Navegando por Palavras-chave "Cesarean section"
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- ItemSomente Metadadados3-D Virtual Reconstruction of a Large Amniocele With Protrusion of Legs and Umbilical Cord Following Asymptomatic Uterine Rupture(Elsevier Inc, 2018) Moreira de Sa, Renato Augusto; de Moraes, Valeria Pereira; da Costa Soares, Marianne Cecilia; Werner, Heron; Ribeiro, Gerson; Lopes, Jorge; Araujo Junior, Edward [UNIFESP]Background: Complete uterine rupture is a rare and severe intrapartum complication with high rates of maternal and fetal mortality. Asymptomatic uterine rupture is a very rare condition with one unique previous case described in the literature. Three-dimensional virtual models allow an immersive virtual reality of maternal-fetal structures with better understanding by the parents and the medical team. Case: We demonstrate a case of asymptomatic rupture uterine with a large amniocele and protruded legs and umbilical cord at 28 weeks of gestation by using a 3-D virtual model from ultrasound scan data. Conclusion: 3-D virtual models may be applied to the assessment of obstetric complications, thereby allowing a novel 3-D spatial view of maternal-fetal structures. Copyright (C) 2018 The Society of Obstetricians and Gynaecologists of Canada/La Societe des obstetriciens et gynecologues du Canada. Published by Elsevier Inc. All rights reserved.
- ItemAcesso aberto (Open Access)Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2013-03-01) Araujo Júnior, Edward [UNIFESP]; Freitas, Rogério Caixeta Moraes De [UNIFESP]; Di Bella, Zsuzsanna Ilona Katalin De Jármy [UNIFESP]; Alexandre, Sandra Maria [UNIFESP]; Nakamura, Mary Uchiyama [UNIFESP]; Nardozza, Luciano Marcondes Machado [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound. METHODS: A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10), vaginal delivery (n=16), and forceps delivery (n=9). Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L) was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test. RESULTS: The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm², respectively, versus 12.4 cm² in the Control Group (elective cesarean). Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25), however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5). CONCLUSION: Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode.
- ItemAcesso aberto (Open Access)Avaliação anatomopatológica de cicatrizes uterinas de acordo com o tipo de sutura cirúrgica (modelo experimental)(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2007-12-01) Guidoni, Rogério Gomes dos Reis; Toledo, Sérgio Floriano de; Saito, Maurício; Buzzini, Rodrigo Ferreira; Pontes, Cesar Cilento; Souza, Eduardo de [UNIFESP]; Camano, Luiz [UNIFESP]; Centro Universitário Lusíada Faculdade de Ciências Médicas; Hospital do Servidor Público Estadual; Universidade Federal de São Paulo (UNIFESP)PURPOSE: to compare macro and microscopically, surgical uterine sutures in female rabbits, after caesarean section utilizing separate, continuous and continuous anchored suture stitches. METHODS: three New Zealand female rabbits in their first pregnancy were used. The caesarean section was carried out at the 26th day of gestation and three incisions were performed in each uterus. The hysterorrhaphy was performed with a 00 Vicryl® thread, and a different suture technique was employed for each incision. Total hysterectomy and adnexectomy were done at the 60th day post-delivery with the preservation of eventual adhesions for the evaluation of the surgical scars. The extent of scar retraction, amount of fibrin deposit and the suture integrity were evaluated through macroscopy. For the evaluation through microscopy, hematoxylin eosin technique was used for cellular colorimetry, and Masson's trichrom to evidence collagen. The statistical non-parametric Friedman's test was employed for the matching hypothesis, and Fisher's exact test to verify the homogeneity of the techniques (level of significance: 5%). RESULTS: a total of 18 scars were obtained (six scars per suture). The following mean values were obtained for the longitudinal (0.5/0.4/0.5, p=0.069) and transversal retraction degrees (0.3/0.4/0.3, p=0.143) respectively for separate, continuous and continuous anchored suture techniques. All sutures presented regular fibrin deposit, no adhesions and integral absorption of the stitches. The mean value of the blood vessels (158.5/139.3/172.1; p=0.293), fibroblasts (351.6/345.8/354.3; p=0.311) and of collagen percentage (44.0/45.5/48.5; p=0.422) were calculated through microscopy, respectively for separate, continuous and continuous anchored suture techniques. CONCLUSIONS: the type of hysterorrhaphy technique of caesarean section in female rabbits did not generate any significant statistical difference in the macroscopic and microscopic parameters evaluated.
