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.

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.

SARS-CoV-2 Infection and Placental Pathology Infecção por SARS-CoV-2 e patologia placentária

Abstract Placental pathophysiology in SARS-CoV-2 infection can help researchers understand more about the infection and its impact on thematernal/neonatal outcomes. This brief review provides an overview about some aspects of the placental pathology in SARSCoV- 2 infection. In total, 11 papers were included. The current literature suggests that there are no specific histopathological characteristics in the placenta related to SARSCoV- 2 infection, but placentas frominfected women aremore likely to show findings of maternal and/or fetal malperfusion. The most common findings in placentas from infected women were fibrin deposition and intense recruitment of inflammatory infiltrates. The transplacental transmission of this virus is unlikely to occur, probably due to low expression of the receptor for SARS-CoV-2 in placental cell types. Further studies are needed to improve our knowledge about the interaction between the virus and the mother-fetus dyad and the impact on maternal and neonatal/fetal outcomes.

Resumo A fisiopatologia da placenta na infecção por SARS-CoV-2 pode ajudar os pesquisadores a entender mais sobre a infecção e seu impacto nos resultados maternos/neonatais. Esta revisão breve fornece uma visão geral sobre alguns aspectos da patologia placentária na infecção por SARS-CoV-2. Ao todo, 11 artigos foram incluídos. A literatura atual sugere que não há características histopatológicas específicas nas placentas relacionadas à infecção por SARS-CoV-2, mas as placentas de mulheres infectadas têm maior probabilidade de apresentar achados de má perfusão materna e/ou fetal. Os achados mais comuns em placentas de mulheres infectadas foram deposição de fibrina e intenso recrutamento de infiltrado inflamatório. A transmissão transplacentária deste vírus é improvável, devido à baixa expressão do receptor para SARS-CoV-2 em tipos de células da placenta. Mais estudos são necessários para melhorar nosso conhecimento sobre a interação entre o vírus e a díade mãe-feto e o impacto nos resultados maternos e neonatais/fetais.

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.

Perinatal COVID-19: a case report, literature review, and proposal of a national system for case record / COVID-19 perinatal: reporte de caso, revisión de la literatura y propuesta de un sistema nacional de registro de casos

Abstract Background: On March 11, 2020, the World Health Organization declared the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, and on February 28, Mexico reported its first case. Internationally, cases in newborns are few and the outcomes, in general, are good. There is no certainty of possible vertical transmission, and the presence of the virus in human milk is improbable. The gold standard for diagnosis is the reverse transcription-polymerase chain reaction (RT-PCR) test. We performed a literature review and presented a case of perinatal COVID-19. Clinical case: We describe the case of a full-term male infant with a birth weight of 3450 g and history of rooming-in with another mother-baby pair, both positive for SARS-CoV-2. On the second day of life, the neonate developed pneumonia, with clinical, X-ray and ultrasound diagnostic confirmation. On the third day of life, RT-PCR was positive for SARS-CoV-2; the mother was also positive but remained asymptomatic. The patient required mechanical ventilation and was transferred to a tertiary level neonatal unit on day 5 of life, where congenital heart disease was ruled out. He evolved satisfactorily with a negative RT-PCR test for SARS-CoV-2 on day 8 and was extubated and discharged on day 21 of life. Telephone follow-up was performed without complications. Conclusions: The present case was classified as horizontal transmission with a short incubation period of COVID-19.

Resumen Introducción: El 11 de marzo de 2020 la Organización Mundial de la Salud declaró la pandemia por SARS-CoV-2 y el 28 de febrero México reportó su primer caso. En todo el mundo, los casos en recién nacidos son pocos y la evolución, en general, es buena. No hay certeza sobre la posible transmisión vertical, y la presencia del virus en la leche humana es altamente improbable. El método de referencia para el diagnóstico es la prueba de reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR). Se presenta un caso clínico de COVID-19 perinatal y se llevó a cabo una revisión de la literatura sobre el tema. Caso clínico: Recién nacido de sexo masculino, de término, con un peso al nacer de 3,450 g, con antecedente de alojamiento conjunto con otro binomio madre-hijo positivo para SARS-CoV-2. Al segundo día de vida desarrolló neumonía diagnosticada por clínica, rayos X y ultrasonido. Presentó prueba positiva para SARS-CoV-2 al día 3 de vida, al igual que la madre, quien permaneció asintomática. El paciente requirió ventilación mecánica y fue trasladado a una unidad neonatal de tercer nivel el día 5 de vida, donde se descartó cardiopatía congénita y evolucionó satisfactoriamente. La prueba de RT-PCR para SARS-CoV-2 fue negativa al día 8, por lo que se realizó extubación y egreso al día 21 de vida. Se realizó seguimiento telefónico, sin complicaciones. Conclusiones: El presente caso fue catalogado como transmisión horizontal con un periodo corto de incubación de COVID-19.

