Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear: A Randomized Controlled Trial.

OBJECTIVE: To evaluate outcomes after pelvic floor muscle therapy, as compared with perineorrhaphy and distal posterior colporrhaphy, in the treatment of women with a poorly healed second-degree obstetric injury diagnosed at least 6 months postpartum. METHODS: We performed a single center, open-label, randomized controlled trial. After informed consent, patients with a poorly healed second-degree perineal tear at minimum 6 months postpartum were randomized to either surgery or physical therapy. The primary outcome was treatment success, as defined by Patient Global Impression of Improvement, at 6 months. Secondary outcomes included the Pelvic Floor Distress Inventory, the Pelvic Floor Impact Questionnaire, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, and the Hospital Anxiety and Depression Scale. Assuming a 60% treatment success in the surgery group and 20% in the physical therapy group, plus anticipating a 20% loss to follow-up, a total of 70 patients needed to be recruited. RESULTS: From October 2015 to June 2018, 70 of 109 eligible patients were randomized, half into surgery and half into tutored pelvic floor muscle therapy. The median age of the study group was 35 years, and the median duration postpartum at enrollment in the study was 10 months. There were three dropouts in the surgery group postrandomization. In an intention-to-treat analysis, with worst case imputation of missing outcomes, subjective global improvement was reported by 25 of 35 patients (71%) in the surgery group compared with 4 of 35 patients (11%) in the physical therapy group (treatment effect in percentage points 60% [95% CI 42-78%], odds ratio 19 [95% CI 5-69]). The surgery group was superior to physical therapy regarding all secondary endpoints. CONCLUSION: Surgical treatment is effective and superior to pelvic floor muscle training in relieving symptoms related to a poorly healed second-degree perineal tear in women presenting at least 6 months postpartum. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02545218.

Characteristics and changes in characteristics of women and babies admitted to residential parenting services in New South Wales, Australia in the first year following birth: a population-based data linkage study 2000-2012.

OBJECTIVE: To examine the characteristics of women and babies admitted to the residential parenting services (RPS) of Tresillian and Karitane in the first year following birth. DESIGN: A linked population data cohort study was undertaken for the years 2000-2012. SETTING: New South Wales (NSW), Australia. PARTICIPANTS: All women giving birth and babies born in NSW were compared with those admitted to RPS. RESULTS: During the time period there were a total of 1 097 762 births (2000-2012) in NSW and 32 991 admissions to RPS. Women in cohort 1: (those admitted to RPS) were older at the time of birth, more likely to be admitted as a private patient at the time of birth, be born in Australia and be having their first baby compared with women in cohort 2 (those not admitted to an RPS). Women admitted to RPS experienced more birth intervention (induction, instrumental birth, caesarean section), had more multiple births and were more likely to have a male infant. Their babies were also more likely to be resuscitated and have experienced birth trauma to the scalp. Between 2000 and 2012 the average age of women in the RPS increased by nearly 2 years; their infants were older on admission and women were less likely to smoke. Over the time period there was a drop in the numbers of women admitted to RPS having a normal vaginal birth and an increase in women having an instrumental birth. CONCLUSION: Women who access RPS in the first year after birth are more socially advantaged and have higher birth intervention than those who do not, due in part to higher numbers birthing in the private sector where intervention rates are high. The rise in women admitted to RPS (2000-2012) who have had instrumental births is intriguing as overall rates did not increase.

From being restrained to recapturing vitality: non-western immigrant women's experiences of undergoing vitamin D treatment after childbirth.

Purpose: Vitamin D deficiency is a complex topic in human health and ill-health and has been studied in a variety of contexts and populations. Few studies examine Vitamin D deficiency among non-western immigrant women and even fewer examine women's perspective on daily life while living with low vitamin D levels after childbirth and undergoing vitamin D treatment. The aim was, therefore, to explore health and ill-health among non-western immigrant women living with low vitamin D levels after childbirth and reaching normalized levels after one year of vitamin D treatment. Method: An explorative qualitative study using qualitative content analysis. Six women aged 25 to 38 years, diagnosed with low 25-hydroxyvitamin D levels during pregnancy, were recruited after having undergone vitamin D treatment. Results: The women told about living a restrained life which gradually transformed into an experience of recaptured vitality. They also experienced a need for continuity in medication, as an interruption of treatment meant returning symptoms. Conclusion: In this study, non-western immigrant women described benefits in everyday life, increased strength, relieved pain and improved sleep quality. The findings can provide valuable knowledge for healthcare providers meeting women with physical weakness, musculoskeletal pain and/or poor sleep quality after childbirth. Further studies using a longitudinal design and larger samples are warranted.

