Navegando por Palavras-chave "Episiotomia"
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- ItemAcesso aberto (Open Access)Aplicabilidade de um algoritmo de apoio à decisão no processo de avaliação perineal na assistência ao parto(Universidade Federal de São Paulo (UNIFESP), 2020-07-30) Cesar, Monica Bimbatti Nogueira [UNIFESP]; Barbieri, Marcia [UNIFESP]; Gabrielloni, Maria Cristina; http://lattes.cnpq.br/6036198226664377; http://lattes.cnpq.br/9352140129630269; http://lattes.cnpq.br/9217981072607049; Universidade Federal de São PauloIntroduction: Among childbirth’s care actions and procedures, two topics are debatable: the perineal evaluation and the decision to either preserve the perineum intact or to perform an episiotomy. There is a lack of evidence-based methods and decision criteria, potentially leading to professional distress regarding maternal practice, besides morbidity due to lacerations in the vaginal canal and perineal region. The use of algorithms, implemented via decision support computer systems (DSS), can standardize evaluations involving multiple variables and suggest a course of action aligned to assistance assurance and to scientific evidence. Objective: To evaluate the applicability of an algorithm to support conscious and safe decisions about maintaining or not perineal integrity in childbirth care. Materials and method: Applied research of technological development. Relevant information acquired in the literature led to the initial algorithm design, which senior healthcare professionals reviewed and validated. In order to evaluate its applicability on the field, this algorithm based the writing of an online mobile decision support system (DSS) prototype. After approval by the Research Ethics Committee, a pilot test took place: obstetric nurses of a public hospital in São Paulo made use of the algorithm in the form of the mobile DSS prototype for two months to support their decisions during 305 vaginal births. Nurses filled out assessment forms about the applicability of DSS. Results: Ten out of twelve study participating professionals declared they would certainly recommend DSS use during perineal evaluation to fellow nurses. Two declared being uncertain about its usage. The study’s data show concordance between DSS suggested procedure and professional’s decision in 93.1% of deliveries. When professionals decided to follow DSS's recommendation, results were favorable to mothers: unfavorable cases, like 2nd or 3rd-degree postpartum laceration, remained as low as 13.4%. Contrarily, when professionals decided not to follow DSS recommendations, such unfavorable cases’ frequency raised to 28.6%. Regarding newborn unfavorable scenarios, like 5-minute Apgar score scoring less than 7, when professionals decided to follow DSS’ recommendations incidence remained as low as 0.4%. That rate raised to 9.5% when professionals did not follow the system’s recommendations. There is a correlation between conduct divergence and number of adverse events (p = 0.001): when DSS recommendation was followed by participating professionals, the incidence of adverse events topped 33.3%. On the other hand, when participants’ actions diverged from DSS recommendation, incidence raised to 66.7%. Thus, it is clear adverse events incidence tends to be lower when DSS recommendations are followed. Conclusion: The proposed Algorithm, implemented as a mobile DSS prototype for perineal assessment, proved to be an applicable and useful tool to guide professionals during delivery care. We believe the continuity of this study may lead to significant improvement and utility of the algorithm and its implementations through more elaborated Decision Support Systems.
- ItemSomente MetadadadosEfeito do tipo de parto vaginal sobre a perda hemática em mulheres(Universidade Federal de São Paulo (UNIFESP), 2010) Armellini, Claudia Junqueira [UNIFESP]; Schirmer, Janine [UNIFESP]
- ItemAcesso aberto (Open Access)Efeito do tipo de parto vaginal sobre a perda hemática em mulheres(Universidade Federal de São Paulo (UNIFESP), 2010-04-28) Armellini, Cláudia Junqueira [UNIFESP]; Schirmer, Janine [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: analyze the prevalence of anemia during pregnancy and its incidence on the postpartum period, as well as the effect of vaginal birth (spontaneous with episiotomy, spontaneous without episiotomy, and forceps with epsiotomy) on the variation of hemoglobin and hematocrit levels after birth. Method: It is an epidemiological, prospective and observational study, developed in two maternities in the city of São Paulo/Brazil, from June 15, 2008 to October 16, 2009. The sample was of 328 primiparous women, who gave birth at term to a single live baby in cephalic presentation, and had at least three prenatal visits registered on the pregnancy card. The data collection was done in three phases: admission, hospital discharge and puerperal evaluation; through a semi-structured form and the collection of venous blood samples. To diagnose anemia, hemoglobin levels were measured; to analyze the effect of the birth procedure on the blood loss, hemoglobin levels and hematocrit concentration were measured. In the data analysis, Student´s t-test, Chi-square test, and Proportion Analysis test were used, according to each variable group studied. The confidence interval was of 95%. Results: The prevalence of anemia was of 4% at admission, with an incidence of 67.4% at hospital discharge, and 5.8% at puerperal evaluation. Forceps with episiotomy deliveries have caused a significant higher hemoglobin decrease between the admission and hospital discharge phases, when compared to spontaneous births with or without episiotomy. Spontaneous deliveries with episiotomy led to a significant higher hemoglobin value reduction between the phases of admission and hospital discharge, when compared to spontaneous deliveries without episiotomy. Spontaneous deliveries without episiotomy resulted in a significantly higher hemoglobin raise between the phases of puerperal evaluation and hospital discharge, when compared to forceps with episiotomy and spontaneous deliveries with episiotomy. Conclusion: Anemia percentage has varied, raising between the admission and hospital discharge phases; and dropping between hospital discharge and puerperal evaluation. Forceps with episiotomy deliveries and spontaneous deliveries with episiotomy, led to higher blood loss, when compared to spontaneous deliveries without episiotomy. Therefore, it is relevant to evaluate blood loss due to birth, considering the early diagnose and treatment of maternal morbidity, especially, of anemia.
