RESUMO

This study aimed to evaluate the relationship between prepartum subclinical hypomagnesemia (pre-SHMg) and the occurrence of dystocia, metritis, clinical mastitis, lameness, and subclinical hypomagnesemia postpartum (post-SHMg) in pasture-based dairy cows. Also, the difference in means of prepartum magnesium (Mg) concentration by postpartum health events was evaluated. A total of 890 dairy cows from 32 commercial farms located in southern Chile were enrolled. Cows were examined twice, once between 30 and 3 days before and once between 3 and 30 days after calving. Blood samples were collected on both assessments, and cows were considered as having SHMg if serum total Mg < 0.65 mmol/L. On the postpartum visit, cows were evaluated for metritis and lameness. Information about clinical mastitis and dystocia was collected from on-farm records. Data were analyzed using multivariable mixed linear models and multivariable mixed logistic regression models. The overall prevalence of pre-SHMg was 9.9%, and its presence was associated with the occurrence of post-SHMg (odd ratio [OR] = 5.7; P < 0.0001) and metritis (OR = 3.1; P = 0.04). However, we did not detect an association between pre-SHMg and dystocia, clinical mastitis, or lameness after calving. Prepartum serum Mg concentrations were lower in cows that developed post-SHMg than those that did not (LSM ± SE = 0.75 ± 0.02 mmol/L vs. 0.83 ± 0.02 mmol/L; P < 0.0001). In conclusion, pre-SHMg was associated with a higher risk of post-SHMg and metritis in grazing dairy cows but not other postpartum health events.

Assuntos

Doenças dos Bovinos , Magnésio , Período Pós-Parto , Animais , Bovinos , Feminino , Chile/epidemiologia , Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/sangue , Gravidez , Magnésio/sangue , Magnésio/análise , Distocia/veterinária , Distocia/epidemiologia , Prevalência , Endometrite/veterinária , Endometrite/epidemiologia , Endometrite/sangue , Deficiência de Magnésio/veterinária , Deficiência de Magnésio/epidemiologia , Deficiência de Magnésio/sangue , Mastite Bovina/epidemiologia , Mastite Bovina/sangue , Coxeadura Animal/epidemiologia , Coxeadura Animal/etiologia , Coxeadura Animal/sangue , Indústria de Laticínios

RESUMO

Introducción: La maniobra Kristeller consiste en hacer presión del fondo uterino en el período expulsivo, la segunda etapa del trabajo de parto. Objetivo: Determinar la prevalencia, características de la aplicación de la maniobra Kristeller y consecuencias físicas y éticas en puérperas de un hospital de alta complejidad en Lima, Perú. Métodos: Diseño descriptivo transversal y prospectivo. Se incluyeron 250 puérperas de parto vaginal, con gestación única a término, atendidas en el Hospital Nacional Hipólito Unanue, entre agosto y diciembre de 2016. Se usó cuestionario -Stop Kristeller- realizado por la Asociación Española El parto es nuestro. Se les aplicó un cuestionario validado por expertos a las puérperas durante su estancia. Se realizó análisis descriptivo mostrando los resultados en frecuencias y porcentajes. Resultados: Se evidenció que a 116 de ellas (46,4 por ciento) se les realizó la maniobra Kristeller. Con respecto a las características de la realización de la maniobra 77,6 por ciento refirió que se realizó con las palmas de las manos, más del 70 por ciento refirió que fue entre una y tres veces y 75,9 por ciento señaló que solo una persona la realizó. El 32,8 por ciento reportó haber sufrido desgarro vaginal y 51,7 por ciento refirió que no solicitaron su consentimiento para realizar la maniobra. Conclusiones: Existe elevada prevalencia de la utilización de la maniobra, las características de su aplicación siguen pautas descritas por Samuel Kristeller, entre las consecuencias físicas encontradas están los desgarros perineales superficiales y profundos y en muchos casos las condiciones bioéticas no se cumplieron(AU)

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Introduction: The Kristeller maneuver consists in making fundal pressure during the second stage of labor. Objective: To determine the prevalence, characteristics of the application of Kristeller maneuver and the physical and ethical consequences in puerperal women of a highly complex hospital in Lima, Peru. Methods: A cross-sectional and prospective descriptive study was carried out in 250 puerperal women of vaginal delivery, with single gestation at term, assisted at Hipólito Unanue National Hospital, from August to December 2016. This research used the Stop Kristeller questionnaire - prepared by the Spanish Association El parto es nuestro. A questionnaire validated by experts was applied to the puerperal women during their stay. A descriptive analysis was made and the results in frequencies and percentages are shown. Results: It was showed that 116 of them (46.4 percent) underwent Kristeller maneuver. Regarding the characteristics of the maneuver performance, 77.6 percent reported that it was performed with hand palms, more than 70 percent reported that this maneuver was done between one and three times and 75.9 percent indicated that only one person performed it. Vaginal tear was reported in 32.8 percent and 51.7 percent reported their consent to perform the maneuver was not requested. Conclusions: There is high prevalence of the use of this maneuver. The characteristics of its application follow the guidelines described by Samuel Kristeller. Superficial and deep perineal tears are among the physical consequences and in many cases, bioethical conditions were not fulfilled(AU)

