Epidemiological profile of gestational syphilis and congenital syphilis in a reference center in Northeast Brazil: risk factors and trend from 2019 to 2021 / Perfil epidemiológico de sífilis gestacional e sífilis congênita em centro de referência no Nordeste do Brasil: fatores de risco e tendência de 2019 a 2021

Introduction: Syphilis is an infectious systemic disease caused by the bacterium Treponema pallidum. The Amaury de Medeiros Integrated University Health Center in Recife is a reference maternity hospital for high-risk pregnancies and the management of the most common Sexually Transmitted Infections during prenatal care, including Gestational Syphilis and Congenital Syphilis. Objective: To determine the epidemiological profile of the population exposed to these conditions, the rate of Gestational Syphilis detection, the incidence of Congenital Syphilis, and the associated unfavorable outcomes in Amaury de Medeiros Integrated University Health Center between January 2019 and December 2021. Methods: This retrospective cohort study included pregnant women and neonates diagnosed with syphilis at Amaury de Medeiros Integrated University Health Center. Data were collected from the Notification/Investigation Forms for Gestational Syphilis and Congenital Syphilis, between January 2019 and December 2021. Results: At Amaury de Medeiros Integrated University Health Center, 463 cases of Gestational Syphilis and 296 of Congenital Syphilis were reported. During the three-year study, 4444, 4360, and 4265 live births were recorded, confirming the Gestational Syphilis detection rates ­ 33.30, 36.92, and 36.10 per 1000 live births, with the incidence of Congenital Syphilis being 26.1, 21.33, and 20.39 per 1000 live births. Pregnant women in their third trimester who were brown, had incomplete primary education, and lived in an urban area were the main sociodemographic variables. In total, 217 (73.3%) patients were diagnosed with Gestational Syphilis during or after delivery, indicating a low prenatal coverage (70.6%). In terms of the progression of Congenital Syphilis, unfavorable outcomes was found in 40 (13.5%) patients, including 16 (40%) abortions, 10 (25%) stillbirths, nine (22.5%) deaths from Congenital Syphilis, and 5 (12.5%) deaths from other causes. Conclusion: Gestational Syphilis detection rates and Congenital Syphilis incidence remain alarming, with abortions and stillbirths being the most common unfavorable outcomes. To change the dramatic situation of Congenital Syphilis in Brazil, the associated factors point to a poor quality of prenatal care and an urgent need to change public policies for pregnant women and newborns, in conjunction with socioeconomic assistance

Progress in research of influenza vaccination in pregnant women / 中华流行病学杂志

Influenza is an acute respiratory infectious disease caused by influenza virus. Pregnancy is associated with physiologic and immunological changes that may increase the risk for influenza virus infection and influenza-related complications. Influenza vaccination is the most effective way to prevent influenza virus infection. WHO and many countries have classified pregnant women as a priority population for influenza vaccination, however, there are still many challenges for promoting influenza vaccination in pregnant women in China, influenza vaccination coverage in pregnant women remains low and some influenza vaccine package inserts list pregnancy as an absolute contraindication. In this paper, we summarize the research progress in the effects of influenza infection and influenza vaccination during pregnancy both at home and abroad, then discuss the strategies to promote influenza vaccination in pregnancy for the purpose of providing reference for the related research and policy development in China.

Recent research on the epidemiology and preventive strategies of neonatal group B Streptococcus infection in the latest decade / 中国当代儿科杂志

Currently, the main strategy for preventing neonatal group B Streptococcus (GBS) infection is prenatal screening combined with intrapartum antibiotic prophylaxis, which has effectively reduced the incidence of neonatal GBS early-onset disease. However, the burden of GBS infection is still significant. The intrapartum antibiotic prophylaxis strategy has limitations such as inducing antibiotic resistance and inability to effectively prevent GBS late-onset disease. It is crucial to develop and evaluate other prevention strategies, while paying close attention to assessing penicillin allergy in pregnant women and how to prevent GBS infection in neonates with negative maternal GBS screening. In recent years, there has been some progress in GBS vaccines and related immunological research, and the use of specific vaccines is expected to significantly reduce GBS infection in neonates.

Características clínicas, obstétricas y perinatales de embarazadas mexicanas con COVID-19 / Clinical, obstetric and perinatal characteristics of Mexican pregnant women with COVID-19

Introducción: la enfermedad COVID-19 en el embarazo es la primera causa de muerte materna en México, y se ha reportado que favorece las formas graves de la enfermedad. Objetivo: describir las características clínicas, obstétricas y perinatales de pacientes embarazadas con enfermedad COVID-19 atendidas en la UMAE "Luis Castelazo Ayala" del Instituto Mexicano del Seguro Social (IMSS). Material y métodos: estudio observacional, transversal y retrospectivo de pacientes embarazadas con COVID-19 atendidas de marzo a diciembre del 2020. Las características epidemiológicas, complicaciones y resultados perinatales se analizaron con estadística descriptiva e inferencial. Resultados: se incluyeron 133 pacientes: 84.5% presentaron enfermedad leve, 8% moderada y 8.5% severa y crítica. Las comorbilidades preexistentes fueron: obesidad, diabetes e hipotiroidismo. Los principales síntomas: tos, cefalea, fiebre, rinorrea y anosmia. En casos severos y críticos la taquicardia, taquipnea e hipoxemia estuvieron presentes. En las formas severa y crítica se observaron: linfoneutropenia, hiperglucemia y transaminasemia. El fibrinógeno y dímero D sin cambios. El parto pretérmino, el oligohidroamnios, la hipertensión gestacional, la preeclampsia severa y la neumonía fueron las principales complicaciones. El 75% de los recién nacidos no presentaron complicaciones. Conclusiones: el comportamiento clínico de la enfermedad fue, en su mayoría, leve, e incluso en los casos moderados así como en los severos y complicados los resultados del binomio fueron favorables. No hubo muerte materna ni se evidenció transmisión vertical.

