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To evaluate the knowledge, attitude, and practice (KAP) of pelvic floor muscle (PFM) preparation for birth among postpartum women, and its related factors.Cross-sectional study conducted in a maternity unit among Brazilian women aged 14 years or older during the first 72 h postpartum, who desired and had vaginal birth. Sociodemographic, clinical, and obstetric data were collected using a standardized form from medical charts. A 15-question questionnaire was used to measure the KAP of PFM preparation for birth. Knowledge was categorized as: poor, average, and good.In all, 326 women completed the survey (mean age 24.3 ± 6.2 years) and 167 (51.2%) women had poor knowledge. The attitude of searching for information on how to prevent perineal trauma was reported by 14 (4.3%) women. Only 13 (4.0%) participants reported that they had practiced at least one session of PFM preparation during pregnancy (PFM training, perineal massage, etc.) Multivariate analysis showed that lower educational level was associated with poor knowledge (P 0.05).The KAP of PFM preparation for birth is inadequate among postpartum women. Health education regarding PFM care during pregnancy and postpartum should be addressed among pregnant women, specifically younger women with lower levels of education and income.

Objective To assess the levels of physical activity and exercise practice, and examine the associated maternal characteristics; as well as the anxiety levels of high-risk pregnant women. Methods A cross-sectional study conducted with pregnant women at a High-risk Prenatal Clinic (HRPC) in a tertiary maternity. Pregnant women of 18 to 40-years-old, with a single fetus, and with gestational age up to 38 weeks were included. The level of physical activity and exercise practice of the study’s participants were investigated using the Pregnancy Physical Activity Questionnaire (PPAQ). Maternal sociodemographic, anthropometric, and medical data were investigated using a specific form. For anxiety levels, the short version of the State-Trait Anxiety Inventory (STAI) was applied. We used the Student t-test, chi-square test, odds ratio (OR) with 95% confidence interval (95% CI) and multiple logistic regression. The significance level was 5%. Results Among the 109 pregnant women included, 82 (75.2%) were classified as sedentary/little active. The higher energy expenditure were for domestic activities (133.81±81.84 METs), followed by work-related activities (40.77±84.71 METs). Only 19.3% women exercised during pregnancy (4.76±12.47 METs), with slow walking being the most reported exercise. A higher level of education was the most important factor associated with women being moderately or vigorously active (OR=29.8; 95% CI 4.9-117.8). Nulliparity (OR=3.1; 95% CI 1.0-9.1), low levels of anxiety (OR=3.6; 95% CI 1.2-10.7), and unemployment (OR=4.8; 95% CI 1.1-19.6) were associated with the practice of exercise during pregnancy. Conclusion Most women with high-risk pregnancies exhibited a sedentary pattern, with low prevalence of physical exercise practice. Recognizing factors that hinder the adoption of a more physically active lifestyle is essential for an individualized guidance regarding exercise during pregnancy. Resumo Objetivo Analisar o nível de atividade física e a prática de exercício físico, examinar as características maternas associadas, assim como níveis de ansiedade de gestantes de alto risco. Métodos Estudo observacional, transversal e quantitativo, realizado no ambulatório de Pré-Natal de Alto Risco (PNAR) de uma maternidade terciária. Foram incluídas gestantes comidade entre de 18 e 40 anos; feto único e comidade gestacional (IG) até 38 semanas.O nível de atividade física e prática de exercício físico das participantes do estudo foram investigados usando o Questionário de Atividade Física na Gestação (QAFG). Os dados sociodemográficos, antropométricos e médicos maternais foram investigados usando um formulário específico. Para níveis de ansiedade, a versão curta do Inventário de Ansiedade Traço-Estado (STAI) foi aplicado. Usamos o teste t de Student, teste qui-quadrado, razão de chances (OR) com um intervalo de confiança de 95% (IC 95%) e regressão logística multinomial. O nível de significância considerado foi 5%. Resultados Das 109 gestantes incluídas no estudo, 82 (75,2%) foi classificada como sedentária/pouco ativa. Os maiores gastos energéticos foram em atividades domésticas (133.81±81.84 METs), seguidas pelas atividades ocupacionais (40.77±84.71 METs). Apenas 19.3% praticaram exercício físico durante a gravidez (4.76±12.47 METs), sendo a caminhada lenta a atividade mais relatada. Maior grau de escolaridade foi o fator mais importante associado a gestante ser moderadamente ou vigorosamente ativa (OR=29,8; IC 95% 4,9-117,8) . Nuliparidade (OR=3,1; IC 95% 1,0-9,1), baixos níveis de ansiedade (OR=3,6; IC 95% 1,2-10,7) e não trabalhar na gestação (OR=4,8; IC 95% 1.1-19,6) foram associados à prática de exercício físico durante a gestação. Conclusão A maioria das gestantes de alto risco desenvolveram um padrão sedentário, com baixa prevalência da prática de exercício físico. Reconhecer os fatores que dificultam a adoção de um estilo de vida mais ativo fisicamente é fundamental para a orientação adequada e individualizada acerca da prática de exercício físico durante a gestação.

Introduction: Behavioral therapy (BT) is an association of techniques that aim to minimize or abolish urinary symptoms, including urinary incontinence (UI), through education about the health condition, changes in lifestyle and nutritional habits, and bladder training. Objective: To analyze whether there is a change in the quality of life and severity of UI after group behavioral therapy in women with UI. Methods: Prospective observational study conducted in a pelvic physical therapy public service. Women with UI of any etiology, over 18 years of age, who completed a protocol of four weekly group BT meetings as the first treatment option for UI were included. Outcomes (impact of UI on QoL and classification of UI severity) were assessed before, immediately after, and one month after BT using the King's Health Questionnaire (KHQ) and the Incontinence Severity Index (ISI). Results: Sample of 146 participants. A reduction in the impact of UI on QoL was observed in the KHQ domains: impact of UI, physical limitations, personal relationships, emotions, general health perception (p < 0.05) immediately after BT. After one month, there was a reduction in the UI impact domains, daily activity limitations, physical limitations, general health perception, emotions, and sleep (p < 0.05). In addition, there was a reduction in the classification of UI severity assessed by the ISI (p < 0.001). Conclusion: There was an improvement in QoL and a decrease in UI severity in women with UI who completed a BT group as the first treatment option. Resumo Introdução: A terapia comportamental (TC) é uma associação de técnicas que visam minimizar ou abolir sintomas urinários, incluindo a incontinência urinária (IU), por meio da educação sobre a condição de saúde, mudanças em hábitos de vida e alimentares e treinamento vesical. Objetivo: Analisar se existe alteração da qualidade de vida e da gravidade da IU após terapia comportamental em grupo de mulheres com IU. Métodos: Estudo observacional prospectivo realizado em um serviço público de fisioterapia pélvica. Mulheres com IU de qualquer etiologia e maiores de 18 anos foram submetidas a um protocolo de quatro encontros de TC em grupo, semanalmente, como primeira opção de tratamento para IU. Os desfechos, impacto da IU na qualidade de vida (QV) e classificação da gravidade da IU foram avaliados antes, imediatamente após e um mês depois da TC pelos questionários King's Health Questionnaire (KHQ) e Incontinence Severity Index (ISI). Resultados: Amostra de 146 participantes. Observou-se redução do impacto da IU na QV nos domínios do KHQ: impacto da IU, limitações físicas, relações pessoais, emoções, percepção geral de saúde (p < 0,05) imediatamente após a TC. Após um mês, observou-se redução nos domínios de impacto da IU nas limitações de atividades diárias, limitações físicas, percepção geral de saúde, emoções e sono (p < 0,05), além da redução na classificação de gravidade da IU avaliada pelo ISI (p < 0,001). Conclusão: Houve melhora da QV e diminuição da gravidade da IU em mulheres com IU submetidas à TC em grupo como primeira opção de tratamento.