Assuntos

Humanos , Feminino , Gravidez , Ética Clínica/educação , Distocia/epidemiologia , Trabalho de Parto Induzido/efeitos adversos , Epidemiologia Descritiva , Estudos Transversais

RESUMO

BACKGROUND: Labor dystocia has been identified as a contributor to the rising cesarean delivery rate in the United States. Allowing more time for vaginal delivery, while being cognizant of maternal and neonatal outcomes, has been identified as a possible strategy to lower cesarean delivery rates. OBJECTIVE: This study aimed to characterize the relationship between the duration of active phase and second-stage labor and maternal and neonatal morbidity. STUDY DESIGN: We present a secondary analysis of the Consortium on Safe Labor project. From labors of 66,940 nonanomalous nulliparous term singleton vertex gestations, we excluded labors for which active phase (≥6 cm dilation) or second stage durations could not be calculated and from sites that did not report determinants of morbidity. For each duration of active phase or second stage labor (grouped in 1-hour increments), the adjusted maternal and neonatal composite morbidity was estimated by and compared with the morbidity associated with a duration <1 hour total and a duration of 1 hour shorter. RESULTS: After exclusions, 48,144 deliveries remained. In adjusted models, compared with labor durations <1 hour total, maternal composite morbidity was significantly higher across active phase and second stage durations (both P<.001); neonatal composite morbidity was higher across the second stage (P<.001), but not active phase (P=.07) duration. These relationships appear linear with no apparent inflection point, and morbidity increases more rapidly. When compared with labor durations 1 hour shorter, significant differences persisted in maternal and neonatal composite morbidity in second stage labor only through 4 and 3 hours, respectively. CONCLUSION: Maternal and neonatal composite morbidity is greater with longer durations of active and second stage labor; however, no clear cutoff point was determined to suggest truncation of either stage of labor for reasons of morbidity. In addition, incrementally higher morbidities that were noted vs duration <1 hour total were obscured when comparison was made with labors 1 hour shorter, which suggests that focusing on short differences in duration of labor may mask important underlying trends.

Assuntos

Distocia , Segunda Fase do Trabalho de Parto , Cesárea , Parto Obstétrico , Distocia/epidemiologia , Feminino , Humanos , Morbidade , Gravidez , Estados Unidos/epidemiologia

RESUMO

OBJECTIVE: To investigate risk factors for neonatal arterial ischemic stroke (NAIS), and compare them with those present in term controls and infants with hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN: Antepartum and intrapartum data were collected at presentation from 79 infants with NAIS and compared with 239 controls and 405 infants with HIE. The relationships between risk factors and NAIS were explored using univariable and multivariable regression. RESULTS: Compared with controls, infants with NAIS more frequently had a family history of seizures/neurologic diseases, primiparous mothers, and male sex. Mothers of infants with NAIS experienced more intrapartum complications: prolonged rupture of membranes (21% vs 2%), fever (14% vs 3%), thick meconium (25% vs 7%), prolonged second stage (31% vs 13%), tight nuchal cord (15% vs 6%), and abnorm8al cardiotocography (67% vs 21%). Male sex (OR 2.8), family history of seizures (OR 6.5) or neurologic diseases (OR 4.9), and ≥1 (OR 5.8) and ≥2 (OR 21.8) intrapartum complications were independently associated with NAIS. Infants with NAIS and HIE experienced similar rates though different patterns of intrapartum complications. Maternal fever, prolonged rupture of membranes, prolonged second stage, tight nuchal cord, and failed ventouse delivery were more common in NAIS; thick meconium, sentinel events, and shoulder dystocia were more frequent in HIE. Abnormal cardiotocography occurred in 67% of NAIS and 77.5% of infants with HIE. One infant with NAIS and no infant with HIE was delivered by elective cesarean (10% of controls). CONCLUSIONS: NAIS is multifactorial in origin and shares risk factors in common with HIE. Intrapartum events may play a more significant role in the pathogenesis of NAIS than previously recognized.

Assuntos

Infarto da Artéria Cerebral Média/epidemiologia , Complicações na Gravidez/epidemiologia , Cardiotocografia , Estudos de Casos e Controles , Distocia/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Febre/epidemiologia , Predisposição Genética para Doença , Humanos , Hipóxia-Isquemia Encefálica/epidemiologia , Recém-Nascido , Segunda Fase do Trabalho de Parto , Estudos Longitudinais , Masculino , Mecônio , Cordão Nucal/complicações , Gravidez , Estudos Retrospectivos , Fatores de Risco , Convulsões/complicações , Fatores Sexuais

