Desfechos obstétricos adversos durante a COVID-19: uma série de casos retrospectiva / Adverse obstetric outcomes during COVID-19: a retrospective case series / Resultados obstétricos adversos durante el COVID-19: serie de casos retrospectiva

Objetivo: analisar as características e os desfechos obstétricos adversos em gestantes/puérperas infectadas pelo SARS-CoV-2 em serviço de referência. Método: série de casos retrospectiva entre gestantes com Covid-19 em um hospital universitário em Minas Gerais, Brasil, atendidas no serviço de 2020 a 2021, coletados em abril de 2022, empregando-se estatística descritiva para análise dos dados através do Statistical Package for the Social Science. Resultados: incluídas 26 gestantes, em sua maioria brancas, que tiveram como principais desfechos obstétricos adversos a internação em UTI (43,5%), parto prematuro (34,6%), dado reestratificado de semanas para dias para investigar o encurtamento da gestação, onde constatou-se média de 38,6 dias potenciais de gravidez perdidos dos 280 dias ideais, e ainda 15,4% evoluíram para óbito materno. Conclusão: o estudo proporcionou evidenciar a necessidade de vigilância e atenção às gestantes com foco nos principais desfechos adversos, podendo-se intervir em tempo oportuno para diminuir adversidades.

Objective: to analyze the characteristics and adverse obstetric outcomes in pregnant/puerperal women infected by SARS-CoV-2 at a reference service. Method: a retrospective case series conducted among pregnant women with Covid-19 in a university hospital from Minas Gerais, Brazil, treated at the service from 2020 to 2021. The cases were collected in April 2022 employing descriptive statistics for data analysis in the Statistical Package for the Social Science. Results: a total of 26 pregnant women were included, mostly white-skinned, whose main adverse obstetric outcomes were admission to the ICU (43.5%), premature birth (34.6%) and data restratified from weeks to days to investigate shortening of pregnancy, where a mean of 38.6 potential days of pregnancy were lost out of the ideal 280 days, and 15.4% resulted in maternal death. Conclusion: the study provided evidence of the need for surveillance and care for pregnant women with a focus on the main adverse outcomes, enabling timely intervention to reduce adversities.

Objetivo: analizar las características y resultados obstétricos adversos en gestantes/puérperas infectadas por SARS-CoV-2 en un servicio de referencia. Método: serie de casos retrospectiva entre gestantes con Covid-19 en un hospital universitario de Minas Gerais, Brasil, atendidas en el servicio de 2020 a 2021. Los datos se recolectaron en abril de 2022, se utilizó estadística descriptiva para analizar los datos mediante el Statistical Package for the Social Science. Resultados: se incluyeron 26 gestantes, la mayoría de raza blanca, cuyos principales resultados obstétricos adversos fueron ingreso a UCI (43,5%), parto prematuro (34,6%), dato reestratificado de semanas a días para investigar el acortamiento de la gestación, que arrojó como resultado un promedio de 38,6. Se comprobó que se perdieron en promedio 38,6 días potenciales de embarazo de los 280 días ideales, y muerte materna (15,4%). Conclusión: la evidencia que proporcionó el estudio indica que es necesario vigilar y atender a las gestantes enfocándose en los principales resultados adversos, lo que permite intervenir de forma oportuna para reducir adversidades.

Descripción de una población de embarazadas con incompatibilidad Rh (D) / Description of a population of pregnant women with Rh (D) incompatibility

Resumen OBJETIVO: Describir los desenlaces maternos y perinatales en embarazadas con incompatibilidad Rh D. MATERIALES Y MÉTODOS: Estudio de cohorte retrospectiva efectuado en la Unidad Materno Infantil de Medellín, Colombia, en pacientes embarazadas atendidas entre 2013 y 2018 con incompatibilidad Rh. Se realizó un muestreo no probabilístico de casos consecutivos y un análisis univariado. RESULTADOS: Se incluyeron 250 pacientes con mediana de edad de 26 años y tipo de sangre O-, que fue el más prevalente (55.2%). El 49.2% de las pacientes había tenido entre 2 y 3 embarazos previos. El 88% de las pacientes no había tenido ningún evento sensibilizante durante el embarazo. El 65.2% tuvo un reporte negativo del primer Coombs y la media de semanas de embarazo al primer Coombs fue de 28. El 48% de las pacientes recibió la inmunoglobulina G anti-D a una mediana de 28 semanas de gestación. CONCLUSIÓN: El estudio confirma datos clínicos y sociodemográficos y sugiere que se requiere fortalecer la oportunidad en la captación temprana de las pacientes para el seguimiento con el Coombs y para la indicación de la profilaxis.

