Obstetrician's risk perception on the prescription of magnesium sulfate in severe preeclampsia and eclampsia: a qualitative study in Brazil

Magnesium sulfate (MgSO4) is the drug of choice for the prevention and control of seizures in the management of severe preeclampsia/eclampsia. Several barriers have been iden-tified in the use of MgSO4, especially in low and middle-income settings. Objective To describe the obstetrician's perception on possible reasons for underutilizing magnesium sulfate to treat preeclampsia/eclampsia. Method A qualitative clinical study, based on phenomenological reference by semi-structured inter-views and open-ended discussions with obstetricians of the public healthcare system in pri-mary care units (PCU) and referral maternity hospitals (RMH), in a southeastern Brazilian city. Results Fear of drug toxicity was the major cause for not prescribing the medication in PCU. Fear was justified by insufficient technical, structural and organizational resources of healthcare facilities and by a shortage of physicians properly trained for adequate drug use. Conclusion Fear of toxicity of magnesium sulfate was the main barrier towards timely and proper drug use. Periodic skill development and training of obstetricians, along with integration of the medical team in the work environment may contribute to decrease fear, ensuring safety of drug prescription and thus possibly reducing adverse outcomes related to PE.Introduction Magnesium sulfate (MgSO4) is the drug of choice for the prevention and control of seizures in the management of severe preeclampsia/eclampsia. Several barriers have been iden-tified in the use of MgSO4, especially in low and middle-income set123sem informaçãosem informaçã

The Significance Of Uterus Removal For Women [o Significado Da Retirada Do útero Para As Mulheres: Um Estudo Qualitativo]

OBJECTIVE. To identify the myths accepted by women about to undergo hysterectomy regarding the consequences that removal of their uterus might have on their lives. METHODS. A sample of 10 hospitalized women with surgical indication for hysterectomy was used to perform a qualitative study, with semi-structured interviews carried out during the preoperative period. A profile questionnaire was used with questions about personal features and semi-structured inquiries to facilitate deeper questioning. With authorization of the subjects, interviews were recorded and transcribed to perform a thematic analysis of the content. RESULTS. The myths most often mentioned during the interviews were: loss of femininity, frigidity, change in personality, possible change in body appearance (since they would be "hollow", "empty", "have a hole inside their belly"), interference in the affective and sexual life and the belief that their companion might change in relation to them (assuming that they would be hollow, cold, and with no sexual attraction). CONCLUSION. The interviewed women accepted a number of myths about the consequences that removal of their uterus would have on their lives. These myths are related to the social identity of the gender and to a lack of knowledge about their body its organs and functions.515270274Novoa, A.M., Histerectomia: Efeitos emocionais na identidade feminina (1996) Opinião, 6, pp. 193-195Parker, R., (1991) Corpos, Prazeres e Paixões: A Cultura Sexual No Brasil Contemporâneo. 2 a Ed., , Tradução de Andrade MTM. São Paulo: Best SellerHeilborn, M.L., Gênero: Uma breve introdução (1995) Gênero e Desenvolvimento Institucional Em ONGs, pp. 9-14. , Ribeiro NMGR, Costa DM, organizadores. Rio de Janeiro: IBAM/ENSUR/NEMPPCosmo, M., Carvalho, J.W.A., Pensando sobre o período pré-operatório na histerectomia (2000) Rev Soc Bras Psicol Hosp, 3, pp. 27-32Anker, L.W., Vivências psicológicas associados à histerectomia: Um enfoque psicanalítico (1993) Rev Psicol Hosp, 5, pp. 20-23Zimmerman, E.B., Os contos de fada: Expressão do desenvolvimento humano (1991) Contos Maravilhosos: Expressão Do Desenvolvimento Humano, pp. 1-11. , Giglio JS, organizador. Campinas: Ed. UnicampPingaud B, Pontalis JB.Laplanche (colab). Freud. Netto C. (trad). São Paulo: Ed. Documentos1969Khastgir, G., Studd, J.W.W., Catalan, J., The psychological outcome of hysterectomy (2000) Gynecol Endocrinol, 14, pp. 132-141Angerami-Camon, V.A., (1998) Urgências Psicológicas No Hospital - As Cirurgias Ginecológicas: Uma Questão para a Psicologia, , São Paulo: Thomson PioneiraPatton, M.Q., Qualitative evaluation and research methods (1990) Designing Qualitative Studies. 2nd Ed., pp. 145-198. , Patton MQ. California: SageSeidel, J., (1998) The Ethnograph [Computer Program]. Version 5.0, , Salt Lake: Qualis Research AssociatesMinayo, M.C.S., (1993) O Desafio Do Conhecimento: Pesquisa Qualitativa Em Saúde. 2 a Ed., , São Paulo: HucitecMcCary, J.L., (1978) Mitos e Crendices Sexuais, , São Paulo: ManoleOsis, M.J.M.D., (2001) Laqueadura e Representações Acerca Da Sexualidade e Do Papel Reprodutivo, , [tese]. Campinas: Faculdade de Ciências Médicas, Universidade Estadual de CampinasCarson, A.C., Entrelaçando consensos: Reflexões sobre a dimensão social da identidade de gênero da mulher (1995) Cadernos Pagu, 4, pp. 187-218Calderón, V.P., Yo (no) soy. Tú eres. Él es. la sexualidad de mujeres polisintomáticas de sectores empobrecidos desde la perspectiva de los servicios de atención primaria de salud (2000) Feminidades Y Masculinidades. Estudios Sobre Salud Reproductiva Y Sexualidad en Argentina, Chile Y Colombia, pp. 23-74. , Gogna M, organizador. Bueno Aires: Cedes - Centro de Estudios de Estado y SociedadHufnagel, V., Golant, S.K., No more hysterectomies (1989) Why Is the Uterus Important?, pp. 81-90. , Hufnagel V, Golant SK. New York: A Plume BookNaughton, M.J., Mcbee, W.L., Qualidade de vida relacionado à saúde pó shisterectomia (1997) Grupo Editorial Moreira Jr., 40, pp. 947-957Penteado, S.R.L., Fonseca, A.M., Bagnolo, V.R., Abdo, C.H.N., Sexualidade no climatério e na senilidade (2000) Ginecol Obstet, 11, pp. 188-192Maldonado, M.T., Canella, P., (1988) A Relação Médico-cliente Em Ginecologia e Obstetrícia. 2 a Ed., , São Paulo: RocaScheeffer, R., (1993) Aconselhamento Psicológico: Teoria e Prática. 7 a Ed., , São Paulo: AtlasChiattoni, H.B.C., A ética em psicologia hospitalar (1997) A Ética Na Saúde, pp. 113-140. , Angerami-Camon VA (org). São Paulo: Thomson Pioneir