Portal de Boas Práticas em Saúde da Mulher, da Criança e do Adolescente

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Sobrepeso e Obesidade

A promoção da alimentação saudável e a manutenção do peso adequado são fundamentais para promover a saúde e o bem-estar durante toda a vida da mulher e principalmente no período do climatério.

Diretrizes brasileiras de obesidade 2016 / ABESO

As Diretrizes de Obesidade foram revisadas e atualizadas com o objetivo de fornecer dados contemporâneos sobre a etiologia, o diagnóstico e o tratamento dietético, cognitivo comportamental, farmacológico em adultos e em crianças e adolescentes do sobrepeso e da obesidade, doença tão prevalente na população mundial. O objetivo desta diretriz é englobar dados úteis para aplicação na prática clínica, objetivando auxiliar na conduta e facilitar o melhor cuidado dos pacientes, incluindo sua triagem, diagnóstico, avaliação, seleção da terapia não farmacológica, objetivo do tratamento e individualização de forma ética, com base em evidência racional e científica da melhor qualidade disponível para aperfeiçoar os desfechos de saúde e a segurança do paciente obeso. As recomendações são práticas, viáveis, clinicamente flexíveis, facilitando assim a divulgação e utilização.

Health Effects of Overweight and Obesity in 195 Countries over 25 Years

Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain. METHODS: We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015. RESULTS: In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease. CONCLUSIONS: The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem. (Funded by the Bill and Melinda Gates Foundation.).

WHO Obesity: preventing and managing the global epidemic

Overweight and obesity represent a rapidly growing threat to the health of populations in an increasing number of countries. Indeed they are now so common that they are replacing more traditional problems such as undernutrition and infectious diseases as the most significant causes of ill-health. Obesity comorbidities include coronary heart disease, hypertension and stroke, certain types of cancer, non-insulin-dependent diabetes, mellitus, gallbladder disease, dyslipidaemia, osteoarthritis and gout, and pulmonary diseases, including sleep apnoea. In addition, the obese suffer from social bias, prejudice and discrimination, on the part not only of the general public but also of health professionals, and this may make them reluctant to seek medical assistance. WHO therefore convened a Consultation on obesity to review current epidemiological information, contributing factors and associated consequences, and this report presents its conclusions and recommendations. In particular, the Consultation considered the system for classifying overweight and obesity based on the body mass index, and concluded that a coherent system is now available and should be adopted internationally.

Segurança do Paciente em Maternidades

Encontro com o especialista Dr. João Batista Marinho de Castro Lima, Médico Obstetra e Diretor Clínico da maternidade do Hospital Sofia Feldman, 14/06/2018, às 15h (horário de Brasília).

Trabalho interdisciplinar na assistência ao parto e nascimento: a atuação da enfermagem obstétrica

A assistência prestada pela enfermagem obstétrica é uma solução vital para os desafios de fornecer cuidados maternos-neonatais de alta qualidade para todas as mulheres e recém-nascidos, em todos os países.

Saúde de mães e crianças no Brasil: progressos e desafios

Nas últimas três décadas, o Brasil experimentou sucessivas transformações nos determinantes sociais das doenças e na organização dos serviços de saúde. Neste artigo, examinamos como essas mudanças afetaram os indicadores de saúde materna e de saúde e nutrição infantil. São utilizados dados de estatísticas vitais, censos populacionais, inquéritos de demografia e saúde e publicações obtidas de diversas outras fontes. Nesse período, os coeficientes de mortalidade infantil foram substancialmente reduzidos, com taxa anual de decréscimo de 5,5% nas décadas de 1980 e 1990 e 4,4% no período 2000-08, atingindo vinte mortes por 1.000 nascidos vivos em 2008. As mortes neonatais foram responsáveis por 68% das mortes infantis. Deficits de altura entre crianças menores de 5 anos diminuíram de 37%, em 1974-75, para 7%, em 2006-07. As diferenças regionais referentes aos deficits de altura e à mortalidade de crianças foram igualmente reduzidas. O acesso à maioria das intervenções de saúde dirigidas às mães e às crianças foi substancialmente ampliado, quase atingindo coberturas universais, e as desigualdades regionais de acesso a tais intervenções foram notavelmente reduzidas. A duração mediana da amamentação aumentou de 2,5 meses nos anos 1970 para 14 meses em 2006-07. Estatísticas oficiais revelam níveis estáveis de mortalidade materna durante os últimos quinze anos, mas estimativas baseadas em modelos estatísticos indicam uma redução anual de 4%, uma tendência que pode não ter sido observada nos dados de registro devido às melhorias no sistema de notificação de óbitos e à ampliação das investigações sobre óbitos de mulheres em idade reprodutiva. As razões para o progresso alcançado pelo Brasil incluem: modificações socioeconômicas e demográficas (crescimento econômico, redução das disparidades de renda entre as populações mais ricas e mais pobres, urbanização, melhoria na educação das mulheres e redução nas taxas de fecundidade); intervenções externas ao setor de saúde (programas condicionais de transferência de renda e melhorias no sistema de água e saneamento); programas verticais de saúde nos anos 1980 (promoção da amamentação, hidratação oral e imunizações); criação do Sistema Nacional de Saúde (SUS), mantido por impostos e contribuições sociais, cuja cobertura foi expandida para atingir as áreas mais pobres do país por intermédio do Programa de Saúde da Família, na metade dos anos 1990; e a implementação de vários programas nacionais e estaduais para melhoria da saúde e nutrição infantil e, em menor grau, para a promoção da saúde das mulheres. Apesar dos muitos progressos, desafios importantes ainda persistem, incluindo a medicalização abusiva (quase 50% dos nascimentos ocorrem por cesariana), mortes maternas causadas por abortos inseguros e a alta frequência de nascimentos pré-termo.