Abstract OBJECTIVE: To determine the maternal and fetal outcomes in pregnant women with Rh D incompatibility. MATERIALS AND METHODS: A Retrospective cohort study carried out in the Maternal and Child Unit of Medellín, Colombia, in pregnant patients attended between 2013 and 2018. RESULTS: 250 patients were included, in which the median age was 26 years. The O- blood type was the most prevalent in pregnant women with 55.2% and 49.2% of the patients had had between 2 and 3 previous pregnancies, in addition, 88% of the patients had not presented any sensitizing event during her pregnancy. 65.2% had a negative first Coombs result and the mean gestational age of the first Coombs was 28 weeks. 48% of patients received immunoglobulin G anti D at a median gestational age of 28 weeks. CONCLUSION: The present study confirms the clinical and sociodemographic data, however it suggests that it may be necessary to strengthen the opportunity in the early recruitment of patients for follow-up with Coombs and for the indication of prophylaxis.

Human error causing inappropriate management of pregnancy associated breast cancer, literature review and experience in Niger delta university teaching hospital, Okolobiri, Bayelsa state, Nigeria

Breast cancer is the commonest cancer in women in Nigeria. Pregnancy Associated Breast Cancer (PABC) is breast cancer occurring in pregnancy up to one year after delivery. Due to some misconceptions, mistakes occur in the management of these patients leading to poor outcomes. There may be difficulties in the diagnosis of PABC due to the clinical features being mistaken for the normal physiologic changes of pregnancy. The physiologic changes may interfere with radiological and pathological interpretations. Fine needle aspiration cytology (FNAC) or a trucut biopsy confirms the diagnosis. There have been debates on maternal versus foetal wellbeing in PABC. Chemotherapy is safe after 10 weeks of pregnancy when organogenesis is complete. Delaying chemotherapy till after pregnancy worsens the prognosis. Hormonal treatment is contraindicated in PABC. Method: This is a retrospective observational study of cases of PABC at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria, from January 2019 to January 2021. Results: Seven cases were seen with ages ranging from 28 to 37. All patients presented with breast lumps. Diagnosis was by FNAC and trucut biopsy. None of the patients received care for the cancer during pregnancy as they were advised by their doctors not to and to present after delivery due to the percermived haful effects of treatment on the foetus. All seven patients presented with advanced stage disease after delivery. They all received chemotherapy and hormonal therapy. Eventually all patients were lost to follow up. Conclusion: Patients diagnosed with PABC in peripheral hospitals should be referred for specialist care. Treatment modalities like surgery and chemotherapy are feasible in PABC and should not be unduly delayed. Continuing education on the topic and feedback to colleagues at peripheral hospitals should be ensured

Validez de contenido de lineamientos de ejercicio físico para mujeres embarazadas / Content validity of guidelines for physical exercise for pregnant

Objetivo: determinar la validez de contenido del procedimiento ejercicio físico para mujeres embarazadas 2018. La prescripción del ejercicio físico en mujeres embarazadas es una de las actividades que mayores beneficios fisiológicos y psicosociales trae a la mujer y al niño. Materiales y métodos: estudio descriptivo. Valoración de contenido con la técnica de juicio de expertos. Resultados: se obtuvo un valor promedio de coeficientes kappa para la dimensión de examen de 0,64 y para la dimensión de intervención de 0,75. El índice kappa para el instrumento fue de 0,69 (acuerdo sustancial).Adicionalmente, para la dimensión de examen fisioterapéutico se obtuvieron valores de proporción de acuerdo medio (̅P a) que superan el umbral de concordancia sustancial, excepto la propiedad de claridad. En la dimensión de intervención los valores de (̅Pa) indican que todas las propiedades de la intervención fisioterapéutica superan el umbral de concordancia sustancial. Conclusiones: el ejercicio físico es una práctica fundamental durante el embarazo, su aplicación requiere de un examen riguroso que conlleve a una intervención individualizada donde se reconozcan los antecedentes de la mujer para así determinar la intensidad adecuada de la prescripción. A partir del procedimiento "lineamientos de ejercicio físico en mujeres embarazadas" los profesionales contarán con una herramienta basada en evidencia científica que incluye una fase de examen y una fase de intervención..Au

