Vacuna contra la COVID-19 y menstruación, desde el desconocimiento a la información: revisión sistemática / Vaccine against COVID-19 and menstruation, from ignorance to information: a systematic review

La creación de una vacuna para enfrentar la pandemia de COVID-19 conllevó un vacío de información sobre las posibles alteraciones del ciclo menstrual. El objetivo fue verificar las posibles alteraciones que se pudiesen haber generado en el ciclo menstrual de las mujeres posterior a la inoculación de la vacuna contra la COVID-19. Se realizó una revisión sistemática en las bases bibliografías Medline, Medline Complete, LILACS, CINAHL y ScIELO, utilizando los descriptores “Women”, “Woman”, “Fertile period”, “Vaccination”, “Mass vaccination”, “Immunization”, “COVID-19 vaccines”, “SARS-CoV-2 infection”, “COVID-19”, “Menstrual cycle”, “Menstruation”, “Endometrial cycle”, “Dysmenorrhea” y “Menstruation disturbances”. Mediante la utilización del protocolo PRISMA, de los 319 artículos localizados, 17 fueron incluidos en el análisis. La mayoría de los estudios incluyeron, principalmente, las vacunas Pfizer, Moderna, AstraZeneca y Johnson&Johnson/Janssen con una a tres dosis administradas. El porcentaje de ciclos menstruales alterados fue del 8,0% al 77,8%, y la alteración con mayor frecuencia referida fue la duración del ciclo menstrual, que fue desde 0,3 hasta 12 días de retraso de la menstruación. Todos los estudios refieren cambios en el ciclo menstrual con diversas prevalencias, con y sin significación estadística; sin embargo, también concluyen que estas alteraciones son reversibles y en un corto periodo de tiempo.

The creation of a vaccine to face the COVID-19 pandemic, led to an information gap on possible alterations of the menstrual cycle. The objective was to verify the possible alterations that could have been generated in the menstrual cycle of women, after the inoculation of the vaccine against COVID-19. A systematic review was carried out in the Medline, Medline Complete, LILACS, CINAHL and ScIELO bibliographic databases, using the descriptors “Women”, “Woman”, “Fertile period”, “Vaccination”, “Mass vaccination”, “Immunization”, “COVID-19 vaccines”, “SARS-CoV-2 infection”, “COVID-19”, “Menstrual cycle”, “Menstruation”, “Endometrial cycle”, “Dysmenorrhea” and “Menstruation disturbances”. Using the PRISMA protocol, of the 319 articles located, 17 were included in the analysis. Most of the studies mainly included the Pfizer, Moderna, AstraZeneca and Johnson&Johnson/Janssen vaccines with one to three doses administered. The percentage of altered menstrual cycles ranged from 8.0% to 77.8%, and the most frequently reported alteration was the length of the menstrual cycle, which occurred from 0.3 to 12 days late in menstruation. All the studies refer to changes in the menstrual cycle with different prevalences, with and without statistical significance; however, the same studies also conclude that these alterations are reversible and in a short period of time.

Uso de anticonceptivos y conocimiento del periodo fértil del ciclo menstrual en adolescentes

Introducción: La comprensión de los cambios fisiológicos que se presentan en las mujeres adolescentes son fundamentales para el cuidado de su salud sexual. Esto favorece un comportamiento anticonceptivo orientado a la elección de métodos seguros y eficaces. Objetivo: Establecer la asociación entre el uso de métodos anticonceptivos y el conocimiento del periodo fértil del ciclo menstrual en adolescentes peruanas. Métodos: Estudio transversal basado en el análisis secundario de la Encuesta Demográfica y de Salud Familiar del año 2021. La muestra fue de 717 de mujeres adolescentes con registro completo en las bases de datos. Se calcularon recuentos ponderados, no ponderados y se aplicó la prueba ji cuadrado con un 95 % de nivel de confianza. Resultados: El 19 % de las adolescentes reconocen el periodo fértil del ciclo menstrual y 6,3 % refirió que este periodo sucede durante la menstruación. El 80,8 % de las mujeres que cursan la adolescencia temprana, no conocen el momento del periodo. Respecto al uso de anticonceptivos, el 21,5 % era usuaria de preservativos y 16,3 % de inyectables; no obstante, 47 % señaló que no utilizaban ningún anticonceptivo. El 53,5 % de las adolescentes en etapa tardía indicaron que sí utilizan anticonceptivos. Entre las que son usuarias de estos métodos, 86,3 % no reconocen el periodo fértil. Conclusiones: En las adolescentes, el uso de métodos anticonceptivos no se asocia de manera significativa con el conocimiento que tienen acerca del periodo fértil del ciclo menstrual.