Probable vertical transmission identified within six hours of life

SUMMARY We present the case of 33 weeks + weeks pregnant patient (G1P0), with proven COVID-19 infection by RT-PCR and, at admission, she presented with a dry cough and "tiredness when talking,". Chest computed tomography was performed, which showed the presence of attenuations with ground glass opacification and bilateral consolidations. She then had a cesarean section because of maternal respiratory decompensation. She was transferred to the ICU of the same hospital with an O2 catheter. The newborn was transferred to the neonatal ICU of the same hospital in ambient air and maintained in respiratory and contact isolation. RT-PCR was collected for SARS-COV-2 at 6 h of life, which was positive. Faced with the knowledge gap on vertical transmission, RT-PCR for SARS-COV-2 at 6 h of life gives cause for concern, thus representing the possibility of vertical transmission by SARS-COV-2, although additional investigations are required.

RESUMO Apresentamos o caso de uma paciente grávida de 33 semanas + (G1P0), com infecção de COVID-19 comprovada por RT-PCR que, na admissão, apresentava tosse seca e "cansaço ao falar". Foi realizada tomografia computadorizada do tórax, que mostrou a presença de atenuações com opacidade em vidro fosco e consolidações bilaterais. Ela então passou por uma cesariana devido a descompensação respiratória materna. Em seguida, foi transferida para a UTI do mesmo hospital com um cateter de O2. O recém-nascido foi transferido para a UTI neonatal do mesmo hospital, em ar ambiente, e mantido em isolamento respiratório e de contato. Material para o RT-PCR para SARS-COV-2 foi coletado às 6h de vida, e o resultado do teste foi positivo. Perante a lacuna de conhecimento sobre a transmissão vertical, o resultado positivo do RT-PCR para SARS-COV-2 às 6h de vida é motivo de preocupação, pois representa uma possível transmissão vertical do SARS-COV-2, embora investigações adicionais sejam necessárias.

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.

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.

Embarazo y nuevo coronavirus: experiencia global reportada / Pregnancy and novel coronavirus: worldwide reported experience

INTRODUCCIÓN: La Organización Mundial de La Salud ha reportado recientemente que el nuevo foco de la pandemia global de la enfermedad Covid-19 es el continente americano. OBJETIVO: Realizar una revisión de la literatura sobre la experiencia internacional de la pandemia Covid 19 y embarazo. MÉTODO: Se realiza una búsqueda de la base de datos PubMed para las palabras clave Pregnancy / Pregnant / Novel Coronavirus / SARS-CoV-2 / Covid-19, desde el 1 de noviembre 2019 hasta el 21 de mayo 2020. RESULTADOS: Un total de 365 artículos fueron inicialmente seleccionados de acuerdo con la estrategia de búsqueda diseñada. El total de artículos revisados de acuerdo con los criterios fueron 42. Las series clínicas seleccionadas acumularon un total de 1098 embarazadas y enfermedad de Covid-19. Las co-morbilidades mas frecuentes fueron hipertensión arterial, diabetes mellitus, obesidad y asma. La mortalidad en relación con el total de pacientes fue de un 1,2 % y la transmisión al recién nacido de 1,7% (15 de 875). CONCLUSIÓN: La información obtenida permite inferir que la presentación clínica de la enfermedad es a lo menos equivalente a la de mujeres de la misma edad no embarazadas. Dada la severidad de la enfermedad por SARS-CoV-2 reportada, las lecciones aprendidas deben ser rápidamente asimiladas y utilizadas en el contexto de la situación nacional epidémica.

