Sexual Life And Dysfunction After Maternal Morbidity: A Systematic Review.

Because there is a lack of knowledge on the long-term consequences of maternal morbidity/near miss episodes on women´s sexual life and function we conducted a systematic review with the purpose of identifying the available evidence on any sexual impairment associated with complications from pregnancy and childbirth. Systematic review on aspects of women sexual life after any maternal morbidity and/or maternal near miss, during different time periods after delivery. The search was carried out until May 22(nd), 2015 including studies published from 1995 to 2015. No language or study design restrictions were applied. Maternal morbidity as exposure was split into general or severe/near miss. Female sexual outcomes evaluated were dyspareunia, Female Sexual Function Index (FSFI) scores and time to resume sexual activity after childbirth. Qualitative syntheses for outcomes were provided whenever possible. A total of 2,573 studies were initially identified, and 14 were included for analysis after standard selection procedures for systematic review. General morbidity was mainly related to major perineal injury (3(rd) or 4(th) degree laceration, 12 studies). A clear pattern for severity evaluation of maternal morbidity could not be distinguished, unless when a maternal near miss concept was used. Women experiencing maternal morbidity had more frequently dyspareunia and resumed sexual activity later, when compared to women without morbidity. There were no differences in FSFI scores between groups. Meta-analysis could not be performed, since included studies were too heterogeneous regarding study design, evaluation of exposure and/or outcome and time span. Investigation of long-term repercussions on women's sexual life aspects after maternal morbidity has been scarcely performed, however indicating worse outcomes for those experiencing morbidity. Further standardized evaluation of these conditions among maternal morbidity survivors may provide relevant information for clinical follow-up and reproductive planning for women.1530

Sexual life and dysfunction after maternal morbidity: a systematic review.

BACKGROUND: Because there is a lack of knowledge on the long-term consequences of maternal morbidity/near miss episodes on women's sexual life and function we conducted a systematic review with the purpose of identifying the available evidence on any sexual impairment associated with complications from pregnancy and childbirth. METHODS: Systematic review on aspects of women sexual life after any maternal morbidity and/or maternal near miss, during different time periods after delivery. The search was carried out until May 22(nd), 2015 including studies published from 1995 to 2015. No language or study design restrictions were applied. Maternal morbidity as exposure was split into general or severe/near miss. Female sexual outcomes evaluated were dyspareunia, Female Sexual Function Index (FSFI) scores and time to resume sexual activity after childbirth. Qualitative syntheses for outcomes were provided whenever possible. RESULTS: A total of 2,573 studies were initially identified, and 14 were included for analysis after standard selection procedures for systematic review. General morbidity was mainly related to major perineal injury (3(rd) or 4(th) degree laceration, 12 studies). A clear pattern for severity evaluation of maternal morbidity could not be distinguished, unless when a maternal near miss concept was used. Women experiencing maternal morbidity had more frequently dyspareunia and resumed sexual activity later, when compared to women without morbidity. There were no differences in FSFI scores between groups. Meta-analysis could not be performed, since included studies were too heterogeneous regarding study design, evaluation of exposure and/or outcome and time span. CONCLUSION: Investigation of long-term repercussions on women's sexual life aspects after maternal morbidity has been scarcely performed, however indicating worse outcomes for those experiencing morbidity. Further standardized evaluation of these conditions among maternal morbidity survivors may provide relevant information for clinical follow-up and reproductive planning for women

Does severe maternal morbidity affect female sexual activity and function? Evidence from a brazilian cohort study

To assess Female Sexual Function Index (FSFI) scores and delay to resume sexual activity associated with a previous severe maternal morbidity. This was a multidimensional retrospective cohort study. Women who gave birth at a Brazilian tertiary maternity between 2008 and 2012 were included, with data extraction from the hospital information system. Those with potentially life-threatening conditions and maternal near miss episodes (severe maternal morbidity) were considered the exposed group. The control group was a random sample of women who had had uncomplicated pregnancy. Female sexual function was evaluated through FSFI questionnaire, and general and reproductive aspects were addressed through specific questions. Statistical analyses were performed using Mann-Whitney and Pearson's Chi-square for bivariate analyses. Logistic regression was used to identify variables independently associated with lower FSFI scores. 638 women were included (315 at exposed and 323 at not exposed groups). The majority of women were under 30 years-old in the control group and between 30 and 46 years-old in the exposed group (p = 0.003). Women who experienced severe maternal morbidity (SMM) had statistically significant differences regarding cesarean section (82.4% versus 47.1% among deliveries without complications, p< 0.001), and some previous pathological conditions. FSFI mean scores were similar among groups ranging from 24.39 to 24.42. It took longer for exposed women to resume sexual activity after index pregnancy (mean 84 days after SMM and 65 days for control group, p = 0.01). Multiple analyses showed no significant association of FSFI below cut-off value with any predictor. FSFI scores were not different in both groups. However, they were lower than expected. SMM delayed resumption of sexual activity after delivery, beyond postpartum period. However, the proportion of women in both groups having sex at 3 months after delivery was similar. Altered sexual response may be evaluated as one of possible long-term consequences after SMM episodes. Further studies on the growing population of women surviving severe maternal conditions might be worth for improvement of care for women1012CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQ471142/2011-

Dialogue on Childbirth with Family Health Teams during Prenatal Care:A Communicative Study