Background: COVID-19 disease is the leading cause of maternal death in Mexico. The data published to date indicate that pregnancy favors severe forms of the disease. Objective: To describe the clinical, obstetric and perinatal characteristics of pregnant women with COVID-19 disease treated at the UMAE "Luis Castelazo Ayala" of the Instituto Mexicano del Seguro Social. Material and methods: Observational, cross-sectional and retrospective study of pregnant women with COVID-19 treated from March to December 2020. The epidemiological characteristics, complications and perinatal results were analyzed with descriptive and inferential statistics. Results: 133 patients included: 84.5% with mild disease, 8 % moderate and 8.5% severe and critical. Pre-existing comorbidities: obesity, diabetes and hypothyroidism. Main symptoms: cough, headache, fever, rhinorrhea and anosmia. In severe and critical cases, tachycardia, tachypnea, and hypoxemia were present. Lymphoneutropenia, hyperglycemia, and transaminasemia were seen in severe and critical forms. Fibrinogen and D dimer stayed unchanged. Preterm delivery, oligohydramnios, gestational hypertension, severe preeclampsia, and pneumonia were the main complications. 75% of the newborns without complications. Conclusions: The clinical behavior of the disease was mostly mild and even in moderate cases, and even in moderate as well as severe and complicated cases, the binomial results were favorable. There was no maternal death.

Resultados del embarazo en mujeres con y sin COVID-19 en un hospital nacional de nivel III de Perú / Pregnancy outcomes among women with and without COVID-19 in a national level III hospital in Peru

OBJETIVO: Comparar los resultados del embarazo entre mujeres con y sin COVID-19 atendidas en un hospital nacional de nivel III de Perú. MÉTODO: Estudio observacional, retrospectivo y comparativo. Participaron gestantes con RT-PCR positiva y negativa en razón 1:1, y 1:2 con gestantes del año 2019. Se recogió información materna y perinatal. Se usó la prueba exacta de Fisher con significancia de 0,05 y razones de prevalencia (RP) con intervalo de confianza del 95% (IC95%). RESULTADOS: Participaron 51 gestantes con RT-PCR positiva, 51 gestantes con RT-PCR negativa y 102 gestantes del año 2019. Se observó asociación entre los resultados de la RT-PCR y el parto pretérmino (p < 0,05). La RP de parto pretérmino en las gestantes con RT-PCR positiva fue de 3,14 (IC95%: 1,29-7,64) veces en comparación con las gestantes de 2019 y de 4,0 (IC95%: 1,13-14,17) veces en comparación con las gestantes con RT-PCR negativa. CONCLUSIONES: Los hallazgos sugieren que puede existir asociación entre COVID-19 y parto pretérmino. Sin embargo, se requieren estudios más amplios para analizar el papel de otros factores maternos en esta asociación.

OBJECTIVE: To compare pregnancy outcomes among women with and without COVID-19 infection attended in a national level III hospital in Peru. METHOD: Observational, retrospective and comparative study. RT-PCR positive pregnant women participated in a 1:1 ratio with negative RT-PCR, and 1:2 with pregnant women of 2019. Maternal and perinatal information was collected. Fishers exact test was used with a significance level of 0.05 and prevalence ratios (PR) with their confidence interval of 95% (CI95%). RESULTS: 51 pregnant women with positive RT-PCR, 51 with negative RT-PCR and 102 pregnant women in 2019 participated. RT-PCR test were associated to preterm delivery (p < 0.05). The PR for preterm delivery in women with positive RT-PCR compared to pregnant women in 2019 was 3.14 (CI95%: 1.29-7.64); and compared to women with negative RT-PCR was 4.0 (CI95%: 1.13-14.17). CONCLUSIONS: The studys findings suggest the existence of an association between maternal COVID-19 and preterm birth. However, more studies are required to analyze the role of maternal factors.

Analysis on influencing factors of HBV intrauterine transmission based on integration of decision tree model and logistic regression model / 中华流行病学杂志

Objective: To investigate the influencing factors of HBV intrauterine transmission and their interaction effects by integrating logistic regression model and Chi-squared automatic interaction detector (CHAID) decision tree model. Methods: A total of 689 pairs of HBsAg-positive mothers and their neonates in the obstetrics department of the Third People's Hospital of Taiyuan from 2007 to 2013 were enrolled, and the basic information of mothers and their neonates were obtained by questionnaire survey and medical record review, such as the general demographic characteristics, gestational week and delivery mode. HBV DNA and HBV serological markers of the mothers and newborns were detected by fluorescence quantitative PCR and electrochemiluminescence immunoassay respectively. The CHAID decision tree model and unconditional logistic regression analysis were used to explore the factors influencing HBV intrauterine transmission in neonates of HBsAg-positive mothers. Results: Among the 689 neonates, the incidence of HBV intrauterine transmission was 11.47% (79/689). After adjusted for confounding factors, the first and second logistic multivariate analysis showed that cesarean delivery was a protective factor for HBV intrauterine transmission (OR=0.25, 95%CI: 0.14-0.43; OR=0.27, 95%CI: 0.15-0.46); both models indicated that maternal HBeAg positivity and HBV DNA load ≥2×105 IU/ml before delivery were risk factors of HBV intrauterine transmission (OR=3.89, 95%CI: 2.32-6.51; OR=3.48, 95%CI: 2.12-5.71), respectively. The CHAID decision tree model screened three significant factors influencing HBV intrauterine transmission, the most significant one was maternal HBeAg status, followed by delivery mode and maternal HBV DNA load. There were interactions between maternal HBeAg status and delivery modes, as well as delivery mode and maternal HBV DNA load before delivery. The rate of HBV intrauterine transmission in newborns of HBeAg-positive mothers by vaginal delivery increased from 19.08% to 29.37%; among HBeAg-positive mothers with HBV DNA ≥2×105 IU/ml, the rate of HBV intrauterine transmission increased to 33.33% in the newborns by vaginal delivery. Conclusions: Maternal HBeAg positivity,maternal HBV DNA ≥2×105 IU/ml and vaginal delivery could be risk factors for HBV intrauterine transmission in newborns. Interaction effects were found between maternal HBeAg positivity and vaginal delivery, as well as vaginal delivery and high maternal HBV DNA load. Logistic regression model and the CHAID decision tree model can be used in conjunction to identify the high-risk populations and develop preventive strategies accurately.

