RESUMO
Since the 1970s, maternal corticosteroid therapy has been used successfully to induce labor. This allows for better monitoring of parturients and provision of first aid to neonates, improving neonatal viability, as this treatment induces maturation in a variety of fetal tissues, thereby reducing morbidity and mortality. Although the effects of corticosteroids are well known, few studies have investigated the influence of this therapy in Santa Inês sheep. This study aimed to evaluate the efficacy of dexamethasone at two doses (8 and 16 mg) to induce lambing in Santa Inês ewes at 145 days of gestation and assess its effects on neonatal vitality. For this study, 58 ewes raised in an extensive system were investigated. Pregnancy was confirmed after artificial insemination at a set time or after controlled mounting. Ewes were separated into three groups: an untreated control group (G1: 0 mg) and groups treated with two doses of dexamethasone (G2: 8 mg and G3: 16 mg). In total, 79 lambs were born. Their vitality was assessed based on their Apgar score, weight, temperature, and postnatal behavior. SAS v9.1.3 (SAS Institute, Cary, NC) was used to analyze data, considering a 5% significance level for all analyses. The births in the induced groups occurred 48.4 ± 22.1 h after induction, while the ewes that underwent non-induced labor gave birth 131.96 ± 41.9 h after placebo application (p < 0.05), confirming the efficacy of dexamethasone to induce and synchronize labor. The induced and non-induced neonates had similar Apgar scores, temperatures, weights, and postnatal behavioral parameters (p > 0.05). This study showed that inducing labor in Santa Inês ewes at 145 days of gestation with a full (16 mg) or half dose (8 mg) of dexamethasone is an effective technique and does not compromise neonate vitality.
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Objetivo: Conhecer as práticas exitosas e satisfação de parturientes quanto ao partejar e puerpério imediato. Método: Estudo bibliográfico, descritivo, tipo revisão integrativa. Pesquisaram-se artigos baseados em consultas de estudos científicos inseridos no Portal Periódicos Capes entre os anos de 2013 a 2018, analisados de forma descritiva e resultados apresentados em formas de figuras. Resultados: Totalizaram-se 1260 publicações referentes à temática e, após rigoroso refinamento da busca, foram elegíveis na íntegra, quando excluídos 1253 estudos por não responderem aos critérios de inclusão, sete artigos, determinando a amostra final para discussão com a literatura. Conclusão: Conclui-se que há evidências de que a satisfação com o atendimento recebido pelas mulheres em Centro de Parto Normal está diretamente relacionada ao acolhimento, satisfação no autocuidado, perspectiva em relação a ambiência onde encontram-se as parturientes, puérperas e acompanhantes, como ocorreu o processo do trabalho de parto, parto e puerpério imediato
Objective: To know the successful practices and parturients' satisfaction regarding childbirth and immediate puerperium period. Method: Bibliographic and descriptive study, typified as integrative review. We sought articles based on consultations of scientific studies inserted in the Capes Periodicals Portal from 2013 to 2018, analyzed descriptively, with their results displayed through figures. Results:A total of 1,260 publications related to the theme and, after accurate search refinement, seven articles were fully eligible, when 1,253 studies were excluded because did not meet the inclusion criteria, thereby providing the final sample for discussion with literature. Conclusion: We conclude that there is evidence that the satisfaction with the care received by women in the Normal Birth Center is directly related to the welcoming, satisfaction in self-care, perspective directed to the environment where the parturients, puerperal women and companions are hosted, as well as the way the labor, birth and immediate puerperium process occurred
Objetivo: Conocer prácticas exitosas y satisfacción de parturientas sobre el parto y puerperio inmediato. Método: Estudio descriptivo y bibliográfico, tipo revisión integradora. Se realizaron búsquedas en artículos basados en consultas de estudios científicos insertados en el Portal Periódicos Capes de 2013 a 2018, analizados descriptivamente, con resultados presentados en figuras. Resultados: Se totalizaron 1.260 publicaciones referentes al tema y, tras un riguroso refinamiento de búsqueda, se escogieron íntegramente siete artículos, cuando se excluyeron 1.253 estudios por no satisfacer los criterios de inclusión, determinando la muestra final para discusión con la literatura. Conclusión: Se concluye que existe evidencia de que la satisfacción con la atención recibida por las mujeres en el Centro de Parto Normal está directamente relacionada con la acogida, la satisfacción en la autoatención, la perspectiva dirigida al entorno donde se encuentran las parturientas, puérperas y acompañantes, así como la ocurrencia del proceso de parto, nacimiento y puerperio inmediato
Assuntos
Humanos , Feminino , Gravidez , Trabalho de Parto , Parto/psicologia , Gestantes/psicologia , Período Pós-Parto/psicologia , Satisfação Pessoal , AcolhimentoRESUMO
Abstract Background The heterogeneity in detection rates of Human immunodeficiency virus, (HIV), Human T lymphotropic virus (HTLV) and Hepatitis B and C infections among pregnant women and the continuous exposure to risk factors limits the adoption of preventive and control actions. Objective To evaluate the HIV, HTLV, Hepatitis B and C seroprevalence rates, and associated risk factors in parturient women in Salvador, Brazil. Methods This was a cross-sectional study in 2099 parturient women attended in two public maternity hospitals in Salvador, Brazil. One blood sample was drawn for serological screening and socio-demographic, obstetric and clinical data were collected. Results HIV seroprevalence rate was 1.5% (of which 0.6% were new cases); seroprevalence rates for HTLV, HBV, and HCV were 0.4%, 0.4%, and 0.1%, respectively. Univariate analysis showed a significant association between socio-demographic and behavioral factors with retroviral infections, while viral hepatitis was mainly associated with parenteral exposure. In a multivariate analysis, multiple sexual partners (OR 3.3; 95% CI: 1.1-9.2), history of sexual/domestic violence (OR 2.8; 95% CI: 1.1-6.9), syphilis co-infection (OR 2.6; 95% CI: 1.0-6.9), use of alcohol or drugs (OR 2.5; 95% CI: 1.2-5.5), and low schooling level (OR 2.3; 95% CI: 1.1-4.9) were independent risk factors for HIV infection. History of stillbirth and low birth weight infants was significantly associated with HTLV positive status, showing a negative impact on gestation. Conclusions The seroprevalence rates for HIV, HCV, HBV, and HTLV were similar to that found in previous studies in other Brazilian regions. The high individual, socioeconomic, and social vulnerability detected in seropositive parturient women indicates the need to improve coverage and effectiveveness of STDs control with prevention, detection and monitoring strategies, focusing in pregnant women exposed to high biopsychosocial risk.