Introduction: The understanding of the physiological changes that occur in adolescent women are essential for the care of their sexual health. Thus, this favors a contraceptive behavior oriented to the choice of safe and effective methods. Objective: To establish the association between the use of contraceptive methods and the knowledge of the fertile period of the menstrual cycle in Peruvian adolescents. Methods: Cross-sectional study based on the secondary analysis of the 2021 Demographic and Family Health Survey. The sample consisted of 717 adolescent women with complete registration in the databases. Weighted and unweighted counts were calculated; and the Chi square test was applied at a 95% confidence level. Results: 19% of adolescents recognize the fertile period of the menstrual cycle and 6.3% reported that this period occurs during menstruation. In addition, 80.8% of women in early adolescence do not know the time of their period. Regarding the use of contraceptives, 21.5% were users of condoms and 16.3% of injectables; however, 47% indicated that they did not use any contraceptive. 53.5% of late-stage adolescents indicated that they do use contraceptives. Among those who are users of these methods, 86.3% do not recognize the fertile period. Conclusions: In adolescents, the use of contraceptive methods is not significantly associated with the knowledge they have about the fertile period of the menstrual cycle.

The effect of maternal anxiety during pregnancy on the social emotional development among toddlers / 中国学校卫生

Objective@#To explore the impact of maternal anxiety during pregnancy on social emotional development of toddlers aged 1-3 year old, so as to provide references for scientific early parenting and early intervention for toddlers with social emotional difficulties.@*Methods@#From September 2022 to March 2023, a total of 815 toddlers aged 1-3 who underwent physical examinations and their mothers at Nantong Maternal and Child Health Hospital were enrolled. The Chinese Infant Toddler Social and Emotional Assessment (CITSEA) was used to evaluate the social emotional ability among toddlers. Maternal anxiety evaluated using the Self rating Anxiety Scale (SAS) during prenatal visit was collected.@*Results@#The average scores on the externalizing, internalizing, dysregulation and competence domains of the CITSEA were (49.40±9.48,47.42±9.60,48.67± 10.15 , 50.07± 10.20), respectively. Among boys, the score of externalizing domain (50.89±9.45) was higher than that of girls (48.76± 9.50 ), while the score of competence domain (49.22±10.30) was lower than that of girls (51.17±9.84), and the differences were statistically significant( t =2.10, -3.03, P <0.05). The detection rates of abnormalities in the externalizing, internalizing, dysregulation, and competence domains were 7.36%, 7.12%, 7.61%, and 7.24%, respectively. Among them, boys (8.43%,6.32%, 7.96 %,7.49%) and girls (6.19%, 7.99 %,7.22%,6.96%) showed no statistical differences ( χ 2=1.50, 0.85, 0.16, 0.09, P >0.05). There were significant differences in externalizing domain scores（47.77±9.52，49.56±8.95，52.51±9.77） and competence domain scores（51.70±10.38，49.65±10.05，46.68±10.03） among toddlers of different maternal anxiety（normal, mild, moderate to severe） （ F =7.05,7.10, P <0.01）. There were significant differences in the abnormal detection rate of externalizing domain （4.81%，7.54%，11.17%） and competence domain（4.81%，6.96%，11.73%）（ χ 2=6.60，7.98， P ＜0.05）.@*Conclusion@#Maternal anxiety during pregnancy has a negative impact on the social emotional development among toddlers. In order to improve social emotional development of toddlers, multidimensional social support and education during pregnancy should be carried out.

Evaluation of the tear parameters of ovulation induction patients in a short time period with anterior segment optical coherence tomography / Avaliação dos parâmetros lacrimais de pacientes submetidas à indução de ovulação por curto período pela tomografia de coerência óptica do segmento anterior

ABSTRACT Purpose: The effects of sex steroid hormones on tearparameters are known. Theaim of this studywas to examine the effects on tear parameters during exposure to high-dose sex steroids in a short period of time. Methods: Forty patients who were admitted to the infertility clinic of our hospital and planned to undergo ovulation induction with exogenous gonadotropins were included in our study. Prior tothe initiation of ovulation induction, the basal levels of estradiol were measured on day 3 of the menstrual cycle and ophthalmologic examinations were performed by the ophthalmology department of our hospital. The estradiol levels were-measured on the day ofovulation induction usinghuman chorionic gonadotropin and compared with basal estra­diol; eye examinations were also repeated. Result: Forty women with reproductive period and average age of 33.3 ± 4.2 years were included in this study. Basal levels of estradiol were significantly (p<0.001) higher after ovulation induction than before induction. The scores in the break-up timeand after induction were 6.2 ± 2.8 sn and 8.4 ± 1.4 sn, respectively. The values of Schirmer's test were 14.3 ± 7.1 mm and 20.6 ± 6.2 mm before and after induction, respectively. Both values were significantly higher after ovulation induction (p<0.001; p=0.001, respectively). Conclusion: We observed impro­vemet in tear function tests following the use of estradiol even for a limited time.The use of estradiol during menopause may improve dry eye symptoms in patients.

