CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / A maternidade exige da mulher adaptaÃÃes fÃsicas, psicolÃgicas e sociais. Para a puÃrpera soropositiva para o HIV alÃm de todas estas adaptaÃÃes, a nova mÃe vivencia experiÃncias delicadas e difÃceis como o nÃo amamentar, o isolamento, a discriminaÃÃo e o estigma que sofre por si mesma, pelos familiares e pela equipe de saÃde que presta cuidados. O medo de morrer e de ter contaminado seus filhos, somado ao nÃo amamentar sÃo fatores que levam a comportamentos de distanciamento, prejudicando a atitude de apego entre o binÃmio mÃe e bebÃ. O apego à essencial para a formaÃÃo do vÃnculo afetivo e da personalidade, podendo prejudicar o desenvolvimento da crianÃa, caso esta seja privada da figura de apego. Nosso trabalho teve como objetivo construir um vÃdeo educativo para a promoÃÃo do apego entre mÃe soropositiva para o HIV e seu filho. O estudo foi do tipo metodolÃgico, ensaio clÃnico, randomizado. Para a construÃÃo e validaÃÃo do vÃdeo educativo, a pesquisa passou por cinco etapas: Desenvolvimento do roteiro; AvaliaÃÃo do roteiro por dois especialistas de conteÃdo e dois da Ãrea tÃcnica; GravaÃÃo e EdiÃÃo do vÃdeo; ExibiÃÃo do vÃdeo e AvaliaÃÃo da InteraÃÃo MÃe e BebÃ. A coleta de dados ocorreu entre maio e outubro de 2008, em uma maternidade do municÃpio de Fortaleza. As participantes foram divididas aleatoriamete em Grupo Controle e Grupo de IntervenÃÃo, totalizando uma amostra de 24 participantes. A populaÃÃo era composta por 27 gestantes soropositivas, sendo que trÃs nÃo obedeceram aos critÃrios de inclusÃo do estudo. Utilizamos como instrumentos para coletar os dados: questionÃrio para avaliaÃÃo do roteiro; formulÃrio do perfil sÃcioeconÃmico; diÃrio de campo e o Protocolo da AvaliaÃÃo da InteraÃÃo MÃe e Bebà de 0 a 6 meses. Para anÃlise dos dados usamos o Teste EstatÃstico Kolmogorov-Smirnov com (p<0,05). Os especialistas concordaram com o desenvolvimento do vÃdeo como estratÃgia educativa, solicitando modificaÃÃes: reduÃÃo do nÃmero de cenas; SubstituiÃÃo de termos tÃcnicos por linguagem coloquial; Efeitos computadorizados de figuras e maior interaÃÃo entre os personagens. ApÃs a criaÃÃo do vÃdeo, o mesmo foi transmitido para as participantes do Grupo de IntervenÃÃo. Foram observados sentimentos como alegria, esperanÃa e ansiedade. ApÃs a entrevista com as participantes dos dois grupos, agendamos de acordo com a data provÃvel do parto, a avaliaÃÃo da interaÃÃo entre mÃe e bebÃ. Nessa etapa participaram trÃs juÃzas que filmaram a dÃade e avaliaram a interaÃÃo entre os mesmos. Os resultados foram mais satisfatÃrio para o Grupo de IntervenÃÃo, ou seja, as mulheres que haviam assistido o vÃdeo e recebido orientaÃÃes da pesquisadora. Para avaliaÃÃo da interaÃÃo entre o binÃmio, o protocolo usado preconiza os seguintes critÃrios para avaliaÃÃo: verbalizaÃÃo; contato visual; atenÃÃo geral da mÃe; afeto positivo; eficiÃncia para consolar; reaÃÃo da mÃe ao choro do bebÃ; resposta ao comportamento social Intensidade da resposta; sensitividade; contato corporal; afeto negativo e intrusividade. Dos comportamentos avaliados os Ãnicos que nÃo tiveram diferenÃas estatÃsticas para os dois grupos foram a verabalizaÃÃo; o afeto negativo e intrusividade. Assim, consideramos importante a criaÃÃo de estratÃgias educativas que visem a promoÃÃo do apego, ressaltamos ser este vÃdeo um apoio para os profissionais que trabalham com esta clientela especÃfica. / The maternity demands from the woman physical, psychological and social adaptations. To the HIV positive person the HIV beyond all these adaptations, the new mother lives deeply delicate and difficult experiences as not to suckle, the isolation, the discrimination and the stigma that suffers for same herself, for the familiar ones and the team of health that cares. The fear to die and to have contaminated her children, added to not suckling are factors that take the distant behaviors, harming the attitude of attachment between the binomial mother and baby. The attachment is essential for the formation of the affective bond and the personality, being able to harm the development of the child, in case she is put off to the attachment figure. Our work had as objective to construct an educative video for the promotion of the attachment between HIV positive mother and her son. This