Introduction: Sarcopenia and obesity are associated with several health conditions. Few studies, however, have analyzed the presence of these conditions in climacteric women with incontinence, and the association between these conditions and the severity of urinary incontinence (UI) is not clear. Objective: To analyze probable sarcopenia, sarcopenia, and obesity in climacteric women with different UI severities, and the association between sarcopenia and UI severity. Methods: This was a cross-sectional study in a public maternity hospital in Northeast Brazil, with women aged ≥ 40 years. Sociodemographic issues, urogynecological history, UI severity (Incontinence Severity Index - ISI), grip strength, and anthropometric measures (waist circumference and body mass index - BMI) were evaluated. Means, standard deviations, absolute and relative frequencies, T test, and Fisher exact test were used (significance at 5%). Results: The sample comprised 177 women, with a mean age of 56.3 (± 9.7) years. Regarding UI, 69 (39.0%) women presented mixed UI, and 53.1% presented moderate UI severity. Only 18.1% women had normal BMIs, and 46.8% had general obesity and 80.3% had abdominal obesity. Probable sarcopenia (low strength) was observed in 35 (20%) women, and sarcopenia, in 3.4%. Women with severe/very severe UI presented lower grip strengths (p = 0.02) and higher BMIs (p = 0.04). Sarcopenia was associated with greater UI severity (p = 0.005). Conclusion: Probable sarcopenia and higher BMI were observed in women with greater UI severities, and sarcopenia was associated with greater UI severity. Preventive measures are needed in such conditions to avoid future complications. Resumo Introdução: Sarcopenia e obesidade têm relação com diversas condições de saúde. Poucos estudos, entretanto, têm analisado a presença destas condições em mulheres incontinentes no climatério, e não está claro se existe associação destas com a gravidade da incontinência urinária (IU). Objetivo: Analisar provável sarcopenia, sarcopenia e obesidade em mulheres com diferentes gravidades de IU na fase do climatério e a associação da sarcopenia com a gravidade da IU. Métodos: Estudo transversal realizado em maternidade pública do nordeste do Brasil, em mulheres com IU a partir de 40 anos. Foram avaliadas questões sociodemográficas, histórico uroginecológico, gravidade da IU (Incontinence Severity Index - ISI), força de preensão e medidas antropométricas (circunferência abdominal e índice de massa corporal - IMC). Foram analisadas médias e desvios-padrão, frequências absolutas e relativas, teste T e exato de Fisher (significância de 5%). Resultados: Amostra de 177 mulheres com média de 56,3 (± 9,7) anos. Sobre a IU, 69 (39,0%) mulheres apresentavam IU mista e 53,1% gravidade moderada. Apenas 18,1% apresentavam IMC normal, 46,8% obesidade geral e 80,3% obesidade abdominal. Provável sarcopenia (baixa força) foi observada em 35 (20%) mulheres e sarcopenia em 3,4%. Mulheres com IU grave ou muito grave apresentaram menor força de preensão (p = 0,02) e maior IMC (p = 0,04). A sarcopenia foi associada à maior gravidade de IU (p = 0,005). Conclusão: Observou-se provável sarcopenia e maior IMC em mulheres com maior gravidade de IU e associação da sarcopenia com a maior gravidade de IU. São necessárias medidas preventivas quanto a tais condições, evitando futuras complicações.

To analyze the relationship between the symptoms of pelvic floor dysfunction (PFD) and quality of life (QoL), as well as the function of the pelvic floor muscle (PFM) in women with urinary incontinence (UI). A cross-sectional study conducted in two centers in Brazil (Northeast and Southeast regions) with women with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). Data on pelvic floor symptoms, discomfort and impact on QoL were collected using the Pelvic Floor Distress Inventory-short form (PFDI-SF-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) instruments. PFM function was assessed by palpation (PERFECT scale) and manometry. Pearson’s correlation test, analysis of variance (ANOVA) and the Student’s t test were used to discriminate the differences, adopting a significance level of 5%. A total of 72 women participated in the study (mean age 51.7 ± 11.9 years). The presence and discomfort of pelvic floor symptoms (PFDI-SF-20) were correlated with QoL (PFIQ-7) (r = 0.52, p

Vaginal delivery is a well‐known risk factor for pelvic floor muscle (PFM) injuries, mainly when associated to prolonged labor, instrumental birth and perineal trauma such as episiotomy and perineal tears. The purpose of this meta-analysis was to test the hypothesis that episiotomy and severe perineal tear may increase the risk of pelvic floor damage. We performed a systematic literature search through electronic databases including MEDLINE via PubMed, LILACS via BVS, Embase via Elsevier and Cochrane Library up to January 2019. We included articles that reported as outcome one or more morphological aspects of the PFM evaluated by ultrasonography in primiparous women three to 24 months postpartum. This review is registered in the PROSPERO database (registration number: CRD42017075750). the final selection was composed of 18 articles for the systematic review, and 10 for the meta-analysis. Women with levator ani muscle (LAM) avulsion were 1.77 times more likely to have undergone episiotomy (OR = 1.77, CI 95% 1.25–2.51, five trials), 4.31 times more likely to have severe perineal tear (OR = 4.31, CI 95% 2.34–7.91, two trials). Women with defects in the anal sphincters were 2.82 times more likely to have suffered severe perineal tear (OR = 2.82, 95% CI 1.71–4.67, three trials). Both episiotomy and severe perineal tear are risk factors for LAM avulsion and anal sphincter injury, and this can be useful for identifying women who are at greater risk of developing PFM dysfunctions.

Resumo Introdução: A gestação predispõe o surgimento de disfunções do assoalho pélvico (DAP), sendo o pós-parto momento oportuno para avaliar essa musculatura. Objetivo: Investigar o efeito das instruções e feedback verbais na capacidade de contração dos músculos do assoalho pélvico (MAP) em puérperas. Métodos: Estudo quase-experimental com 109 mulheres no pós-parto vaginal imediato em uma maternidade de referência em Fortaleza-CE. Realizou-se inspeção visual dos MAP pela escala visual de contração (0 = nenhuma contração visível; 1 = contração visível fraca; 2 = contração visível com elevação perineal), além de observação da utilização de musculatura e movimentos acessórios. As avaliações foram em momentos consecutivos: 1 - contração dos MAP ao comando verbal; 2 - contração após instruções sobre estrutura, função e correta contração; e 3 - contração após feedback sobre a utilização de musculatura acessória e reforço da correta contração. Para comparação dos desfechos entre os momentos foi utilizado o teste Q de Cochran e significância de 5%. Resultados: No primeiro momento, 15,6% das puérperas não apresentaram contração visível dos MAP (grau 0). Dessas, 70,5% modificaram o grau de contração após instruções e feedback. Ao final, 45,9% das mulheres contraíram corretamente os MAP com elevação perineal (grau 2) (p < 000,1). A utilização de músculos acessórios (adutores, abdominais e glúteos) diminuiu após instruções e feedback (p < 000,1). Trauma perineal, parto a fórceps, informações prévias e medo de sentir dor não se associaram ao grau de contração. Conclusão: Instruções e feedback verbais são ferramentas úteis para contração correta dos MAP no pós-parto imediato.