RESUMO Objetivo: Os efeitos dos hormônios esteróides se­xuais nos parâmetros lacrimais são conhecidos. O objetivo deste estudo foi examinar como os efeitos nos parâmetros lacrimais durante a exposição a altas doses de esteróides sexuais em um curto período de tempo. Métodos: Quarenta pacientes que foram admitidas na clínica de infertilidade do nosso hospital e planejavam a indução de ovulação por gonadotropinas exógenas. Antes do início da indução da ovulação, os níveis basais de estradiol foram medidos no terceiro dia do ciclo menstrual e os exames oftalmológicos foram efetuados pelo Departamento de Oftalmologia do nosso hospital. Os níveis de estradiol foram medidos no dia da indução da ovulação usando gonadotrofina coriónica humana e comparados aos estradiol basal; exames oftalmológicos também foram repetidos. Resultado: Quarenta mulheres com período reprodutivo e idade média de 33,3 ± 4,2 anos foram incluídas neste estudo. Os níveis basais de estradiol foram significativamente maiores (p<0,001) após a indução da ovulação do que antes desta. Os resultados dos testes de ruptura do filme lacrimal e após a indução foi de 6,2 ± 2,8 s e 8,4 ± 1,4 s respectivamente. Os valores do teste de Schirmer foram 14,3 ± 7,1 mm e 20,6 ± 6,2 mm, respectivamente antes e depois da indução. Ambos os valores foram significativamente maiores após a indução da ovulação (p<0,001; p=0,001 respectivamente). Conclusão: Observamos uma melhora nos testes de função lacrimal após o uso de estradiol, mesmo por tempo limitado. O uso de estradiol durante a menopausa poderá melhorar os sintomas do olho seco em pacientes.

Neonatal umbilical cord blood vitamin D status and related factors / 中国新生儿科杂志

Objective To study neonatal umbilical cord blood vitamin D status and related factors.Method From January to March 2016,pregnant mothers and their neonates admitted to our hospital were enrolled.According to maternal intake of vitamin D in the third trimester,they were assigned into non supplement group,＜ 400 IU/d group and ≥ 400 IU/d group.Binary Logistic regression was used to examine factors related to neonatal umbilical cord blood vitamin D status.The predictive value of maternal third trimester vitamin D intaken and umbilical cord blood vitamin D level were determined using receiver operator characteristic (ROC) curve.Result A total of 109 newborns were enrolled in the study.The median concentration of 25 (OH)D in the umbilical cord blood was (17.5 ± 7.7) ng/ml.The incidences of 25 (OH) D sufficiency,insufficiency and deficiency was 33.9％ (37/109),22.0％ (24/109) and 39.4％(43/109),and 4 cases(4.6％) had serious deficiency.The median concentration of 25 (OH)D were (12.9 ± 6.5),(18.2 ± 6.9),(21.7 ± 8.4) ng/ml in the non-supplementation group,＜ 400 IU/d intake group and ≥400 IU/d intake group,respectively,with statistically significant differences(P ＜ 0.05).The three groups had similar birth weight,height,bregma and head circumference (P ＞ 0.05).25 (OH) D level in neonatal umbilical cord blood was positively correlated with the amount of maternal third trimester vitamin D supplementation (P ＜ 0.05).The Youden index was highest (0.403) when vitamin D supplement was 187 IU/d,the corresponding sensitivity was 0.514,the specificity was 0.889 and the area under the ROC curve was 0.777 (95％ CI 0.685 ～ 0.870).Conclusion Vitamin D insufficiency is common in neonatal umbilical cord blood among our patients.The maternal third trimester vitamin D supplementation dosage is related to the neonatal umbilical cord blood vitamin D level,which has a certain predictive value for vitamin D level in newborn.

Expression of integrin β3 in the endometrial implantation window of patients with cesarean section scar infertility and its correlation with endometrial receptivity / 中国基层医药

Objective@#To investigate the expression of integrin β3 in the endometrial implantation window of patients with cesarean scar and infertility, and its correlation with endometrial receptivity.@*Methods@#A total of 40 patients with previous cesarean scar defect (PCSD) secondary infertility treated in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from April 2018 to December 2019 were enrolled as the observation group.The natural cycle of 40 normal women who were examined in our hospital at the same time were selected as the control group.The two groups were enrolled in the endometrium of the glandular epithelial cells for MMP-9, TIMP-1 and LIF immunohistochemical staining, and statistical analysis was performed.The serum E2 and P levels of the implantation group were compared.The E2/P ratio was measured and compared, and the expression level of integrin β3 endometrial planting window was compared.@*Results@#The MMP-9, TIMP-1 and LIF in the observation group [(175.31±56.36), (201.46±51.34), (209.23±45.23)] were significantly lower than those in the control group [(252.35±78.43), (257.23±74.13), (298.34±72.35)] (t=5.334, 5.766, 6.023, all P<0.05), but the E2, P and E2/P in the observation group [(515.31±56.36)pmol/L, (53.71±8.34)pmol/L, (13.23±5.23)] were higher than those in the control group[(352.35±78.43)pmol/L, (33.13±4.13)pmol/L, (8.17±2.91)] (t=7.334, 4.251, 3.241, all P<0.05). The level of beta 3 in the observation group (0.163±0.013) was significantly lower than that in the control group (0.253±0.031) (t=4.342, P<0.05). The thickness of endometrium in the observation group [(9.12±2.03)mm] was significantly thinner than that in the control group [(12.24±2.45)mm] (t=3.226, P<0.05).@*Conclusion@#The expression of integrin β3 in the endometrial implantation window of patients with cesarean section scar infertility has a certain influence on endometrial receptivity.

