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OBJECTIVES: Changes in placental features, such as maternal and fetal vascular malperfusion, are associated with SARS-CoV-2 infection. The anatomopathologic study of the placenta is crucial for understanding pregnancy and fetal complications. To that end, this study aimed to describe placental features and analyze the association between placental findings and perinatal outcomes in a cohort of pregnant women with severe COVID-19. METHODS: This nested study within a prospective cohort study consisted of 121 singleton pregnant women with a diagnosis of severe COVID-19. Placental pathologic findings were described, and the associations between severe COVID-19 and clinical parameters and perinatal outcomes were assessed. RESULTS: The prevalence of maternal vascular malperfusion was 52.1%, followed by fetal vascular malperfusion at 21.5%, ascending intrauterine infections at 11.6%, and inflammatory lesions at 11.6%. Other lesions were observed in 39.7% of the placentas examined. Inflammatory lesions were an independent factor (P = .042) in 5-minute Apgar scores below 7. Ascending infection was associated with fetal death (P = .027). CONCLUSIONS: Maternal vascular malperfusion was the most prevalent placental feature in patients with severe COVID-19. Chorangiosis is associated with poor perinatal outcomes.
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Background: Few studies have evaluated the effects of the Coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, on maternal and perinatal health at a populational level. We investigated maternal and perinatal health indicators in Brazil, focusing on the effects of the COVID-19 pandemic, and SARS-CoV-2 vaccination campaign for pregnant women. Methods: Utilizing interrupted time series analysis (January 2013-December 2022), we examined Maternal Mortality Ratio, Perinatal Mortality Rate, Preterm Birth Rate, Cesarean Section Rate, and other five indicators. Interruptions occurred at the pandemic's onset (March 2020) and pregnant women's vaccination (July 2021). Results were expressed as percent changes on time series' level and slope. Findings: The COVID-19 onset led to immediate spikes in Maternal Mortality Ratio (33.37%) and Perinatal Mortality Rate (3.20%) (p < 0.05). From March 2020 to December 2022, Cesarean Section and Preterm Birth Rates exhibited upward trends, growing monthly at 0.13% and 0.23%, respectively (p < 0.05). Post start of SARS-CoV-2 vaccination (July 2021), Maternal Mortality Ratio (-34.10%) and Cesarean Section Rate (-1.87%) promptly declined (p < 0.05). Subsequently, we observed a monthly decrease of Maternal Mortality Ratio (-9.43%) and increase of Cesarean Section Rate (0.25%) (p < 0.05), while Perinatal Mortality Rate and Preterm Birth Rate showed a stationary pattern. Interpretation: The pandemic worsened all analyzed health indicators. Despite improvements in Maternal Mortality Ratio, following the SARS-CoV-2 vaccination campaign for pregnant women, the other indicators continued to sustain altered patterns from the pre-pandemic period. Funding: No funding.
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INTRODUÇÃO: A mortalidade perinatal se refere ao óbito de um filho entre a 22ª semana de gestação e o 7º dia de vida ou quando o feto já possui ao menos 500g. Estes dados se referem a cerca de 15,5% dos nascimentos totais, o que leva a mortalidade perinatal a ser considerada uma questão de saúde pública. Evidencia-se a importância do respeito e cuidado com quem passa por esse evento, tanto por parte dos profissionais como da família e da sociedade no processo de luto. Nota-se a carência de material bibliográfico sobre o assunto. OBJETIVOS: Compreender as vivências maternas sobre a experiência do luto de seus bebês. Observar o suporte familiar e da equipe de saúde oferecido às mães enlutadas e entender o desenvolvimento de estratégias de enfrentamento. MÉTODO: Estudo qualitativo realizado com nove mulheres que passaram pela perda de um bebê no período perinatal. Foram realizadas entrevistas semiestruturadas e os relatos foram tabulados e organizados utilizando o Discurso do Sujeito Coletivo. RESULTADOS: As mulheres participantes dessa pesquisa relataram reações emocionais experienciadas no processo de luto e formas com as quais puderam retomar seus cotidianos, o que pode ser relacionado com o Modelo do Processo Dual de Luto. É relevante destacar que houve relatos de percepção de ausência de apoio por parte da equipe de saúde. CONSIDERAÇÕES FINAIS: Foi valorizada na fala das entrevistadas a importância de viver o processo do luto, a ambivalência frente uma gravidez subsequente e a importância de recursos de enfrentamento.
