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[PMID]:29474397
[Au] Autor:Cranmer JN; Dettinger J; Calkins K; Kibore M; Gachuno O; Walker D
[Ad] Endereço:Emory University, Atlanta, Georgia, United States of America.
[Ti] Título:Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness.
[So] Source:PLoS One;13(2):e0184252, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Globally, the rate of reduction in delivery-associated maternal and perinatal mortality has been slow compared to improvements in post-delivery mortality in children under five. Improving clinical readiness for basic obstetric emergencies is crucial for reducing facility-based maternal deaths. Emergency readiness is commonly assessed using tracers derived from the maternal signal functions model. OBJECTIVE-METHOD: We compare emergency readiness using the signal functions model and a novel clinical cascade. The cascades model readiness as the proportion of facilities with resources to identify the emergency (stage 1), treat it (stage 2) and monitor-modify therapy (stage 3). Data were collected from 44 Kenyan clinics as part of an implementation trial. FINDINGS: Although most facilities (77.0%) stock maternal signal function tracer drugs, far fewer have resources to practically identify and treat emergencies. In hypertensive emergencies for example, 38.6% of facilities have resources to identify the emergency (Stage 1 readiness, including sphygmomanometer, stethoscope, urine collection device, protein test). 6.8% have the resources to treat the emergency (Stage 2, consumables (IV Kit, fluids), durable goods (IV pole) and drugs (magnesium sulfate and hydralazine). No facilities could monitor or modify therapy (Stage 3). Across five maternal emergencies, the signal functions overestimate readiness by 54.5%. A consistent, step-wise pattern of readiness loss across signal functions and care stage emerged and was profoundly consistent at 33.0%. SIGNIFICANCE: Comparing estimates from the maternal signal functions and cascades illustrates four themes. First, signal functions overestimate practical readiness by 55%. Second, the cascade's intuitive indicators can support cross-sector health system or program planners to more precisely measure and improve emergency care. Third, adding few variables to existing readiness inventories permits step-wise modeling of readiness loss and can inform more precise interventions. Fourth, the novel aggregate readiness loss indicator provides an innovative and intuitive approach for modeling health system emergency readiness. Additional testing in diverse contexts is warranted.
[Mh] Termos MeSH primário: Parto Obstétrico
Serviços de Saúde Materna/organização & administração
[Mh] Termos MeSH secundário: Pré-Escolar
Feminino
Seres Humanos
Lactente
Mortalidade Infantil
Recém-Nascido
Quênia/epidemiologia
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180224
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184252


  2 / 23105 MEDLINE  
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Texto completo SciELO Brasil
Texto completo SciELO Saúde Pública
[PMID]:29364356
[Au] Autor:Monguilhott JJDC; Brüggemann OM; Freitas PF; d'Orsi E
[Ad] Endereço:Departamento Acadêmico de Saúde e Serviços, Instituto Federal de Educação, Ciência e Tecnologia de Santa Catarina, Florianópolis, SC, Brasil.
[Ti] Título:Nascer no Brasil: the presence of a companion favors the use of best practices in delivery care in the South region of Brazil.
[So] Source:Rev Saude Publica;52:1, 2018.
[Is] ISSN:1518-8787
[Cp] País de publicação:Brazil
[La] Idioma:por; eng
[Ab] Resumo:OBJECTIVE To analyze if the presence of a companion favors the use of best practices in the delivery care in the South region of Brazil. METHODS This is a cross-sectional analysis of the longitudinal study Nascer no Brasil. We analyzed data from 2,070 women from the South region of Brazil who went into labor. The data were collected between February and August 2011, by interviews and medical records. We performed a bivariate and multivariate analysis, calculating the crude and adjusted prevalence ratios using Poisson regression with robust variance estimation. The level of significance adopted was 5%. RESULTS Most women had a companion during labor (51.7%), but few remained during delivery (39.4%) or cesarean section (34.8%). Less than half of the women had access to several recommended practices, while non-recommended practices continue to be performed. In the model adjusted for age, education level, source of payment for the delivery, parity, and score of the Brazilian Association of Market Research Institutes, the presence of a companion was statistically associated with a greater supply of liquids and food (aPR = 1.34), dietary prescription (aPR = 1.34), use of non-pharmacological methods for pain relief (aPR = 1.37), amniotomy (aPR = 1.10), epidural or spinal analgesia (aPR = 1.84), adoption of non-lithotomy position in the delivery (aPR = 1.77), stay in the same room during labor, delivery, and postpartum (aPR = 1.62), skin-to-skin contact in the delivery (aPR = 1.81) and cesarean section (PR = 2.43), as well as reduced use of the Kristeller maneuver (aPR = 0.67), trichotomy (aPR = 0.59), and enema (aPR = 0.49). CONCLUSIONS In the South region of Brazil, most women do not have access to the best practices in addition to undergoing several unnecessary interventions. The presence of a companion is associated with several beneficial practices and the reduction in some interventions, although other interventions are not impacted.
[Mh] Termos MeSH primário: Parto Obstétrico/normas
Humanismo
Trabalho de Parto/psicologia
Serviços de Saúde Materna/normas
Guias de Prática Clínica como Assunto
[Mh] Termos MeSH secundário: Adolescente
Adulto
Brasil
Criança
Comparação Transcultural
Estudos Transversais
Parto Obstétrico/psicologia
Família
Feminino
Conhecimentos, Atitudes e Prática em Saúde
Seres Humanos
Direitos do Paciente
Segurança do Paciente/normas
Gravidez
Relações Profissional-Paciente
Fatores Socioeconômicos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE


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[PMID]:29385135
[Au] Autor:Sabde Y; Chaturvedi S; Randive B; Sidney K; Salazar M; De Costa A; Diwan V
[Ad] Endereço:Department of Community Medicine, R.D. Gardi Medical College, Ujjain, India.
[Ti] Título:Bypassing health facilities for childbirth in the context of the JSY cash transfer program to promote institutional birth: A cross-sectional study from Madhya Pradesh, India.
[So] Source:PLoS One;13(1):e0189364, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Bypassing health facilities for childbirth can be costly both for women and health systems. There have been some reports on this from Sub-Saharan African and from Nepal but none from India. India has implemented the Janani Suraksha Yojana (JSY), a large national conditional cash transfer program which has successfully increased the number of institutional births in India. This paper aims to study the extent of bypassing the nearest health facility offering intrapartum care in three districts of Madhya Pradesh, India, and to identify individual and facility determinants of bypassing in the context of the JSY program. Our results provide information to support the optimal utilization of facilities at different levels of the healthcare system for childbirth. Data was collected from 96 facilities (74 public) and 720 rural mothers who delivered at these facilities were interviewed. Multilevel logistic regression was used to analyze the data. Facility obstetric care functionality was assessed by the number of emergency obstetric care (EmOC) signal functions performed in the last three months. Thirty eighth percent of the mothers bypassed the nearest public facility for their current delivery. Primiparity, higher education, arriving by hired transport and a longer distance from home to the nearest facility increased the odds of bypassing a public facility for childbirth. The variance partition coefficient showed that 37% of the variation in bypassing the nearest public facility can be attributed to difference between facilities. The number of basic emergency obstetric care signal functions (AOR = 0.59, 95% CI 0.37-0.93), and the availability of free transportation at the nearest facility (AOR = 0.11, 95% CI 0.03-0.31) were protective factors against bypassing. The variation between facilities (MOR = 3.85) was more important than an individual's characteristics to explain bypassing in MP. This multilevel study indicates that in this setting, a focus on increasing the level of emergency obstetric care functionality in public obstetric care facilities will allow more optimal utilization of facilities for childbirth under the JSY program thereby leading to better outcomes for mothers.
[Mh] Termos MeSH primário: Parto Obstétrico
Instalações de Saúde
[Mh] Termos MeSH secundário: Adulto
África ao Sul do Saara
Estudos Transversais
Feminino
Instalações de Saúde/economia
Seres Humanos
Índia
Gravidez
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189364


