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Original Article03-25-2013
Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(3):117-122
Abstract
Original ArticleAssessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(3):117-122
DOI 10.1590/S0100-72032013000300005
Views152See morePURPOSE: To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound. METHODS: A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10), vaginal delivery (n=16), and forceps delivery (n=9). Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L) was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test. RESULTS: The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm², respectively, versus 12.4 cm² in the Control Group (elective cesarean). Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25), however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5). CONCLUSION: Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode.
Views152
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleAssessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(3):117-122
DOI 10.1590/S0100-72032013000300005
Views152See morePURPOSE: To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound. METHODS: A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10), vaginal delivery (n=16), and forceps delivery (n=9). Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L) was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test. RESULTS: The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm², respectively, versus 12.4 cm² in the Control Group (elective cesarean). Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25), however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5). CONCLUSION: Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article05-11-2012
Ultrasound evaluation of uterine scar after segmental transverse cesarean surgery
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):221-227
Abstract
Original ArticleUltrasound evaluation of uterine scar after segmental transverse cesarean surgery
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):221-227
DOI 10.1590/S0100-72032012000500006
Views121See morePURPOSE: To evaluate the thickness of the lower uterine segment by transvaginal ultrasound in a group of non-pregnant women and to describe the morphologic findings in the scar of those submitted to cesarean section. METHODS: A retrospective study of 155 transvaginal ultrasound images obtained from premenopausal and non-pregnant women, conducted between January 2008 and November 2011. the subjects were divided into three groups: women who were never pregnant (Control Group I), women with previous vaginal deliveries (Control Group II) and women with previous cesarean section (Observation Group). We excluded women with a retroverted uterus, intrauterine device users, pregnant women and those with less than one year of tsince the last obstetrical event. The data were analyzed statistically with Statistica®, version 8.0 software. ANOVA and LSD were used to compare the groups regarding quantitative variables and the Student's t-test was used to compare the thickness of the anterior and posterior isthmus. The Spearman correlation coefficient was calculated to estimate the association between quantitative variables. P values <0.05 were considered statistically significant. RESULTS: There was significant difference between the thickness of the anterior and posterior isthmus only in the group of women with previous cesarean section. Comparing the groups two by two, no significant differences between the thickness of the anterior and posterior isthmus were observed in the Control Groups, but this difference was significant when we compared the Observation Group with each Control Group. In the Observation Group, no correlation was found between the thickness of the isthmus and the number of previous cesarean deliveries or the time elapsed since the last birth. A niche was found in the cesarean scar in 30.6% of the women in the Observation Group, 93% of whom complained of post-menstrual bleeding. CONCLUSION: The relationship between the thickness of the anterior and posterior wall of the lower uterine segment by transvaginal ultrasound is a suitable method for the evaluation of the uterine lower segment in women with previous cesarean sections.
Views121This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleUltrasound evaluation of uterine scar after segmental transverse cesarean surgery
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):221-227
DOI 10.1590/S0100-72032012000500006
Views121See morePURPOSE: To evaluate the thickness of the lower uterine segment by transvaginal ultrasound in a group of non-pregnant women and to describe the morphologic findings in the scar of those submitted to cesarean section. METHODS: A retrospective study of 155 transvaginal ultrasound images obtained from premenopausal and non-pregnant women, conducted between January 2008 and November 2011. the subjects were divided into three groups: women who were never pregnant (Control Group I), women with previous vaginal deliveries (Control Group II) and women with previous cesarean section (Observation Group). We excluded women with a retroverted uterus, intrauterine device users, pregnant women and those with less than one year of tsince the last obstetrical event. The data were analyzed statistically with Statistica®, version 8.0 software. ANOVA and LSD were used to compare the groups regarding quantitative variables and the Student's t-test was used to compare the thickness of the anterior and posterior isthmus. The Spearman correlation coefficient was calculated to estimate the association between quantitative variables. P values <0.05 were considered statistically significant. RESULTS: There was significant difference between the thickness of the anterior and posterior isthmus only in the group of women with previous cesarean section. Comparing the groups two by two, no significant differences between the thickness of the anterior and posterior isthmus were observed in the Control Groups, but this difference was significant when we compared the Observation Group with each Control Group. In the Observation Group, no correlation was found between the thickness of the isthmus and the number of previous cesarean deliveries or the time elapsed since the last birth. A niche was found in the cesarean scar in 30.6% of the women in the Observation Group, 93% of whom complained of post-menstrual bleeding. CONCLUSION: The relationship between the thickness of the anterior and posterior wall of the lower uterine segment by transvaginal ultrasound is a suitable method for the evaluation of the uterine lower segment in women with previous cesarean sections.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article12-20-2011
Analysis of maternal and child health indicators: the parallel between Portugal and Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(9):234-239
Abstract
Original ArticleAnalysis of maternal and child health indicators: the parallel between Portugal and Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(9):234-239
DOI 10.1590/S0100-72032011000900003
Views103PURPOSE: To analyze comparatively the conditions of birth in Portugal and Brazil from 1975 to 2007. METHODS: Indicators of maternal and child health: rates of maternal death and neonatal mortality, cesarean rate and public spending on health were retrospectively collected from electronic databases of health information from the Unified Health System (DATASUS) and the National Institute of Statistics of Portugal (INE), among others. Their values were descriptively analyzed in terms of trends and the temporal sanitary scenarios were presented and discussed, comparing, when possible, the information from the two countries. RESULTS: Births in Portugal were characterized by lower maternal mortality (12.2x76.2/100.000) and neonatal mortality (2.2x14.6/1000), compared to Brazil, considering the average of the years from 2004 to 2007. The history of the conquest of maternal and child indicators of excellence in Portugal involved a phase that paralleled the significant socio-economic improvements and the increasing contribution of public health, followed by another from the 1990s, involving better equipped health care units. In Brazil, rates of maternal and neonatal mortality are declining, but satisfactory values have not yet been achieved. The historical difference in the amount of social spending on health, both in current and historical values, was a crucial difference between countries. Despite the disparities in maternal and neonatal outcomes, cesarean section rates were equally ascendant (34.5% in Portugal and 45.5% in Brazil), considering the average for the period from 2004 to 2007. CONCLUSION: The indicators of maternal and neonatal death in Portugal and Brazil have aligned themselves to social, economic and contributions of public investments in health. The increasing rates of caesarean section do not explain the discrepancies in maternal and neonatal outcome between countries.
Key-words BrazilCesarean sectionhealth careMaternal mortalityMaternal-child health servicesNeonatal mortality (Public Health)PortugalQuality indicatorsSee moreViews103This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleAnalysis of maternal and child health indicators: the parallel between Portugal and Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(9):234-239
DOI 10.1590/S0100-72032011000900003
Views103PURPOSE: To analyze comparatively the conditions of birth in Portugal and Brazil from 1975 to 2007. METHODS: Indicators of maternal and child health: rates of maternal death and neonatal mortality, cesarean rate and public spending on health were retrospectively collected from electronic databases of health information from the Unified Health System (DATASUS) and the National Institute of Statistics of Portugal (INE), among others. Their values were descriptively analyzed in terms of trends and the temporal sanitary scenarios were presented and discussed, comparing, when possible, the information from the two countries. RESULTS: Births in Portugal were characterized by lower maternal mortality (12.2x76.2/100.000) and neonatal mortality (2.2x14.6/1000), compared to Brazil, considering the average of the years from 2004 to 2007. The history of the conquest of maternal and child indicators of excellence in Portugal involved a phase that paralleled the significant socio-economic improvements and the increasing contribution of public health, followed by another from the 1990s, involving better equipped health care units. In Brazil, rates of maternal and neonatal mortality are declining, but satisfactory values have not yet been achieved. The historical difference in the amount of social spending on health, both in current and historical values, was a crucial difference between countries. Despite the disparities in maternal and neonatal outcomes, cesarean section rates were equally ascendant (34.5% in Portugal and 45.5% in Brazil), considering the average for the period from 2004 to 2007. CONCLUSION: The indicators of maternal and neonatal death in Portugal and Brazil have aligned themselves to social, economic and contributions of public investments in health. The increasing rates of caesarean section do not explain the discrepancies in maternal and neonatal outcome between countries.
