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Abstract

BackgroundMaternal near miss (MNM) investigation is a useful tool for monitoring standards for obstetric care. This study evaluated the prevalence and the determinants of severe maternal morbidity (SMM) and MNM in a tertiary referral hospital in Teresina, Piauí, Brazil.MethodsA transversal and prospective study was conducted between September 2012 and February 2013. The cases were included according to criteria established by the WHO. Odds ratio, their respective confidence intervals, and multivariate analyses were examined.ResultsFive thousand eight hundred forty one live births, 343 women with SMM, 56 cases of MNM, and 10 maternal deaths were investigated. The rate for severe maternal outcomes was 11.2 cases per 1000 live births, the rate of MNM was 9.6 cases/1000 live births, and the rate for mortality was 171.2 cases/100,000 live births. Management criteria were most frequently observed among MNM/death cases. Hypertensive diseases (86.1 %) and hemorrhagic complications (10.0 %) were the main determinants of MNM, but infectious abortion was the most common isolated cause of maternal death. There was a correlation between MNM/death and hospitalized more than 5 days (p = 0.023) and between termination of pregnancy by cesarean (p = 0.002) and APGAR < 7 in the 1st minute (p = 0.015).ConclusionsSMM and MNM were quite prevalent in the population studied. Women whose condition progressed to MNM/death had a higher association with terminating pregnancy by cesarean, longer hospitalization times, and worse perinatal results. The results from the study can be useful to improve the quality of obstetric care and consequently diminish maternal mortality in the region.

In Brazil, to have a legal abortion in the case of rape, the woman's statement that rape has occurred is considered sufficient to guarantee the right to abortion. The aim of this study was to understand the practice and opinions about providing abortion in the case of rape among obstetricians-gynecologists (OBGYNs) in Brazil. A mixed-method study was conducted from April to July 2012 with 1,690 OBGYNs who responded to a structured, electronic, self-completed questionnaire. In the quantitative phase, 81.6% of the physicians required police reports or judicial authorization to guarantee the care requested. In-depth telephone interviews with 50 of these physicians showed that they frequently tested women's rape claim by making them repeat their story to several health professionals; 43.5% of these claimed conscientious objection when they were uncertain whether the woman was telling the truth. The moral environment of illegal abortion alters the purpose of listening to a patient - from providing care to passing judgement on her. The data suggest that women's access to legal abortion is being blocked by these barriers in spite of the law. We recommend that FEBRASGO and the Ministry of Health work together to clarify to physicians that a woman's statement that rape occurred should allow her to access a legal abortion.

Introduction Sexuality education has been valued since the 1960s in medical schools worldwide. Although recent studies reaffirm the importance of incorporating sexuality into medical education, there are data gaps concerning how this happens in Brazil. Aim To understand how Brazilian medical school professors teach sexuality in undergraduate courses. Methods An exploratory, cross-sectional descriptive study was conducted. A total of 207 professors from 110 Brazilian medical schools responded to an online semistructured questionnaire about the characteristics of the sexuality-related topics offered. Main Outcome Measures The main variables assessed were contact hours devoted to sexuality, disciplines in which sexuality topics were taught, sexuality-related course titles, and sexuality-related topics addressed. Questionnaires were tabulated and analyzed using descriptive statistics for frequency distribution. Results The response rate to the questionnaire was 77.2%. Almost all professors (96.3%) addressed sexuality-related topics mainly in the third and fourth years as clinical disciplines, with a 6-hour load per discipline. Gynecology was the discipline in which sexuality-related topics were most often taught (51.5%), followed by urology (18%) and psychiatry (15%). Sexuality-related topics were addressed mainly in classes on sexually transmitted diseases and AIDS (62.4%) and on the anatomy and physiology of the reproductive system (55.4%). About 25% of the professors reported teaching courses with a sexuality-related title. There was emphasis on the impact of diseases and sexual habits (87.9%) and sexual dysfunction (75.9%). Less than 50% of professors addressed nonnormative sexuality or social aspects of sexuality. Conclusions The teaching of sexuality in Brazilian medical schools occurred in a nonstandardized and fragmented fashion across several disciplines. The topic was incorporated with an organic and pathological bias, with a weak emphasis on the social aspects of sexuality and the variety of human sexual behaviors. The results point to the need for change in the provision of sexuality education in Brazilian medical schools.

Este artigo analisa como se constrói a verdade do estupro para que a mulher que se apresenta como vítima tenha acesso ao aborto legal no Brasil. Foram entrevistados 82 profissionais de saúde de cinco serviços de referência para aborto legal, um de cada região do país, entre médicos, enfermeiros, técnicos em enfermagem, assistentes sociais e psicólogos. As entrevistas buscaram compreender procedimentos e práticas a que a mulher é submetida para ter acesso ao aborto legal. Apesar de particularidades na organização e no funcionamento dos serviços, identificamos um regime compartilhado de suspeição à narrativa da mulher que se expressa por práticas periciais de inquérito em torno do acontecimento da violência e da subjetividade da vítima. A verdade do estupro para o aborto legal não se resume à narrativa íntima e com presunção de veracidade, mas é uma construção moral e discursiva produzida pela submissão da mulher aos regimes periciais dos serviços.

Sexualidade; -Educação Sexual; -Currículo; -Estudantes de Medicina. RESUMO Realizou-se estudo descritivo e transversal com 242 alunos matriculados no internato em medicina de duas universidades públicas e duas faculdades privadas em Teresina, Piauí. Foi aplicado questionário semiestruturado para conhecer como a sexualidade humana foi ensinada nos cursos médicos. A taxa de resposta ao questionário foi de 86,3%. O ensino da sexualidade foi identificado por 95,2% dos alunos em algum momento do curso. As disciplinas que mais falaram sobre o assunto foram: ginecologia (91,9%), psiquiatria (55,3%), psicologia médica (30,6%) e urologia (24,1%). A sexualidade foi tema de aula em apenas 8,4% dos relatos, mas foi comentada em outras aulas, como: câncer (70,9%), aborto (67,5%), DST e HIV/Aids (67%). Quando o docente falou sobre sexualidade, enfatizou as disfunções sexuais (84,1%), com menor evidência para homossexualidade (50%) e direitos sexuais e reprodutivos (40,6%).Os alunos apontaram influências positivas do ensino da sexualidade na graduação (96,1%). Esses dados indicam que a sexualidade foi ofertada com destaque para a discussão de aspectos biológicos e de doenças associadas à sexualidade, com menor ênfase na construção social do tema e orientação sexual. ABSTRACT We conducted a descriptive and cross-sectional study with 242 medical undergraduates at two public universities and two private colleges in Teresina, Piauí. A semi-structured questionnaire to understand how human sexuality was taught in medical courses was applied. The questionnaire response rate was 86.3%. The teaching of sexuality was identified by 95.2% of students at some time during the course. Gynecology was the discipline that discussed sexuality the most (91.9%), followed by Psychiatry (55.3%), Medical Psychology (30.6%) and Urology (24.1%). Sexuality was cited as a specific topic in only 8.4% of the reports, but it was reported in classes about other topics such as cancer (70.9%), abortion (67.5%), STD and HIV/AIDS (67%). In class, the teacher emphasized sexual dysfunctions (84.1%), with less emphasis on homosexuality (50%) and sexual and reproductive rights (40.6%). Students indicated that there were positive influences of sexual education in undergraduate study (96.1%). There was great emphasis on the discussion of biological aspects and diseases associated with sexuality, with less emphasis on the social construction of the theme and sexual orientation.

Maus