The State of the World’s Midwifery 2014. A Universal Pathway …

The State of the World’s Midwifery (SoWMy) 2014 presents findings on midwifery from 73 low and middle- income countries. The report, produced by UNFPA, the International Confederation of Midwives (ICM), the World Health Organization (WHO) and several other partners, shows the progress and trends that have taken place since the inaugural 2011 edition, and also identifies the barriers and challenges to future progress. The report focuses on the urgent need to improve the availability, accessibility, acceptability and quality of midwifery services. Despite a steady drop in maternal and newborn deaths since 1990, hundreds of thousands of women and newborns continue to die each year during pregnancy and childbirth: An estimated 289,000 women and about 3 million newborn babies died in 2013 alone. The vast majority lost their lives due to complications and illnesses that could have been prevented with proper antenatal care and the presence of a skilled midwife during delivery.

Midwife-led continuity models versus other models of care for childbearing women

Background Midwives are primar y providers of care for childbearing women around the world. However, th ere is a lack of synthesised informationto establish wheth er there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-ledcontinuity models and othe r models of care.ObjectivesTo compare midwife-led continuity models of care with other models of care for childbearing women and their infants.Search methodsWe searched the Cochrane Pregnancy and Childbirth Gr oup’s Trials Register (25 January 2016) and reference lists of retrieved studies.Selection criteriaAll published and unpublished trials in which pregnant women are randomly al located to midwife-led continuity models of care orother model s of care during pregnancy and birth.Data collection and analysisTwo review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them f or accuracy. Thequality of the evidence was assessed using the GRADE approach.Main resultsWe included 15 trials involving 17,674 women. We assessed th e quality of the trial evidence for all primary outcomes (i.e. regionalanalgesia (e pidural/spinal), caesarean birth, instrumental vaginal birth (forceps/vacuum), spontaneous vaginal birth, intact perineum,preterm birth (less than 37 weeks) and all fetal loss before and afte r 24 weeks plus neonatal death using the GRADE methodology: allprimary outcomes were graded as of high quality.For the primary outcomes, women who had midwife-led continuity model s of care were less likely to experience regional analgesia(average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.78 to 0.92; participants = 17,674; studies = 14; high quality), instrumental vaginal birth (average RR 0.90, 95% CI 0.83 to 0.97; participants = 17,501; studies = 13; high quality), preterm birth less than 37weeks (average RR 0.76, 95% CI 0.64 to 0.91; participants = 13,238; studies = eight; high quality) and less all fetal loss before andafter 24 weeks plus neonatal death (average RR 0.84, 95% CI 0.71 to 0.99; participants = 17,561; studies = 13; high quality evidence).Women who had midwife-led continuity models of care were more likely to experience spontaneous vaginal birth (average RR 1.05,95% CI 1.03 to 1.07; par ticipants = 16,687; studies = 12; high quality). There were no diffe rences between groups for caesarean birthsor intact perineum.For the secondary outcomes, women who had midwife-led continuity models of care were less likely to experience amniotomy (averageRR 0.80, 95% CI 0.66 to 0.98; participants = 3253; studies = four), e pisiotomy (average RR 0.84, 95% CI 0.77 to 0.92; participants= 17,674; studies = 14) and fetal loss less than 24 weeks and neonatal death (average RR 0.81, 95% CI 0.67 to 0.98; participants =15,645; studies = 11). Women who had midwife-led continuity models of care were more likely to experience no intrapartum analgesia/anaesthesia (average RR 1.21, 95% CI 1.06 to 1.37; participants = 10,499; studies = se ven), have a longer mean le ngth of labour(hours) (mean difference (MD) 0.50, 95% CI 0.27 to 0.74; participants = 3328; studies = three) and more likely to be attended atbirth by a known midwife (average RR 7.04, 95% CI 4.48 to 11.08; participants = 6917; studies = seven). The re were no differencesbetween groups for fetal loss equal to/after 24 weeks and neonatal death, induction of l abour, antenatal hospitalisation, antepartumhaemorrhage, augmentation/artificial oxytocin during labour, opiate analgesia, perineal laceration requiring suturing, postpartumhaemorrhage, breastfeeding initiation, l ow birthweight infant, five-minute Apgar score less th an or equal to seven, neonatal convulsions,admission of infant to special care or neonatal intensive care unit(s) or in mean length of neonatal hospital stay (days).Due to a lack of consistency in measuring women’s satisfaction and assessing the cost of various maternity models, these outcomes wererepor ted narratively. The majority of included studies reported a higher rate of maternal satisfaction in midwife-le d continuity modelsof care. Similarly, there was a trend towards a cost-saving effect for midwife-led continuity care compared to othe r care models.Authors’ conclusionsThis review suggests that women who received midwife-led continuity models of care were less likely to experience intervention andmore likely to be satisfied with their care with at least comparable adverse outcomes for women or their infants than women whoreceived other models of care.Further research is needed to explore findings of fewer preterm births and fewer fetal de ath s less than 24 weeks, and all fetal loss/neonatal death associated with midwife-led continuity model s of care.

