A multidisciplinary program of preparation for childbirth and motherhood: maternal anxiety and perinatal outcomes

Background: To study maternal anxiety and perinatal outcomes in pregnant women submitted to a Multidisciplinary Program for Childbirth and Motherhood Preparation (MPCM).Methods: This is a not randomized controlled trial on 67 nulliparous pregnant women divided into two groups according to participation (MPCM Group; n = 38) or not (Control Group; n = 29) in MPCM. the program consisted of 10 meetings (between the 18th and the 38th gestational week) during which educational, physiotherapeutic and interaction activities were developed. Anxiety was quantified at the beginning and at the end of the gestational period by the Trace-State Anxiety Inventory (STAI).Results: Initial maternal anxiety was equivalent between the groups. At the end of the gestational period, it was observed that anxiety levels increased in the Control Group and were maintained in the MPCM Group. A higher occurrence of vaginal deliveries (83.8%) and hospital discharge of three-day-older newborns (81.6%) as a result of MPCM was also significant. Levels of state-anxiety at the end of pregnancy showed a negative correlation with vaginal delivery, gestational age, birth weight and Apgar index at the first minute and positive correlation with the hospital period remaining of the newborns.Conclusion: in the study conditions, MPCM was associated with lower levels of maternal anxiety, a larger number of vaginal deliveries and shorter hospitalization time of newborns. It was not related to adverse perinatal outcomes.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Univ Estadual Paulista, Botucatu Sch Med, Dept Neurol Psychol & Psychiat, Botucatu, SP, BrazilUniv Estadual Paulista, Botucatu Sch Med, Dept Gynecol & Obstet, Botucatu, SP, BrazilUniv Sagrado Coracao, Dept Hlth Sci, Physiotherapy Sch, Bauru, BrazilSão Paulo Fed Univ Unifesp, Dept Hlth Sci, Phys Therapy Program, Santos, BrazilSão Paulo Fed Univ Unifesp, Dept Hlth Sci, Phys Therapy Program, Santos, BrazilWeb of Scienc

Mecanismo de centralização: Da insuficiência placentária à adaptação circulatória fetal

The application and development of obstetric Dopplervelocimetry provide a basis for the investigation of placental insuf ciency and demonstrate the dynamic behavior of fetal circulation during hypoxia. In clinical practice, assessing hemodynamics in three vascular regions involved in pregnancy, namely the uterine, umbilical and middle cerebral arteries, has become routine. Roughly, the cerebral artery expresses the balance between uterine artery oxygen supply and umbilical artery oxygen uptake. Currently, when such balance is unfavorable, the fetal cardiac reserve is investigated by assessing the venous duct. However, determining and interpreting vascular resistance indexes is not an easy task. The starting point is to know the physiopathology of placental insuf ciency and fetal circulatory adaptation through which Doppler con rmed its role in the assessment of fetal well-being

Medical students’ personal choice for mode of delivery in Santa Catarina, Brazil: a cross-sectional, quantitative study

<p>Abstract</p> <p>Background</p> <p>The increase in overall rates of cesarean sections (CS) in Brazil causes concern and it appears that multiple factors are involved in this fact. In 2009, undergraduate students in the first and final years of medical school at the University of Santa Catarina answered questionnaires regarding their choice of mode of delivery. The aim of the study was to evaluate whether the education process affects decision-making regarding the waay of childbirth preferred by medical students.</p> <p>Methods</p> <p>A cross-sectional, quantitative study was conducted based on data obtained from questionnaires applied to medical students. The questions addressed four different scenarios in childbirth, as follows: under an uneventful pregnancy; the mode of delivery for a pregnant woman under their care; the best choice as a healthcare manager and lastly, choosing the birth of their own child. For each circumstance, there was an open question to explain their choice.</p> <p>Results</p> <p>A total of 189 students answered the questionnaires. For any uneventful pregnancy and for a pregnant woman under their care, 8.46% of the students would opt for CS. As a healthcare manager, only 2.64% of the students would recommend CS. For these three scenarios, the answers of the students in the first year did not differ from those given by students in the sixth year. In the case of the student’s own or a partner’s pregnancy, 41.4% of those in the sixth year and 16.8% of those in the first year would choose a CS. A positive association was found between being a sixth year student and a personal preference for CS according to logistic regression (OR = 2.91; 95%CI: 1.03–8.30). Pain associated with vaginal delivery was usually the reason for choosing a CS.</p> <p>Conclusions</p> <p>A higher number of sixth year students preferred a CS for their own pregnancy (or their partner’s) compared to first year students. Pain associated with vaginal delivery was the most common reason given for haven chosen a CS. The students’ preference for childbirth changed over time during their graduation in favor of cesarean sections. This finding deserves considerable attention when structuring medical education in Obstetrics.</p

