Posición prono en embarazada con neumonía grave por COVID-19 / Prone position in pregnant woman with severe COVID-19 pneumonia

Resumen Se han comunicado buenos resultados clínicos al poner en posición prono a pacientes con Síndrome de Distrés Respiratorio Agudo por COVID-19. Objetivo: Describir la maniobra prono, sus resultados clínicos y cuidados asociados, en una mujer de 34 años de edad con 26 semanas de embarazo, que estaba en ventilación mecánica, por un cuadro clínico de neumonía multifocal por COVID-19. Se realizó maniobra prono lateralizada hacia izquierda, en tres etapas, preparación, ejecución y evaluación. Luego de 62 h de prono, se observó una recuperación favorable de la gestante: la relación PaO2/FiO2 aumentó de 151 a 368 mmHg, y disminuyó el compromiso radiológico pulmonar, sin que se detectaran complicaciones fetales. Conclusiones: Esta maniobra que puede beneficiar a pacientes con insuficiencia respiratoria grave, en embarazadas debe ser una técnica protocolizada, con equipos de trabajo experimentados e implementación adecuada.

Good clinical results have been reported when placing patients with acute respiratory distress syndrome due to COVID-19 in a prone position. Objective: To describe the prone maneuver, its clinical results and associated care in a 34-year-old woman with 26 weeks of pregnancy, who was on mechanical ventilation, due to a clinical picture of COVID-19 multifocal pneumonia. Lateralized prone maneuver was carried out to the left, in three stages, preparation, execution and evaluation. After 62 hours of prone, a favorable recovery of the pregnant woman was observed: PaO2/FiO2 ratio increased from 151 to 368 mmHg, and the pulmonary radiological compromise decreased, without fetal complications being detected. Conclusions: This maneuver that might benefit patients with severe respiratory failure, in pregnant women should be a protocolized technique, with experienced work teams and adequate implementation.

Recomendaciones para el diagnóstico y el manejo de la infección por citomegalovirus en la mujer embarazada y el recién nacido / Recommendations for the diagnosis and management of cytomegalovirus infection in pregnant women and newborns

Resumen La Sociedad Chilena de Infectología, a través de su Comité de Infecciones Neonatales, en conjunto con la Sociedad Chilena de Obstetricia y Ginecología, proponen un documento de diagnóstico y manejo de la infección por citomegalovirus (CMV) en la mujer embarazada y el recién nacido. Esta guía aborda el manejo de la infección en el binomio, su enfrentamiento diagnóstico y terapéutico, orientado al equipo de salud que atiende a mujeres embarazadas y recién nacidos con infección por CMV en Chile. Considera la situación epidemiológica global y latinoamericana, con recomendaciones para la evaluación clínica y de laboratorio; establece criterios de diagnóstico, propone enfoques terapéuticos de acuerdo a la situación clínica, analiza las medidas de prevención y establece una propuesta nacional para el seguimiento de esta enfermedad. Se ha puesto especial énfasis en entregar, de forma práctica, y con la mayor evidencia posible, las recomendaciones para el manejo del binomio con infección por CMV.

Abstract The Chilean Society of Infectology, through its Neonatal Infections Committee in conjunction with the Chilean Society of Obstetrics and Gynecology, propose a document for the Diagnosis and Management of Cytomegalovirus Infection in Pregnancy and Newborn. This guideline suggests the management of mother and child infection, its diagnostic and therapeutic options. Considers the global and Latin American epidemiology, with recommendations for clinical and laboratory evaluation, diagnostic criteria, therapeutic approaches according to the clinical situation, analyzes prevention measures and establishes a national proposal for monitoring this disease.

Clinical Features and Maternal-fetal Results of Pregnant Women in COVID-19 Times / Características clínicas e resultados materno-fetais de mulheres grávidas com COVID-19

Abstract Objective Coronavirus disease 2019 (COVID-19) is a disease caused by a newly discovered coronavirus, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), which usually leads to non-specific respiratory symptoms. Although pregnant women are considered at risk for respiratory infections by other viruses, such as SARS and Middle East respiratory syndrome (MERS), little is known about their vulnerability to SARS-CoV-2. Therefore, this study aims to identify and present the main studies on the topic, including the postpartum period. Methods In this narrative review, articles were searched in various databases, organizations, and health entities using keywords compatible with medical subject headings (MeSH), such as: COVID-19, pregnancy, vertical transmission, coronavirus 2019, and SARS-CoV-2. Results The review of the scientific literature on the subject revealed that pregnant women with COVID-19 did not present clinical manifestations significantly different from those of non-pregnant women; however, there are contraindicated therapies. Regarding fetuses, studies were identified that reported that infection by SARS-CoV-2 in pregnant women can cause fetal distress, breathing difficulties and premature birth, but there is no substantial evidence of vertical transmission. Conclusion Due to the lack of adequate information and the limitations of the analyzed studies, it is necessary to provide detailed clinical data on pregnant women infected with SARS-CoV-2 and on the maternal-fetal repercussions caused by this infection. Thus, this review may contribute to expand the knowledge of professionals working in the area as well as to guide more advanced studies on the risk related to pregnant women and their newborns. Meanwhile, monitoring of confirmed or suspected pregnant women with COVID-19 is essential, including in the postpartum period.

