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Rev Bras Ginecol Obstet. 2023;45(1):03-10
, , , , , To evaluate the association between pain intensity in the active phase of the first stage of labor with the use or not of nonpharmacological methods for pain relief in a real-life scenario.
This was an observational cross-sectional study. The variables analyzed were obtained by a questionnaire with the mothers (up to 48 hours postpartum) to investigate the intensity of pain during labor using the visual analog scale (VAS). The nonpharmacological pain relief methods routinely used in obstetric practice were evaluated by consulting medical records. The patients were separated into two groups: Group I – patients who did not use nonpharmacological methods for pain relief and Group II –patients who used these methods.
A total of 439 women who underwent vaginal delivery were included; 386 (87.9%) used at least 1 nonpharmacological method and 53 (12.1%) did not. The women who did not use nonpharmacological methods had significantly lower gestational age (37.2 versus 39.6 weeks, p < 0.001) and shorter duration of labor (24 versus 114 min, p < 0.001) than those who used the methods. There was no statistically significant difference in the pain scale score using the VAS between the group that used nonpharmacological methods and the group that did not (median 10 [minimum 2– maximum 10] versus 10 [minimum 6–maximum 10] p = 0.334).
In a real-life setting, there was no difference in labor pain intensity between the patients who used nonpharmacological methods and those who did not use them during the active phase of labor.
Summary
Rev Bras Ginecol Obstet. 2023;45(1):03-10
, , , , , To evaluate the association between pain intensity in the active phase of the first stage of labor with the use or not of nonpharmacological methods for pain relief in a real-life scenario.
This was an observational cross-sectional study. The variables analyzed were obtained by a questionnaire with the mothers (up to 48 hours postpartum) to investigate the intensity of pain during labor using the visual analog scale (VAS). The nonpharmacological pain relief methods routinely used in obstetric practice were evaluated by consulting medical records. The patients were separated into two groups: Group I – patients who did not use nonpharmacological methods for pain relief and Group II –patients who used these methods.
A total of 439 women who underwent vaginal delivery were included; 386 (87.9%) used at least 1 nonpharmacological method and 53 (12.1%) did not. The women who did not use nonpharmacological methods had significantly lower gestational age (37.2 versus 39.6 weeks, p < 0.001) and shorter duration of labor (24 versus 114 min, p < 0.001) than those who used the methods. There was no statistically significant difference in the pain scale score using the VAS between the group that used nonpharmacological methods and the group that did not (median 10 [minimum 2– maximum 10] versus 10 [minimum 6–maximum 10] p = 0.334).
In a real-life setting, there was no difference in labor pain intensity between the patients who used nonpharmacological methods and those who did not use them during the active phase of labor.
Summary
Rev Bras Ginecol Obstet. 2006;28(1):10-17
DOI 10.1590/S0100-72032006000100003
PURPOSE: to describe to emotional process experienced with termination of pregnancy after the diagnosis of lethal fetal malformation. METHODS: thirty-five pregnant women who underwent termination of pregnancy for lethal fetal anomaly after judicial permission were interviewed. The most frequent fetal malformation was anencephaly (71.5%). The patients were submitted to an open interview as soon as the diagnosis of fetal malformation was confirmed, allowing them to express their feelings and stimulating them to think about asking for termination of pregnancy. The mean time spent until the judicial agreement was 16.6 days. The women who requested and were submitted to the procedure of abortion were invited to return for psychological evaluation after 30-60 days. At this moment, a semi-structured interview was performed to find the emotional aspects and feelings that existed. RESULTS: thirty-five patients were interviewed. The decision-making feelings about termination of pregnancy were negative for 60%, 51.4% declared that they had no doubts about the assumed decision and 65.7% declared that their own opinion was more important for decision than anyone else's. Most of the women (89%) affirmed to remember the facts about the procedure that they experienced, 91% affirmed that they would have the same attitude in the case of another similar situation in the future and 60% declared that they would advise someone to opt for termination of pregnancy if asked about the same situation. CONCLUSIONS: the anguish experienced showed that the process of thinking is very important for the decision-making process and posterior satisfaction with the assumed posture. The psychological follow-up allows to review the moral and cultural values in order to help the decision-making process with the aim of minimizing the suffering.
