Clinical characteristics of severe pre-eclampsia in a single tertiary referral center of Xiamen City / 中华妇产科杂志

Objective: To explore the key points for preventing and reducing severe pre-eclampsia (SPE) and its severe complications in the tertiary medical referral system of a second-tier city by analyzing the clinical characteristics of SPE. Methods: The clinical data of 341 patients with SPE who terminated pregnancy in Women and Children's Hospital, School of Medicine, Xiamen University, from January 1, 2020 to December 31, 2022 were retrospectively analyzed, and the pre-eclampsia (PE) risk factors, clinical characteristics and severe complications of SPE between the patients referred from primary hospitals (referral group) and the patients received regular prenatal care in the tertiary referral center (central group) were compared, as well as the influence of the referral timing on the maternal and perinatal outcomes. Results: Among the 341 cases of SPE, 92 cases were in the referral group and 249 cases were in the central group. (1) Analysis of PE risk factors: there was no statistical difference in the proportion of risk factors of PE between these two groups [75.0% (69/92) vs 71.9% (179/249); χ2=0.328, P=0.567]. (2) Analysis of clinical features: the gestational ages at the PE early warning factors onset, at the PE first symptom onset and at SPE diagnosed, pregnancy terminated and onset of SPE severe complications in the referral group were significantly earlier than those in the central group (all P<0.05), the proportions of terminating pregnancy before 32 weeks of gestation, between 32 and 34 weeks of gestation, intensive care unit (ICU), neonatal ICU hospitalization and fetal growth restriction in single pregnancies were higher than those in the central group, while the live birth rate was lower than that in the central group (all P<0.05). (3) Analysis of SPE severe complications: the rates of SPE severe complications in the referral group was higher than that in the central group [28.3% (26/92) vs 13.7% (34/249); χ2=9.885, P=0.002]. Among them, the rates of placental abruption [7.6% (7/92) vs 2.8% (7/249); χ2=3.927, P=0.048] and still birth [6.5% (6/92) vs 0.4% (1/249); χ2=9.656, P=0.002] in the referral group were significantly higher than those in the central group. (4) Analysis of referral timings: the timings included referral after onset of SPE severe complications (9.8%, 9/92), referral after SPE diagnosed (63.0%, 58/92), referral after detection of SPE early warning signs (20.7%, 19/92) and referral after detection of PE risk factors (6.5%, 6/92). The gestational ages at SPE diagnosed and pregnancy terminated in group of referral after onset of SPE severe complications and group of referral after SPE diagnosed were significantly earlier than those in group of referral after detection of PE early warning signs and group of referral after detection of PE risk factors (P<0.05). The earlier the referral, the higher the live birth rates (P<0.05). Conclusions: The tertiary referral center of the second-tier city plays an important role in reducing the maternal and perinatal damage of PE. The timing of referral in primary medical institutions is the key point of reducing the occurrence of SPE severe complications and maternal, perinatal damage of PE. It is necessary for medical institutions of all levels in all regions to improve the ability of early identification and early intervention for PE, to enhance the awareness of SPE and its severe complications prevention and control. Primary medical institutions should especially pay attention to raise the consciousness of PE risk factors and early warning signs, and to improve the ability of PE risk factors and early warning signs screening.

Research progress on long-term developmental outcomes of offspring of pregnant women with systemic lupus erythematosus / 中国当代儿科杂志

Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease that affects multiple organs and systems. It is more common in women of childbearing age. Compared with the general population, pregnant women with SLE are at a significantly increased risk of adverse perinatal outcomes such as preterm birth and intrauterine growth restriction. In addition, the offspring of SLE patients may also be adversely affected by in utero exposure to maternal autoantibodies, cytokines, and drugs. This article summarizes the long-term developmental outcomes of offspring of pregnant women with SLE in terms of the blood system, circulatory system, nervous system, and immune system.

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

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

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

Relationship between the number of prenatal care visits and the occurrence of adverse perinatal outcomes

SUMMARY OBJECTIVE: The objective of this study was to analyze the relationship between the number of prenatal care visits and the occurrence of adverse perinatal outcomes in an average city in the state of Minas Gerais, Brazil. METHODS: This was a prospective and observational study. The variables analyzed were obtained through a questionnaire administered to postpartum women (between 1 and 48 h postpartum) and information contained in prenatal cards. The pregnant women were classified into three groups: Group I, <3 prenatal care visits; Group II, 3-5 prenatal care visits; and Group III, ≥6 prenatal care visits. RESULTS: Group I had a lower median weight (57.0 vs. 64.0 kg, p<0.001), body mass index (22.1 vs. 24.3 kg/m2, p<0.001), and weight gain (9.0 vs. 12 kg, p=0.002) than Group III. The prevalence of admission to the neonatal intensive care unit (11.6 vs. 4.2%, p=0.02) and the newborn mortality rate within the first 72 h of life (2.3 vs. 0%, p<0.001) were higher in Group I than in Group III. Group II had a higher prevalence of admission to the adult intensive care unit (5.7 vs. 0.6%, p<0.001) and a higher newborn mortality rate within the first 72 h of life (1.6% vs. 0%, p<0.001) than Group III. CONCLUSIONS: Having ≥6 prenatal care visits was associated with lower rates of admission to the neonatal and adult intensive care unit, as well as a lower newborn mortality rate within the first 72 h of life.

