parturition Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2007;29(12):633-638
DOI 10.1590/S0100-72032007001200006
PURPOSE: to compare macro and microscopically, surgical uterine sutures in female rabbits, after caesarean section utilizing separate, continuous and continuous anchored suture stitches. METHODS: three New Zealand female rabbits in their first pregnancy were used. The caesarean section was carried out at the 26th day of gestation and three incisions were performed in each uterus. The hysterorrhaphy was performed with a 00 Vicryl® thread, and a different suture technique was employed for each incision. Total hysterectomy and adnexectomy were done at the 60th day post-delivery with the preservation of eventual adhesions for the evaluation of the surgical scars. The extent of scar retraction, amount of fibrin deposit and the suture integrity were evaluated through macroscopy. For the evaluation through microscopy, hematoxylin eosin technique was used for cellular colorimetry, and Masson's trichrom to evidence collagen. The statistical non-parametric Friedman's test was employed for the matching hypothesis, and Fisher's exact test to verify the homogeneity of the techniques (level of significance: 5%). RESULTS: a total of 18 scars were obtained (six scars per suture). The following mean values were obtained for the longitudinal (0.5/0.4/0.5, p=0.069) and transversal retraction degrees (0.3/0.4/0.3, p=0.143) respectively for separate, continuous and continuous anchored suture techniques. All sutures presented regular fibrin deposit, no adhesions and integral absorption of the stitches. The mean value of the blood vessels (158.5/139.3/172.1; p=0.293), fibroblasts (351.6/345.8/354.3; p=0.311) and of collagen percentage (44.0/45.5/48.5; p=0.422) were calculated through microscopy, respectively for separate, continuous and continuous anchored suture techniques. CONCLUSIONS: the type of hysterorrhaphy technique of caesarean section in female rabbits did not generate any significant statistical difference in the macroscopic and microscopic parameters evaluated.
Summary
Rev Bras Ginecol Obstet. 2007;29(12):633-638
DOI 10.1590/S0100-72032007001200006
PURPOSE: to compare macro and microscopically, surgical uterine sutures in female rabbits, after caesarean section utilizing separate, continuous and continuous anchored suture stitches. METHODS: three New Zealand female rabbits in their first pregnancy were used. The caesarean section was carried out at the 26th day of gestation and three incisions were performed in each uterus. The hysterorrhaphy was performed with a 00 Vicryl® thread, and a different suture technique was employed for each incision. Total hysterectomy and adnexectomy were done at the 60th day post-delivery with the preservation of eventual adhesions for the evaluation of the surgical scars. The extent of scar retraction, amount of fibrin deposit and the suture integrity were evaluated through macroscopy. For the evaluation through microscopy, hematoxylin eosin technique was used for cellular colorimetry, and Masson's trichrom to evidence collagen. The statistical non-parametric Friedman's test was employed for the matching hypothesis, and Fisher's exact test to verify the homogeneity of the techniques (level of significance: 5%). RESULTS: a total of 18 scars were obtained (six scars per suture). The following mean values were obtained for the longitudinal (0.5/0.4/0.5, p=0.069) and transversal retraction degrees (0.3/0.4/0.3, p=0.143) respectively for separate, continuous and continuous anchored suture techniques. All sutures presented regular fibrin deposit, no adhesions and integral absorption of the stitches. The mean value of the blood vessels (158.5/139.3/172.1; p=0.293), fibroblasts (351.6/345.8/354.3; p=0.311) and of collagen percentage (44.0/45.5/48.5; p=0.422) were calculated through microscopy, respectively for separate, continuous and continuous anchored suture techniques. CONCLUSIONS: the type of hysterorrhaphy technique of caesarean section in female rabbits did not generate any significant statistical difference in the macroscopic and microscopic parameters evaluated.