Resumo Objetivo A Coronavirus disease 2019 (COVID-19) é uma doença causada por um coronavírus recém descoberto, o severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), que geralmente leva a sintomas respiratórios não específicos. Embora mulheres grávidas sejam consideradas em risco de infecções respiratórias por outros vírus, como SARS e Middle East respiratory syndrome (MERS), pouco se sabe sobre sua vulnerabilidade ao SARS-CoV-2. Portanto, este estudo tem como objetivo identificar e apresentar os principais estudos sobre o tema incluindo o período pós-parto. Métodos Nesta revisão narrativa, foram pesquisados artigos em diversas bases de dados, organizações e entidades de saúde, utilizando palavras-chave compatíveis com o MeSH, tais como: COVID-19, gravidez, transmissão vertical, coronavírus 2019, e SARSCoV-2. Resultados A revisão da literatura científica sobre o assunto revelou que as gestantes com COVID-19 não apresentaram manifestações clínicas significativamente diferentes das não gestantes, porém existem terapias contraindicadas. Em relação aos fetos, foramidentificados estudos que relataram que a infecção por SARS-CoV-2 em mulheres grávidas pode causar sofrimento fetal, dificuldades respiratórias e parto prematuro, mas não há evidências substanciais de transmissão vertical. Conclusão Devido à falta de informações adequadas e às limitações dos estudos analisados, é necessário fornecer dados clínicos detalhados sobre as gestantes infectadas pelo SARS-CoV-2 e sobre as repercussões materno-fetais causadas por esta infecção. Assim, esta revisão pode contribuir para ampliar o conhecimento dos profissionais que atuam na área, bem como para orientar estudos mais avançados sobre o risco relacionado à gestante e seu recém-nascido. Enquanto isso, o monitoramento de gestantes confirmadas ou suspeitas com COVID-19 é essencial, incluindo o pós-parto.

Infección por listeria monocytogenes en el embarazo, asociado a desprendimiento de placenta y complicaciones perinatales: reporte de un caso / Listeria monocytogenes infection in pregnancy, associated with placental abruption and perinatal complications: case report

INTRODUCCIÓN la listeriosis, aunque es una infección infrecuente, debe ser considerada en pacientes inmunocomprometidos y gestantes, especialmente en aquellos que consumen alimentos crudos o productos lácteos no pasteurizados, lo que pone en riesgo a un gran número de mujeres embarazadas en países de habla hispana. Es importante que el médico considere su inclusión en los posibles diagnósticos diferenciales cuando la sospecha clínica lo amerite, lo que permitirá hacer un diagnóstico temprano y por lo tanto un tratamiento oportuno, evitando así las posibles complicaciones en el binomio madre-hijo. CASO CLÍNICO clínico multigestante, con embarazo de 33 + 5 semanas, que ingresó a una institución de alto nivel de complejidad en la ciudad de Medellín, Colombia, por síndrome febril asociado a sepsis obstétrica debido a infección intraamniótica por Listeria monocytogenes, que requirió cesárea de urgencia, en donde se evidenció un desprendimiento placentario del 100 % secundario al proceso infeccioso y asociado a complicaciones neonatales. CONCLUSIONES: el diagnóstico de listeriosis gestacional supone un reto clínico por su presentación inespecífica y baja incidencia. Sin embargo, las consecuencias obstétricas arrastran una gran morbilidad de la madre y morbi-mortalidad neonatal, lo que hace de suma importancia que el clínico lo tenga presente en su arsenal diagnóstico, ya que una vez diagnosticado, el tratamiento oportuno tiene desenlaces clínicos favorables.

INTRODUCTION: although listeriosis is a rare infection, it should be considered in immunocompromised patients and pregnancy, especially in those who consume raw food or unpasteurized dairy, which puts a large number of pregnant women in Hispanic countries at risk. It is of special importance for physicians to include listeriosis among possible diagnoses when clinical suspicion arises in order to timely treat it and thus avoid the complications that may occur in the mother-child binomial. CLINICAL CASE: a pregnant woman (33 + 5 weeks) with multiple gestations, was admitted to a high level of complexity institution in the city of Medellín, Colombia, presenting a febrile syndrome associated with obstetric sepsis due to intra-amniotic infection by Listeria monocytogenes, which required emergency cesarean section where a 100 % placental abruption was evidenced secondary to the infectious process and associated with neonatal complications. CONCLUSIONS: The diagnosis of gestational listeriosis is a clinical challenge due to its nonspecific presentation and low incidence. However, the obstetric consequences drag a great maternal morbidity and neonatal morbidity and mortality, which is why it is important for physicians to consider this in the diagnostic arsenal because once diagnosed, the appropriate treatment has favorable clinical outcomes.

Improvement of quality of care for gestational syphilis in the municipality of Rio de Janeiro / Melhoria da qualidade do cuidado à sífilis gestacional no município do Rio de Janeiro

ABSTRACT OBJECTIVE To analyze the effect of a multifaceted intervention in the care of pregnant women with syphilis in primary health care. METHODS This is a quality improvement project performed in 26 basic care units in the municipality of Rio de Janeiro, between January and December 2017. It has a quasi-experimental mixed design, with previous, later and time series analyses. We evaluated the care provided to all pregnant women with syphilis whose prenatal care that ended during the studied period, using ten quality criteria and one indicator. The intervention was multifaceted, covering permanent education, improvement of records and information systems, audit and feedback, patient education, organizational changes and work processes. We estimated absolute and relative improvements of the criteria and their statistical significance (α = 5%). The facilitators and hinders of the intervention were analyzed according to the Model for Understanding Success in Quality. RESULTS After the intervention, there was a total absolute improvement of 6.7% (64.4% versus 71.0%) and relative of 28.8% (p > 0.05). Eight of the ten quality criteria had an improvement, which was significant in four of them (p < 0.05). The monthly indicator of adequate treatment also improved (p < 0.05), but maintained low performance throughout the project. The increase in the compliance of the treatment scheme with the protocol (91.4% versus 99.1%) positively stood out, but the main opportunities for improvement were testing (42.8% versus 48.5%) and treatment of sexual partnerships (42.8% versus 44.2%). Regulatory pressures to improve the monthly indicator and the political-economic crisis experienced by the municipality modulated the effect of the intervention. CONCLUSION The project was useful to identify priorities and guide interventions to improve the quality of care for syphilis, although there is still ample room for improvement. The identified problems, as well as the contextual modulators of the effect, should be considered in future interventions.