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[PMID]:29374885
[Au] Autor:Wang HL; Yang Z; Shen Y; Wang QL
[Ad] Endereço:Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.
[Ti] Título:[Clinical outcome of therapeutic cervical cerclage in short cervix syndrome].
[So] Source:Zhonghua Fu Chan Ke Za Zhi;53(1):43-46, 2018 Jan 25.
[Is] ISSN:0529-567X
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To investigate the clinical effect of therapeutic cervical cerclage on short cervix syndrome for anti-premature birth in the second trimester. Totally 44 singleton pregnant patients were diagnosed as short cervix syndrome, which was cervical length ≤2.5 cm without cervical dilatation, and received treatment from January 2008 and July 2015 in Peking University Third Hospital were collected. Among them, 30 patients who received therapeutic cervical cerclage were defined as cerclage group and another 14 cases who received conservative treatment were defined as un-cerclage group. The days of conservative treatment, delivery rate of different gestational weeks, birth weight of newborns, neonatal survival rate within 7 days of birth were analyzed between the two groups. There were no significant differences between the two groups in days of pregnancy conservative treatment [103 (84-141) vs 105 (85-114) days], delivery weeks [38.0 (35.5-39.4) vs 38.5 (37.3-39.5) weeks], birth weight of newborns [3 120 (2 750-3 400) vs 3 130 (2 760-3 545) g], and survival rate of newborns [100% (30/30) vs 13/14]. The fetuses of both groups were all delivered after 28 weeks. There was no significant difference in accumulated delivery rate between the two groups after 32 weeks, 34 weeks, and 37 weeks, respectively (all 0.05) . The treatment of cervical cerclage is not superior to conservative means in single pregnancy of cervical length ≤2.5 cm without cervical dilatation. For such patients with short cervix syndrome, the treatment of cervical cerclage may not be necessary, but dynamic monitoring and search for the causing factors and prompt treatment are more important.
[Mh] Termos MeSH primário: Cerclagem Cervical
Colo do Útero/fisiopatologia
Resultado da Gravidez/epidemiologia
Incompetência do Colo do Útero/terapia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Peso ao Nascer
Parto Obstétrico
Feminino
Idade Gestacional
Seres Humanos
Recém-Nascido
Parto
Gravidez
Complicações na Gravidez
Segundo Trimestre da Gravidez
Nascimento Prematuro
Incompetência do Colo do Útero/diagnóstico
Incompetência do Colo do Útero/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180129
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0529-567X.2018.01.009


  5 / 23105 MEDLINE  
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[PMID]:27776074
[Au] Autor:American College of Obstetricians and Gynecologists' Committee on Obstetric Practice
[Ti] Título:Committee Opinion No. 679: Immersion in Water During Labor and Delivery.
[So] Source:Obstet Gynecol;128(5):e231-e236, 2016 11.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Immersion in water during labor or delivery has been popularized over the past several decades. The prevalence of this practice in the United States is uncertain because it has not been studied in births outside of the home and birth centers, and the data are not recorded on birth certificates. Among randomized controlled trials included in a 2009 Cochrane systematic review that addressed immersion in the first stage of labor, results were inconsistent with regard to maternal benefits. Neither the Cochrane systematic review nor any individual trials included in that review reported any benefit to the newborn from maternal immersion during labor or delivery. Immersion in water during the first stage of labor may be associated with shorter labor and decreased use of spinal and epidural analgesia and may be offered to healthy women with uncomplicated pregnancies between 37 0/7 weeks and 41 6/7 weeks of gestation. There are insufficient data on which to draw conclusions regarding the relative benefits and risks of immersion in water during the second stage of labor and delivery. Therefore, until such data are available, it is the recommendation of the American College of Obstetricians and Gynecologists that birth occur on land, not in water. A woman who requests to give birth while submerged in water should be informed that the maternal and perinatal benefits and risks of this choice have not been studied sufficiently to either support or discourage her request. Facilities that plan to offer immersion during labor and delivery need to establish rigorous protocols for candidate selection; maintenance and cleaning of tubs and pools; infection control procedures, including standard precautions and personal protective equipment for health care personnel; monitoring of women and fetuses at appropriate intervals while immersed; and moving women from tubs if urgent maternal or fetal concerns or complications develop.
[Mh] Termos MeSH primário: Parto Obstétrico/métodos
Imersão
Trabalho de Parto/fisiologia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Imersão/efeitos adversos
Recém-Nascido
Gravidez
Água
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
059QF0KO0R (Water)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


  6 / 23105 MEDLINE  
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[PMID]:27776071
[Au] Autor:American College of Obstetricians and Gynecologists' Committee on Practice Bulletins­Obstetrics
[Ti] Título:Practice Bulletin No. 173: Fetal Macrosomia.
[So] Source:Obstet Gynecol;128(5):e195-e209, 2016 11.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Suspected fetal macrosomia is encountered commonly in obstetric practice. As birth weight increases, the likelihood of labor abnormalities, shoulder dystocia, birth trauma, and permanent injury to the neonate increases. The purpose of this document is to quantify those risks, address the accuracy and limitations of methods for estimating fetal weight, and suggest clinical management for a pregnancy with suspected fetal macrosomia.
[Mh] Termos MeSH primário: Macrossomia Fetal
[Mh] Termos MeSH secundário: Cesárea
Parto Obstétrico
Feminino
Macrossomia Fetal/diagnóstico
Macrossomia Fetal/etiologia
Macrossomia Fetal/terapia
Peso Fetal
Seres Humanos
Trabalho de Parto Induzido
Gravidez
Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


