Introdução: Nas últimas décadas, as taxas de cesarianas vêm aumentando significativamente em todo o mundo, com índices excessivamente superiores aos 15% recomendados pela Organização Mundial da Saúde (OMS). Nos diversos países, as taxas são variáveis, bem como nas diferentes regiões brasileiras. Na região Sudeste, as taxas atingem 58,2%, e na região Norte, são de 41,8%. Objetivos: 1. Verificar a prevalência e as indicações de cesarianas de gestantes atendidas em um serviço de pré-natal de baixo risco; 2. Verificar a associação das cesarianas com as variáveis sociodemográficas e obstétricas. Método: estudo transversal realizado no Amparo Maternal, maternidade filantrópica de São Paulo, cujo atendimento é feito exclusivamente pelo Sistema Único de Saúde às mulheres de baixo risco obstétrico. O atendimento pré-natal é de responsabilidade de enfermeiras obstétricas e, no parto, a assistência obstétrica é conduzida por obstetrizes/enfermeiras obstétricas, e a atuação médica ocorre na assistência aos partos cirúrgicos e intercorrências. Os dados foram obtidos de prontuários de seguimento de pré-natal e da internação para o parto de 264 mulheres. No estudo, foram incluídas as mulheres matriculadas no pré-natal em 2011 e que deram à luz na mesma instituição. As indicações da cesariana foram classificadas em: fetais, materno-fetais e maternas. A análise descritiva dos dados sociodemográficos e obstétricos foi feita, e para indicar a associação entre o tipo de parto e as variáveis maternas foi calculada a razão de prevalência com intervalo de confiança de 95%. O projeto foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: A prevalência de cesariana foi de 28,4%; as indicações fetais (44,0%) foram as mais frequentes, seguidas das maternas (33,3%) e das materno-fetais (22,7%). A cesariana atual apresentou associação com: cesariana prévia (RP=6,07; IC95%: 2,96-12,46); obesidade (RP=2,07; IC95%: 1,31-3,27); idade gestacional de 41 semanas (RP=1,57; IC95%: 1,00-2,47); colo impérvio na internação (RP=8,16; IC95%: 3,45-19,31); dilatação cervical 1 a 4 cm (RP=3,03; IC95%: 1,27-7,24); apresentação pélvica/córmica (RP=3,36; IC95%: 2,32-4,87); peso ao nascer 4.000g (RP=1,90; IC95%: 1,03-3,52). Ter idade inferior a 20 anos (RP=0,49; IC95%: 0,26-0,92) e ter recebido infusão de ocitocina (RP=0,29; IC95%: 0,20-0,44) foram fatores de proteção para a cesariana na gestação atual. Conclusões: Tratando-se de mulheres de baixo risco, a prevalência de cesariana foi superior ao limite recomendado pela OMS, e os fatores associados correspondem aos encontrados nas literaturas nacional e internacional. / Introduction: In recent decades, cesarean rates have increased significantly worldwide, with rates excessively above the 15% recommended by the World Health Organization (WHO). Rates vary across countries and in the different regions of Brazil. In southeastern rates reach 58.2%, while the in north is 41.8%. Objectives: 1. Check the prevalence and indications for cesarean sections of pregnant women attending an antenatal low risk; 2. Check the association of cesarean sections with sociodemographic and obstetric variables. Methods: cross-sectional study in Amparo Maternal, philanthropic maternity hospital in São Paulo, whose service is provided exclusively by the Health System to women at low obstetric risk. The prenatal care is the responsibility of nurse-midwives, childbirth, obstetric care is conducted by nurse-midwives and medical action occurs in cesarean section and complications. The data were obtained from medical records tracking prenatal and hospitalizations of 264 women. The study included women enrolled in prenatal care in 2011 and who gave birth at the same institution. The indications for cesarean section were classified as fetal, maternal-fetal and maternal. The data analysis were made of sociodemographic and obstetric and to identify the association between mode of delivery and maternal variables was calculated prevalence ratio with a confidence interval of 95%. The project was approved by the Ethics in Research. Results: The prevalence of cesarean section was 28.4%; fetal indications (44.0%) were the most frequent, followed by maternal (33.3%) and maternal-fetal (22.7%). The actual cesarean section was associated with cesarean section in a previous pregnancy (PR = 6.07, 95% CI: 2.96, 12.46), obesity (PR = 2.07, 95% CI: 1.31, 3.27), 41 weeks gestational age (PR = 1.57, 95% CI: 1.00, 2.47); impervious lap at admission (PR = 8.16, 95% CI: 3.45, 19.31) dilation 1 to 4 cm (PR = 3.03, 95% CI: 1.27, 7.24); mal presentations (PR = 3.36, 95% CI: 2.32, 4.87); birthweight 4.000g (RP = 1.90, 95% CI: 1.03, 3.52). Aged less than 20 years (PR = 0.49, 95% CI: 0.26, 0.92) and having received oxytocin infusion (PR = 0.29, 95% CI: 0.20, 0.44) were factors protection for caesarean section in the current pregnancy. Conclusions: The prevalence of cesarean section in low risk women higher than the limit recommended by WHO and the indications were strictly medical. The risk factors correspond to those found in the national and international literature.

