A evolução da mortalidade materna e o impacto da COVID-19 na Região Norte do Brasil: uma análise de 2012 a 2021 / Evolution of maternal mortality and impact of COVID-19 in the Northern Region of Brazil: an analysis from 2012 to 2021

Analisar o comportamento da razão de mortalidade materna de 2012 a 2021, na Região Norte do Brasil. Estudo ecológico descritivo de base populacional e série temporal, de 2012 a 2021, com dados secundários da Região Norte do Brasil, disponíveis no Painel de Monitoramento de Mortalidade Materna e Nascidos Vivos. Entre 2012 e 2019, na Região Norte, a média da razão de mortalidade materna foi 72,19, mas, com a pandemia de COVID-19, elevou-se consideravelmente, sendo 92,16 em 2020 e 164 em 2021. Roraima apresentou a maior mortalidade materna na pandemia, em fevereiro de 2021 (705,65). Neste ano, o colapso do sistema de saúde do Amazonas impactou a razão de mortalidade materna, que foi 436,90 em fevereiro de 2021.A COVID-19 colaborou com o aumento da mortalidade materna, evidenciando desigualdades interestaduais e vulnerabilidades na assistência pré-natal, na infraestrutura hospitalar e socioeconômica da Região Norte, especialmente em Roraima e Amazonas.

To analyze the behavior of the maternal mortality ratio from 2012 to 2021 in the North Region of Brazil. Population-based descriptive ecological study and time series, from 2012 to 2021, with secondary data from the Northern Region of Brazil, available on the Monitoring Panel for Maternal Mortality and Live Births. Between 2012 and 2019, in the North Region, the average maternal mortality ratio was 72.19, but, with the COVID-19 pandemic, it increased considerably, being 92.16 in 2020 and 164 in 2021. Roraima presented higher maternal mortality in the pandemic, in February 2021 (705.65). That year, the collapse of the health system in Amazonas affected the maternal mortality ratio, which was 436.90 in February 2021.COVID-19 collaborated with the increase in maternal mortality, highlighting interstate inequalities and vulnerabilities in prenatal care, hospital, and socioeconomic infrastructure in the North Region, especially in Roraima and Amazonas.

Síndrome respiratória aguda grave por covid-19: perfil epidemiológico em gestantes e puérperas no Amazonas / Severe acute respiratory syndrome by covid-19: epidemiological profile in pregnant and postpartum women in the state of Amazonas

Objetivos: descrever o perfil epidemiológico de gestantes e puérperas com Síndrome Respiratória Aguda Grave (SRAG) por COVID-19 no Amazonas. Métodos: trata-se de um estudo quantitativo, transversal que extraiu dados de gestantes e puérperas residentes no estado do Amazonas que foram notificadas no Sistema de Informação da Vi-gilância Epidemiológica da Gripe (SIVEP-Gripe) e tiveram diagnóstico confirmado de SRAG por COVID-19 de 16 de fevereiro de 2020 a 31 de dezembro de 2021. Foram coletados dados sociodemográficos e características clínicas como internação em Unidade de Terapia Intensiva, uso de suporte ventilatório, uso de terapia antiviral e desfechos. Os dados foram analisados e apresentados em frequências absolutas e relativas. Resultados e Discussão: duran-te o período pesquisado, o Amazonas registrou 828 casos de SRAG por COVID-19 em gestantes e puérperas. Des-tes, 58 casos permaneciam em andamento, sem desfecho. A maioria das mulheres tinha idade entre 20 e 34 anos, cor parda, ensino médio, residiam em zona urbana e estavam no terceiro trimestre da gestação no momento do diagnóstico. Em relação às manifestações clínicas, houve predominância de tosse, desconforto respiratório, febre e dispneia. As comorbidades mais frequentes foram asma, doença cardiovascular crônica, diabetes mellitus e obe-sidade. Em relação aos dados clínicos, 19,7% das gestantes e puérperas foram internadas em UTI. Destas, 70,6% utilizaram ventilação mecânica invasiva, 80,2% fizeram uso de terapia antiviral e 79 (10,3%) evoluíram para óbito. Conclusão: o estudo permitiu a caracterização do perfil epidemiológico de gestantes e puérperas com SRAG por COVID-19 no Amazonas e demonstrou taxa elevada de óbito no período estudado, sobretudo na capital. Esse perfil pode ter relação com os determinantes sociais da saúde e as dificuldades de acesso aos serviços de saúde podem ter papel fundamental na assistência. Com isso, o atendimento às gestantes e puérperas com SRAG por COVID-19 deve ser prioridade nos serviços de saúde, principalmente nos casos em que as pacientes possuem comorbidades (AU)

