Increase of incidence of congenital syphilis in santa catarina state between 2007-2017: temporal trend analysis / Aumento da incidência de sífilis congênita no estado de santa catarina no período de 2007 a 2017: análise da tendência temporal

ABSTRACT Objective: To estimate the incidence of congenital syphilis and temporal trends of the reported cases of the disease in the state of Santa Catarina between 2007 and 2017. Methods: Observational study with retrospective cohort design, with secondary data from the Injury of Notification Information System (SINAN). Linear trend test and geoprocessing were performed to verify the behavior of the cases in the period. Results: There were 2,898 reported cases of congenital syphilis in the period, with an average of 2.9 per 1,000 live births in the period. There was an exponential increase of 0.9 percentage points per year, considered statistically significant (p<0.001). There was no difference between the incidences of cases in the different regions of the State. The fatality rate was 8.5%, considering deaths from syphilis, miscarriages and stillbirths. The profile was predominant of white mothers, with low schooling and 11.8% did not perform prenatal care. For this reason, 26.9% of them had a diagnosis of syphilis at the time of delivery. Most of the pregnant women (51.9%) had inadequate pharmacological treatment and 65.1% of the partners were not treated. Conclusions: There was an exponential increase tendency in cases of congenital syphilis in the State of Santa Catarina in the period studied in all regions of the State, which reveals the failure of prenatal care, late diagnosis and inadequate treatment of the pregnant woman and her partner.

RESUMO Objetivo: Estimar a incidência de sífilis congênita e a tendência temporal dos casos notificados da doença no estado de Santa Catarina no período entre 2007 e 2017. Métodos: Estudo observacional com desenho de coorte retrospectiva, com dados secundários coletados no Sistema de Informação de Agravos de Notificação (SINAN). Foi realizado o teste de tendência linear e o geoprocessamento para verificar o comportamento dos casos no período. Resultados: No período, foram notificados 2.898 casos de sífilis congênita, com média de 2,9 a cada mil nascidos vivos. Houve crescimento exponencial de 0,9 ponto percentual ao ano, sendo estatisticamente significante (p<0,001). Não houve diferença entre a incidência de casos nas diferentes regiões do Estado. A taxa de letalidade foi de 8,5%, considerando os óbitos por sífilis, os abortos e os natimortos. O perfil predominante foi de mães da raça branca e com baixa escolaridade. Do total de mães analisadas, 11,8% não realizaram pré-natal - por esse motivo, 26,9% delas tiveram o diagnóstico de sífilis no momento do parto. A maioria das gestantes (51,9%) teve tratamento farmacológico inadequado e 65,1% dos parceiros não foram tratados. Conclusões: No período estudado, houve tendência de aumento exponencial dos casos de sífilis congênita em todas as regiões do Estado de Santa Catarina, o que revela a falha no pré-natal, o diagnóstico tardio e o tratamento inadequado da gestante e do seu parceiro.

Trends associated with stillbirth in a maternity hospital school in the north zone of são paulo: a cross-sectional study / Tendências associadas à natimortalidade em umamaternidadeescola na zona norte de São Paulo: um estudo transversal

Abstract Objective To evaluate conditions associated with stillbirth (SB), and possible trends related with it, in a maternity hospital school in the North zone of São Paulo. Methods An observational, cross-sectional study conducted at the Hospital Maternidade- escola de Vila Nova Cachoeirinha with 1,139 SBs in the period of 2003 to 2017. Cases of intermediate SB (ISB) (weight between 500 and 999 g) and late SB (LSB) (weight ≥ 1,000 g) were compared. We evaluated clinical data, laboratory tests, and fetal and placental studies. Data were stored in Windows Excel (Microsoft Corp., Redmond, WA, USA) worksheets, according to which graphs and tables were constructed. We used the statistical software SPSS for Windows version 18.0 (SPSS In., Chicago, IL, USA), estimating the prevalence ratio (PR) and odds ratio (OR), considering the 95% confidence interval (95% CI). Results The general SB rate was 11.9%, and the in-hospital SB rate was 2.8%. Pregnant women younger than 16 years of age were more likely to have ISB (OR 0.32, 0.15- 0.76), while patients older than 40 years old had a higher chance of LSB (PR 0.85, 0.72- 0.99). A total of 25.7% of the general population did not have prenatal care, and 77.1% of the cases presented fetal death at admission. The cases of ISB had a statistically significant association with home birth (OR 0.61, 0.46-0.80). Cesarean section was performed in 16.1% of the subjects, and misoprostol was the most used method for induction. Necropsy and placental study of the fetuses were performed, respectively, in 94.2% and 97.3% of the cases. Associated causes were not identified in 22.1% of the cases, and the main causes identified were amniotic sac infections (27.9%), fetal malformations (12.5%), placental abruption (11.2%), hypertensive syndromes (8.5%), and maternal syphilis (3.9%), the latter with an increasing trend. Conclusion Among the factors associated to SB were: hypertensive syndromes, amniotic sac infections, fetal malformations, placental abruption and syphilis. There was a growing trend in the number of cases of syphilis, which translates an alert. Diagnostic limitations justify indeterminate causes.