Blood interleukin-6, interleukin-8 and metal matrix protease-9 in neonatal rat lung injury caused by intrauterine infection / 中国新生儿科杂志

Objective To investigate the significance of interleukin-6 IL-6),interleukin-8 (IL-8) and metal matrix protease-9 (MMP-9) in lung injury caused by intrauterine infection in ueonatal rats.Method Eighteen 18-day-old SD pregnant rats were selected and randomly assigned into 0.6,0.7,0.8,0.9,1.0 mg/kg lipopolysaccharide (LPS) groups and control group.Rats of LPS group were injected intraperitoneally with LPS 0.6.0.7,0.8,0.9,1.0 mg/kg,those of control group was injected with equal volume of sterile saline.After 24 hours of injection,one pregnant rat from each group underwent cesarean seetion and placentae were collected for pathological evaluation.The other pregnant rats delivered spontaneously.When the neonatal rats came to 1,3,and 7 days of age,8 rats were randomly selected from each group.The respiratory frequency,body weight,lung weight,and blood samples for detecting inflammatory factors using enzyme-linked immunosorbent assay were measured among 3-day-old neonatal rats.Lung tissue for hematoxylin-eosin staining and lung pathology score were taken in the 1,3 and 7-day-old neonatal rats.Result (1) The mortality rate of neonatal rats increased gradually with the increasing dose of LPS injection.The mortality rate of neonatal rats in the LPS 1.0 mg/kg group was 20％.The placental pathology score and the frequency of 3-day-old neonatal rats in LPS 0.8,0.9,and 1.0 mg/kg groups were higher than control group and other LPS groups (P ＜ 0.05).(2) The histopathological scores of the neonatal rats in the control group and LPS 0.6,0.7,0.8,0.9,1.0 mg/kg groups on the first day after birth were (0.08±0.08),(0.17±0.11),(1.33±0.19),(1.75±0.33),(1.92±0.36),(2.67±0.14),respectively,and that of the third day after birth were (0.00 ± 0.00),(0.50 ± 0.15),(0.67 ±0.19),(1.33 ±0.36),(2.17 ±0.21),(2.92 ±0.08),respectively.LPS 1.0 mg/kg group on the 1st and 3rd day after birth were significantly different from the other groups (P ＜0.05),LPS 0.8 mg/kg group on the 1st and 3rd day after birth were significantly different from the control group and LPS 0.6 mg/kg group (P ＜ 0.05),and there was significant difference among the LPS 0.9 mg/kg group and the other groups on the 3rd day after birth (P ＜ 0.05).When the concentration of LPS was less than 0.8 mg/kg,there was no significant difference in the pathological scores of the lung tissues between each group (P ＞0.05).(3) The concentrations of IL-6,IL-8,and MMP-9 in the neonatal rats of LPS 0.7,0.8,0.9,and 1.0 mg/kg groups were significantly higher than those in the control group at 3 days of age,and the difference among LPS groups were statistically significant (P ＜ 0.05).Conclusion The intraperitoneal injection of LPS in rats 18 days after gestation can lead to lung injury,pulmonary edema,and increasing level of blood IL-6,IL-8,and MMP-9 in the neonatal rats,and this damage lasts until 7 days after birth which suggests the important meaning for lung diseases caused by intrauterine infection.

Nested case-control study on the relationship between risk factors of pregnancy and infantile eczema in Uygur and Han ethnic / 中国实用护理杂志

Objective To investigate the prevalence of infantile eczema in Uygur and Han nationalities and the relationship between pregnancy factors and 0-6 months infant eczema, so as to provide a scientific basis for formulating preventive strategies. Methods From January-August 2016 in the Xinjiang Autonomous Region People's Hospital of obstetric and follow-up to fill out the questionnaire in 570 pregnant women and their babies as the research object to establish the baseline survey cohort, pregnancy related information to pregnant women, and 6 months (January, March, on maternal June) follow-up, observe the occurrence of infantile eczema a total of 502, successful follow-up to maternal and child. Using nested case-control study, the cohort occurred in 182 cases of infant eczema as case group, will be in the queue without eczema in 320 infants as control group, using multivariate logistic regression analysis of risk factors during pregnancy baby eczema. Results 0-6 months infant eczema incidence rate was 36.25％, the incidence of Uygur infant eczema (20.43％) was significantly lower than that of Han nationality infant eczema incidence (50.19％) (OR=0.45,95％CI:0.35-0.69) P<0.01). Social and economic factors affecting the occurrence of infantile eczema comparison results showed that the ethnic factors and infant eczema, and more prone to eczema than that of Uygur nationality; and Uygur compared mothers influence allergic history of Han infantile eczema more (χ2=7.09, P=0.008). Multivariate logistic regression analysis showed that the mother has a history of atopy (OR=7.17,95％CI:4.15-12.37), mother′s education level (OR=1.91,95％CI:1.51-2.74), the higher the monthly income (OR=2.68,95％CI:2.17-3.33), maternal smoking during pregnancy (secondhand smoke) (OR=2.42,95％CI:1.96-2.97), frequently eating spicy spicy foods during pregnancy (OR=1.94,95％CI: 1.41-2.68) will increase the risk of infant eczema Supplementation of probiotics (OR=0.13,95％CI:0.07-0.25) and vitamin D (OR=0.13,95％CI:0.06-0.26) during pregnancy is a protective factor in the development of infantile eczema. Conclusions Compared to Uygur, Han Chinese infants are more likely occur eczema, and family history of allergies, education, economic income, pregnancy dietand smoking are risk factors for infant eczema. The same risk factors among Uygur and Han ethnic ,but it had a different results. Compared to Han, Uygur pregnant women eating spicy food caused the risk of infant eczema occurrence is higher, but the short period of housing renovation caused the risk of infant eczema occurrence is lower. Therefore, it is necessary to strengthen nutrition andmonitor living environment during pregnancy. Avoiding to eat spicy food and supplying probiotics and vitamin D, it can prevent or reduce the occurrence of infantile eczema.