Prevalence of syphilis, HIV and toxoplasmosis in prenatal screening in the population of the northern region of the state of Rio de Janeiro, Brazil / Prevalência de Sífilis, HIV e Toxoplasmose no pré-natal em uma população no Norte Fluminense

Introduction: There is a need for studies to know the real situation and outline measures to guarantee a reduction in the rates of pregnant women diagnosed with HIV, Syphilis and Toxoplasmosis. Objective: To determine the prevalence of Syphilis, HIV and toxoplasmosis in puerperal women assisted at the largest public maternity hospital in Campos dos Goytacazes in 2016. Methods: Cross-sectional study, using secondary data from the puerperal women assisted at the largest maternity hospital in the northern region of the State of Rio de Janeiro, in the year 2016. Results: There were 970 puerperal women, with a prevalence of HIV, Syphilis and Toxoplasmosis in pregnancy of 1.6, 2.7 and 2%, respectively. Most pregnant women were diagnosed at delivery due to low serological coverage during pregnancy. Conclusion: The high prevalence of Syphilis, HIV and Toxoplasmosis in pregnancy requires efficient prenatal care for its identification and approach.

Introdução: São necessários estudos para conhecer a real situação e delinear medidas que garantam a redução dos índices de gestantes com diagnóstico de vírus da imunodeficiência humana, sífilis e toxoplasmose. Objetivo: Determinar a prevalência de sífilis, vírus da imunodeficiência humana e toxoplasmose em puérperas atendidas na maior maternidade pública de Campos dos Goytacazes (RJ) no ano de 2016. Métodos: Estudo transversal, utilizando dados secundários das puérperas atendidas na maior maternidade do Norte Fluminense no ano de 2016. Resultados: Foram 970 puérperas, com prevalência de vírus da imunodeficiência humana, sífilis e toxoplasmose na gestação de 1,6, 2,7 e 2%, respectivamente. A maioria das gestantes foi diagnosticada no momento do parto em razão da baixa cobertura sorológica durante a gestação. Conclusão: A alta prevalência de sífilis, vírus da imunodeficiência humana e toxoplasmose na gravidez requer um pré-natal eficiente para sua identificação e abordagem.

Clinical and Obstetric Aspects of Pregnant Women with COVID-19: A Systematic Review / Aspectos clínicos e obstétricos de gestantes com COVID-19: Uma revisão sistemática

Abstract Objective To analyze the clinical and obstetric aspects of pregnant women with COVID-19. Methods A systematic literature review in the MEDLINE/PubMed, LILACS, SCIELO, and CNKI databases was performed from March to May 2020, with the descriptors: Pregnancy; 2019-nCov; Coronavirus; SARS-Cov-2, Covid-19. Of those chosen were original titles, without language and period restriction and that addressed pregnant women with a clinical and/or laboratory diagnosis of COVID-19. Revisions, editorials, and duplicate titles were excluded. The Newcastle-Ottawa (NOS) and Murad et al. scales were used to assess the quality of the studies. Results We included 34 articles with 412 pregnant women infected with severe acute respiratory syndrome (SARS-Cov-2), with an average age of 27.5 years of age and 36.0 gestational weeks. The most common symptom was fever (205 [49.7%]), and 89 (21.6%) pregnant women progressed to severe viral pneumonia. Laboratory tests showed an increase in C-reactive protein (154 [37.8%]), and radiological tests showed pneumonia with peripheral ground-glass pattern (172 [51.4%]). Emergency cesarean delivery was indicated for most pregnant women, and the most common gestational complication was premature rupture of ovarian membranes (14 [3.4%;]). We detected 2 (0.5%) neonatal deaths, 2 (0.5%) stillbirths, and 1 (0.2%) maternal death. Conclusion Pregnant women with COVID-19 presented a clinical picture similar to that of non-infected pregnant women, with few obstetric or neonatal repercussions. There was a greater indication of cesarean deliveries before the disease aggravated, and there was no evidence of vertical transmission of the infection.