Summary
Rev Bras Ginecol Obstet. 2006;28(1):10-17
DOI 10.1590/S0100-72032006000100003
PURPOSE: to describe to emotional process experienced with termination of pregnancy after the diagnosis of lethal fetal malformation. METHODS: thirty-five pregnant women who underwent termination of pregnancy for lethal fetal anomaly after judicial permission were interviewed. The most frequent fetal malformation was anencephaly (71.5%). The patients were submitted to an open interview as soon as the diagnosis of fetal malformation was confirmed, allowing them to express their feelings and stimulating them to think about asking for termination of pregnancy. The mean time spent until the judicial agreement was 16.6 days. The women who requested and were submitted to the procedure of abortion were invited to return for psychological evaluation after 30-60 days. At this moment, a semi-structured interview was performed to find the emotional aspects and feelings that existed. RESULTS: thirty-five patients were interviewed. The decision-making feelings about termination of pregnancy were negative for 60%, 51.4% declared that they had no doubts about the assumed decision and 65.7% declared that their own opinion was more important for decision than anyone else's. Most of the women (89%) affirmed to remember the facts about the procedure that they experienced, 91% affirmed that they would have the same attitude in the case of another similar situation in the future and 60% declared that they would advise someone to opt for termination of pregnancy if asked about the same situation. CONCLUSIONS: the anguish experienced showed that the process of thinking is very important for the decision-making process and posterior satisfaction with the assumed posture. The psychological follow-up allows to review the moral and cultural values in order to help the decision-making process with the aim of minimizing the suffering.
Summary
Rev Bras Ginecol Obstet. 2012;34(3):107-112
DOI 10.1590/S0100-72032012000300003
PURPOSE: To analyze the influence of maternal nutritional status, weight gain and energy consumption on fetal growth in high-risk pregnancies. METHODS: A prospective study from August 2009 to August 2010 with the following inclusion criteria: puerperae up to the 5th postpartum day; high-risk singleton pregnancies (characterized by medical or obstetrical complications during pregnancy); live fetus at labor onset; delivery at the institution; maternal weight measured on the day of delivery, and presence of medical and/or obstetrical complications characterizing pregnancy as high-risk. Nutritional status was assessed by pregestational body mass index and body mass index in late pregnancy, and the patients were classified as: underweight, adequate, overweight and obese. A food frequency questionnaire was applied to evaluate energy consumption. We investigated maternal weight gain, delivery data and perinatal outcomes, as well as fetal growth based on the occurrence of small for gestational age and large for gestational age neonates. RESULTS: We included 374 women who were divided into three study groups according to newborn birth weight: adequate for gestational age (270 cases, 72.2%), small for gestational age (91 cases, 24.3%), and large for gestational age (13 cases, 3.5%). Univaried analysis showed that women with small for gestational age neonates had a significantly lower mean pregestational body mass index (23.5 kg/m², p<0.001), mean index during late pregnancy (27.7 kg/m², p<0.001), and a higher proportion of maternal underweight at the end of pregnancy (25.3%, p<0.001). Women with large for gestational age neonates had a significantly higher mean pregestational body mass index (29.1 kg/m², p<0.001), mean index during late pregnancy (34.3 kg/m², p<0.001), and a higher proportion of overweight (30.8%, p=0.02) and obesity (38.5%, p=0.02) according to pregestational body mass index, and obesity at the end of pregnancy (53.8%, p<0.001). Multivariate analysis revealed the index value during late pregnancy (OR=0.9; CI95% 0.8-0.9, p<0.001) and the presence of hypertension (OR=2.6; 95%CI 1.5-4.5, p<0.001) as independent factors for small for gestational age. Independent predictors of large for gestational age infant were the presence of diabetes mellitus (OR=20.2; 95%CI 5.3-76.8, p<0.001) and obesity according to body mass index during late pregnancy (OR=3.6; 95%CI 1.1-11.7, p=0.04). CONCLUSION: The maternal nutritional status at the end of pregnancy in high-risk pregnancies is independently associated with fetal growth, the body mass index during late pregnancy is a protective factor against small for gestational age neonates, and maternal obesity is a risk factor for large for gestational age neonates.
