Assuntos
Apresentação Pélvica , Humanos , Gravidez , Feminino , Apresentação Pélvica/terapia , Parto Obstétrico , BrasilRESUMO
In this paper, we assess the effects of a national policy implemented in Brazil to avoid unnecessary cesareans. The policy has a supply-side component that prohibits elective c-sections before the 39th gestational week and a demand-side awareness component. Since the policy is not binding for cases with a strong medical c-section indication, we use births of breech- and transverse-positioned babies as a counterfactual for births of cephalic-positioned babies in a difference-in-differences framework. Our results reveal that the policy decreases the rate of c-sections by 1.6 percentage point, and slightly increases gestational time, birthweight, and first-minute APGAR scores. There is evidence that policy effectiveness is driven by its demand-side component.
Assuntos
Apresentação Pélvica , Gravidez , Feminino , Humanos , Brasil , Cesárea , Peso ao NascerRESUMO
This report describes the case of a pregnant woman who arrived for preanesthetic assessment of External Cephalic Version (ECV) for fetus in breech presentation and cesarean section in case of ECV failure. Although the technique seems simple, attempts to rotate the fetus can result in elevated intracranial pressure, which might cause malformation bleeding. The most appropriate anesthetic technique in cases of arteriovenous malformations during C-sections has not been determined. Neuroaxial anesthesia is safe only in stable brain cavernomas, but the presence of spinal malformations contraindicates it. Anesthetic goals include stabilizing the blood pressure and reducing the risk of rupture.
Assuntos
Anestesia , Anestésicos , Apresentação Pélvica , Versão Fetal , Cesárea , Feminino , Humanos , Gravidez , Versão Fetal/métodosAssuntos
Apresentação Pélvica , Versão Fetal , Apresentação Pélvica/terapia , Cesárea , Parto Obstétrico , Feminino , Humanos , GravidezRESUMO
OBJECTIVE: To determine whether there was any difference in neonatal and maternal outcomes between breech vaginal delivery and cephalic vaginal delivery. METHODS: A retrospective, case-control study was conducted between January 2015 and December 2017 in a Portuguese hospital. A total of 26 cases of breech vaginal delivery were considered eligible and 52 pregnant women formed the control group. RESULTS: Induced labor was more frequent in the breech vaginal delivery group (46% versus 21%, p = 0.022). Episiotomy was more common in the breech vaginal delivery group (80% versus 52%, p = 0.014), and one woman had a 3rd degree perineal laceration. Newborns in the study group had a lower birthweight (2,805 g versus 3,177 g, p < 0.001). There was no significant difference in the neonatal outcomes. CONCLUSION: The present study showed that breech vaginal delivery at term compared with cephalic presentation was not associated with significant differences in neonatal and maternal morbidity. It also suggests that breech vaginal delivery remains a safe option under strict selection criteria and in the presence of an experienced obstetrician.
OBJETIVO: Avaliar se existem diferenças nos desfechos perinatal e materno entre os partos pélvicos vaginais e eutócicos. MéTODOS: Realizou-se um estudo retrospectivo, caso controle, entre janeiro de 2015 e dezembro de 2017 em um hospital terciário em Portugal. Foram incluídos 26 casos de parto pélvico vaginal e o grupo controle foi formado por 52 grávidas. RESULTADOS: A indução do trabalho de parto ocorreu com mais frequência no grupo do parto pélvico vaginal (46% versus 21%, p = 0.022), bem como a realização de episiotomia (80% versus 52%, p = 0.014). Verificou-se um caso de laceração perineal de 3° grau. Os recém-nascidos do grupo de estudo apresentaram um peso inferior ao nascimento (2.805 g versus 3.177 g, p < 0.001). Em relação aos desfechos perinatais, não se observaram diferenças estatisticamente significativas. CONCLUSãO: O presente estudo mostrou que o parto pélvico vaginal no termo quando comparado com o parto eutócico não se associou a diferenças estatisticamente significativas na morbidade perinatal e materna, e sugere ainda que o parto pélvico vaginal parece ser uma opção segura em casos rigorosamente selecionados e na presença de um obstetra experiente.