Resumo Objetivo Analisar os aspectos clínicos e obstétricos de gestantes com COVID-19. Métodos Revisão sistemática da literatura nas bases: MEDLINE/PubMed, LILACS, SCIELO e CNKI, realizada de março a maio de 2020, com os descritores Pregnancy; 2019-nCov; Coronavirus; SARS-Cov-2, Covid-19. Elegeram-se títulos originais, sem restrição de idioma e período e que abordassem gestantes com diagnóstico clínico e/ou laboratorial de COVID-19. Excluíram-se revisões, editoriais, títulos duplicados. As escalas de Newcastle-Ottawa (NOS, na sigla em inglês) e a de Murad et al. foram utilizadas para avaliar a qualidade dos estudos. Resultados Foram incluídos 34 artigos com 412 gestantes infectadas pela síndrome respiratória aguda grave (SARS-Cov, na sigla em inglês) com idade média de 27,5 anos e média de 36,0 semanas gestacionais. O sintoma mais incidente foi a febre (49,7%;205). e 89 (21,6%) gestantes evoluíram para pneumonia viral grave. Os exames laboratoriais demonstraram aumento da proteína C reativa (37,8%; 154) e os radiológicos mostraram pneumonia com padrão em vidro fosco periférico (51,4%; 172). O parto cesáreo de emergência foi indicado para a maior parte das gestantes, e a complicação gestacional mais comum foi a ruptura prematura de membranas ovulares (3,4%; 14). Foram detectados 2 (0,5%) mortes neonatais, 2 (0,5%) natimortos, e 1 (0,2%) morte materna. Conclusão Gestantes com doença coronavírus (COVID-19, na sigla em inglês apresentaram quadro clínico semelhante a gestantes não infectadas, com poucas repercussões obstétricas ou neonatais. Houve uma maior indicação de partos cesáreos antes do agravamento da doença e não se observaram evidências de transmissão vertical da infecção.

Complicações clínicas na gravidez: uma revisão sistemática de estudos com gestantes brasileiras / Clinical complications during pregnancy: a systematic review of studies with pregnant Brazilian women

Resumo Objetivou-se descrever as principais complicações clínicas em gestantes brasileiras relatadas na literatura, identificando os fatores de exposição mais relevantes e seus desfechos na saúde materno-infantil. Foi realizada uma revisão sistemática de artigos publicados entre 2010 e 2018. Foram incluídos três revisões e 36 artigos empíricos; transtornos mentais (n=9), doenças infecciosas (n=9) e morbidade materna grave (n=8) foram as principais complicações clínicas na gravidez. Ainda, quatro artigos enfocaram a determinação das principais afecções ou causas de internação, citando-se com maiores frequências a Infecção do Trato Urinário, a anemia e as doenças hipertensivas. Idade materna nos extremos reprodutivos, menor escolaridade, vulnerabilidade socioeconômica, características raciais e uso de serviços públicos de saúde foram os fatores de exposição mais relevantes. Resultados de saúde desfavoráveis associados a complicações clínicas na gravidez foram verificados nos oito artigos com esse perfil. A frequência de gestantes com complicações clínicas potenciais de ameaça à vida é elevada no país, evidenciando a importância da cobertura da atenção básica e a implantação de intervenções para sua redução e prevenção de desfechos maternos e infantis adversos.

Abstract The scope of this paper was to describe the main clinical complications among pregnant Brazilian women reported in the literature, identifying the most relevant exposure factors and their outcomes in maternal and child health. This is a systematic review of articles published between 2010 and 2018. Three reviews and 36 empirical articles were included; mental disorders (n=9), infectious diseases (n=9) and severe maternal morbidity (n=8) were the main clinical complications during pregnancy. In addition, four articles focused on determining the main conditions or causes of hospitalization, with a higher frequency of Urinary Tract Infection, anemia and hypertensive diseases. Maternal age at reproductive extremes, lower schooling, socioeconomic vulnerability, racial characteristics and the use of public health services were the most relevant exposure factors. Unfavorable health outcomes associated with clinical complications in pregnancy were verified in the eight articles with this profile. The frequency of pregnant women with potential life-threatening clinical complications is high in the country, highlighting the importance of primary care coverage and the implementation of interventions to reduce and prevent adverse maternal and child outcomes.

Prevalence and diagnostic accuracy of microcephaly in a pediatric cohort in Brazil: a retrospective cross-sectional study

Abstract Objective We sought to describe the prevalence of microcephaly and to compare the different cutoff points established by the Brazilian Ministry of Health at various times during a Zika virus epidemic. As a secondary aim, we investigated the possible etiology of the microcephaly. Method This retrospective study utilized newborn participants in the Zika Cohort Study Jundiaí. Newborns from the Zika Cohort Study Jundiaí with an accurate gestational age determination and complete anthropometric data were analyzed, and microcephaly was diagnosed according to the INTERGROWTH-21st curve. At delivery, fluids were tested for specific antibodies and for viruses. Brain images were evaluated for microcephaly. Receiver Operating Characteristic curves were plotted to define the accuracy of different cutoff points for microcephaly diagnosis. Results Of 462 eligible newborns, 19 (4.1%) were positive for microcephaly. Cutoff points corresponding to the curves of the World Health Organization yielded the best sensitivity and specificity. Three of the microcephaly cases (15.8%) were positive for Zika virus infections; nine (47.4%) had intrauterine growth restriction; one had intrauterine growth restriction and was exposed to Zika virus; three had a genetic syndrome (15.8%); and three had causes that had not been determined (15.8%). Conclusions Microcephaly prevalence was 4.1% in this study. Cutoff values determined by the World Health Organization had the highest sensitivity and specificity in relation to the standard IG curve. The main reason for microcephaly was intrauterine growth restriction. All possible causes of microcephaly must be investigated to allow the best development of an affected baby.

