Prenatal care Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(6):259-267
DOI 10.1590/S0100-72032012000600004
PURPOSE: To compare the filling out of the prenatal care card of pregnant women at a school-service and other services, as well as to verify the concordance between these records and verbal information provided by the puerperae. METHODS: A two-stage epidemiological, cross-sectional study was performed with stratified sampling, proportional to number of births. In the first stage, the information recorded on the prenatal care card in the school-service was compared to that recorded in units not linked to higher health education in Recife (PE). In the second stage, the information about prenatal care was collected with a semi-structured questionnaire applied to women during the puerperal period. A total of 262 puerperae older than 19 years, who had a prenatal care card at the time of delivery were included in the study from May to July 2008. Data were analyzed statistically by the χ² test, Student´s t-test or Mann-Whitney test, all one-sided to the right, with the level of significance set at 5%. RESULTS: The information more often recorded on the prenatal care card in the school-service was: schooling (86.5 versus 70.3%; p=0.002), marital status, (83.7 versus 70.9%; p=0.01), weight prior to pregnancy (72.1 versus 46.8%; p<0.001), height (62.5 versus 45.6%; p=0.007), and educational practices (76.9 versus 11.4%; p<0.001) and, at other services, only birth weight <2,500 g (15.4 versus 27.2% at the school-service; p=0.02). There were significant discrepancies between data obtained by verbal information and the prenatal care records of the pregnant women. At the school-service, 40.3% of pregnant women received adequate prenatal care versus 20.3% at other units. CONCLUSIONS: In all services, there was a predominance of recorded information directly related to delivery, while information about actions with preventive characteristics during prenatal care was neglected.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(6):259-267
DOI 10.1590/S0100-72032012000600004
PURPOSE: To compare the filling out of the prenatal care card of pregnant women at a school-service and other services, as well as to verify the concordance between these records and verbal information provided by the puerperae. METHODS: A two-stage epidemiological, cross-sectional study was performed with stratified sampling, proportional to number of births. In the first stage, the information recorded on the prenatal care card in the school-service was compared to that recorded in units not linked to higher health education in Recife (PE). In the second stage, the information about prenatal care was collected with a semi-structured questionnaire applied to women during the puerperal period. A total of 262 puerperae older than 19 years, who had a prenatal care card at the time of delivery were included in the study from May to July 2008. Data were analyzed statistically by the χ² test, Student´s t-test or Mann-Whitney test, all one-sided to the right, with the level of significance set at 5%. RESULTS: The information more often recorded on the prenatal care card in the school-service was: schooling (86.5 versus 70.3%; p=0.002), marital status, (83.7 versus 70.9%; p=0.01), weight prior to pregnancy (72.1 versus 46.8%; p<0.001), height (62.5 versus 45.6%; p=0.007), and educational practices (76.9 versus 11.4%; p<0.001) and, at other services, only birth weight <2,500 g (15.4 versus 27.2% at the school-service; p=0.02). There were significant discrepancies between data obtained by verbal information and the prenatal care records of the pregnant women. At the school-service, 40.3% of pregnant women received adequate prenatal care versus 20.3% at other units. CONCLUSIONS: In all services, there was a predominance of recorded information directly related to delivery, while information about actions with preventive characteristics during prenatal care was neglected.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(4):147-152
DOI 10.1590/S0100-72032012000400002