Prenatal exposure to ambient air pollution and congenital heart disease: a Meta-analysis / 中华流行病学杂志

Objective To explore the association between exposure to ambient air pollution during pregnancy and congenital heart disease so as to provide evidence for primary prevention of congenital heart disease.Methods Epidemiologic studies on ambient air pollution and congenital heart diseases were reviewed.Summary risk estimates were calculated at high versus low exposure levels and risk per-unit-increase in continuous pollutant concentration.Meta-analysis was conducted with Stata 12.0 software.Results A total of 20 articles in English were qualified for inclusion.Results from Meta-analysis showed that CO exposures were related to the increase on the risk of tetralogy of fallot (high versus low exposure level OR=1.22,95％CI:1.03-1.44),while the exposures to NO2 were related to the increase on risk of coarctation of aorta (per 10 mm3/m3 OR=1.01,95％CI:1.01-1.20).Exposures to O3 were related to the increase on risk of atrial septal defect (per 10 mm3/m3 OR=1.14,95％CI:1.03-1.26),and PM10 exposures were related to the increase on risk of atrial septal defect (per 10 μg/m3 OR=1.10,95％CI:1.03-1.19).In addition,there were inverse associations between CO and atrial septal defect and between PM10 and ventricular septal defect.Conclusion Exposures to CO,NO2,O3,PM10 during pregnancy seemed to be associated with congenital heart diseases.

Prenatal exposure to ambient air pollution and congenital heart disease: a Meta-analysis / 中华流行病学杂志

Objective To explore the association between exposure to ambient air pollution during pregnancy and congenital heart disease so as to provide evidence for primary prevention of congenital heart disease.Methods Epidemiologic studies on ambient air pollution and congenital heart diseases were reviewed.Summary risk estimates were calculated at high versus low exposure levels and risk per-unit-increase in continuous pollutant concentration.Meta-analysis was conducted with Stata 12.0 software.Results A total of 20 articles in English were qualified for inclusion.Results from Meta-analysis showed that CO exposures were related to the increase on the risk of tetralogy of fallot (high versus low exposure level OR=1.22,95％CI:1.03-1.44),while the exposures to NO2 were related to the increase on risk of coarctation of aorta (per 10 mm3/m3 OR=1.01,95％CI:1.01-1.20).Exposures to O3 were related to the increase on risk of atrial septal defect (per 10 mm3/m3 OR=1.14,95％CI:1.03-1.26),and PM10 exposures were related to the increase on risk of atrial septal defect (per 10 μg/m3 OR=1.10,95％CI:1.03-1.19).In addition,there were inverse associations between CO and atrial septal defect and between PM10 and ventricular septal defect.Conclusion Exposures to CO,NO2,O3,PM10 during pregnancy seemed to be associated with congenital heart diseases.

Effects of prenatal exposure to lipopolysaccharide on insulin resistance in offspring rats / 天津医药

Objective To explore the effects of prenatal exposure to lipopolysaccharide (LPS) on insulin resistance in adult offspring rats. Methods Nulliparous, time-matched Sprague-Dawley rats were randomly divided into two groups (n=10 for each group):control group and LPS group. On the pregnant day 8, 10 and 12, rats in control group and LPS group were administered intraperitoneally with saline 0.5 mL or LPS 0.40 mg/kg, respectively. The blood levels of fasting plasma glucose (FPG), insulin and Leptin were detected at 90 days of age in offspring. The steady state insulin resistance index (HOMA-IR) and insulin sensitivity index (QUICKI) were evaluated in adult offspring rats. Results Compared with the control group, blood levels of FPG (mmol/L:7.72 ± 0.42 vs 7.02 ± 0.42), insulin (mIU/L:8.78 ± 4.10 vs 1.51 ± 0.27) and Leptin (μg/L:3.88 ± 1.40 vs 1.00±0.33) were significantly increased in offsping of LPS group, as well as HOMA-IR (3.01±1.41 vs 0.47±0.09) in-creased, while QUICKI (0.57±0.07 vs 0.99±0.08) decreased in offsping of LPS-treated rats. Conclusion Prenatal exposure to LPS can result in abnormality of insulin resistance in offspring rats.