Musculoskeletal Pelvic Pain and Sexual Function in the First Year After Childbirth.

OBJECTIVE: To characterize sexual function in women with and without musculoskeletal pelvic pain during the first year after childbirth. DESIGN: Cross-sectional descriptive study. SETTING: Outpatient women's health clinic in a Midwestern U.S. academic medical center. PARTICIPANTS: Women who gave birth to singleton infants within the past year. METHODS: Women were recruited from various outpatient settings. We obtained baseline demographic variables and used selected components from the Wilson and Cleary Health-Related Quality of Life model. Participants completed questionnaires related to sexual health, pain symptoms, and general quality of life. They were asked to indicate their pain on a pain diagram and to quantify it with the use of a numeric rating scale (NRS). Examiners used validated examination techniques to assess pelvic floor muscle tenderness, strength, and pelvic girdle pain. Participants who reported pelvic pain and had at least one positive physical examination finding were classified in the pain group. RESULTS: Forty-five participants completed the study, and 20 participants were in the pain group. Most participants with pain had pelvic girdle pain (n = 15) and pelvic floor myofascial pain (n = 20). Participants with pain reported less sexual satisfaction (t[43] = 2.84, p = .007) and reduced quality of life (t[36] = 5.25, p < .001) compared with participants without pain. CONCLUSION: Participants who experienced musculoskeletal pelvic pain in the first year after childbirth were significantly more likely to report problems with sexual function compared with their counterparts without pain.

The effect of rehabilitation exercises combined with direct vagina low voltage low frequency electric stimulation on pelvic nerve electrophysiology and tissue function in primiparous women: A randomised controlled trial.

AIM AND OBJECTIVE: To evaluate the effect of rehabilitation exercises combined with Direct Vagina Low Voltage Low Frequency Electric Stimulation (DES) on pelvic nerve electrophysiology and tissue function after delivery. BACKGROUND: Whether and how DES effects pelvic floor dysfunction (PFD) are not known clearly. DESIGN: This was a randomised, controlled clinical trial. METHODS: The 189 primiparous women 20-35 years old and with an episiotomy or second degree episiotomy tear were divided into three groups: the control group (n = 60) received routine postpartum guidance 2 hr postpartum, the training group (n = 63) performed rehabilitation exercises (Kegel exercises and pelvic movements) from 2 days postpartum until 3 months postpartum, and the combination group (n = 66) received DES 15 times (3 times a week for 30 min at a time) beginning at the sixth week postpartum in addition to performing rehabilitation exercises. Adopt international standard scale and score method to inspect maternal life treatment, such as pelvic organ prolapse situation (POP-Q division), the degree of incontinence score and pelvic floor muscle intensity of muscular contraction. Data were collected during the third month after delivery. RESULTS: Three months postpartum, there were differences among the three groups in the POP-Q grade, the degree of incontinence score, the Oxford grade for pelvic floor muscle strength and the pelvic floor muscle electrophysiology condition. Additionally, there were significant differences regarding the pubic symphysis clearance. Rehabilitation exercises can promote healing of the maternal pubic symphysis and recovery of the pelvis. The total electrical value, type I muscle fibre strength and type II muscle fibre strength were significantly increased in the combination group after treatment than before treatment. CONCLUSION: Rehabilitation exercises combined with DES were beneficial to the recovery of postpartum pelvic nerve tissue function, and a synergistic effect was observed when the two methods were combined. RELEVANCE TO CLINICAL PRACTICE: These conclusions justify that rehabilitation exercise combined with DES can better relieve uncomfortable symptoms postpartum and improve the women's quality of life.

Intervenciones de enfermería para la atención del parto de bajo riesgo de la mujer en el primer nivel de atención / Nursing interventions for low-risk delivery of women at the first level of care

Intervenciones de enfermería para la atención del parto de bajo riesgo de la mujer en el primer nivel de atención.Introducción. Diariamente mueren 1500 mujeres por complicaciones en el embarazo y el parto. Por tanto, la mejora de la salud materna es considerada como uno de los ocho objetivos del Milenio adoptados en la Cumbre del Mileno de las Naciones Unidas en el año 2000.Métodos. Con “Delivery, Obstetric” como descriptor y el planteamiento de preguntas clínicas, se realizó la búsqueda sistemática en: PUBMED, BvS, Trip Database y Scielo para la revisión de meta análisis, revisiones sistemáticas, guías clínicas y ensayos clínicos aleatorizados, cuyas evidencias y recomendaciones con mayor gradación y fuerza respectivamente, dieran respuesta en la detección de factores de riesgo, atención del parto y prevención de complicaciones. Se incluyeron documentos en inglés, portugués y español publicados entre 2011-2015.Resultados. Se analizaron 213 documentos, de los cuales 15 fueron utilizados en esta guía. La evidencia científica enfatiza la valoración oportuna de riesgos como: hipertensión arterial, infecciones de vías urinarias recurrentes, sangrado durante el embarazo, multiparidad, edad mayor a 35 años y nivel socioeconómico bajo, considerados como causas obstétricas de mortalidad materna y la prevención de posibles complicaciones derivadas de la atención del parto. Además, vigilar la evolución del parto, uso y reacción adversa de uterotónicos, constantes vitales de la mujer y la actividad cardíaca fetal así como cuidados que faciliten la atención humanizada. Conclusiones. Las intervenciones de enfermería basadas en evidencia científica influyen en la calidad de la atención del parto con el menor riesgo de morbilidad y mortalidad materna. Palabras clave. Parto obstétrico, factores de riesgo, enfermería, complicaciones.