INTRODUCTION: The World Health Organization has recently reported that the new focus of the global pandemic of Covid-19 disease is the American continent. OBJECTIVE: To conduct a literature review on the international experience of the Covid 19 pandemic and pregnancy. METHOD: A PubMed database search is performed for the keywords Pregnancy / Pregnant / Novel Coronavirus / SARS-CoV-2 / Covid-19, from November 1, 2019 to May 21, 2020. RESULTS: A total of 365 articles were initially selected according to the designed search strategy. The total of articles reviewed according to the criteria was 42. The selected clinical series accumulated a total of 1098 pregnant women and Covid-19 disease. The most frequent comorbidities were hypertension, diabetes mellitus, obesity, and asthma. Mortality in relation to the total number of patients was 1.2% and transmission to the newborn was 1.7% (15 of 875). CONCLUSION: The information obtained allows us to infer that the clinical presentation of the disease is at least equivalent to that of non-pregnant women of the same age. Given the severity of the reported SARS-CoV-2 disease, the lessons learned must be quickly assimilated and used in the context of the national epidemic situation.

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.

Coronavirus (COVID 19) Infection in Pregnancy / Coronavirus (COVID 19) Infección en el embarazo

Abstract Coronavirus illness 2019 (COVID-19) is an airways infection caused by the new coronavirus (SARS-CoV-2) which has been quickly disseminated all over the world, affecting to the general population including women in pregnancy time. As being a recent infection, the evidence that supports the best practices for the management of the infection during pregnancy is limited, and most of the questions have not been completely solved yet. This publication offers general guidelines focused on decision-making people, managers, and health's teams related to pregnant women attention and newborn babies during COVID-19 pandemic. Its purpose is to promote useful interventions to prevent new infections as well as prompt and adequate attention to avoid serious complications or deaths, trying to be adapted to the different contexts in which attention to expectant mothers is provided. Guidelines are set within a well-scientific evidence and available recommendations up to date.

Resumen La enfermedad por coronavirus 2019 (COVID-19) es una infección de las vías respiratorias causada por un nuevo virus (SARS-CoV-2) que se ha diseminado rápidamente en el mundo, afectando a la población general, incluida la población de mujeres cursando un embarazo. Por ser una infección de aparición reciente, la información que soporta las mejores prácticas para el manejo de la infección durante la gestación es escasa y muchas de las preguntas no están completamente resueltas. Esta publicación brinda lineamientos generales orientados a tomadores de decisión, gerentes y equipos de salud en relación con el cuidado de mujeres gestantes y recién nacidos durante la pandemia por COVID 19. Su finalidad es promover intervenciones beneficiosas para prevenir nuevos contagios, y la atención oportuna y adecuada de la gestante para evitar complicaciones graves y/o muertes, adecuándose a los distintos contextos en los que se proporciona atención médica. Los lineamientos se enmarcan en la mejor información científica y las recomendaciones disponibles hasta la fecha.

Análise do conceito síndrome congênita pelo Zika vírus / Analysis of the concept of the Zika Virus congenital syndrome

Resumo O objetivo deste artigo é analisar o conceito de Síndrome Congênita pelo Zika Vírus. Trata-se de uma análise de conceito, baseado em Walker e Avant. Para operacionalização da busca foi realizada uma revisão sistemática. A essência do conceito Síndrome Congênita pelo Zika Vírus é determinada pelos atributos: calcificação intracraniana, ventriculomegalia e volume cerebral diminuído. Para que essa síndrome aconteça faz-se necessário que ocorram os antecedentes: transmissão via transplacentária de mãe infectada pela picada do mosquito Aedes SSP ou por via sexual. Com isso, resultam um conjunto de sinais e sintomas além da microcefalia fetal ou pós-natal, como por exemplo, atraso no desenvolvimento neuropsicomotor, anormalidades auditivas e visuais, desproporção craniofacial, suturas cranianas sobrepostas, osso occipital proeminente, excesso de pele nucal, epilepsia, irritabilidade, discinesia, hipertonia, hipotonia, hemiplegia, hemiparesia, espasticidade, hiperreflexia. O conceito de Síndrome Congênita pelo Zika Vírus é recém conhecido. O que determinará a presença do conjunto de sinais e sintomas pela infecção congênita do Zika vírus é a calcificação intracraniana e volume cerebral diminuído, podendo apresentar microcefalia já ao nascer ou apenas posteriormente.