Key-words BrazilCesarean sectionhealth careMaternal mortalityMaternal-child health servicesNeonatal mortality (Public Health)PortugalQuality indicatorsSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Review Article08-26-2011
Strategies directed to professionals for reducing unnecessary cesarean sections in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(5):252-262
Abstract
Review ArticleStrategies directed to professionals for reducing unnecessary cesarean sections in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(5):252-262
DOI 10.1590/S0100-72032011000500008
Views90See moreBrazil is among the countries with the highest cesarean section rates, especially in the supplementary health sector. However, some characteristics are similar in both the public and private sectors in terms of the wishes and expectations of pregnant women regarding their delivery. There is a preference for vaginal delivery among women of all social, economic, and cultural levels, a fact that shifts the focus of the negative influence of this variable from women to other subjects involved in delivery care. No isolated factor is able to justify the complexity of making a decision for cesarean section, but the physician and the type of hospital are the main associated factors. The several harmful effects of a non-judicious performance of cesarean section are scientifically recognized. It is important to raise the awareness of doctors and of other health professionals about the real consequences of this decision, the ethical deviations when conducts are chosen without exclusively focusing on the patient`s health, and the need for constant updating for the management of the various possible conditions of childbirth.
Views90This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Review ArticleStrategies directed to professionals for reducing unnecessary cesarean sections in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(5):252-262
DOI 10.1590/S0100-72032011000500008
Views90See moreBrazil is among the countries with the highest cesarean section rates, especially in the supplementary health sector. However, some characteristics are similar in both the public and private sectors in terms of the wishes and expectations of pregnant women regarding their delivery. There is a preference for vaginal delivery among women of all social, economic, and cultural levels, a fact that shifts the focus of the negative influence of this variable from women to other subjects involved in delivery care. No isolated factor is able to justify the complexity of making a decision for cesarean section, but the physician and the type of hospital are the main associated factors. The several harmful effects of a non-judicious performance of cesarean section are scientifically recognized. It is important to raise the awareness of doctors and of other health professionals about the real consequences of this decision, the ethical deviations when conducts are chosen without exclusively focusing on the patient`s health, and the need for constant updating for the management of the various possible conditions of childbirth.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article07-02-2010
Myomectomy in the second trimester of pregnancy: case report
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(4):198-201
Abstract
Original ArticleMyomectomy in the second trimester of pregnancy: case report
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(4):198-201
DOI 10.1590/S0100-72032010000400008
Views109See moreUterine leiomyomas are characterized as a benign disease and are observed in 2 to 3% of all normal pregnancies. Out of these, about 10% may present complications during pregnancy. We present a case of a pregnant patient sought emergency obstetric care at the 17th week, complaining of severe pain, presenting with painful abdominal palpation and sudden positive decompression. Ultrasonography revealed a myoma nodule measuring 9.1 x 7.7 cm; the patient was hospitalized and medicated, being also submitted to laparotomy and myomectomy due to worsening of her condition. Prenatal care revealed no further abnormalities, with resolution of gestation at 39 weeks. The newborn weighed 3,315 g, with Apgar scores of 9 and 10. In such cases, clinical treatment should always be attempted and surgery should be considered only in selected cases, mainly in the impossibility of conservative treatment or when the patient's clinical features require immediate intervention. In this case, myomectomy was effective against maternal-fetal obstetric complications.
