Umbilical cord separation time, predictors and healing complications in newborns with dry care.

OBJECTIVE: The objective of this study was to explore the umbilical cord separation time, predictors, and healing complications from birth until the newborn was one month old. DESIGN: A quantitative longitudinal observational analytical study by stratified random sample was adopted. SETTING: Public health system hospitals in southern Spain and at newborns' homes. PARTICIPANTS: Between April 2016 and December 2017, the study included 106 neonates born after 35-42 weeks of gestation whose umbilical cord was cured with water and soap and dried later as well as newborns without umbilical canalisation whose mothers enjoyed a low-risk pregnancy. METHODS: The data collection procedure comprised two blocks: from birth to the time of separation of the umbilical cord and from cord separation to the first month of life of the newborn. Umbilical cord separation time was measured in minutes; socio-demographic and clinical characteristics were measured by means of questionnaires, and the external diameter of the umbilical cord was measured using an electronic stainless-steel calliper and trailing roller. RESULTS: The mean umbilical separation time: 6.61 days (±2.33, IC 95%:6.16-7.05). Incidence of omphalitis was 3.7%; granuloma was 8.6%. Separation time predictors were wetting recurrence, birth weight, intrapartum antibiotics, birth season, and Apgar < 9 (R2 = 0.439 F: 15.361, p <0.01). CONCLUSION: The findings support the World Health Organization recommendations: dry umbilical cord cares is a safe practice that soon detaches the umbilical cord, taking into account the factors studied that will vary the length of time until the umbilical cord is separated.

Dry care versus chlorhexidine cord care for prevention of omphalitis. Systematic review with meta-analysis / Cura a seco versus cura com clorexidina para prevenção da onfalite. Revisão sistemática com metanálise / Cura seca frente a cura con clorhexidina para prevención de onfalitis. Revisión sistemática con metaanálisis

ABSTRACT Objective: to compare the effect of dry care and the application of chlorhexidine to the umbilical cord of newborns at risk of developing omphalitis. Method: systematic review with meta-analysis. Clinical trials comparing dry care with the application of clorexidine to evaluate omphalitis were selected. Methodological quality was evaluated using the Consolidated Standards of Reporting Trials. Results: the joint analysis of the studies shows a significant decrease in the risk of omphalitis in the chlorhexidine group compared to the dry care group (RR=0.58, CI: 0.53-0.64). However, in the analysis by subgroups, chlorhexidine umbilical cord care did not reduce the risk of omphalitis in hospital births (RR=0.82, CI: 0.64-1.05), in countries with a low infant mortality rate (RR=0.8, CI: 0.5-1.28), or at chlorhexidine concentrations below 4% (RR=0.55, CI: 0.31-1). Chlorhexidine acted as a protective factor at a concentration of 4% (RR=0.58, CI: 0.53-0.64), when applied in cases of home births (RR=0.57, CI: 0.51-0.62), in countries with a high infant mortality rate (RR=0.57, CI: 0.52-0.63). Conclusion: dry cord care is effective in countries with low infant mortality rate and in hospital births. However, 4% chlorhexidine for umbilical cord care protects against omphalitis in home births, in countries with a high infant mortality rate.

RESUMO Objetivo: comparar o efeito da cura a seco e da aplicação de clorexidina no cordão umbilical de recém-nascidos em risco de desenvolver onfalite. Método: revisão sistemática com metanálise. Foram selecionados os ensaios clínicos que comparavam a cura a seco com a aplicação de clorexidina para avaliar a onfalite. A qualidade metodológica foi avaliada com Consolidated Standards of Reporting Trials. Resultados: a análise conjunta dos estudos mostra uma redução significativa do risco de onfalite no grupo da clorexidina em comparação com a cura a seco (RR=0,58; IC 0,53-0,64). Entretanto, na análise por subgrupos, a cura com clorexidina não reduziu o risco de onfalite em nascimentos hospitalares (RR=0,82; IC: 0,64-1,05), nos países com baixa taxa de mortalidade infantil (RR=0,8; IC: 0,5-1,28), ou com concentrações de clorexidina abaixo de 4% (RR=0,55; IC: 0,31-1). A clorexidina atuou como fator de proteção na concentração de 4% (RR=0,58; IC: 0,53-0,64), aplicada em nascimentos no domicílio (RR=0,57; IC: 0,51-0,62), em países com taxas de mortalidade infantil elevadas (RR=0,57; IC: 0,52-0,63). Conclusão: a cura a seco é eficaz em países com baixa taxa de mortalidade infantil e em nascimentos no contexto hospitalar. No entanto, a cura com clorexidina 4% protege contra a onfalite nos nascimentos domiciliares, em países com elevada mortalidade infantil.