Abstract The scope of this article is to analyze the concept of the Zika Virus Congenital Syndrome. It is a conceptual analysis, based on Walker and Avant. In order to operationalize the search, a systematic review was conducted. The essence of the concept of the Zika Virus Congenital Syndrome is determined by the following attributes: intracranial calcification, ventriculomegaly, and diminished brain volume. For this syndrome to occur, it is necessary to have the following antecedents: transplacental transmission of a mother infected by the bite of the Aedes SSP mosquito or by sexual contact. Accordingly, this entails a set of signs and symptoms that go beyond fetal or postnatal microcephaly, such as, for example, delayed neuropsychomotor development, auditory and visual abnormalities, craniofacial disproportion, overlapping cranial sutures, prominent occipital bone, excess nuchal skin, epilepsy, irritability, dyskinesia, hypertonia, hypotonia, hemiplegia, hemiparesis, spasticity and hyperreflexia. The concept of the Zika Virus Congenital Syndrome is newly acknowledged. The presence of the set of signs and symptoms by the Zika Virus Congenital Syndrome is determined by intracranial calcification and decreased brain volume, and the baby may present microcephaly at birth or subsequently.

Dinâmica familiar de criança com a síndrome congênita do Zika vírus no Município de Petrolina, Pernambuco, Brasil / Family dynamics of children with congenital Zika syndrome in Petrolina, Pernambuco State, Brazil / Dinámica familiar de niños afectados por el síndrome congénito del virus Zika, municipio de Petrolina, Pernambuco, Brasil

No Brasil, houve aumento no número de casos de microcefalia detectados em crianças nascidas no segundo semestre de 2015. Esses casos tiveram incremento significativo no país. Em 2014, foram 162 ocorrências, aumentando, em 2015, para 1.608. Essa condição está associada a vários acometimentos nas funções do organismo, levando a limitações no desenvolvimento infantil. Esta pesquisa objetiva analisar a dinâmica familiar de criança com a síndrome congênita associada ao Zika vírus (SCZV) no Município de Petrolina, Pernambuco. Como instrumento de coleta, utilizou-se a consulta ao prontuário e a realização de entrevista por meio de roteiro semiestruturado. Empregou-se abordagem quali-quantitativa, envolvendo a totalidade das mães e dos familiares que acompanhavam as crianças com a SCZV na unidade de saúde de referência, AME Amália Granja Alencar. Na análise dos discursos, aplicou-se a técnica de análise de conteúdo. Os resultados relacionados à categoria mudanças da vida diária de familiares de criança com a SCZV foram agrupados em três subcategorias: atividade da vida diária (AVD); impactos financeiros e no trabalho associados à descoberta da SCZV; e mudança na relação conjugal após a descoberta da SCZV. A pesquisa demonstrou majoritariamente que o cuidado da criança com SCZV está centrado na figura feminina e que o diagnóstico traz significativas mudanças na dinâmica familiar, como maior dependência da criança ao cuidador, aumento de gastos financeiros e absenteísmo no trabalho.

Brazil witnessed a significant increase in the number of cases of microcephaly in infants born in the second semester of 2015. There were 162 cases in 2014, increasing to 1,608 in 2015. The condition is associated with impairments in various bodily functions, leading to limitations in infant development. This study aims to analyze the family dynamics of children with congenital Zika syndrome (CZS) in Petrolina, Pernambuco State. Data collection used consultation in patient charts and interviews with parents using a semi-structured script. A qualitative/quantitative approach was used, including all of the mothers and other family members accompanying children with CZS at the referral unit, the Amália Granja Alencar Clinic. Discourse analysis applied the content analysis technique. The results in the category "changes in daily living" for families of children with CZS were grouped into three subcategories: activities of daily living (ADL), financial and occupational impacts associated with the CZS diagnosis, and changes in the marital relationship after the diagnosis. The study showed that care for the child with CZS is mostly concentrated in women in the family, and that the diagnosis leads to significant changes in the family dynamics, with the child's extensive dependence on the caregiver, increasing expenses, and work absenteeism.