RESUMO OBJETIVO Analisar o efeito de uma intervenção multifacetada no cuidado das gestantes com sífilis na atenção primária à saúde. MÉTODOS Trata-se de projeto de melhoria da qualidade realizado em 26 unidades básicas de saúde do município do Rio de Janeiro, entre janeiro e dezembro de 2017. O desenho foi quase-experimental misto, com análises anteriores, posteriores e de série temporal. Avaliou-se o cuidado prestado a todas as gestantes com sífilis e pré-natal encerrado no período, mediante dez critérios de qualidade e um indicador. A intervenção foi multifacetada, abrangendo educação permanente, melhoria dos registros e sistemas de informação, auditoria e feedback, educação do paciente, mudanças organizacionais e nos processos de trabalho. Estimaram-se as melhorias absoluta e relativa dos critérios e sua significância estatística (α = 5%). Os facilitadores e dificultadores da intervenção foram analisados segundo o Model for Understanding Success in Quality. RESULTADOS Após a intervenção, observou-se melhoria absoluta total de 6,7% (64,4% versus 71,0%) e relativa de 28,8% (p > 0,05). Oito dos dez critérios de qualidade tiveram melhoria, sendo esta significativa em quatro deles (p < 0,05). O indicador mensal de tratamento adequado também melhorou (p < 0,05), porém manteve baixo desempenho em todo o projeto. Destacou-se positivamente o aumento da conformidade do esquema de tratamento com o protocolo (91,4% versus 99,1%), porém as principais oportunidades de melhoria foram a testagem (42,8% versus 48,5%) e o tratamento das parcerias sexuais (42,8% versus 44,2%). Pressões regulatórias para melhorar o indicador mensal e a crise político-econômica vivenciada pelo município modularam o efeito da intervenção. CONCLUSÃO O projeto foi útil para identificar prioridades e orientar intervenções para a melhoria da qualidade da assistência à sífilis, embora ainda exista ampla margem para avanços. Os problemas identificados, bem como os moduladores contextuais do efeito, devem ser considerados em futuras intervenções.

Manejo de la sepsis en el embarazo. Revisión de la literatura / Management of sepsis in pregnancy: a review of the literature

Introducción: la sepsis se reconoce como una enfermedad común y mortal, cuya epidemiología obliga al médico tratante a realizar un diagnóstico oportuno por el alto riesgo de complicaciones o muerte. En las gestantes hay una gran vulnerabilidad debido a los cambios físicos y hormonales que están afrontado. Es indispensable iniciar el tratamiento tan pronto se tenga el diagnóstico, para evitar que sea mortal tanto para la madre como para el feto. Objetivo: es por esto que el objetivo es una revisión sobre la intervención en las pacientes con diagnóstico de sepsis en estado de embarazo al ingreso a la UCI. Discusión: se consideraron los siguientes ejes temáticos: definición clara de sepsis en el embarazo, factores de riesgo, intervención terapéutica en UCI y consecuencias para el feto durante su intervención. Conclusiones: se concluye que el manejo de la sepsis en las embarazadas es muy similar a las que no lo están. Hacen falta investigaciones con evidencia científica, velando siempre por la vida ya que no solo se trata un ser humano sino de dos.

Sepsis is considered a common condition and a major cause of death. Due to its epidemiologic features the treating physician must make a timely diagnosis for patients are at a high risk of developing complications or dying. Pregnant women are more vulnerable to infection due to the physiologic and hormonal changes they undergo. Early initiation of treatment when sepsis is recognized is critical to prevent mother or fetal death. Thus, the objective of this study was to conduct a review of interventions in pregnant patients with sepsis admitted to the ICU, using the following search headings: clear definition of sepsis in pregnancy, risk factors, therapeutic intervention at the ICU and consequences for the fetus during the intervention. We concluded that the management of sepsis in pregnant women is very similar to that in non-gravid women. There is a lack of evidenced-based studies focused in always protecting life for it implies the preservation of not only one human life but two lives.

Prevención de la transmisión vertical de VIH en mujeres migrantes internacionales: escenario actual y desafíos / Prevention of vertical transmission of HIV in international migrant women: current scenario and challenges

La prevención de la transmisión vertical de VIH es un desafío para todos los países del mundo. Esto se ve complejizado por la construcción permanente de sociedades globales, con grado variable de población migrante internacional. Las políticas, programas y acciones sanitarias para la prevención de transmisión vertical de VIH en gestantes migrantes demandan una perspectiva intercultural, en donde se aborden todas las dimensiones sociales, culturales y de género asociadas a la infección. El entender la realidad local en cuanto a la prevención de transmisión vertical de VIH en población migrante internacional en Chile es esencial para llevar acciones concretas que favorezcan la prevención de transmisión madre-hijo de VIH. En este artículo se presentan algunos conceptos esenciales relacionados a esta temática. También se expone información internacional y nacional sobre riesgos de transmisión vertical de VIH en migrantes gestantes, la importancia del plan nacional de preven ción de transmisión vertical de VIH en nuestro país, y algunos esfuerzos que se están realizando para adaptar dicho plan a la realidad de diversidad social y cultural que migrantes gestantes presentan hoy en Chile, como un valioso insumo de salud pública con perspectiva intercultural.