RESUMEN Objetivo: comparar el efecto de la cura seca y de la aplicación de clorhexidina en el cordón umbilical de los recién nacidos en el riesgo de desarrollo de onfalitis. Método: revisión sistemática con metaanálisis. Se seleccionaron ensayos clínicos que compararan la cura seca con la aplicación de clorhexidina evaluando la onfalitis. Calidad metodológica evaluada con Consolidated Standards of Reporting Trials. Resultados: el análisis conjunto de los estudios muestra una reducción significativa del riesgo de onfalitis en el grupo de clorhexidina en comparación con cura seca (RR=0,58; IC: 0,53-0,64). Sin embargo, en el análisis por subgrupos, la cura con clorhexidina no aportó reducción del riesgo de onfalitis en nacimientos hospitalarios (RR=0,82; IC: 0,64-1,05) en países con baja tasa de mortalidad infantil (RR=0,8; IC: 0,5-1,28), ni a concentraciones de clorhexidina inferiores al 4% (RR=0,55; IC: 0,31-1). La clorhexidina actuó como factor protector a concentraciones del 4% (RR=0,58; IC: 0,53-0,64), aplicada en nacimientos en el hogar (RR=0,57; IC: 0,51-0,62), en países con elevada mortalidad infantil (RR=0,57; IC: 0,52-0,63). Conclusión: la cura seca es eficaz en países con baja tasa de mortalidad infantil y nacimientos en ámbito hospitalario. Sin embargo, la cura con clorhexidina al 4% protege de onfalitis en nacimientos en el hogar, en países con elevada mortalidad infantil.

Influencia de la analgesia epidural en la aparición de la fiebre intraparto / The influence of epidural anaesthesia on intrapartum fever

OBJETIVO: describir la evidencia científica disponible sobre el uso de la analgesia epidural durante el trabajo de parto y su relación con la aparición de fiebre durante el mismo MÉTODO: revisión integrativa de la bibliografía de estudios cuantitativos en las bases de datos más relevantes tanto en inglés como en español: Pubmed, Scopus, CINHAL, Cuiden, Embase, Medline y Cochrane Library. Se incluyeron estudios analíticos y descriptivos publicados entre 1985 y2013. Los estudios fueron evaluados empleando la herramienta estandarizada de evaluación crítica del Instituto Joanna Briggs (JBI-QARI). RESULTADOS: se incluyeron un total de 13 estudios. La mayoría de ellos parecen demostrar que existe una clara relación entre la aparición de un aumento de la temperatura corporal materna y la inserción del catéter y administración de analgesia epidural. Los estudios pueden estar induciendo a pensar que la fiebre se debe a la asociación con la analgesia epidural cuando realmente se están obviando otras posibles causas como el tiempo de trabajo de parto, de bolsa rota, el número de tactos vaginales o la nuliparidad de la gestante. Asimismo, también se debe tener en cuenta los posibles factores piréticos producidos por distintos fármacos empleados en la analgesia. CONCLUSIONES: el uso de catéter epidural durante el trabajo de parto favorece el incremento de la temperatura materna, pero debido al gran número de factores que intervienen en el proceso de dilatación es necesario realizar ensayos aleatorizados en nuestro medio que estudien la asociación real del incremento de la temperatura corporal en la gestante, discriminando entre todos los factores de riesgo posibles, para analizar realmente la repercusión de este tipo de analgesia en los mecanismos de la fiebre

