[Overview of long COVID in Brazil: a preliminary analysis of a survey to think about health policies]. / Panorama da COVID longa no Brasil: análise preliminar de um inquérito para pensar políticas de saúde.

Characterized by symptoms that remain or appear for the first time within three months of SARS-CoV-2 infection, long COVID can manifest itself in different ways, including in non-hospitalized or asymptomatic cases. Thus, this study offers an overview of long COVID in Brazil, especially of its diagnosis, symptoms, and challenges for new health management. Data from a study that investigated long COVID in people affected by COVID-19 were used. These original data stem from a survey with adult Brazilians (aged 18 years or older) who had COVID-19 that collected information from March 14 to April 14, 2022, by a questionnaire on social media. The questionnaire addressed sociodemographic characteristics, history of COVID-19 infections, vaccination against the disease, investigation of health status and quality of life before and after COVID-19, and search and access to treatment. Of the 1,728 respondents, 720 were considered eligible for analysis, of which 496 (69%) had long COVID. Individuals with long COVID reported clinical manifestations such as anxiety (80%), memory loss (78%), generalized pain (77%), lack of attention (75%), fatigue (73%), hair loss (71%), sleep changes (70%), mood swings (62%), malaise (60%), and joint pain (59%). Most sought health services during and after the acute phase of COVID-19 (94 and 80%, respectively), representing the need to structure the healthcare system for these patients.

Caracterizada por sintomas que permanecem ou aparecem pela primeira vez em até três meses após a infecção pelo SARS-CoV-2, a COVID longa pode se manifestar de diferentes formas, inclusive entre casos não hospitalizados ou assintomáticos. Nesse sentido, este artigo apresenta um panorama da COVID longa no Brasil, com ênfase no diagnóstico, nos sintomas e nos desafios para a nova gestão da saúde. Foram utilizados dados de um estudo realizado com objetivo de investigar a COVID longa em pessoas acometidas pela COVID-19, com dados originais de um inquérito com indivíduos brasileiros adultos (18 anos ou mais) que tiveram COVID-19, coletados entre 14 de março e 14 de abril de 2022, por meio de questionário divulgado em redes sociais. O questionário abordou características sociodemográficas, histórico de infecções por COVID-19, vacinação contra a doença, investigação da situação de saúde e da qualidade de vida antes e após a COVID-19, além da busca e acesso a tratamento. Dos 1.728 respondentes, 720 foram considerados elegíveis para a análise. Desses, 496 (69%) tiveram COVID longa. Os indivíduos com COVID longa reportaram manifestações clínicas como ansiedade (80%), perda de memória (78%), dor generalizada (77%), falta de atenção (75%), fadiga (73%), queda de cabelo (71%), alterações de sono (70%), alterações de humor (62%), indisposição (60%) e dor nas articulações (59%). A maioria procurou os serviços de saúde durante e após a fase aguda de COVID-19 (94% e 80%, respectivamente), o que representa a necessidade de estruturar o sistema de saúde para atender esses pacientes.

Caracterizado por síntomas que permanecen o aparecen por primera vez dentro de los tres meses posteriores a la infección por SARS-CoV-2, la COVID larga puede manifestarse de diferentes formas, incluso entre casos no hospitalizados o asintomáticos. En este sentido, este artículo presenta un panorama la COVID larga en Brasil, con énfasis en el diagnóstico, los síntomas y los desafíos para la nueva gestión de la salud. Se utilizaron datos de una encuesta realizada para investigar la COVID larga en personas afectadas por COVID-19. Se trata de datos originales de una encuesta con individuos brasileños adultos (18 años o más), que tuvieron COVID-19, con datos recolectados entre el 14 de marzo y el 14 de abril de 2022, por medio de un cuestionario divulgado en las redes sociales. El cuestionario abordó características sociodemográficas, historial de infecciones por COVID-19, vacunación contra la enfermedad, investigación de la situación de salud y de la calidad de vida antes y después de COVID-19, además de la búsqueda y acceso a tratamiento. De los 1.728 encuestados, 720 fueron considerados elegibles para el análisis. De ellos, 496 (69%) tenían COVID larga. Las personas con COVID larga informaron manifestaciones clínicas como ansiedad (80%), pérdida de memoria (78%), dolor generalizado (77%), falta de atención (75%), fatiga (73%), pérdida de cabello (71%), cambios en el sueño (70%), cambios de humor (62%), malestar (60%) y dolor en las articulaciones (59%). La mayoría recurrió a los servicios de salud durante y después de la fase aguda de COVID-19 (94% y 80%, respectivamente), lo que representa la necesidad de estructurar el sistema de salud para atender a estos pacientes.

Zika Brazilian Cohorts (ZBC) Consortium: Protocol for an Individual Participant Data Meta-Analysis of Congenital Zika Syndrome after Maternal Exposure during Pregnancy.

