Evidence of possible SARS-CoV-2 vertical transmission according to World Health Organization criteria in asymptomatic pregnant women.

OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vertical transmission has been investigated extensively. Recently, the World Health Organization (WHO) published strict criteria to classify the timing of mother-to-child transmission of SARS-CoV-2 into different categories. The aim of this study was to investigate the possibility of vertical transmission in asymptomatic SARS-CoV-2-positive women. METHODS: Pregnant women attending for delivery at a perinatology center in Mexico City, Mexico, who had a SARS-CoV-2-positive nasopharyngeal swab 24-48 h before delivery, were asymptomatic at the time of the test and had an obstetric indication for Cesarean section were eligible for inclusion in this study. Amniotic fluid was collected during Cesarean delivery, and neonatal oral and rectal swabs were collected at birth and at 24 h after birth. SARS-CoV-2 detection was carried out using real-time reverse-transcription polymerase chain reaction in all samples. Relevant medical information was retrieved from clinical records. The WHO criteria for classifying the timing of mother-to-child transmission of SARS-CoV-2 were applied to the study population. RESULTS: Forty-two SARS-CoV-2-positive asymptomatic pregnant women fulfilled the inclusion criteria. Twenty-five (59%) women developed mild disease after discharge. Neonatal death occurred in three (7%) cases, of which one had a positive SARS-CoV-2 test at birth and none had coronavirus disease 2019-related symptoms. There were five (12%) cases with strong evidence of intrauterine transmission of SARS-CoV-2, according to the WHO criteria, as amniotic fluid samples and neonatal samples at birth and at 24 h after birth were positive for SARS-CoV-2. Our results also showed that 40-60% of infected neonates would have been undetected if only one swab (oral or rectal) was tested. CONCLUSION: This study contributes evidence to reinforce the potential for vertical transmission of SARS-CoV-2 even in asymptomatic women and highlights the importance of testing more than one neonatal sample in order to increase the detection rate of SARS-CoV-2 in affected cases. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

[Proposal for a death certificate to improve recording and reporting of perinatal mortality]. / Propuesta de un certificado de defunción para mejorar el registro y reporte de la muerte en el periodo perinatal.

OBJECTIVE: To analyze perinatal births and deaths recording at the Mexican Institute of Social Security (MISS), and to evaluate the correct classification of perinatal deaths. MATERIAL AND METHODS: From January to March 2000, data were collected from the 37 MISS districts on the total number of births and deaths occurring during 1999, deaths occurring before the seventh day of life, and gestational age and weight at birth. Early neonatal and infant mortality rates were analyzed including or separating newborns with < 1,000 g and < 28 weeks of gestational age. RESULTS: During 1999 there were 634,892 live births--whose gestational age and birth weight are unknown- and 3,984 stillbirths > or = 28 gestation weeks. There were 4,556 newborns who died before the seventh day of extrauterine life; 1,385 of them (30.4%) weighted less than 1,000 g and had a gestational age < 28 weeks. The analysis of mortality with and without these newborns shows a decrease of two points in early neonatal and infant mortality rates. CONCLUSIONS: This study shows that classification and reporting of perinatal mortality are inappropriate. A proposal is made to develop information systems that include weight and gestational age of all births. A new perinatal death certificate replacing current fetal and general death certificates would allow proper mortality classification and comparisons between countries.

[Experience and knowledge about climateric and menopause in women in Mexico City]. / Experiencias y conocimientos sobre climaterio y menopausia en mujeres de la ciudad de México.

OBJECTIVE: To know the experiences and knowledge about climateric and menopause in a group of women covered by Instituto Mexicano del Seguro Social (IMSS). The purpose was to contribute for planning some strategies to increase seeking for medical care at these periods of life. MATERIAL AND METHODS: Descriptive survey study in a randomized sample of women aged 50-59 years, currently users of medical services in family medicine system of IMSS en Mexico City, with a confidence interval of 95%. RESULTS: Mean age at menopause was 47.8 years. Most frequent climateric symptoms were: hot flushes (70.9%), depression (60.2%), insomnia (53.5%) and menstrual disturbances (37.8%). 51.1% of women seeked medical care due to climateric symptoms but only 12.1% received treatment, majority hormonals (81.6%). Past users were 14.9% and they received hormones too in 87.8%. In this survey, 83.8% of women had some knowledge about main symptoms of climateric and 90.1% knew about osteoporosis but only 37.2% had some knowledge about cardiovascular risk after menopause. The prevention of osteoporosis and coronary disease was associated with calcium and exercise; only in 1% with use of hormonals. CONCLUSIONS: It exists an acceptable level of information about climateric syndrome and postmenopausal osteoporosis in these women, but it is low for risk of cardiovascular disease. Probably, their information is got from the mass media communication and did not for the activities of medical institutions in health education.

[Indications and justification of cesarean sections at the Instituto Mexicano del Seguro Social]. / Indicaciones y justificación de las cesáreas en el Instituto Mexicano del Seguro Social.

OBJECTIVE: In view of the high frequency rates of cesarean section at the Instituto Mexicano del Seguro Social (IMSS), we carried out a study to know main causes and its justification. MATERIAL AND METHOD: Retrospective study in a randomized national sample of clinical records in 3,232 cesarean cases between June 1997 and June 1999. RESULTS: The most frequent indications were cephalopelvic disproportion (29.6%), one previous section (20.9%), acute fetal distress (14.1%), iterative section (11.9%), and premature rupture of amniotic membranes (10.7%). In cephalopelvic disproportion cases, mean weight of newborns was 3,430 g., 70.6% of patients had irregular uterine contractility, and 21.7% received oxytocin; 78.2% had integrity of membranes and 4 cm or less in cervical dilation. In previous section and cephalopelvic disproportion the mean weight of newborns was 3,425 g; 81.7% did not have regular contractility and, 4.8 received oxytocin. In sections due to acute fetal distress, 94.9% had an Apgar in 8 or more at 5 minutes after delivery. CONCLUSION: The cesarean indications at the IMSS were similar to those are informed most to date in Mexico and throughout the world, but we did not find justification most of cases in this study.