Influencia de la COVID-19 en el embarazo desde la perspectiva de los cuidados intensivos / Influence of COVID-19 on pregnancy from the intensive care practice point of view / Influencia de la COVID-19 no embarazo desde a perspectiva de los cuidados intensivos

RESUMEN Introducción: Se revelan limitaciones en la socialización de las consecuencias de la infección por coronavirus 2 causal de la enfermedad COVID-19 en la salud materna y perinatal. Objetivo: Recopilar información en relación con la influencia de la COVID-19 sobre el embarazo. Método: Entre enero y febrero de 2021, se efectuó una investigación en el Hospital General Docente "Dr. Agostinho Neto", Guantánamo, que consistió en una revisión narrativa. Se realizó el estudio documental de referencias, que incluyeron revisiones sistemáticas y artículos originales. La búsqueda se ejecutó en las bases de datos bibliográficas PubMed, Medline, Science Direct y SciELO, con el buscador Google Académico y el uso de las palabras clave y conectores COVID-19 AND embarazo; SARS-CoV-2 AND gestación y los correspondientes términos en español. Desarrollo: Se sintetizaron aspectos epidemiológicos, clínicos, inmunológicos e implicaciones clínicas de la enfermedad en pacientes embarazadas, pilares respecto al uso de medicamentos, para un abordaje de este tipo de paciente con COVID-19. Conclusiones: La gestante infectada por el SARS-CoV-2 es más vulnerable que el resto de la población, sin embargo, se requiere de investigaciones científicas que certifiquen su influencia real sobre la salud de la gestante y la perinatal, así como aquellos factores que modulan la enfermedad durante el embarazo.

ABSTRACT Introduction: Some limitations are revealed for socializing the consequences asociated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), virus that causes COVID-19, in maternal and perinatal health. Objective: To gathered information related to the influence of COVID-19 on pregnancy. Method: From January throughout February 2021, a narrative review was conducted for a research at the Hospital General Docente "Dr. Agostinho Neto" in Guantánamo. A documentary study of references was carried out, in which were included systematic reviews and original articles. Searches were conducted in the following bibliographic databases: PubMed, Medline, Science Direct and SciELO, via Google Scholar and using as keywords and linkers COVID-19 AND pregnancy, SARS-CoV-2 AND gestation and the correct terms in Spanish. Development: Epidemiological, clinical, immunological aspects and clinical implications of the disease in pregnant patients, pillars with respect to the use of drugs, were synthesized for an approach to this type of patient with COVID-19. Conclusions: Pregnant patients infected with SARS-CoV-2 are more vulnerable than the rest of the population, however, scientific research is required to certify its real influence on the health of pregnant and perinatal women, as well as those factors that modulate the disease during pregnancy.

RESUMO Introdução: Revelam-se limitações na socialização das consequências da infecção pelo coronavírus 2 causador da doença COVID-19 na saúde materna e perinatal. Objetivo: Coletar informações sobre a influência do COVID-19 na gravidez. Método: Entre janeiro e fevereiro de 2021, foi realizada investigação no Hospital General Docente "Dr. Agostinho Neto", Guantánamo, que consistiu numa revisão narrativa. Foi realizado o estudo documental das referências, que incluiu revisões sistemáticas e artigos originais. A busca foi realizada nas bases de dados bibliográficas PubMed, Medline, Science Direct e SciELO, com a ferramenta de busca Google Scholar e a utilização das palavras-chave e conectores COVID-19 AND pregn; SARS-CoV-2 AND gestation e os termos correspondentes em espanhol. Desenvolvimento: Aspectos epidemiológicos, clínicos, imunológicos e implicações clínicas da doença em gestantes, pilares quanto ao uso de medicamentos, foram sintetizados para uma abordagem desse tipo de paciente com COVID-19. Conclusões: A gestante infectada pelo SARS-CoV-2 é mais vulnerável que o restante da população, porém, pesquisas científicas são necessárias para atestar sua real influência na saúde da gestante e perinatal, bem como daqueles fatores que as mesmas modular a doença durante a gravidez.

Prevalencia de la infección por Chlamydia trachomatis y su potencial impacto perinatal en pacientes chilenas / Prevalence of Chlamydia trachomatis infection and a potential perinatal impact in Chilean patients

Resumen Chlamydia trachomatis es la infección de transmisión sexual bacteriana más frecuente en el mundo. Según datos de la Organización Mundial de la Salud, su prevalencia se estima alrededor de 4,2% en mujeres. Es una infección silente; sin embargo, puede desarrollar complicaciones en la fertilidad o durante el embarazo. El objetivo de esta revisión es describir la prevalencia de C. trachomatis en estudios recientes en Chile, que utilicen para su detección reacción de polimerasa en cadena (RPC), revisar las posibles complicaciones perinatales asociadas, conocer las recomendaciones de tamizaje en gestantes en otros países y discutir la necesidad de incluir en nuestro país un programa de tamizaje prenatal.

Abstract Chlamydia trachomatis is the most frequent bacterial sexually transmitted disease around the world. Estimated prevalence by WHO is 4,2% for women. Most cases are asymptomatic, but complications in fertility and during pregnancy are possible. The aim of this review is to describe the prevalence of C. trachomatis in Chilean studies using polymerase chain reaction (PCR) for detection, to describe the possible perinatal complications, to know recommendations about pregnancy screening in other countries, and to discuss the possibility of implementing in Chile.

SARS-CoV-2 (COVID-19) en gestación y placenta: una revisión narrativa sobre el estado del arte / SARS-CoV-2 (COVID-19) in pregnancy and placenta: a narrative review on state of the art

Resumen La crisis sanitaria por la pandemia de COVID-19, enfermedad generada por la infección con el SARS-CoV-2, ha llevado a la pérdida de más de 25,000 vidas en Chile, con más de 370,000 mujeres entre 15 y 44 años con infección confirmada. Se ha reportado una mayor vulnerabilidad de las mujeres gestantes en cuanto a desarrollar cuadros de COVID-19 graves o críticos, con un aumento de la incidencia de resultados obstétricos y perinatales adversos. Es relevante considerar que un alto porcentaje de las gestantes infectadas con SARS-CoV-2 son asintomáticas, lo cual nos pone en alerta en cuanto a que ciertos efectos del virus durante la gestación podrían no ser evidentes para la observación clínica. Se ha demostrado la presencia de SARS-CoV-2 en la placenta, asociándose la infección placentaria con alteraciones vasculares que podrían afectar el flujo útero-placentario. Por otro lado, la transmisión vertical al feto parece que es poco frecuente, pero factible. Se resumen las evidencias disponibles hasta el momento sobre los principales efectos de la COVID-19 en la gestación, con énfasis en los estudios sobre los efectos de la infección por SARS-CoV-2 en la placenta. El objetivo es relevar el tema, destacando que son diversas las preguntas que necesitan ser abordadas, considerando el impacto que esta pandemia podría tener sobre la salud gestacional.

