RESUMO
This is a qualitative study that explores the perspectives and experiences of a group of Mexican women who experienced institutionalized childbirth care in the first and second waves of the COVID-19 pandemic. Through a semi-structured script, nine women who experienced childbirth care were interviewed between March and October 2020 in public and private hospitals in the city of San Luis Potosí, Mexico. Under the Grounded Theory analysis proposal, it was identified that the health strategies implemented during the pandemic brought with them a setback in the guarantee of humanized childbirth. Women described themselves as distrustful of the protocols that personnel followed to attend to their births in public sector hospitals and very confident in those implemented in the private sector. The intervention of cesarean sections without a clear justification emerged as a constant, as did early dyad separation. Healthcare personnel's and institutions' willingness and conviction to guarantee, protect and defend the right of women to experience childbirth free of violence remain fragile. Resistance persists to rethink childbirth care from a non-biomedicalizing paradigm.
Estudio de tipo cualitativo que explora las perspectivas y experiencias de un grupo de mujeres mexicanas que vivieron la atención institucionalizada del parto en la primera y segunda ola de la pandemia por COVID-19. A través de un guión semiestructurado se entrevistó a nueve mujeres que vivieron la experiencia de la atención del parto entre marzo y octubre de 2020, en hospitales públicos y privados de la ciudad de San Luis Potosí, en México. Bajo la propuesta de análisis de la teoría fundamentada, se identificó que las estrategias sanitarias implementadas en el marco de la pandemia, trajeron consigo un retroceso en la garantía del parto humanizado, las mujeres se narraron desconfiadas en los protocolos que siguió el personal para la atención de sus partos en los hospitales del sector público y muy confiadas en los que se implementaron en el sector privado. La realización de cesáreas sin una justificación clara emergió como una constante, igual que la separación temprana de los binomios. Continúa frágil la disposición y el convencimiento del personal sanitario y las instituciones para garantizar, proteger y defender el derecho de las mujeres a vivir el parto libre de violencia. Persisten resistencias para repensar la atención del parto desde un paradigma no biomédicalizante.
Assuntos
COVID-19 , Hospitais Públicos , Pesquisa Qualitativa , Humanos , México , Feminino , COVID-19/epidemiologia , Gravidez , Adulto , Parto Obstétrico , Hospitais Privados , Entrevistas como Assunto , Cesárea/estatística & dados numéricos , Parto/psicologia , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/organização & administração , Teoria Fundamentada , Adulto JovemRESUMO
OBJECTIVE: This study aimed to analyze the relationship between the participation of professionals in simulation-based training and an increase in the rate of vaginal deliveries. METHODS: This retrospective observational study analyzed professionals' participation in high-fidelity simulation training during the pilot phase of the Appropriate Delivery Project, spanning from May 21, 2015 to May 21, 2016, along with the rates of vaginal deliveries across various hospitals. Data for participation by nurses and physicians were examined using a gamma distribution model to discern the predictors influencing the changes in the percentage of vaginal births. RESULTS: Data from 27 hospitals involved in the project were analyzed. A total of 339 healthcare professionals, including 147 nurses and 192 doctors, underwent the simulation-based training. During the pilot test, the percentage of vaginal births increased from 27.8% to 36.1%, which further increased to 39.8% in the post-intervention period, particularly when the participation rate of nurses exceeded the median. CONCLUSION: This study suggests that simulation-based training is a valuable strategy for achieving positive changes in obstetric practice, specifically an increase in the rate of vaginal births. These findings underscore the potential advantages of incorporating simulation training into improvement initiatives, as evidenced by the correlation between higher training adoption rates and substantial and sustained enhancements in vaginal birth rates.