Resumo Objetivo Avaliar aspectos relacionados à ocorrência da condição de natimortalidade em uma maternidade-escola na zona norte de São Paulo e possíveis tendências associadas aos fatores causais. Métodos Estudo observacional, transversal, realizado no Hospital Maternidadeescola Vila Nova Cachoeirinha com 1.139 óbitos fetais (OF) no período de 2003 a 2017. Foram comparados os casos de OF intermediários (OFI) (peso entre 500 e 999 g) e OF tardios (OFT) (≥ 1,000 g). Avaliamos dados clínicos, exames laboratoriais, e estudos do feto e da placenta; estes foram armazenados em planilhas de Windows Excel (Microsoft Corp., Redmond, WA USA0, utilizando-se para avaliação estatística o programa SPSS v.18 (SPSS Inc., Chicago, IL, EUA). Foram ainda estimadas a razão de prevalência (RP) e a razão de chances (RC), com intervalo de confiança de 95% (IC 95%). Resultados Ocoeficiente de natimortalidade geral foi de 11,9% e o intra-hospitalar foi de 2,8%. Gestantes com menos de 16 anos de idade apresentaram maior chance de ter OFI (RC 0.32, 0.15-0.76) enquanto que pacientes com mais de 40 anos de idade apresentaram maior chance de OFT (RP 0,85; 0,72-0,99). Não fizeram prenatal 25,7% da população geral, sendo que em 77,1% dos casos, a morte fetal já tinha sido apresentada na internação. Os casos de OFI apresentaram associação estatisticamente significante com parto domiciliar (RC 0,42; 0,23-0,75). A cesárea foi realizada em 16,1% das pacientes, sendo o misoprostol o método mais utilizado para indução. Necropsia foi feita em 94,2% dos fetos, e 97,3% das placentas foram para estudo. As causas associadas não foram identificadas em 22,1% dos casos, sendo que as principais causas identificadas foram infecções do saco amniótico e membranas (27,9%), malformações (12,5%), descolamento prematuro de placenta (11,2%), síndromes hipertensivas (8,5%), e sífilis (3,9%), sendo esta última com uma tendência crescente. Conclusão Destacaram-se como fatores associados à natimortalidade: síndromes hipertensivas, corioamnionites, malformações fetais, descolamento placentário e sífilis. Houve tendência de aumento no número de casos de sífilis, o que traduz uma alerta. Limitações diagnósticas justificam as causas indeterminadas.

Obstetric profile of perinatal deaths on a capital of the Northeast of Brazil / Perfil obstétrico dos óbitos perinatais em uma capital do Nordeste Brasileiro

Abstract Objectives: to analyze the obstetric and sociodemographic profile on perinatal deaths in Teresina the capital of Piauí, from data obtained from the Sistema de Informação de Mortalidade e Sistema de Informação de Nascidos Vivos (Brazilian Mortality Information System and Livebirth Information System). Methods: this is a retrospective cohort on perinatal deaths of mothers whose babies were born and resided in Teresina between 2010 and 2014. The analyzed variables were age and the mother´s schooling, gestational age, type of pregnancy (singleton or multiple), route of delivery (vaginal or cesarean), place of death (in and out hospital), time of death in relation to the delivery (prior, during or after), and birth weight. Results: the perinatal mortality coefficient (PMC) varied from 17.5 to 19.3 per 1,000 births. We found similarities in the sociodemographic profile and in the obstetric fetal and non-fetal deaths, both with a great incidence on 20 to 27 years-old mothers, vaginal delivery and singleton pregnancy. Low birth weight was positively related to early neonatal deaths. Conclusions: perinatal mortality presented a statistical correlation in gestational age, birth weight, and type of delivery. The PMC in our study was higher than other Brazilian capitals.