Introduction. Every day 1500 women die from complications in pregnancy and childbirth. Therefore, improving maternal health it is regarded as one of the eight Millennium Development Goals adopted at the Millennium Summit of the United Nations in 2000.Methods. With ""Delivery, Obstetric"" as descriptor and approach to clinical questions, the systematic search was conducted: PUBMED, BvS, Trip Database and Scielo for review of meta-analyzes, systematic reviews, clinical guidelines and randomized clinical trials, whose evidence and recommendations more gradation and strength respectively, would respond in detecting risk factors, delivery care and prevention of complications. documents in English, Portuguese and Spanish published between 2011-2015 were included.Results. 213 documents were analyzed, of which 15 were used in this guide. Scientific evidence emphasizes the timely assessment of risks such as low blood pressure, infections recurrent urinary tract infections, bleeding during pregnancy, multiparity, older than 35 years, and socioeconomic status considered obstetric causes of maternal mortality and the prevention of possible complications of care delivery. In addition, monitoring the progress of labor, use and adverse reaction of uterotonics, vitals of women and fetal heart activity and facilitate care humanized care.Conclusions. Nursing interventions based on scientific evidence influence the quality of care delivery with lower risk of maternal morbidity and mortality.Keywords. obstetrical delivery, risk factors, nursing, complications.

As intervenções de enfermagem para prestação de cuidados de mulheres de baixo risco no primeiro nível de atenção.Introdução. Todos os dias 1500 mulheres morrem de complicações na gravidez e no parto. Portanto, melhorar a saúde materna é considerado como um dos oito Objectivos de Desenvolvimento do Milénio adoptados na Cimeira do Milénio das Nações Unidas em 2000.Métodos. Com ""Parto Obstétrico"" como descritor e abordagem de questões clínicas, a busca sistemática foi conduzida: PubMed, BvS, Banco de Dados de viagem e Scielo para revisão de meta-análises, revisões sistemáticas, diretrizes clínicas e estudos clínicos randomizados, cujas provas e recomendações mais gradação e força, respectivamente, iria responder na detecção de fatores de risco, assistência ao parto e prevenção de complicações. documentos em Inglês, Português e Espanhol, publicados entre 2011-2015 foram incluídos.Resultados. 213 documentos foram analisadas, dos quais 15 foram usadas neste guia. A evidência científica enfatiza a avaliação atempada dos riscos, tais como pressão arterial baixa, infecções do trato urinário infecções recorrentes, sangramento durante a gravidez, multiparidade, mais de 35 anos e nível socioeconômico considerado causas obstétricas de mortalidade materna ea prevenção de possíveis complicações da prestação de cuidados. Além disso, o monitoramento do progresso do trabalho de parto, uso e de reacções adversas de uterotônicos, sinais vitais de mulheres e atividade cardíaca fetal e facilitar o atendimento cuidado humanizado.Conclusões. As intervenções de enfermagem baseadas em evidências científicas influenciar a qualidade da prestação de cuidados a um menor risco de morbidade e mortalidade materna. entrega obstétrica, fatores de risco, enfermagem, complicações.

[Post-partum: Guidelines for clinical practice--Short text]. / Post-partum: recommandations pour la pratique Clinique--Texte court.

