3 grupos de acordo com o comprimento do colo uterino: grupo Colo Curto para comprimentos cervicais ≥ 15mm e < 25mm (n = 68), grupo Colo Muito Curto para comprimentos cervicais < 15mm (n = 18) e grupo Controle, composto por 162 gestantes com comprimento cervical uterino ≥ 25 mm. Resultados Ao analisar a história obstétrica apenas de pacientes não nulíparas, foi relatadauma associação significativa entre a presença de colo uterino curto na gravidez atual e pelo menos um episódio de parto prematuro anterior (p = 0,021). Comprimento e volume do colo uterino foram correlacionados positivamente (coeficiente de Pearson = 0,587, p < 0,0001). O parâmetro índice de fluxo (IF) da vascularização cervical foi significativamente diferente entre os grupos Controle e Colo Muito Curto. Entretanto, após regressão linear, na presença de informações de volume, não encontramos associação entre os grupos e o parâmetro IF. Também não foi encontrada relação entre o Doppler da artéria uterina e o encurtamento cervical. Conclusão O presente estudo mostrou uma associação significativa entre a presença de colo uterino curto na gravidez atual e pelo menos um episódio de parto prematuro anterior. Nenhum dos índices de vascularização se correlaciona com o comprimento cervical como parâmetro independente, assim como o Doppler da artéria uterina também não está relacionado ao comprimento do colo uterino.

Aspectos reprodutivos de mulheres celíacas no Brasil / Reproductive aspects in brazilian celiac women

ABSTRACT BACKGROUND: Celiac disease (CD) is a chronic enteropathy in response to ingestion of gluten. CD was associated with gynecological disorders. OBJECTIVE: In this retrospective study, we aimed to investigate the age of menarche, age of menopause, number of pregnancies and abortions in Brazilian celiac patients. METHODS: We studied 214 women diagnosed with CD and as control group 286 women were investigated. RESULTS: Regarding the mean age of menarche, a significant difference was found (12.6±1.40 in CD and 12.8±1.22 years in healthy group; P=0.04). Regarding abortions, in CD women 38/214 (17.8%) and 28/286 (9.8%) in the control group reported abortion (P=0.0092, OR:1.98; CI95%=1.1- 3.3). There was no significant difference in the mean age of menopause nor number of pregnancies per woman. CONCLUSION: In this study, we found that celiac women had a higher mean age of menarche and higher risk of spontaneous abortions.

RESUMO CONTEXTO: A doença celíaca é uma enteropatia crônica em resposta à ingestão de glúten e já foi associada a distúrbios ginecológicos. OBJETIVO: Neste estudo retrospectivo, visamos investigar a idade da menarca, idade da menopausa, número de gestações e abortos em pacientes celíacas brasileiras. MÉTODOS: Foram estudadas 214 mulheres com diagnóstico de doença celíaca e no grupo controle, 286 mulheres foram investigadas. RESULTADOS: Em relação à média de idade da menarca foi encontrada diferença significativa (12,6±1,40 na doença celíaca e 12,8±1,22 anos no grupo controle; P=0,04). Em relação aos abortos, nas mulheres com doença celíaca 38/214 (17,8%) relataram ter tido pelo menos um abortamento espontâneo, enquanto que 28/286 (9,8%) no grupo controle relataram aborto (P=0,0092, OR: 1,98; IC95% = 1,1-3,3). Não houve diferença significativa na idade média da menopausa nem no número de gestações por mulher. CONCLUSÃO: Neste estudo, constatamos que as mulheres celíacas apresentaram maior idade média de menarca e maior risco de abortos espontâneos.

Dermatoses in the early neonatal period: their association with neonatal, obstetric and demographic variables / Dermatoses no período neonatal precoce: associação com variáveis neonatais, obstétricas e demográficas

ABSTRACT Objective: To evaluate the prevalence of neonatal dermatoses in the early neonatal period and to associate them with neonatal, demographic and obstetric variables. Methods: A cross-sectional study with neonates and their respective mothers, who were hospitalized in a public maternity hospital in Curitiba, PR, Brazil. Data collection was performed using information present in the medical records and a physical examination of the newborn during the period between April 2015 and May 2016. Results: 350 neonates were evaluated. 54.8% were male, and 94.8% (332/350) presented a dermatosis. Among them, 84.6% had, concomitantly, two or more dermatoses. A total of 23 types of dermatoses were diagnosed. The most prevalent were: sebaceous hyperplasia (66%); fluff (42.6%); and salmon patches (41.4%). The mean age of the mothers was 24.9±4.9 years old, and they were predominately white (57.7%). Vernix caseosa was associated with the female gender (p=0.034). Nonwhite mothers were associated with genital hyperpigmentation (p=0.03) and Mongolian spots (p=0.001). Physiological flaking was associated with cesarean deliveries (p=0.03) and a gestational age of over 40 weeks (p=0.054). Salmon patches was associated with primiparity (p=0.0001). Conclusions: There was a high prevalence of neonatal dermatosis in the studied population. Each newborn had, on average, three different dermatoses. Dermatosis in neonates was associated with primiparity, nonwhites, a gestational age of over 40 weeks, and the sex of the newborn.

