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Antecedentes: Hasta el momento actual, el abordaje bioético de los cuidados materno-perinatales se proyecta desde la visión integral de la salud bio - psico - social, la perspectiva de derechos humanos y el enfoque de género. En general, no se ha incorporado a los cuidados materno-perinatales la bioética ambiental, que surge de la perspectiva de la salud ambiental; integrando la ética global, la perspectiva de la consiliencia, el derecho al ambiente saludable y la ética ambiental. La actual situación de crisis global por la combinación de la Pandemia COVID 19 y la Sindemia Global, que caracterizaremos como Pan-sindemia, incrementa los riesgos y daños en el proceso reproductivo, sobre todo en las poblaciones vulneradas en sus derechos. Justificación: Es necesario minimizar el efecto de la Pan-sindemia en el proceso reproductivo. En la agenda global, la humanidad debe revertir las causas que provocan la Pan-sindemia. Mientras tanto, los profesionales y equipos de salud deben reformular su rol a la hora de los cuidados materno-perinatales, incorporando a la clínica el derecho a un ambiente saludable para la reproducción. Perspectivas: Las modificaciones en la práctica clínica de los equipos de salud sexual y reproductiva deben orientarse a: - incorporar la bioética ambiental a los cuidados materno-perinatales desde la formación hasta la práctica clínica - desarrollar un abordaje integral de los grandes síndromes obstétricos perinatales, la prematurez y la restricción de crecimiento, para minimizar el impacto de la Pan-sindemia en el proceso reproductivo humano.
Background: Until now, the bioethical approach to maternal perinatal care is projected from the integral vision of bio-psycho-social health, the perspective of Human Rights and the gender perspective. In general, environmental bioethics, which arises from the perspective of environmental health has not been incorporated into maternal-perinatal care with global ethics, the perspective of consilience, the right to a healthy environment and environmental ethics. The current global crisis situation due to the combination of the COVID 19 Pandemic and the Global Syndemic, characterized as Pan Syndemic, increases the risks and damages in the reproductive process, especially in populations violated in their rights. Justification: It is necessary to minimize the effect of the Pan Syndemic on the human reproductive process. On the global agenda, humanity must reverse the causes of the Pan Syndemic. Meanwhile, health professionals and teams must reformulate their role when it comes to maternal-perinatal care, incorporating into the clinic the right to a healthy environment for reproduction. Perspectives: Modifications in the clinical practice of sexual and reproductive health teams should be aimed at: incorporate environmental bioethics into maternal perinatal care from training to clinical practice; develop a comprehensive approach to major perinatal obstetric syndromes, prematurity and fetal growth restriction, to minimize the impact of the Pan Syndemic on the human reproductive process.
Até o momento, a abordagem bioética da atenção materna perinatal se projeta a partir da visão integral da saúde biopsicossocial, da perspectiva dos direitos humanos e da perspectiva de gênero. De modo geral, a bioética ambiental não foi incorporada à assistência materno-perinatal que surge na perspectiva da saúde ambiental; integrando a ética global, a perspectiva da consiliência, o direito ao ambiente saudável e a ética ambiental. A atual situação de crise global devido à combinação da Pandemia COVID 19 e da Sindemia Global, que caracterizaremos como Pan-sindêmica, aumenta os riscos e danos no processo reprodutivo, especialmente em populações cujos direitos são violados. Justificação: É necessário minimizar o efeito da Pan-sindemia no processo reprodutivo. Na agenda global, a humanidade deve reverter as causas que causam a Pan-sindemia. Nesse ínterim, os profissionais e equipes de saúde devem reformular seu papel no que se refere à assistência materno-perinatal, incorporando à clínica o direito a um ambiente saudável para a reprodução. Panorama: As modificações na prática clínica das equipes de saúde sexual e reprodutiva devem ter como objetivo: - incorporar a bioética ambiental ao cuidado perinatal materno, desde o treinamento até a prática clínica - desenvolver uma abordagem abrangente para as principais síndromes obstétricas perinatais, prematuridade e restrição de crescimento, para minimizar o impacto da Pan-sindemia no processo reprodutivo humano.