Physical activity in gestational trimesters and perinatal outcomes in SUS puerperal women / Atividade física nos trimestres gestacionais e desfechos perinatais em puérperas do SUS

ABSTRACT OBJECTIVE Test the association between the practice of physical activity (PA) according to the gestational trimesters and the occurrence of cesarean delivery, prematurity, and low birth weight in puerperal women assisted in the Unified Health System of Santa Catarina, Brazil. METHODS A cross-sectional study was conducted with a probabilistic sample of puerperal women who gave birth in public maternity hospitals in Santa Catarina from January to August 2019. The cesarean delivery outcome was self-reported, and information on premature birth (< 37 gestational weeks) and low birth weight (< 2,500 grams) were obtained from medical records. The practice of PA during pregnancy and according to each trimester was self-reported. Multivariate Logistic Regression analyses and interviews with 3,580 puerperal women were carried out. RESULTS PA practice during any period of pregnancy was reported by 20.6% of the sample, with a gradual reduction in prevalence according to the gestational trimester (16.2%, 15.4%, and 12.8%). The highest prevalences of outcomes concerning the total sample were observed in puerperal women who did not practice PA in the third trimester, with 43.9% for cesarean delivery, 7.7% for low birth weight, and 5.5% for premature birth. The odds of cesarean delivery (OR = 1.40; 95%CI 1.10-1.76) and low birth weight (OR = 1.99; 95%CI 1.04-3.79) were, respectively, 40% and 99% higher among puerperal women who did not practice PA in the third trimester of pregnancy when compared to those who practiced PA. There was no association between PA practice and prematurity. CONCLUSION Puerperal women who did not practice PA in the third trimester of pregnancy were more likely to have cesarean delivery and low birth weight newborns.

RESUMO OBJETIVO Testar a associação entre a prática de atividade física (AF) de acordo com os trimestres gestacionais e a ocorrência de parto cesáreo, prematuridade e baixo peso ao nascer em puérperas atendidas no Sistema Único de Saúde de Santa Catarina, Brasil. MÉTODOS Estudo transversal realizado com amostra probabilística de puérperas que tiveram seus partos em maternidades da rede pública de Santa Catarina no período de janeiro a agosto de 2019. O desfecho parto cesáreo foi autorreferido e as informações sobre parto prematuro (< 37 semanas gestacionais) e baixo peso ao nascer (< 2.500 gramas) foram obtidas dos prontuários. A prática de AF durante a gestação e conforme cada trimestre foi autorreferida. Foram realizadas análises de Regressão Logística Multivariável e entrevistas com 3.580 puérperas. RESULTADOS A prática de AF durante qualquer período da gestação foi relatada por 20,6% da amostra, com redução gradativa das prevalências conforme os trimestres gestacionais (16,2%, 15,4% e 12,8%). As maiores prevalências dos desfechos em relação à amostra total, foram observadas nas puérperas não praticantes de AF no terceiro trimestre, sendo 43,9% para o parto cesáreo, 7,7% para o baixo peso ao nascer e 5,5% para o parto prematuro. As chances de parto cesáreo (OR = 1,40; IC95% 1,10-1,76) e de baixo peso ao nascer (OR = 1,99; IC95% 1,04-3,79) foram, respectivamente, 40% e 99% maiores entre as puérperas que não praticaram AF no terceiro trimestre da gestação quando comparadas àquelas que praticaram AF. Não houve associação da prática de AF com a prematuridade. CONCLUSÃO As puérperas que não praticavam AF no terceiro trimestre da gestação tiveram maiores chances de parto cesáreo e de terem recém-nascidos com baixo peso.

Air pollution and children's health-a review of adverse effects associated with prenatal exposure from fine to ultrafine particulate matter

BACKGROUND@#Particulate matter (PM), a major component of ambient air pollution, accounts for a substantial burden of diseases and fatality worldwide. Maternal exposure to PM during pregnancy is particularly harmful to children's health since this is a phase of rapid human growth and development.@*METHOD@#In this review, we synthesize the scientific evidence on adverse health outcomes in children following prenatal exposure to the smallest toxic components, fine (PM@*RESULTS@#Maternal exposure to fine and ultrafine PM directly and indirectly yields numerous adverse birth outcomes and impacts on children's respiratory systems, immune status, brain development, and cardiometabolic health. The biological mechanisms underlying adverse effects include direct placental translocation of ultrafine particles, placental and systemic maternal oxidative stress and inflammation elicited by both fine and ultrafine PM, epigenetic changes, and potential endocrine effects that influence long-term health.@*CONCLUSION@#Policies to reduce maternal exposure and health consequences in children should be a high priority. PM

Untreated Prior Pulmonary Tuberculosis Adversely Affects Pregnancy Outcomes in Infertile Women Undergoing / 生物医学与环境科学（英文）

Objective@#Prior pulmonary tuberculosis (PTB) on chest X-ray (CXR) was commonly found in infertile patients receiving examinations before @*Method@#We conducted a retrospective cohort study of 14,254 infertile patients who had received IVF-ET at Peking University Third Hospital in 2017. Prior PTB was defined as the presence of signs suggestive of old or inactive PTB on CXR, with or without a clinical TB history. Patients who had prior PTB on CXR but had not received a clinical diagnosis and anti-TB therapy were included for analysis. Live birth, clinical pregnancy, and miscarriage rates were compared between the untreated PTB and non-PTB groups.@*Results@#The untreated PTB group had significantly lower clinical pregnancy (31.7% @*Conclusions@#Untreated PTB was associated with adverse pregnancy outcomes after IVF-ET, especially in patients with unexplained infertility, highlighting the clinical significance of PTB in this specific patient population.

