Riesgo de depresión durante el embarazo en la atención prenatal de riesgo habitual / Risk of depression during pregnancy in usual risk antenatal care / Risco de depressão na gravidez na assistência pré-natal de risco habitual

Objetivo: identificar el riesgo de depresión durante el embarazo en gestantes de riesgo habitual incluidas en el control prenatal y los factores asociados. Método: estudio transversal, realizado con 201 gestantes, en el consultorio de prenatal de riesgo habitual de una maternidad universitaria. Para la recolección de datos se utilizó un formulario electrónico que contenía un instrumento de caracterización y la Escala de Riesgo de Depresión del Embarazo. La variable dependiente fue el riesgo de depresión en el embarazo. El análisis estadístico se realizó mediante el cálculo de la razón de posibilidades (Odds Ratio) y utilizando las pruebas de Chi-cuadrado y exacta de Fischer. Resultados: entre las participantes, 68,2% tenían mayor riesgo de depresión durante el embarazo. Hubo asociación estadísticamente significativa entre mayor riesgo de depresión durante el embarazo y la variable ocupación (p=0,04), o sea, la ausencia del trabajo (OR = 2,00) duplicó la probabilidad de ocurrencia. Conclusión: la alta prevalencia de riesgo de depresión durante el embarazo destaca la necesidad de planificación, priorización e integración de la salud mental en los servicios de salud prenatal, especialmente en el ámbito de la Atención Primaria de Salud, por parte de los gestores de salud y de los formuladores de políticas.

Objective: to identify the risk of depression during pregnancy among pregnant women receiving routine prenatal care and the associated factors. Method: a cross-sectional study, carried out with 201 pregnant women, in a routine prenatal clinic of a university maternity hospital. Data were collected using an electronic form containing a characterization instrument and the Escala de Risco de Depressão na Gravidez (Depression during Pregnancy Scale). The dependent variable was the risk of depression during pregnancy. Statistical analysis was performed by calculating the Odds Ratio and using the Chi-square and Fischer's Exact tests. Results: among the participants, 68.2% had a higher risk of depression during pregnancy. There was a statistically significant association between a higher risk of depression during pregnancy and occupation (p=0.04), that is, unemployment (OR=2.00) doubled the risk of depression. Conclusion: the high prevalence of the risk of depression during pregnancy indicates the necessity of planning, prioritizing, and integrating mental health into prenatal health services, especially in the primary healthcare environment, by health managers and policymakers.

Objetivo: identificar o risco de depressão na gravidez entre gestantes inseridas na assistência pré-natal de risco habitual e os fatores associados. Método: estudo transversal, realizado com 201 gestantes, no ambulatório de pré-natal de risco habitual de uma maternidade universitária. A coleta de dados utilizou um formulário eletrônico contendo um instrumento de caracterização e a Escala de Risco de Depressão na Gravidez. A variável dependente foi o risco de depressão na gravidez. A análise estatística deu-se pelo cálculo da razão de chances (Odds Ratio) e pelos testes Qui-quadrado e Exato de Fischer. Resultados: entre as participantes, 68,2% apresentaram maior risco de depressão na gravidez. Houve associação estatisticamente significativa entre o maior risco de depressão na gravidez e a variável ocupação (p=0,04), ou seja, a ausência de emprego (OR = 2,00) aumentou em duas vezes a chance de ocorrência. Conclusão: a alta prevalência de risco de depressão na gravidez evidencia a necessidade de planejamento, priorização e integração da saúde mental nos serviços de saúde pré-natal, principalmente no ambiente da Atenção Primária à Saúde, por parte de gestores de saúde e formuladores de políticas.

Relação entre a condição bucal de gestantes internadas e desfechos adversos na gestação / Relationship between the oral condition of hospitalized pregnant women and adverse pregnancy outcomes

Objetivo: avaliar se a condição bucal favoreceu a presença de desfechos adversos da gestação (DAG) em mulheres internadas e acompanhadas em um hospital escola. Métodos: um estudo de coorte retrospectiva com mulheres grávidas que foram internadas entre setembro de 2019 e início de março de 2020 e que continuaram o acompanhamento obstétrico. Resultados: Das 65 gestantes que seguiram acompanhamento, 27 (41,5%) dos bebês nasceram pré-termo e 20 (30,8%) com baixo peso, sendo que as duas condições estavam presentes em 15 crianças (23,1%), sendo significantemente relacionadas com a menor semana gestacional na internação. Ao relacionar diferentes fatores com o desfecho pré-termo, houve diferença significante em gestantes com a ocupação "do lar" e com o tempo de internação igual ou maior que 10 dias e com a presença de baixo peso ao nascer. Não foi observada relação dos dados avaliados da condição bucal das gestantes na internação com o parto pré-termo. Conclusões: Gestantes que necessitam de internação hospitalar durante a gravidez, independente da condição bucal, aumentam a possibilidade de apresentarem DAG, sendo fundamental a realização do correto acompanhamento pré-natal.(AU)

Objective: to assess whether the oral condition favored the presence of adverse effects during pregnancy in pregnant women hospitalized and followed up at a teaching hospital. Methods: a retrospective cohort study with mothers who were hospitalized during pregnancy between September 2019 and early March 2020 and who continued obstetric follow-up. Results: 83 pregnant women were interviewed and 65 were followed up Of the 65 pregnant women who followed up, 27 (41.5%) of the babies were born preterm and 20 (30.8%) with low birth weight, and both conditions were present in 15 children (23.1%), being significantly related to the shortest gestational week at admission. When relating different factors with the preterm outcome, there was a significant difference in pregnant women with the occupation "housewife" and with the length of hospital stay equal to or greater than 10 days and with the presence of low birth weight. There was no relationship between the evaluated data on the oral condition of pregnant women during hospitalization and preterm delivery. Conclusions: Pregnant women who require hospitalization during pregnancy, regardless of oral condition, increase the possibility of having negative pregnancy outcomes, and correct prenatal care is essential. (AU)

Clinical analysis of 15 pregnant women complicated with moyamoya disease / 中华妇产科杂志

