RESUMO
PONTOS-CHAVE Quando utilizados na técnica correta, fórcipes e vácuo-extratores apresentam baixos índices de complicações. Para o feto com sinais de hipóxia no período expulsivo, o parto vaginal operatório tem potencial para reduzir a exposição aos fatores intraparto que promovem a encefalopatia hipóxico-isquêmica. Fórcipes médios e/ou rotacionais são opções apropriadas em circunstâncias selecionadas e exigem habilidade e experiência. Os fórcipes são mais resolutivos do que os vácuo-extratores para o parto vaginal operatório, porém são mais associados a lacerações perineais graves. Céfalo-hematoma é mais provável de ocorrer com o aumento na duração da vácuo-extração. Os vácuo-extratores de campânulas flexíveis apresentam taxas maiores de falha, porém apresentam menores incidências de trauma no couro cabeludo do neonato. (AU)
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Trabalho de Parto , Extração Obstétrica/métodos , Vácuo-Extração/efeitos adversos , Recém-Nascido/líquido cefalorraquidiano , Cesárea , Ultrassonografia Pré-Natal , Isquemia , Hipóxia , Forceps Obstétrico/efeitos adversosRESUMO
The idea of using an instrument to assist natural childbirth is not new and it was in the 18th and 19th centuries that the forceps was developed. It is only after the Second World War that the suction cup provides an alternative to instrumental childbirth, but still based on prehension and traction. In 1950, Emile Thierry, in France, presented his spatulas based on the then original principle of propulsion. The diffusion of spatulas is almost non-existent in the Anglo-Saxon world but is not limited to France since its use was real by the Iberians and Latin Americans. There are currently three types of spatula, two of which are French and one Colombian. This review takes up the saga of this instrument for more than 70 years, develops its particularities and describes the present literature.
Assuntos
Extração Obstétrica , Forceps Obstétrico , Gravidez , Feminino , Humanos , Colômbia , Parto Obstétrico , Instrumentos CirúrgicosRESUMO
BACKGROUND: A prolonged and complicated second stage of labour is associated with serious perinatal complications. The Odon device is an innovation intended to perform instrumental vaginal delivery presently under development. We present an evaluation of the feasibility and safety of delivery with early prototypes of this device from an early terminated clinical study. METHODS: Hospital-based, multi-phased, open-label, pilot clinical study with no control group in tertiary hospitals in Argentina and South Africa. Multiparous and nulliparous women, with uncomplicated singleton pregnancies, were enrolled during the third trimester of pregnancy. Delivery with Odon device was attempted under non-emergency conditions during the second stage of labour. The feasibility outcome was delivery with the Odon device defined as successful expulsion of the fetal head after one-time application of the device. RESULTS: Of the 49 women enrolled, the Odon device was inserted successfully in 46 (93%), and successful Odon device delivery as defined above was achieved in 35 (71%) women. Vaginal, first and second degree perineal tears occurred in 29 (59%) women. Four women had cervical tears. No third or fourth degree perineal tears were observed. All neonates were born alive and vigorous. No adverse maternal or infant outcomes were observed at 6-weeks follow-up for all dyads, and at 1 year for the first 30 dyads. CONCLUSIONS: Delivery using the Odon device is feasible. Observed genital tears could be due to the device or the process of delivery and assessment bias. Evaluating the effectiveness and safety of the further developed prototype of the BD Odon Device™ will require a randomized-controlled trial. TRIAL REGISTRATION: ANZCTR ACTRN12613000141741 Registered 06 February 2013. Retrospectively registered.