- ItemAcesso aberto (Open Access)O desenvolvimento da taquipnéia transitória do recém-nascido e desconforto respiratório precoce: associação à via de parto(Universidade Federal de São Paulo (UNIFESP), 2010) Minozzi, Andrea Simões [UNIFESP]; Scudeller, Tânia Terezinha [UNIFESP]; http://lattes.cnpq.br/8631669167306600; http://lattes.cnpq.br/5395611302717505; Universidade Federal de São Paulo (UNIFESP)Introdução: Um dos distúrbios respiratórios mais frequentes do período neonatal é a Taquipnéia Transitória do Recém-nascido (TTRN) e o Desconforto Respiratório Precoce (DRP). Acredita-se que um dos principais fatores de risco para esses distúrbios seja a via de parto, indicando o parto cesáreo como possível causador dessa morbidade perinatal pela. ausência de compressão do canal de parto no tórax do feto e consequente acúmulo de líquido pulmonar no neonato. Objetivo: Correlacionar o desenvolvimento da TTRN e DRP com a via de parto. Desenho do estudo: Tratou-se de um estudo clínico observacional com descrição retrospectiva de casos e amostra constituída de 412 neonatos, sendo que 206 nascidos de cesárea (PC) e 206 de parto vaginal (PV), na maternidade da Irmandade da Santa Casa de Santos. Entre os grupos (PC x PV) foram comparadas a idade gestacional do parto (IG), índice de Apgar de primeiro e quinto minuto, peso do neonato, freqüência respiratória (FR), necessidade de oxigenoterapia, ventilação mecânica invasiva (VMI) ou não-invasiva (VMNI), internação na Unidade de Terapia Intensiva Neonatal (UTIN), e presença de DRP e/ou TTRN. As médias foram avaliadas pelo teste Mann-Whitney e as proporções, pelo teste do qui-quadrado (X 2 ), com p< 0,05. Resultados: Na amostra estudada encontrou-se 26,41% de ocorrência de DRP ou TTRN sem diferença significativa entre as vias de parto. As variáveis de Apgar de 5 0 minuto, IG, VMI, VMNI e Oxigenoterapia, foram estatisticamente iguais entre os grupos PC e PV. No entanto, os valores médios do peso dos neonatos foi significativamente menor nos nascidos de PV enquanto que a média do Apgar de 1 o minuto foi maior nesse mesmo grupo (p=0,004). Os neonatos que apresentaram DRP/TTRN, nascidos por PC demonstraram FR maior quando comparados ao grupo PV. Conclusão: O PC não foi precursor de DRP/TTRN, como também não apresentou relação causal com o uso de oxigenioterapia, VMI, VMNI e internação em UTIN. O PV favoreceu melhor vitalidade neonatal e valores de peso de recém-nascidos (RN) menores, comparados ao PC. A cesárea foi fator determinante nos índices de FR neonatal mais elevados, em RN diagnosticados com DRP ou TTRN, sugerindo maior sofrimento neonatal. Não há critérios estabelecidos para uso de oxigenioterapia, confirmado pela freqüência significativa desta intervenção terapêutica mesmo em recém-nascidos saudáveis (80,42%)
- ItemAcesso aberto (Open Access)Do Italian women prefer cesarean section? Results from a survey on mode of delivery preferences(Biomed Central Ltd, 2013-03-26) Torloni, Maria Regina [UNIFESP]; Betran, Ana Pilar; Montilla, Pilar; Scolaro, Elisa; Seuc, Armando; Mazzoni, Agustina; Althabe, Fernando; Merzagora, Francesca; Donzelli, Gian Paolo; Merialdi, Mario; Universidade Federal de São Paulo (UNIFESP); WHO; Osservatorio Nazl Salute Donna; Inst Clin Effectiveness & Hlth Policy; Univ FlorenceBackground: About 20 million cesareans occur each year in the world and rates have steadily increased in almost all middle- and high-income countries over the last decades. Maternal request is often argued as one of the key forces driving this increase. Italy has the highest cesarean rate of Europe, yet there are no national surveys on the views of Italian women about their preferences on route of delivery. This study aimed to assess Italian women's preference for mode of delivery, as well as reasons and factors associated with this preference, in a nationally representative sample of women.Methods: This cross sectional survey was conducted between December 2010-March 2011. An anonymous structured questionnaire asked participants what was their preferred mode of delivery and explored the reasons for this preference by assessing their agreement to a series of statements. Participants were also asked to what extent their preference was influenced by a series of possible sources. the 1st phase of the study was carried out among readers of a popular Italian women's magazine (Io Donna). in a 2nd phase, the study was complemented by a structured telephone interview.Results: A total of 1000 Italian women participated in the survey and 80% declared they would prefer to deliver vaginally if they could opt. the preference for vaginal delivery was significantly higher among older (84.7%), more educated (87.6%), multiparous women (82.3%) and especially among those without any previous cesareans (94.2%). the main reasons for preferring a vaginal delivery were not wanting to be separated from the baby during the first hours of life, a shorter hospital stay and a faster postpartum recovery. the main reasons for preferring a cesarean were fear of pain, convenience to schedule the delivery and because it was perceived as being less traumatic for the baby. the source which most influenced the preference of these Italian women was their obstetrician, followed by friends or relatives.Conclusion: Four in five Italian women would prefer to deliver vaginally if they could opt. Factors associated with a higher preference for cesarean delivery were youth, nulliparity, lower education and a previous cesarean.
