Developing strategies to be added to the protocol for antenatal care: an exercise and birth preparation program

To describe the implementation process of a birth preparation program, the activities in the protocol for physical and birth preparation exercises, and the educational activities that have been evaluated regarding effectiveness and women's satisfaction. The birth preparation program described was developed with the following objectives: to prevent lumbopelvic pain, urinary incontinence and anxiety; to encourage the practice of physical activity during pregnancy and of positions and exercises for non-pharmacological pain relief during labor; and to discuss information that would help women to have autonomy during labor. The program comprised the following activities: supervised physical exercise, relaxation exercises, and educational activities (explanations of lumbopelvic pain prevention, pelvic floor function, labor and delivery, and which non-pharmacological pain relief to use during labor) provided regularly after prenatal consultations. These activities were held monthly, starting when the women joined the program at 18-24 weeks of pregnancy and continuing until 30 weeks of pregnancy, fortnightly thereafter from 31 to 36 weeks of pregnancy, and then weekly from the 37 th week until delivery. Information and printed materials regarding the physical exercises to be performed at home were provided. Clinicaltrials. gov: NCT01155804. The program was an innovative type of intervention that systematized birth preparation activities that were organized to encompass aspects related both to pregnancy and to labor and that included physical, educational and home-based activities. The detailed description of the protocol used may serve as a basis for further studies and also for the implementation of birth preparation programs within the healthcare system in different settings704231236COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPsem informação08/10392-

Approaching literature review for academic purposes: The Literature Review Checklist

A sophisticated literature review (LR) can result in a robust dissertation/thesis by scrutinizing the main problem examined by the academic study; anticipating research hypotheses, methods and results; and maintaining the interest of the audience in how the dissertation/thesis will provide solutions for the current gaps in a particular field. Unfortunately, little guidance is available on elaborating LRs, and writing an LR chapter is not a linear process. An LR translates students’ abilities in information literacy, the language domain, and critical writing. Students in postgraduate programs should be systematically trained in these skills. Therefore, this paper discusses the purposes of LRs in dissertations and theses. Second, the paper considers five steps for developing a review: defining the main topic, searching the literature, analyzing the results, writing the review and reflecting on the writing. Ultimately, this study proposes a twelve-item LR checklist. By clearly stating the desired achievements, this checklist allows Masters and Ph.D. students to continuously assess their own progress in elaborating an LR. Institutions aiming to strengthen students’ necessary skills in critical academic writing should also use this tool

Curva de altura uterina por idade gestacional e diagnóstico de desvios do crescimento fetal