Subject(s)
Humans , Maternal-Child Health Services/ethics , Pandemics , Reproductive Health/ethics , SyndemicABSTRACT
RESUMEN La mortalidad materna y perinatal representan un asunto prioritario de salud pública cuyo control reviste especial dificultad en zonas de frontera. Objetivos. Describir el comportamiento de la mortalidad materna y perinatal en los territorios fronterizos de Colombia, entre 1998 y 2016 y establecer su asociación con factores sociodemográficos, geográficos y de atención sanitaria. Métodos. Estudio observacional retrospectivo, basado en registros oficiales. Se calcularon las razones de mortalidad materna (RMM) y perinatal (RMP) para el período 1998-2016, identificando los puntos de inflexión mediante análisis de Joinpoint. Así mismo, se realizaron análisis bivariados y multivariados. Resultados. De los 54 municipios y 12 corregimientos de frontera, pertenecientes a 12 Departamentos, se obtuvieron 687 registros de mortalidad materna y 12,786 de mortalidad perinatal. Las razones observadas fueron 88 x 100,000 NV para la RMM y 16 x 1,000 NV para la RMP. La tendencia de estos tipos de mortalidad fue descendente, Los valores más altos de mortalidad perinatal se asociaron significativamente con la edad materna de 35 a 54 años, atención por régimen subsidiado, nivel educativo bajo, mujeres sin pareja, y embarazos múltiples. Conclusión. La mortalidad materna y perinatal registrada en los municipios fronterizos está por encima del promedio nacional.
ABSTRACT Abstract: Maternal and perinatal mortality is a priority public health issue that is particularly difficult to control in border areas. Objectives: To describe the behavior of maternal and perinatal mortality in the border territories of Colombia, between 1998 and 2016; and to establish its association with sociodemographic, geographic and health care factors. Methods: Retrospective observational study, based on official records. Maternal mortality ratio (MMR) and perinatal mortality ratio (RMP) were calculated for the period 1998-2016, identifying inflection points through Joinpoint analysis. Likewise, bivariate and multivariate analyses were performed. Results: From 54 municipalities and 12 borders townships belonging to 12 Departments, 687 records maternal mortality records and 12,786 perinatal mortality records were obtained. The ratios observed were 88 x 100,000 BA for MMR and 16 x 1,000 NV for PMR. The trend of these types of mortality was downward. The highest values of perinatal mortality were significantly associated with maternal age 35-54 years, care by subsidized regime, low educational level, women without a partner, and multiple pregnancies. Conclusion: Maternal and perinatal mortality registered in border municipalities is above the national average.
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Objective@#To explore the prevalence and trend of premature delivery in Shaoxing Maternal and Child Health Care Hospital from 2007 to 2018, so as to provide evidence for prevention of premature birth and promotion of perinatal health care. @*Methods@#The data of live births in Shaoxing Maternal and Child Health Care Hospital from 2007 to 2018 were collected,and premature birth rate,proportion of premature infants in different gestational weeks,as well as the trend of gender ratio,asphyxia and birth weight with gestational weeks were analyzed.@*Results@#From 2007 to 2018,there were 10 506 premature infants born in Shaoxing Maternal and Child Health Care Hospital. The preterm birth rate increased year by year （P<0.05）,and the annual average was 9.09%. The rate of multiple premature birth was 57.80%,which was higher than that of single premature birth （7.26%,P<0.05）. There were 110 cases of extremely preterm birth （1.05%）,2 997 cases of early preterm birth （28.53%）,and 7 399 cases of mild preterm birth （70.43%）. The proportions of extremely and early preterm birth increased year by year （P<0.05）. The asphyxia rate of premature infants was 9.70% （1 019 cases）,which decreased with the increase of gestational weeks （P<0.05）. The birth weight of premature infants decreased with the increase of gestational weeks （P<0.05）. The ratio of male to female in preterm infants was 1.22∶1,which was higher than 1.10∶1 in term infants （P<0.05）.@*Conclusion@#From 2007 to 2018,the preterm birth rate of Shaoxing Maternal and Child Health Care Hospital increased year by year,especially in extremely and early preterm birth.
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Alma Ata is still in force in those experiences of comprehensive health care from all and for all that some countries have managed to implement, especially in the rural areas with populations affected by exclusion and poverty. Peru has several of them that find their roots in experiences previous to the 1978 Conference. It is interesting to confirm that many of these were initially dedicated to the care of pregnant women and newborns, and then they have translated their lessons learned to the care of the whole population.