Midwifery and quality care: findings from a new evidence-informed framework …

In this fi rst paper in a series of four papers on midwifery, we aimed to examine, comprehensively and systematically, the contribution midwifery can make to the quality of care of women and infants globally, and the role of midwives and others in providing midwifery care. Drawing on international defi nitions and current practice, we mapped the scope of midwifery. We then developed a framework for quality maternal and newborn care using a mixed-methods approach including synthesis of fi ndings from systematic reviews of women’s views and experiences, eff ective practices, and maternal and newborn care providers. The framework diff erentiates between what care is provided and how and by whom it is provided, and describes the care and services that childbearing women and newborn infants need in all settings. We identifi ed more than 50 short-term, medium-term, and long-term outcomes that could be improved by care within the scope of midwifery; reduced maternal and neonatal mortality and morbidity, reduced stillbirth and preterm birth, decreased number of unnecessary interventions, and improved psychosocial and public health outcomes. Midwifery was associated with more effi cient use of resources and improved outcomes when provided by midwives who were educated, trained, licensed, and regulated. Our fi ndings support a system-level shift from maternal and newborn care focused on identifi cation and treatment of pathology for the minority to skilled care for all. This change includes preventive and supportive care that works to strengthen women’s capabilities in the context of respectful relationships, is tailored to their needs, focuses on promotion of normal reproductive processes, and in which fi rst-line management of complications and accessible emergency treatment are provided when needed. Midwifery is pivotal to this approach, which requires eff ective interdisciplinary teamwork and integration across facility and community settings. Future planning for maternal and newborn care systems can benefi t from using the quality framework in planning workforce development and resource allocation.

Midwifery: An Executive Summary for The Lancet’s Series

The essential needs of childbearing women in all countries, and of their babies and families, are the focus of this thought-provoking series of international studies on midwifery. Many of those needs are still not being met, decades after they have been recognized. New solutions are required. The Series provides a framework for quality maternal and newborn care (QMNC) that firmly places the needs of women and their newborn infants at its centre. It is based on a definition of midwifery that takes account of skills, attitudes and behaviours rather than specific professional roles. The findings of this Series support a shift from fragmented maternal and newborn care provision that is focussed on identification and treatment of pathology to a whole-system approach that provides skilled care for all.

The projected effect of scaling up midwifery

We used the Lives Saved Tool (LiST) to estimate deaths averted if midwifery was scaled up in 78 countries classified into three tertiles using the Human Development Index (HDI). We selected interventions in LiST to encompass the scope of midwifery practice, including prepregnancy, antenatal, labour, birth, and post-partum care, and family planning. Modest (10%), substantial (25%), or universal (95%) scale-up scenarios from present baseline levels were all found to reduce maternal deaths, stillbirths, and neonatal deaths by 2025 in all countries tested. With universal coverage of midwifery interventions for maternal and newborn health, excluding family planning, for the countries with the lowest HDI, 61% of all maternal, fetal, and neonatal deaths could be prevented. Family planning alone could prevent 57% of all deaths because of reduced fertility and fewer pregnancies. Midwifery with both family planning and interventions for maternal and newborn health could avert a total of 83% of all maternal deaths, stillbirths, and neonatal deaths. The inclusion of specialist care in the scenarios resulted in an increased number of deaths being prevented, meaning that midwifery care has the greatest effect when provided within a functional health system with effective referral and transfer mechanisms to specialist care.