En Brasil, se produjo un aumento en el número de casos de microcefalia detectada en niños nacidos en el segundo semestre de 2015. Estos casos sufrieron un incremento significativo en el país. En 2014, fueron 162 incidencias, aumentando, en 2015, hasta 1.608. Esta enfermedad está asociada con varias alteraciones en las funciones del organismo, provocando limitaciones en el desarrollo infantil. El objetivo de esta investigación fue analizar la dinámica familiar de niños con el síndrome congénito asociado al virus Zika (SCZ) en el municipio de Petrolina, Pernambuco. Como instrumento de recogida, se realizaron consultas del historial clínico, así como una entrevista semiestructurada. Se empleó un abordaje cuali-cuantitativo, implicando a la totalidad de las madres y de los familiares que acompañaban a los niños con el SCZ en la unidad de salud de referencia, AME Amália Granja Alencar. En el análisis de los discursos se aplicó la técnica de análisis de contenido. Los resultados relacionados con la categoría cambios de la vida diaria de familiares del niño con el SCZ se agruparon en tres subcategorías: actividad de la vida diaria (AVD), impactos financieros y en el trabajo asociados al descubrimiento del SCZ y cambios en la relación conyugal tras el descubrimiento del SCZ. La investigación demostró que mayoritariamente el cuidado del niño con SCZ está centrado en la figura femenina, y que el diagnóstico conlleva significativos cambios en la dinámica familiar, como una mayor dependencia del niño del cuidador, aumento de gastos financieros y absentismo en el trabajo.

Cribado de virus de hepatitis B en mujeres embarazadas: inmigrantes, y chilenas con conductas de riesgo. Manejo del binomio madre-hijo: Plan piloto / Screening of hepatitis B in high risk Chilean and immigrant pregnant women: management of mother to child transmission

Resumen Introducción: Chile es un país de baja endemia de virus de hepatitis B (VHB), pero los países de mayor flujo migratorio hacia Chile tienen una endemia intermediaalta. La inmunoprofilaxis (IP) en el recién nacido (RN) es fundamental para evitar la transmisión vertical de VHB. Objetivos: Determinar la prevalencia de HBsAg en mujeres embarazadas: inmigrantes, y chilenas con conductas de riesgo (CR), y evaluar el cumplimiento de la indicación de IP a los RN de madre con HBsAg reactivo. Material y Métodos: Cohorte prospectiva de cribado de HBsAg a mujeres embarazadas inmigrantes, y chilenas con CR, entre julio 2017 y junio 2018 en CABL. Los RN de madre con HBsAg reactivo se les administró IP adecuada (antes de 12 h de vida). Resultados: Se realizó un total de 1.415 HBsAg: 1.265 a inmigrantes y 150 a chilenas con CR. Se obtuvieron 37 pacientes con HBsAg reactivos. Dos falsos positivos. La prevalencia HBsAg en inmigrantes fue 2,7% y 0,66% en chilenas con CR (p < 0,05). El 91,1% provenía de Haití, con una prevalencia de 3,5% en nuestra área. Todos los RN (36) recibieron IP. La mediana de administración de IP fue 3:02 h. Conclusiones: La prevalencia de VHB en mujeres gestantes inmigrantes fue superior a lo reportado en la población general y en mujeres chilenas con CR. Planteamos la necesidad de implementar el cribado universal en el embarazo, y en especial, en mujeres embarazadas provenientes de países con endemia intermedia-alta.

Background: Chile is a low-endemic HBV country, but countries with the highest migratory flow to Chile have an intermediate-high endemicity. In order to avoid vertical transmission of HBV, immunoprophylaxis (IP) in the newborn (NB) is a key factor. Aim: To identify HBsAg prevalence in pregnant immigrants and Chilean pregnant women with risk behaviors (RB) and to asses IP use in the NB. Material and Methods: Prospective HBsAg screening cohort of immigrant and Chilean pregnant women with RB, between July 1, 2017 and June 30, 2018 in CABL. IP of all NB of reactive HBsAg mothers was assessed. Results: 1,415 HBsAg samples, 1,265 immigrants and 150 Chileans with RB. 37 reactive HBsAg. Two false positive. HBsAg prevalence in immigrant pregnant women was 2.7% and 0.66% in Chileans with RB (p < 0.05). 91.1% came from Haiti, with a prevalence of 3.5% in our region. All NB (36) received IP with a median of administration of 3:02 h. Conclusions: The prevalence in immigrant pregnant women was higher than that reported in the general population and in Chilean women with RB. We proposed the need for universal screening in pregnancy, especially in pregnant women from countries with intermediate-high endemicity.

