Epidemiology of major paediatric trauma in a European Country - trends of a decade.

OBJECTIVES: This study investigates causes, characteristics and temporal trends of paediatric major trauma over a 10-year period and assesses potential preventive areas. METHODS: Single-centre retrospective study of paediatric trauma patients admitted to a Paediatric Intensive Care Unit (PICU) in a tertiary university hospital in Europe with a level 1 paediatric trauma centre, from 2009 to 2019. Paediatric major trauma patients were defined as patients aged < 18 years with Injury Severity Score > 12, admitted for intensive care for more than 24 h following trauma. Demographic, social and clinical information, including place and mechanism of trauma, injury pattern, pre-hospital and in-hospital procedures, and length of stay in PICU was extracted from PICU medical records. RESULTS: Total 358 patients included (age 11 ± 4,9 years; 67% male); 75% were involved in road traffic accidents: 30% motor vehicle collision, 25% pedestrian, 10% motorcycle and bicycle each. Falls from height injured 19% of children, 4% during sports activities. Main injuries were to head/neck (73%) and extremities (42%). The incidence of major trauma was highest in teenagers and did not show a decreasing trend during the study years. All fatalities (1,7%; n = 6) were related to head/neck injuries. Motor vehicle collisions resulted in higher need for blood transfusion (9 vs. 2 mL/kg, p = 0,006) and the highest ICU-mortality (83%; n = 5). Children in motorcycle accidents had longer ICU length-of-stay (6,4 vs. 4,2 days, p = 0,036). Pedestrians had 25% higher risk of head/neck injuries (RR 1,25; 1,07 - 1,46; p = 0,004), and higher incidence of severe brain injury (46% vs. 34%, p = 0,042). Most children in motor-vehicle/bicycle accidents were not using restraints/protective devices (45%) or were using them inappropriately (13%). CONCLUSIONS: Over the last decade, the absolute numbers of paediatric major trauma did not decrease. Road traffic accidents remain the leading cause of injury and death. Teenagers are at highest risk for severe trauma. Appropriate use of child restraints and protective equipment remain key for prevention.

Inborn Errors of Metabolism in a Tertiary Pediatric Intensive Care Unit.

Few studies exist describing resources and care of pediatric patients with inborn errors of metabolism (IEM) admitted to pediatric intensive care unit (PICU). This study aims to characterize the PICU admissions of these patients to provide better diagnostic and therapeutic care in the future. Retrospective analysis of pediatric patients with IEM admitted to the PICU of a tertiary care center at a metabolic referral university hospital from 2009 to 2019 was included. Clinical information and demographic data were collected from PICU clinical records. During this period, 2% ( n = 88 admissions, from 65 children) out of 4,459 PICU admissions had clinical features of IEM. The median age was 3 years (range: 3 days-21 years) and 33 were male. Median age at diagnosis was 3 months; 23/65 patients with intoxication disorders, 21/65 with disorders of energy metabolism, 17/65 with disorders of complex molecules, and 4/65 with other metabolic diseases (congenital lipodystrophy, Menkes' disease, hyperammonemia without a diagnosis). From a total of 88 admissions, 62 were due to metabolic decompensation (infection-38, neonatal period decompensation-14, external accident-5, prolonged fasting-2, and therapeutic noncompliance-3) and 26 elective admissions after a scheduled surgery/elective procedure. The most frequent clinical presentations were respiratory failure (30/88) and neurological deterioration (26/88). Mechanical ventilation was required in 30 patients and parenteral nutrition in 6 patients. Extracorporeal removal therapy was required in 16 pediatric patients (12 with maple syrup urine disease and 4 with hyperammonemia) with a median duration of 19 hours. The median length of PICU stay was 3.6 days (3 hours-35 days). Eight patients died during the studied period (cerebral edema-2, massive hemorrhage-5, and malignant arrhythmia-1). Acute decompensation was the main cause of admission in PICU in these patients. The complexity of these diseases requires specialized human and technical resources, with an important impact on the recovery and survival of these patients.

Extracorporeal Membrane Oxygenation: The First 10 Years Experience of a Portuguese Pediatric Intensive Care Unit.