OBJECTIVE: To determine the post-partum management of women and their newborn whatever the mode of delivery. MATERIAL AND METHODS: The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS: Because breastfeeding is associated with a decrease in neonatal morbidity (lower frequency of cardiovascular diseases, infectious, atopic or infantile obesity) (EL2) and an improvement in the cognitive development of children (EL2), exclusive and extended breastfeeding is recommended (grade B) between 4 to 6 months (Professional consensus). In order to increase the rate of breastfeeding initiation and its duration, it is recommended that health professionals work closely with mothers in their project (grade A) and to promote breastfeeding on demand (grade B). There is no scientific evidence to recommend non-pharmacological measures of inhibition of lactation (Professional consensus). Pharmacological treatments for inhibition of lactation should not be given routinely to women who do not wish to breastfeed (Professional consensus). Because of potentially serious adverse effects, bromocriptin is contraindicated in inhibiting lactation (Professional consensus). For women aware of the risks of pharmacological treatment of inhibition of lactation, lisuride and cabergolin are the preferred drugs (Professional consensus). Whatever the mode of delivery, numeration blood count is not systematically recommended in a general population (Professional consensus). Anemia must be sought only in women with bleeding or symptoms of anemia (Professional consensus). The only treatment of post-dural puncture headache is the blood patch (EL2), it must not be carried out before 48 h (Professional consensus). Women vaccination status and their family is to be assessed in the early post-partum (Professional consensus). Immediate postoperative monitoring after caesarean delivery should be performed in the recovery room, but in exceptional circumstances, it may be performed in the delivery unit provided safety rules are maintained and regulatory authorities are informed (Professional consensus). An analgesic multimodal protocol developed by the medical team should be available and oral way should be favored (Professional consensus) (grade B). For every cesarean delivery, thromboprophylaxis with elastic stockings applied on the morning of the surgery and kept for at least 7 postoperative days is recommended (Professional consensus) with or without the addition of LMWH according to the presence or not of additional risk factors, and depending on the risk factor (major, minor). Early postoperative rehabilitation is encouraged (Professional consensus). Postpartum visit should be planned 6 to 8 weeks after delivery and can be performed by an obstetrician, a gynecologist, a general practitioner or a midwife, after normal pregnancy and delivery (Professional consensus). Starting effective contraception later 21 days after delivery in women who do not want closely spaced pregnancy is recommended (grade B), and to prescribe it at the maternity (Professional consensus). According to the postpartum risk of venous thromboembolism, the combined hormonal contraceptive use before six postpartum weeks is not recommended (grade B). Rehabilitation in asymptomatic women in order to prevent urinary or anal incontinence in medium or long-term is not recommended (Expert consensus). Pelvic-floor rehabilitation using pelvic-floor muscle contraction exercises is recommended to treat persistent urinary incontinence at 3 months postpartum (grade A), regardless of the type of incontinence. Postpartum pelvic-floor rehabilitation is recommended to treat anal incontinence (grade C). Postpartum pelvic-floor rehabilitation is not recommended to treat or prevent prolapse (grade C) or dyspareunia (grade C). The optimal time for maternity discharge for low risk newborn depends more on the organisation of the post-discharge follow up (Professional consensus). The months following the birth are a transitional period, and psychological alterations concern all parents (EL2). It is more difficult in case of psychosocial risk factors (EL2). In situations of proven psychological difficulties, the impact on the psycho-emotional development of children can be important (EL3). Among these difficulties, postpartum depression is the most common situation. However, the risk is generally higher in the perinatal period for all mental disorders (EL3). CONCLUSION: Postpartum is, for clinicians, a unique and privileged opportunity to address the physical, psychological, social and somatic health of their patients.

[Postnatal visit: Routine and particularity after complicated pregnancy--Guidelines for clinical practice]. / Modalités de la consultation postnatale et spécificités en cas de pathologie de la grossesse: recommandations pour la pratique clinique.