RESUMO Objetivo: Avaliar a prevalência de dermatoses no período neonatal precoce e associar sua ocorrência a variáveis neonatais, demográficas e obstétricas. Métodos: Estudo transversal com neonatos e respectivas puérperas internados em alojamento conjunto de uma maternidade pública de Curitiba (PR). A coleta de dados foi realizada por meio de informações presentes nos prontuários e no exame físico do recém-nato durante o período de abril de 2015 a maio de 2016. Resultados: Foram avaliados 350 recém-nascidos, 54,8% do sexo masculino, e 332 (94,8%) apresentaram dermatoses. Desses 332, 84,6% tiveram, concomitantemente, duas ou mais dermatoses. Diagnosticou-se o total de 23 tipos de dermatoses, sendo mais prevalentes: hiperplasia sebácea (66,6%); lanugem (42,6%); e mancha salmão (41,4%). A média de idade das puérperas foi de 24,9±4,9 anos, com predomínio de etnia branca (57,7%). Vérnix foi associado a sexo feminino (p=0,034). A etnia materna não branca associou-se à hiperpigmentação genital (p=0,030) e mancha mongólica (p=0,001). A descamação fisiológica associou-se ao parto cesáreo (p=0,030) e à idade gestacional acima de 40 semanas (p=0,054); e mancha salmão, à primiparidade (p=0,0001). Conclusões: Verificou-se alta prevalência de dermatose neonatal na população estudada, sendo cada recém-nascido acometido em média por três tipos. Houve associação da presença de dermatoses com primiparidade, mães não brancas, idade gestacional superior a 40 semanas e sexo do neonato.

Comparison of the Kelly's plication and TOT simultaneously with vaginal hysterectomy, on the incontinence, and sexual functions

ABSTRACT Purpose: To compare the effect of vaginal hysterectomy-anterior/posterior colporrhaphy with Kelly's plication(VH-KP), versus vaginal hysterectomy-anterior/posterior colporrhaphy-transobturator tape(VH-TOT) surgeries on incontinence, quality of life, and sexual functions in patients with pelvic organ prolapse(POP), and concurrent obvious stress urinary incontinence(SUI). Materials and Methods: Between 2013 and 2017, fifty patients treated with VH-KP(n = 25), and VH-TOT(n = 25) due to POP and SUI, were evaluated prospective consecutively. Age, parity, duration of urinary incontinence, and the daily pad use were recorded. Patients were filled "rinary Distress Inventory-6(UDI-6)", "Incontinence Impact Questionnaire 7(IIQ-7)" and "Index of Female Sexual Function(IFSI)" questionnaire forms at preoperatively, and postoperative 6th month. No usage of pads was accepted as subjective cure rate. Intraoperative, and postoperative complications were noted. Results: There was no statistically significant difference between two groups, for the mean age of the patients, parity, duration of SUI, and the daily pad use, preoperatively (p > 0.05). Decreased UDI-6 scores, IIQ-7 scores and daily pad usage, and increased IFSF scores were found statistical significantly in each group, at the postoperative 6 th month (p < 0.05). However, VH-TOT group had higher improvement rates, on UDI-6 scores (69.5% vs 63.0%, p = 0.04). In addition, it was notable that the the rates of the patients had IFSF scores ≥ 25 was higher in VH-KP group (p = 0.05). Four (16%) patients had recurrent SUI in the VH-KP group (p = 0.039) and vaginal extrusion occurred in 2 (8%) patients in the VH-TOT group (p = 0.153), postoperatively. Conclusions: Although the effects of VH-TOT surgery are superior to conventional methods for incontinence and quality of life; negative effects on sexual functions are notable. In addition, although recurrence rates of TOT are low, complications such as vaginal extrusion are accompanied by drawbacks of mesh usage.

Longitudinal study of lung function in pregnant women: Influence of parity and smoking

OBJECTIVES: To evaluate pulmonary function in the first and third trimesters of pregnancy and analyze the influence of parity and smoking on spirometry parameters. METHODS: This longitudinal prospective study included a cohort of 120 pregnant women. The inclusion criteria were as follows: singleton pregnancy, gestational age less than 13.86 weeks, and no preexisting maternal diseases. The exclusion criteria were as follows: change of address, abortion, and inadequate spirometry testing. ClinicalTrials.gov: NCT02807038. RESULTS: A decrease in values of forced vital capacity and forced expiratory volume were noted in the first second from the first to third trimester. In the first and third trimesters, multiparous women demonstrated lower absolute forced vital capacity and forced expiratory volume values in the first second compared with nulliparous women (p<0.0001 and p=0.001, respectively). Multiparous women demonstrated reduced forced expiratory flow in 25% to 75% of the maneuver compared with nulliparous women in the first (p=0.005) and third (p=0.031) trimesters. The absolute values of forced expiratory flow in 25% to 75%, forced expiratory volume in the first second and predicted peak expiratory flow values in the third trimester were higher in smokers compared with nonsmokers (p=0.042, p=0.039, p=0.024, and p=0.021, respectively). CONCLUSION: There was a significant reduction in forced vital capacity and forced expiratory volume values in the first second during pregnancy. Parity and smoking significantly influence spirometric variables.