Objective: To explore the effects of pregnancy complicated with moyamoya disease on maternal and fetal outcomes. Methods: The general clinical data and maternal and fetal outcomes of 20 pregnancies of 15 patients with moyamoya disease admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to October 2022 were retrospectively analyzed. Results: (1) General information: among the 20 pregnancies of 15 clearly diagnosed pregnant women complicated with moyamoya disease, 12 were diagnosed before pregnancy (60%, 12/20), 3 were diagnosed during pregnancy (15%, 3/20), and 5 were diagnosed during puerperal period (25%, 5/20). There were 7 cases of primipara (35%, 7/20) and 13 cases of multipara (65%, 13/20). (2) Pregnancy complications and maternal and infant outcomes: among the 20 pregnancies of 15 pregnant women with moyamoya disease, there were 9 pregnancy complications (45%, 9/20), including 5 gestational hypertension (25%, 5/20), 2 severe pre-eclampsia (10%, 2/20), 1 hyperlipidemia and 1 gestational diabetes mellitus (5%, 1/20). There were 2 case of drug abortion in the first trimester, 3 cases of labor induction in the second trimester, and 15 cases of delivery during the third trimester. All the 15 deliveries were cesarean section, of which 11 (11/15) were cesarean sections with medical indications, and 4 (4/15) were cesarean sections caused by personal factors. General anesthesia was used in 5 cases (5/15), epidural block anesthesia in 7 cases (7/15), and combined spinal and epidural anesthesia in 3 cases (3/15). The median gestational age of 15 neonates was 37.2 weeks (34.0 to 40.8 weeks), with 10 cases (10/15) were full-term infants, and 5 (5/15) were preterm infants (3 of which were associated with hypertensive disorder complicating pregnancy). The birth weight of 15 neonates was (2 853±454) g. Four neonates were admitted to neonatal intensive care unit (NICU), of which 3 cases were admitted to NICU due to premature delivery and 1 case was admitted to NICU due to neonatal jaundice. There was no neonatal asphyxia or death. All neonates were followed up from 4 months to 6 years after birth, and all grew well. (3) Neurological symptoms during pregnancy: 8 cases (40%, 8/20) had neurological symptoms during pregnancy, and 6 cases (30%, 6/20) had hemorrhagic symptoms, of which 3 cases occurred during the puerperal period (3/6). There were 2 cases of ischemic symptoms (10%, 2/20), all of which occurred during the puerperal period (2/2). (4) Analysis of factors related to the occurrence of cerebral hemorrhage: the incidence of cerebral hemorrhage in patients with moyamoya disease diagnosed before pregnancy was significantly lower than that in those without a clear diagnosis, and the incidence of cerebral hemorrhage in women with moyamoya disease was lower than that in primipara (all P<0.01). The incidence of cerebral hemorrhage in moyamoya patients without hypertensive disorder complicating pregrancy was lower than that in patients with hypertensive disorder complicating pregrancy, but the difference was not statistically significant (P>0.05). Conclusions: Pregnancy combined with moyamoya disease has adverse effects on maternal and infant outcomes, and the incidence of pregnancy complications increases. Cerebral hemorrhage occurres in prenatal and puperium, while cerebral ischemia occurres mainly in puperium.

Research progress on long-term developmental outcomes of offspring of pregnant women with systemic lupus erythematosus / 中国当代儿科杂志

Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease that affects multiple organs and systems. It is more common in women of childbearing age. Compared with the general population, pregnant women with SLE are at a significantly increased risk of adverse perinatal outcomes such as preterm birth and intrauterine growth restriction. In addition, the offspring of SLE patients may also be adversely affected by in utero exposure to maternal autoantibodies, cytokines, and drugs. This article summarizes the long-term developmental outcomes of offspring of pregnant women with SLE in terms of the blood system, circulatory system, nervous system, and immune system.

Perinatal risk factors for the occurrence of singleton apparently stillborn infants / 中国当代儿科杂志

OBJECTIVES@#To identify the perinatal risk factors for the occurrence of singleton apparently stillborn infants.@*METHODS@#This was a case-control study. A total of 154 singleton neonates with gestational age ≥28 weeks and Apgar score of 0-1 who were subsequently successfully resuscitated in the Obstetrics and Gynecology Hospital of Fudan University from January 2006 to December 2015 were enrolled as the case group (apparently stillborn group). A total of 616 singleton infants born from January 2006 to December 2015 (1-minute Apgar score >1) were randomly selected in a 1:4 ratio as the control group. Univariate analysis and multivariate logistic regression were used to analyze the perinatal risk factors for the occurrence of apparently stillborn infants.@*RESULTS@#The gestational age and birth weight in the apparently stillborn group were significantly lower than those in the control group (P<0.05). The incidences of fetal hydrops, cord prolapse, grade III meconium-stained amniotic fluid, placental abruption, breech presentation, severe pre-eclampsia, maternal general anesthesia at delivery, abnormal antenatal fetal heart monitoring and decreased fetal movement were significantly higher in the apparently stillborn group than those in the control group (P<0.05). The multivariate logistic analysis showed that the mother had general anesthesia at delivery (OR=34.520), decreased antenatal fetal movement (OR=28.168),placental abruption (OR=15.641), grade III meconium-stained amniotic fluid (OR=6.365), abnormal antenatal fetal heart monitoring (OR=5.739), and breech presentation (OR=2.614) were risk factors for the occurrence of apparently stillborn infants (P<0.05), while higher gestational age was a protective factor (OR=0.686, P<0.05).@*CONCLUSIONS@#Attention needs to be paid to mothers with abnormal prenatal fetal heart monitoring, decreased fetal movement, preterm labor, placental abruption, breech presentation, grade III meconium-stained amniotic fluid, and general anesthesia. Preparations for resuscitation should be done to rescue apparently stillborn infants.