Preventing vertical transmission of HIV is a challenge for all countries worldwide. The permanent construction of global societies with a variable degree of international migrant population has made it more complex. Health policies, programs, and actions for preventing vertical transmission of HIV in pregnant migrants demand an intercultural perspective, where social, cultural, and gender dimen sions associated with the infection are addressed. Understanding the local reality regarding the pre vention of vertical transmission in the international migrant population in Chile is essential to carry out concrete actions that favor the prevention of mother-to-child transmission of HIV. This article presents some essential concepts related to this topic. It also presents international and national in formation on risks of vertical transmission in pregnant migrants, the importance of the national plan for preventing vertical transmission of HIV in our country, and some ongoing efforts to adapt such plan to the reality of social and cultural diversity that pregnant migrants currently present in Chile, as a useful public health instrument with an intercultural perspective.

SARS-CoV-2 and pregnancy: A review of the facts / SARS-CoV-2 e gestação: uma revisão dos fatos

Abstract Objective The present comprehensive review aims to show the full extent of what is known to date and provide a more thorough view on the effects of SARS-CoV2 in pregnancy. Methods Between March 29 and May, 2020, the words COVID-19, SARS-CoV2, COVID- 19 and pregnancy, SARS-CoV2 and pregnancy, and SARS and pregnancy were searched in the PubMed and Google Scholar databases; the guidelines from well-known societies and institutions (Royal College of Obstetricians and Gynaecologists [RCOG], American College of Obstetricians and Gynecologists [ACOG], International Society of Ultrasound in Obstetrics & Gynecology [ISUOG], Centers for Disease Control and Prevention [CDC], International Federation of Gynecology and Obstetrics [FIGO]) were also included. Conclusion The COVID-19 outbreak resulted in a pandemic with > 3.3 million cases and 230 thousand deaths until May 2nd. It is caused by the SARS-CoV2 virus and may lead to severe pulmonary infection and multi-organ failure. Past experiences show that unique characteristics in pregnancy make pregnant women more susceptible to complications from viral infections. Yet, this has not been reported with this new virus. There are risk factors that seem to increase morbidity in pregnancy, such as obesity (body mass index [BMI] > 35), asthma and cardiovascular disease. Current reports describe an increased rate of pretermbirth and C-section. Vertical transmission

Resumo Objetivo A presente revisão detalhada busca fornecer dados objetivos para avaliar o que se sabe até o momento e possibilitar uma visãomais ampla dos efeitos do SARSCoV2 na gravidez. Métodos Entre 29 demarço e 2 de maio de 2020, foi realizada uma busca nos bancos de dados PubMed e Google Scholar com as palavras COVID-19, SARS-CoV2, COVID-19 e gravidez, SARS-CoV2 e gravidez, e SARS e gravidez. As recomendações dos principais órgãos sobre o tema também foram acessadas. Conclusão O surto de COVID-19 resultou em uma pandemia com> 3.3 milhões de casos e 230 mil mortes até 2 de maio. É uma condição causada pelo vírus SARS-CoV2 e pode levar ao acometimento pulmonar difuso e à falência de múltiplos órgãos. Características únicas da gestante tornam essa população mais propensas a complicações de infecções virais. Até o momento, essa tendência não foi observada para esse novo vírus. Os fatores que parecem estar associados à maior morbidade materno-fetal são obesidade (índice demassa corporal [IMC] > 35), asma e doença cardiovascular. Há descrição de aumento de parto prematuro e parto cesáreo. Não se pode descartar a possibilidade de transmissão vertical da doença, devido a relatos de positividade de reação em cadeia de polimerase (RT-PCR) de swab nasal, RT-PCR de líquido amniótico e imunoglobulina M (IgM) de recém-nascidos. Tratamentos devem ser analisados caso a caso, dada a falta de qualidade de estudos que comprovem a sua eficácia e segurança na gravidez. O corpo clínico deve utilizar equipamentos de proteção individual (EPI) ao manusear pacientes suspeitos ou confirmados e ficar atento aos sinais de descompensação respiratória.

Pronóstico Perinatal en embarazadas de tercer trimestre recuperadas de infección por COVID-19 / Perinatal Prognosis in third trimester pregnant women recovered from COVID-19 infection

INTRODUCCIÓN Y OBJETIVOS: COVID-19 es una patología producida por el virus RNA SARS-CoV-2, declarada pandemia por la OMS en marzo de 2020. La literatura mundial describe mayor incidencia de parto prematuro y cesáreas en pacientes infectadas por COVID-19 principalmente de origen iatrogénico, sin embargo, existen escasos datos del pronóstico del embarazo al decidir diferir el parto hasta después del período infeccioso del virus. Este trabajo reporta un grupo de embarazadas diagnosticadas con COVID-19 en tercer trimestre donde se decidió no interrumpir el embarazo y diferir su parto hasta recuperación de la patología. MÉTODOS: Estudio observacional retrospectivo que analiza resultados materno-perinatales en 9 casos de mujeres infectadas por COVID, diagnosticadas posterior a las 33 semanas y cuyo parto se verificó después de recuperadas del COVID. RESULTADOS: Se observó un 77% de pacientes sintomáticas, 77% requirieron hospitalización, 33% por COVID, todas ingresaron a unidad de paciente crítico, sólo una requirió ventilación mecánica no invasiva. Dos cursaron con cetoacidosis normo-glicémica y dos con neumonía por COVID-19. Un 88% resultó en parto de término, sólo una paciente tuvo parto prematuro de causa obstétrica. La vía de parto fue un 67% vaginal y 33% por cesárea, todas por indicación obstétrica. La latencia al parto promedio fue de 17.3 días. Los puntajes de Apgar fueron todos mayor a 7 al minuto y 5 minutos. CONCLUSIÓN: Los resultados de esta serie sugieren que, en casos seleccionados, los partos posteriores al período infeccioso del COVID se asocian a buenos resultados materno-perinatales, sin embargo, resulta importante aumentar la casuística.

