Contacto pele-a-pele e amamentação na primeira hora de vida

Enquadramento – O contacto pele-a-pele na primeira hora de vida tem benefícios para a mãe e para o recém-nascido, bem como um papel importante no estabelecimento da amamentação. Objetivos – Analisar a evidência científica dos benefícios do contacto pele-a-pele e amamentação na primeira hora de vida; determinar a prevalência do contacto pele-a-pele e da amamentação na primeira hora de vida; verificar quais são os fatores (variáveis sociodemográficas, contextuais da gravidez e do parto, e variáveis relativas ao recémnascido) que interferem nas práticas do contacto pele-a-pele e amamentação na primeira hora de vida. Método – Revisão sistemática da literatura no estudo empírico I. Efetuou-se uma pesquisa na PUBMED, The Cochrane Library, Scielo e Google Académico, estudos publicados entre janeiro de 2011 e dezembro de 2014. Destes foram selecionados 4 estudos, posteriormente analisados, que tiveram em consideração os critérios de inclusão previamente estabelecidos. Dois revisores avaliaram a qualidade dos estudos a incluir utilizando a grelha para avaliação crítica de um estudo descrevendo um ensaio clínico prospetivo, aleatório e controlado de Carneiro (2008). No estudo empírico II seguiu-se um tipo de estudo quantitativo e descritivo simples, de coorte transversal, desenvolvido no serviço de Obstetrícia do Centro Hospitalar Cova da Beira, segundo um processo de amostragem não probabilística por conveniência (n = 382). A recolha de dados efetuou-se através da consulta dos processos clínicos, entre janeiro e dezembro de 2014, das mulheres com idade ≥ 18 anos que tiveram um parto vaginal com feto vivo após as 37 semanas de gestação. Resultados – Evidência de que o contacto precoce pele-a-pele, imediatamente após o parto, é um potencial estímulo sensorial, que abrange o aquecimento do recém-nascido e a estimulação tátil e olfativa, maior estabilização da temperatura, frequência respiratória e nível de glicémia, com diminuição do choro. Está associado à promoção espontânea da amamentação. Na amostra constituída por 382 mulheres, dos 18 aos 46 anos, verificou-se que o contacto pele-a-pele ocorreu em apenas 26,6% da amostra. Cerca de 92,6% da amostragem deu de mamar na primeira hora de vida. No grupo de mulheres em que houve contacto pele-a-pele e amamentação, prevalecem as que têm idade igual ou inferior a 34 anos (66,3%) e predomínio das mulheres que tiveram 5 ou mais consultas (95,9%) de vigilância da gravidez. Conclusão – Face a estes resultados e com base na evidência científica disponível que recomenda o contacto pele-a-pele imediatamente após o parto e promoção da amamentação na primeira hora de vida, assume-se como indispensável que os profissionais invistam na sua formação e assumam um papel importante para a realização deste contacto, estimulando e facilitando esta prática, assim como a realização de mais estudos científicos com contributos para o estabelecimento e manutenção desta prática. Palavras-chave: Contacto pele-a-pele; amamentação; primeira hora de vida.

Parallel image-processing for automated cervical smear analysis,

"COO-2118-0029."

A Study of the Association of Maternal Occupations and Deliveries by Cesarean Section for Infants Born in Washington, 2011-2013

Thesis (Master's)--University of Washington, 2016-06

Birth-to-pregnancy intervals and adverse perinatal outcomes among African-born black women in Washington State.