Assuntos
Extração Obstétrica/instrumentação , Adulto , Argentina , Colo do Útero/lesões , Extração Obstétrica/efeitos adversos , Extração Obstétrica/métodos , Feminino , Humanos , Períneo/lesões , Projetos Piloto , Gravidez , Resultado da Gravidez , Estudo de Prova de Conceito , África do SulRESUMO
OBJECTIVES: To establish the prevalence of external (EAS) and internal (IAS) anal sphincter defects present 15-24 years after childbirth according to mode of delivery, and their association with development of fecal incontinence (FI). The study additionally aimed to compare the proportion of women with obstetric anal sphincter injuries (OASIS) reported at delivery with the proportion of women with sphincter defect detected on ultrasound 15-24 years later. METHODS: This was a cross-sectional study including 563 women who delivered their first child between 1990 and 1997. Women responded to a validated questionnaire (Pelvic Floor Distress Inventory) in 2013-2014, from which the proportion of women with FI was recorded. Information about OASIS was obtained from the National Birth Registry. Study participants underwent four-dimensional transperineal ultrasound examination. Defect of EAS or IAS of ≥ 30° in at least four of six slices on tomographic ultrasound was considered a significant defect and was recorded. Four study groups were defined based on mode of delivery of the first child. Women who had delivered only by Cesarean section (CS) constituted the CS group. Women in the normal vaginal delivery (NVD) group had NVD of their first child and subsequent deliveries could be NVD or CS. The forceps delivery (FD) group included women who had FD, NVD or CS after FD of their first born. The vacuum delivery (VD) group included women who had VD, NVD or CS after VD of their first born. Multiple logistic regression was used to calculate adjusted odds ratios (aORs) for comparison of prevalence of an EAS defect following different modes of delivery and to test its association with FI. Fisher's exact test was used to calculate crude odds ratios (ORs) for IAS defects. RESULTS: Defects of EAS and IAS were found after NVD (n = 201) in 10% and 1% of cases, respectively, after FD (n = 144) in 32% and 7% of cases and after VD (n = 120) in 15% and 4% of cases. No defects were found after CS (n = 98). FD was associated with increased risk of EAS defect compared with NVD (aOR = 3.6; 95% CI, 2.0-6.6) and VD (aOR = 3.0; 95% CI, 1.6-5.6) and with increased risk of IAS defect compared with NVD (OR = 7.4; 95% CI, 1.5-70.5). The difference between VD and NVD was not significant for EAS or IAS. FI was reported in 18% of women with an EAS defect, in 29% with an IAS defect and in 8% without a sphincter defect. EAS and IAS defects were associated with increased risk of FI (aOR = 2.5 (95% CI, 1.3-4.9) and OR = 4.2 (95% CI, 1.1-13.5), respectively). Of the ultrasonographic sphincter defects, 80% were not reported as OASIS at first or subsequent deliveries. CONCLUSIONS: Anal sphincter defects visualized on transperineal ultrasound 15-24 years after first delivery were associated with FD and development of FI. Ultrasound revealed a high proportion of sphincter defects that were not recorded as OASIS at delivery. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Assuntos
Canal Anal/lesões , Extração Obstétrica/efeitos adversos , Incontinência Fecal/epidemiologia , Lacerações/epidemiologia , Adulto , Canal Anal/diagnóstico por imagem , Estudos Transversais , Extração Obstétrica/estatística & dados numéricos , Incontinência Fecal/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Prevalência , Fatores de Risco , Inquéritos e Questionários , Ultrassonografia/métodosRESUMO
ResumenLas prácticas del cuidado del embarazo y el parto varían ampliamente entre los países, las instituciones y los diferentes equipos encargados del cuidado obstétrico: en este contexto con prácticas tan diversas, la práctica clínica basada en la evidencia permite que el accionar de los profesionales encargados del cuidado obstétrico se fundamente en la mejor evidencia disponible. El objetivo del presente estudio es analizar la mejor evidencia científica disponible sobre los efectos adversos del uso del balón cervical durante y posterior a la labor de parto, en comparación con el uso de prostaglandinas endocervicales para la inducción del parto en mujeres con embarazo a término. La secuencia de etapas para la recolección de la información se inició con la aplicación del mapa de búsqueda en las bases de datos MEDLINE, PUBMED y COCHRANE LIBRARY, a partir de los siguientes criterios de filtro de información: artículos publicados entre los años 2010 al 2015, mujeres gestantes de cualquier edad, únicamente se incluyó estudios como ensayos aleatorizados controlados, revisiones sistemáticas, meta-análisis o guías de práctica clínica y de preferencia artículos científicos en idioma inglés o portugués. Esta búsqueda y análisis de la evidencia encontrada se realizó durante los meses de abril y mayo del año 2015 por dos revisores. Los resultados obtenidos para el análisis crítico fueron revisados minuciosamente a través de la plataforma informática FCL 2.0 con las plantillas de ensayo clínico y revisión sistemática incluidas en los anexos. Se concluye que la utilización del balón endocervical comparado con el uso de prostaglandinas endocervicales presenta menos efectos adversos de manera específica durante la labor del parto. En relación con los efectos adversos posteriores, no se encuentra mayor diferencia entre uno u otro método.
