Chrysin attenuates epithelial prostatic hyperplasia in the ventral prostate of spontaneously hypertensive rats.

The aim of this study was to evaluate the effects of chrysin on the ventral prostate of spontaneously hypertensive rats (SHR). Ten-week-old male Wistar and SHR rats received 100 mg/kg/day of chrysin (TW and TSHR) or 200 µL/day of the dilution vehicle (CW and CSHR) for 70 days. After the treatment, the animals were euthanized and the prostates were dissected out, fixed, and processed for further morphological, immunohistochemical, and biochemical analyses. Blood was collected for serological analysis. Chrysin did not interfere with the blood pressure. Morphologically, the epithelial height increased in TW and decreased in TSHR. Stereology showed an increase in the epithelial and stromal relative frequency, and a decrease in the lumen of TW, whereas the epithelium in TSHR was reduced. Normal alveoli decreased, and hyperplastic alveoli had an increment in TW, whereas in TSHR normal alveoli increased and intense hyperplasia decreased. The secretion area was reduced in TW. Immunohistochemical analysis showed a smaller number of PCNA-positive cells in TW. Finally, the biochemical analysis showed a reduction in malondialdehyde, carbonylated proteins, superoxide dismutase, and catalase in TW and TSHR. We concluded that the chrysin effect is dependent on the context in which this flavonoid is employed. In normal conditions, the anabolic potential of the chrysin was favored, disrupting the morphology of the prostate. However, when used in animals predisposed to develop hyperplasia, this flavonoid attenuates the hyperplastic status, improving the morphology of the gland.

The experience of pregnant women and their families who were infected with covid-19 before vaccination: A qualitative approach within a multicenter study in Brazil.

BACKGROUND: Pregnant and postpartum women infected by COVID-19 are at increased risk of adverse outcomes, including negative effects on their mental health. Brazilian maternal mortality rate due to COVID-19 is 2.5 times higher than overall mortality rates. This study aimed to understand how pregnant/postpartum women experienced the COVID-19 suspicion/investigation or confirmed infection in different Brazilian cities, the pandemic's consequences to women and their families, and their needs to improve maternal health services during public health emergencies. METHODS: We conducted a qualitative study with 27 women with COVID-19 and 6 of their family members, as part of a multicenter study among 15 maternity hospitals in Brazil. We applied in-depth interviews through telephone calls when women received the diagnostic or had a suspect infection and after 60 days. Another semi-structured interview was applied to their close family members. The interviews were considered through thematic analysis. RESULTS: From the thematic content analysis three major themes emerged from the first and second interviews: (Cucinotta and Vanelli, 2020) assistance received by the woman and newborn in the medical services; (World Health Organization (WHO) 2021) stigma/fear of contamination from health workers and from family and friends reported by the women; (Allotey et al., 2020) the COVID-19 pandemic impact. CONCLUSION: Before the availability of the COVID-19 vaccine, pregnant women experienced fear of death, hospitalization, quarantine, loss of family members, and financial repercussions, resulting in physical, psychological, and socioeconomic impacts on these women's lives.

The effect of body mass index on maternal and perinatal outcomes in COVID-19 infection during pregnancy and postpartum: Secondary analysis from the REBRACO cohort study.

OBJECTIVES: To compare maternal and perinatal outcomes among women with obesity, overweight, and normal body mass index, associated with COVID-19 infection during pregnancy and postpartum. METHOD: Prospective Cohort Study, within the REBRACO (Brazilian Network of COVID-19 in Pregnancy) multicenter initiative. Confirmed positive cases of SARS-CoV-2 were included, and women categorized into three groups according to their pre-pregnancy BMI: obesity (BMI ≥ 30), overweight (BMI <30 but >25), and normal BMI. Sociodemographic, clinical, and obstetric characteristics and different maternal and perinatal outcomes were compared, and a multiple regression analysis was performed to investigate factors independently associated with adverse maternal and perinatal outcomes. RESULTS: Two hundred eighty-nine women positive for SARS-CoV-2 infection were considered, and 202 had available data on maternal BMI for the current analysis. Overall, 72 (35.6%)obese, 68 (33.6%) overweight, and 60 (29.7%) normal BMI. Obesity was associated with increased adverse clinical outcomes including sepsis (P = 0.02), acute respiratory distress syndrome (P = 0.002), and the need for mechanical ventilation (P = 0.044). Considering perinatal outcomes, a multiple regression model confirmed obesity as an independent factor associated with adverse results (adjusted odds ratio 3.73, 95% CI 1.54-9.08). CONCLUSION: Obesity and overweight were associated with worse clinical outcomes, severe/critical COVID-19, and adverse perinatal outcomes.

