Risk of adverse pregnancy and infant outcomes associated with prenatal Zika virus infection: a post-epidemic cohort in Central-West Brazil.

This study aimed to estimate the risks of adverse infant outcomes in the first year of life related to prenatal Zika virus (ZIKV) exposure. A prospective cohort of pregnant women with rash was recruited in Central-West Brazil in a post-epidemic period (January 2017 to April 2019). We evaluated participants' medical histories and performed ZIKV diagnostic testing using molecular (reverse transcription polymerase chain reaction [RT-PCR]) and serologic (immunoglobulin [Ig]M and plaque reduction neutralization tests [PRNT90]) assays. The ZIKV-positive group included both RT-PCR-confirmed cases as well as IgM and/or PRNT90-positive probable cases. Children were evaluated at birth and in the first 12 months of life. Transfontanellar ultrasound, central nervous system computed tomography, eye fundoscopy and retinography were performed. We estimated the absolute risk and 95% confidence interval (95% CI) of adverse infant outcomes among confirmed prenatally ZIKV-exposed children. Among 81 pregnant women with rash, 43 (53.1%) were ZIKV infected. The absolute risk of microcephaly among offspring of ZIKV-infected pregnant women was 7.0% (95% CI: 1.5-19.1), including the two cases of microcephaly detected prenatally and one detected postnatally. In total, 54.5% (95% CI: 39.8-68.7) of children in the ZIKV-exposed group had at least one ophthalmic abnormality, with the most frequent abnormalities being focal pigmentary mottling and chorioretinal atrophy or scarring. Our findings reinforce the importance of long-term monitoring of prenatally ZIKV-exposed children born apparently asymptomatic for Congenital Zika Syndrome.

Risk of adverse outcomes in offspring with RT-PCR confirmed prenatal Zika virus exposure: An individual participant data meta-analysis of 13 cohorts in the Zika Brazilian Cohorts Consortium.

Background: Knowledge regarding the risks associated with Zika virus (ZIKV) infections in pregnancy has relied on individual studies with relatively small sample sizes and variable risk estimates of adverse outcomes, or on surveillance or routinely collected data. Using data from the Zika Brazilian Cohorts Consortium, this study aims, to estimate the risk of adverse outcomes among offspring of women with RT-PCR-confirmed ZIKV infection during pregnancy and to explore heterogeneity between studies. Methods: We performed an individual participant data meta-analysis of the offspring of 1548 pregnant women from 13 studies, using one and two-stage meta-analyses to estimate the absolute risks. Findings: Of the 1548 ZIKV-exposed pregnancies, the risk of miscarriage was 0.9%, while the risk of stillbirth was 0.3%. Among the pregnancies with liveborn children, the risk of prematurity was 10,5%, the risk of low birth weight was 7.7, and the risk of small for gestational age (SGA) was 16.2%. For other abnormalities, the absolute risks were: 2.6% for microcephaly at birth or first evaluation, 4.0% for microcephaly at any time during follow-up, 7.9% for neuroimaging abnormalities, 18.7% for functional neurological abnormalities, 4.0% for ophthalmic abnormalities, 6.4% for auditory abnormalities, 0.6% for arthrogryposis, and 1.5% for dysphagia. This risk was similar in all sites studied and in different socioeconomic conditions, indicating that there are not likely to be other factors modifying this association. Interpretation: This study based on prospectively collected data generates the most robust evidence to date on the risks of congenital ZIKV infections over the early life course. Overall, approximately one-third of liveborn children with prenatal ZIKV exposure presented with at least one abnormality compatible with congenital infection, while the risk to present with at least two abnormalities in combination was less than 1.0%.

Socioeconomic disparities associated with symptomatic Zika virus infections in pregnancy and congenital microcephaly: A spatiotemporal analysis from Goiânia, Brazil (2016 to 2020).