Assuntos
Feminino , Humanos , Lactente , Gravidez , Infecções por HTLV-I/epidemiologia , Infecções por HIV/epidemiologia , Estudos Soroepidemiológicos , Hepatite C/epidemiologia , Hepatite B/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Fatores de Risco , HIVRESUMO
BACKGROUND: The heterogeneity in detection rates of Human immunodeficiency virus, (HIV), Human T lymphotropic virus (HTLV) and Hepatitis B and C infections among pregnant women and the continuous exposure to risk factors limits the adoption of preventive and control actions. OBJECTIVE: To evaluate the HIV, HTLV, Hepatitis B and C seroprevalence rates, and associated risk factors in parturient women in Salvador, Brazil. METHODS: This was a cross-sectional study in 2099 parturient women attended in two public maternity hospitals in Salvador, Brazil. One blood sample was drawn for serological screening and socio-demographic, obstetric and clinical data were collected. RESULTS: HIV seroprevalence rate was 1.5% (of which 0.6% were new cases); seroprevalence rates for HTLV, HBV, and HCV were 0.4%, 0.4%, and 0.1%, respectively. Univariate analysis showed a significant association between socio-demographic and behavioral factors with retroviral infections, while viral hepatitis was mainly associated with parenteral exposure. In a multivariate analysis, multiple sexual partners (OR 3.3; 95% CI: 1.1-9.2), history of sexual/domestic violence (OR 2.8; 95% CI: 1.1-6.9), syphilis co-infection (OR 2.6; 95% CI: 1.0-6.9), use of alcohol or drugs (OR 2.5; 95% CI: 1.2-5.5), and low schooling level (OR 2.3; 95% CI: 1.1-4.9) were independent risk factors for HIV infection. History of stillbirth and low birth weight infants was significantly associated with HTLV positive status, showing a negative impact on gestation. CONCLUSIONS: The seroprevalence rates for HIV, HCV, HBV, and HTLV were similar to that found in previous studies in other Brazilian regions. The high individual, socioeconomic, and social vulnerability detected in seropositive parturient women indicates the need to improve coverage and effectiveveness of STDs control with prevention, detection and monitoring strategies, focusing in pregnant women exposed to high biopsychosocial risk.
Assuntos
Infecções por HIV/epidemiologia , Infecções por HTLV-I/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Estudos Soroepidemiológicos , Brasil/epidemiologia , Estudos Transversais , Feminino , HIV , Humanos , Lactente , Gravidez , Fatores de RiscoRESUMO
The induction of labor aims to concentrate births to follow up better the parturient and the first care to the neonates. However, even if the labor induction technique with dexamethasone administration has been successfully described since the late 1970s, few studies report the technique of birth development and neonatal vitality in Santa Inês sheep. This study aimed to evaluate the efficiency of dexamethasone use in two doses (8 and 16mg) in labor induction of Santa Inês ewes at 145 days of gestation and to evaluate its effects on the birth characteristics. In this study, 58 ewes were used, raised in an extensive system in the experimental farms of UFBA, with confirmation pregnancy after fixed-time artificial insemination or controlled breeding. These female ewes were separated into three groups according to the dose of dexamethasone administered (G1 = 0mg, G2 = 8mg, and G3 = 16mg). From these births, 79 lambs were born. This study analyzed the period from induction of labor to birth, fetal presentation at birth, the weight of the placenta, and the period for placenta expulsion. The data were analyzed by the Statistical Analysis System (SAS v.9.1.3®, 2002), and the significance level considered for all analyzes was 5%. Births of induced groups occurred on average at 48.4±22.17 hours after induction, while the females with non-induced labor gave birth 131.96±41.9 hours on average after the placebo application (P<0.05), confirming the efficiency of both doses for induction of labor. The period from induction to birth did not differ (P>0.05) between the doses used. There were no differences in delivery about the fetal static relation, time to placental attachment, and weight. With this study, it can be concluded that the induction at 145 days of gestation with eight or 16mg of dexamethasone is a useful technique and does not alter the labor in Santa Inês sheep.(AU)