Mortalidade materna na adolescência e juventude: tendência temporal e correlação com cobertura pré-natal na Bahia, 2000-2020 / Maternal mortality in adolescents and young adults: temporal trend and correlation with prenatal care coverage in the state of Bahia, Brazil, 2000-2020 / Mortalidade materna na adolescência e juventude: tendência temporal e correlação com cobertura pré-natal na Bahia, 2000-2020

Objetivo: analisar a tendência temporal da mortalidade materna e correlacioná-la com a cobertura pré-natal entre adolescentes e adultas jovens, Bahia, Brasil, 2000-2020. Métodos: estudo ecológico de série temporal e correlação entre óbitos maternos e consulta de pré-natal aos 10-19 e 20-24 anos, utilizando-se o Sistema de Informações sobre Mortalidade; a tendência foi analisada pela regressão de Prais-Winsten, segundo raça/cor da pele, causas e momento do óbito; para a correlação, utilizou-se o coeficiente de Spearman. Resultados: no período, foram registrados 418 óbitos de adolescentes e 574 de adultas jovens; razão de mortalidade materna de 59,7 e 63,2 óbitos/100 mil nascidos vivos, com tendência decrescente significante (-2,2% e -2,9% respectivamente); observou-se correlação inversa entre maior número de consultas e mortalidade materna, nos grupos etários. Conclusão: a mortalidade materna apresentou tendência de redução no período, porém com altas proporções de óbito; houve correlação significante entre cobertura pré-natal e mortalidade materna, entre adolescentes e adultas jovens.

Objective: to analyze the temporal trend of maternal mortality and correlate it with prenatal care coverage among adolescents and young adults, state of Bahia, Brazil, 2000-2020. Methods: this was an ecological time-series study and correlation between maternal deaths and prenatal care visits in 10-19 and 20-24 age groups, using the Mortality Information System; the trend analysis was performed by means of Prais-Winsten regression, according to race/skin color, timing and causes of death; and Spearman coefficient was used for correlation. Results: in the study period, 418 deaths among adolescents and 574 among young adults were recorded; maternal mortality ratio was 59.7 and 63.2 deaths/100,000 live births, with a significant decreasing trend (-2.2% and -2.9% respectively); it could be seen an inverse correlation between a higher number of prenatal care visits and maternal mortality in the age groups. Conclusion: maternal mortality showed a decreasing trend in the study period, but with high proportions of death; there was a significant correlation between prenatal care coverage and maternal mortality among adolescents and young adults.

Objetivo: analizar la tendencia temporal de la mortalidad materna y correlacionarla con la cobertura prenatal, entre adolescentes y adultas jóvenes, en el estado de Bahía, período 2000-2020. Métodos: estudio ecológico de series temporales y correlación entre muertes maternas y atención prenatal, en grupos de edad de 10-19 y 20-24, utilizando el Sistema de Información de Mortalidad. Analizó la tendencia mediante regresión de Prais-Winsten, según raza/color de piel, causas y hora de muerte; para correlación, el coeficiente de Spearman. Resultados: en el período se registraron 418 muertes de adolescentes y 574 de adultas jóvenes; razón de mortalidad materna de 59,7 y 63,2 muertes/100.000 nacidos vivos, con importante tendencia a la baja (-2,2%; -2,9%, respectivamente). Se observó correlación inversa entre el mayor número de consultas y la mortalidad materna en grupos. Conclusión: la mortalidad materna mostró tendencia descendente en el período, pero con altas proporciones de muertes. Hubo una correlación significativa entre la cobertura prenatal y la mortalidad materna, adolescente y adulta joven.

Biometry and pathological ultrasound findings in multiple pregnancies / Características ecográficas y hallazgos patológicos en embarazos múltiples

Resumo Objectives: to determine the prevalence of pathological findings according to the type of chorionicity in pregnancies in two institutions in Bogotá, Colombia. Methods: descriptive, retrospective, cohort study. Biometric variables were calculated, and pathological findings were evaluated according to the type of chorionicity in multiple pregnancies. Statistical characterization was performed with absolute frequencies, calculation of relative frequencies in qualitative variables, standard deviation measures, median and interquartile range. In addition, a descriptive analysis of the information was carried out. Results: 528 studies were carried out in 141 pregnant women, 98.5% (n = 139) twins and 1.4% (n = 2) triplets. A prevalence of 35.4% of fetal complications was calculated. The most frequent was fetal growth restriction (p=0.37). According to each type of chorionicity, fetal growth restriction was presented in 50% (1/2) of the trichorionics, 16.6% (7/42) of the monochorionics, and 11.3% (11/97) of the dichorionics. Conclusion: fetal growth restriction was the most common finding, both in trichorionics, monochorionics and dichorionics pregnancies.

Resumen Objetivos: el objetivo del estudio fue determinar la prevalencia de los hallazgos patológicos ecográficos en embarazos múltiples de acuerdo con la corionicidad en dos instituciones en Bogotá-Colombia. Métodos: estudio de cohorte, descriptivo, retrospectivo. Las variables biométricas realizadas y los hallazgos patológicos se evaluaron de acuerdo con el tipo de embarazo gemelar. Se realizó caracterización estadística con frecuencias absolutas, cálculo de frecuencias relativas en variables cualitativas, medidas de desviación estándar, mediana y rango intercuartílico. Además, se realizó análisis descriptivo de la información. Resultados: se realizaron 528 estudios en 141 gestantes, encontrando 98,5% (n=139) gemelares y 1,4% (n=2) triples. Se calculó una prevalencia de 35,4% de complicaciones fetales siendo más frecuente la restricción del crecimiento fetal (p=0,37). Según la corionicidad, esta complicación se presentó en 50% (1/2) de los tricoriónicos, 16,6% (7/42) de los monocoriónicos y 11,3% (11/97) de los dicoriónicos. Conclusión: la restricción del crecimiento fetal fue el hallazgo más común en los embarazos múltiples en la población estudiada.

Perfil epidemiológico de sífilis gestacional no hospital público-privado em um município do oeste do Paraná / Epide miological profile of gestational syphilis in a public-private hospital in a municipality in western Paraná

Objetivo: Determinar o perfil epidemiológico da sífilis gestacional em um hospital público-privado localizado no município de Toledo, Paraná, no período de janeiro de 2017 a dezembro de 2019. Métodos: Estudo observacional, retrospectivo, com forma de abordagem quantitativa, descritiva e indireta, a partir de uma pesquisa documental em um hospital público-privado e na 20ª Regional de Saúde do Paraná, localizados no município de Toledo, Paraná, Brasil. Resultados: Foram avaliadas 163 gestantes com sífilis gestacional. A média de idade foi 24,42 anos. Entre as gestantes, 47,24% são mulheres brancas, 39,88% têm ensino médio completo, 66,26% residentes na cidade de Toledo, 98,16% realizaram pré-natal, 65,64% foram diagnosticadas no primeiro trimestre. O tratamento adequado ocorreu em 45,40% das gestantes e em 53,99% o parceiro foi tratado em conjunto. Conclusão: A sífilis gestacional apresentou predomínio em gestantes na faixa etária de 20 a 29 anos, mulheres brancas, com ensino médio completo, residentes em Toledo, Paraná. Retratou-se boa cobertura de pré-natal, assim como apontou-se o tratamento do parceiro sexual como o maior obstáculo para a gestante ser tratada adequadamente e indicou-se que a sífilis em gestantes pode ser considerada uma causa importante da ocorrência de desfechos perinatais desfavoráveis.