Auditory findings associated with Zika virus infection: an integrative review / Achados auditivos associados à infecção pelo Zika vírus: uma revisão integrativa

Abstract Introduction: Possible associations between Zika virus infection and hearing loss were observed during the epidemic in the Americas. Objective: To describe the auditory alterations, pathogenesis and recommendations for follow-up in individuals with prenatal or acquired Zika virus infection. Methods: Bibliographic research conducted in March/2018-April/2019 at the main available databases. Article selection, data extraction and quality evaluation were carried out by two independent reviewers. Studies containing auditory evaluation of patients with congenital or acquired Zika virus infection; and/or hypotheses or evidences on the pathophysiology of auditory impairment associated with Zika virus; and/or recommendations on screening and follow-up of patients with auditory impairment by Zika virus were included. Results: A total of 27 articles were selected. Sensorineural and transient hearing loss were reported in six adults with acquired Zika virus infection. Of the 962 studied children, 482 had microcephaly and 145 had diagnostic confirmation of Zika virus; 515 of the 624 children with auditory evaluation performed only screening tests with otoacoustic emissions testing and/or automated click-stimuli auditory brainstem response testing. Studies in prenatally exposed children were very heterogeneous and great variations in the frequency of altered otoacoustic emissions and automated click-stimuli auditory brainstem response occurred across the studies. Altered otoacoustic emissions varied from 0% to 75%, while altered automated click-stimuli auditory brainstem response varied from 0% to 29.2%. Sensorineural, retrocochlear or central origin impairment could not be ruled out. One study with infected mice found no microscopic damage to cochlear hair cells. Studies on the pathogenesis of auditory changes in humans are limited to hypotheses and recommendations still include points of controversy. Conclusion: The available data are still insufficient to understand the full spectrum of the involvement of the auditory organs by Zika virus, the pathogenesis of this involvement or even to confirm the causal association between auditory involvement and virus infection. The screening and follow-up recommendations still present points of controversy.

Resumo Introdução: Possíveis associações entre a infecção pelo Zika vírus e perda auditiva foram observadas durante a epidemia nas Américas. Objetivo: Descrever as alterações auditivas, a patogênese e as recomendações de seguimento em indivíduos com infecção por Zika vírus pré-natal ou adquirida. Método: Uma pesquisa bibliográfica foi realizada em março/2018 a abril/2019 nas principais bases de dados disponíveis. A seleção dos artigos, extração de dados e avaliação de qualidade foram realizadas por dois revisores independentes. Estudos com avaliação auditiva de pacientes com infecção por Zika vírus congênita ou adquirida; e/ou hipóteses ou evidências sobre a fisiopatologia do comprometimento auditivo associado ao Zika vírus; e/ou recomendações sobre triagem e seguimento de pacientes com comprometimento auditivo pelo Zika vírus foram incluídos na pesquisa. Resultados: Um total de 27 artigos foram selecionados. Perdas auditivas neurossensorial e transitória foram relatadas em seis adultos com infecção pelo Zika vírus adquirida. Das 962 crianças estudadas, 482 apresentavam microcefalia e 145 tinham confirmação diagnóstica do Zika vírus; 515 das 624 crianças com avaliação auditiva haviam realizado apenas testes de triagem com teste de emissões otoacústicas e/ou teste de potencial evocado auditivo de tronco encefálico automático com estímulo clique. Estudos em crianças expostas no período pré-natal foram muito heterogêneos e grandes variações na frequência de emissões otoacústicas e potencial evocado auditivo de tronco encefálico automático alterados ocorreram ao longo dos estudos; alterações nas emissões otoacústicas variaram de 0% a 75%, enquanto as alterações no potencial evocado auditivo de tronco encefálico automático variaram de 0% a 29,2%. Não foi possível descartar comprometimento neurossensorial, retrococlear ou de origem central. Um estudo com camundongos infectados não encontrou dano microscópico nas células ciliadas da cóclea. Estudos sobre a patogênese das alterações auditivas em humanos estão limitados a hipóteses e recomendações ainda apresentam pontos de controvérsia. Conclusão: Os dados disponíveis ainda são insuficientes para compreender todo o espectro do envolvimento dos órgãos auditivos pelo Zika vírus, a patogênese desse envolvimento ou até mesmo para confirmar a associação causal entre o envolvimento auditivo e a infecção pelo vírus. As recomendações de triagem e seguimento ainda apresentam pontos de controvérsia.

