Prolonged second stage of labor, excessive gestational weight gain and cesarean delivery has been associated with adverse maternal and fetal outcomes. Physical activity during pregnancy is a modifiable risk factor which has never been studied among Hispanic women. Gestational weight gain, another modifiable risk factor has only been evaluated as a risk factor for cesarean delivery in two studies among women induced for labor. To date, no study has examined the effect of duration of second stage of labor on intra-ventricular hemorrhage in very preterm births. We examined these maternal risk factors for prolonged second stage of labor, rate of cesarean delivery and fetal outcomes. The first study evaluated the association between physical activity and duration of second stage of labor. Prior studies regarding physical activity and duration of second stage of labor have been conflicting and none have examined the Hispanic population. During pregnancy, activities such as household chores, childcare, sports and women's occupation constitute a significant proportion of physical activity but have not been considered in prior studies. We examined the association between total physical activity (occupational, sport/exercise, household/care giving, and active living) during pre, early and mid-pregnancy and duration of second stage of labor in a prospective cohort of 1,231 Hispanic participants. Physical activity was quantified using the Kaiser Physical Activity Survey administered during pregnancy. Using multivariate linear regression we did not find statistically significant association between pre, early and mid-pregnancy physical activity and duration of second stage of labor. The second study focused on the effect of gestational weight gain on the cesarean delivery rate after induction of labor. The rate of induction of labor (IOL) has more than doubled from 9.5% in 1990 to 22.5% in 2006. Cesarean delivery usually follows a failed IOL and is associated with maternal and fetal morbidity. One of the two studies evaluating the effect of gestational weight gain on the rate of cesarean section in patients undergoing IOL was restricted to women with normal Body Mass Index (BMI) and the other was subjected to bias because more than half of the patients were missing BMI data. Therefore, we evaluated the effect of gestational weight gain on the rate of cesarean delivery after labor induction. In a retrospective cohort study design, using data from May 2005 to June 2008 and a multivariate logistic regression we found a 13% increase in risk of cesarean delivery with 5 kg increase in gestational weight gain. Finally, we evaluated the effect of mode of delivery and duration of second stage of labor on intra-ventricular hemorrhage (IVH) among early preterm births. IVH is a serious complication associated with preterm birth and important predictors of cerebral palsy and neurodevelopmental delays. Prior studies on this relationship in early preterm births are sparse. In a retrospective cohort study of newborns born less than 30 weeks or less than 1500 g between May 2003 and August 2008, we found an increase in risk of IVH after vaginal delivery. However, duration of second stage of labor had no significant effect on risk of IVH.

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T13:59:45Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_BrunaDedavidDaRocha.pdf: 3098153 bytes, checksum: 1698c7dd175fcba85762ee697a724231 (MD5) / Made available in DSpace on 2018-08-22T13:59:45Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_BrunaDedavidDaRocha.pdf: 3098153 bytes, checksum: 1698c7dd175fcba85762ee697a724231 (MD5) Previous issue date: 2017-08-18 / The model of obstetric and neonatal care at the national level, is experiencing important changes regarding the qualification and humanization of care. The importance of the insertion of obstetrical nurses in this scenario and the carrying out of research based on scientific evidence are highlighted. The objective was to perform a systematic review with meta-analysis to investigate whether the adoption of vertical positions by the woman, in childbirth, compared to the lithotomic position, prevents perineal lacerations. The first manuscript was an integrative review of literature, by searching the bases PubMed and Lilacs, on methods for prevention of perineal lacerations. The final sample consisted of 16 articles and emerged three thematic categories: factors related to the practice of episiotomy and the occurrence of perineal lacerations and indications for the performance, approach of the professional that provides assistance to normal delivery and strategies for prevention of perineal lacerations.The second manuscript concerns a systematic review. For this study, the Lilacs, Pubmed, Cinahl, Cochrane Library, Web of Science, Science Direct, Scopus, Google Schoolar and Open Gray databases were delineated as the main descriptors in english and portuguese: posture, second stage labor, posição and segunda fase de trabalho de parto. Moreover, only primary studies were carried out, which included parturients in active labor, who adopted vertical positions or lithotomic position at the time of delivery, and the prevention or not of perineal lacerations when adopting these positions. No temporal or language cut of studies was delimited. The relevance tests I and II were performed by two independent reviewers. The quality of the evidence was evaluated, according to the GRADE System, and meta-analysis of the results. Scientific evidence has emerged that it is not possible to say with certainty that vertical positions prevent perineal lacerations, compared to the lithotomic position. The product resulting from the research process is a systematic review with meta-analysis, which, based on evidence-based practice, is the best evidence available for clinical decision-making. / O modelo de assistência obstétrica e neonatal em âmbito nacional, está vivenciando mudanças importantes, referentes a qualificação e humanização da assistência. Destaca-se a importância da inserção de enfermeiras obstétricas nesse cenário e a realização de pesquisas baseadas em evidências científicas. Objetivou-se realizar uma revisão sistemática com metanálise, para investigar se a adoção de posições verticalizadas pela mulher, no parto, comparada à posição litotômica, previne lacerações perineais. Emergiram dois artigos da dissertação. O primeiro manuscrito realizado foi uma revisão integrativa de literatura, elaborada a partir do projeto de pesquisa. Foi realizada busca nas bases Pubmed e Lilacs, sobre métodos para prevenção de lacerações perineais. A amostra final foi composta de 16 artigos e emergiram três categorias temáticas quais sejam: fatores relacionados à prática da episiotomia e ocorrência de lacerações perineais e indicações para a realização; abordagem do profissional que presta assistência ao parto normal e estratégias para prevenção de lacerações perineais. O segundo manuscrito diz respeito a uma revisão sistemática. Para esse estudo foram elencadas as bases de dados Lilacs, Pubmed, Cinahl, Cochrane Library, Web of Science, Science Direct, Scopus, Google Schoolar e Open Gray e delimitados como principais descritores em inglês e português: posture, second stage labor, posição e segunda fase de trabalho de parto. Ainda, selecionou-se apenas estudos primários, que contemplassem parturientes em trabalho de parto ativo, que adotaram posições verticalizadas ou posição litotômica, no momento do parto, e a prevenção ou não de lacerações perineais ao adotarem essas posições. Não foi delimitado recorte temporal ou idioma dos estudos. Os testes de relevância I e II foram realizados por dois revisores independentes. Foi avaliada a qualidade da evidência científica dos estudos, de acordo com o Sistema GRADE, e realizada metanálise dos resultados. Emergiu a evidência científica de que não é possível afirmar com certeza, que as posições verticalizadas previnem lacerações perineais, quando comparadas à posições horizontais. O produto resultante do processo da pesquisa configura-se como revisão sistemática com metanálise, a qual, mediante a prática baseada em evidências, se fundamenta como a melhor evidência disponível para a tomada de decisão clínica.