La multiparidad como factor de riesgo de diabetes mellitus gestacional / Multiparity as a Risk Factor for Gestational Diabetes Mellitus

Introducción: se estima que en Perú la prevalencia de Diabetes Mellitus es de 7 por ciento y uno de cada 100 de estos casos es de tipo gestacional. Un reporte previo menciona que la Diabetes Mellitus Gestacional afecta al 4 por ciento de las gestantes peruanas. Objetivo: determinar los factores de riesgo potenciales para desarrollar diabetes mellitus gestacional. Métodos: estudio de casos y controles realizado en el Hospital Alberto Sabogal mediante recolección de historias clínicas desde 2009 hasta 2014. Se define como caso las gestantes con diagnóstico de diabetes mellitus gestacional mediante una prueba de tolerancia oral a la glucosa, previa glucosa en ayunas anormal y control a la gestante sin valores indicativos de diabetes mellitus gestacional. Las variables de interés fueron paridad, antecedente de cesáreas, abortos y recién nacido con mayor peso. Los modelos de regresión logística fueron calculados para estimar odd ratios e intervalos de confianza al 95 por ciento. Resultados: se incluyeron 84 casos y 336 controles. En el modelo multivariado, la multiparidad incrementó el riesgo de diabetes mellitus gestacional (OR= 3,54; IC 95 por ciento 1,55 - 8,14). También hubo antecedente de abortos, a partir del segundo (OR= 3,40, IC 95 por ciento 1,55-7,44) y cesáreas previas (una cesárea OR= 3,5 IC 95 por ciento 1,89-6,47 y más de dos cesáreas OR= 8,35 IC 95 por ciento 3,50-19,95). La multiparidad, dos o más abortos y mayor número de cesáreas son factores de riesgo para diabetes mellitus gestacional. Conclusiones: el presente estudio describe la asociación de la diabetes mellitus gestacional con algunos antecedentes obstétricos como la multiparidad, el antecedente de cesáreas y/o abortos. Por esta razón, se recomienda implementar medidas de prevención e identificación de gestantes con signos de alarma de diabetes mellitus gestacional para realizar un diagnóstico temprano, así como el seguimiento de estas pacientes en el posparto(AU)

Introduction: the prevalence of diabetes mellitus is estimated to be 7 percent in Peru. One in 100 of these cases is gestational type. A previous report said gestetional diabetes mellitus affects 4 percent of Peruvian pregnant. Objectives: identify risk factors for gestational diabetes mellitus (GDM). Methods: acase-control study was performed in Alberto Sabogal Hospital, collecting medical records from 2009 to 2014. 84 cases and 336 controls were included. A case was defined as a pregnant women diagnosed with GDM by an oral glucose tolerance test (OGTT) after an abnormal fasting glucose and control was defined as a pregnant women without GDM indicative values. The study outcome was GDM. The variables of interest were multiparity, previous cesarean section, abortions, newborn with the greatest weight. Logistic regression were used to calculate the odds ratio (OR) and a confidence interval of 95 percent (IC95 percent). Conclusions: this study describes the association of gestational diabetes mellitus with some obstetrical history as multiparity, history of caesarean sections and / or abortions. For this reason, it is recommended to implement prevention and identification of pregnant women with warning signs of gestational diabetes mellitus for early diagnosis and monitoring of these patients in the postpartum period(AU)

Parturient perineal distensibility tolerance assessed by EPI-NO: an observational study / Tolerância da parturiente à extensibilidade perineal avaliada pelo EPI-NO: estudo observacional / Tolerância da parturiente à extensibilidade perineal avaliada pelo EPI-NO: estudo observacional

Objective : To determine how parturient women tolerate the use of a perineal distensibility assessment technique using the EPI-NO device. Methods : An observational study with a total of 227 full-term parturient women was performed. During the evaluation with EPI-NO, parturient patients were asked about their sensation of discomfort. The degree of discomfort was measured using the Visual Analogue Scale, with a score from zero to 10. The Mann-Whitney test was applied to assess perineal distensibility measured by EPI-NO and the degree of discomfort caused by the test according to parity. The relation between perineal distensibility and discomfort was analyzed by using the Spearman correlation test (r). Results : The test with EPI-NO caused only slight discomfort (mean Visual Analogue Scale of 3.8), and primiparous women reported significantly greater discomfort (mean Visual Analogue Scale of 4.5) than did multiparous (mean Visual Analogue Scale=3.1), with p<0.001 women. A negative correlation was observed, in other words, the greater the perineal distensibility on the EPI-NO, the lower the pain reported by the patients (r=-0.424; p<0.001). Conclusion : The assessment of perineal distensibility with EPI-NO was well tolerated by the parturient women. .