INTRODUCTION: Perinatal mortality refers to the death of a child between the 22nd week of pregnancy and the 7th day of life, or when the fetus already weighs at least about 1.1 lb. These data refer to approximately 15.5% of total births, making perinatal mortality a public health issue. The importance of respect and care for those who go through this event is evident from professionals, family, and society during the grieving process. There is a lack of bibliographic material on the subject. OBJECTIVES: Understand maternal experiences regarding their babies' grief experience. Observe the family and health team support offered to bereaved mothers and understand the development of coping strategies. METHOD: A qualitative study was conducted with nine women who experienced the loss of a baby in the perinatal period. Semi-structured interviews were carried out, and the reports were tabulated and organized using the Collective Subject Discourse. RESULTS: The women participating in this research reported emotional reactions experienced during the grieving process and ways in which they were able to resume their daily lives, which can be related to the Dual Grief Process Model. It is important to highlight that there were reports of a perceived lack of support from the healthcare team. FINAL CONSIDERATIONS: In the interviewees' speeches, the importance of experiencing the grieving process, the ambivalence towards a subsequent pregnancy, and the importance of coping resources were emphasized.
INTRODUCCIÓN: La mortalidad perinatal se refiere al fallecimiento de un hijo entre la semana 22 de gestación y el séptimo día de vida, o cuando el feto pesa al menos 500g. Este fenómeno representa aproximadamente el 15,5% del total de nacimientos, lo que se convierte en un problema de salud pública. Se destaca la importancia del respeto y cuidado hacia quienes atraviesan este evento, tanto por parte de los profesionales, como de la familia y la sociedad durante el proceso de duelo. Hay una notable carencia de material bibliográfico sobre el tema. OBJETIVOS: Comprender las vivencias maternas durante el duelo por la pérdida de sus bebés. Observar el apoyo familiar y del equipo de salud ofrecido a las madres en duelo y entender el desarrollo de estrategias de afrontamiento. MÉTODO: Estudio cualitativo con nueve mujeres que pasaron por la pérdida de un bebé en el período perinatal. Se realizaron entrevistas semiestructuradas y los relatos se tabularon y organizaron utilizando el Discurso del Sujeto Colectivo. RESULTADOS: Las mujeres participantes relataron reacciones emocionales durante el duelo y las formas en que retomaron sus rutinas, lo cual puede relacionarse con el Modelo del Proceso Dual de Duelo. Es relevante señalar que hubo percepciones de falta de apoyo por parte del equipo de salud. CONSIDERACIONES FINALES: Las entrevistadas valoraron la importancia de vivir el proceso de duelo, la ambivalencia frente a un embarazo subsecuente y la importancia de recursos de afrontamiento.
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Luto , Mortalidade Perinatal , SolidãoRESUMO
RESUMEN No existe consenso sobre la curva de crecimiento a utilizar para evaluar el crecimiento fetal. Validar unas curvas personalizadas y estudiar su rendimiento en la detección de neonatos con restricción de crecimiento intrauterino (RCIU), así como su precisión diagnóstica. Inicialmente se diseñó unas curvas personalizadas con 2,792 fetos únicos de embarazos de riesgo bajo; se calculó el peso óptimo a las 40 semanas = 1,496.202 + (64.379 x sexo fetal) + (831.362 x talla materna) + (9.567 x peso pregestacional), ecuación que se combinó con una función de proporcionalidad estándar para ajustar los pesos según su edad gestacional. Posteriormente se evaluó su rendimiento aplicándola en una cohorte retrospectiva de neonatos de 24 a 40 semanas nacidos entre 2018 y 2022 en un hospital de tercer nivel de Lima, Perú. Se excluyeron gemelos y anomalías congénitas. Se estudió 6,598 neonatos. Las curvas personalizadas mostraron buena concordancia con INTERGROWTH-21 (IG21) (kappa = 0,68; IC95% = 0,62 a 0,74). Se detectó un 2,8% de RCIU (184/6,598), similar al 3,1% de IG21 (205/6,598). Las curvas mostraron alta especificidad y valor positivo negativo (VPN) (97% y 98%; IC95% = 97 a 98% y 98 a 99%, respectivamente). El riesgo para muerte perinatal (RR =7,2; IC95% = 4,6 a 11) y su exactitud (96; IC95% = 95 a 96%) fueron superiores a los de la Fundación de Medicina Fetal (FMF) (RR = 3,6; IC95% = 2,5 a 5,2 y exactitud = 89%; IC95% = 88 a 89%, respectivamente). Las curvas peruanas personalizadas resultaron fiables para evaluar la RCIU. Su capacidad de detección y su precisión diagnóstica fueron similares a otras curvas internacionales, aunque algo superiores a las de la FMF.