The effect of small size uterine fibroids on pregnancy outcomes in high-risk pregnancies

Abstract Objective To evaluate the obstetric outcomes of singleton high-risk pregnancies with a small size uterine fibroid. Methods This retrospective cohort study was conducted among 172 high-risk pregnant women who were followed-up by a single surgeon between 2016 and 2019. Pregnant women with preconceptionally diagnosed small size (< 5 cm) single uterine fibroids (n = 25) were compared with pregnant women without uterine fibroids (n = 147) in terms of obstetric outcomes. Results There was no statistically significant difference between the groups in terms of adverse pregnancy outcomes. The size of the fibroids was increased in 60% of the cases, and the growth percentage of the fibroids was 25% during pregnancy. Intrapartum and short-term complication was not observed in women who underwent cesarean myomectomy. Conclusion Small size uterine fibroids seem to have no adverse effect on pregnancy outcomes even in high-risk pregnancies, and cesarean myomectomy may be safelyperformed in properly selected cases.

Is there an Increased Risk for unfavorable obstetric outcomes in women with endometriosis? an evaluation of evidences / Existe um risco maior para desfechos obstétricos desfavoráveis em mulheres com endometriose? uma avaliação das evidências

Abstract Objective The present study is a systematic review of the literature to assess whether the presence of endometriosis determines or contributes to adverse obstetric outcomes. Data Sources The present work was carried out at the Hospital Israelita Albert Einstein, São Paulo, state of São Paulo, Brazil, in accordance to the PRISMA methodology for systematic reviews. A review of the literature was performed using PubMed, Web of Science and Scopus databases. The keywords used were: pregnancy outcome, pregnancy complications, obstetrical complications, obstetrics, obstetric outcomes and endometriosis. The survey was further completed by a manually executed review of cross-referenced articles, which was last performed on November 30, 2018. Selection of studies The survey disclosed a total of 2,468 articles, published from May 1946 to October 2017. A total of 18 studies were selected to be further classified according to their quality and relevance. Data Collection The Newcastle-Ottawa Quality Assessment Scale was used for classification. Five studies of greater impact and superior evidence quality and 13 studies of moderate evidence quality were selected. We analyzed the studies for the characteristics of their patients plus how endometriosis was diagnosed and their respective obstetric outcomes taking into account their statistical relevance. Data Synthesis Analyses of the higher impact and better quality studies have shown high incidence of preterm birth and placenta previa in patients with endometriosis. Conclusion Placenta previa and preterm birth are the most statistically significant outcomes related to endometriosis, as indicated by our systematic review. The present information is useful to alert obstetricians and patients about possible unfavorable obstetric outcomes.

Resumo Objetivo Realizar uma revisão sistemática e crítica da literatura de modo a avaliar se a presença de endometriose determina desfechos obstétricos adversos na gestação. Fonte dos dados O presente estudo foi realizado no Hospital Israelita Albert Einstein, São Paulo, SP, Brasil, de acordo com a metodologia PRISMA para revisões sistemáticas. As bases de dados usadas para a revisão de literatura foram Pubmed, Web of Science e Scopus. As palavras-chave usadas foram: pregnancy outcome, pregnancy complications, obstetrical complications, obstetrics, obstetric outcomes e endometriosis. Uma revisão manual de artigos com referências cruzadas completou a pesquisa, que foi realizada pela última vez em 30 de novembro de 2018. Seleção dos estudos A pesquisa contou com o total de 2.468 artigos, publicados de maio de 1946 a outubro de 2017. Foram selecionados 18 estudos com base em sua relevância. Coleta de dados A metodologia Newcastle-Ottawa Quality Assessment Scale foi usada para selecionar 5 estudos cuja evidência era de melhor qualidade e 13 estudos de moderada qualidade de evidência. As características das populações dos estudos foram analisadas, assim como a doença endometriose foi diagnosticada e os respectivos desfechos obstétricos nas pacientes observando-se a relevância estatística dos estudos. Síntese dos dados A análise dos estudos de maior impacto e de melhor qualidade de evidência mostram que placenta prévia e ocorrência de nascimentos pré-termo são os desfechos obstétricos desfavoráveis de maior incidência em pacientes com endometriose. Conclusão Placenta prévia e nascimentos pré-termo são os desfechos obstétricos com maior significância estatística relacionados à endometriose. Esta informação é útil para alertar obstetras e pacientes com endometriose para possíveis desfechos obstétricos desfavoráveis.

Obstetric analgesia in labor and its association with neonatal outcomes / Analgesia obstétrica en el trabajo de parto y su asociación con resultados neonatales / Analgesia obstétrica no trabalho de parto e sua associação com desfechos neonatais

ABSTRACT Objetives: To investigate the association between analgesia during labor and occurrence of neonatal outcomes. Methods: Retrospective cohort study with medical records of 850 parturient. The exposure variable of interest was receiving pharmacological analgesia during labor and neonatal outcomes were: one- and five-minute Apgar, resuscitation maneuvers and referral of the newborn to Neonatal ICU. A logistic regression was carried out to obtain Odds Ratios and 95% confidence interval, with adjustment for confounding factors. Results: Among the women studied, 35% received analgesia and this use was associated with a greater chance of neonatal outcomes such as one-minute Apgar < 7 (p <0.0001), resuscitation maneuvers (p <0.001) and referral to the Neonatal ICU (p = 0.004), mostly were among low-risk pregnant women, even after adjustments. Conclusions: The use of pharmacological analgesia during labor is associated with one-minute Apgar < 7, resuscitation maneuvers and referral to the Neonatal ICU.