The Zika virus (ZIKV) epidemic, which was followed by an unprecedented outbreak of congenital microcephaly, emerged in Brazil unevenly, with apparent pockets of susceptibility. The present study aimed to detect high-risk areas for ZIKV infection and microcephaly in Goiania, a large city of 1.5 million inhabitants in Central-West Brazil. Using geocoded surveillance data from the Brazilian Information System for Notifiable Diseases (SINAN) and from the Public Health Event Registry (RESP-microcefalia), we analyzed the spatiotemporal distribution and socioeconomic indicators of laboratory confirmed (RT-PCR and/or anti-ZIKV IgM ELISA) symptomatic ZIKV infections among pregnant women and clinically confirmed microcephaly in neonates, from 2016 to 2020. We investigated temporal patterns by estimating the risk of symptomatic maternal ZIKV infections and microcephaly per 1000 live births per month. We examined the spatial distribution of maternal ZIKV infections and microcephaly cases across the 63 subdistricts of Goiania by manually plotting the geographical coordinates. We used spatial scan statistics estimated by discrete Poisson models to detect high clusters of maternal ZIKV infection and microcephaly and compared the distributions by socioeconomic indicators measured at the subdistrict level. In total, 382 lab-confirmed cases of maternal ZIKV infections, and 31 cases of microcephaly were registered in the city of Goiania. More than 90% of maternal cases were reported between 2016 and 2017. The highest incidence of ZIKV cases among pregnant women occurred between February and April 2016. A similar pattern was observed in the following year, although with a lower number of cases, indicating seasonality for ZIKV infection, during the local rainy season. Most congenital microcephaly cases occurred with a time-lag of 6 to 7 months after the peak of maternal ZIKV infection. The highest estimated incidence of maternal ZIKV infections and microcephaly were 39.3 and 2.5 cases per 1000 livebirths, respectively. Districts with better socioeconomic indicators and with higher proportions of self-identified white inhabitants were associated with lower risks of maternal ZIKV infection. Overall, the findings indicate heterogeneity in the spatiotemporal patterns of maternal ZIKV infections and microcephaly, which were correlated with seasonality and included a high-risk geographic cluster. Our findings identified geographically and socio-economically underprivileged groups that would benefit from targeted interventions to reduce exposure to vector-borne infections.

Temporal trend and spatial distribution of syphilis in pregnancy and congenital syphilis in Goiás, Brazil, 2007-2017: an ecological study. / Tendência temporal e distribuição espacial da sífilis gestacional e congênita em Goiás, 2007-2017: um estudo ecológico.

OBJECTIVE: To analyze temporal trend and spatial distribution of syphilis in pregnancy and congenital syphilis in Goiás State, Brazil, between 2007 and 2017. METHODS: This was an ecological time series and spatial distribution study with data obtained from the Notifiable Health Conditions Information System. Prais-Winsten Regression was used to analyze indicator trends by health macro-region. Descriptive spatial analysis was performed to verify case distribution in three different years in the period. RESULTS: Between 2007 and 2017, 7,679 cases of syphilis in pregnancy and 1,554 congenital syphilis cases were reported. A rising trend was found in the rates of syphilis in pregnancy (annual percent change [APC] = 18.0 - 95% confidence interval [95%CI] 15.3;20.8) as well as in congenital syphilis rates (APC=16.8 - 95%CI 20.1;33.8); and a 326% increase in the number of municipalities with a congenital syphilis incidence rate >0.5/1,000 live births. CONCLUSION: Growth in syphilis in pregnancy and congenital syphilis detection rates was identified, as was growth in the number of municipalities reporting cases.

Alterations in peripheral blood monocyte and dendritic cell subset homeostasis in relapsing-remitting multiple sclerosis patients.

Antigen-presenting cells participate and are implicated in the pathogenesis of multiple sclerosis. In our study we assessed the frequency of plasmacytoid (pDC) and myeloid (mDC) dendritic cells and the classical, intermediate and non-classical monocytes subsets, as well as their phenotypic and functional profile. We evaluated peripheral blood from relapsing-remitting patients treated with IFN-ß in remission and relapse phases and from healthy subjects. In remission, we observed a decrease of mDC/pDC ratio and a return to normal values in relapse. In both phases the frequency of non-classical monocytes decreases. Concerning the phenotypic characterization, an increased HLA-DR expression was observed in remission and a decrease in relapse, revealing alterations in monocytes and dendritic cells homeostasis.