Orientadores: Jose Guilherme Cecatti, Helaine Maria Besteti Pires Milanez / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T04:53:54Z (GMT). No. of bitstreams: 1 Nascimento_MariaLauraCostado_M.pdf: 1430969 bytes, checksum: d6876f4a7fd820af8e7cd1d6109e0303 (MD5) Previous issue date: 2008 / Resumo: Introdução: Auditoria e Feedback, estratégia de intervenção na prática médica, sendo um resumo da atuação durante certo período, com posterior formulação de recomendações para a melhoria do serviço estudado. Sua efetividade ainda é incerta em Obstetrícia. Objetivo: Estudar o processo de Auditoria e Feedback em Obstetrícia e implementar o uso do material da Reproductive Health Library. Avaliar o possível efeito da intervenção sobre as taxas de parto por cesárea, com a utilização da classificação de Robson. Métodos: coleta prospectiva de dados sobre os seis parâmetros obstétricos selecionados segundo publicações baseadas em evidência, antes e depois de um período de intervenção, preparado após análise dos índices de prevalência de cada prática: episiotomia seletiva, cardiotocografia contínua durante o trabalho de parto em gestações de baixo risco, antibioticoprofilaxia no parto por cesárea, uterotônico no terceiro período do parto, indução de parto às 41 semanas em gestações de baixo risco e suporte contínuo durante o trabalho de parto. Realizado agrupamento de todos os partos segundo a classificação de Robson, em 10 grupos, levando em conta o antecedente obstétrico, tipo de gestação, curso do trabalho de parto e idade gestacional. Resultados: os dois períodos foram similares quanto às características obstétricas gerais. Com relação aos parâmetros selecionados, foi observada redução significativa do uso de episiotomia seletiva (RR 0.84 IC95% 0.73-0.97), embora o mesmo não tenha ocorrido entre as primigestas (p=0,315), aumento na presença de acompanhante durante o trabalho de parto (RR 1.42; 1.24-1.63) e adequação de uso de uterotônico (ocitocina 10UI) no terceiro período (p<0,0001). Segundo a classificação de Robson, não ocorreu alteração no índice global de partos cesárea nos dois períodos estudados (respectivamente 45.5% e 43.3%). Houve predomínio do Grupo 3 (multipara sem cesárea anterior, feto único, cefálico, de termo, trabalho de parto espontâneo) com índices de 28.5 e 26.8% respectivamente. O segundo mais prevalente foi o Grupo 1 (nulípara, feto único, cefálico, termo e trabalho de parto espontâneo), com 25.5 e 22.6% do total de partos, seguido pelo Grupo 5 (multípara com cesárea prévia, feto único, cefálico, gestação de termo), com taxas de 22.9 e 21.3% respectivamente. O Grupo 5 foi também responsável pela maior contribuição ao número total de cesáreas (36.4 e 34.6% nos dois períodos). Os Grupos 2 (nulípara, feto único, cefálico, de termo, em trabalho de parto induzido ou cesárea antes de trabalho de parto) e 4 (multípara, feto único, cefálico, de termo, em trabalho de parto induzido ou cesárea antes de trabalho de parto), embora tenham pouca contribuição ao número total de partos, demonstraram altos índices de cesárea dentro do seus grupos. O grupo 10, composto por prematuros, foi o quarto mais prevalente, também com altos índices de cesárea no seu grupo, porém com redução significativa entre os períodos pré e pós-intervenção (p=0.0058). Conclusão: o processo de Auditoria e feedback pode ser utilizado como mecanismo de implementação em obstetrícia, sobretudo quando a equipe é receptiva a mudanças. / Abstract: Background: Audit and feedback is a widely used strategy to improve professional practice and can be defined as any summary of clinical performance of health care over a period of time, which may include recommendations for clinical action. Its effectiveness is still uncertain in Obstetrics. Objectives: to assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes and to implement the use of RHL material as a routine in medical practice; to evaluate the effect of the intervention over the incidence of caesarean sections, according to the Robson's classification, in 10 groups. Methods: The study proposed has an audit and feedback design and was conducted in the obstetric Unit of the University of Campinas, Brazil, between the years 2007- 2008. It started by providing up to date estimates of prevalence rates of six audit standards underwritten by evidence-based recommendations: selective episiotomy; continuous electronic fetal monitoring during uncomplicated labour of low risk pregnant women; antibiotic prophylaxis for women undergoing caesarean section; use of oxytocin after delivery as one of the procedures of active management of third stage of labour; routine induction of labour at 41 weeks for uncomplicated pregnancies and continuous support for women during childbirth. The results were then analyzed and presented as feedback to clinical practice. Active information based on the WHO Reproductive Health Library (RHL) was prepared to remind important and reliable health care interventions during meetings with the whole maternity staff. After four months, the same practices were again