RESUMEN Objetivos: Investigar la asociación entre la analgesia en el trabajo de parto y la aparición de resultados neonatales. Métodos: Estudio de cohorte retrospectivo con datos de 850 parturientas. La exposición fue recibir analgesia farmacológica en el trabajo de parto, resultados: Apgar del primer y quinto minuto < 7, maniobras de reanimación y derivación a la UCIN. La regresión logística se utilizó para obtener el Odds Ratio (OR) y el intervalo de confianza del 95% (IC95%), ajustado por variables de confusión. Resultados: De las mujeres estudiadas, el 35% recibió analgesia y su uso se asoció con una mayor probabilidad de resultados como: Apgar en el primer minuto < 7 (p<0,0001), maniobras de reanimación (p<0,001) y derivación a la UCIN (p=0,004). Conclusiones: el uso de analgesia farmacológica durante el trabajo de parto se asoció con Apgar < 7 en el primer minuto, maniobras de reanimación y derivación a la UCIN.

RESUMO Objetivos: Investigar a associação entre analgesia no trabalho de parto e ocorrência de desfechos neonatais. Métodos: Estudo de coorte retrospectiva com dados de prontuários de 850 parturientes. A exposição foi receber analgesia farmacológica no trabalho de parto e os desfechos: Apgar do primeiro e quinto minuto < 7, manobras de reanimação e encaminhamento para Unidade de Terapia Intensiva Neonatal (UTI). Utilizou-se regressão logística para obter Odds Ratio (OR) e intervalo de 95% de confiança (IC95%), sendo ajustados por confundidores. Resultados: Das mulheres estudadas, 35% receberam analgesia e seu uso esteve associado a maior chance de desfechos, como: Apgar do primeiro minuto < 7 (p<0,0001), manobras de reanimação (p<0,001) e encaminhamento para UTI Neonatal (p=0,004), principalmente entre gestantes de risco habitual, mesmo após ajustes. Conclusões: O uso de analgesia farmacológica durante o trabalho de parto foi associado a Apgar do primeiro minuto < 7, manobras de reanimação e encaminhamento para UTI neonatal.

Obstetric analgesia in labor and its association with neonatal outcomes / Analgesia obstétrica en el trabajo de parto y su asociación con resultados neonatales / Analgesia obstétrica no trabalho de parto e sua associação com desfechos neonatais

ABSTRACT Objetives: To investigate the association between analgesia during labor and occurrence of neonatal outcomes. Methods: Retrospective cohort study with medical records of 850 parturient. The exposure variable of interest was receiving pharmacological analgesia during labor and neonatal outcomes were: one- and five-minute Apgar, resuscitation maneuvers and referral of the newborn to Neonatal ICU. A logistic regression was carried out to obtain Odds Ratios and 95% confidence interval, with adjustment for confounding factors. Results: Among the women studied, 35% received analgesia and this use was associated with a greater chance of neonatal outcomes such as one-minute Apgar < 7 (p <0.0001), resuscitation maneuvers (p <0.001) and referral to the Neonatal ICU (p = 0.004), mostly were among low-risk pregnant women, even after adjustments. Conclusions: The use of pharmacological analgesia during labor is associated with one-minute Apgar < 7, resuscitation maneuvers and referral to the Neonatal ICU.

RESUMEN Objetivos: Investigar la asociación entre la analgesia en el trabajo de parto y la aparición de resultados neonatales. Métodos: Estudio de cohorte retrospectivo con datos de 850 parturientas. La exposición fue recibir analgesia farmacológica en el trabajo de parto, resultados: Apgar del primer y quinto minuto < 7, maniobras de reanimación y derivación a la UCIN. La regresión logística se utilizó para obtener el Odds Ratio (OR) y el intervalo de confianza del 95% (IC95%), ajustado por variables de confusión. Resultados: De las mujeres estudiadas, el 35% recibió analgesia y su uso se asoció con una mayor probabilidad de resultados como: Apgar en el primer minuto < 7 (p<0,0001), maniobras de reanimación (p<0,001) y derivación a la UCIN (p=0,004). Conclusiones: el uso de analgesia farmacológica durante el trabajo de parto se asoció con Apgar < 7 en el primer minuto, maniobras de reanimación y derivación a la UCIN.

RESUMO Objetivos: Investigar a associação entre analgesia no trabalho de parto e ocorrência de desfechos neonatais. Métodos: Estudo de coorte retrospectiva com dados de prontuários de 850 parturientes. A exposição foi receber analgesia farmacológica no trabalho de parto e os desfechos: Apgar do primeiro e quinto minuto < 7, manobras de reanimação e encaminhamento para Unidade de Terapia Intensiva Neonatal (UTI). Utilizou-se regressão logística para obter Odds Ratio (OR) e intervalo de 95% de confiança (IC95%), sendo ajustados por confundidores. Resultados: Das mulheres estudadas, 35% receberam analgesia e seu uso esteve associado a maior chance de desfechos, como: Apgar do primeiro minuto < 7 (p<0,0001), manobras de reanimação (p<0,001) e encaminhamento para UTI Neonatal (p=0,004), principalmente entre gestantes de risco habitual, mesmo após ajustes. Conclusões: O uso de analgesia farmacológica durante o trabalho de parto foi associado a Apgar do primeiro minuto < 7, manobras de reanimação e encaminhamento para UTI neonatal.

