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Aims and objectives To compare polyurethane and silicone peripherally inserted central catheters (PICCs) in newborns regarding the success rates of insertion and duration and the reasons for nonelective removal. Background Previous studies have attempted to identify predictors of PICC complications in newborns, such as lower extremity insertion or femoral catheter insertion, procedures that require 60 minutes or more, duration longer than 30 days and non-central position of the catheter tip. However, there is little evidence on which type of PICC material causes less complications, especially in newborns. Design Retrospective cohort, guided by the STROBE tool. Methods We divided the newborns into two groups according to the type of PICC material: polyurethane and silicone. Our sample was composed of 449 PICCs, of which 246 polyurethane PICCs and 203 silicone PICCs, inserted in 294 newborns. Bivariate analysis was performed for data comparison. All statistically significant variables in the bivariate analysis were included in the logistic regression (p ≤ .05). Results Of the 449 PICCs that we analysed, the central position of the catheter tip predominated for both types of materials, with a higher prevalence of false passage for the polyurethane group. There was no difference between the average duration. The incidence of nonelective PICC removal was 49.27% for the silicone group, and infiltration/extravasation and rupture were among the reasons for nonelective removal. Conclusion The overall success rates in the insertion and duration of the PICC were almost identical for both types of material, despite the high incidence of false passage for polyurethane PICCs. Nonelective removals were higher for silicone PICCs, which also had a higher incidence for infiltration/extravasation and rupture. Relevance to clinical practice Can contribute to the knowledge of the strengths and weaknesses of polyurethane and silicone PICCs, with a view to reduce the incidence of nonelective removals.

To compare a new simple algorithm for preeclampsia (PE) prediction among Brazilian women with two international guidelines - National Institute for Clinical Excellence (NICE) and American College of Obstetricians and Gynecologists (ACOG).We performed a secondary analysis of two prospective cohort studies to predict PE between 11 and 13+6weeks of gestation, developed between August 2009 and January 2014. Outcomes measured were total PE, early PE (34weeks), preterm PE (37weeks), and term PE (≥37weeks). The predictive accuracy of the models was assessed using the area under the receiver operator characteristic curve (AUC-ROC) and via calculation of sensitivity and specificity for each outcome.Of a total of 733 patients, 55 patients developed PE, 12 at early, 21 at preterm and 34 at term. The AUC-ROC values were low, which compromised the accuracy of NICE (AUC-ROC: 0.657) and ACOG (AUC-ROC: 0.562) algorithms for preterm PE prediction in the Brazilian population. The best predictive model for preterm PE included maternal factors (MF) and mean arterial pressure (MAP) (AUC-ROC: 0.842), with a statistically significant difference compared with ACOG (p0.0001) and NICE (p=0.0002) guidelines.The predictive accuracies of NICE and ACOG guidelines to predict preterm PE were low and a simple algorithm involving maternal factors and MAP performed better for the Brazilian population.

Aim: To propose a simple model for predicting preeclampsia (PE) in the 1st trimester of pregnancy on the basis of maternal characteristics (MC) and mean arterial pressure (MAP). Methods: A prospective cohort was performed to predict PE between 11 and 13+6 weeks of gestation. The MC evaluated were maternal age, skin color, parity, previous PE, smoking, family history of PE, hypertension, diabetes mellitus and body mass index (BMI). Mean arterial blood pressure (MAP) was measured at the time of the 1st trimester ultrasound. The outcome measures were the incidences of total PE, preterm PE (delivery Results: We analyzed 733 pregnant women; 55 developed PE, 21 of those developed preterm PE and 34 term PE. For total PE, the best model was MC+MAP, which had an area under the receiver operating characteristic curve (AUC ROC) of 0.79 [95% confidence interval (CI)=0.76–0.82]. For preterm PE, the best model was MC+MAP, with an AUC ROC of 0.84 (95% CI=0.81–0.87). For term PE, the best model was MC, with an AUC ROC of 0.75 (0.72–0.79). The MC+MAP model demonstrated a detection rate of 67% cases of preterm PE, with a false-positive rate of 10%, positive predictive value of 17% and negative predictive value of 99%. Conclusion: The MC+MAP model showed good accuracy in predicting preterm PE in the 1st trimester of gestation.