RESUMO

OBJECTIVES: To determine the expected proportion of term cerebral palsy (CP) after neonatal encephalopathy (NE) that could theoretically be prevented by hypothermia and elucidate the perinatal factors associated with CP after NE in those who do not meet currently used clinical criteria required to qualify for hypothermia ("cooling criteria"). STUDY DESIGN: Using the Canadian CP Registry, we categorized children born at ≥ 36 weeks with birth weight ≥ 1800 g with CP after moderate or severe NE according to the presence or absence of cooling criteria. Maternal, perinatal, postnatal, and placental factors were compared between the 2 groups. A number needed to treat of 8 (95% CI 6-17) to prevent one case of CP was used for calculations. RESULTS: Among the 543 term-born children with CP, 155 (29%) had moderate or severe NE. Sixty-four of 155 (41%) met cooling criteria and 91 of 155 (59%) did not. Shoulder dystocia was more common in those who did not meet cooling criteria (OR 8.8; 95% CI 1.1-71.4). Low birth weights (20% of all singletons), small placentas (42%), and chorioamnionitis (13%) were common in both groups. CONCLUSIONS: The majority of children with CP after NE did not meet cooling criteria. An estimated 5.1% (95% CI 2.4%-6.9%) of term CP after NE may be theoretically prevented with hypothermia. Considering shoulder dystocia as an additional criterion may help recognize more neonates who could potentially benefit from cooling. In all cases, a better understanding of the antenatal processes underlying NE is essential in reducing the burden of CP.

Assuntos

Paralisia Cerebral/prevenção & controle , Hipotermia Induzida/estatística & dados numéricos , Hipóxia-Isquemia Encefálica/epidemiologia , Paralisia Cerebral/epidemiologia , Corioamnionite/epidemiologia , Diabetes Gestacional/epidemiologia , Distocia/epidemiologia , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Placenta/patologia , Gravidez , Quebeque/epidemiologia , Sistema de Registros , Índice de Gravidade de Doença

RESUMO

A ocorrência de distocias em vacas representa um grande empecilho num sistema de produção, elevando os custos e alguns riscos para a parturiente. Com isso objetivou-se realizar um estudo retrospectivo dos achados clínico-epidemiológicos em vacas acometidas com distocias, atendidas na rotina clínica da Clínica de Bovinos, Campus – Garanhuns (CBG) da Universidade Federal Rural de Pernambuco (UFRPE), onde foram resgatadas informações das fichas clinicas de vacas (n = 837), com situações de distocias (materno e/ou fetal), entre o período de 2000 a 2010. Foram realizadas ainda, as determinações do cortisol, creatina quinase (CK), Ácidos Graxos não Esterificados (NEFA) e dos minerais: cálcio, fósforo e magnésio em 189 amostras colhidas no momento do parto em vacas em condição de distocia e de partos normais. Esses animais foram divididos em grupos: grupo (I) distocia materna (n=79), grupo (II) distocia fetal (n=82), grupo (III) distocia materno-fetal (n=15) e grupo (IV) parto normal (n=13). A análise estatística dos dados foi realizada de forma descritiva, determinando as distribuições de frequências das variáveis analisadas, associadas às diferentes situações de distocias. Esta enfermidade representou 17,5% (837/4782) da casuística de bovinos atendidos na CBG/UFRPE. A manipulação prévia nas propriedades por pessoas inabilitadas ocorreu em 86,5% dos casos; destes 60% dos produtos vieram a óbito, assim como 15% das vacas manipuladas. Na análise hormonal, bioquímica e mineral, dos grupos com distocia materna, fetal, materno/fetal e de parto normal, constataram-se, respectivamente, níveis médios elevados de cortisol (188,85ng/mL; 279,90ng/mL; 204,09 ng/mL e 149ng/mL), creatina quinase (1.012,11 mg/dL; 928 mg/dL; 992,42 mg/dL e 631 mg/dL) e NEFA (0,95 mmol/L; 0,85 mmol/L; 0,90 mmol/L e 1,06 mmol/L) em todos os grupos, além de uma hipocalcemia sub-clínica nas vacas com distocias (6,89 mg/gL; 7,9 mg/gL; 7,46 mg/gL e 8,38 mg/L), se destacando as com distocia materna que apresentou valor 30% menor que o limiar inferior de normalidade. Com isso vale ressaltar a importância da suplementação alimentar adequada para atender suas exigências principalmente nesse período conturbado de transição.

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The occurrence of dystocia represents a major obstacle in livestock, increasing costs and some risks to the mother. The aim was perform a study of retrospective clinical and epidemiological findings in cows with dystocias assisted in the clinical routine at the Garanhuns Bovine Clinic, Campus- Garanhuns (CBG) from the Federal Rural University of Pernambuco (UFRPE), which were retrieved information from clinical records of cows (n= 837), with dystocia (maternal and/or fetal), between the period from 2000 to 2010. Analysis of cortisol, creatine kinase (CK), nonesterified fatty acids (NEFA) and minerals: calcium, phosphorus and magnesium, in 189 samples taken at time of delivery in cows in the condition of dystocia and normal labor were performed. These animals were divided into groups: maternal dystocia (n = 79), fetal dystocia (n = 82), maternalfetal dystocia (n = 15) and normal vaginal delivery (n = 13). Statistical analysis was performed descriptively determining the frequency distributions of the variables associated to different dystocia situations. This disease accounted for 17.5% (837/4782) of the sample from cattle treated at CBG /UFRPE. Previous manipulation in the properties by unqualified people occurred in 86.5% of cases, 60% of these products came to obit, as well as 15% of cows handled. Hormonal analysis, biochemical and mineral, groups with maternal dystocia, fetal, maternal/fetal and normal labor, were found, respectively, higher average levels of cortisol (188.85ng/mL; 279.90ng/mL; 204.09ng/mL and 149ng/mL), creatine kinase (1012.11mg/dL; 928mg/dL; 992.42mg/dLand 631mg/dL)and NEFA (0 , 95mmol/L; 0.85mml /L; 0.90mmol/L and 1.06mmol/L) in all groups, in addition to a subclinical hypocalcemia in cows with dystocia (6.89mg/gL; 7.9 mg/gL, 7.46 mg/L and 8.38mg/L) highlighting the mother who presented 30% lower dystocia values compared to lower limit of normality. With this study we can emphasize the importance of adequate food supplementation to meet their particular requirements in this troubled period of transition.