INTRODUCTION AND OBJECTIVES: COVID-19 is a pathology produced by the RNA virus SARS-CoV-2, declared a pandemic by the WHO in March of 2020. The world literature describes more preterm birth and caesarean section in pregnant women infected by COVID-19, principally by medical indication, but it has not been described in depth what happens when we differ delivery after the infectious period. This report reviews a subgroup of patients who were diagnosed with COVID-19 in the third trimester and decided to differ birth until they recovered from the disease. METHODS: Retrospective observational study that analyzes maternal and perinatal outcome of 9 women who were diagnosed with COVID-19 after the 33 weeks of pregnancy, decided to differ delivery and had their birth recovered from the disease. RESULTS: We observed 77% of patients symptomatic, 77% required hospitalization, 33% because of COVID, all admited to critical patient care, only one required non invasive mechanical ventilation. 2 patients suffered normoglycemic ketoacidosis, 2 had COVID-19 pneumonia. An 88% resulted in term birth, only 1 was prematurely interrupted by obstetric cause. 66% patients had vaginal delivery and 33.3% caesarean section, all by obstetric cause. The average latency to birth was 17.3 days. Apgar scores were all more than 7 at minute 1 and 5. CONCLUSION: The results of this series suggest that in selected cases where the clinical characteristics allow it, to differ interruption of pregnancy until after the infectious period can associate to good outcomes of maternal and neonatal morbimortality, however, it's fundamental to continue research.

Inducción de trabajo de parto en pacientes COVID-19: experiencia en el Hospital San Juan de Dios / Labor induction in COVID-19 patients: experience in the San Juan de Dios Hospital

INTRODUCCIÖN Y OBJETIVOS: Describir la experiencia de los partos en gestantes con diagnóstico confirmado de COVID 19 mediante RT-PCR asintomáticas o con sintomatología leve y aquellas sin la enfermedad, y determinar la tasa de éxito de parto vaginal en inducción de trabajo de parto. MÉTODOS: Análisis retrospectivo de pacientes que tuvieron su parto entre 15 de Abril y 03 de Julio del 2020 en el Hospital San Juan de Dios. Se incluyeron las pacientes inducidas con Dinoprostona, Oxitocina o ambas de manera secuencial y se dividieron según estatus COVID 19 mediante RT-PCR al ingreso. Se caracterizó demográficamente el grupo de pacientes positivas y se determinaron los datos de ambos grupos en relación a la necesidad de inducción de trabajo de parto y su éxito para parto vaginal. RESULTADOS: De un total de 657 nacimientos, hubo un 9.7% (n=64) de pacientes con COVID 19, de las cuales un 23.4% (n=15) requirió inducción de trabajo de parto, con una tasa de éxito para parto vaginal de un 66.7% (n=10). De estas pacientes, un 50% recibió Oxitocina, un 40% Dinosprostona y un 10% ambos medicamentos de forma secuencial. En las pacientes negativas, hubo un total de 568 nacimientos, con un 29.8% (n=169) de usuarias que requirieron inducción. La tasa de éxito para parto vaginal en este grupo fue de 72.2% (n=122), utilizando un 50% Oxitocina; un 27% Dinoprostona; un 14.8% ambas; y un 8.2% Balón de Cook. CONCLUSIONES: Sabemos que los resultados de este estudio están limitados por el bajo número de pacientes incluidas, sin embargo, podemos observar que, en nuestra experiencia con las pacientes que arrojaron PCR SARS-CoV-2 positivas, asintomáticas o con enfermedad leve, se logró realizar la inducción de trabajo de parto según protocolos habituales, obteniendo porcentajes de éxito para partos vaginales, similares a las pacientes sin la enfermedad.

INTRODUCTION AND OBJECTIVES: Describe the experience of deliveries in pregnant women with a confirmed diagnosis of COVID 19 by asymptomatic RT-PCR or with mild symptoms and those without the disease, and determine the success rate of vaginal delivery in the induction of labor. METHODS: Retrospective study of patients who had their delivery between 15th April and 03rd of July, 2020 in the San Juan de Dios Hospital. Patients induced with Dinoprostone, Oxytocin or both sequentially were included, and were divided according to COVID 19 status by RT-PCR on their admission process. The group of positive patients was demographically characterized and the data of both groups was determined in relation to the need for labor induction and its success for vaginal delivery. RESULTS: Of a total of 657 births, there were 9.7% (n = 64) of patients with COVID 19, of which 23.4% (n = 15) required labor induction, with a success rate for vaginal delivery of 66.7% (n = 10). Of these patients, 50% received Oxytocin, 40% Dinosprostone and 10% both drugs sequentially. In the negative patients, there were a total of 568 births, with 29.8% (n = 169) of users requiring labor induction. The success rate for vaginal delivery in this group was 72.2% (n = 122); 50% using Oxytocin; 27% Dinoprostone; 14.8% using both; and 8.2% using Cook's Catheter. CONCLUSIONS: We know that the results of this study are limited by the low number of patients included, however, in our experience, we can observe that, in patients with SARS-CoV-2 PCR positive, asymptomatic or with mild disease, it was possible to perform induction of labor according to standard protocols, achieving success rates for vaginal deliveries, similar to patients without the disease.