was a methodological type study, clinical assay, randomized. To the construction and validation of the educative video, the research went through five stages: Development of the script; Evaluation of the script for two specialists of content and two of the technique area; Writing and Edition of the video; Exhibition of the video and Evaluation of the Interaction Mother and Baby. The collection of data occurred between May and October of 2008, in a maternity of the city of Fortaleza. The participants had been divided randomized in Group Control and Group of Intervention, totalizing a sample of 24 participants. The population was composed for 27 HIV positive pregnant, where three had not obeyed the criteria of inclusion of the study. We use as instruments to collect the data: questionnaire for evaluation of the script; form of the socioeconomic profile; field diary and the Protocol of the Evaluation of the Interaction Mother and Baby of 0 the 6 months. For the analysis of the data we use the Statistical Test Kolmogorov-Smirnov with (p<0, 05). The specialists had agreed to the development of the video as educative strategy, requesting modifications: reduction of the number of scenes; Substitution of terms technician for colloquial language; computerized effect of figures and greater interaction between the personages. After the creation of the video, it was transmitted for the participants of the Group of Intervention. Feelings had been observed as joy, hope and anxiety. After the interview with the participants of the two groups, we set appointments in accordance with the probable date of the childbirth, the evaluation of the interaction between mother and baby. Three female judges who had filmed dÃade and had evaluated the interaction between the same ones took part in this stage. The results had been more satisfactory for the Group of Intervention, that is, the women who had attended the video and received orientations from the researcher. For evaluation of the interaction between the binomials, the used protocol praises the following criteria for evaluation: verbalization; visual contact; general attention of the mother; positive affection; efficiency to console; reaction of the mother I cry to it of the baby; reply to the social behavior Intensity of the reply; sensitivity; corporal contact; negative affection and intrusivity. Of the evaluated behaviors only that they had not had statistical differences for the two the groups had been the verbalization; the negative affection and intrusivity. Thus, we consider important the creation of educative strategies that aim at the promotion of the attachment; we believe to be this video a support for the professionals who work with this specific clientele.

OBJETIVO: Determinar la relación entre las características de la atención obstétrica y del trabajo de parto con el desarrollo de endometritis puerperal en pacientes atendidas en el servicio de hospitalización del Hospital Nacional Docente “San Bartolomé” durante el periodo del 2013 al 2014. METODOLOGÍA:Estudio de tipo analítico correlacional, de corte transversal y retrospectivo, en el cual participaron 200 pacientes con diagnóstico de endometritis puerperal (grupo1) y 200 pacientes sin diagnóstico de endometritis puerperal (grupo 2), atendidas en el Hospital Nacional Docente San Bartolomé durante el año 2013 al 2014. Los datos recolectados se procesaron en el programa estadístico SPSS v.21. Para el análisis inferencial, se utilizó el Chi-cuadrado para variables cualitativas y la prueba t Student para las variables continuas. RESULTADOS:El 56% de las pacientes con endometritis puerperal y el 57.5% de las pacientes sin endometritis puerperal tuvieron de 6 a más atenciones prenatales (p=0.762). El inicio tardío de la atención prenatal se asoció con el desarrollo de la atención prenatal (p=0.022), pues el 70% de las pacientes con endometritis puerperal inició tardíamente su atención prenatal (≥ 14 semanas) comparado con el 59% de las pacientes sin endometritis puerperal. Durante el trabajo de parto, el número de tactos vaginales mayor o igual a 4 se relacionó con el desarrollo de endometritis puerperal (p=0.000), debido a que al 70% de las pacientes con endometritis puerperal se les realizó de 4 a más tactos vaginales, a diferencia del 41% de pacientes sin endometritis