Assuntos
Apresentação Pélvica , Parto Obstétrico , Cuidado Pré-Natal , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Portugal , Gravidez , Resultado da Gravidez , Estudos RetrospectivosRESUMO
Abstract Objective: To determine whether there was any difference in neonatal and maternal outcomes between breech vaginal delivery and cephalic vaginal delivery. Methods: A retrospective, case-control study was conducted between January 2015 and December 2017 in a Portuguese hospital. A total of 26 cases of breech vaginal delivery were considered eligible and 52 pregnant women formed the control group. Results: Induced labor was more frequent in the breech vaginal delivery group (46% versus 21%, p = 0.022). Episiotomy was more common in the breech vaginal delivery group (80% versus 52%, p = 0.014), and one woman had a 3rd degree perineal laceration. Newborns in the study group had a lower birthweight (2,805 g versus 3,177 g, p < 0.001). There was no significant difference in the neonatal outcomes. Conclusion: The present study showed that breech vaginal delivery at term compared with cephalic presentation was not associated with significant differences in neonatal and maternal morbidity. It also suggests that breech vaginal delivery remains a safe option under strict selection criteria and in the presence of an experienced obstetrician.
Resumo Objetivo: Avaliar se existem diferenças nos desfechos perinatal e materno entre os partos pélvicos vaginais e eutócicos. Métodos: Realizou-se um estudo retrospectivo, caso controle, entre janeiro de 2015 e dezembro de 2017 em um hospital terciário em Portugal. Foram incluídos 26 casos de parto pélvico vaginal e o grupo controle foi formado por 52 grávidas. Resultados: A indução do trabalho de parto ocorreu com mais frequência no grupo do parto pélvico vaginal (46% versus 21%, p = 0.022), bem como a realização de episiotomia (80% versus 52%, p = 0.014). Verificou-se um caso de laceração perineal de 3° grau. Os recém-nascidos do grupo de estudo apresentaram um peso inferior ao nascimento (2.805 g versus 3.177 g, p < 0.001). Em relação aos desfechos perinatais, não se observaram diferenças estatisticamente significativas. Conclusão: O presente estudo mostrou que o parto pélvico vaginal no termo quando comparado com o parto eutócico não se associou a diferenças estatisticamente significativas na morbidade perinatal e materna, e sugere ainda que o parto pélvico vaginal parece ser uma opção segura em casos rigorosamente selecionados e na presença de um obstetra experiente.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Cuidado Pré-Natal , Apresentação Pélvica , Parto Obstétrico , Portugal , Resultado da Gravidez , Estudos de Casos e Controles , Estudos RetrospectivosRESUMO
Background: Point-of-care ultrasound (POCUS) implemented through task shifting to nontraditional users has potential as a diagnostic adjuvant to enhance acute obstetrical care in resource-constrained environments with limited access to physician providers. Objective: This study evaluated acute obstetrical needs and the potential role for POCUS programming in the North East region of Haiti. Methods: Data was collected on all women presenting to the obstetrical departments of two Ministry of Public Health and Population (MSPP)-affiliated public hospitals in the North East region of Haiti: Fort Liberté Hospital and Centre Medicosocial de Ouanaminthe. Data was obtained via retrospective review of hospital records from January 1 through March 31, 2016. Trained personnel gathered data on demographics, obstetrical history, diagnoses, clinical care and outcomes using a standardized tool. Diagnoses a priori, defined as those diagnoses whose detection could be assisted with POCUS, included multi-gestations, non-vertex presentation, cephalopelvic disproportion, placental abruption, placenta previa, spontaneous abortions, retained products and ectopic pregnancy. Results: Data were collected from 589 patients during the study period. Median maternal age was 26 years and median gestational age was 38 weeks. The most common reason for seeking care was pelvic pain (85.2%). Sixty-seven (11.5%) women were transferred to other facilities for higher-level care. Among cases not transferred, post-partum hemorrhage, infant mortality and maternal mortality occurred in 2.4%, 3.0% and 0.6% of cases, respectively. There were 69 cases with diagnoses that could have benefited from POCUS use. Between sites, significantly more cases had the potential for improved diagnostics with POCUS at Fort Liberté Hospital (19.8%) than Centre Medicosocial de Ouanaminthe (8.2%) (p < 0.001). Conclusion: Acute obstetrical care is common and POCUS has the potential to impact the care of obstetrical patients in the North East region of Haiti. Future programs evaluating the feasibility of task shifting and the sustainable impacts of acute obstetric POCUS in Haiti will be important.