Resumo Introdução: Sarcopenia e obesidade têm relação com diversas condições de saúde. Poucos estudos, entretanto, têm analisado a presença destas condições em mulheres incontinentes no climatério, e não está claro se existe associação destas com a gravidade da incontinência urinária (IU). Objetivo: Analisar provável sarcopenia, sarcopenia e obesidade em mulheres com diferentes gravidades de IU na fase do climatério e a associação da sarcopenia com a gravidade da IU. Métodos: Estudo transversal realizado em maternidade pública do nordeste do Brasil, em mulheres com IU a partir de 40 anos. Foram avaliadas questões sociodemográficas, histórico uroginecológico, gravidade da IU (Incontinence Severity Index - ISI), força de preensão e medidas antropométricas (circunferência abdominal e índice de massa corporal - IMC). Foram analisadas médias e desvios-padrão, frequências absolutas e relativas, teste T e exato de Fisher (significância de 5%). Resultados: Amostra de 177 mulheres com média de 56,3 (± 9,7) anos. Sobre a IU, 69 (39,0%) mulheres apresentavam IU mista e 53,1% gravidade moderada. Apenas 18,1% apresentavam IMC normal, 46,8% obesidade geral e 80,3% obesidade abdominal. Provável sarcopenia (baixa força) foi observada em 35 (20%) mulheres e sarcopenia em 3,4%. Mulheres com IU grave ou muito grave apresentaram menor força de preensão (p = 0,02) e maior IMC (p = 0,04). A sarcopenia foi associada à maior gravidade de IU (p = 0,005). Conclusão: Observou-se provável sarcopenia e maior IMC em mulheres com maior gravidade de IU e associação da sarcopenia com a maior gravidade de IU. São necessárias medidas preventivas quanto a tais condições, evitando futuras complicações.

Resumo Introdução: A terapia comportamental (TC) é uma associação de técnicas que visam minimizar ou abolir sintomas urinários, incluindo a incontinência urinária (IU), por meio da educação sobre a condição de saúde, mudanças em hábitos de vida e alimentares e treinamento vesical. Objetivo: Analisar se existe alteração da qualidade de vida e da gravidade da IU após terapia comportamental em grupo de mulheres com IU. Métodos: Estudo observacional prospectivo realizado em um serviço público de fisioterapia pélvica. Mulheres com IU de qualquer etiologia e maiores de 18 anos foram submetidas a um protocolo de quatro encontros de TC em grupo, semanalmente, como primeira opção de tratamento para IU. Os desfechos, impacto da IU na qualidade de vida (QV) e classificação da gravidade da IU foram avaliados antes, imediatamente após e um mês depois da TC pelos questionários King's Health Questionnaire (KHQ) e Incontinence Severity Index (ISI). Resultados: Amostra de 146 participantes. Observou-se redução do impacto da IU na QV nos domínios do KHQ: impacto da IU, limitações físicas, relações pessoais, emoções, percepção geral de saúde (p < 0,05) imediatamente após a TC. Após um mês, observou-se redução nos domínios de impacto da IU nas limitações de atividades diárias, limitações físicas, percepção geral de saúde, emoções e sono (p < 0,05), além da redução na classificação de gravidade da IU avaliada pelo ISI (p < 0,001). Conclusão: Houve melhora da QV e diminuição da gravidade da IU em mulheres com IU submetidas à TC em grupo como primeira opção de tratamento.

To evaluate the responsiveness of Brazilian-Portuguese version of Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) after pelvic floor muscle training (PFMT) in women with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI).This is an observational study with 72 women (51.8 ± 11.9SD years) with SUI (n = 33) and MUI (n = 39). Participants answered PFDI-20 and PFIQ-7 before and after PFMT, which consisted of a 12 weeks protocol supervised by a physiotherapist once a week with 30 min of a duration. Wilcoxon test, effect size (ES) and standardized response mean (SRM) were performed on baseline and after three months.We found a significant reduction in PFDI-20 and PFIQ-7 after PFMT (p 0.001), except for Pelvic Organ Prolapses Distress Inventory (POPDI-16), Colorectal-Anal Impact Questionnaire (CRAIQ-7) and Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7). The responsiveness of both questionnaires was considered moderate for PFDI-20 (ES = 0.49; SEM = 0.61; p 0.0001) and PFIQ-7 (ES = 0.51; SEM = 0.52; p 0.0001).PFDI-20 and PFIQ-7 Brazilian Portuguese version presented moderate responsiveness in women with SUI and MUI who performed a PFMT.

Objective This study aimed to adapt the Questionnaire for Urinary Incontinence Diagnosis (QUID) into Brazilian Portuguese (QUID-Br) and evaluate its measurement properties, given as reliability, validity, and responsiveness in women with urinary incontinence. Study design It was a methodological study which enrolled 168 women (mean age = 55.1, standard deviation = 17.9 years old). Translation and cross-cultural adaptation were done and subsequently analysis of the measurement properties of QUID-Br were tested: structural validity (by exploratory and confirmatory factory analysis) internal consistency (Cronbach’s α) construct validity (Pearson Correlation), and test-retest reliability (Intraclass Correlation Coefficient). Results The QUID-Br two-factor was confirmed showing two domains with three items each: stress urinary incontinence (SUI) and urge urinary incontinence (UUI). Furthermore, QUID-Br showed acceptable internal consistency for both scales (Cronbach’s α > 0.70), reliability [intraclass correlation coefficient (ICC = 0.85 for SUI and 0.87 for UUI)] with 95 % confidence interval (CI) and construct validity - with all the hypothesis raised a priori being confirmed. Conclusions The results of the present investigation showed that the QUID-Br is a valid, reliable, and consistent instrument to be administered to Brazilian women and its use is recommended in clinical practice and research.

To analyze the Cesarean Section (CS) rate in Brazilian women according to category of health insurance and individual characteristics associated with the mode of delivery.A cross-sectional study was performed in three maternity services (one public tertiary referral center, one maternity service for both public and private care, and one private maternity service) in Campinas city, Brazil. Eligibility criteria were: inpatient during the immediate postpartum period, hospital birth, single pregnancy, and live newborn. Sociodemographic and anthropometric data, reproductive history, pregnancy planning, and prenatal care information was obtained from participants. Comorbidities, type of birth, and newborn data were collected from medical records. The mode of delivery was categorized as either CS or vaginal delivery.A total of 1276 women were included in this study. The overall CS rate was 57.5%. CS rates were 41.6, 54.8, and 90.1% for public, mixed (public and private), and private maternity services, respectively. Mean age was higher in women who had a CS (28.0 ± 6.0 years versus 25.9 ± 6.5 years, p .0001) as was the mean Body Mass Index (25.2 ± 5.3 kg/mThe overall CS rate was high (greater than 50%); in the private service, almost all participants had a CS delivery (90.1%). Better socioeconomic conditions and primiparity were associated with higher CS rates in Brazil. Political pressure for the management of unnecessary CSs is vital in Brazil. Together with the provision of real incentives for normal deliveries in public and, most importantly, private services.