puerperal. Así mismo la revisión instrumentada de la cavidad vaginal se relaciona con el desarrollo de endometritis puerperal (p=0.000). La duración del periodo expulsivo (p=0.001) y del alumbramiento (p=0.017) se asociaron con el desarrollo de endometritis puerperal. En cuanto a las características del trabajo de parto, las membranas rotas (p=0.001), la ruptura prematura de membranas (p=0.008) y el parto por cesárea (p=0.000) se asociaron con el desarrollo de endometritis puerperal. CONCLUSIÓN:Las características de la atención obstétrica y del trabajo de parto que se relacionan con el desarrollo de endometritis puerperal fueron el inicio de la atención prenatal a partir de las 14 semanas, la realización de 4 a más tactos vaginales durante el trabajo de parto, la revisión instrumentada de la cavidad vaginal, las membranas rotas, la duración del expulsivo, la duración del alumbramiento y el parto por cesárea. / OBJECTIVE:To determine the relationship between the characteristics of obstetric care and labor with the development of puerperal endometritis in patients treated at the hospital department National Teaching Hospital San Bartolomé during the period from 2013 to 2014. METHODOLOGY:It is a correlational study analytic, cross-sectional, retrospective held at the National Teaching Hospital San Bartolomé from 2013 to 2014. RESULTS:During this period two groups were selected: the first group consisted of 200 patients diagnosed with postpartum endometritis and the second group was estimated at 1: 1 ratio comprised of 200 patients without a diagnosis of postpartum endometritis. It was observed that 56% of patients with puerperal endometritis and 57.5% of patients without puerperal endometritis had 6 more prenatal care. The initiation of prenatal care, in the present investigation was delayed, the number of greater than or equal to 4 pelvic exams related to the development of postpartum endometritis. Also after vaginal delivery, the instrumented review of the vaginal cavity was associated with the development of puerperal endometritis and cesarean delivery was associated with the development of puerperal endometritis. CONCLUSIONS: The characteristics of obstetric care and labor that relate to the development of puerperal endometritis in patients treated at the hospital department National Teaching Hospital "San Bartolomé" during the period from 2013 to 2014 were the beginning of prenatal care after 14 weeks, performing 4 more vaginal examinations during labor, the duration of the second period, the duration of delivery, the instrumented review of the vaginal cavity, ruptured membranes, premature rupture of membranes and cesarean delivery. KEYWORDS:Endometritis, obstetric care,during labor. / Tesis

Risken att drabbas av postpartumendometrit efter vaginal förlossning är cirka en till fyra procent. Efter kejsarsnitt är risken 10 till 20 procent. De flesta fall av postpartumendometrit orsakas av streptokocker, tarmbakterier, agens från sexuellt överförbara infektioner och bakterier från vaginalfloran. Riskfaktorer för att utveckla postpartumendometrit är bland annat kejsarsnitt, multipla vaginala undersökningar, lång vattenavgång och låg socioekonomisk status. Många fall av postpartumendometrit är lättbehandlade men en del infektioner utvecklas snabbt till ett mer allvarligt tillstånd - puerperalsepsis. Mödradödligheten är globalt sett hög, framför allt i vissa delar av världen, där infektion efter förlossning är en bidragande orsak. Syftet med denna litteraturöversikt var att undersöka hur barnmorskan kan förebygga postpartumendometrit och därmed också minska risken för mödrar att utveckla puerperalsepsis under postpartumperioden. För att besvara syftet användes metoden rapid review och totalt 15 studier inkluderades i arbetet, varav en av studierna var av kvalitativ ansats och 14 med kvantitativ ansats. Under dataanalysen framkom tre huvudkategorier; Kliniska interventioner, Verktyg för barnmorskans proaktiva arbete samt Kunskap, motivation och följsamhet. En del kliniska interventioner, användandet av varningssystem för riskfaktorer och tidiga tecken på infektion samt kunskap, motivation och följsamhet hos vårdpersonal är viktiga faktorer i det preventiva arbetet mot postpartumendometrit. Slutsatsen belyser vikten av det preventiva arbetet mot postpartumendometrit och ett