Resumo Objetivos: analisar o perfil obstétrico e sociodemográfico dos óbitos perinatais ocorridos em Teresina, capital do Piauí, a partir de dados provenientes dos Sistema de Informação de Mortalidade e Sistema de Informação de Nascidos Vivos. Métodos: coorte retrospectiva de óbitos perinatais nascidos de mães residentes em Teresina, entre 2010 e 2014. As variáveis analisadas foram faixa etária e escolaridade da mãe, idade gestacional, tipo de gravidez (única ou múltipla), via de parto (vaginal ou cesáreo), local do óbito (intra ou extra-hospitalar), momento do óbito em relação ao parto (antes, durante ou após), e peso do concepto. Resultados: o coeficiente de mortalidade perinatal (CMP) variou entre 17,5 e 19,3 por mil nascidos. Verificaram-se semelhanças quanto ao perfil sociodemográfico e obstétrico dos óbitos fetais e não fetais, ambos com maior incidência em mães com faixa etária entre 20 e 27 anos, em parto vaginal e no tipo de gravidez única. Baixo peso ao nascer se relacionou positivamente com os óbitos neonatais precoces. Conclusões: a mortalidade perinatal apresentou correlação estatística com a idade gestacional, o peso ao nascer, e o tipo de parto. O CMP no nosso estudo foi mais elevado do que o de outras capitais brasileiras.

Prevalence of stillbirth at the Buea Regional Hospital, Fako Division south-west region, Cameroon

Introduction: the study investigated the prevalence of stillbirth at the Buea Regional Hospital, by taking cases of pregnant women who attended antenatal clinic(s) and those who did not attend but had thier deiveries at the Buea regional hospital. The study specifically estimated the prevalence of stillbirths; identified possible risk factors associated with stillbirths, and determined whether the number of antenatal clinic visits is related to the occurrence of stillbirths-because during antenatal clinic visits, pregnant women are educated on risk factors of stillbirths such as: preterm deliveries; sex of the stillbirth; history of stillbirth; history of abortion(s); what age group of mothers are more likely to have a stillbirth.Methods: the study was a hospital based retrospective study at the maternity in which there were 3577 deliveries registered at the Buea Regional Hospital dated May 1st, 2014 to April 30th, 2017. With the aid of a checklist data was collected, analysed and presented with the use of tables, pie-charts and bar charts.Results: the prevalence of stillbirths was 26‰; possible risk factors associated with stillbirths included: preterm deliveries; women aged 20-29 years; history of abortion(s); a history of stillbirth; sex of stilbirths were more of females than males; and insufficient antenatal clinic attendance (≤1 antenatal clinic attendence) had more stillbirths. Conclusion: the study estabished that stillbirths can occur in any woman of child-bearing age. possible risk factors associated with stillbirths included: preterm deliveries; women aged 20-29 years; history of abortion(s); a history of stillbirth; gender of stilbirths were more of females than males; and insufficient antenatal clinic attendance (≤1 antenatal clinic attendence) had more stillbirths

Stillbirth prevalence in Brazil: an exploration of regional differences / Prevalência de natimortos no Brasil: investigação de diferenças regionais

Abstract Objective Brazil is a large, heterogeneous, and diverse country, marked by social, economic, and regional inequalities. Stillbirth is a global concern, especially in low- and middle-income countries. This study investigated the prevalence and possible determinants of stillbirth in different regions of Brazil. Methods This is a cross-sectional study including all women of reproductive age who had had a pregnancy in the last five years, enrolled in the most recent Brazilian Demographic and Health Survey (DHS/PNDS-2006/07). Logistic regression was used to assess the association between region and other maternal characteristics and stillbirth risk. Results The prevalence of stillbirth in Brazil was 14.82 per 1000 births, with great variation by region of the country, and a higher prevalence among the most deprived. The North and Northeast regions had the highest odds of stillbirth compared to the Center-West, which persisted after adjustment for multiple confounders - including deprivation level and ethnicity. Low maternal age and maternal obesity were also related to higher odds of stillbirth. Conclusion In Brazil, the region influences stillbirth risk, with much higher risk in the North and Northeast. Variation in socioeconomic level does not explain this finding. Further research on the subject should explore other possible explanations, such as antenatal care and type of delivery, as well as the role of the private and public health systems in determining stillbirth. Preventive strategies should be directed to these historically disadvantaged regions, such as guaranteeing access and quality of care during pregnancy and around the time of birth.