Assuntos

Feminino , Animais , Gravidez , Bovinos , Distocia/epidemiologia , Saúde Reprodutiva/estatística & dados numéricos , Suplementos Nutricionais/efeitos adversos , Distocia/veterinária , Estudos Retrospectivos

RESUMO

A Distócia de Ombro é definida, de acordo com os Colégios Americano e Britânico de Obstetrícia e Ginecologia, como parto que necessita de manobras obstétricas adicionais, após falência da tração da cabeça fetal para liberar os ombros. Apesar de sua baixa incidência, é uma complicação com importante morbidade para o recém nascido e que pode levar a intercorrências maternas, sendo entretanto passível de ser evitada. Esse artigo de revisão se propõe a sumarizar a epidemiologia, fisiopatologia, conduta e complicações, enfocando os fatores de risco e as manobras mais utilizadas, dada a importância de ambos na prevenção dessa complicação. (AU)

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The Shoulder Dystocia is defined, according to British and American Colleges of Obstetrics and Gynecology, as delivery which requires additional obstetric maneuvers after failure of traction of the fetal head to release the shoulders. Despite its low incidence, it is a complication with significant morbidity for the newborn and wich can lead to maternal complications. Despite of this, is able to be avoided. This review aims to summarize the epidemiology, pathophysiology, management and complications, focusing on risk factors and the most commonly used maneuvers, due to the importance of both in preventing this complication. (AU)

Assuntos

Humanos , Feminino , Gravidez , Recém-Nascido , Trabalho de Parto , Assistência Perinatal , Distocia/epidemiologia , Plexo Braquial/lesões , Lacerações/complicações , Distocia/fisiopatologia , Distocia/prevenção & controle , Hipóxia Fetal/complicações , Hemorragia/complicações , Complicações do Trabalho de Parto/fisiopatologia , Complicações do Trabalho de Parto/prevenção & controle

RESUMO

OBJETIVO: Estimar a prevalência de cesarianas em um centro de parto normal intra-hospitalar e identificar fatores associados. MÉTODOS: Estudo transversal com análise de prontuários de 2.441 partos assistidos em março e abril de 2005 em um centro de parto normal intra-hospitalar de São Paulo, SP. A variável dependente (tipo de parto) foi classificada como parto normal e operação cesariana. As variáveis independentes foram categorizadas em quatro grupos: demográficas; história obstétrica pregressa e atual; assistência intraparto; e resultados perinatais. A razão de prevalência e o intervalo de 95 por cento de confiança (IC95 por cento) foram calculados para identificar associação entre tipo de parto e variáveis maternas e do recém-nascido. RESULTADOS: Do total de partos, 14,9 por cento foram operações cesarianas. Ter sido submetida a cesariana na gestação atual esteve associado a cesariana em gestação anterior (RP = 3,19; IC95 por cento: 2,64;3,84), idade gestacional > 40 semanas (RP = 1,32; IC95 por cento: 1,09;1,61), ser admitida com cervicodilatação até 4 cm (RP = 3,22; IC95 por cento: 2,31;4,50), líquido amniótico meconial (RP = 2,5; IC95 por cento: 2,05;3,06). Quanto ao recém-nascido, a cesariana associou-se a peso > 4kg (RP = 1,86; IC95 por cento: 1,29;2,66). Entre as mulheres com cesariana em gestação anterior, ter também parto normal prévio foi fator de proteção para cesariana na gestação atual (RP = 0,46; IC95 por cento 0,30;0,71). Fatores relacionados à condição fetal, como estresse fetal, líquido amniótico meconial, apresentação pélvica e macrossomia corresponderam a 47,8 por cento (175) das indicações para a realização da cesariana; condições ligadas ao mecanismo do parto, como parada de progressão, distócia funcional e distócia de rotação totalizaram 31,3 por cento (115) das indicações. CONCLUSÕES: A prevalência de cesariana mostrou-se dentro dos limites propostos pela Organização Mundial da Saúde. Mulheres com cesariana em gestação anterior, admitidas com até 4 cm de dilatação, idade gestacional > 40 semanas, com líquido amniótico meconial e recém-nascido > 4 kg tiveram maior risco para cesariana.