Summary
Rev Bras Ginecol Obstet. 2006;28(9):523-529
DOI 10.1590/S0100-72032006000900004
PURPOSE: to determine the values of perineal muscular force (PMF) in the lying and seated positions and to identify the values of PMF between first pregnancy, according to type and the characteristics of the vaginal delivery and cesarean section. METHODS: study of the transversal type, performed in a maternity of Brazilian Public the Health System (SUS) in the city of São Paulo. The sample consisted of 95 primiparae at term. Evaluation occurred between the 40th and 45 th, day with an interview, physical examination and measurement of PMF using a perineometer of the Kegel type. The measurement was carried out in the lying and seated positions, muscular status (at rest and in maximum contraction), and the average of three measures for each position and muscular state were considered. RESULTS: 76.8% (73) of the women had vaginal delivery and 23.2% (22) cesarean section. After vaginal delivery, intact perineum in 18.9%, (18), perineal rupture in 24.2% (23), and episiotomy in 33.7% (32) were observed. Obtained values of the PMF were: lying position muscular rest 18. 9 mmHg, lying position maximum contraction: 30,7 mmHg, seated position muscular rest: 34.5 mmHg, seated positions maximum muscular contraction: 46.5 mmHg. CONCLUSION: there was association between the type and the characteristics of the delivery and PMF.
Summary
Rev Bras Ginecol Obstet. 2006;28(9):523-529
DOI 10.1590/S0100-72032006000900004
PURPOSE: to determine the values of perineal muscular force (PMF) in the lying and seated positions and to identify the values of PMF between first pregnancy, according to type and the characteristics of the vaginal delivery and cesarean section. METHODS: study of the transversal type, performed in a maternity of Brazilian Public the Health System (SUS) in the city of São Paulo. The sample consisted of 95 primiparae at term. Evaluation occurred between the 40th and 45 th, day with an interview, physical examination and measurement of PMF using a perineometer of the Kegel type. The measurement was carried out in the lying and seated positions, muscular status (at rest and in maximum contraction), and the average of three measures for each position and muscular state were considered. RESULTS: 76.8% (73) of the women had vaginal delivery and 23.2% (22) cesarean section. After vaginal delivery, intact perineum in 18.9%, (18), perineal rupture in 24.2% (23), and episiotomy in 33.7% (32) were observed. Obtained values of the PMF were: lying position muscular rest 18. 9 mmHg, lying position maximum contraction: 30,7 mmHg, seated position muscular rest: 34.5 mmHg, seated positions maximum muscular contraction: 46.5 mmHg. CONCLUSION: there was association between the type and the characteristics of the delivery and PMF.
Summary
Rev Bras Ginecol Obstet. 2005;27(10):627-634
DOI 10.1590/S0100-72032005001000010
Arterial hypertension is one of the most frequent causes of maternal death. The most important types found in pregnancy are gestational hypertension, clinically defined by increased arterial pressure after the 20th week of pregnancy, and preeclampsia associated with proteinuria. In the initial phase, the disease is asymptomatic, but when not treated or when the pregnancy is not interrupted, it naturally progresses to serious forms such as eclampsia and HELLP syndrome. Eclampsia is defined by one or more generalized tonic-clonic seizures or coma in a pregnant woman with gestational hypertension or preeclampsia, and without neurological disease. It may occur during pregnancy, labor, and immediately after delivery. It is often preceded by signs and symptoms of imminent eclampsia (central nervous system, visual and gastric disorders). Its association with hemolysis, low platelet count, and hepatic dysfunction had already been reported in the literature of the 1950's. In 1982, Weinstein grouped these alterations as a syndrome under the acronym of HELLP, meaning hemolysis (H), elevated liver enzyme levels (EL), and low platelet (LP) count. The literature differs in relation to the parameter values that define the syndrome. Sibai et al. (1986) proposed a system of laboratory and biochemical diagnosis standards which has been adopted by the Brazilian Health Ministry. Clinical manifestations are sometimes imprecise; common complaints are epigastric pain, general malaise, loss of appetite, nausea, and vomiting. Early diagnosis is exclusively by laboratory tests and should be systematically investigated in women with serious preeclampsia/eclampsia or pain in the superior right abdominal quadrant. Differentiating HELLP syndrome from others with similar clinical or laboratory manifestations is not easy. Differential diagnosis is particularly difficult regarding diseases such as thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, or acute fatty liver of pregnancy, due to poor clinical history, and similar physiopathological aspects. An understanding of preeclampsia physiopathology, early diagnosis, and precise action at the right moment in situations complicated by eclampsia or HELLP syndrome, allows a better maternal and perinatal prognosis.