- ItemSomente MetadadadosEstudo da morbidade febril pós-cesariana e dos fatores que a ela predispõem, quando empregada a profilaxia antibiótica(Universidade Federal de São Paulo (UNIFESP), 1991) Souza, Eduardo de [UNIFESP]; Camano, Luiz [UNIFESP]
- ItemAcesso aberto (Open Access)Modelo Preditivo para Cesariana com Uso de Fatores de Risco(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2002-01-01) Cunha, Alfredo De Almeida [UNIFESP]; Portela, Margareth Crisóstomo [UNIFESP]; Amed, Abes Mahmed [UNIFESP]; Camano, Luiz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: to investigate antepartum factors related to cesarean section and develop a cesarean section predictive model. Methods: the study design was a retrospective cohort which included all the cared 843 deliveries in a third level unit from June 1993 through November 1994. Children with 1,000 g birthweight and above were included. The dependent variable was cesarean section (c-section). Independent variables were antepartum factors related to c-section. Logistic regression was used to develop a predictive model. Results: our model showed risk of c-section according to the following variables: maternal age under 20 years (OR = 0.396) and over 28 years (OR = 2.133); previous vaginal deliveries (OR = 0.626); previous c-section (OR = 4.576); prenatal care (OR = 2.346); breech presentation (OR = 4.174); twin pregnancies (OR = 14.065); late obstetrical hemorrhage (OR = 28.189); mild preeclampsia (OR = 2.180); severe preeclampsia OR=16.738; chronic hypertension OR=4.927 and other clinical problems (OR = 2.012). The predictive model had a concordance of 82.3% between probabilities and responses. Conclusions: our study identified 12 antepartum factors related to c-section. It was possible to develop a cesarean section predictive model taking into account all previously identified antepartum risk factors.
- ItemAcesso aberto (Open Access)Morbidade febril puerperal em pacientes infectadas pelo HIV(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2003-04-01) De Marcos, Andrea [UNIFESP]; Lunardi, Luciana [UNIFESP]; Lindsey, Prescilla Chow [UNIFESP]; Amed, Abes Mahmed [UNIFESP]; Castelo Filho, Adauto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: the morbidity in HIV-positive patients due to puerperal fever was studied and correlated to the method and duration of labor, the duration of premature rupture of the membranes, CD4+ cell count and the viral load (VL) at peridelivery. METHODS: a total of 207 HIV-positive women with prenatal examinations and deliveries between May 1997 and December 2001 were enrolled. Of these, 32 had natural childbirth and 175 had a cesarean section. Of the total of enrolled patients, 62.8% were submitted to elective cesarean section. The average age of the group was 27.4 years, and 25.6% were nulliparous and 26% were primiparous. At the moment of the delivery the average gestational age was 37.8 weeks. At the end of pregnancy the average of the CD4+ cell count was approximately 481 cells/mm³ and the viral load 49,100 copies/mL. RESULTS: puerperal morbidity occurred in 34 patients, with 33 after cesarean section and one after natural childbirth. The most usual intercurrent post-cesarean infection was that of the surgical wound (13% of the infection cases). Analyzed factors, such as delivery duration, duration of rupture of the membranes, number of CD4+ cells or the viral load at peridelivery, did not interfere in puerperal morbidity. CONCLUSIONS: puerperal morbidity was 16.8% and occurred more frequently after cesarean sections (18.9%) than after vaginal deliveries (3.1%). The other factors did not present a significant effect on puerperal morbidity.