Maria Clara Estanislau do Amaral

Caracterização das cesarianas em centro de parto normal

OBJECTIVE To estimate the prevalence of cesarean sections in a birth center of a hospital and identify factors associated. METHODS Cross-sectional study including medical records of 2,441 births assisted in a birth center in the city of São Paulo, southeastern Brazil, between March and April 2005. The dependent variable (type of delivery) included vaginal delivery and cesarean section. The independent variables were grouped into four categories: demographic characteristics; current and past obstetric history; intrapartum care; and perinatal outcomes. Prevalence ratios and 95% confidence intervals (95% CI) were estimated to assess the association between type of delivery and maternal and newborn variables. RESULTS Of all deliveries, 14.9% were cesarean sections. Cesarean section in the current pregnancy was associated with past cesarean sections (PR = 3.19, 95%CI: 2.64,3.84); gestational age > 40 weeks (PR = 1.32, 95%CI: 1.09;1.61); cervical dilation of up to 4 cm on admission (PR = 3.22, 95%CI: 2.31;4.50); and meconium-stained amniotic fluid (PR = 2.5, 95%CI: 2.05;3.06). Regarding newborn characteristics cesarean section was associated with birth weight >4 kg (PR = 1.86, 95%CI: 1.29;2.66). Among women with history of past cesarean sections, having had also a prior vaginal delivery was a protective factor for cesarean section in the current pregnancy (PR = 0.46, 95%CI: 0.30;0.71). Factors related to fetal conditions including fetal stress, meconium-stained amniotic fluid, breech presentation and macrosomia accounted for 47.8% (175) while those related to the mechanism of birth including arrest disorders, functional dystocia and malposition accounted for 31,3% (115) of all indications for a cesarian section [corrected]. CONCLUSIONS Prevalence of c-section was consistent with World Health Organization recommendations. Increased risk of c-section was associated with prior history of c-sections, cervical dilation of at least 4 cm upon admission, gestational age > 40 weeks, meconium-stained amniotic fluid, and birthweight > 4 kg.OBJETIVO: Estimar a prevalencia de cesarianas em um centro de parto normal intra-hospitalar e identificar fatores associados. METODOS: Estudo transversal com analise de prontuarios de 2.441 partos assistidos em marco e abril de 2005 em um centro de parto normal intra-hospitalar de Sao Paulo, SP. A variavel dependente (tipo de parto) foi classificada como parto normal e operacao cesariana. As variaveis independentes foram categorizadas em quatro grupos: demograficas; historia obstetrica pregressa e atual; assistencia intraparto; e resultados perinatais. A razao de prevalencia e o intervalo de 95% de confianca (IC95%) foram calculados para identificar associacao entre tipo de parto e variaveis maternas e do recem-nascido. RESULTADOS: Do total de partos, 14,9% foram operacoes cesarianas. Ter sido submetida a cesariana na gestacao atual esteve associado a cesariana em gestacao anterior (RP = 3,19; IC95%: 2,64;3,84), idade gestacional > 40 semanas (RP = 1,32; IC95%: 1,09;1,61), ser admitida com cervicodilatacao ate 4 cm (RP = 3,22; IC95%: 2,31;4,50), liquido amniotico meconial (RP = 2,5; IC95%: 2,05;3,06). Quanto ao recem-nascido, a cesariana associou-se a peso > 4kg (RP = 1,86; IC95%: 1,29;2,66). Entre as mulheres com cesariana em gestacao anterior, ter tambem parto normal previo foi fator de protecao para cesariana na gestacao atual (RP = 0,46; IC95% 0,30;0,71). Fatores relacionados a condicao fetal, como estresse fetal, liquido amniotico meconial, apresentacao pelvica e macrossomia corresponderam a 47,8% (175) das indicacoes para a realizacao da cesariana; condicoes ligadas ao mecanismo do parto, como parada de progressao, distocia funcional e distocia de rotacao totalizaram 31,3% (115) das indicacoes. CONCLUSOES: A prevalencia de cesariana mostrou-se dentro dos limites propostos pela Organizacao Mundial da Saude. Mulheres com cesariana em gestacao anterior, admitidas com ate 4 cm de dilatacao, idade gestacional > 40 semanas, com liquido amniotico meconial e recem-nascido > 4 kg tiveram maior risco para cesariana.