measured and analyzed to compare data and assess if the intervention was effective. All caesarean sections were evaluated according to Robson's Classification to study a possible effect of the intervention on caesarean rates. Results: both periods studied showed equivalency in the total number of deliveries, vaginal and caesarean births, forceps and deliveries in nulliparous. Considering the obstetric practices evaluated, there was a significant reduction in selective episiotomy (RR 0.84 95%CI 0.73-0.97), but not in nulliparous (p=0.315); an increase in continuous support for women during childbirth (RR 1.42; 1.24-1.63). There was also a change in the institution protocol for the use of uterotonic (oxitocyn) during third stage of labor, with a shift to the WHO recommended dosage of 10UI (p<0.0001). There was no change observed in the use of continuous electronic fetal monitoring, routine induction of labour at 41 weeks for uncomplicated pregnancies and antibiotic prophylaxis in caesarean sections. Considering caesarean sections, there was no prevalence change after intervention. Robson's classification was applied and Group 3 (multiparous excluding previous CS, single, cephalic, =37 weeks, spontaneous labour) accounted for the largest proportion of deliveries, 28.5% and 26.8% in both periods. Group 1 (nulliparous, single, cephalic, =37 weeks, spontaneous labour) was the second largest one, with 25.5% and 22.6% respectively, while Group 5 (previous caesarean section, single, cephalic, =37 weeks) was the third, with percentages of 22.9% and 21.3% respectively. Group 5 also represented the most prevalent when considering only caesarean sections, accounting for 36.4% and 34.6% in both periods. Groups 2 (nulliparous, single, cephalic, =37 weeks, induction or CS before labour) and 4 (multiparous excluding previous CS, single, cephalic, =37 weeks, induction or CS before labour) had low contribution for the total number of deliveries, however they had higher rates of caesarean sections within each group. Group 10 (all single, cephalic, = 36 weeks, including previous CS) represented the fourth largest among all deliveries, with respectively 6.6% and 8.6%. Within its group, the rate of caesarean section was high, with a significant decrease from 70.5% to 42.6%, from pre to post intervention period (p=0.0058). Conclusion: Audit and feedback can be used as a successful implementation tool in obstetrics, especially when the medical staff is open and receptive to change. / Mestrado / Tocoginecologia / Mestre em Tocoginecologia

Orientador: Ilza Maria Urbano Monteiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T19:58:08Z (GMT). No. of bitstreams: 1 Santos_AnaRaquelGouvea_M.pdf: 962766 bytes, checksum: e715593c7f98a14aacfd9c4d956e7c8d (MD5) Previous issue date: 2012 / Resumo: Introdução: A anticoncepção intrauterina é um método bastante eficiente, porém sub-utilizada. Uma das causas que diminuem seu uso são as dificuldades que o profissional enfrenta no momento da inserção bem como a dor que a paciente sente durante o procedimento. Recentemente o sistema intrauterino liberador de levonorgestrel (SIU-LNG) foi introduzido como uma nova opção de dispositivo intrauterino com características que ampliaram a indicação e uso do mesmo. A introdução do SIU-LNG retomou a discussão sobre seu uso em cada vez mais mulheres inclusive nas nunca engravidaram. Objetivo: Identificar e comparar as dificuldades técnicas na inserção do SIU-LNG e o grau de dor referida entre nuligestas e multíparas com e sem cesárea anterior. Métodos: Setenta e quatro mulheres que procuraram o serviço de planejamento familiar do CAISM/UNICAMP para primeira colocação de SIU - LNG como método anticoncepcional (MAC) foram incluídas no estudo, de Maio a Dezembro de 2011. As mulheres foram divididas em três grupos: 23 nuligestas, 28 multíparas com antecedente de cesárea e 23 sem antecedente de cesárea. Após serem submetidas à inserção do SIU-LNG foi pedido que classificassem a dor segundo a Escala Visual Analógica (EVA) de 0 (sem dor) a 10 (maior dor possível). No retorno, entre 45 e 60 dias após a inserção, foram questionadas novamente sobre a dor que sentiram no dia da inserção segundo o mesmo score. O profissional responsável pela inserção classificou a inserção em fácil, com dificuldade esperada, mais difícil que o esperado ou impossível de realizar inserção. O mesmo também classificou a causa da dificuldade encontrada em: estenose cervical, irregularidade da cavidade uterina, dor da paciente, reação vagal. Foi realizada uma análise de comparação de médias entre os três grupos sobre a dor e de características clínicas que poderiam estar associadas com a mesma. Grau de significância 5% com poder do teste de 80%. Resultados: Todas as mulheres referiram dor no momento da inserção. Não houve diferença nas médias de dor de acordo com paridade ou via de parto. Não houve diferença também quando classificamos a dor em leve, moderada ou severa. Apesar da dor, 93% das mulheres referiram que submeteriam-se novamente a inserção do SIU-LNG tanto no momento