Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-03-22T10:52:36Z No. of bitstreams: 1 marialuciasalimmirandamachado.pdf: 7872528 bytes, checksum: 15a268af9e36f43642cae7f5a7e11723 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-04-24T02:17:04Z (GMT) No. of bitstreams: 1 marialuciasalimmirandamachado.pdf: 7872528 bytes, checksum: 15a268af9e36f43642cae7f5a7e11723 (MD5) / Made available in DSpace on 2016-04-24T02:17:04Z (GMT). No. of bitstreams: 1 marialuciasalimmirandamachado.pdf: 7872528 bytes, checksum: 15a268af9e36f43642cae7f5a7e11723 (MD5) Previous issue date: 2013-03-22 / O câncer do colo uterino ainda é um problema de saúde pública no contexto mundial, com maior gravidade nos países menos desenvolvidos. Contudo é um câncer que apresenta um longo período de evolução e pode ser detectado e prevenido através do rastreamento com o exame de Papanicolaou, o que lhe confere um dos mais altos potenciais de prevenção e cura entre todos os tipos de câncer. O presente estudo tem como objetivo avaliar a cobertura do teste de Papanicolaou e os fatores associados à realização do mesmo, em mulheres da área de abrangência de uma UAPS em Juiz de Fora/MG. Com este projeto, pretendeu-se reforçar a captação das mulheres e contribuir para o aumento do índice de cobertura da área adscrita. Foi realizado um estudo transversal de setembro de 2010 a março de 2012. Todas as mulheres, na faixa etária de 20 a 59 anos, moradoras na área de abrangência, foram recrutadas nos seus domicílios pelos agentes comunitários de saúde. Através de questionário estruturado, aplicado por pesquisadores treinados, foram coletados dados de todas as 1.301 mulheres que compareceram ao posto de saúde após o recrutamento. Os resultados do estudo mostram uma cobertura pelo exame de Papanicolaou de 78%, a maioria realizado em serviços do SUS (76%). O estudo buscou identificar, das mulheres que nunca fizeram o preventivo do colo do útero (4,7%) e das que não estavam com o preventivo em dia (17%), quais foram às principais dificuldades para a sua não realização. Das 280 mulheres que responderam a pergunta, 36% referiram não achar necessário, 25% relataram dificuldades no serviço de saúde para marcar uma consulta, menos de 10% atribuiu ao medo, incômodo e vergonha. A falta de tempo das entrevistadas respondeu por 6,7% dos relatos, seguido pelo descuido, comodismo e desânimo com 4,2%. Neste trabalho os fatores associados a não realização do preventivo do câncer do colo do útero referidos em vários estudos não foram identificados, apontando para a equidade no acesso ao exame da citologia oncótica entre as mulheres desta área de abrangência. Tal fato pode ser atribuído à atuação desta UAPS que tem como modelo de assistência a saúde a Estratégia da Saúde Família (ESF) há cerca de 10 anos. / The cervical cancer is still a problem for the public health all over the world, mainly for the underdeveloped countries. However, it is a desease that has a long evolution period and can be detected and prevented with Papanicolaou test. Because of that, this kind of cancer, among all others, has the greatest chances of prevention and cure. This study aims at evaluating the coverage of Papanicolaou test and the factors linked to its realization, on women of the coverage area of a UAPS in Juiz de Fora. Other goal of this project was to reinforce the collection of women, contributing to increasing the coverage of that area. A transversal study was done from September 2010 to March 2012. All women, between 20 to 59 years old, residents of the chosen area, were recruited at their houses by the community health workers. Through a questionnaire, applied by trained researchers, we collected the data of 1301 women, who appeared at the UBS after recruited. Results show that there is a coverage of 78% by Papanicolaou test, mainly as a SUS service (76%). This study has sought to identify the mainly difficulties for the non-realization of Papanicolaou, among women that have never done the test (4,7%) and women that were not in time with the test (17%). From the 280 women who answered the questions, 36% thought that the test was not necessary, 25% said that they have had difficulties in the health service for making an appointment, less than 10% was afraid, uncomfortable or ashamed to make it, 6,7% have had no time, and carelessness, laziness and discouragement was the cause for 4,2%. In this work, the factors linked to the non-realization of the cervical cancer test, referred in many studies, were not identified, pointing out to an equity in the access to the test of oncotic cytology, among the studied area. This fact can be attributed to the performance of UAPS, that has had as health care model the Family Health Strategy for 10 years.

