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BACKGROUND: The use of the pelvic floor muscle training for urinary incontinence treatment is well established but little is known about its effects in labor and newborn outcomes. OBJECTIVES: To evaluate the effects of antenatal pelvic floor muscle training and strength in labor and newborn outcomes in low-income pregnant women. METHODS: This is a randomized controlled trial that recruited forty-two nulliparous healthy pregnant women aged between 18-36 years old and able to contract the pelvic floor muscles. The participants were included in the study with 20 weeks of gestational age and had their pelvic floor muscles measured by vaginal squeeze pressure. They were randomly allocated into two groups: training group and a non-intervention control group. Then, all participants had their labor and newborn outcomes evaluated through consultation of medical records by a blinded researcher. RESULTS: There were no statistically significant differences between the groups regarding gestational age at birth, type of labor, duration of the second stage of labor, total time of labor, prevalence of laceration, weight and size of the baby, and Apgar score. No correlation was observed between pelvic floor muscle strength and the second stage or the total length of labor. CONCLUSIONS: This randomized controlled trial did not find any effect of pelvic floor muscle training or pelvic floor muscle strength on labor and newborn outcomes.CONTEXTUALIZAÇÃO: O treinamento da musculatura do assoalho pélvico para tratamento da incontinência urinária é bem estabelecida, mas pouco se sabe sobre seus efeitos sobre o parto e o recém-nascido. OBJETIVOS: Avaliar se os desfechos do parto e os resultados dos recém-nascidos são influenciados pelo treinamento e força da musculatura do assoalho pélvico realizados por gestantes de baixa renda. MÉTODOS: Trata-se de um ensaio clínico randomizado que incluiu 42 gestantes nulíparas de baixo risco, com idade entre 18 e 36 anos, e que eram capazes de contrair a musculatura do assoalho pélvico. As gestantes foram incluídas no estudo com 20 semanas de idade gestacional, e realizava-se a avaliação da pressão de contração vaginal pela contração da musculatura do assoalho pélvico. Elas foram randomizadas em dois grupos: grupo de treinamento e grupo controle. Todas as voluntárias tiveram o trabalho de parto e os resultados dos recém-nascidos avaliados por meio de consulta ao prontuário por um pesquisador não envolvido com o grupo de treinamento. RESULTADOS: Não houve diferença significativa entre os grupos quanto à idade gestacional no nascimento, tipo de parto, duração da segunda fase de trabalho de parto, tempo total de trabalho de parto, prevalência da laceração perineal, peso e tamanho do bebê e índice de Apgar. Nenhuma correlação foi encontrada entre a força muscular do assoalho pélvico e a segunda fase ou a duração total do trabalho de parto. CONCLUSÕES: Este ensaio clínico randomizado não verificou qualquer influência do treinamento muscular do assoalho pélvico e da força dos músculos do assoalho pélvico sobre o trabalho de parto e os resultados do recém-nascido.

Milena B Brito1,2, Rui A Ferriani1,2, Silvana M Quintana1, Marcos F Silva de Sá1,2, Carolina S Vieira1,21Department of Gynecology and Obstetrics, University of Sao Paulo, Ribeirao Preto School of Medicine, Ribeirão Preto, Brazil; 2National Institute of Hormones and Women’s Health, Ribeirão Preto, BrazilObjective: To evaluate the safety, in terms of renal and hepatic function, of the etonogestrel (ENG)-releasing contraceptive implant inserted immediately postpartum.Methods: A total of 40 healthy women were randomized; 20 received the ENG-releasing implant inserted 24 to 48 hours after delivery (ENG group), and 20 received depot medroxyprogesterone acetate in the sixth week postpartum (control group). Alkaline phosphatase, gamma-glutaryl transferase, alanine aminotransferase, aspartate aminotransferase, total bilirubin and its fractions, albumin, urea, and creatinine were analyzed.Results: There was no statistically significant difference between the groups in serum hepatic markers or urea levels during the study. Creatinine levels increased in both groups during the first six weeks, more significantly in the ENG group than in the control group (ENG +40% versus control +20%, P = 0.04). This increase was followed by a greater decrease in the ENG group than in the control group 6–12 weeks postpartum (ENG -14.3% versus control -3.8%, P = 0.02). However, these changes were still within the normal ranges for the assays performed.Conclusion: The ENG-releasing contraceptive implant inserted immediately postpartum was not associated with clinically significant changes in serum markers of liver or kidney function.Keywords: etonogestrel, renal, hepatic, postpartum period, contraception, implant

Foetal exposure to lead (Pb) during pregnancy is a major problem. However, no previous study has examined whether Pb concentrations in blood (Pb-B) and in serum (Pb-S) from pregnant women correlate with Pb-B and Pb-S in the foetuses. This hypothesis was tested in the present study. We measured Pb-B and Pb-S in 120 healthy pregnant women (more than 38 weeks of gestation) and their respective umbilical cord samples. The analyses were carried out with an inductively coupled plasma mass spectrometer. We found higher Pb-B levels in the women compared with their respective umbilical cord samples (1.736 ± 0.090 μg/dL and 1.194 ± 0.062 μg/dL, respectively; p0.05). In parallel, we found higher Pb-S levels in the women compared with their respective umbilical cord samples (0.042 ± 0.003 μg/dL and 0.032 ± 0.003 μg/dL, respectively; p0.05). However, similar %Pb-S/Pb-B ratios were found in the women compared with their respective umbilical cord samples (2.414 ± 0.210% and 2.740 ± 0.219%, respectively; p0.05). Interestingly, we found positive correlations between Pb-B in the umbilical cords and Pb-B in the respective pregnant women (rs = 0.5714; p0.0001), and between Pb-S in the umbilical cords and Pb-S in the respective pregnant women (rs = 0.3902; p0.0001) as well as between %Pb-B/Pb-S in the umbilical cords and %Pb-B/Pb-S in the respective pregnant women (rs = 0.3767; p0.0001). These results indicate that the assessment of Pb-B and Pb-S in pregnant women provides relevant indexes of foetal exposure to Pb. Moreover, the similar %Pb-S/Pb-B in pregnant women and in the umbilical cords shows that the foetuses are directly exposed to the rapidly exchangeable Pb fraction found in their mothers.

Importante foco de atenção em Saúde Pública tem sido a avaliação de determinados micronutrientes no ser humano, em especial aqueles que se encontram associados à vulnerabilidade orgânica, conseqüente ao desiquilíbrio ou à deficiência desses micronutrientes. Entre os micronutrientes, a hipovitaminose A tem sido objeto de realce devido à significante prevalência em populações de países em desenvolvimento. Este artigo aborda a Vitamina A, enfocando seu metabolismo e as repercussões deletérias, decorrentes de sua deficiência sobre o organismo, suas manifestações no ciclo gravidopuerperal, e sua interação em situações clínicas, específicas.