- ItemSomente MetadadadosEstudo randomizado controlado entre as posições de parto: litotomica e lateral-esquerda(Universidade Federal de São Paulo (UNIFESP), 2001) Basile, Anatalia Lopes de Oliveira [UNIFESP]; Schirmer, Janine [UNIFESP]A assistencia ao parto e nascimento no Brasil tem se caracterizado por intervencoes rotineiras que exclui a mulher do processo. Com intuito de devolver a mulher seu papel de protagonista implantou-se um Centro de Parto Normal com filosofia humanista, baseado nas recomendacoes da OMS, para atencao ao Parto. O estudo teve por objetivo: caracterizar as mulheres primigestas, segundo variaveis socio-demograficas; avaliar a frequencia de episiotomia no parto normal realizado por enfermeira obstetra em centro de parto normal (CPN) nas posicoes litotomica (LT) e lateral esquerda (LE); comparar a presenca de traumatismo perineal; e comparar as condicoes neonatais dos recem-nascidos nas duas posicoes de parto. Trata-se estudo clinico prospectivo e randomizado sobre utilizacao da posicao LT e LE na assistencia ao parto normal sem distocia realizado em CPN do Hospital Geral de Itapecerica de Serra, São Paulo, durante o 2º semestre de 1999 e 1º de 2000. A amostra estudada foi de 104 primigestas de termo que concordaram a participar do estudo. A selecao por sorteio foi realizado no final do 1º periodo clinico do parto, sendo 53 na posicao LT e 51 LE. Os dados foram colhidos a partir de formulario com perguntas fechadas incluindo variaveis socio-demograficas, praticas assistencias orientadas pela equipe de Saúde, evolucao do 1º periodo clinico do parto, posicao de parto, parto e nascimento e condicoes neonatais. Os resultados mostram que 51,9 por cento eram adolescentes, 42,6 por cento concluindo ensino fundamental, 61,5 por cento de cor branca e 77,9 por cento desempregadas. As parturientes aceitaram em mais de 90 por cento a orientacao para deambular, tomar banhos prolongados de chuveiro, realizar exercicio respiratorios, receber massagem, ingerir liquidos, manifestar as eliminacoes vesicais espontaneas, e ter ao lado o acompanhante (companheiro ou familiar). Na posicao LE houve reducao significante do traumatismo perineal (p=0,007 RR 1,33 (1,07-1,65). A episiotomia foi utilizada em 33,6 por cento das primigestas, sendo que na posicao LE foi de 6,7 por cento (RR 3,849 (1,848 -8,016) p> 0,001. As principais indicacoes da episiotomia foram reunidas como outras, 26,9 por cento (perineo posterior <3 cm, expulsivo prolongado, bossa sero-sanguinea, edema vulvar, parada de progressao, presenca de hemorroidas, distensibilidade restrita, ansiedade do profissional e meconio fluido. O local dos traumas perneais mais frequente foi furcula do perine...(au)
- ItemAcesso aberto (Open Access)Mensuração e caracterização da dor após episiotomia e sua relação com a limitação de atividades(Associação Brasileira de Enfermagem, 2012-04-01) Beleza, Ana Carolina Sartorato [UNIFESP]; Ferreira, Cristine Homsi Jorge; Sousa, Ligia De; Nakano, Ana Márcia Spanó; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)This is a descriptive study, involving fifty women after vaginal delivery with episiotomy. The study aimed to measure and to characterize the perineal pain in primiparae who have had a natural childbirth with episiotomy and to verify the activities limited by the perineal pain. For evaluation of perineal pain, a Numeric Scale and the McGill Pain Questionnaire were used, as well as another questionnaire to analyze the activities limited. In the Numeric Scale, the median of perineal pain referred were five. The sensory and subjective evaluation categories were the most selected in the McGill questionnaire. The perineal pain was characterized as pulsing, pulling, hot, stinging, hurting, annoying, troublesome, tight and tense. The most limited activities were sitting, laying down (onto the bed), and walking. In conclusion, it was possible to verify the presence of perineal pain between women in the postpartum period caused by episiotomy and identify the activities of sitting, lying down and walking were limited for this symptom.
- ItemSomente MetadadadosPrematuridade(Universidade Federal de São Paulo (UNIFESP), 2007) Rabello, Miriam Siqueira do Carmo [UNIFESP]