Objetivo : Determinar como a mulher parturiente tolera o uso de uma nova técnica de extensibilidade perineal, por meio do aparelho EPI-NO. Métodos : Estudo observacional com um total de 227 gestantes a termo. Durante a avaliação pelo EPI-NO, as parturientes foram perguntadas sobre a sensação de desconforto. O grau de desconforto foi medido usando a Escala Visual Analógica, com escore entre zero a 10. O teste de Mann-Whitney foi usado para avaliar a extensibilidade perineal avaliada pelo EPI-NO e o grau de desconforto causado pelo teste de acordo com a paridade. A relação entre extensibilidade perineal e desconforto foi avaliada pelo teste de correlação de Spearman (r). Resultados : O teste com EPI-NO causou apenas leve desconforto (média da Escala Visual Analógica de 3,8), sendo que as primíparas reportaram mais desconforto de modo significativo (média da Escala Visual Analógica de 4,5) que as multíparas (média da Escala Visual Analógica de 3,1), com p<0,001. Observou-se correlação negativa, ou seja, a maior extensibilidade no EPI-NO foi acompanhada de menor dor referida pelas pacientes (r=-0,424; p<0,001). Conclusão : A avaliação da extensibilidade perineal com EPI-NO foi bem tolerada pelas parturientes. .

Estudio de factores obstétricos, nutricionales y hormonales y su influencia en el desarrollo de cáncer de mama / Association between obstetric factors, hormone levels and nutritional status with the development of breast cancer

Background: Recent studies suggest that the age at first pregnancy, number of children and the lapse between births may protect against breast cancer. Furthermore, serum levels of estrogen, prolactin and progesterone appear to contribute to the development of this tumors in obese women. Aim: To verify whether the variables age at first pregnancy, number of children, birth interval, hormone levels and nutritional status are associated with the age at diagnosis of breast cancer. Material and Methods: Retrospective analysis of medical records of550female patients, diagnosed and treated for breast cancer at a hospital in Spain between 2009 and 2012. Results: We found a significant and positive association between age at diagnosis of cancer and the variables age at first pregnancy, parity and interval between pregnancies. There was also a significant correlation (p < 0.000) between serum levels of estrogen, prolactin and progesterone and nutritional status of patients. Conclusions: In this sample, age at first pregnancy or number of children, hormone levels and nutritional status are related to the age of onset of cancer.

Pelvic floor muscle strength evaluation in different body positions in nulliparous healthy women and its correlation with sexual activity

Objective The aim of this study was to assess pelvic floor muscle (PFM) strength in different body positions in nulliparous healthy women and its correlation with sexual activity. Materials and Methods Fifty healthy nulliparous women with mean age of 23 years were prospectively studied. Subjective evaluation of PFM was assessed by transvaginal digital palpation (TDP) of anterior and posterior areas regarding the vaginal introitus. A perineometer with inflatable vaginal probe was used to assess the PFM strength in four different positions: supine with extended lower limbs (P1); bent-knee supine (P2); sitting (P3); standing (P4). Results Physical activity, 3 times per week, was reported by 58% of volunteers. Sexual activity was observed in 80% of women and 82% of them presented orgasm. The average body mass index (BMI) was 21.76 kg/m2, considered as normal according World Health Organization (WHO). We observed that 68% of volunteers were conscious about the PFM contraction. TDP showed concordance of 76% when anterior and posterior areas were compared (p = 0.00014). There was not correlation between PFM strength and orgasm in subjective evaluation. The PFM strength was significantly higher in standing position when compared with the other positions (p < 0.000). No statistical difference was observed between orgasm and PFM strength when objective evaluations were performed. Conclusions There was concordance between anterior and posterior areas in 76% of cases when subjective PFM strength was assessed. In objective evaluation, higher PFM strength was observed when volunteers were standing. No statistical correlation was observed between PFM strength and orgasm in nulliparous healthy women. .

Development of the BG-Malaria trap as an alternative to human-landing catches for the capture of Anopheles darlingi

Although the human-landing catch (HLC) method is the most effective for collecting anthropophilic anophelines, it has been increasingly abandoned, primarily for ethical considerations. The objective of the present study was to develop a new trap for the collection of Anopheles darlingi . The initial trials were conducted using the BG-Sentinel trap as a standard for further trap development based on colour, airflow direction and illumination. The performance of the trap was then compared with those of the CDC, Fay-Prince, counterflow geometry trap (CFG) and HLC. All trials were conducted outdoors between 06:00 pm-08:00 pm. Female specimens of An. darlingi were dissected to determine their parity. A total of 8,334 anophelines were captured, of which 4,945 were identified as An. darlingi . The best trap configuration was an all-white version, with an upward airflow and no required light source. This configuration was subsequently named BG-Malaria (BGM). The BGM captured significantly more anophelines than any of the other traps tested and was similar to HLC with respect to the number and parity of anophelines. The BGM trap can be used as an alternative to HLC for collecting anophelines.

Força muscular respiratória: comparação entre primigestas e nuligestas / Respiratory muscle strength: comparison between primigravidae and nulligravidae