Abstract In Chile, the COVID-19 pandemic, a disease induced by infection with SARS-CoV-2, has caused more than 25,000 deaths. More than 370,000 women between 15 and 44 years have been detected with the infection. The greater vulnerability of pregnant women has been reported, mainly related to a higher risk for severe or critical COVID-19, with an increased incidence of adverse obstetrics and perinatal outcomes. It is relevant to consider that a high percentage of pregnant women infected with SARS-CoV-2 are asymptomatic for COVID-19, which indicates that specific effects of the virus during pregnancy may not be evident from clinical observation. The presence of SARS-CoV-2 in the placenta has been demonstrated, associating placental infection with vascular alterations that could affect utero-placental flow. On the other hand, vertical transmission to the fetus is rare but feasible. This manuscript summarizes the evidence available to date on the main effects of COVID-19 in pregnancy, emphasizing studies about the impact of SARS-CoV-2 in the placenta. This review aims to promote this issue, highlighting that several questions need to be addressed, considering the effect this pandemic could have on gestational health.

Frecuencia de disfunción olfatoria en mujeres embarazadas con infección por SARS-CoV-2 / Frequency of olfactory dysfunction in pregnant women with SARS-CoV-2 infection

Resumen Introducción: En pacientes con COVID-19 se ha reportado disfunción olfatoria y anosmia; en la mujer embarazada se presenta hasta en 24.2 %. Objetivo: Conocer la frecuencia con la que las mujeres embarazadas e infección por SARS-CoV-2 tienen disfunción olfatoria. Métodos: Se preguntó edad, edad gestacional, temperatura, presencia de constipación nasal o rinorrea, mialgias, cefalea, tos o dolor torácico, además de evaluar si las mujeres percibían e identificaban el aroma de jugo de uva, café en polvo y mentol. Se utilizaron medidas de tendencia central y dispersión, frecuencias y porcentajes. Se calculó sensibilidad, especificidad, valor predictivo positivo y negativo. La U de Mann-Whitney y el contraste de proporciones sirvieron para las comparaciones entre los grupos. Resultados: Hubo mayor proporción de mujeres con tos, cefalea, disnea, mialgias, odinofagia, rinorrea, dolor torácico y anosmia en mujeres positivas a SARS-CoV-2. De las pacientes sin COVID-19, 88.9 % detectó cada uno de los aromas; solo 31.8 % del grupo positivo detectó el aroma a uva, 47.7 % el de café y 59.1 % el de mentol, el cual tuvo los porcentajes más altos en sensibilidad (40 %), especificidad (21 %), valores predictivos positivo (59 %) y negativo (11 %). Conclusión: la disfunción olfatoria se presenta en un porcentaje importante de las mujeres embarazadas con COVID-19.

Abstract Introduction: In patients with COVID-19, olfactory dysfunction and anosmia have been reported, which in pregnant women occur in up to 24.2 %. Objective: To know the frequency in which pregnant women with SARS-CoV-2 infection have olfactory dysfunction. Methods: Age, gestational age, temperature, presence of nasal constipation or rhinorrhea, myalgia, headache, cough or chest pain were asked. Whether patients perceived and identified the scent of grape juice, coffee powder and menthol was evaluated. Central tendency and dispersion measures, frequencies and percentages were used. Sensitivity, specificity, positive and negative predictive value were calculated. Mann-Whitney's U-test and contrast of proportions were used for comparisons between groups. Results: There was a higher proportion of women with cough, headache, dyspnea, myalgia, odynophagia, rhinorrhea, chest pain, and anosmia in SARS-CoV-2-positive women. In patients without COVID-19, 88.9 % detected each one of the scents; only 31.8 % of the positive group detected grapes scent, 47.7 % coffee and 59.1 % menthol, which had the highest percentages of sensitivity (40 %), specificity (21 %), positive predictive value (59 %) and negative predictive value (11 %). Conclusion: Olfactory dysfunction occurs in a significant percentage of pregnant women with COVID-19.

Conhecimento e atitude das gestantes de alto risco sobre a transmissibilidade do vírus zika / Knowledge and attitude of women with high-risk pregnancy about the Zika virus transmission

Resumo Objetivou analisar o conhecimento e a atitude das gestantes de alto risco sobre a zika. Trata-se de um estudo transversal, quantitativo, com amostra de 201 gestantes de alto risco, que realizam pré-natal no Ambulatório Médico de Especialidades. Aplicou-se um instrumento auto administrado, aplicados após a consulta com o médico. Os critérios de inclusão utilizados foram a presença das gestantes no dia da entrevista e seu consentimento de participação. Os de exclusão as que não aceitaram participar e não estarem realizando o pré natal no período do estudo. Para análise de dados, utilizou-se qui-quadrado e exato de Fisher, nos softwares Epi info 7.1 e Bioestat 5.0. Das gestantes, 76% acreditavam que, em seu bairro, é provável a infecção pelo vírus e utilizam medidas para controlar a proliferação do mosquito, como não deixar água parada (n = 154). Em relação ao conhecimento, houve associação entre a zika e a microcefalia (p ≤ 0,0001) e o apontamento da necessidade de mais informações (p = 0,0439). Para impedir o contágio, 76% não tomaram nenhuma atitude; houve, ainda, associação entre a necessidade de conhecimento sobre o assunto e as ações realizadas no combate ao vírus (p = 0,0049). Conclui-se que o conhecimento e a atitude das gestantes sobre a zika é falho.