Prevalence and causes of congenital microcephaly in the absence of a Zika virus outbreak in southern Brazil / Prevalência e causas da microcefalia congênita sem a presença do surto do vírus Zika no Sul do Brasil

Abstract Objective: The aim of this study was to identify the causes of congenital microcephaly in Rio Grande do Sul, a state in southern Brazil, where no ZIKV outbreak was detected, from December 2015 to December 2016, which was the period when ZIKV infection was at its peak in northeast Brazil. Methods: This was a cross-sectional study where all notifications of congenital microcephaly in the state of Rio Grande do Sul were included for analysis. Evaluation of cases followed the guidelines of the Brazilian Ministry of Health. Dysmorphological and neurological evaluations were performed by a specialized team, and genetic tests and neuroimaging were performed when clinically indicated. STORCH infections were diagnosed using standard tests. ZIKV infection was diagnosed through maternal serum RT-PCR and/or neuroimaging associated with clinical/epidemiological criteria. Results: From 153 744 registered live births in the study period, 148 cases were notified, but 90 (60.8%) of those were later excluded as "non-confirmed" microcephaly. In the 58 confirmed cases of microcephaly (prevalence = 3.8/10 000 live births), congenital infections (syphilis, toxoplasmosis, cytomegalovirus, and ZIKV) constituted the predominant etiology (50.0%), followed by isolated CNS (15.5%), and genetic syndromes (10.3%). Congenital ZIKV syndrome (CZS) with typical phenotype was diagnosed in three cases (5.2% of all confirmed microcephaly cases or 10.4% of all congenital infections). Conclusion: In Rio Grande do Sul, where no outbreak of ZIKV infection was recorded, congenital infections were the leading cause of congenital microcephaly, and the attributable risk for CZS in the etiology of microcephaly was 5.2%.

Resumo: Objetivo: Identificar as causas da microcefalia congênita no Rio Grande do Sul, Região Sul do Brasil, onde não foi detectado surto de ZIKV, de dezembro de 2015 a dezembro de 2016. Esse foi o período em que a infecção por ZIKV estava em seu auge no Nordeste do Brasil. Métodos: Este é um estudo transversal no qual todas as notificações de microcefalia congênita no estado do Rio Grande do Sul foram incluídas para análise. A avaliação dos casos seguiu as orientações do Ministério da Saúde. A avaliação dismorfológica e neurológica foi feita por uma equipe especializada e os testes genéticos e as neuroimagens foram feitos quando indicado clinicamente. As infecções STORCH (Sífilis, Toxoplasmose, Rubéola, Citomegalovírus e Herpes simples) foram diagnosticadas utilizando testes padrão. A infecção por ZIKV foi diagnosticada por meio da transcriptase reversa seguida de reação em cadeia da polimerase (RT-PCR) no soro materno e/ou neuroimagem associada a critérios clínicos/epidemiológicos. Resultados: De 153.744 nascidos vivos registrados no período do estudo, 148 bebês foram casos notificados, porém 90 (60,8%) casos foram excluídos posteriormente como microcefalia "não confirmada". Nos 58 casos confirmados de microcefalia (prevalência = 3,8/10.000 nascidos vivos), as infecções congênitas (sífilis, toxoplasmose, citomegalovírus e ZIKV) constituíram a etiologia predominante (50,0%), seguidas de doenças ligadas ao SNC isolado (15,5%) e síndromes genéticas (10,3%). A síndrome congênita do ZIKV (SCZ) com fenótipo típico foi diagnosticada em três casos (5,2% de todos os casos confirmados de microcefalia ou 10,4% de todas as infecções congênitas). Conclusão: No Rio Grande do Sul, Brasil, onde não foi registrado surto de infecção por ZIKV, a principal causa de microcefalia congênita foram infecções congênitas e o risco atribuível para SCZ na etiologia de microcefalia foi de 5,2%.