Despite great advances in our knowledge of the consequences of Zika virus to human health, many questions remain unanswered, and results are often inconsistent. The small sample size of individual studies has limited inference about the spectrum of congenital Zika manifestations and the prognosis of affected children. The Brazilian Zika Cohorts Consortium addresses these limitations by bringing together and harmonizing epidemiological data from a series of prospective cohort studies of pregnant women with rash and of children with microcephaly and/or other manifestations of congenital Zika. The objective is to estimate the absolute risk of congenital Zika manifestations and to characterize the full spectrum and natural history of the manifestations of congenital Zika in children with and without microcephaly. This protocol describes the assembly of the Consortium and protocol for the Individual Participant Data Meta-analyses (IPD Meta-analyses). The findings will address knowledge gaps and inform public policies related to Zika virus. The large harmonized dataset and joint analyses will facilitate more precise estimates of the absolute risk of congenital Zika manifestations among Zika virus-infected pregnancies and more complete descriptions of its full spectrum, including rare manifestations. It will enable sensitivity analyses using different definitions of exposure and outcomes, and the investigation of the sources of heterogeneity between studies and regions.

Prenatal factors associated with fetal visceral adiposity.

OBJECTIVE: To assess fetal visceral adiposity and associated factors during pregnancy. METHODS: Secondary analysis of prospective cohort data with 172 pairs (pregnant woman/fetus) treated at public health units. Anthropometric data, metabolic (glucose, glycated hemoglobin, insulin, insulin resistance, total cholesterol and fractions, triglycerides) measures, fetal biometry, and visceral and subcutaneous adiposity in the binomial (pregnant woman/fetus) were evaluated at the 16th, 28th and 36th gestational weeks by ultrasonography. Pearson's correlation coefficient and multiple linear regression were used, with a significance level of 5%. RESULTS: At the 16th week, the mean age of the pregnant women was 26.6±5.8 years and mean weight was 62.7±11.5kg; 47.0% had normal weight, 28.3% were overweight, 13.3% were underweight, and 11.2% were obese. At 36 weeks, 44.1% had inadequate gestational weight gain, 32.5% had adequate gestational weight gain, and 23.3% had excessive gestational weight gain. Fetal visceral adiposity at week 36 showed a positive correlation with maternal variables: weight (r=0.15) and body mass index (r=0.21) at the 16th; with weight (r=0.19), body mass index (r=0.24), and gestational weight gain (r=0.21) at the 28th; and with weight (r=0.22), body mass index (r=0.26), and gestational weight gain (r=0.21) at the 36th week. After multiple linear regression, adiposity at the 28th week remained associated with fetal variables: abdominal circumference (p<0.0001), head circumference (p=0.01), area (p<0.0001), and thigh circumference (p<0.001). At the 36th week, adiposity remained associated with the abdominal circumference of the 28th (p=0.02) and 36th weeks (p<0.001). CONCLUSION: Adiposity was positively correlated with the measurements of the pregnant woman. After the multivariate analysis, the persistence of the association occurred with the abdominal circumference, a central adiposity measurement with a higher metabolic risk.

[Association between maternal physical activity, gestational weight gain and birth weight in a cohort of 118 pregnant women in Campina Grande, Northeast of Brazil]. / Associação entre o padrão de atividade física materna, ganho ponderal gestacional e peso ao nascer em uma coorte de 118 gestantes no município de Campina Grande, Nordeste do Brasil.

OBJECTIVE: This survey evaluated the effects of physical activity on gestational weight gain and birth weight of pregnant women attended by the Family Health Program in Campina Grande, Northeast of Brazil. METHODS: A cohort study enrolling 118 pregnant women was conducted between 2005 and 2006. Evaluation of the initial nutritional status was performed following Atalah's criteria and gestational weight gain was evaluated according to the Institute of Medicine. The pattern of physical activity was evaluated according to METs (metabolic equivalent) and its association with weight gain and birth weight was determined. RESULTS: The predominant physical activity pattern at 16 weeks was mild, in 85.6% of pregnant women. An important reduction of physical activity levels was observed with evolution of pregnancy and 98.3% of pregnant women were sedentary at 24 weeks and 100% at 32 weeks. In the initial evaluation of nutritional status 50% were normal, 23% had low weight and 27% had overweight/obesity. At second and third trimesters about 45% of pregnant women had excessive weight gain. Adequate birth weight for gestational age was found in 85.6% of neonates but macrosomia was highly frequent (8.5%). A significant association between METs at 24 weeks and gestational weight gain was found in the second trimester (p=0.045). CONCLUSION: All the pregnant women were sedentary in the third trimester and a significant association between physical activity pattern and gestational weight gain was found in the second trimester, but there was no association between this pattern and birth weight.

Panorama da COVID longa no Brasil: análise preliminar de um inquérito para pensar políticas de saúde / Overview of long COVID in Brazil: a preliminary analysis of a survey to think about health policies / Panorama de la COVID larga en Brasil: un análisis preliminar de una encuesta para pensar en políticas de salud

