Associação entre as características macroscópicas do cordão umbilical, gestação de alto risco e repercussões neonatais

Abstract

Objective:To verify the association between the macroscopic characteristics of the umbilical cord, high-risk pregnancy and neonatal repercussions. Method: A crosssectional study carried out from January 2012 to January 2015 in a public maternity hospital in Goiânia/GO. The study population consisted of 126 recent puerperal women with diagnosis of high-risk pregnancy, and 139 clinically normal women (control group). Macroscopic features of the umbilical cord, maternal, fetal and neonatal diseases, gestational age, Apgar score, birth weight, head circumference and parity were evaluated. Data were descriptively analyzed. Results: 265 puerperal women and their respective newborns participated in the study. The most frequent characteristics of the umbilical cord of those with high-risk pregnancy and those from the control group were the absence of true knots (97.6% and 2.4%, respectively), length between 35 and 70 centimeters and paracentral insertion (81.7% and 18.3%). A statistical difference was observed between the high-risk pregnancy group and extremes of maternal age (p=0.004). Conclusion:The analysis and description of the characteristics of the umbilical cord carried out by the nurse lend important information about the neonatal prognosis. This evaluation subsidizes clinical practice and seeks to ensure the safety of the (mother-baby) binomial throughout the perinatal period. DESCRIPTORS INTRODUCTIONIn the gestational process, the line between normality and disease is extremely thin and the imbalance represents a high risk of maternal-fetal morbidity and mortality (1)(2) . About 20% of pregnancies have some type of complication (3) . Thus, women with alterations during pregnancy constitute a group known as "high-risk pregnant women"; a small number of pregnant women who have specific characteristics or because they suffer some injury are more likely to develop an unfavorable pregnancy (4) . In Brazil, high-risk pregnancies occur in 10% to 20% of the cases and are related to the occurrence of some disorders, the most frequent of which are gestational hypertension (GH) and gestational diabetes mellitus (GDM) (5) . Nearly 3/4 of maternal deaths in the world occur due to direct obstetric causes, and among them deaths due to hypertensive disorders represent about 14% (6) . There is a close relationship between placenta/umbilical cord, fetus and the change in its functions, as in the cases of GH and GDM. This relationship establishes different patterns of pregnancy outcomes and also the evolution of fetal and/or maternal injury (3) . The umbilical cord is an essential structure for maintenance of intrauterine life, and it can be used for assessing adverse perinatal conditions, thus contributing to a good neonatal prognosis (7) . This evaluation is performed through the macroscopic identification of umbilical cord alterations, and could, for example, elucidate causes of perinatal hypoxia which are not evidenced in the clinic, thus providing a better understanding of the physiopathogenesis of fetal events.I...

Diabetes Gestacional E Assistência Pré-Natal No Alto Risco

“…Forward, the inability to achieve metabolic balance, the pregnant women are indicated to the medical service for the treatment of insulin therapy. [5][6][7][8][9] It is noteworthy that the main consequences of the GDM are, for women, the cesarean, the development of pre-eclampsia and the risk of developing Diabetes Mellitus after childbirth; and, for the conceptus, prematurity, fetal growth excessive (macrosomia), the shoulder dystocia, hypoglycemia and perinatal death. [7][8][9][10][11][12] It should be emphasized that, for pregnant women, living with the illness may be a factor of insecurity and emotional instability, especially when the pre-natal begins late and, consequently, the educative actions of care and changes in lifestyle are affected.…”

“…[5][6][7][8][9] It is noteworthy that the main consequences of the GDM are, for women, the cesarean, the development of pre-eclampsia and the risk of developing Diabetes Mellitus after childbirth; and, for the conceptus, prematurity, fetal growth excessive (macrosomia), the shoulder dystocia, hypoglycemia and perinatal death. [7][8][9][10][11][12] It should be emphasized that, for pregnant women, living with the illness may be a factor of insecurity and emotional instability, especially when the pre-natal begins late and, consequently, the educative actions of care and changes in lifestyle are affected. 6 • To analyze the prenatal care from the number of obstetric consultations and nutrition during pregnancy and its relationship with the gestational diabetes.…”

Atuação do enfermeiro na gestação de alto risco: uma revisão sistemática

“…Grande parte das gestações de alto risco estão relacionadas a alguns transtornos, sendo mais frequentes as síndromes hipertensivas da gravidez e o diabetes mellitus gestacional, onde aproximadamente 3/4 das mortes maternas no mundo ocorrem por causas obstétricas diretas (Salge et al, 2017). Quanto às patologias que podem acometer a mulher na gestação, algumas aparecem com maior frequência no primeiro e segundo trimestre, sendo elas as hemorragias, hiperêmese gravídica, abortamento e gravidez ectópica.…”

Atenção individual e coletiva à saúde materna e infantil no cenário brasileiro

“…A maioria das gestações progride sem complicações, no entanto alguns aspectos podem interferir em seu curso normal, causando risco elevado de mortalidade materno-fetal. Deste modo, as gestantes com alterações fisiológicas importantes ou fator de risco gestacional integram a categoria de gravidez de alto risco, que torna algumas gestações propícias à progressão patológica (ALVES et al, 2019;SALGE et al, 2017;BRASIL, 2012 Comparando-se os níveis pressóricos obtidos na primeira e última consulta depreendeuse que houve elevação do percentual inerente a normotensão em 7% das gestantes acompanhadas. No tocante às pré-hipertensas, houve diminuição em 5% dos valores quando comparadas a admissão e última consulta.…”