Assuntos
Parto Obstétrico , Treinamento por Simulação , Humanos , Feminino , Brasil , Treinamento por Simulação/métodos , Treinamento por Simulação/estatística & dados numéricos , Estudos Retrospectivos , Gravidez , Parto Obstétrico/educação , Parto Obstétrico/estatística & dados numéricos , Parto Obstétrico/métodos , Competência Clínica/estatística & dados numéricos , Projetos Piloto , Hospitais/estatística & dados numéricos , Adulto , Obstetrícia/educação , Obstetrícia/estatística & dados numéricosRESUMO
AIM: To develop evidence-based clinical algorithms for the assessment and management of spontaneous, uncomplicated labour and vaginal birth. POPULATION: Pregnant women at any stage of labour, with singleton, term pregnancies considered to be at low risk of developing complications. SETTING: Health facilities in low- and middle-income countries. SEARCH STRATEGY: We searched for relevant published algorithms, guidelines, systematic reviews and primary research studies on Cochrane Library, PubMed, and Google on terms related to spontaneous, uncomplicated labour and childbirth up to 01 June 2023. CASE SCENARIOS: Three case scenarios were developed to cover assessments and management for spontaneous, uncomplicated first, second and third stage of labour. The algorithms provide pathways for definition, assessments, diagnosis, and links to other algorithms in this series for management of complications. CONCLUSIONS: We have developed three clinical algorithms to support evidence-based decision making during spontaneous, uncomplicated labour and vaginal birth. These algorithms may help guide health care staff to institute respectful care, appropriate interventions where needed, and potentially reduce the unnecessary use of interventions during labour and childbirth.
Assuntos
Algoritmos , Trabalho de Parto , Humanos , Feminino , Gravidez , Parto Obstétrico/métodos , Parto , Complicações do Trabalho de Parto/terapia , Complicações do Trabalho de Parto/diagnósticoRESUMO
OBJECTIVES: To evaluate the association between perinatal and obstetric factors as potential triggers for the early onset of T1DM. METHODS: This was a retrospective cohort study enrolling 409 patients diagnosed with T1DM, in Bauru, São Paulo, Brazil, from 1981 to 2023. Data were retrieved from medical records, regarding sociodemographic parameters as age, sex, ethnicity, and socioeconomic status. Perinatal and obstetric factors as delivery type, gestational age, filiation order, length of exclusive breastfeeding, maternal age, maternal and fetal blood types, and occurrence of maternal gestational diabetes were also analyzed. An adapted survival analysis was employed to gauge the impact of each assessed variable at the age of T1DM diagnosis. RESULTS: The median age of T1DM diagnosis was 10.3 years with an interquartile range between 6.4 and 15.5 years. Delivery type and filiation order were the only factors statistically significantly associated with an early age at T1DM diagnosis. Patients who were born through cesarean section and who were firstborns showed a 28.6 and 18.0â¯% lower age at T1DM diagnosis, respectively, compared to those born through vaginal delivery and those that were nonfirstborns. CONCLUSIONS: Being born by cesarean section and being firstborn showed to be statistically significant factors to determine an early T1DM diagnosis.
Assuntos
Diabetes Mellitus Tipo 1 , Humanos , Feminino , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/diagnóstico , Estudos Retrospectivos , Masculino , Adolescente , Gravidez , Criança , Brasil/epidemiologia , Fatores de Risco , Idade de Início , Cesárea/estatística & dados numéricos , Idade Materna , Seguimentos , Parto Obstétrico/estatística & dados numéricos , Pré-Escolar , Prognóstico , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Recém-Nascido , Adulto , Idade Gestacional , Lactente , Estudos de CoortesRESUMO
Objective: Evaluate the prevalence of macrosomic newborns (birth weight above 4000 grams) in a high-risk maternity from 2014 to 2019, as well as the maternal characteristics involved, risk factors, mode of delivery and associated outcomes, comparing newborns weighing 4000-4500 grams and those weighing above 4500 grams. Methods: This is an observational study, case-control type, carried out by searching for data in hospital's own system and clinical records. The criteria for inclusion in the study were all patients monitored at the service who had newborns with birth weight equal than or greater than 4000 grams in the period from January 2014 to December 2019, being subsequently divided into two subgroups (newborns with 4000 to 4500 grams and newborns above 4500 grams). After being collected, the variables were transcribed into a database, arranged in frequency tables. For treatment and statistical analysis of the data, Excel and R software were used. This tool was used to create graphs and tables that helped in the interpretation of the results. The statistical analysis of the variables collected included both simple descriptive analyzes as well as inferential statistics, with univariate, bivariate and multivariate analysis. Results: From 2014 to 2019, 3.3% of deliveries were macrosomic newborns. The average gestational age in the birth was 39.4 weeks. The most common mode of delivery (65%) was cesarean section. Diabetes mellitus was present in 30% of the deliveries studied and glycemic control was absent in most patients. Among the vaginal deliveries, only 6% were instrumented and there was shoulder dystocia in 21% of the cases. The majority (62%) of newborns had some complication, with jaundice (35%) being the most common. Conclusion: Birth weight above 4000 grams had a statistically significant impact on the occurrence of neonatal complications, such as hypoglycemia, respiratory distress and 5th minute APGAR less than 7, especially if birth weight was above 4500 grams. Gestational age was also shown to be statistically significant associated with neonatal complications, the lower, the greater the risk. Thus, macrosomia is strongly linked to complications, especially neonatal complications.