OBJECTIVE: To validate a new symphysis-fundal curve for screening fetal growth deviations and to compare its performance with the standard curve adopted by the Brazilian Ministry of Health. METHODS: Observational study including a total of 753 low-risk pregnant women with gestational age above 27 weeks between March to October 2006 in the city of João Pessoa, Northeastern Brazil. Symphisys-fundal was measured using a standard technique recommended by the Brazilian Ministry of Health. Estimated fetal weight assessed through ultrasound using the Brazilian fetal weight chart for gestational age was the gold standard. A subsample of 122 women with neonatal weight measurements was taken up to seven days after estimated fetal weight measurements and symphisys-fundal classification was compared with Lubchenco growth reference curve as gold standard. Sensitivity, specificity, positive and negative predictive values were calculated. The McNemar χ2 test was used for comparing sensitivity of both symphisys-fundal curves studied. RESULTS: The sensitivity of the new curve for detecting small for gestational age fetuses was 51.6% while that of the Brazilian Ministry of Health reference curve was significantly lower (12.5%). In the subsample using neonatal weight as gold standard, the sensitivity of the new reference curve was 85.7% while that of the Brazilian Ministry of Health was 42.9% for detecting small for gestational age. CONCLUSIONS: The diagnostic performance of the new curve for detecting small for gestational age fetuses was significantly higher than that of the Brazilian Ministry of Health reference curve.OBJETIVO: Validar la curva de referencia de altura uterina por edad de gestación para el rastreo de desvíos del crecimiento fetal y comparar su performance con la curva estándar adoptada por el Ministerio de la Salud de Brasil. MÉTODOS: Estudio observacional que envolvió 753 gestantes de bajo riesgo de Joao Pessoa, Noreste de Brasil, entre marzo y octubre de 2006, con edad de gestación por encima de 27 semanas. La altura uterina fue medida de acuerdo con técnica recomendada por el Ministerio de la Salud. El patrón-oro fue el peso fetal, estimado por el ultrasonido con base en la curva de referencia brasilera por edad de gestación. Una sub-muestra de 122 casos con pesos neonatales obtenidos hasta siete días después de la estimación del peso fetal, la clasificación de la altura uterina fue comparada con la curva de Lubchenco como estándar-oro. La sensibilidad, la especificidad y los valores predictivos positivo y negativo fueron calculados. Para comparar el desempeño de la sensibilidad entre ambas curvas de altura uterina, se utilizó la prueba chi-cuadrado de McNemar. RESULTADOS: La sensibilidad de la nueva curva para la detección de fetos pequeños para la edad de gestación fue de 51,6%, mientras que la curva del patrón-oro fue significativamente menor (12,5%). En la sub-muestra que tuvo el peso neonatal como estándar-oro, la sensibilidad de la nueva curva de referencia fue de 87,7%, mientras que la del Ministerio de la Salud exhibió 42,9% de sensibilidad para la detección de fetos pequeños para la edad de gestación. CONCLUSIONES: La capacidad diagnóstica de la nueva curva de referencia para detectar fetos pequeños para la edad de gestación fue significativamente mejor que la curva recomendada por el Ministerio de la Salud.OBJETIVO: Validar curva de referência de altura uterina por idade gestacional para o rastreamento de desvios do crescimento fetal e comparar sua performance com a curva-padrão adotada pelo Ministério da Saúde do Brasil. MÉTODOS: Estudo observacional que envolveu 753 gestantes de baixo risco de João Pessoa, PB, entre março e outubro de 2006, com idade gestacional acima de 27 semanas. A altura uterina foi medida de acordo com técnica preconizada pelo Ministério da Saúde. O padrão-ouro foi o peso fetal, estimado pelo ultrassom com base na curva de referência brasileira por idade gestacional. Uma subamostra de 122 casos com pesos neonatais obtidos até sete dias depois da estimativa do peso fetal, a classificação da altura uterina foi comparada com a curva de Lubchenco como padrão-ouro. A sensibilidade, a especificidade e os valores preditivos positivo e negativo foram calculados. Para comparar o desempenho da sensibilidade entre ambas as curvas de altura uterina, utilizou-se o teste χ2 de McNemar. RESULTADOS: A sensibilidade da nova curva para a detecção de fetos pequenos para a idade gestacional foi de 51,6%, enquanto a da curva do padrão-ouro foi significativamente menor (12,5%). Na subamostra que teve o peso neonatal como padrão-ouro, a sensibilidade da nova curva de referência foi de 85,7%, enquanto a do Ministério da Saúde exibiu 42,9% de sensibilidade para a detecção de fetos pequenos para a idade gestacional. CONCLUSÕES: A capacidade diagnóstica da nova curva de referência para detectar fetos pequenos para a idade gestacional foi significativamente melhor do que a da curva recomendada pelo Ministério da Saúde

Symphysis-fundal Height Curve In The Diagnosis Of Fetal Growth Deviations.

To validate a new symphysis-fundal curve for screening fetal growth deviations and to compare its performance with the standard curve adopted by the Brazilian Ministry of Health. Observational study including a total of 753 low-risk pregnant women with gestational age above 27 weeks between March to October 2006 in the city of João Pessoa, Northeastern Brazil. Symphisys-fundal was measured using a standard technique recommended by the Brazilian Ministry of Health. Estimated fetal weight assessed through ultrasound using the Brazilian fetal weight chart for gestational age was the gold standard. A subsample of 122 women with neonatal weight measurements was taken up to seven days after estimated fetal weight measurements and symphisys-fundal classification was compared with Lubchenco growth reference curve as gold standard. Sensitivity, specificity, positive and negative predictive values were calculated. The McNemar χ2 test was used for comparing sensitivity of both symphisys-fundal curves studied. The sensitivity of the new curve for detecting small for gestational age fetuses was 51.6% while that of the Brazilian Ministry of Health reference curve was significantly lower (12.5%). In the subsample using neonatal weight as gold standard, the sensitivity of the new reference curve was 85.7% while that of the Brazilian Ministry of Health was 42.9% for detecting small for gestational age. The diagnostic performance of the new curve for detecting small for gestational age fetuses was significantly higher than that of the Brazilian Ministry of Health reference curve.441031-