Alma Ata sigue vigente en aquellas experiencias de Cuidado Integral de la Salud por todos y para todos que algunos países han logrado implementar, sobre todo en zonas rurales con poblaciones afectadas por la exclusión y la pobreza. El Perú detenta varias de ellas, que incluso encuentran sus raíces en experiencias previas a la Conferencia de 1978. Es interesante confirmar que muchas de estas se abocaron primero a la atención de las gestantes y recién nacidos, y luego han trasladado sus lecciones aprendidas al cuidado de toda la población.
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Objective To analyze the factors correlated with perinatal death so as to provide the basis for reducing the perinatal mortality.Methods A respective study was conducted with analysis of perinatal mortality monitoring data,birth defects data and the health status report of non-registered pregnant women from 2012 to 2016 in Taizhou. We compared the differences in the indexes of perinatal mortality,birth defects rate and the proportion of elderly pregnant women in different years,domicile place and regions.Results The perinatal mortality rate was 6.80‰,decreasing annually from 2012 to 2016 (P<0.01). The average perinatal mortality rate of floating population was 9.28‰,which is higher than the 5.64‰ rate of local population (P<0.01). The proportion of elderly pregnant women was 10.30%,showing an upward trend (P<0.01) and the perinatal mortality of elderly pregnant women was 10.60‰,significantly higher than the total mortality (P<0.01). The leading cause of perinatal death was birth defect and the defect rate of perinatal birth was 35.86‰,showing an upward trend (P<0.01) while the average mortality rate of birth defects was decreasing (P<0.01). There were statistically significant differences(P<0.01) in perinatal mortality,birth defects,sex ratio and proportion of elderly pregnant women in different regions of Taizhou. Compared with the perinatal in local population,mother age,education background,maternal times and register time of pregnant women of the perinatal in floating population was significantly different (P<0.01). Conclusion The perinatal mortality in Taizhou declined year by year. Elderly pregnant age,birth defects,and floating population are the main positive factors of perinatal mortality.
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Few studies are available about racial inequalities in perinatal health in Brazil and little is known about whether the existing inequality is due to socioeconomic factors or to racial discrimination per se. Data regarding the Ribeirão Preto birth cohort, Brazil, whose mothers were interviewed from June 1, 1978 to May 31, 1979 were used to answer these questions. The perinatal factors were obtained from the birth questionnaire and the ethnic data were obtained from 2063 participants asked about self-reported skin color at early adulthood (23-25 years of age) in 2002/2004. Mothers of mulatto and black children had higher rates of low schooling (ú4 years, 27.2 and 38.0 percent) and lower family income (ú1 minimum wage, 28.6 and 30.4 percent). Mothers aged less than 20 years old predominated among mulattos (17.0 percent) and blacks (14.0 percent). Higher rates of low birth weight and smoking during pregnancy were observed among mulatto individuals (9.6 and 28.8 percent). Preterm birth rate was higher among mulattos (9.5 percent) and blacks (9.7 percent) than whites (5.5 percent). White individuals had higher rates of cesarean delivery (34.9 percent). Skin color remained as an independent risk factor for low birth weight (P < 0.001), preterm birth (P = 0.01), small for gestational age (P = 0.01), and lack of prenatal care (P = 0.02) after adjustment for family income and maternal schooling, suggesting that the racial inequalities regarding these indicators are explained by the socioeconomic disadvantage experienced by mulattos and blacks but are also influenced by other factors, possibly by racial discrimination and/or genetics.