A indução do parto visa concentrar os nascimentos para melhor acompanhamento das parturientes e primeiros cuidados aos neonatos. Contudo, mesmo que a técnica de indução de parto, com administração de dexametasona, tenha sido descrita com sucesso desde o final da década de 70, existem estudos escassos que relatam a influência desta técnica sobre o parto em ovinos da raça Santa Inês. Dessa forma, o objetivo do estudo foi avaliar a eficácia da dexametasona em duas doses (8 e 16mg), para a indução do parto de ovelhas Santa Inês com 145 dias de gestação e avaliar os seus efeitos nas características de desencadeamento e finalização do parto. Para este estudo foram utilizadas 58 ovelhas, criadas em sistema extensivo nas fazendas experimentais da UFBA, com prenhez confirmada após inseminação artificial em tempo fixo ou monta controlada. Essas fêmeas foram separadas em três grupos, de acordo com a dose de dexametasona administrada (G1 = 0mg, G2 = 8mg e G3 = 16mg). Destes partos nasceram 79 cordeiros. Foram avaliados o período em horas da indução do parto aos nascimentos, a apresentação fetal ao nascimento, assim como o peso da placenta e o período para o delivramento. Os dados foram analisados pelo pacote estatístico Statistical Analysis System (SAS v.9.0®, 2002) sendo considerado para todas as análises o nível de significância de 5%. Os nascimentos dos grupos induzidos ocorreram em média com 48,4±22,1 horas após a indução, enquanto que as fêmeas com parto não induzido pariram em média 131,96±41,9 horas após aplicação do placebo (P<0,05), confirmando a eficácia de ambas as doses para indução do parto. O período da indução até o parto não diferiu (P>0,05) entre as doses utilizadas. Não ocorreram diferenças no parto em relação à estática fetal, tempo para o delivramento e peso da placenta nos diferentes grupos. Com este estudo, conclui-se que a indução de parto em ovelhas aos 145 dias de gestação com oito e 16 mg de dexametasona é uma técnica eficaz e que não altera o trabalho de parto nas ovelhas da raça Santa Inês.(AU)
Assuntos
Animais , Feminino , Gravidez , Dexametasona , Ovinos , Trabalho de Parto Induzido/métodos , Trabalho de Parto Induzido/veterináriaRESUMO
The induction of labor aims to concentrate births to follow up better the parturient and the first care to the neonates. However, even if the labor induction technique with dexamethasone administration has been successfully described since the late 1970s, few studies report the technique of birth development and neonatal vitality in Santa Inês sheep. This study aimed to evaluate the efficiency of dexamethasone use in two doses (8 and 16mg) in labor induction of Santa Inês ewes at 145 days of gestation and to evaluate its effects on the birth characteristics. In this study, 58 ewes were used, raised in an extensive system in the experimental farms of UFBA, with confirmation pregnancy after fixed-time artificial insemination or controlled breeding. These female ewes were separated into three groups according to the dose of dexamethasone administered (G1 = 0mg, G2 = 8mg, and G3 = 16mg). From these births, 79 lambs were born. This study analyzed the period from induction of labor to birth, fetal presentation at birth, the weight of the placenta, and the period for placenta expulsion. The data were analyzed by the Statistical Analysis System (SAS v.9.1.3®, 2002), and the significance level considered for all analyzes was 5%. Births of induced groups occurred on average at 48.4±22.17 hours after induction, while the females with non-induced labor gave birth 131.96±41.9 hours on average after the placebo application (P<0.05), confirming the efficiency of both doses for induction of labor. The period from induction to birth did not differ (P>0.05) between the doses used. There were no differences in delivery about the fetal static relation, time to placental attachment, and weight. With this study, it can be concluded that the induction at 145 days of gestation with eight or 16mg of dexamethasone is a useful technique and does not alter the labor in Santa Inês sheep.(AU)
A indução do parto visa concentrar os nascimentos para melhor acompanhamento das parturientes e primeiros cuidados aos neonatos. Contudo, mesmo que a técnica de indução de parto, com administração de dexametasona, tenha sido descrita com sucesso desde o final da década de 70, existem estudos escassos que relatam a influência desta técnica sobre o parto em ovinos da raça Santa Inês. Dessa forma, o objetivo do estudo foi avaliar a eficácia da dexametasona em duas doses (8 e 16mg), para a indução do parto de ovelhas Santa Inês com 145 dias de gestação e avaliar os seus efeitos nas características de desencadeamento e finalização do parto. Para este estudo foram utilizadas 58 ovelhas, criadas em sistema extensivo nas fazendas experimentais da UFBA, com prenhez confirmada após inseminação artificial em tempo fixo ou monta controlada. Essas fêmeas foram separadas em três grupos, de acordo com a dose de dexametasona administrada (G1 = 0mg, G2 = 8mg e G3 = 16mg). Destes partos nasceram 79 cordeiros. Foram avaliados o período em horas da indução do parto aos nascimentos, a apresentação fetal ao nascimento, assim como o peso da placenta e o período para o delivramento. Os dados foram analisados pelo pacote estatístico Statistical Analysis System (SAS v.9.0®, 2002) sendo considerado para todas as análises o nível de significância de 5%. Os nascimentos dos grupos induzidos ocorreram em média com 48,4±22,1 horas após a indução, enquanto que as fêmeas com parto não induzido pariram em média 131,96±41,9 horas após aplicação do placebo (P<0,05), confirmando a eficácia de ambas as doses para indução do parto. O período da indução até o parto não diferiu (P>0,05) entre as doses utilizadas. Não ocorreram diferenças no parto em relação à estática fetal, tempo para o delivramento e peso da placenta nos diferentes grupos. Com este estudo, conclui-se que a indução de parto em ovelhas aos 145 dias de gestação com oito e 16 mg de dexametasona é uma técnica eficaz e que não altera o trabalho de parto nas ovelhas da raça Santa Inês.(AU)