AIMS To assess the effects of individual pelvic floor muscle (PFM) training vs individual training (IT) progressing to group training (GT) vs group-only training in women with stress urinary incontinence (SUI). METHODS Randomized controlled and pragmatic clinical trials with 90 women with SUI. Participants were randomly allocated to one of three groups: IT, GT, or four individual sessions progressing to group training (IPGT). The intervention included 12 sessions, once a week, with direct supervision by a physical therapist. PRIMARY OUTCOME severity according to the King's Health Questionnaire. SECONDARY OUTCOMES PFM function by palpation and manometer, bladder and exercise diaries, PFM training adherence, and self-efficacy. Reassessments were conducted at the end of the intervention, 3 and 6 months after the intervention. Intra- and intergroup analysis for all outcomes was performed using a multivariate analysis of variance. In the mixed-effects model used, the evaluation groups and times and their interactions were considered. A significance level of 5% was adopted. RESULTS After the intervention, the severity measure improved in all three groups (P

To explore information available in the literature about the possible benefits resulting from physical activity (PA) in non-risky pregnant women, repercussion on maternal organism, fetal development, and on long-term offspring health.Critical narrative review using online databases.Through critical discussion of studies focused on PA practiced during pregnancy, it was observed that some of the outcomes investigated on both mother and offspring showed conflicting findings. Considering the impact of maternal PA in certain offspring characteristics, due to the fact that their findings come from studies with small samples, they do not allow the stablishment of scientific evidence. However, a feature that shows broad consensus among studies is the view of PA during pregnancy as a safe intervention for mother and fetus. In situations where studies employing PA of moderate-intensity have not enough power to ensure a positive influence on certain clinical outcomes, what is observed is the lack of their influence, not negative impacts. Regarding epigenetic modulations measured late in the offspring, it has been attributed to PA a positive modulatory role on metabolic, hemodynamic and even on behavioral characteristics. However, possible mechanisms involved in these epigenetic changes have not been sufficiently explored.Maternal PA appears to be safe for both mother and fetus, and additional studies are needed to confirm the real influence of this practice in the offspring, as well as the perpetuation and transfer of these features between generations.

To identify, by qualitative and quantitative studies, the psychological aspects considered and/or evaluated during the prenatal care of obese pregnant women, as well as the psychological interventions adopted by health services.Systematic review of literature using a mixed method approach, integrating both quantitative and qualitative studies. We used databases (Medline/PubMed, Web of Science, Embase, and SciELO) and publications from January 2003 to June 2013 using "Obesity," "Pregnancy," "Psy,*" or "Psychology" as Medical Subject Headings (MeSH terms). Prospective cohort, cross-sectional, case-control, clinical trial, and qualitative research studies were included. Eight articles are included in this review, three with qualitative and five with quantitative methodology.The majority of the studies demonstrate that emotional problems such as depression, anxiety, and stress are associated with the raising of Body Mass Index (BMI) during pregnancy. The results of the qualitative studies show psychological distress related to humiliation and exposure to stigmas surrounding obesity and its connection with gestation.There is an emotional demand related to obesity during pregnancy, which should be considered by prenatal multidisciplinary care team. There is a need to increasing attention and support provided for obese pregnant women.

Introduction Many studies have been developed to investigate the relationship between urinary incontinence (UI) and female sexuality especially how it interferes on the sexual function of affected women, but many questions remain unclear. Objectives To summarize the relevant scientific literature published in the last 10 years that focused on the study of the impact of UI on the sexual function of incontinent women. Methods The PubMed and Bireme databases were searched using the keyword string “urinary incontinence” and “sexual function” or “sexual satisfaction” or “sexuality” for studies focusing the impact of UI on the sexual function of affected women older than 18 years, published in the last 10 years. Main outcome measures The main outcome measure was the review of published literature on the impact of UI on sexual function by reporting study design, group of population studied, type of UI, and findings. Results 18 studies were selected for the study. UI has a negative impact on sexual function. The type of UI affected the quality of life and sexual function of the women in different ways. There is a shortage of articles that further study the underlying mechanisms of negative UI outcomes in sexual function. Conclusion UI has negative impact on sexual function. It is probable that this interference, directly or indirectly, contributes decisively to the avoidance of women in having sex. The way this influence occurs remains unclear, especially when we seek to understand the mechanisms involved in this outcome. Pinheiro Sobreira Bezerra LR, Britto DF, Ribeiro Frota IP, et al. The Impact of Urinary Incontinence on Sexual Function: A Systematic Review. Sex Med 2020;8:393–402.

To analyze the relationship between parity, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG).This observational controlled study was conducted from November 2013 to April 2014, with postpartum women who started antenatal care up to 14 weeks and had full-term births. Data were collected from medical records and antenatal cards. Descriptive and bivariate analyses were performed. The significance level was 5%.Data were collected from 130 primiparous and 160 multiparous women. At the beginning of prenatal care, 54.62% of the primiparous were eutrophic, while the majority of multiparous were overweight or obese (62.51%). Multiparas are two times more likely to be obese at the beginning of their pregnancies, when compared to primiparas. The average pre-pregnancy weight and final pregnancy weight was significantly higher in multiparous, however, the mean GWG was higher among primiparous.We found an inverse correlation between parity and the total GWG, but initial BMI was significantly higher in multiparas. Nevertheless, monitoring of the GWG through actions that promote a healthier lifestyle is needed, regardless of parity and nutritional status, in order to prevent excessive GWG and postpartum weight retention and consequently inadequate pre-pregnancy nutritional status in future pregnancies.

Objective To evaluate the relation between changes the body mass index (BMI) percentile, reflected in the Atalah curve, and perinatal outcomes. Methods A cross-sectional study with 1,279 women was performed. Data regarding gestational weight, sociodemographic characteristics and perinatal outcomes were collected through medical charts, prenatal card and interviews in the postpartum period. Women could be classified according to the Atalah curve in the following categories: low weight, adequateweight, overweight, and obese. The BMIwas calculated at the first and at the last prenatal care visits, and these values were compared. Results An increase in the BMI category according to the Atalah classification occurred in 19.9% of pregnant women, and an increase of 3.4, 5.8 and 6.4 points of BMI were found for women respectively classified in the adequate weight, overweight and obese categories at the first prenatal visit. Women with high school education presented a lower chance of increasing their BMI (odds ratio [OR] 0:47 [0.24- 0.95]). Women who evolved with an increase in the the Atalah classification were associated with cesarean section (OR 1.97-2.28), fetalmacrosomia (OR 4.13-12.54) and large for gestational age newborn (OR 2.88-9.83). Conclusion Pregnant women who gained enough weight to move up in their BMI classification according to the Atalah curve had a higher chance of cesarean section and macrosomia. Women classified as obese, according to the Atalah curve, at the first prenatal visit had a high chance of cesarean section and delivering a large for gestational age newborn. Resumo Objetivo Avaliar a relação entre mudanças no percentual do índice de massa corporal (IMC), refletidas na curva de Atalah, e resultados perinatais. Métodos Foi realizado um estudo transversal com 1.279 mulheres. Os dados sobre o peso na gestação, características sociodemográficas e resultados perinatais foram coletados através de prontuários, cartão pré-natal e entrevistas no pós-parto. As mulheres foramclassificadas de acordo coma curva de Atalah nas seguintes categorias: baixo peso, peso adequado, sobrepeso e obesidade. O IMC foi calculado na primeira e na última visita ao pré-natal e esses valores foram comparados. Resultados Houve aumento na categoria do IMC segundo a classificação de Atalah em 19,9% das mulheres grávidas e um aumento de 3,4; 5,8 e 6,4 pontos do IMC foram encontrados para mulheres respectivamente classificadas nas categorias peso adequado, sobrepeso e obesidade na primeira consulta pré-natal. As mulheres com educação secundária apresentaram menor chance de aumentar sua classificação de IMC (odds ratio [OR] 0:47 [0,24- 0,95]). As mulheres que evoluíram com o aumento na classificação de Atalah foramassociadas a cesariana (OR 1,97-2,28),macrossomia fetal (OR 4,13-12,54) e recém-nascido grande para a idade gestacional (OR 2,88-9,83). Conclusão Gestantes com ganho de peso excessivo, o suficiente para aumentar sua classificação do IMC segundo a curva de Atalah, tiverammaiores chances de cesariana e macrossomia. As mulheres classificadas como obesas na primeira visita pré-natal, de acordo com a curva de Atalah, tiveram uma grande chance de cesariana e recémnascido grande para a idade gestacional.