A influência do engajamento paterno na qualidade de vida de mães de crianças com deficiência / The influence of paternal engagement on the quality of life of mothers of children with disabilities

Resumo A literatura frequentemente descreve a sobrecarga vivida pelas mães como um dos principais desafios enfrentados pelas famílias com crianças com deficiência, o que pode levar a problemas de saúde mental. Pouco se encontra sobre a participação dos pais e sobre como essa participação impacta a qualidade de vida das mães. Objetiva-se aqui, assim, investigar a correlação entre o engajamento paterno e a qualidade de vida das mães de crianças com deficiência. Trata-se de um estudo transversal, descritivo, quantitativo e qualitativo, realizado com pais e mães de crianças com deficiência em tratamento em uma clínica de reabilitação neurofuncional. Encontrou-se, a partir das respostas de 35 pais e 35 mães, que não há correlação linear entre as variáveis pesquisadas, entretanto, a maioria das mães desejam mais ajuda para cuidar dos filhos e gostariam que os pais fossem mais envolvidos no tratamento deles. O engajamento dos pais de filhos com deficiência demonstrou-se semelhante ao dos pais de crianças típicas, estando mais atrelado ao suporte emocional do que à realização de cuidados diretos e indiretos. Conclui-se que são necessários estudos como este em populações com diferentes características para verificar o comportamento das variáveis e abordagens qualitativas com os pais.

Abstract The literature often describes the burden experienced by mothers as one of the main challenges faced by families with children with disabilities, which can lead to mental health problems. Little is found about the participation of fathers and how this participation impacts the quality of life of mothers. The objective is to investigate the correlation between paternal engagement and the quality of life of mothers of children with disabilities. This is a cross-sectional, descriptive, quantitative and qualitative study, carried out with fathers and mothers of children with disabilities undergoing treatment at a neurofunctional rehabilitation clinic. It was found, based on the responses of 35 fathers and 35 mothers, that there is no linear correlation between the variables surveyed, however most mothers want more help to take care of their children and would like fathers to be more involved in their treatment. The engagement of parents of children with disabilities was similar to that of parents of typical children, being more linked to emotional support than direct and indirect care. It is concluded that studies like this are necessary in populations with different characteristics, to verify the behavior of the variables; and qualitative approaches with parents are needed.

Pharmacological Characteristics of the Hydroethanolic Extract of Acmella oleracea (L) R. K. Jansen Flowers: ADME/Tox In Silico and In Vivo Antihypertensive and Chronic Toxicity Evaluation.

Acmella oleracea (L.) R. K. Jansen, popularly known as jambu in Northern Brazil, is widely used in folk medicine and local cuisine. Its consumption in different ways reinforces the need for safety assessments. In this study, the major compounds found in the hydroethanolic extract of A. oleracea flowers (EHFAO) were characterized by ultra-performance liquid mass spectrometry (UHPLC-ESI-QTOF-MS/MS). The effects of oral administration of 100/mg/kg of EHFAO extract over 60 days in male spontaneously hypertensive (SHR) and Wistar (WR) rats and the in silico ADME/Tox predictions, lipophilicity, and water solubility were accomplished for the compounds identified. Spilanthol was detected as the foremost major compound at a concentration of 97.7%, followed by 1.53% scopoletin and 0.77% d-limonene. The treatment with EHFAO did not alter the animals´ weight over the studied period. Moderate alterations were observed solely in the hepatic enzymes AST (WR = 97 UI/L and SHR = 150 UI/L ∗ p < 0.05) and ALT (WR = 55 UI/L and SHR = 95 UI/L ∗ p < 0.05), while no relevant histopathological alterations were found. The in-silico study confirmed the in vivo findings, as the identified compounds were considered highly bioactive orally, due to their drug similarity profiles, adequate lipid solubility, bioavailability, and pharmacokinetics. Therefore, the chronic treatment with EHFAO was found safe at the concentration of 100/mg/kg, with no interference in the blood pressure levels neither appreciable toxic effects.