Introducción. La pandemia por coronavirus 2019 (COVID-19) se ha extendido en más de 100 países. La información específica sobre su comportamiento en el embarazo y parto sigue siendo limitada. Objetivo. Describir las características materno perinatales de pacientes gestantes con COVID-19 en un hospital terciario. Métodos. Estudio descriptivo. Se seleccionó todas las gestantes hospitalizadas por el servicio de emergencia de gineco-obstetricia entre el 24 de marzo y el 07 de mayo del 2020 y que tuvieron diagnóstico de infección por SARS-CoV-2, mediante la prueba rápida o la prueba RT-PCR. Se revisó la historia clínica y registros hospitalarios buscando variables sociodemográficas, antecedentes, manifestaciones clínicas, serología materna, complicaciones obstétricas, vía de parto y aspectos perinatales. Resultados. Se encontró 41 casos de pacientes con diagnóstico de SARS-CoV-2. Un 9,2% tuvo resultado de prueba rápida positiva, Los síntomas más comunes fueron tos en 84,6%, fiebre en 76,9% y dolor de garganta en 61,5%. Un 68.2% estuvo asintomática, 19,5% tuvo enfermedad leve y 7,3% moderada. Dos casos de neumonía severa requirieron ventilación no invasiva. No se registró muerte materna. 21,7% de los partos fue vía vaginal y 78,3% por cesárea. Hubo un caso de neonato por parto vaginal con PCR positivo al octavo día de vida. Conclusiones. Hubo un alto porcentaje de pacientes gestantes PCR positivas asintomáticas. Es necesario implementar el tamizaje universal en parturientas en el protocolo de flujo de gestantes en cada institución. / Introduction: The pandemic of coronavirus disease 2019 (COVID-19) has spread to more than 100 countries. Specific information about its behavior in pregnancy is still limited. Objective: To describe the maternal and perinatal characteristics of pregnant patients infected with COVID-19 and their newborns in a tertiary referral hospital. Methods: Descriptive study. Subjects were all pregnant patients admitted to the OB/ GYN Emergency Department of the Edgardo Rebagliati Martins National Hospital from March 24 to May 7, 2020, who were diagnosed with SARS-CoV-2 infection by rapid test or by RT-PCR test. Medical and hospital records were reviewed to retrieve sociodemographic data, patient’s history, clinical manifestations, maternal serology, obstetric complications, delivery mode and perinatal aspects. Results: 41 patients diagnosed with SARS-CoV-2 were identified. 9.2% of all admissions had a positive rapid test. The most common symptoms were cough in 84.6%, fever in 76.9% and sore throat in 61.5%. 68.2% of the patients were asymptomatic, 19.5% had mild illness and 7.3 %, moderate. 2 cases progressed to severe pneumonia requiring non-invasive ventilation. No maternal deaths were recorded. 21.7% were vaginal deliveries, while 78.3% were C-sections. One baby born in a vaginal delivery had a positive PCR result on day 8. Conclusions: A large percentage of asymptomatic pregnant patients had a positive PCR test. Implementing universal screening among patients in l flow protocol is necessary for all institutions.