Caracterizada por sintomas que permanecem ou aparecem pela primeira vez em até três meses após a infecção pelo SARS-CoV-2, a COVID longa pode se manifestar de diferentes formas, inclusive entre casos não hospitalizados ou assintomáticos. Nesse sentido, este artigo apresenta um panorama da COVID longa no Brasil, com ênfase no diagnóstico, nos sintomas e nos desafios para a nova gestão da saúde. Foram utilizados dados de um estudo realizado com objetivo de investigar a COVID longa em pessoas acometidas pela COVID-19, com dados originais de um inquérito com indivíduos brasileiros adultos (18 anos ou mais) que tiveram COVID-19, coletados entre 14 de março e 14 de abril de 2022, por meio de questionário divulgado em redes sociais. O questionário abordou características sociodemográficas, histórico de infecções por COVID-19, vacinação contra a doença, investigação da situação de saúde e da qualidade de vida antes e após a COVID-19, além da busca e acesso a tratamento. Dos 1.728 respondentes, 720 foram considerados elegíveis para a análise. Desses, 496 (69%) tiveram COVID longa. Os indivíduos com COVID longa reportaram manifestações clínicas como ansiedade (80%), perda de memória (78%), dor generalizada (77%), falta de atenção (75%), fadiga (73%), queda de cabelo (71%), alterações de sono (70%), alterações de humor (62%), indisposição (60%) e dor nas articulações (59%). A maioria procurou os serviços de saúde durante e após a fase aguda de COVID-19 (94% e 80%, respectivamente), o que representa a necessidade de estruturar o sistema de saúde para atender esses pacientes.

Characterized by symptoms that remain or appear for the first time within three months of SARS-CoV-2 infection, long COVID can manifest itself in different ways, including in non-hospitalized or asymptomatic cases. Thus, this study offers an overview of long COVID in Brazil, especially of its diagnosis, symptoms, and challenges for new health management. Data from a study that investigated long COVID in people affected by COVID-19 were used. These original data stem from a survey with adult Brazilians (aged 18 years or older) who had COVID-19 that collected information from March 14 to April 14, 2022, by a questionnaire on social media. The questionnaire addressed sociodemographic characteristics, history of COVID-19 infections, vaccination against the disease, investigation of health status and quality of life before and after COVID-19, and search and access to treatment. Of the 1,728 respondents, 720 were considered eligible for analysis, of which 496 (69%) had long COVID. Individuals with long COVID reported clinical manifestations such as anxiety (80%), memory loss (78%), generalized pain (77%), lack of attention (75%), fatigue (73%), hair loss (71%), sleep changes (70%), mood swings (62%), malaise (60%), and joint pain (59%). Most sought health services during and after the acute phase of COVID-19 (94 and 80%, respectively), representing the need to structure the healthcare system for these patients.

Caracterizado por síntomas que permanecen o aparecen por primera vez dentro de los tres meses posteriores a la infección por SARS-CoV-2, la COVID larga puede manifestarse de diferentes formas, incluso entre casos no hospitalizados o asintomáticos. En este sentido, este artículo presenta un panorama la COVID larga en Brasil, con énfasis en el diagnóstico, los síntomas y los desafíos para la nueva gestión de la salud. Se utilizaron datos de una encuesta realizada para investigar la COVID larga en personas afectadas por COVID-19. Se trata de datos originales de una encuesta con individuos brasileños adultos (18 años o más), que tuvieron COVID-19, con datos recolectados entre el 14 de marzo y el 14 de abril de 2022, por medio de un cuestionario divulgado en las redes sociales. El cuestionario abordó características sociodemográficas, historial de infecciones por COVID-19, vacunación contra la enfermedad, investigación de la situación de salud y de la calidad de vida antes y después de COVID-19, además de la búsqueda y acceso a tratamiento. De los 1.728 encuestados, 720 fueron considerados elegibles para el análisis. De ellos, 496 (69%) tenían COVID larga. Las personas con COVID larga informaron manifestaciones clínicas como ansiedad (80%), pérdida de memoria (78%), dolor generalizado (77%), falta de atención (75%), fatiga (73%), pérdida de cabello (71%), cambios en el sueño (70%), cambios de humor (62%), malestar (60%) y dolor en las articulaciones (59%). La mayoría recurrió a los servicios de salud durante y después de la fase aguda de COVID-19 (94% y 80%, respectivamente), lo que representa la necesidad de estructurar el sistema de salud para atender a estos pacientes.

[Severe maternal morbidity in an obstetric ICU in Recife, Northeast of Brasil]. / Morbidade materna grave em UTI obstétrica no Recife, região nordeste do Brasil.

OBJECTIVES: To evaluate patients admitted with near miss maternal mortality criteria to an Obstetric ICU. METHODS: This is a secondary analysis of a study conducted in an Obstetric ICU of IMIP (Recife, Pernambuco), from February 2003 to February 2007, from which 291 patients with near miss criteria or severe maternal morbidity were selected. Data concerning cause of admission, time of admission related to delivery, age, parity, education, prenatal care, associated clinical conditions, gestational age at admission and delivery, diagnosis, complications and procedures as well as length of ICU stay were collected. RESULTS: The most common reasons of admission were hypertensive disorders (78.4%), haemorrhage (25.4%) and infection (16.5%). The great majority of patients was admitted after delivery (80.4%) and transferred from other units. Patient age ranged from 12 to 44 years, median of parity was 1 and prenatal care was absent in 9.9% of cases. Cesarean section was the mode of delivery in 68.4%. Medical conditions were present in 18.7% of the patients, 37% required blood product transfusions, 10.8% vasoactive infusions, 9.1% mechanical ventilation and 13.4% a central line. Eclampsia was present in 38.8 % of the patients, hemorrhagic shock in 27.1%, renal failure in 11.7%, and pulmonary edema in 9.1% and respiratory failure in 6.5%. CONCLUSION: Patients classified as near miss maternal mortality constitute an important group admitted to an Obstetric ICU. Better information about these patients is fundamental to improve care and prevent maternal mortality.