Summary
Rev Bras Ginecol Obstet. 2005;27(10):627-634
DOI 10.1590/S0100-72032005001000010
Arterial hypertension is one of the most frequent causes of maternal death. The most important types found in pregnancy are gestational hypertension, clinically defined by increased arterial pressure after the 20th week of pregnancy, and preeclampsia associated with proteinuria. In the initial phase, the disease is asymptomatic, but when not treated or when the pregnancy is not interrupted, it naturally progresses to serious forms such as eclampsia and HELLP syndrome. Eclampsia is defined by one or more generalized tonic-clonic seizures or coma in a pregnant woman with gestational hypertension or preeclampsia, and without neurological disease. It may occur during pregnancy, labor, and immediately after delivery. It is often preceded by signs and symptoms of imminent eclampsia (central nervous system, visual and gastric disorders). Its association with hemolysis, low platelet count, and hepatic dysfunction had already been reported in the literature of the 1950's. In 1982, Weinstein grouped these alterations as a syndrome under the acronym of HELLP, meaning hemolysis (H), elevated liver enzyme levels (EL), and low platelet (LP) count. The literature differs in relation to the parameter values that define the syndrome. Sibai et al. (1986) proposed a system of laboratory and biochemical diagnosis standards which has been adopted by the Brazilian Health Ministry. Clinical manifestations are sometimes imprecise; common complaints are epigastric pain, general malaise, loss of appetite, nausea, and vomiting. Early diagnosis is exclusively by laboratory tests and should be systematically investigated in women with serious preeclampsia/eclampsia or pain in the superior right abdominal quadrant. Differentiating HELLP syndrome from others with similar clinical or laboratory manifestations is not easy. Differential diagnosis is particularly difficult regarding diseases such as thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, or acute fatty liver of pregnancy, due to poor clinical history, and similar physiopathological aspects. An understanding of preeclampsia physiopathology, early diagnosis, and precise action at the right moment in situations complicated by eclampsia or HELLP syndrome, allows a better maternal and perinatal prognosis.
Summary
Rev Bras Ginecol Obstet. 2005;27(6):357-365
DOI 10.1590/S0100-72032005000600011
The multiple factors involved in maternal complications and maternal mortality make the task of their long-term control difficult and time-consuming. Professional care for pregnant women and/or those in labor certainly represents a key point for obtaining good outcomes, either maternal or perinatal. From the starting point that an adequate professional medical care for delivery has the capacity of decreasing the occurrence of complications associated with maternal morbidity and mortality, the evidence regarding some interventions included in this care is summarily presented. The evidence derived from studies performed with a strong methodological and scientific approach, mainly randomized controlled trials, on interventions to reduce complications and maternal mortality. These main interventions basically refer to: institutional care to is focused delivery, skilled professional care, use of traditional birth attendants in some contexts, use of appropriate technologies including partograph, place of birth, position for delivery, use of episiotomy, type of delivery, use of oxytocin during the active phase of labor, performance of push efforts during the second stage, active management of the third stage, and prophylaxis for post-partum hemorrhage. Although the effect of avoiding maternal death is difficult to be evaluated due to its low frequency, its rational and standardized use, through manuals and guidelines for intervention care, has a positive effect on the quality of care for childbirth. This is part of the human and technical context of the right that every woman has to the best possible care in this so special moment of her life.
Summary
Rev Bras Ginecol Obstet. 2005;27(6):357-365
DOI 10.1590/S0100-72032005000600011
The multiple factors involved in maternal complications and maternal mortality make the task of their long-term control difficult and time-consuming. Professional care for pregnant women and/or those in labor certainly represents a key point for obtaining good outcomes, either maternal or perinatal. From the starting point that an adequate professional medical care for delivery has the capacity of decreasing the occurrence of complications associated with maternal morbidity and mortality, the evidence regarding some interventions included in this care is summarily presented. The evidence derived from studies performed with a strong methodological and scientific approach, mainly randomized controlled trials, on interventions to reduce complications and maternal mortality. These main interventions basically refer to: institutional care to is focused delivery, skilled professional care, use of traditional birth attendants in some contexts, use of appropriate technologies including partograph, place of birth, position for delivery, use of episiotomy, type of delivery, use of oxytocin during the active phase of labor, performance of push efforts during the second stage, active management of the third stage, and prophylaxis for post-partum hemorrhage. Although the effect of avoiding maternal death is difficult to be evaluated due to its low frequency, its rational and standardized use, through manuals and guidelines for intervention care, has a positive effect on the quality of care for childbirth. This is part of the human and technical context of the right that every woman has to the best possible care in this so special moment of her life.