A multidisciplinary program of preparation for childbirth and motherhood: maternal anxiety and perinatal outcomes

Abstract Background To study maternal anxiety and perinatal outcomes in pregnant women submitted to a Multidisciplinary Program for Childbirth and Motherhood Preparation (MPCM). Methods This is a not randomized controlled trial on 67 nulliparous pregnant women divided into two groups according to participation (MPCM Group; n = 38) or not (Control Group; n = 29) in MPCM. The program consisted of 10 meetings (between the 18th and the 38th gestational week) during which educational, physiotherapeutic and interaction activities were developed. Anxiety was quantified at the beginning and at the end of the gestational period by the Trace-State Anxiety Inventory (STAI). Results Initial maternal anxiety was equivalent between the groups. At the end of the gestational period, it was observed that anxiety levels increased in the Control Group and were maintained in the MPCM Group. A higher occurrence of vaginal deliveries (83.8%) and hospital discharge of three-day-older newborns (81.6%) as a result of MPCM was also significant. Levels of state-anxiety at the end of pregnancy showed a negative correlation with vaginal delivery, gestational age, birth weight and Apgar index at the first minute and positive correlation with the hospital period remaining of the newborns. Conclusion In the study conditions, MPCM was associated with lower levels of maternal anxiety, a larger number of vaginal deliveries and shorter hospitalization time of newborns. It was not related to adverse perinatal outcomes.</p

Resultado perinatal de fetos com malformações do trato urinário

OBJETIVO: analisar a evolução perinatal de fetos portadores de malformações do trato urinário. MÉTODOS: estudo retrospectivo envolvendo 35 fetos portadores de malformações do trato urinário. As malformações foram classificadas de acordo com as seguintes características: tipo de uropatia e acometimento. As uropatias estudadas foram: hidronefrose, classificada em alta e baixa, displasia e agenesia renal; quanto à lateralidade da malformação, foi considerado o acometimento uni e bilateral. O resultado perinatal foi confrontado com as características citadas. A análise estatística foi realizada usando-se o teste do c² e teste exato de Fisher, sendo adotado 5% como limite de significância (p<0,05). RESULTADOS: a incidência de hidronefrose foi de 68,6% e o acometimento foi bilateral em metade destes fetos. Displasia renal ocorreu em 17,1% e, em 83,3% destes, foi bilateral. A incidência de agenesia renal foi de 14,3%, sendo sempre bilateral. No grupo displasia/agenesia observou-se 91% de oligoâmnio, prematuridade, baixo peso ao nascimento e de óbito. Nos casos de uropatia bilateral foi significativa a ocorrência de oligoâmnio, prematuridade, baixo peso, óbito, infecção do trato urinário e permanência hospitalar por mais de sete dias. Entre os fetos com obstrução baixa, a permanência hospitalar por mais de sete dias foi significativa. CONCLUSÕES: neste estudo, foram mais freqüentes o acometimento bilateral e a hidronefrose e, dentre elas, as obstruções baixas; o grupo displasia/agenesia apresentou pior prognóstico quando comparado ao grupo hidronefrose; o acometimento renal bilateral determinou pior prognóstico em relação àqueles com acometimento unilateral; a obstrução baixa do trato urinário determinou maior tempo de internação em relação às obstruções altas

Características das Curvas de Regressão da Gonadotrofina Coriônica Pós-mola Hidatiforme Completa