OBJETIVO: Descrever e comparar os valores de PImáx e de PEmáx em primigestas e nuligestas na faixa etária de 20-29 anos pareadas por idade. MÉTODOS: Foram estudadas 120 primigestas de baixo risco obstétrico, da 5ª a 40ª semana gestacional, e 40 nuligestas, eutróficas, não praticantes de atividade física, provenientes da região metropolitana do Recife (PE). Os valores de PImáx e PEmáx foram obtidos, respectivamente, a partir do VR e da CPT através de um manovacuômetro digital. A comparação entre os grupos foi feita pelo teste t de Student, e a relação dos fatores grupo e idade cronológica sobre as pressões foi avaliada através de regressão linear múltipla. RESULTADOS: No grupo de primigestas e nuligestas, a média de PImáx foi de, respectivamente, 88,5 ± 16,52 cmH2O e 94,22 ± 22,63 cmH2O (p = 0,08), enquanto a média de PEmáx foi de 99.76 ± 18,19 cmH2O e 98,67 ± 20,78 cmH2O (p = 0,75). Não houve correlação entre a idade gestacional e PImáx (r = -0,06; p = 0,49) ou PEmáx (r = -0,11; p = 0,22). A relação entre idade cronológica e PImáx/PEmáx não diferiu entre primigestas e nuligestas (coeficiente angular = 0,028 e 0,453, respectivamente). CONCLUSÕES: As pressões respiratórias de mulheres primigestas mantiveram-se estáveis durante o ciclo gestacional e não diferem significativamente dos valores das nuligestas na faixa etária de 20-29 anos.

OBJECTIVE: To describe and to compare MIP and MEP in primigravidae and nulligravidae in the 20-29 year age bracket and paired by age. METHODS: We included 120 primigravidae with low obstetric risk (5th-40th week of gestation) and 40 nulligravidae. All of the participants were of normal weight and none exercised regularly. All were recruited from the metropolitan area of Recife, Brazil. Measurements of MIP and MEP were obtained from RV and TLC, respectively, with a digital manometer. We used Student's t-test to compare the two groups, and we used multiple linear regression in order to determine whether group or chronological age correlated with MIP or MEP. RESULTS: In the primigravida and nulligravida groups, the mean MIP values were 88.50 ± 16.52 cmH2O and 94.22 ± 22.63 cmH2O, respectively, (p = 0.08), whereas the mean MEP values were 99.76 ±18.19 cmH2O and 98.67 ± 20.78 cmH2O (p = 0.75). Gestational age did not correlate with MIP (r = -0.06; p = 0.49) or MEP (r = -0.11; p = 0.22). The relationship between chronological age and MIP/MEP did not differ between primigravidae and nulligravidae (angular coefficient = 0.028 and 0.453, respectively). CONCLUSIONS: Within this sample of women in the 20-29 year age bracket, the respiratory pressures of primigravidae remained stable during pregnancy and did not differ significantly from those of nulligravidae.

Comparison of pelvic floor muscle strength evaluations in nulliparous and primiparous women: a prospective study

OBJECTIVE: This study aimed to compare the pelvic floor muscle strength of nulliparous and primiparous women. METHODS: A total of 100 women were prospectively distributed into two groups: Group 1 (G1) (n = 50) included healthy nulliparous women, and Group 2 (G2) (n = 50) included healthy primiparous women. Pelvic floor muscle strength was subjectively evaluated using transvaginal digital palpation. Pelvic floor muscle strength was objectively assessed using a portable perineometer. All of the parameters were evaluated simultaneously in G1 and were evaluated in G2 during the 20th and 36th weeks of pregnancy and 45 days after delivery. RESULTS: In G2, 14 women were excluded because they left the study before the follow-up evaluation. The median age was 23 years in G1 and 22 years in G2; there was no significant difference between the groups. The average body mass index was 21.7 kg/m² in G1 and 25.0 kg/m² in G2; there was a significant difference between the groups (p = 0.0004). In G2, transvaginal digital palpation evaluation showed significant impairments of pelvic floor muscle strength at the 36th week of pregnancy (p = 0.0006) and 45 days after vaginal delivery (p = 0.0001) compared to G1. Objective evaluations of pelvic floor muscle strength in G2 revealed a significant decrease 45 days after vaginal delivery compared to nulliparous patients. CONCLUSION: Pregnancy and vaginal delivery may cause weakness of the pelvic floor muscles.

Postergación de la maternidad en Chile: Una realidad oculta / Association between motherhood postponement and socioeconomic status

Background: Delayed motherhood is a common phenomenon in the developed world, where the age at frst delivery is around 30 years. In Chile the National Institute of Statistics established that this age has remained around 23 years for more than two decades. Motherhood postponement may be modulated by socioeconomic status. Aim: To determine whether the age at frst delivery is higher in a private clinic compared to a public hospital. Patients and Methods: Two cohorts of primiparous women delivering in 1998 and 2008 in the public hospital San Borja Arriarán (HSBA) and a private setting Clínica Las Condes (CLC), were analyzed. Results: The age of all delivering women was significantly lower in HSBA than in CLC in both study periods (26.3 ± 0.8 and 25.7 ± 0.9 compared to 31.6 ± 0.1 and 32.7 ± 0.1 years, respectively). Likewise, the frequency of adolescent pregnancy was significantly higher in HSBA than CLC in both study periods (38.8 and 42.2 percent compared to 1.7 and 1.6 percent respectively). The age at frst delivery was significantly lower in both periods in HSBA (21.8 and 21.3 years compared to 28.6 and 30.6 years, respectively). Excluding primiparous women of less than 20 years, the difference in age was smaller, but remained still significant (24.6 and 24.2 versus 29.9 and 31.0 years, respectively). Conclusions: In Santiago, the postponement of motherhood is more marked among women of high socioeconomic status.