Assuntos
Macrossomia Fetal , Humanos , Feminino , Recém-Nascido , Gravidez , Estudos de Casos e Controles , Prevalência , Macrossomia Fetal/epidemiologia , Adulto , Fatores de Risco , Brasil/epidemiologia , Gravidez de Alto Risco , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Masculino , Adulto Jovem , Complicações na Gravidez/epidemiologia , Parto Obstétrico/estatística & dados numéricosRESUMO
Las fracturas con hundimiento de cráneo sin una explicación clara sobre su origen orientan al traumatismo con un objeto romo y a la sospecha de maltrato infantil. En el caso de los bebés recién nacidos, su corta edad es un factor de vulnerabilidad y obliga a una exhaustiva evaluación. Ante la sospecha de maltrato infantil, resulta importante evaluar los diagnósticos diferenciales para realizar la intervención más adecuada posible. Es necesario evitar tanto intervenciones excesivas como omitir la intervención que sea necesaria. Las fracturas craneales deprimidas congénitas, descritas como "fracturas pingpong", son raras (0,3 a 2/10 000 partos). Pueden aparecer sin antecedentes traumáticos o en partos instrumentalizados. Se describe en este artículo el caso de un recién nacido con una fractura ping-pong como ejemplo de una fractura no intencional.
Depressed skull fractures without a clear explanation as to their origin point to trauma with a blunt object and suspected child abuse. In the case of newborn infants, their young age is a vulnerability factor and requires an exhaustive assessment. When child abuse is suspected, an assessment of the differential diagnoses is required to make the most appropriate intervention possible. Both an excessive intervention and an omission of a necessary intervention should be avoided. Congenital depressed skull fractures, described as "ping-pong fractures", are rare (0.3 to 2/10 000 births). They may appear without any trauma history or in instrumentalized childbirth. Here we describe the case of a newborn infant with a ping-pong fracture as an example of an accidental fracture.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Maus-Tratos Infantis/diagnóstico , Fratura do Crânio com Afundamento/congênito , Fratura do Crânio com Afundamento/diagnóstico , Parto Obstétrico , Diagnóstico Diferencial , Abuso FísicoRESUMO
This paper studies the patterns and consequences of birth timing manipulation around the carnival holiday in Brazil. We document how births are displaced around carnival and estimate the effect of displacement on birth indicators. We show that there is extensive birth timing manipulation in the form of both anticipation and postponement that results in a net increase in gestational length and reductions in neonatal and early neonatal mortality, driven by postponed births that would otherwise happen through scheduled c-sections. We also find a reduction in birthweight for high-risk births at the bottom of the weight distribution, driven by anticipation. Therefore, restrictions on usual delivery procedures due to the carnival holiday can be both beneficial and detrimental, raising a double-sided issue to be addressed by policymakers.