Objective: To determine the epidemiological profile of gestational syphilis in a public- private hospital, located in the city of Toledo, Paraná, from January 2017 to December 2019. Methods: Observational, retrospective study, with a quantitative, descriptive and indirect approach, based on a documentary research in a public-private hospital and in the 20th Regional Health of Paraná, located in the city of Toledo, Paraná, Brazil. Results: 163 pregnant women with gestational syphilis were evaluated. The average age was 24,42 years. 47,24% are white women, 39,88% have completed high school, 66,26% live in the city of Toledo. 98,16% had prenatal care, 65,64% were diagnosed in the 1st trimester. Appropriate treatment occurred in 45,40% of the pregnant women and in 53,99% the partner was treated together. Conclusion: Gestational syphilis was predominant in pregnant women aged 20 to 29 years, white women, with complete high school, living in Toledo, Paraná. It portrayed good prenatal coverage, as well as pointing out the treatment of the sexual partner as the biggest obstacle for the pregnant woman to be treated properly and indicated that syphilis in pregnant women can be considered an important cause of the occurrence of unfavorable perinatal outcomes.

Desfechos maternos e neonatais em servidoras públicas estaduais de São Paulo com idade materna avançada / Maternal and neonatal outcomes in state public servants of São Paulo with advanced maternal age

Objetivo: Caracterizar a população das gestantes em diferentes faixas etárias; avaliar desfechos maternos e neonatais em pacientes com idade materna avançada; determinar a faixa etária a partir da qual os desfechos adversos foram mais prevalentes. Métodos: Parturientes atendidas no Hospital do Servidor Público Estadual de São Paulo entre junho/2019 e maio/2020 foram divididas em três grupos ­ 20 a 34 anos; 35 a 39 anos; 40 anos ou mais ­ e analisadas quanto a diversas variáveis. Resultados: Entre as gestantes do Serviço, 44,2% tinham idade materna avançada. A amostra foi composta por 927 pacientes, a maioria com relacionamento conjugal estável (75,2%) e ensino de nível superior (74,7%). Independentemente do grupo etário, foram observados elevados índices de obesidade (25,9%), sobrepeso (39,7%) e cesariana (76,4%). A frequência de iteratividade, diabetes gestacional e doença hipertensiva específica da gestação foi maior a partir dos 35 anos, e a frequência de hipertensão arterial crônica foi maior a partir dos 40 anos. Neonatos de pacientes com 40 anos ou mais tiveram maiores índices de baixo peso ao nascer, óbito neonatal, Apgar de quinto minuto < 7 e necessidade de reanimação neonatal. Conclusão: Pacientes com idade materna avançada representaram porcentagem expressiva da população e tiveram maior frequência de desfechos adversos. Complicações obstétricas foram mais prevalentes a partir dos 35 anos, com destaque para diabetes gestacional e distúrbios hipertensivos. Resultados neonatais desfavoráveis, como baixo peso ao nascer e óbito neonatal, foram mais prevalentes a partir de 40 anos.

Objective: Featuring the population of pregnant women in different age groups; assessing maternal and neonatal outcomes in patients at advanced maternal age; determining the threshold age for the potential prevalence of adverse outcomes. Methods: Women in labor assisted at Hospital do Servidor Público Estadual de São Paulo between June/2019 and May/2020 were divided into three age groups ­ 20 to 34 years; 35 to 39 years; over 40 years ­, who were assessed for several variables. Results: 44.2% of pregnant women in this Service were at advanced maternal age. The sample counted on 927 patients, most of them declared stable marital relationships (75.2%) and College degree (74,7%). High obesity levels (25.9%), overweight (39.7%) and cesarean delivery (76.4%) were observed, regardless of age group. Maternal request was the main indication for cesarean surgery. Iteration frequency, gestational diabetes and pregnancy-specific hypertensive disease was higher from the age of 35 years, on. Chronical high blood pressure was higher in the age group over 40 years. Newborns from patients older than over 40 years presented higher low weight at birth index, neonatal death, 5th minute Apgar score < 7 and the need of neonatal resuscitation. Conclusion: Patients at advanced maternal age recorded higher obstetric adversity frequency in the age group over 35 years, with emphasis on gestational diabetes and high blood pressure. Unfavorable neonatal outcomes related to low weight at birth and neonatal death were more prevalent in the age group over 40 years.

Measurement of the prevalence of intervention/complication in puerperal women attending a university hospital during the pandemic of COVID-19 by the maternity safety thermometer / Medida da prevalência de intervenção/complicação em puérperas atendidas em hospital universitário durante a pandemia de COVID-19 pelo termômetro de segurança da maternidade

Abstract Objectives: measuring the prevalence of interventions and/or complications based on the Maternity Safety Thermometer (MST) criteria and verifying associations with sociodemographic, clinical, and obstetric factors. Methods: prospective observational study conducted with postpartum women admitted to the maternity ward of a tertiary hospital, from October 10th to December 30th, 2020. Data were collected from medical records and self-administered questionnaires from 260 patients. Results: harm-free care was detected in 17.7% of participants, 66.9% had low-temperature damage (one or less intervention/complication) and 33.1% of patients had elevated temperature damage (two or more intervention/complication). The most frequent intervention was the "scar", given that 38.5% had abdominal scarring (cesarean section) and 26.5% had perineal scarring (2nd-degree tear or greater - spontaneous or by episiotomy). The second most frequent MST item was related to the perception of safety (30%), followed by complications to the newborn (12.3%), infection (11.2%), and hemorrhage (9.2%). Factors related to high temperature were: being of social class A or B, having a previous cesarean section, and being hospitalized during pregnancy. Conclusions: one-third of the participating women had two or more complications/interventions (high temperature by the MST), factors that are related to this temperature were: being of social class A or B, having a previous cesarean section, and being hospitalized during pregnancy.