Alterations in circulating T cell functional subpopulations in interferon-beta treated multiple sclerosis patients: A pilot study.

Our work consists of a pilot study to characterize circulating Th/c1, Th/c2, Th/c17, Treg and Tfh-like populations and IL-17 serum levels of relapsing-remitting (RR) MS patients treated with IFN-ß, compared with healthy controls. In remission RRMS patients, we observe increased Th/c17 cells frequency committed to a Th1 profile and increased soluble IL-17 levels. Moreover, a shift toward Th/c2 with reduction of Tc1 cells and decrease in effector/terminal differentiated compartment of Th1 cells were also observed. Despite RRMS patients being an inactive disease phase, IL-17 and Th/c17 cells seemed to contribute to perpetuating chronic inflammation, besides the altered ratio Th1/Th2.

A different vision of translational research in biomarker discovery: a pilot study on circulatory mitochondrial proteins as Parkinson's disease potential biomarkers.

Background: The identification of circulating biomarkers that closely correlate with Parkinson's Disease (PD) has failed several times in the past. Nevertheless, in this pilot study, a translational approach was conducted, allowing the evaluation of the plasma levels of two mitochondrial-related proteins, whose combination leads to a robust model with potential diagnostic value to discriminate the PD patients from matched controls. Methods: The proposed translational approach was initiated by the analysis of secretomes from cells cultured under control or well-defined oxidative stress conditions, followed by the identification of proteins related to PD pathologic mechanisms that were altered between the two states. This pipeline was further translated into the analysis of undepleted plasma samples from 28 control and 31 PD patients. Results: From the secretome analysis, several mitochondria-related proteins were found to be differentially released between control and stress conditions and to be able to distinguish the two secretomes. Similarly, two mitochondrial-related proteins were found to be significantly changed in a PD cohort compared to matched controls. Moreover, a linear discriminant model with potential diagnostic value to discriminate PD patients was obtained using the combination of these two proteins. Both proteins are associated with apoptotic mitochondrial changes, which may correspond to potential indicators of cell death. Moreover, one of these proteins, the VPS35 protein, was reported in plasma for the first time, and its quantification was only possible due to its previous identification in the secretome analysis. Conclusions: In this work, an adaptation of a translational pipeline for biomarker selection was presented and transposed to neurological diseases, in the present case Parkinson's Disease. The novelty and success of this pilot study may arise from the combination of: i) a translational research pipeline, where plasma samples are interrogated using knowledge previously obtained from the evaluation of cells' secretome under oxidative stress; ii) the combined used of statistical analysis and an informed selection of candidates based on their link with relevant disease mechanisms, and iii) the use of SWATH-MS, an untargeted MS method that allows a complete record of the analyzed samples and a targeted data extraction of the quantitative values of proteins previously identified.

Interferon-beta treated-multiple sclerosis patients exhibit a decreased ratio between immature/transitional B cell subset and plasmablasts.

Our aim was to quantify circulating B cell subsets; immature/transitional, naïve, CD27- and CD27+ memory cells and plasmablasts, in relapsing-remitting multiple sclerosis patients treated with IFN-ß. The most relevant findings were a significant increase of plasmablasts and a decrease of immature/transitional B cells, resulting in a decreased ratio between those cells in relapse RRMS, together with an increase of CD27- and CD27+IgM+ memory B cell subsets in both phases of the disease. These alterations point to an active B cell response, particularly in relapse, and the above referred ratio could constitute a good biomarker of relapse in patients that underwent IFN-ß treatment.

Understanding the relation between Zika virus infection during pregnancy and adverse fetal, infant and child outcomes: a protocol for a systematic review and individual participant data meta-analysis of longitudinal studies of pregnant women and their infants and children.

