Risk factors for seroconversion of HIV among children exposed in the State of Santa Catarina, 2007-2017 / Fatores de risco para a soroconversão de crianças expostas ao HIV no Estado de Santa Catarina, 2007-2017

Abstract Objectives: to estimate the proportion of seroconversion cases among infants exposed to HIV and verify the risk factors associated. Methods: this was a historical cohort study conducted in the State of Santa Catarina between 2007 and 2017. The data were obtained from the Notifable Diseases Information System (SINAN - Portuguese acronym) that records HIV-infected pregnant women and HIV-exposed infants. The public health service monitored the infants from birth to 18 months of age to determine whether HIV seroconversion occurred. Results: a total of 5,554 HIV-infected pregnant women were included in the study (mean age 26.7±6.5 years). They were predominantly white, with poor education level, and were diagnosed with HIV until the 2nd trimester of pregnancy. A total of 4,559 records of HIV-exposed infants were screened, of which 130 cases (2.9%) of seroconversion were confrmed. Non-use of antiretroviral drugs during pregnancy (OR=9.31, CI95%=5.97-14.52; p<0.001) and breastfeeding (OR=3.10, CI95%=1.34-7.20; p=0.008) were independent risk factors for seroconversion. Conclusions: these data demonstrate gaps in prenatal care, regarding adherence to treatment and monitoring of HIV-infected mothers, resulting in new cases of HIV among children, which could be avoided.

Resumo Objetivos: estimar a proporção de soroconversão da criança exposta ao HIV e verificar os fatores de risco associados, no período de 2007-2017 em Santa Catarina. Métodos: o delineamento utilizado foi de coorte histórica e os dados obtidos no Sistema de Informação de Agravos de Notificação (SINAN) que registra as gestantes infectadas e as crianças expostas ao HIV. As crianças foram acompanhadas pelo serviço de saúde desde o nascimento até o 18º mês de vida, para determinar a ocorrência de soroconversão pelo HIV. Resultados: foram identificadas 5.554 gestantes infectadas pelo HIV com média de idade de 26,7±6,5 anos, predomínio da raça branca, baixa escolaridade e que receberam o diagnóstico para o HIV até o 2º trimestre gestacional. Foram incluídas 4.559 fichas de crianças expostas ao HIV, das quais 130 casos (2,9%) de soroconversão foram confrmados. O não uso de antirretroviral durante a gestação (OR=9,31, IC95%=5,97-14,52; p<0,001) e aleitamento materno (OR=3,10, IC95%=1,34-7,20; p=0,008) foram fatores de risco independentes para a soroconversão. Conclusões: esses dados demonstram lacunas na assistência pré-natal, quanto a adesão ao tratamento e acompanhamento de mães infectadas pelo HIV, resultando em casos novos de HIV entre crianças, que poderiam ser evitados.

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.

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

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

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

Evaluation of the level of knowledge and prevalence of Toxoplasma gondii infection in pregnant women in Santa Catarina, Brazil

This study aimed to determine the prevalence of Toxoplasma gondii (T. gondii) infection in pregnant women in Santa Catarina, as well as to analyze the knowledge about zoonosis in the study population. Methods: Therefore, 109 volunteers evaluated in Basic Health Units in the city of Blumenau and Brusque were evaluated. The data were collected through questionnaires and analysis of the pregnant woman's handbooks with medical records. Results: In this study, the prevalence of IgG anti-T. gondii was 53.7%, with positivity for IgM anti-T. gondii was 1.0%. Seronegativity for toxoplasmosis was verified in 45.3% of the participants. In addition, the data demonstrated that the majority of pregnant women have not any knowledge of the disease. Conclusion: The results of obtained demonstrated that health actions promotion is crucial to clarify about T. gondii infection, in order to prevent this disease during pregnancy.