ABSTRACT There is no consensus on the growth curve to be used to assess fetal growth. To validate customized curves and study their performance in the detection of neonates with intrauterine growth restriction (IUGR), as well as their diagnostic accuracy. Initially, customized curves were designed with 2,792 singleton fetuses from low-risk pregnancies; the optimal weight at 40 weeks = 1,496.202 + (64.379 x fetal sex) + (831.362 x maternal length) + (9.567 x pregestational weight) was calculated and combined with a standard proportionality function to adjust the weights according to gestational age. Subsequently, its performance was evaluated by applying it in a retrospective cohort of neonates aged 24-40 weeks born between 2018-2022 in a tertiary hospital in Lima-Peru. Twins and congenital anomalies were excluded. A total of 6,598 neonates were studied. Customized curves showed good agreement with INTERGROWTH-21 (IG21) (kappa = 0.68; 95%CI = 0.62-0.74). They detected 2.8% of IUGR (184/6,598), similar to the 3.1% for IG21 (205/6,598). They showed high specificity and negative positive value (NPV) (97% and 98%; 95%CI = 97-98% and 98-99%, respectively). The risk for perinatal death (RR = 7.2; 95%CI = 4.6-11) and accuracy (96; 95%CI = 95-96%) were higher than those of the Fetal Medicine Foundation (FMF) (RR=3.6; 95%CI = 2.5-5.2 and accuracy= 89%; 95%CI = 88-89%, respectively). The customized Peruvian curves were reliable in assessing IUGR. Their detection capacity and diagnostic accuracy were similar to other international curves, although somewhat higher than those of the FMF.
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ABSTRACT BACKGROUND: Concerns regarding high open surgery-related maternal morbidity have led to improvements in minimally invasive fetal surgeries. OBJECTIVE: To analyze the perinatal and maternal outcomes of minimally invasive fetal surgery performed in Rio de Janeiro, Brazil. DESIGN AND SETTING: Retrospective cohort study conducted in two tertiary reference centers. METHODS: This retrospective descriptive study was conducted using medical records from 2011 to 2019. The outcomes included maternal and pregnancy complications, neonatal morbidity, and mortality from the intrauterine period to hospital discharge. RESULTS: Fifty mothers and 70 fetuses were included in this study. The pathologies included twin-twin transfusion syndrome, congenital diaphragmatic hernia, myelomeningocele, lower urinary tract obstruction, pleural effusion, congenital upper airway obstruction syndrome, and amniotic band syndrome. Regarding maternal complications, 8% had anesthetic complications, 12% had infectious complications, and 6% required blood transfusions. The mean gestational age at surgery was 25 weeks, the mean gestational age at delivery was 33 weeks, 83% of fetuses undergoing surgery were born alive, and 69% were discharged from the neonatal intensive care unit. CONCLUSION: Despite the small sample size, we demonstrated that minimally invasive fetal surgeries are safe for pregnant women. Perinatal mortality and prematurity rates in this study were comparable to those previously. Prematurity remains the most significant problem associated with fetal surgery.
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Resumo: O Brasil apresenta elevada morbimortalidade materna e perinatal. Casos de morbidade materna grave, near miss materno e óbitos perinatais são indicadores importantes de saúde e compartilham dos mesmos determinantes sociais, tendo estreita relação com as condições de vida e qualidade da assistência perinatal. Este artigo pretende apresentar o protocolo de estudo que visa estimar a taxa de mortalidade perinatal e a incidência de morbidade materna grave e near miss materno no país, assim como identificar seus determinantes. Trata-se de estudo transversal integrado à pesquisa Nascer no Brasil II, realizada entre 2021 e 2023. Serão incluídas neste estudo 155 maternidades públicas, mistas e privadas, com mais de 2.750 partos por ano, participantes do Nascer no Brasil II. Nessas maternidades, será realizada coleta retrospectiva de dados de prontuário materno e neonatal de todas as internações ocorridas num período de 30 dias, com aplicação de uma ficha de triagem para identificação de casos de morbidade materna e de óbito perinatal. Dados de prontuário de todos os casos identificados serão coletados após a alta hospitalar, utilizando instrumento padronizado. Casos de morbidade materna grave e near miss materno serão classificados por meio da definição adotada pela Organização Mundial da Saúde. Será estimada a taxa de mortalidade perinatal e a incidência de morbidade materna grave e near miss materno. Os casos serão comparados a controles obtidos na pesquisa Nascer no Brasil II, pareados por hospital e duração da gestação, visando a identificação de fatores associados aos desfechos negativos. Espera-se que os resultados deste artigo contribuam para o conhecimento sobre a morbidade materna e a mortalidade perinatal no país, bem como para a elaboração de estratégias de melhoria do cuidado.