AbstractPregnancy and childbirth care practices vary widely across countries, institutions, and different obstetrical care teams: in this context with such diverse practices, evidence-based clinical practice allows the Obstetric care is based on the best available evidence. The objective of the present study is to analyze the best available scientific evidence on the adverse effects of cervical balloon use during and after labor, compared to the use of endocervical prostaglandins for induction of labor in women with term pregnancy. The sequence of steps for the collection of information was initiated with the application of the search map in the databases MEDLINE, PUBMED and COCHRANE LIBRARY, based on the following information filter criteria: articles published between the years 2010 to 2015, Pregnant women of any age, only included studies such as randomized controlled trials, systematic reviews, meta-analyzes or guidelines of clinical practice and preferably scientific papers in English or Portuguese. This search and analysis of the evidence found was carried out during the months of April and May of the year 2015 by two reviewers. The results obtained for the critical analysis were carefully reviewed through the FCL 2.0 computer platform with the clinical trial templates and systematic review included in the annexes. It is concluded that the use of the endocervical balloon compared to the use of endocervical prostaglandins presents less adverse effects specifically during labor. In relation to the subsequent adverse effects, no greater difference is found between one or the other method.
ResumoPráticas de cuidados a gravidez eo parto variam amplamente entre os países, instituições e diferentes equipas de cuidados obstétricos; neste contexto como práticas diversas, a prática clínica baseada em evidências permite que as ações dos profissionais responsáveis pela assistência obstétrica é baseada na melhor evidência disponível. O objetivo deste estudo é analisar a melhor evidência científica disponível sobre os efeitos adversos durante e após o parto com o uso de bola cervical em comparação com o uso de prostaglandina endocervical para indução do parto em mulheres com gravidez a termo. A sequência dos passos para a recolha de dados começa com a busca do mapa aplicação em Medline, PubMed e os dados Cochrane Library, onde os seguintes critérios de filtro de informação artigos introduzidos foram seleccionados publicação período entre 2010 e 2015, a população foi delimitada a mulheres grávidas de qualquer idade, digite apenas ensaios estudos clínicos randomizados, revisões sistemáticas, meta-análises ou diretrizes de prática clínica e artigos científicos de preferência em Inglês ou Português foram incluídos. Esta pesquisa e análise da evidência encontrada foi realizado durante os meses de Abril e Maio de 2015, dois colaboradores. Os resultados obtidos para a análise crítica foram cuidadosamente controlados através da plataforma FCL computador 2,0 modelos ensaio clínico e revisão sistemática estão incluídos nos anexos. Concluiu-se que o uso de bola endocervical em comparação com a utilização de prostaglandinas endocervicais tem menos efeitos adversos especificamente durante o trabalho de parto. Em ligação com os efeitos adversos subsequentes não é maior diferença entre qualquer um dos métodos.
Assuntos
Extração Obstétrica/instrumentação , Complicações do Trabalho de Parto , Trabalho de Parto Induzido , Enfermeiros ObstétricosRESUMO
Resumo Objetivo: Investigar associação entre analgesia farmacológica e desfechos do parto. Métodos: Estudo transversal que utilizou amostra representativa dos partos realizados em 2013, em uma maternidade de Belo Horizonte, Minas Gerais. Foram incluídos dados de 978 partos, excluindo-se as cesarianas eletivas. A exposição principal foi o uso de analgesia farmacológica durante o trabalho de parto e o desfecho classificado como parto vaginal, vaginal instrumentalizado e cesariana. Verificou-se a associação entre analgesia e os desfechos do parto por meio de regressão logística multinominal para obter as estimativas de Odds Ratio (OR) com seus respectivos intervalos de 95% de confiança, e o modelo final foi ajustado por idade da mulher, número de partos anteriores, presença de acompanhante ou doula e dilatação cervical no momento da analgesia. Resultados: Do total de nascimentos, 87,1% foram vaginais e 12,9% cesariana. A prevalência do uso de analgesia farmacológica foi 34,2% e do parto instrumentalizado de 8,4%. Cerca de 70% das mulheres tiveram gestação de risco habitual. Mesmo após ajuste por confundidores, o uso da analgesia aumentou em 3,5 vezes a chance de parto instrumentalizado (p<0,0001) e para as mulheres com gestação de alto risco esse aumento foi ainda superior (OR=4,62; p<0,0001). Não houve associação do uso da analgesia com a cesariana (p=0,320). Conclusão: O uso de analgesia farmacológica modifica o desfecho do parto, aumentando as chances de parto instrumentalizado, principalmente em mulheres com gravidez de alto risco. Nesse contexto considera-se importante orientar as mulheres quanto aos potenciais riscos e benefícios da analgesia para uma escolha segura.