[Mortality caused by congenital anomalies in Pernambuco, Brazil from 1993 to 2003]. / Mortalidade determinada por anomalias congênitas em Pernambuco, Brasil, de 1993 a 2003.

BACKGROUND: To establish magnitude and temporal trend of deaths by congenital malformations in Pernambuco state in Northeast of Brazil, from 1993 to 2003. METHODS: This is an observational descriptive study, with the temporal trend including all cases of death caused by congenital malformations, obtained from the database of the Mortality Information System of the Ministry for Health. RESULTS: From 1993 to 2003, 3.960 infant deaths and 989 stillbirths caused by congenital malformations were registered in Pernambuco. The coefficients of fetal, early neonatal, perinatal, neonatal and infant (< 1 year) mortality were 0.57, 1.20, 1.76, 1.59 and 2.33, respectively. A rising tendency was observed in the temporal curve from 1993 to 2003 when coefficients of early neonatal (p = 0.003), perinatal (p = 0.005), neonatal (p = 0.0007) and infant (p = 0.02) mortality were studied but no statistical significance was detected for the fetal mortality coefficient (p= 0.55). CONCLUSION: From 1993 to 2003 a rising tendency in the coefficients of early neonatal, perinatal, neonatal and infant mortality was found in the state of Pernambuco. This trend may have been be influenced by an improvement in the death registration records and by a decline of infant mortality in the state of Pernambuco.

[Serologic profile of toxoplasmosis in pregnant women attended at a teaching-hospital in Recife]. / Perfil sorológico para toxoplasmose em gestantes atendidas em maternidade.

OBJECTIVES: To determine the serologic profile of toxoplasmosis and the main factors associated with susceptibility (patients without IgM and IgG antibodies) in pregnant women attended at a teaching-hospital in Recife, Brasil. METHODS: A cross-sectional study was carried out, enrolling 503 pregnant women submitted to serology for toxoplasmosis at IMIP (Recife) from October 2004 to April 2005. Anti-Toxoplasma IgG and IgM antibodies were studied by IFA. A short questionnaire was administered to patients to provide identification, demographic and obstetrical characteristics, past history of morbidity, habits and dwelling conditions. The chi-square and Fisher-exact tests were used at a 5% level of significance. RESULTS: Immunity for toxoplasmosis was present in 74.7%, susceptibility in 22.5% and "possible" active infection in 2.8% of patients. No significant associations were observed between toxoplasmosis susceptibility and age, location, conditions of morbidity, habits, dwelling conditions and sewage system, living with animals, pregnancy and gestational age. A significant association between toxoplasmosis susceptibility and schooling was found, with a higher frequency of susceptibility among women with eight or more years of schooling. CONCLUSION: Susceptibility for toxoplasmosis was relatively low in these prenatal patients and schooling was the only identifiable predictive factor.

[Magnetic resonance imaging of the liver in postpartum stable women with HELLP syndrome]. / Ressonância magnética hepática em puérperas estáveis com síndrome HELLP.

OBJECTIVES: To describe magnetic resonance (MR) findings in the liver of stable patients with HELLP syndrome in the puerpuerium. METHODS: A descriptive study was carried out from August 2005 to July 2006, involving a series of 40 postpartum patients admitted to an obstetric intensive therapy unit in IMIP (Instituto Materno Infantil Prof. Fernando Figueira) with diagnosis of HELLP syndrome (complete and partial). Complete HELLP syndrome was defined when all laboratory parameters were present and incomplete when one or more but not all laboratory findings were present. All patients had stable clinical conditions and were evaluated with magnetic resonance of the liver and the main findings were recorded. RESULTS: Average maternal age was 26.8 +/- 6.4 years and gestational age at delivery was 34 +/- 26.8 weeks. The MR imaging was performed between eight and 96 hours after diagnosis of HELLP syndrome (56 +/- 31 h). The most frequent findings were ascitis in 20% (n = 8), pleural effusion in 17.5% and hepatic steatosis in 7.5%. The periportal intensity signal was normal in all cases. Cases of liver infarction and sub-capsular or parenchymatous hematoma were not observed. CONCLUSION: Findings of magnetic resonance imaging of the liver in stable HELLP syndrome postpartum patients were few and unspecific. Severe liver injuries such as parenchymatous or sub-capsular hematoma, entailing life risk were not found. Results do not corroborate the use of magnetic resonance as routine examination for stable patients with HELLP syndrome.

[Chlamydia infection in patients with and without cervical intra-epithelial lesions]. / Infecção por Chlamydia em pacientes com e sem lesões intra-epiteliais cervicais.