O presente trabalho teve por objetivo determinar a prevalência de infecção pelo Toxoplasma gondii (T. gondii) entre gestantes de Santa Catarina, bem como analisar o conhecimento sobre a zoonose na população em estudo. Métodos: Para tanto, foram avaliadas 109 voluntárias atendidas em Unidades Básicas de Saúde dos municípios de Blumenau e Brusque. Os dados foram coletados por meio de questionários e análise de cadernetas da gestante. Resultados: Neste estudo, a prevalência global de anti-T. gondii IgG foi de 53,7%, sendo que a positividade para anti-T. gondii IgM foi de 1,0%. A soronegatividade para toxoplasmose foi verificada em 45,3% das participantes. Além disso, os dados revelaram que a maioria das gestantes não tem conhecimento acerca da doença. Conclusão: Os resultados deste estudo demostraram a necessidade da promoção de ações de saúde voltadas ao esclarecimento sobre o T. gondii visando prevenir a infecção durante a gestação.

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.

The use of convalescent plasma therapy in the management of a pregnant woman with COVID-19: a case report

ABSTRACT The coronavirus disease 19 (COVID-19) is responsible for the current worldwide pandemic. Treatment and prophylaxis are still under investigation. Convalescent plasma therapy could be an alternative. We report a case of a 41-year-old patient, at 28 weeks of gestation, was hospitalized with COVID-19. On the 10th day after onset of symptoms, the clinical picture worsened, and she required high-flow oxygen therapy (30L/minute), with 92% oxygen saturation, and chest X-ray showing mild bilateral opacities at lung bases. Blood tests showed D-dimer 1,004ng/mL, C-reactive protein 81mg/L, pro-calcitonin 0.05ng/mL and interleukine-6 42.9pg/mL. The therapy chosen was Tazocin® 12g/day, vancomycin 2g/day, and methylprednisolone 40mg/day. In addition, convalescent plasma therapy was administered (275mL) uneventfully, including SARS-CoV-2 antibodies and neutralizing antibodies >1:160. The patient had a fast recovery. The early administration of convalescent plasma, with high titers of neutralizing antibodies, may be an alternative option for severe COVID-19 during pregnancy, until further studies demonstrate an efficient and safe treatment or prophylaxis.

Infecção por COVID-19 na gestação / COVID-19 infection in pregnancy

SARS-CoV-2 é um novo agente infeccioso e pouco se sabe acerca do risco de sua infecção para o desenvolvimento embrionário e fetal humano, por isso é de extrema importância identificar o quadro clínico da infecção em gestantes, bem como registrar as complicações perinatais associadas à COVID-19. O quadro clínico em gestantes é semelhante ao do restante da população, contudo foi observado um aumento potencial de desfechos adversos em gestantes ­ como admissão em unidade de terapia intensiva, necessidade de ventilação mecânica e maior risco de parto prematuro e de cesáreas ­ e as taxas de mortalidade são semelhantes às da população em geral. Uma questão recorrente e ainda não elucidada seria a possibilidade de transmissão vertical do SARS-CoV-2.(AU)

SARS-CoV-2 is a new infectious agent, which little is known about the risk of its infection for human embryonic and fetal development, it is extremely important to identify the clinical symptoms of the infection in pregnant women, as well as to record the perinatal complications associated with COVID-19. The clinical symptoms in pregnant women is similar to the rest of the population, an increase in the risk of adverse outcomes in pregnant women was observed, such as: intensive care unit admission, need for mechanical ventilation, a higher risk of prematurity and cesarean, however mortality rates are similar to the general population. A recurring and unexplained issue would be the possibility of vertical transmission of SARS-CoV-2.(AU)

Perfil das gestantes diagnosticadas com sífilis durante o pré-natal ou parto admitidas em maternidade de Belo Horizonte ­ MG / Profile of pregnant women diagnosed with syphilis in the maternity in Belo Horizonte ­ MG