Caracterização das puérperas assistidas pela fonoaudiologia de uma maternidade escola / Characterization of parturients assisted by the speech therapy care service of a school maternity

TEMA: puérperas atendidas por serviço de Fonoaudiologia. OBJETIVOS: caracterizar a população de puérperas assistidas pelo Serviço de Fonoaudiologia, participantes da segunda etapa do Método Mãe-Canguru, em uma Maternidade Escola referência em alto risco, no ano de 2006. MÉTODOS: estudo descritivo analítico retrospectivo desenvolvido através da análise de 204 prontuários. Foram utilizadas técnicas de estatística descritiva, testes de Mann-Withney para comparação das variáveis sem distribuição normal, considerando significativos valores de p < 0,05. RESULTADOS: a idade média das genitoras foi 24,61 anos (dp = 7,36), sendo 125 (61,27 por cento) oriundas do interior do estado e 102 (50 por cento) solteiras. A maioria da população atendida referiu 4 a 7 anos de estudo (35,29 por cento), ocupação principal atividades domésticas (76,47 por cento) e ausência de experiência prévia quanto ao aleitamento materno (53,43 por cento). O tipo de parto predominante foi cesárea em 98 (48,03 por cento) mulheres e 89 (43,62 por cento) mencionaram a realização de um a três consultas no pré-natal. CONCLUSÃO: a população assistida pelo Serviço de Fonoaudiologia se caracterizou por predominantemente primíparas solteiras, do interior do estado, de baixa renda familiar, sem trabalho remunerado, porém elevada escolaridade, em anos de estudo. Também foram detectados baixo número de consultas pré-natais, tipo de parto cesárea, idade gestacional baixa e elevado tempo de internação hospitalar.

BACKGROUND: parturients assisted by a speech therapy care service. AIM: to characterize the parturient population assisted by the Speech Therapy Care Service, who were participating of the second phase of the Kangaroo Mother Method, in a school maternity, reference for high risk cases, in 2006. METHOD: retrospective analytical descriptive study by means of the analysis of 204 medical registers. Descriptive statistical techniques were used as well as the Mann-Whitney test for the comparison of variables without normal distribution. The adopted significance level was of 5 percent. RESULTS: the mean age of the mothers was of 24.61 years (SD = 7.36), being 125 (61.27 percent) from the countryside and 201 (50 percent) single. Most of the assisted population had been to school for 4 to 5 years (35.29 percent), most were housewives (76.47 percent) and had no previous experience concerning breastfeeding (53.43 percent). The prevalent birth method was Caesarean section (n=98; 48.03 percent) and 89 (43.62 percent) reported 1 to 3 sessions of pre-natal care counseling. CONCLUSION: the population assisted by the Speech Therapy Care Service was characterized mainly as single precipitous from the countryside, who had low income and no remunerated job, however they presented high schooling in terms of study years. Also a low number of pre-natal counseling sessions was observed, as well as caesarean section, low pregnancy age and extended hospital stay time.

Fatores associados ao peso insuficiente ao nascimento / Factors associated with insufficient birth weight

OBJETIVO: Identificar, por meio das Declarações de Nascidos Vivos (DNV) de Campinas (SP), os fatores associados com peso insuficiente (PI) ao nascimento. MÉTODOS: Foram analisadas 14.444 DNV de 2001; o peso de nascimento variou de 285g a 5.890g, com média de 3.142g; 65,1 por cento das crianças nasceram com 3.000g ou mais e 25,7 por cento com PI. Selecionou-se 12.770 RNs a termo, de gestação única, com peso > 2.500g. Utilizou-se o peso de nascimento como variável dependente e as características maternas, as relacionadas à gestação, ao parto e ao recém-nascido como independentes. Para análise estatística empregou-se o teste de Qui quadrado e calcularam-se valores de odds ratio (OR) brutos. Para os valores de OR ajustados, empregou-se modelo de regressão logística. RESULTADOS: Houve associação entre PI e RNs de sexo feminino (ORaj = 1,57 [IC95 por cento 1,44 - 1,70]), mães primíparas (ORaj = 1,47 [IC95 por cento 1,35 - 1,60]), as que fizeram menos que sete consultas de pré-natal (ORaj = 1,42 [IC95 por cento 1,29 - 1,58]) e as submetidas a parto vaginal (ORaj = 1,23 [IC95 por cento 1,13 - 1,34]). CONCLUSÃO: O risco para peso insuficiente foi maior para os RN do sexo feminino, os filhos de primíparas, das mulheres que fizeram pré-natal inadequado e das submetidas a parto vaginal.