Vid en vaginal förlossning är det vanligt förekommande att kvinnor drabbas av perinealbristningar. Perinealbristningar kan uppstå spontant vid en födsel men även på grund av yttre orsaker, som vid instrumentell förlossning. Perinealbristningar kan medföra komplikationer, och eftersom det är vanligt med perinealbristningar ville författarna förstå hur kvinnor upplever att bristningen och dess konsekvenser inverkar på deras dagliga liv. Därför var syftet att beskriva kvinnors upplevelser av sitt dagliga liv efter en perinealbristning i samband med vaginal förlossning. Metoden som valdes för att besvara syftet var en litteraturöversikt, som inkluderande 15 vetenskapliga artiklar. Analys av artiklarna utfördes enligt integrerad analys. I resultatet identifierades två kategorier samt tillhörande underkategorier. Kategorierna kom att kallas “En perinealbristnings påverkan på det dagliga livet och “Kontakt med vården efter en perinealbristning”. Resultatet visade att en perinealbristning i samband med vaginal förlossning medförde påverkningar i det dagliga livet. Kvinnor beskrev upplevelser av att leva med smärta och inkontinens, samt hur perinealbristningens besvär inverkade på deras självförtroende, sexuella funktion och tankar på framtida förlossning. I resultatet framkom även upplevelser angående brister från vården gällande information om bristningen, samt att kvinnor inte upplevde sig betrodda av vårdpersonal. Slutsatsen som kan påvisas genom denna litteraturöversikt är att kvinnor kan uppleva sig begränsade och känna en förlust av kontroll i sitt dagliga liv efter en perinealbristning. Barnmorskor har en viktig roll i arbetet för kvinnor efter att de drabbats av en perinealbristning. / During a vaginal delivery its common for women to suffer from a perineal tear. Perineal tear can occur spontaneously at birth but also due to external causes, such as instrumental delivery. Perineal tears can lead to complications, and since perineal tears are common, the authors wanted to understand how women experience the perineal tear and their consequences affecting their daily lives. Therefore, the aim of this study was to describe women's experiences of their daily lives after a perineal tear in connection with vaginal delivery. The method chosen to answer this aim was a literature review, which included 15 scientific articles. Analysis of the articles was performed according to integrated analysis. In the result, two categories and associated subcategories were identified. The categories came to be called "The impact of a perineal rupture on the daily life" and “Contact with care after a perineal rupture". The results showed that a perineal rupture in connection with vaginal delivery had an impact on daily life. Women described experiences of living with pain and incontinence, as well as how perineal rupture affected their self-confidence, sexual function and thoughts of future childbirth. The results also revealed experiences regarding lack of information from the care regarding information about the rupture, and that women did not feel trusted by care staff. The conclusion that can be demonstrated through this literature review is that women may feel limited and feel a loss of control in their daily lives after a perineal rupture. Midwives play an important role in the work of women after suffering from a perineal rupture.

Bakgrund: Bäckenbottenskador är vanligt förekommande vid vaginala förlossningar och kan orsaka många besvärande symtom. Den fysiska påfrestningen påverkar även kvinnors välmående och kan leda till psykisk ohälsa. Syfte: Syftet var att beskriva psykologiska konsekvenser av bäckenbottenskador i samband med förlossning för kvinnor. Metod: Syftet besvarades genom att göra en allmän litteraturstudie baserad på nio kvalitativa artiklar. Artiklarna kvalitetsgranskades och analyserades, därefter skapades en övergripande huvudkategori och tre underkategorier. Resultat: Huvudkategorin var Förlossningsskador medför psykiskt lidande, och dess underkategorier Känsla av skuld och skam, Förlust av kvinnlighet och sexualitet och Besvikelse över vårdens bristande information och stöd. I resultatet framkom att psykologiska konsekvenser såsom oro, skam, ångest, hopplöshet, depression och posttraumatiskt stressyndrom, är en följd av bäckenbottenskador och dess somatiska besvär. Vidare framkom att kvinnor inte fick den vård de var i behov av och upplevde att vården försummade dem och orsakade ytterligare psykisk påfrestning. Konklusion: Litteraturstudien bidrar till en ökad förståelse om hur bäckenbottenskador påverkar kvinnors psykiska välmående. Det behövs utveckling av riktlinjer vad gäller uppföljning och behandling av förlossningsskador. Vidare forskning krävs om hur bäckenbottenskador och sekundärt psykiskt trauma kan förebyggas, repareras, behandlas och rehabiliteras. / Background: Pelvic floor injuries are common due to vaginal delivery and can cause many troublesome symptoms. The physical symptoms affect women’s well-being and can lead to psychological morbidity. Aim: The aim was to describe the psychological consequences of pelvic floor injuries in relation to childbirth for women. Method: The aim was answered by conducting a general literature study based on nine qualitative articles. The articles were quality-tested and analysed, then one overreaching head category were created and three under categories. Results: The head category was Birth injuries causes psychological suffering, and it’s under categories Feeling guilt and shame, Loss of femininity and sexuality and Disappointment with the lack of information and support in healthcare. Women experienced psychological consequences such as shame, anxiety, hopelessness, depression and post-traumatic stress syndrome, secondary to pelvic floor injuries. It was also found that women didn’t receive the care they needed and felt that healthcare professionals neglected them and caused further psychological distress. Conclusion: The general literature study contributes to an increased understanding of how pelvic floor injuries affect women’s mental well-being. There is a need for development of guidelines as to monitoring and treatment of birth injuries. Further research is needed on how pelvic floor injuries and secondary to it psychological trauma can be prevented, repaired, treated and rehabilitated.