OBJECTIVES: To propose guidelines for clinical practice for routine postnatal visit and after pathological pregnancies. MATERIALS AND METHODS: Bibliographic searches were performed with PubMed and Cochrane databases, and within international guidelines references. RESULTS: Postpartum visit should be planned 6 to 8 weeks after delivery and can be performed by an obstetrician, a gynecologist, a general practitioner or a midwife, when after normal pregnancy and delivery (Professional consensus). If any complication occurred, this visit should be handled by an obstetrician (Professional consensus). Physical examination should focus on patient symptoms and pregnancy complications (Professional consensus). Gynecological examination is not systematic (Professional consensus). Pap smear should be performed if previous exam was done more than 2years ago or when the previous exam was abnormal (Professional consensus). Weight should be measured to encourage weight loss (Professional consensus), with the aim to catch up preconceptional weight within 6 months after delivery (gradeC). Professional intervention may reduce weight retention (professional consensus). Tobacco, alcohol and illicit drugs cessation should be promoted (grade B) and supported by a professional (grade A). Obstetrical risks consecutive to short interval between pregnancies should be explained (evidence level [EL]: 3) and contraception discussed regarding family project (Professional consensus). Mother mood, mother to child relationship and breastfeeding troubles should be systematically evaluated (professional consensus). Pelvic-floor rehabilitation should be performed only when urinary of fecal incontinence persist 3 months after delivery (Professional consensus). Serological screening for toxoplamosis (grade B) and blood hemoglobin concentration should not be systematically performed (gradeC). After spontaneous preterm birth, women should be screened for uterine anomalies and treatment should be discussed (Professional consensus). Evidence is lacking to recommend any exploration to diagnose cervical incompetence (Professional consensus). When investigations are performed, there is no argument to recommend a specific exam (Professional consensus). Women should be screened for antiphospholipid antibodies after severe or early pre-eclampsia, IUGR or intra-uterine fetal death (Professional consensus) but screening for inherited thrombophilia is not recommended (grade B). Women with persistent proteinuria and/or hypertension 3 months after pre-eclampsia should be referred to a nephrologist (Professional consensus). Normalization of liver enzymes should be checked 8 to 12 weeks after intrahepatic cholestasis of pregnancy (Professional consensus). A synthetic document should be send to the women corresponding physicians (Professional consensus). Preconceptional counseling is recommended (Professional consensus). CONCLUSION: A postpartum visit is recommended 6 to 8 weeks after delivery, including mother physical and psychological evaluation and information about contraception, short interval between pregnancy, weight loss, smoking cessation (Professional consensus). To ensure continuity in the management of women health, relevant medical elements will be pass on to the corresponding physicians (Professional consensus).

[Postpartum pelvic floor muscle training and abdominal rehabilitation: Guidelines]. / Rééducation périnéale et abdominale dans le post-partum: recommandations.

OBJECTIVE: Provide guidelines for clinical practice concerning postpartum rehabilitation. METHODS: Systematically review of the literature concerning postpartum pelvic floor muscle training and abdominal rehabilitation. RESULTS: Pelvic-floor rehabilitation using pelvic floor muscle contraction exercises is recommended to treat persistent urinary incontinence at 3 months postpartum (grade A), regardless of the type of incontinence. At least 3 guided sessions with a therapist is recommended, associated with pelvic floor muscle exercises at home. This postpartum rehabilitation improves short-term urinary incontinence (1 year) but not long-term (6-12 years). Early pelvic-floor rehabilitation (within 2 months following childbirth) is not recommended (grade C). Postpartum pelvic-floor rehabilitation in women presenting with anal incontinence, is associated with a lower prevalence of anal incontinence symptoms in short-term (1 year) (EL3) but not long-term (6 and 12) (EL3). Postpartum pelvic-floor rehabilitation is recommended to treat anal incontinence (grade C) but results are not maintained in medium or long term. No randomized trials have evaluated the pelvic-floor rehabilitation in asymptomatic women in order to prevent urinary or anal incontinence in medium or long term. It is therefore not recommended (expert consensus). Rehabilitation supervised by a therapist (physiotherapist or midwife) is not associated with better results than simple advice for voluntary contraction of the pelvic floor muscles to prevent/correct, in short term (6 months), a persistent prolapse 6 weeks postpartum (EL2), whether or not with a levator ani avulsion (EL3). Postpartum pelvic-floor rehabilitation is not associated with a decrease in the prevalence of dyspareunia at 1-year follow-up (EL3). Postpartum pelvic-floor rehabilitation guided by a therapist is therefore not recommended to treat or prevent prolapse (grade C) or dyspareunia (grade C). No randomized trials have evaluated the effect of pelvic floor muscle training after an episode of postpartum urinary retention or bladder outlet obstruction symptoms, or for the primary prevention of anal incontinence following third-degree anal sphincter tear or in patients presenting with anal incontinence after third-degree anal sphincter tear. The electrostimulation devices used alone were not assessed in this postpartum context (regardless of symptoms); therefore, isolated pelvic floor electrostimulation is not recommended (expert consensus). CONCLUSION: Pelvic floor muscle therapy is recommended for persistent postpartum urinary (grade A) or anal (grade C) incontinence (3 months after delivery).

[Maternal care after vaginal delivery and management of complications in immediate post-partum--Guidelines for clinical practice]. / Soins maternels après accouchement voie basse et prise en charge des complications du post-partum immédiat: recommandations pour la pratique clinique.