Views109This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleMyomectomy in the second trimester of pregnancy: case report
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(4):198-201
DOI 10.1590/S0100-72032010000400008
Views109See moreUterine leiomyomas are characterized as a benign disease and are observed in 2 to 3% of all normal pregnancies. Out of these, about 10% may present complications during pregnancy. We present a case of a pregnant patient sought emergency obstetric care at the 17th week, complaining of severe pain, presenting with painful abdominal palpation and sudden positive decompression. Ultrasonography revealed a myoma nodule measuring 9.1 x 7.7 cm; the patient was hospitalized and medicated, being also submitted to laparotomy and myomectomy due to worsening of her condition. Prenatal care revealed no further abnormalities, with resolution of gestation at 39 weeks. The newborn weighed 3,315 g, with Apgar scores of 9 and 10. In such cases, clinical treatment should always be attempted and surgery should be considered only in selected cases, mainly in the impossibility of conservative treatment or when the patient's clinical features require immediate intervention. In this case, myomectomy was effective against maternal-fetal obstetric complications.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article07-02-2010
Cesarean section in fetal death
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(4):169-175
Abstract
Original ArticleCesarean section in fetal death
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(4):169-175
DOI 10.1590/S0100-72032010000400004
Views110See morePURPOSE: to determine the factors associated with cesarean section in pregnancies with fetal death at a maternity hospital in Recife, Pernambuco, Brazil. METHODS: a cross-sectional study was performed, which analyzed data from the information system about mortality and medical records, from January 2005 to December 2008, of Hospital Barão de Lucena (HBL). We analyzed women with fetal death diagnosis, with gestational age of 20 weeks or more, in terms of sociodemographic characteristics, causes and types of fetal death, obstetrical precedents and birth characteristics. The associations between the variables were analyzed by the χ2 test of association and Fisher exact test, with the level of significance set at 5%. We calculated the prevalence ratio as the measure of risk and the confidence interval (CI) at 95%. Logistic regression analysis was also performed and the Odds Ratio (OR) was calculated. RESULTS: among the 258 pregnant women with fetal death, 27.5% (n=71) underwent cesarean section. After multivariate analysis, the factors that remained significantly associated with cesarean section were maternal age below 20 years (OR=0.23; 95%CI=0.06-0.85), history of one or more cesarean sections (OR=7.02; 95%CI=2.29-21.55), multiple gestation (OR=9.06; 95%CI=2.01-40.71), use of misoprostol for birth induction (OR=0.07; 95%CI=0.01-0.32), fetal death occurring during birth (OR=4.01; 95%CI=1.13-14.24), low birth weight (OR=0.33; 95%CI=0.11-0.94), presence of hypertensive disorders (OR=3.7; 95%CI=1.46-9.39) and abruptio placentae (OR=13.9; 95%CI=4.67-41.69). CONCLUSION: in HBL, the risk factors for cesarean section in pregnancies with fetal death were previous cesarean section, multiple gestation, intrapartum deaths, hypertensive disorders and abruptio placentae. The protective factors were teenage pregnancy, use of misoprostol and low birth weight.
Views110This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleCesarean section in fetal death
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(4):169-175
DOI 10.1590/S0100-72032010000400004
Views110See morePURPOSE: to determine the factors associated with cesarean section in pregnancies with fetal death at a maternity hospital in Recife, Pernambuco, Brazil. METHODS: a cross-sectional study was performed, which analyzed data from the information system about mortality and medical records, from January 2005 to December 2008, of Hospital Barão de Lucena (HBL). We analyzed women with fetal death diagnosis, with gestational age of 20 weeks or more, in terms of sociodemographic characteristics, causes and types of fetal death, obstetrical precedents and birth characteristics. The associations between the variables were analyzed by the χ2 test of association and Fisher exact test, with the level of significance set at 5%. We calculated the prevalence ratio as the measure of risk and the confidence interval (CI) at 95%. Logistic regression analysis was also performed and the Odds Ratio (OR) was calculated. RESULTS: among the 258 pregnant women with fetal death, 27.5% (n=71) underwent cesarean section. After multivariate analysis, the factors that remained significantly associated with cesarean section were maternal age below 20 years (OR=0.23; 95%CI=0.06-0.85), history of one or more cesarean sections (OR=7.02; 95%CI=2.29-21.55), multiple gestation (OR=9.06; 95%CI=2.01-40.71), use of misoprostol for birth induction (OR=0.07; 95%CI=0.01-0.32), fetal death occurring during birth (OR=4.01; 95%CI=1.13-14.24), low birth weight (OR=0.33; 95%CI=0.11-0.94), presence of hypertensive disorders (OR=3.7; 95%CI=1.46-9.39) and abruptio placentae (OR=13.9; 95%CI=4.67-41.69). CONCLUSION: in HBL, the risk factors for cesarean section in pregnancies with fetal death were previous cesarean section, multiple gestation, intrapartum deaths, hypertensive disorders and abruptio placentae. The protective factors were teenage pregnancy, use of misoprostol and low birth weight.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article08-13-2009
