Assessment of sexual and body esteem in postpartum women with or without perineal laceration: a cross-sectional study with cultural translation and validation of the Vaginal Changes Sexual and Body Esteem Scale.

Objective: We aimed to translate and determine cultural validity of the Vaginal Changes Sexual and Body Esteem Scale (VSBE) for Brazilian Portuguese language in postpartum women who underwent vaginal delivery with or without perineal laceration and cesarean section. Methods: A cross-sectional study conducted virtually, with online data collection through a survey with 234 postpartum women of 975 that were invited. Clinical, sociodemographic, and psychometric variables from the VSBE questionnaire were analyzed (content validity index, internal consistency, test-retest reliability, construct/structural and discriminant validity). Multivariate analysis was performed to explore associated factors with the presence of perineal laceration. Results: One-hundred fifty-eight women experienced vaginal delivery, of which 24.79% had an intact perineum, 33.33% had perineal laceration, and 9.4% underwent episiotomy; and 76 participants had cesarean sections. Women with perineal laceration were older, presented dyspareunia and previous surgeries than women without perineal laceration (p<0.05). For VSBE, a high internal consistency (Cronbach's α > 0.7) was observed, but it did not correlate with Body Attractiveness Questionnaire and Female Sexual Function Index; however, it correlated with the presence of women sutured for perineal laceration. Moreover, VSBE presented good structural validity with two loading factors after exploratory factor analysis. VSBE also demonstrated discriminant validity between the presence or absence of perineal laceration. The presence of urinary incontinence (UI) (OR=2.716[1.015-4.667];p=0.046) and a higher VSBE total score (OR=1.056[1.037-1.075];p<0.001) were the only factors associated with perineal laceration. Conclusion: Vaginal Changes Sexual and Body Esteem Scale demonstrated appropriate translation and good internal consistency, discriminant/construct validity and reliability. Vaginal Changes Sexual and Body Esteem Scale total score and presence of UI were associated with women that underwent perineal laceration.

Professional activity and experience after a residency training program in ObGyn: A 10-year analysis.

OBJECTIVE: To describe the profile and professional trajectory of the obstetrics and gynecology (ObGyn) graduates over the past decade, at a referral university hospital. METHODS: A cross-sectional study was conducted, utilizing a survey that targeted graduates of the ObGyn residency program from the last decade, asking about demographics, medical undergraduate, residency details, post-residency trajectory, satisfaction levels, and social media usage. A descriptive analysis was performed. Comparative analyses, including gender-based differences, were assessed using chi-squared or Fisher exact tests (P < 0.05). RESULTS: Among 126 graduates, 84 agreed to participate (66.67%), predominantly comprising females with an average age of 33 years. Most identified themselves as white. The majority had pursued their undergraduate studies at the same institution (78.6%) and subsequently acquired specialized titles in ObGyn from the national society. Most of them were employed in both public and private sectors (71.08%). Male graduates held the majority of medical shifts in obstetrics. A significant gender-based salary discrepancy was noted, favoring males. More than half of the professionals utilized social media for work-related purposes. Many expressed the necessity for supplementary education beyond public health, particularly career management. CONCLUSION: The findings highlight a predominance of female and white individuals among the graduates. Overall, graduates expressed contentment with their education and professional engagements. A gender-based income disparity was identified, favoring male graduates. Studies like this can provide insights for improving medical residency education.

Uso de misoprostol em obstetrícia / Misoprostol use in obstetrics

PONTOS-CHAVE O misoprostol é um análogo da prostaglandina E1 (PGE1) que consta na Lista de Medicamentos Essenciais da Organização Mundial da Saúde (OMS) desde 2005 O Brasil possui uma das regulações mais restritivas do mundo relacionadas ao uso do misoprostol, estabelecendo que o misoprostol tem uso hospitalar exclusivo, com controle especial, e venda, compra e propaganda proibidas por lei Atualmente, o misoprostol é a droga de referência para tratamento medicamentoso nos casos de aborto induzido, tanto no primeiro trimestre gestacional quanto em idades gestacionais mais avançadas O misoprostol é uma medicação efetiva para o preparo cervical e indução do parto O misoprostol é um medicamento essencial para o manejo da hemorragia pós-parto

Robson's Ten Group Classification System to Evaluate Cesarean Section Rates in Honduras: The Relevance of Labor Induction.