Búsqueda intencionada y reclasificación de muertes maternas en México: el efecto en la distribución de las causas / Intentional search and reclassification of maternal deaths in Mexico: The effect on the distribution of causes

Objetivo. Corregir la mala clasificación y mejorar la calidad de la información sobre la mortalidad materna en México. Material y métodos. A través de los registros clínicos y autopsias verbales, se estudiaron todas las defunciones certificadas como maternas y una selección de defunciones de mujeres en edad fértil, cuyas causas fueron consideradas como sospechosas de encubrir una muerte materna; todas ocurridas durante 2011 en México. Resultados. La búsqueda intencionada y reclasificación de muertes maternas permitió rescatar más de 100 muertes que no habían sido registradas ni codificadas inicialmente como maternas y se ratificaron o rectificaron las causas anotadas en los certificados de defunción. Este procedimiento también permitió reclasificar como muertes maternas 297 defunciones de la base preliminar del Instituto Nacional de Estadística y Geografía. Conclusiones. La Búsqueda Intencionada y Reclasificación de Muertes Maternas es un procedimiento muy útil para mejorar la calidad de la información sobre la mortalidad materna.

Objective. To correct the misclassification and improve the quality of information on maternal mortality in Mexico. Materials and methods. Using clinical records and verbal autopsies, we studied all deaths certified as maternal deaths as well as a selection of deaths of women of childbearing age whose causes were considered as suspected of hiding a maternal death, all of which occurred during 2011 within Mexico. Results. The deliberate search of maternal deaths and reclassification allowed the rescue of just over 100 deaths that were not originally registered or coded as maternal and confirmed or corrected the causes of death recorded on death certificates as confirmed maternal deaths. This procedure also allowed the reclassification of 297 maternal deaths of women in the groundwork of the National Institute of Statistics and Geography. Conclusions. International Search and Reclassification of Maternal Deaths is a very useful procedure for improving the classification of cases that were not classified as maternal deaths and the effect was greater with the coding of indirect obstetric deaths.

Mulheres em idade fértil: causas de internação em unidade de terapia intensiva e resultados / Women of childbearing age: causes of hospitalization in intensive care unit and results

INTRODUÇÃO: Pacientes obstétricas representam uma fração significativa das admissões em unidades de cuidado intensivo e consistem em um desafio para a equipe. OBJETIVO: Analisar as principais causas de internação e morte materna de mulheres em idade fértil ocorridas em unidades de terapia intensiva de hospitais de um município do Noroeste do Paraná, Sul do Brasil. MÉTODOS: Estudo exploratório, descritivo, retrospectivo, realizado com mulheres em idade fértil (10 a 49 anos) internadas em três unidades de terapia intensiva existentes em um município do Noroeste do Paraná, por causas obstétricas e não obstétricas, no período de janeiro de 2005 a dezembro de 2009. RESULTADOS: Foram encontradas 775 internações de mulheres em idade fértil, com uma média de idade de 33,7±10,3 anos, com duração média de internação de 5,0±8,4 dias. A maior parte das mulheres era do município estudado (67,2%), com baixa escolaridade (nível primário, 68,2%). Entre as causas obstétricas de internação, a pré-eclâmpsia grave e a eclâmpsia se constituíram na principal causa (71,3%); a pielonefrite se destacou sob outras condições no período gestacional (53%). Não foi encontrada associação estatística entre internações por causas obstétricas em unidade de terapia intensiva e óbito. CONCLUSÃO: As causas não obstétricas representaram a maioria das internações de mulheres em idade fértil nas unidades de terapia intensiva do município, no período estudado e, entre as causas obstétricas, a pré-eclâmpsia grave e a eclâmpsia constituíram a principal causa.

INTRODUCTION: Obstetric patients represent a significant fraction of admissions to intensive care units and consist of a challenge to the team. Objective: To analyze the main causes of maternal death and hospitalization of women of childbearing age occurring in intensive care units of hospitals in a city in Northwestern Paraná, Southern Brazil. METHODS: Exploratory, descriptive and retrospective study, conducted with women of childbearing age (10-49 years) admitted in three intensive care units existing in a city of Northwest Paraná, for obstetric and non-obstetric causes, from January 2005 to December 2009. RESULTS: There were 775 admissions of women of childbearing age, with a mean age of 33.7±10.3 years; the mean duration of hospitalization was 5.0±8.4 days. Most of the women were from the municipality (67.2%), with low education level (primary level, 68.2%). Among the obstetric causes of hospitalization, pre-eclampsia and eclampsia constituted the main cause (71.3%); pyelonephritis stood out other conditions during pregnancy (53%). There was no statistical association betweenhospital admissions for obstetric causes in intensive care unit and death. CONCLUSION: Non-obstetric causes accounted for the majority of hospitalizations of women of childbearing age in the intensive care unit of this municipality during the study period; among obstetric causes, pre-eclampsia and eclampsia were the main causes.