Abstract Objective: To investigate the association between pharmacological analgesia and childbirth outcomes. Methods: A cross-sectional study using a representative sample of childbirth performed in 2013, at a maternity hospital in Belo Horizonte, Minas Gerais. Data from 978 childbirths were included, excluding elective cesareans. The main exposure was the use of pharmacological analgesia during labor, with the outcome classified as vaginal, instrumental vaginal, or cesarean delivery. The association between analgesia and childbirth outcomes was assessed using multinomial logistic regression to obtain Odds Ratio (OR) estimates with their respective 95% confidence intervals. The final model was adjusted for the woman's age, number of previous births, presence of companion or doula, and cervical dilatation at the time of analgesia. Results: Among the total number of births, 87.1% were vaginal and 12.9% were cesarean. The prevalence of the use of pharmacological analgesia was 34.2%, and delivery with instrumentation was 8.4%. About 70% of the women had a normal risk pregnancy. Even after adjusting for confounding variables, the use of analgesia increased the chance of delivery with instrumentation by 3.5 times (p<0.0001); for women with high-risk pregnancies, this increase was even higher (OR=4.62; p<0.0001). There was no association between analgesia and cesarean section (p=0.320). Conclusion: The use of pharmacological analgesia modifies the outcome of childbirth, increasing the chances of delivery with instrumentation, especially in women with high-risk pregnancies. In this context, it is important to guide women about the potential risks and benefits of analgesia so they may make a safe choice.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Adulto Jovem , Trabalho de Parto , Analgesia Obstétrica , Dor do Parto , Extração Obstétrica , Prontuários Médicos , Estudos TransversaisRESUMO
BACKGROUND: The most common cause of anal sphincter injuries in women is vaginal birth. Endo-anal ultrasound is currently used for the diagnosis of anal sphincter defect. However, due to the inconvenience caused, it is not an applicable technique during the immediate post-partum. The aim of this study was to determine whether transperineal ultrasound in 3/4D is a useful diagnostic method for the assessment of anal sphincter during the immediate post-partum. MATERIAL AND METHODS: A prospective study was conducted on the vaginal deliveries performed between September 2012 and June 2013 in the Valme University Hospital (Seville). Obstetric and foetal parameters that could influence the onset of perineal tears were studied. The patients underwent a transperineal 3/4D ultrasound and a multislice study (48hours after birth). RESULTS: The study included 146 puerperal women. The sphincter complex was assessed in all of them during the immediate post-partum. External anal injuries were observed in 10.3% of the cases. In 8.2% of cases, the primary suture of the external anal sphincter was detected during ultrasound examination, and 2.1% of asymptomatic lesions were diagnosed only with post-partum ultrasound. None of the patients reported discomfort or pain. CONCLUSIONS: The 3-dimensional transperineal ultrasound is helpful in determining the primary repair of the anal sphincter during the immediate post-partum, with no discomfort for patients, as well as for establishing those early sphincter injuries that go unnoticed during vaginal delivery.
Assuntos
Canal Anal/lesões , Parto Obstétrico/efeitos adversos , Imageamento Tridimensional/métodos , Períneo , Período Pós-Parto , Ultrassonografia/métodos , Adulto , Canal Anal/cirurgia , Doenças Assintomáticas , Extração Obstétrica/efeitos adversos , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Tomografia Computadorizada Multidetectores , Períneo/lesões , Gravidez , Estudos Prospectivos , Técnicas de Sutura , Técnicas de Fechamento de Ferimentos , Adulto JovemRESUMO
El cáncer de ovario presenta alta prevalencia con 238.719 casos reportados a nivel mundial, cuya mortalidad alcanza y supera el 50%, siendo la mayor causada por cáncer ginecológico.Objetivo: Describir las características de las pacientes diagnosticadas o tratadas por cáncer de ovario en el Servicio de Ginecología Oncológica del Hospital de San José en el periodo 2009-2013.Materiales y métodos. Serie de casos retrospectiva.Resultados: Se incluyeron 68 pacientes con edad promedio de 49 años (DE: 15,5, mínima: 14 y máxima: 82); 57,5% (n=39) fueron posmenopáusicas. El tipo histológico seroso papilar fue el más común en pre y menopáusicas. El 70,6% se diagnosticaron en estadios III-IV. Se logró citorreducción óptima (R1) o total (R0) en el 40,9%. Se administró quimioterapia adyuvante al 74,24%. La supervivencia libre de recurrencia fue de 63,23% y la supervivencia global de 54,41%.Conclusión. En nuestra población el cáncer de ovario se diagnosticó en edades más tempranas que lo reportado a nivel mundial. Coincidiendo con la literatura la histología más frecuente fue el seroso papilar, que se detectó en etapas avanzadas y con alta mortalidad...