da inserção como um mês após. A média de dor referida após um mês foi semelhante entre os grupos e não foi significativamente menor do que imediatamente após a inserção. Nas nuligestas o tipo de dificuldade mais encontrada foi estenose cervical, nas multíparas com cesárea anterior foi irregularidade da cavidade uterina e nas multíparas sem cesárea anterior foi dor da paciente no momento da inserção. Não houve maior dificuldade de inserção em nenhum dos grupos. Não houve associação de algum dos tipos de dificuldade com maiores média de dor. Conclusões: Todas as mulheres independente da paridade ou via e parto referiram dor no momento da inserção do SIU-LNG. A dor não consistiu em um empecilho para a escolha do SIU-LNG. A principal causa de dificuldade variou de acordo com a paridade. A inserção do SIU-LNG é possível para todos os grupos de pacientes / Abstract: Background: Despite the high contraceptive effectiveness and non-contraceptive benefits there are still concerns of use of the levonorgestrel-releasing intrauterine system (LNG-IUS) in nulligravida women. Objective: Evaluate ease of insertion and cause of difficulty by health proffessionals and women pain at insertion of the LNG-IUS in nulligravida women compared to parous women with and without cesarean section (C-section). Methods: Three groups were constituted: one with 23 nulligravida women, one with 28 parous women with previous cesarean and one with 23 parous women without previous C-section who received an LNG-IUS. The pain at insertion was evaluated immediately after insertion on the Visual Analogic Scale (VAS). On the second visit after one month women were asked again about the pain at insertion according to the VAS. The ease of insertion was evaluated as easy or difficult and was classified by the health professional according to cause (cervical stenosis, uterine irregularity, pain) after insertion. Results: Almost all patients reported pain at insertion, independent of parity and delivery. Despite reporting pain about 93% of the women would submit themselves to LNG-IUS insertion once again if necessary. In the followup control there was no diference, as well in the pain scores among the groups. In nulligravida the type of difficulty most common was cervical stenosis, in parous women with C-section was uterine cavity irregularity in parous women without C-section was pain. There was no association between type of difficulty and high pain scores. Conclusions: All women reported pain at insertion. Pain at insertion is not a problem for the use of the method among patients. Type of difficulty at insertion is related to parity. There was no difference in difficulty for any group / Mestrado / Fisiopatologia Ginecológica / Mestre em Ciências da Saúde

Background: Emergency Cesarean section is the most common major surgical procedure in Africa and anesthesia is required for Cesarean sections. Aim: The aim of the study was to describe the actions of the perioperative team, with the main objective on the nurse anesthetist during a Cesarean section in Ghana. Methods: An ethnographic design with unstructed participant observations was carried out for this qualitative study. This overt descriptive study was carried out during 2 weeks in January 2011 at the Oda Government Hospital in Akim-Oda in Ghana. The content was analyzed through thematic content analysis based on field notes. Results: During 7 observations the writers found that the nurse anesthetists at the work alone without an anesthesiologist. The content analysis identified 5 different categories of the nurse anesthetists practice and the surgical team during a Cesarean section: Work environment, Care and treatment of the patient, Resources, Hygiene, Safety and security. Conclusion: The different treatment of the patient in Ghana and in Sweden was substantial. However; the writers found the working environment for the nurse anesthetist to be functioning, with limited means and resources. / Bakgrund: Akut Kejsarsnitt är det vanligaste större kirurgiska ingrepp i Afrika och anestesi krävs för Kejsarsnitt. Syfte: Syftet med studien var att beskriva åtgärderna av ett perioperativ team, med huvudfokus på anestesisjuksköterskan, under ett Kejsarsnitt i Ghana. Metod: En etnografisk design med ostrukturerade deltagande observationer utfördes för denna kvalitativa studie. Studien genomfördes under 2 veckor i januari 2011 på Oda regions sjukhus i Akim-Oda i Ghana. Innehållet analyserades genom tematiska innehållsanalyser av field notes. Resultat: Vid 7 observationer fann författarna att anestesisjuksköterskan arbetade ensam utan en anestesiolog. Innehållsanalysen uppvisade 5 olika kategorier av anestesisjuksköterskans praxis och det kirurgiska teamet under ett Kejsarsnitt. Arbetsmiljö, vård och behandling av patienten, resurser, hygien, säkerhet och trygghet. Slutsats: Behandlingen av patienten jämfört med vården som ges till patienter i Sverige var märkbart annorlunda . Trots detta fann författarna att arbetsmiljön för anestesisjuksköterskan fungerade, med begränsade medel och resurser.