Prevalencia de la endometriosis en mujeres sometidas a esterilización quirúrgica laparoscópica en un hospital de Santiago de Chile / Prevalence of endometriosis in 287 women undergoing surgical sterilization in Santiago Chile

Background: The clinical manifestations of endometriosis are infertility, dysmenorrhea, sexuality disturbances, and chronic pelvic pain. It is the cause of 30 to 50% of infertility cases. In developed countries, the prevalence of endometriosis among women undergoing surgical sterilization is approximately 6%. Aim: To determine the prevalence of endometriosis among women with proven fertility in Santiago de Chile. Material and Methods: Review of surgical protocols of 287 women aged 25 to 49 years, subjected to a surgical sterilization between 2007 and 2011. Results: Endometriosis was found in 14 of the 287 women (4.9%). In spite of being asymptomatic, five of the 14 women with endometriosis were classified as severe, due to the presence of at least one endometrioma. In order of frequency, the most commonly affected anatomical sites were the ovary, the peritoneum, the posterior cul-de-sac and uterosacral ligaments. Conclusions: Our findings are very similar to those found elsewhere and suggest that fertile women could better tolerate endometriosis than their infertile counterparts.

Risco da radiação ionizante em mulheres férteis submetidas à ablação por radiofrequência / Risk of ionizing radiation in women of childbearing age undergoing radiofrequency ablation

FUNDAMENTO: A Comissão Internacional de Radiologia indica rastreamento com teste de gravidez a todas pacientes do gênero feminino em período fértil que serão submetidas a exame radiológico. Sabe-se que a radiação é teratogênica e que seu efeito é cumulativo. O potencial teratogênico inicia-se com doses próximas às das utilizadas durante esses procedimentos. Não se sabe a prevalência de teste de gravidez positivo em pacientes submetidos a estudo eletrofisiológico e/ou à ablação por cateter em nosso meio. OBJETIVO: Avaliar a prevalência de teste de gravidez positivo em pacientes do gênero feminino encaminhadas para estudo eletrofisiológico e/ou ablação por radiofrequência. MÉTODOS: Estudo transversal com análise de 2.966 pacientes submetidos a estudo eletrofisiológico e/ou ablação por cateter, de junho 1997 a fevereiro 2013, no Instituto de Cardiologia do Rio Grande do Sul. Foram realizados 1.490 exames em mulheres sendo que, destas, 769 encontravam-se em idade fértil. Todas as pacientes foram rastreadas com teste de gravidez no dia anterior ao procedimento. RESULTADOS: Detectou-se positividade do teste em três pacientes, impossibilitando a realização do exame. Observou-se prevalência de 3,9 casos por 1.000 mulheres em idade fértil. CONCLUSÃO: Devido ao baixo custo e à segurança, indica-se a realização de teste de rastreamento para gravidez a todas pacientes em idade fértil, uma vez que o grau de radiação ionizante necessária nesse procedimento é muito próximo ao limiar de teratogenicidade, principalmente no primeiro trimestre, quando os sinais de gestação não são exuberantes.

BACKGROUND: The International Commission of Radiology recommends a pregnancy screening test to all female patients of childbearing age who will undergo a radiological study. Radiation is known to be teratogenic and its effect is cumulative. The teratogenic potential starts at doses close to those used during these procedures. The prevalence of positive pregnancy tests in patients undergoing electrophysiological studies and/or catheter ablation in our midst is unknown. OBJECTIVE: To evaluate the prevalence of positive pregnancy tests in female patients referred for electrophysiological study and/or radiofrequency ablation. METHODS: Cross-sectional study analyzing 2966 patients undergoing electrophysiological study and/or catheter ablation, from June 1997 to February 2013, in the Institute of Cardiology of Rio Grande do Sul. A total of 1490 procedures were performed in women, of whom 769 were of childbearing age. All patients were screened with a pregnancy test on the day before the procedure. RESULTS: Three patients tested positive, and were therefore unable to undergo the procedure. The prevalence observed was 3.9 cases per 1000 women of childbearing age. CONCLUSION: Because of their safety and low cost, pregnancy screening tests are indicated for all women of childbearing age undergoing radiological studies, since the degree of ionizing radiation needed for these procedures is very close to the threshold for teratogenicity, especially in the first trimester, when the signs of pregnancy are not evident.

Estratégia para seleção e investigação de óbitos de mulheres em idade fértil / Strategy for the selection and investigation of deaths of women of reproductive age

INTRODUÇÃO: Diversas estratégias vêm sendo desenvolvidas para o enfretamento da mortalidade materna. Em 2008, o Ministério da Saúde tornou obrigatória a investigação de todos os óbitos de mulheres em idade fértil, medida de difícil cumprimento no Estado do Rio de Janeiro devido ao grande volume de óbitos ocorridos e dificuldades operacionais dos serviços de saúde. O objetivo deste trabalho foi desenvolver uma estratégia de seleção dos óbitos de mulheres em idade fértil a serem investigados prioritariamente pelos serviços de saúde. MÉTODO: Foram selecionados para investigação todos os óbitos de mulheres em idade fértil ocorridos entre maio e setembro de 2008 nos municípios de Belford Roxo e Niterói e classificados segundo prioridade de investigação, considerando-se as informações da causa básica e os campos 43 e 44 da declaração de óbito. RESULTADOS: Em Belford Roxo e Niterói respectivamente 46,7% e 47,1% das declarações de óbitos analisadas apresentaram incompletudes de preenchimento, e os percentuais de recuperação da informação dos campos 43 e 44 foram de 73,3% e 74,5% nestes municípios. Em 132 investigações realizadas foram identificados quatro óbitos ocorridos durante o ciclo gravídico-puerperal, todos classificados como prioritários para a investigação, e três deles foram recertificados como óbitos maternos. A metodologia de definição de prioridade de investigação desenvolvida mostrou-se adequada.

