Perineal Analgesia With an Ice Pack After Spontaneous Vaginal Birth: A Randomized Controlled Trial

Methods: We conducted a randomized controlled trial at the Amparo Maternal Birth Center in Sao Paulo, Brazil. Study participants included 114 nulliparous women divided into 3 groups (n = 38 per group): experimental (ice packs on the perineum), placebo (water packs at set temperature), and control (no treatment). Results: A numerical scale (0 to 10) was used for pain assessment. A comparison of the average pain at the beginning and after 20 minutes showed a significant reduction of pain (P < .001) in the 3 groups, and the experimental group had a lower average score for pain compared with the control group (1.6 versus 3.3, P = .032). Discussion: The use of ice packs for 20 minutes was effective for perineal pain relief after vaginal birth.

Increasing the percentage of vaginal birth in the private sector in Brazil through the redesign of care model

OBJETIVO: Implantar um novo modelo de cuidado ao parto e reduzir o percentual de cesarianas entre as gestantes da UNIMED Jaboticabal.MÉTODOS: Estudo descritivo desenvolvido em uma instituição do interior paulista, que teve início em 2012 e propôs o redesenho do modelo de cuidado ao parto com a revisão de todo o processo assistencial por meio da Ciência da Melhoria Contínua. Para medir os resultados das mudanças, foram selecionados nove indicadores e suas respectivas metas.RESULTADOS: O indicador de partos vaginais atingiu a meta de 40%, após sete meses do início da intervenção. Este indicador entre as gestantes do SUS atingiu 66%. A taxa de mortalidade perinatal decresceu 25% comparando-se 2012 a 2014 e a taxa de prematuridade foi de 3/100 nascidos vivos em 2014. O percentual de gestantes da UNIMED com 6 ou mais consultas de pré-natal atingiu 95%. Em relação aos custos hospitalares per capita referentes à assistência ao parto, notou-se um decréscimo de 27%, quando comparados os anos de 2012 e 2013. Tal queda não se sustentou e o custo hospitalar per capita, em 2014, retornou aos mesmos patamares de 2012. A remuneração dos obstetras registrou um acréscimo de 72%, se comparados os anos de 2012, 2013 e 2014. Houve queda de 61% dos custos com a unidade de terapia intensiva (UTI) neonatal, comparando os anos de 2012 e 2013. A taxa de admissão em UTI neonatal acompanhou a redução dos custos e foi de 55%, se comparados os anos de 2012 a 2014, entre as gestantes da UNIMED. Não houve o alcance da meta de 80% de participação das gestantes nos cursos de preparação para o nascimento. A porcentagem de gestantes satisfeitas e muito satisfeitas com a assistência ao parto atingiu 86%.CONCLUSÃO: Este projeto atingiu seus objetivos, reduzindo o percentual de cesarianas entre as gestantes da UNIMED Jaboticabal, e constituiu-se em um exemplo concreto da realização do triplo objetivo em saúde: melhorar a experiência dos envolvidos e os resultados de saúde de populações e indivíduos e realizar estas duas tarefas com menor custo, eliminando desperdícios assistenciais.

Caesarean Birth vs. Vaginal Delivery: Effects upon Maternal Satisfaction, Maternal Confidence and Maternal Perception of the Newborn Behaviour

In order to test the hypothesis that caesarean birth has negative consequences upon newly mothers’ satisfaction and perceptions, women delivering by caesarean birth (WCB) were compared with women delivering by vaginal birth (WVB). Subjects: 180 newly mothers; 93 WCB and 87 WVB. Instruments: A Socio-Demographic Questionnaire developed for this research, the Childbirth Perceptions Questionnaire and the Mother and Baby Scales. Results: WCB had significantly lower scores in perceptions of baby as alert/responsive and nearly significant lower scores for baby as alert during feeds. WVB showed a significantly higher level of satisfaction with delivery and conduct during labour, as also had significantly lower scores for perceptions of baby as irritable during feeds and for lack of confidence in feeds. After controlling for the kind of anesthesia received in labour, three conclusions must be taken into account: 1) between WCB with regional anaesthesia and WCB with general anaesthesia there is only one significant difference, with the former having higher scores for perception of baby as alert during feeds; 2) between WVB with regional anaesthesia and WVB with no anaesthesia there are only two significant differences, with the former having higher scores for lack of confidence in feeding and having lower scores for global confidence; 3) between WCB with regional anaesthesia and WVB with regional anaesthesia four significant differences emerge, with the former having a lower level of satisfaction with delivery and conduct in labour and having lower scores for perception of baby as alert responsive, and also having higher scores of perception of baby as irritable in feeds and higher scores for lack of confidence in feeding. Data seem compatible with the hypothesis that caesarean birth has some negative consequences upon mothers’ satisfaction and perceptions and, for this reason, psychological surveys should constitute a routine procedure in maternity hospitals, especially when newly mothers pertain to families affected by risks of psychological or social nature.