Geospatial analysis of births with congenital disorders, Paraná, 2008-2015: ecological study / Análisis geoespacial de los nacimientos con anomalías congénitas, Paraná, 2008-2015: un estudio ecológico / Análise geoespacial dos nascimentos com anomalias congênitas, Paraná, 2008-2015: estudo ecológico

ABSTRACT Objective: analyze the pattern of spatial distribution of the prevalence rate of births with congenital disorders and its relationship with social, economic, health care and environmental indicators in Paraná, Brazil, from 2008 to 2015. Method: ecological study with variables extracted from secondary banks, related to the births of children of mothers residing in Paraná, in two quadrennial (2008-2011 and 2012-2015). The analysis of the rates was performed with univariate spatial (Moran) and multivariate approach (Ordinary Least Squares and Geographically Weighted Regression). Results: the occurrence of congenital disorders presented a significant association (p<0.05) with: registration in primary care of pregnant women over 20 years of age; urbanization degree; consumption of pesticides; and balance of female formal employment. Conclusion/Final considerations: social, health care and environmental variables showed a non-stationary spatial pattern in the analyzed period and influenced positively and negatively the rates.

RESUMEN Objetivo: Evaluar el patrón de distribución espacial de la tasa de prevalencia de los nacimientos con anomalías congénitas y su relación con los indicadores sociales, económicos, medioambientales, de atención a la salud en el estado de Paraná, Brasil, de 2008 a 2015. Método: Estudio ecológico con variables de bancos secundarios, relativas a los nacimientos de hijos de madres residentes en el estado de Paraná, en dos cuatrienios (2008-2011 y 2012-2015). Se hizo el análisis de las tasas desde el análisis espacial univariada (Moran) y multivariante (Ordinary Least Squares y Geographically Weighted Regression). Resultados: La presencia de anomalías congénitas presentó una asociación significativa (p <0,05) con: el registro en la atención primaria de gestantes mayores de 20 años de edad; el grado de urbanización; el consumo de agrotóxicos; y el saldo de empleo formal femenino. Conclusión: Las variables sociales, medioambientales y de atención a la salud demostraron haber un patrón espacial no estacionario en el período analizado, además influenciaron positiva y negativamente las tasas.

RESUMO Objetivo: Analisar o padrão de distribuição espacial da taxa de prevalência dos nascimentos com anomalias congênitas e sua relação com indicadores sociais, econômicos, de atenção à saúde e ambientais no estado do Paraná, Brasil, de 2008 a 2015. Método: Estudo ecológico com variáveis extraídas de bancos secundários, relativas aos nascimentos de filhos de mães residentes no estado do Paraná, em dois quadriênios (2008-2011 e 2012-2015). A análise das taxas foi realizada com abordagem espacial univariada (Moran) e multivariada (Ordinary Least Squares e Geographically Weighted Regression). Resultados: A ocorrência de anomalias congênitas apresentou associação significativa (p<0,05) com: cadastramento na atenção primária de gestantes maiores de 20 anos; grau de urbanização; consumo de agrotóxicos; e saldo de emprego formal feminino. Conclusão: As variáveis sociais, de atenção à saúde e ambientais demonstraram padrão espacial não estacionário no período analisado e influenciaram positiva e negativamente as taxas.

Inequidades sociales en madres adolescentes y la relación con resultados perinatales adversos en poblaciones sudamericanas / Social inequities in teenage mothers and the relationship to adverse perinatal outcomes in South American populations / Iniquidades sociais em mães adolescentes e sua relação com resultados perinatais adversos em populações sul-americanas

Resumen: El objetivo fue explicar las diferencias en la frecuencia de eventos perinatales adversos entre madres adolescentes con baja y alta escolaridad. La muestra poblacional se recogió en la base de datos del Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC). Entre 2.443.747 nacimientos ocurridos en 93 hospitales, se reclutaron 66.755 recién nacidos vivos, sin defectos congénitos, durante el período 2000-2017. Las madres adolescentes se clasificaron según su escolaridad en: baja, media y alta. Se utilizó un modelo multivariado, que incluyó efectos reproductivos, acceso a servicios de salud, variables demográficas-socioeconómicas, así como de grupo étnico. El modelo de descomposición de Fairlie se aplicó para cuantificar la contribución de variables explicativas en las frecuencias de eventos perinatales adversos. De los 66.755 recién nacidos investigados, el 21,1% (n = 14.078) fue primigrávida de madres adolescentes. La distribución por escolaridad materna fue de 24,2%, 59,8% y 16% para baja, media y alta escolaridad, respectivamente. Las mayores frecuencias de eventos perinatales adversos se observaron en madres adolescentes con baja escolaridad. La variable "acceso a servicios de salud" explicó un 35%, 37% y 23% de las disparidades en el bajo peso al nacimiento, prematuridad y retardo de crecimiento intrauterino, respectivamente, entre madres adolescentes con baja y alta escolaridad. El bajo número de consultas prenatales fue el único factor de riesgo para los dos niveles de escolaridad y la variable que mejor explica las diferencias entre las frecuencias de eventos perinatales adversos. Desde el punto de vista de la salud pública, ellos representan una intervención de bajo coste, con posibilidad de que se incrementen mediante información adecuada para la población y medidas sistemáticas en los niveles de atención primaria.