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OBJECTIVE: To estimate the prevalence of cesarean sections in a birth center of a hospital and identify factors associated. METHODS: Cross-sectional study including medical records of 2,441 births assisted in a birth center in the city of São Paulo, southeastern Brazil, between March and April 2005. The dependent variable (type of delivery) included vaginal delivery and cesarean section. The independent variables were grouped into four categories: demographic characteristics; current and past obstetric history; intrapartum care; and perinatal outcomes. Prevalence ratios and 95 percent confidence intervals (95 percent CI) were estimated to assess the association between type of delivery and maternal and newborn variables. RESULTS: Of all deliveries, 14.9 percent were cesarean sections. Cesarean section in the current pregnancy was associated with past cesarean sections (PR = 3.19, 95 percentCI: 2.64,3.84); gestational age > 40 weeks (PR = 1.32, 95 percentCI: 1.09;1.61); cervical dilation of up to 4 cm on admission (PR = 3.22, 95 percentCI: 2.31;4.50); and meconium-stained amniotic fluid (PR = 2.5, 95 percentCI: 2.05;3.06). Regarding newborn characteristics cesarean section was associated with birth weight >4 kg (PR = 1.86, 95 percentCI: 1.29;2.66). Among women with history of past cesarean sections, having had also a prior vaginal delivery was a protective factor for cesarean section in the current pregnancy (PR = 0.46, 95 percentCI: 0.30;0.71). Factors related to fetal conditions including fetal stress, meconium-stained amniotic fluid, breech presentation and macrosomia accounted for 47.8 percent (175) while those related to the mechanism of birth including arrest disorders, and functional and rotation dystocia accounted for 31.3 percent (115) of all indications for a cesarean section. CONCLUSIONS: Prevalence of c-section was consistent with World Health Organization recommendations. Increased risk of c-section was associated with prior history of c-sections, cervical dilation of at least 4 cm upon admission, gestational age > 40 weeks, meconium-stained amniotic fluid, and birthweight > 4 kg.

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OBJETIVO: Estimar la prevalencia de cesáreas en un centro de parto normal intra-hospitalario e identificar factores asociados. MÉTODOS: Estudio transversal con análisis de prontuarios de los 2.441 partos asistidos en marzo y abril de 2005 en Centro de Parto Normal de Sao Paulo, Sureste de Brasil. La variable dependiente (tipo de parto) fue clasificada como parto normal y operación cesárea. Las variables independientes fueron categorizadas en cuatro grupos: demográficas; historia obstétrica anterior y actual; asistencia intraparto; y resultados prenatales. La tasa de prevalencia y el intervalo con 95 por ciento de confianza (IC95 por ciento) fueron calculados para identificar asociación entre tipo de parto y variables maternas y del recién nacido. RESULTADOS: Del total de partos, 14,9 por ciento fueron operaciones cesáreas. Haber tenido parto por cesárea en la gestación actual estuvo asociada a cesárea en gestación anterior (RP=3,19; IC95 por ciento: 2,64;3,84), edad gestacional >40 semanas (RP=1,32;IC95 por ciento: 1,09;1,61), ser admitida con dilatación cervical hasta 4 cm (RP=3,22; IC95 por ciento: 2,31;4,50), liquido amniótico meconial (RP=2,5; IC95 por ciento: 2,05;3,06). con relación al recién nacido, la cesárea se asoció al peso>4kg (RP=1,86; IC 95 por ciento: 1,29;2,66). Entre las mujeres con cesárea en gestación anterior, tener también parto normal previo fue factor de protección para cesárea en la gestación actual (RP=0,46; IC95 por ciento: 0,30;0,71). Factores relacionados a la condición fetal, como estrés fetal, liquido amniótico meconial, presentación pélvica y macrosomia correspondieron a 41,8 por ciento (175) de las indicaciones para la realización de la cesárea; condiciones ligadas al mecanismo del parto, como parada de progresión, distoccia funcional y distoccia de rotación totalizaron 31,3 por ciento (115) de las indicaciones. CONCLUSIONES: La prevalencia de cesárea se mostró dentro de los límites propuestos por la Organización Mundial de la Salud. Mayor riesgo para cesárea fue asociado a cesárea en gestación anterior, dilatación cervical hasta 4 cm, edad gestacional >40 semanas, presencia de liquido amniótico meconial y peso del recién nacido >4 kg.

Assuntos

Adulto , Feminino , Humanos , Gravidez , Cesárea , Complicações na Gravidez/epidemiologia , Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Brasil , Apresentação Pélvica/epidemiologia , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Distocia/epidemiologia , Sofrimento Fetal/epidemiologia , Idade Gestacional , Idade Materna , Paridade , Fatores de Risco