Objective: to estimate medicine consumption during breastfeeding and the risk to the infant. Methods: descriptive study, carried out in a Primary Health Care Unit with 130 infants. The data collection was done through a form with objective questions, analyzed in Epiinfo. Results: 73 (56.0%) nursing mothers had used medication during breastfeeding. The most used drugs were antianemics (n=48, 66.0%) and analgesic/antipyretic drugs (n=11, 14.4%). The majority of the drugs consumed were compatible with breastfeeding (n=71, 97.2%), except for Phenobarbital (n=1, 1.4%) and Losartan (n=1, 1.4%. Conclusion: it was evidenced that medicine consumption during breastfeeding was high among nursing mothers, but most of the drugs presented low risk, that is, they were drugs compatible with lactation. Objetivo: estimar o consumo de medicamentos durante a amamentação e o risco para o lactente. Métodos: estudo descritivo, realizado em Unidade de Atenção Primária à Saúde com 130 lactantes. A coleta de dados ocorreu por meio de formulário com perguntas objetivas, sendo analisados no Epiinfo. Resultados: usaram medicação durante a amamentação 73 (56,0%) lactantes. Os medicamentos mais utilizados foram antianêmico (n=48; 66,0%) e analgésico/antipirético (n=11; 14,4%). A maioria dos medicamentos consumidos era de uso compatível com a amamentação (n=71; 97,2%), exceto o Fenobarbital (n=1; 1,4%) e o Losartana (n=1; 1,4%). Conclusão: evidenciou-se que o consumo de medicamentos durante a amamentação foi alto entre as lactantes, porém foi visto que a maioria dos medicamentos apresentou baixo risco, ou seja, eram drogas compatíveis com a lactação.

Objectives: Check the reliability and validity of Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF) in Brazilian adolecent puerperal mothers who have recently given birth; and evaluate the association of scores of the BSES-SF with the socioeconomic and obstetric variables of the studied population. Methods: Methodological and quantitative study developed in a public maternity in Fortaleza involving 79 adolescent puerperal mothers. The BSES-SF and a form with socioeconomic and obstetric variables were used. Data were analyzed using the SPSS program, considering the Cronbach's Alpha (α) as a measure of reliability, and Pearson's correlation, with significance of 5%. Results: The BSES-SF is a reliable and valid measure (α = 0.807). The teenagers proved to be confident about the practice of breastfeeding (56.15 points). Only education level showed significant association with maternal self-efficacy of adolescents in breastfeeding (p = 0.032). Conclusion: The BSES-SF is a safe and effective tool in the detection of self-efficacy of adolescent mothers in breastfeeding, favoring their assistance in the process of breastfeeding and, hence, the reduction of early weaning.Key words: Breastfeeding; Self-efficacy; Adolescents; Reliability and Validity.

To evaluate the prenatal care assistance in the primary health care network in Fortaleza-CE, considering the structure, process and results. Methods: A cross sectional descriptive study, of quantitative approach, performed between October 2009 and February 2011, in 30 Health Units randomly selected, keeping the ratio for each Regional Executive Secretary. For analysis of the structure, the information obtained was scored and classified as: excellent, satisfactory, precarious or insufficient. The form used was submitted to four experts for validation. In evaluating the process and results, data was available by the Municipal Health Secretary of Fortaleza for obtainance of the indicators recommended by the Ministry of Health. Results: There was, in general, a satisfactory structure. As for the process and result, we obtained: pregnant women who had, at least, six prenatal visits (7.6%); pregnant women who received tetanus immunization (22.8%); newborns with congenital syphilis (1.4%); newborns with neonatal tetanus (0%); maternal mortality rate (78.5% in 2008 and 51% in 2009) and total neonatal mortality rate (10.1% in 2008 and 11.2% in 2009). Conclusions: Despite good results with regard to the structure, the reflections on the process and outcome indicators were not positive, with low rates compared to those expected by the World Health Organization or the Ministry of Health, or in comparison with other regions