Abstract Objective was to analyze the knowledge and attitude of high risk pregnant women about zika. This is a cross-sectional study, quantitative, with a sample of 201 high risk women who perform prenatal the Ambulatory Medical Specialties. A self-administered instrument, was applied after consultation with the doctor. Inclusion criteria were the presence of pregnant women on the day of the interview and their consent to participate. Exclusion criteria were those who did not agree to participate and were not performing prenatal care during the study period. For the data analysis we used chi square and fisher exact, in software Epi info 7.1 and Bioestat 5.0. Of the pregnant women, 76% believed that their neighborhood was likely to be infected by the virus and used measures to control mosquito proliferation, such as not leaving standing water (n = 154). In relation to knowledge, there was an association between Zika and microcephaly (p≤ 0.0001) and the need for more information (p = 0.0439). To prevent infection, 76% took no action, there was an association between the need for knowledge about the subject and the actions taken to combat the virus (p = 0.0049). We conclude that pregnant women's knowledge and attitude about zika is failed.

Análise da sífilis em gestantes nos anos de 2010 a 2019 em Joinville - SC / Syphilis' analysis in pregnant women from years 2010 to 2019 in joinville - SC

A sífilis é uma infecção sexualmente transmissível comum em todo o mundo. Objetivo: Analisar os casos notificados/confirmados de sífilis gestacional em Joinville - SC. Método: Estudo descritivo, realizado por meio da análise de dados secundários de forma retrospectiva, no período de 2010 a 2019. Foram investigadas 1039 gestantes com sífilis, a partir dos dados extraídos do Sistema de Processamento de Dados do DATASUS. Resultados: A maioria das gestantes possuía idade igual ou inferior a 29 anos, sem ocupação remunerada e de baixa renda. A maior parte teve o diagnóstico da sífilis e foi notificada no 3o trimestre de gestação. A classificação clínica da sífilis predominante foi sífilis latente. 92% das gestantes foram tratadas e 52% dos parceiros. Conclusões: Observou-se que mulheres jovens, sem ocupação remunerada e baixa renda estão mais suscetíveis a Infecções Sexualmente Transmissíveis. Outros achados foram o diagnóstico tardio da sífilis entre as gestantes e a condição de parceiros não tratados.

Avaliação das oportunidades perdidas no controle da transmissão vertical do HIV em Rio Branco, Acre, Brasil / Evaluation of missed opportunities in the control of vertical HIV transmission in Rio Branco, Acre State, Brazil / Evaluación de las oportunidades perdidas en el control de la transmisión vertical del VIH en Río Branco, Acre, Brasil

Resumo: A transmissão vertical do HIV ainda representa um importante problema de saúde pública no mundo. O objetivo deste estudo foi verificar a transmissão vertical do HIV em Rio Branco, Acre, Brasil, e avaliar a possibilidade de eliminação. Foi realizado estudo transversal dos casos de HIV em gestante e longitudinal sobre a incidência da transmissão vertical do HIV na base populacional de gestantes residentes no Município de Rio Branco, no período de 2007-2015. As coortes de gestantes foram formadas por mulheres que tiveram filhos nascidos vivos, mortos ou abortos. Os dados foram obtidos do Sistema de Informação de Agravos de Notificação (SINAN), Sistema de Informações sobre Nascidos Vivos (SINASC), Sistema de Informação sobre Mortalidade (SIM) e Sistema de Informações Hospitalares (SIH). Foi realizado o relacionamento entre as bases de dados utilizando o software OpenRecLink. Foram calculadas as prevalências de HIV em gestante, a taxa de transmissão vertical e os principais fatores associados. A prevalência de HIV em gestante apresentou tendência de aumento, e a prevalência média foi de 0,18%, as variáveis estatisticamente associadas à ocorrência de HIV em gestantes foram idade materna ≥ 20 anos (p = 0,007), menor escolaridade (p = 0,054) e não ter companheiro (p = 0,001). A transmissão vertical foi de 6,9%. O uso de terapia antirretroviral (TARV) no pré-natal, mesmo entre as gestantes que já sabiam ser portadoras do vírus, foi menor que 90%. A realização de cesáreas eletivas ficou abaixo de 60%, e o uso de TARV no parto e pelo recém nascido nas primeiras 24 horas apresentou variações, dependendo do período em que o diagnóstico materno foi realizado. Embora as estratégias de eliminação da transmissão vertical do HIV estejam bem estabelecidas, os resultados deste estudo ainda apontam falhas importantes na cascata de cuidados das gestantes infectadas em Rio Branco.