Resumen: Brasil tiene una alta morbimortalidad materna y perinatal. Los casos de morbilidad materna severa, maternal near miss y muertes perinatales son importantes indicadores de salud y comparten los mismos determinantes sociales, y tienen una estrecha relación con las condiciones de vida y la calidad de la asistencia perinatal. Este artículo pretende presentar el protocolo de estudio que tiene como objetivo estimar la tasa de mortalidad perinatal y la incidencia de morbilidad materna severa y maternal near miss en el país, así como identificar sus determinantes. Se trata de un estudio transversal integrado a la investigación Nacer en Brasil II, realizada entre el 2021 y el 2023. Este estudio incluirá 155 maternidades públicas, mixtas y privadas, con más de 2.750 partos al año, que participan en el Nacer en Brasil II. En estas maternidades, se realizará una recopilación retrospectiva de datos de las historias clínicas maternas y neonatales de todas las hospitalizaciones ocurridas en un período de 30 días, con la aplicación de un formulario de triaje para identificar casos de morbilidad materna y de muerte perinatal. Los datos de las historias clínicas de todos los casos identificados se recopilarán tras el alta hospitalaria, mediante un instrumento estandarizado. Los casos de morbilidad materna severa y maternal near miss se clasificarán por medio de la definición adoptada por la Organización Mundial de la Salud. Se estimará la tasa de mortalidad perinatal y la incidencia de morbilidad materna severa y maternal near miss. Los casos se compararán con los controles obtenidos en el estudio Nacer en Brasil II, emparejados por hospital y duración del embarazo, para identificar factores asociados con desenlaces negativos. Se espera que los resultados de este artículo contribuyan al conocimiento sobre la morbilidad materna y la mortalidad perinatal en el país, así como a la elaboración de estrategias para mejorar el cuidado.
Abstract: Brazil presents high maternal and perinatal morbidity and mortality. Cases of severe maternal morbidity, maternal near miss, and perinatal deaths are important health indicators and share the same determinants, being closely related to living conditions and quality of perinatal care. This article aims to present the study protocol to estimate the perinatal mortality rate and the incidence of severe maternal morbidity and maternal near miss in the country, identifying its determinants. Cross-sectional study integrated into the research Birth in Brazil II, conducted from 2021 to 2023. This study will include 155 public, mixed and private maternities, accounting for more than 2,750 births per year, participating in the Birth in Brazil II survey. We will collect retrospective data from maternal and neonatal records of all hospitalizations within a 30-day period in these maternities, applying a screening form to identify cases of maternal morbidity and perinatal deaths. Medical record data of all identified cases will be collected after hospital discharge, using a standardized instrument. Cases of severe maternal morbidity and maternal near miss will be classified based on the definition adopted by the World Health Organization. The perinatal deaths rate and the incidence of severe maternal morbidity and maternal near miss will be estimated. Cases will be compared to controls obtained in the Birth in Brazil II survey, matched by hospital and duration of pregnancy, in order to identify factors associated with negative outcomes. Results are expected to contribute to the knowledge on maternal morbidity and perinatal deaths in Brazil, as well as the development of strategies to improve care.
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RESUMEN La mortalidad perinatal es un indicador que refleja el impacto de la atención materno-infantil de un país. Este estudio presenta nueve casos de la mortalidad perinatal ocurridos en el municipio de Panchimalco, El Salvador. La información se obtuvo de los informes de auditorías. Las madres de los fallecidos tenían edades entre 17 a 43 años, sin uso de anticonceptivos, con controles prenatales incompletos y un promedio de edad gestacional de 31 semanas, tres partos fueron atendidos en la comunidad. La mayoría de muertes perinatales ocurrieron antes del parto de causa desconocida y los nacidos vivos fueron prematuros. Se identificaron factores como el déficit en la atención integral a la mujer. Se requiere de nuevos estudios para determinar los principales factores que influyen en las muertes perinatales en El Salvador.