Assessment of eutrophication from phosphorus remobilization after resuspension of coastal sediments from an urban tropical estuary.

Dredging activities cause sediment resuspension, which can change the bioavailability of nutrients such as phosphorus (P) in aquatic ecosystems due to remobilization. This study evaluated the remobilization of P in the solid and dissolved phase before and after sediment resuspension in the Meriti and Iguaçu River estuaries and the Rio de Janeiro and Niterói harbor in Guanabara Bay (Rio de Janeiro, Brazil). Three water and sediment samples were collected at each point. Dissolved phosphorus (DP), total phosphorus (TP), organic phosphorus (OP), and inorganic phosphorus (IP) were analyzed before and after resuspension. Resuspension directly impacted the fine-grained samples, causing the release of P into the water column after resuspension, increasing eutrophication of the estuary and risk to biota. The phosphorus enrichment index (PEI) was calculated in the four areas, and in all areas, the index was above 1, which means high ecological risk. The area with sandy granulometry and a lower percentage of organic matter showed an increase in the index after resuspension. The resuspension may impact the increase of eutrophication in some areas, due to the remobilization of the sediment and the adsorbed contaminants.

Geochemistry of a spheroidal weathering profile in a tropical mountainous landscape, Rio de Janeiro, Brazil.

Boulders are an important material in debris flow and their source is coupled with spheroidal weathering profiles that produce corestones. The goal of this work was to establish the geochemical transformations that produced corestones and distinguished them from the surrounding grus in two tropical granite weathering profiles (P1 and P2). Sampling was not performed in a vertical profile; instead, we gathered 13 (P1) to 16 (P2) samples displaying different weathering degrees (corestone and saprolite) and spatial positions in the profiles. We conducted the geochemistry (EDXRF/EDX and INAA) and mineralogy (petrography and XRD) of the samples. The CIA values ranged from 46 (corestones) to 93 (saprolite). Granite spheroidal weathering under a tropical mountainous slope develops mostly due to feldspar weathering (foremost plagioclase) in the following sequence: porosity growth, kaolinite, and gibbsite crystallization. Zircon weathering stability and its probable mobility as grain along the weathering profile play an important role in REE concentration. Spheroidal weathering is mainly a lixiviation process, yet specific locations (below the individualized corestones) presented REE enrichment due to translocation. They are hosted mainly by clay minerals and, to some extent, by amorphous Fe oxyhydroxide. The evolution of spheroidal weathering results in a vertical patchy weathering profile.

The COVID-19 pandemic in Brazilian pregnant and postpartum women: results from the REBRACO prospective cohort study.

Brazil presented a very high number of maternal deaths and evident delays in healthcare. We aimed at evaluating the characteristics of SARS-CoV-2 infection and associated outcomes in the obstetric population. We conducted a prospective cohort study in 15 Brazilian centers including symptomatic pregnant or postpartum women with suspected COVID-19 from Feb/2020 to Feb/2021. Women were followed from suspected infection until the end of pregnancy. We analyzed maternal characteristics and pregnancy outcomes associated with confirmed COVID-19 infection and SARS, determining unadjusted risk ratios. In total, 729 symptomatic women with suspected COVID-19 were initially included. Among those investigated for COVID-19, 51.3% (n = 289) were confirmed COVID-19 and 48% (n = 270) were negative. Initially (before May 15th), only 52.9% of the suspected cases were tested and it was the period with the highest proportion of ICU admission and maternal deaths. Non-white ethnicity (RR 1.78 [1.04-3.04]), primary schooling or less (RR 2.16 [1.21-3.87]), being overweight (RR 4.34 [1.04-19.01]) or obese (RR 6.55 [1.57-27.37]), having public prenatal care (RR 2.16 [1.01-4.68]), planned pregnancies (RR 2.09 [1.15-3.78]), onset of infection in postpartum period (RR 6.00 [1.37-26.26]), chronic hypertension (RR 2.15 [1.37-4.10]), pre-existing diabetes (RR 3.20 [1.37-7.46]), asthma (RR 2.22 [1.14-4.34]), and anaemia (RR 3.15 [1.14-8.71]) were associated with higher risk for SARS. The availability of tests and maternal outcomes varied throughout the pandemic period of the study; the beginning was the most challenging period, with worse outcomes. Socially vulnerable, postpartum and previously ill women were more likely to present SARS related to COVID-19.