OBJECTIVE: To identify risk factors for insufficient birth weight, in the Brazilian city of Campinas from the Live Birth Certificates. METHODS: A cross-sectional study was conducted consulting data from 14,444 Live Birth Certificates from the year 2001. These newborn birth weights ranged from 285g to 5,890g (mean 3,142g), 65.1 percent of them weighted 3,000g or more, while 25.7 percent had insufficient weight. A sample of 12,779 term newborn from single pregnancies, with a birth weight > 2,500g was selected. Birth weight was the dependent variable and maternal, pregnancy, delivery and newborn characteristics were the independent variables. Association among variables was assessed by Chi-square test, crude odds-ratio (OR) was calculated. For adjusted odds-ratio (adjOR) values, a logistic regression model was used. RESULTS: Results showed association between insufficient birth weight and newborn of the female gender (adjOR = 1.57 [95 percentCI 1.44 - 1.70]), birth from primiparous mothers (adjOR = 1.47 [95 percentCI 1.35 - 1.60]), inadequate prenatal care (adjOR = 1.42 [95 percentCI 1.29 - 1.58]) and vaginal delivery (adjOR = 1.23 [95 percentCI 1.13 - 1.34]). CONCLUSION: The risk for insufficient birth weight was higher for female newborn, offspring of primiparous women, of women who had inadequate prenatal care and had vaginal delivery.

Sintomas urinários irritativos após parto vaginal ou cesárea / Irritative bladder symptoms after vaginal delivery or c-section

OBJETIVO: Avaliar a frequência de Sintomas Urinários Irritativos (SUI) três anos após o parto em mulheres previamente entrevistadas no terceiro trimestre da gestação e sua associação com a via de parto exclusiva, a paridade, a idade materna, o peso do RN, a realização da episiotomia e o uso de fórcipe. MÉTODOS: Das 340 mulheres, originalmente avaliadas no terceiro trimestre da gestação, 120 foram localizadas e entrevistadas por telefone, três anos após o parto, entre junho e outubro de 2006. Foi analisada a associação entre SUI e via exclusiva de parto (vaginalou cesáreo), paridade,idade materna, peso do recém-nascido, realização da episiotomia e uso de fórcipe. Os resultados foram avaliados por meio de estatística descritiva, teste Qui quadrado e cálculo da razão de prevalência (p< 0,05). RESULTADOS: O grupo de mulheres estudadas consistiu de primíparas (37,5 por cento) e multíparas (62,5 por cento). As 95 que tiveram via exclusiva de parto foram categorizadas em vaginal (53) e cesáreas (42). Não houve associação significativa entre a presença de SUI após o parto e a via de parto exclusiva e a paridade. Também não encontramos associação entre a presença de SUI e a idade materna (> 35) peso do recém-nascido (> 4000g), realização da episiotomia e uso de fórcipe. CONCLUSÃO: A via de parto e a paridade não foram fatores determinantes para a disfunção do trato urinário inferior após o parto, representada pelos sintomas urinários irritativos, tampouco, a idade materna, o peso do RN, a realização da episiotomia e o uso de fórcipe.

OBJECTIVE: This study intended to investigate the frequency of irritative bladder symptoms three years after delivery in women previously interviewed in the third trimester of pregnancy and its correlation to mode of delivery, parity, maternal age, birth weight, episiotomy and forceps. METHODS: From 340 women previously evaluated at the third trimester of pregnancy, 120 were interviewed three years after delivery, between June and October 2006. Correlation of postpartum irritative bladder symptoms and mode of delivery (exclusively vaginal or c-section), parity, maternal age, birth weight, episiotomy and forceps was analyzed. Associations between irritative bladder symptoms and obstetric parameters were assessed by the Fisher's exact test and Chi-square (p< 0.05). RESULTS: The study group consisted of 37.5 percent primiparous and 62.5 percent multiparous women. Mode of delivery was exclusively vaginal in 53 women and exclusively c-section in 42. No statistical difference was found between irritative bladder symptoms and mode of delivery and parity. No statistical difference was found between irritative symptoms and maternal age (> 35), birth weight (> 4000g), episiotomy and forceps. CONCLUSION: After childbirth, dysfunction of the lower urinary tract, characterized by irritative bladder symptoms, was not associated with mode of delivery, parity, maternal age, birth weight, episiotomy and forceps.

Effect of two pushing techniques [Valsalva's maneuver and spontaneous pushing] during the second stage of labor on maternal and neonatal conditions as well as the progress of labor in nulliparous women

The second stage of labor has provided debates concerning when maternal pushing efforts should begin and how long they should last for, in order to safeguard maternal and neonatal wellbeing. Therefore, the aim of study was to contrast the effect of two pushing techniques [Valsalva's Maneuver and Spontaneous Pushing] during the Second Stage of Labor on maternal and neonatal conditions as well as the progress of labor in Nulliparous Women. The study was conducted at El- Shatby Maternity University Hospital throughout a period of three months, using a cross-sectional analytical design on purposeful sample of [60] women was further subdivided randomly into two groups, a study group were Valsalva's Maneuver was applied for them and a control group were Spontaneous Pushing is redemonstrated by them. Data were collected through an assessment sheet covering socio-demographic and obstetric characteristics of women enrolled in the study sample plus the examination of women during labor. An observation form for birth outcomes was also used for evaluation of the effect of the two selected pushing techniques on maternal condition such as, [degree of perineal tearing, and blood loss more than 500 mL]. neonatal condition was evaluated through items including, [Apgar scores at I and 5 mm]. As well as progress of labor based on length of the second stage of labor. The main study findings showed that, there was a statistically significant differences between the Valsalva and Spontaneous Pushing groups in relation to incidence of extended episiotomy with tears, Apgar scoring at first minute and length of second stage ad expulsions phase of labor with positive results to the spontaneous pushing group. No statistical significant difference was found regarding incidence of post-partum hemorrahg and Apgar scoring at fifth minute. Moreover, the study concluded that, Spontaneous Pushing efforts are accompanied by adequate labor progress and result in less perineal trauma. In the light of the study results, it is recommended that further examination of the common practice of encouraging women to bear down spontaneously during the second stage, responding to their involuntary urge, is recommended

