Interpregnancy interval and perinatal outcomes across Latin America from 1990 to 2009: a large multi-country study.

OBJECTIVE: To determine the relationship of interpregnancy interval with maternal and offspring outcomes. DESIGN: Retrospective study with data from the Perinatal Information System database of the Latin American Centre for Perinatology and Human Development, Uruguay. SETTING: Latin America, 1990-2009. POPULATION: A cohort of 894 476 women delivering singleton infants. METHODS: During 1990-2009 the Perinatal Information System database of the Latin American Centre for Perinatology identified 894 476 women with defined interpregnancy intervals: i.e. the time elapsed between the date of the previous delivery and the first day of the last normal menstrual period for the index pregnancy. Using the interval 12-23 months as the reference category, multiple logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) of the association between various interval lengths and maternal and offspring outcomes. MAIN OUTCOME MEASURES: Maternal death, pre-eclampsia, eclampsia, puerperal infection, fetal death, neonatal death, preterm birth, and low birthweight. RESULTS: In the reference interval there was 0.05% maternal death, 1.00% postpartum haemorrhage, 2.80% pre-eclampsia, 0.15% eclampsia, 0.28% puerperal infection, 3.45% fetal death, 0.68% neonatal death, 12.33% preterm birth, and 9.73% low birthweight. Longer intervals had increased odds of pre-eclampsia (>72 months), fetal death (>108-119 months), and low birthweight (96-107 months). Short intervals of <12 months had increased odds of pre-eclampsia (aOR 0.80; 95% CI 0.76-0.85), neonatal death (aOR 1.18; 95% CI 1.08-1.28), and preterm birth (aOR 1.16; 95% CI 1.11-1.21). Statistically, the interval had no relationship with maternal death, eclampsia, and puerperal infection. CONCLUSIONS: A short interpregnancy interval of <12 months is associated with pre-eclampsia, neonatal mortality, and preterm birth, but not with other maternal or offspring outcomes. Longer intervals of >72 months are associated with pre-eclampsia, fetal death, and low birthweight, but not with other maternal or offspring outcomes. TWEETABLE ABSTRACT: A short interpregnancy interval of <12 months is associated with neonatal mortality and preterm birth.

A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study.

OBJECTIVE: To generate a global reference for caesarean section (CS) rates at health facilities. DESIGN: Cross-sectional study. SETTING: Health facilities from 43 countries. POPULATION/SAMPLE: Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10,045,875 women giving birth from 43 countries for model testing. METHODS: We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. MAIN OUTCOME MEASURES: Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. RESULTS: According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/). CONCLUSIONS: This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. TWEETABLE ABSTRACT: The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems.

Sistema Informático Perinatal (SIP): programas utilitarios y diagrama de redes: instrucciones de configuración del sistema

Las nuevas versiones de los programas del Sistema Informático Perinatal han sido preparadas para funcionar conformando una red hospitalaria, regional o nacional según diferentes modelos de complejidad. Esta nueva posibilidad facilita el flujo de información entre niveles para la major atención de la gestante y recién nacido, así como también para la gestión del sector, permitiendo centralizar bases de datos con información actualizada para evaluación y toma de decisiones de manera oportuna...

Saúde Sexual e Reprodutiva: Guias para a Atenção Continuada da Mulher e do Recém-Nascido focalizadas na APS

[Extraído do Prólogo]. "O presente manual tem como antecedente o livro “Atendimento Pré-natal e Parto de Baixo Risco”, que foi publicado pelo CLAP em 1995, sendo atualizado em todos os assuntos e com o seu enfoque ampliado, aprofundando os conteúdos dos cuidados pré-gestacionais com um critério de promoção e de prevenção que procura melhorar o estado de saúde da mulher, do seu parceiro e do seu filho/a, com medidas relativamente simples. Incorpora também novos aspectos sobre planejamento familiar com um enfoque de direitos, onde é incluída a anticoncepção de emergência e o conceito de atendimento integral para evitar as oportunidades perdidas e melhorar a eficiência dos contatos do pessoal de saúde com a mulher e seu filho/a" .

Sistema informático perinatal (SIP): historia clínica perinatal: formulario complementario para mujeres en situación de aborto: instrucciones de llenado y definición de términos

En este manual se describe en detalle la forma de llenado y la definición e interpretación de cada una de las variables que presenta la Historia Clínica Perinatal y del sector correspondiente a Mujeres en Situación de Aborto. La Historia Clínica deberá facilitar la atención, el monitoreo y la supervisión del cumplimiento de las normas, de tal manera que el sistema de salud cuente con información precisa y oportuna para la toma de decisiones. La riqueza de datos contenidos en la Historia Clínica Perinatal y sus formularios complementarios permiten constituir el banco de datos más valioso con que cuenta el equipo de salud, ya sea para conocer las características de la población prestataria, evaluar los resultados de la atención brindada, identificar los problemas prioritarios, monitorizar indicadores claves y realizar investigaciones operacionales y epidemiológicas.