Bakgrund: Rädsla och oro inför en operation och inför generell anestesi förekommer i högre grad hos kvinnor än hos män. Dessutom beskrivs ofta litotomipositionen som en otrygg upplevelse av kvinnor vid vaginala undersökningar. Vid vaginala operationer ligger kvinnor i denna position och det är rimligt att anta att det även i denna situation kan påverka trygghetsupplevelsen. Det finns många fördelar med att genomföra gynekologiska operationer vaginalt jämfört med abdominella eller laparoskopiska operationer och blir alltmer en vanligare operationsmetod. Det är av betydelse att kvinnor känner trygghet och välbefinnande inför operationen, inte minst för att de ska kunna återhämta sig optimalt postoperativt. Syfte: Syftet med denna studie var att beskriva kvinnors perioperativa upplevelser av trygghet vid vaginala operationer under generell anestesi. Metod: Kvinnor intervjuades genom semistrukturerade intervjuer som sedan analyserades med kvalitativ innehållsanalys. Resultat: Resultatet består av tre stycken kategorier: Att ha någon närvarande som ser en genom operationens alla delar; Att någon berättar vad som ska ske och att få tillräckligt med information; och Att få känna sig skyld och påklädd då man är i en utsatt situation. Slutsats: Kvinnor upplevde både trygghet och otrygghet perioperativt vid vaginala operationer under generell anestesi. Ögonkontakt och beröring samt att informera kvinnor vad som ska ske ökade trygghetskänslan. Att inte få tillräckligt med information både pre-, intra- och post-operativt uppfattades som otryggt. Gynställningen upplevdes som ett orosmoment och skapade otrygghet hos kvinnor där de påtalade vikten av att bli sövd innan positionering

Bakgrund: I Sverige år 2022 förlöstes färre än ett av tio barn som låg i sätesbjudning genom vaginal sätesförlossning. Om denna siffra slås ut på antalet barnmorskor i Sverige blir det tydligt att vaginala sätesförlossningar är något som är svårt att få praktisk erfarenhet av som barnmorska. Barnmorskan förväntas ha kompetens att kunna handlägga en vaginal sätesförlossning. Det råder nationell enighet i att vaginala sätesförlossningar bör handläggas av barnmorskor och obstetriker med god erfarenhet. Att uppnå god erfarenhet av vaginala sätesförlossningar kan ses som ett problem när majoriteten av sätesfödslarna sker med kejsarsnitt. Syfte: Att beskriva barnmorskors erfarenheter av att handlägga vaginala sätesförlossningar Metod: Datainsamlingen utfördes genom tio enskilda intervjuer. Som analysmetod valdes en kvalitativ innehållsanalys med en induktiv ansats. Resultat: Insamlade data genererade tre kategorier, Ryggsäcken barnmorskan bär på, Handläggning vid vaginal sätesförlossning och Faktorer som påverkar trygghet vid vaginal sätesförlossning med totalt åtta underkategorier. Barnmorskors syn och inställning till vaginala sätesförlossningar påverkas av tidigare erfarenheter. Barnmorskorna påtalar vikten av en lugn miljö vid en vaginal sätesförlossning samt diskuterar val av förlossningsposition. Teamet har en betydande roll för barnmorskornas känsla av trygghet och det uttrycks ett behov av utökad träning kring vaginala sätesförlossningar. Slutsats: Samtliga barnmorskor i studien uttrycker en vilja att bistå fler sätesförlossningar men att de ser ett behov av ytterligare träning och kompetensutveckling. Genom utökad träning och kompetensutveckling inom detta område kan teamet stärkas vilket på sikt skulle kunna öka barnmorskans trygghet vid handläggningen av vaginala sätesförlossningar. / Background: In Sweden in 2022, fewer than one in ten babies who were breech were delivered by vaginal breech birth. If this figure is divided between the number of midwives in Sweden it is difficult to gain practical experience with vaginal breech births as a midwife. The midwife is expected to have the competence to handle a vaginal breech birth. There is national consensus that vaginal breech births should be managed by midwives and obstetricians with good experience. Achieving that good experience with vaginal breech births can be a problem when most breech births are by caesarean section. Aim: To describe midwives' experiences of handling vaginal breech births Method: The data collection was carried out through ten individual interviews. A qualitative content analysis with an inductive approach was chosen as the analysis method. Results: Collected data generated three categories, The backpack the midwife carries, Handling of vaginal breech birth and Factors affecting safety during vaginal breech birth with a total eight subcategories. Midwives' views and attitudes towards vaginal breech births are influenced by previous experiences. The midwives point out the importance of a calm environment during a vaginal breech birth and discuss the choice of birth position. The team has a significant role in the midwives' sense of security and there is a need for increased training around vaginal breech births. Conclusion: All midwives in the study expressed a desire to assist more breech births, but they are aware of the need for continiuous training and skill development.  Through increased training and competence development in this area, the team can be strengthened, which in the long run could increase the midwife's safety when handling vaginal breech births.