OBJECTIVES: To determine the frequency of Chlamydia trachomatis infection in patients with and without intraepithelial cervical lesions attended at specialized ambulatory in Recife (2007) and its association with biologic and demographic variables, habits, reproductive, clinical and gynecologic characteristics. METHODS: A cross-sectional study was conducted including 70 women (35 with cytological cervical lesions and 35 with normal smears). Colposcopy and biopsy when necessary were performed and Chlamydia infection was determined by direct immunofluorescence. Analysis variables were age, race, precedence, schooling, marital status, menarche, age at first sexual intercourse, parity, number of sexual partners, vaginal discharge, previous Pap smear, STD episodes, cervical cauterization, contraceptive methods, familial antecedents of cervical cancer, alcohol intake, use of illicit and immunosuppressive drugs, Papanicolaou result and cervical Chlamydia l infection. To determine the strength of association prevalence ratio (PR) and its 95% confidence interval were calculated. Multivariate analysis was performed for controlling potentially confounding variables. RESULTS: the frequency of Chlamydia l infection was significantly greater in patients with intraepithelial cervical lesions (80.0% vs. 14.3%; PR=5.60; 95% CI=2.44-12.82). When the factors associated with Chlamydia l infection were analyzed, the only variable that remained significantly associated after multivariate analysis was previous episode of STD (OR=63.47; 95% CI=13.93-289.09). CONCLUSION: Chlamydia trachomatis infection is associated with intraepithelial cervical lesions and history of STD should be considered for treatment and follow-up of these patients.

Perineal Pain Management with Cryotherapy after Vaginal Delivery: A Randomized Clinical Trial.

Introduction Systematic reviews that evaluate the perineal cryotherapy to reduce pain in the vaginal postpartum are inconclusive. Purpose To evaluate clinical effectiveness of cryotherapy in the management of humanized postpartum perineal pain and vaginal edema. Methods A double-bind randomized controlled clinical trial (UTN number: U1111-1131-8433) was conducted in a hospital in Northeastern, Brazil. Women were included following humanized childbirth. All had vaginal deliveries of a single, full-term pregnancy with cephalic presentation. Exclusion criteria included previous perineal lesion, episiotomy during the current delivery, instrumental delivery, uterine curettage and postpartum hemorrhage. In the experimental group, an ice pack was applied six times on the perineum for 20 minutes, reducing the temperature between 10 and 15 ° C, then 60 minutes without exposure to cold. In the non-cryotherapy, a water bag unable to reduce the temperature to this extent was used, compliance with the same application protocol of the first group. Perineal temperature was monitored at zero, 10 and 20 minutes for application in both groups. Evaluations were made immediately before and after the applications and 24 hours after delivery spontaneous, to determine the association between variables. Results A total of 80 women were included in the study, 40 in each group. There was no significant difference in scores of perineal pain and edema between the groups with or without cryotherapy until 24 hours after childbirth. There was no difference between groups when accomplished repeated measures analysis over the 24 hours after delivery, considering the median perineal pain (p = 0.3) and edema (p = 0.9). Perineal cryotherapy did not influence the amount of analgesics used (p = 0.07) and no adverse effect was registered. Conclusion The use of cryotherapy following normal vaginal delivery within the concept of humanized minimally interventionist childbirth had no effect on perineal pain and edema, since it was already substantially lower, nor the need for pain medicaments.

Prenatal factors associated with fetal visceral adiposity / Fatores pré-natais associados à adiposidade visceral fetal

Abstract Objective: To assess fetal visceral adiposity and associated factors during pregnancy. Methods: Secondary analysis of prospective cohort data with 172 pairs (pregnant woman/fetus) treated at public health units. Anthropometric data, metabolic (glucose, glycated hemoglobin, insulin, insulin resistance, total cholesterol and fractions, triglycerides) measures, fetal biometry, and visceral and subcutaneous adiposity in the binomial (pregnant woman/fetus) were evaluated at the 16th, 28th and 36th gestational weeks by ultrasonography. Pearson's correlation coefficient and multiple linear regression were used, with a significance level of 5%. Results: At the 16th week, the mean age of the pregnant women was 26.6 ± 5.8 years and mean weight was 62.7 ± 11.5 kg; 47.0% had normal weight, 28.3% were overweight, 13.3% were underweight, and 11.2% were obese. At 36 weeks, 44.1% had inadequate gestational weight gain, 32.5% had adequate gestational weight gain, and 23.3% had excessive gestational weight gain. Fetal visceral adiposity at week 36 showed a positive correlation with maternal variables: weight (r = 0.15) and body mass index (r = 0.21) at the 16th; with weight (r = 0.19), body mass index (r = 0.24), and gestational weight gain (r = 0.21) at the 28th; and with weight (r = 0.22), body mass index (r = 0.26), and gestational weight gain (r = 0.21) at the 36th week. After multiple linear regression, adiposity at the 28th week remained associated with fetal variables: abdominal circumference (p < 0.0001), head circumference (p = 0.01), area (p < 0.0001), and thigh circumference (p < 0.001). At the 36th week, adiposity remained associated with the abdominal circumference of the 28th (p = 0.02) and 36th weeks (p < 0.001). Conclusion: Adiposity was positively correlated with the measurements of the pregnant woman. After the multivariate analysis, the persistence of the association occurred with the abdominal circumference, a central adiposity measurement with a higher metabolic risk.