RESUMO

OBJECTIVE: To estimate the prevalence of cesarean sections in a birth center of a hospital and identify factors associated. METHODS: Cross-sectional study including medical records of 2,441 births assisted in a birth center in the city of São Paulo, southeastern Brazil, between March and April 2005. The dependent variable (type of delivery) included vaginal delivery and cesarean section. The independent variables were grouped into four categories: demographic characteristics; current and past obstetric history; intrapartum care; and perinatal outcomes. Prevalence ratios and 95% confidence intervals (95% CI) were estimated to assess the association between type of delivery and maternal and newborn variables. RESULTS: Of all deliveries, 14.9% were cesarean sections. Cesarean section in the current pregnancy was associated with past cesarean sections (PR = 3.19, 95%CI: 2.64,3.84); gestational age > 40 weeks (PR = 1.32, 95%CI: 1.09;1.61); cervical dilation of up to 4 cm on admission (PR = 3.22, 95%CI: 2.31;4.50); and meconium-stained amniotic fluid (PR = 2.5, 95%CI: 2.05;3.06). Regarding newborn characteristics cesarean section was associated with birth weight >4 kg (PR = 1.86, 95%CI: 1.29;2.66). Among women with history of past cesarean sections, having had also a prior vaginal delivery was a protective factor for cesarean section in the current pregnancy (PR = 0.46, 95%CI: 0.30;0.71). Factors related to fetal conditions including fetal stress, meconium-stained amniotic fluid, breech presentation and macrosomia accounted for 47.8% (175) while those related to the mechanism of birth including arrest disorders, functional dystocia and malposition accounted for 31,3% (115) of all indications for a cesarian section [corrected]. CONCLUSIONS: Prevalence of c-section was consistent with World Health Organization recommendations. Increased risk of c-section was associated with prior history of c-sections, cervical dilation of at least 4 cm upon admission, gestational age > 40 weeks, meconium-stained amniotic fluid, and birthweight > 4 kg.

Assuntos

Cesárea/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Adulto , Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Brasil , Apresentação Pélvica/epidemiologia , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Distocia/epidemiologia , Feminino , Sofrimento Fetal/epidemiologia , Idade Gestacional , Humanos , Idade Materna , Paridade , Gravidez , Fatores de Risco

RESUMO

OBJECTIVE: To assess the risk factors for shoulder dystocia in Jamaica. METHODS: A retrospective cohort analysis of all cases of shoulder dystocia, and birth weight-matched controls identified from January 1, 2000 to December 31, 2004. Multiple factors were analyzed individually and in combination to identify risk factors. RESULTS: The incidence of shoulder dystocia was 0.83%. Nulliparity, a first stage of labor greater than 7 hours, a second stage lasting more than 1 hour, and use of oxytocin augmentation were found to be statistically significant factors with unadjusted odds ratios (95% confidence interval) of 1.78 (0.86-3.34), 1.89 (0.91-3.94), 2.78 (0.24-31.47), and 1.56 (0.77-3.15), respectively. The incidence of shoulder dystocia decreased as parity increased when adjusted for age. CONCLUSION: Individual risk factors for shoulder dystocia remain obscure. The nulliparous pelvis, when controlled for neonatal weight, was associated with a statistically increased risk of shoulder dystocia; this risk decreased with increasing parity.

Assuntos

Distocia/etiologia , Adulto , Distocia/epidemiologia , Feminino , Macrossomia Fetal , Hospitais Universitários , Humanos , Jamaica/epidemiologia , Razão de Chances , Paridade , Gravidez , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Ombro

RESUMO

OBJECTIVES: To evaluate the ability of population surveys to estimate the occurrence of maternal morbidities. STUDY DESIGN AND SETTING: A literature search was conducted using MEDLINE, EMBASE, POPLINE references from relevant papers and proceedings of scientific meetings. No restrictions were made regarding language, date, design, journal, or country. Potentially relevant papers were independently evaluated by two reviewers. Eligible studies were critically evaluated, particularly with respect to complications: eclampsia and other hypertensive complications, hemorrhages, dystocias, and infections. The questions with the highest combined values for sensitivity and specificity were identified in each study. RESULTS: Seven hospital-based studies involving 2,907 women were included. The gold standard was the clinical records, and the validation strategy consisted of applying questionnaires and comparing them with the gold standard. Questions regarding eclampsia and other hypertensive complications performed satisfactorily in four studies; questions on dystocia and infection in two studies each, and questions regarding hemorrhagic complications in only one study. In general, when the actual prevalence of the condition is low (

Assuntos

Complicações na Gravidez/epidemiologia , Distocia/epidemiologia , Eclampsia/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Prevalência , Psicometria , Projetos de Pesquisa , Inquéritos e Questionários