Objectives: To describe the epidemiological profile of pregnant and postpartum women with severe acute res-piratory syndrome (SARS) caused by severe acute respiratory syndrome corona virus (SARS-CoV-2) in Amazonas. Methods: This quantitative, cross-sectional study extracted data from pregnant and postpartum women residing in the state of Amazonas who were notified in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) and had a confirmed diagnosis of SARS during corona virus disease (COVID-19) from February 16, 2020, to December 31, 2021. Sociodemographic data and clinical characteristics, such as admission to the intensive care unit, use of ventilatory support, use of antiviral therapy, and outcomes were collected. Data were analyzed and presented with relative frequencies. Results and Discussion: During the study period, Amazonas recorded 828 cases of SARS caused by SARS-CoV-2 in pregnant and postpartum women. Of these, 58 patients remained in progress with no outcomes. Most women were aged between 20 and 34 years, educated to high school level, lived in urban areas, and were in the third trimester of pregnancy at the time of diagnosis. Predominant clinical manifes-tation was cough, respiratory distress, fever, and dyspnea. The most frequent comorbidities were asthma, chronic cardiovascular diseases, diabetes mellitus, and obesity. 19.7% of pregnant and postpartum women were admitted to the intensive care unit (ICU). Of these, 70.6% needed invasive mechanical ventilation, 80.2% antiviral therapy, and 79 patients (10.3%) died. Conclusion: This study characterized the epidemiological profile of pregnant and postpartum women with SARS caused by SARS-CoV-2 in Amazonas and showed a high death rate during the study period, especially in the capital (AU)

Associated factors with neonatal near miss in twin pregnancies in a public referral maternity unit in Brazil

Objective: The aim was to analyze the factors associated with neonatal near miss (NNM) in twin pregnancies in a public referral maternity unit in Brazil. Material and Methods: This retrospective, cross-sectional study included 697 twin newborns. Cases of fetal and neonatal deaths were excluded. Neonates were divided into those meeting NNM criteria (5 min Apgar score <7, birth weight <1,500 g, gestational age at delivery <32 weeks, use of mechanical ventilation or congenital malformation, transfer before 28 days of life) and those who did not. In the bivariate analysis, the chi-square and Fisher's exact tests were used. Variables with a p-value ≤0.20 were subjected to the multiple analyses, which followed the Poisson regression model. Results: The cohort consisted of 130 (18.7%) neonates meeting NNM criteria and 567 (81.3%) with no NNM criteria after multiple analyses, the following variables were associated with NNM: no previous pregnancy, prevalence ratio (PR): 1.38 [95% confidence interval (CI), 1.03-1.85]; >3 previous pregnancies, PR: 1.93 (95% CI, 1.38-2.69); premature rupture of membranes, PR: 1.50 (95% CI, 1.70-2.12); intrauterine growth restriction, PR: 2.28 (95% CI, 1.53-3.33); premature labor, PR: 1.63 (95% CI, 1.13-2.35); resuscitation in the delivery room, PR: 1.80 (95% CI, 1.24-2.62); and transfusion of blood products, PR: 4.44 (95% CI, 3.14-6.28). Conclusion: The study findings indicate that having had 0 or >3 previous pregnancies, premature rupture of the membranes, intrauterine growth restriction, resuscitation in the delivery room, premature labor, and transfusion of blood products were associated with NNM in twin pregnancies.