Ovarian cancer has high prevalence, with 238,719 cases reported worldwide. The death rate is greater than 50%, and accounts for the most cancer deaths from gynaecological tumours.Objective: To describe the features of patients diagnosed or treated for ovarian cancer at the Oncological Gynaecology Department of the Hospital de San José during the period 2009-2013.Materials and methods. A retrospective case series.Results: A total of 68 patients were included, with a mean age of 49 years (SD 15.5: range: 14 - 82), of whom 39 (57.5%) were post-menopausal. Serous papillary tumours were the most common histology in pre- and menopausal patients, with 70.6% being diagnosed in stages III-IV. Optimal cytoreduction (R1) or total cytoreduction (R0) was achieved in 40.9%. Adjuvant chemotherapy was administered to 74.24%. Tumour-free survival rate was 63.23%, and overall survival rate was 54.41%.Conclusion: In our population, ovarian cancer is diagnosed at a more early age than that reported in the world literature. Coinciding with the literature, the serous papillary histotype in advanced stages is the most frequently detected type with a high mortality rate...
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Ovarianas , Recidiva , Extração Obstétrica , MortalidadeRESUMO
OBJECTIVE: We aimed to determine whether a threshold number of forceps deliveries in residency predicts use of forceps in independent practice. STUDY DESIGN: We surveyed obstetrics and gynecology residency graduates of 2 academic programs from 2008 through 2012 regarding the use of operative vaginal delivery in practice. At these programs, residents are trained in both forceps and vacuums. Individual case log data were obtained with the number of forceps deliveries performed by each respondent during residency. Respondents were grouped as currently using any forceps or vacuums alone. A logistic regression model estimated the probability of forceps use, predicted by the number of residency forceps deliveries. From the resulting receiver-operating characteristic curve, we assessed sensitivity, specificity, positive predictive value, and area under the curve. RESULTS: The response rate was 85% (n = 58) and 90% (n = 52) practice obstetrics. Seventy-nine percent (n = 41) use forceps in practice. The mean number of forceps performed during residency was 22.3 ± 1.3 (mean ± SE) in the any-forceps group and 18.5 ± 2.1 in the vacuums-only group (P = .14). Although the model performed only moderately (area under the curve, 0.61, 95% confidence interval [CI], 0.42-0.81), more than 13 residency forceps deliveries corresponded to a 95% sensitivity (95% CI, 84-99) and a positive predictive value of 83% (95% CI, 69-92) for using forceps in practice. The specificity of this threshold is 27% (95% CI, 6-61). CONCLUSION: Although exceeding 13 forceps deliveries made it highly likely that obstetricians would use them in practice, further study is necessary to set goals for a number of resident forceps deliveries that translate into use in practice.
Assuntos
Extração Obstétrica/estatística & dados numéricos , Internato e Residência , Obstetrícia/educação , Adulto , Feminino , Humanos , Modelos Logísticos , Masculino , Forceps Obstétrico , Gravidez , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: The objective of the study was to define maternal tissue adaptations in pregnancy associated with uncomplicated spontaneous vaginal delivery using anatomical and biological outcomes. STUDY DESIGN: Nulliparous gravidas were prospectively enrolled in the first trimester at 2 institutions. Demographic and delivery data were chart abstracted. Vaginal elastase activity (units per milligram of protein) and Pelvic Organ Prolapse Quantification measurements of pelvic organ support were obtained in the first and third trimesters. A subset underwent 3-dimensional ultrasound measures of levator hiatus. Uncomplicated spontaneous vaginal delivery (VD) was defined as no cesarean, forceps, vacuum, shoulder dystocia, third- or fourth-degree perineal laceration, or prolonged second stage labor. RESULTS: We enrolled 173 women in their first trimester, 50 of whom had ultrasounds. Mean age was 25.5 ± 5.5 years with a body mass index of 28.0 ± 7.3 kg/m(2). Sixty-seven percent were white/Caucasian, 27% black/African American, and 6% Hispanic/Latina. Mean delivery gestational age was 38.5 ± 2.9 weeks, with 23% delivering by cesarean and 59% achieving uncomplicated spontaneous VD. Vaginal support changed significantly over trimesters with posterior vaginal and hiatal relaxation, vaginal lengthening, and increased levator hiatus area during strain. Women achieving uncomplicated spontaneous VD demonstrated significantly greater relaxation on third-trimester Pelvic Organ Prolapse Quantification for anterior, apical, and hiatal measures than those without uncomplicated spontaneous VD. Higher first-trimester vaginal elastase activity was strongly associated with uncomplicated spontaneous VD (geometric mean activity 0.289 ± 0.830 U/mg vs -0.029 ± 0.585 U/mg, P = .009). Higher first-trimester elastase, younger age, lower first-trimester body mass index, and more third-trimester vaginal support laxity in points C and GH were predictive of VD success. CONCLUSION: Significant maternal adaptations occur in the vagina during pregnancy, presumably in preparation for vaginal delivery. Greater adaptation, including vaginal descent and higher first-trimester elastase activity, is associated with an increased likelihood of uncomplicated spontaneous VD.