Neurologic vigor of term newborns according to the type of delivery and obstetric maneuvers
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(6):279-284
Abstract
Original ArticleNeurologic vigor of term newborns according to the type of delivery and obstetric maneuvers
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(6):279-284
DOI 10.1590/S0100-72032009000600003
Views111See morePURPOSE: to evaluate the effect of delivery type and usual obstetric procedures on the neurologic condition of a sample of consecutive term and healthy neonates, in the first 48 hours of life, using the Neurologic Adaptative Capacity Score (NACS) system. METHODS: cohort prospective study with 313 neonates, from a neonatology unit: Unidade de Neonatologia e Alojamento Conjunto. The variables analyzed were obstetric variables; clinical outcome: low neurologic vigor phase, evaluated by NACS, at 4, 24 and 48 hours of life. The data have been assessed twice: once with the whole sample and the other comparing the Vigorous Group, whose neonates kept a score of 35 or more during the three evaluations, and the Low Vigor Group, with less than 35 scores during the three consecutive evaluations. Bivariate and multivariate analyses have been done. Possible associations between low neurologic vigor phase and the type of delivery, as well between the low neurologic vigor phase and obstetric variables have been searched. RESULTS: in the bivariate analysis, the delivery type and the obstetric variables were not associated with the low neurologic vigor phase. Nevertheless, the association between the amniotic fluid and the low neurologic vigor phase reached values very close to significance and, then, it was included in the multivariate analysis. In the multivariate analysis, the only variable associated with low neurologic vigor was the presence of meconium stained amniotic fluid, which has shown to be 8.1 times more risky for the neurologic scoring, when Vigorous Group and Low Vigor Group were compared. In the analysis of the whole sample, the same risk was 1.7. CONCLUSIONS: neither the delivery type, nor the usual obstetric procedures were associated with low neurologic vigor phase. This is useful information, clinically or legally speaking, mainly for obstetricians. According to this sample data, when the term neonate is healthy, the delivery type and the usual obstetric procedures have no impact in the neurologic condition.
Views111This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleNeurologic vigor of term newborns according to the type of delivery and obstetric maneuvers
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(6):279-284
DOI 10.1590/S0100-72032009000600003
Views111See morePURPOSE: to evaluate the effect of delivery type and usual obstetric procedures on the neurologic condition of a sample of consecutive term and healthy neonates, in the first 48 hours of life, using the Neurologic Adaptative Capacity Score (NACS) system. METHODS: cohort prospective study with 313 neonates, from a neonatology unit: Unidade de Neonatologia e Alojamento Conjunto. The variables analyzed were obstetric variables; clinical outcome: low neurologic vigor phase, evaluated by NACS, at 4, 24 and 48 hours of life. The data have been assessed twice: once with the whole sample and the other comparing the Vigorous Group, whose neonates kept a score of 35 or more during the three evaluations, and the Low Vigor Group, with less than 35 scores during the three consecutive evaluations. Bivariate and multivariate analyses have been done. Possible associations between low neurologic vigor phase and the type of delivery, as well between the low neurologic vigor phase and obstetric variables have been searched. RESULTS: in the bivariate analysis, the delivery type and the obstetric variables were not associated with the low neurologic vigor phase. Nevertheless, the association between the amniotic fluid and the low neurologic vigor phase reached values very close to significance and, then, it was included in the multivariate analysis. In the multivariate analysis, the only variable associated with low neurologic vigor was the presence of meconium stained amniotic fluid, which has shown to be 8.1 times more risky for the neurologic scoring, when Vigorous Group and Low Vigor Group were compared. In the analysis of the whole sample, the same risk was 1.7. CONCLUSIONS: neither the delivery type, nor the usual obstetric procedures were associated with low neurologic vigor phase. This is useful information, clinically or legally speaking, mainly for obstetricians. According to this sample data, when the term neonate is healthy, the delivery type and the usual obstetric procedures have no impact in the neurologic condition.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article06-30-2009