steg att minska mödradödlighet orsakat av puerperalsepsis. / The risk of postpartum endometritis after vaginal delivery is about one to four percent. After a caesarean section, the risk is 10 to 20 percent. Most cases of postpartum endometritis are caused by streptococci, intestinal bacteria, STI agents and bacteria from the vaginal flora. Risk factors for developing postpartum endometritis include caesarean section, multiple vaginal examinations, prolonged fluid leakage and low socioeconomic status. Many cases of postpartum endometritis are mild and easily treated, but some infections quickly progress to a more serious condition - puerperal sepsis. Maternal mortality is high, particularly in some parts of the world, with postpartum infection as a contributing factor. The aim of this literature review was to investigate how midwives can prevent postpartum endometritis and thereby also reduce the risk of mothers developing puerperal sepsis in the postpartum period. To answer the aim, the rapid review method was used and a total of fifteen studies were included in the work, one of these conducted a qualitative approach and fourteen a quantitative approach. Three main categories emerged during the data analysis: Clinical interventions, Tools for midwives' proactive work and Knowledge, motivation and compliance. Some clinical interventions, the use of alert systems for risk factors and early signs of infection, and knowledge, motivation and compliance of health care workers are important in the preventive work against postpartum endometritis. The conclusion highlights the importance of the prevention of postpartum endometritis as a step in reducing maternal mortality caused by puerperal sepsis.

Adolescent pregnancy has been of longstanding societal concern primarily because of the inability of most young mothers to provide adequately for their infants. Depression often results in disengagement from mother-child interaction. Adolescent mothers identified as depressed are at increased risk of future psychopathology, with additional deleterious effects on their infants&rsquo / lives. The purpose of this study was to explore adolescent mothers&rsquo / experiences of motherhood and memories of feeling depressed during or after the birth of their babies. The first aim was to explore the young women&rsquo / s experiences of mothering, by focusing upon the practice of being a mother. The second aim was to explore the young women&rsquo / s experiences of depression, by focusing on their physical behaviour and emotional experiences. The third aim was to explore their perceptions of the causes of their depression. The rationale for this study was that these issues will further enhance the body of knowledge available to practitioners working with adolescent mothers. It will also provide a source of insights and hypotheses for preventive intervention research. The study was located within a feminist standpoint framework that begins from the perspective of women with the aim to explore women&rsquo / s accounts of their experiences in relation to depression as an important source of knowledge. A qualitative research design and methodology was employed in the region of the Western Cape. Eight adolescent mothers between the ages of 16 and 19 were recruited and interviewed. The interviews were semi-structured and consisted out of open-ended questions. Interviews were recorded, transcribed verbatim and thematic analysis of data was carried out. The findings of this research yielded some interesting areas for future research and implications for treatment and intervention with first-time adolescent mothers. The adolescent mothers in this study experienced similar depressive symptoms to adult mothers in previous research. All the participants revealed that they feared their parents&rsquo / disappointment in them for being pregnant. This factor contributed to their depression, because they received very little (if any) support from their parents or the father of their baby. The participants discussed that their pregnancy or giving birth was linked to various aspects of themselves that they had lost as an adolescent. Before they received counselling, none of the participants understood why they experienced depressive symptoms or what was happening to them at the time after their pregnancies.