OBJECTIVE: to describe the scientific evidence available about the use of epidural anaesthesia during labor, and its relationship with the development of fever during this stage, METHOD: an integrative review on the bibliography of quantitative studies in the most relevant databases, both in English and in Spanish: Pubmed, Scopus, CINHAL, Cuiden, Embase, Medline and Cochrane Library. Analytical and descriptive studies published between 1985 and 2013 were included. The studies were assessed using the standard Joanna Briggs Institute's Critical Appraisal Tool (JBI-QARI). RESULTS: thirteen (13) studies in total were included. The majority seem to demonstrate that there is a clear relationship between the development of an increase in maternal body temperature and the insertion of the catheter and administration of epidural anaesthesia. Studies might lead to think that fever is caused by the association with epidural anaesthesia, when in fact other potential causes are being left out, such as labor duration, water breaking, number of pelvic examinations, or nulliparity of the mother. Moreover, the potential pyretic factors caused by the different drugs used for analgesia should also be taken into account. CONCLUSIONS: the use of an epidural catheter during labor will favour the increase in maternal temperature; but due to the high number of factors involved in the dilation process, it is necessary to conduct randomized clinical trials in our setting in order to study the real association with the increase in the body temperature of the mother, differentiating between all the potential risk factors, in order to analyze the real impact of this type of anaesthesia on fever mechanisms

Enfermedad de von Willebrand y proceso de trabajo de parto / Von Willebrand disease and the labor process

El reconocimiento y tratamiento de los trastornos hematológicos que se producen durante el embarazo es difícil debido a la escasez de pruebas disponibles para guiar a los especialistas. La enfermedad de von Willebrand es el problema de coagulación más frecuente, causado por una deficiencia del factor de von Willebrand. Se expone el caso de una gestante de 33 años que comenzó su proceso de trabajo de parto pendiente de confirmar si sufría esta enfermedad, por lo que se le prestaron los cuidados pertinentes tanto en el intraparto como en el postparto inmediato en la unidad. El manejo exitoso de situaciones como estas implica el reconocimiento rápido de la hemorragia postparto para evitar posibles complicaciones que pueden alterar tanto el bienestar fetal como materno

It is difficult to identify and treat those haematological disorders developed during pregnancy, because there are not many tests available to guide specialists. Von Willbrand Disease is the most frequent coagulation problem, caused by a deficit in Von Willebrand Factor. We present the case of a 33-year-oldpregnant woman who started her labor process pending confirmation of whether she suffered this disease, and therefore she was provided with the relevant care both during labor and in the immediate post-labor stage at the Labor &Delivery Unit. The successful management of this type of situations involves a fast identification of post-labor bleeding in order to prevent any potential complications which might alter the wellbeing of both foetus and mother

Emotional state of primigravid women with pregnancy susceptible to prolongation.

OBJECTIVE: This study sought to know the perception of the emotional state of women with pregnancy susceptible to prolongation. METHODOLOGY: The research was conducted with qualitative descriptive methodology, founded on in-depth individual interviews of 7 gestants susceptible to prolongation, with ages between 21 and 32 years and duration of the pregnancy comprised between 40+5 and 41+4 weeks. RESULTS: The emotional state varies throughout the pregnancy; once the probable date of delivery has passed, the emotional well-being is altered by fear of pain during delivery, possible complications, and caring for the newborn, presenting a state of nervousness due to the imminent delivery. In addition, the women described the need for the presence of a companion during and after the delivery. CONCLUSION: Fear can affect negatively the subjective experience of the pregnancy during its final phase, the delivery process, and the transition to maternity in gestants with pregnancy susceptible to prolongation. These women need support and specific education from the midwife according to their individual needs.

Percepción de síntomas en primigestas con embarazo en vías de prolongación / Perception of simptoms in primigravid with post-term pregnancy

Durante el embarazo acontecen importantes cambios psicológicos, fisiológicos y socio-culturales que influyen en la gestante, la manera en la que ella vive esos cambios repercute de forma directa en su vivencia sobre la maternidad. Con el objetivo de conocer la percepción de síntomas presentes en la fase final del embarazo se llevó a cabo una investigación con metodología cualitativa de tipo fenomenológico, fundamentada en entrevistas individuales a siete gestantes en vías de prolongación que tuvieran como hospital de referencia el Complejo Hospitalario de Jaén. Resultados: los síntomas percibidos por las embarazadas en vías de prolongación han sido escasos, el dolor en la parte baja del abdomen y el aumento de la micción nocturna son los más repetidos. Conclusiones: conocer la percepción de síntomas de las gestantes en esta fase final del embarazo nos ayuda a prestar una atención integral hacia la promoción de la salud física en las mujeres embarazadas

