The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson's Ten Group Classification System

Background: Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. Methods: Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. Results: Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). Conclusion: Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR. (AU)

Clinical biochemistry profile of American Quarter Horse broodmares fed Tifton-85 (Cynodon spp. ) hay and haylage / Perfil bioquímico clínico de matrizes Quarto de Milha alimentadas com feno e haylage Tifton 85 (Cynodon spp. )

The conservation of haylage (a pre-dried feed) can be challenging, since there is an increased risk of mould growth, which can contaminate this foodstuff with mycotoxins. However, when the hygienic quality is secured, haylage enhances grass palatability and provide enough supply of dry matter throughout the year. Due to the lack of information regarding its effect on blood parameters in horses fed exclusively with this foodstuff, the aim of this study is to provide information regarding its use in comparison to hay and ensure that it does not affect horses' biochemical profile. Twelve Quarter Horse broodmares were distributed into two groups, each fed with Tifton-85 (Cynodon spp.) hay or haylage for a period of 28 days, and the biochemical profile was done in five different times (T0 before the experiment started and, chronologically, seven days apart - T1, T2, T3 and T4), It was analyzed total protein (TP) and its fractioning; enzymes alanine aminotransferase, aspartate aminotransferase and γ-glutamyl-transferase; endogenous catabolism products urea and creatinine; and ions calcium and phosphorus. Mycotoxins in haylage were also investigated and remained below the legislation thresholds. Only TP was higher in the last sampling (T4) of the haylage group, which may be related to the foodstuff's higher protein digestibility. No differences were observed between serum enzymes, urea, creatinine and Ca/P from both experimental groups. Haylage has proven to be safe, when well prepared for horses, without causing impairing side effects, as shown by the normal serum biochemistry parameters presented in this study.(AU)

A conservação do haylage (alimento pré-seco) pode ser desafiadora, considerando o aumento do risco de crescimento de fungos, com consequente produção de micotoxinas. Entretanto, quando a qualidade da higiene e armazenamento é assegurada, o haylage aumenta a palatabilidade da forragem e fornece suplemento de matéria seca suficiente ao longo do ano. Devido à falta de informação relativa aos efeitos dessa alimentação nos parâmetros sanguíneos de equinos alimentados exclusivamente com essa dieta, o objetivo do presente estudo é avaliar o perfil bioquímico sanguíneo dos equinos após administração da haylage em comparação com feno. Doze matrizes Quarto de Milha foram distribuídas em dois grupos, cada um recebendo feno ou haylage de Tifton 85 (Cynodon spp.) por um período de 28 dias. O perfil bioquímico foi realizado em cinco tempos (T) diferentes (T0, antes do início do experimento e cronologicamente, a cada sete dias após o fornecimento das dietas - T1, T2, T3 e T4) para análise de proteína total (PT) e seu perfil fracionado, das enzimas alanina aminotransferase, aspartato aminotransferase, γ-glutamil-transferase, dos produtos de catabolismo creatinina e ureia e, dos íons cálcio e fósforo. Micotoxinas no haylage foram investigadas e mantiveram-se abaixo dos limites determinados pela legislação brasileira. O perfil bioquímico revelou, somente, elevação da PT em T4 no grupo que recebeu haylage, o que pode estar relacionado à sua maior digestibilidade proteica. Nenhuma diferença foi observada nos outros parâmetros estudados em ambos os grupos experimentais. Conclui-se que Haylage é comprovadamente seguro, quando bem preparado para equinos, sem causar efeitos na saúde geral, conforme demonstrado pelos exames bioquímicos no presente estudo.(AU)