Resumo Objetivo O Brasil é um país grande, heterogêneo e diverso, marcado por desigualdades sociais, econômicas e regionais. A natimortalidade é uma preocupação global, principalmente em países de renda baixa e média. Este estudo investigou a prevalência e os possíveis determinantes da natimortalidade em diferentes regiões do Brasil. Métodos Estudo transversal que incluiu todas as mulheres em idade reprodutiva que estiveram grávidas nos últimos cinco anos registradas na Pesquisa Nacional sobre Demografia e Saúde (PNDS-2006/07). A regressão logística foi usada para avaliar a relação entre região e outras características maternas e risco de natimortalidade. Resultados A prevalência de natimortos no Brasil foi de 14,82 a cada 1.000 nascimentos, com grande variação de acordo com a região do país e uma prevalência mais alta entre as mais precárias. As regiões Norte e Nordeste tiveram as taxas de natimortalidade mais altas em comparação com a região Centro-Oeste, que perdurou após o ajuste das diversas variáveis de confusão - inclusive nível de pobreza e etnia. A baixa idade e a obesidade maternas também estavam relacionadas a taxas de natimortalidade mais elevadas. Conclusão No Brasil, a região influencia o risco de natimortalidade, com riscos muito mais altos no Norte e no Nordeste. A variação no nível de pobreza não explica esse achado. Futuras pesquisas sobre o assunto devem explorar outras possíveis explicações, como cuidado pré-natal e tipo de parto, bem como o papel dos sistemas de saúde público e privado com relação à natimortalidade. As estratégias de prevenção devem ser direcionadas a essas regiões historicamente desfavorecidas, como garantir acesso e qualidade da assistência durante a gravidez e perto do momento do nascimento.

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

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

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

Óbitos perinatais evitáveis por intervenções do Sistema Único de Saúde do Brasil / Muertes perinatales evitables por intervención del Sistema de Salud Pública / Perinatal deaths preventable by intervention of the Unified Health System of Brazil

Resumo OBJETIVO Descrever características epidemiológicas dos óbitos perinatais por ações do Sistema Público de Saúde. MÉTODOS Estudo descritivo de análise temporal, população composta por óbitos perinatais de mães residentes no Recife, 2010-2014. Utilizado Lista de causas de mortes evitáveis para classificar a evitabilidade e EpiInfo versão 7 para análise das variáveis. RESULTADOS Ocorreram 1.756 óbitos perinatais (1.019 fetais e 737 neonatais precoce), observou-se redução dos óbitos neonatais precoces (-15,8%) e aumento dos fetais (12,1%). Apresentou como principais causas: feto e recém-nascido afetado por afecção materna e asfixia/hipóxia ao nascer. CONCLUSÕES A maior parte dos óbitos foi evitável, concentrando-se no grupamento de assistência adequada dispensada à mulher na gestação. Lacunas na assistência dispensada à mulher no parto, explicam o percentual de asfixia/hipóxia. Redução da mortalidade perinatal evitável associa-se à ampliação do acesso e qualidade da assistência para garantir promoção, prevenção, tratamento, cuidados específicos e oportunos.

Resumen OBJETIVO Describir las características epidemiológicas de las muertes perinatales por acciones del Sistema de Salud Pública. MÉTODOS Estudio descriptivo del análisis temporal, población compuesta por muertes perinatales de madres residentes en Recife, 2010-2014. Lista de causas de muertes evitables para clasificar la evitación y, EpiInfo versión 7 para el análisis de variables. RESULTADOS Hubo 1.756 muertes perinatales (1.019 fetales, 737 prematuros neonatos), reducción de muertes neonatales tempranas (-15,8%) y aumento fetal (12,1%). Principales causas: feto y recién-nacido afectados por afección materna y asfixia / hipoxia al nacer. CONCLUSIONES La mayoría de las muertes fueron evitables, concentrándose en la agrupación adecuada de la atención prestada a la mujer durante el embarazo. Las fallas en el cuidado dado a la mujer al nacer explican el porcentaje de asfixia/hipoxia. La reducción de la mortalidad perinatal prevenible se asocia con un mayor acceso y calidad de atención para asegurar la promoción, prevención, tratamiento y atención específica y oportuna.