Summary
Rev Bras Ginecol Obstet. 2012;34(3):107-112
DOI 10.1590/S0100-72032012000300003
PURPOSE: To analyze the influence of maternal nutritional status, weight gain and energy consumption on fetal growth in high-risk pregnancies. METHODS: A prospective study from August 2009 to August 2010 with the following inclusion criteria: puerperae up to the 5th postpartum day; high-risk singleton pregnancies (characterized by medical or obstetrical complications during pregnancy); live fetus at labor onset; delivery at the institution; maternal weight measured on the day of delivery, and presence of medical and/or obstetrical complications characterizing pregnancy as high-risk. Nutritional status was assessed by pregestational body mass index and body mass index in late pregnancy, and the patients were classified as: underweight, adequate, overweight and obese. A food frequency questionnaire was applied to evaluate energy consumption. We investigated maternal weight gain, delivery data and perinatal outcomes, as well as fetal growth based on the occurrence of small for gestational age and large for gestational age neonates. RESULTS: We included 374 women who were divided into three study groups according to newborn birth weight: adequate for gestational age (270 cases, 72.2%), small for gestational age (91 cases, 24.3%), and large for gestational age (13 cases, 3.5%). Univaried analysis showed that women with small for gestational age neonates had a significantly lower mean pregestational body mass index (23.5 kg/m², p<0.001), mean index during late pregnancy (27.7 kg/m², p<0.001), and a higher proportion of maternal underweight at the end of pregnancy (25.3%, p<0.001). Women with large for gestational age neonates had a significantly higher mean pregestational body mass index (29.1 kg/m², p<0.001), mean index during late pregnancy (34.3 kg/m², p<0.001), and a higher proportion of overweight (30.8%, p=0.02) and obesity (38.5%, p=0.02) according to pregestational body mass index, and obesity at the end of pregnancy (53.8%, p<0.001). Multivariate analysis revealed the index value during late pregnancy (OR=0.9; CI95% 0.8-0.9, p<0.001) and the presence of hypertension (OR=2.6; 95%CI 1.5-4.5, p<0.001) as independent factors for small for gestational age. Independent predictors of large for gestational age infant were the presence of diabetes mellitus (OR=20.2; 95%CI 5.3-76.8, p<0.001) and obesity according to body mass index during late pregnancy (OR=3.6; 95%CI 1.1-11.7, p=0.04). CONCLUSION: The maternal nutritional status at the end of pregnancy in high-risk pregnancies is independently associated with fetal growth, the body mass index during late pregnancy is a protective factor against small for gestational age neonates, and maternal obesity is a risk factor for large for gestational age neonates.
, , , , , Summary
Rev Bras Ginecol Obstet. 2023;45(3):109-112
, , , , , , , , , , , , Summary
Rev Bras Ginecol Obstet. 2023;45(3):109-112
, , , , , , , , , , , , Summary
Rev Bras Ginecol Obstet. 2002;24(2):113-120
DOI 10.1590/S0100-72032002000200007
Purpose: to study fetal surveillance examinations in pregnancies complicated by pregestational diabetes mellitus, and to correlate them with large for gestational age (LGA) newborns. Methods: Between March 1999 and June 2001, 46 singleton pregnancies with pregestational diabetes mellitus without fetal anomalies were followed prospectively. From the 28th gestational week on, the following examinations were performed weekly: fetal biophysical profile, amniotic fluid index (AFI), and dopplervelocimetry of umbilical and middle cerebral arteries. The newborns with birthweight above the 90th percentile according to local standard values were characterized as LGA infants. Fisher's exact test and Student's t test were used for statistical analysis. Results: The mean gestational age at delivery was 37.6 weeks and 15 (32.6%) newborns were LGA. LGA fetuses showed significant increase in the AFI mean performed in the 32nd (16.5 cm, p=0.02), 33rd (16.7 cm, p=0.03), 34th (17.0 cm, p=0.02), 35th (17.9 cm, p=0.000), 36th (15.8 cm, p=0.03) and 37th (17.5 cm, p=0.003) weeks. Non-LGA fetuses presented the following mean AFI values: 13.5cm (32nd week), 13.1cm (33th week), 13.4 (34th week), 12.8 (35th week), 12.5 (36th week) and 12.8cm (37th week). AFI values equal to or above 18.0 cm were associated with the occurrence of LGA infants, when detected at the following gestational ages: 34th (60%, p=0.03), 35th (71.4%, p=0.01), 36th (80%, p=0.02) and 37th (66.7%, p=0.04) week. Non-LGA infants presented the following proportion of AFI values equal to or above 18.0 cm: 40.0% (34th week), 28.6% (35th week), 20.0% (36th week), and 33.3% (37th week). Conclusions: abnormal increase in AFI, mainly with values equal to or above 18.0 cm, is related to LGA infants at delivery. The maternal treatment should be adjusted to achieve the best result for maternal-fetal control, according to the AFI values during pregnancy.