Assuntos
Aborto Espontâneo/diagnóstico por imagem , Complicações do Trabalho de Parto/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Gravidez Ectópica/diagnóstico por imagem , Ultrassonografia Pré-Natal , Descolamento Prematuro da Placenta/diagnóstico por imagem , Doença Aguda , Adulto , Apresentação Pélvica/diagnóstico por imagem , Desproporção Cefalopélvica/diagnóstico por imagem , Cesárea , Estudos Transversais , Parto Obstétrico , Feminino , Haiti , Humanos , Apresentação no Trabalho de Parto , Mortalidade Materna , Obstetrícia , Transferência de Pacientes , Mortalidade Perinatal , Placenta Prévia/diagnóstico por imagem , Testes Imediatos , Hemorragia Pós-Parto , Gravidez , Gravidez Múltipla , Adulto JovemRESUMO
RESUMEN Objetivo: revisar los conceptos que subyacen al trabajo de parto con feto en presentación pelviana, su semiología y las maniobras obstétricas que facilitan un resultado materno perinatal exitoso. Materiales y métodos: a partir de un caso hipotético que ambienta de manera práctica el tema, se crea un documento explicativo construido a partir de una revisión narrativa, en donde se examinan los preceptos relacionados con el diagnóstico, el mecanismo del parto en presentación pelviana y el manejo intraparto de la gestante, con énfasis en la adecuada ejecución de las maniobras que facilitan la extracción fetal. Resultados: el parto en presentación pelviana debe ser atendido por vía vaginal cuando se encuentra en periodo expulsivo con encajamiento cumplido. Para su diagnóstico y atención es esencial hacer una adecuada identificación de la presentación, así como conocer su fisiología, la indicación y adecuada ejecución de las maniobras obstétricas que facilitan un parto sin complicaciones. Conclusiones: el mecanismo del parto en presentación pelviana es complejo y requiere, cuando no hay otra alternativa para la atención, que tanto el obstetra como el médico general conozcan su fisiología y las múltiples maniobras obstétricas que facilitan obtener buen resultado materno perinatal.
ABSTRACT Objective: To review the concepts underlying breech presentation delivery as well as the semiology and the obstetric maneuvers contributing to a successful perinatal maternal outcome. Materials and methods: Based on a hypothetical scenario to set the stage for a practical approach to the topic, an explanatory paper built on a narrative review is created in order to examine the principles related to diagnosis, mechanism of delivery and maternal care, emphasizing maneuvers to ease fetal extraction. Results: Breech presentation delivery must be managed through the vaginal canal when already in the expulsion phase with fetal engagement. For diagnosis and care, it is essential to know the unique semiology and physiology of this condition as well as the obstetric maneuvers to facilitate an uncomplicated delivery. Conclusions: The mechanism of childbirth in breech presentation is complex and requires knowledge of its physiology and multiple obstetric maneuvers on the part of the obstetrician as well as the general practitioner, in order to ensure adequate care when there is no other option.