Abstract OBJECTIVE To describe the epidemiological characteristics of perinatal deaths through the actions of the Unified Health System. METHODS This is a descriptive study of temporal analysis with a population of perinatal deaths of mothers residing in Recife, Brazil, from 2010 to 2014. A list was used to classify the preventable diseases and the variables were analysed using Epi lnfo™ version 7 RESULTS The perinatal deaths totalled 1,756 (1,019 foetal and 737 neonatal premature) with a reduction of neonatal deaths (-15.8%) and an increase of foetal deaths (12.1%) in the study period. The main causes of death were foetus and newborn affected by the mother´s condition and asphyxia/hypoxia at birth. CONCLUSIONS Most deaths were avoidable, especially in the group of appropriate care to mothers during pregnancy. Faults in the care provided to women at birth explain the percentage of deaths caused by asphyxia/hypoxia. The reduction of preventable perinatal mortality is associated with the increased access and quality of care, which ensures health promotion, disease prevention, treatment and specific and timely care.

Incidence and determinants of stillbirth among women who gave birth in Jimma University specialized hospital, Ethiopia

Introduction: worldwide approximately 2.7 million are stillborn, more than 98% of these occur in developing countries. To address the problem, incidence and determinants of stillbirth must be understood. Therefore the aim of this study was to assess incidence and determinants of stillbirth among women who gave birth in Jimma University specialized hospital.Methods: a cross-sectional study design among 413 mothers who gave birth in Jimma specialized hospital was employed. Study subjects were selected by systematic sampling technique from the list of women who gave birth in hospital in one month study period. Data were collected by using pretested and structured questionnaire. Data were edited, cleaned, coded, entered and analyzed using SPSS-20 statistical software. Univarate and bivariate (logistic regressions) analysis was employed.Results: the incidence rate of stillbirth in the Hospital during a month period was 8% or 80 per 1000 total births. The predictors that showed an independent close association with stillbirth were absence of complication (OR = 0.1, 95% CI (0.04-0.2)), referral from other health facility (OR = 0.3, 95% CI (0.1-0.7)), having antenatal care (OR = 0.3, 95% CI (0.1-0.7)) and normal vaginal delivery (OR = 0.2, 95% CI ( 0.1-0.8)). Conclusion: the incidence rate of stillbirths in our setting is high and the identified determinants were related to both ante-partum and intra-partum-period. Therefore, effort should be made to improve antenatal, obstetric services and delivery services in terms awareness, access, timing and referral system to emergency care and specialized service to reduce the number of stillbirths

Método de clasificación de mortinatos según condición obstétrica relevante de la muerte fetal, en un hospital público de Chile (Método CORM) / A new fetal death classification system

Background: Stillbirth is the mayor contributor to perinatal mortality. Aim: To report a system for classification of fetal deaths. Material and Methods: Retrospective cohort study of 29,916 births with 258 fetal deaths that occurred in a public hospital. Data were obtained from audit reports of stillbirths. The method for classification “obstetric condition relevant to the death” was applied, based on obstetric and placental pathological findings analyzed exclusively by a single obstetrician and a single pathologist. Results: Ninety two percent of obstetric conditions causing fetal death were identified. The most commonly reported were ascending bacterial infection in 26%, congenital anomalies in 19%, arterial hypertension in 12% and placental pathology in 12%. Fetal growth restriction was identified in 50% of stillbirths. Ninety percent were secondary to a primary obstetric condition and 10% had an unexplained cause. Placental abruption as the final cause of fetal death was identified in 60% of cases with arterial hypertension, 43% of cases with placental pathology and 37% of ascending infections. Fetal deaths occurred during pregnancy in 82% of cases and during labor in 17%. Intrapartum asphyxia occurred in 0.8% of stillbirths and presented in term pregnancies. Conclusions: The “obstetric condition relevant to the death” method for classification of fetal death is effective to identify the originating obstetric cause of stillbirth and reduces the impact of fetal growth restriction and intrapartum asphyxia as the leading causes of death.

Informe epidemiológico nº 15 – semana epidemiológica (se) 08 /2016 (21 a 27 /02 /201 6) monitoramento dos casos de microcefalia no Brasil / Epidemiological report 15 - epidemiological week (if) 08/2016 (21-27 / 02/201 6) monitoring of cases of microcephaly in Brazil

Este documento constam as informações epidemiológicas referentes à microcefalia e/ou alterações do SNC, previstas nas definições vigentes no “Protocolo de Vigilância e Resposta à Ocorrência de MicrocefaliaVersão 1.3/2016”, disponível no site www.saude.gov.br/svs.