Assuntos
Animais , Feminino , Gravidez , Dexametasona , Ovinos , Trabalho de Parto Induzido/métodos , Trabalho de Parto Induzido/veterináriaRESUMO
Bupivacaine, a local anesthetic, is commercialized as a racemic mixture of R-bupivacaine and S-bupivacaine enantiomers. HIV infection increases the expression of placental P-glycoprotein (P-gp), and antiretroviral (ARV) therapy inhibits cytochrome P450 3A and P-gp. The present study evaluates the kinetic disposition of bupivacaine enantiomers in HIV-infected parturient women on ARV therapy. In this study, HIV-infected parturient women (n = 10) treated with zidovudine, lamivudine, lopinavir, and ritonavir were investigated. Anesthesia and/or analgesia was achieved by the administration of 0.5% racemic bupivacaine hydrochloride with 1:200000 epinephrine in the epidural space at doses of 2.5 to 22.5 mg. Maternal serial blood samples were obtained at the time immediately before and 5, 15, 30, 45, and 60 minutes and 2, 4, 6, 8, 10, 12, and 14 hours after administration of the bupivacaine. At the time of delivery, samples of maternal and umbilical cord vein blood were also collected. The results suggest that bupivacaine pharmacokinetics are enantioselective, revealing higher maternal plasma concentrations of the R-bupivacaine enantiomer (area under the total plasma concentration-time curve was calculated by the trapezoid method with extrapolation to infinity/dose(S)/(R) = 0.91; P < .05). The plasma unbound fraction of the drug (0.09 vs 0.06) and the umbilical cord vein/maternal plasma ratio (0.47 vs 0.39) were higher for the R-bupivacaine enantiomer than the S-bupivacaine enantiomer (P < .05). ARV therapy with ritonavir confers an enantioselective interaction between the enantiomers of bupivacaine and placental P-gp, producing greater inhibition of efflux transport of the R-bupivacaine enantiomer. Possible changes in the well-being of the fetuses of mothers under analgesia may be a consequence of the increased placental transfer of bupivacaine enantiomers to the fetal circulation.
RESUMO
Bupivacaine, a drug used in obstetric anesthesia and analgesia, is commercially available as a racemic mixture of the R-bupivacaine and S-bupivacaine enantiomers, which show differences in pharmacokinetics, efficacy and toxicity. Changes in bupivacaine plasma protein binding is of clinical relevance considering its high protein binding (approximately 95%) and its classification as an intermediate hepatic extraction ratio drug (E = 0.38). Furthermore, the plasma protein binding of bupivacaine is also of clinical relevance considering that pregnancy is a physiological condition associated with reduced plasma albumin concentration. Also, different pathological conditions, such as pre-eclampsia, can reduce the maternal plasma protein concentrations and consequently increase the bupivacaine placental transfer. This report describes the development and validation of analytical methods for the sequential analysis of the total and unbound concentrations of bupivacaine enantiomers in human plasma using liquid chromatography coupled to mass spectrometry (LC-MS/MS) with a sensitivity compatible with application in pharmacokinetic studies including placental transfer. Aliquots of 200 µL of plasma or plasma ultra-filtrate were extracted with n-hexane in alkaline medium after the deproteinization of the matrix with acetonitrile and water. The separation of bupivacaine enantiomers was obtained on a Chirex® 3020 chiral stationary phase column using as a mobile phase a mixture of 95% n-hexane:ethanol (80:20, v/v) at a flow rate of 0.8 mL/min. The lower limit of quantification was 0.25 ng of each enantiomer/mL of plasma as the total concentration and 0.125 ng of each enantiomer/mL of plasma as the unbound concentration. The methods were applied to study the pharmacokinetics of bupivacaine enantiomers after the administration of 2.5 mg of 0.5% racemic bupivacaine hydrochloride with 1:200,000 epinephrine via the epidural route to an HIV-positive parturient woman undergoing antiretroviral treatment. The parturient showed lower AUC0-∞ (25.42 vs. 30.57 ng.h/mL) and higher volume of distribution (841.96 vs 655.05 L) and total clearance (98.34 vs 81.79 L/h) for the R-bupivacaine enantiomer. The pharmacokinetics of bupivacaine were enantioselective displaying a lower plasma proportion of the enantiomer R-bupivacaine (AUC(R)/(S) ratio equal to 0.83). The placental transfer was approximately 60% for both bupivacaine enantiomers. The unbound fraction (Fu) for the R-bupivacaine enantiomer was higher (10.84%) than the eutomer S-bupivacaine (6.29%).