Objetivos: construir a curva de regressão do b-hCG pós-mola hidatiforme completa (MHC) com remissão espontânea e comparar com a curva de regressão pós-MHC com tumor trofoblástico gestacional (TTG). Análise comparativa da curva de regressão do b-hCG das portadoras de MHC, acompanhadas no Serviço, com a curva de regressão observada por outros autores1-3. Métodos: foi realizada avaliação clínica e laboratorial (dosagem sérica de b-hCG), na admissão e no segmento pós-molar, de todas as pacientes com MHC, atendidas entre 1990 e 1998 no Hospital das Clínicas de Botucatu - Unesp. O resultado da determinação seriada do b-hCG foi analisado em curvas log de regressão. A evolução da curva de regressão do b-hCG foi analisada e comparada em MHC com remissão espontânea e MHC com TTG numa curva log de regressão, com intervalo de confiança de 95%. A curva log de regressão do grupo de remissão espontânea foi comparada com curvas consideradas padrão1,2. Foram construídas curvas log individuais de todas as pacientes e classificadas de acordo com os quatro tipos de curva (I, II, III e IV), propostos para o seguimento pós-molar³. Resultados: 61 pacientes com MHC tiveram seguimento pós-molar completo, 50 (82%) apresentaram remissão espontânea e 11 (18%) desenvolveram TTG. No grupo de pacientes com MHC e remissão espontânea, o tempo para alcançar a normalização dos níveis do b-hCG, após o esvaziamento molar, foi até 20 semanas. As pacientes que desenvolveram TTG apresentaram desvio precoce da curva de regressão normal do b-hCG, 4 a 6 semanas após o esvaziamento molar. Nestas pacientes, a quimioterapia foi introduzida em média na 9ª semana pós-esvaziamento molar. Conclusões: a curva de regressão do b-hCG pós-MHC com remissão espontânea apresentou declínio log exponencial, semelhante ao observado por outros autores1,2, e diferente das MHC com TTG. Foram identificados três tipos de curvas de regressão do b-hCG, semelhantes aos de Goldstein³, I, II e IV, e outros dois tipos diferentes de regressão do b-hCG: V (regressão normal) e VI (regressão anormal).Purpose: to construct a b-human chorionic gonadotropin (b-hCG) regression curve following complete hydatidiform mole (CHM) of patients with spontaneous remission, and then compare it to that of CHM patients with gestational trophoblastic tumor (GTT). Also, to compare the b-hCG regression curve of CHM patients followed-up at the Service to the regression curve of other authors1-3. Methods: clinical and laboratory evaluations (serum determinations of b-hCG) were performed on admission and during post-molar follow-up of CHM patients treated at the University Hospital of Botucatu between 1990 and 1998. The result of the serial b-hCG determinations was analyzed using log regression curves. The evolution of the b-hCG regression curve was analyzed and compared between cases of CHM with spontaneous remission and with GTT using a log regression curve, with 95% confidence interval. The log regression curve of the spontaneous remission group was compared to those of other authors1,2. Individual log curves for each patient were constructed and classified according to the four curve types (I, II, III, and IV) proposed by Goldstein³ for post-molar follow-up. Results: sixty-one patients received complete post-molar follow-up, 50 (82%) showing spontaneous remission and 11 (18%) developing GTT. In the group of patients with CHM and spontaneous remission, the time to return to normal b-hCG levels after mole emptying was 20 weeks. The patients who developed GTT showed early deviation from normal b-hCG regression curve 4 to 6 weeks after mole emptying. These patients received chemotherapy normally starting during the 9th post-mole emptying week. Conclusions: the regression curve of post-CHM b-hCG in patients with spontaneous remission showed a log-exponential decline similar to that observed by other authors1,2, but different from that of CHM patients who developed GTT. Three types of b-hCG regression curves similar to Goldstein's³, I, II, and IV, were identified, as well as two other different types: V (normal regression) and VI (abnormal regression)

Maternal and perinatal outcomes of first pregnancy after chemotherapy for gestational trophoblastic neoplasia in Brazilian women

