Manejo de las gestantes durante la pandemia COVID-19 y experiencia en un hospital de A Coruña / Management of pregnant women during the COVID-19 pandemic and experience in a Coruña’s hospital

Objetivo: Describir el seguimiento y la atención al parto de las gestantes durante la pandemia por Covid- 19 en el Complejo Hospitalario de A Coruña. Recopilar evidencia y recomendaciones científicas en el seguimiento de la mujer gestante durante la pandemia Covid-19. Método: Se ha realizado una búsqueda bibliográfica en bases de datos como Medline, Cochrane y CUIDEN, además de en sitios web: OMS, el Ministerio de Sanidad y el SERGAS. Se han utilizado los términos MeSH: “Covid-19”, “Pregnancy”, “Pregnant women”, “lactation”, “vaccination in pregnant and lactating women”, “obstetrics”, “midwife” y “vertical transmission”. No se establecieron límites temporales ya que se trata de una enfermedad reciente. Se han filtrado por artículos publicados en español, inglés y gallego. Resultados: Se explica el circuito de control de atención primaria y hospitalaria del embarazo, parto y posparto en el hospital de A Coruña durante la pandemia. Conclusiones: Tras comparar la experiencia en hospital de A Coruña y atención primaria con los artículos y guías encontradas sobre el manejo y recomendaciones de las gestantes durante la pandemia de la covid-19, se observó que las actuaciones llevadas a cabo se ajustaron a las recomendaciones en ese momento y tras investigaciones posteriores del Covid se modificaron para dar una mejor asistencia a las gestantes. Es necesario la realización de nuevos estudios para corroborar que el manejo y las recomendaciones actuales son adecuadas. (AU)

Objective: To describe the follow-up and delivery care of pregnant women during the Covid-19 pandemic at the Hospital of A Coruña. Compile evidence and scientific recommendations in the follow-up of pregnant women during the Covid-19 pandemic Method: A bibliographic search has been carried out in databases such as Medline, Cochrane and CUIDEN, as well as in websites: WHO, the Ministry of Health and SERGAS. The MeSH terms have been used: “Covid-19”, “Pregnancy”, “Pregnant women”, “lactation”, “vaccination in pregnant and lactating women”, “obstetrics”, “midwife” and “vertical transmission”. We have not established time limits because it is a recent illness. They have been filtered by articles published in Spanish, English and Galician. Results: The primary and hospital care control circuit for pregnancy, childbirth and postpartum in the A Coruña hospital during the pandemic is explained. Conclusions: After comparing the experience in the A Coruña hospital and primary care with the articles and guides found on the management and recommendations of pregnant women during the covid-19 pandemic, it was observed that the actions carried out were in line with the recommendations in that time and after subsequent investigations of the Covid, they were modified to provide better assistance to pregnant women. It is necessary to carry out new studies to corroborate that the current management and recommendations are adequate. (AU)

Influencia de la luna en el inicio y la evolución de los partos / Influence of the moon on the start and evolution of childbirth

Objetivos: Establecer si existe una asociación del inicio y la evolución del parto con las fases lunares. Métodos: Estudio observacional retrospectivo de los partos ocurridos en el Hospital Universitario Lucus Augusti (HULA) en Lugo (España) en 2014. Análisis descriptivo inferencial. Variables de estudio: tipo de inicio del parto, fecha de la última regla, paridad y edad gestacional, duración del preparto y parto, tipo de inicio y finalización. La información de las fases lunares se obtuvo del Instituto Geográfico Nacional. Resultados: Se estudiaron 1409 partos. El 58,3 % de los partos fueron espontáneos y el 34,6 % inducidos. Eutócicos el 54,2 %, instrumentales el 19,2 % y cesáreas el 26,6 %, de las cuales el 25,4 % fueron programadas, el 22,5 % se realizaron por riesgo de pérdida de bienestar fetal y el 19,8 % por no progresión del parto.En el 34,3 % de las dilataciones inferiores a 3 horas, el parto tuvo lugar en luna llena, y el 32% de las amniorrexis espontáneas y el 28,6% de los nacimientos tuvieron lugar también en luna llena. Conclusiones: Los resultados de este estudio no pudieron demostrar la influencia de las fases lunares en los nacimientos. No obstante, se observa una discreta relación de eventos obstétricos con la luna llena. (AU)