INTRODUCTION: Zika virus (ZIKV) infection during pregnancy is a known cause of microcephaly and other congenital and developmental anomalies. In the absence of a ZIKV vaccine or prophylactics, principal investigators (PIs) and international leaders in ZIKV research have formed the ZIKV Individual Participant Data (IPD) Consortium to identify, collect and synthesise IPD from longitudinal studies of pregnant women that measure ZIKV infection during pregnancy and fetal, infant or child outcomes. METHODS AND ANALYSIS: We will identify eligible studies through the ZIKV IPD Consortium membership and a systematic review and invite study PIs to participate in the IPD meta-analysis (IPD-MA). We will use the combined dataset to estimate the relative and absolute risk of congenital Zika syndrome (CZS), including microcephaly and late symptomatic congenital infections; identify and explore sources of heterogeneity in those estimates and develop and validate a risk prediction model to identify the pregnancies at the highest risk of CZS or adverse developmental outcomes. The variable accuracy of diagnostic assays and differences in exposure and outcome definitions means that included studies will have a higher level of systematic variability, a component of measurement error, than an IPD-MA of studies of an established pathogen. We will use expert testimony, existing internal and external diagnostic accuracy validation studies and laboratory external quality assessments to inform the distribution of measurement error in our models. We will apply both Bayesian and frequentist methods to directly account for these and other sources of uncertainty. ETHICS AND DISSEMINATION: The IPD-MA was deemed exempt from ethical review. We will convene a group of patient advocates to evaluate the ethical implications and utility of the risk stratification tool. Findings from these analyses will be shared via national and international conferences and through publication in open access, peer-reviewed journals. TRIAL REGISTRATION NUMBER: PROSPERO International prospective register of systematic reviews (CRD42017068915).

Characterization of circulating gamma-delta T cells in relapsing vs remission multiple sclerosis.

We characterized circulating gamma-delta T cells in relapsing-remitting multiple sclerosis (RRMS) patients, during remission and relapse phases. In relapse, we observed a decrease of circulating CCR5+ γδ TEMRA cell subset, together with a decrease in EOMES and granzyme B mRNA expression in γδ T cells, suggesting a reduction of the cytotoxic potential of this subset. Moreover, we also found a higher frequency of IFNγ+ γδ T cells, which may indicate that these cells are assuming a more regulatory function associated to a Th1 profile. These results suggest a specific release from the periphery of a particular γδ T cell subset, expressing CCR5 and belonging to an effector compartment, supporting the idea that γδ T cells could play a role in MS relapse.

Tendência temporal e distribuição espacial da sífilis gestacional e congênita em Goiás, 2007-2017: um estudo ecológico / Tendencia temporal y distribución espacial de la sífilis gestacional y congénita en Goiás, Brasil, 2007-2017: un estudio ecológico / Temporal trend and spatial distribution of syphilis in pregnancy and congenital syphilis in Goiás, Brazil, 2007-2017: an ecological study

Objetivo: Analisar a tendência temporal e a distribuição espacial de sífilis gestacional (SG) e sífilis congênita (SC) em Goiás, Brasil, no período 2007-2017. Métodos: Estudo ecológico de série temporal com dados do Sistema de Informação de Agravos de Notificação. Utilizou-se a regressão de Prais-Winsten para analisar a tendência dos indicadores, por macrorregião de saúde. Realizou-se análise espacial descritiva para verificar a distribuição espacial dos casos, em três anos da série. Resultados: Foram registrados 7.679 casos de SG e 1.554 de SC no período. Observou-se tendência crescente das taxas de detecção de SG (variação percentual anual [VPA] de 18,0 ­ intervalo de confiança de 95% [IC95%] de 15,3 a 20,8) e de SC (VPA=16,8 ­ IC95% 20,1;33,8); e um acréscimo de 326% no número de municípios com taxa de incidência de SC >0,5/1 mil nascidos vivos. Conclusão: Foi identificado crescimento das taxas de detecção da sífilis gestacional e congênita e do número de municípios notificantes.