Abstract: The aim was to explain differences in the rates of adverse perinatal events in teenage mothers with low and high schooling. The sample was collected from the Latin American Colaborative Study of Congenital Malformations (ECLAMC) database. From a total of 2,443,747 births in 93 hospitals, 66,755 live newborns without congenital malformations were recruited from 2000 to 2017. Teenage mothers were classified according to low, medium, and high schooling. A multivariate model was used that included reproductive history, access to health services, demographic and socioeconomic variables, and ethnic group. The Fairlie decomposition model was applied to quantify the contribution of explanatory variables to the adverse perinatal event rates. Of the 66,755 newborns analyzed, 21.1% (n = 14,078) were born to teenage mothers. Distribution of maternal schooling was 24.2%, 59.8%, and 16% for low, medium, and high schooling, respectively. The highest rates of adverse perinatal events were seen in teenage mothers with low schooling. The variable "access to health services" explained 35%, 37%, and 23% of the disparities in low birthweight, prematurity, and intrauterine growth restriction, respectively, among teenage mother with low and high schooling. Low number of prenatal visits was the only risk factor for the two levels of schooling and the variable that best explained the differences between the rates of adverse perinatal events. From the public health perspective, prenatal care represents a low-cost intervention with the possibility of increased implementation through adequate information for the population and systematic measures in primary care.

Resumo: O objetivo foi explicar as diferenças na frequência de eventos perinatais adversos entre mães adolescentes com baixa e alta escolaridade. A amostra populacional foi coletada na base de dados do Estudo Colaborativo Latino-Americano de Malformações Congênitas (ECLAMC). Entre 2.443.747 nascimentos ocorridos em 93 hospitais, 66.755 recém-nascidos vivos sem defeitos congênitos foram recrutados no período 2000-2017. As mães adolescentes foram classificadas segundo sua escolaridade em: baixa, média e alta. Foi utilizado um modelo multivariado que incluiu efeitos reprodutivos, acesso a serviços de saúde, variáveis demográficas-socioeconômicas e de grupo étnico. O modelo de decomposição de Fairlie foi aplicado para quantificar a contribuição de variáveis explicativas nas frequências de eventos perinatais adversos. Dos 66.755 recém-nascidos pesquisados, o 21,1% (n = 14.078) foi a mãe adolescente. A distribuição por escolaridade materna foi de 24,2%, 59,8% e 16% para baixa escolaridade, média escolaridade e alta escolaridade, respectivamente. As maiores frequências de eventos perinatais adversos foram observadas em mães adolescentes com baixa escolaridade. A variável "acesso a serviços de saúde"; explicou 35%, 37% e 23% das disparidades no baixo peso ao nascer, prematuridade e retardo de crescimento intrauterino, respectivamente, entre mães adolescentes com baixa e alta escolaridades. O baixo número de consultas pré-natais foi o único fator de risco para os dois níveis de escolaridade e a variável que melhor explica as diferenças entre as frequências de eventos perinatais adversos. Do ponto de vista da saúde pública, eles representam uma intervenção de baixo custo, com possibilidade de ser incrementadas por meio de informações adequadas à população e medidas sistemáticas nos níveis de atenção primária.

Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore

INTRODUCTION@#Pregnant women are reported to be at increased risk of severe coronavirus disease 2019 (COVID-19) due to underlying immunosuppression during pregnancy. However, the clinical course of COVID-19 in pregnancy and risk of vertical and horizontal transmission remain relatively unknown. We aim to describe and evaluate outcomes in pregnant women with COVID-19 in Singapore.@*METHODS@#Prospective observational study of 16 pregnant patients admitted for COVID-19 to 4 tertiary hospitals in Singapore. Outcomes included severe disease, pregnancy loss, and vertical and horizontal transmission.@*RESULTS@#Of the 16 patients, 37.5%, 43.8% and 18.7% were infected in the first, second and third trimesters, respectively. Two gravidas aged ≥35 years (12.5%) developed severe pneumonia; one patient (body mass index 32.9kg/m2) required transfer to intensive care. The median duration of acute infection was 19 days; one patient remained reverse transcription polymerase chain reaction (RT-PCR) positive >11 weeks from diagnosis. There were no maternal mortalities. Five pregnancies produced term live-births while 2 spontaneous miscarriages occurred at 11 and 23 weeks. RT-PCR of breast milk and maternal and neonatal samples taken at birth were negative; placenta and cord histology showed non-specific inflammation; and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulins were elevated in paired maternal and umbilical cord blood (n=5).@*CONCLUSION@#The majority of COVID-19 infected pregnant women had mild disease and only 2 women with risk factors (obesity, older age) had severe infection; this represents a slightly higher incidence than observed in age-matched non-pregnant women. Among the women who delivered, there was no definitive evidence of mother-to-child transmission via breast milk or placenta.

