Educating future professionals in perinatal medicine: the attitude of medical and nursing students towards childbirth.

OBJECTIVES: The main objective of the present study was to evaluate what educational needs were being neglected in current perinatal educational program in the University of Malaga. METHODS: We performed a cross-sectional study using the Students' questionnaire on attitudes towards childbirth (CAVE-st) in a sample of 378 students who were finishing their undergraduate or postgraduate academic perinatal program, including medical and nursing students. RESULTS: The Cronbach's alpha reliability coefficient was 0.895. The mean score of CAVE-st in the sample was 200.34 (DT 21.0). The scores were below the median value in more than 53% of the students, especially in medical students. Female students scored systematically higher in the overall scale and its subscales, even after adjusting for study groups. On the other hand, the students with children scored significantly lower in the subscale that explored their attitudes towards unexpected results. A huge margin for improvement was recognizable in those subscales related with childbirth medicalization, respect to women decisions, and health-care prioritization. CONCLUSIONS: Students' attitude towards childbirth need to be improved as a means to improve women's childbirth experience and prevent birth-related trauma. The current undergraduate and postgraduate training in perinatal care lacks a comprehensive and biopsychosocial perspective that would improve the quality of clinical practice during childbirth.

Post-traumatic stress disorder after subsequent birth to a gestational loss: An observational study / Trastorno de estrés postraumático tras una gestación posterior a una pérdida gestacional: Un estudio observacional

Abstract Introduction The loss of a pregnancy puts women at risk of suffering post-traumatic stress disorder. This circumstance can influence a subsequent pregnancy, and the link with the future baby. Objective The main objective of this work was to identify the prevalence of post-traumatic stress disorder (PTSD) among post-partum women who give birth after having suffered a previous gestational loss and to identify possible relationships between PTSD and the variables studied. Method An observational, descriptive, and cross-sectional study. A total of 115 puerperal women who had suffered a previous gestational loss completed questionnaires containing sociodemographic variables, obstetric history, and responses to the Davidson Trauma Scale. Results A score of 40 was established as a cut-off point in the Davidson Trauma Scale for the identification of PTSD. 21.7% of the participants scored 40 or above. Significant differences were found related to age (p = .030), number of pregnancies (p = .033), and number of gestational losses (p = .001). The probability of PTSD increases significantly in relation to the number of losses. Respondents are 2.55 times (β = .94 p = .027) more likely to suffer PTSD the higher the number of gestational losses suffered. Discussion and conclusion There are significant differences in the presence of PTSD among puerperal women in terms of age, number of pregnancies, and number of gestational losses. Post-partum women are more likely to suffer PTSD after a gestational loss the higher the number of gestational losses suffered.

Resumen Introducción La pérdida de un embarazo sitúa a las mujeres en riesgo de padecer un trastorno por estrés postraumático. Esta circunstancia puede influir en un embarazo posterior, y el vínculo con el futuro bebé. Objetivo El objetivo principal de este trabajo fue identificar la prevalencia de trastorno por estrés postraumático entre puérperas que dan a luz tras haber sufrido una pérdida gestacional previa e identificar posibles relaciones entre el trastorno por estrés postraumático y las variables estudiadas. Método Se trata de un estudio observacional, descriptivo y transversal. Un total de 115 puérperas que habían sufrido una pérdida gestacional anterior llenaron cuestionarios que contenían variables sociodemográficas, de la historia obstétrica y la Escala de Trauma de Davidson. Resultados Se estableció 40 como punto de corte en la Escala de Trauma de Davidson para identificar el trastorno por estrés postraumático. Se identificó en un 21.7% de las participantes. Se encontraron diferencias significativas relacionadas con la edad (p = .030), el número de embarazos (p = .033) y el número de pérdidas gestacionales (p = .001). La probabilidad de trastorno por estrés postraumático aumenta significativamente en relación con el número de pérdidas. Es 2.55 veces (β = .94 p = .027) más probable padecer un trastorno por estrés postraumático cuanto mayor sea el número de pérdidas gestacionales sufridas. Discusión y conclusión Existen diferencias significativas en la prevalencia de trastorno por estrés postraumático entre las puérperas en cuanto a la edad, el número de embarazos y el número de pérdidas gestacionales. Es más probable padecer trastorno por estrés postraumático tras una gestación posterior a una pérdida gestacional cuanto mayor sea el número de pérdidas gestacionales sufridas.