Objetivo: Analizar la tendencia temporal y distribución espacial de la sífilis gestacional (SG) y la sífilis congénita (SC) en Goiás, Brasil, entre 2007 y 2017. Métodos: Estudio de series temporales y enfoque espacial con datos del Sistema de Información para Enfermedades de Notificación. Se utilizó la regresión de Prais-Winsten para analizar la tendencia de los indicadores por macroregión de salud. Fue realizado un análisis espacial para verificar la distribución espacial de los casos en tres años de la serie. Resultados:Se registraron 7.679 casos de sífilis gestacional y 1.554 casos de congénita. Hubo una tendencia creciente en las tasas de detección de SG con (Variación Porcentual Anual [VPA] de 18,0 ­ intervalo de confianza del 95% [IC95%] de 15,3 a 20,8) y de SC (VPA=16,8 ­ IC95% 20,1; 33,8); y un aumento del 326% en el número de municipios con una tasa de incidencia de sífilis congénita >0,5/1000 nacidos vivos. Conclusión: Se identificó um aumento creciente de sífilis gestacional y sífilis congénita y del número de municipios notificantes en Goiás.

Objective: To analyze temporal trend and spatial distribution of syphilis in pregnancy and congenital syphilis in Goiás State, Brazil, between 2007 and 2017. Methods: This was an ecological time series and spatial distribution study with data obtained from the Notifiable Health Conditions Information System. Prais-Winsten Regression was used to analyze indicator trends by health macro-region. Descriptive spatial analysis was performed to verify case distribution in three different years in the period. Results: Between 2007 and 2017, 7,679 cases of syphilis in pregnancy and 1,554 congenital syphilis cases were reported. A rising trend was found in the rates of syphilis in pregnancy (annual percent change [APC] = 18.0 ­ 95% confidence interval [95%CI] 15.3;20.8) as well as in congenital syphilis rates (APC=16.8 ­ 95%CI 20.1;33.8); and a 326% increase in the number of municipalities with a congenital syphilis incidence rate >0.5/1,000 live births. Conclusion: Growth in syphilis in pregnancy and congenital syphilis detection rates was identified, as was growth in the number of municipalities reporting cases.

Caracterização dos casos notificados de zika vírus em gestantes em um hospital da região centro-oeste / Characterization of the reported cases of zika virus in pregnant women in a hospital in the midwest brazil region

Objetivo: Caracterizar o perfil das gestantes notificadas para Zika Vírus (ZIKV) em um hospital da região Centro-Oeste. Metodologia: Estudo transversal, descritivo, quantitativo e retrospectivo, composto por 311 casos suspeitos de ZIKV em gestantes atendidas em um Hospital Público de referência no período dezembro de 2015 a dezembro de 2017. Análise com teste de qui-quadrado e Exato de Fisher. Resultados: Foram confirmados 180 (58%) casos, predominou mulheres com idade entre 19-35 anos 250 (61%), residente em Goiânia 126 (70%). Houve associação estatisticamente significante em relação aos casos confirmados em gestantes na faixa etária de 19 a 35 anos (p<0.0071), ocorrência de casos durante o segundo semestre de 2015 (p<0.0028), e o primeiro semestre de 2016 (p<0.0000001). Conclusão: Mediante o agravo que a infecção pelo ZIKV pode ocasionar durante a gestação, é imprescindível que os casos suspeitos sejam monitorados. (AU)

Objective: To characterize the profile of pregnant women reported for Zika Virus (ZIKV) in a hospital in the Midwest. Methodology: A cross-sectional, descriptive, quantitative and retrospective study of 311 suspected ZIKV cases in pregnant women attending a Reference Public Hospital during the period of December 2015 to December 2017. Analysis using chi-square test and Fisher's exact test. Results: 180 (58%) cases were confirmed, predominantly women aged between 19-35 years 250 (80%), living in Goiânia 126 (70%). There was a statistically significant association with confirmed cases in pregnant women aged 19-35 years (p<0.0071), occurrence of cases during the second half of 2015 (p<0.0028), and the first half of 2016 (p<0.0000001). Conclusion: Due to the complications that infection by ZIKV can cause during pregnancy, it is necessary that the suspected cases are monitored. (AU)