  7 / 23105 MEDLINE  
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[PMID]:27776069
[Ti] Título:Committee Opinion No. 679 Summary: Immersion in Water During Labor and Delivery.
[So] Source:Obstet Gynecol;128(5):1198-1199, 2016 11.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Immersion in water during labor or delivery has been popularized over the past several decades. The prevalence of this practice in the United States is uncertain because it has not been studied in births outside of the home and birth centers, and the data are not recorded on birth certificates. Among randomized controlled trials included in a 2009 Cochrane systematic review that addressed immersion in the first stage of labor, results were inconsistent with regard to maternal benefits. Neither the Cochrane systematic review nor any individual trials included in that review reported any benefit to the newborn from maternal immersion during labor or delivery. Immersion in water during the first stage of labor may be associated with shorter labor and decreased use of spinal and epidural analgesia and may be offered to healthy women with uncomplicated pregnancies between 37 0/7 weeks and 41 6/7 weeks of gestation. There are insufficient data on which to draw conclusions regarding the relative benefits and risks of immersion in water during the second stage of labor and delivery. Therefore, until such data are available, it is the recommendation of the American College of Obstetricians and Gynecologists that birth occur on land, not in water. A woman who requests to give birth while submerged in water should be informed that the maternal and perinatal benefits and risks of this choice have not been studied sufficiently to either support or discourage her request. Facilities that plan to offer immersion during labor and delivery need to establish rigorous protocols for candidate selection; maintenance and cleaning of tubs and pools; infection control procedures, including standard precautions and personal protective equipment for health care personnel; monitoring of women and fetuses at appropriate intervals while immersed; and moving women from tubs if urgent maternal or fetal concerns or complications develop.
[Mh] Termos MeSH primário: Parto Obstétrico/métodos
Imersão
Trabalho de Parto
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Recém-Nascido
Gravidez
Água
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
059QF0KO0R (Water)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


  8 / 23105 MEDLINE  
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[PMID]:29287096
[Au] Autor:Gorain A; Barik A; Chowdhury A; Rai RK
[Ad] Endereço:Society for Health and Demographic Surveillance, Suri, Birbhum, West Bengal, India.
[Ti] Título:Preference in place of delivery among rural Indian women.
[So] Source:PLoS One;12(12):e0190117, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:India accounts for the highest number of maternal and child deaths globally. A large body of empirical research suggests that improvement in the coverage of institutional delivery is essential to reduce the burden of maternal and child death. However the dynamics of choice of place of delivery is poorly understood. Using qualitative survey data consisting of twelve focus group discussions, conducted in a rural setting of West Bengal, India, this study aims to understand the reasons behind preferring home or institution for delivery. Findings reveal that some women who underwent an institutional delivery preferred to deliver their baby at home. On the other hand, of women who delivered their baby at home, 60% wanted to deliver their babies in institutions but could not do so, primarily due to the unwillingness of family members and misreporting of the onset of true labour pain. With the help of Accredited Social Health Activists, the village level health workers, there is need for an intervention that focuses on educating household members (essentially targeting husbands and mother-in-laws) about birth preparedness, and identification of true labour pain.
[Mh] Termos MeSH primário: Parto Obstétrico
População Rural
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Índia
Gravidez
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171230
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190117