OBJETIVO: verificar a acurácia das dosagens séricas maternas do peptídeo atrial natriurético (ANP) e óxido nítrico (NO) para predição de complicações da gravidez. MÉTODOS: a casuística compreendeu 49 mulheres primigestas. As gestantes foram incluídas no estudo na 18ªsemana, momento em que foi coletada a amostra sangüínea para a realização das dosagens séricas. O ANP foi dosado pelo método de radioimunoensaio, utilizando kits Euro-dianostica (2000), considerando anormais valores superiores a 237,4 pg/mL (percentil 95). A dosagem do NO foi realizada pelo método de quimiluminescência, sendo considerados como anormais valores superiores a 17,8 µmol/L (percentil 95). Para análise estatística, utilizaram-se o teste t não pareado para a análise das variáveis quantitativas contínuas de distribuição normal; o teste de Mann-Whitney para amostras quantitativas não-paramétricas; o teste exato de Fisher na avaliação dos parâmentros qualitativos; e o teste de Pearson na avaliação das correlações. RESULTADOS: os dados não mostraram diferença significativa na concentração sérica do ANP, considerando o grupo que apresentou complicações gestacionais e/ou perinatais (média de 139,3±77,1 pg/mL) e o grupo controle (média de 119,6±47,0 pg/mlL), e nem na concentração sérica do NO, entre o grupo com complicações gestacionais e/ou perinatais (média de 11,1±4,6 µmol/L) e o grupo controle (média de 10,0±3,4 µmol/L). CONCLUSÕES: os resultados mostram que o ANP e o NO não foram bons indicadores de complicações da gestação. PURPOSE: to verify the effectiveness of the maternal blood serum assays of the atrial natriuretic peptide (ANP) and nitric oxide (NO) to predict pregnancy complications. METHODS: the sample was made of 49 primigravidae women. They were included in the study at the 18th week of gestation, when blood sample was collected in order to analyze the serum assays. ANP was assayed by radioimmunoassay, using Euro-dianostica kits (2000), considering abnormal values over 237.4 pg/ml (95 percentil). NO level was evaluated by the chemiluminescence method, considering abnormal values over 17.8 mmol/l (percentil 95). For the statistical analysis of continuous quantitative variables with normal distribution, the unpaired t test was used; Mann-Whitney’s test was used for non parametrical quantitative samples; Fisher’s exact test, for the qualitative parameter assessment; and Pearson’s test for the assessment of correlations. RESULTS: there was no significant difference in the blood serum concentration of ANP between the group that presented complications during pregnancy and/or peridelivery (139.3±77.1 pg/ml) and the control group (119.6±47.0 pg/ml), nor in the serum concentration of NO, either, among the ones with complications in the pregnancy and/or in the peridelivery (11.1±4,6 mmol/l) and the control group (10.0±3.4 mmol/l). CONCLUSIONS: the results show that ANP and NO serum levels are not good predictors of pregnancy complications.

Objective: evaluating the effects of using a flipchart as an educational intervention in improving maternal self-efficacy inbreastfeeding. Methods: a quasi-experimental study with 41 postpartum women: Intervention Group (n = 20) and ControlGroup (n = 21) of a public hospital. The intervention consisted of implementing the flipchart “I can breastfeed my baby” inthe immediate postpartum and were contacted by telephone after 15 days. For both groups, Breastfeeding Self-Efficacy Scale-Short Form was applied at baseline and after 30 days. Results: before the intervention, the intervention group was 75% withhigh self-efficacy and 71% of the mothers in the control group of had high self-efficacy. It was found that after educationalintervention, all the mothers in the intervention group showed high self-efficacy, while the percentage remained similar tobefore in the control group (76%). Conclusion: the flipchart had a positive effect on the elevation of self-efficacy in nursingmothers.

OBJETIVO: verificar a quantidade de células CD68+ no estroma das vilosidades coriônicas na placenta de gestações submetidas ou não ao trabalho de parto. MÉTODOS: estudo transversal, com gestantes saudáveis a termo, das quais 31 placentas foram examinadas pela técnica de imunoistoquímica. Vinte placentas foram obtidas após partos vaginais (GVAG) e 11 obtidas em cesarianas eletivas (GCES). Lâminas foram preparadas com amostras de vilosidades coriônicas e submetidas à marcação com anticorpo anti-CD68, específico para macrófagos. Foram contadas as células marcadas e as não marcadas dentro das vilosidades. Testes estatísticos não-paramétricos foram utilizados para a análise. RESULTADOS: entre 6.424 células contadas no estroma das vilosidades das 31 placentas, 1.135 células (17,6%) foram marcadas pelo CD68+. Em cada amostra placentária, a média de células coradas pelo anticorpo anti-CD68 foi de 22±18 para o grupo GVAG e de 20±16 para o grupo GCES. CONCLUSÕES: não houve diferenças significantes no percentual de macrófagos (CD68+) em associação com o trabalho de parto.