Clinical and epidemiological aspects of microcephaly in the state of Piauí, northeastern Brazil, 2015-20166 / Aspectos clínicos e epidemiológicos da microcefalia no Estado do Piauí, Nordeste do Brasil, 2015-2016

Abstract Objectives: To describe aspects of the microcephaly epidemic in the state of Piauí. Methods: All cases of congenital microcephaly confirmed in the state between 2015 and 2016 were included (n = 100). Investigation forms of the Regional Reference Center for Microcephaly were reviewed. Discarded cases (n = 63) were used as a comparison group. Results: In October, November, and December 2015 incidence rates reached 4.46, 6.33 and 3.86/1000 live births, respectively; 44 cases were reported in the state capital. Among the mothers of confirmed and discarded cases, the frequency of skin rash during pregnancy was 50/97 (51.5%) and 8/51 (15.7%), respectively (p < 0.001); 33 confirmed cases (35.9%) had a head circumference z-score between −2 and −3, 23 (25%) between −3 and −4, and 8 (8.7%) had a z-score of less than −4. Head computer tomography scans revealed calcifications in 78/95 (82.1%) cases. Lissencephaly, hydrocephalus and agenesis of the corpus callosum were also frequently observed. Ophthalmic findings included retinal pigment epithelium rarefaction and atrophy. Absence of otoacoustic emissions was observed in 21/70 cases. One newborn also presented lower limb muscle atrophy. There were no significant differences in vaccination rates for influenza, diphtheria-tetanus-acellular pertussis, and hepatitis B in either group. Conclusions: The state of Piauí, like others in the northeastern region, faced an epidemic of congenital microcephaly between 2015 and 2016, presumably related to congenital Zika virus infection, more intense in the capital. Current challenges include the improvement of vector control, basic research, scaling-up of diagnostic tools for pre-natal screening of Zika virus, vaccines, and health care for affected children.

Resumo Objetivos: Descrever os aspectos da epidemia de microcefalia no Estado do Piauí. Métodos: Foram incluídos todos os casos de microcefalia congênita confirmados no estado entre 2015-2016 (n = 100). Os formulários de investigação do Centro Regional de Referência em Microcefalia foram analisados. Os casos descartados (n = 63) foram usados como grupo de comparação. Resultados: Em outubro, novembro e dezembro de 2015, as taxas de incidência atingiram 4,46, 6,33 e 3,86/1.000 nascidos vivos, respectivamente; 44 casos foram relatados na capital do estado. Entre as mães de casos confirmados e descartados, a frequência de erupção cutânea durante a gravidez foi 50/97 (51,5%) e 8/51 (15,7%), respectivamente (p < 0,001); 33 casos confirmados (35,9%) apresentaram um escore z de perímetro cefálico entre -2 e -3, 23 (25%) entre -3 e -4 e 8 (8,7%) apresentaram escore z inferior a -4. As tomografias computadorizadas cerebrais revelaram calcificações em 78/95 (82,1%) dos casos. Lisencefalia, hidrocefalia e agenesia do corpo caloso também foram observadas com mais frequência. Os achados oftalmológicos incluíram rarefação e atrofia do epitélio pigmentar da retina. Foram observadas ausência de emissões otoacústicas em 21/70 casos. Um recém-nascido também apresentou atrofia muscular dos membros inferiores. Não houve diferenças significativas nas taxas de vacinação para gripe, vacina difteria tétano e coqueluche acelular e hepatite B em qualquer grupo. Conclusões: O Estado do Piauí, como outros na região Nordeste, enfrentou, entre 2015 e 2016, uma epidemia de microcefalia congênita, supostamente relacionada à infecção congênita pelo vírus Zika, mais intensa na capital. Os desafios atuais incluem melhora do controle de vetores, pesquisa básica, ampliação de ferramentas de diagnóstico para exame pré-natal do vírus Zika, vacinas e cuidados de saúde para crianças afetadas.