Orientador: Antonieta Keiko Kakuda Shimo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Enfermagem / Made available in DSpace on 2018-08-24T10:50:57Z (GMT). No. of bitstreams: 1 Mafetoni_ReginaldoRoque_M.pdf: 1765630 bytes, checksum: 7421b5f67d41e9a6d29e4c7abd2d5fdf (MD5) Previous issue date: 2014 / Resumo: Objetivos: Avaliar os efeitos da acupressão no ponto Sanyinjiao (BP6) sobre a dor na primeira fase do trabalho de parto, o consumo de drogas analgésicas e analgesias/anestesias, o incômodo pelo tratamento recebido, o tempo de trabalho de parto, a taxa de cesárea o índice de Apgar no 1º e 5º minuto do recém-nascido e a satisfação pessoal em utilizar o tratamento entre os grupos. Método: Trata-se de um ensaio clínico controlado e randomizado, de caráter pragmático, com características simples-cego na avaliação da dor e duplo-cego nos desfechos de tempo de trabalho de parto e taxa de cesárea. Foram selecionadas 156 gestantes, com ? 37 semanas, dilatação cervical ? 4 cm e ? 2 contrações em 10 minutos, divididas em três grupos por meio de uma lista de números aleatórios, em um hospital universitário do interior do estado de São Paulo, Brasil, para receber acupressão, placebo ou participar como controle. Todas as participantes foram orientadas e estimuladas a realizar uma técnica de exercício respiratório e relaxamento muscular. A acupressão foi aplicada no ponto BP6 e a intensidade da dor avaliada por uma Escala Analógica e Visual (EAV) antes do tratamento, imediatamente (20 minutos) e 1 hora após o tratamento. Resultados: A média do escore de dor da EAV não foi diferente nos três grupos na admissão (p=0.0929), porém, as diferenças se fizeram imediatamente (p=<0.0001) e com 1 hora após o tratamento (p=<0.0001) de forma significativa entre os grupos. O incomodo do tratamento foi pequeno, informado por três participantes do grupo BP6. A média de duração do trabalho de parto apresentou diferença significativa nos três grupos a partir do tratamento até o nascimento do neonato (p=0.0047). A taxa de cesárea não mostrou diferença entre os grupos (p=0.2526) nem a avaliação de Apgar no primeiro e quinto minuto de vida do neonato (p=0.7218). O uso de analgésicos, anestesias e a satisfação pessoal do tratamento oferecido para um provável uso no futuro foram homogêneos entre os grupos, porém, a recordação sobre o alívio da dor durante o trabalho de parto foi maior no grupo acupressão BP6 (p=0.0018). Não houve diferença no uso de ocitocina (p=0.0521) e prostaglandina (p=0.9801), embora as participantes do grupo controle recebessem no total menos indução durante o trabalho de parto (p=0.0065). Conclusões: A acupressão no ponto BP6 se mostrou uma medida útil no alívio da dor, complementar para conduzir o trabalho de parto, encurtando este período, não invasiva e uma via de melhorar a qualidade dos cuidados à parturiente, sem ocasionar efeitos adversos para mãe ou para o neonato, entretanto, não houve diferença na taxa de cesárea neste estudo / Abstract: Purposes: To evaluate the effects of applying acupressure at the Sanyinjiao point (SP6) on pain in the first stage of labor, the use of analgesic drugs and anesthetics, the discomfort from the treatment received, delivery time in women in labor, the cesarean section rate, Apgar score at 1st and 5th minute of newborn, and personal satisfaction in using the treatment offered among groups. Method: The study design was a randomized controlled clinical trial of pragmatic character using a single-blind method to the evaluation of pain and a double-blinded for delivery time and cesarean section rate. 156 pregnant women were selected, with ? 37 weeks, cervical dilatation ? 4 cm and ? 