Nicole de Oliveira Bernardes

Prevalência de diástase dos músculos retoabdominais no puerpério imediato: comparação entre primíparas e multíparas

OBJECTIVES: To investigate the prevalence of diastasis of the rectus abdominis muscles (DRAM) among primiparae and multiparae immediately after vaginal delivery, and to compare DRAM above and below the umbilicus and correlate these with the mothers age, body mass index, gestational age and duration of labor. METHODS: A cross-sectional study was carried out. Personal information, obstetric history and DRAM measurements 4.5 cm above and below the umbilicus were recorded. DRAM was graded by the number of fingerbreadths (approximately 1.5 cm each) between the medial edges of this muscle. DRAM was considered present and relevant if the separation was >2 cm at any measurement point. RESULTS: Data from 467 women were analyzed. Above the umbilicus, the prevalence of DRAM >2 cm was 68%. Below the umbilicus, the prevalence of DRAM >2 cm was 32%. The prevalence of DRAM above the umbilicus among primiparae and multiparae was identical (68%), and the prevalence below the umbilicus was greater among multiparae (19.8% and 29.2%). The mean DRAM above the umbilicus was 2.8 cm (±1.2) and the mean DRAM below the umbilicus was 1.5 cm (±1.1), representing a significant difference (p=0.0001) and a weak correlation (r=0.461). The mean DRAM below the umbilicus was significantly greater among the multiparae (p<0.018) and there was no correlation with the mothers age, body mass index, gestational age or duration of labor. CONCLUSIONS: The prevalence of DRAM and mean DRAM were greater above the umbilicus both among multiparae and primiparae. Below the umbilicus, the mean DRAM was significantly greater among multiparae. DRAM below the umbilicus presented a weak correlation with DRAM above the umbilicus.

Atendimento de puérperas pela fisioterapia em uma maternidade pública humanizada

O objetivo foi descrever o perfil de puerperas atendidas pela fisioterapia em uma maternidade publica de Betim, MG, e o atendimento a elas prestado, visando contribuir para a assistencia fisioterapeutica obstetrica. Foi feito um levantamento de 215 fichas de avaliacao fisioterapeutica de puerperas, contendo dados demograficos e clinicos, alem dos registros especificos da fisioterapia. A maioria da puerperas era jovem, do lar, casadas, multiparas e de Betim. Quanto a avaliacao das mamas, a maioria apresentou mamas simetricas, secretantes, mamilos protrusos, tendo sido observados poucos traumas mamilares ou dificuldade na amamentacao; 62,3% das puerperas apresentavam diafragma normocinetico, 85,1% som timpânico a percussao abdominal, involucao uterina dentro da normalidade, 87,9% contracao do assoalho pelvico presente, 30,3% edema em membros inferiores; a diastase dos musculos reto-abdominais foi de 2±1 e 1±1 dedos supra e infra-umbilical, respectivamente. As condutas adotadas foram: exercicios respiratorios diafragmaticos, abdominais isometricos, contracao do assoalho pelvico; exercicios circulatorios de membros inferiores, manobras de eliminacao de flatos, deambulacao e orientacao. O perfil das puerperas atendidas correspondeu ao esperado, encontrando-se elas em estado de recuperacao puerperal. A conduta proposta pela fisioterapia foi realizada pela grande maioria das puerperas.

Incidence and anatomy of cardiac malformations in children con- ceived by assisted reproduction techniques - A review

The aim of this study is to identify the occurrence of car- diac malformations occurred in children conceived by as- sisted reproduction techniques (ART) in the international literature in Medline database from 1999 to 2012. The search returned data on 32,000 births, whose 21,000 were conceived naturally and 11,000 were conceived by ICSI and/or IVF. The incidence of cardiac malformations in general population situations was 0.4%. The incidence of cardiac malformations by ART was 1.8% from ICSI and IVF. Among the situations of conceived naturally was observed 88 cases of cardiac malforma- tions, which were: Atrial Septal Defect: 26 cases 29.55%, Change in the interventricular septum: 18 cases 20.45%, coarctation of the aorta: 13 cases 14.77%, aortic stenosis: 11 cases 12.5%, tetralogy of Fallot: 5.68% 5 cases, steno- sis of the pulmonary trunk: 5 cases 5.68% other: 11.37% 10 cases. In cases of cardiac malformations in children conceived by IVF and ICSI, 198 cases were found, which were: CIA: 58 cases 29.30%, Change in the interventric- ular septum: 37 cases 18.69%, coarctation of the aorta: 20 cases 10.10%, aortic stenosis: 18 cases 9.09%, tetral- ogy of Fallot: 11 cases 5.55%, stenosis of the pulmonary trunk: 6 cases 3.03%, Other: 48 cases 24.24%. There remain opened questions about infertility and risk factors involving ART. Further research is clearly required. Health care providers should counsel infertile couples seeking as- sisted reproduction by IVF and technology.