Assuntos
Humanos , Gravidez , Recém-Nascido , Complicações do Trabalho de Parto , Apresentação Pélvica , Distocia , Educação Médica ContinuadaRESUMO
O objetivo deste estudo foi descrever e analisar as representações sociais de profissionais de saúde sobre a assistência ao parto e violências em um hospital universitário do sul do Brasil. Como método foi utilizada a observação participante no interior de um centro obstétrico e entrevistas com profissionais de saúde de um hospital universitário. Adotou-se o referencial socioantropológico das Representações Sociais para a interpretação dos dados. Os resultados mostram que as práticas na atenção ao parto ainda são predominantemente pautadas no modelo de atendimento tecnocrático e no descumprimento dos protocolos estabelecidos no âmbito do Sistema Único de Saúde. Observou-se também que a comunicação conflituosa entre as equipes é uma fonte de tensões que se reflete nas práticas obstétricas. Concluiu -se que é indispensável que ocorram mudanças na formação de profissionais de saúde, com foco nas boas práticas do parto e nascimento, com vistas a implantação do modelo de atenção humanista. (AU)
The aim of this study was to describe and analyze the social representations of health professionals about childbirth care and violence in a university hospital in southern Brazil. The method used was participant observation in an obstetric center, and interviews with health professionals from a university hospital. The socio-anthropological framework of Social Representations was adopted for data interpretation. The results show that childbirth care practices are still predominantly based on the technocratic care model and on non-compliance with the protocols established within the Unified Health System. It was also observed that the conflicting communication between the teams is a source of tensions that are reflected on obstetric practices. It was concluded that changes in the training of health professionals are indispensable, focusing on the good practices of childbirth, with a view to the implementation of the humanistic care model. (AU)
Assuntos
Humanos , Feminino , Gravidez , Apresentação Pélvica , Conflito de Interesses , Pessoal de Saúde , Parto , Violência contra a Mulher , Hospitais Universitários , Antropologia Cultural , ObstetríciaRESUMO
OBJECTIVE: To classify cesarean sections according to the Robson Model in the obstetrics unit of an intermediate complexity hospital. METHODS: Descriptive cross-sectional study conducted in the obstetrics unit of the San Felipe General Hospital (HGSF), Tegucigalpa, Honduras, between April and June 2017. Out of 477 clinical records of patients undergoing elective and/ or emergency surgery during the study period, 89 were selected using probabilistic random selection. A descriptive analysis of sociodemographic variables, clinical/obstetric indications, and categories of the Robson model was conducted. Authorization from the institution was obtained. RESULTS: The proportion of cesarean sections during the study period was 59.8% (477/797; 95% CI:56.3-63.3). Of the cases studied, 48/89 (53.9%) were classified as "no risk pregnancy" (categories 1-4); the most frequent indications in this group were low fetal reserve in 22/48 (22/48*100%) and cephalopelvic disproportion in 16/48 (16/48*100%). In the "risk group" (categories 5-10), in 41/89 (46.1%), indications were cephalopelvic disproportion and breech presentation, (8/41) (8/41*100%), respectively. The main contributors to cesarean section were groups 1 (17/89; 19.1%), 2 (20/89, 22.5%) and 5 (20/89; 22.5%), for a total of 64.1%. CONCLUSIONS: The Robson model is applicable in our setting and the classification provides information that can be used as a diagnostic and surveillance tool for cesarean sections in a level II institution.
TITULO: CLASIFICACIÓN DE CESÁREAS SEGÚN EL MODELO DE ROBSON, UNIDAD OBSTÉTRICA, HOSPITAL GENERAL SAN FELIPE, HONDURAS, ABRIL-JUNIO DE 2017. OBJETIVO: Clasificar las cesáreas según el modelo de Robson en la unidad obstétrica de un hospital de nivel medio de complejidad. METODOS: Estudio descriptivo, transversal, llevado a cabo en unidad obstétrica del HGSF, Tegucigalpa, Honduras, entre abril y junio de 2017. Se seleccionan 89 de 477 historias clínicas de pacientes sometidas a cesárea electiva o de emergencia en el periodo del estudio mediante selección aleatoria probabilística. Se realiza análisis descriptivo de variables sociodemográficas, indicaciones clínicas/obstétricas y categorías del modelo de Robson. Se obtuvo autorización institucional. RESULTADOS: La proporción de cesáreas en el periodo fue 59,8 % (477/797; IC 95 %:56,3-63,3). Se clasificaron 48/89 (53,9%) cesáreas estudiadas como embarazo "sin riesgo" (categorías 1-4); la indicación más frecuente en este grupo fue baja reserva fetal 22/48 (22/48*100 %) y desproporción céfalo-pélvica 16/48 (16/48*100 %). En el grupo "de riesgo" (categorías 5-10) en 41/89 (46,1 %) las indicaciones fueron desproporción céfalo-pélvica y presentación pélvica (8/41) (8/41*100 %) respectivamente. Los principales aportantes de cesárea fueron los grupos 1 (17/89; 19,1 %), 2 (20/89, 22,5 %) y 5 (20/89; 22,5 %) para totalizar 64,1 %. CONCLUSIONES: El modelo de Robson es aplicable en nuestro medio y la clasificación aporta información como herramienta de diagnóstico y vigilancia en la realización de cesáreas en una institución de segundo nivel.