Kelly Pereira Coca

Factors associated with nipple trauma in the maternity unit

OBJECTIVE To identify factors associated with nipple trauma in women breastfeeding exclusively in a maternity unit. METHODS This was a case-control study that recruited 146 recently-delivered mothers in rooming-in wards: 73 cases, defined as women with nipple trauma, and 73 controls, defined as women free from this pathology. Women breastfeeding exclusively were tested daily for a diagnosis of nipple injury, identified using a magnifying glass. Sociodemographic, obstetric and neonatal variables were studied. A logistic regression model was used for statistical analysis. RESULTS Cases and controls proved to be comparable in terms of their sociodemographic variables, although the women with nipple trauma were more likely not to be living with a partner. The following variables were found to be factors associated with nipple trauma: primiparity (OR 3.16; 95%CI 1.19-8.42), not living with a partner (OR 3.25; 95%CI 1.18-8.93), turgid and/or engorged breasts (OR 12.31; 95%CI 4.48-33.78), semi-protruding and/or malformed nipples (OR 4.69; 95%CI 1.50-14.62), and depigmentation of nipples (OR 13.98; 95%CI 4.43-44.06). CONCLUSION Primiparity, not living with a partner, turgid and/or engorged breasts, semi-protruding and/or malformed nipples, and depigmentated nipples are associated with nipple trauma.

A posição de amamentar determina o aparecimento do trauma mamilar

The aim of the study was to identify the breast feeding position and holding variables related to nipple trauma. This case-control study assessed the onset of nipple trauma among women hospitalized at a University Hospital in the city of São Paulo, in 2004 and 2005. Subjects were puerperae diagnosed with unilateral or bilateral nipple trauma. Data analysis was performed using chi-square, Students t, and odds ratio tests (CI = 95%) and correspondence analysis. Participants were 146 puerperal women and their newborns, being 73 cases and 73 controls. Statistically significant position and holding variables for causing lesions were the following: newborns with their necks bent/contorted, chin away from the breast and lip-related defect (turned inward). Trauma prevention at the beginning of breast feeding is crucial for continuing this practice. Following adequate positioning is decisive for establishing effective and prolonged breast feeding.The aim of the study was to identify the breast feeding position and holding variables related to nipple trauma. This case-control study assessed the onset of nipple trauma among women hospitalized at a University Hospital in the city of Sao Paulo, in 2004 and 2005. Subjects were puerperae diagnosed with unilateral or bilateral nipple trauma. Data analysis was performed using chi-square, Students t, and odds ratio tests (CI= 95%) and correspondence analysis. Participants were 146 puerperal women and their newborns, being 73 cases and 73 controls. Statistically significant position and holding variables for causing lesions were the following: newborns with their necks bent/contorted, chin away from the breast and lip-related defect (turned inward). Trauma prevention at the beginning of breast feeding is crucial for continuing this practice. Following adequate positioning is decisive for establishing effective and prolonged breast feeding.

Padrão de aleitamento materno no primeiro mês de vida em mulheres submetidas a cirurgia de redução de mamas e implantes