Programa educativo em medidas de precaução universais: uma metodologia de abordagem

No Centro de Atencao Integral a Saude da Mulher (CAISM) desenvolveu-se um programa de reciclagem sobre as Medidas de Precaucao Universais (MPU) e divulgou-se, atraves de uma cartilha, essas medidas e os procedimentos em caso de acidente de trabalho. Primeiramente, o funcionario era sensibilizado para a questao do estresse e sua influencia sobre a qualidade de vida e, apos, era realizada a reciclagem promovendo-se a reflexao sobre as consequencias da nao adocao das MPU. Foram respondidos e analisados 286 pre-testes e 242 pos-testes com um indice de acertos significativamente maior nestes ultimos (p<0,01), principalmente quanto ao uso adequado de luvas.An updating program on measures of universal precautions (M.U.P.) was developed at the Center of Whole Care of Womans Health (Centro de Atencao Integral a Saude da Mulher - CAISM). These measures and the procedures in the case of work accident were published in a booklet. First, servants should be aware of the matter of stress and its influence on the quality of life. Then, updating was carried through encouraging the reflection on the consequences of the non-adoption of M.U.P. The answers to 286 pre-tests and 242 post-tests were analyzed and the results showed a significantly higher index of correct answers (p< 0,01), mainly regarding the appropriate use of glove.El Centro de Atencion Integral a la Salud de la Mujer (CAISM) desarrollo un programa de reciclaje sobre Medidas de Precaucion Universales (MPU). Se divulgo por medio de un material educativo (cartilla) las MPU y procedimientos en caso de accidentes de trabajo. En primer lugar se cuestiono al funcionario sobre el stress y su influencia en la calidad de vida, llevando se a cabo el reciclaje en el cual se promovio la reflexion sobre consecuencias cuando las MPU no son adoptadas. Fueron respondidas y analizadas 286 pre-test y 242 pos-test con un indice de acierto significativamente mayor en este ultimo (p < 0,01), principalmente con relacion al uso adecuado de los guantes.An updating program on measures of universal precautions (M.U.P.) was developed at the Center of Whole Care of Womans Health (Centro de Atenção Integral à Saúde da Mulher-CAISM). These measures and the procedures in the case of work accident were published in a booklet. First, servants should be aware of the matter of stress and its influence on the quality of life. Then, updating was carried through encouraging the reflection on the consequences of the non-adoption of M.U.P. The answers to 286 pre-tests and 242 post-tests were analyzed and the results showed a significantly higher index of correct answers (p < 0.01), mainly regarding the appropriate use of glove.

Fatores maternos e neonatais associados ao mecônio no líquido amniótico em um centro de parto normal

OBJECTIVE To identify the frequency and maternal and neonatal factors associated with meconium-stained amniotic fluid at birth. METHODS Cross-sectional study carried out with 2,441 births at an in-hospital birth center in the city of São Paulo (Southeastern Brazil) in March and April, 2005. The association between meconium-stained amniotic fluid and the independent variables (maternal age, parity, previous c-section or not, gestational age, obstetric history, oxytocin use in the labor, cervical dilation at admission, mode of current delivery, newborn weight, Apgar score at the 1st and 5th minute) was expressed as prevalence ratio (PR). RESULTS Meconium-stained amniotic fluid was verified in 11.9% of the births; 68.2% of these were normal births and 38.8% c-sections. Meconium was associated with: primiparity (PR=1.49, 95%CI 1.29; 1.73), gestational age ≥ 41 weeks (PR = 5.05, 95%CI 1.93;13.25), oxytocin in labor (PR = 1.83, 95%CI 1.60; 2.10), c- section (PR = 2.65, 95%CI 2.17; 3.24) and Apgar scores < 7 at the 5th minute (PR = 2.96, 95%CI 2,94;2,99). Neonatal mortality was 1.6/1,000 live births. Meconium-stained amniotic fluid was found in 50% of neonatal deaths and it was associated with higher rates of surgical deliveries. CONCLUSIONS Oxytocin use, worse conditions of the newborn after the delivery and increased c-section rates were factors associated with meconium-stained amniotic fluid. Routine use of oxytocin in the intrapartum period could be evaluated due to its association with meconium-stained amniotic fluid.OBJETIVO: Analizar la frecuencia y los factores maternos y neonatales asociados al meconio en el liquido amniotico en el parto. METODOS: Estudio transversal con 2.441 nacimientos en un centro de parto normal hospitalario en Sao Paulo, SP, en marzo y abril de 2005. La asociacion entre meconio en el liquido amniotico y las variables independientes (edad materna, paridad, tener o no cesarea previa, edad de gestacion, antecedentes obstetricos, uso de ocitocina en el trabajo de parto, dilatacion cervical en la admision, tipo de parto actual, peso del RN, indice de Apgar de 1o y 5o minutos de vida) fue expresada como el cociente de prevalencia. RESULTADOS: Se verifico meconio en el liquido amniotico en 11,9% de los partos; 68,2% de estos fueron normales y 38,8%, con cesarea. El meconio estuvo asociado a: primiparidad (RP = 1,49; IC95% 1,29;1,73), edad de gestacion ≥ 41 semanas (RP = 5,05; IC95% 1,93;13,25), ocitocina en el parto (RP = 1,83, IC95% 1,60;2,10), cesarea (RP = 2,65; IC95% 2,17;3,24) e indice de Apgar < 7 no 5o minuto (RP = 2,96, IC95% 2,94;2,99). La mortalidad neonatal fue 1.6/1.000 nacidos vivos; meconio en el liquido amniotico fue encontrado en 50% de las muertes neonatales y asociado a mayores tasas de partos quirurgicos. CONCLUSIONES: Empleo de ocitocina, peores condiciones del recien-nacido posterior al parto y aumento de tasas de cesarea fueron factores asociados al meconio. La utilizacion rutinaria de ocitocina en el intraparto podria ser revisada por su asociacion con meconio en el liquido amniotico.