Resumo Objetivo: Avaliar a adiposidade visceral fetal e fatores associados na gestação. Métodos: Análise secundária de dados de coorte prospectiva com 172 pares (gestantes/fetos) atendidas em unidades públicas de saúde. Foram avaliadas nas gestantes na 16a, 28a e 36a semana gestacional: medidas antropométricas, metabólicas (glicose, hemoglobina glicada, insulina, resistência à insulina, colesterol total e frações, triglicerídeos), biometria fetal e adiposidade visceral e subcutânea no binômio (gestantes/feto) por ultrassonografia. Utilizamos o coeficiente de correlação de Pearson e regressão linear múltipla, com nível de significância de 5%. Resultados: Na 16ª semana a média de idade das gestantes foi de 26,6 ± 5,8 anos e peso 62,7 ± 11,5 quilogramas, 47,0% eram eutróficas, 28,3% sobrepeso, 13,3% baixo peso e 11,2% obesas. Na 36a semana, 44,1% tiveram ganho ponderal gestacional insuficiente, 32,5% adequado e 23,3% excessivo. A adiposidade visceral fetal na 36a semana apresentou correlação positiva com variáveis maternas: peso (r = 0,15) e índice de massa corpórea (r = 0,21) na 16a; com peso (r = 0,19), índice de massa corpórea (r = 0,24) e ganho ponderal gestacional (r = 0,21) na 28a; com peso (r = 0,22), índice de massa corpórea (r = 0,26) e ganho ponderal gestacional (r = 0,21) na 36a semana. Após regressão linear múltipla a adiposidade na 28a semana permaneceu associada com variáveis fetais: circunferência abdominal (p < 0,0001), circunferência cefálica (p = 0,01), área (p < 0,0001) e circunferência da coxa (p < 0,001). Na 36a semana com circunferência abdominal da 28a (p = 0,02) e 36a semana (p < 0,001). Conclusão: A adiposidade foi positivamente correlacionada com medidas da gestante, após análise multivariada a persistência da associação deu-se com a circunferência abdominal, medida de adiposidade central, de maior risco metabólico.

Perineal Pain Management with Cryotherapy after Vaginal Delivery: A Randomized Clinical Trial / Manejo da dor perineal com crioterapia no pós-parto vaginal: ensaio clínico randomizado

Abstract Introduction Systematic reviews that evaluate the perineal cryotherapy to reduce pain in the vaginal postpartum are inconclusive. Purpose To evaluate clinical effectiveness of cryotherapy in the management of humanized postpartum perineal pain and vaginal edema. Methods A double-bind randomized controlled clinical trial (UTN number: U1111- 1131-8433) was conducted in a hospital in Northeastern, Brazil.Women were included following humanized childbirth. All had vaginal deliveries of a single, full-term pregnancy with cephalic presentation. Exclusion criteria included previous perineal lesion, episiotomy during the current delivery, instrumental delivery, uterine curettage and postpartum hemorrhage. In the experimental group, an ice pack was applied six times on the perineum for 20 minutes, reducing the temperature between 10 and 15° C, then 60 minutes without exposure to cold. In the non-cryotherapy, a water bag unable to reduce the temperature to this extent was used, compliance with the same application protocol of the first group. Perineal temperature wasmonitored at zero, 10 and 20 minutes for application in both groups. Evaluations were made immediately before and after the applications and 24 hours after delivery spontaneous, to determine the association between variables. Results A total of 80 women were included in the study, 40 in each group. There was no significant difference in scores of perineal pain and edema between the groups with or without cryotherapy until 24 hours after childbirth. There was no difference between groups when accomplished repeated measures analysis over the 24 hours after delivery, considering the median perineal pain (p = 0.3) and edema (p = 0.9). Perineal cryotherapy did not influence the amount of analgesics used (p = 0.07) and no adverse effect was registered. Conclusion The use of cryotherapy following normal vaginal delivery within the concept of humanized minimally interventionist childbirth had no effect on perineal pain and edema, since it was already substantially lower, nor the need for pain medicaments.

Resumo Introdução Revisões sistemáticas que avaliam a crioterapia perineal para redução da dor no pós-parto por via vaginal são inconclusivas. Objetivo Avaliar a efetividade clínica da crioterapia para controlar a dor e o edema perineais após parto vaginal humanizado. Métodos Ensaio clínico (n° UTN: U1111-1131-8433) randomizado controlado duplocego, realizado em uma maternidade no Nordeste do Brasil. Incluíram-se mulheres após parto vaginal humanizado, de gestação única, cefálica, a termo, e foram excluídas aquelas com lesão perineal prévia, episiotomia no parto atual, parto instrumental e hemorragia perineal ativa. O grupo experimental foi submetido a seis aplicações de bolsa de gelo triturado na região do períneo, por 20minutos, reduzindo a temperatura entre 10 e 15°C, com 60 minutos entre as aplicações. O grupo sem crioterapia recebeu uma bolsa de água, que não reduzia a temperatura a esse nível, respeitando o mesmo protocolo de aplicação do primeiro grupo. Amonitorização da temperatura perineal foi realizada nos minutos zero, 10 e 20 de aplicação, emambos os grupos. Para determinar a associação entre as variáveis, foramrealizadas avaliações imediatamente antes e após as aplicações e 24 horas após o parto. Resultados Foram incluídas 80 puérperas no estudo, sendo 40 em cada grupo. Não houve diferença significativa para os escores de dor e edema perineais entre os grupos comou sem crioterapia até 24 horas após o parto. Não houve diferença entre os grupos quando realizada análise de medidas repetidas em todas as avaliações, considerando a mediana dos escores de dor (p = 0,3) e edema (p = 0,9) perineais. A crioterapia perineal não influenciou na quantidade de analgésicos utilizados (p = 0,07) e nenhum efeito adverso foi registrado. Conclusões A utilização da crioterapia após parto vaginal humanizado, minimamente intervencionista, nãomodifica escores de dor e edema perineais, por já serem, substancialmente, baixos, tampouco altera a necessidade de medicamentos analgésicos.