Objectives: To establish if there is an association of the beginning and evolution of labor with the lunar phases. Methods: A retrospective observational study of births at Hospital Universitario Lucus Augusti in Lugo (Spain) in 2014. Descriptive and inferential analysis. Study variables: type of onset of labor, date of last period, parity and gestational age, duration of labor and delivery, type of onset and completion. The information on the lunar phases was obtained from the National Geographic Institute. Results: 1409 births were studied. 58.3% of births were spontaneous and 34.6% were induced. Eutocic 54.2 %, instrumental 19.2% and cesarean sections 26.6 %, of which 25.4 % were scheduled, 22.5 % were performed due to risk of loss of fetal well-being and 19.8 % due to non-progression of labor. In 34.3% of dilations of less than 3 hours, delivery took place on a full moon, and 32% of spontaneous amniorrhexis and 28.6% of births also took place on a full moon. Conclusions: The results of this study could not demonstrate the influence of lunar phases on births. However, a discreet relationship of obstetric events with the full moon is observed. (AU)

Advanced Maternal Age as an Obstetric Risk Factor: Current Experience in a Hospital from Northwestern Spain.

INTRODUCTION: Studies updating the evidence in advanced maternal age as an independent factor of obstetric risk are needed. The aim of this study was to determine the prevalence of ≥ 35-years-old pregnant women who give birth in a Spanish hospital in Northwestern Spain, and to describe the incidence of maternal and perinatal morbidity and mortality. MATERIAL AND METHODS: Retrospective follow-up observational study including women ≥ 20 years-old who gave birth over one year (n = 1378). Data were collected from medical records, including socio-demographic characteristics, comorbidities, gestational conditions, variables related with the delivery and perinatal outcomes. Multivariable logistic regression analysis was performed to determine the association of advanced maternal age with obstetric and perinatal outcomes. RESULTS: Forty-two percent of pregnant women were ≥ 35 years old. In the multivariable analysis, advanced maternal age was associated with the likelihood of gestational diabetes (OR = 1.84; 95% CI = 1.10 - 3.07), hypothyroidism (OR = 2.11; 95% CI = 1.17 - 3.80), lower probability of an eutocic delivery (OR = 0.74; 95% CI = 0.56 - 0.98), and a hospital admission > four days (OR = 2.91; 95% CI = 1.95 - 4.35). An association with the rate of C-sections was not found (OR = 1.24; 95% CI = 0.89 - 1.72). CONCLUSION: A high prevalence of pregnant women of advanced maternal age was confirmed. There was a higher rate of comorbidities and longer hospital admissions in older women but not a higher rate of higher C-sections and other complications.

Introdução: São necessários estudos que atualizem as evidências sobre a idade materna avançada como fator independente de risco obstétrico. O objetivo deste estudo foi determinar a prevalência de mulheres grávidas com idade igual ou superior a 35 anos admitidas para o parto num hospital espanhol do Noroeste da Espanha, e descrever a incidência de morbilidade e mortalidade materna e perinatal. Material e Métodos: Estudo observacional retrospetivo que inclui mulheres com idade igual ou superior a 20 anos admitidas para o parto ao longo de um ano (n = 1378). Os dados foram recolhidos em prontuários médicos, incluindo características sociodemográficas, comorbilidades, patologia gestacional, variáveis relacionadas com o parto e resultados perinatais. Foi realizada uma análise de regressão logística multivariada para determinar a relação da idade materna avançada com os resultados obstétricos e perinatais. Resultados: Quarenta e dois por cento das mulheres grávidas tinham idade igual ou superior a 35 anos. Na análise multivariada, a idade materna avançada estava associada com maior probabilidade de diabetes gestacional (OR = 1,84; 95% CI = 1,10 - 3,07), hipotiroidismo (OR = 2,11; 95% CI = 1,17 - 3,80), menor probabilidade de parto eutócico (OR = 0,74; 95% CI = 0,56 - 0,98), e hospitalização superior a quatro dias (OR = 2,91; 95% CI = 1,95 - 4,35). Não foi encontrada uma associação com a taxa de cesarianas (OR = 1,24; 95% CI = 0,89 - 1,72). Conclusão: A elevada prevalência de mulheres grávidas com idade materna avançada foi confirmada. As mulheres mais velhas apresentaram maior número de comorbilidades e maior tempo de hospitalização, mas não apresentaram uma maior ocorrência de cesarianas e outras complicações.