Objetivo: Conhecer o perfil epidemiológico e identificar fatores de risco, eficácia do diagnóstico e tratamento durante o pré-natal de pacientes com histórico de sífilis admitidas em uma maternidade de Belo Horizonte, com o intuito de atuar de forma preventiva quanto à população local. Métodos: Estudo transversal, retrospectivo, com análise de prontuários e banco de dados de notificações de sífilis congênita e em gestantes obtidos entre janeiro/2017 e dezembro/2019, referentes a pacientes admitidas para parto, internação clínica ou atendimento de urgência. Resultados: Foram identificadas 198 gestantes com idade média de 24 anos. Avaliando os dados pré-natais, 65% foram acompanhadas no risco habitual com uma média de seis consultas. Na análise do diagnóstico, 58% não possuíam registro de teste treponêmico e 31,8% apresentaram teste reagente. Entre as pacientes, 21% relataram já ter tido sífilis previamente. O esquema de tratamento em 74,7% foi penicilina benzatina 7.200.000 UI. O tratamento concomitante do parceiro era desconhecido em 46% dos casos e confirmado em 33%. Na avaliação neonatal, 95 recém-nascidos apresentaram VDRL positivo; desses, 33% apresentaram titulação maior que a diluição de 1:8. No desfecho gestacional, houve quatro decessos fetais e dois abortamentos. Conclusão: Apesar de recursos diagnósticos e terapêuticos simples e de baixo custo, o controle da sífilis na gestação mostra-se um desafio. O rastreio da infecção durante o pré-natal nem sempre acontece em momento oportuno e a taxa de reinfecção materna é significativa, mostrando que orientações para prevenção ou tratamento não foram realizadas adequadamente.(AU)

Objective: To know the epidemiological profile, identify risk factors, effectiveness of diagnosis and treatment during prenatal care of patients admitted to the Maternity in Belo Horizonte with a history of syphilis, in order to act preventively towards the local population. Methods: Cross-sectional study, retrospective study, with analysis of medical records and a database of congenital syphilis notifications and in pregnant women obtained between January/2017 and December/2019, referring to patients admitted for delivery, clinical hospitalization or emergency care. Results: 198 pregnant women with an average age of 24 years were identified. Evaluating the prenatal data, 65% were followed up at usual risk with an average of six consultations. In the analysis of the diagnosis, 58% did not have a treponemal test record and 31.8% had a reagent test. 21% of patients reported having previously had syphilis. The treatment regimen in 74.7% was benzathine penicillin 7,200,000 IU. Concomitant treatment of the partner was unknown in 46% of cases and confirmed in 33%. In the neonatal assessment, 95 newborns showed positive VDRL test, of which 33% had a higher titre than the 1:8 dilution. In the gestational outcome, there were four fetal deceases and two abortions. Conclusion: Despite simple and low-cost diagnostic and therapeutic resources, controlling syphilis during pregnancy is a challenge. Screening for infection during prenatal care does not always happen in an opportune moment and the rate of maternal reinfection is significant, showing that guidelines for prevention or treatment have not been carried out.(AU)

Análise dos desfechos maternos e fetais relacionados à COVID-19 durante a gestação / Analysis of maternal and fetal outcomes related to COVID-19 during pregnancy

O SARS-CoV-2 é um vírus RNA transmitido pelo contato direto ou indireto por gotículas infectadas. No que se refere à COVID-19 e à gestação, referências apontam que nesse período as mulheres possuem maior susceptibilidade a complicações obstétricas e perinatais. O presente estudo objetiva compreender e compilar aspectos da infecção e os principais desfechos negativos maternos e fetais documentados na literatura atual, relacionados à infecção pelo novo coronavírus durante a gestação. Trata-se de uma revisão integrativa de literatura embasada pela análise de 2.441 artigos no total, dos quais 62 foram incluídos na pesquisa, sendo 38 deles da base de dados PubMed e 24 da BVS (Biblioteca Virtual em Saúde), nos idiomas inglês e português. Em conclusão, mulheres grávidas com diagnóstico da patologia podem precisar de assistência de alta complexidade. A associação à doença pode apresentar riscos ou complicações como coagulopatias, pré-eclâmpsia, prematuridade e outros desfechos negativos que serão abordados neste artigo.(AU)

SARS-CoV-2 is an RNA virus, transmitted by direct or indirect contact by infected droplets. Regarding to COVID-19 and pregnancy, references indicate that during this period, women are more susceptible to obstetric and perinatal complications. This study aims to understand and compile aspects of infection and the main negative maternal and fetal outcomes documented in the current literature, related to the infection by the new coronavirus during pregnancy. This is an integrative literature review based on the analysis of 2,441 articles in total, of which 62 were included in the survey, 38 from the PubMed database and 24 from BVS (Biblioteca Virtual em Saúde) in English and Portuguese languages. In conclusion, pregnant women diagnosed with the pathology may need highly complex assistance. The association with the disease may present risks for complications such as coagulopathies, pre-eclampsia, prematurity and other negative outcomes that will be addressed in this article.(AU)