2 contractions in 10 minutes, randomly divided into three groups in a university hospital in the state of São Paulo, Brazil. The women received acupressure, placebo or received standard care (control group). All of them were guided and stimulated to perform a technique of breathing exercises and muscle relaxation. The intervention was applied at the point SP6 and pain intensity was assessed by Visual Analog Scale (VAS) before the treatment, immediately (20 minutes) and 1 hour after the treatment. Results: The average pain score of VAS was no different in the three groups at baseline (p=0.0929), but the difference was immediately made (p=<0.0001) and at 1 hour after treatment (p=<0.0001) significantly between groups. The discomfort of treatment was small, reported by three participants in the SP6 group. The average duration of labor showed significant difference among the three groups, from the treatment until the birth (p=0.0047). The cesarean section rate showed no difference between the groups (p=0.2526) or the assessment of Apgar at the first and fifth minute of the newborn's life (p=0.7218). The use of analgesics, anesthetics and personal satisfaction of treatment offered for probable future use were homogeneous between the groups, but the memory on the reduction of pain during labor was greater in the acupressure group SP6 (p =0.0018). There was no difference in the use of oxytocin (p=0.0521) and prostaglandin (p=0.9801), although the participants in the control group received total less induction during labor (p=0.0065). Conclusions: The acupressure point SP6 showed a helpful measure to relieve pain, complementary to induce labor, shortening this period, non-invasive and a way of improving the quality of care the patient received without causing adverse effects to the mother or the newborn. However, there was no difference in cesarean section rate in this study / Mestrado / Enfermagem e Trabalho / Mestre em Ciências da Saúde

Bakgrund: Kejsarsnitt är ett ingrepp som blir allt vanligare världen över vilket resulterar till att fler kvinnor drabbas av komplikationer. I takt med att kejsarsnitt blivit säkrare har vårdtiden för kvinnorna blivit kortare, vilket gör att det uppstår en osäkerhet och rädsla kring komplikationer efter utskrivning för dessa kvinnor. Syfte: Syftet var att belysa kvinnors upplevelse kring komplikationer vid panerat kejsarsnitt efter utskrivning. Metod: Studien är en litteraturstudie med induktiv ansats där sju kvalitativa resultatartiklar ligger till grund för resultatet. Resultat: Utefter syftet identifierades fyra teman: att leva med långvarig smärta orsakad av genomgånget planerat kejsarsnitt, upplevelse av information, upplevelse av postnatal infektion samt skam och ångest kring planerat kejsarsnitt. Kvinnor upplever sin egen kunskap otillräcklig för att identifiera komplikationer samt vart kvinnan skall vända sig när komplikationer uppstår. Informationen som kvinnan får postoperativt kring infektion och smärtans utveckling vid planerat kejsarsnitt efter utskrivning, ansåg kvinnan bristfällig med avsaknad av personcentrerat förhållningssätt. Kvinnor upplever även en stigmatisering kring planerat kejsarsnitt från hälso- och sjukvårdspersonal samt samhället. Konklusion: Hälso- och sjukvården behöver få en större förståelse för kvinnans upplevelse kring komplikationer vid planerat kejsarsnitt efter utskrivning samt förbättra vården med ett personcentrerat förhållningssätt i form av stöd och information. / Background: Cesarean section is a procedure that is becoming more common around the world, which means that more women are suffering from complications. As the operation has become safer, the care time for the women has become shorter, which indicates that there is an uncertainty about complications after discharge. Aim: The aim was to illustrate women's experience of complications during elective cesarean section after discharge. Method: The study is a literature study with an inductive approach where seven qualitative articles formed the result. Result: According to the purpose, four themes were identified: living with long-term pain caused by elective cesarean section, experience of information, experience of postnatal infection and shame and anxiety around a planned cesarean section. Women experience insufficient knowledge to identify complications and where the woman should turn once it occurs. Postoperative information is not designed to be easily absorbed, as well as a stigma surrounding the woman's elective cesarean section in meetings with health and medical profession and society. Conclusion: The health care needs to gain a greater understanding of the woman's experience of complications after elective caesarean section at discharge and improve care with a person-centered approach in the form of support and information.