INTRODUCTION: In Portugal, extracorporeal membrane oxygenation (ECMO) is used in pediatric patients since 2010. The aim of this study was to describe the clinical characteristics of patients, indications, complications and mortality associated with the use of ECMO during the first 10-years of experience in the Pediatric Intensive Care Unit located in Centro Hospitalar Universitário Lisboa Norte. MATERIAL AND METHODS: Retrospective observational cohort study of all patients supported with ECMO in a Pediatric Intensive Care Unit, from the 1st of May 2010 up to 31st December 2019. RESULTS: Sixty-five patients were included: 37 neonatal (≤ 28 days of age) and 28 pediatric patients (> 28 days). In neonatal cases, congenital diaphragmatic hernia was the main reason for ECMO (40% of neonatal patients and 23% of total). Among pediatric patients, respiratory distress was the leading indication for ECMO (47% of total). The median length of ECMO support was 12 days. Clinical complications were more frequent than mechanical complications (65% vs 35%). Among clinical complications, access site bleeding was the most prevalent with 38% of cases. The overall patient survival was 68% at the time of discharge (65% for neonatal and 71% for pediatric cases), while the overall survival rate in Extracorporeal Life Support Organization registry was 61%. The number of ECMO runs has been increasing since 2011, even though in a non-linear way (three cases in 2010 to 11 cases in 2019). DISCUSSION: In the first 10 years we received patients from all over the country. Despite continuous technological developments, circuitrelated complications have a significant impact. The overall survival rate in the Pediatric Intensive Care Unit was not inferior to the one reported by the Extracorporeal Life Support Organization. CONCLUSION: The overall survival of our Pediatric Intensive Care Unit is not inferior to one reported by other international centers. Our experience showed the efficacy of the ECMO technique in a Portuguese centre.

Introdução: Em Portugal, a oxigenação por membrana extracorporal (ECMO) é utilizado em doentes pediátricos de forma consistente desde 2010. O nosso objetivo é descrever as características clínicas, indicações, complicações e sobrevivência associadas à utilização da ECMO nos primeiros 10 anos de experiência na nossa unidade. Material e Métodos: Estudo de coorte retrospetivo dos doentes tratados com ECMO na Unidade de Cuidados Intensivos Pediátricos do Hospital de Santa Maria, de 1 de maio de 2010 a 31 de dezembro de 2019. Resultados: Foram incluídos 65 doentes: 37 neonatais (≤ 28 dias de idade) e 28 pediátricos (> 28 dias). Nos neonatais, a hérnia diafragmática congénita foi a principal indicação (40% dos recém-nascidos e 23% do total). Relativamente aos doentes pediátricos, a insuficiência respiratória constituiu a principal indicação para ECMO (47% do total). A mediana de duração da técnica foi de 12 dias. As complicações clínicas foram mais frequentes do que as mecânicas (65% vs 35%). Entre as complicações clínicas, a hemorragia no local de acesso foi a mais frequente (38% dos casos). A sobrevivência global do total da amostra foi de 68% no momento da alta (65% nos neonatais e 71% nos pediátricos), enquanto que a sobrevivência descrita no registo da Extracorporeal Life Support Organization é de 61%. O número de casos de utilização de ECMO tem vindo a aumentar desde 2011, embora de forma não linear (três casos em 2010 para 11 casos em 2019). Discussão: Nos primeiros 10 anos de experiência em ECMO na Unidade de Cuidados Intensivos Pediátricos recebemos doentes oriundos de várias partes do país. Apesar da evolução tecnológica contínua, as complicações relacionadas com o circuito têm um impacto significativo. A taxa de sobrevida global no nosso centro não foi inferior à reportada no relatório da Extracorporeal Life Support Organization. Conclusão: A sobrevida global na Unidade de Cuidados Intensivos Pediátricos não é inferior à descrita no registo internacional. A nossa experiência demonstra a eficácia da ECMO num centro Português.

The Impact of Focused Cardiac Ultrasound Performed by Pediatric Intensivists: A Prospective Study.