OBJETIVO: Descrever o padrao de aleitamento materno no primeiro mes de vida da crianca em mulheres que se submeteram a dois tipos de cirurgias mamarias - reducao e implante - e comparar com o padrao praticado por mulheres que nao se submeteram as cirurgias. METODOS: Coorte prospectiva controlada com 25 mulheres submetidas a cirurgia redutora, 24 a cirurgia de implante e 25 sem cirurgia de mama, que tiveram seus filhos no Hospital Israelita Albert Einstein, Sao Paulo (SP). Os dados foram coletados por meio de avaliacoes realizadas entre 48 e 72 horas, entre os quinto e setimo dias e 30 dias apos o parto. Para analise dos dados, usaram-se os testes qui-quadrado, exato de Fisher, curva de Kaplan-Meier e regressao de Cox. RESULTADOS: A probabilidade de uma crianca estar em aleitamento exclusivo no final do primeiro mes de vida foi de 29% em mulheres com cirurgia redutora e 54% nas com cirurgia de implante, e 80% nas mulheres sem cirurgia. A probabilidade do aleitamento misto estar presente neste mesmo periodo foi de 68% entre maes com cirurgia de reducao, 32% com cirurgia de implante e apenas 16% entre as mulheres sem cirurgia mamaria. O risco de uma crianca estar em aleitamento nao exclusivo foi cinco vezes maior entre maes do grupo submetido a reducao, quando comparado aquelas do grupo sem cirurgia (p = 0,002). Para o grupo de mulheres com implante, o risco de uma crianca estar em aleitamento nao exclusivo foi 2,6 vezes aquele observado entre criancas cujas maes fazem parte do grupo sem cirurgia (p = 0,075). CONCLUSAO: A cirurgia redutora de mama e de implante refletiu em menor taxa de aleitamento materno exclusivo no primeiro mes de vida da crianca.

An evaluation of the effect ov lanolin in healing nipple injuries

Objective: To evaluate the effect of anhydrous lanolin-based ointment in the process of healing nipple injuries. Methods: This is a descriptive experimental study was performed in two Maternity Hospitals in Sao Paulo. The random sample consisted of 50 puerperium women with nipple injuries, hospitalized in the period of June 2002 to July 2003. Participants were randomly assigned into control and experimental groups, by the means of a draw. Statistical analysis was performed using Qui-square, Student’s t test, and ANOVA (a at 5%).Results: The size of the injury in the control group reduced in 0.41 ± 0.11 cm (right breast) and 0.29 ± 0.06 cm (left breast) compared to the experimental group, from the first to the second evaluation (p < 0.001), showing to be statistically significant. Conclusion: The lanolin is effective in treating nipple injuries.OBJETIVO: Avaliar o efeito da pomada a base de lanolina anidrica na cicatrizacao de lesoes mamilares apresentadas por puerperas internadas em duas maternidades do Municipio de Sao Paulo. METODOS: Estudo experimental descritivo realizado em duas maternidades do Municipio de Sao Paulo. A amostra aleatoria foi constituida de 50 puerperas com trauma mamilar internadas no periodo de junho de 2002 a julho de 2003. A amostra foi composta por meio de sorteio aleatorio, distribuida entre os grupos controle e experimental. Utilizou-se testes Qui-quadrado, t de Student e ANOVA (a of 5%). RESULTADOS: Observou-se uma diferenca na diminuicao do tamanho da lesao mamilar de 0,41 ± 0,11 cm (mama direita) e 0,29 ± 0,06 cm (mama esquerda) nas puerperas do grupo experimental para o grupo controle, da primeira para a segunda avaliacao (p < 0,001), mostrando ser estatisticamente significativa. CONCLUSAO: A lanolina foi favoravel no tratamento das lesoes mamilares.

Does breast feeding position influence the onset of nipple trauma

The aim of the study was to identify the breast feeding position and holding variables related to nipple trauma. This case-control study assessed the onset of nipple trauma among women hospitalized at a University Hospital in the city of São Paulo, in 2004 and 2005. Subjects were puerperae diagnosed with unilateral or bilateral nipple trauma. Data analysis was performed using chi-square, Students t, and odds ratio tests (CI = 95%) and correspondence analysis. Participants were 146 puerperal women and their newborns, being 73 cases and 73 controls. Statistically significant position and holding variables for causing lesions were the following: newborns with their necks bent/contorted, chin away from the breast and lip-related defect (turned inward). Trauma prevention at the beginning of breast feeding is crucial for continuing this practice. Following adequate positioning is decisive for establishing effective and prolonged breast feeding.The aim of the study was to identify the breast feeding position and holding variables related to nipple trauma. This case-control study assessed the onset of nipple trauma among women hospitalized at a University Hospital in the city of Sao Paulo, in 2004 and 2005. Subjects were puerperae diagnosed with unilateral or bilateral nipple trauma. Data analysis was performed using chi-square, Students t, and odds ratio tests (CI= 95%) and correspondence analysis. Participants were 146 puerperal women and their newborns, being 73 cases and 73 controls. Statistically significant position and holding variables for causing lesions were the following: newborns with their necks bent/contorted, chin away from the breast and lip-related defect (turned inward). Trauma prevention at the beginning of breast feeding is crucial for continuing this practice. Following adequate positioning is decisive for establishing effective and prolonged breast feeding.