Prevalencia de complicaciones en pacientes sometidas a cesárea en el periodo comprendido entre enero a diciembre del 2016 en el Hospital Universitario San José de Popayán, Colombia 2016 / Prevalence of complications in patients undergoing caesarean section in the period from January to December 2016 at the San José de Popayán University Hospital, Colombia 2016

Resumen INTRODUCCIÓN La cesárea es el procedimiento quirúrgico que se realiza con el fin de obtener el nacimiento de un feto, con el objetivo de disminuir la morbimortalidad materna y perinatal asociada con el momento del nacimiento cuando el parto vaginal podría traer consigo complicaciones. En los últimos 30 años la incidencia de la cesárea se ha incrementado significativamente en casi todos los países occidentales, con valores que superan el 15% al 35%, este procedimiento está asociado a varias complicaciones, entre las más frecuentes se encuentran: infecciones, hemorragia obstétrica, histerectomía periparto, necesidad de unidad de cuidados intensivos y acretismo placentario. OBJETIVO Determinar la prevalencia de complicaciones quirúrgicas en pacientes sometidas a cesárea en un Hospital de alta complejidad y explorar factores asociados. MATERIALES Y MÉTODOS Estudio de prevalencia con análisis secundario en el que se incluyeron historias clínicas de pacientes sometidas a cesárea de urgencias y programadas. La variable resultado fue la complicación reportada durante un periodo menor a 30 días. Se tomó el universo, se recolectaron variables sociodemográficas, biológicas y clínicas. Para determinar la prevalencia se tomó como numerador el total de complicaciones y como denominador el total de historias analizadas, para explorar los factores asociados se utilizó el Odds Ratio como medida de asociación con un intervalo de confianza al 95%. RESULTADOS En 899 historias clínicas analizadas se encontró una prevalencia de complicaciones del 5.22% (IC95%: 3.86-6.89), dentro de los factores asociados positivamente se encontró tener una gestación pretermino (OR: 2.05, IC95%: 1.01-4.02); tener al menos una comorbilidad (OR: 2.51, IC 95%: 1.17-5.98) y la prioridad clasificada como urgente (OR: 3.01, IC 95%: 1.07-11.65). CONCLUSIONES La prevalencia encontrada en esta institución es similar a la de la mayor parte de los estudios publicados. El ser un procedimiento de urgencia, la presencia de comorbilidades siendo la preeclampsia la principal y el embarazo pretermino fueron los factores asociados positivamente con complicaciones, las más frecuentes fueron el requerimiento de transfusión, hemorragia, hematoma, la dehiscencia de sutura y la infección de sitio operatorio.

SUMMARY INTRODUCTION Caesarean section is the surgical procedure that is performed in order to obtain the birth of a fetus, with the aim of reducing maternal and perinatal morbidity and mortality associated with the time of birth when vaginal delivery could lead to complications. Last 30 years the incidence of caesarean section has increased significantly in almost all western countries, with values exceeding 15% to 35%, this procedure is associated with several complications, among the most frequent are: infections, obstetric hemorrhage, peripartum hysterectomy, need for intensive care unit and placental acretism. OBJECTIVE To determine the prevalence of surgical complications in patients undergoing caesarean section in a hospital of high complexity and explore associated factors. MATERIALS AND METHODS Prevalence study with secondary analysis, which included clinical records of patients undergoing emergency caesarean section and scheduled. The outcome variable was the complication reported for a period of less than 30 days. The universe was taken, sociodemographic, biological and clinical variables were collected. To determine the prevalence, the total number of complications was taken as a numerator and as the denominator the total of analyzed stories, to explore the associated factors the Odds Ratio was used as a measure of association with a 95% confidence interval. RESULTS In 899 clinical histories analyzed a prevalence of complications of 5.22% was found (95% CI: 3.86-6.89), among the positively associated factors it was found to have a preterm pregnancy (OR: 2.05, 95% CI: 1.01-4.02); have at least one comorbidity (OR: 2.51, 95% CI: 1.17-5.98) and the priority classified as urgent (OR: 3.01, 95% CI: 1.07-11.65). CONCLUSIONS The prevalence found in this institution is similar to that of most of the published studies. Being an emergency procedure, the presence of comorbidities being the main preeclampsia and preterm pregnancy were the factors positively associated with complications, the most frequent were the requirement of transfusion, hemorrhage, hematoma, suture dehiscence, operative and the site infection.

Progesterone's serum level and a new ultrasonographic parameter in the first trimester pregnancy - prognostic factors for embryonic demise

Abstract Objective The etiology of embryonic demise is multifactorial, with chromosomal abnormalities being the most common (40%). The purpose of the present study is to evaluate the correlation between a serum biomarker, progesterone, and an ultrasonographic parameter, the distance between yolk sac and embryo (DYSE) in assessing the prognosis of pregnancy outcome in the 1st trimester. Methods The present study is a prospective case-control analysis that includes 2 groups of patients: 81 patients with first-trimester normal evolutive pregnancy and 89 patients with embryonic demise, all of the patients having between 6 and 11 weeks of amenorrhea. Endovaginal ultrasonographic exploration was performed to evaluate the distance between the lower pole of the embryo and the yolk sac. From each subject enrolled in the study, 20ml of blood was collected for progesterone serum level measurement. Results Regarding the DYSE in the case group, lower values were observed compared with the control group, the difference being statistically significant. In the statistical analysis of serum progesterone values, statistically significant differences were observed between the 2 groups (p<0.05). Conclusion The DYSE has a high positive predictive value in identifying pregnancies with potentially reserved outcome, with the present study demonstrating that a DYSE<3mm causes an unfavorable evolution of the pregnancy. Low serum levels of progesterone are associated with an increased rate of nonviable embryos. The correlation between these two parameters increases the effectiveness of screening methods in prenatal monitoring and improves the diagnostic methods for the firsttrimester pregnancies whose outcome potential can be reserved.