SISPRENATAL as a tool for evaluating quality of prenatal care

OBJECTIVE: To evaluate coverage by the Prenatal and Birth Humanization Program, according to its minimal requirements and process indicators, by comparing information from prenatal booklets to SISPRENATAL (System to Accompany the Prenatal and Birth Humanization Program). METHODS: A cross-sectional study was carried out with prenatal data from 1,489 women in the postpartum period after birth in the Brazilian Unified Health System, between November 2008 to October 2009 in São Carlos municipality, Southeastern Brazil. Data were collected from the prenatal booklet and afterwards from the SISPRENATAL. Information from both sources was compared using the McNemar Χ2 test for related samples. RESULTS: Prenatal coverage in relation to the number of live births was 97.1% according to the prenatal booklet and 92.8% according to SISPRENATAL. There were statistical significant differences between both sources of information for all the minimum requirements of the Prenatal and Birth Humanization Program, and also the process indicators. Except for the first prenatal visit, the prenatal booklet always had greater frequencies than SISPRENATAL. The proportion of women with six or more prenatal visits and all basic exams was 72.5%, according to the prenatal booklet and 39.4% by the official system. These differences remained for the five health regions in the municipality. CONCLUSIONS: SISPRENATAL was not a reliable source for evaluating the available information on care during pregnancy. There was high adherence to the Prenatal and Birth Humanization Program, but documentation of information was insufficient for all the minimum requirements and process indicators. Ten years after the start of the program, municipalities should provide adequate quality of care and build health professional capacity for proper documentation of health information.OBJETIVO: Avaliar a cobertura do Programa de Humanização do Pré-natal e Nascimento segundo o cumprimento dos seus requisitos mínimos e indicadores de processo, comparando as informações do cartão da gestante com os do Susprenatal. MÉTODOS: Estudo transversal com dados do pré-natal de 1.489 puérperas internadas para parto pelo Sistema Único de Saúde entre novembro de 2008 e outubro de 2009 no município de São Carlos, SP. Os dados foram coletados no cartão da gestante e depois no Sistema de Acompanhamento do Programa de Humanização no Pré-Natal e Nascimento (Sisprenatal). As informações das duas fontes foram comparadas utilizando o teste de Χ2 de McNemar para amostras relacionadas. RESULTADOS: A cobertura de pré-natal em relação ao número de nascidos vivos foi de 97,1% de acordo com o cartão de pré-natal e de 92,8% segundo o Sisprenatal. Houve diferença significativa entre as fontes de informação para todos os requisitos mínimos do Programa de Humanização do Pré-natal e Nascimento, e também na comparação dos indicadores de processo. Com exceção da primeira consulta de pré-natal, o cartão de pré-natal sempre apresentou registro de informações superior ao do Sisprenatal. A proporção de mulheres com seis ou mais consultas de pré-natal e com todos os exames básicos foi de 72,5% pelo cartão de pré-natal e de 39,4% pelo sistema oficial. Essas diferenças mantiveram-se para as cinco áreas regionais de saúde do município. CONCLUSÕES: O Sisprenatal não foi uma fonte segura para avaliação da informação disponível sobre acompanhamento na gestação. Houve grande adesão ao Programa de Humanização do Pré-natal e Nascimento, mas a documentação da informação foi insuficiente quanto a todos os requisitos mínimos e indicadores de processo. Após dez anos da criação do programa, cabe agora aos municípios adequar a qualidade da assistência e capacitar seus profissionais para a correta documentação de informação em saúde.OBJETIVO: Evaluar la cobertura del Programa de Humanización del Prenatal y Nacimiento según el cumplimiento de sus requisitos mínimos e indicadores de proceso, comparando las informaciones de la tarjeta de la gestante con los del Sisprenatal. MÉTODOS: Estudio transversal con datos del prenatal de 1.489 puérperas internadas para parto por el Sistema Único de Salud entre noviembre de 2088 y octubre de 2009 en el municipio de Sao Carlos, Sureste de Brasil. Los datos fueron colectados en la tarjeta de la gestante y después en el Sistema de Acompañamiento del Programa de Humanización en el Prenatal y Nacimiento (Sisprenatal). Las informaciones de las dos fuentes fueron comparadas utilizando la prueba de c2 de McNemar para muestras relacionadas. RESULTADOS: La cobertura de prenatal con relación al número de nacidos vivos fue de 97,1% de acuerdo con la tarjeta de prenatal y de 92,8% según el Sisprenatal. Hubo diferencia significativa entre las fuentes de información para todos los requisitos mínimos del Programa de Humanización del Prenatal y Nacimiento, y también en la comparación de los indicadores de proceso. Con excepción de la primera consulta de prenatal, la tarjeta de prenatal siempre presentó registro de informaciones superior al del Sisprenatal. La proporción de mujeres con seis o más consultas de prenatal y con todos los exámenes básicos fue de 72,5% por la tarjeta de prenatal y de 39,4% por el sistema oficial. Estas diferencias se mantuvieron para las cinco áreas regionales de salud del municipio. CONCLUSIONES: El Sisprenatal no fue una fuente segura para evaluación de la información disponible sobre acompañamiento en la gestación. Hubo gran adhesión al Programa de Humanización del Prenatal y Nacimiento, pero la documentación de la información fue insuficiente con respecto a todos los requisitos mínimos e indicadores de proceso. Posterior a diez años de la creación del programa, le corresponde ahora a los municipios adecuar la calidad de la asistencia y capacitar sus profesionales para la correcta documentación de información en salud.85486