[Comparison of Doppler indexes to predict small infants for gestational age in pregnant women with hypertensive syndromes]. / Comparação entre os índices doplervelocimétricos na predição de recém-nascidos pequenos para idade gestacional em gestantes com síndromes hipertensivas.

PURPOSE: to determine the best Doppler flow velocimetry index to predict small infants for gestational age (SGAI), in pregnant women with hypertensive syndromes. METHODS: a cross-sectional study was conducted enrolling 129 women with high blood pressure, submitted to doppler velocimetry up to 15 days before delivery. Women with multiple fetuses, fetal malformations, genital bleeding, placental abruption, premature rupture of fetal membranes, smoking, use of illicit drugs, and chronic diseases were excluded. A receiver operating characteristic (ROC) curve for each Doppler variable was constructed to diagnose SGAI and the sensitivity (Se), specificity (Sp), positive (PLR) and negative (NLR) likelihood ratio were calculated. RESULTS: the area under the ROC curve for the middle cerebral artery resistance index was 52% (p=0.79) with Se, Sp, PLR, and NLR of 25.0, 89.1, 2.3 and 0.84% for a resistance index lower than 0.70, respectively. While the area under the ROC curve for the resistance index of the umbilical artery was 74% (p=0.0001), with Se=50.0%, Sp=90.0%, PLR=5.0 and NLR=0.56, for a resistance index higher or equal to 0.70. The area under the ROC curve for the resistance index umbilical artery/middle cerebral artery ratio was 75% (p=0.0001). When it was higher than 0.86, the Se, Sp, PLR and NLR were 70.8, 80.0, 3.4 and 0.36%, respectively. For the resistance index of the middle cerebral artery/uterine artery ratio, the area under the ROC curve was 71% (p=0.0001). We found a Se=52.2%, Sp=85.9%, PLR=3.7 and NLR=0.56, when the ratio was lower than 1.05. When we compared the area under the ROC curve of the four doppler velocimetry indexes, we observed that only the resistance index umbilical artery/middle cerebral artery, resistance index middle cerebral artery/uterine artery and resistance index umbilical artery ratios seem to be useful for the prediction of SGA. CONCLUSION: in patients with high blood pressure during pregnancy, all doppler velocimetry parameters, except the middle cerebral artery resistance index, can be used to predict SGAI. The umbilical artery/middle cerebral artery ratio seems to be the most recommended one.

[Factors associated with stillbirth in a school maternity in Pernambuco: a case control study]. / Fatores associados à natimortalidade em uma maternidade escola em Pernambuco: estudo caso-controle.

PURPOSE: to investigate the main factors associated with fetal death in the city of Recife, Pernambuco, Brazil. METHODS: an observational, case-control study, including cases attended from June 1st 2004 to 31st March 2005. A number of 116 stillbirth cases and 472 live birth controls, with deliveries assisted at the service, were included. The cases were identified in the record book from the delivery room. The puerperium women were identified by the name and register number at a puerperium infirmary. The controls were selected, using the puerperium infirmary neighborhood criterion, identifying the beds with numbers immediately lower (two patients) and higher (two patients) than the patient's, as far as they had delivered live babies. In case they did not agree to participate in the research, the next beds with numbers consecutively lower or higher were approached. The chi2 association and Fisher's exact tests were used when necessary to test the association between the independent (predictive) and dependent (stillborn) variables, considering 5% as the significance level. To determine the association strength, the estimate of relative risk for case-control cases, Odds Ratio (OR) was used, with 95% as the confidence interval (CI). Logistic regression analysis according to the hierarchy model was done to control confounding factors. RESULTS: the fetal mortality rate corresponded to 24.4 by 1,000 births. After the multivariate analysis, the variables which kept significantly associated with fetal death were: malformation (OR=7.5; CI=3.2-17.4), number of pre-natal appointments lower than six (OR=4.4; CI=2.5-7.5), hemorrhagic syndromes (OR=2.9; CI=1.4-5.7), attendance in another hospital unit along the 24 hours which preceded the patient's admission in the institution (OR=2.9; CI=1.8-4.6), mothers' age over or equal to 35 years old (OR=2.2; CI=1.0-4.9) and schooling lower than eight years (OR=1.6; CI=1.02-2.6). CONCLUSIONS: it was found a high fetal mortality coefficient, the main factors associated with death were: malformation, number of pre-natal appointments lower than six, hemorrhagic syndromes, history of attendance previous to the hospital admission, mothers' age over or equal to 35 and schooling lower than eight years.