Injuries Resulted From Breastfeeding: A New Approach To A Known Problem

This study aimed at analyzing nipple trauma resulted from breastfeeding based on dermatological approach. Two integrative reviews of literature were conducted, the first related to definitions, classification and evaluation methods of nipple trauma and another about validation studies related to this theme. In the first part were included 20 studies and only one third defined nipple trauma, more than half did not defined the nipple’s injuries reported, and each author showed a particular way to assess the injuries, without consensus. In the second integrative review, no validation study or algorithm related to nipple trauma resulted from breastfeeding was found. This fact demonstrated that the nipple’s injuries mentioned in the first review did not go through validation studies, justifying the lack of consensus identified as far as definition, classification and assessment methods of nipple trauma.This study aimed at analyzing nipple trauma resulted from breastfeeding based on dermatological approach. Two integrative reviews of literature were conducted, the first related to definitions, classification and evaluation methods of nipple trauma and another about validation studies related to this theme. In the first part were included 20 studies and only one third defined nipple trauma, more than half did not defined the nipples injuries reported, and each author showed a particular way to assess the injuries, without consensus. In the second integrative review, no validation study or algorithm related to nipple trauma resulted from breastfeeding was found. This fact demonstrated that the nipples injuries mentioned in the first review did not go through validation studies, justifying the lack of consensus identified as far as definition, classification and assessment methods of nipple trauma.

Breastfeeding pattern in the first month of life in women submitted to breast reduction and augmentation.

OBJECTIVE To describe the breastfeeding pattern in the first month of life in women submitted to two types of surgery - breast reduction and augmentation - and to compare it with the pattern exhibited by women who had no surgery. METHODS Controlled prospective cohort with 25 women submitted to reduction surgery, 24 submitted to augmentation surgery and 25 with no breast surgery, who gave birth at Hospital Israelita Albert Einstein, São Paulo, Brazil. The data were obtained from assessments carried out 48 to 72 hours, between the 5th and 7th days, and 30 days after delivery. The following tests were used for data analysis: chi-square test, Fishers exact test, Kaplan-Meier curve and Cox regression. RESULTS The probability of an infant being on exclusive breastfeeding at the end of the first month of life was 29% in women with reduction surgery, 54% in those with augmentation surgery, and 80% in women who had no surgery. The probability of mixed breastfeeding being adopted during this same period amounted to 68% among women with reduction surgery, 32% in those with augmentation surgery, and only 16% among those without any breast surgery. The risk of an infant being on non-exclusive breastfeeding was five times greater in women submitted to reduction surgery when compared to those women with no surgery (p = 0.002). Among women with augmentation surgery, the risk of an infant being on non-exclusive breastfeeding was 2.6 times greater than that observed in infants whose mothers had no breast surgery (p = 0.075). CONCLUSION Breast reduction and augmentation surgeries led to lower rates of exclusive breastfeeding in the first month of life.