Evaluación de un modelo remoto de seguimiento de pacientes embarazadas y puérperas con infección por SARS-CoV-2 / Evaluation of a remote control model for pregnant and post-partum patients with SARS-CoV-2infection

INTRODUCCIÓN: Ante el escenario de pacientes obstétricas diagnosticadas por la nueva enfermedad por coronavirus (COVID-19), se hace imprescindible la necesidad de realizar un seguimiento adecuado tanto desde el punto de vista de obstétrico como del cuadro viral, durante el período de aislamiento domiciliario. Con este objetivo, se desarrolló un programa de seguimiento remoto por la Unidad de Medicina Materno Fetal (MMF) de nuestro centro, desde el diagnóstico de la infección hasta el alta médica según los criterios vigentes del Ministerio de Salud (MINSAL). OBJETIVO: Evaluar la satisfacción del paciente en el seguimiento remoto de embarazadas y puérperas con diagnóstico de infección por SARS-CoV-2. Material y Métodos: Estudio descriptivo mediante la aplicación de una encuesta anónima y voluntaria de satisfacción usuaria, a través de una plataforma online. El instrumento fue una adaptación de la versión en español del "Telehealth Usability Questionnaire" (TUQ) previamente validado. RESULTADOS: Se obtuvo un 94,5% de respuestas a la encuesta. El 86% de las pacientes evaluó como "Muy Bueno" o "Bueno" el control virtual. El 91% no experimentó problemas técnicos. El 14% de las pacientes prefiere un control virtual, el 26% presencial y el 60% un control mixto. El 80% cumplió todas sus necesidades con el control virtual. CONCLUSIONES: En el contexto de pandemia e infección por SARS-CoV-2, el seguimiento remoto ha sido evaluado globalmente en forma positiva con niveles aceptables de satisfacción de las pacientes.

INTRODUCTION: Given the scenario of obstetric patients diagnosed with the new coronavirus disease (COVID-19), the need for proper follow-up both obstetric and of the infection, during the period of home isolation, is essential. A remote monitoring program was developed by the Maternal Fetal Medicine Unit (MFM) of our center from the diagnosis of the infection until medical discharge according to the current criteria of the Ministry of Health (MINSAL). OBJECTIVE: To assess patient satisfaction of remote monitoring of pregnant and postpartum patients diagnosed with SARS-CoV-2 infection. METHODS: This is a descriptive-survey research. We performed a patient satisfaction survey through an online platform to pregnant and postpartum patients with remote monitoring for SARS-CoV-2 infection in our center. The survey was anonymous and voluntary. The instrument for this purpose was the Spanish adapted version of "Telehealth Usability Questionnaire" (TUQ) that has been previously validated. RESULTS: The survey was answered by 94,5% of the patients. The results show that 86% of the patients rated the virtual control as "Very Good" or "Good"; 91% did not experienced technical problems. 14% of the patients prefer virtual control, 26% prefer face-to-face control and 60% both virtual and face-to-face control. 80% fulfilled all their needs with virtual control. CONCLUSIONS: In the context of pandemic and SARS-CoV-2 infection, remote monitoring has been positively evaluated with acceptable levels of patient's satisfaction.

Reporte de caso: manejo multidisciplinario en gestante con embarazo de 31 semanas y COVID-19 positivo con evolución grave / Case report: multidisciplinary management in case of 31 weeks pregnant woman and COVID 19 infection with severe disease presentation

INTRODUCCIÓN: En diciembre de 2019 se reporta un brote de neumonía atípica causada por un nuevo coronavirus: SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2), cuya enfermedad se denomina COVID-19 (Coronavirus Disease 2019). Desde entonces su distribución se ha ampliado mundialmente causando una emergencia en los sistemas de salud. MÉTODO: Corresponde al reporte de caso clínico. Este estudio es descriptivo y se basa en el manejo realizado a paciente embarazada con COVID-19 confirmado. Esta publicación cuenta con la autorización del comité de ética local para la revisión de ficha clínica. CASO: Mujer de 40 años con un embarazo de 31 semanas, se le diagnostica COVID-19 tras contacto estrecho con caso confirmado. Evoluciona con disnea y por posibilidad de interrupción del embarazo se traslada a centro de mayor complejidad. Allí se pesquisa compromiso de función pulmonar, uso de musculatura accesoria y alteración sensorial, requiriendo oxigenoterapia. Se evalúa interdisciplinariamente decidiendo intubar y realizando manejo en unidad de cuidados intensivos (UCI). Se realiza cesárea de urgencia a las 31+4 semanas debiendo realizarse histerectomía total por inercia uterina. Tras el procedimiento evoluciona tórpidamente con deterioro de función pulmonar, describiéndose un pronóstico catastrófico con probabilidad de fallecer por insuficiencia respiratoria. Un mes después despierta con una mejoría en su función pulmonar, sin otra falla orgánica. Actualmente se encuentra en buenas condiciones y es tratada multidisciplinariamente para lograr una rehabilitación integral. DISCUSIÓN: En epidemias pasadas, las embarazadas mostraron altas tasas de letalidad y riesgo de ingreso a UCI. Basados en una revisión de reportes de casos, parece ser que COVID-19 durante el embarazo se asocia a morbilidad materna severa, riesgo que aumenta en mujeres con comorbilidades, lo cual hace cuestionarnos si la infección por COVID-19 intensifica el riesgo materno o estos casos ya eran embarazos de riesgo. Se necesitan futuras investigaciones al respecto.