Assisted reproductive technology: prevalence and associated factors in Southern Brazil

ABSTRACT OBJECTIVE: To assess the prevalence of successful assisted reproductive technology and to identify the associated factors. METHODS: This population-based birth cohort study was carried out with 4,333 pregnant women expected to deliver in 2015 in the urban area of Pelotas, Southern Brazil. Use of an assisted reproductive technology procedure, type of assisted reproductive technology [in vitro fertilization or intracytoplasmic sperm injection or artificial insemination], number of embryos transferred, success of embryo transfer, number of attempts, and reported reasons for seeking assisted reproductive technology were the main outcomes measured. Use of an assisted reproductive technology procedure was analyzed according to sociodemographic, nutritional, reproductive history, and behavioral characteristics. Unadjusted and adjusted analyses were performed by logistic regression. RESULTS: Among the 4,275 newborns enrolled in the Pelotas 2015 Birth Cohort Study, 18 births (0.4%) were conceived by assisted reproductive technology. Most cases of assisted reproductive technology were by in vitro fertilization (70.6%). All cycles were performed in private clinics under direct out-of-pocket payment. Even after controlling for confounders, maternal age > 35 years, nulliparity and high family monthly income were strongly associated with assisted reproductive technology. CONCLUSIONS: The use of assisted reproductive technology services was reported by only a few women in the Pelotas 2015 Birth Cohort Study. Our study highlights sociodemographic factors associated to assisted reproductive technology procedures. To better understand the patterns and barriers in overall use of assisted reproductive technology services over time, national-level trend studies in assisted reproductive technology treatments and outcomes, as well as studies exploring the characteristics of women who have sought this kind of treatment are needed in low-middle income countries.

The impact of malaria parasites on the placenta and perinatal outcome at Korle Bu teaching hospital, Accra, Ghana: a case control study

Objective: Malaria remains a complex and overwhelming health problem affecting vulnerable groups such as pregnant women and their infants in Ghana. Malaria during pregnancy does not only pose a threat to the mother but can cause serious structural damages to the placenta and subsequently affect the pregnancy outcome. The aim of the study was to investigate the impact of Plasmodium parasites on the placenta and perinatal outcome of women delivering at Korle Bu Teaching Hospital. A better understanding of the impact of malaria parasites on the placenta morphology and prenatal outcome is crucial for better management of pregnant women and their babies. Methods: The study involved testing blood collected from postpartum placentas and examining the placental tissue for Plasmodium parasites, after which they were classified as study group (Plasmodium positive) or control (Plasmodium negative). The patients in the study group with similar gestational and maternal age were matched with patients from the control group. The morphological characteristics of the placenta and the perinatal outcome of the two patient groups were compared using an unpaired t-test. Results: Sixteen (16, 13.6%) out of 118 women tested positive for Plasmodium parasites on the maternal side of the placenta by both rapid diagnostic test and microscopy and /or tested positive for malarial parasite during pregnancy, whiles the rest (102, 86.4%) had no history of malaria in the index pregnancy and tested negative. The mean placenta weight was significantly reduced in the study group (difference: -102.0g; 95% Confidence Interval [CI]: 424.4g, 486.6g) who delivered during early term (p=0.02). Patients in the study group, who delivered during late term, had a significantly reduced mean placenta diameter (difference: -2.5cm; 95% CI: 20.0cm, 21.4cm) (p=0.003) and delivered infants with lower mean birth weight (difference: - 0.693kg; 95 CI: 3.268kg, 3.475kg) (p<0.001). Conclusion: Malaria during pregnancy does not only pose a threat to the mother but to the fetus and our results add evidence that malaria parasites cause alterations to certain morphological characteristics of the placenta which subsequently affect the birth weight as the pregnancy progresses to late term

Pregnancy outcomes in young mothers with perinatally and behaviorally acquired HIV infections in Rio de Janeiro

ABSTRACT Background: Perinatally HIV-infected children are surviving into adulthood, and getting pregnant. There is a scarcity of information on health and pregnancy outcomes in these women. Aim: To evaluate characteristics related to HIV disease and pregnancy outcomes in perinatally infected women, and to compare these women with a group of youth with behaviorally acquired HIV-infection, at a reference hospital in Rio de Janeiro, Brazil. Methods: A cohort study. Epidemiological, clinical, and laboratory data were compared between perinatally (PHIV) and behaviorally HIV-infected (BHIV) pregnant youth with the primary aim to study pregnancy outcomes in the PHIV group and compare with outcomes to BHIV group. Results: Thirty-two pregnancies occurred in PHIV group, and 595 in BHIV group. A total of seven (22%) PHIV women and 64 (11%) BHIV women had a premature delivery (p = 0.04), however, when adjusting for younger age at pregnancy, and antiretroviral therapy initiation in 1st trimester of pregnancy (OR = 18.66, 95%CI = 5.52-63.14), the difference was no longer significant. No cases of mother-to-child HIV transmission (MTCT) were observed in the PHIV group while there was a 2% MTCT rate in BHIV group. Conclusion: Pregnancy among PHIV was as safe as among BHIV. The differences between those groups were probably related to treatment and prolonged care in the first group.