Objective: to determine the content validity of the procedure guidelines for physical exercise for pregnant women 2018. Prescribing physical exercise in pregnant women is one of the recommendations that brings the greatest physiological and psychosocial benefits to women and children. Materials and methods: descriptive study. Content validity with expert judgment technique. Results: an average value of kappa coefficients was obtained for the examination dimension of 0.64 and for the intervention dimension of 0.75. The Kappa index for the instrument was 0.69 (substantial agreement). Additionally, for the physiotherapeutic examination dimension, mean agreement ratio (̅P a) values were obtained that exceed the threshold of substantial agreement except the property of clarity. In the intervention dimension, the values of (̅Pa) indicate that all the properties of the physiotherapeutic intervention exceed the threshold of substantial agreement. Conclusions: physical exercise is a fundamental practice during pregnancy, its application requires a rigorous examination that leads to an individualized intervention where the woman's history is recognized in order to determine the appropriate intensity of the prescription. Starting with the procedure "Guidelines for physical exercise in pregnant women", professionals will have a tool based on scientific evidence that includes an examination phase and an intervention phase..Au

The characteristics of adolescent pregnancy in Wenzhou from 2015 to 2019 / 预防医学

Objective@#To learn the characteristics of adolescent pregnancy in Wenzhou from 2015 to 2019, so as to provide basis for protecting adolescent physical and mental health. @*Methods@#Data of demographic characteristics, pregnancy and delivery outcomes of the women aged under 19 years ( adolescent pregnant ) and 20 to 34 years ( right-age pregnant ) who delivered in Wenzhou from 2015 to 2019 were collected from Wenzhou Maternal and Child Health Information Management System. The incidence of pregnancy complication, comorbidity and adverse delivery outcomes of adolescent pregnant women was compared with that of right-age pregnant women.@*Results@#Among 536 753 parturients reported in Wenzhou from 2015 to 2019, there were 22 419 ( 4.18% ) of adolescent pregnancy and 430 163 ( 80.14% ) of right-age pregnancy. The average age of adolescent pregnant women was (18.11±0.82) years ( range, 10-19 years ). The majority of adolescent pregnant women were migrant population (19 437 cases, 86.70%), had an education level of junior high school and below ( 18 594 cases, 82.94% ), and had no occupation (19 192 cases, 85.61%). The incidence rates of anemia, gestational diabetes, postpartum hemorrhage, perineal laceration and premature delivery in adolescent pregnant women increased from 2015 to 2019 ( all P<0.05 ). The incidence rates of gestational diabetes, anemia, gestational hypertension, placental abruption, postpartum hemorrhage, perineal laceration, premature delivery, low birth weight, fetal death and stillbirth were 1.65%, 11.76%, 0.19%, 0.26%, 3.19%, 24.52%, 6.03%, 5.53%, 0.50% and 0.04% in adolescent pregnant women, which were significant different from 5.49%, 8.94%, 0.13%, 0.01%, 0.17%, 23.46%, 4.66%, 3.08%, 0.26% and 0.01% in the right-age pregnant women, respectively ( all P<0.05 ). @*Conclusions@#The adolescent pregnant population in Wenzhou are mainly migrant population with lower education level and no occupation. The incidence rates of pregnancy complication, comorbidity and adverse birth outcomes in adolescent pregnant population are higher than those in right-age pregnant population, and are increasing year by year.