OBJECTIVES: Focused cardiac ultrasound is an echocardiographic method used by medical intensivists for fast and reliable hemodynamic assessment. Prospective studies and guidelines have defined its role in adult critical care. Data regarding its use in pediatric critical care are scarce. This is the first prospective study that aims to evaluate its impact in this setting. METHODS: This is a single-center prospective study performed in a tertiary referral hospital pediatric intensive care unit (PICU). For a period of 6 months, when performing an echocardiogram, pediatric intensivists filled out a questionnaire that included the patient's clinical data and indication for the examination. The intensivists had to record both the clinical impression regarding that indication and therapeutic plan before and after the echocardiogram. All the patients with an echocardiogram performed by the pediatric intensive care unit medical staff were included. RESULTS: There were 80 echocardiograms performed on 35 patients during the study period. The most common patient diagnostic groups were respiratory infections (38%, n = 30) and septic shock (21%, n = 17). The main indication for the examination was assessment of intravascular volume status and left ventricular systolic function. After the echocardiogram, the clinical impression was maintained in 49% (n = 39) and changed in 44% (n = 35). There were new findings unrelated to the initial evaluation in 7% (n = 6). The planned treatment was maintained in 55% (n = 44) and changed in 45% (n = 36). CONCLUSIONS: The echocardiogram changed the clinical impression and therapeutic plan in almost half of the patients. These data show the value of focused cardiac ultrasound as a diagnostic and hemodynamic monitoring tool in pediatric intensive care and emphasize the importance of a rigorous training program.

[ECMO in Neonates with Congenital Diaphragmatic Hernia: The Experience of a Portuguese ECMO Referral Center]. / ECMO em Recém-nascidos com Hérnia Diafragmática Congénita: A Experiência de um Centro de Referência de ECMO em Portugal.

INTRODUCTION: The use of extracorporeal membrane oxygenation (ECMO) is considered by many authors as one of the most important technological advances in the care of newborns with congenital diaphragmatic hernia. The main objective of this study was to report the experience of a Portuguese ECMO center in the treatment of congenital diaphragmatic hernia. MATERIAL AND METHODS: Descriptive retrospective study of newborns with congenital diaphragmatic hernia requiring ECMO support in a Pediatric Intensive Care Unit from January 2012 to December 2019. Data collection using the Extracorporeal Life Support Organization registration and unit data base. RESULTS: Fourteen newborns were included, all with left congenital diaphragmatic hernia, in a total of 15 venoarterial ECMO cycles. The median gestational age was 38 weeks and the median birth weight was 2.950 kg. Surgical repair was performed before entry into ECMO in six, during in seven and after in one newborn. The average age at placement was 3.3 days and the median cycle duration was 16 days. Prior to ECMO, all newborns had severe hypoxemia and acidosis despite optimized ventilatory support, with nitric oxide and inotropic therapy. After 24 hours on ECMO, there was correction of acidosis, improvement of oxygenation and hemodynamic stability. All cycles presented mechanical complications, the most frequent being the presence of clots in the circuit. The most frequent physiological complications were hemorrhagic and embolic (three newborns suffered an ischemic stroke during the cycle). Five newborns (35.7%) died, all associated with complications (two strokes, two massive bleedings and one accidental decannulation). Chronic lung disease, poor weight gain and psychomotor developmental delay were the most frequent long-term morbidities. DISCUSSION: Despite technological advances in respiratory care and improved safety of the ECMO technique, the management of these newborns is complex and there are still several open questions, including the appropriate selection of patients, the best approach and time for surgical correction, and the treatment of pulmonary hypertension in the presence of persistent fetal shunts. CONCLUSION: Survival rate was higher than reported in 2017 Extracorporeal Life Support Organization report (64% versus 50%). Mechanical and hemorrhagic complications were very frequent.