Avaliação do efeito da lanolina na cicatrização dos traumas mamilares

Objective: To evaluate the effect of anhydrous lanolin-based ointment in the process of healing nipple injuries. Methods: This is a descriptive experimental study was performed in two Maternity Hospitals in Sao Paulo. The random sample consisted of 50 puerperium women with nipple injuries, hospitalized in the period of June 2002 to July 2003. Participants were randomly assigned into control and experimental groups, by the means of a draw. Statistical analysis was performed using Qui-square, Student’s t test, and ANOVA (a at 5%).Results: The size of the injury in the control group reduced in 0.41 ± 0.11 cm (right breast) and 0.29 ± 0.06 cm (left breast) compared to the experimental group, from the first to the second evaluation (p < 0.001), showing to be statistically significant. Conclusion: The lanolin is effective in treating nipple injuries.OBJETIVO: Avaliar o efeito da pomada a base de lanolina anidrica na cicatrizacao de lesoes mamilares apresentadas por puerperas internadas em duas maternidades do Municipio de Sao Paulo. METODOS: Estudo experimental descritivo realizado em duas maternidades do Municipio de Sao Paulo. A amostra aleatoria foi constituida de 50 puerperas com trauma mamilar internadas no periodo de junho de 2002 a julho de 2003. A amostra foi composta por meio de sorteio aleatorio, distribuida entre os grupos controle e experimental. Utilizou-se testes Qui-quadrado, t de Student e ANOVA (a of 5%). RESULTADOS: Observou-se uma diferenca na diminuicao do tamanho da lesao mamilar de 0,41 ± 0,11 cm (mama direita) e 0,29 ± 0,06 cm (mama esquerda) nas puerperas do grupo experimental para o grupo controle, da primeira para a segunda avaliacao (p < 0,001), mostrando ser estatisticamente significativa. CONCLUSAO: A lanolina foi favoravel no tratamento das lesoes mamilares.

Disfunção sexual e fatores associados relatados no período pós-parto

Objective To estimate the prevalence and factors associated with sexual dysfunction in the postpartum period.Methods Cross-sectional study of 200 postpartum women in their resumption to sexual activity. Data were collected in a private place, through interviews and recorded in forms, containing information regarding sexual life of postpartum women.Results Among the women studied, it was found that 33.5%, 76.0% and 43.5% had sexual dysfunction before pregnancy, during and after delivery, respectively. The types of dysfunction most frequently identified were dyspareunia, vaginismus, dysfunction of desire, orgasmic and arousal. The significantly associated factors were Catholic or protestant religions, vaginal delivery with suture, dyspareunia during pregnancy, vaginismus before pregnancy and working hours over 8 hours/daily.Conclusion The prevalence of sexual dysfunction was high and associated factors were religion, working hours, previous history of dysfunction and type of delivery.

CONJUNTO DE MEDIDAS PARA O INCENTIVO DO ALEITAMENTO MATERNO EXCLUSIVO INTRA-HOSPITALAR: EVIDÊNCIAS DE REVISÕES SISTEMÁTICAS.

ABSTRACT Objective: To identify the main recommendations found in systematic reviews regarding exclusive breastfeeding protective factors. Data source: Integrative review based on the guiding question: What evidence is found in literature regarding the protective factors of exclusive breastfeeding during the intrahospital period? A search was conducted in the Cochrane Library, PubMed/MEDLINE and LILACS database using the keyword “Breast Feeding” and the word “Breastfeeding”. Systematic reviews published from 2007 to 2016 that answered the guiding question were included in the study, whereas systematic reviews that analyzed breastfeeding of preterm infants and breastfeeding of children with orofacial malformation were excluded. The sample included eight systematic reviews. Data synthesis: The recommendations related to the protective factors for exclusive in-hospital breastfeeding found in the systematic reviews were: early skin-to-skin contact, rooming-in care, intervention for treating painful nipples during breastfeeding, restriction of infant supplementation, baby-led breastfeeding and educational interventions and support for mothers during hospital stay. The proposed measures included the six practices presented as protective factors. Conclusions: The review enabled the identification of evidence to support the recommended measures from delivery room to hospital discharge, with the aim of encouraging breastfeeding and preventing intrahospital weaning,