Clinical Outcome Analysis of Single Embryo Transfer / 中山大学学报(医学科学版)

@#【Objective】To explore the application prospect of single embryo transfer（SET）in assisted reproduction. 【Methods】A total of 5 130 cases of fresh and frozen embryo transfer in the Reproductive Center of the First Affiliated Hospital，Sun Yat-sen University in the recent two years were analyzed retrospectively. To analyze the main outcome of clinical pregnancy in different age groups，we classified the SET cycles into 4 groups of fresh or frozen，elective or obliged.【Results】In non-preimplantation genetic testing（PGT）elective SET cycles，the clinical pregnancy rate of the day 3 embryos（D3）and day 6 embryos（D6）in patients under 35 were as high as 35%. The clinical pregnancy rate of day 5 embryos（D5）was 50% approximately. While in PGT cycles，the clinical pregnancy rate of patients less than 42 years old was 45%，especially implantation rate of D5 embryos was close to 60% in all patients under 40. With the increase of age，the pregnancy rate of SET decreased. In non-PGT group，D3 embryos showed significant difference in either elective/obliged or fresh/frozen cycles（P < 0.001 for all）. In general，elective SET showed a higher pregnancy rate than obliged cycles. There was no significant difference between the elective and obliged frozen cycles of D5 or D6 embryos regarding clinical pregnancy rate（P = 0.074 and P = 0.596，respectively）. Elective D5 embryo transfer group had a higher pregnancy rate than that of the obliged group（P = 0.011）. However，there was no significant difference of clinical pregnancy rate between elective and obliged groups of D6 embryos（P = 0.979）. In non-PGT cycles，clinical pregnancy rate was significantly different among different age groups of either elective/obliged or fresh/ frozen cycles（P < 0.001）. Obliged D3 and D6 embryo transfer groups showed the lowest pregnancy rate，and in PGT cycles of patients under 40，D5 embryo showed a higher pregnancy rate than that of D6 group as a whole（P < 0.001）.【Conclusion】The outcome of SET strategy seemed good in the last 2 years. In order to avoid perinatal complications caused by multiple fetuses，clinicians and patients should actively promote and choose SET.

Monitoring period and factors being in effect of pregnant womenbeing surveyed at family healthcare centers / Шинэ санаа Шинэ нээлт

Although in the 5th goal of the millennial development goals it is stated that by within 2015 iscarriages will be reduced by 75% from the year 1990. So far it has been reduced by 34%, only third of its intended goal. Around 358.000 miscarriages happen in a year, which leads to around 1000-1500 miscarriages per day during numerous stages such as: pregnancy, labor, or after birth. Thisproblem has been gathering a lot of attention around the world that it had been added in to the goalsof the millennium development goals. Of the 130 million babies who are born in a year 7.6 millionof them are born with birth defects and 3.2 million die while they are still infants, and 3.6 millioninfants are left handicapped. Of 40-50 million pregnancies that are reported in Asia and the PacificOceania, 30500-50000 women miscarry, and 300000 infants die within the first day since birth. In the Mongolian government’s population development policy, it is stated that the government shall support population growth, to provide a safe living environment for people to live a long prosperous life, and to improve healthcare services for mothers and babies. The total population as of late 2014 is 2 million 995.9 thousand it has risen up by 65.9 thousand since the previous year a 2.2 percent increase. 48.9 percent of the population are males and 51.1 percent are females the ratio of gender is 96:100 for every 100 females there are 96 males. As for age, 28 percent of the population is under 15 years old, 68 percent of the population is between the ages 15-64, 4 percent of the population is 64 years old or older. We have selected this topic because there are no sufficient scientific researchmaterials regarding to pregnancy monitoring despite there are regular reports being made about pregnancy monitoring in accordance to Mongolia’s maternity orders. 135 pregnant women who are routinely monitored at family healthcare centers were selected randomly, the results have been calculated by the SPSS 20 program and statistic information provided by pregnancy monitoring guides, and by a 48 question survey made in accordance by the 338th rule of the pregnancy monitoring of regularly processed women.Of the total 135 pregnant women, 88 (65.2%) have been checked on time. While 47 (34.8%) haven’t been checked on time. Furthermore, of women who are married 72.2 % got checked on time while only a third of the women who weren’t married (33.3%) got checked on time. Marital status was also a key factor in women being on time for regular monitoring (p=0.006). Around 70 percent ofwomen with higher education have shown up on time for regular monitoring whereas only 55 percent of women with secondary education got monitored. Considering the age structure 66.7 percent of women aged 20-24, 82.6 percent of women aged 30-34, 83.3 percent of women aged 35 and higher have been involved in regular checks on time. (p=0.031). Employment has been a factor in checkupattendance. 92.9 percent of women who work at state authorities, 63.6 of women who work in nongovernmentorganizations, 51.6 percent of women who are self-employed, 57.9 percent of students,57.9 percent of unemployed women have participated in checkups on time.(p=0.017).From the women who were surveyed, 57 (41.3%) women who didn’t show up on time for their second examination, by the looks of the women 10(83.3%) who went in monitoring on the second three months into pregnancy were pregnant before. It is clear that the women who were pregnant before lose concern about being monitored.87 (63%) of the women took pregnancy class, of the 51 (37%) who didn’t 13 (15%) took the class because they weren’t able to claim their pregnancy benefits and 35 (68.8%) of the women who didn’t take the pregnancy class have stated that they hadn’t had the time. 16 (31.4%) have claimed that it wasn’t needed. This shows that class attendance is insufficient and people only attend to claim their pregnancy benefits. Because of the lack of special service for pregnant women at district hospitals, women are forced to get service elsewhere. It is clear that local doctors give little advice and information about birth, miscarriage and prevention of misbirth.