RESUMO

BACKGROUND: In South America, and particularly Ecuador, cesarean section rates have risen markedly over the past five years. The associated increases in maternal morbidity and healthcare costs indicate the need for alternative strategies. Operative vaginal delivery is minimally utilized in Ecuador, as neither vacuum nor forceps have been available. OBJECTIVE: As vacuum delivery was recently introduced to our clinical service, we sought to examine our initial experiences (i.e., maternal and neonatal outcome) with operative vaginal delivery for prolonged second stage of labor. METHODS: Following an initial educational program at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador, vacuum extraction cups (Mityvac, Cooper Surgical) were offered to laboring women with term singleton gestations and cephalic presentations no higher than +3 station. Maternal and neonatal data were analyzed. RESULTS: During the study period, 100 vacuum applications were performed on laboring women complicated with prolonged second stage of labor. Mean maternal age was 23.8 +/- 6.4 years (range 14-41 years) with 57% of patients nulliparous. Left anterior and right posterior fetal positions were the most frequent (85% and 11%, respectively). Maternal complications included need for blood transfusion (1%), shoulder dystocia (1%) and perineal tears (first degree 6%, second degree 5%). Vaginal delivery was successful in 97% of cases. Among neonates, the average weight was 3149 +/- 410 g, with 10% neonates small for gestational age and 5% large for gestational age. Only 1% of infants presented an Apgar score <7 at 5 min. There were no scalp lacerations, cephalohematomas, or subgaleal bleeds. CONCLUSIONS: In this initial observational study, vacuum extraction for prolonged second stage was safe and effective. We propose that the introduction of operative vaginal delivery to developing countries will mitigate rising cesarean section rates.

Assuntos

Segunda Fase do Trabalho de Parto , Complicações do Trabalho de Parto/cirurgia , Vácuo-Extração , Adolescente , Adulto , Índice de Apgar , Peso ao Nascer , Transfusão de Sangue , Distocia/epidemiologia , Equador/epidemiologia , Feminino , Humanos , Recém-Nascido , Períneo/lesões , Gravidez , Resultado da Gravidez , Ombro , Resultado do Tratamento

RESUMO

BACKGROUND: the dystocic delivery is a frequent complication and its perinatal repercussions vary from minor lesions to severe brain damage. It has been reported diverse factors associated with this medical complication. OBJECTIVE: to identify the risk factors with significant association with dystocic delivery. MATERIAL AND METHODS: a case-control study was carried out. There were included 750 patients, divided into 250 women with dystocic deliveries (cases) and 500 women with eutocic deliveries (controls). Demographic and clinical variables were registered. The statistical analysis was performed with percentages, arithmetic media, standard deviation, Student t test, chi2 and logistic regression analysis. An alpha value was set at 0.05. RESULTS: the factors with statistical significance were: advanced age (p < 0.001), major patient's height (p < 0.001), major new born's weight (p = 0.009), lower parity (p < 0.001), and prolonged duration of labor (p = 0.04). Other variables such as number of pregnancies, previous cesarean sections, spontaneous abortions, weight of the patient, weight earned during pregnancy, number of medical appointments during antenatal care, previous dystocic delivery, and premature rupture of the membranes, were not significant. CONCLUSIONS: there are clinical and demographic risk factors associated with dystocic delivery. To identify this risk factors during the antenatal care could diminish the frequency of dystocic deliveries and therefore to avoid the associated maternal-fetal complications.

Assuntos

Distocia/epidemiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , México , Gravidez , Fatores de Risco

Assuntos

Humanos , Feminino , Gravidez , Recém-Nascido , Distocia/epidemiologia , Distocia/etiologia , Distocia/terapia , Ombro/lesões , Parto Obstétrico/métodos , Traumatismos do Nascimento , Clavícula/lesões , Complicações do Diabetes , Macrossomia Fetal/etiologia , Cuidado Pré-Natal , Plexo Braquial/lesões , Fatores de Risco

Assuntos

Humanos , Feminino , Gravidez , Recém-Nascido , Distocia/epidemiologia , Distocia/etiologia , Distocia/terapia , Ombro/lesões , Parto Obstétrico/métodos , Plexo Braquial/lesões , Clavícula/lesões , Cuidado Pré-Natal , Fatores de Risco , Macrossomia Fetal/etiologia , Complicações do Diabetes , Traumatismos do Nascimento

RESUMO

The objective of the present study was to evaluate in penned sows the effect of two commercial oxytocin products on umbilical cord pathology, degree of asphyxia and intra-partum mortality. This study included 120 sows divided in three groups of 40 animals with eight animals for parities one to five per subgroup, respectively. Group 1 (G(1)) or control received saline solution while oxytocin groups (G(2)) and (G(3)) were injected at the onset of fetal expulsion with two oxytocin products. The doses of oxytocin were as follow: Primiparous sows weighing less than 130 kg received 20 IU; multiparous sows weighing 130-180 g received 30 IU, and those above 250 kg, 40 IU. Piglets born alive and/or dead were classified at birth using a subjective scale based on the degree of meconium staining on skin. Umbilical cords of intra-partum stillbirths (IPS) were classified as adhered or ruptured and subdivided into four categories: without pathological changes, edematous, congested and hemorrhagic. Result analyses revealed significant differences (P < 0.01) between groups 1 and 2, and 1 and 3 regarding the following traits: expulsion interval (min) (X: G(1) 27.7; G(2) 22.6; G(3) 22.2), IPS with a severe stain degree (X: G(1) 0.10; G(2) 0.45; G(3) 0.50), IPS with ruptured umbilical cords (X: G(1) 0.07; G(2) 0.42; G(3) 0.47), and detectable heartbeats in IPS (X: G(1) 0.27; G(2) 0.25; G(3) 0.22). Treatment with oxytocin reduced the duration of the expulsion of the fetus, increased the number of IPS with ruptured umbilical cords and with severe meconium-stain degree and reduced the number of fetuses with inspiration attempts. Furthermore, the use of this hormone increased the need for obstetric assistance due to increased frequency of dystocia.