Women`s opinions about mode of birth in Brazil: a qualitative study in a public teaching hospital

Objective: to describe women`s feelings about mode of birth. Design: exploratory descriptive design. Semi-structured interviews were conducted using a questionnaire that had been developed previously (categorical data and open-and closed-ended questions). Qualitative analysis of the results was performed through a context analysis technique. Setting: the largest public university hospital in Brazil. Participants: 48 women in their third trimester of pregnancy. Findings: most women expressed a preference for vaginal birth, as they perceived that they would have a faster recovery. Women who expressed a preference for caesarean section did so because of lack of pain during the birth and the need for tubal sterilisation. The majority of women considered it important to have experience with a mode of birth in order to choose a preference. Complications associated with maternal illness were very influential in the decision-making process. Key conclusions: these results provide a useful first step towards the identification of aspects of women`s feelings about modes of birth. Most women expressed a preference for vaginal birth. Further exploration of women`s feelings regarding parturition and the decision-making process is required. (C) 2008 Elsevier Ltd. All rights reserved.

Risk factors for birth-related perineal trauma: a cross-sectional study in a birth centre

Aim and objectives. To identify maternal, newborn and obstetric factors associated with birth-related perineal trauma in one independent birth centre. Background. Risk factors for birth-related perineal trauma include episiotomy, maternal age, ethnicity, parity and interventions during labour including use of oxytocin, maternal position at time of birth and infant birth weight. Understanding more about these factors could support the management of vaginal birth to prevent spontaneous perineal trauma, in line with initiatives to reduce routine use of episiotomy. Design. Cross-sectional study. Methods. Data were retrospectively collected from one independent birth centre in Brazil, during 20062009. The dependent variable (perineal trauma) was classified as: (1) intact perineum or first-degree laceration, (2) second-degree laceration and (3) episiotomy (right mediolateral or median). Results. There were 1079 births during the study period. Parity, use of oxytocin during labour, position at time of giving birth and infant birth weight were associated with second-degree lacerations and episiotomies. After adjusting for parity, oxytocin, maternal position at the expulsive stage of labour and infant birth weight influenced perineal outcomes among primiparae only. Conclusions. Although the overall rate of episiotomies in this study was low compared with national data, it was observed that younger women were most vulnerable to this intervention. In this age group in particular, the use of oxytocin as well as semi-upright positions at the time of birth was associated with second-degree lacerations and episiotomies. Relevance to clinical practice. The use of upright alternative positions for birth and avoidance of use of oxytocin could reduce the risk of perineal trauma from lacerations and need to perform episiotomy.

Comparison of application times for ice packs used to relieve perineal pain after normal birth: a randomised clinical trial

Aims and objectives. To compare the effect of an ice pack applied for 10, 15 and 20 minutes to relieve perineal pain after birth. Background. Perineal pain after vaginal birth, with or without vaginal trauma, is one of the most common morbidities reported for postnatal women. Cryotherapy has been used in postpartum period to relieve perineal pain and investigated in several studies. However, cryotherapy treatment protocols in perineal care vary widely regarding temperature, frequency and duration of the application. Design. A controlled trial, randomised for two groups and with a third group as a historical control. Method. The intervention was carried out in a maternity hospital in Sao Paulo, Brazil. The study population consisted of three groups of 38 women who used an ice pack on the perineum, in a single application: group A-10 minutes; group B-15 minutes; group C-20 minutes (historical control from another clinical trial). Participants perineal pain magnitude was evaluated through a numerical scale (010), at four different points: before the cryotherapy; immediately after and at 20 and 40 minutes after cryotherapy. Results. After application of the ice pack, there was no statistical difference when comparing the perineal pain among groups in the second, third and fourth evaluations. Most of the postnatal women reported pain relief, with 72.8% reporting a decrease in pain >50%; 21.9% reported a decrease between 3050%. All postnatal women subjected to cryotherapy were favourable to the procedure. Conclusion. There is no difference in pain scores following ice pack application in three different times (10, 15 and 20 minutes) in women who report moderate or intense perineal pain after normal delivery. Relevance for clinical practice. Ice treatment is safe, and application times of 10 or 15 minutes are as beneficial as an application time of 20 minutes to relieve perineal pain.