Summary
Rev Bras Ginecol Obstet. 2002;24(2):113-120
DOI 10.1590/S0100-72032002000200007
Purpose: to study fetal surveillance examinations in pregnancies complicated by pregestational diabetes mellitus, and to correlate them with large for gestational age (LGA) newborns. Methods: Between March 1999 and June 2001, 46 singleton pregnancies with pregestational diabetes mellitus without fetal anomalies were followed prospectively. From the 28th gestational week on, the following examinations were performed weekly: fetal biophysical profile, amniotic fluid index (AFI), and dopplervelocimetry of umbilical and middle cerebral arteries. The newborns with birthweight above the 90th percentile according to local standard values were characterized as LGA infants. Fisher's exact test and Student's t test were used for statistical analysis. Results: The mean gestational age at delivery was 37.6 weeks and 15 (32.6%) newborns were LGA. LGA fetuses showed significant increase in the AFI mean performed in the 32nd (16.5 cm, p=0.02), 33rd (16.7 cm, p=0.03), 34th (17.0 cm, p=0.02), 35th (17.9 cm, p=0.000), 36th (15.8 cm, p=0.03) and 37th (17.5 cm, p=0.003) weeks. Non-LGA fetuses presented the following mean AFI values: 13.5cm (32nd week), 13.1cm (33th week), 13.4 (34th week), 12.8 (35th week), 12.5 (36th week) and 12.8cm (37th week). AFI values equal to or above 18.0 cm were associated with the occurrence of LGA infants, when detected at the following gestational ages: 34th (60%, p=0.03), 35th (71.4%, p=0.01), 36th (80%, p=0.02) and 37th (66.7%, p=0.04) week. Non-LGA infants presented the following proportion of AFI values equal to or above 18.0 cm: 40.0% (34th week), 28.6% (35th week), 20.0% (36th week), and 33.3% (37th week). Conclusions: abnormal increase in AFI, mainly with values equal to or above 18.0 cm, is related to LGA infants at delivery. The maternal treatment should be adjusted to achieve the best result for maternal-fetal control, according to the AFI values during pregnancy.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):137-143
DOI 10.1590/S0100-72032001000300002
Purpose: to study, in high risk pregnancies with cerebral redistribution of blood flow, the fetal surveillance and perinatal outcome, according to umbilical artery dopplervelocimetry. Methods: a total of 717 high-risk pregnancies attended at the Fetal Surveillance Unit were included. The last examination performed until 72 h prior to delivery was taken into account. Multiple gestations and fetal anomalies were excluded. The redistribution of blood flow was diagnosed if the pulsatility index of middle cerebral artery was below the 5th percentile for gestational age. The umbilical artery dopplervelocimetry was abnormal when A/B ratio was more than the 95th p. Results: in the group with normal umbilical artery dopplervelocimetry (560 cases -- 78.1%), significant correlation was found only between redistribution of blood flow and suspected or abnormal cardiotocography (17.1%). In the group with abnormal umbilical artery dopplervelocimetry (157 cases -- 21.9%) we found significant correlation between redistribution of blood flow (105 cases -- 66.9%) and cardiotocography abnormalities (57.2%), abnormal 1st(43.8%) and 5th (12.4%) minute Apgar scores. In these cases, the mean values of gestational age at delivery (34.4 ± 3.6 weeks), birth weight (1,810.5 ± 769.3 g), and pH at birth (7.20 ± 0.1) were significantly lower. Conclusion: The redistribution of fetal blood flow characterized by means of middle cerebral artery dopplervelocimetry is related to perinatal results when some level of placental insufficiency occurs, and does not present association to perinatal outcome when pregnancy shows normal fetal-placental blood flow.
Summary
Rev Bras Ginecol Obstet. 2001;23(3):137-143
DOI 10.1590/S0100-72032001000300002
Purpose: to study, in high risk pregnancies with cerebral redistribution of blood flow, the fetal surveillance and perinatal outcome, according to umbilical artery dopplervelocimetry. Methods: a total of 717 high-risk pregnancies attended at the Fetal Surveillance Unit were included. The last examination performed until 72 h prior to delivery was taken into account. Multiple gestations and fetal anomalies were excluded. The redistribution of blood flow was diagnosed if the pulsatility index of middle cerebral artery was below the 5th percentile for gestational age. The umbilical artery dopplervelocimetry was abnormal when A/B ratio was more than the 95th p. Results: in the group with normal umbilical artery dopplervelocimetry (560 cases -- 78.1%), significant correlation was found only between redistribution of blood flow and suspected or abnormal cardiotocography (17.1%). In the group with abnormal umbilical artery dopplervelocimetry (157 cases -- 21.9%) we found significant correlation between redistribution of blood flow (105 cases -- 66.9%) and cardiotocography abnormalities (57.2%), abnormal 1st(43.8%) and 5th (12.4%) minute Apgar scores. In these cases, the mean values of gestational age at delivery (34.4 ± 3.6 weeks), birth weight (1,810.5 ± 769.3 g), and pH at birth (7.20 ± 0.1) were significantly lower. Conclusion: The redistribution of fetal blood flow characterized by means of middle cerebral artery dopplervelocimetry is related to perinatal results when some level of placental insufficiency occurs, and does not present association to perinatal outcome when pregnancy shows normal fetal-placental blood flow.