PURPOSE: To assess medication adherence therapeutic during pregnancy in a sample of Brazilian women during the post-partum period. METHODS: We conducted a cross-sectional study in the obstetric unit of a university hospital, Brazil, between August and November 2010. We recruited patients aged 18 years or more, with a gestational age of more than 22 weeks whose newborns weighed more than 500 g. Patients were excluded if they used sedatives or other mind-altering drugs. Data were collected after labor using a structured questionnaire containing questions about sociodemographic characteristics, medication use, number of previous pregnancies, contraceptive methods, prenatal care, and medication adherence. Medication adherence was assessed using the four-item Morisky medication adherence scale - MMAS-4, groups were compared by the Fisher exact Test and Kruskal-Wallis Test and Χ2 de Pearson Test. RESULTS: Mean age was 22.5 years (SD=6.5), and 53.8% of the pregnant women had initiated prenatal care during the first trimester of pregnancy. Of the 130 patients interviewed, 96.9% had used at least one prescribed drug during pregnancy, with an average of 2.8 drugs per patient. The major classes prescribed were antianemics (55.1%), analgesics, anti-inflammatories, and antipyretics (19.0%) and anti-infectives (7.2%). 71.6% took two to four drugs. Only 19.2% of patients were considered adherent. The variables that showed a negative influence on adherence were: higher level of education, having one's own income, earlier prenatal care and previous abortion. CONCLUSION: Our findings indicate that, although most of the patients used prescribed drugs during pregnancy, the rate of medication adherence was low, which indicates the need for further investigation about the impact of non-adherence during pregnancy and its causes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(4):147-152
DOI 10.1590/S0100-72032012000400002
PURPOSE: To assess medication adherence therapeutic during pregnancy in a sample of Brazilian women during the post-partum period. METHODS: We conducted a cross-sectional study in the obstetric unit of a university hospital, Brazil, between August and November 2010. We recruited patients aged 18 years or more, with a gestational age of more than 22 weeks whose newborns weighed more than 500 g. Patients were excluded if they used sedatives or other mind-altering drugs. Data were collected after labor using a structured questionnaire containing questions about sociodemographic characteristics, medication use, number of previous pregnancies, contraceptive methods, prenatal care, and medication adherence. Medication adherence was assessed using the four-item Morisky medication adherence scale - MMAS-4, groups were compared by the Fisher exact Test and Kruskal-Wallis Test and Χ2 de Pearson Test. RESULTS: Mean age was 22.5 years (SD=6.5), and 53.8% of the pregnant women had initiated prenatal care during the first trimester of pregnancy. Of the 130 patients interviewed, 96.9% had used at least one prescribed drug during pregnancy, with an average of 2.8 drugs per patient. The major classes prescribed were antianemics (55.1%), analgesics, anti-inflammatories, and antipyretics (19.0%) and anti-infectives (7.2%). 71.6% took two to four drugs. Only 19.2% of patients were considered adherent. The variables that showed a negative influence on adherence were: higher level of education, having one's own income, earlier prenatal care and previous abortion. CONCLUSION: Our findings indicate that, although most of the patients used prescribed drugs during pregnancy, the rate of medication adherence was low, which indicates the need for further investigation about the impact of non-adherence during pregnancy and its causes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):228-234
DOI 10.1590/S0100-72032012000500007
PURPOSE: To evaluate habits of sun exposure and sun protection of pregnant women in a public hospital, to assess orientation about photo protection during the prenatal care, and to detect the presence of melasma and its impact on their quality of life. METHODS: A descriptive cross sectional study conducted among women of 18 years old and older, after delivery, who participated in a program of prenatal care in the South Region of Brazil. The sample was non-probabilistic by convenience. Data collection occurred from July to August 2011 through direct interview using a structured questionnaire to obtain personal information and photo protection habits during pregnancy, skin assessment and photographic record of lesions through informed consent. The skin was classified per Fitzpatrick's phototypes and the melasma was diagnosed clinically. In the patients with melasma, the MELASQoL-PB version was applied. The analysis was performed using Statistica®, version 8.0, and the significance level of p<0.05. RESULTS: In the sample (109 mothers) predominated white women (60.6% phototype III), young (average age 24.4 years SD=6.1) and housewives (59.6%). The majority (80%) stayed exposed to sunlight for 1-2 hours per