OBJECTIVE: To use the Robson Ten Group Classification (RTGC) to analyze cesarean section (CS) rates in a Honduran maternity hospital, with focus in groups that consider induction of labor. METHODS: Cross-sectional study. Women admitted for childbirth (August 2017 to October 2018) were classified according to the RTGC. The CS rate for each group and the contribution to the overall CS rate was calculated, with further analyses of the induction of labor among term primiparous (group 2a), term multiparous (group 4a), and cases with one previous CS (group 5.1). RESULTS: A total of 4,356 women were considered, with an overall CS rate of 26.1%. Group 3 was the largest group, with 38.6% (1,682/4,356) of the cases, followed by Group 1, with 30.8% (1,342/4,356), and Group 5, with 10.3% (450/4,356). Considering the contribution to overall CS rates per group, Group 5 contributed with 30.4% (345/1,136) of the CSs and within this group, 286/345 (82.9%) had 1 previous CS, with a CS rate > 70%. Groups 1 and 3, with 26.6% (291/1,136) and 13.5% (153/1,136), respectively, were the second and third larger contributors to the CS rate. Groups 2a and 4a had high induction success, with low CS rates (18.4 and 16.9%, respectively). CONCLUSION: The RTGC is a useful tool to assess CS rates in different healthcare facilities. Groups 5, 1, and 3 were the main contributors to the CS rate, and groups 2 and 4 showed the impact and importance of induction of labor. These findings may support future interventions to reduce unnecessary CS, especially among primiparous and in women with previous CS.

OBJETIVO: Utilizar a Classificação de Dez Grupos de Robson (RTGC, na sigla em inglês) para analisar as taxas de cesárea (CS, na sigla em inglês) em uma maternidade hondurenha. MéTODOS: Estudo de corte transversal em uma maternidade em Honduras. As mulheres internadas para o parto (agosto de 2017 a outubro de 2018) foram classificadas segundo a RTGC. Calculou-se a taxa de CS para cada grupo e a contribuição para a taxa geral de CS, com análises adicionais da indução do trabalho de parto entre as primíparas a termo (grupo 2a), multíparas a termo (grupo 4a) e casos com uma CS anterior (grupo 5.1). RESULTADOS: foram consideradas 4.356 mulheres, com uma taxa geral de CS de 26.1%. O Grupo 3 foi o maior grupo, com 38,.6% (1.682/4.356) dos casos; seguido pelo Grupo 1, com 30,8% (1.342/4.356), e pelo Grupo 5, com 10,3% (450/4,356). Considerando a contribuição para as taxas globais de CS por grupo, o Grupo 5 contribuiu com 30,4% (345/1,136) das CS, dos quais 286 (82.9%) tinha uma CS anterior, com um índice de CS > 70%. Os grupos 1 e 3, com 291/1.136 (26.6%) e 153/1.136 (13,5%), respectivamente, foram o segundo e terceiro maiores contribuintes para a taxa de CS. Os grupos 2a e 4a tiveram alto sucesso de indução, com baixas taxas de CS (18.4 e 16.9%, respectivamente). CONCLUSãO: O RTGC é uma ferramenta útil para avaliar as taxas de CS em diferentes unidades de saúde. Os grupos 5, 1 e 3 foram os principais contribuintes para a taxa de CS. Estes achados podem apoiar intervenções futuras para reduzir as CS desnecessárias, especialmente entre primíparas e em mulheres com uma CS anterior.

Robson's Ten Group Classification System to Evaluate Cesarean Section Rates in Honduras: The Relevance of Labor Induction / Sistema de classificação de dez grupos de Robson para avaliar taxas de parto cesárea: A importância da indução do trabalho de parto

Abstract Objective To use the Robson Ten Group Classification (RTGC) to analyze cesarean section (CS) rates in a Honduran maternity hospital, with focus in groups that consider induction of labor. Methods Cross-sectional study. Women admitted for childbirth (August 2017 to October 2018) were classified according to the RTGC. The CS rate for each group and the contribution to the overall CS rate was calculated, with further analyses of the induction of labor among term primiparous (group 2a), term multiparous (group 4a), and cases with one previous CS (group 5.1). Results A total of 4,356 women were considered, with an overall CS rate of 26.1%. Group 3 was the largest group, with 38.6% (1,682/4,356) of the cases, followed by Group 1, with 30.8% (1,342/4,356), and Group 5, with 10.3% (450/4,356). Considering the contribution to overall CS rates per group, Group 5 contributed with 30.4% (345/1,136) of the CSs and within this group, 286/345 (82.9%) had 1 previous CS, with a CS rate > 70%. Groups 1 and 3, with 26.6% (291/1,136) and 13.5% (153/1,136), respectively, were the second and third larger contributors to the CS rate. Groups 2a and 4a had high induction success, with low CS rates (18.4 and 16.9%, respectively). Conclusion The RTGC is a useful tool to assess CS rates in different healthcare facilities. Groups 5, 1, and 3 were the main contributors to the CS rate, and groups 2 and 4 showed the impact and importance of induction of labor. These findings may support future interventions to reduce unnecessary CS, especially among primiparous and in women with previous CS.