Introduction This study aims to compare pelvic floor muscle (PFM) function in postmenopausal women with and without pelvic floor dysfunction (PFD) and the relation between PFM function and quality of life. Material and methods A case-control study with 216 postmenopausal women with (n = 126) and without (n = 90) PFD. PFM function was assessed by digital vaginal palpation using the PERFECT scale. Specific quality of life was evaluated using the King's Health Questionnaire for women with urinary incontinence and the Prolapse Quality-of-Life Questionnaire for women with pelvic organ prolapse. We analyzed women with PFD into two categories: Oxford's grade ≤2 or ≥3 using a chi-squared test. Results Out of 126 womem with PFD 44 (34.9%) presented stress urinary incontinence, 21 (16.6%) had pelvic organ prolapse and 61 (48.4%) had urinary incontinence + pelvic organ prolapse. Strength had a median value 2 (0-5) in all women studied and most of them had insufficient strength, reduced endurance and repetition without statistical difference between groups. Incontinent women with strength ≤2 had worse perception of general health domain of King's Health Questionnaire (p = 0.007). No association was found between PFM function and Prolapse Quality-of-Life Questionnaire. Conclusions PFM function assessed by bidigital palpation in postmenopausal women was not sufficiently sensitive to differentiate between women with vs. women without PFM dysfunction and was not related with specific quality of life in women with urinary incontinence and pelvic organ prolapse, respectively. These data should be used to reinforce the widespread recommendation that PFM training is essencial in PFD treatment.

Little is known about public perspectives of scientific and therapeutic uses of placentas. Gaps in knowledge potentiate ethical and clinical problems regarding collection and applications. As such, this study sought to assess the perspectives of placenta donation of a sample of women. Postpartum women’s perspectives on placental donation were assessed at the State University of Campinas in the Centro de Atençäo Integral a Saúde da Mulher (CAISM) maternity hospital using a cross-sectional survey ( n = 384) and semi-structured interviews ( n = 12). Surveys were analyzed quantitatively and interviews were analyzed qualitatively using grounded coding; results were compared. The average age of respondents was 27. Fifty-six percent had more than one child, 45% were Caucasian, 38% were mixed-race, 74% identified with a Christian faith, 52% had high school education or higher, 13% regarded the placenta as spiritually important, 72% felt that knowing what happens to the placenta after birth was somewhat or very important, 78% supported the use of the placenta in research and medicine, 59% reported that consent to collect the placenta was very or somewhat important, 78% preferred their doctor to invite donation, and only 7% preferred the researcher to invite donation. Interviews suggested women appreciate being part of research and that receiving information about studies was important to them. Informed by these results, we argue that women support scientific and therapeutic uses of placentas, want to be included in decision making, and desire information about the placenta. Placentas should not be viewed as “throwaway” organs that are poised for collection without the involvement and permission of women. Women want to be meaningfully included in research processes.

Gestational weight gain (GWG) may interfere in perinatal outcomes and also cause future problems throughout woman’s life. The aim of this population-based study is to evaluate the GWG in Campinas city, southeast of Brazil. A total of 1052 women, who delivered in the three major maternity hospitals in Campinas, were interviewed during postpartum period. The general average of GWG was 13.08±6.08. Of total women, 13.6% were obese and 24.6% were overweight and, in these groups, 55.9% and 53.7%, respectively, exceeded GWG according to the Institute of Medicine recommendations. 6.2% of total women had low body mass index (BMI) and 35.5% in this group had insufficient GWG. Overweight and obese women had a higher risk of excessive GWG and delivery by c-section. The c-section rate was 58.9% and increased according to GWG. Prematurity was more prevalent first in obese and then in low BMI women. Considering the high BMI in women in reproductive age, it is necessary to take effective guidelines about lifestyle and nutritional orientation in order to help women reach adequate GWG. All of them could improve prenatal outcomes and women’s heath as a whole.

Introduction: Twenty years ago, the first study was conducted to access adverse childhood experiences (ACEs) and their relation to outcomes in adulthood. The effects of exposure to childhood trauma can also be transmitted to other generations. There are some studies that suggest the hypothesis that intergenerational transmission may begin during intrauterine life through the change in placental-fetal physiology due to maternal exposure to adverse events in childhood. Those exposures can lead to a variety of conditions such as altered brain architecture, increase in placental corticotrophin hormone (pCRH) at the end of gestation, or emotional and behavioral changes during childhood and adolescence. The systematic review, therefore, is established to determine if there is a reliable association between maternal ACEs in childhood and altered child development. Method: We will conduct a systematic review according to the guidelines of the meta-analysis of observational studies in epidemiology (MOOSE) and with the preferred reporting items for systematic review with a focus on health equity (PRISMA-E). A comprehensive search strategy will be conducted in the following databases: MEDLINE, EMBASE, CINAHL, Web of Science, SCOPUS, Lilacs, and SciELO. Following a 2-step screening process, data including the full reference, objectives, target population, description of the exposure (ACEs), outcome measures, study design, length of follow-up period, and the study results will be extracted, synthesized, and reported. Risk of bias and quality of the studies will also be assessed. Dissemination and ethics: The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review has been published, this review does not require ethical approval. Discussion: This systematic review of the last 20 years will summarize and present the evidence for the relationship between maternal ACEs and the development of her child. Systematic Review registration: PROSPERO #CRD42018111456. Abbreviations: ACEs = adverse childhood experiences, MOOSE = meta-analysis of observational studies in epidemiology, pCRH = placental corticotrophin hormone, PECOS = population, exposure, controls, outcomes, and study designs.

For women of reproductive age, excessive gestational weight gain and/or postpartum weight retention can increase the risk of obesity. This systematic review evaluates the effectiveness of lifestyle modification control trials that utilize exercise interventions, with or without dietary intervention, on weight loss among postpartum women. A search of randomized clinical trials (RCT) was performed using the follow databases and the bibliography of candidate studies: MEDLINE, Web of Science, EMBASE, CENTRAL/Cochrane and Physiotherapy Evidence Database. English language RCT papers published up to 31 October 2012, which present changes on maternal body weight from baseline to the end of exercise intervention were included. The primary meta-analysis examined the effects of exercise interventions, with or without complementary dietary intervention, on weight loss during the postpartum period compared with usual standard of care. Five subgroup analyses were performed to examine differences in study interventions and exercise modalities: duration of intervention, quality of study methodology, supervision of exercise intervention, exercise intervention goals used and the type of dietary intervention. In total 11 studies met eligibility criteria with 769 participants, 409 under intervention and 360 in the control group. The primary meta-analysis included all 11 studies and found a mean difference (MD) on weight loss of -2.57 kg (95% CI -3.66 to -1.47). The subgroup analysis demonstrated that the most effective interventions in reducing weight in postpartum women were exercise programs with objectively defined goals, such as the use of heart rate monitors or pedometer (MD of -4.09 kg-95% CI -4.94 to -3.25, I(2)=0%) and exercise combined with intensive dietary intervention (MD of -4.34 kg-95% CI -5.15 to -3.52, I(2)=0%). Thus, there is benefit from overall lifestyle interventions on weight loss in postpartum women and exercise plus intensive diet and objective targets are the most effective intervention strategies.