Factors associated with neonatal near miss and death in public referral maternity hospitals / Fatores associados ao near miss e óbito neonatais em maternidade pública de referência

Abstract Objectives: to evaluate factors associated with neonatal near miss and death in reference hospitals. Methods: this case-control study included 364 cases and 728 controls among 4,929 births. Cases were identified by Apgar < 7 at 5 minutes, weight < 1500 g, gestational age <32 weeks, mechanical ventilation or congenital malformation. After follow-up, outcomes were reclassified into: true controls, near miss and neonatal death. Hierarchically, variables with a p-value < 0.20 were included in the multiple logistic regression. Results: the neonatal near miss rate was 54.1 per 1,000 live births, and the near-miss-to-death ratio was 2.75. Between the control and near miss groups, the predictor variables were neonatal intensive care admission [OR = 35.6 (16.7 - 75.9)] and central venous access [OR= 74.8 (29.4 - 190.4)]. Between the control and death groups, neonatal intensive care admission [OR = 100.4 (18.8 - 537.0)] and central venous access [OR = 12.7 (3.7 - 43.2)] were significant. Between the near miss and death groups, only Apgar < 7 at 5 minutes [OR = 4.1 (1.6 - 10.6)] and vasoactive drug use [OR = 42.2 (17.1 - 104.5)] were significant. Conclusion: factors associated with a greater chance of near miss and/or neonatal death were: Apgar score <7 at 5 minutes, neonatal intensive care confinement, having central venous access, and use of vasoactive drugs.

Resumo Objetivos: avaliar fatores associados à morbidade "near miss" e óbito neonatal em maternidade pública de referência. Métodos: estudo caso-controle com 4,929 nascimentos encontrou 364 casos e 728 controles. Os casos foram identificados pelos critérios: Apgar< 7 no 5° minuto, peso <1500g, idade gestacional < 32 semanas, ventilação mecânica ou malformação congênita. Reclassificou-sequanto aos desfechos: sobrevivência ao período neonatal sem critérios de near miss ("controles" verdadeiros), "near miss" e "óbito neonatal". Hierarquicamente, as variáveis com p< 0,20 foram incluídas na regressão logística múltipla. Resultados: a taxa de near miss neonatal foi 54,1 por mil nascidos vivos, a razão de near miss e óbito foi 2,75. As variáveis preditoras, entre controles e near miss foi internamento em terapia intensiva neonatal: OR 35,6 (16,7 - 75,9) e acesso venoso central: OR= 74,8 (29,4 -190,4); entre controles e óbito internamento em terapia intensiva neonatal: OR=100,4 (18,8 - 537,0)e acesso venoso central: OR 12,7 (3,7 - 43,2); entre near miss e óbito Apgar no 5°minuto < 7: OR= 4,1 (1,6 - 10,6) e uso de drogas vasoativas: OR= 42,2 (17,1 - 104,5). Conclusão: fatores associados à ocorrência de near miss e/ou óbito neonatal foram: Apgar < 7 no 5° minuto, internamento em terapia intensiva neonatal, acesso venoso central e drogas vasoativas.

Delays in obstetric care increase the risk of neonatal near-miss morbidity events and death: a case-control study.

BACKGROUND: To evaluate the association between delays in obstetric care and neonatal near-miss mortality events and death in a public maternity referral center. METHODS: This case-control study enrolled 142 neonates, meeting the near-miss criteria of 5-min Apgar < 7, weight < 1500 g, gestational age < 32 weeks, and use of mechanical ventilation or congenital malformation, as well as 284 controls (without the near-miss criteria), at a ratio of 1:2. After follow-up, the following outcomes were reclassified: survival of the neonatal period without the near-miss criteria (true "controls"), "near-miss," and "neonatal death." Maternal sociodemographic characteristics, prenatal care, and pregnancy resolution were evaluated. Pearson's chi-square and Fisher's exact tests were used. Simple logistic regression was performed to determine the association between the three delay factors with near-miss outcomes and/or neonatal death. The variables that had maintained values of p < 0.05 were subjected to multinomial logistic regression. RESULTS: Comparisons revealed the following associations: for controls and near-miss events, delayed access to health services due to a lack of specialized services (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.8-5.1) and inappropriate conduct with the patient (OR, 12.1; 95% CI, 1.3-108.7); for controls and death, absent or inadequate prenatal care (OR, 3.3; 95% CI, 1.6-7.1) and delayed access to health services due to a lack of specialized services (OR, 2.5; 95% CI, 1.1-5.6); and for near-miss events and death, absent or inadequate prenatal care (OR, 2.2; 95% CI, 1.0-5.0). Logistic regression for the combined outcome (near-miss plus neonatal deaths) revealed absent or inadequate prenatal care (OR, 1.9; 95% CI, 1.2-2.8), lack of specialized services (OR, 2.8; 95% CI, 1.7-4.5), and improper conduct with the patient (OR, 10.6; 95% CI, 1.2-91.8). CONCLUSIONS: The delays in obstetric care associated with the presence of near-miss and/or neonatal death included absent or inadequate prenatal care, delayed access to health services due to a lack of specialized services, and inappropriate conduct with the patient.