Assuntos
Adaptação Fisiológica/fisiologia , Parto Obstétrico/estatística & dados numéricos , Parto/fisiologia , Diafragma da Pelve/fisiologia , Gravidez/fisiologia , Vagina/fisiologia , Adulto , Cesárea/estatística & dados numéricos , Extração Obstétrica/estatística & dados numéricos , Feminino , Humanos , Imageamento Tridimensional , Elastase Pancreática/metabolismo , Diafragma da Pelve/diagnóstico por imagem , Primeiro Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Ultrassonografia , Vagina/diagnóstico por imagem , Vagina/metabolismo , Adulto JovemRESUMO
BACKGROUND: Intrapartum complications are responsible for approximately half of all maternal deaths, and two million stillbirth and neonatal deaths per year. Prolonged second stage of labour is associated with potentially fatal maternal complications such as haemorrhage and infection and it is a major cause of stillbirth and newborn morbidity and mortality. Currently, the three main options for managing prolonged second stage of labour are forceps, vacuum extractor and caesarean section. All three clinical practices require relatively expensive equipment (e.g., a surgical theatre for caesarean section) and/or highly trained staff which are often not available in low resource settings. The specific aim of the proposed study is to test the safety and feasibility of a new device (Odón device) to effectively deliver the fetus during prolonged second stage of labour. The Odón device is a low-cost technological innovation to facilitate operative vaginal delivery and designed to minimize trauma to the mother and baby. These features combined make it a potentially revolutionary development in obstetrics, particularly for improving intrapartum care and reducing maternal and perinatal morbidity and mortality in low resource settings. METHODS/DESIGN: This will be a hospital-based, multicenter prospective phase 1 cohort study with no control group. Delivery with the Odón device will be attempted under normal labour and non-emergency conditions on all the women enrolled in the study. One-hundred and thirty pregnant women will be recruited in tertiary care facilities in Argentina. Safety will be assessed by examining maternal and infant outcomes until discharge. Feasibility will be evaluated by observing successful expulsion of the fetal head after one-time application of the device under standardized conditions (full cervical dilation, anterior presentation, +2 station, normal fetal heart rate). TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR). Identifier: ACTRN12613000141741.
Assuntos
Segurança de Equipamentos , Extração Obstétrica/instrumentação , Adulto , Argentina , Estudos de Coortes , Extração Obstétrica/métodos , Estudos de Viabilidade , Feminino , Humanos , Trabalho de Parto , Gravidez , Instrumentos CirúrgicosRESUMO
OBJECTIVE: To assess the efficacy of paracetamol (acetaminophen) for neonatal pain relief. STUDY DESIGN: Randomized, double-blind placebo-controlled trial in 3 Swiss university hospitals. Term and near-term infants (n = 123) delivered by forceps or vacuum were randomized to receive 2 suppositories with paracetamol (60/80/100 mg in infants <3000 g/3000-4000 g/>4000 g birth weight) or placebo at 2 and 8 hours of life. Pain and discomfort during the first 24 hours was assessed by the échelle de douleur et d'inconfort du nouveau né [neonatal pain and discomfort scale] score. The response to the subsequent heel prick for metabolic screening at days 2-3 of life was investigated by the Bernese Pain Scale for Neonates (BPSN). RESULTS: The échelle de douleur et d'inconfort du nouveau né [neonatal pain and discomfort scale] pain scale ratings after assisted vaginal delivery were low and declined within 4 hours of life (P < .01) irrespective of paracetamol administration. At 2-3 days of life, BPSN scores after heel prick were significantly higher in infants who had received paracetamol, compared with controls, both when BPSN were scored by nurses at the bedside (median [IQR] 4 [2-7] vs 2 [0-5], P = .017) or off-site from videos (4 [2-8] vs 2 [1-7], P = .04). Thirty-five of 62 (57%) infants treated with paracetamol cried after heel prick, compared with 25 of 61 (41%) controls (P = .086). CONCLUSIONS: Infants born by assisted vaginal delivery have low pain scores in the immediate period after birth. Paracetamol given to newborns soon after birth may aggravate a subsequent stress response.