Adolescent pregnancy has been of longstanding societal concern primarily because of the inability of most young mothers to provide adequately for their infants. Depression often results in disengagement from mother-child interaction. Adolescent mothers identified as depressed are at increased risk of future psychopathology, with additional deleterious effects on their infants&rsquo / lives. The purpose of this study was to explore adolescent mothers&rsquo / experiences of motherhood and memories of feeling depressed during or after the birth of their babies. The first aim was to explore the young women&rsquo / s experiences of mothering, by focusing upon the practice of being a mother. The second aim was to explore the young women&rsquo / s experiences of depression, by focusing on their physical behaviour and emotional experiences. The third aim was to explore their perceptions of the causes of their depression. The rationale for this study was that these issues will further enhance the body of knowledge available to practitioners working with adolescent mothers. It will also provide a source of insights and hypotheses for preventive intervention research. The study was located within a feminist standpoint framework that begins from the perspective of women with the aim to explore women&rsquo / s accounts of their experiences in relation to depression as an important source of knowledge. A qualitative research design and methodology was employed in the region of the Western Cape. Eight adolescent mothers between the ages of 16 and 19 were recruited and interviewed. The interviews were semi-structured and consisted out of open-ended questions. Interviews were recorded, transcribed verbatim and thematic analysis of data was carried out. The findings of this research yielded some interesting areas for future research and implications for treatment and intervention with first-time adolescent mothers. The adolescent mothers in this study experienced similar depressive symptoms to adult mothers in previous research. All the participants revealed that they feared their parents&rsquo / disappointment in them for being pregnant. This factor contributed to their depression, because they received very little (if any) support from their parents or the father of their baby. The participants discussed that their pregnancy or giving birth was linked to various aspects of themselves that they had lost as an adolescent. Before they received counselling, none of the participants understood why they experienced depressive symptoms or what was happening to them at the time after their pregnancies.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

Paper one is a metasynthesis of studies exploring mothers' experiences of recovery from postnatal mental illness. Four databases were systematically searched using key words and index terms to identify the qualitative literature exploring mothers' experiences of recovery from postnatal mental illness. Fourteen studies met the inclusion criteria and were critically appraised and synthesised. These papers reported the views of 395 women's experiences of recovery from postnatal mental illness. Five core themes emerged from the synthesis to describe four key processes that facilitate recovery. This experience begins with recognising the problem through crisis and relational distress. Women then go through the process of seeking help which consists of subthemes of accepting help and help to access help. The next process in the in the journey is achieving recovery which includes subthemes of sharing with others like me, coping strategies and noticing recovery. The final process of maintaining recovery consists of incorporating coping strategies into daily life; acquiring a different model of motherhood and processing the experience. The role of the family was interwoven through each stage of recovery. Recommendations were made for professionals who come into contact with this group of women and their families. The review highlighted gaps in the existing evidence and made recommendations for future research. The findings and limitations were discussed with reference to the existing literature. Paper two explored the role of the baby in 12 mothers' experiences of recovery from psychosis after childbirth. A thematic analysis of the data identified three core themes that described the role of the baby in the mothers' recovery. Findings revealed that the baby was central to women's recovery and could be experienced as both helpful and unhelpful. The baby interacted with the mother; increasing self efficacy and reducing emotional distress. The baby could act as a barrier to recovery by increasing the women's emotional distress and hindering access to help and self care. The findings recommended that women receive specialist treatment in mother and baby units where they can access interventions that support parent-infant interactions. The findings of the study add to the existing evidence base on recovery from psychosis after childbirth and highlighted areas for future research. Paper three is a critique of the research carried out in Papers one and two. This paper discussed the rationale for the research design in both papers. Approaches to data sampling and data analysis are reviewed with reference to researcher reflexivity. The search strategy and critical appraisal of techniques of the metasynthesis are also critiqued. Paper three closes with personal reflections and conclusions drawn from both papers.

