Giselle Tomasso

A pilot randomized controlled trial of controlled cord traction to reduce postpartum blood loss

To evaluate whether controlled cord traction (CCT) for management of the third stage of labor reduced postpartum blood loss compared with a “hands‐off” management protocol.

Latin American Consensus on Gastroesophageal Reflux Disease: An Update on Therapy

Clinica de Gastroenterologia, Facultad de Medicina, Montevideo Ex-Presidente de AIGE Kansas University School of Medicine, USA Master University, Hamilton, Ontario, Canada Gastroenterology Departament, Sao Paulo University, Brazil Departamento de Gastroenterologia, Hospital Posadas, Buenos Aires, Argentina Departamento de Gastroenterologia, Hospital C.B. Udaondo, Buenos Aires, Argentina Grupo de Consenso ERGE para America Latina Departamento de Gastroenterologia, Hospital St. Joseph, Bogota, Colombia Available online 6 de agosto de 2009

Overall and abortion-related maternal mortality rates in Uruguay over the past 25 years and their association with policies and actions aimed at protecting women’s rights

To evaluate changes in maternal mortality rates in Uruguay over the past 25 years, as well as their distribution by cause, and their temporal relationship with social changes and Human Development Index (HDI) indicators.

Prevalencia de la enfermedad por reflujo gastroesofágico en Uruguay

BACKGROUND Gastroesophageal reflux disease (GERD) is a common condition, with wide geographical differences worldwide. There are no epidemiological data on this disease for Uruguay. OBJECTIVE To estimate the prevalence of GERD in two adult populations in Uruguay (urban and hospital) through the Gastroesophageal reflux disease Questionnaire (GerdQ) questionnaire and evaluation of typical symptoms. MATERIAL AND METHOD A descriptive, cross-sectional study was carried out through the use of two diagnostic methods administered in two settings: an urban and a hospital setting. The first method consisted of administration of the standardized GerdQ structured questionnaire and the other consisted of evaluating the typical symptoms of GERD. A total of 1141 persons from the urban population, with a mean age of 52 years (± 18 years), and 163 persons from a gastroenterology polyclinic, with a mean age of 53 years (± 16 years), were included. RESULTS The prevalence of GERD in Uruguay was 4.69%, (95% CI 2.92-6.46%) when the GerdQ questionnaire was used, but increased to 14.14% (95% CI 12.57-15.71) when only typical symptoms were considered. In the hospital sample, the prevalence was 11.66% (95% CI 6.42-16.89%) and 20.25% (95% CI 14.01-26.48), respectively. CONCLUSION The prevalence obtained in the urban population of Uruguay with the GerdQ questionnaire in the symptomatic (hospital) population was more than double that in the general population, 11.66% and 4.69%, respectively. Evaluation of symptoms, pyrosis and/or regurgitation systematically yields a higher prevalence. Consensus on the definition of GERD and on the instrument used for its diagnosis are essential to interpret and compare epidemiological studies.

Supply kits for antenatal and childbirth care during antenatal care and delivery: a mixed-methods systematic review, the qualitative approach.

Antenatal care reduces maternal and perinatal mortality and morbidity through the detection and treatment of some conditions, but its coverage is less than optimal within certain populations. Supply kits for maternal health were designed to overcome barriers present when providing care during pregnancy and childbirth particularly to women from underserved population.We conducted a mixed-methods systematic review on the use of supply kits. This manuscript presents the findings from qualitative studies that reported barriers, facilitators, and user’s recommendation in the adoption and implementation of any type of kit designed to be used during pregnancy or childbirth.This review included eight studies, and seven were implemented in developing countries. Most studies assessed the implementation of clean delivery kits to be used during labour and delivery, and contributed to gain insights into factors that may hinder or foster the use of kits.Clean delivery kits were conceived to cope with barriers related mainly to access. The most important barrier identified were those related to the socio-cultural and the lack of knowledge dimension such as who held the decision-making authority in the household, as well as popular beliefs behind the idea that birth preparation could bring bad luck, may prevent clients from adhering to their use. In addition, financial constraints and limited understanding of the instructions of use were accessibility barriers found. On the other hand, once used, clean delivery kits for maternal health were accepted by women and health workers. Convenience, hygienic components, and avoidance of delays in receiving care were viewed as satisfactory features.Supply kits are mostly affordable and easily deployable. Increasing awareness among the population about the offered kits and providing information on their benefits emerges as a critical step to foster use in settings where kits are available. Implementation of this strategy requires low complexity resources and could make the use of kits an accepted alternative to increase the use of evidence-based interventions and thus improve quality of care during pregnancy, childbirth and neonatal period mainly at the community level in low income countries and remote areas with low access.

