Percepção das parturientes sobre violência obstétrica: a dor que querem calar / Parturients' perception of obstetric violence: the pain they want to silence / Percepción de las parturientas acerca de la violencia obstétrica: el dolor que quieren silenciar

Objetivou-se identificar o conhecimento das parturientes sobre violência obstétrica, levantar se conseguem identificar as principais ações presentes na violência obstétrica, detectar os impactos físicos e psicológicos da violência obstétrica. Os sujeitos desse estudo foram 14 puérperas residentes do estado do Rio de Janeiro. Foi realizado um estudo do tipo descritivo, exploratório com abordagem quali-quantitativa. A coleta de dados foi realizada por meio de um formulário eletrônico online, na qual foi viabilizado um formulário individual composto de perguntas relacionadas ao objetivo da pesquisa sendo de fácil e rápido acesso ao sujeito participante. Concluiu-se através dos resultados desta pesquisa que as mulheres possuem um conhecimento limitado acerca da violência obstétrica, podendo estar relacionado à falta de informação durante o pré-natal.(AU)

The aim was to identify the parturients' knowledge about obstetric violence, to get up if they can identify the main actions present in obstetric violence, to detect the physical and psychological impacts of obstetric violence. The subjects of this study were 14 puerperal women living in the state of Rio de Janeiro. A descriptive, exploratory study with a qualitative and quantitative approach was carried out. Data collection was performed using an online electronic form, in which an individual form was made available, consisting of questions related to the research objective, being easily and quickly accessed by the participating subject. It was concluded through the results of this research that women have limited knowledge about obstetric violence, which may be related to the lack of information during prenatal care.(AU)

El objetivo era identificar el conocimiento de las parturientas sobre la violencia obstétrica, levantarse si pueden identificar las principales acciones presentes en la violencia obstétrica, detectar los impactos físicos y psicológicos de la violencia obstétrica. Los sujetos de este estudio fueron 14 mujeres puerperales que viven en el estado de Rio de Janeiro. Se realizó un estudio exploratorio descriptivo con enfoque cualitativo y cuantitativo. La recopilación de datos se realizó mediante un formulario electrónico en línea, en el que se puso a disposición un formulario individual, que consta de preguntas relacionadas con el objetivo de la investigación, de fácil y rápido acceso por parte del sujeto participante. A través de los resultados de esta investigación, se concluyó que las mujeres tienen un conocimiento limitado sobre la violencia obstétrica, que puede estar relacionada con la falta de información durante la atención prenatal.(AU)

Implementação de práticas assistenciais para prevenção e reparo do trauma perineal no parto / Implementación de prácticas asistenciales para la prevención y reparación de trauma perineal en el parto / Implementation of care practices to prevent and repair perineal trauma in childbirth

RESUMO Objetivos Implementar práticas assistenciais para prevenção e reparo do trauma perineal no parto normal. Métodos Estudo quase-experimental, realizado no Hospital da Mulher Mãe-Luzia, Macapá, AP. Realizaram-se 74 entrevistas com enfermeiros e médicos e 70 com puérperas, e analisaram-se dados de prontuários (n=555). O desenvolvimento da pesquisa se deu em três fases: pré-auditoria e auditoria de base (fase 1); intervenção educativa e implementação de boas práticas assistenciais (fase 2); auditoria pós-implementação (fase 3); a análise foi pela comparação das fases 1 e 3. Resultados Após a intervenção educativa, menos profissionais incentivavam puxos dirigidos, realizavam episiotomia e suturavam lacerações de primeiro grau; mais mulheres informaram que o parto foi em posição litotômica; mais registros nos prontuários indicaram o uso de Vicryl® na sutura da mucosa e pele. Conclusões A intervenção educativa melhorou os cuidados e os desfechos perineais, porém há lacunas na implementação das evidências e inadequações no manejo do cuidado perineal.