INTRODUCTION: Different approaches have been developed in order to deal with maternal mortality. In 2008 the Brazilian Ministry of Health made mandatory the investigation of all deaths of women of reproductive age. So far, completeness of investigation has not been thoroughly accomplished in the State of Rio de Janeiro (RJ) due to the constrained capacity of public health services to investigate the large number of eligible deaths. Our aim was to develop a strategy to improve the selection of deaths of women of reproductive age for investigation under maternal death surveillance. METHODS: The study population comprised all deaths of women of reproductive age that occurred in the counties of Belford Roxo and Niterói, RJ, between May and September of 2008. Deaths were classified according to priority for investigation, based on data regarding its underlying cause and relation to either pregnancy, delivery or puerperium, as registered in deaths certificate's fields 43 and 44 (related to maternal deaths). RESULTS: Data related to fields 43 and 44 was missing in around 47% of death certificates; following investigation it was recovered for approximately 74% of such deaths. Of the 132 deaths investigated, four occurred either during pregnancy, delivery or puerperium and were classified as priority for investigation, among which three were classified as maternal deaths. The strategy developed to improve the selection of deaths of women of reproductive age for investigation under maternal death surveillance was considered appropriate.

Seroprevalencia contra agentes ToRCH en mujeres indígenas en edad fértil, estado Zulia, Venezuela / Prevalence of infectious agents in indigenous women of childbearing age in Venezuela

Introducción. El termino ToRCH comprende a los patógenos Toxoplasma gondii, virus de la rubéola, citomegalovirus y virus herpes simple 1 y 2. En mujeres embarazadas expuestas pueden ser causa de abortos y malformaciones congénitas en el neonato. Objetivo. Determinar la seroprevalencia de infección por los agentes causantes del síndrome ToRCH en mujeres en edad fértil de algunas comunidades indígenas yukpa de Venezuela. Materiales y métodos. En el año 2007 fueron seleccionadas 109 muestras de 151 mujeres, en edades comprendidas entre 14 y 40 años. La detección de anticuerpos se hizo por el método de inmunoensayo enzimático indirecto o ELISA de Smartest Diagnostics™. Resultados. El 85,5 % presentó anticuerpos contra T. gondii, el 95,4 % para rubéola, el 75,2 % para citomegalovirus y el 97,2 % para el virus herpes simple 1 y 2. Se observa que el 21,1 % y el 30,2 % presentaron relación entre la variable aborto y las infecciones por citomegalovirus y virus herpes simple 1 y 2, respectivamente. Conclusiones. Existe alta seroprevalencia de infecciones por los agentes causantes del síndrome ToRCH en mujeres en edad fértil de la etnia indígena yukpa. Las condiciones sanitarias precarias y el consumo de agua contaminada con ooquistes, favorecen la adquisición de la infección por T. gondii. El hacinamiento, el inicio a temprana de edad de la actividad sexual y el número de parejas, pueden incidir en la presencia de citomegalovirus y virus herpes simple 1 y 2.

Introduction. The ToRCH syndrome includes the following infectious pathogens: Toxoplasma gondii, rubella, cytomegalovirus and herpes simplex virus 1 and 2. In susceptible pregnant women, these pathogens can cause abortions and congenital malformation in the newborn babies. Objective. The seroprevalence of infection by ToRCH agents was determined in women of childbearing age in several Venezuelan Yukpa indigenous communities. Material and methods. In 2007, 109 samples were selected from 151 women with an age range of 14 to 40 years old. The determination of antibodies against ToRCH agents was carried out through the indirect enzyme immunoassay technique by ELISA´s technique of Smartest Diagnostics. Results. Of the 109 samples, 85.5% presented antibodies against T. gondii, 95.4% for rubella, 75.2% for cytomegalovirus and 97.2% for and herpes simplex virus 1 and 2. A relationship between abortion and infection by cytomegalovirus and herpes simplex virus 1and 2 was noted in 21.1% and 30.2% of women presented, respectively. Conclusions. The findings show a high prevalence of ToRCH agents in women in childbearing age in Yukpa indigenous communities in Venezuela. Poor sanitary conditions and consumption of water contaminated with oocysts may be an important way of transmission of T. gondii. Overcrowding in the communities, sexual activity at an early age and number of partners and may be related to the presence of cytomegalovirus and herpes simplex virus HSV-1 and 2.