Capacidade funcional de idosos assistidos pela estratégia saúde da família em um bairro de Teresina ­ PI / Functional capacity of elderly people assisted by the family's health strategy in a district of Teresina - PI

OBJETIVO: Avaliar a capacidade funcional e analisar as características associadas à incapacidade dos idosos atendidos em uma equipe da Estratégia Saúde da Família em Teresina (PI). MÉTODOS: Trata-se de um estudo transversal, descritivo de abordagem quantitativa. Para a avaliação das atividades básicas e instrumentais da vida diária foram empregados o índice de Katz e a escala de Lawton, respectivamente. Os dados coletados foram distribuídos e analisados no programa estatístico Statitical Package for the Social Sciences, versão 21.0. Realizou-se análise descritiva dos dados com os valores apresentados em frequências absolutas e porcentagens. Para associar o desfecho com os dados clínicos, sociodemográficos e econômicos, foi utilizado o Teste Exato de Fischer. Consideraram-se os valores de p<0,05 como significativos. O projeto recebeu anuência da Fundação Municipal de Saúde de Teresina e foi submetido e aprovado no Comitê de Ética em Pesquisa da Universidade Estadual do Piauí, conforme parecer nº 1.991.901. RESULTADOS: Foram entrevistados 37 idosos cuja idade variou de 60-92 anos, média 72,2 anos (DP ±7,4). Destes, 73% foram considerados independentes quanto à capacidade funcional para atividades diárias e 75,7% classificados como dependentes para atividades instrumentais. A independência para atividades básicas foi associada à faixa etária (p=0,003), assim idosos de 60-70 apresentam- se mais independentes. Idosos com idade ≥ 71 anos (p=0,035); do sexo feminino (p=0,023) e; idosos casados ou viúvos (p=0,013) apresentam-se maior dependência para atividades instrumentais. Não houve associação da capacidade funcional, para atividades básicas ou instrumentais da vida diária, com a presença de doenças crônicas não transmissíveis (p>0,05).

OBJECTIVE: To evaluate the functional capacity and analyze the characteristics associated to the incapacity of elderly people assisted in a team of the Family's Health Strategy in Teresina (PI). METHODS: This is a cross-sectional, descriptive, quantitative study. For the evaluation of basic and instrumental activities of daily living, the Katz index and the Lawton scale were used, respectively. The collected data were distributed and analyzed in the statistical program Statistical Package for the Social Sciences, version 21.0. A descriptive analysis of the data was performed with the values presented in absolute frequencies and percentages. The Fischer Exact Test was used to associate the outcome with the clinical, sociodemographic and economic data. Values of p <0.05 were considered significant. The project was approved by the Municipal Health Foundation of Teresina and was submitted to and approved by the Research Ethics Committee of the Piauí State University, according to opinion nº 1,991,901. RESULTS: A total of 37 elderly people aged 60-92 years, mean age 72.2 years (SD ± 7.4) were interviewed. Of these, 73% were considered independent regarding functional capacity for daily activities and 75.7% classified as dependent for instrumental activities. Independence for basic activities was associated with the age group (p = 0.003), so the elderly of 60-70 were more independent. Elderly patients aged ≥ 71 years (p = 0.035); female (p = 0.023) and; aged or widowed (p = 0.013) showed greater dependence on instrumental activities. There was no association of functional capacity for basic or instrumental activities of daily living, with the presence of chronic noncommunicable diseases (p> 0.05).