Objetivo: Caracterizar el perfil de las mujeres embarazadas notificadas para Zika Virus (ZIKV) en un hospital de la región Centro-Oeste. Metodología: Estudio transversal, descriptivo, cuantitativo y retrospectivo, compuesto por 311 casos sospechosos de ZIKV en mujeres embarazadas atendidas en un Hospital Público de referencia en el período de diciembre de 2015 a diciembre de 2017. Análisis con prueba de chi-cuadrado y Exacto de Fisher. Resultados: Se confirmaron 180 (58%) casos, predominó mujeres con edad entre 19-35 años 250 (80%), residentes en Goiânia 126 (70%). Se observó asociación estadísticamente significativa en relación a los casos confirmados en mujeres embarazadas en el grupo de edad de 19 a 35 años (p<0.0071), ocurrencia de casos durante el segundo semestre de 2015 (p<0.0028), y el primer semestre de 2016 (p<0.0000001). Conclusión: Mediante las complicaciones que la infección por el ZIKV puede ocasionar durante la gestación, es imprescindible que los casos sospechosos sean monitoreados. (AU)

Impacto da corticoterapia no prognóstico do prematuro tardio / Impact of corticoisteroids on late preterm prognosis: systematic review

Pouco se sabe sobre os efeitos da corticoterapia antenatal (CTA) nos fetos pré-termo tardios (PTT). Esta revisão tem como proposta examinar se há, ou não, benefícios no uso de corticoide para o incremento da maturação pulmonar fetal e melhoria dos resultados perinatais. Vários estudos avaliando as desordens respiratórias no neonato, a redução da morbimortalidade neonatal e duração do tempo de internação deram suporte a esta revisão. Parece não haver melhora da morbidade respiratória e suas complicações com a utilização da corticoterapia nos PTT, concluindo-se pela necessidade de mais estudos, em especial direcionados para casos de gestações que não apresentem maturidade pulmonar após 34 semanas com maior risco de parto prematuro.(AU)

Little is known about the effects of antenatal corticosteroids in late pre-term fetuses. This review clarify whether there is benefits in using steroids in late pre-term fetus to increase fetal lung maturation and improve perinatal outcomes, or not. Several studies in which the primary outcomes were respiratory disorders, neonatal mortality and hospitalization length were examined in this review. It seems that corticosteroids do not improve respiratory morbidity or its complications. It is concluded that more studies, in particular those including pregnancies with fetal lung immaturity after 34 weeks presenting higher risk of premature labor.(AU)

Estratégias de promoção e manutenção do aleitamento materno baseadas em evidência: revisão sistemática / Evidence based strategies of promotion and maintenance of breastfeeding: systematic review

Identificar estratégias desenvolvidas para melhorar os índices de aleitamento materno cuja eficácia tenha sido testada por estudos randomizados. Foi feita uma revisão sistemática da literatura, em que foram selecionados ensaios clínicos randomizados, publicados nos últimos 15 anos, que tiveram o intuito de testar técnicas ou estratégias de promoção e/ou manutenção da amamentação. As bases de dados utilizadas foram: Medline-PubMed, BIREME, SciELO, Lilacs e Cochrane Library. Foram incluídos 14 artigos, com um total de 20.800 pares de mães e respectivos recém-nascidos, dos quais 3 avaliaram iniciação e 11 estudaram iniciação e manutenção do aleitamento materno. Estudos que tiveram como tática suporte individualizado e mais prolongado para as pacientes e maior capacitação da equipe de saúde se mostraram mais efetivos na melhoria das taxas de amamentação. Ações educativas isoladas são pouco eficazes no aumento das taxas de amamentação. Programas que se baseiam em suporte mais amplo e aconselhamento individual se mostraram mais efetivos.(AU)