Assuntos

Hipóxia Fetal/veterinária , Ocitocina/efeitos adversos , Doenças dos Suínos/epidemiologia , Animais , Animais Recém-Nascidos , Distocia/epidemiologia , Distocia/veterinária , Feminino , Morte Fetal/epidemiologia , Morte Fetal/veterinária , Abrigo para Animais , Ocitocina/administração & dosagem , Paridade , Gravidez , Resultado da Gravidez , Ruptura Espontânea/epidemiologia , Ruptura Espontânea/veterinária , Suínos , Cordão Umbilical

RESUMO

OBJECTIVE: Considering a population with an African culture traditionally opposed to a caesarean section, vertex engagement with a vacuum extractor could be a good alternative. PATIENTS AND METHODS: In a retrospective study of 50 cases of trial engagement with a vacuum extractor in French Guyana, there were 94% of vaginal deliveries. RESULTS: A high level of shoulder dystocia (14%) was noted, and the failure of this technique was the consequence of disproportions between foetus and pelvis that had not been correctly diagnosed. CONCLUSION: In this article, feasibility and obstetrical conditions to carry out a trial engagement with a vacuum extractor are discussed.

Assuntos

Vácuo-Extração/instrumentação , Adolescente , Adulto , Peso ao Nascer , Distocia/diagnóstico , Distocia/epidemiologia , Feminino , Guiana Francesa , Idade Gestacional , Humanos , Gravidez , Estudos Retrospectivos , Ombro , Falha de Tratamento

RESUMO

Se revisaron 116 historias de pacientes con embarazos simples y presentación de frente atendidas en la Maternidad Concepción Palacios entre 1984 y 1988 en 115699 partos de vértice, dando una incidencia de 0,10// o sea 1 por cada 997 partos. La edad osciló entre 15 y 38 años, promedio 26. Fueron primigestas 25,86// y 74,14// tenían 2 o más gestaciones. En 81,90// fueron embarazos a término, 11,21// pretérmino y 6,90// postérmino. En 78,45// se hizo el diagnóstico durante el trabajo de parto y en 21,55// mediante estudio radiológico y ecosonograma. La variedad naso anterior se encontró en 45,69//, la naso transversa en 20,69//, la naso posterior en 18,10// y en 15,52// se desconoció. En 57,76// se hizo cesárea y en 42,25// parto vaginal. La puntuación de Apgar al nacer fue de 8 y 10 en 41,38//, 4 y 7 en 30,17// y menor en 11,21//. La morbilidad materna fue de 16,38// y la fetal de 27,59//. Hubo 3 muertes neonatales y 2 mortinatos

Assuntos

Gravidez , Recém-Nascido , Humanos , Masculino , Feminino , Distocia/complicações , Apresentação no Trabalho de Parto , Distocia/epidemiologia

RESUMO

A nine-year review of 103 cases of shoulder dystocia identified obesity, diabetes mellitus and post-datism as important predisposing risk factors. There was a positive correlation with birthweight. Abnormal labour patterns were invariably absent and perinatal outcome was disastrous. The best strategy is to anticipate and avoid this obstetrical emergency.

Assuntos

Distocia/epidemiologia , Adolescente , Adulto , Diabetes Mellitus , Feminino , Macrossomia Fetal , Idade Gestacional , Humanos , Obesidade , Gravidez , Fatores de Risco , Ombro

RESUMO

El estudio comprendido 874 gestantes adolescentes de 18 años o menos, del 1 de enero de 1987 al 1 de enero de 1988, siendo 292 del Hospital A. Loayza y 582 de la Maternidad de Lima, con incidencia de 8.70 y 9.78 por ciento respectivamente. Las edades fluctuaron entre 13 y 18 años, siendo la mayoría solteras y convivientes, con bajo grado de instrucción. Tuvieron control prenatal el 61.51 por ciento de las pacientes de la Maternidad y el 78.42 por ciento de las del Hospital A. Loayza. La incidencia de morbilidad durante la gestación fue de 22.16 por ciento y de 35.27 por ciento respectivamente, siendo las principales la vulvovaginitis, enfermedad hipertensiva del embarazo, infección urinaria, ruptura prematura de menbranas y anemia. La mayoría de los recién nacidos tuvieron un peso entre 2501 y 3500 grs, y un score Apgar mayor de 7. El porcentaje de cesareas fue de 9.45 y 14.38 por ciento respectivamente, siendo la principal indicación la incompatibilidad fetopélvica. La endometritis fue la complicación puerperal más frecuente en ambas sedes

Assuntos

Humanos , Gravidez , Feminino , Adolescente , Recém-Nascido , Complicações na Gravidez , Gravidez na Adolescência , Aborto Espontâneo/epidemiologia , Cesárea , Distocia/epidemiologia , Escolaridade , Endometrite/epidemiologia , Hipertensão/epidemiologia , Peru , Complicações na Gravidez/epidemiologia , Vulvovaginite/epidemiologia