Distributive characteristics of HBV DNA CpG islands in HBsAg positive mothers and its relationship with intrauterine transmission / 中华流行病学杂志

Objective: To investigate the type, length, and CG loci of HBV DNA CpG islands in HBsAg positive maternal C genotype and its relationship with intrauterine HBV transmission, so as to provide a new perspective for the study of intrauterine transmission of HBV. Methods: From June 2011 to July 2013, HBsAg-positive mothers and their newborns who delivered in the obstetrics and gynecology department of the Third People's Hospital of Taiyuan were collected. Epidemiological data were collected through face-to-face questionnaires and electronic medical records. Serum HBV markers and serum HBV DNA were detected by electrochemiluminescence and quantitative fluorescence PCR, respectively. Intrauterine transmission of HBV was determined by positive HBsAg and/or HBV DNA in femoral venous blood before injection of HBV vaccine/Hepatitis B immunoglobulin within 24 h of birth. A total of 22 mothers and their newborns with HBV DNA load ≥106 IU/ml in intrauterine transmission were selected as the intrauterine transmission group, and 22 mothers with HBV DNA load ≥106 IU/ml without intrauterine transmission were chosen as the control group by random seed method. The distribution prediction of CpG islands of HBV DNA in 39 mothers with genotype C by HBV DNA sequencing was analyzed. Results: Among 39 mothers with HBV C genotype, 19 were in the intrauterine transmission group, and 20 were in the control group. The HBV DNA of 39 patients with genotype C traditional CpG island Ⅱ and Ⅲ, while the control group had traditional CpG island Ⅰ and novel CpG island Ⅳ and Ⅴ. The length of CpG island Ⅱ and Ⅲ and the number of CG loci of CpG island Ⅱ in the intrauterine transmission group differed from those in the control group (P<0.05). The CpG island Ⅱ length ≥518 bp and the number of CG loci ≥40 in the intrauterine transmission group (11/19) were significantly higher than those in the control group (2/20) (P<0.05). The length of CpG island Ⅱ and the number of CG loci in the X gene promoter region (Xp region) were higher than those in the control group (P<0.05). In the HBV intrauterine transmission group, most of maternal (12/19) HBV DNA CpG island Ⅱ completely covered the Xp region, which was significantly higher than that in the control group (5/20), and the number of HBV DNA Xp region CG loci was higher than that in the control group (P<0.05). Conclusions: The distribution of maternal C genotype HBV DNA CpG islands is related to intrauterine transmission. The length of CpG island Ⅱ and the number of CG sites may increase the risk of intrauterine transmission of HBV.

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

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

Effect of intrapartum antibiotic prophylaxis of group B streptococcus infection on the incidence and bacteriological profile of early-onset neonatal sepsis / 中国当代儿科杂志

OBJECTIVES@#To study the effect of intrapartum antibiotic prophylaxis (IAP) of group B streptococcus (GBS) infection on the incidence and bacteriological profile of early-onset neonatal sepsis (EONS).@*METHODS@#A retrospective analysis was performed on the medical data of 494 pregnant women with positive GBS screening results and 526 neonates born by these women. According to whether the pregnant woman received IAP, the neonates were divided into two groups: IAP (n=304) and control (n=222). The two groups were compared in terms of clinical indices, incidence rate of EONS, and distribution of pathogenic bacteria in blood culture.@*RESULTS@#Compared with the control group, the IAP group had a significantly lower proportion of children with abnormal clinical manifestations (P<0.001) and a significantly lower incidence rate of EONS (P=0.022). In the IAP group, Escherichia coli (2.3%) was the most common type of pathogenic bacteria in blood culture of the neonates with EONS, while GBS (3.2%) was the most common type of pathogenic bacteria in the control group. The IAP group had a significantly higher detection rate of ampicillin-resistant Escherichia coli than the control group (P=0.029).@*CONCLUSIONS@#Although IAP can significantly reduce the incidence rate of EONS in neonates born to pregnant women with positive GBS screening results, the infection rate of ampicillin-resistant Escherichia coli may increase after IAP treatment. Therefore, it is needed to enhance the monitoring of blood culture results of neonates with EONS and timely adjust treatment plan according to drug susceptibility test results.