  9 / 23105 MEDLINE  
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Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
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[PMID]:29236628
[Au] Autor:Semrau KEA; Hirschhorn LR; Marx Delaney M; Singh VP; Saurastri R; Sharma N; Tuller DE; Firestone R; Lipsitz S; Dhingra-Kumar N; Kodkany BS; Kumar V; Gawande AA; BetterBirth Trial Group
[Ad] Endereço:From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Departme
[Ti] Título:Outcomes of a Coaching-Based WHO Safe Childbirth Checklist Program in India.
[So] Source:N Engl J Med;377(24):2313-2324, 2017 12 14.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The prevalence of facility-based childbirth in low-resource settings has increased dramatically during the past two decades, yet gaps in the quality of care persist and mortality remains high. The World Health Organization (WHO) Safe Childbirth Checklist, a quality-improvement tool, promotes systematic adherence to practices that have been associated with improved childbirth outcomes. METHODS: We conducted a matched-pair, cluster-randomized, controlled trial in 60 pairs of facilities across 24 districts of Uttar Pradesh, India, testing the effect of the BetterBirth program, an 8-month coaching-based implementation of the Safe Childbirth Checklist, on a composite outcome of perinatal death, maternal death, or maternal severe complications within 7 days after delivery. Outcomes - assessed 8 to 42 days after delivery - were compared between the intervention group and the control group with adjustment for clustering and matching. We also compared birth attendants' adherence to 18 essential birth practices in 15 matched pairs of facilities at 2 and 12 months after the initiation of the intervention. RESULTS: Of 161,107 eligible women, we enrolled 157,689 (97.9%) and determined 7-day outcomes for 157,145 (99.7%) mother-newborn dyads. Among 4888 observed births, birth attendants' mean practice adherence was significantly higher in the intervention group than in the control group (72.8% vs. 41.7% at 2 months; 61.7% vs. 43.9% at 12 months; P<0.001 for both comparisons). However, there was no significant difference between the trial groups either in the composite primary outcome (15.1% in the intervention group and 15.3% in the control group; relative risk, 0.99; 95% confidence interval, 0.83 to 1.18; P=0.90) or in secondary maternal or perinatal adverse outcomes. CONCLUSIONS: Birth attendants' adherence to essential birth practices was higher in facilities that used the coaching-based WHO Safe Childbirth Checklist program than in those that did not, but maternal and perinatal mortality and maternal morbidity did not differ significantly between the two groups. (Funded by the Bill and Melinda Gates Foundation; Clinical Trials number, NCT02148952 .).
[Mh] Termos MeSH primário: Lista de Checagem
Parto Obstétrico/normas
Tocologia
[Mh] Termos MeSH secundário: Adulto
Lista de Checagem/utilização
Distribuição de Qui-Quadrado
Parto Obstétrico/educação
Feminino
Fidelidade a Diretrizes
Seres Humanos
Índia/epidemiologia
Recém-Nascido
Análise de Intenção de Tratamento
Mortalidade Materna
Tocologia/educação
Avaliação de Resultados (Cuidados de Saúde)
Mortalidade Perinatal
Gravidez
Transtornos Puerperais/epidemiologia
Melhoria de Qualidade
Padrão de Cuidado
Organização Mundial da Saúde
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171214
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1701075


  10 / 23105 MEDLINE  
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[PMID]:29304045
[Au] Autor:Lysell H; Dahlin M; Viktorin A; Ljungberg E; D'Onofrio BM; Dickman P; Runeson B
[Ad] Endereço:Department of Clinical Neuroscience, Karolinska Institutet, Centre for psychiatry research, Stockholm, Sweden.
[Ti] Título:Maternal suicide - Register based study of all suicides occurring after delivery in Sweden 1974-2009.
[So] Source:PLoS One;13(1):e0190133, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Recent research suggests that having a newborn child is associated with substantially reduced risk for maternal suicide. We studied postpartum suicides in a national cohort of mothers and the role of mental disorder, self-harm and delivery related factors. METHODS: We used a nested case-control design with data from Swedish registries. The cohort consisted of all women given birth in Sweden 1974-2009. Mothers who died by suicide during follow-up were considered cases (n = 1,786) and risk of suicide was estimated with proximity to delivery as the explanatory variable. In a second step, association between suicide during the first year following delivery (n = 145) and mental disorder, self-harm and delivery related variables risk factors were analyzed. RESULTS: The first postpartum year was associated with a lower risk of suicide, compared to later (RR 0.80, 95%CI 0.66-0.96), which was unaltered after adjustment for socio-economic status and history of self-harm (aRR 0.82, 95%CI 0.68-0.99). Compared to living mothers, suicide victims of the postpartum year more often had affective disorders (aRR 133.94, 95%CI 45.93-390.61), psychotic disorders (aRR 83.69, 95%CI 36.99-189.31) and history of self-harm (aRR 47.56, 95%CI 18.24-124.02). The aRR of stillbirth was 2.66 (95%CI 0.63-11.30). CONCLUSIONS: We found only a weak negative association between childbirth during the preceding year and suicide, when using mothers as controls. A severe mental disorder after delivery and a history of self-harm was strongly associated with increased risk of suicide in the postpartum year and may inform the clinical assessment postpartum.
[Mh] Termos MeSH primário: Mães
Período Pós-Parto
Sistema de Registros
Suicídio/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos de Casos e Controles
Estudos de Coortes
Parto Obstétrico
Feminino
Seres Humanos
Gravidez
Fatores de Risco
Comportamento Autodestrutivo
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180106
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190133



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