The challenge of adequately reporting preeclampsia for epidemiological surveillance: An example from a referral center in a middle-income country.

Adequately reporting of preeclampsia is a challenge. The aim of this study was to compare the diagnosis of preeclampsia based on clinical and laboratory findings and ICD-10 codes (International Classification of Diseases) at admission and discharge in a referral center, over a one-year period. Among 2,839 women admitted for childbirth, 208 presented confirmed preeclampsia, based on chart audits. Among these, 77.4% at admission presented ICD-10 codes assigned as hypertension, and 47.1% at discharge. In 14.4% of confirmed preeclampsia, ICD-10 codes for hypertension were not used. Adequate reporting of preeclampsia is key for clinical surveillance, counselling and guiding public health interventions.

Diabetes among women with preterm births: outcomes of a Brazilian multicenter study.

OBJECTIVE: The objective was to compare the maternal and perinatal characteristics and outcomes between women with and without diabetes in a Brazilian cohort of women with preterm births. METHODS: This was an ancillary analysis of the Brazilian Multicenter Study on Preterm Birth, which included 4,150 preterm births. This analysis divided preterm births into two groups according to the presence of diabetes; pregestational and gestational diabetes were clustered in the same Diabetes Group. Differences between both groups were assessed using χ 2 or Student's t tests. RESULTS: Preterm births of 133 and 4,017 women with and without diabetes, respectively, were included. The prevalence of diabetes was 3.2%. Pregnant women aged ≥35 years were more common in the Diabetes Group (31.6% versus 14.0% non-diabetic women, respectively). The rate of cesarean section among patients with diabetes was 68.2% versus 52.3% in non-diabetic cases), with a gestational age at birth between 34 and 36 weeks in 78.9% of the cases and 62.1% of the controls. Large-for-gestational-age babies were 7 times more common in the Diabetes Group. CONCLUSION: Preterm birth among Brazilian women with diabetes was more than twice as prevalent; these women were older and had regular late preterm deliveries, usually by cesarean section. They also had a greater frequency of fetal morbidities, such as malformations and polyhydramnios, and a higher proportion of large-for-gestational-age and macrosomic neonates.

Validation of the fullPIERS model for prediction of adverse outcomes in preeclampsia at a referral center.

OBJECTIVES: To validate the use of fullPIERS to predict maternal and perinatal adverse outcomes in a referral center. METHODS: Cross-sectional study including all pregnant women with preeclampsia (PE) at a referral center in southeast Brazil. The prevalence of PE and adverse outcomes were assessed. The fullPIERS score was tested on three composites of adverse outcomes: maternal adverse outcome; fetal adverse outcomes; and the combination of these two. Furthermore, the fullPIERS risk calculator, was considered to define the cutoff that better estimates adverse outcomes. RESULTS: 2839 women were screened in a one year period, with 208 (7.3%) cases of PE; most were preterm (56.7%); with severe features (74.5%). HELLP syndrome (6.7%), eclampsia (3.8%) and placental abruption (2.4%) were the most frequent complications. FullPIERS assessement had a median of 1.2% (0.45 - 2.3%) and the score had an excelent performance to predict adverse maternal outcome (AUC = 0.845, confidence interval 0.776 - 0.914, p-value < 0.01). For perinatal adverse outcomes (AUC = 0.699, confidence interval 0.581 - 0.816, p-value < 0.01) and the composite of maternal and perinatal adverse outcome (AUC = 0.804, confidence interval 0.736 - 0.872, p-vale < 0.01), fullPIERS score had a suboptimal performance. The cutoff value that best performed for the assessment of maternal adverse outcome was 2.15% (sensitivity of 75% and specificity of 83%). CONCLUSION: Preeclampsia was a significant complication during pregnancy. The fullPIERS model was an excellent tool to predict maternal adverse outcomes; with a cutoff value of 2.15% in the tested population.

Can pre-eclampsia explain higher cesarean rates in the different groups of Robson's classification?

OBJECTIVE: To evaluate the impact of pre-eclampsia on cesarean delivery by using the Robson classification. METHODS: A retrospective cross-sectional study including all women who delivered in a referral maternity hospital in southeast Brazil from January 2017 to February 2018. Women were classified into 1 of 10 Robson groups and then further subdivided into pre-eclampsia (PE) and non-PE (NPE) groups. Frequency of cesarean was determined for each group and compared by using χ2 and prevalence ratio. RESULTS: Overall, 3102 women were included, of whom 1578 (50.9%) delivered by cesarean. Classification in Robson group 5 was the most frequent among all women (n=727, 23.4%). In the PE group (n=258, 8.3%), group 10 was the most frequent classification (n=120, 46.5%); in NPE, Robson group 5 was the most frequency (n=682, 24.0%). Pre-eclampsia was associated with a higher occurrence of cesarean (77.5% vs 48.4%; prevalence ratio, 2.29; 95% confidence interval, 1.82-2.82), owing to higher rates in Robson groups 1, 5, and 10. CONCLUSION: Pre-eclampsia was associated with a higher occurrence of cesarean delivery in some Robson groups. Robson classification may be used to evaluate the impact of specific conditions at a facility level to help plan future interventions to optimize the use of cesarean.

Diabetes among women with preterm births: outcomes of a Brazilian multicenter study

ABSTRACT Objective The objective was to compare the maternal and perinatal characteristics and outcomes between women with and without diabetes in a Brazilian cohort of women with preterm births. Methods This was an ancillary analysis of the Brazilian Multicenter Study on Preterm Birth, which included 4,150 preterm births. This analysis divided preterm births into two groups according to the presence of diabetes; pregestational and gestational diabetes were clustered in the same Diabetes Group. Differences between both groups were assessed using χ 2 or Student's t tests. Results Preterm births of 133 and 4,017 women with and without diabetes, respectively, were included. The prevalence of diabetes was 3.2%. Pregnant women aged ≥35 years were more common in the Diabetes Group (31.6% versus 14.0% non-diabetic women, respectively). The rate of cesarean section among patients with diabetes was 68.2% versus 52.3% in non-diabetic cases), with a gestational age at birth between 34 and 36 weeks in 78.9% of the cases and 62.1% of the controls. Large-for-gestational-age babies were 7 times more common in the Diabetes Group. Conclusion Preterm birth among Brazilian women with diabetes was more than twice as prevalent; these women were older and had regular late preterm deliveries, usually by cesarean section. They also had a greater frequency of fetal morbidities, such as malformations and polyhydramnios, and a higher proportion of large-for-gestational-age and macrosomic neonates.