Resumo Objetivos: mensurar a prevalência de intervenções e/ou complicações a partir dos critérios estabelecidos pelo Termômetro de Segurança da Maternidade (TSM) e avaliar associações com fatores sociodemográficos, clínicos e obstétricos. Métodos: estudo observacional prospectivo realizado com puérperas internadas na maternidade de hospital terciário, de 10 de outubro a 30 de dezembro de 2020. Foram coletados dados do prontuário e de questionários autoaplicáveis de 260 pacientes. Resultados: um cuidado livre de intervenções/complicações foi detectado em 17,7% das participantes, 66,9% apresentaram baixa temperatura (até uma intervenção/complicação) e 33,1% tiveram alta temperatura de intervenções/complicações (2 ou mais). A intervenção mais frequente foi a denominada "cicatriz", sendo que 38,5% tiveram cicatriz abdominal (cesariana) e 26,5% tiveram "cicatriz" perineal (laceração de 2º grau ou mais - espontânea ou por episiotomia). O segundo dano mais frequente foi o relacionado à percepção de segurança (30%), seguido de complicações do recémnascido (12,3%), infecção (11,2%), e hemorragia (9,2%). Houve associação de ter alta temperatura com ser de classe social A ou B, ter cesárea anterior e ser internada na gestação. Conclusões: das mulheres participantes, um terço teve duas ou mais complicações/intervenções (alta temperatura no TSM), estiveram relacionados a essa temperatura: ser de classe social A ou B, ter cesárea anterior e ser internada ao longo da gestação.

Malnutrición por exceso durante la gestación: análisis de tendencia secular y de factores asociados, Región de La Araucanía, Chile / Secular trend for overweight and excessive weight gain during pregnancy in a Southern Chilean region

BACKGROUND: Overweight during pregnancy has increased in Chile. In the region of La Araucanía it occurs in 67% of pregnancies, which exceeds the national indicators. AIM: To analyze the secular trend during eight years of the nutritional status at the beginning of gestation, the excessive weight gain during pregnancy, and its association with individual factors in pregnant women cared the public health system of two Southern Chilean neighboring cities. MATERIAL AND METHODS: This is an analytical observational study with a cross-sectional and longitudinal trend design. We used an anonymized database with 17,270 reproductive data of urban pregnant women who were cared between 2009 and 2016. Trend analysis was performed to evaluate secular changes (nptrend < 0.05) in nutritional indicators and logistic regression to determine the association with individual characteristics. RESULTS: In the study period, overweight at the beginning of pregnancy increased by 13.1 percentage points. Forty percent of pregnant women with normal initial body mass index, were overweight or obese at the end of pregnancy. The excessive weight gain decreased slightly (z=-3.33, p = 0.001), but unevenly in both cities. Adolescent pregnancy, a low education and low socio-economic level of household together with previous overweight and a family or personal history of chronic diseases are associated with excessive gestational weight gain. Conclusions: The results show social inequality. Female malnutrition by excess is a problem that must be addressed through a robust public policy, centered on primary health care level and with a focus on social determinants. Prenatal care provides a window of opportunity to intervene.

Predictive factors for premature birth and respiratory exacerbation in pregnancies of women with cystic fibrosis

Abstract Objective: In this present study, the authors evaluated the predictive factors for adverse maternal-fetal outcomes in pregnancies of women with cystic fibrosis (CF). Patients were followed up by a referral center for adults in southern Brazil. Methods: This is a retrospective cohort study that used data from electronic medical records regarding pregnancies of women diagnosed with CF. Results: The study included 39 pregnancies related to 20 different women. The main adverse outcomes were high prevalence rates of premature birth (38.5%) and maternal respiratory exacerbation (84.6%). Lower body mass index (BMI) values (< 20.8) and younger ages of CF diagnosis increased the risk of premature birth. The presence of methicillin-resistant and absence of methicillin-sensitive Staphylococcus aureus, as well as a younger age of diagnosis, increased the risk of maternal respiratory exacerbation during pregnancy. Conclusions: Conception in women with CF is often associated with maternal and fetal complications. Continuous monitoring by a multidisciplinary team should emphasize appropriate nutritional status, investigation of bacterial colonization, and immediate attention to respiratory exacerbations.

Fatores associados à morbidade materna grave em Ribeirão Preto, São Paulo, Brasil: estudo de corte transversal / Factors associated with serious maternal morbidity in Ribeirão Preto, São Paulo State, Brazil: a cross-sectional cohort study / Factores asociados a la morbilidad materna grave en Ribeirão Preto, São Paulo, Brasil: estudio de corte transversal

Este estudo investigou os fatores associados à morbidade materna grave entre mulheres atendidas em maternidades públicas do Município de Ribeirão Preto, São Paulo, Brasil. Trata-se de um estudo quantitativo, analítico, transversal. Participaram 1.098 puérperas com parto em uma das quatro maternidades públicas do município. A coleta de dados ocorreu entre 3 de agosto de 2015 e 2 de fevereiro de 2016, a partir de entrevistas face a face, obtenção de informações dos prontuários e dos cartões da gestante. Para a análise de dados, considerou-se como variável dependente a ocorrência de morbidade materna grave, ou seja, quando a mulher era classificada como near miss materno ou condição potencialmente ameaçadora à vida a partir dos critérios de elegibilidade da Organização Mundial de Saúde. Calculou-se a razão do near miss materno, odds ratio (OR), intervalo de 95% de confiança (IC95%) e regressão logística múltipla. A razão do near miss materno foi de 3,6 casos por mil nascidos vivos. As complicações ocorreram principalmente na gravidez (53,8%) e os distúrbios hipertensivos foram os mais frequentes (49,4%). A análise de regressão múltipla mostrou associação entre morbidade materna grave e gestação de risco (OR = 4,5; IC95%: 2,7-7,7) e com trabalho de parto induzido (OR = 2,1; IC95%: 1,2-3,9). A ocorrência de morbidade materna grave, principalmente na gestação, com destaque para as síndromes hipertensivas, aponta para a necessidade de melhor rastreamento e manejo da elevação dos níveis pressóricos no pré-natal. A associação entre morbidade materna grave e gestação de risco também remonta ao pré-natal, para a demanda de uma maior atenção às mulheres classificadas como risco gestacional. A qualidade da assistência é ponto chave para o enfretamento da morbimortalidade materna no país.