OBJETIVO: Comparar a eficácia do Doppler das artérias uterinas e de marcadores séricos maternos na predição de complicações da gestação. MATERIAIS E MÉTODOS: Trata-se de um estudo prospectivo com 49 primigestas, incluídas no estudo na 18ª semana, sendo coletada a amostra sanguínea para a realização das dosagens séricas, realizadas pelo método de quimioluminescência (alfa-fetoproteína, gonadotrofina coriônica humana e óxido nítrico) e radioimunoensaio (peptídio atrial natriurético). O Doppler das artérias uterinas foi realizado entre 24-26 semanas, determinando a presença ou ausência de incisura na onda de velocidade de fluxo. Na análise estatística utilizou-se o teste de Mann-Whitney, para amostras não-paramétricas, e o teste exato de Fisher, para parâmetros qualitativos. RESULTADOS: Os valores de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo foram, respectivamente, de 8,3%, 97,0%, 50,0% e 74,4% para a alfa-fetoproteína; 8,3%, 87,9%, 20,0% e 72,5% para a gonadotrofina coriônica humana; 16,7%, 97,0%, 33,3% e 76,2% para o peptídio atrial natriurético; e 16,7%, 93,9%, 50,0% e 75,6% para o óxido nítrico. A sensibilidade do Doppler foi de 75,0%, especificidade de 63,6%, valor preditivo positivo de 57,1% e valor preditivo negativo de 87,5%. CONCLUSÃO: O Doppler das artérias uterinas é melhor preditor de complicações da gestação quando comparado a alguns marcadores séricos em populações de baixo risco. OBJECTIVE: To compare the effectiveness of uterine artery Doppler and maternal serum screening in the prediction of pregnancy complications. MATERIALS AND METHODS: Prospective study with 49 primigravidae at their 18th gestational week, when a blood sample was collected for serum dosage by chemiluminescence (alpha-fetoprotein, human chorionic gonadotropin and nitric oxide) and radioimmunoassay (atrial natriuretic peptide). Uterine artery Doppler was performed between the 24th and 26th gestational weeks, for determining the presence or absence of notch in the flow velocity waveform. The non-parametric Mann-Whitney test was utilized for statistical analysis, and the Fisher exact test for analysis of qualitative parameters. RESULTS: Sensitivity, specificity, positive and negative predictive values were, respectively, 8.3%, 97.0%, 50.0% and 74.4% for alpha-fetoprotein; 8.3%, 87.9%, 20.0% and 72.5% for human chorionic gonadotropin; 16.7%, 97.0%, 33.3% and 76.2% for atrial natriuretic peptide; and 16.7%, 93.9%, 50.0% and 75.6% for nitric oxide. The uterine artery Doppler sensitivity was 75.0%, specificity 63.6%, positive predictive value 57.1%, and negative predictive value 87.5%. CONCLUSION: Uterine artery Doppler is an effective method for prediction of pregnancy complications as compared with maternal serum screening in low risk populations.

O objetivo da pesquisa foi avaliar autoeficácia em amamentar entre adolescentes lactantes. Estudo quantitativo, que envolveu 172 adolescentes lactantes, realizado em 14 Unidades Básicas de Saúde de municípios do nordeste do Brasil. Para a coleta utilizou-se um formulário e aplicou-se a Breastfeeding Self-Efficacy Scale-Short Form. Os dados foram analisados em programa estatístico. Os resultados apontaram elevada autoeficácia em amamentar (84%), com maior adesão aos itens: “Eu sempre percebo se o meu bebê está pegando o peito direitinho durante toda a mamada” (91%) e “Eu sempre sei quando o meu bebê terminou a mamada” (93%) e menor referente a alimentar o bebê sem usar leite em pó (18%) e amamentar na frente das pessoas (14%). Constatou-se que as mães adolescentes estudadas apresentaram elevada autoeficácia em amamentar, evidenciando um novo conhecimento em relação a esse público específico, em geral, relacionado a vulnerabilidade diante do aleitamento materno.

Medicações, álcool e fumo podem gerar danos fetais. Este estudo transversal foi realizado entre 2006 e 2007, com 326 puérperas do Hospital Geral de Fortaleza, para avaliar o uso de medicamentos, álcool e fumo na gestação e potencial teratogênico relacionado a diferentes características populacionais. Incluíram-se as puérperas com partos no local da pesquisa e excluíram-se as que não tinham seus filhos internados. Na análise, utilizaram-se os testes Qui-quadrado e t de Student, adotando p < 0,05. O consumo de medicamentos ocorreu em 96,6% (2,8 medicamentos/gestante), e 11,3% automedicaram-se. Solteiras utilizaram mais medicações com alto risco teratogênico (p = 0,037). Foram observados 11 casos de malformação fetal, sendo cinco expostos a elevado risco teratogênico, na gestação. O tabagismo ocorreu em 11,3%, e o etilismo em 16%. Observou-se como fator de risco para exposição a maior risco teratogênico o estado civil solteira. Outras variáveis sociodemográficas e a qualidade do pré-natal não se mostraram relacionadas ao risco teratogênico das exposições. Medications, alcohol and smoking can cause fetal damage. A cross-sectional study was conducted with 326 mothers of the Fortaleza General Hospital to evaluate the use of drugs, alcohol and smoking during pregnancy and its relation to teratogenic potential in different population characteristics, between 2006 and 2007. Postpartum women who had their babies in the research site were included and those whose babies were not admitted as hospital inpatients were excluded. Chi-square tests and t-tests were used in the analysis, with a p value