A multifaceted intervention to increase prophylactic oxytocin use during the third stage of labor and to reduce routine episiotomies in Nicaragua

To assess the effect of a multifaceted intervention among skilled birth attendants on the use of oxytocin during the third stage of labor, the active management of the third stage of labor (AMTSL), and the rate of routine episiotomy during vaginal births in two health districts in Nicaragua.

Supply kits for antenatal and childbirth care: a systematic review

IntroductionIt is critical to increase the uptake of interventions proven to be effective to improve maternal and perinatal outcomes. Supply kits have been suggested to be a feasible strategy designed to ensure timely availability and effective follow-up of care.ObjectiveWe conducted a systematic review to summarize the evidence on the uptake, effectiveness and safety of supply kits for maternal care.Search strategyMEDLINE, the Cochrane Pregnancy and Childbirth Group’s Trials Register, Campbell Collaboration, Lilacs, Embase and unpublished studies were searched.Selection criteriaStudies that reported the efficacy, safety and use of supply kits for maternal healthcare were eligible. Participants were pregnant women or in childbirth. Supply kits were defined as a collection of medicines, supplies or instruments packaged together with the aim of conducting a healthcare task.Data collection and analysisTwo reviewers independently performed the screening, data extraction, and methodological and quality assessment.Main results24 studies were included: 4 of them were systematic reviews and 20 primary studies. Eighteen studies evaluated a so-called “clean delivery kit”. In all but two studies, the kits were used by more than half of the participants. A meta-analysis was deemed inappropriate due to the heterogeneity in study design, in the components of the interventions implemented, in the content of the kits, and in outcomes. Nine studies assessed neonatal outcomes and found statistically significant reductions in cord infection, sepsis and tetanus-related mortality in the intervention group. Three studies showed evidence of reduced neonatal mortality (OR 0.52, 0.60 and 0.71) with statistically significant confidence intervals in all cases. Four studies reported odd ratios for maternal mortality, but only one showed evidence of a statistically significant decrease in this outcome but it was ascribed to hand washing prior to childbirth and not with the use of kits.ConclusionThis review suggests potential benefits in the use of supply kits to improve maternal and neonatal health. However, the observational nature of the studies, the heterogeneity and the use of kits incorporated within complex interventions limit the interpretation of the findings.

Overview of fetal monitoring

Maternal viral infections can be transmitted and potentially affect the fetus during pregnancy and it is therefore important to try to prevent and identify the occurrence of these infections in pregnancy. In many cases maternal infections during pregnancy occur without specific symptoms or can even be asymptomatic. The clinical diagnosis is therefore rarely helpful. Viral infections stimulate production of specific antibodies but not always provide immunity and reinfection with consequent fetal transmission can occur. The risk of fetal compromise is, however, lower in recurrent infections. Ideally immune status should be assessed before conception to be able to identify seroconversion in pregnancy. In practice in most cases serology tests are performed after conception. Identification of mother susceptible of infections in early pregnancy allow adequate counseling for risk factors. Early identification of maternal infection allow to institute invasive or non invasive procedures of prenatal diagnosis. In order to effectively assess fetal risk and institute appropriate management strategies, accurate knowledge of epidemiology, risk factors, natural history, rate of sequelae, methods and limitations of prenatal diagnosis and preventive and therapeutic measures need to be well known. Preventive and diagnostic program need to be balanced against cost/benefit to society considering economic but also psychological and emotional factors. It is clearly impossible to screen all fertile women, either prenatally or during gestation, for all potential infective disease that can be transmitted to the fetus. The European Association of Perinatal Medicine has issued recommendations for maternal screening for infective diseases that can be transmitted to the fetus, that are summarized as follow. To be clinically sound and cost-effective the screening should only be instituted when the following criteria are met: *Maternal disease should clearly be associated with embryonic and fetal damage when contracted during pregnancy, alternatively the pathogen must be able to induce persistent postnatal problems. *The offending micro-organism should also be frequently encountered in the patient’s environment and the possibility of contracting the infection should be high enough to justify testing. *Sensitive and specific diagnostic techniques should be available for confirmation of maternal infection in order to identify fetuses at risk of congenital infection:Prenatal diagnostic techniques should be either available or under investigation and there should also be a possibility of treating fetal infection or of protecting the infant from the consequences of his exposure to the offending agent.