Women's satisfaction with childbirth and postpartum care and associated variables.

OBJECTIVE: To determine the level of satisfaction with childbirth and the postpartum period. METHOD: This is a longitudinal, observational study. Clinical variables of the patients and delivery were collected, and a descriptive and inferential analysis was performed. The validated state-trait anxiety inventory (STAI) and the satisfaction survey Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) in Spanish were used. RESULTS: A total of 381 women was included in the study and grouped into satisfied vs. dissatisfied (94.54% vs. 5.46%). Women having given birth by eutocic delivery (p = 0.005), as well as those who had skin-to-skin time with their newborn (p = 0.012) after delivery, report more satisfaction. Mothers who were separated from their babies reported being less satisfied (p = 0.004), as did those who did not meet the expectations raised in the birth plan (p = 0.013). All the women with minimal anxiety are satisfied (p = 0.004), the same happening for those showing postpartum anxiety (p <0.001). CONCLUSION: The percentage of satisfied women is high; it is necessary to monitor childbirth and postpartum care, promoting good practices in childbirth care, as well as in women's emotional well-being.

Women's satisfaction with childbirth and postpartum care and associated variables / Satisfação da gestante com a assistência ao parto e pós-parto e variáveis associadas / Satisfacción de las gestantes con los cuidados en el parto y puerperio y variables asociadas

ABSTRACT Objective: To determine the level of satisfaction with childbirth and the postpartum period. Method: This is a longitudinal, observational study. Clinical variables of the patients and delivery were collected, and a descriptive and inferential analysis was performed. The validated state-trait anxiety inventory (STAI) and the satisfaction survey Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) in Spanish were used. Results: A total of 381 women was included in the study and grouped into satisfied vs. dissatisfied (94.54% vs. 5.46%). Women having given birth by eutocic delivery (p = 0.005), as well as those who had skin-to-skin time with their newborn (p = 0.012) after delivery, report more satisfaction. Mothers who were separated from their babies reported being less satisfied (p = 0.004), as did those who did not meet the expectations raised in the birth plan (p = 0.013). All the women with minimal anxiety are satisfied (p = 0.004), the same happening for those showing postpartum anxiety (p <0.001). Conclusion: The percentage of satisfied women is high; it is necessary to monitor childbirth and postpartum care, promoting good practices in childbirth care, as well as in women's emotional well-being.

RESUMO Objetivo: Determinar o grau de satisfação no parto e puerpério. Método: Estudo observacional longitudinal. Foram coletadas variáveis clínicas das pacientes e do parto, realizando-se análise descritiva e inferencial. Foram utilizados os questionários validados de ansiedade como traço e estado (STAI) e a pesquisa de satisfação da Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) em espanhol. Resultados: 381 mulheres foram incluídas no estudo, agrupadas em satisfeitas vs. não satisfeitas (94,54% vs. 5,46%). Mulheres com parto eutócico relataram estar mais satisfeitas (p = 0,005), assim como aquelas que realizaram contato pele-a-pele com o recém-nascido (p = 0,012). As mães que se separaram de seus bebês relataram estar menos satisfeitas (p = 0,004), assim como aquelas que não tiveram atendidas as expectativas refletidas no plano de parto (p = 0,013). 100% das mulheres com ansiedade mínima estão satisfeitas (p = 0,004), o mesmo ocorre com o grau de ansiedade pós-parto (p <0,001). Conclusão: O percentual de mulheres satisfeitas é alto, é necessário cuidar da assistência ao parto e puerpério, promovendo boas práticas na assistência ao parto, bem como o bem-estar emocional da mulher.

RESUMEN Objetivo: Determinar el grado de satisfacción en el parto y puerperio. Método: Estudio observacional longitudinal. Se recogieron variables clínicas de las pacientes y del parto, realizándose un análisis descriptivo e inferencial. Se utilizaron los cuestionarios validados de ansiedad estado y rasgo (STAI) y la encuesta de satisfacción Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) en Español. Resultados: Se incluyeron en el estudio 381 mujeres que se agruparon en satisfechas vs. no-satisfechas (94,54% vs. 5,46%). Las mujeres con un parto eutócico refieren estar más satisfechas (p=0,005), así como aquellas que realizaron piel con piel con su recién nacido (p=0,012). Las madres que se separaron de sus bebés refieren estar menos satisfechas (p=0,004), al igual que las que no cumplieron las expectativas reflejadas en el plan de nacimiento (p=0,013). El 100% de las mujeres con ansiedad mínima están satisfechas (p=0,004), de igual manera sucede con el grado de ansiedad estado postparto (p<0,001). Conclusión: El porcentaje de mujeres satisfechas es elevado, es necesario cuidar la atención al parto y puerperio, fomentando las buenas prácticas de atención al parto, así como el bienestar emocional de las mujeres.