12 PáginasO diálogo entre gestantes e profissionais de saúde sobre parto pode ser uma importante ferramenta para mudanças na prática de cesáreas no Brasil. Entretanto, a priorização desse tema no pré-natal e a forma como ele é abordado estão diretamente relacionadas à sua valorização e às dificuldades de abordagem. Objetivos: analisar, junto com equipes de saúde da família, os elementos que dificultam a abordagem do parto no pré-natal. Materiais e método: pesquisa qualitativa, que utilizou a metodologia comunicativa para identificar elementos facilitadores e dificultadores para o exercício de uma prática ou benefício. Foram realizados grupos de discussão comunica-tivos com as equipes, entre 2013 e 2014. Resultados: os elementos dificultadores perpassam a formação profissional, o processo e as condições de trabalho nas unidades, que interferem nas atividades educativas, na falta de articulação entre a atenção básica e a hospi-talar, e nas próprias vivências pessoais dos profissionais com o tema, aspectos que influenciam negativamente a abordagem do parto. Conclusões: é necessário investimento na qualificação dos profissionais nas questões referentes ao parto, com espaços de diálogo que permitam explorar as possibilidades de superação das dificuldades institucionais e expressar suas próprias vivências, a fim de desfazer mitos e crenças em relação ao parto.El diálogo entre gestantes y profesionales de la salud acerca del parto puede ser una importante herramienta para cambios en la práctica de cesarianas en Brasil. Sin embargo, la priorización del tema en el prenatal y la forma como este es abordado están directamente relacionadas a su valoración y a dificultades de enfoque. Objetivos: analizar, junto con equipos de salud de la familia, los elementos que dificultan el abordaje del parto en prenatal. Materiales y método: investigación cualitativa, que utilizó la metodología comunicativa para identificar elementos facilitadores y dificultadores para el ejercicio de una práctica o beneficio. Se realizaron grupos de discusión comunicativos con los equipos, entre el 2013 y el 2014. Resultados: los elementos dificultadores permean la formación profesional, el proceso y las condiciones de trabajo en las unidades, e interfieren en las actividades educacionales, en la falta de articulación entre la atención básica y la hospitalaria, y en las propias vivencias personales de los profesionales con el tema, aspectos que influencian negativamente el abordaje del parto. Conclusiones: se necesita inversión en la capacitación de los profesionales en cuestiones referentes al tema, con espacios de diálogo que permitan explorar las posibilidades de superación de dificultades institucionales y expresar sus propias vivencias, con el fin de deshacer mitos y creencias en relación con el parto

Does Severe Maternal Morbidity Affect Female Sexual Activity and Function? Evidence from a Brazilian Cohort Study.

to assess Female Sexual Function Index (FSFI) scores and delay to resume sexual activity associated with a previous severe maternal morbidity.This was a multidimensional retrospective cohort study. Women who gave birth at a Brazilian tertiary maternity between 2008 and 2012 were included, with data extraction from the hospital information system. Those with potentially life-threatening conditions and maternal near miss episodes (severe maternal morbidity) were considered the exposed group. The control group was a random sample of women who had had uncomplicated pregnancy. Female sexual function was evaluated through FSFI questionnaire, and general and reproductive aspects were addressed through specific questions. Statistical analyses were performed using Mann-Whitney and Pearson´s Chi-square for bivariate analyses. Logistic regression was used to identify variables independently associated with lower FSFI scores.638 women were included (315 at exposed and 323 at not exposed groups). The majority of women were under 30 years-old in the control group and between 30 and 46 years-old in the exposed group (p = 0.003). Women who experienced severe maternal morbidity (SMM) had statistically significant differences regarding cesarean section (82.4% versus 47.1% among deliveries without complications, p<0.001), and some previous pathological conditions. FSFI mean scores were similar among groups ranging from 24.39 to 24.42. It took longer for exposed women to resume sexual activity after index pregnancy (mean 84 days after SMM and 65 days for control group, p = 0.01). Multiple analyses showed no significant association of FSFI below cut-off value with any predictor.FSFI scores were not different in both groups. However, they were lower than expected. SMM delayed resumption of sexual activity after delivery, beyond postpartum period. However, the proportion of women in both groups having sex at 3 months after delivery was similar. Altered sexual response may be evaluated as one of possible long-term consequences after SMM episodes. Further studies on the growing population of women surviving severe maternal conditions might be worth for improvement of care for women

Mean and median values for FSFI total and domain scores according to maternal morbidity.

<p>* Nonparametric test: Mann-Whitney</p><p>Missing information for a: 3; b: 10; c: 46; d: 55 cases</p><p>SMM: severe maternal morbidity; PLTC: potentially life threatening condition; MNM: maternal near miss. Values in bold mean that they are statistically significant (p<0.05).</p

Flow chart for study inclusion.

<p>Flow chart for study inclusion.</p

Mean values of FSFI scores according to maternal morbidity by some maternal and delivery characteristics.

<p>* Nonparametric test: Mann-Whitney</p><p>Missing information for a: 52 cases; b: 57; c: 56; d: 99 cases.</p><p>Values in bold mean that they are statistically significant (p<0.05).</p

Sexual life and dysfunction after maternal morbidity: a systematic review

Because there is a lack of knowledge on the long-term consequences of maternal morbidity/near miss episodes on women´s sexual life and function we conducted a systematic review with the purpose of identifying the available evidence on any sexual impairment associated with complications from pregnancy and childbirth