Alpha-1 Acid Glycoprotein Reduction Differentiated Recovery from Remission in a Small Cohort of Cats Treated for Feline Infectious Peritonitis.

Feline infectious peritonitis (FIP) is a systemic immune-mediated inflammatory perivasculitis that occurs in a minority of cats infected with feline coronavirus (FCoV). Various therapies have been employed to treat this condition, which was previously usually fatal, though no parameters for differentiating FIP recovery from remission have been defined to enable clinicians to decide when it is safe to discontinue treatment. This retrospective observational study shows that a consistent reduction of the acute phase protein alpha-1 acid glycoprotein (AGP) to within normal limits (WNL, i.e., 500 µg/mL or below), as opposed to duration of survival, distinguishes recovery from remission. Forty-two cats were diagnosed with FIP: 75% (12/16) of effusive and 54% (14/26) of non-effusive FIP cases recovered. Presenting with the effusive or non-effusive form did not affect whether or not a cat fully recovered (p = 0.2). AGP consistently reduced to WNL in 26 recovered cats but remained elevated in 16 cats in remission, dipping to normal once in two of the latter. Anaemia was present in 77% (23/30) of the cats and resolved more quickly than AGP in six recovered cats. The presence of anaemia did not affect the cat's chances of recovery (p = 0.1). Lymphopenia was observed in 43% (16/37) of the cats and reversed in nine recovered cats but did not reverse in seven lymphopenic cats in the remission group. Fewer recovered cats (9/24: 37%) than remission cats (7/13: 54%) were lymphopenic, but the difference was not statistically different (p = 0.5). Hyperglobulinaemia was slower than AGP to return to WNL in the recovered cats. FCoV antibody titre was high in all 42 cats at the outset. It decreased significantly in 7 recovered cats but too slowly to be a useful parameter to determine discontinuation of antiviral treatments. Conclusion: a sustained return to normal levels of AGP was the most rapid and consistent indicator for differentiating recovery from remission following treatment for FIP. This study provides a useful model for differentiating recovery from chronic coronavirus disease using acute phase protein monitoring.

The golden hour for postpartum hemorrhage: Results from a prospective cohort study.

OBJECTIVE: To evaluate the predictive capacity of vital signs for the diagnosis of postpartum hemorrhage (PPH). METHODS: A prospective cohort study performed at the University of Campinas, Brazil, between February 2015 and March 2016 with women who delivered vaginally. Vital signs and postpartum bleeding were collected over 24 h. Exploratory data analysis was performed plus receiver operating characteristic curve analysis where the areas under the curve was used to determine the best cutoff points for sensitivity, specificity, likelihood ratio, and diagnostic odds ratio. RESULTS: For the 270 women recruited, mean blood loss after 120 min was 427.49 ± 335.57 ml, while 84 (31.1%) and 22 (8.1%) women had blood loss ≥500 and ≥1000 ml, respectively. Heart rate cutoff point of 105 bpm measured between 21-40 min after birth identified blood loss ≥1000 ml with 90% specificity. A shock index (SI) of 0.965 at 41-60 min after birth identified blood loss ≥500 and ≥1000 ml within 2 h with approximately 95% specificity. CONCLUSION: Shock index and heart rate measured after birth showed high specificity with low sensitivity to identify PPH. In clinical practice, "The rule of 1s" should receive special attention: SI ≥1, or heart rate >100 bpm, or estimated blood loss ≥1 L.

Understanding How Health Providers Identify Women with Postpartum Hemorrhage: A Qualitative Study.

OBJECTIVE: To identify how health providers recognize postpartum hemorrhage early and the difficulties involved in it. METHODS: An exploratory, descriptive study using a qualitative approach through a semi-structured interview technique. In total, 27 health professionals (nursing technicians, nurses, medical residents in Gynecology and Obstetrics, hired medical doctors, and medicine professors) working in a tertiary-level hospital of reference in women's health care in the State of São Paulo, Brazil, participated in the study through an invitation. After they accepted the invitation, they signed the free and informed consent form. All interviews were recorded and transcribed, and a thematic analysis was conducted. We found three analysis categories: a) perception of the severity: "there is something wrong with the women"; b) difficulties in the early diagnosis of postpartum hemorrhage; and c) the process to improve obstetrical care. RESULTS: Caregivers believe teamwork and communication should be improved. Besides the visual estimation of blood loss, the nursing team is attentive to behavioral symptoms like irritability, while the medical staff follow protocols and look for objective signs, such as altered vital signs. CONCLUSION: Besides the objective evaluations, the subjective perceptions of the providers are involved in the clinical judgement regarding the diagnosis of postpartum hemorrhage, and this should be included in a broader diagnosis strategy.