Hintergrund: Die Bedeutung der intra- und postpartalen Betreuungserfahrung für die psychische und physische Gesundheit von Mutter und Kind ist weitgehend anerkannt. Aktuelle Daten aus größeren Untersuchungen im deutschen klinischen Kontext liegen nicht vor. Die Evidenzen zur Betreuungszufriedenheit in Abhängigkeit vom Geburtsmodus sind uneinheitlich, der Einfluss einzelner Betreuungsdimensionen auf die Gesamtzufriedenheit ist speziell im Bereich der postpartalen Versorgung wenig untersucht. Ziel: Ermittlung der Dimensionen der intra- und postpartalen Betreuungserfahrungen in deutschen Kliniken, Analyse des Einflusses des Geburtsmodus auf diese Dimensionen sowie Prüfung des Einflusses der Dimensionen auf die Betreuungszufriedenheit insgesamt. Methode: Analyse der Daten aus 235 postalischen Befragungen in 129 geburtshilflichen Abteilungen, durchgeführt vom Picker Institut Deutschland gGmbH zwischen 2002 und 2009. Teilnehmerinnen: 16.315 Wöchnerinnen, die ihr Kind nach der vollendeten 37. Schwangerschaftswoche in einem deutschen Krankenhaus zur Welt gebracht haben. Ergebnisse: Ermittelt wurden 9 Dimensionen, die die intra- und postpartale Betreuung, die postpartale Schmerzlinderung sowie Hotelaspekte der Versorgung im Krankenhaus abbilden. Generell zeigte sich eine hohe Zufriedenheit, jedoch wird die postpartale Betreuung kritischer beurteilt als die intrapartale Betreuung. Es zeigte sich eine unterschiedliche Betreuungszufriedenheit bei Frauen mit geplanter und ungeplanter Sectio, mit einer Tendenz zu höherer Unzufriedenheit bei letzteren. Im Vergleich zu Frauen mit vaginaler Geburt sind Frauen mit geplantem Kaiserschnitt mit der ärztlichen Betreuung zufriedener (OR 0,7, 99% KI 0,6 - 0,9), Frauen mit ungeplantem Kaiserschnitt mit der Hebammenbetreuung unzufriedener (OR 1,5, 99% KI 1,3 - 1,9) und Frauen sowohl mit geplanter als auch ungeplanter Sectio mit der postpartalen Schmerzlinderung unzufriedener (OR 1,8, 99% KI 1,5 - 2,1 bzw. OR 1,8, 99% KI 1,6 - 2,0). Die Dimension Betreuung auf der Wochenbettstation weist den mit Abstand stärksten Einfluss auf die Zufriedenheit mit der klinischen Betreuung insgesamt auf. Darüber hinaus sind es vor allem die Dimensionen mit Fokus auf der Interaktion mit den betreuenden Fachkräften, die maßgeblich die Gesamtzufriedenheit beeinflussen. Der subjektive Gesundheitszustand, die Zuversicht, mit dem Kind zuhause zurecht zu kommen, und die Verweildauer erwiesen sich als weitere wichtige Prädiktoren der Zufriedenheit mit den Betreuungsdimensionen und der Gesamtzufriedenheit. Schlussfolgerung: Die maßgebliche Bedeutung der interpersonellen Betreuungsaspekte sowie die kritischere Beurteilung der postpartalen Betreuung im Vergleich zur intrapartalen bestätigen sich auch für den deutschen klinischen Kontext. Der Geburtsmodus scheint insbesondere für die Zufriedenheit mit der intrapartalen Betreuung sowie der postpartalen Schmerzlinderung eine Rolle zu spielen. Die größere Unzufriedenheit mit der postpartalen Schmerzlinderung bei Kaiserschnittgeburt deutet auf die Notwendigkeit eines effektiveren Schmerzmanagements hin. Vor dem Hintergrund der negativen Auswirkungen starker Schmerzen auf den Aufbau der Mutter-Kind-Beziehung sollte die Entscheidung zum geplanten Kaiserschnitt ebenso wie der Einsatz von Interventionen, die einen ungeplanten Kaiserschnitt begünstigen, sehr sorgfältig abgewogen werden. Den konstituierenden Dimensionen und Einflussfaktoren der postpartalen Betreuungszufriedenheit sollte mehr Aufmerksamkeit gewidmet werden, insbesondere mit Blick auf effektive Betreuungskonzepte und eine systematische Verzahnung mit der ambulanten Betreuung.

OBJECTIVES: The effect of body mass index (BMI) was assessed on unplanned cesarean section (CS) rate and its indications among healthy, nulliparous women without other risk factors for CS. METHOD: A cross sectional study was performed on 1649 healthy, nulliparous women at term who were admitted in spontaneous labor and delivered at Boston Medical Center between Jan 1st 2008 and Dec 31st 2012. The demographics and outcomes were compared by using a logistic regression analyses. RESULT: There were no statistically significant differences in unplanned CS rates between the three BMI groups (19% in normal weight, 24% in overweight, and 21% in obese women, p=0.1). Compared with normal weight women the crude odds ratio for overweight women was 1.34 (95%CI 1.03-1.76) and for obese women 1.04 (95%CI 0.84-1.54). A multivariate logistic regression analysis was used to adjust for maternal age, birth weight, race and augmentation of labor. The adjusted ORs were 1.073 (95%CI 0.781-1.473) for obese and 1.291 (95%CI 0.978-1.705) for overweight women. Obese women had a higher rate of CS for non-reassuring fetal status (56%, p= 0.01) compared to overweight (46.5%) and normal weight women (37%). CONCLUSION: high maternal BMI per se does not appear to be an independent risk factor for unplanned CS in healthy nulliparous women presenting at term with a singleton pregnancy in spontaneous labor.