Objectives. To evaluate the association between physical exercise supervised in pregnant women with chronic hypertension and/or previous preeclampsia and maternal and neonatal outcomes.Method. Randomized controlled trial, which included 116 pregnant women with chronic hypertension and/or previous preeclampsia, considered risk of preeclampsia development. They were divided into two groups: study group that performed physical exercise with a stationary bicycle once a week, for 30 minutes; the intensity was controlled (heart rate 20% above resting values), under professional supervision and a control group that was not engaged in any physical exercise. The data was retrieved from medical charts. Significance level assumed was 5%.Results. Women from study group performed 9.24 ± 7.03 of physical exercise sessions. There were no differences between groups comparing type of delivery and maternal outcomes, including maternal morbidity and hospitalization in intensive unit care, and neonatal outcomes, including birth weight, adequacy of weight to gestational age, prematurity, Apgar scale at first and fifth minutes, hospitalization in intensive unit care, and neonatal morbidity.Conclusions. Physical exercise using a stationary bicycle in pregnant women with chronic hypertension and/or previous preeclampsia, once a week, under professional supervision, did not interfere in the delivery method and did not produce maternal and neonatal risks of the occurrence of morbidity. This trial is registered with ClinicalTrials.govNCT01395342.

Mastectomy negatively affects scapulothoracic and glenohumeral kinematics. Breast reconstructive methods such as the latissimus dorsi flap can result in anatomical modifications that may in theory further affect the shoulder apparatus. The purpose of this study was to examine the effects of latissimus dorsi flap reconstruction on the recovery of shoulder motion and other postsurgical problems during the first year after mastectomy.This was a prospective cohort study of 104 consecutive mastectomies (47 with immediate latissimus dorsi flaps). Shoulder range of motion was assessed before and at 1, 3, 6, and 12 months after surgery. Pain, tissue adhesion, scar enlargement, and web syndrome were assessed during follow-up.There was a 30 percent decrease of shoulder range of motion 1 month after surgery, with gradual recovery over time. However, mean abduction and flexion capacities did not reach baseline levels and were on average 5 to 10 percent lower than baseline, even after 1 year. Over time, the latissimus dorsi flap was not associated with restriction of flexion or abduction. Scar enlargement (at the first month, p = 0.009) and tissue adhesion (at month 12, p = 0.032) were significantly less common in the latissimus dorsi flap group.The authors' study clearly suggests that the additional anatomical manipulation required for the latissimus dorsi flap procedure does not further affect shoulder kinematics and is associated with a lower incidence of tissue adhesion.Therapeutic, II.

Após cirurgia por câncer de mama, as mulheres estão sujeitas a desenvolver algumas complicações físicas. Os objetivos deste trabalho foram: investigar o desfecho dessas mulheres, que, durante o primeiro mês pós-operatório, foram submetidas a um programa de reabilitação e identificar ao longo de dois anos as complicações mais frequentes e as condutas fisioterapêuticas mais adotadas. Foi um estudo descritivo, retrospectivo, com dados de 707 prontuários de mulheres operadas por câncer de mama no Hospital da Mulher Professor Doutor José Aristodemo Pinotti da Universidade Estadual de Campinas, entre janeiro de 2006 e dezembro de 2007, atendidas pelo Setor de Fisioterapia. A análise foi feita por meio de médias, desvio padrão e frequências absolutas e relativas. Ao final do programa, 55% das mulheres receberam alta, 17% necessitaram de atendimento adicional e 26% não aderiram a ele. As complicações mais frequentes foram: aderência pericicatricial (26%), restrição da amplitude de movimento (24%) e deiscência cicatricial (17%). No primeiro ano após a cirurgia (n=460), foram relatados dor (28,5%), sensação de peso (21,5%) e restrição da amplitude de movimento do ombro (16,7%); já no segundo (n=168), houve dor (48,2%), sensação de peso (42,8%) e linfedema (23,2%). Concluiu-se que, ao final do programa, a maioria das mulheres recebeu alta. Ao longo dos anos, houve redução da frequência de restrição da amplitude de movimento do ombro com aumento de linfedema. Cuidados com o braço, exercícios domiciliares e autodrenagem foram as condutas mais adotadas. After breast cancer surgery, women may develop some physical complications. Thus, the aims of this study were to investigate the outcome of these women, who participated in a rehabilitation program for one month, as well to identify along two years the most frequent complications and adopted physical therapy conducts. It was a descriptive and retrospective study with 707 medical records of women treated for breast cancer at the Women's Hospital Professor Doutor José Aristodemo Pinotti, Universidade Estadual de Campinas, between January 2006 and December 2007, admitted in the Division of Physical Therapy. Analysis was performed by means, standard deviation, absolute and relative frequencies. By the end of the program, 55% of women were discharged, 17% required additional treatment, and 26% did not join it. The most frequent complications were: pericicatricial adherence (26%), range of motion (ROM) restriction (24%), and scar dehiscence (17%). In the first year after surgery (n=460), the main complaints were: pain (28.5%), heaviness (21.5%), and restriction of shoulder range of motion (16.7%); in the second year (n=168), they were pain (48.2%), heaviness (42.8%), and lymphedema (23.2%). It was concluded that most women were discharged in the end of the program and, over the years, they presented reduction of shoulder range of motion frequency and lymphedema increase. Care of the arm, home exercises, and self-lymphatic drainage were the most adopted conducts.

Após cirurgia por câncer de mama, as mulheres estão sujeitas a desenvolver algumas complicações físicas. Os objetivos deste trabalho foram: investigar o desfecho dessas mulheres, que, durante o primeiro mês pós-operatório, foram submetidas a um programa de reabilitação e identificar ao longo de dois anos as complicações mais frequentes e as condutas fisioterapêuticas mais adotadas. Foi um estudo descritivo, retrospectivo, com dados de 707 prontuários de mulheres operadas por câncer de mama no Hospital da Mulher Professor Doutor José Aristodemo Pinotti da Universidade Estadual de Campinas, entre janeiro de 2006 e dezembro de 2007, atendidas pelo Setor de Fisioterapia. A análise foi feita por meio de médias, desvio padrão e frequências absolutas e relativas. Ao final do programa, 55% das mulheres receberam alta, 17% necessitaram de atendimento adicional e 26% não aderiram a ele. As complicações mais frequentes foram: aderência pericicatricial (26%), restrição da amplitude de movimento (24%) e deiscência cicatricial (17%). No primeiro ano após a cirurgia (n=460), foram relatados dor (28,5%), sensação de peso (21,5%) e restrição da amplitude de movimento do ombro (16,7%); já no segundo (n=168), houve dor (48,2%), sensação de peso (42,8%) e linfedema (23,2%). Concluiu-se que, ao final do programa, a maioria das mulheres recebeu alta. Ao longo dos anos, houve redução da frequência de restrição da amplitude de movimento do ombro com aumento de linfedema. Cuidados com o braço, exercícios domiciliares e autodrenagem foram as condutas mais adotadas.After breast cancer surgery, women may develop some physical complications. Thus, the aims of this study were to investigate the outcome of these women, who participated in a rehabilitation program for one month, as well to identify along two years the most frequent complications and adopted physical therapy conducts. It was a descriptive and retrospective study with 707 medical records of women treated for breast cancer at the Women's Hospital Professor Doutor José Aristodemo Pinotti, Universidade Estadual de Campinas, between January 2006 and December 2007, admitted in the Division of Physical Therapy. Analysis was performed by means, standard deviation, absolute and relative frequencies. By the end of the program, 55% of women were discharged, 17% required additional treatment, and 26% did not join it. The most frequent complications were: pericicatricial adherence (26%), range of motion (ROM) restriction (24%), and scar dehiscence (17%). In the first year after surgery (n=460), the main complaints were: pain (28.5%), heaviness (21.5%), and restriction of shoulder range of motion (16.7%); in the second year (n=168), they were pain (48.2%), heaviness (42.8%), and lymphedema (23.2%). It was concluded that most women were discharged in the end of the program and, over the years, they presented reduction of shoulder range of motion frequency and lymphedema increase. Care of the arm, home exercises, and self-lymphatic drainage were the most adopted conducts.