Abstract: Vertical HIV transmission is still an important global public health problem. This study aimed to verify vertical HIV transmission in Rio Branco, Acre, Brazil, and to assess the possibility of its elimination. A cross-sectional study was conducted of HIV in pregnant women and a longitudinal study on the incidence of vertical HIV transmission in pregnant women living in the municipality (county) of Rio Branco in 2007-2015. The cohorts of pregnant women consisted of women who had liveborn children, stillbirths, or abortions. The data were obtained from the Brazilian Information System for Notificable Diseases (SINAN), Brazilian Information System on Live Births (SINASC), Brazilian Mortality Information System (SIM), and Brazilian Hospital Information Systems (SIH). Databases. Probabilistic database linkage was performed with the OpenRecLink software. The authors calculated the HIV prevalence rate in pregnant women, the vertical transmission rate, and the principal associated factors. HIV prevalence in pregnant women showed an upward trend, and the mean prevalence was 0.18%. Variables statistically associated with the occurrence of HIV in pregnant women were maternal age ≥ 20 years (p = 0.007), lower schooling (p = 0.054), and unmarried conjugal status/without partner (p = 0.001). Vertical HIV transmission was 6.9%. Use of antiretroviral therapy (ART) during prenatal care, even among pregnant women that already knew they were HIV-positive, was less than 90%. The elective cesarean rate was less than 60%, and the use of ART during delivery and by the newborn in the first 24 hours showed variations, depending on the period in which the maternal diagnosis was made. Although the strategies for the elimination of vertical HIV transmission are well established, this study's results point to important flaws in the cascade of care for HIV-infected pregnant women in Rio Branco.

Resumen: La transmisión vertical del VIH todavía representa un importante problema de salud pública en el mundo. El objetivo de este estudio fue verificar la transmisión vertical del VIH en Río Branco-Acre y evaluar la posibilidad de su eliminación. Se realizó un estudio transversal de los casos de VIH en gestantes y longitudinal sobre la incidencia de la transmisión vertical del VIH en la base poblacional de gestantes residentes en el municipio de Río Branco, durante el período de 2007-2015. Las cohortes de gestantes estuvieron formadas por mujeres que tuvieron hijos nacidos vivos, muertos o abortos. Los datos se obtuvieron del Sistema Brasileño de Información de Enfermedades de Notificación (SINAN), Sistema de Información sobre Nacidos Vivos (SINASC), Sistema de Información sobre Mortalidad (SIM) y Sistema de Informaciones Hospitalarias (SIH). Se realizó la relación entre las bases de datos, utilizando el software OpenRecLink. Se calcularon las prevalencias de VIH en gestantes, la tasa de transmisión vertical y sus principales factores asociados. La prevalencia de VIH en gestantes presentó una tendencia de aumento y la prevalencia media fue de 0,18%, las variables estadísticamente asociadas a la ocurrencia de VIH en gestantes fueron: edad materna ≥ 20 años (p = 0,007), menor escolaridad (p = 0,054) y no contar con compañero (p = 0,001). La transmisión vertical fue de un 6,9%. El uso de terapia antirretroviral viral (TARV) durante el período prenatal, incluso entre las gestantes que ya se sabían portadoras del virus, fue menor de un 90%. La realización de cesáreas electivas quedó por debajo de un 60% y el uso de TARV en el parto y por el recién nacido en las primeras 24 horas presentó variaciones, dependiendo del período en que el diagnóstico materno fue realizado. A pesar de que las estrategias de eliminación de la transmisión vertical del HIV estén bien establecidas, los resultados de este estudio todavía apuntan fallos importantes en la cascada de cuidados de las gestantes infectadas en Río Branco.

Factors associated with prematurity in reported cases of congenital syphilis / Fatores associados à prematuridade em casos notificados de sífilis congênita

ABSTRACT OBJECTIVE: To analyze the factors associated with prematurity in reported cases of congenital syphilis in the city of Fortaleza, Ceará, Brazil. METHODS: Cross-sectional study conducted in ten public maternity hospitals in Fortaleza, Ceará, Brazil. A total of 478 reported cases of congenital syphilis were included in 2015, and data were collected from notification forms, from mothers' and babies' medical records and from prenatal cards. For the bivariate analysis, Pearson's chi-squared and Fisher's exact tests were used, considering p < 0.05. Multiple logistic regression was conducted, presenting odds ratio (OR) with a 95% confidence interval. RESULTS: We found 15.3% prematurity in pregnant women with syphilis. The titration of the VDRL test > 1:8 at delivery (OR 2.46; 95%CI: 1.33-4.53; p = 0.004) and the non-treatment of the pregnant women or treatment with drugs other than penicillin during prenatal care (OR 3.52; 95%CI: 1.74-7.13; p< 0.001) were associated with higher chances of prematurity. CONCLUSION: The prematurity due to congenital syphilis is a preventable condition, provided that pregnant women with syphilis are treated appropriately. Weaknesses in prenatal care are associated with this outcome, which highlights the importance of public policies oriented to improve the quality of prenatal care.

RESUMO OBJETIVO: Analisar os fatores associados à prematuridade em casos notificados de sífilis congênita no município de Fortaleza, Ceará, Brasil. MÉTODOS: Estudo transversal realizado em dez maternidades públicas de Fortaleza, Ceará, Brasil. Foram incluídos 478 casos notificados de sífilis congênita em 2015, e os dados foram coletados das fichas de notificação, dos prontuários das mães e dos bebês e do cartão de pré-natal. Para a análise bivariada, foram utilizados os testes do qui-quadrado de Pearson e exato de Fisher, considerando p < 0,05. Realizou-se regressão logística múltipla, apresentando razão de chances (OR) com intervalo de confiança de 95%. RESULTADOS: Encontrou-se 15,3% de prematuridade em gestantes com sífilis. A titulação do teste VDRL > 1:8 no parto (OR 2,46; IC95%: 1,33-4,53; p = 0,004), o não tratamento da gestante ou tratamento realizado com drogas diferentes da penicilina durante o pré-natal (OR 3,52; IC95%: 1,74-7,13; p < 0,001) estiveram associados a maiores chances de prematuridade. CONCLUSÃO: A prematuridade decorrente da sífilis congênita é um agravo evitável, desde que as gestantes com sífilis sejam tratadas adequadamente. As fragilidades na assistência pré-natal estão associadas a este desfecho, o que ressalta a importância de implementar políticas públicas voltadas a melhorar a qualidade do pré-natal.