Cesarean sections in a birth center

OBJECTIVE To estimate the prevalence of cesarean sections in a birth center of a hospital and identify factors associated. METHODS Cross-sectional study including medical records of 2,441 births assisted in a birth center in the city of São Paulo, southeastern Brazil, between March and April 2005. The dependent variable (type of delivery) included vaginal delivery and cesarean section. The independent variables were grouped into four categories: demographic characteristics; current and past obstetric history; intrapartum care; and perinatal outcomes. Prevalence ratios and 95% confidence intervals (95% CI) were estimated to assess the association between type of delivery and maternal and newborn variables. RESULTS Of all deliveries, 14.9% were cesarean sections. Cesarean section in the current pregnancy was associated with past cesarean sections (PR = 3.19, 95%CI: 2.64,3.84); gestational age > 40 weeks (PR = 1.32, 95%CI: 1.09;1.61); cervical dilation of up to 4 cm on admission (PR = 3.22, 95%CI: 2.31;4.50); and meconium-stained amniotic fluid (PR = 2.5, 95%CI: 2.05;3.06). Regarding newborn characteristics cesarean section was associated with birth weight >4 kg (PR = 1.86, 95%CI: 1.29;2.66). Among women with history of past cesarean sections, having had also a prior vaginal delivery was a protective factor for cesarean section in the current pregnancy (PR = 0.46, 95%CI: 0.30;0.71). Factors related to fetal conditions including fetal stress, meconium-stained amniotic fluid, breech presentation and macrosomia accounted for 47.8% (175) while those related to the mechanism of birth including arrest disorders, functional dystocia and malposition accounted for 31,3% (115) of all indications for a cesarian section [corrected]. CONCLUSIONS Prevalence of c-section was consistent with World Health Organization recommendations. Increased risk of c-section was associated with prior history of c-sections, cervical dilation of at least 4 cm upon admission, gestational age > 40 weeks, meconium-stained amniotic fluid, and birthweight > 4 kg.OBJETIVO: Estimar a prevalencia de cesarianas em um centro de parto normal intra-hospitalar e identificar fatores associados. METODOS: Estudo transversal com analise de prontuarios de 2.441 partos assistidos em marco e abril de 2005 em um centro de parto normal intra-hospitalar de Sao Paulo, SP. A variavel dependente (tipo de parto) foi classificada como parto normal e operacao cesariana. As variaveis independentes foram categorizadas em quatro grupos: demograficas; historia obstetrica pregressa e atual; assistencia intraparto; e resultados perinatais. A razao de prevalencia e o intervalo de 95% de confianca (IC95%) foram calculados para identificar associacao entre tipo de parto e variaveis maternas e do recem-nascido. RESULTADOS: Do total de partos, 14,9% foram operacoes cesarianas. Ter sido submetida a cesariana na gestacao atual esteve associado a cesariana em gestacao anterior (RP = 3,19; IC95%: 2,64;3,84), idade gestacional > 40 semanas (RP = 1,32; IC95%: 1,09;1,61), ser admitida com cervicodilatacao ate 4 cm (RP = 3,22; IC95%: 2,31;4,50), liquido amniotico meconial (RP = 2,5; IC95%: 2,05;3,06). Quanto ao recem-nascido, a cesariana associou-se a peso > 4kg (RP = 1,86; IC95%: 1,29;2,66). Entre as mulheres com cesariana em gestacao anterior, ter tambem parto normal previo foi fator de protecao para cesariana na gestacao atual (RP = 0,46; IC95% 0,30;0,71). Fatores relacionados a condicao fetal, como estresse fetal, liquido amniotico meconial, apresentacao pelvica e macrossomia corresponderam a 47,8% (175) das indicacoes para a realizacao da cesariana; condicoes ligadas ao mecanismo do parto, como parada de progressao, distocia funcional e distocia de rotacao totalizaram 31,3% (115) das indicacoes. CONCLUSOES: A prevalencia de cesariana mostrou-se dentro dos limites propostos pela Organizacao Mundial da Saude. Mulheres com cesariana em gestacao anterior, admitidas com ate 4 cm de dilatacao, idade gestacional > 40 semanas, com liquido amniotico meconial e recem-nascido > 4 kg tiveram maior risco para cesariana.