Natimorto: uma revisão dos sistemas de classificação / Stillbirth: a review of the classification systems

A contagem dos natimortos é fundamental para avaliação do cuidado obstétrico. No mundo, são mais de três milhões e, no Brasil mais, de 30.000 por ano. Entretanto, não basta contá-los, é preciso analisar os números para compreender melhor o problema e com este objetivo já foram criados mais de 34 sistemas de classificação de natimortos. Foi consultada a Bireme (www.bireme.br) para identificação dos Descritores em Ciências da Saúde e foram selecionados "natimorto" e "classificação" com seus correspondentes em inglês "stillbirth" e "classification". Foram utilizadas as bases de dados Lilacs e PubMed. Foram identificadas, por ordem cronológica, nove sistemas de classificação de natimortos. Não existe sistema de classificação de natimortos perfeito ou ideal, devido a que cada um difere dos demais pelo modelo que constrói para a análise, dando prioridade à causa ou a fatores que pretendem auxiliar prioritariamente na gestão do sistema de saúde. Hoje, na Inglaterra, são utilizados três sistemas de classificação de natimortos e alguns países europeus têm sistemas próprios (Noruega, Suécia) bem como a Austrália e Nova Zelândia. No Brasil, o Ministério da Saúde adotou a classificação de Wigglesworth modificada. Recomenda-se sua adoção e avaliação do seu desempenho.(AU)

The counting of stillbirths is fundamental to assess birth care. There are more than three million stillbirths in the world and more than 30,000 in Brazil per year. However, it is not enough to count them, we must analyze the numbers to better understand the problem and with this objective have already been created more than 34 stillborn classification systems. Bireme (www.birem.br) was consulted for identification of Health Sciences descriptors and were selected "stillbirth" and "classification" with their corresponding in Portuguese "natimorto" and "classificação". Lilacs and PubMed were the databases consulted. Nine stillborn classification systems were identified in chronological order, There is no perfect ranking system or ideal stillborn classification due to difference among them by the model building for analysis, giving priority to the cause, or factors that aim to assist primarily in the management of the health system. Today, in England, three classification systems of stillbirths are used and some European countries have their own systems (Norway, Sweden) as well as Australia and New Zealand. In Brazil, the Ministry of Health adopted the modified Willgesworth classification. Its use is recommended as well as the evaluation of its performance.(AU)

Resultados obstétricos e perinatais subsequentes à morte intrauterina na primeira gravidez / Obstetric and perinatal outcomes after intrauterine death in the first pregnancy

Introdução: A história de um óbito fetal apresenta risco aumentado do mesmo evento nas gravidezes subsequentes, ainda que existam resultados conflitantes quanto à taxa de prematuridade e de recém-natos de baixo peso. O objetivo do estudo foi avaliar os resultados obstétricos e perinatais de pacientes secundíparas que apresentaram morte fetal na gravidez anterior. Métodos: Trata-se de um estudo do tipo caso-controle, com seleção de casos incidentes e controles consecutivos, realizado no período de Março/1998 a Dezembro/2008, em que foram analisadas variáveis maternas e perinatais. Para a análise estatística utilizaram-se médias, desvios padrões, teste T de Student e Mann-Whitney para variáveis numéricas, qui-quadrado para variáveis categóricas e estimativa de risco pelo Odds Ratio com IC95%. Para todos os testes foi adotado nível de significância (alfa) de 5%. Resultados: De um total de 15.450 gestantes, foram selecionadas 58 gestantes (0,38%) secundíparas cuja primeira gestação tenha sido relacionada a óbito fetal. Os fatores de exposição identificados foram recém-nascidos com peso ≤2.500g [12(20,7%) vs. 4(2,3%); p<0,0001; OR 11,1], internação em ambiente de intensivismo neonatal [15(27,8%) vs. 22(13,0%); p<0,05; OR 2,4] e neomortalidade precoce [5(8,9%) vs. 2(1,2); p<0,01; OR 8,1], na gestação subsequente. Não foi observada associação com índices de Apgar <7 no 1º e 5º minutos, recorrência do óbito fetal e ocorrência de síndrome hipertensiva. Conclusão: Os fatores de exposição foram maior incidência de neonatos de baixo peso, de internação em ambiente de intensivismo neonatal e de neomortalidade precoce (AU)