Assuntos
Acetaminofen/administração & dosagem , Acetaminofen/efeitos adversos , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/efeitos adversos , Hiperalgesia/induzido quimicamente , Dor/tratamento farmacológico , Administração Retal , Método Duplo-Cego , Extração Obstétrica/efeitos adversos , Feminino , Humanos , Recém-Nascido , Masculino , Dor/etiologia , Medição da Dor , Estudos ProspectivosAssuntos
Extração Obstétrica/história , Forceps Obstétrico/história , Analgesia Obstétrica/métodos , Procedimentos Cirúrgicos Eletivos/história , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Episiotomia/história , Episiotomia/estatística & dados numéricos , Desenho de Equipamento , Extração Obstétrica/estatística & dados numéricos , Feminino , História do Século XX , Humanos , Recém-Nascido , Mortalidade Materna/tendências , México/epidemiologia , Forceps Obstétrico/estatística & dados numéricos , Mortalidade Perinatal/tendências , Gravidez , Resultado da GravidezAssuntos
Parto Obstétrico/história , Distocia/história , Apresentação no Trabalho de Parto , Aborto Induzido/história , Traumatismos do Nascimento/etiologia , Traumatismos do Nascimento/prevenção & controle , Cesárea/história , Parto Obstétrico/métodos , Distocia/etiologia , Distocia/terapia , Emergências , Desenho de Equipamento , Extração Obstétrica/história , Feminino , História do Século XX , Humanos , Recém-Nascido , Morte Materna/história , Forceps Obstétrico/história , Ocitócicos/administração & dosagem , Gravidez , Natimorto , Versão Fetal/históriaRESUMO
A solução do parto no período expulsivo é um desafio, ainda nos dias de hoje. Apesar de ser praticado em cerca de 10% dos partos no mundo ocidental, há discussões sobre as indicações do parto vaginal operatório, a escolha do instrumento e sua aplicação sequenciada. Foi feita revisão da literatura, que se mostrou pobre em ensaios clínicos. A evidência maior do uso do fórceps repousou em estudos observacionais, muito dos quais com tamanho amostral limitado. Também, foram consultadas as diretrizes de algumas sociedades (ACOG, SOGC, RCOG e FEBRASGO) para as recomendações. Concluiu-se que ainda há necessidade da prática do fórceps, mas que esse ato deve ser realizado por obstetra experiente e em ambiente que permita a prática da cesárea. As indicações fetais para parto a fórceps são a parada de progressão e o sofrimento fetal, e as indicações maternas são aquelas em que o esforço expulsivo é fator de risco para complicações (cardiopatias, pneumopatias, encefalopatias). A falha do fórceps ou do vácuo é indicação para cesárea, não sendo recomendado o seu uso sequenciado. Foi verificado que há necessidade de programas de treinamento na prática do fórceps.
The solution of second stage of childbirth is still a challenge. Despite being practiced in 10% of births in the Western world, there are discussions about the indications for operative vaginal deliveries, choice of instrument and its application. Literature review was conducted, which proved to be poor in clinical trials. The best evidence rested in observational studies, many of which with limited sample size. Some guidelines were consulted (ACOG, SOGC, RCOG and FEBRASGO) for recommendations. It was concluded that there is still need for the practice of forceps, but this surgery must be performed by experienced obstetrician and in an environment that allow the practice of caesarean section. Fetal indications for forceps deliveries are lack of progression in the second stage and fetal distress. Maternal indications are those in which the expulsive effort is risk factor for complications (heart, lung or cerebral diseases). The failure of the forceps or vacuum is indication of caesarean section, not being recommended its use in sequence. There is a need for training programs in the practice of forceps.
Assuntos
Humanos , Feminino , Gravidez , Cesárea , Extração Obstétrica/instrumentação , Extração Obstétrica/métodos , Sofrimento Fetal , Forceps Obstétrico , Segunda Fase do Trabalho de Parto , Complicações do Trabalho de Parto , Parto Obstétrico/instrumentaçãoRESUMO
Ankylosis of the temporomandibular joint following forceps delivery is a rare anomaly. The aetiopathogenesis involves wrongful application of the forceps or forceful closure of the forceps handle against the condyle with haemathrosis, organisation and subsequent ankylosis. Because of the lack of epidemiological data, there is little information about the true incidence and the management of this rare anomaly. The purpose of this presentation is to report the challenges encountered in the airway management of a six-year old female with right temporomandibular joint ankylosis following forceps delivery in a private hospital setting.
Assuntos
Manuseio das Vias Aéreas/métodos , Anquilose/cirurgia , Extração Obstétrica/efeitos adversos , Transtornos da Articulação Temporomandibular/cirurgia , Anquilose/etiologia , Criança , Feminino , Humanos , Côndilo Mandibular/lesões , Transtornos da Articulação Temporomandibular/etiologiaRESUMO
Ankylosis of the temporomandibular joint following forceps delivery is a rare anomaly. The aetiopathogenesis involves wrongful application of the forceps or forceful closure of the forceps handle against the condyle with haemathrosis, organisation and subsequent ankylosis. Because of the lack of epidemiological data, there is little information about the true incidence and the management of this rare anomaly. The purpose ofthis presentation is to report the challenges encountered in the airway management of a six-year old female with right temporomandibular joint ankylosis following forceps delivery in a private hospital setting.