Exercise and physical activity have been studied and suggested as a way to reduce or minimize the effects of pre-eclampsia. Our aim was to evaluate the association between exercise and/or physical activity and occurrence of pre-eclampsia. We conducted electronic searches without year of publication and language limitations. This was a systematic review designed according to PRISMA. Different databases accessed were as follows: PubMed®; Latin-American and Caribbean Literature in Health Sciences (LILACS); Scientific Electronic Library On-line (SciELO); Physiotherapy Evidence Database (PEDro); and ISI web of Knowledge(SM) . The Medical Subject Headings (MeSH) were as follows: ("exercise" OR "motor activity" OR "physical activity") AND ("pre-eclampsia" OR "eclampsia" OR "hypertension, pregnancy-induced"). Inclusion criteria were studies conducted in adults who were engaged in some physical activity. The selection and methodological evaluation were carried out by two independent reviewers. Risk assessment was made by the odds ratio (OR) and incidence of pre-eclampsia in the population who performed physical activity/exercise. A total of 231 articles were found, 214 of which were excluded based on title and full-text, so that 17 remained. Comparison of six case-control studies showed that physical activity had a protective effect on the development of pre-eclampsia [OR 0.77, 95% confidence interval (CI) 0.64-0.91, p < 0.01]. The 10 prospective cohort studies showed no significant difference (OR 0.99, 95% CI 0.93-1.05, p= 0.81). The only randomized clinical trial showed a protective effect on the development of pre-eclampsia in the stretching group (OR 6.34, 95% CI 0.72-55.37, p= 0.09). This systematic review indicates a trend toward a protective effect of physical activity in the prevention of pre-eclampsia.

Objective To evaluate the effectiveness and safety of physical exercise in terms of maternal/perinatal outcomes and the perception of quality of life (QoL) in pregnant obese and overweight women. Design A randomised controlled clinical trial.

Esta revisão objetivou avaliar os efeitos do exercício físico no ganho de peso e nos resultados perinatais de gestantes com sobrepeso e obesidade, através de revisão sistemática da literatura em bases de dados específicas: MEDLINE/PubMed, EMBASE, SciELO e LILACS. Foram incluídos dez ensaios clínicos que avaliaram a efetividade do exercício combinado ou não com dieta no controle do ganho de peso gestacional. Três estudos são randomizados e a qualidade metodológica foi avaliada através do CONSORT 2010 Checklist, porém nenhum deles cumpriu todos os critérios. Quatro estudos obtiveram diferença quanto ao ganho de peso entre os grupos. A maioria dos estudos (60%) não demonstrou diferença quanto aos resultados perinatais (via de parto, idade gestacional ao nascer, peso do recém-nascido). Poucos estudos confirmam o efeito positivo do exercício no controle do ganho de peso gestacional, necessitando mais pesquisas neste sentido. O exercício em intensidade leve a moderada parece não ser determinante nos resultados perinatais, sendo uma prática segura para gestantes com sobrepeso e obesidade.

Aim The study aimed to analyze the correlation between the intensity of urinary incontinence (UI) in women by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and sexual function by the Female Sexual Function Index (FSFI). Methods: Cross-sectional, correlational and quantitative study. It was developed in the urogynecology clinic with 110 women with stress or mixed UI. Exclusion criteria: overactive bladder syndrome, stage of pelvic organ prolapsed >3, neurological disease or dementia. The FSFI consists of 19 questions assessing female sexual function in the last 4 weeks in the areas of sexual desire, arousal, vaginal lubrication, orgasm, sexual satisfaction and pain. It was considered final score ≤ 26.5 indicative of sexual dysfunction. The UI was evaluated using the (ICIQ-SF) consists of 4 items such as frequency of UI, volume, impact of UI on daily life and urinary symptoms. Results: There was a statistically significant relationship between the final ICIQ-SF result (mean = 13) and the final FSFI score (mean = 23.4), (p = 0.004). The higher the ICIQ-SF final score, the lower the final FSFI score. The FSFI domains most affected by UI severity as evidenced by ICIQ-SF were: sexual desire (p =0.000), sexual arousal (p =0.036) and satisfaction (p =0.010). Conclusions: There was a strong correlation between the severity of stress and mixed UI and sexual function in the studied population. The UI negatively interferes with the woman's desire, arousal, and sexual satisfaction.

Physical exercise is recommended for all healthy pregnant women. Regular practice of exercises during pregnancy can provide many physical and psychological benefits, with no evidence of adverse outcomes for the fetus or the newborn when exercise is performed at mild to moderate intensity. However, few pregnant women engage in this practice and many still have fears and doubts about the safety of exercise. The objective of the present study was to inform the professionals who provide care for Brazilian pregnant women about the current recommendations regarding physical exercise during pregnancy based on the best scientific evidence available. In view of the perception that few systematic models are available about this topic and after performing several studies in this specific area, we assembled practical information of interest to both the professionals and the pregnant women. We also provide recommendations about the indications, contraindications, modalities (aerobics, resistance training, stretching and pelvic floor training), frequency, intensity and duration indicated for each gestational trimester. The review addresses physical exercise recommendation both for low risk pregnant women and for special populations, such as athletes and obese, hypertensive and diabetic subjects. The advantages of an active and healthy lifestyle should be always reinforced during and after gestation since pregnancy is an appropriate period to introduce new habits because pregnant women are usually more motivated to adhere to recommendations. Thus, routine exams, frequent returns and supervision are recommended in order to provide new guidelines that will have long-term beneficial effects for both mother and child.

This review aims to provide an update on the recent evidence concerning exercise during pregnancy including effects for mother and fetus and the types, frequency, intensity, duration and rate of progression of exercise performed.Exercises during pregnancy are associated with higher cardiorespiratory fitness, prevention of urinary incontinence and low back pain, reduced symptoms of depression, gestational weight gain control, and for cases of gestational diabetes, reduced number of women who required insulin. There is no association with reduction in birth weight or preterm birth rate. The type of exercise shows no difference on results, and its intensity should be mild or moderate for previous sedentary women and moderate to high for active women. The exercise recommendations still are based on the current guidelines on moderate-intensity, low-impact, aerobic exercise at least three times a week. Yet, new guidelines propose increasing weekly physical-activity expenditure while incorporating vigorous exercise and adding light strength training to the exercise routine of healthy pregnant women. In the case of other chronic diseases like hypertension, there are still few data, and therefore more studies should be performed to assess the safety of the intervention.Physical exercise is beneficial for women during pregnancy and also in the postpartum period; it is not associated with risks for the newborn and can lead to changes in lifestyle that imply long-term benefits.