Introduction: The history of a stillbirth increases the risk of the same event in subsequent pregnancies, although there are conflicting results regarding the rate of premature and newborn babies of low birth weight. The aim of this study was to evaluate the obstetric and perinatal outcome of secundiparous women who presented fetal death in previous pregnancy. Methods: This is a case-control study, with selection of incident cases and consecutive controls conducted from Mar 1998 to Dec 2008, in which maternal and perinatal variables were analyzed. For the statistical analysis we used means, standard deviations, Student's t test and Mann-Whitney test for numeric variables, chi-square test for categorical variables, and odds ratios with 95% CI for risk estimate. The level of significance (alpha) was 5% for all tests. Results: From a total of 15,450 pregnant women, we selected 58 secundiparous women (0.38%) whose first pregnancy was associated with fetal death. The exposure factors found were infants weighing ≤ 2,500 g [12 (20.7%) vs. 4 (2.3%), p <0.0001, OR 11.1], admission to neonatal intensive care environment [15 (27.8%) vs. 22 (13.0%), p <0.05, OR 2.4] and early neonatal mortality [5 (8.9%) vs. 2 (1.2), p <0.01, OR 8.1] in the subsequent pregnancy. No association was observed with Apgar scores <7 at 1 and 5 minutes, recurrent fetal death and occurrence of hypertensive syndrome. Conclusion: The exposure factors were higher incidence of low birth weight newborns, admission to neonatal intensive care environment, and early neonatal mortality (AU)

Malformaciones congénitas en Chile y Latino América: Una visión epidemiológica del ECLAMC del período 1995-2008 / Congenital malformations in Latin America in the period 1995-2008

Background: The Latin American Study of Congenital Malformations (ECLAMC) hasperformed an epidemiológica! surveillance of congenital malformations since 1967. This allows to detectany unexpected change in the incidence of malformations, possibly caused by a new environmental teratogenic agent. Aim: To report a summary ofthe results thusfar obtained in this study. Material ana Methods: The ECLAMC datábase was analyzed and all Uve births and stillbirths ofmore than 500 grams in the period 1995-2008, were analyzed. Results: There were 2,409,407 births in the nine participant countries. Ofthese 31,516 (1.3 percent) were stillbirths. The global rate of congenital malformations in this sample was 2.7 percent. In the studied period, there was a significant reduction in the rates of anencephaly and spina bifida in Chile and Argentina. In the rest ofthe countries, the global rates of malformations increased. Venezuela had the higher rate of teenage pregnancies (25 percent), followed by Colombia (23 percent). Chile had the higherpercentage ofwomen aged 35years or moregiving birth (14 percent), followed by Uruguay (13 percent). However, Chile had the higher rate of Down syndrome and Uruguay, the lowest (24.7 and 13.6per 10000). Conclusions: There is a tendency towards an increase in the rates of congenital malformations in this sample, with significant differences among countries.

Congenital malformations at birth in Central India: A rural medical college hospital based data.

OBJECTIVE: To study the incidence of congenital anomalies and the associated risk factors in Department of Pediatrics at Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, a rural medical college hospital in central Maharashtra. MATERIALS AND METHODS: All the intramural deliveries between 1 January 2005 and 31 July 2007 comprised 9386 births and their 9324 mothers (62 mothers gave birth to twin babies). The newborns were examined and assessed systematically for the presence of congenital anomalies, system wise distribution of anomalies and risk factors attributable. RESULTS: Out of the total 9386 deliveries, 9194 were live births and 192 were stillbirths. The total number of babies with congenital malformations was 179 (1.91%). Out of the 9262 singleton births, 177 (1.05%) were malformed, whereas 2 of the 62 pairs of twins had birth defects. Nine of the 179 malformed babies (5.02%) were still born. Prematurity, increased maternal age, increasing birth order and low birth weight were found to have a higher risk of congenital anomalies. Cardiovascular malformations were most common in live births, followed by musculoskeletal and genitourinary anomalies. CONCLUSION: Congenital anomalies are a major cause of stillbirths and infant mortality. Evaluation of cardiovascular system to rule out congenital heart disease in high-risk mothers’ babies is the important factor to be considered.