Summary
Summary
Rev Bras Ginecol Obstet. 2002;24(3):153-160
DOI 10.1590/S0100-72032002000300002
Purpose: to study the fetal hemodynamic profile in high-risk pregnancy and correlate it with perinatal results. Methods: transverse prospective study of 108 patients of the Obstetric Clinic of the Hospital das Clínicas, São Paulo University School of Medicine. The patients were evaluated at the Fetal Surveillance Unit, and Doppler examinations of umbilical, aorta, middle cerebral artery, inferior vena cava and ductus venosus were performed. The criteria for inclusion were patients whose delivery was in the next 24 hours after evaluation. Twin pregnancies and fetal malformations were excluded. Results: the hemodynamic implications in the fetal circulation were demonstrated by changes in the Doppler ultrasonographic results in the umbilical artery, aorta, middle cerebral artery, ductus venosus and in the inferior vena cava. The Doppler examinations were abnormal in the umbilical artery (25.9%), fetal aorta (24%), middle cerebral artery (34.2%), ductus venosus (18.2%) and inferior vena cava (46,6%). Segments of the fetal circulation which best correlated with the perinatal results were the umbilical artery and the ductus venosus. The abnormal results in the umbilical artery were significantly associated with 1st minute Apgar score <7 in 42.8% and need of neonatal intensive care unit in 50% of the cases. The abnormal results in the ductus venosus Doppler ultrasonography showed statistical association with 1st minute Apgar score <7 (52.6%), 5th min Apgar <7 (15.7%), acidemia at birth (60%), need of neonatal intensive care unit (52.6%) and neonatal death (21.1%). The predictive values of the ductus venosus Doppler for fetal acidemia were: sensitivity of 39.1; specificity of 90.4; positive predictive value of 60.0 and negative predictive value of 80.2. Conclusion: the Doppler ultrasonography allowed us to evaluate the fetal hemodynamics in the most varied situations and the study of the venous duct is an important examination in the evaluation of fetal hemodynamic response to hypoxia.
Summary
Rev Bras Ginecol Obstet. 2002;24(3):153-160
DOI 10.1590/S0100-72032002000300002
Purpose: to study the fetal hemodynamic profile in high-risk pregnancy and correlate it with perinatal results. Methods: transverse prospective study of 108 patients of the Obstetric Clinic of the Hospital das Clínicas, São Paulo University School of Medicine. The patients were evaluated at the Fetal Surveillance Unit, and Doppler examinations of umbilical, aorta, middle cerebral artery, inferior vena cava and ductus venosus were performed. The criteria for inclusion were patients whose delivery was in the next 24 hours after evaluation. Twin pregnancies and fetal malformations were excluded. Results: the hemodynamic implications in the fetal circulation were demonstrated by changes in the Doppler ultrasonographic results in the umbilical artery, aorta, middle cerebral artery, ductus venosus and in the inferior vena cava. The Doppler examinations were abnormal in the umbilical artery (25.9%), fetal aorta (24%), middle cerebral artery (34.2%), ductus venosus (18.2%) and inferior vena cava (46,6%). Segments of the fetal circulation which best correlated with the perinatal results were the umbilical artery and the ductus venosus. The abnormal results in the umbilical artery were significantly associated with 1st minute Apgar score <7 in 42.8% and need of neonatal intensive care unit in 50% of the cases. The abnormal results in the ductus venosus Doppler ultrasonography showed statistical association with 1st minute Apgar score <7 (52.6%), 5th min Apgar <7 (15.7%), acidemia at birth (60%), need of neonatal intensive care unit (52.6%) and neonatal death (21.1%). The predictive values of the ductus venosus Doppler for fetal acidemia were: sensitivity of 39.1; specificity of 90.4; positive predictive value of 60.0 and negative predictive value of 80.2. Conclusion: the Doppler ultrasonography allowed us to evaluate the fetal hemodynamics in the most varied situations and the study of the venous duct is an important examination in the evaluation of fetal hemodynamic response to hypoxia.