Objective. To evaluate maternal and perinatal outcomes of first pregnancy after chemotherapy for gestational trophoblastic neoplasia (GTN) in Brazilian patients.Methods. This study included 252 subsequent pregnancies after chemotherapy for GTN treated between 1960-2005. Correlations of maternal and perinatal outcomes with chemotherapy regimen (single or multiagent) and the time interval between chemotherapy completion and first subsequent pregnancy were investigated.Results. There was a significant increase in adverse maternal outcomes in women who conceived 12 months (76.2% and 21.7%; P12 months (9.4%; p<0.0001: OR=23.97: CI 95%=8.21-69.91) after chemotherapy. There was no difference in adverse perinatal outcomes (stillbirth, fetal malformation, and preterm birth) related to the interval after chemotherapy and Subsequent pregnancy. The overall occurrence of adverse maternal and perinatal outcomes did not significantly differ between patients on single or multiagent regimens.Conclusion. Adverse maternal outcomes and spontaneous abortion were more frequent among patients who conceived within 6 months of chemotherapy completion. In these cases, careful prenatal monitoring and hCG level measurement 6 weeks after the completion of any new pregnancy are recommended. (C) 2008 Elsevier B.V. All rights reserved

Resultado perinatal de fetos com malformações do trato urinário

PURPOSE: to evaluate the perinatal outcome of fetuses with congenital anomalies of the urinary tract. METHODS: we reviewed the perinatal outcome of 35 fetuses with congenital anomalies of the urinary tract. The following characteristics related to the uropathy were analyzed: type (hydronephrosis, dysplasia and renal agenesis), side of lesion (bilateral or unilateral), and level of the obstruction (high or low, in hydronephrosis). The perinatal outcome was evaluated according to these characteristics. The data were analyzed by the c² test and by the exact Fisher test. The level of significance was 0.05. RESULTS: the incidence of hydronephrosis was 68.6%. Half of the fetuses had unilateral hydronephrosis. Renal dysplasia occurred in 17.1% of the cases; 83.3% of these were bilateral and 16.7%, unilateral. The incidence of renal agenesis was 14.3%, all bilateral. The fetuses with dysplasia/agenesis had a 91% incidence of oligohydramnios, preterm birth, low birth weight, and death. In the group with bilateral disease the presence of oligohydramnios, preterm birth, low birth weight, death, urinary tract infections, and the need of hospitalization for a period greater than 7 days was significant when compared to the group with unilateral disease. The need of hospitalization for a period greater than 7 days in patients with low obstruction was significantly higher when compared to the patients with high obstruction. CONCLUSIONS: hydronephrosis, bilateral disease, and lower obstruction were the most frequent uropathies. The dysplasia/agenesis group had a worse prognosis when compared with the hydronephrosis group. Bilateral disease had a worse prognosis when compared with the unilateral disease group. In the low obstruction group, the need for a period of hospitalization greater than seven days was higher than in the high obstruction group.OBJETIVO: analisar a evolução perinatal de fetos portadores de malformações do trato urinário. MÉTODOS: estudo retrospectivo envolvendo 35 fetos portadores de malformações do trato urinário. As malformações foram classificadas de acordo com as seguintes características: tipo de uropatia e acometimento. As uropatias estudadas foram: hidronefrose, classificada em alta e baixa, displasia e agenesia renal; quanto à lateralidade da malformação, foi considerado o acometimento uni e bilateral. O resultado perinatal foi confrontado com as características citadas. A análise estatística foi realizada usando-se o teste do c² e teste exato de Fisher, sendo adotado 5% como limite de significância (p<0,05). RESULTADOS: a incidência de hidronefrose foi de 68,6% e o acometimento foi bilateral em metade destes fetos. Displasia renal ocorreu em 17,1% e, em 83,3% destes, foi bilateral. A incidência de agenesia renal foi de 14,3%, sendo sempre bilateral. No grupo displasia/agenesia observou-se 91% de oligoâmnio, prematuridade, baixo peso ao nascimento e de óbito. Nos casos de uropatia bilateral foi significativa a ocorrência de oligoâmnio, prematuridade, baixo peso, óbito, infecção do trato urinário e permanência hospitalar por mais de sete dias. Entre os fetos com obstrução baixa, a permanência hospitalar por mais de sete dias foi significativa. CONCLUSÕES: neste estudo, foram mais freqüentes o acometimento bilateral e a hidronefrose e, dentre elas, as obstruções baixas; o grupo displasia/agenesia apresentou pior prognóstico quando comparado ao grupo hidronefrose; o acometimento renal bilateral determinou pior prognóstico em relação àqueles com acometimento unilateral; a obstrução baixa do trato urinário determinou maior tempo de internação em relação às obstruções altas