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

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Portaria GM/MS Nº 426 de 22 de março de 2005

O MINISTRO DE ESTADO DA SAÚDE, no uso de suas atribuições, e Considerando a necessidade de estruturar no Sistema Único de Saúde - SUS uma rede de serviços regionalizada e hierarquizada que permita atenção integral em reprodução humana assistida e melhoria do acesso a esse atendimento especializado; Considerando que a assistência em planejamento familiar deve incluir a oferta de todos os métodos e técnicas para a concepção e a anticoncepção, cientificamente aceitos, de acordo com a Lei nº 9.263, de 12 de janeiro de 1996, que regula o § 7º do art. 226 da Constituição Federal, que trata do planejamento familiar; Considerando que, segundo a Organização Mundial da Saúde- OMS e sociedades científicas, aproximadamente, 8% a 15% dos casais têm algum problema de infertilidade durante sua vida fértil, sendo que a infertilidade se define como a ausência de gravidez após 12 (doze) meses de relações sexuais regulares, sem uso de contracepção; Considerando que as técnicas de reprodução humana assistida contribuem para a diminuição da transmissão vertical e/ou horizontal de doenças infectocontagiosas, genéticas, entre outras; Considerando a necessidade de estabelecer mecanismos de regulação, fiscalização, controle e avaliação da assistência prestada aos usuários; e Considerando a necessidade de estabelecer os critérios mínimos para o credenciamento e a habilitação dos serviços de referência de Média e Alta Complexidade em reprodução humana assistida na rede SUS

Assistência Integral à Saúde da Mulher: bases de ação programática…

O atendimento à mulher pelo sistema de saúde tem-se limitado, quase que exclusivamente, ao período gravídico-puerperal, e, mesmo assim, de forma deficiente. Ao lado de exemplos sobejamente conhecidos, como a assistência preventiva e de diagnóstico precoce de doenças ginecológicas malignas, outros aspectos, como a prevenção, detecção e terapêutica de doenças de transmissão sexual, repercussões biopsicossociais da gravidez não desejada, abortamento e acesso a métodos e técnicas de controle da fertilidade, tem sido relegados a plano secundário. Esse quadro assume importância ainda maior o se considerar a crescente presença da mulher na força de trabalho, além do seu papel fundamental no núcleo familiar. Em relação à atenção à mulher – objeto primordial desta proposta - Os serviços de saúde devem ser dotados de meios adequados, articulando-se os esforços do governo federal, dos estados e municípios, com o objetivo de oferecer atividades de assistência integral clínico-ginecológica e educativa, voltadas para o aprimoramento do controle pré-natal, do parto e do puerpério; a abordagem dos problemas presentes desde a adolescência até a terceira idade; o controle das doenças transmitidas sexualmente, do câncer cérvico-uterino e mamário, e a assistência para concepção e contracepção.

Avaliação do bem-estar fetal intraparto

A avaliação do bem-estar fetal durante o trabalho de parto é crucial para a tomada de decisão sobre uma intervenção oportuna e apropriada.

Intrapartum Care for Healthy Women and Babies

This guideline covers the care of healthy women and their babies, during labour and immediately after the birth. It focuses on women who give birth between 37 and 42 weeks of pregnancy (‘term’). The guideline helps women to make an informed choice about where to have their baby. It also aims to reduce variation in areas of care such as fetal monitoring during labour and management of the third stage of labour.

Intrapartum fetal heart rate monitoring: nomenclature, interpretation …

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol. 2009 Jul;114(1):192-202.

Continuous cardiotocography (CTG) as a form of electronic fetal monitoring…

Cardiotocography (CTG) records changes in the fetal heart rate and their temporal relationship to uterine contractions. The aim is to identify babies who may be short of oxygen (hypoxic) to guide additional assessments of fetal wellbeing, or determine if the baby needs to be delivered by caesarean section or instrumental vaginal birth. This is an update of a review previously published in 2013, 2006 and 2001. To evaluate the effectiveness and safety of continuous cardiotocography when used as a method to monitor fetal wellbeing during labour.CTG during labour is associated with reduced rates of neonatal seizures, but no clear differences in cerebral palsy, infant mortality or other standard measures of neonatal wellbeing. However, continuous CTG was associated with an increase in caesarean sections and instrumental vaginal births. The challenge is how best to convey these results to women to enable them to make an informed decision without compromising the normality of labour.The question remains as to whether future randomised trials should measure efficacy (the intrinsic value of continuous CTG in trying to prevent adverse neonatal outcomes under optimal clinical conditions) or effectiveness (the effect of this technique in routine clinical practice). Along with the need for further investigations into long-term effects of operative births for women and babies, much remains to be learned about the causation and possible links between antenatal or intrapartum events, neonatal seizures and long-term neurodevelopmental outcomes, whilst considering changes in clinical practice over the intervening years (one-to-one-support during labour, caesarean section rates). The large number of babies randomised to the trials in this review have now reached adulthood and could potentially provide a unique opportunity to clarify if a reduction in neonatal seizures is something inconsequential that should not greatly influence women's and clinicians' choices, or if seizure reduction leads to long-term benefits for babies. Defining meaningful neurological and behavioural outcomes that could be measured in large cohorts of young adults poses huge challenges. However, it is important to collect data from these women and babies while medical records still exist, where possible describe women's mobility and positions during labour and birth, and clarify if these might impact on outcomes. Research should also address the possible contribution of the supine position to adverse outcomes for babies, and assess whether the use of mobility and positions can further reduce the low incidence of neonatal seizures and improve psychological outcomes for women.