OBJETIVO: Identificar como os profissionais de saúde reconhecem precocemente os casos de hemorragia pós-parto e as suas dificuldades. MéTODOS: Realizou-se um estudo exploratório, descritivo, com uma abordagem qualitativa por meio da técnica de entrevista semiestruturada. Por meio de um convite, participaram do estudo 27 profissionais saúde (técnicas de enfermagem, enfermeiras, residentes de Ginecologia e Obstetrícia, e médicos contratados e docentes) que trabalhavam em um hospital de nível terciário de referência no atendimento à saúde da mulher no estado de São Paulo. Depois que os participantes aceitaram o convite, eles assinaram o termo de consentimento livre e esclarecido. Todas as entrevistas foram gravadas, transcritas, e realizou-se uma análise temática. Identificaram-se três categorias de análise: a) percepção da gravidade: "há algo de errado com as mulheres"; b) dificuldades no diagnóstico precoce da hemorragia pós-parto; e c) o processo para melhorar a atenção em obstetrícia. RESULTADOS: Os profissionais de saúde acreditavam que o trabalho em equipe e a comunicação deviam ser aperfeiçoados. Além da estimativa visual da perda de sangue, a equipe de enfermagem estava atenta a sintomas comportamentais como irritabilidade, ao passo que o pessoal médico seguia protocolos e procurava sinais objetivos, como sinais vitais alterados. CONCLUSãO: Além das avaliações objetivas, as percepções subjetivas dos provedores estão envolvidas no julgamento clínico do diagnóstico de hemorragia pós-parto, e isto deve ser incluído em uma estratégia de diagnóstico mais ampla.

Understanding How Health Providers Identify Women with Postpartum Hemorrhage: A Qualitative Study / Compreendendo como os profissionais de saúde identificam as mulheres com hemorragia pós-parto: um estudo qualitativo

Abstract Objective To identify how health providers recognize postpartum hemorrhage early and the difficulties involved in it. Methods An exploratory, descriptive study using a qualitative approach through a semi-structured interview technique. In total, 27 health professionals (nursing tech nicians, nurses, medical residents in Gynecology and Obstetrics, hired medical doctors, and medicine professors) working in a tertiary-level hospital of reference in women's health care in the State of São Paulo, Brazil, participated in the study through an invitation. After they accepted the invitation, they signed the free and informed consent form. All interviews were recorded and transcribed, and a thematic analysis was conducted. We found three analysis categories: a) perception of the severity: "there is something wrong with the women"; b) difficulties in the early diagnosis of postpartum hemorrhage; and c) the process to improve obstetrical care. Results Caregivers believe teamwork and communication should be improved. Besides the visual estimation of blood loss, the nursing team is attentive to behavioral symptoms like irritability, while the medical staff follow protocols and look for objective signs, such as altered vital signs. Conclusion Besides the objective evaluations, the subjective perceptions of the providers are involved in the clinical judgement regarding the diagnosis of postpartum hemorrhage, and this should be included in a broader diagnosis strategy.

Resumo Objetivo Identificar como os profissionais de saúde reconhecem precocemente os casos de hemorragia pós-parto e as suas dificuldades. Métodos Realizou-se um estudo exploratório, descritivo, com uma abordagem qualitativa por meio da técnica de entrevista semiestruturada. Por meio de um convite, participaram do estudo 27 profissionais saúde (técnicas de enfermagem, enfermeiras, residentes de Ginecologia e Obstetrícia, e médicos contratados e docentes) que trabalhavam em um hospital de nível terciário de referência no atendimento à saúde da mulher no estado de São Paulo. Depois que os participantes aceitaram o convite, eles assinaram o termo de consentimento livre e esclarecido. Todas as entrevistas foram gravadas, transcritas, e realizou-se uma análise temática. Identificaram-se três categorias de análise: a) percepção da gravidade: "há algo de errado com as mulheres"; b) dificuldades no diagnóstico precoce da hemorragia pós-parto; e c) o processo para melhorar a atenção em obstetrícia. Resultados Os profissionais de saúde acreditavam que o trabalho em equipe e a comunicação deviam ser aperfeiçoados. Além da estimativa visual da perda de sangue, a equipe de enfermagem estava atenta a sintomas comportamentais como irritabilidade, ao passo que o pessoal médico seguia protocolos e procurava sinais objetivos, como sinais vitais alterados. Conclusão Além das avaliações objetivas, as percepções subjetivas dos provedores estão envolvidas no julgamento clínico do diagnóstico de hemorragia pós-parto, e isto deve ser incluído em uma estratégia de diagnóstico mais ampla.