Magister Psychologiae - MPsych / Adolescent pregnancy has been of longstanding societal concern primarily because of the inability of most young mothers to provide adequately for their infants. Depression often results in disengagement from mother-child interaction. Adolescent mothers identified as depressed are at increased risk of future psychopathology, with additional deleterious effects on their infants&rsquo; lives. The purpose of this study was to explore adolescent mothers&rsquo; experiences of motherhood and memories of feeling depressed during or after the birth of their babies. The first aim was to explore the young women&rsquo;s experiences of mothering, by focusing upon the practice of being a mother. The second aim was to explore the young women&rsquo;s experiences of depression, by focusing on their physical behaviour and emotional experiences. The third aim was to explore their perceptions of the causes of their depression. The rationale for this study was that these issues will further enhance the body of knowledge available to practitioners working with adolescent mothers. It will also provide a source of insights and hypotheses for preventive intervention research. The study was located within a feminist standpoint framework that begins from the perspective of women with the aim to explore women&rsquo;s accounts of their experiences in relation to depression as an important source of knowledge. A qualitative research design and methodology was employed in the region of the Western Cape. Eight adolescent mothers between the ages of 16 and 19 were recruited and interviewed. The interviews were semi-structured and consisted out of open-ended questions. Interviews were recorded, transcribed verbatim and thematic analysis of data was carried out. The findings of this research yielded some interesting areas for future research and implications for treatment and intervention with first-time adolescent mothers. The adolescent mothers in this study experienced similar depressive symptoms to adult mothers in previous research. All the participants revealed that they feared their parents&rsquo; disappointment in them for being pregnant. This factor contributed to their depression, because they received very little (if any) support from their parents or the father of their baby. The participants discussed that their pregnancy or giving birth was linked to various aspects of themselves that they had lost as an adolescent. Before they received counselling, none of the participants understood why they experienced depressive symptoms or what was happening to them at the time after their pregnancies. / South Africa

Submitted by Haroudo Xavier Filho (haroudo.xavierfo@ufpe.br) on 2016-03-01T19:18:54Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Mestrado.pdf: 2528294 bytes, checksum: 69ec2d4350eed1f6344f027d79b47ebb (MD5) / Made available in DSpace on 2016-03-01T19:18:54Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Mestrado.pdf: 2528294 bytes, checksum: 69ec2d4350eed1f6344f027d79b47ebb (MD5) Previous issue date: 2015-05-25 / Os períodos de gestação e puerpério nem sempre são marcados por alegrias e realizações. É exatamente nesta fase que muitas mulheres experimentam alterações importantes do humor e/ou ansiedade, sendo o pós-parto o período de maior vulnerabilidade para o aparecimento de transtornos psiquiátricos. Apesar de ser hoje uma das condições clínicas mais estudadas da psiquiatria e de ser bastante conhecida na prática clínica, a depressão pós-parto ainda não apresenta consensos conceituais e metodológicos importantes para um maior grau de confiabilidade no diagnóstico e na comparação de dados de pesquisas. Assim, esta pesquisa busca minimizar a carência de uniformização e consenso a respeito deste tema tão relevante. Este estudo corresponde a uma revisão sistemática descritiva, no qual foram utilizados três bancos de dados: PubMed/MEDLINE, Scientific Electronic Library Online (SciELO) e Literatura Latino-americana e do Caribe em ciências da saúde (LILACS) e foram incluídos os artigos originais em língua inglesa, nos últimos 5 anos até 30 de junho de 2014, em humanos do sexo feminino. Foram excluídos os artigos não originais, os artigos de revisão e os relatos ou séries de casos. Após a exclusão dos artigos não pertinentes, restaram 356 que foram avaliados por dois revisores e apenas 154 artigos preencheram os critérios de inclusão. O resultado evidencia uma grande heterogeneidade nos instrumentos de pesquisa, com 38 instrumentos de triagem, diagnóstico e avaliação distintos. A verificação do instrumento principal dos estudos, registra uma predominância do Edimburg Depression Postpatum Scale (EPDS) em cerca de 65% dos artigos, apresentando pontos de corte com uma variação total de 7 a 20 e predominância entre 12 e 13. Quanto ao tempo, verifica-se que a maior parte das aferições dos instrumentos foram realizadas no primeiro trimestre do puerpério (45%), contudo foram grandes os percentuais de registros fora deste período, 43% acima de 3 meses do puerpério e 12% durante a gestação. Em relação aos períodos com maior prevalência de casos após o nascimento, constata-se que 65% encontra-se nos primeiros 3 meses após