In partial fulfilment of the requirements for the degree Masters of Arts in Clinical Psychology, 2006. / The purpose of this research was to describe the experience of working with patients with HIV/AIDS, in particular performing caesarean sections, from a medical practitioner's perspective. A phenomenological study method was employed in which each participant used in the research was interviewed in a single session. The original sample consisted of 9 participants. They were selected by means of criterion sampling from the gynaecology and obstetrics department of different public hospitals in Johannesburg, Pretoria and Cape Town. Six protocols were selected for phenomenological explication based on the interviews with the 9 original participants. The sample consisted of 3 females and 3 males, from different cultural backgrounds, who regularly perform surgical gynaecological procedures on patients with HIV/AIDS. The results were presented in the form of an integrative text, which accounted for all of the individual variations of the experience of working with patients with HIV/AIDS. Out of this text the researcher explicated natural meaning units, specific to each participant, which were used in formulating a specific description of experiencing the performance of a caesarean section on a patient with HIV/AIDS. This study concluded with a discussion of the results, as well as a formulation of a general description of experiencing the performance of caesarean sections on patients with HIV/AIDS for all 6 participants. Overall, this research explicated unique descriptions of individual experiences, and contributes to a general understanding of the experience of performing a caesarean section on a patient with HIV/AIDS. Operational definitions • Phenomenology - A department of the inductive sciences concerned with the facts that form the basis of its system. • Caesarean section - A mode of childbirth in which a surgical incision is made through a pregnant woman's abdomen and uterus to deliver a baby. • Human Immunodeficiency Vinis- A retrovirus that attacks and severely damages the body's immune system and for which there is presently no cure. • Life-wortd- The space occupied by any one person in the external, physical world, as well as the internal lived-in world, consisting of emotions and cognitions.

Av de 110 000–120 000 barn som föds årligen i Sverige, avslutas ca 18,6 procent av förlossningarna med kejsarsnitt och ca tio procent av alla barn behöver vårdas på neonatalvårdsavdelning. Vid en normal förlossning främjas amningen och anknytningen mellan mor och barn genom hud mot hudkontakt som stimulerar barnets medfödda beteenden. Oxytocinfrisättningen stimuleras vilket underlättar moderns återhämtning och främjar bindningen till barnet. När mor och barn behöver separeras direkt efter födseln uteblir dessa normala förhållanden.   Syftet med denna studie var att belysa konsekvenserna för relationen mellan mor och barn av tidig separation efter födseln. Metoden som tillämpades var litteraturöversikt med systematisk design. Artikelsökningen genomfördes i databaserna PubMed, CINAHL och PsycInfo vilket genererade 16 artiklar till studiens resultat. Artiklarnas kvalité granskades via en kvalitetsgranskningsmall för att säkerställa god kvalité och öka resultatets tillförlitlighet. För att samla in, analysera och sammanställa data från de olika studierna användes en integrerad analys.   Resultatet har sammanställts i form av två huvudkategorier och fem underrubriker som tillsammans underbygger studiens syfte. Studiens resultat visar på att separation har både kortsiktiga och långsiktiga konsekvenser. Separationen påverkar moderns förmåga att binda till sitt nyfödda barn, begränsar hennes möjlighet att delta i omvårdnaden av barnet, ökar risken för depression, hindrar tidig hud mot hudkontakt samt har en negativ inverkan på amningen.  Slutsatsen från studien är att separation medför flertalet konsekvenser för mor och barns fysiska och mentala hälsa. Vårdpersonal bör vara medvetna om att separation bör undvikas i den mån det är möjligt. Om separation inträffat bör vårdpersonal ha kunskap om konsekvenserna för att erbjuda stöd som minimerar de negativa konsekvenserna. / Of the 110 000-120 000 babies born annually in Sweden, approximately 18.6 percent of births ends with a caesarean section and approximately ten percent of all newborns need to be cared for in the neonatal care unit. During a normal delivery, breastfeeding and attachment between mother and child are promoted through skin-to-skin contact that stimulates the child's innate behaviors. Oxytocin release is stimulated which facilitates the mother's recovery and promotes bonding. When mother and child are separated early after birth, these normal conditions are absent. The aim of this study was to highlight the consequences for the relationship between mother and child of early separation after birth. The method applied was a literature review with systematic design. The article search was conducted in the databases PubMed, CINAHL, and PsycInfo, generating 16 articles for the study's result. The quality of the articles was reviewed using a quality assessment template to ensure good quality and increase reliability. An integrated analysis was used to collect, analyze, and summarize data from the various studies. The results have been summarized in two main categories and five subheadings that together support the purpose of the study. The results showed that separation has both short-term and long-term consequences. Separation affects the mother's ability to bond with her newborn, limits her ability to participate in the baby's care, increases risk of depression, hinders early skin to skin contact, and has a negative impact on breastfeeding. The conclusion of the study is that separation has numerous physical and mental health consequences for both mother and baby. Healthcare professionals should be aware that separation should be avoided as far as possible. If separation occurs, healthcare professionals should have knowledge of the consequences it causes so they can offer support that minimizes the negative consequences.