Condições potencialmente ameaçadoras à vida no ciclo gravídico-puerperal / Condiciones potencialmente amenazantes para la vida en el ciclo gravídico puerperal / Potentially life-threatening conditions determinants in pregnancy-puerperal cycle

ABSTRACT Objetivo: Descrever as principais condições potencialmente ameaçadoras à vida de mulheres durante o ciclo gravídico e puerperal e variáveis relacionadas a esses agravos. Método: Estudo do tipo documental, descritivo e quantitativo, realizado com prontuários de gestantes, parturientes e puérperas internadas em hospital de média complexidade, que apresentaram Condições Potencialmente Ameaçadoras à Vida (CPAV). Foram excluídos os de acesso impossibilitado por estarem sob judice. A amostra foi temporal e a análise univariada. Resultados: Inclui-se 181 prontuários. A maioria das condições ocorreu em mulheres de 16 a 34 anos de idade (61,3%), união estável (60,8%), pardas (31,5%), sem renda ocupacional (29,2%), multíparas (28,87%), com complicações no primeiro trimestre gestacional (32,6%). Verificaram-se a realização de um número insuficiente de consultas (13,8%), dados referentes ao pré-natal ignorados (68%). As principais CPAV foram as síndromes hemorrágicas (28,2%), hipertensivas (25,4%) e infecção (13,3%). Como desfecho, foram observados prevalência de aborto não especificado (22,1%), morte perinatal por doença infecciosa e parasitária da mãe (2,2%). Conclusão: As principais CPAV foram as síndromes hemorrágicas, hipertensivas e infecções. Como desfecho, foram observados alta hospitalar, aborto, referenciamento à UTI, morte perinatal e morte materna.

RESUMEN Objetivo: describir las principales condiciones potencialmente amenazantes para la vida de las mujeres durante el ciclo gravídico y puerperal, además de las variables relacionadas con estos agravios. Método: estudio del tipo documental, descriptivo y cuantitativo, realizado con registros médicos de gestantes, parturientes y puérperas internadas en hospital de mediana complejidad, que presentaron Condiciones Potencialmente Amenazantes a la Vida (CPAV). Se excluyeron los de acceso imposibilitado por estar bajo juicio. La muestra fue temporal y el análisis univariado. Resultados: se incluyen 181 registros médicos. La mayoría de las condiciones ocurrió en mujeres de 16 a 34 años de edad (61,3%), unión estable (60,8%), pardas (31,5%), sin ingreso ocupacional (29,2%), multíparas (28,87%), con complicaciones en el primer trimestre gestacional (32,6%). Se constató un número insuficiente de consultas (13,8 %), datos relativos al prenatal ignorados (68 %). Las principales CPAV fueron los trastornos hemorrágicos (28,2%), hipertensivos (25,4%) e infecciosos (13,3%). Como resultado, se observaron: prevalencia de aborto no especificado (22,1%), muerte perinatal por enfermedad infecciosa y parasitaria de la madre (2,2%). Conclusión: las principales CPAV fueron los trastornos hemorrágicos, hipertensivos e infecciones. Como resultado, se observó alta hospitalaria, aborto, referencia a la UCI, muerte perinatal y muerte materna.

ABSTRACT Objective: To describe the main conditions potentially threatening the lives of women during the pregnancy and puerperal cycle and variables related to these diseases. Method: Documentary, descriptive and quantitative study, conducted with medical records of pregnant women, women giving birth and puerperal women hospitalized in a hospital of medium complexity, who presented Potentially Life Threatening Conditions (PLTC). Those with access unable to be sob judice were excluded. The sample was temporal and the analysis was univariate. Results: This includes 181 medical records. Most conditions occurred in women aged 16 to 34 years (61.3%), stable union (60.8%), brown (31.5%), without occupational income (29.2%), multiparous (28.87%), with complications in the first gestational trimester (32.6%). There was an insufficient number of consultations (13.8%), data regarding prenatal care ignored (68%). The main CPAV were hemorrhagic syndromes (28.2%), hypertensive (25.4%) and infection (13.3%). As an outcome, we observed a prevalence of unspecified miscarriage (22.1%), perinatal death from infectious and parasitic disease of the mother (2.2%). Conclusion: The main CPAV were hemorrhagic, hypertensive and infections syndromes. As an outcome, hospital discharge, miscarriage, ICU referral, perinatal death and maternal death were observed.