Preparação do enfermeiro para o atendimento í múltiplas ví­timas no resgate aéreo / Preparation of nurses to meet multiple victims in air recue

Objetivo: Caracterizar a atuação do enfermeiro de bordo, com ênfase no atendimento à múltiplas vítimas. Metodologia: Estudo exploratório e qualitativo. Os dados foram obtidos por meio de questionários semiestruturados, aplicados nosenfermeiros debordo em Belo Horizonte/MG. Utilizada a técnica metodológica de Bola de Neve (Snowball Sampling) e analisesob o conteúdo de Laurence Bardin. Resultado: Dos enfermeiros atuantes no resgate aéreo, que aceitaram participar, a maioria são do sexo masculino, possuem a renda familiar média de nove salários mínimos, mais de um vínculo empregatício, experiência média de seis anos. A partir da análise dos dados, as categorias elencadas foram: Atendimento Sistematizado e Capacitação Aeromédica. Conclusão: É preciso reconhecer o papel do enfermeiro no atendimento as vítimas no resgate aeromédico. Vale ressaltar a importância da capacitação para alcançar a excelência, no ambiente hostil confinado.(AU)

Objective: To characterize the role of the nurse on board, with an emphasis on attending to multiple wounds. Methodology: Exploratory and qualitative study. Data were obtained through semi-structured, scientific questionnaires on board nurses in Belo Horizonte / MG. The Snowball methodological technique was used and analyzed under the content of Laurence Bardin. Result: Of the nurses working in the air rescue, who agreed to participate: the majority are male, have an average family income of nine relative, more than one job, average experience of six years. From the analysis of the data, according to the categories listed were: Systematized Service and Aeromedical Training. Conclusion: It is necessary to recognize the role of the nurse in the care aswounds in the aeromedical rescue. It is worth emphasizing the importance of training to achieve excellence in a confined hostile environment.(AU)

Objetivo: Caracterizar a atuação do enfermeiro de bordo, com ênfase no atendimento à múltiplas vítimas. Metodologia: Estudo exploratório e qualitativo. Os dados foram obtidos por meio de questionários semiestruturados, aplicados nosenfermeiros debordo em Belo Horizonte/MG. Utilizada a técnica metodológica de Bola de Neve (Snowball Sampling) e analisesob o conteúdo de Laurence Bardin. Resultado: Dos enfermeiros atuantes no resgate aéreo, que aceitaram participar, a maioria são do sexo masculino, possuem a renda familiar média de nove salários mínimos, mais de um vínculo empregatício, experiência média de seis anos. A partir da análise dos dados, as categorias elencadas foram: Atendimento Sistematizado e Capacitação Aeromédica. Conclusão: É preciso reconhecer o papel do enfermeiro no atendimento as vítimas no resgate aeromédico. Vale ressaltar a importância da capacitação para alcançar a excelência, no ambiente hostil confinado.(AU)

Long-Term Consequences of Severe Maternal Morbidity on Infant Growth and Development.