day between 10 am and 3 pm, and from those (72%) did not apply any photoprotection due to lack of sunscreen habit. Other physical means of sun protection were used by 15% of these patients. Information during prenatal care about the risks of sun exposure was reported by 34% of the mothers interviewed. There was a trend toward a significant association between prenatal guidance and daily use of sunscreen (p=0.088). About 20% of mothers had melasma. The average score MELASQol-PB (25) showed a negative impact on quality of life of these patients. CONCLUSION: In these women, sun exposure occurred at inappropriate times, without proper guidance and without the use of an effective sunscreen. The mothers with melasma complained about the appearance of their skin, frustration and embarrassment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):228-234
DOI 10.1590/S0100-72032012000500007
PURPOSE: To evaluate habits of sun exposure and sun protection of pregnant women in a public hospital, to assess orientation about photo protection during the prenatal care, and to detect the presence of melasma and its impact on their quality of life. METHODS: A descriptive cross sectional study conducted among women of 18 years old and older, after delivery, who participated in a program of prenatal care in the South Region of Brazil. The sample was non-probabilistic by convenience. Data collection occurred from July to August 2011 through direct interview using a structured questionnaire to obtain personal information and photo protection habits during pregnancy, skin assessment and photographic record of lesions through informed consent. The skin was classified per Fitzpatrick's phototypes and the melasma was diagnosed clinically. In the patients with melasma, the MELASQoL-PB version was applied. The analysis was performed using Statistica®, version 8.0, and the significance level of p<0.05. RESULTS: In the sample (109 mothers) predominated white women (60.6% phototype III), young (average age 24.4 years SD=6.1) and housewives (59.6%). The majority (80%) stayed exposed to sunlight for 1-2 hours per day between 10 am and 3 pm, and from those (72%) did not apply any photoprotection due to lack of sunscreen habit. Other physical means of sun protection were used by 15% of these patients. Information during prenatal care about the risks of sun exposure was reported by 34% of the mothers interviewed. There was a trend toward a significant association between prenatal guidance and daily use of sunscreen (p=0.088). About 20% of mothers had melasma. The average score MELASQol-PB (25) showed a negative impact on quality of life of these patients. CONCLUSION: In these women, sun exposure occurred at inappropriate times, without proper guidance and without the use of an effective sunscreen. The mothers with melasma complained about the appearance of their skin, frustration and embarrassment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(2):56-62
DOI 10.1590/S0100-72032012000200003
PURPOSE: To describe the characteristics of pregnancies complicated by maternal syphilis and fetal death. METHODS: Retrospective descriptive study performed by reviewing the medical records of 48 pregnant women with maternal syphilis and fetal death outcome admitted to Hospital Geral de Nova Iguaçu, Baixada Fluminense, State of Rio de Janeiro, during the period from 2005 to 2008. Birth weight >500 g and fetal death documented by Death Certificate were the inclusion criteria. The following aspects were analyzed: sociodemographic factors, reproductive history, aspects of the current pregnancy, prenatal care, Venereal Disease Research Laboratory (VDRL) testing, and other gestational conditions, in addition to syphilis. The fetal deaths were classified as maternal, placental or fetal. Percentage, mean, standard deviation (SD), maximum and minimum values were reported. RESULTS: The mean maternal age was 22.7 years (SD=0.9 years), and at least 50% of the patients had low educational level. At hospital admission, 68.8% of the subjects were in the third trimester, with a mean gestational age of 29.2 weeks (SD=0.5), and more than 50% were in labor. The vast majority of fetal deaths (93%) occurred before maternal hospitalization. Among the patients who received prenatal care (54.2%), 30.8% had no VDRL test, 30.8 and 15.4% had a reactive and non-reactive result, respectively, and none had more than one prenatal VDRL test. At the time of childbirth, most of the mothers (95.8%) carried out VDRL testing. Overall, the VDRL titers varied from 1:1 to 1:512, with predominant values >1:4 (91.7%). In 23% of cases other clinical conditions related to fetal death, in addition to syphilis, were found. CONCLUSIONS: The infection was the main clinically identified cause of fetal death in this patient series. Fetal death occurred during the preterm period and in the presence of high titers of maternal infection, suggesting recent syphilis infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(2):56-62