This study investigated the factors associated with serious maternal morbidity (SMM) in women seen at public maternity hospitals in Ribeirão Preto, São Paulo State, Brazil. This was a cross-section analytical quantitative study. Participation included 1,098 postpartum women who had given birth at one of the four maternity hospitals in the municipality. Data were collected from August 3, 2015, to February 2, 2016, using face-to-face interviews and data obtained from patient records and prenatal cards. The dependent variable for data analysis was the serious maternal morbidity, that is, when the woman was classified as maternal near miss or potentially life-threatening condition based on WHO eligibility criteria. The study calculated the maternal near miss ratio, odds ratio (OR), 95% confidence interval (95%CI), and multiple logistic regression. The maternal near miss ratio was 3.6 cases per 1,000 live births. Complications occurred mainly during pregnancy (53.8%), and hypertensive disorders were the most frequent (49.4%). Multiple regression analysis showed an association between serious maternal morbidity and high-risk pregnancy (OR = 4.5, 95%CI: 2.7-7.7) and induced labor (OR = 2.1, 95%CI: 1.2-3.9). The occurrence of serious maternal morbidity mainly during pregnancy, featuring hypertensive syndromes, points to the need for better screening and management of high blood pressure in the prenatal period. The association between serious maternal morbidity and high-risk pregnancy also calls attention to prenatal care, for the demand for greater care for women classified as having gestational risk. Quality of care is a key point for dealing with maternal morbidity and mortality in Brazil.

Este estudio investigó los factores asociados a la morbilidad materna grave entre mujeres atendidas en maternidades públicas del municipio de Ribeirão Preto, São Paulo, Brasil. Se trata de un estudio cuantitativo, analítico, transversal. Participaron 1.098 puérperas con parto en una de las cuatro maternidades públicas del municipio. La recogida de datos se produjo entre el 3 de agosto de 2015 al 2 de febrero de 2016, mediante entrevistas cara a cara, obtención de información de los historiales y cartillas de las gestantes. Para el análisis de datos, se consideró como variable dependiente la ocurrencia de morbilidad materna grave, o sea, cuando la mujer era clasificada como near miss materno o condición potencialmente amenazadora para la vida, a partir de los criterios de elegibilidad de la Organización Mundial de Salud. Se calculó la razón del near miss materno, odds ratio (OR), intervalo de 95% de confianza (IC95%) y regresión logística múltiple. La razón de near miss materno fue de 3,6 casos por 1.000 nacidos vivos. Las complicaciones se produjeron principalmente en el embarazo (53,8%) y las alteraciones hipertensivas fueron las más frecuentes (49,4%). El análisis de regresión múltiple mostró asociación entre morbilidad materna grave y gestación de riesgo (OR = 4,5; IC95%: 2,7-7,7) y con trabajo de parto inducido (OR = 2,1; IC95%: 1,2-3,9). La ocurrencia de morbilidad materna grave, principalmente en la gestación, resaltando los síndromes hipertensivos, apunta la necesidad de un mejor rastreo y gestión de la elevación de los niveles presión arterial en el período prenatal. La asociación entre morbilidad materna grave y gestación de riesgo también se remonta al período prenatal, con el fin de que se preste una mayor atención a las mujeres clasificadas como de riesgo gestacional. La calidad de la asistencia es un punto clave para combatir la morbimortalidad materna en el país.

Obstructive Sleep Apnea in Pregnancy / 中国医学科学院学报

The incidence of obstructive sleep apnea (OSA) is higher in pregnancy than in non-pregnancy,and obesity is a major risk factor.OSA in pregnancy can lead to multiple organ dysfunction and is associated with hypertensive disorders in pregnancy,gestational diabetes mellitus,premature birth,and fetal growth restriction. Therefore,early screening and diagnosis are essential for the prevention and treatment of OSA in pregnancy.

Sleep quality and sleep disturbances in Chinese pregnant women: a multicenter cross-sectional study / 中华耳鼻咽喉头颈外科杂志

Objective: This study aims to investigate the sleep quality of pregnant women in Xuhui District, Shanghai, and the related factors of sleep disturbances during pregnancy. Methods: From February 2019 to February 2021, we used online integrated sleep questionnaire (including PSQI, BQ, ESS, AIS) in Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, The International Peace Maternity and Child Health Hospitals of China Welfare Institution, and Shanghai Eighth People's Hospital, to investigate the sleep quality across pregnancy. We also collected maternal physical examination results, childbearing history, sociodemographic, and other clinical data. The prevalences and related factors of various sleep disturbances in pregnant women were analyzed, including insufficient/excessive nighttime sleep, low sleep efficiency, difficulty falling asleep, poor sleep quality, insomnia, daytime sleepiness, and high risk of sleep-disordered breathing (SDB). Results: This study includes 1 898 cases in the first trimester (T1), 3 099 cases in the second trimester (T2), and 1 539 cases in the third trimester (T3). Poor sleep quality (38.6%), daytime sleepiness (mild 41.9%, moderate 17.7%, severe 2.1%), and suspicious insomnia (32.3%) are most prevalent among women in T1 (P<0.01). In comparison, short sleep time (2.7%), long sleep time (8.6%), difficulty falling asleep (12.2%), poor sleep efficiency (35.4%), very poor sleep quality (6.7%), clinical insomnia (21.8%), and high-risk SDB (6.4%) are most prevalent among women in T3 (P<0.05). During pregnancy, late gestation (OR=1.016, 95%CI: 1.006-1.025) and multiple induced/drug abortions (OR=1.329, 95%CI: 1.043-1.692) are risk factors for poor sleep quality (PSQI>5), while multiple full-term deliveries (OR=0.800, 95%CI: 0.675-0.949) is its protective factor. Advanced maternal age (OR=0.976, 95%CI: 0.956-0.997), multiple full-term deliveries (OR=0.808, 95%CI: 0.680-0.959), late gestation (OR=0.983, 95%CI: 0.974-0.992) and hypertension (OR=0.572, 95%CI: 0.401-0.814) are protective factors for daytime sleepiness (ESS>6). The high-risk pregnancy category (OR=9.312, 95%CI: 1.156-74.978) is a risk factor for insomnia (AIS≥4), while multiple full-term deliveries (OR=0.815, 95%CI: 0.691-0.961) is its protective factor. High BMI (OR=1.334, 95%CI: 1.270-1.402) and hypertension (OR=4.427, 95%CI: 2.539-7.719) are risk factors for high-risk SDB in pregnant women. Conclusions: The prevalences of various sleep disturbances are high throughout pregnancy. Noticeably, symptoms of maternal SDB develop along with pregnancy. Different types of sleep disturbances are associated with different factors. Women of high-risk pregnancy category, in late gestation, with high BMI, hypertension, a history of induced/drug abortion, or without a history of full-term delivery can be at high risk of sleep disturbances during pregnancy.