Maternal factors and short-term outcome associated with episiotomy during vaginal delivery at the Women and Newborn Hospital, Lusaka, Zambia

Objective:To explore the maternal factors and short-term outcomes associated with episiotomy during vaginal delivery at Women and Newborn Hospital, Lusaka, Zambia.Materials and Methods:An unmatched case control study was conducted in postnatal wards of Women and New-born hospital in Lusaka, Zambia between November 2019 and April 2020 with convenient sample for the cases and systematic sample for the controls.Asemi-structuredintervieweradministered questionnaire was used and 102 participants (cases) who had episiotomy performed were recruited while 204(controls) werewithoutepisiotomy.Results:Atotal of 306 (102 are cases and 204 are control) were included. Age was found to be a good predictor of episiotomy in that those younger than 18 years were more than seven times likely to have an episiotomy (AOR=7.65; 95%CI 1.36-18.21; p=0.035). It was also found out that primi gravidas were five times likely to have an episiotomy performed compared to parous women (OR=4.96; 95%CI 2.58-9.52; p<0.001). Out of those delivered by a midwife, 73(28.3%) participants had an episiotomy performed compared to 29(60.4%) deliveredbyamedicalofficer.Multivariateregression it was shown that being delivered by a midwife was protective against an episiotomy (OR=0.260; 95%CI 0.14-0.49; p=0.001). Out of the 102 participants who had an episiotomy, only two had third degree tear extension. It was also noted that 99 out of 102 (97%) participants who had an episiotomy experienced post-delivery perineal pain compared to 94 out of 204(46%) of those who had no episiotomies. In univariate analysis, it was found that post-delivery perineal pain was associated with episiotomy (p<0.001). It was further found that those who had an episiotomy performed were about 4 times likely to experience perineal pain post- delivery (OR=3.8; 95%CI 1.2-12.3) Conclusion:Maternal factors associated with episiotomy includedage,parity,method of induction,and the personnel conducting the elivery. Shorttermmaternaloutcomesofepisiotomy were perineal tear extension, and post-delivery perineal pain. It was found that 8.5% of women had undergone an episiotomy done on them. Health professional conducting deliveries should be educated on indications of episiotomy, patient selection during episiotomy and trained on surgical skills to repair episiotomy to reduce morbidity associated the procedure.

COVID-19 in pregnant women in South Africa: A retrospective review

Background. The majority of maternal deaths in South Africa (SA) occur as a result of non-pregnancy-related infections (NPRI). Pregnancy is a known risk factor in severe COVID-19, increasing the burden of NPRI in SA. In this study, we describe the prevalence, profile and clinical outcomes of pregnant women with COVID-19 admitted to a tertiary facility.Objectives. To describe the prevalence, profile and clinical outcomes of pregnant women with COVID-19 admitted to a tertiary facility in Gauteng, SA.Methods. We performed a retrospective review of all pregnant women with COVID-19 admitted to Charlotte Maxeke Johannesburg Academic Hospital between 6 March and 30 August 2020. Data collected included demographics, medical history, obstetric history, clinical findings and laboratory variables. Outcomes assessed were mortality, admission to intensive care unit (ICU), symptomatic v. asymptomatic disease, maternal and fetal outcome and mode of delivery.Results. A total of 204 pregnant women were included in the study. Of these, 33 (16.2%) women were critically ill, with 21 (10.3%) admitted to the ICU and 3 (1.5%) deaths related to COVID-19. The median gestational age was 37 weeks and median birthweight 2 940 g. Sixty-seven women (33%) were HIV-positive, in keeping with national statistics regarding HIV in pregnancy. Caesarean section was the most common mode of delivery (n=105, 60%). However, no women underwent caesarean section for indications related to COVID-19. Conclusion. COVID-19-related mortality in our cohort was higher than that seen internationally, likely due to differences in background maternal mortality rates and difficulty in accessing care.