Assuntos
Anestésicos Locais/sangue , Proteínas Sanguíneas/metabolismo , Bupivacaína/sangue , Troca Materno-Fetal , Equilíbrio Ácido-Base/efeitos dos fármacos , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/métodos , Anestésicos Locais/química , Anestésicos Locais/farmacocinética , Bupivacaína/química , Bupivacaína/farmacocinética , Cromatografia Líquida de Alta Pressão/instrumentação , Cromatografia Líquida de Alta Pressão/métodos , Feminino , Feto/efeitos dos fármacos , Feto/metabolismo , Voluntários Saudáveis , Humanos , Gravidez , Ligação Proteica , Estereoisomerismo , Espectrometria de Massas em Tandem/instrumentação , Espectrometria de Massas em Tandem/métodosRESUMO
Objetivos: Determinar la prevalencia de la depresión postparto en mujeres puérperas de la ciudad de Arequipa. Material y métodos: Estudio descriptivo. Se evaluaron a 113 madres que acudieron a sus controles postnatales en una posta de salud de la ciudad. Se utilizó la Escala de Depresión Postparto de Edimburgo, previo consentimiento informado. Para efectos del estudio, se valoraron las propiedades psicométricas del instrumento, reportándose adecuados niveles de validez y confiabilidad para la muestra evaluada. Resultados: Los resultados indican que aproximadamente, el 41% de las madres no tiene riesgo de depresión postparto, 14% presenta riesgo y 45% tiene síntomas de depresión postparto. Asimismo, se encontró que el grado de instrucción se relaciona de manera negativa con los niveles de depresión postparto, pero no hubo diferencias significativas en función del tipo de parto ni el estado civil de las madres. Conclusiones: Se concluye que el 45% de las mujeres puérperas evaluadas tienen síntomas de depresión postparto y que el grado de instrucción presenta correlaciones negativas con esta variable. (AU)
Objectives: To determine the prevalence of postpartum depression in puerperal women in the city of Arequipa. Methods: A descriptive study was conducted in 113 puerperal women that attended peripheral health care centers for postpartum control. Edinburgh scale for depression was used after getting inform consent. Psychometric properties of the tool were evaluated. Results: Our results indicate that 41% of mothers are not at risk of postpartum depression; 14% are at risk and 45% have symptoms of postpartum depression; the degree of education was inversely correlated with postpartum depression and we did not find statistical association with route of delivery and marital status. Conclusions: We conclude that 45% of puerperal women evaluated had depression and that the degree of education inversely correlated with it. (AU)
Assuntos
Humanos , Feminino , Família , Depressão Pós-Parto , Período Pós-Parto , Epidemiologia DescritivaRESUMO
The Latin American 2015-2016 Zika virus (ZIKV) outbreak was associated with an increase in microcephaly predominantly in northeastern Brazil. To comparatively investigate infectious causes of congenital malformations, we performed a nested case-control study in 32 mothers of cases of suspected congenital Zika syndrome (CZS) and 160 age-matched controls from Bahia, northeastern Brazil. We collected clinical and imaging data and assessed past exposure to ZIKV, Chikungunya virus (CHIKV), dengue virus, and 8 established TORCH (Toxoplasma gondii, Treponema pallidum, rubella virus, cytomegalovirus, herpes simplex virus 1 [HSV-1] and HSV-2, varicella-zoster virus, parvovirus B19) pathogens using multiple serological tests. Heterogeneous symptoms prevented unequivocal diagnosis of CZS on clinical grounds. Only ZIKV and CHIKV seroprevalence rates differed significantly between cases and controls (93.8% versus 67.8% for ZIKV [Fisher's exact text, P = 0.002] and 20.7% versus 8.2% for CHIKV [χ2, P = 0.039]). High ZIKV seroprevalence rates in cases could not be explained by previous dengue virus infections potentially eliciting cross-reactive antibody responses affecting ZIKV serological tests. In conditional logistic regression analyses, only ZIKV was significantly associated with congenital malformations (P = 0.030; odds ratio, 4.0 [95% confidence interval, 1.1 to 14.1]). Our data support an association between maternal ZIKV exposure and congenital malformations. Parallels between the discrepant ZIKV and CHIKV seroprevalence rates between cases and controls and similar seroprevalence rates between cases and controls for the sexually transmitted T. pallidum and HSV-2 may suggest the occurrence of predominantly vector-borne transmission in our study population. High seroprevalence of TORCH pathogens suggests that exhaustive diagnostics will be necessary in the aftermath of the ZIKV outbreak and provides baseline data for longitudinal studies on ZIKV pathogenesis.IMPORTANCE The Latin American Zika virus (ZIKV) outbreak had a major impact on reproductive health worldwide. The reasons for the massively increased reports of neonatal microcephaly in northeastern Brazil are still unclear. Beyond the technical limitations of laboratory diagnostics, unambiguous diagnosis of ZIKV as the cause of congenital malformations is hampered by similar clinical pictures elicited by other pathogens known as TORCH pathogens. We performed a case-control study comparing mothers of children with congenital malformations to age-matched controls from Salvador, Brazil, one of the areas most extensively affected by the ZIKV outbreak. The ZIKV and Chikungunya virus seroprevalence rates differed significantly, whereas the levels of maternal exposure to TORCH pathogens were similar between cases and controls. Our data support a link between maternal ZIKV infection and congenital malformations and suggest the occurrence of predominantly vector-borne ZIKV transmission in these cases. In addition, some highly prevalent TORCH pathogens may be misinterpreted as representative of ongoing ZIKV activity in the absence of exhaustive diagnostics in northeastern Brazil.