Discutindo a Posição Canguru

A Posição Canguru consiste em manter o recém-nascido em contato pele a pele, junto do peito da mãe ou do pai, em decúbito prono e na posição vertical. Seus benefícios são comprovados por evidências científicas.

Time of initiation of skin-to-skin contact in extremely preterm in Sweden

To describe the time of first skin-to-skin contact in extremely preterm infants in a national perspective and to investigate possible factors affecting the time of first skin-to-skin contact. Extremely preterm infants in Sweden experience first skin-to-skin contact with the parent at a median of six postnatal days (range 0-44). Low gestational age, a high score on the clinical risk index for babies, and the number of days on a ventilator tended to delay first skin-to-skin contact. A statistically significant difference was also found between regional hospitals. There is a difference in the time of first skin-to-skin contact based on the infant's medical condition and the tradition in the neonatal intensive care unit at the regional hospital where the infant is born.

Neurophysiologic assessment of neonatal sleep organization: preliminary …

Sleep is important to brain organization, but few strategies to promote sleep among premature infants have been tested. Behaviorally based measures of sleep have shown increased quiet sleep (QS) and decreased active sleep (AS) during skin-to-skin contact (SSC) with the mother, but these results have not been confirmed with objective electroencephalographic/polysomnographic measures of sleep organization. Important differences exist between behavioral and electroencephalographic/polysomnographic definitions of sleep state. Results showed that arousals were significantly lower in the SSC group, compared with the control group, for the entire study period and for test-pretest matched segments of QS and AS. Rapid eye movement was significantly lower for the SSC group for the study period and AS segments. Indeterminate sleep was significantly lower for the SSC group when confounding environmental variables were included in the regression analysis. When 4 subjects who experienced excessive ambient light levels during SSC were removed from analysis, QS increased during SSC. The patterns demonstrated by the SSC group are analogous to more-mature sleep organization. SSC may be used as an intervention to improve sleep organization in this population of preterm infants.

Early contact versus separation: effects on mother-infant interaction one year later

A tradition of separation of the mother and baby after birth still persists in many parts of the world, including some parts of Russia, and often is combined with swaddling of the baby. The aim of this study was to evaluate and compare possible long-term effects on mother-infant interaction of practices used in the delivery and maternity wards, including practices relating to mother-infant closeness versus separation. Skin-to-skin contact, for 25 to 120 minutes after birth, early suckling, or both positively influenced mother-infant interaction 1 year later when compared with routines involving separation of mother and infant.

Initiation and extent of skin-to- skin care at two Swedish neonatal intensive care units

To describe initiation and extent of parents' application of skin-to-skin care (SSC) with their preterm infants at two Swedish neonatal intensive care units. The duration of SSC was recorded in 104 infants' medical charts during their hospital stay, and the parents answered a questionnaire. Both parents were involved in the practice of SSC. Three infants experienced SSC directly after birth, 34 within 1 h, 85 within 24 h and the remaining 19 at 24-78 h postbirth. SSC commenced earlier (median age of 50 min) in infants whose first SSC was with their father instead of with their mother (median age of 649 min: p < 0.001). The earlier the SSC was initiated, the longer the infant was cared for skin-to-skin per day during his/her hospital stay (p <0.001). The median daily duration of SSC was 403 min. Early initiation of SSC had positive impact on the extent of parents' application of SSC. Even though the infants in this study were cared for skin-to-skin to a high extent, there is a potential for extended use of SSC in this type of hospital setting for reducing separation between infants and parents.

Principais Questões sobre Rastreio do Câncer de Colo de Útero

O Câncer de colo de útero é uma doença prevenível e temos todas as tecnologias para ter sucesso na sua prevenção. A dificuldade do Brasil, como também de outros países, é chegar às mulheres que estão sob risco e garantir acesso aos serviços de saúde.