OBJECTIVE: Severe maternal morbidity (SMM) is already known to be associated with adverse neonatal outcomes, however, its association with long-term deficits of weight and height, and impairment in neurodevelopment among children was not yet fully assessed. We aim to evaluate whether SMM has repercussions on the weight and height-for-age and neurodevelopmental status of the child. METHODS: A retrospective cohort analysis with women who had SMM events in a tertiary referral center in Brazil. They were compared to a control group of women who had not experienced any SMM. Childbirth and perinatal characteristics, weight and height-for-age deficits and neurodevelopmental impairment suspicion by Denver II Test were comparatively assessed in both groups using RR and 95% CI. Multiple regression analysis was used addressing deficit of weight-for-age, height-for-age and an altered Denver Test, estimating their independent adjusted RR and 95% CI. RESULTS: 634 women with perinatal outcomes available (311 with SMM and 323 without) and 571 children were assessed. Among women with SMM, increased rates in perinatal deaths, Apgar lower than 7 at five minutes, shorter breastfeeding period, preterm birth (49.0% × 11.1%), low birthweight (45.8% × 11.5%), deficits of weight-for-age [RR 3.11 (1.60-6.04)] and height-for-age [RR 1.52 (1.06-2.19)] and altered Denver Test [RR 1.5 (1.02-2.36)] were more frequently found than in the control group. SMM was not identified as independently associated with any of the main outcomes. CONCLUSION: SMM showed to be associated with a negative impact on growth and neurodevelopment aspects of perinatal and infant health. These findings suggest that effective health policies directed towards appropriate care of pregnancy may have an impact on the reduction of maternal, neonatal and infant morbidity and mortality.

Multidimensional assessment of women after severe maternal morbidity: the COMMAG cohort study.

OBJECTIVES: To perform a multidimensional assessment of women who experienced severe maternal morbidity (SMM) and its short-term and medium-term impact on the lives and health of women and their children. DESIGN: A retrospective cohort study. SETTING: A tertiary maternity hospital from the southeast region of Brazil. PARTICIPANTS: The exposed population was selected from intensive care unit admissions if presenting any diagnostic criteria for SMM. Controls were randomly selected among women without SMM admitted to the same maternity and same time of childbirth. PRIMARY AND SECONDARY OUTCOME VARIABLES: Validated tools were applied, addressing post-traumatic stress disorder (PTSD) and quality of life (SF-36) by phone, and then general and reproductive health, functioning (WHO Disability Assessment Schedule), sexual function (Female Sexual Function Index (FSFI)), substance abuse (Alcohol, Smoking and Substance Involvement Screening Test 2.0) and growth/development (Denver Developmental Screening Test) of children born in the index pregnancy in a face-to-face interview. RESULTS: All instruments were applied to 638 women (315 had SMM; 323 were controls, with the assessment of 264 and 307 children, respectively). SF-36 score was significantly lower in the SMM group, while PTSD score was similar between groups. Women who had SMM became more frequently sterile, had more abnormal clinical conditions after the index pregnancy and a higher score for altered functioning, while proportions of FSFI score or any drug use were similar between groups. Furthermore, children from the SMM group were more likely to have weight (threefold) and height (1.5 fold) for age deficits and also impaired development (1.5-fold). CONCLUSION: SMM impairs some aspects of the lives of women and their children. The focus should be directed towards monitoring these women and their children after birth, ensuring accessibility to health services and reducing short-term and medium-term repercussions on physical, reproductive and psychosocial health.

General and reproductive health among women after an episode of severe maternal morbidity: Results from the COMMAG study.

OBJECTIVE: To assess general and reproductive health in women after severe maternal morbidity (SMM). METHODS: A retrospective cohort study was performed at a tertiary maternity hospital. Women with SMM criteria who delivered during 2008-2012 were included in the SMM group. The control group included a random sample of women without SMM delivering in the same year of cases. Both groups were compared regarding sociodemographic/obstetric characteristics, general and reproductive health, using χ2 , Yates χ2 , Fisher exact, and Mann-Whitney tests. RESULTS: There were 315 women in the SMM group and 323 women in the control group. The SMM group was older and had a history of more medical conditions (hypertension, diabetes, obesity), cesarean deliveries, preterm births, and perinatal deaths. Breastfeeding was negatively affected in these women, as was fertility. The SMM group had a non-significant trend of fewer children after index pregnancy, had new complications in subsequent pregnancies, and required specialized medical care, besides higher risk of death. CONCLUSION: Women experiencing SMM are at higher risk of general and reproductive health problems after pregnancy, including risk of death. Therefore, their surveillance and follow-up should continue beyond 42 days postpartum, highlighting the importance of more specialized health care.

Postpartum psychoactive substance abuse after severe maternal morbidity.