Meconium-stained amniotic fluid and maternal and neonatal factors associated

OBJECTIVE To identify the frequency and maternal and neonatal factors associated with meconium-stained amniotic fluid at birth. METHODS Cross-sectional study carried out with 2,441 births at an in-hospital birth center in the city of São Paulo (Southeastern Brazil) in March and April, 2005. The association between meconium-stained amniotic fluid and the independent variables (maternal age, parity, previous c-section or not, gestational age, obstetric history, oxytocin use in the labor, cervical dilation at admission, mode of current delivery, newborn weight, Apgar score at the 1st and 5th minute) was expressed as prevalence ratio (PR). RESULTS Meconium-stained amniotic fluid was verified in 11.9% of the births; 68.2% of these were normal births and 38.8% c-sections. Meconium was associated with: primiparity (PR=1.49, 95%CI 1.29; 1.73), gestational age ≥ 41 weeks (PR = 5.05, 95%CI 1.93;13.25), oxytocin in labor (PR = 1.83, 95%CI 1.60; 2.10), c- section (PR = 2.65, 95%CI 2.17; 3.24) and Apgar scores < 7 at the 5th minute (PR = 2.96, 95%CI 2,94;2,99). Neonatal mortality was 1.6/1,000 live births. Meconium-stained amniotic fluid was found in 50% of neonatal deaths and it was associated with higher rates of surgical deliveries. CONCLUSIONS Oxytocin use, worse conditions of the newborn after the delivery and increased c-section rates were factors associated with meconium-stained amniotic fluid. Routine use of oxytocin in the intrapartum period could be evaluated due to its association with meconium-stained amniotic fluid.OBJETIVO: Analizar la frecuencia y los factores maternos y neonatales asociados al meconio en el liquido amniotico en el parto. METODOS: Estudio transversal con 2.441 nacimientos en un centro de parto normal hospitalario en Sao Paulo, SP, en marzo y abril de 2005. La asociacion entre meconio en el liquido amniotico y las variables independientes (edad materna, paridad, tener o no cesarea previa, edad de gestacion, antecedentes obstetricos, uso de ocitocina en el trabajo de parto, dilatacion cervical en la admision, tipo de parto actual, peso del RN, indice de Apgar de 1o y 5o minutos de vida) fue expresada como el cociente de prevalencia. RESULTADOS: Se verifico meconio en el liquido amniotico en 11,9% de los partos; 68,2% de estos fueron normales y 38,8%, con cesarea. El meconio estuvo asociado a: primiparidad (RP = 1,49; IC95% 1,29;1,73), edad de gestacion ≥ 41 semanas (RP = 5,05; IC95% 1,93;13,25), ocitocina en el parto (RP = 1,83, IC95% 1,60;2,10), cesarea (RP = 2,65; IC95% 2,17;3,24) e indice de Apgar < 7 no 5o minuto (RP = 2,96, IC95% 2,94;2,99). La mortalidad neonatal fue 1.6/1.000 nacidos vivos; meconio en el liquido amniotico fue encontrado en 50% de las muertes neonatales y asociado a mayores tasas de partos quirurgicos. CONCLUSIONES: Empleo de ocitocina, peores condiciones del recien-nacido posterior al parto y aumento de tasas de cesarea fueron factores asociados al meconio. La utilizacion rutinaria de ocitocina en el intraparto podria ser revisada por su asociacion con meconio en el liquido amniotico.