Post-traumatic stress and related symptoms in a gestation after a gestational loss: narrative review / Estrés postraumático y síntomas relacionados en un embarazo posterior a una pérdida gestacional: revisión narrativa

Abstract Background Around 30% of pregnancies conclude in a gestational loss. Most women who suffer a gestational loss become pregnant again. However, mothers who have experienced this situation live the new pregnancy with fear and anxiety. Objective To perform an update of the main works done in the study of post-traumatic stress and related symptoms during pregnancy after a gestational loss. Method The Medline database was consulted. Articles published from 2007 to date were selected. Key words related to the topic of study were used. Results The studies reviewed showed five entities that deserve attention during a pregnancy achieved after a gestational loss: post-traumatic stress, depression, anxiety, relationship, and relationship with the future child. There is a relationship between the presence of post-traumatic stress and the risk of developing depression and anxiety. Discussion and conclusion Women who experience perinatal loss, regardless of the type of loss and the gestational age in which it occurs, are at risk of continuing grief, symptoms of depression, anxiety, and post-traumatic stress in later pregnancy. The gestational age and the time elapsed between the perinatal loss and the next pregnancy seem to be the most influential factors in the development of post-traumatic stress sindrome, and symptoms of dysfunctional grief, anxiety, and depression.

Resumen Antecedentes Alrededor de un 30% de los embarazos concluyen en una pérdida gestacional; de este porcentaje, la mayoría de las mujeres vuelve a quedar embarazada. Sin embargo quienes han experimentado esta situación viven con miedo y ansiedad su nuevo embarazo. Objetivo Realizar una actualización de los principales trabajos realizados en cuanto al estudio del estrés postraumático y los síntomas relacionados con el embarazo posterior a una pérdida gestacional. Método Se consultó la base de datos Medline y se seleccionaron artículos publicados desde 2007 hasta la fecha. Se emplearon palabras clave relacionadas con el tema de estudio. Resultados Los estudios revisados mostraron cinco entidades que merecen atención durante un embarazo experimentado tras una pérdida gestacional: estrés postraumático, depresión, ansiedad, relación de pareja y vínculo con el futuro infante. Se encontró que existe una relación entre la presencia de estrés postraumático y el riesgo de desarrollar depresión y ansiedad. Discusión y conclusión Las mujeres que experimentan pérdida perinatal, independientemente del tipo de pérdida y de la edad gestacional en la que se produce, corren el riesgo de continuar el duelo, los síntomas de depresión, la ansiedad y el estrés postraumático durante el embarazo posterior. La edad gestacional y el tiempo transcurrido entre la pérdida perinatal y el siguiente embarazo parecen ser los factores más influyentes en el desarrollo del síndrome de estrés postraumático, así como de síntomas de duelo disfuncional, ansiedad y depresión.

Las Matronas de la Beneficencia Municipal y su atención a las mujeres pobres de Málaga (1900-1956) / As Parteiras de Assistência Municipal e atenção às mulheres pobres de Málaga (1900-1956) / The Municipal Welfare Midwives and attention to the poor women of Malaga (1900-1956)

El objetivo de este estudio consiste en conocer las características del desarrollo profesional y la práctica clínica de las Matronas de la Beneficencia Municipal Malagueña en el período de 1900-1956. Material y Método: Se ha realizado un estudio histórico descriptivo. La recogida de información se ha realizado a través de fuentes primarias y secundarias. Resultados: El proceso para instalar las casas de socorro en la ciudad de Málaga, se inició en 1862 por orden del Gobernador Civil que urgió al Ayuntamiento para que las estableciese. Conclusiones: La incorporación de la Matrona al escenario sanitario permitió una cobertura durante el proceso reproductivo a las mujeres pobres de Málaga a través de la Beneficencia Municipal (AU)