This study aimed to evaluate the effects of exercise on weight gain and perinatal outcomes among overweight and obese pregnant women, through a systematic review in MEDLINE/PubMed, EMBASE, LILACS, and SciELO. We included ten clinical trials that evaluated the effectiveness of exercise with or without combined diet in the control of gestational weight gain. Three studies were randomized, and methodological quality was assessed using the CONSORT 2010 Checklist, but none met all the criteria. Four studies showed weight gain differences between groups. The majority (60%) of studies showed no differences in perinatal outcomes (mode of delivery, gestational age at birth, birth weight). In conclusion, few studies confirmed the positive effect of exercise in controlling weight gain during pregnancy, thus requiring more research in this direction. Regarding perinatal outcomes, mild to moderate exercise does not appear to be decisive for perinatal outcomes, and is safe for pregnant women with overweight and obesity.

ObjectiveTo assess the physical activity levels of pregnant women and to examine the characteristics associated with the practice of exercise and the activities of daily living during pregnancy.MethodsFor this cross-sectional study, 1,279 women were recruited within 72 hours postpartum. They were interviewed about their socio-demographic data and obstetric history and were administered self-report questionnaires about exercise and daily physical activities during pregnancy. Data on the current pregnancy, labor, delivery, and newborn outcomes were collected from participants' medical records. To analyze factors related to the practice of exercise, we used the student t-test, X², and odds ratio (OR), with a corresponding 95% confident interval (CI), followed by a multiple logistic regression. The significance level was 5%.ResultsCompared to the pre-pregnancy period, the prevalence of physical activity among participants was lower throughout pregnancy (20.1%) (p = 0.01). Half of the women interrupted practicing physical exercise due to pregnancy. The lowest prevalence of exercise was observed in the first (13.6%) and third trimesters (13.4%). Less than half of women received exercise guidance during prenatal care meetings (47.4%). Walking was the most commonly reported exercise, followed by water aerobics. Factors positively associated with exercise practice were higher educational level (OR= 1.82; CI 95% 1.28-2.60), primiparity (OR=1.49; CI 95% 1.07-2.07), exercising before pregnancy (OR= 6.45; CI 95% 4.64-8.96), and exercise guidance during prenatal care (OR=2.54; CI 95% 1.80-3.57). Mildly intense exercise and domestic activities were most frequently reported among pregnant women. There were no differences in maternal and perinatal outcomes between active and sedentary pregnant women.ConclusionThe findings indicate that promoting physical activity remains a priority in public health policy, and women of childbearing age, especially those planning a pregnancy, should be encouraged to adopt an exercise routine or maintain an active lifestyle during pregnancy in order to avoid sedentary- and obesity-associated risks.

Introduction Chronic hypertension (CH) and previous preeclampsia (PE) are considered risk factors for developing PE. Physical activity (PA) has been proposed as an important part of hypertension's treatment and has been studied as a possibility for the prevention of PE and its complications.PA is recommended during pregnancy because it may be beneficial to maternal health.Furthermore, it is considered a safe activity for the mother and fetus. Objectives The objective of this study was to assess the association between exercise in pregnant women with CH and/or previous PE and type of delivery, maternal and neonatal outcomes. Methods Randomized clinical trial performed between January, 2008 and November, 2011, at the Women's Hospital Dr.Jose Aristodemo Pinotti–CAISM/Unicamp, Brazil, enrolled 116 pregnant women presenting CH, previous PE or both factors associated.Women from 12 to 20 gestational weeks were selected from the prenatal outpatient clinic and randomly allocated to the study (SG) or non-interventional group (NIG). Women at the SG performed physical exercise using stationary bicycle (horizontal bench model) during 30min, once a week, under physical therapist supervision.The HR was maintained at 20% above resting heart rate and up to 140 beats per minute.The NIG followed regular prenatal routine.After birth the data related to type of delivery, maternal and neonatal outcomes were collected from medical records and analyzed comparing groups.The statistical analyzes was performed by Chi-square test and Fisher'sexact test.The program was SAS 9.1 version.Significance was assumed as p Results We had 6 drop-outs and 7 that did not deliver at our hospital and we could not retrieve the data.A total of 103 pregnant women were analyzed (53 in the SG and 50 in the NIG). The mean age was 31.4±5.9 and mean of Body Mass Index (BMI) was 34.9±7.9kg/m 2 .Considering the sociodemographic and clinical characteristics the SG and NIG were similar and homogeneous.The average exercise sessions conducted by the SG was 10.11 sessions.The cesarean rate was 69.9% in this study, and the most prevalent indication was cephalopelvic disproportion with 34.3%.However, no statistical differences was observed between groups on type of delivery ( p = 0.1901), indications for cesarean delivery and maternal outcomes, including maternal morbidity, rate of PE events and admission in the Intensive Unit Care (ICU). The neonatal outcomes were no significant differences:newborn weigh ( p =0.69), adequacy for gestational age ( p =0.40), gestational age by recent ultrasound ( p =0.20), Apgar 1 min scores ( p =0.12), Apgar 5 min score ( p =0.24), admission to the ICU ( p =0.95) and neonatal morbidity ( p =0.39). Conclusion Exercise using stationary bicycle in pregnant women of high risk for PE (CH and/or previous PE) performed once a week, under physical therapist supervision does not seem to interfere in the type of delivery or maternal and neonatal outcomes. This study suggests that exercise with controlled intensity is safe, with no additional harm towards newborn health and with possible benefits to women's future health.

This report summarizes a meeting, Obesity Prevention from Conception, held in Ottawa in 2012. This planning workshop was funded by the Canadian Institutes of Health Research (CIHR) to bring together researchers with expertise in the area of maternal obesity (OB) and weight gain in pregnancy and pregnancy-related disease to attend a one-day workshop and symposium to discuss the development of a cross-Canada lifestyle intervention trial for targeting pregnant women. This future intervention will aim to reduce downstream OB in children through encouraging appropriate weight gain during the mother's pregnancy. The workshop served to (i) inform the development of a lifestyle intervention for women with a high pre-pregnancy body mass index (BMI), (ii) identify site investigators across Canada, and (iii) guide the development of a grant proposal focusing on the health of mom and baby. A brief summary of the presentations as well as the focus groups is presented for use in planning future research.

s / The Breast 20 (2011) S12–S55 S35 Endocrine therapy for hormon dependent breast cancer is vital part of complex treatment for the disease. There are different modalities for the breast cancer treatment: radiotherapy, operation, medication therapy. On our clinic we use medical treatment. About 25 % of patients with the breast cancer are premenopausal, and nearly 60 % of the breast cancers are hormon dependent because for they growth they use complex regulatoring mechanisms which vital part are female sex hormons. Zoladex is available in original package of 3,6 mg or 10,8 mg with outer layer which provide protection for medical staff,it application is simple. The aim of this work: To investigate possible side effects with the application of the medicine Patients and methods: Investigationwas conducted on Clinic of Oncology KC Banja Luka during the period of one year (from 01.01.2009 to 01.01.2010). Based on a questionnaire wewere observing appearance of adverse effects in patients receiving therapy and time frame for menstruation cycle recurrence after discontinuation of the treatment. Conclusion: Zoladex is not related with unpleasent adverse effects which are associated with chemotherapy Menstrual cycle is restored in most of the patients after treatment is terminated.