Assuntos
Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/patologia , Troca Materno-Fetal , Viroses/complicações , Viroses/epidemiologia , Adulto , Infecções Bacterianas/complicações , Infecções Bacterianas/epidemiologia , Brasil/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Gravidez , Estudos Soroepidemiológicos , Toxoplasmose/complicações , Toxoplasmose/epidemiologia , Adulto JovemRESUMO
Reliable diagnosis of congenital Zika virus (ZIKV) infection is challenging. Here, we assessed ZIKV-specific neutralizing antibodies in 28 mothers of children with microcephaly (cases) and 122 controls from northeastern Brazil using plaque reduction neutralization tests. ZIKV-specific antibody titers were significantly higher in cases than in controls (t test, P < .0001). We identified a putative case of congenital Zika syndrome retrospectively by unusually high ZIKV-specific antibody titers. High ZIKV-specific antibody titers in cases were unrelated to prior dengue virus infection. Our data suggest a strong immunological stimulus from prolonged placental or transplacental ZIKV shedding and potential utility of maternal antibody titers to corroborate congenital ZIKV infection.
Assuntos
Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , Complicações Infecciosas na Gravidez , Infecção por Zika virus/congênito , Infecção por Zika virus/diagnóstico , Zika virus/imunologia , Adolescente , Adulto , Brasil , Feminino , Humanos , Lactente , Recém-Nascido , Microcefalia/etiologia , Testes de Neutralização , Gravidez , Estudos Retrospectivos , Ensaio de Placa Viral , Adulto JovemRESUMO
Objective: To know the nursing care of the teenager during labor, and thus to identify the factors influencing, and analyze the nursing care of the adolescent woman in labor. Method: It is an exploratory qualitative research through interviews with 08 midwives of the maternity ward of University Hospital Professor Alberto Antunes (UFAL). Data were categorized according to Bardin analysis technique and the theoretical reference the Theory of Basic Human Needs Wanda Horta. Results: It was possible to identify 03 thematic units that show the care of Nursing to the adolescent parturient, emphasizing the reception, the approach of the team and formation of the bond and of the nurses, and the care itself. Conclusion: The study made it possible to highlight the care provided, which happens in a generalized way, thus making it possible to identify the factors that determine how care is provided and its difficulties.
Objetivo: Conhecer os cuidados de Enfermagem prestados à adolescente durante o trabalho de parto, e assim identificar os fatores os influenciam, e analisar os cuidados de Enfermagem prestados à parturiente adolescente. Método: É uma pesquisa qualitativa exploratória, realizada através de entrevista com 08 enfermeiras obstétricas da maternidade do Hospital Universitário Professor Alberto Antunes (UFAL). Os dados foram categorizados de acordo com a técnica de análise de Bardin e tendo como referencial teórico a Teoria das Necessidades Humanas Básicas de Wanda Horta. Resultados: Foi possível identificar 03 unidades temáticas que evidenciam o cuidado de Enfermagem à parturiente adolescente, destacando-se o acolhimento, a aproximação da equipe e formação do vínculo e das enfermeiras, e os cuidados em si. Conclusão: O estudo possibilitou evidenciar os cuidados prestados, que acontecem de forma generalizada, possibilitando assim identificar os fatores que determinam como os cuidados são prestados e suas dificuldades.
Objetivo: Conocer los cuidados de enfermería de la adolescente durante el parto, y por lo tanto para identificar los factores que influyen y analizar los cuidados de enfermería a la mujer adolescentes en el trabajo. Método: Es una investigación cualitativa exploratoria a través de entrevistas con 08 parteras de la sala de maternidad del Hospital Universitario Profesor Alberto Antunes (UFAL). Los datos se clasifican de acuerdo a la técnica de análisis de Bardin y la referencia teórica la Teoría de las Necesidades Humanas Básicas de Wanda Horta. Resultados: Fue posible identificar 03 unidades temáticas que evidencian el cuidado de Enfermería a la parturienta adolescente, destacándose la acogida, la aproximación del equipo y la formación del vínculo y de las enfermeras, y los cuidados en sí. Conclusión: El estudio posibilitó evidenciar los cuidados prestados, que ocurren de forma generalizada, posibilitando así identificar los factores que determinan cómo los cuidados son prestados y sus dificultades.