Lower uterine segment thickness measurement in pregnant women with previous Cesarean section: reliability analysis using two- and three-dimensional transabdominal and transvaginal ultrasound

Objective To evaluate the reliability of two- and three-dimensional ultrasonographic measurement of the thickness of the lower uterine segment (LUS) in pregnant women by transvaginal and transabdominal approaches. Methods This was a study of 30 pregnant women who bad bad at least one previous Cesarean section and were between 36 and 39 weeks` gestation, with singleton pregnancies in cephalic presentation. Sonographic examinations were performed by two observers using both 4-7-MHz transabdominal and 5-8-MHz transvaginal volumetric probes. LUS measurements were performed using two- and three-dimensional ultrasound, evaluating the entire LUS thickness transabdominally and the LUS muscular thickness transvaginally. Each observer measured the LUS four times by each method. Reliability was analyzed by comparing the mean of the absolute differences, the intraclass correlation coefficients, the 95% limits of agreement and the proportion of differences <1 mm. Results Transvaginal ultrasound provided greater reliability in LUS measurements than did transabdominal ultrasound. The use of three-dimensional ultrasound improved significantly the reliability of the LUS muscular thickness measurement obtained transvaginally. Conclusions Ultrasonographic measurement of the LUS muscular thickness transvaginally appears more reliable than does that of the entire LUS thickness transabdominally. The use of three-dimensional ultrasound should be considered to improve measurement reliability. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.

Rotura Uterina em Mulheres com Cesariana Anterior em Prova de Trabalho de Parto

Uterine rupture during a trial of labor after previous cesarean (TOLAC) delivery is a rare, but serious complication. Several factors can increase the risk of uterine rupture, so the assessment of individual risks with adequate counseling is ne - cessary. The initial signs and symptoms are usually nonspecific, hampering timely diagnosis and prompt delivery of the fetus, necessary for optimal outcome. The purpose of this document is to review the risks factors for uterine rupture during TOLAC, as well as the current clinical value of the classically described premonitory signs and symptoms.

Valoración del nivel de satisfacción en un grupo de mujeres de Granada sobre atención al parto, acompañamiento y duración de la lactancia.

INTRODUCTION: The satisfaction's analysis is being used as an instrument to create different sanitary reforms to improve the quality and numerous studies aim to the increase the mother's satisfaction directly related to the maternity care. OBJECTIVES: [corrected] Identify the woman satisfaction's degree about birth attention, accompaniment during nativity and the breastfeeding's term. MATERIAL AND METHOD: [corrected] Descriptive transversal study in the university hospital San Cecilio in Granada (España), during the time of August 2011 to 2012, it performed with a second prospective tracing phase to a N = 60 mothers. It used a protocol (Annex 1) after 24 hours in hospital and at 14 days by telephone. After 3 months, it performed a tracing pertaining to the baby food. RESULTS: The global satisfaction's level about birth is high in study population. It has been shown that breastfeeding (P = 0,514) and vaginal birth without epidural (P = 0,320) creates higher satisfaction for mother. On the other hand, birth satisfaction related with duration of breastfeeding. CONCLUSION: Satisfactory mothers' opinion related with birth care and accompaniment during nativity increases in women whose birth happened in a uncomplicated way without epidural and they started early breastfeeding.

Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil

PURPOSE: 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.