Translucencia nucal aumentada y cariotipo normal / Increased nuchal translucency and normal kariotype

Antecedentes: La exploración ecográfica entre las semanas 11 y 14 tiene un papel fundamental en el cribado de anomalías cromosómicas, siendo la medida de la translucencia nucal un método bien establecido y ampliamente aceptado para este fin. Objetivo: Evaluar retrospectivamente la evolución de los fetos con translucencia nucal aumentada y cariotipo normal. Método: Se recogieron los datos de 104 fetos con TN >percentil 95 (p95) entre las semanas 11 y 14, evaluados en nuestro centro. En los 61 que resultaron eu-ploides, se estudió la incidencia de anomalías estructurales diagnosticadas tanto prenatalmente como tras el nacimiento, así como las pérdidas fetales anteparto. De estos fetos, nacieron sanos el 80 por ciento cuando la TN estaba entre p95 y 3,4 mm, el 50 por ciento con TN entre 3,5 y 4,4 mm, el 30 por ciento con TN entre 4,5 y 5,4 mm, y el 18 por ciento con TN > 5,5 mm. Entre los 4 recién nacidos euploides con patología, hubo 3 con cardiopatía. Conclusión: La presencia de TN aumentada entre las 11 -14 semanas en fetos euploides se asocia a un incremento del riesgo de anomalías estructurales mayores, principalmente cardiacas. La prevalencia de malformaciones aumenta significativamente con TN >3,5 mm, y el pronóstico gestacional adverso empeora conforme aumenta la medida de la TN.

Background: Ultrasound scan has a main role at the 11-14 weeks screening for chromosomal abnormalities. The measurement of nuchal translucency (NT) thickness is a widespread stablished method to achieve this target. Objective: To assess retrospectively the outcome of fetuses with increased nuchal translucency and normal karyotype. Method: Data were collected from 104 fetuses with NT > 95th percentile at 11 to 14 weeks of gestation, followed in our institution. The sixty one euploid fetuses were studied in order to determine the incidence of structural abnormalities, diagnosed either before or after delivery, as well as antenatal fetal loss. Among these fetuses, there were no malformations at birth in 80 percent for NT between the 95th percentile and 3.4 mm; 50 percent for NT between 3.5 and 4.4 mm; 30 percent for NT of 4.5-5.4 mm; and 18 percent for NT > 5.5 mm. There were 4 euploid newborns with some kind of structural defect at birth, 3 of them presented a cardiac malformation. Conclusion: The presence of increased NT at 11-14 weeks scan in euploid fetuses it's associated with a higher risk of major structural abnormalities, mainly cardiac ones. The prevalence of malformations is significantly increased for NT > 3.5 mm, and the adverse perinatal outcome is directly associated with the thickness of NT.

[Determinants of neonatal mortality in a Tunisian population]

In Tunisia, perinatal mortality remains a public health problem, currently estimated at 28%, including 15% of still birth rate and 10 to 15% of early neonatal mortality rate. The recent investigations show that about half of the deaths at less than five years old are of perinatal origin and that neonatal mortality represents two thirds of infant mortality. Published data regarding neonatal mortality and the causes of death are sparse. to evaluate the neonatal mortality rate over a 2 year period in our population study and to present data collected prospectively on the risk factors and the causes of all neonatal deaths. a prospective cohort compiling all live births reported between January 2007 and December 2008 at Charles Nicolle hospital [Tunis-Tunisia]. All the neonatal deaths that occurred before or after discharge or transferred to other hospitals and subsequently died are included. Births from termination of pregnancy were excluded from all the analyses. Causes of deaths were assigned according the International Classification of Diseases, Tenth Revision [ICD10]. 88 neonatal deaths were recorded over 7285 live births [LB] that is a NMR of 12%o LB. Early neonatal death occurred in 79 cases [88.7%], that is an ENMR of 10.8%o LB. Risk factors directly related to neonatal mortality were prematurity [aOR=6.03- 95%CI: [2-18.13] p=0.001], neonatal respiratory distress [aOR=16.12 - 95%CI: [5.67-45.78] p<10 [-3]], perinatal asphyxia [aOR=11.49- 95%CI: [3.68-35.92] p<10[-3]], nosocomial infection aOR=8.71- 95%CI: [1.77-42.70] p=0.008, and small for gestational age aOR-7.11- 95%CI: [2.23-22.69] p=0.001. 80.6% of underlying causes and 88.6% of immediate causes of death are gathered in the chapter [Certain conditions originating in the perinatal period]. Maternal hypertensive disorders and extreme immaturity due to spontaneous prematurity were respectively responsible for 13.6% and 10.2% of underlying causes of neonatal death. Neonatal mortality remains high, dominated by the conditions originating in the perinatal period. The multitude of the risk factors implies the need for a multidisciplinary strategy of intervention, engaging the pre and perinatal prevention