Hemoglobina materna en el Perú: diferencias regionales y su asociación con resultados adversos perinatales / Maternal hemoglobin in Perú: regional differences and its asociation with adverse perinatal outcomes

Objetivos. Establecer la frecuencia de anemia y eritrocitosis en gestantes de diferentes regiones del Perú y la asociación con los resultados adversos perinatales utilizando los datos del Sistema de Información Perinatal (SIP) del Ministerio de Salud (MINSA). Materiales y métodos. Se obtuvieron datos de 379 816 partos de 43 centros asistenciales del Ministerio de Salud entre los años 2000 y 2010. Se determinó la frecuencia de anemia y eritrocitosis en cada región geográfica así como de los resultados adversos perinatales. Resultados. La frecuencia de anemia leve fue mayor en la costa (25,8 por ciento) y en la selva baja (26,2 por ciento). La frecuencia de anemia moderada/severa es más alta en la selva baja (2,6 por ciento) seguido de la costa (1,0 por ciento). En la sierra, las frecuencia más alta de anemia moderada/severa se observa en la sierra sur (0,6 por ciento). La mayor frecuencia de eritrocitosis (Hb>14,5 g/dL) fue encontrada en la sierra centro (23,7 por ciento), seguido de 11,9 por ciento en la sierra sur y 9,5 por ciento en la sierra norte. La anemia severa y la eritrocitosis estuvieron relacionadas con los resultados adversos perinatales. Conclusiones. Hay diferencias por región geográfica en la frecuencia de anemia. En la sierra central se encontró mayor frecuencia de eritrocitosis con respecto a la sierra sur. Tanto la anemia severa como la eritrocitosis aumentan los resultados adversos perinatales.

Objectives. To evaluate hemoglobin (Hb) levels in pregnant women from different geographical regions from Peru; to establish anemia and erythrocytocis rates and to establish the role of Hb on adverse perinatal outcomes using the Perinatal Information System (PIS) database of Peruvian Ministry of Health. Materials and methods. Data were obtained from 379,816 births of 43 maternity care units between 2000 and 2010. Anemia and erythrocytocis rates were determined in each geographical region as well as rates of adverse perinatal outcomes. To analyze data the STATA program (versión 10.0,Texas, USA) was used. The results were considered significant at p<0.01. Results. Mild anemia rate was higher in the coast (25.8 percent) and low forest (26.2 percent). Moderate/severe anemia rate in low forest was 2.6 percent and at the coast was 1.0 percent. In the highland, the highest rate of moderate/severe anemia was in the southern highlands (0.6 percent). The highest rate of erythrocytocis was found in the central highland (23.7 percent), 11.9 percent in the southern highland and 9.5 percent in the north highland. Severe anemia and erythrocytocis were associated with adverse perinatal outcomes. Conclusions. There are differences by Peruvian geographical region in anemia rates. In the central highlands were found the highest rates of erythrocytocis due to hypoxia effect in the high altitudes; however in the southern highlands, erythrocytocis was lower. Severe anemia and erythrocytosis were associated with increased adverse perinatal outcomes.