Many biological, somatic, psychological and social factors take place in pregnancy. Some of them influence in pregnant women: the way they affront those changes, it will have repercussions on motherhood. We therefore conducted a qualitative research methodology, descriptive phenomenological. It is based on depth individual interviews to pregnant women who are in process of extension. They had the Jaén hospital as a reference with the aim to know the perception of symptoms. The results obtained indicate that preceived sympthoms by the pregnant women have been scare, pain and the increase of the night micturition are the most repeated. Conclusions: To know the perception of symptoms of pregnancy-way extension can help us to provide comprehensive care to promote physical health in pregnant women

Estado emocional de mujeres primigestas con embarazo en vías de prolongación / Estado emocional de mulheres primigestas com gravidez em via de prolongamento / Emotional state of primigravid women with pregnancy susceptible to prolongation

Objetivo. Conocer la percepción del estado emocional de las mujeres con embarazo en vías de prolongación. Metodología. Se llevó a cabo una investigación con metodología cualitativa descriptiva, fundamentada en entrevistas individuales en profundidad a siete gestantes en vías de prolongación, con edades entre los 21 y 32 años y una duración del embarazo comprendida entre 40+5 y 41+4. Resultados. El estado emocional varía a lo largo del embarazo, una vez pasada la fecha probable de parto. En este sentido, el bienestar emocional se ve alterado por el miedo que es genera el dolor del parto, a las posibles complicaciones y al cuidado del recién nacido, por lo que presentan un estado de nerviosismo por el parto inminente. Las mujeres, además, necesitan de la presencia de un acompañante durante el parto y después del mismo. Conclusión. El miedo puede afectar negativamente la experiencia subjetiva del embarazo en la fase final del mismo, al proceso de trabajo del parto y a la transición hacia la maternidad en las gestantes con embarazo en vías de prolongación. Estas mujeres necesitan el apoyo y educación específica por parte de la enfermera matrona según sus necesidades individuales...

Objective. This study sought to know the perception of the emotional state of women with pregnancy susceptible to prolongation. Methodology. The research was conducted with qualitative descriptive methodology, founded on in-depth individual interviews of 7 gestants susceptible to prolongation, with ages between 21 and 32 years and duration of the pregnancy comprised between 40+5 and 41+4 weeks. Results. The emotional state varies throughout the pregnancy; once the probable date of delivery has passed, the emotional well-being is altered by fear of pain during delivery, possible complications, and caring for the newborn, presenting a state of nervousness due to the imminent delivery. In addition, the women described the need for the presence of a companion during and after the delivery. Conclusion. Fear can affect negatively the subjective experience of the pregnancy during its final phase, the delivery process, and the transition to maternity in gestants with pregnancy susceptible to prolongation. These women need support and specific education from the midwife according to their individual needs...

Objetivo. Conhecer a percepção do estado emocional das mulheres com gravidez em via de prolongamento. Metodologia. Levou-se a cabo uma investigação com metodologia qualitativa descritiva, fundamentada em entrevistas individuais em profundidade a 7 gestantes em via de prolongamento, com idades entre os 21 e 32 anos e uma duração da gravidez compreendida entre 40+5 e 41+4. Resultados. O estado emocional varia ao longo da gravidez, uma vez passada a data provável de parto, o bem-estar emocional se vê alterado pelo medo à dor do parto, às possíveis complicações e ao cuidado do recém nascido, apresentando um estado de nervosismo pelo parto iminente. As mulheres ademais descrever a necessidade da presença de um acompanhante durante o parto e depois do mesmo. Conclusão. O medo pode afetar negativamente à experiência subjetiva da gravidez na fase final do mesmo, ao processo de trabalho do parto e à transição para a maternidade nas gestantes com gravidez em via de prolongamento. Estas mulheres precisam o apoio e educação específica por parte da enfermeira matrona segundo suas necessidades individuais...