Embarazo en la adolescencia como reto para el primer nivel de atención / Pregnancy in Adolescence as a Challenge for the First Level of Healthcare

Introducción: El embarazo en la adolescencia es el ocurrido en el lapso de vida entre los 10 y 19 años de edad; se presenta antes de que la madre haya alcanzado la suficiente madurez emocional para asumir la compleja tarea de la maternidad. A nivel mundial, se reconoce un aumento de la actividad sexual de los adolescentes, es un problema social que afecta, en mayor o menor proporción, a todas las regiones del mundo. Objetivo: Definir el alcance y la naturaleza de la literatura científica existente sobre el embarazo en la adolescencia, prevención y sus complicaciones. Métodos: Revisión bibliográfica sistemática para hacer un análisis crítico reflexivo de documentos, donde se incluyeron libros, tesis de doctorado, de maestría, artículos originales y de revisión. La estrategia de búsqueda utilizada en cada base de datos, SciELO y Google académico se reunió mediante la aceptación de los descriptores Adolescencia, Embarazo, Prevención y Complicaciones, con los operadores booleanos AND y OR. Conclusiones: Para la prevención del embarazo en la adolescencia, se necesita de una mayor divulgación de sus consecuencias y formas de evitarlo que podría lograrse con la puesta en práctica de estrategias educativas de forma didácticas y agradables, que puedan constituir interés para los adolescentes(AU)

Introduction: Pregnancy in adolescence is that one occurring in the period of life from the age of ten to nineteen years old. It occurs before the mother has reached enough emotional maturity to take on the complex task of motherhood. Worldwide, an increase in adolescent sexual activity is recognized; it is a social concern that affects, to a greater or lesser extent, all regions of the world. Objective: To define the scope and nature of the existing scientific literature on adolescent pregnancy, as well as its prevention and complications. Methods: Systematic bibliographic review carried out in view of a reflective-critical analysis of documents, which included books, doctoral and master's theses, as well as original and review articles. The search strategy used in each database, SciELO and Google Scholar, was designed by accepting the descriptors Adolescencia [Adolescence], Embarazo [Pregnancy], Prevención [Prevention] and Complicaciones [Complications], with the Boolean operators AND and OR. Conclusions: For the prevention of pregnancy in adolescence, greater spread of its consequences and ways for avoiding it is needed, which could be achieved with the implementation of educational strategies in a didactic and pleasant way, in order for it to become of interest to adolescents(AU)

Índice de necesidad de tratamiento periodontal en embarazadas y no embarazadas que asisten a la maternidad provincial de Córdoba, Argentina / Periodontal index for treatment needs in pregnant and non-pregnant women attending the provincial maternity hospital in Córdoba, Argentina

Objetivo: Comparar la salud periodontal de embaraza- das y no embarazadas mediante la aplicación del Índice de Periodontal Comunitario (IPC). Materiales y métodos: Se realizó un estudio ob- servacional de corte transversal. Se reclutaron 100 mujeres embarazadas (EMB) y 50 no embarazadas (NoEMB) que concurrieron al Hospital Materno Provincial de la Ciudad de Córdoba, Dr. Raúl F. Lucini. En todas se registró el IPC con la sonda periodontal WHO 621 en los 6 sextantes de la boca. Los datos se analizaron con el software Infostat/SP; el nivel de significación establecido fue de P <0,05. Resultados: El 70% de las pacientes presentó edades de entre 18 y 25 años. En las EMB el código 3 del IPC fue el más frecuente presente en 240 sextantes (40,1%) y en las NoEMB el código 2 fue el más frecuente con 39 sextantes (43%). A ambos grupos de estudio les corresponde el trata- miento de instrucción de higiene bucal, instrumentación supra y/o subgingival, y/o regularización de obturaciones. Conclusiones: El código 3 fue el más frecuente entre las EMB, a quienes les corresponde un Código de tratamiento periodontal (CTP) 2; las NoEMB presentaron un IPC de 1 y 2 como los más frecuentes y se vinculan con un CTP 1 y 2. Nos encontramos frente a una situación clínica periodontal posible de resolver con terapia básica que puede ser realizada por odontólogos generalistas (AU)

Aim: To compare the periodontal health of pregnant and non-pregnant women by applying the Community Periodontal Index (CPI). Materials and methods: In an observational, cross-sec- tional study, 100 pregnant women (PREG) and 50 non-preg- nant women (NonPREG) were recruited at the Dr. Raúl F. Lu- cini Provincial Maternity Hospital in Córdoba City. The CPI was determined in the 6 sextants of the mouth using a WHO 621 periodontal probe. The data were analyzed with Infostat SP software. P <0.05 was considered significant. Results: 70% of the patients were 18 to 25 years old. In the PREG group, CPI Code 3 was the most frequent, present in 240 sextants (40.1%), while in the non-PREG group, CPI Code 2 was the most frequent, with 39 sextants (43%). Treat- ment needs in both study groups are oral hygiene instruction, supra- and/or subgingival instrumentation, and/or correction of plaque retentive margins. Conclusions: Code 3 was the most frequent among preg- nant women, which corresponded to Periodontal Treatment Code (CTP) 2. CPI 1 and 2 were the most frequent in non-pregnant women, corresponding to CTP 1 and 2. This periodontal clinical condition can be treated with initial dental hygiene therapy, which can be performed by general dentists (AU)

Profile of women affected with premature childbirth and neonatal outcomes / Perfil de mulheres acometidas por parto prematuro e desfechos neonatais