o parto e 35% após os 3 meses. Desta forma, apesar de se averiguar uma heterogeneidade significativa entre os estudos, há uma predominância do EPDS como método de triagem mais utilizado. Já em relação ao tempo, os resultados indicam que ele está muito além do que atualmente é preconizado nos manuais diagnósticos, com episódios depressivos desde a gestação até o período de um ano após o parto, relacionando-se ao nascimento do filho. Os resultados deste estudo ajudam a diminuir as discordâncias metodológicas e conceituais sobre as depressões relacionadas ao parto e podem embasar políticas em saúde para melhorar as estratégias na busca de um diagnóstico mais preciso e precoce e, desta forma, ajudar na prevenção e assistência às mães acometidas por essa enfermidade. / Periods of pregnancy and postpartum are not always marked by joys and achievements. It is precisely at this stage that many women experience major changes of mood and / or anxiety, and the postpartum period has the greatest vulnerability to the onset of psychiatric disorders. Although it is now one of the most studied clinical conditions of psychiatry and being well known in clinical practice, the postpartum depression still does not present conceptual and methodological consensus important for a greater degree of reliability in the diagnosis and the data comparison of survey. Therefore, this research seeks to minimize the lack of standardization and consensus on this issue as relevant. This study represents a descriptive systematic review, in which was used three databases: PubMed / MEDLINE, Scientific Electronic Library Online (SciELO) and Latin American and Caribbean Literature in Health Sciences (LILACS) and original articles were included in English in the last five years until June 30, 2014, in human females. Non-original articles, review articles and reports or case series were excluded. After exclusion of irrelevant articles, remaining 356 that were evaluated by two reviewers and only 154 articles met the inclusion criteria. The result shows a great heterogeneity in research tools, with 38 screening tools, diagnostic and distinct evaluation. Verification of the main instrument of the studies, reports a prevalence of Edimburg Depression Postpatum Scale (EPDS) in about 65% of the articles, with cutoff points with a total variation 7-20 and prevalence between 12 and 13. As for the time, it appears that most of the instruments measurements were carried out in the first quarter of the puerperium (45%), however, were large percentage of the records outside of this period, 43% over 3 months postpartum and 12% during pregnancy. For periods with higher prevalence of cases after birth, it appears that 65% is the first 3 months after delivery and 35% after 3 months. Thus, although to ascertain significant heterogeneity between studies, there is a predominance of the EPDS as the most used screening method. In relation to time, the results indicate that it is far beyond what is currently recommended in the diagnostic manual, with depressive episodes from pregnancy to one year after delivery, relating to the birth of the child. The results of this study help to decrease the methodological and conceptual disagreements over the depressions related to childbirth and can to base health policies to improve the strategies in the search for a more accurate diagnosis and early and thus help prevent and assistance to affected mothers by this disease.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-31T12:58:55Z No. of bitstreams: 2 Dissertação - Bruna de Castro Fernandes - 2016.pdf: 2210765 bytes, checksum: 136b45973bd7330378b172409344ae8f (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-31T13:01:17Z (GMT) No. of bitstreams: 2 Dissertação - Bruna de Castro Fernandes - 2016.pdf: 2210765 bytes, checksum: 136b45973bd7330378b172409344ae8f (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-08-31T13:01:17Z (GMT). No. of bitstreams: 2 Dissertação - Bruna de Castro Fernandes - 2016.pdf: 2210765 bytes, checksum: 136b45973bd7330378b172409344ae8f (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-03-31 / Introduction: to overcome the challenges that affect the quality of services offered by Primary Care, the Ministry of Health proposes several initiatives focused on training, among them is the National Programme for Improving Access and Quality of Primary Care - PMAQ-AB. By relating the effectiveness and quality of prenatal and postpartum care to the maternal mortality rate above the overall target and expanding the coverage of prenatal care, delivery and postpartum care, it is observed that the actions taken in those areas of attention still constitute a challenge for health policies for women. Objective: this study aimed to analyze the actions and services of primary care as ordering network of prenatal care and puerperal in the state of Goias. Methodology: This is a cross-sectional, multicenter study, linked to the second evaluation cycle PMAQ-AB to the state of Goias. This was a clipping national database variables related to sociodemographic characteristics of users of services, prenatal care natal to welcoming to pregnant and postpartum care, given the indicators agreed by primary care teams and municipal managers to the strategic area of women's health. The analysis was done by micro health. Results: the survey covered 