The aim of this study was focused on knowing professional development characteristics and Clinical Practice of Midwives in the Municipal Charity of Malaga in 1900-1956. Method and Materials: This was descriptive and historic study. The collection of information has been made through primary and secondary sources. Results: The process to install the relief houses in the City of Malaga, started in 1862 by Order of the Civil Governor. Conclusions: The incorporation of the healthcare scenario allowed Midwives coverage during the reproductive process of poor women of Malaga through the Municipal Welfare (AU)

O objetivo deste estudo é compreender as características do desenvolvimento profissional e prática clínica das Parteiras Municipal de Assistência Malagueña no período 1900-1956. Material e Métodos: Foi realizado um estudo descritivo histórico. A coleta de informações foi realizada por meio de fontes primárias e secundárias. Resultados: O processo para a instalação de casas de socorro na cidade de Malaga, começou em 1862 por ordem do Governador Civil instou o Conselho da Cidade de estabelecer. Conclusões: A adição do cenário da saúde permitiu a cobertura matrona durante o processo reprodutivo de Málaga mulheres pobres através da Previdência Municipal (AU)

Incremento de la participación de Atención Primaria en la asistencia al virus de la inmunodeficiencia humana: opinan los profesionales de las unidades hospitalarias / Increasing participation of Primary Care in the management of people with human immunodeficiency virus: Hospital care professionals express their views

OBJETIVO: Conocer las opiniones de los profesionales de enfermedades infecciosas sobre las posibilidades de seguimiento del paciente con VIH en Atención Primaria (AP). DISEÑO: Estudio cualitativo fenomenológico mediante entrevistas en profundidad. Emplazamiento: Unidad de Enfermedades Infecciosas del Hospital Universitario «Virgen de la Victoria» de Málaga. Participantes: Profesionales de la salud con más de un año de experiencia laboral en enfermedades infecciosas. Un total de 25 entrevistados: 5 médicos, 15 enfermeras y 5 auxiliares enfermería. MÉTODO: Muestreo por conveniencia. Se realizaron entrevistas semiestructuradas que se transcribieron literalmente. Análisis de contenido según Taylor y Bogdan con soporte informático. Validación de la información mediante análisis complementarios, participación de expertos y devolución de parte de los resultados a los participantes. RESULTADOS: Los profesionales de AH atribuyeron características de complejidad al VIH en relación a la enfermedad, el tratamiento y sus aspectos sociales, con repercusiones sobre el nivel organizativo de la atención. Los profesionales resaltaron los beneficios de una atención especializada, aunque difieren las opiniones de facultativos y de enfermería en relación con el seguimiento en AP. Surgieron dudas sobre los niveles de formación, la gestión del secreto y la presión asistencial en este nivel, pero también se manifestaron las ventajas potenciales en cuanto a la accesibilidad de los pacientes a AP. CONCLUSIONES: Los facultativos perciben dificultades en el seguimiento del VIH en AP, incluso para usuarios con buen control del VIH. Enfermeras y auxiliares de enfermería se muestran más abiertos a esta posibilidad por la cercanía domiciliaria y la promoción de la salud de AP

AIM: To determine the opinions of infectious diseases professionals on the possibilities of monitoring patients with HIV in Primary Care. DESIGN: Qualitative study using in-depth interviews. Location: Infectious Diseases Unit in the University Hospital «Virgen de la Victoria» in Málaga. Participants: Health professionals with more than one year experience working in infectious diseases. A total of 25 respondents: 5 doctors, 15 nurses and 5 nursing assistants. METHOD: Convenience sample. Semi-structured interviews were used that were later transcribed verbatim. Content analysis was performed according to the Taylor and Bogdan approach with computer support. Validation of information was made through additional analysis, expert participation, and feedback of part of the results to the participants. RESULTS: Hospital care professionals considered the disease-related complexity of HIV, treatment and social aspects that may have an effect on the organizational level of care. Professionals highlighted the benefits of specialized care, although opinions differed between doctors and nurses as regards follow up in Primary Care. Some concerns emerged about the level of training, confidentiality and workload in Primary Care, although they mentioned potential advantages related to accessibility of patients. CONCLUSIONS: Physicians perceive difficulties in following up HIV patients in Primary Care, even for those patients with a good control of their disease. Nurses and nursing assistants are more open to this possibility due to the proximity to home and health promotion in Primary Care

[Increasing participation of primary care in the management of people with human immunodeficiency virus: hospital care professionals express their views]. / Incremento de la participación de Atención Primaria en la asistencia al virus de la inmunodeficiencia humana: opinan los profesionales de las unidades hospitalarias.