Made available in DSpace on 2014-07-29T15:29:06Z (GMT). No. of bitstreams: 1 Eliceia marcia.pdf: 803085 bytes, checksum: 16c4eb53244b37150026be253bd8c31f (MD5) Previous issue date: 2010-11-17 / Childbirth may determine pelvic floor modifications that may cause dysfunctions such as urinary/fecal incontinence and pelvic organ prolapse. Furthermore, delivery may be associated with a decrease in pelvic floor muscle (PFM) strength. Objectives: to compare PFM strength in women who delivered vaginally or by cesarean section and nulliparae, investigate the factors associated with PFM strength and demonstrate a correlation between measurements of PFM strength obtained by vaginal digital examination and by perineometer. Methods: a cross-sectional study was conducted, including 31 women following vaginal delivery, 30 following cesarean section and 30 nulliparae. PFM strength was investigated by vaginal digital examination (modified Oxford grading system) and by perineometer. Multiple linear regression analysis with adjustment for covariables was used to compare the mean PFM strength and identify factors associated with PFM strength. The Kendall test was applied to investigate the correlation between vaginal digital examination and a perineometer. Results: the mean age of the participants who delivered vaginally, underwent cesarean section and those who were nulliparous was 32.3±5.8 years, 30.5±5.4 years and 27.2±5.9 years (p<0.01), respectively. The mean PFM strength of women undergoing vaginal delivery and cesarean section was 25.6±14.5cmH2O and 39.6±22.0cmH2O (p<0.01, adjusted for covariables), respectively. A correlation between measurements of PFM strength obtained by vaginal digital examination and perineometer device was observed (tau=0.82; p<0.01). Non-white race/ethnicity was negatively associated with PFM strength (coefficient: -10.2424; p=0.02). Conclusions: women with a history of vaginal delivery had a lower PFM strength than those delivering by cesarean section. Non-white race/ethnicity negatively affected PFM strength. Our data suggest that vaginal digital examination may be applied in clinical practice because of its expressive correlation with a perineometer. / O parto pode determinar modificações do assoalho pélvico, que podem ocasionar disfunções tais como incontinência urinária e fecal e prolapso de órgãos pélvicos. Além disso, o parto pode associar-se à diminuição da força muscular perineal (FMP). Objetivos: comparar a FMP em mulheres submetidas ao parto vaginal, à cesárea e nulíparas, investigar os fatores associados à FMP e verificar a correlação entre as medidas da FMP obtidas por meio do exame vaginal digital e pelo perineômetro. Métodos: conduziu-se estudo de corte transversal, incluindo 31 mulheres pós-parto vaginal, 30 pós-cesárea e 30 nulíparas. A FMP foi investigada por meio do exame vaginal digital (escala modificada de Oxford) e pelo perineômetro. Utilizou-se a análise de regressão linear múltipla com ajuste por covariáveis para comparar a média da FMP e identificar os fatores associados à FMP. Aplicou-se o teste de Kendall para investigar a correlação entre o exame vaginal digital e o perineômetro. Resultados: a média de idade das participantes submetidas ao parto vaginal, à cesárea e das nulíparas foi de 32,3±5,8anos, 30,5±5,4 anos e 27,2±5,9 anos (p<0,01), respectivamente. A média da FMP de mulheres submetidas ao parto vaginal e à cesárea foi de 25,6±14,5cmH2O e de 39,6±22,0cmH2O (p<0,01, ajustado por covariáveis), respectivamente. Verificou-se correlação entre as medidas da FMP obtidas por meio do exame vaginal digital e pelo perineômetro (tau=0,82; p<0,01). A raça/etnia não branca associou-se negativamente à FMP (coeficiente: -10,2424; p=0,02). Conclusões: mulheres com antecedente de parto vaginal apresentaram menor FMP quando comparada àquelas submetidas à cesárea. Raça/etnia não branca afetou negativamente a força muscular do assoalho pélvico. Nossos dados sugerem que o exame vaginal digital pode ser aplicado na prática clínica, uma vez que apresentou expressiva correlação com o perineômetro.