Saúde, dor e atividades de vida diária entre idosos praticantes de Lian Gong e sedentários

It is a well-known fact that the practice of physical activity on a regular basis among elderly people contributes to the prevention and reduction of pain, as well as promote active ageing. Based on this premise, the scope of this study was to evaluate the presence of chronic pain among elderly people attended in a primary health care unit in a city in the interior of Sao Paulo State, Brazil, by comparing those who practice Chinese gymnastics (Lian Gong) and the sedentary. Sixty elderly people were divided between 30 sedentary and 30 who participate in a group practicing Lian Gong. The presence of pain was assessed through the Nordic Questionnaire on Musculoskeletal Symptoms, already adapted and validated for Brazilian culture. When questioned about pain in the last seven days, the Lian Gong group showed a higher presence (62,3%) of pain when compared to the sedentary group, although they had fewer difficulties in performing daily activities (55,5%). Among the active elderly the presence of lower back pain was statistically inferior (p < 0.05) when comparing the groups. The practice of Lian Gong was associated to a more positive perception of ones health, less use of medicines, as well as the adopting of self-care practices and the feeling of fewer impairments in performing daily activities.

Factores maternos y neonatales asociados al meconio en el líquido amniótico en un centro de parto normal

OBJECTIVE To identify the frequency and maternal and neonatal factors associated with meconium-stained amniotic fluid at birth. METHODS Cross-sectional study carried out with 2,441 births at an in-hospital birth center in the city of São Paulo (Southeastern Brazil) in March and April, 2005. The association between meconium-stained amniotic fluid and the independent variables (maternal age, parity, previous c-section or not, gestational age, obstetric history, oxytocin use in the labor, cervical dilation at admission, mode of current delivery, newborn weight, Apgar score at the 1st and 5th minute) was expressed as prevalence ratio (PR). RESULTS Meconium-stained amniotic fluid was verified in 11.9% of the births; 68.2% of these were normal births and 38.8% c-sections. Meconium was associated with: primiparity (PR=1.49, 95%CI 1.29; 1.73), gestational age ≥ 41 weeks (PR = 5.05, 95%CI 1.93;13.25), oxytocin in labor (PR = 1.83, 95%CI 1.60; 2.10), c- section (PR = 2.65, 95%CI 2.17; 3.24) and Apgar scores < 7 at the 5th minute (PR = 2.96, 95%CI 2,94;2,99). Neonatal mortality was 1.6/1,000 live births. Meconium-stained amniotic fluid was found in 50% of neonatal deaths and it was associated with higher rates of surgical deliveries. CONCLUSIONS Oxytocin use, worse conditions of the newborn after the delivery and increased c-section rates were factors associated with meconium-stained amniotic fluid. Routine use of oxytocin in the intrapartum period could be evaluated due to its association with meconium-stained amniotic fluid.OBJETIVO: Analizar la frecuencia y los factores maternos y neonatales asociados al meconio en el liquido amniotico en el parto. METODOS: Estudio transversal con 2.441 nacimientos en un centro de parto normal hospitalario en Sao Paulo, SP, en marzo y abril de 2005. La asociacion entre meconio en el liquido amniotico y las variables independientes (edad materna, paridad, tener o no cesarea previa, edad de gestacion, antecedentes obstetricos, uso de ocitocina en el trabajo de parto, dilatacion cervical en la admision, tipo de parto actual, peso del RN, indice de Apgar de 1o y 5o minutos de vida) fue expresada como el cociente de prevalencia. RESULTADOS: Se verifico meconio en el liquido amniotico en 11,9% de los partos; 68,2% de estos fueron normales y 38,8%, con cesarea. El meconio estuvo asociado a: primiparidad (RP = 1,49; IC95% 1,29;1,73), edad de gestacion ≥ 41 semanas (RP = 5,05; IC95% 1,93;13,25), ocitocina en el parto (RP = 1,83, IC95% 1,60;2,10), cesarea (RP = 2,65; IC95% 2,17;3,24) e indice de Apgar < 7 no 5o minuto (RP = 2,96, IC95% 2,94;2,99). La mortalidad neonatal fue 1.6/1.000 nacidos vivos; meconio en el liquido amniotico fue encontrado en 50% de las muertes neonatales y asociado a mayores tasas de partos quirurgicos. CONCLUSIONES: Empleo de ocitocina, peores condiciones del recien-nacido posterior al parto y aumento de tasas de cesarea fueron factores asociados al meconio. La utilizacion rutinaria de ocitocina en el intraparto podria ser revisada por su asociacion con meconio en el liquido amniotico.