975 services of Primary Care, with 1180 health teams and 884 users. Most services are Basic Health Units (842; 86.4%) and most health teams proffer prenatal care (1143: 96.9%) and puerperal (1059: 89.7%). As for existence of printed material used in prenatal care, it was found that most health facilities in all the regions, always available to book the pregnant woman. The increased availability has been identified in the micro Northeast I (100%) and the lowest on the Railroad (73.3%). There was the regular supply of prevalence of vaccine in health services in AB, in the regions Serra da Mesa and West II supply happens in all study participants health services (100%), the lowest bid is in the micro Southwest I (58 , 9%). Of female participants, 637 (72.1%) received prenatal consultation in the last pregnancy, and almost all health micro predominated six or more visits. The most common procedures were checking the uterine height (570; 89.5%), and measurement of blood pressure (96.9%). Examination of the mouth and breasts was reported by 252 (39.6%) participants. The procedure was performed less collection preventive screening of cervical cancer (162; 25.4%). group participated and / or educational activities during prenatal only 221 (34.7%) of women. Of the women with children under two years (n = 884), 316 (35.7%) underwent childbirth review consultation (puerperal consultation). Conclusions: care services Basic prenatal and postpartum health of micro-regions of the State of Goiás presented, in most cases, adequate infrastructure as the information management resources, biopharmaceuticals and laboratory support, with the exception of rapid tests. There was uniformity of actions and services that involve prenatal care and postpartum, most of the micro-regions, and access one of the factors favorable to their use. The gaps were highlighted in the participation of women in educational activities during prenatal and conducting puerperal consultation. / Introdução: Para superar os desafios que interferem na qualidade dos serviços oferecidos pela Atenção Básica, o Ministério da Saúde propõe diversas iniciativas com foco na qualificação, entre elas está o Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica - PMAQ-AB. Ao relacionar a efetividade e a qualidade da assistência pré-natal e puerperal com a taxa de mortalidade materna acima da meta global e ampliação na cobertura do acompanhamento pré-natal, ao parto e puerpério, observa-se que as ações desenvolvidas nessas áreas de atenção ainda constituem desafio para as políticas de saúde da mulher. Objetivo geral: analisar as ações e serviços da Atenção Básica como rede ordenadora do cuidado pré-natal e puerperal no estado de Goiás. Metodologia: trata-se de um estudo transversal, multicêntrico, vinculado ao segundo ciclo de avaliação do PMAQ-AB para o estado de Goiás. Foi realizado um recorte de variáveis do banco de dados nacional, relacionadas às características sociodemográficas das usuárias dos serviços, à assistência pré-natal, ao acolhimento à gestante e à assistência puerperal, atendendo aos indicadores pactuados pelas equipes de atenção básica e gestores municipais para a área estratégica de saúde da mulher. A análise foi feita por regiões de saúde. Resultados: a pesquisa abrangeu 975 serviços da Atenção Básica, com 1180 equipes de saúde e 884 usuárias. A maioria dos serviços são Unidades Básicas de Saúde (842; 86,4%) e a maioria das equipes de saúde ofertam atenção pré-natal (1143; 96,9%) e de puerpério (1059; 89,7%). Quanto a existência dos materiais impressos utilizados na atenção pré-natal, verificou-se que a maioria das unidades de saúde, de todas as regiões, disponibiliza sempre a caderneta da gestante. A maior disponibilidade foi identificada na região Nordeste I (100%) e a menor na Estrada de Ferro (73,3%). Houve o predomínio de oferta regular de vacina nos serviços de saúde na AB, nas regiões Serra da Mesa e Sudoeste II a oferta acontece em todos os serviços de saúde participantes do estudo (100%), a menor oferta está na região Sudoeste I (58,9%). Das mulheres participantes, 637 (72,1%) realizaram consulta de pré-natal na última gestação e, em quase todas as regiões de saúde, houve predomínio de seis ou mais consultas. Os procedimentos mais realizados foram verificação da altura uterina (570; 89,5%) e aferição da pressão arterial (96,9%). Exame da boca e das mamas foi referido por 252 (39,6%) participantes. O procedimento menos realizado foi a coleta de exame preventivo de câncer de colo de útero (162; 25,4%). Participaram de grupo e/ou atividade educativa durante o pré-natal apenas 221 (34,7%) das mulheres. Do total de mulheres com filhos menores de dois anos (n=884), 316 (35,7%) realizaram consulta de revisão de parto (consulta de puerpério). Conclusões: os serviços de Atenção Básica ao pré-natal e puerpério das regiões de saúde do Estado de Goiás apresentaram, em sua maioria, adequada infraestrutura quanto aos recursos de gestão da informação, imunobiológicos e apoio laboratorial, com exceção dos testes rápidos. Houve uniformidade das ações e serviços que envolvem o cuidado pré-natal e puerperal, na maioria das regiões, sendo o acesso um dos fatores favoráveis à sua utilização. As lacunas em destaque foram a participação das mulheres em atividades educativas durante o pré-natal e a realização de consulta puerperal.