Assuntos
Feminino , Humanos , Adolescente , Saúde do Adolescente , Serviços de Saúde do Adolescente , Trabalho de Parto , Cuidados de Enfermagem , Enfermagem Obstétrica , Gestantes , BrasilRESUMO
Resumo: Introdução: O parto em nossa história era considerado como um evento parte da vida da família. Com o passar dos anos, este foi sendo institucionalizado e realizado em um ambiente direcionado pelos profissionais. Com a implantação de Portarias e Leis, hoje temos um avanço, frente ao retorno da participação familiar, porém com enfoque voltado à parturiente, e nem sempre em um ambiente que promova conforto, tanto à parturiente como ao acompanhante. Objetivo: Descrever a vivência do acompanhante da parturiente no processo de trabalho de parto e parto. Método: Trata-se de uma pesquisa descritiva de abordagem qualitativa, realizada em um Hospital Público Federal, na Unidade da Mulher e do Recém-nascido (UMRN) da região Sul no período de 01.01.2015 á 30.01.2015. A população estudada compreendeu 21 acompanhantes, que estiveram junto à parturiente durante o trabalho de parto e parto. A coleta dos dados foi feita de forma intencional, por meio de entrevistas face a face, com o apoio de um instrumento semiestruturado com perguntas abertas. Para o processamento de dados foi utilizado o software, que recebe o nome de Iramuteq (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), desenvolvido por Pierre Ratinaud (2009),livre, ancorado no Software R, e com cinco diferentes análises estatísticas, sendo a escolhida para este estudo o método da classificação hierárquica descendente (CHD). Para a realização do processamento, foi necessária a preparação do "corpus" ou matriz de dados com todos os textos provenientes das entrevistas, onde cada uma foi transcrita em um único arquivo, dando origem a uma Unidade de Contexto Inicial (UCI), que agrupadas quanto às ocorrências das palavras através das suas raízes, deram origem as Unidades de Contexto elementar (UCEs), resultando na criação de um dicionário com formas reduzidas, utilizando-se para tanto o teste de qui-quadrado (x2), que revela a força associativa entre as palavras e sua respectiva classe e analisada quando maior que 3,84. A partir dessa classificação, as classes que surgiram foram: 1.A informação como meio de valorização da participação do acompanhante; 2.A experiência vivenciada pelo acompanhante e a importância do acolhimento como fator de influência; 3. A participação do acompanhante como escolha; 4.O pré-natal como fonte de preparo ao acompanhante.; 5. O conhecimento sobre o processo de trabalho de parto e parto e as ações executadas pelo acompanhante. A análise destas classes teve como base a proposta de John Creswell (2010). Conclusão: Observado que toda a vivência do acompanhante esteve ligada a sua intenção em estar presente junto à parturiente, dando apoio e carinho e no quanto às ações desenvolvidas por ele como dar a mão, incentivar, fazer massagem, auxiliar no banho e na deambulação, feitas por instinto, ou por orientação da equipe, foram realizadas com satisfação e orgulho. Assim como essa experiência irá influenciar em sua vida familiar junto ao recém-nato, em sua relação com a parturiente, e na importância da equipe de saúde, em informar, acolher e valorizar esse acompanhante, proporcionando condições favoráveis e necessárias, a inseri-lo nesse ambiente, não somente como fonte de apoio, mas como protagonista do processo de trabalho de parto e parto, junto à parturiente.
Abstract: Introduction: The birth in our history was considered as a part of family life event. Over the years , the birth was being institutionalized and performed in a oriented environment by professionals. With the implementation of Laws and Ordinances, today we have a progress, forward to there turn of family participation, but focusing parturient, andnot always in an environment that promotes comfort,both parturient as the companion. Objective: Discribe the experience sof the parturient companion during labor and delivery. Method: This was a descriptive and qualitative approach study, realized in a Public Hospital Federal, in the Women's Unit and the Newborn (UMRN), in South region in the period from 01.01.2015 will 01.30.2015. The study population contained 21 parturient companions, who were next to parturiente during labor and delivery. Data collection was done intencionally, through face to face interviews, with the support of a semi -structured instrument with open questions.For the data processing a software was used, which is called Iramuteq (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), developed by Pierre Ratinaud (2009), free, anchored in Software R,and five different statistical analyses, were chosen for this study the Downward Method of Hierarchical Classification (CHD). To carry out the processing, preparation of the " corpus " or data matrix with all information emanating from the interviews was necessary, where each one was transcribed into a single file, originating an Initial Context Unit (UCI), that grouped about the occurrences of words through their roots, They led the Elementary Context Units(UCEs), resulting in the creation of a dictionary with reduced forms , using for both the Chi- Square Test (x2), revealing the associative strength between words and their respective class and analyzed when greater than 3.84.Based on this classification , the classes that arose were: 1.information as a means of valuing participation parturient companion; 2. the experience lived by the parturient companion and the importance of the welcome as a factor of influence; 3. The participation of the parturient companion as choice; 4. Prenatal as a source of preparation to the parturient companion; 5. Knowledge about labor and delivery and the actions taken by the parturient companion. The analysis of these classes was based on the proposal of John Creswell (2010). Conclusion: Observed that the whole experience of the parturient companion was linked to his intention to be present with the parturient, giving support and love and as the actions taken by him as giving a hand, encourage, do massage,help with bathing and walking,made by instinct, or by health staff orientation, were performed with satisfaction and pride. As this experience will influence in his family life with the new born, in the relationship with the parturient, and the importance of the health staff , to inform , welcome and appreciate this parturient companion, providing favorable and necessary conditions to enter him in this environment,not only as a source of support, but as the protagonist of the labor and delivery, with the parturient.