Tendência temporal e distribuição espacial dos casos de transmissão vertical do HIV em Santa Catarina, 2007-2017: um estudo ecológico / Tendencia temporal y distribución espacial de los casos de transmisión vertical del VIH en el estado de Santa Catarina, Brasil, 2007-2017: un estudio ecológico / Temporal trend and spatial distribution of cases of mother-to-child transmission of HIV in the state of Santa Catarina, Brazil, 2007-2017: an ecological study

Objetivo: Analisar a tendência temporal e a distribuição espacial dos casos de transmissão vertical do HIV, Santa Catarina, 2007-2017. Métodos: Estudo ecológico misto, com dados do Sistema de Informação de Agravos de Notificação. Realizou-se regressão linear para análise de série temporal; calcularam-se as taxas médias no período e variações percentuais médias anuais das taxas de gestantes infectadas pelo HIV, de crianças expostas ao HIV na gestação e de soroconversão das crianças expostas ao HIV/aids na gestação, além do geoprocessamento dos dados. Resultados: Foram registradas 5.554 gestantes infectadas pelo HIV, com taxa de 5,6 gestantes/1 mil nascidos vivos. A taxa média de soroconversão foi de 13,5/100 mil nascidos vivos (IC95% 6,8;20,1) e apresentou tendência decrescente (APC = -99,4%; IC95% -99,9;-93,1). A taxa de soroconversão foi mais elevada em municípios de pequeno porte. Conclusão: A taxa de gestantes infectadas pelo HIV foi estável; houve diminuição de crianças infectadas com HIV por via vertical.

Objetivo: Estimar la tendencia temporal y la distribución de casos de VIH por transmisión vertical en Santa Catarina, 2007-2017. Métodos: Estudio ecológico mixto con datos del Sistema de Información de Enfermedades de Declaración Obligatoria. Se utilizó la regresión lineal para análisis de series temporales y se calcularon las tasas medias en el período y los cambios porcentuales medios anuales en las tasas de mujeres embarazadas infectadas por el VIH; de niños expuestos al VIH; y seroconversión de niños expuestos al VIH/SIDA durante el embarazo, además del geoprocesamiento de datos Resultados: Había 5.554 gestantes infectadas por el VIH, con tasa de 5,6 gestantes/1.000 nacidos vivos. La tasa media de seroconversión fue 13,5/100.000 de nacidos vivos (IC95% 6,8;20,1) y mostró tendencia decreciente (APC = -99,4%; IC95%-99,9;-93,1). La tasa de seroconversión fue más expresiva en los municipios pequeños. Conclusão: Hubo una tasa estable de mujeres embarazadas infectadas por el VIH, mientras que el número de niños infectados por el VIH disminuyó.

Objective: To analyze the temporal trend and spatial distribution of mother-to-child HIV transmission in Santa Catarina between 2007 and 2017. Methods: This was a mixed ecological study with data from the Notifiable Health Conditions Information System. Linear regression was performed for time series analysis and the mean rates in the period and mean annual percentage changes in the rates of HIV-infected pregnant women were calculated, children exposed to HIV during pregnancy, and seroconversion of children exposed to HIV/AIDS during pregnancy, in addition to data geoprocessing. Results: There were 5,554 records of HIV-infected pregnant women, with a rate of 5.6 pregnant women per 1,000 live births. The mean seroconversion rate was 13.5/100,000 live births (95%CI 6.8;20.1) and it showed a falling trend (APC = -99.4%; 95%CI -99.9;-93.1). The seroconversion rate was more expressive in small towns. Conclusion: The rate of HIV-infected pregnant women was stable in the period, whereas the number of children infected with HIV through mother-to-child transmission decreased.