Introdução: A cesárea vem aumentando progressivamente no Brasil e no mundo. Dentre os fatores associados a esse evento, destaca-se a cesárea prévia. Embora a maioria dos partos realizados em mulheres com história de cesárea seja cirúrgico, autores tem demonstrado altos índices de partos vaginais após cesárea - PVAC com baixa incidência de complicações. Diante do alarmante crescimento das taxas de cesárea, o presente estudo objetiva identificar a proporção e o perfil das mães com história de repetição de cesárea - RC no Estado de São Paulo, em 2012. Métodos: Os dados provenientes do Sistema de Informações Sobre Nascidos Vivos foram vinculados aos do Cadastro Nacional de Estabelecimentos de Saúde. Os resultados a respeito das características das mães com história de RC foram analisados segundo características da gestação, do recém-nascido RN e segundo tipo do hospital do parto. Os dados foram descritos na forma de medidas de proporção (frequências), com diferenças entre variáveis de interesse verificadas pelos testes de proporção e de médias (nível de significância de 5 por cento ). Resultados: Foram estudados 273.329 nascidos vivos de mães com pelo menos um filho anterior. Destes, 43 por cento nasceram por RC e 7,4 por cento por PVAC. As mães que realizaram CR são mais velhas e mais escolarizadas e os RNs nascidos desse grupo apresentaram menor proporção de baixo peso ao nascer. O início do pré-natal no primeiro trimestre e a realização de 7 ou mais consultas de pré-natal foi mais frequente no grupo CR. Termo precoce foi a classificação mais frequente para idade gestacional dos que nasceram por CR. Em contrapartida, os RNs por parto vaginal apresentaram maiores proporções de termo tardio do que aqueles por repetição de cesárea. A RC foi mais frequente nos hospitais sem vínculo com o Sistema Único de Saúde - SUS (44,1 por cento ). Dentre esses, a maioria (54,3 por cento ) teve idade gestacional classificada como termo precoce. Somente o grupo SUS alcança uma melhor proporção de termo pleno (46,5 por cento ), contudo esse grupo tem a frequência mais elevada de termos tardios (10,9 por cento ). Conclusão: As altas taxas de cesárea de repetição, principalmente no setor privado, evidenciam a necessidade de melhoras no modelo de atenção ao parto no Estado de São Paulo. / Background: Cesarean section has been progressively increasing in Brazil and worldwide. Among the factors associated with this event stands out a prior cesarean delivery. Although most deliveries in women with a prior cesarean delivery is surgical, authors have demonstrated high levels of vaginal births after cesarean - VBAC with low incidence of complications. Given the alarming increase in cesarean rates, this study aims to identify the proportion and profile of mothers with repeat cesarean delivery - RCD in the State of São Paulo, in 2012. Methods: Data from Live Births Information Systems were linked to the National Health Establishments Registration. The results about the characteristics of mothers with RCD were analyzed according to characteristics of pregnancy, newborn and type of maternity hospital. Data were presented in the form of proportion measures (frequencies), with differences between variables of interest verified by the proportion and average tests (5 per cent significance level). Results: 273 329 live births of mothers with at least one previous child were studied. 43 per cent of these were born by RCD and 7.4 per cent by PVAC. Mothers who underwent RCD are older and more highly educated and newborn infants in this group had a lower incidence of low birth weight. The beginning of prenatal care in the first trimester and the realization of 7 or more prenatal visits was more frequent in the RCD group. Early term was the most frequent rating for gestational age born by RCD. In contrast, newborns by vaginal delivery had greater proportions of late term than those by repeat cesarean. The RCD was more common in hospitals not affiliated with the Unified Health System - UHS (44.1 per cent ). In these, the majority (54.3 per cent ) of newborn had gestational age of early term. Only the UHS group achieves a better proportion of full term (46.5 per cent ), however, this group has the highest frequency of late terms (10.9 per cent ). Conclusion: The high repeat cesarean rates, especially in the private sector, highlight the need for improvements in childbirth care model in São Paulo.