OBJECTIVE: To provide recommendations on maternal care after vaginal delivery, and management of complications in immediate post-partum period. METHODS: Bibliographic research from the Pubmed database and recommendations issued by the main scientific societies, and assignment of a level of evidence and a recommendation grade. RESULTS: After a vaginal delivery, monitoring of blood pressure, heart rate, bleeding, uterine involution, genital pain, urination, temperature, transit and signs of phlebitis is recommended (professional consensus). Post-partum Anemia is defined by a hemoglobin<11 g/dL at 48 hours (grade C). Anemia must be searched only in women who have bled during delivery or who present symptoms of anemia (professional consensus). Oral iron supplementation is only proposed in cases of biologically proven anemia (professional consensus). In case of post-partum hypertension or de novo preeclampsia, the prescription rules for antihypertensive treatments and magnesium sulfate are the same as in prenatal period (professional consensus). Oral NSAIDs are effective for perineal pain and uterine involution (EL2). In case of broken down perineal wounds following childbirth, there is no argument in favor of suturing or not suturing, however the suturing is to be preferred for large dehisced perineal wounds (professional consensus). Infection of perineal scar justifies an oral broad-spectrum antibiotics, in addition to local nursing (professional consensus). In case of obstetric anal sphincter injuries, an antibiotic prophylaxis is recommended (grade B). Hygiene advice should be given to all women who had an episiotomy or a perineal tear (professional consensus). The only etiological treatment of post-dural puncture headache is the blood patch (EL2). It must not be carried out before 48 hours (professional consensus). Thromboembolic risk after a vaginal birth is about 1‰ (EL2). The prescription of thromboprophylaxis with LMWH and graduated compression stockings should be based on risk factors (professional consensus). CONCLUSION: During the immediate post-partum period, complications may be unrecognized or confused with the natural post-partum evolution, which implies a strong vigilance from practitioners. This vigilance is all the more necessary that the maternal residence durations are shortened.

[Uterine packing efficacy in postpartum hemorrhage. About 99 cases. The experience of a French hospital level 2 A]. / Le méchage intra-utérin: utilité et place dans la prise en charge de l'hémorragie du post-partum immédiat. À propos de 99 cas. L'expérience d'un centre hospitalier français de niveau 2 A.

OBJECTIVE: To show place and usefulness of intra-uterine compression in management of post-partum haemorrhage (PPH). MATERIAL AND METHODS: Retrospective cohort study, monocentric, including all consecutive cases of PPH during four years in an obstetric department of level IIa. The compression technique was the use of intra-uterine meshes, and efficacy was defined as a total and immediate bleeding interruption. Apart of meshes, patients received sulprostone then ocytocine and antibiotics. RESULTS: The rate of PPH was 3.8% on 3913 deliveries. One hundred and fifty patients with PPH were managed following CNGOF guidelines. Ninety-nine patients were also treated with intra-uterine meshes during 24hours. The rate of mesh success was 91.9%. Sixty-two cases of subsequent pregnancies were also reported. CONCLUSION: In case of PPH, intra-uterine compression using meshes is simple, cheap and efficient. That technique could avoid the use of invasive surgical procedures and a safer post-natal transfer.

Using the lives saved tool (LiST) to model mHealth impact on neonatal survival in resource-limited settings.

While the importance of mHealth scale-up has been broadly emphasized in the mHealth community, it is necessary to guide scale up efforts and investment in ways to help achieve the mortality reduction targets set by global calls to action such as the Millennium Development Goals, not merely to expand programs. We used the Lives Saved Tool (LiST)--an evidence-based modeling software--to identify priority areas for maternal and neonatal health services, by formulating six individual and combined interventions scenarios for two countries, Bangladesh and Uganda. Our findings show that skilled birth attendance and increased facility delivery as targets for mHealth strategies are likely to provide the biggest mortality impact relative to other intervention scenarios. Although further validation of this model is desirable, tools such as LiST can help us leverage the benefit of mHealth by articulating the most appropriate delivery points in the continuum of care to save lives.

Ultrasound and Doppler assessment of uterus during puerperium after normal delivery.

OBJECTIVE: To describe the biometric and morphological characteristics of the uterus through ultrasound (US) and Doppler on the uterine arteries in the initial and late puerperium after normal delivery. METHODS: This was a prospective longitudinal study on full-term singleton pregnancies without complications. The patients were divided into two groups: 31 primiparous and 28 multiparous women. Two US exams were carried out with Doppler evaluation: firstly, within the initial 48 h; and secondly, between 31 and 50 days after childbirth. The US assessed the position and biometry of the uterus, appearance of the myometrium, measurement and content of the uterine cavity, and Doppler velocimetry indices of uterine arteries. To compare the groups at the two times, the paired Student t-test, Fisher's exact test and chi-square test were used. RESULTS: In the initial puerperium, the position of the uterus was retroversion (98.3%); the appearance of the myometrium was heterogeneous (96.6%); the uterine cavity was filled with some type of material (72.9%). After the 30th day, a position was anteversion (74.6%); the appearance of the myometrium was homogeneous (91.5%); and the uterine cavity was empty (81.3%). There was an evolution in the pulsatility index between the two US exams, with an increase of 52.03% among the primiparous and 53.13% among the multiparous for the right uterine artery. CONCLUSION: Significant changes were observed in the morphological and biometric characteristics of the uteruses evaluated through US, as well as in the uterine arteries Doppler, between the initial and late puerperium.

