Feasibility of a pregnancy intervention mimicking viral transmission mitigation measures on the incidence of preterm birth in high-risk pregnant women enrolled in antenatal clinics in Melbourne, Australia: protocol for a pilot, randomised trial.

INTRODUCTION: Preterm birth is a leading cause of perinatal morbidity and mortality. During the COVID-19 pandemic, reduction in rates of preterm birth in women exposed to viral mitigation measures was reported by multiple studies. In addition, others and we observed a more pronounced reduction of preterm birth in women who had previously experienced a preterm birth. The aim of this pilot study is to establish the feasibility of a lifestyle intervention based on viral mitigation measures in high-risk pregnancies, with the ultimate aim to reduce the incidence of preterm birth. METHODS AND ANALYSIS: One hundred pregnant women, enrolled in antenatal clinics at two tertiary maternity centres in Melbourne, Australia, who have had a previous preterm birth between 22 and 34 weeks gestation will be recruited. This is a two-arm, parallel group, open-label randomised controlled feasibility trial: 50 women will be randomised to the intervention group, where they will be requested to comply with a set of lifestyle changes (similar to the viral mitigation measures observed during the pandemic). Another 50 women will be randomised to the control group, where they will undergo standard pregnancy care. The primary outcome of this trial is feasibility, which will be assessed by measuring patient eligibility rate, recruitment rate, compliance rate and data completion rate. Secondary outcomes include incidence of preterm birth, maternal satisfaction, maternal quality of life and other pregnancy outcomes. Standard methods in statistical analysis for randomised controlled trials on an intention to treat basis will be followed. ETHICS AND DISSEMINATION: This trial has been approved by the Monash Human Research Ethics Committee; approval reference number RES-22-0000-122A. Study findings will be reported and submitted to peer-reviewed journals for publication, and presentation at conferences. TRIAL REGISTRATION NUMBER: ACTRN12622000753752; Pre-results.

Association between cervical length and gestational age at birth in singleton pregnancies: a multicentric prospective cohort study in the Brazilian population.

BACKGROUND: Short cervical length measured during the second trimester of pregnancy is an important risk factor for spontaneous preterm birth (sPTB). The aim of this study is to identify the association between mid-pregnancy cervical length (CL) and gestational age at birth in asymptomatic singleton pregnant women. METHODS: This is a prospective cohort study involving singleton pregnant women who participated in the screening phase of a Brazilian multicenter randomized controlled trial (P5 trial) between July 2015 and March 2019. Transvaginal ultrasound to measure CL was performed from 18 to 22 + 6 weeks. Women with CL ≤ 30 mm received vaginal progesterone (200 mg/day) until 36 weeks' gestation. For this analysis we considered all women with CL ≤ 30 mm receiving progesterone and a random selection of women with CL > 30 mm, keeping the populational distribution of CL. We obtained prognostic effectiveness data (area under receive operating characteristic curve (AUC), sensitivity and specificity and estimated Kaplan-Meier curves for preterm birth using different CL cutoff points. RESULTS: We report on 3139 women and identified a negative association between cervical length and sPTB. CL ≤ 25 mm was associated with sPTB < 28, sPTB < 34 and sPTB < 37 weeks, whereas a CL 25-30 mm was directly associated with late sPTB. CL by transvaginal ultrasound presented an AUC of 0.82 to predict sPTB < 28 weeks and 0.67 for sPTB < 34 weeks. Almost half of the sPTB occurred in nulliparous women and CL ≤ 30 mm was associated with sPTB at < 37 weeks (OR = 7.84; 95%CI = 5.5-11.1). The number needed to screen to detect one sPTB < 34 weeks in women with CL ≤ 25 mm is 121 and we estimated that 248 screening tests are necessary to prevent one sPTB < 34 weeks using progesterone prophylaxis. CONCLUSIONS: CL measured by transvaginal ultrasound should be used to predict sPTB < 34 weeks. Women with CL ≤ 30 mm are at increased risk for late sPTB.

Understanding of changes in abortion rate following liberalization of abortion law among Brazilian residents in obstetrics and gynecology.

OBJECTIVE: To evaluate residents' knowledge about the evolution of abortion rates in countries where abortion has been legalized, and to assess whether such knowledge correlates with residents' sociodemographic characteristics and experience in abortion care. METHODS: A multicenter, cross-sectional study was conducted in 21 Brazilian hospitals with 404 medical residents in obstetrics and gynecology. Data collection occurred during February 2015 through January 2016. Data were collected through a self-administered, anonymous questionnaire. The χ2 test, Fisher exact test, and multiple logistic regression analysis were performed. RESULTS: Of residents, 60% believed that the abortion rate would increase after legalization; 82% had been involved in the care of women with incomplete abortion and 71% in the care of women admitted for legal abortion. Associations were found between knowledge of the evolution of the abortion rate after legalization and region of birth, region of medical school, and importance attached to religion. Multiple regression confirmed that studying medicine in the south/southeast of Brazil and attaching little importance to religion were associated with knowing that legalization does not lead to an increase in abortion rate. CONCLUSION: Information relating to abortion in medical schools and during residency is very limited and should be improved.

Ability of shock index and heart rate to predict the percentage of body blood volume lost after vaginal delivery as an indicator of severity: results from a prospective cohort study.

BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, but it mainly affects women from low- and middle-income countries. Despite being a treatable condition, the high number of maternal deaths resulting from PPH is outstanding for at least 25 years. Late diagnosis and difficulties in identifying women who will develop severe postpartum bleeding can, in part, explain the high incidence of PPH. Over the past few years, researchers have focused on identifying a simple, accessible and low-cost diagnostic tool that could be applied to avoid maternal deaths. In particular, it has been suggested that vital signs and shock index (SI) could be useful. The objective of this study was to evaluate whether vital signs are correlated with the percentage of body blood volume (BBVp) lost after vaginal delivery. METHODS: A prospective cohort study was performed at the Women's Hospital of UNICAMP, Brazil. The inclusion criteria were women delivering vaginally who did not suffer from hypertension, hyper- or hypothyroidism, cardiac disease, infections or coagulopathy. Blood loss was measured over 24 hours using a calibrated drape and by weighing compresses, gauzes and pads. Vital signs were measured up to 24 hours after delivery. We evaluated the BBVp lost, and generated a Receiver operating characteristics (ROC) curve with area under the curve (AUC) analysis to determine the cut-off values for vital signs to determine the likelihood of postpartum bleeding above the 90th percentile within 24 hours of delivery. RESULTS: A total of 270 women were included. The mean blood loss within 24 hours of vaginal delivery was 570.66 ± 360.04 mL. In the first 40 minutes, 73% of the total blood loss over the 24-hour period had occurred, and within 2 hours, 91% of women had bled 90% of the total blood loss. Changes in SI and heart rate (HR) were statistically significant in predicting postpartum bleeding (P ≤ 0.05). Higher values for likelihood ratio (LR) to identify BBVp loss above the 90th percentile within 2 hours were a SI above 1.04 at 41-60 minutes after birth (LR = +11.84) and a HR above 105.2 bpm at 21-40 minutes after birth (LR = +4.96). Both measures showed high specificity but low sensitivity. CONCLUSION: Values of SI and HR are statistically significant in predicting postpartum bleeding with high specificity but low sensitivity. The cut-off points were 1.04 for SI and 105 bpm for HR.