Subject(s)
Adult , Female , Humans , Infant, Newborn , Male , Pregnancy , Racial Groups , Pregnancy Outcome/epidemiology , Social Justice , Birth Weight , Brazil/epidemiology , Brazil/ethnology , Cohort Studies , Gestational Age , Interviews as Topic , Parity , Socioeconomic FactorsABSTRACT
We describe three birth cohort studies, respectively carried out in 1978/79 and 1994 in Ribeirão Preto, a city located in the most developed region of Brazil, and in 1997/98 in São Luís, a city located in a less developed region. The objective of the present report was to describe the methods used in these three studies, presenting their history, methodological design, objectives, developments, and difficulties faced along 28 years of research. The first Ribeirão Preto study, initially perinatal, later encompassed questions regarding the repercussions of intrauterine development on future growth and chronic adult diseases. The subjects were evaluated at birth (N = 6827), at school age (N = 2861), at the time of recruitment for military service (N = 2048), and at 23/25 years of age (N = 2063). The study of the second cohort, which started in 1994 (N = 2846), permitted comparison of aspects of perinatal health between the two groups in the same region, such as birth weight, mortality and health care use. In 1997/98, a new birth cohort study was started in São Luís (N = 2443), capital of the State of Maranhão. The 1994 Ribeirão Preto cohort and the São Luís cohort are in the second phase of joint follow-up. These studies permit comparative temporal analyses in the same place (Ribeirão Preto 1978/79 and 1994) and comparisons of two contrasting populations regarding cultural, economic and sociodemographic conditions (Ribeirão Preto and São Luís).
Subject(s)
Humans , Cohort Studies , Brazil , Cultural Characteristics , Socioeconomic FactorsABSTRACT
Objectives: The aim of this study is to examine the utilities of antenatal care with comprehensive health education qualified in Phnom Penh for the health of mothers and infants during perinatal and postpartum periods. Attention was given to the existing socioeconomic disparities among women in this urban area, and the utilities were discussed irrespective of socioeconomic status. Methods: A total of 436 pregnant women in an urban area in Phnom Penh were selected using a complete survey in randomly sampled villages and were followed up. Participating in antenatal care with comprehensive health education at least three times was regarded as the use of “qualified antenatal care” during pregnancy. In this study, we investigated the independent associations of the use of qualified antenatal care with the following outcome variables after the adjustment for the influence of socioeconomic variables: postpartum maternal health knowledge, postpartum maternal anemia, low birth weight, and infant immunization. Results: Of the 314 subjects who completed the follow-up examination, 66.8% used qualified antenatal care during pregnancy. The use of qualified antenatal care was positively associated with postpartum maternal health knowledge (OR=2.38, 95%CI: 1.12–5.05), and reductions in the incidences of postpartum anemia (OR=0.22, 95%CI: 0.05–0.95) and low birth weight (OR=0.06, 95%CI: 0.01–0.39) after the adjustment of the influence of socioeconomic status. The infants born to mothers who used qualified antenatal care had significantly higher coverage of BCG , DPT1, and DPT3 immunizations (P<0.001, P<0.001, and P<0.01, respectively), independent of their socioeconomic conditions. Conclusion: This study shows the solid utilities of qualified antenatal care in Phnom Penh for perinatal health.
Subject(s)
Health , Postpartum PeriodABSTRACT
<p><b>OBJECTIVES</b>The aim of this study is to examine the utilities of antenatal care with comprehensive health education qualified in Phnom Penh for the health of mothers and infants during perinatal and postpartum periods. Attention was given to the existing socioeconomic disparties among women in this urban area, and the utilities were discussed irrespective of socioeconomic status.</p><p><b>METHODS</b>A total of 436 pregnant women in an urban area in Phnom Penh were selected using a complete survey in randomly sampled villages and were followed up. Participating in antenatal care with comprehensive health education at least three time was regarded as the use of "qualified antenatal care" during pregnancy. In this study, we investigated the independent associations of the use of qualified antenatal care with the following outcome variables after the adjustment for the influence of socieconomic variables: postpartum maternal health knowledge, postpartum maternal anemia, low birth weight, and infant immunization.</p><p><b>RESULTS</b>Of the 314 subjects who completed the follow-up examination, 66.8% used qualified antenatal care during pregnancy. The use of qualified antenatal care was positively associated with postpartum maternal health knowledge (OR=2.38, 95% CI: 1.12-5.05). and reductions in the incidences of postpartum anemia (OR=0.22,95% CI: 0.05-0.95) and low birth weight (OR=0.05,95% CI: 0.01-0.39) after the adjustment of the influence of socioeconomic status. The infants born to mothers who used qualified antenatal care had significantly higher coverage of BCG, DPT(1), and DTP(3) immunizations (P<0.001,P<0.001, andP<0.01, respectively), independent of their socioeconomic conditions.</p><p><b>CONCLUSION</b>This study shows the solid utilities of qualified antenatal care in Phnom Penh for perinatal health.</p>