Decline in head circumference growth and associated factors in congenital Zika syndrome / Declínio no crescimento do perímetro cefálico e fatores associados à síndrome congênita associada à infecção pelo vírus Zika / Disminución del crecimiento del perímetro cefálico y factores asociados en el síndrome congénito del Zika

Little is known about the evolution of head circumference (HC) in children with congenital Zika syndrome (CZS). This study aims to evaluate HC growth in children with CZS in the first three years of life and identify associated factors. HC data obtained at birth and in neuropediatric consultations from 74 children with CZS were collected from the Child's Health Handbook, parents' reports, and medical records. Predictors of HC z-score were investigated using different mixed-effects models; Akaike's information criterion was used for model selection. The HC z-score decreased from -2.7 ± 1.6 at birth to -5.5 ± 2.2 at 3 months of age, remaining relatively stable thereafter. In the selected adjusted model, the presence of severe brain parenchymal atrophy and maternal symptoms of infection in the first trimester of pregnancy were associated with a more pronounced reduction in the HC z-score in the first three years of life. The decrease of HC z-score in CZS children over the first three months demonstrated a reduced potential for growth and development of the central nervous system of these children. The prognosis of head growth in the first 3 years of life is worse when maternal infection occurs in the first gestational trimester and in children who have severe brain parenchymal atrophy.

Pouco se sabe sobre a evolução do perímetro cefálico (PC) em crianças com síndrome congênita associada à infecção pelo vírus Zika (SCZ) em acompanhamentos contínuos. Este estudo buscou avaliar o crescimento do PC em crianças com SCZ nos primeiros três anos de suas vidas e identificar os fatores associados a ele. Os dados do PC ao nascimento e obtidos em consultas neuropediátricas de 74 crianças com SCZ foram coletados no Cartão da Criança, nos laudos paternos e em seus prontuários. Os preditores de escore-z para PC foram investigados utilizando-se diferentes modelos de efeitos mistos. O critério de informação de Akaike foi utilizado para selecionar os modelos usados. O escore-z de PC diminuiu de -2,7 ± 1,6 ao nascimento para -5,5 ± 2,2 aos 3 meses de idade, mas permaneceu relativamente estável desde então. No modelo ajustado selecionado, a presença de atrofia parênquimal cerebral grave e sintomas maternos de infecção no primeiro trimestre de sua gravidez estiveram associados a uma redução mais acentuada no escore-z de PC nos primeiros três anos de vida dos participantes. A diminuição do escore-z de PC em crianças com SCZ nos primeiros 3 meses de sua vida monstra o potencial reduzido de crescimento e desenvolvimento do sistema nervoso central dessas crianças. O prognóstico de crescimento do perímetro cefálico nos primeiros 3 anos de vida é pior quando a infecção materna ocorreu no primeiro trimestre gestacional e em crianças que tiveram atrofia parênquimal grave.

Se conoce poco sobre la evolución del perímetro cefálico (PC) en niños con síndrome de Zika congénito (SZC) en los seguimientos continuos. El objetivo del estudio fue evaluar el crecimiento del PC en niños con SZC en los primeros 3 años de vida e identificar los factores asociados. Se recogieron datos del PC al nacimiento y obtenidos en las consultas de neuropediatría de 74 niños con SZC a partir de la Tarjeta del Niño, los informes de los padres y los registros médicos. Se investigaron los predictores de la puntuación Z del PC mediante diferentes modelos de efectos mixtos; se utilizó el criterio de información de Akaike para la selección del modelo. La puntuación Z del PC disminuyó de -2,7 ± 1,6 al nacer a -5,5 ± 2,2 a los 3 meses de edad, pero a partir de entonces se mantuvo relativamente estable. En el modelo ajustado seleccionado, la presencia de atrofia grave del parénquima cerebral y los síntomas maternos de infección en el primer trimestre del embarazo se asociaron con una reducción más pronunciada de la puntuación Z del PC en los primeros 3 años de vida. La disminución de la puntuación Z del PC en los niños con SZC durante los primeros 3 meses demuestra el menor potencial de crecimiento y desarrollo del sistema nervioso central de estos niños. El pronóstico del crecimiento de la cabeza en los primeros 3 años de vida es peor cuando la infección materna se produjo en el primer trimestre gestacional y en los niños que tenían una atrofia grave del parénquima cerebral.