ABSTRACT Perinatal mortality is an indicator that reflects the impact of maternal and infant care in a country. This study presents nine cases of perinatal mortality that occurred in the municipality of Panchimalco, El Salvador. The information was obtained from audit reports. The mothers of the deceased infants were aged between 17 and 43 years, did not use contraceptive methods, had incomplete prenatal controls and averaged a gestational age of 31 weeks. Three deliveries were attended in the community. Most perinatal deaths occurred before delivery due to unknown causes, and live births were preterm. We identified factors such as deficits in comprehensive care for women. Further studies are needed to determine the main factors influencing perinatal deaths in El Salvador.
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Humanos , Feminino , Gravidez , Morte FetalRESUMO
OBJECTIVES: Hypertensive disorders of pregnancy (HDP) exert a heavy mortality burden in low- to middle-income countries (LMIC). ACOG revised HDP diagnostic guidelines to improve identifying pregnancies at greatest risk but whether they are used in LMIC is unknown. STUDY DESIGN: We held a workshop to review ACOG guidelines in La Paz, Bolivia (BO) and then reviewed prenatal, labor and delivery records for all HDP diagnoses and twice as many controls at its three largest delivery sites during the year before and the nine months after a workshop (n = 1376 cases, 2851 controls during the two periods). MAIN OUTCOME MEASURES: HDP diagnoses, maternal, and infant characteristics. RESULTS: Bolivian and ACOG criteria identified similar frequencies of gestational hypertension (GH) or eclampsia, but preeclampsia with severe features (sPE) was under- and preeclampsia without severe features (PE) over-reported during both periods. Increases occurred after the workshop in testing for proteinuria and the detection of abnormal laboratory values and severe hypertension in HDP women. Any adverse maternal outcome occurred more frequently after the workshop in women with BO PE or sPE diagnoses who met ACOG sPE criteria. CONCLUSIONS: Utilization of ACOG guidelines increased following the workshop and improved identification of PE or sPE pregnancies with adverse maternal outcomes. Continued use of a CLAP perinatal form recognizing HELLP as the only kind of sPE resulted in under-reporting of sPE. FUNDING: NIH TW010797, HD088590, HL138181.
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Síndrome HELLP , Hipertensão Induzida pela Gravidez , Pré-Eclâmpsia , Gravidez , Feminino , Humanos , Pré-Eclâmpsia/diagnóstico , Bolívia , Países em DesenvolvimentoRESUMO
Introduction: perinatal mortality is characterized by fetal deaths that occur after the 22nd week of management and neonatal deaths that precede six full days of life. This indicator has been a matter of concern and discussion on the part of entities and organizations involved in comprehensive health care for women and children.Objective: to characterize perinatal deaths in the Metropolitan Region of Greater Vitória (RMGV) in Espírito Santo and identify associated maternal factors in the period between 2008 and 2017.Methods: ecological and descriptive study with a quantitative approach, carried out in 2019 on perinatal mortality from 2008 to 2017 at RMGV. Data collection was performed by extracting data from the SIM, SINASC, IBGE databases of the Espírito Santo State Health Department, about perinatal deaths and associated maternal factors. The research respects the ethical precepts of resolution 466/12 of the National Health Council.Results: the distribution of deaths did not occur homogeneously in the municipalities in the RMGV. The municipality of Vitória had the lowest perinatal mortality rates during the study period, on the other hand, in the comparative analysis between the different municipalities that make up the RMGV, the municipality of Fundão presents the worst scenario regarding perinatal mortality over the years. Regarding the underlying causes of death, it is noted that in this study, the three causes with the highest number of occurrences are complications of the placenta, umbilical cord and maternal affections, not necessarily related to the current pregnancy and intrauterine hypoxia.Conclusion: there were no significant changes in mortality rates in the Metropolitan Region of Greater Vitória. However, the main deaths occurred in neighborhoods with greater socioeconomic inequalities. Maternal causes were highly representative of deaths, raising issues associated with the improvement of public health policies.