INTRODUCTION: The coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, was first reported in december 2019 in China as an atypipical pneumonia. Since then its distribution has globally expanded causing a public health emergency. METHOD: Corresponds to a case report. A descriptive study about the management of a pregnant woman whith COVID-19. CASE: A 40 year old pregnant woman, 31 weeks gestational age, was admitted with a diagnosis of COVID-19. She developed dyspnea and preterm birth risk that needed a more complex hospital level. Thereafter, the patient developed respiratory distress, use of accessory breathing muscles and neurological alteration, requiring oxygen therapy. An interdisciplinary medical team evaluation decided to manage her condition at intensive care unit (ICU). Cesarean delivery was performed at 31+4 weeks. After the procedure, the pulmonary function declined to a life threatening condition. A month later, the patient woke up with improved pulmonary function, without any organ failure. Currently the patient is in a good general condition with a multidisciplinary rehabilitation treatment ongoing. DISCUSSION: In previous epidemic outbrakes, pregnant women presented high fatality rates and intensive care tratment risk. Based on a case report review, COVID-19 in pregnancy is associated with severe maternal morbidity, specially in women with associated comorbidities. This situation raises the question whether the COVID-19 infection intensifies the maternal risk or whether these cases were already a high risk pregnancies. Additional studies are needed to answer this issue.

Interrupción de embarazo en tiempos de COVID-19, Hospital Carlos Van Buren, Valparaiso: a propósito de 6 casos / Interruption of pregnancy in times of COVID-19, Carlos Van Buren Hospital, Valparaiso: about 6 clinical cases

Introducción: La Pandemia ocasionada por el nuevo coronavirus SARS-CoV-2 ha tenido repercusión también en nuestra región. Las embarazadas constituyen un grupo especial dentro de la población. Casos Clínicos: Se reportan 6 casos de pacientes embarazadas interrumpidas en el Hospital Carlos Van Buren hasta Julio de 2020 con PCR positivo para SARS-CoV-2, donde una cursó con neumonía grave, 3 con síntomas leves y 2 asintomáticas. El 100% fue interrumpido por cesárea. 50% de los recién nacidos fue ingresado a neonatología. En ninguno se evidenció transmisión vertical. Conclusiones: La infección por SARS-CoV-2 no constituye una indicación inmediata por cesárea, sin embargo, se ha visto un gran aumento. No se ha observado clara evidencia de transmisión vertical, pero faltan estudios de mejor calidad.

Introduction: The pandemic caused by the new SARS-CoV-2 coronavirus has also had repercussions in our region. Among others, pregnant women constitute a special group within the affected population. Clinical Cases: There are 6 reported cases of pregnant patients interrupted in Hospital Carlos Van Buren are reported until July 2020 with a positive PCR for SARS-CoV-2, where one was treated with severe pneumonia, 3 with mild symptoms and 2 were asymptomatic. The 100% was interrupted by caesarean section. 50% of the newborns were admitted to neonatology. Vertical transmission was not evident in any of them. Conclusions: SARS-CoV-2 infection is not an immediate indication for cesarean section. However, a considerable increase in the tendency for the surgery has been observed. No clear evidence of vertical transmission has been observed, but better quality studies are needed.

Covid-19 and pregnancy: an overview / Covid-19 e gravidez: uma visão geral

Abstract Since the World Health Organization (WHO) declared coronavirus infection (COVID-19) a Public Health Emergency of International Concern in January 2020, there have been many concerns about pregnant women and the possible effects of this emergency with catastrophic outcomes inmany countries. Information on COVID-19 and pregnancy are scarce and spread throughout a fewcase series, with no more than 50 cases in total. The present review provides a brief analysis of COVID-19, pregnancy in the COVID-19 era, and the effects of COVID-19 on pregnancy.

Resumo Desde que a Organização Mundial da Saúde (OMS) declarou a infecção por coronavírus (COVID-19) uma emergência de saúde pública de interesse internacional emjaneiro de 2020, houve muitas preocupações sobre mulheres grávidas e os possíveis efeitos dessa emergência com resultados catastróficos em muitos países. As informações sobre COVID-19 e gravidez são escassas e se espalham por algumas séries de casos, com não mais do que 50 casos no total. A presente revisão fornece uma breve análise da COVID- 19, gravidez na era COVID-19 e os efeitos da COVID-19 na gravidez.

Childbirth, puerperium and abortion care protocol during the Covid-19 pandemic / Protocolo de cuidados no parto, no puerpério e no abortamento durante a pandemia de Covid-19

Abstract The new coronavirus (severe acute respiratory syndrome-related coronavirus 2, SARSCoV- 2) is a virus that causes a potentially serious respiratory disease that has spread in several countries, reaching humans in all age groups, including pregnant women. The purpose of this protocol is to provide technical and scientific support to Brazilian obstetricians regarding childbirth, postpartum and abortion care during the pandemic.

Resumo O novo coronavírus (severe acute respiratory syndrome-related coronavirus 2, SARS-CoV- 2) é umvírus que causa uma doença respiratória potencialmente grave que se espalhou por vários países, acometendo seres humanos de todas as faixas etárias, incluindo gestantes. O propósito deste protocolo é fornecer apoio técnico e científico aos obstetras brasileiros com relação aos cuidados no parto, pós-parto e aborto durante a pandemia.