[Clinical and laboratorial profile and complications of patients with HELLP syndrome admitted in an obstetric intensive care unit]. / Perfil clínico, laboratorial e complicações de pacientes com síndrome HELLP admitidas em uma unidade de terapia intensiva obstétrica.

PURPOSE: to describe the clinical and laboratorial profile of HELLP syndrome patients admitted at an Obstetric Intensive Care Unit (ICU) and included in a randomized clinical trial to evaluate the efficacy of dexamethasone in this clinical setting. METHODS: the present study is a secondary analysis of a randomized clinical trial design to evaluate the efficacy of dexamethasone in patients with HELLP syndrome. This sample of patients was composed of patients in the puerperium, with the diagnosis of HELLP syndrome (diagnosis made before or after delivery) who were not chronic corticosteroid users and not carriers of any chronic disease which could modify HELLP syndrome's laboratorial parameters. Patients who were too critical or whose condition did not allow them to consent to participate were not included. Data were extracted from the records used in the randomized clinical trial. Age, parity, gestational age at admission and delivery, time of diagnosis (before or after delivery), HELLP syndrome classification (partial or complete), arterial blood pressure, and diuresis at admission were considered for analysis. Among laboratorial findings, hemoglobin, platelet count, liver enzymes, LDH, and serum bilirubin were analyzed. Complications presented by the patients were also analyzed as well as need of blood transfusions and duration of hospitalization. Analysis was made by the Epi-Info 3.3.2 program. RESULTS: one hundred and five patients were analyzed. Age varied from 14 to 49 years (means of 26.7). Regarding parity, 56 patients (53.8%) were primiparas. Analyzing the timing of the diagnosis, 47 patients (45.2%) had the diagnosis before delivery. The mean gestational age in these patients was 32.4 weeks. Hemorrhagic manifestations were observed in 36 patients (34.3%), oliguria was present in 49 patients (46.7%) and criteria for acute renal failure were seen in 21 (20%) of the cases. Hemotransfusions were necessary in 35 (33.3%) patients. Seven patients (6.7%) had pulmonary edema and four patients died, corresponding to 3.8% of the cases. The mean time from diagnosis of HELLP syndrome to discharge or death was 10.3 days, varying from 1 to 33 days. CONCLUSIONS: HELLP syndrome is an ominous diagnosis, which implicates in elevated maternal morbimortality. Among complications, oliguria and hemorrhagic manifestations were the most common findings and hemotransfusions were frequently required. Lethality reached 3.8%.

Distocia de ombro: proposta de um novo algorítmo para conduta em partos em posições não supinas / Shoulder dystocia: proposal for a new algorithm of management in births in non-supine positions

Distocia de ombro é um evento imprevisível e profissionais habilitados para assistir ao parto devem estar capacitados para diagnosticar e instituir manobras efetivas para sua resolução. Tais manobras têm por objetivo aumentar a pelve funcional, reduzir o diâmetro biacromial e melhorar a relação feto-pélvica, facilitando o desprendimento do concepto dentro de sete minutos do diagnóstico, para prevenir complicações. Vários algoritmos têm sido propostos, com o desenvolvimento de mnemônicos para treinamento profissional, sendo o mais famoso o do Advanced Life Support in Obstetrics (ALSO), conhecido como HELPERR(em inglês) ou ALEERTA (em português). No entanto, estes são úteis quando a parturiente se encontra em decúbito dorsal. Propõe-se um novo protocolo, considerando os benefícios associados aos partos em posição não supina e a necessidade de iniciar a conduta das manobras menos para as mais invasivas. O mnemônico proposto é A SAIDA e consiste em: A = chamar ajuda, avisar parturiente, aumentar agachamento; S = pressãosuprapúbica; A = alterar posição para quatro apoios (manobra de Gaskin); I = manobras internas (Rubin II, Wood,parafuso invertido); D = desprender ombro posterior; A = avaliar manobras de resgate...

Shoulder dystocia is an unpredictable event and skilled birth attendants should be trained to diagnose and implement effective maneuvers to solve it. These maneuvers aim to increase the functional pelvis, to reduce biacromial diameter and to improve the relationship between the pelvis and the fetus, favoring the conceptus release within seven minutes of the diagnosis, in order to prevent complications.Several algorithms have been proposed including mnemonics for professional training, being the most famous the one developed by Advanced Life Support in Obstetrics (ALSO), known as HELPERR (in English) or ALEERTA(in Portuguese). However, these sequences of maneuvers are useful when the mother is in a supine position.A new protocol is proposed, considering the benefits of deliveries in non-supine positions, as well as the need for implementing less invasive maneuvers first. The proposed mnemonic is A SAÍDA and consists of A = ask for help, acquaint the mother, augment the squat; S = suprapubic pressure; A = alter the position to all fours (Gaskinmaneuver); I = internal maneuvers (Rubin II, Wood, inverted spin); D = deliver the posterior arm; A = assess theneed for rescue maneuvers...