Geoprocessing to identify the pattern of birth profile in Vale do Paraíba
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(4):171-176
Abstract
Original ArticleGeoprocessing to identify the pattern of birth profile in Vale do Paraíba
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(4):171-176
DOI 10.1590/S0100-72032009000400003
Views104PURPOSE: to apply geoprocessing techniques for the spatial birth profile analysis of each municipality. METHODS: ecological and exploratory study, using data from the Health Information System about born alive babies in 2004, and using geoprocessing techniques. The spatial autocorrelations of the variables: cesarean section, mother's schooling, low birth weight, Apgar score at five minutes, prematurity, number of medical appointments and adolescent mothers, besides the map with the index of human development were estimated. For the detection of spatial events aggregates, Moran's I M statistics, through the program Terra View 3.13 (developed by INPE and available to the public) was used. Spatial maps with those variables were built, and Pearson's correlation coefficients, estimated. RESULTS: results have shown that the rate of born alive babies, from mothers with school level over primary school and from cesarean sections, presented a spatial pattern visually identifiable and significant spatial self-correlation. Low birth weight, prematurity, Apgar score, number of pre-natal appointments and adolescent mothers have presented a random spatial pattern, showing that, in this analysis scale, those markers have not discriminated the risk groups, despite their unquestionable predictive value for children's morbidity-mortality at individual level. There has been a positive correlation between cesarean section and schooling, and between cesarean section and human development index; and a negative correlation between adolescent mothers and human development index, with statistical significance (p<0.05). CONCLUSIONS: this methodology has allowed us to identify spatial clusters for the variables cesarean section and mother's schooling, besides deepening our knowledge on birth profile in the municipalities, presenting good potential on how to direct actions for specific areas.
Key-words AdolescentCesarean sectionHealth profileInfant mortalityInfant, low birth weightLive birthMorbidityParturitionPregnancyResidence characteristicsSee moreViews104This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleGeoprocessing to identify the pattern of birth profile in Vale do Paraíba
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(4):171-176
DOI 10.1590/S0100-72032009000400003
Views104PURPOSE: to apply geoprocessing techniques for the spatial birth profile analysis of each municipality. METHODS: ecological and exploratory study, using data from the Health Information System about born alive babies in 2004, and using geoprocessing techniques. The spatial autocorrelations of the variables: cesarean section, mother's schooling, low birth weight, Apgar score at five minutes, prematurity, number of medical appointments and adolescent mothers, besides the map with the index of human development were estimated. For the detection of spatial events aggregates, Moran's I M statistics, through the program Terra View 3.13 (developed by INPE and available to the public) was used. Spatial maps with those variables were built, and Pearson's correlation coefficients, estimated. RESULTS: results have shown that the rate of born alive babies, from mothers with school level over primary school and from cesarean sections, presented a spatial pattern visually identifiable and significant spatial self-correlation. Low birth weight, prematurity, Apgar score, number of pre-natal appointments and adolescent mothers have presented a random spatial pattern, showing that, in this analysis scale, those markers have not discriminated the risk groups, despite their unquestionable predictive value for children's morbidity-mortality at individual level. There has been a positive correlation between cesarean section and schooling, and between cesarean section and human development index; and a negative correlation between adolescent mothers and human development index, with statistical significance (p<0.05). CONCLUSIONS: this methodology has allowed us to identify spatial clusters for the variables cesarean section and mother's schooling, besides deepening our knowledge on birth profile in the municipalities, presenting good potential on how to direct actions for specific areas.
Key-words AdolescentCesarean sectionHealth profileInfant mortalityInfant, low birth weightLive birthMorbidityParturitionPregnancyResidence characteristicsSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cesarean section Archives - Revista Brasileira de Ginecologia e Obstetrícia