RESUMEN Objetivo Implementar prácticas asistenciales para la prevención y reparación del trauma perineal en el parto. Método Estudio casi experimental, conducido en el Hospital da Mulher Mãe-Luzia, Macapá, AP. Se realizaron 74 entrevistas con médicos y enfermeras y 70 con puérperas y se analizaron los datos de registros médicos (n=555). La investigación se desarrolló en tres fases: preauditoría y auditoría de base (fase 1); intervención educativa e implementación de buenas prácticas asistenciales (fase 2); auditoría posimplementación (fase 3); el análisis fue comparando las fases 1 y 3. Resultados Después de la intervención educativa, menos profesionales incentivaban pujo dirigido, realizaban episiotomía y suturaban desgarros de primer grado; más mujeres tuvieron el parto en posición litotomía; más registros indicaban uso de Vicryl® para suturar la mucosa y piel. Conclusión La intervención educativa ha mejorado el cuidado y los resultados perineales, pero hay lagunas en la implementación de evidencias y deficiencias en el cuidado perineal.

ABSTRACT Objective To implement care practices for perineal trauma prevention and repairing in normal birth. Method Quasi-experimental study conducted at Hospital da Mulher Mãe-Luzia, in Macapá, AP, Brazil. Seventy-four (74) nurses and obstetricians and 70 post-partum women were interviewed and the records of 555 patients were analyzed. The study was conducted in three stages: pre-audit and baseline audit (phase 1); educational intervention and implementation of best practices (phase 2); post-implementation audit (phase 3). Data was analyzed by comparison of the results of phases 1 and 3. Results Following the educational intervention, a lower number of health professionals encouraged directed pushing, performed episiotomies and repaired first-degree lacerations; more women reported lithotomy position; more patient records indicated the use of Vicryl™ to suture the perineal mucosa and skin. Conclusion The educational intervention improved birth care and perineal outcomes. Nevertheless, gaps were identified in the implementation of evidence, as well as inappropriate perineal care management

Indicações do parto a fórceps / Indications for forceps deliveries

A solução do parto no período expulsivo é um desafio, ainda nos dias de hoje. Apesar de ser praticado em cerca de 10% dos partos no mundo ocidental, há discussões sobre as indicações do parto vaginal operatório, a escolha do instrumento e sua aplicação sequenciada. Foi feita revisão da literatura, que se mostrou pobre em ensaios clínicos. A evidência maior do uso do fórceps repousou em estudos observacionais, muito dos quais com tamanho amostral limitado. Também, foram consultadas as diretrizes de algumas sociedades (ACOG, SOGC, RCOG e FEBRASGO) para as recomendações. Concluiu-se que ainda há necessidade da prática do fórceps, mas que esse ato deve ser realizado por obstetra experiente e em ambiente que permita a prática da cesárea. As indicações fetais para parto a fórceps são a parada de progressão e o sofrimento fetal, e as indicações maternas são aquelas em que o esforço expulsivo é fator de risco para complicações (cardiopatias, pneumopatias, encefalopatias). A falha do fórceps ou do vácuo é indicação para cesárea, não sendo recomendado o seu uso sequenciado. Foi verificado que há necessidade de programas de treinamento na prática do fórceps.

The solution of second stage of childbirth is still a challenge. Despite being practiced in 10% of births in the Western world, there are discussions about the indications for operative vaginal deliveries, choice of instrument and its application. Literature review was conducted, which proved to be poor in clinical trials. The best evidence rested in observational studies, many of which with limited sample size. Some guidelines were consulted (ACOG, SOGC, RCOG and FEBRASGO) for recommendations. It was concluded that there is still need for the practice of forceps, but this surgery must be performed by experienced obstetrician and in an environment that allow the practice of caesarean section. Fetal indications for forceps deliveries are lack of progression in the second stage and fetal distress. Maternal indications are those in which the expulsive effort is risk factor for complications (heart, lung or cerebral diseases). The failure of the forceps or vacuum is indication of caesarean section, not being recommended its use in sequence. There is a need for training programs in the practice of forceps.