Abstract Objectives: to describe the profile of women affected with premature childbirth and neonatal outcomes at a referral maternity in the city of Fortaleza-CE, Brazil. Methods: descriptive and retrospective documentary type study, with a quantitative approach, carried out from January to December, 2017, with 253 medical records of women who had premature childbirth in a referral maternity. Results: the average age was 28, with the prevalence of women living in a stable union, graduated from high school and without formal work. The gestational mean average was three pregnancies, gestational age of 34 weeks and three days, and six prenatal consultations, starting in the first trimester. The major intercurrence was pre-eclampsia. In relation to the neonatal data, there was a prevalence of male newborns, with an average of 2.251 kg and a score of seven on the 1-minute Apgar and eight on the 5-minute Apgar. Newborns in going to a hospital accommodation after childbirth and in room air, spending an average of 12.71 days in the hospital. Conclusion: in this case of this research, knowing the woman's profile and the outcomes in premature newborns is useful to encourage public policies and reduce the sequelae on mother and baby

Resumo Objetivos: descrever o perfil de mulheres acometidas por parto prematuro e os desfechos neonatais em maternidade de referência, na cidade de Fortaleza-CE, Brasil. Métodos: estudo do tipo documental, descritivo, retrospectivo, com abordagem quantitativa, realizadode janeiro a dezembro de 2017, com 253 prontuários de mulheres que tiveram parto prematuro em maternidade de referência. Resultados: média de idade de 28 anos, com prevalência de mulheres vivendo em união estável, ensino médio completo, sem trabalho formal. A média gestacional foi de três gravidezes, idade gestacional de 34 semanas e trêsdias e seis consultas de pré-natal, iniciando no primeiro trimestre. A maior intercorrência foi a pré-eclâmpsia. Relacionado aos dados neonatais, houve prevalência de recém-nascidos do sexo masculino, com média de 2,251 quilos e escore sete no Apgar do 1º minuto e oito, no Apgar do 5º minuto. Recémnascidos indo para alojamento conjunto após o parto e em ar ambiente, tendo passado, em média, 12,71 dias internados. Conclusões: no caso da pesquisa, conhecer o perfil dessa mulher e os desfechos do recém-nascido prematuro é útil para estimular as políticas públicas e diminuir as sequelas para mãe e bebê.

Complicações clínicas na gravidez: uma revisão sistemática de estudos com gestantes brasileiras / Clinical complications during pregnancy: a systematic review of studies with pregnant Brazilian women

Resumo Objetivou-se descrever as principais complicações clínicas em gestantes brasileiras relatadas na literatura, identificando os fatores de exposição mais relevantes e seus desfechos na saúde materno-infantil. Foi realizada uma revisão sistemática de artigos publicados entre 2010 e 2018. Foram incluídos três revisões e 36 artigos empíricos; transtornos mentais (n=9), doenças infecciosas (n=9) e morbidade materna grave (n=8) foram as principais complicações clínicas na gravidez. Ainda, quatro artigos enfocaram a determinação das principais afecções ou causas de internação, citando-se com maiores frequências a Infecção do Trato Urinário, a anemia e as doenças hipertensivas. Idade materna nos extremos reprodutivos, menor escolaridade, vulnerabilidade socioeconômica, características raciais e uso de serviços públicos de saúde foram os fatores de exposição mais relevantes. Resultados de saúde desfavoráveis associados a complicações clínicas na gravidez foram verificados nos oito artigos com esse perfil. A frequência de gestantes com complicações clínicas potenciais de ameaça à vida é elevada no país, evidenciando a importância da cobertura da atenção básica e a implantação de intervenções para sua redução e prevenção de desfechos maternos e infantis adversos.

Abstract The scope of this paper was to describe the main clinical complications among pregnant Brazilian women reported in the literature, identifying the most relevant exposure factors and their outcomes in maternal and child health. This is a systematic review of articles published between 2010 and 2018. Three reviews and 36 empirical articles were included; mental disorders (n=9), infectious diseases (n=9) and severe maternal morbidity (n=8) were the main clinical complications during pregnancy. In addition, four articles focused on determining the main conditions or causes of hospitalization, with a higher frequency of Urinary Tract Infection, anemia and hypertensive diseases. Maternal age at reproductive extremes, lower schooling, socioeconomic vulnerability, racial characteristics and the use of public health services were the most relevant exposure factors. Unfavorable health outcomes associated with clinical complications in pregnancy were verified in the eight articles with this profile. The frequency of pregnant women with potential life-threatening clinical complications is high in the country, highlighting the importance of primary care coverage and the implementation of interventions to reduce and prevent adverse maternal and child outcomes.

Temporal Evolution of Maternal Mortality: 1980-2019 / Evolução temporal da mortalidade materna: 1980-2019

Abstract Objective To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution. Methods Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327). Results After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%). Conclusion Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.

Resumo Objetivo Determinar o perfil dos óbitos maternos ocorridos no período de 2000 a 2019 no Hospital de Clínicas de Porto Alegre (HCPA) e comparar com os óbitos maternos entre 1980 e 1999 na mesma instituição. Métodos Estudo retrospectivo que analisou 2.400 prontuários de mulheres entre 10 e 49 anos que morreram entre 2000 e 2019. O presente estudo foi aprovado pelo Comitê de Ética (CAAE 78021417600005327). Resultados Após revisão de 2.481 prontuários de mulheres que morreram em idade reprodutiva, 43 mortes ocorreram durante a gravidez ou no período pós-parto. Destas, 28 foram considerados óbitos maternos. A taxa de mortalidade materna foi de 37.6 por 100.000 nascidos vivos. Em relação às causas, 16 óbitos (57.1%) estiveram diretamente associados à gravidez, 10 (35.1%) estiveram indiretamente associados e 2 (7.1%) não estiveram relacionados. A principal causa de morte foi hipertensão na gravidez (31.2%) seguida de esteatose hepática aguda da gravidez (25%). No estudo anterior, publicado em 2003 na mesma instituição4, a taxa de mortalidade foi de 129 por 100.000 nascidos vivos, e a maioria dos óbitos estava relacionada a causas obstétricas diretas (62%). As principais causas de óbito neste período foram por complicações hipertensivas (17.2%), seguidas de infecção pós-cesárea (16%). Conclusão Em comparação com os dados anteriores à década de 2000, houve uma redução importante das mortes maternas por causas infecciosas.