Caracterización de las cesáreas en centro de parto normal

OBJECTIVE To estimate the prevalence of cesarean sections in a birth center of a hospital and identify factors associated. METHODS Cross-sectional study including medical records of 2,441 births assisted in a birth center in the city of São Paulo, southeastern Brazil, between March and April 2005. The dependent variable (type of delivery) included vaginal delivery and cesarean section. The independent variables were grouped into four categories: demographic characteristics; current and past obstetric history; intrapartum care; and perinatal outcomes. Prevalence ratios and 95% confidence intervals (95% CI) were estimated to assess the association between type of delivery and maternal and newborn variables. RESULTS Of all deliveries, 14.9% were cesarean sections. Cesarean section in the current pregnancy was associated with past cesarean sections (PR = 3.19, 95%CI: 2.64,3.84); gestational age > 40 weeks (PR = 1.32, 95%CI: 1.09;1.61); cervical dilation of up to 4 cm on admission (PR = 3.22, 95%CI: 2.31;4.50); and meconium-stained amniotic fluid (PR = 2.5, 95%CI: 2.05;3.06). Regarding newborn characteristics cesarean section was associated with birth weight >4 kg (PR = 1.86, 95%CI: 1.29;2.66). Among women with history of past cesarean sections, having had also a prior vaginal delivery was a protective factor for cesarean section in the current pregnancy (PR = 0.46, 95%CI: 0.30;0.71). Factors related to fetal conditions including fetal stress, meconium-stained amniotic fluid, breech presentation and macrosomia accounted for 47.8% (175) while those related to the mechanism of birth including arrest disorders, functional dystocia and malposition accounted for 31,3% (115) of all indications for a cesarian section [corrected]. CONCLUSIONS Prevalence of c-section was consistent with World Health Organization recommendations. Increased risk of c-section was associated with prior history of c-sections, cervical dilation of at least 4 cm upon admission, gestational age > 40 weeks, meconium-stained amniotic fluid, and birthweight > 4 kg.OBJETIVO: Estimar a prevalencia de cesarianas em um centro de parto normal intra-hospitalar e identificar fatores associados. METODOS: Estudo transversal com analise de prontuarios de 2.441 partos assistidos em marco e abril de 2005 em um centro de parto normal intra-hospitalar de Sao Paulo, SP. A variavel dependente (tipo de parto) foi classificada como parto normal e operacao cesariana. As variaveis independentes foram categorizadas em quatro grupos: demograficas; historia obstetrica pregressa e atual; assistencia intraparto; e resultados perinatais. A razao de prevalencia e o intervalo de 95% de confianca (IC95%) foram calculados para identificar associacao entre tipo de parto e variaveis maternas e do recem-nascido. RESULTADOS: Do total de partos, 14,9% foram operacoes cesarianas. Ter sido submetida a cesariana na gestacao atual esteve associado a cesariana em gestacao anterior (RP = 3,19; IC95%: 2,64;3,84), idade gestacional > 40 semanas (RP = 1,32; IC95%: 1,09;1,61), ser admitida com cervicodilatacao ate 4 cm (RP = 3,22; IC95%: 2,31;4,50), liquido amniotico meconial (RP = 2,5; IC95%: 2,05;3,06). Quanto ao recem-nascido, a cesariana associou-se a peso > 4kg (RP = 1,86; IC95%: 1,29;2,66). Entre as mulheres com cesariana em gestacao anterior, ter tambem parto normal previo foi fator de protecao para cesariana na gestacao atual (RP = 0,46; IC95% 0,30;0,71). Fatores relacionados a condicao fetal, como estresse fetal, liquido amniotico meconial, apresentacao pelvica e macrossomia corresponderam a 47,8% (175) das indicacoes para a realizacao da cesariana; condicoes ligadas ao mecanismo do parto, como parada de progressao, distocia funcional e distocia de rotacao totalizaram 31,3% (115) das indicacoes. CONCLUSOES: A prevalencia de cesariana mostrou-se dentro dos limites propostos pela Organizacao Mundial da Saude. Mulheres com cesariana em gestacao anterior, admitidas com ate 4 cm de dilatacao, idade gestacional > 40 semanas, com liquido amniotico meconial e recem-nascido > 4 kg tiveram maior risco para cesariana.