effects of regular exercise on pregnancy outcome

Most women who report increased levels of physical activity are not at an increased risk of preterm delivery or reduced intrauterine growth. This study was conducted to look into the safety and effects of regularly timed aerobic exercises during pregnancy on both the mother and the neonate. A prospective, case-control study was done on 120 healthy pregnant women in their first trimester. The data were collected in the prenatal outpatient care, labor and delivery rooms of a university-based Obstetrics Department. After completing basic information forms, the pregnant women were educated on the specific exercises in 8 stages throughout the pregnancy. Sixty-three patients presenting for delivery without any history of physical exercise were selected as the control group. There was no significant difference between the two groups regarding their occupation. The exercising group experienced significantly decreased durations of labor. There was no significant difference in neonatal birth weight or apgar scores. There were a significant decreased number of assisted deliveries in the exercising group. Exercise during pregnancy shortens the duration of the second stage of labor and reduces the risk of assisted delivery while is safe for the neonate too

effect of the mode of delivery on the time-to-conceive and outcome of subsequent delivery

The objective of this study is to compare the impact of the different types of the last delivery [CS, instrumental and NVD] on the time-to-conceive [and in particular since when the couple planned for pregnancy], and the effect on subsequent mode [and outcome] of delivery. The two main study groups were patients with secondary infertility [group I] and multiparous pregnant women [group II]. The last delivery in group I was caesarean section [CS] in 64.28% of patients, instrumental vaginal delivery [IVD] in 23.12% of patients and spontaneous vaginal delivery [SVD] in 12.58% of patients. In group II the median time-to-pregnancy following CS was 44.33 months, a time period that was significantly longer than that observed following IVD [24.00 months] and the latter was significantly longer than that observed following SVD [22.46 months]. However, if the median time-to-pregnancy was calculated only from since when the partners decided for a further pregnancy, the corresponding figures were 40.08 months following CS, 12.12 months following instrumental vaginal delivery and 9.59 months following SVD [the corresponding comparisons were significant too]. The success rate of trial of vaginal delivery after a previous LSCS [group II, A] was 79.72% . Most of these vaginal deliveries [95.25%] were unassisted ones. Although the rate of vaginal delivery after CS was reasonably high, it was significantly higher in the IVD group [88%] and in the SVD group [90.04%]. It can be concluded that caesarean delivery adversely affects women's future fertility [secondary infertility becomes more common and time-to-conceive may become longer]. Obstetricians should consider the overall reproductive outcome for an individual woman, should be encouraged to conduct trial of scar and should be retrained in the arts of vaginal breech delivery, external cephalic version and instrumental delivery. Trial of scar is safe and has a high success rate

Principales indicaciones y repercusiones maternofetales por ejecución de partos con espátulas / Main indications and mother-fetus implications due to deliveries performed with spatula

Se realizó un estudio descriptivo, transversal y retrospectivo de los 50 partos ejecutados con espátulas en el Hospital Materno Sur “Mariana Grajales” de Santiago de Cuba desde enero del 2004 hasta febrero del 2005, a fin de determinar las principales indicaciones y repercusiones maternofetales que justificaron su uso, así como los factores biosociales más comúnmente asociados a esa decisión, que en este caso resultaron ser: la primiparidad, el peso normal del feto y el cordón umbilical apretado o laxo alrededor de su cuello. Los datos obtenidos al respecto revelaron que la indicación básica para utilizar ese tipo de instrumento fue el período expulsivo prolongado; la complicación materna predominante, el desgarro cervical; y las complicaciones fetales prevalecientes: la bolsa serosanguínea, no provocada directamente por la manipulación con las paletas, y la herida facial. A pesar de los muchos detractores del procedimiento, en este hospital ha proporcionado buenos resultados para extraer al producto de la concepción en circunstancias desfavorables para su espontáneo nacimiento

Subgaleal hematoma and seven exchange transfusions.

A 3 kg baby was delivered by cesarean section after prolonged labor. He had massive subgaleal hematoma. He developed anemia requiring packed cell transfusions and hyperbilirubinemia requiring a total of seven exchange transfusions and highly intensive phototherapy. There were no adverse complications of the hyperbilirubinemia or the exchange transfusion.