Assuntos
Humanos , Masculino , Feminino , Adulto , Política Pública , Recém-Nascido , Parto Humanizado , Parto , Cuidados de EnfermagemRESUMO
BACKGROUND: The occurrence of syphilis and HIV-1 infections during pregnancy are major risks to the fetus due to mother-to-child transmission (MTCT). OBJECTIVES: To determine peripartum seroprevalence and risk factors of syphilis and HIV-1 infection among pregnant women in Salvador, Brazil, and the rate of HIV-1 MTCT. METHODS:Cross-sectional study of pregnant women who were admitted for delivery in a reference maternity hospital between May 2008 and March 2009 was conducted. Women were screened for HIV-1 infection and syphilis, and interviewed regarding demographic, behavioral and obstetric data. Newborns to HIV-infected mothers were tested by b-DNA and DNA-PCR to detect HIV-1. RESULTS: A total 3300/8516 women were evaluated. Mean age was 25.8 ± 7.3 years. HIV-1 and syphilis seroprevalence rates were 0.84% (28/3300) and 0.51% (17/3300), respectively. HIV-1 infection was associated with: low education (p = 0.04), having a partner with known HIV infection (p < 0.0001) or with previous sexually transmitted infection (p < 0.0001), blood transfusion (p = 0.003), or accidental exposure to blood (p = 0.003). Syphilis was associated with being Caucasian (p = 0.02), having no steady partner (p = 0.02), being a housewife (p = 0.01), having an intravenous drug user (IVDU) sexual partner (p = 0.04) or a sexual partner with previous STI (p < 0.001). Higher education (p = 0.04) was protective against HIV-infection. Attending a prenatal care program was protective against syphilis (p = 0.008) and HIV-1 (p = 0.02). No case of HIV-1 MTCT was detected, but 25% of children born to HIV-infected mothers were lost to follow up. CONCLUSIONS: In Salvador, peripartum prevalence of syphilis and HIV-1 infection among pregnant women were low, and associated with classic risk factors for both infections. The great proportion of very late diagnosis of HIV infection, and the high rate of loss of follow-up among positive mothers and their infants are of high concern.
Assuntos
Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Infecções por HIV/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Sífilis/epidemiologia , Brasil/epidemiologia , Métodos Epidemiológicos , Infecções por HIV/diagnóstico , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Complicações Infecciosas na Gravidez/diagnóstico , Fatores Socioeconômicos , Sífilis/diagnósticoRESUMO
Foi realizada uma análise da morbidade neonatal e materna e a mortalidade neonatal de acordo com o tipo de parto, cesariana ou vaginal. Foram estudadas prospectivamente 170 parturientes sem complicações gestacionais e com nascimento a termo: Grupo 1 (n = 95), puérpera com parto por via vaginal, Grupo 2 (n = 75), puérpera submetida à cesariana. Parâmetros maternos e fetais foram avaliados. Foi observada maior incidência de partos por via vaginal nas pacientes que estudaram até o ensino fundamental incompleto (p = 0,0045). Houve prevalência maior de partos prévios por via vaginal no Grupo 1 e de cesáreas no Grupo 2 (p < 0,001). Observou preferência de 78 (82,1 por cento) das mulheres do Grupo 1 pelo parto vaginal contra apenas 28 (37,3 por cento) das mulheres do Grupo 2, pela cesárea (p = 0,0002). Houve dor intensa no pós-operatório nas pacientes submetidas a parto cesáreo (oito casos) (p = 0,018). Traumas obstétricos foram verificados em catorze recém-nascidos do Grupo 1 e em sete do Grupo 2 (p = 0,28). Concluímos que existe maior morbidade neonatal em recém-natos de parto por via vaginal quando comparada com neonatos de cesárea e maior morbidade materna em puérperas com parto cesariana.
An evaluation of infant morbimortality and mother morbidity was undertaken according to the type of delivery. A prospective study was undertaken on 170 puerperal patients divided into two groups: Group 1 (n = 95), natural or vaginal delivery, Group 2 (n = 75), submitted to caesarean delivery. Complications in mothers were classified in small, moderate and severe. The infant parameters were: period of pregnancy, weight on birth, Apgar score, necessity of intensive care and neurological disorders. Mothers who had not completed elementary school (p=0.0045) had more vaginal delivery. Previous vaginal deliveries were more common in Group 1 than caesarean section in Group 2 (p = < 0.001) (OR = 104.00; 21.11 < OR < 610.99). In Group 1, vaginal delivery was preferred by 78 (82,1 percent) of mothers comparing to 28 (37.3 percent) from Group 2, who preferred caesarean section (p = 0.0002) (OR = 4; 1.77 < OR < 9.17). Post-operative was more intense and frequent after caesarean section (8 cases) than patients of Group 1 (2 cases) (p = 0.018) (OR = 0.18; 0.03 < OR < 0.96). Obstetric trauma was found in 14 deliveries of Group 1 and 7 of Group 2 (p = 0.28). Infant hospitalization was greater in Group 2 (3.43 +/- 0.70 days) in comparison with Group 1 (2.71 +/- 0.67 days) (p < 0.0001). The infant morbidity was greater after vaginal deliveries, but maternal morbidity was greater after caesarean deliveries.