O USO DO ENTEROCLISMA NO PREPARO PARA O PARTO: ANÁLISE DE SUAS VANTAGENS E DESVANTAGENS

Se investigaron los efectos de los enemas sobre la contaminacion fecal durante el trabajo de parto y el parto, entre mujeres atendidas en un hospital-escuela. La poblacion estuvo constituida por 90 mujeres (43 partos normales, 27 con forceps y 20 por cesarea). Se realizo un ensayo clinico aleatorio, se consideraron grupos: con y sin enemas. Se puede concluir que el enema no disminuyo el tiempo de trabajo de parto y no redujo la contaminacion fecal. Aun asi, las mujeres, que realizaron el enema tuvieron opinion mas favorable sobre este que aquellas que no lo realizaron.This study aimed at investigating the effects of intestinal cleansers on fecal contamination during labor and delivery amongst women assisted in a university hospital. The subjects were 90 pregnant women (43 normal births, 27 forceps and 20 caesarean sections). The population was divided in two randomized groups: with and without the use of intestinal cleansers. It was possible to conclude that intestinal cleansers did not provide faster labor and did not reduce fecal contamination. However, the women who had used an intestinal cleanser tended to regard it as positive.Investigaram-se os efeitos do enteroclisma sobre a contaminacao fecal, durante o trabalho de parto e parto, entre mulheres atendidas num hospital-escola. A populacao foi constituida por 90 parturientes (43 partos normais, 27 forceps e 20 cesareas). Realizou-se um ensaio clinico randomizado, considerando-se dois grupos: com e sem enteroclisma. Pode-se concluir que o enteroclisma nao abreviou o tempo de trabalho de parto e nao reduziu a contaminacao fecal. Entretanto, as mulheres que realizaram o enteroclisma tiveram opiniao mais favoravel sobre ele do que as que nao o realizaram.

EL USO DE ENEMAS EN LA PREPARACIÓN PARA EL PARTO: ANALISIS DE SUS VENTAJAS Y DESVENTAJAS

Se investigaron los efectos de los enemas sobre la contaminacion fecal durante el trabajo de parto y el parto, entre mujeres atendidas en un hospital-escuela. La poblacion estuvo constituida por 90 mujeres (43 partos normales, 27 con forceps y 20 por cesarea). Se realizo un ensayo clinico aleatorio, se consideraron grupos: con y sin enemas. Se puede concluir que el enema no disminuyo el tiempo de trabajo de parto y no redujo la contaminacion fecal. Aun asi, las mujeres, que realizaron el enema tuvieron opinion mas favorable sobre este que aquellas que no lo realizaron.This study aimed at investigating the effects of intestinal cleansers on fecal contamination during labor and delivery amongst women assisted in a university hospital. The subjects were 90 pregnant women (43 normal births, 27 forceps and 20 caesarean sections). The population was divided in two randomized groups: with and without the use of intestinal cleansers. It was possible to conclude that intestinal cleansers did not provide faster labor and did not reduce fecal contamination. However, the women who had used an intestinal cleanser tended to regard it as positive.Investigaram-se os efeitos do enteroclisma sobre a contaminacao fecal, durante o trabalho de parto e parto, entre mulheres atendidas num hospital-escola. A populacao foi constituida por 90 parturientes (43 partos normais, 27 forceps e 20 cesareas). Realizou-se um ensaio clinico randomizado, considerando-se dois grupos: com e sem enteroclisma. Pode-se concluir que o enteroclisma nao abreviou o tempo de trabalho de parto e nao reduziu a contaminacao fecal. Entretanto, as mulheres que realizaram o enteroclisma tiveram opiniao mais favoravel sobre ele do que as que nao o realizaram.