Women's satisfaction with childbirth and postpartum care and associated variables / Satisfação da gestante com a assistência ao parto e pós-parto e variáveis associadas / Satisfacción de las gestantes con los cuidados en el parto y puerperio y variables asociadas

ABSTRACT Objective: To determine the level of satisfaction with childbirth and the postpartum period. Method: This is a longitudinal, observational study. Clinical variables of the patients and delivery were collected, and a descriptive and inferential analysis was performed. The validated state-trait anxiety inventory (STAI) and the satisfaction survey Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) in Spanish were used. Results: A total of 381 women was included in the study and grouped into satisfied vs. dissatisfied (94.54% vs. 5.46%). Women having given birth by eutocic delivery (p = 0.005), as well as those who had skin-to-skin time with their newborn (p = 0.012) after delivery, report more satisfaction. Mothers who were separated from their babies reported being less satisfied (p = 0.004), as did those who did not meet the expectations raised in the birth plan (p = 0.013). All the women with minimal anxiety are satisfied (p = 0.004), the same happening for those showing postpartum anxiety (p <0.001). Conclusion: The percentage of satisfied women is high; it is necessary to monitor childbirth and postpartum care, promoting good practices in childbirth care, as well as in women's emotional well-being.

RESUMO Objetivo: Determinar o grau de satisfação no parto e puerpério. Método: Estudo observacional longitudinal. Foram coletadas variáveis clínicas das pacientes e do parto, realizando-se análise descritiva e inferencial. Foram utilizados os questionários validados de ansiedade como traço e estado (STAI) e a pesquisa de satisfação da Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) em espanhol. Resultados: 381 mulheres foram incluídas no estudo, agrupadas em satisfeitas vs. não satisfeitas (94,54% vs. 5,46%). Mulheres com parto eutócico relataram estar mais satisfeitas (p = 0,005), assim como aquelas que realizaram contato pele-a-pele com o recém-nascido (p = 0,012). As mães que se separaram de seus bebês relataram estar menos satisfeitas (p = 0,004), assim como aquelas que não tiveram atendidas as expectativas refletidas no plano de parto (p = 0,013). 100% das mulheres com ansiedade mínima estão satisfeitas (p = 0,004), o mesmo ocorre com o grau de ansiedade pós-parto (p <0,001). Conclusão: O percentual de mulheres satisfeitas é alto, é necessário cuidar da assistência ao parto e puerpério, promovendo boas práticas na assistência ao parto, bem como o bem-estar emocional da mulher.

RESUMEN Objetivo: Determinar el grado de satisfacción en el parto y puerperio. Método: Estudio observacional longitudinal. Se recogieron variables clínicas de las pacientes y del parto, realizándose un análisis descriptivo e inferencial. Se utilizaron los cuestionarios validados de ansiedad estado y rasgo (STAI) y la encuesta de satisfacción Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) en Español. Resultados: Se incluyeron en el estudio 381 mujeres que se agruparon en satisfechas vs. no-satisfechas (94,54% vs. 5,46%). Las mujeres con un parto eutócico refieren estar más satisfechas (p=0,005), así como aquellas que realizaron piel con piel con su recién nacido (p=0,012). Las madres que se separaron de sus bebés refieren estar menos satisfechas (p=0,004), al igual que las que no cumplieron las expectativas reflejadas en el plan de nacimiento (p=0,013). El 100% de las mujeres con ansiedad mínima están satisfechas (p=0,004), de igual manera sucede con el grado de ansiedad estado postparto (p<0,001). Conclusión: El porcentaje de mujeres satisfechas es elevado, es necesario cuidar la atención al parto y puerperio, fomentando las buenas prácticas de atención al parto, así como el bienestar emocional de las mujeres.