OBJECTIVE: To evaluate drug use among mothers during the postpartum period after a severe pregnancy-related complication. METHODS: A retrospective cohort study of maternal morbidity including maternal near-miss and control groups conducted in a tertiary hospital in Campinas, Brazil, between July 2008 and June 2012. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess drug use during lifetime, pregnancy, and in the previous 3 months. RESULTS: Of 638 women evaluated, drug use was reported by 165 (25.8%). Alcohol was the most common substance used (n=133, 20.6%), followed by tobacco (n=85, 13.2%), and cocaine (n=15, 2.3%). The highest risk for postpartum drug use was among those using drugs during pregnancy. There were no differences between the morbidity and control groups, but there was a significant difference in the need for intervention to reduce alcohol consumption in the severe maternal morbidity group. Risk for substance abuse intervention increased three-fold in women with PTSD criteria, and all aspects of quality of life were worse among drug users. CONCLUSION: Drug use during pregnancy and maternal complications are linked to postpartum drug abuse. These women should be managed during pregnancy; postpartum follow-up requires updated guidance and must go beyond family planning.

Lessons from the Field Beyond the Numbers: Narratives of Professionals on Women who Experienced Severe Maternal Morbidity.

OBJECTIVE: Several factors might affect the health and the quality of life of women who had a severe maternal morbidity (SMM) or a maternal near-miss (MNM) episode. The objective of the present study was to explore the perspectives of the professionals on the repercussions of SMM or of MNM after interviewing women who survived such episodes. METHOD: Selected cases that captured the attention of professionals were reported. The professionals built individually 10 narratives, which were analyzed with the technique of content analysis. RESULTS: According to the perspectives of the professionals, women surviving a severe maternal condition and their families experienced clinical and psychosocial consequences. Some cases portrayed the intense psychological distress in mourning for the loss of the fetus or of their reproductive capacity and changes in family dynamics generating emotional overload, depression, and gender violence. CONCLUSION: The analysis of narratives may offer an idea on the complexity of the perception of care by professionals and on the need for an interdisciplinary follow-up of women surviving an SMM or an MNM episode.

OBJETIVO: Diversos fatores podem afetar a saúde e a qualidade de vida das mulheres que tiveram um episódio de morbidade materna grave (MMG) ou near-miss materno (NMM). O objetivo do presente estudo foi explorar as perspectivas dos profissionais sobre as repercussões da MMG ou do NMM após terem entrevistados mulheres que sobreviveram a um desses episódios. MéTODOS: Casos selecionados que chamaram a atenção dos profissionais foram relatados. Estes profissionais construíram individualmente 10 narrativas, que foram analisadas com a técnica de análise de conteúdo. RESULTADOS: Segundo as perspectivas dos profissionais, as mulheres que sobreviveram a uma condição materna grave e suas famílias vivenciaram consequências clínicas e psicológicas. Alguns casos relataram um intenso estresse psicológico no luto pela perda do feto ou de sua capacidade reprodutiva e de mudanças da dinâmica familiar, gerando sobrecarga emocional, depressão e violência de gênero. CONCLUSãO: A análise das narrativas pode oferecer uma ideia sobre a complexidade da percepção do cuidado de profissionais e sobre a necessidade de um seguimento interdisciplinar das mulheres sobreviventes de um episódio de MMG ou de NMM.

Reference ranges for ultrasound measurements of fetal kidneys in a cohort of low-risk pregnant women.

PURPOSE: Alterations in renal dimensions may be an early manifestation of deviation from normality, with possible repercussions beyond intrauterine life. The objective of this study was to establish reference curves for fetal kidney dimensions and volume from 14 to 40 weeks of gestation. METHODS: This is a prospective longitudinal study of 115 Brazilian participants in the "WHO multicentre study for the development of growth standards from fetal life to childhood: the fetal component". Pregnant women with clinical and sociodemographic characteristics allowing the full potential fetal growth were followed up from the first trimester until delivery. These women underwent serial sonographic evaluation of fetal kidneys. The longitudinal, anteroposterior and transverse diameters of both fetal kidneys were measured, in addition to calculation of kidney volume. By quantile regression analysis, reference curves of renal measurements related to gestational age were built. RESULTS: Standard normal sonographic values of renal biometry were defined during pregnancy. Reference values for the 10th, 50th and 90th centiles of different fetal kidney measurements (longitudinal, anteroposterior, transverse and volume) from the 14th to the 40th week of gestation were fitted. CONCLUSION: The reference curves presented should be of the utmost importance for screening and diagnosis of alterations in renal development during the intrauterine period.