Introdução: A utilização de oxigenação por membrana extracorporal (ECMO) é considerada por muitos autores como um dos maisimportantes avanços tecnológicos nos cuidados de recém-nascidos com hérnia diafragmática congénita. O principal objetivo deste estudo foi reportar a experiência de um centro de oxigenação por membrana extracorporal português no tratamento de hérnia diafragmática congénita.Material e Métodos: Estudo retrospetivo descritivo dos recém-nascidos com hérnia diafragmática congénita com necessidade de suporte de ECMO, numa unidade de Cuidados Intensivos Pediátricos de janeiro de 2012 a dezembro de 2019. Colheita de dados com recurso ao registo da Extracorporeal Life Support Organization e registo da unidade.Resultados: Incluídos 14 recém-nascidos, todos com hérnia diafragmática congénita esquerda, num total de 15 ciclos de ECMO veno-arterial. Mediana de idade gestacional de 38 semanas e de peso ao nascer de 2,950 kg. A correção cirúrgica foi realizada antes da entrada em ECMO em seis, durante em sete e após ciclo em um caso. A mediana de idade de colocação foi de 3,3 dias e a média de duração do ciclo foi de 16 dias. Previamente à ECMO, todos os recém-nascidos apresentavam hipoxemia e acidose grave apesar de suporte ventilatório otimizado, com terapêutica com oxido nítrico e inotrópicos. Após 24 horas em ECMO, verificou-se correção de acidose, melhoria de oxigenação e estado hemodinâmico. Todos os ciclos apresentaram complicações mecânicas, sendo a mais frequente a presença de coágulos no circuito. As complicações fisiológicas mais frequentes foram as hemorrágicas e embólicas (três recém-nascidos sofreram acidente vascular cerebral isquémico durante o ciclo). Cinco crianças (35,7%) morreram, estando todos os casos associados a complicações (duas com acidente vascular cerebral, duas com hemorragia maciça e uma descanulação acidental). A doença pulmonar crónica, má progressão ponderal e atraso do desenvolvimento psicomotor foram as morbilidades a longo prazo mais frequentes.Discussão: Apesar dos avanços tecnológicos nos cuidados respiratórios e melhoria da segurança da técnica ECMO, o manuseamento destes recém-nascidos é complexo e existem ainda várias questões em aberto, incluindo a selecção apropriada dos doentes, amelhor abordagem e tempo de correcção cirúrgica, e o tratamento da hipertensão pulmonar na presença de shunts fetais persistentes.Conclusão: A taxa de sobrevivência foi superior à reportada no relatório da Extracorporeal Life Support Organization de 2017 (64% vs 50%). As complicações mecânicas e hemorrágicas foram muito prevalentes.

LCIA framework and cross-cutting issues guidance within the UNEP-SETAC Life Cycle Initiative.

Increasing needs for decision support and advances in scientific knowledge within life cycle assessment (LCA) led to substantial efforts to provide global guidance on environmental life cycle impact assessment (LCIA) indicators under the auspices of the UNEP-SETAC Life Cycle Initiative. As part of these efforts, a dedicated task force focused on addressing several LCIA cross-cutting issues as aspects spanning several impact categories, including spatiotemporal aspects, reference states, normalization and weighting, and uncertainty assessment. Here, findings of the cross-cutting issues task force are presented along with an update of the existing UNEP-SETAC LCIA emission-to-damage framework. Specific recommendations are provided with respect to metrics for human health (Disability Adjusted Life Years, DALY) and ecosystem quality (Potentially Disappeared Fraction of species, PDF). Additionally, we stress the importance of transparent reporting of characterization models, reference states, and assumptions, in order to facilitate cross-comparison between chosen methods and indicators. We recommend developing spatially regionalized characterization models, whenever the nature of impacts shows spatial variability and related spatial data are available. Standard formats should be used for reporting spatially differentiated models, and choices regarding spatiotemporal scales should be clearly communicated. For normalization, we recommend using external normalization references. Over the next two years, the task force will continue its effort with a focus on providing guidance for LCA practitioners on how to use the UNEP-SETAC LCIA framework as well as for method developers on how to consistently extend and further improve this framework.

Unwitnessed head trauma: the bamboo did it.

Unwitnessed penetrating head injuries (PHIs) are often challenging. The inability to locate a foreign body should not exclude this diagnosis nor should it delay treatment. Attempts must be made to clarify the mechanism of injury, as this may allow for a better understanding of the patient's condition.

Individual-based ant-plant networks: diurnal-nocturnal structure and species-area relationship.

Despite the importance and increasing knowledge of ecological networks, sampling effort and intrapopulation variation has been widely overlooked. Using continuous daily sampling of ants visiting three plant species in the Brazilian Neotropical savanna, we evaluated for the first time the topological structure over 24 h and species-area relationships (based on the number of extrafloral nectaries available) in individual-based ant-plant networks. We observed that diurnal and nocturnal ant-plant networks exhibited the same pattern of interactions: a nested and non-modular pattern and an average level of network specialization. Despite the high similarity in the ants' composition between the two collection periods, ant species found in the central core of highly interacting species totally changed between diurnal and nocturnal sampling for all plant species. In other words, this "night-turnover" suggests that the ecological dynamics of these ant-plant interactions can be temporally partitioned (day and night) at a small spatial scale. Thus, it is possible that in some cases processes shaping mutualistic networks formed by protective ants and plants may be underestimated by diurnal sampling alone. Moreover, we did not observe any effect of the number of extrafloral nectaries on ant richness and their foraging on such plants in any of the studied ant-plant networks. We hypothesize that competitively superior ants could monopolize individual plants and allow the coexistence of only a few other ant species, however, other alternative hypotheses are also discussed. Thus, sampling period and species-area relationship produces basic information that increases our confidence in how individual-based ant-plant networks are structured, and the need to consider nocturnal records in ant-plant network sampling design so as to decrease inappropriate inferences.