Mothers and their pregnancies: a comparison of three population-based cohorts in Southern Brazil / Mães e suas gestações: uma comparação de três coortes de base populacional no Sul do Brasil

Mothers from the 1982, 1993 and 2004 Pelotas birth cohorts were compared across biological, socioeconomic, demographic and reproductive characteristics. Women in the 2004 cohort had higher levels of education, gained more weight during pregnancy, and were heavier at the beginning and end of their pregnancy than mothers who gave birth in 1993 and 1982. There was an important increase in obesity rates (body mass index > 30kg/m²) over the 22 years of the study. Mean parity decreased from 1.3 in 1982 to 1.1 in 2004, with a growing proportion of primiparas and a decline in the proportion of women with > 4 children. The mean birth interval increased from 33.5 months in 1982 to 65.7 in 2004. Smoking during pregnancy decreased from 35.6 percent in 1982 to 25.1 percent in 2004. As with other characteristics, the change in smoking status differed according to income, with higher reductions among the wealthiest (from 24.9 percent to 8.7 percent) than among the poorest mothers (from 43.7 percent to 33.6 percent). In general terms, between 1993 and 2004 there was a decrease in the prevalence of maternal risk factors for unfavorable perinatal outcomes.

As mães das coortes de nascimentos de Pelotas de 1982, 1993 e 2004 foram comparadas em relação a características biológicas, sócio-econômicas, demográficas e reprodutivas. As mães da coorte de 2004 tinham escolaridade mais alta, ganharam mais peso durante a gestação e pesavam mais no início e final da gestação, comparadas com as mães de 1993 e 1982. Houve um aumento importante nas taxas de obesidade (índice de massa corporal >30kg/m²) ao longo dos 22 anos do estudo. A paridade média diminuiu de 1,3 em 1982 para 1,1 in 2004, com um aumento na proporção de mulheres primíparas e um declínio na proporção de mulheres com > 4 crianças. O intervalo médio entre nascimentos aumentou de 33,5 meses em 1982 para 65,7 em 2004. O hábito de fumar durante a gravidez diminuiu de 35,6 por cento em 1982 para 25,1 por cento m 2004. Assim como outras características, a mudança no tabagismo mostrou diferenças de acordo com renda familiar, com uma redução menor nas mães de maior renda (de 24,9 por cento para 8,7 por cento), comparadas com as mais pobres (de 43,7 por cento para 33,6 por cento). Em termos gerais, entre 1993 e 2004 houve uma diminuição na prevalência de fatores de risco maternos para desfechos perinatais desfavoráveis.

Uniparidade em pacas criadas em cativeiro (Agouti paca, Linnaeus, 1766) / Uniparity in pacas bred in captivity (Agouti paca, Linnaeus, 1766)

Durante quatro anos foram detectadas 25 prenhezes, em 13 diferentes pacas, por meio de ultra-sonografia. Após a detecção ultra-sonográfica, as fêmeas foram separadas em baias individuais para o nascimento dos filhotes e aí mantidas até o desmame. Houve nascimento de apenas um animal por parto, ressaltando a característica reprodutiva de uniparidade, o que sugere a tendência de nascimento de apenas um filhote por parto, nessa espécie.

During four years 25 pregnancies were detected in 13 different pacas by means of ultrasonography at a wild animal section. After ultrasound detection, females were separated in individual sets for delivering and kept until weaning of newborns. Only one newborn by delivery occurred, remarking the reproductive characteristic of uniparity, what suggests the trend of only one newborn in each delivery.

Partograma en mujeres multíparas con manejo médico del trabajo de parto / Graphic analyses of labor in multiparous womens with medical management

Antecedentes. La evaluación gráfica del parto fue descrito originalmente por Friedman, sin embargo, una descripción de la evolución del trabajo de parto con un manejo médico contemporáneo no ha sido completamente evaluado. Objetivo: Analizar el efecto de un manejo médico estandarizado del trabajo de parto, que incluye anestesia regional, rotura artificial de membranas y conducción ocitócica, sobre la fase activa del trabajo de parto en multíparas. Método. Análisis retrospectivo de 130 multíparas en trabajo de parto espontáneo, que ingresaron con 3 a 4 cm de dilatación. Resultados. Se observó una duración de la fase activa del trabajo de parto de aproximadamente 3,5 horas, con una progresión promedio de 1,5 cm/ h, produciéndose la mayor progresión entre los 7 y 9 cm de dilatación con 1,9 cm/h. La segunda fase del trabajo de parto presento una duración promedio de 28 minutos. Conclusiones. Nuestros resultados muestran que el manejo médico estandarizado del trabajo de parto no reduce los tiempos de la fase activa ni de la segunda fase en multíparas. Creemos que es necesario implementar estudios randomizados para determinar la influencia de este tipo manejo del trabajo de parto en la incidencia de cesáreas.