Efecto de un programa de ejercicio físico en la recuperación post-parto. Estudio piloto / Effect of the physical exercise program on the recovery post-partum period. Pilot study

Un hecho fisiológico como es el proceso de embarazo y parto, puede condicionar en gran medida la futura salud y calidad de vida de la mujer. La retención del peso gestacional, los episodios de pérdida de orina y la depresión postparto son algunos de los problemas más frecuentes a los que la mujer ha de enfrentarse tras el nacimiento de su bebé. Con este estudio se pretendió valorar si un programa de ejercicio físico supervisado puede favorecer la recuperación del peso pre-gestacional, evitar las pérdidas de orina y mejorar el estado psicológico de la mujer. Para ello se diseñó un trabajo experimental, de tipo aleatorizado, no apareado, controlado y no enmascarado que se ha desarrollado por medio de un proyecto de colaboración entre el Hospital Universitario de Fuenlabrada y la Facultad de Ciencias de la Actividad Física y el Deporte (FCCAFD-INEF) de la Universidad Politécnica de Madrid (UPM). Se seleccionaron dos grupos de mujeres, el grupo de intervención y el grupo de control, que sin contraindicaciones absolutas y con el consentimiento médico para la práctica de actividad física, se encontrasen en los primeros 3 meses del período post-parto. El grupo de intervención llevó a cabo un programa de ejercicio físico de 12 semanas de duración con una frecuencia semanal de tres veces por semana y una duración de una hora por sesión. Las variables medidas fueron: recuperación del peso pregestacional (peso, índice de masa corporal), depresión postnatal, incidencia de los problemas sociales ocasionados por la pérdida de orina y percepción sobre el estado de salud propio. Los resultados muestran una aparente asociación positiva entre el ejercicio físico programado y la percepción del estado de salud propio (15,69 vs 10,08; p=0,03). El resto de variables no presentaron diferencias significativas entre los grupos de estudio (AU)

The pregnancy processes and the delivery can condition in great measure the future health and quality of the woman’s life. The retention of the maternal weight gain, the episodes of loss of urine and the postpartum depression are some of the most frequent problems which the woman has to face after the birth of his baby. The aim of this study is to value if a program of supervised physical exercise can favor the recovery of the pre-gestacional weight, avoid the losses of urine and improve the psychological condition of the woman. This investigation project was developed by means of a collaboration between the Fuenlabrada Hospital and the Faculty of Physical Activity and the Sports Sciences (FCCAFD-INEF) UPM. An experimental work, randomized type, not controlled and not masked was designed. Two groups of women were selected, the intervention group and control group without absolute contraindications and medical consent for physical activity, they were in the first 3 months of the postpartum period. The intervention group conducted an exercise program of 12 weeks duration with a frequency of three times per week and a duration of one hour per session. The variables measured were: pregestational weight regain (weight, body mass index), postnatal depression, incidence of social problems caused by the loss of urine and perception of health status. The results show an apparent positive association between physical exercise program and the perception of health (15.69vs 10.08, p = 0.03). Other variables did not show significant difference between the study groups (AU)

Association of smoking with wound complications after cesarean delivery.

OBJECTIVE: To determine whether smoking is an independent risk factor for wound dehiscence after cesarean delivery. METHODS: In this case-control study, medical records were reviewed for all patients with wound dehiscence after cesarean delivery during a 7-month period. Wound dehiscence was defined as separation of wound edges requiring treatment. Three control patients without such complications were randomly selected for each case patient. Univariate associations were assessed using t test or Fisher's exact test; univariate odds ratios (OR) and 95% confidence intervals (CI) were calculated with logistic regression. Multivariate associations were assessed with logistic regression on variables with a univariate association significant at p ≤ 0.10. RESULTS: Of 597 cesarean deliveries, 30 cases (5 %) with wound dehiscence were identified. As individual variables, smoking (46.7 vs. 21.1%, p < 0.01, cases vs. controls), histological chorioamnionitis (27.6 vs. 6.7%, p < 0.01) and preoperative hematocrit (34.0 ± 3.2 vs. 35.4 ± 3.4, p < 0.05) were significantly associated with wound complications. In a multivariate logistic regression model, only smoking (OR 5.32; 95% CI 1.77-15.97, p < 0.01) and histological chorioamnionitis (OR 5.62; 95% CI 1.43-22.11, p < 0.01) were independently associated with wound dehiscence. CONCLUSIONS: Smoking and histological chorioamnionitis are independently associated with wound dehiscence after cesarean delivery.