DOI 10.1590/S0100-72032012000200003
PURPOSE: To describe the characteristics of pregnancies complicated by maternal syphilis and fetal death. METHODS: Retrospective descriptive study performed by reviewing the medical records of 48 pregnant women with maternal syphilis and fetal death outcome admitted to Hospital Geral de Nova Iguaçu, Baixada Fluminense, State of Rio de Janeiro, during the period from 2005 to 2008. Birth weight >500 g and fetal death documented by Death Certificate were the inclusion criteria. The following aspects were analyzed: sociodemographic factors, reproductive history, aspects of the current pregnancy, prenatal care, Venereal Disease Research Laboratory (VDRL) testing, and other gestational conditions, in addition to syphilis. The fetal deaths were classified as maternal, placental or fetal. Percentage, mean, standard deviation (SD), maximum and minimum values were reported. RESULTS: The mean maternal age was 22.7 years (SD=0.9 years), and at least 50% of the patients had low educational level. At hospital admission, 68.8% of the subjects were in the third trimester, with a mean gestational age of 29.2 weeks (SD=0.5), and more than 50% were in labor. The vast majority of fetal deaths (93%) occurred before maternal hospitalization. Among the patients who received prenatal care (54.2%), 30.8% had no VDRL test, 30.8 and 15.4% had a reactive and non-reactive result, respectively, and none had more than one prenatal VDRL test. At the time of childbirth, most of the mothers (95.8%) carried out VDRL testing. Overall, the VDRL titers varied from 1:1 to 1:512, with predominant values >1:4 (91.7%). In 23% of cases other clinical conditions related to fetal death, in addition to syphilis, were found. CONCLUSIONS: The infection was the main clinically identified cause of fetal death in this patient series. Fetal death occurred during the preterm period and in the presence of high titers of maternal infection, suggesting recent syphilis infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(10):286-291
DOI 10.1590/S0100-72032011001000003
PURPOSES: To determine the rate of low birth weight and some of the risk factors associated with this event among adolescents. METHODS: A cross-sectional study conducted between October 1994 and December 2009 at a maternity in Campinas, in Brazil, using information generated from the computerized obstetric form. After selection of adolescents who delivered at this hospital, two groups were created, with and without low birth weight, respectively. Relative risk and 95% confidence interval for all independent variables (risk factors) and the Χ2 test for some perinatal results were performed. The level of significance was set at 5%. RESULTS: During the study period, 24,000 births occurred at CAISM. Of these, 2,404 occurred among 2,357 teenagers (10.02%) and the frequency of low birth weight was 15.1%. Adolescent pregnancy recurred in 294 (8.2%). Age less than 15 years-old, anemia, smoking, and hypertension were not significantly associated with low birth weight. Antecedent of miscarriage and association with systemic lupus erythematosus increased the risk of low birth weight. Cesarean section and an Apgar score below seven were more prevalent among adolescents with low birth weight, and 85% of all adolescents had less than six prenatal visits. CONCLUSIONS: The prevalence of low birth weight is higher among adolescents than among adult women, and there was a large number of adolescents with less than six prenatal visits . The antecedent of miscarriage and the presence of systemic lupus erythematosus were risk factors associated with the occurrence of low birth weight among adolescents.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(10):286-291
DOI 10.1590/S0100-72032011001000003