Made available in DSpace on 2016-03-22T17:27:11Z (GMT). No. of bitstreams: 1 Rodrigo Garcia.pdf: 889273 bytes, checksum: 3279ba766fcf2bab133a11dfa53e04a8 (MD5) Previous issue date: 2013-12-10 / PURPOSE: This descriptive study to determine factors influencing the perception of adolescents with perinatal care, type of delivery and choice of future procedures. METHODS: Cross-sectional study nested in a cohort study conducted in the city of Pelotas included 481 pregnant teenagers up to 19 years. Frequency analysis of the independent variables (age, skin color, social class, education, living with a partner and perform pre-natal) and perception of perinatal care (satisfaction with the type of delivery) were made eight variables were listed (birth to term, baby with syndrome or problem at birth, type of delivery, pain, satisfaction with health care professionals, control of the situation, or would recommend the procedure and required ICU) which were compared with the type of delivery. RESULTS: It was found that 49,1% (235) of the babies were delivered vaginally and 50,9% (244) by caesarean section. 77,3% (368) of the adolescents showed themselves satisfied with the quality of care provided by health professionals during childbirth, the greatest degree of dissatisfaction was those who underwent cesarean delivery (67,9%). The pain was experienced intensely by 43,7% (209) of adolescents, reported not having felt pain was higher among those who underwent cesarean delivery (71,2%). About how much control of the situation felt 35,3% (159) felt inserted in the process, with no significant difference between the different types of delivery. Recommend or repeat the same procedure experienced 45,9 % (213) of the adolescents, and of these 65,3% (139) underwent vaginal delivery and 34,7% (74) C-section. CONCLUSION: Although the percentage of pain sensation in pregnant adolescents who underwent vaginal delivery was higher than in those who underwent cesarean delivery, most of these proved to be satisfied with the quality of the care and recommend and/or do the same procedure on future / OBJETIVO: Estudo descritivo para determinar fatores capazes de influenciar a percepção de adolescentes com o atendimento perinatal, tipo de parto e a escolha de futuros procedimentos. MÉTODOS: estudo transversal aninhado em um estudo de coorte, realizado na cidade de Pelotas-RS, incluiu 481 gestantes adolescentes com até 19 anos. Foram feitas análises de frequência das variáveis independentes (idade, cor da pele, classe social, escolaridade, morar com companheiro e realizar pré-natal) e para percepção do atendimento perinatal (satisfação com o tipo de parto) foram elencadas oito variáveis (nascimento a termo, bebê com síndrome ou problema ao nascer, tipo de parto, dor, satisfação de cuidados com os profissionais de saúde, controle da situação, recomendaria ou faria o procedimento e precisou de UTI) as quais foram comparadas com o tipo de parto. RESULTADOS: foi constatado que 49,1% (235) dos partos foram realizados por via vaginal e 50,9% (244) por cesariana. 77,3% (368) das adolescentes se mostravam satisfeitas com a qualidade dos cuidados prestados pelos profissionais de saúde durante o parto, o maior grau de insatisfação foi daquelas que realizaram parto cesariano (67,9%). A dor foi vivenciada de forma intensa por 43,7% (209) das adolescentes, o relato de não ter sentido dor foi maior naquelas que realizaram parto cesariano (71,2%).Sobre o quanto sentiu controle da situação 35,3% (159) sentiram-se inseridas no processo, não havendo diferença significativa entre os diferentes tipos de parto.Recomendariam ou repetiriam o mesmo procedimento vivenciado 45,9% (213) das adolescentes, sendo que destas 65,3% (139) realizaram parto por via vaginal e 34,7% (74) cesariana.CONCLUSÃO: Embora o percentual de sensação de dor nas gestantes adolescentes que realizaram parto normal tenha sido maior do que naquelas que realizaram parto cesariano, a maioria destas se mostrou satisfeita com a qualidade dos cuidados dos profissionais e recomendaria e/ou faria o mesmo procedimento no futuro