Impaired lactation performance following elective delivery at term: role of maternal levels of cortisol and prolactin.

OBJECTIVE: Lactation performance depends on stress surrounding labor and delivery, and it is likely to be different in women who underwent elective cesarean delivery (ECD) or vaginal (VD). The aim of this study was to assess the relationship between cortisol and human prolactin (hPRL), following ECD and lactation performance, from the delivery room to the 6th month of life. METHODS: A total of 106 mothers were consecutively enrolled: 38 after ECD, 28 after emergency cesarean delivery (EmCD), and 40 after VD. RESULTS: Basal stress-, lactogenic-hormones, cortisol, and hPRL were comparable on day 3 postpartum in all the women. Multivariate analysis indicated that ECD has a negative impact (OR; 95% CI) on breastfeeding prevalence on the seventh day (0.14; 0.0-0.44, p=0.008) and at third month post partum (0.19; 0.05-0.71, p=0.05) in comparison to VD. In addition, hPRL levels proved to have a statistically significant role in early breastfeeding (1.01; 1-1.01, p=0.002). CONCLUSIONS: ECD is a risk factor for successful lactation performance. This information should be provided to mothers and caregivers for extra breastfeeding guidance.

The effect of postnatal breastfeeding education/support offered at home 3 days after delivery on breastfeeding duration and knowledge: a randomized trial.

OBJECTIVE: The aim of this study was to determine the effects of breastfeeding education/support offered at home on day 3 postpartum on breastfeeding duration and knowledge. METHODS: The study included a total of 60 women who gave birth at Zübeyde Hanim Maternity Hospital located in Aydin, Turkey. In addition to a standard breastfeeding education in the first few hours after delivery, which was provided to all women in this "baby-friendly initiative" (BFI) hospital, the mothers in the intervention group received breastfeeding education at home on day 3 postpartum from supporters. RESULTS: Both groups were comparable in terms of maternal and neonatal characteristics. The breastfeeding education/support offered during a home visit on day 3 postpartum was associated with a significant increase in the percentage of exclusively breastfed infants both at 2 weeks and 6 weeks, and at 6 months, and was also associated with a significant increase in exclusive breastfeeding and in total breastfeeding duration. In addition, increased breastfeeding knowledge scores were observed in the intervention group at 2 weeks and at 6 weeks after delivery, when compared with the respective scores in the control group. CONCLUSION: Breastfeeding education offered at home on day 3 postpartum was effective in increasing the breastfeeding duration and breastfeeding knowledge.

Effect of epidural analgesia on labor and delivery: a retrospective study.

Two groups of women have been retrospectively compared: 155 women who received analgesia and 1355 women who delivered without analgesia. The duration of the first stage, second stage, and total duration of labor was longer in epidural group, however epidural analgesia was not demonstrated as an independent risk factor for a prolonged labor. The variable most influencing the total duration of labor and the duration of the first stage was nulliparity; the variables most influencing the duration of the second stage were the older age, a reduced body mass index, a high newborn weight and nulliparity.

Perinatal urinary and fecal incontinence: suffering in silence.

This article focuses on the prevention, identification, and management of urinary and fecal incontinence in the perinatal period. Both urinary and fecal incontinence are common concerns affecting women throughout pregnancy, intrapartum, and postpartum. These are the problems that are not approached by healthcare providers during the initial antepartal assessment, nor are they fully investigated after delivery. Many women hesitate to disclose this information. Women tend to consider this to be a minor discomfort of pregnancy and a consequence resulting from childbirth in the postpartum period. Intervention strategies and nursing care components in the perinatal period will be presented.

Late preterm: obstetric management.

Late preterm is the recommended definition for infants born at 34 0/7 to 36 6/7 weeks' gestation after the onset of the mother's last menstrual period. Late-preterm infants are known to have greater mortality and morbidity when compared with term infants during the neonatal period. Obstetric management plays a substantial role in influencing neonatal outcomes. We conducted a retrospective study on late-preterm births based on data collected by regional certificates of birth attendance, comparing overall data with those relative to our Department, the aim of our study was to evaluate if obstetric management, related to different delivery settings, could influence the prevalence and the method of delivery in late preterm gestational age. Preterm births represent about 10% of 25,011 births in Sardinia, and 72.6% of them are late preterm. Elective cesarean section results significantly higher in late preterm than in term deliveries. In our Department, both late-preterm delivery rate and elective cesarean sections rate were lower if compared with country region data. Obstetric management strategies play an important role in delaying deliveries and reducing late-preterm birth rates.