PURPOSES: To determine the rate of low birth weight and some of the risk factors associated with this event among adolescents. METHODS: A cross-sectional study conducted between October 1994 and December 2009 at a maternity in Campinas, in Brazil, using information generated from the computerized obstetric form. After selection of adolescents who delivered at this hospital, two groups were created, with and without low birth weight, respectively. Relative risk and 95% confidence interval for all independent variables (risk factors) and the Χ2 test for some perinatal results were performed. The level of significance was set at 5%. RESULTS: During the study period, 24,000 births occurred at CAISM. Of these, 2,404 occurred among 2,357 teenagers (10.02%) and the frequency of low birth weight was 15.1%. Adolescent pregnancy recurred in 294 (8.2%). Age less than 15 years-old, anemia, smoking, and hypertension were not significantly associated with low birth weight. Antecedent of miscarriage and association with systemic lupus erythematosus increased the risk of low birth weight. Cesarean section and an Apgar score below seven were more prevalent among adolescents with low birth weight, and 85% of all adolescents had less than six prenatal visits. CONCLUSIONS: The prevalence of low birth weight is higher among adolescents than among adult women, and there was a large number of adolescents with less than six prenatal visits . The antecedent of miscarriage and the presence of systemic lupus erythematosus were risk factors associated with the occurrence of low birth weight among adolescents.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(9):246-251
DOI 10.1590/S0100-72032011000900005
PURPOSE: To estimate the prevalence of folic acid supplementation during pregnancy and to identify maternal factors associated with its consumption. METHODS: This was a cross-sectional study with 280 women from the city of Diamantina (MG), Brazil. The dependent variable was use of a folic acid supplement during pregnancy, and the independent variables were age and maternal schooling, number of prenatal care visits, parity, marital status and presence or absence of anemia. Poisson regression analysis was used to assess the association of independent variables with the dependent variable. RESULTS: Women with less education, adolescents, and number of prenatal visits less than seven were 1.61 (95%CI=1.34-1.93), 1.18 (95%CI=1.03-1.35) e 1.18 (95%CI=1.02-1.37) more likely not to consume the supplement during pregnancy, respectively. CONCLUSIONS: The prevalence of consumption of folic acid among pregnant women was low, associated with maternal age and education and number of prenatal visits.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(9):246-251
DOI 10.1590/S0100-72032011000900005
PURPOSE: To estimate the prevalence of folic acid supplementation during pregnancy and to identify maternal factors associated with its consumption. METHODS: This was a cross-sectional study with 280 women from the city of Diamantina (MG), Brazil. The dependent variable was use of a folic acid supplement during pregnancy, and the independent variables were age and maternal schooling, number of prenatal care visits, parity, marital status and presence or absence of anemia. Poisson regression analysis was used to assess the association of independent variables with the dependent variable. RESULTS: Women with less education, adolescents, and number of prenatal visits less than seven were 1.61 (95%CI=1.34-1.93), 1.18 (95%CI=1.03-1.35) e 1.18 (95%CI=1.02-1.37) more likely not to consume the supplement during pregnancy, respectively. CONCLUSIONS: The prevalence of consumption of folic acid among pregnant women was low, associated with maternal age and education and number of prenatal visits.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(9):227-233
DOI 10.1590/S0100-72032011000900002
PURPOSE: To evaluate the coping strategies of women facing a diagnosis of fetal heart disease. METHODS: We interviewed 50 women who had received a diagnosis of fetal heart disease. For data collection we used a semi-directed and Coping Strategy Inventory. The interview was conducted, on average, 22 days after the diagnosis. RESULTS: When asked how they felt about the baby, 56.0% reported concern and fragility, while the remaining 44.0% said they were happy and well. The strategies most used by women were problem solving (73.0%), social support (69.1%) and escape/avoidance (62.7%), and the least used strategy was removal (17.3%). It was found that women with partners, as well as those with 1 or 2 children, used more the problem-solving strategy (p<0.05). CONCLUSIONS: The active coping strategies, focused on problem solving and seeking social support, coupled with the responsibility and the need for specific care for the survival and welfare of the baby, brought about a closer relationship with the pregnancy, strengthening the maternal-fetal bond.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(9):227-233