Introdução: a mortalidade perinatal caracteriza-se pelos óbitos fetais que ocorrem a partir da 22ª semana de gestão e os óbitos neonatais que antecedem seis dias completos de vida. Este indicador tem sido motivo de preocupação e discussão por parte de entidades e organizações envolvidas na atenção à saúde integral da mulher e da criança. Objetivo: caracterizar os óbitos perinatais da Região Metropolitana da Grande Vitória (RMGV) no Espírito Santo e identificar fatores maternos associados, no período entre 2008 e 2017. Método: estudo ecológico e descritivo de abordagem quantitativa, realizado no ano de 2019 acerca da mortalidade perinatal entre os anos de 2008 a 2017 na RMGV. A coleta de dados foi realizada através extração dos dados das bases SIM, SINASC, IBGE da Secretaria de Saúde do Estado do Espírito Santo, acerca dos óbitos perinatais e fatores maternos associados. A pesquisa respeita os preceitos éticos da resolução 466/12 do Conselho Nacional de Saúde. Resultados: a distribuição dos óbitos não ocorreu de forma homogênea nos municípios na RMGV. O município de Vitória apresentou os menores índices de mortalidade perinatal durante o período estudado, em contrapartida, na análise comparativa entre os diferentes municípios que compõe a RMGV, o município de Fundão apresenta o pior cenário relativo à mortalidade perinatal ao longo dos anos. Acerca das causas bases de óbitos, nota-se que neste estudo, as três causas com maior número de ocorrência são complicações da placenta, do cordão umbilical e afecções maternas, não obrigatoriamente relacionadas com a gravidez atual e hipóxia intrauterina. Conclusão: não houve mudanças significativas nas taxas de mortalidade na Região Metropolitana da Grande Vitória. Contudo, os principais óbitos ocorreram em bairros com maiores desigualdades socieconomicas. As causas maternas representaram uma grande representatividade frente aos óbitos, levantando questões associadas a melhora de políticas públicas de saúde.
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RESEARCH QUESTION: What was the utilization, effectiveness and safety of assisted reproductive technology (ART) in Latin America during 2020? DESIGN: Retrospective collection of multinational data on ART performed by 188 institutions in 16 countries. RESULTS: Overall, 87,732 initiated cycles resulted in 12,778 deliveries and 14,582 births. The major contributors were Brazil (46.0%), Mexico (17.0%) and Argentina (16.8%). However, the highest utilization (cycles/million inhabitants) was Uruguay with 558, followed by Argentina with 490 and Panama with 425 cycles/million. Globally, women aged ≥40 years increased to 34% while women ≤34 dropped to 24.7%. After removing freeze-all cycles, the delivery rate per oocyte retrieval was 14.8% for intracytoplasmic sperm injection and 15.6% for IVF. Single-embryo transfer (SET) represented 38.3% of all fresh transfers, with delivery rate per transfer of 20.0%; this increased to 32.4% for elective SET (eSET) and 34.2% for blastocyst eSET, compared with blastocyst elective double embryo transfer (eDET) of 37.9%. However, multiple births increased from 1% in eSET to 30.5% in eDET. Perinatal mortality increased from 7.7 in singletons to 24.4 in twins and 64.0 in triplets. Frozen embryo transfer (FET) represented 66.6% of all transfers, with a delivery rate/transfer of 29.0%, significantly higher than 23.9% after fresh transfers at all ages (p<0.0001). Preimplantation genetic testing, reported in 8920 cycles, significantly improved delivery rate and decreased miscarriage rates at all ages (p≤0.041), including oocyte donation (p=0.002). Endometriosis was diagnosed in 28.3% of cases. The delivery rate in 5779 women after removal of peritoneal endometriosis was significantly better than tubal and endocrine factors in women aged 35-39 (p=0.0004) and women aged ≥40 (p=0.0353). CONCLUSIONS: Systematic collection and analysis of big data in a south-south cooperation model allow regional growth by implementing evidence-based reproductive decisions.