Assuntos
Peso ao Nascer , Mortalidade Infantil , Humanos , Brasil , Feminino , Recém-Nascido , Gravidez , Idade Gestacional , Intervalo entre Nascimentos , Parto Obstétrico , Cesárea/estatística & dados numéricos , LactenteRESUMO
This article analyzes the speeches of leading doctors in the creation of the specialty in childbirth care: gynecotology. Between 1920 and 1940, under the influence of eugenic and maternalist thinking, in a context of valuing the well-being of children, medicine built a new obstetric interventionism under the foundation of improving fetal viability. The supposed female "maternal instinct" was, thus, appealed to improve acceptance of the medical mandate. At the same time, doctors recognized their difficulties in providing adequate care. They did not wait long enough and tended to intervene in unnecessary physiological processes.
En este artículo se analizan discursos de médicos de referencia en la creación de la especialidad en la atención del parto: la ginecotocología. Entre 1920 y 1940, bajo la influencia del pensamiento eugenésico y maternalista, en un contexto de valorización del bienestar de la infancia, la medicina construyó un nuevo intervencionismo obstétrico bajo el fundamento de mejorar la viabilidad fetal. En ese marco se apeló al supuesto "instinto maternal" femenino para mejorar la aceptación del mandato médico. A la vez, los médicos reconocieron sus dificultades para asistir de forma adecuada. No esperaban el tiempo suficiente y tendían a intervenir más de lo necesario en procesos fisiológicos que no lo requerían.
Assuntos
Obstetrícia , História do Século XX , Humanos , Feminino , Uruguai , Gravidez , Obstetrícia/história , Eugenia (Ciência)/história , Parto , Parto Obstétrico/históriaRESUMO
The article aims to verify the influence of MNFs on the duration of the birth process. A systematic review was carried out in the MEDLINE, Web of Science and LILACS databases, through a combination of terms that cover the topic addressed, from 1996 to 2021/April. The Excel spreadsheet was used to collect data to extract information regarding each selected article, in turn, data analysis included the evaluation and classification of quality, reliability and risk of bias, thus, the following tools were used: Cochrane RoB 2, Checklist and Newcastle-Ottawa Scale. Warm bath, walking, exercises with a birthing ball, breathing techniques, supine position, acupuncture, acupressure and water birth reduced labor time. While spontaneous pushing, massage and immersion baths prolonged labor. Non-pharmacological methods capable of reducing the duration of labor were hot/warm shower, walking, birth ball exercises, breathing techniques, maternal mobility, dorsal position, acupuncture, acupressure and water birth, as well. associated applied techniques such as hot/warm bath, ball exercises and lumbosacral massage, as well as immersion bath, ball exercises, aromatherapy, vertical postures and maternal mobility with alternating vertical postures, shortened the birth time.
Assuntos
Trabalho de Parto , Humanos , Fatores de Tempo , Feminino , Gravidez , Trabalho de Parto/fisiologia , Parto Obstétrico/métodos , Reprodutibilidade dos Testes , PartoRESUMO
Worldwide, there is an alert due to the increase in the seroprevalence of hepatitis B virus (HBV). This can cause up to 3.5% of chronic diseases, of which 40% present secondary complications and/ or early death. OBJECTIVE: To determine the seroprevalence of HBV in pregnant women at the time of delivery. PATIENTS AND METHOD: Observational, descriptive, cross-sectional study with cross-association between 2018 and 2019 at the Hospital Carlos Van Buren (HCVB), in Valparaiso, Chile. All pregnant women admitted for delivery care or with an immediate newborn who had HBV surface antigen study were included. Data were collected from the pregnant woman (age, nationality, education level, parity, type of delivery, and peripartum HIV-syphilis serology) and the newborn (gestational age, weight, and APGAR score). Inferential and multivariate analysis was performed using the Stata software. RESULTS: 1,355 pregnant women were analyzed. 87.7% were Chilean, 5.5% Haitian, 4.2% Venezuelan, and 2.6% were of other nationalities. 0.3% were positive for HBV. The prevalence of HBV in Chileans was 0.08% and in Haitians 4%. Haitian nationality was at higher risk of HBV (OR = 83) vs. Chilean nationality (p = 0.0001). None presented coinfection with HIV and/or syphilis. CONCLUSIONS: HBV seroprevalence in HCVB pregnant women was 0.3%, similar to that described in the general population in Chile. There was no coinfection with other sexually transmitted diseases. The only predictor of HBV infection was Haitian nationality.