Factors associated with inadequate follow-up of children with congenital syphilis / Fatores associados ao seguimento não adequado de crianças com sífilis congênita

ABSTRACT OBJECTIVE To analyze factors associated with outpatient follow-up of children with congenital syphilis. METHODS A non-concurrent cohort study performed in primary care units and three reference maternity hospitals in Fortaleza (Ceará State). Data were collected from September 2013 to September 2016 in the notification forms and in the medical records of hospitalization and outpatient follow-up, and they were presented considering an adequate and inadequate follow-up. Children who attended the primary care unit or referral outpatient clinic during the period recommended by the Ministry of Health were considered adequately followed up and performed the recommended examinations. Pearson's chi-square and Fisher's exact tests were used in the comparative analysis. The estimated risk of adequate non-follow-up was verified by simple and multiple logistic regression. RESULTS The total of 460 children with congenital syphilis were notified, of which 332 (72.2%) returned for at least one appointment and were part of the study. Exactly 287 (86.4%) children attended the primary health unit; however, there was no reference to congenital syphilis in 236 (71.1%) medical records and no information on the venereal disease research laboratory (VDRL) test was found in 264 (79.5%) children. There was nonadherence to subsequent appointments by 272 (81.9%) individuals. The following variables had a statistically significant association with the non-adequate follow-up of the children: marital status of the mothers, number of prenatal appointments, number of pregnancies, blood count, and radiography of long bones. CONCLUSIONS Most children with congenital syphilis attended primary care for follow-up, but the services do not meet the recommendations of the Brazilian Ministry of Health for adequate follow-up.

RESUMO OBJETIVO Analisar fatores associados ao seguimento ambulatorial não adequado de crianças notificadas com sífilis congênita. MÉTODOS Estudo de coorte não concorrente, realizado em unidades de atenção primária e três maternidades de referência de Fortaleza (Ceará). Os dados foram coletados de setembro de 2013 a setembro de 2016 nas fichas de notificação e nos prontuários médicos de internamento e de seguimento ambulatorial, e apresentados considerando o seguimento adequado e não adequado. Foram consideradas adequadamente seguidas as crianças que compareceram à unidade de atenção primária ou ao ambulatório de referência no período recomendado pelo Ministério da Saúde e realizaram os exames preconizados. Utilizou-se os testes qui-quadrado de Pearson e exato de Fisher na análise comparativa. O risco estimado de não seguimento adequado foi verificado por regressão logística simples e múltipla. RESULTADOS Foram notificadas 460 crianças com sífilis congênita, das quais 332 (72,2%) retornaram para pelo menos uma consulta e fizeram parte do estudo. Compareceram à unidade primária de saúde 287 (86,4%) crianças; entretanto, não havia referência à sífilis congênita em 236 (71,1%) prontuários e não foram encontradas informações acerca da solicitação do exame venereal disease research laboratory (VDRL) em 264 (79,5%). Houve não adesão às consultas subsequentes por parte de 272 (81,9%) indivíduos. As seguintes variáveis apresentaram associação estatisticamente significativa com o seguimento não adequado das crianças: estado civil das genitoras, número de consultas no pré-natal, número de gestações, hemograma e radiografia de ossos longos. CONCLUSÕES A maioria das crianças notificadas com sífilis congênita comparecem à atenção primária para seguimento, porém os serviços não atendem às recomendações do Ministério da Saúde para o seguimento adequado.

Análise dos casos de sífilis gestacional e congênita nos anos de 2008 a 2010 em Fortaleza, Ceará, Brasil / Analysis of cases of gestational and congenital syphilis between 2008 and 2010 in Fortaleza, State of Ceará, Brazil

Resumo O presente estudo analisa os casos notificados de sífilis em gestantes e os possíveis desfechos para o feto e o recém-nascido em Fortaleza, Ceará. Estudo transversal que analisou 175 casos notificados de sífilis em gestantes, pareados com as correspondentes notificações de sífilis congênita durante os anos de 2008 a 2010. Utilizou-se estatística descritiva com frequências absolutas e relativas, medidas de tendência central e dispersão e qui-quadrado de Pearson para analisar a significância estatística, utilizando o valor de p < 0,05. Foram analisadas variáveis sociodemográficas das gestantes/puérperas, da assistência prestada aos recém-nascidos e o desfecho dos casos. Os resultados mostraram a ocorrência da sífilis em mulheres jovens com mais de 85,0% de tratamentos inadequados, 62,9% dos parceiros sexuais não tratados ou com informação ignorada e percentuais elevados da não realização dos exames preconizados para a investigação de sífilis congênita nas crianças. Dentre os conceptos, cinco foram natimortos, um aborto e três óbitos neonatais. A falta de tratamento adequado dos casos de sífilis em gestantes pode estar associada à morbimortalidade dos conceptos, mantendo essa infecção como um fardo no rol dos problemas de saúde pública.

Abstract This study analyzes the reported cases of syphilis in pregnant women and the possible outcomes for fetuses and the newborn in Fortaleza, Ceará. It is a cross-sectional study that analyzed 175 reported cases of syphilis in pregnant women matched with the corresponding reports of congenital syphilis during the years 2008-2010. Descriptive statistics with absolute and relative frequencies, central tendency and dispersion measures, and the Pearson's chi-square test were used to analyze the statistical significance using the p-value <0.05. Sociodemographic variables of pregnant/postpartum women, the assistance provided to newborns and the outcome of cases were analyzed. The results showed the occurrence of syphilis in young women with more than 85% of inappropriate treatment, 62.9% of untreated sexual partners or lack of statistics and high percentages of non-realization of the recommended tests for congenital syphilis investigation in children. Among the fetuses, five were stillborn, one miscarried and there were three neonatal deaths. The lack of adequate treatment of pregnant women may be associated with morbidity and mortality of fetuses, maintaining this infection as a burden on the list of public health problems.