Ore grade decrease as life cycle impact indicator for metal scarcity: the case of copper.

In the life cycle assessment (LCA) of products, the increasing scarcity of metal resources is currently addressed in a preliminary way. Here, we propose a new method on the basis of global ore grade information to assess the importance of the extraction of metal resources in the life cycle of products. It is shown how characterization factors, reflecting the decrease in ore grade due to an increase in metal extraction, can be derived from cumulative ore grade-tonnage relationships. CFs were derived for three different types of copper deposits (porphyry, sediment-hosted, and volcanogenic massive sulfide). We tested the influence of the CF model (marginal vs average), mathematical distribution (loglogistic vs loglinear), and reserve estimate (ultimate reserve vs reserve base). For the marginal CFs, the statistical distribution choice and the estimate of the copper reserves introduce a difference of a factor of 1.0-5.0 and a factor of 1.2-1.7, respectively. For the average CFs, the differences are larger for these two choices, i.e. respectively a factor of 5.7-43 and a factor of 2.1-3.8. Comparing the marginal CFs with the average CFs, the differences are higher (a factor 1.7-94). This paper demonstrates that cumulative grade-tonnage relationships for metal extraction can be used in LCA to assess the relative importance of metal extractions.

A 3-month-old baby with H1N1 and Guillain-Barré syndrome.

Majority of children with pandemic influenza A (H1N1)pdm09 experience mild illness with full recovery without treatment. A previously healthy two and a half month-old girl was admitted to our paediatric intensive care unit because of severe respiratory failure with A (H1N1)pdm09 infection. Despite initial clinical improvement all attempts to extubate to non-invasive ventilation were unsuccessful and 2 to 3 weeks after symptom onset she started periods of cardiovascular instability and a progressive neurological deterioration with distal symmetrical progressive motor weakness and areflexia. All investigations were normal except elevated liver enzymes and cerebrospinal fluid examination that revealed elevated protein without pleocytosis. A possible diagnosis of Guillain-Barré syndrome (GBS) was considered and electromyogram was compatible with axonal form of GBS. To our knowledge this is the youngest case of GBS acquired postnatally and the first in children associated with H1N1 virus.

[Subdural empyema due to gemella morbillorum as a complication of acute sinusitis]. / Empiema subdural a gemella morbillorum como complicação de sinusite aguda.

Subdural empyema is a life-threatening infection that may complicate acute sinusitis. The authors report the case of a previously healthy 10 year-old girl who presented with subdural empyema due to Gemella morbillorum after an untreated maxillary, ethmoidal and esphenoidal sinusitis. Despite immediate drainage of the empyema and underlying primary infection and treatment with broad spectrum antibiotics, she later developed frontal cerebritis and refractory intracranial hypertension, needing urgent decompressive craniectomy. She recovered gradually, maintaining to date slight right hemyparesis and aphasia. Even though it is considered a low virulence organism, G. morbillorum has been increasingly described in central nervous system infection. In this case, the prompt institution of broad spectrum antibiotics and surgical drainage, as well as the agressive treatment of complications, including decompressive craniectomy, were crucial to the patient's recovery.

Successful intravenous thrombolysis in a 14-year-old boy with ischemic stroke.

We report a healthy 14-year-old boy with an acute left middle cerebral artery stroke, treated 2 hours after the onset of symptoms with intravenous recombinant tissue plasminogen activator (r-TPA). Recanalization of the middle cerebral artery was documented with transcranial Doppler during the first 5 minutes of intravenous r-TPA perfusion, and progressive recovery of the neurological deficits occurred. Although lack of evidence regarding safety and efficacy in children precludes the recommendation of systematic use of r-TPA in pediatric stroke, we propose that this option should be considered and discussed with the parents, especially in older children presenting within 3 hours in centers with experience in adult thrombolysis.

[Polytraumatism in childhood - it can be more than it seems!]. / Criança politraumatizada - nem sempre é só o que parece!