Resumo Objetivo Utilizar a Classificação de Dez Grupos de Robson (RTGC, na sigla em inglês) para analisar as taxas de cesárea (CS, na sigla em inglês) em uma maternidade hondurenha. Métodos Estudo de corte transversal em uma maternidade em Honduras. As mulheres internadas para o parto (agosto de 2017 a outubro de 2018) foram classificadas segundo a RTGC. Calculou-se a taxa de CS para cada grupo e a contribuição para a taxa geral de CS, com análises adicionais da indução do trabalho de parto entre as primíparas a termo (grupo 2a), multíparas a termo (grupo 4a) e casos com uma CS anterior (grupo 5.1). Resultados foram consideradas 4.356 mulheres, com uma taxa geral de CS de 26.1%. O Grupo 3 foi o maior grupo, com 38,.6% (1.682/4.356) dos casos; seguido pelo Grupo 1, com 30,8% (1.342/4.356), e pelo Grupo 5, com 10,3% (450/4,356). Considerando a contribuição para as taxas globais de CS por grupo, o Grupo 5 contribuiu com 30,4% (345/1,136) das CS, dos quais 286 (82.9%) tinha uma CS anterior, com um índice de CS > 70%. Os grupos 1 e 3, com 291/1.136 (26.6%) e 153/1.136 (13,5%), respectivamente, foram o segundo e terceiro maiores contribuintes para a taxa de CS. Os grupos 2a e 4a tiveram alto sucesso de indução, com baixas taxas de CS (18.4 e 16.9%, respectivamente). Conclusão O RTGC é uma ferramenta útil para avaliar as taxas de CS em diferentes unidades de saúde. Os grupos 5, 1 e 3 foram os principais contribuintes para a taxa de CS. Estes achados podem apoiar intervenções futuras para reduzir as CS desnecessárias, especialmente entre primíparas e em mulheres com uma CS anterior.

Risk factors for mediolateral episiotomy at a tertiary hospital: a cross-sectional study.

OBJECTIVE: The main aim of this study was to assess the associated factors for selective mediolateral episiotomy at a tertiary, academic hospital. METHODS: A retrospective cohort analysis between 2017 and 2019 was performed. The primary outcome was the prevalence of selective mediolateral episiotomy. Independent variables were maternal, intrapartum, and neonatal characteristics. A significance level of 5% was established, and univariate and multivariate analyses with logistic regression models were performed. RESULTS: From 2,761 vaginal deliveries eligible for inclusion during this period, the prevalence of selective mediolateral episiotomy was 18.7%. Univariate analysis has shown that non-white women were protective factors (OR=0.77 [0.63-0.96]; p=0.02) for episiotomy; primiparity (OR=2.61 [2.12-3.21]; p<0.01), number of vaginal examinations between 6-10 repetitions (OR=3.16 [2.48-4.01]; p<0.01) and 11-20 repetitions (OR=5.40 [3.69-7.90]; p<0.01), longer second stage duration (OR=1.01 [1.00-1.02]; p<0.01), and women with gestational age more than 37 weeks were risk factors. Multivariate analysis reported that second stage duration (AOR=1.01 [1.00-1.03]; p<0.01), primiparity (AOR=2.03 [1.34-3.06]; p<0.01), and number of vaginal examinations between 6-10 repetitions (AOR=2.36 [1.50-3.70]; p<0.01) and 11-20 repetitions (AOR=3.29 [1.74-6.20]; p<0.01) were remained as risk factors for selective mediolateral episiotomy. CONCLUSION: A higher number of vaginal examinations during labor (over six repetitions), longer duration of second stage labor, and primiparity were risk factors associated with selective mediolateral episiotomy.

Risk factors for mediolateral episiotomy at a tertiary hospital: a cross-sectional study