To identify strategies developed to improve breastfeeding rates, whose effectiveness have been tested by randomized trials. A systematic review was made, where Randomized Controlled Trials, published in the last fifteen years, were selected if designed to test techniques or strategies for breastfeeding promotion and/or maintenance. The databases accessed were: Medline-PubMed, BIREME, SciELO, Lilacs and Cochrane Library. We included 14 articles with a total of 20800 pairs of mothers and their newborns, of which three evaluated initiation and 11 studied initiation and maintenance of breastfeeding. Studies using strategies of longer individualized support for the patients and better health staff training were more effective in improving breastfeeding rates. Isolated educational strategies are ineffective in increasing breastfeeding rates. Programs that are based on more extensive and individual counseling support proved to be more effective.(AU)

Eficácia da progesterona na prevenção do trabalho de parto prematuro gemelar: revisão sistemática / Progesterone efficacy for twin preterm labor prevention: a systematic review

Este estudo teve como objetivo realizar uma revisão sistemática de ensaios clínicos randomizados que analisaram a eficácia do uso da progesterona em reduzir o parto pré-termo na gravidez gemelar no período de 1994 até 2014. Segundo critérios pré-estabelecidos, foram incluídos dez artigos, com um total de 3.432 gestantes de gêmeos randomizadas para tratamento com progesterona versus placebo ou nenhum tratamento, entre os quais somente um estudo demonstrou algum benefício, mas com amostragem muito pequena. Concluímos, com o presente estudo, que as evidências não comprovam a eficácia da progesterona na prevenção de parto prematuro gemelar, em geral. São necessários estudos com maior número de gestantes gemelares que tenham fatores de risco para parto prematuro, tais como aquelas com colo curto e/ou história de parto prematuro prévio.

The goal of our study was to make a systematic review of randomized controlled trials that analyzed the efficacy of progesterone to reduce preterm birth in twin pregnancies published from 1994 to 2014. According to predetermined criteria, ten studies were included, with a total of 3,432 pregnant woman with twins randomized either to treatment with progesterone versus placebo or no treatment, among which only one study showed benefits, but with a very small sample. We conclude, from this study, that there is no evidence that progesterone prevents twin preterm birth, in general. More studies, that focus the use of progesterone in high risk twin pregnancies, such as short cervix or/and preterm birth history, are required.

Impacto da cesárea eletiva no desfecho neonatal gemelar: revisão sistemática / Impact of elective cesarean on the outcome of twin newborn: a systematic review

Esta revisão teve como objetivo buscar ensaios randomizados publicados nos últimos 30 anos que analisaram a assistência ao parto nas gestações gemelares e sua relação com o desfecho fetal e neonatal, com o intuito de, possivelmente, estabelecer a via de parto mais adequada. Segundo critérios preestabelecidos, foram incluídos dois artigos, o primeiro de um único centro e o segundo multicêntrico, num total de 2.864 mulheres randomizadas para cesárea eletiva ou parto vaginal planejado. Ainda que verificadas algumas diferenças entre os estudos, ambos concluem que em casos selecionados de gestação gemelar a cesárea eletiva não influenciou significativamente o risco de óbito fetal ou neonatal ou a morbidade neonatal severa em relação ao parto vaginal planejado.(AU)

This review aimed to search for randomized trials published in the last 30 years that analyzed the relation between type of delivery in twin pregnancies and their relationship to fetal and neonatal outcome in order to probably determine the most appropriate route of delivery. According to established criteria, two articles were included; the first from a single-center and the second was a multicenter trial, with a total of 2,864 women randomized either to elective cesarean section or planned vaginal birth. Although there were some differences between studies, both found that in selected cases of twin pregnancy, elective caesarean section did not significantly influence the risk of fetal or neonatal death or severe neonatal morbidity compared to planned vaginal birth.(AU)