Severe maternal morbidity (near miss) as a sentinel event of maternal death. An attempt to use routine data for surveillance

<p>Abstract</p> <p>Background</p> <p>To identify all the records within the Brazilian Hospital Information System (HIS) that contained information suggestive of severe maternal morbidity (near miss); to describe the diagnoses and procedures used; to identify variables associated with maternal death.</p> <p>Methods</p> <p>A descriptive population study with data from the HIS and Mortality Information System (MIS) files of records of women during pregnancy, delivery and in the postpartum period in all the capital cities of the Brazilian states in 2002. Initially, records of women between 10 and 49 years of age were selected; next, those records with at least one criterion suggestive of near miss were selected. For the linkage of HIS with MIS and HIS with itself, a blocking strategy consisting of three independent steps was established. In the data analysis, near miss ratios were calculated with corresponding 95% confidence interval and the diagnoses and procedures were described; a multiple logistic regression model was adjusted. Primary and secondary diagnoses and the requested and performed procedures during hospitalization were the main outcome measures.</p> <p>Results</p> <p>The overall maternal near miss ratio was 44.3/1,000 live births. Among the records indicating near miss, 154 maternal deaths were identified. The criteria of severity most frequently found were infection, preeclampsia and hemorrhage. Logistic regression analysis resulted in 12 variables, including four significant interactions.</p> <p>Conclusion</p> <p>Although some limitations, the perspective of routinely using this information system for surveillance of near miss and implementing measures to avoid maternal death is promising.</p

Situational analysis of facilitators and barriers to availability and utilization of magnesium sulfate for eclampsia and severe preeclampsia in the public health system in Brazil

Background: Eclampsia is the main cause of maternal death in Brazil. Magnesium sulfate is the drug of choice for seizure prevention and control in the management of severe preeclampsia and eclampsia. Despite scientific evidence demonstrating its effectiveness and safety, there have been delays in managing hypertensive disorders, including timely access to magnesium sulfate. To conduct a general situational analysis on availability and use of magnesium sulfate for severe preeclampsia and eclampsia in the public health system. Method: A situational analysis was conducted with two components: a documental analysis on information available at the official websites on the policy, regulation and availability of the medication, plus a cross sectional study with field analysis and interviews with local managers of public obstetric health services in Campinas, in the southeast of Brazil. We used the fishbone cause and effect diagram to organize study components. Interviews with managers were held during field observations using specific questionnaires. Results: There was no access to magnesium sulfate in primary care facilities, obstetric care was excluded from urgency services and clinical protocols for professional guidance on the adequate use of magnesium sulfate were lacking in the emergency mobile care service. Magnesium sulfate is currently only administered in referral maternity hospitals. Conclusion: The lack of processes that promote the integration between urgency/emergency care and specialized obstetric care possibly favors the untimely use of magnesium sulfate and contributes to the high maternal morbidity/mortality rates16sem informaçã