SUMMARY OBJECTIVE: The main aim of this study was to assess the associated factors for selective mediolateral episiotomy at a tertiary, academic hospital. METHODS: A retrospective cohort analysis between 2017 and 2019 was performed. The primary outcome was the prevalence of selective mediolateral episiotomy. Independent variables were maternal, intrapartum, and neonatal characteristics. A significance level of 5% was established, and univariate and multivariate analyses with logistic regression models were performed. RESULTS: From 2,761 vaginal deliveries eligible for inclusion during this period, the prevalence of selective mediolateral episiotomy was 18.7%. Univariate analysis has shown that non-white women were protective factors (OR=0.77 [0.63-0.96]; p=0.02) for episiotomy; primiparity (OR=2.61 [2.12-3.21]; p<0.01), number of vaginal examinations between 6-10 repetitions (OR=3.16 [2.48-4.01]; p<0.01) and 11-20 repetitions (OR=5.40 [3.69-7.90]; p<0.01), longer second stage duration (OR=1.01 [1.00-1.02]; p<0.01), and women with gestational age more than 37 weeks were risk factors. Multivariate analysis reported that second stage duration (AOR=1.01 [1.00-1.03]; p<0.01), primiparity (AOR=2.03 [1.34-3.06]; p<0.01), and number of vaginal examinations between 6-10 repetitions (AOR=2.36 [1.50-3.70]; p<0.01) and 11-20 repetitions (AOR=3.29 [1.74-6.20]; p<0.01) were remained as risk factors for selective mediolateral episiotomy. CONCLUSION: A higher number of vaginal examinations during labor (over six repetitions), longer duration of second stage labor, and primiparity were risk factors associated with selective mediolateral episiotomy.

Antenatal corticosteroid therapy modulates hepatic AMPK phosphorylation and maternal lipid metabolism in early lactating rats.

Antenatal corticosteroid therapy is used to reduce neonatal mortality in preterm infants but it is currently unknown whether this intervention affects lipid metabolism at the peripartum. This study aimed to evaluate if antenatal corticosteroid therapy in pregnant rats and women affects lipid metabolism during early lactation. We evaluated women at risk of preterm delivery that received corticosteroid therapy (CASE) and women that were not exposed to corticosteroid and were not at risk of preterm delivery (CONTROL). Samples were collected to measure serum and milk triacylglycerol (TAG) three days after delivery. Rats were treated with dexamethasone (DEX) between the 15th and the 20th days of pregnancy. Samples were collected at different days after delivery (L3, L8 and L14). TAG was measured in serum, liver and mammary gland (MG). TAG appearance rates were measured after tyloxapol injection and gavage with olive oil. We also evaluated the expression of key genes related to lipid metabolism in the liver and in the MG and hepatic phosphorylation of AMP-activated protein kinase (AMPK) and acetyl-CoA carboxylase (ACC). CASE volunteers delivered earlier than CONTROL but presented unaltered milk and serum TAG concentrations. Early lactating DEX rats exhibited increased TAG in serum, MG and milk. No changes in CD36 and LPL were detected in the MG and liver. Early lactating DEX rats displayed increased TAG appearance rate and reduced hepatic AMPK/ACC phosphorylation. Our data revealed that antenatal corticosteroid therapy reduces hepatic AMPK/ACC phosphorylation during early lactation that reflects in increased TAG concentration in serum, MG and milk.

Maternal outcomes and risk factors for COVID-19 severity among pregnant women.

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease.

Severe Perineal Trauma in a Brazilian Southeastern Tertiary Hospital: A Retrospective Cohort Study.

OBJECTIVE: This study aimed to investigate the prevalence of severe perineal trauma (obstetric and anal sphincter injury [OASIS]) in a tertiary high-risk pregnancy facility and the associated factors. METHODS: A retrospective electronic chart review on perineal lacerations was performed from the period of April 2017 to February 2019. Obstetric and anal sphincter injury was diagnosed by a rectal examination. Primary outcome was the prevalence of OASIS (third- and fourth-degree perineal tear). Independent variables were maternal, intrapartum, and neonatal characteristics. Univariate and multivariate analyses with logistic regression models were performed. A P value lower than 0.05 was considered significant. RESULTS: The prevalence of OASIS (third/fourth-degree laceration) was 1.51% (43/2846) in our population. Our population was mostly white (66.3%) and mostly primiparous (52.1%). By comparison, the prevalence of first/second-degree laceration was 43% (1223/2846). Selective episiotomy occurred in 18.73% (517/2761) of patients, and it was not associated with OASIS (P = 0.211). Advanced maternal age (P = 0.196), higher number of vaginal examinations (P = 0.169), fetal presentation (P = 0.533), and duration of second stage (P = 0.757) were not associated with OASIS. Univariate analysis has found that forceps delivery (odds ratio [OR], 3.68 [1.74-7.79]; P = 0.001), neonatal macrossomy (OR, 3.42 [1.02-11.43]; P = 0.045), and larger head circumference (OR, 1.15 [1.02-1.32]; P = 0.026) were risk factors for OASIS, whereas higher gravidity reduced the risk (OR, 0.61 [0.42-0.91] for OASIS. However, after multivariate analysis, only head circumference (OR, 1.86 [1.10-3.14]; P = 0.020) remained as a risk factor. CONCLUSIONS: Larger neonatal head circumference increased in 86% the risk for severe perineal trauma in this cohort of women.