Maternal serum progesterone, estradiol and estriol levels in successful dinoprostone-induced labor

Hormone-mediated quiescence involves the maintenance of a decreased inflammatory responsiveness. However, no study has investigated whether labor induction with prostanoids is associated with changes in the levels of maternal serum hormones. The objective of this study was to determine whether labor induction with dinoprostone is associated with changes in maternal serum progesterone, estradiol, and estriol levels. Blood samples were obtained from 81 pregnant women at term. Sixteen patients had vaginal birth after spontaneous labor, 12 required cesarean section after spontaneous labor and 16 underwent elective cesarean. Thirty-seven patients had labor induction with dinoprostone. Eligible patients received a vaginal insert of dinoprostone (10 mg) and were followed until delivery. Serum progesterone (P4), estradiol (E2) and estriol (E3) levels and changes in P4/E2, P4/E3 and E3/E2 ratios were monitored from admission to immediately before birth, and the association of these measures with the resulting clinical classification outcome (route of delivery and induction responsiveness) was assessed. Progesterone levels decreased from admission to birth in patients who underwent successful labor induction with dinoprostone [vaginal and cesarean birth after induced labor: 23% (P < 0.001) and 18% (P < 0.025) decrease, respectively], but not in those whose induction failed (6.4% decrease, P > 0.05). Estriol and estradiol levels, P4/E2, P4/E3 and E3/E2 ratios did not differ between groups. Successful dinoprostone-induced labor was associated with reduced maternal progesterone levels from induction to birth. While a causal relationship between progesterone decrease and effective dinoprostone-induced labor cannot be established, it is tempting to propose that dinoprostone may contribute to progesterone withdrawal and favor labor induction in humans.

Förlossningsrädda kvinnors erfarenheter av Aurorasamtal ett till två år efter förlossning

Bakgrund: Av alla gravida kvinnor räknas omkring 5 % lida av svår förlossningsrädsla. Kvinnor med förlossningsrädsla löper högre risk för komplikationer under och efter graviditeten. I Sverige läggs idag mycket resurser på Auroraverksamhet för att hjälpa kvinnor med förlossningsrädsla. Det saknas omfattande utvärdering av Auroraverksamheten. Syfte: Syftet med detta fördjupningsarbete var att undersöka upplevelse och effekt av Aurorasamtal inför förlossning samt upplevelse av den efterföljande förlossningen bland först- och omföderskor. Metod: Studien har en retrospektiv studiedesign där datainsamling skedde via en enkätundersökning. Datamaterialet sammanställdes därefter i SPSS. Resultat: Majoriteten av kvinnorna upplevde att samtalen hjälpte dem till en mer positiv förlossningsupplevelse. Fler förstföderskor än omföderskor önskade planerat kejsarsnitt när de kom till Auroramottagningen. De flesta kvinnor som önskade vaginal förlossning blev vaginalt förlösta. Över hälften av kvinnorna som deltog i studien var mindre rädda för förlossning 1 – 2 år efter förlossningen än de upplevde att de var innan Aurorasamtalet och förlossningen. Konklusion: Aurorasamtal förefaller ha störst betydelse för omföderskor och för de kvinnor som önskar vaginal förlossning.

Granskning av riktlinjer vid Sveriges förlossningskliniker gällande sfinkterskada i samband med förlossning : Innehållsanalys med en kombination av en deduktiv och induktiv ansats

Background: Sphincter injury is serious complication in connection to vaginal childbirth. Desire to avoid vaginal birth again is seen in women who previously suffered from a sphincter injury. Objective: To identify and evaluate obstetric guidelines in Sweden regarding sphincter injury in relation to childbirth Method: Content analysis with a combination of a deductive and inductive approach. Results: The most frequently occurring risk factors and prevention with help of perineal protection were described in the guidelines. The physician made diagnosis and repaired the sphincter injury at the theatre.  Complications such as coital pain and anal incontinence were described in the guidelines. Paracetamol and diclofenac was most common analgesic regimen given for pain. Prophylaxis such as antibiotic treatment and laxative were common. Information given to women was described. Follow-up by physician, midwife and physiotherapist was recommended after four weeks to six months. For future birth a cesarean section was recommended. Conclusion: The guidelines were constructed in the same way and had to a large extent similar content. The authors of the present work recommend a national guideline.