Este estudo caracterizou e relacionou as leveduras do gênero Candida isoladas das mucosas oral e vaginal de mulheres com lesões causadas por HPV de alto risco para câncer do colo do útero. Foram examinadas 42 mulheres tratadas no ambulatório de Patologia do Trato Genital Inferior do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo sendo, 30 com lesões uterinas de alto grau (G1) com média de idade de 36,5 anos ± 11,1 e 12 com lesões uterinas de baixo grau (G2) com média de idade de 34,75 anos ± 15,5. Condições clínicas e dados laboratoriais sobre HPV foram coletados do prontuário médico das pacientes; os dados sócio-demográficos obtidos a partir de um questionário apropriado. Para o estudo de associação entre as variáveis foi utilizada a análise de razão de chance (Odds Ratio) a partir do programa STATA 13.1. Foram identificadas associação entre lesões uterinas de baixo grau com cultura positiva em mucosa oral (OR= 0,215) e com presença de doenças crônicas (OR = 0,167), sendo que pacientes com lesões uterinas de alto grau possuem maior prevalência para diabetes e os resultados indicaram 23% de prevalência de Candida spp. em mucosa oral e 27% em mucosa vaginal, em pacientes do G1,no G2 foi de 42% em mucosa oral e de 33% em mucosa vaginal. Entre as espécies encontradas em mucosa oral e vaginal das pacientes, Candida albicans foi a mais isolada com 88%, seguida de C. tropicalis (8%)e C. glabrata (4%). As cepas de C. albicans isoladas de ambas as mucosas apresentaram sensibilidade a todos os antifúngicos testados, ao contrário da cepa de C. tropicalis isolada no Grupo 2, em mucosa vaginal, que apresentou um perfil de resistência ao fluconazol. Assim, torna-se importante o acompanhamento e supervisão por meio de exames clínicos e laboratoriais das pacientes com HPV, reforçando a necessidade sobre cuidados, tratamento e prevenção de infecções relacionadas ao HPV e a Candida spp. / This study characterized and related yeasts of the genus Candida isolated from the oral and vaginal mucous membranes of women with lesions caused by high-risk HPV for cervical cancer. Forty-two women treated at the Lower Genital Tract Pathology Clinic of the University of São Paulo Medical School\'s Hospital of Clinics were examined, with 30 high-grade (G1) uterine lesions with a mean age of 36.5 years ± 11, 1 and 12 with low grade (G2) uterine lesions with a mean age of 34.75 years ± 15.5. Clinical conditions and laboratory data on HPV were collected from patients\' medical records; the socio-demographic data obtained from an appropriate questionnaire. For the study of association between the variables, Odds Ratio analysis was used from the STATA 13.1 program. An association between low grade uterine lesions with positive culture in oral mucosa (OR = 0.215) and presence of chronic diseases (OR = 0.167) was identified. Patients with high grade uterine lesions had a higher prevalence for diabetes and the results indicated 23% prevalence of Candida spp. In oral mucosa and 27% in vaginal mucosa, in G1 patients, in G2 it was 42% in oral mucosa and 33% in vaginal mucosa. Among the species found in oral and vaginal mucosa of patients, Candida albicans was the most isolated with 88%, followed by C. tropicalis (8%) and C. glabrata (4%). The strains of C. albicans isolated from both mucosa presented sensitivity to all tested antifungal agents, unlike the C. tropicalis strain isolated in Group 2, in vaginal mucosa, which presented a resistance profile to fluconazole. Thus, monitoring and supervision through clinical and laboratory testing of HPV patients is important, reinforcing the need for care, treatment and prevention of HPV-related infections and Candida spp.