AIM: To determine the opinions of infectious diseases professionals on the possibilities of monitoring patients with HIV in Primary Care. DESIGN: Qualitative study using in-depth interviews. LOCATION: Infectious Diseases Unit in the University Hospital "Virgen de la Victoria" in Málaga. PARTICIPANTS: Health professionals with more than one year experience working in infectious diseases. A total of 25 respondents: 5 doctors, 15 nurses and 5 nursing assistants. METHOD: Convenience sample. Semi-structured interviews were used that were later transcribed verbatim. Content analysis was performed according to the Taylor and Bogdan approach with computer support. Validation of information was made through additional analysis, expert participation, and feedback of part of the results to the participants. RESULTS: Hospital care professionals considered the disease-related complexity of HIV, treatment and social aspects that may have an effect on the organizational level of care. Professionals highlighted the benefits of specialized care, although opinions differed between doctors and nurses as regards follow up in Primary Care. Some concerns emerged about the level of training, confidentiality and workload in Primary Care, although they mentioned potential advantages related to accessibility of patients. CONCLUSIONS: Physicians perceive difficulties in following up HIV patients in Primary Care, even for those patients with a good control of their disease. Nurses and nursing assistants are more open to this possibility due to the proximity to home and health promotion in Primary Care.

La maniobra de Kristeller: revisión de las evidencias científicas / Kristeller maneuver, a review of evidences

Aún en nuestros días, la maniobra descrita por Samuel Kristeller en1867, que consiste en una presión del fondo uterino para la ayuda delexpulsivo, continúa siendo una práctica habitual en muchos hospitalesde nuestro entorno. El objetivo de la presente revisión es traer a debateesta maniobra partiendo de la evidencia que hay en torno a ella.En numerosos países esta técnica está proscrita, y en otros muchos sesigue usando sin consenso ni aprendizaje y sin reflejarlo en la historiaclínica para eludir posibles pleitos legales.En el Foro Internacional del Parto (Roma, 2005) se estableció que era imposiblecuantificar el daño causado a las parturientas y a los recién nacidos pordicha maniobra, ya que muchas veces no se registran por razones legales.Objetivo: Examinar la bibliografía disponible para valorar si es mássegura la maniobra de Kristeller en partos vaginales que la utilizaciónde tocurgia (vacuo, fórceps, espátulas...), que acorta el expulsivo y minimizalos riesgos fetales respecto al parto instrumental, y si dicha maniobrapuede sustituir a la tocurgia.Conclusiones: No existen informes o registros en la historia clínicaacerca del uso de la maniobra de Kristeller, lo que dificulta la recogida dedatos para realizar estudios observacionales. Tampoco se informa de losresultados adversos, para no entrar en conflictos con supuestas cuestionesmedicolegales, y apenas existen ensayos clínicos aleatorizados queindiquen, con un elevado nivel de evidencia, el camino a seguir (AU)

Even nowadays the maneuver described by Samuel Kristeller in 1867consisting of pressure of the uterus fundus aids with expulsion, it stillcontinues as a common practice in many hospitals in our environment.The purpose of this review is to bring to debate this maneuver based onthe evidence that exists.There are many countries where this technique is banned and manymore where it is still used without learning and without consensus andit was not shown in the clinical records to avoid potential lawsuits.In the international forum of Labor, Rome 2005 it was reported that itwas impossible to quantify the harm done to women in labor and thenewborns by such maneuver as many times the damages caused by itare not reported intentionally for legal reasons.Objective: To review available bibliography in order to assess if theKristeller the use of uteral fundal pressure maneuver vaginal births thatusing vaginal instrumental (vacuum, forceps, spatulas ...), shorteningthe expulsion and minimizing fetal risk in respect with instrumental laborand if this can be substituted.Conclusions: No records exist in the clinical reports of the use of the Kristellermaneuver; this makes it difficult for the research of data for the observationalstudies. The adverse effects are not informed to avoid entering inconflict areas with legal medical questioning and there are only a few randomizedstudies that show a high level of evidence of the way to be followed (AU)