Thesis (Master's)--University of Washington, 2016-06

Midline rectovaginal fascial plication for repair of rectocele and obstructed defecation

OBJECTIVE: To estimate the efficacy of midline fascial plication of the posterior vaginal wall in women with rectoceles and obstructed defecation. METHODS: Prospective evaluation of 38 consecutive women with symptomatic rectoceles (stage II or greater) and obstructed defecation included pre- and postoperative standardized pelvic floor questions, pelvic organ prolapse quantification measurements, validated bowel function questionnaires, defecating proctogram, and patient satisfaction. Reviews were conducted by nonsurgical coauthors. RESULTS: The median follow-up was 12.5 months (range 2.5-26 months). The subjective success rates were 97% (95% confidence interval [CI] 0.83-1.00%) at 12 months and 89% (95% CI 0.55-0.98%) at 24 months. The objective success rates were 87% (95% CI 0.64-0.96%) at 12 months and 79% (95% CI 0.51-0.92%) at 24 months. The average points, Ap and Bp, were significantly reduced from -0.1 (range -2 to 3) and 1.1 (range -1 to 8), preoperatively, to -2.6 (range -3 to -1) and -2.5 (range -3 to 0), postoperatively, respectively (P

Prevalence of rectocele in young nulliparous women

Background: It is generally assumed that fascial defects in the rectovaginal septum are the result of childbirth. However, rectoceles do occur in women who have never delivered vaginally. Aims: To determine the incidence of rectocele in a cohort of asymptomatic, young nulliparous women. Methods: Observational cohort study on 178 nulliparous caucasian women (aged 18-24) recruited for a twin study of pelvic floor dysfunction. All women were interviewed and examined by translabial ultrasound, supine and after voiding. In 52 women, 3D imaging was obtained and 171 datasets were complete and available for analysis. Ultrasound findings were reviewed for rectovaginal septal integrity by an assessor blinded against interview and demographic data for rectovaginal septal integrity. Results: A discontinuity of the anterior rectal wall with extrusion of rectal mucosa or contents (depth of ! 10 mm) was observed in 21/171 (12%). The depth of this herniation ranged from 10 to 25 mm and was filled with stool (n = 10) or rectal mucosa (n = 11). Defects were associated with a higher BMI (P = 0.049), with the complaint of constipation (P = 0.049) and non-significantly with straining at stool (P = 0.09). Descent of the ampulla to beyond the level of the symphysis pubis without fascial defect, that is, significant perineal relaxation, was observed in 23/171 (13%). Conclusions: Twelve percent of 171 young nulligravid caucasian women showed a defect of the rectovaginal septum. Associations were observed with higher body mass index and a history of constipation. It is hypothesised that in some women defects of the rectovaginal septum and perineal hypermobility may be congenital in nature.

Progesterone supplementation for preventing preterm birth: A systematic review and meta-analysis

Aim. The aim of this study is to assess the role of progesterone in preterm birth prevention. Methods. A MEDLINE search (from 1966 to the present; date of last search January 2005) was performed - using the key words progesterone, pregnancy, preterm birth, preterm labor, and randomized, controlled trial - in order to identify randomized, controlled trials in which progesterone (either intramuscular or vaginal administration) was compared with placebo or no treatment. Data were extracted and a meta-analysis was performed. Results. Seven randomized, controlled trials were identified. Women who received progesterone were statistically significantly less likely to give birth before 37 weeks (seven studies, 1020 women, RR = 0.58, 95% CI = 0.48-0.70), to have an infant with birth weight of

Defenses against oxidative stress in Neisseria gonorrhoeae: A system tailored for a challenging environment

Neisseria gonorrhoeae is a host-adapted pathogen that colonizes primarily the human genitourinary tract. This bacterium encounters reactive oxygen and reactive nitrogen species as a consequence of localized inflammatory responses in the urethra of males and endocervix of females and also of the activity of commensal lactobacilli in the vaginal flora. This review describes recent advances in the understanding of defense systems against oxidative stress in N. gonorrhoeae and shows that while some of its defenses have similarities to the paradigm established with Escherichia coli, there are also some key differences. These differences include the presence of a defense system against superoxide based on manganese ions and a glutathione-dependent system for defense against nitric oxide which is under the control of a novel MerR-like transcriptional regulator. An understanding of the defenses against oxidative stress in N. gonorrhoeae and their regulation may provide new insights into the ways in which this bacterium survives challenges from polymorphonuclear leukocytes and urogenital epithelial cells.