Thoracic injuries can occur in 50% of polytraumatized children, but rupture of the airway is extremely rare. We describe the case of a three-year-old child victim of fall of fourth floor, with head, spine, thoracic and abdominal trauma. On admission she had left side hemothorax and hypertensive pneumothorax and a chest drainage was inserted. Imagiological studies showed left lung contusion, fracture of L1-L4 with spinal cord bone splint and spinal cord injury (D11-L3). On day 3, because of hematic chest drainage and persistent left lung opacity, a bronchoscopy was performed and showed total section of the left main bronchus. She underwent surgical reconstruction of the bronchial tree with atypical resection of the lower lobe of the left lung, with good recovery. This case demonstrates the complexity and the importance of the multidisciplinary approach to the polytraumatized child.

Septic Pulmonary Embolism Case Report: Optimal Outcome after Insertion of an Inferior Vena Cava Filter in a Patient with Staphylococcus aureus Bacteraemia.

A 14-year-old patient presented with bilateral pneumonia and pleural effusions, septic arthritis of the hip, deep venous thrombosis, and pulmonary thromboembolism. Methicillin-sensitive Staphylococcus aureus (S. aureus) containing the Panton Valentine Leukocidin (PVL) genes was isolated. Contraindication to anticoagulation prompted inferior vena cava filter placement. He completed 4 weeks of treatment with flucloxacillin, with good clinical outcome. S. aureus containing PVL genes should be sought in cases of necrotizing pneumonia as it seems to increase the risk of severe multifocal infection and thrombotic complications. There are few reports of placement of filters during S. aureus sepsis and bacteraemia. This case highlights that when anticoagulation is not feasible, an inferior vena cava filter can be inserted safely, even in patients with active sepsis and high risk for seeding of the filter. Long-term follow-up confirmed a successful outcome with sterilization of the septic thrombosis with no further pulmonary embolism or additional sepsis episodes.

[Endovascular thrombolysis for massive cerebral venous thrombosis in a teenager with nephrotic syndrome]. / Trombose venosa cerebral maciça submetida a trombólise endovascular num adolescente com síndrome nefrótica.

Cerebral venous thrombosis is a rare but potentially severe condition in children. We present the case of a teenager with corticodependent nephrotic syndrome diagnosed at five months of age and treated with cyclosporine A. In the context of recurrence of nephrotic syndrome he presented with headache, vomiting and severe intracranial hypertension. While the raised intracranial pressure and the status epilepticus were controlled, the brain imaging revealed venous thrombosis of all venous sinus, with absence of venous drainage. He was submitted to local thrombolysis with recombinant tissue plasminogen activator, with recanalization of the venous sinuses. The outcome was favourable, without neurological deficits. In this case, the early radiologic intervention was crucial, enabling a full neurological recovery, in a teenager whose initial prognosis was very poor.

[The lay midwife care to woman upon delivery and her childbirth]. / A parteira leiga no atendimento à mulher no parto e nascimento do seu filho.

It is a research aimed at finding out the lay midwives' practices while attending women upon delivery and their childbirth. The methodology was supported by the oral history of the midwives, using Bardin's thematic analysis. The findings regarding the midwives' activities reveal the domestic character of their practices, being themselves one of these resources, besides others that they have adopted to perform their practices. The rescue of those practices may lead health professionals to think about the current proposals to humanize delivery and childbirth.

A parteira leiga no atendimento à mulher no parto e nascimento do seu filho / The lay midwife care to woman upon delivery and her childbirth

Trata-se de uma pesquisa que teve como objetivo conhecer as práticas de parteiras leigas durante o acompanhamento às mulheres no parto e nascimento de seus filhos. A metodologia apoiou-se na história oral de parteiras, com análise temática de Bardin. Os achados referentes às atividades das parteiras revelam o caráter doméstico de suas práticas, constituindo-se elas próprias em um dos recursos desta prática, além de outros que adotavam na execução de suas atividades. O resgate destas práticas poderá servir de reflexão para os profissionais da saúde, em um momento em que se discutem propostas de humanização do parto e do nascimento

Resgate das práticas de parteiras leigas: a humanização da atenção ao parto / Humanization of childbirth attention: rescuing the midwives´ practices

Trata-se de uma pesquisa qualitativa na linha histórica, que teve como objetivo conhecer as práticas de três parteiras leigas, atualmente moradoras na cidade de Porto Alegre e que atuaram nas décadas de 1960, 1970 e 1980, no interior do Rio Grande do Sul. Através da história oral temática, resgataram-se as ações que elas desenvolviam durante o acompanhamento de mulheres, na gestação, parto e puerpério...