Applying the new concept of maternal near-miss in an intensive care unit

OBJECTIVES: The World Health Organization has recommended investigating near-misses as a benchmark practice for monitoring maternal healthcare and has standardized the criteria for diagnosis. We aimed to study maternal morbidity and mortality among women admitted to a general intensive care unit during pregnancy or in the postpartum period, using the new World Health Organization criteria. METHODS: In a cross-sectional study, 158 cases of severe maternal morbidity were classified according to their outcomes: death, maternal near-miss, and potentially life-threatening conditions. The health indicators for obstetrical care were calculated. A bivariate analysis was performed using the Chi-square test with Yate's correction or Fisher's exact test. A multiple regression analysis was used to calculate the crude and adjusted odds ratios, together with their respective 95&#37; confidence intervals. RESULTS: Among the 158 admissions, 5 deaths, 43 cases of maternal near-miss, and 110 cases of potentially lifethreatening conditions occurred. The near-miss rate was 4.4 cases per 1,000 live births. The near-miss/death ratio was 8.6 near-misses for each maternal death, and the overall mortality index was 10.4&#37;. Hypertensive syndromes were the main cause of admission (67.7&#37; of the cases, 107/158); however, hemorrhage, mainly due to uterine atony and ectopic pregnancy complications, was the main cause of maternal near-misses and deaths (17/43 cases of near-miss and 2/5 deaths). CONCLUSIONS: Hypertension was the main cause of admission and of potentially life-threatening conditions; however, hemorrhage was the main cause of maternal near-misses and deaths at this institution, suggesting that delays may occur in implementing appropriate obstetrical care

Women's well-being and functioning after evidence-based antenatal care: a protocol for a systematic review of intervention studies.

INTRODUCTION: The 2016 WHO antenatal guidelines propose evidence-based recommendations to improve maternal outcomes. We aim to complement these recommendations by describing and estimating the effects of the interventions recommended by WHO on maternal well-being or functioning. METHODS AND ANALYSIS: We will conduct a systematic review of experimental and quasi-experimental studies evaluating women's well-being or functioning following the implementation of evidence-based antenatal interventions, published in peer-reviewed journals through a 15-year interval (2005-2020). The lead reviewer will screen all records identified at MEDLINE, EMBASE, CINAHL Plus, LILACS and SciELO. Two other reviewers will control screening strategy quality. Quality and risk of bias will be assessed using a specially designed instrument. Data synthesis will consider the instruments applied, how often they were used, conditions/interventions for positive or negative effects documented, statistical measures used to document effectiveness and how results were presented. A random-effects meta-analysis comparing frequently used instruments may be conducted. ETHICS AND DISSEMINATION: The study will be a systematic review with no human beings' involvement, therefore not requiring ethical approval. Findings will be disseminated through peer-reviewed publication and scientific events. PROSPERO REGISTRATION NUMBER: CRD42019143436

Sequential Organ Failure Assessment Score for Evaluating Organ Failure and Outcome of Severe Maternal Morbidity in Obstetric Intensive Care

Objective. To evaluate the performance of Sequential Organ Failure Assessment (SOFA) score in cases of severe maternal morbidity (SMM). Design. Retrospective study of diagnostic validation. Setting. An obstetric intensive care unit (ICU) in Brazil. Population. 673 women with SMM. Main Outcome Measures. mortality and SOFA score. Methods. Organ failure was evaluated according to maximum score for each one of its six components. The total maximum SOFA score was calculated using the poorest result of each component, reflecting the maximum degree of alteration in systemic organ function. Results. highest total maximum SOFA score was associated with mortality, 12.06 ± 5.47 for women who died and 1.87 ± 2.56 for survivors. There was also a significant correlation between the number of failing organs and maternal mortality, ranging from 0.2% (no failure) to 85.7% (≥3 organs). Analysis of the area under the receiver operating characteristic (ROC) curve (AUC) confirmed the excellent performance of total maximum SOFA score for cases of SMM (AUC = 0.958). Conclusions. Total maximum SOFA score proved to be an effective tool for evaluating severity and estimating prognosis in cases of SMM. Maximum SOFA score may be used to conceptually define and stratify the degree of severity in cases of SMM