DOI 10.1590/S0100-72032011000900002
PURPOSE: To evaluate the coping strategies of women facing a diagnosis of fetal heart disease. METHODS: We interviewed 50 women who had received a diagnosis of fetal heart disease. For data collection we used a semi-directed and Coping Strategy Inventory. The interview was conducted, on average, 22 days after the diagnosis. RESULTS: When asked how they felt about the baby, 56.0% reported concern and fragility, while the remaining 44.0% said they were happy and well. The strategies most used by women were problem solving (73.0%), social support (69.1%) and escape/avoidance (62.7%), and the least used strategy was removal (17.3%). It was found that women with partners, as well as those with 1 or 2 children, used more the problem-solving strategy (p<0.05). CONCLUSIONS: The active coping strategies, focused on problem solving and seeking social support, coupled with the responsibility and the need for specific care for the survival and welfare of the baby, brought about a closer relationship with the pregnancy, strengthening the maternal-fetal bond.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(8):182-187
DOI 10.1590/S0100-72032011000800003
PURPOSE:to evaluate psychosocial adaptation to pregnancy by translating and cross-culturally adapting a specific assessment instrument to be used with Brazilian women. METHODS: this was a cross-sectional observational study. the translation and cross-cultural adaptation and of the Prenatal Self-evaluation Questionnaire (PSeQ) was performed following all the required methodological steps. another questionnaire was applied to characterize the sociodemographic and clinical status of the pregnant women (n=36). Statistical analysis consisted of the determination of the mean and standard deviation (SD) and of absolute and relative frequency. the statistical test used for the analysis of internal consistency was Cronbach's alpha coefficient, using SPSS version 17.0. RESULTS: the volunteers were of low socioeconomic status, aged on average 25.1 years ( 5.5), and had an average gestational age of 25.9 weeks ( 8.1). 58.3% of these volunteers had not planned their current pregnancy. the pretest showed that 75% of the pregnant women found the questionnaire easy to understand. Regarding the PSeQ instrument, the identification with the maternal role was the subcategory which showed the highest average, 24.8 ( 5.6), while the relationship with the mother had the lowest average 15.4 ( 7.7). the internal consistency ranged from 0.52 to 0.89. CONCLUSION: the assessment of psychosocial adaptation to pregnancy in pregnant women is very important during the progress of pregnancy and permits intervention through obstetric-neonatal actions of promotion and prevention regarding the well-being of mother and child.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(8):182-187
DOI 10.1590/S0100-72032011000800003
PURPOSE:to evaluate psychosocial adaptation to pregnancy by translating and cross-culturally adapting a specific assessment instrument to be used with Brazilian women. METHODS: this was a cross-sectional observational study. the translation and cross-cultural adaptation and of the Prenatal Self-evaluation Questionnaire (PSeQ) was performed following all the required methodological steps. another questionnaire was applied to characterize the sociodemographic and clinical status of the pregnant women (n=36). Statistical analysis consisted of the determination of the mean and standard deviation (SD) and of absolute and relative frequency. the statistical test used for the analysis of internal consistency was Cronbach's alpha coefficient, using SPSS version 17.0. RESULTS: the volunteers were of low socioeconomic status, aged on average 25.1 years ( 5.5), and had an average gestational age of 25.9 weeks ( 8.1). 58.3% of these volunteers had not planned their current pregnancy. the pretest showed that 75% of the pregnant women found the questionnaire easy to understand. Regarding the PSeQ instrument, the identification with the maternal role was the subcategory which showed the highest average, 24.8 ( 5.6), while the relationship with the mother had the lowest average 15.4 ( 7.7). the internal consistency ranged from 0.52 to 0.89. CONCLUSION: the assessment of psychosocial adaptation to pregnancy in pregnant women is very important during the progress of pregnancy and permits intervention through obstetric-neonatal actions of promotion and prevention regarding the well-being of mother and child.