La anquilosis de la articulacion temporomandibular tras el uso de forceps siguientes es una rara anomalia. La etiopatogenesis implica la aplicacion indebida de los forceps o el cierre forzoso del mango de los forceps contra el condilo con hemartrosis, organizacion y subsiguiente anquilosis. Debido a lafalta de datos epidemiologicos, hay poca informacion acerca de la verdadera incidencia y el tratamiento de esta rara anomalia. El objetivo de esta presentacion es informar los problemas encontrados en el tratamiento de las vias respiratorias de una niha de seis ahos con anquilosis de la articulacion temporomandibular derecha tras de un parto con forceps en el contexto de un hospital privado.
Assuntos
Criança , Feminino , Humanos , Manuseio das Vias Aéreas/métodos , Anquilose/cirurgia , Extração Obstétrica/efeitos adversos , Transtornos da Articulação Temporomandibular/cirurgia , Anquilose/etiologia , Côndilo Mandibular/lesões , Transtornos da Articulação Temporomandibular/etiologiaRESUMO
A conduta ideal a ser adotada no segundo período do trabalho de parto deveria se basear no balanço entre a probabilidade de um parto vaginal, que deve ser maximizada, contra os riscos maternos e perinatais, que devem ser minimizados. Entretanto, ainda não existe consenso sobre o manejo do período expulsivo, a começar por sua definição e os limites estabelecidos para sua duração. Realizou-se uma revisão da literatura em busca das melhores evidências disponíveis sobre a assistência ao trabalho de parto. Foram abordados aspectos como duração do período expulsivo, posição e puxos das pacientes, monitorização fetal, necessidade de episiotomia, manobras para redução do trauma perineal, parto instrumental, acolhimento do recém-nascido e ligadura do cordão umbilical. Também foi abordada a conduta no terceiro e quarto períodos. Não há evidências suficientes para delimitar a duração ideal do período expulsivo; porém, há guidelines, como os do American College of Obstetricians and Gynecologists (ACOG), que estabelecem limites de acordo com a paridade e a utilização ou não de analgesia. Posições não supinas devem ser priorizadas durante o segundo estágio, respeitando-se a preferência das parturientes. A monitorização da frequência cardíaca fetal deve ser intermitente, reservando-se a monitorização contínua para casos especiais. O uso rotineiro de cardiotocografia intraparto associa-se com o aumento das indicações de cesariana. A episiotomia não deve ser realizada de rotina, documentando-se diversos benefícios quando o procedimento pode ser evitado: menos perda sanguínea, menor uso de suturas, menos dor e menos complicações perineais. O parto instrumental só está indicado em situações especiais, e a decisão por vácuo ou fórceps deve considerar potenciais vantagens e desvantagens, habilidade do operador e opinião da parturiente. O contato precoce pele a pele entre mãe e bebê deve ser estimulado, e o cordão umbilical deve ser ligado tardiamente...
The ideal management of the second stage of labor should be based in the balance between the vaginal delivery probability, which should be maximized, against the maternal and perinatal risks, which should be minimized. Notwithstanding, there is no consensus about second stage management, beginning with its definition and the limits for its duration. A literature review was conducted in search of the best available evidence about labor and delivery management. Several aspects were analyzed, such as maternal position, pushing, fetal monitoring, episiotomy, perineal protection, instrumental delivery, neonatal care and cord clamping. The third and fourth stages management was also considered. There is not enough evidence to establish the ideal duration of the second stage of labor, but American College of Obstetricians and Gynecologists (ACOG) guidelines suggest limits according to parity and analgesia utilization. Nonsupine positions should be considered according to the woman's preference. Fetal heart rate monitoring should be intermittent, and continuous monitoring should be used only in special conditions. Routine use of intrapartum cardiotocography is associated with the increased rate of cesarean sections. The episiotomy should not be routinely performed, and several benefits are documented when this procedure can be avoided: reduced blood loss, fewer sutures, less pain and fewer perineal complications. Instrumental delivery is indicated only in special conditions, and the decision for forceps or vacuum should take into account potential advantages and disadvantages, the operator's skills and the woman's opinion. Early skin contact between mother and baby should be encouraged and late cord clamping should be performed. The safest and most effective recommendation for the third stage management is routine use of oxytocin for preventing postpartum hemorrhage.