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Endometriose , Resultado da Gravidez , Gravidez , Masculino , Humanos , Feminino , Resultado da Gravidez/epidemiologia , América Latina/epidemiologia , Estudos Retrospectivos , Sêmen , Técnicas de Reprodução Assistida , Sistema de RegistrosRESUMO
La edad materna avanzada guarda relación directamente proporcional con el riesgo de complicaciones obstétricas y no obstétricas durante la gestación, tanto para la gestante como para el feto. Esto es particularmente importante debido a que a las tasas de fecundidad de las mujeres de mayor edad han aumentado. En Estados Unidos, el 10% del primer nacimiento y el 20% de todos los nacimientos ocurren en mujeres con 35 años o más. Históricamente la edad materna avanzada se ha definido como una edad mayor o igual a 35 años, punto de corte que sustentado en la disminución de la fecundidad y el mayor riesgo de anomalías genéticas en la descendencia de las mujeres mayores a esta edad. Sin embargo, los efectos relacionados al aumento de edad son continuos y el riesgo es mayor mientras mayor sea la edad al momento de la concepción más que como efecto de pasar el umbral de los 35 años. Diferentes investigaciones han mostrado que las gestantes añosas tienen mayor riesgo de complicaciones tempranas de la gestación como aborto espontáneo, embarazo ectópico, anomalías cromosómicas y malformaciones congénitas, así como, preeclampsia, diabetes gestacional, patología placentaria, parto pretérmino, peso bajo al nacer, mortalidad perinatal, embarazo múltiple, parto distócico, parto por cesárea y mortalidad materna. En este artículo se revisa publicaciones recientes sobre el tema y se incluye estadística de un importante hospital de Lima, Perú, y de la Encuesta Nacional de Demografía y Salud Familiar - ENDES 2022.
Advanced maternal age is directly proportional to the risk of obstetric and nonobstetric complications during gestation, both for the pregnant woman and the fetus. This is particularly important because the fertility rates of older women have increased. In the US, 10% of first births and 20% of all births occur to women 35 years of age or older. Historically, advanced maternal age has been defined as an age greater than or equal to 35 years, a cutoff point that is supported by declining fertility and the increased risk of genetic abnormalities in the offspring of women older than this age. However, the effects related to increasing age are continuous and the risk is greater the older the age at conception rather than as an effect of passing the 35 years threshold. Research has shown that older pregnant women are at increased risk of early pregnancy complications such as miscarriage, ectopic pregnancy, chromosomal abnormalities and congenital malformations, as well as, preeclampsia, gestational diabetes, placental pathology, preterm delivery, low birth weight, perinatal mortality, multiple pregnancy, dystocic delivery, cesarean delivery and maternal mortality. This article reviews recent publications on the subject and includes statistics from a major hospital in Lima, Peru, and from the National Demographic and Family Health Survey - ENDES, 2022.
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Introducción: La muerte fetal es uno de los accidentes obstétricos más difíciles de enfrentar, tanto para la paciente y su familia como para el personal de salud que atiende a la gestante. Objetivo: Identificar los factores de riesgo maternos asociados con la muerte fetal tardía en el contexto santaclareño. Métodos: Se realizó un estudio descriptivo, longitudinal y retrospectivo en el municipio Santa Clara, provincia Villa Clara, en el período comprendido de enero de 2015 a diciembre de 2019. La población estuvo conformada por 71 gestantes con fetos muertos en una etapa tardía y sus productos; en el análisis y procesamiento de los datos, se usó el software SPSS versión 20 para Windows. Resultados: Existió predominio de gestantes multíparas (56,3 %), en edad reproductiva óptima (69 %) y con uno a tres factores de riesgo (71,8 %). Conclusiones: Los factores maternos asociados con mayor frecuencia a la muerte fetal tardía pueden agruparse en: los vinculados a las enfermedades crónicas, en primer lugar la hipertensión arterial y en segundo el hipotiroidismo, y los relacionados con las afecciones del tracto genital, entre las que prevalece la vaginitis.
Introduction: fetal death is one of the most difficult obstetric accidents to face, both for patients and their families as well as for the health personnel who take care of the pregnant women. Objective: to identify the maternal risk factors associated with late fetal death in the Santa Clara context. Methods: a descriptive, longitudinal and retrospective study was carried out in Santa Clara municipality, Villa Clara province, from January 2015 to December 2019. The population consisted of 71 pregnant women with late fetal demise and their products; the SPSS software version 20.0 for Windows was used in the data processing and analysis. Results: multiparous pregnant women predominated (56.3%), in optimal reproductive age (69%) and from one to three risk factors (71.8%). Conclusions: the most frequently maternal factors associated with late fetal death can be grouped into those that were linked to chronic diseases, firstly arterial hypertension and secondly hypothyroidism, and those related to disorders of the genital tract, among which vaginitis prevails.
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Natimorto , Mortalidade Perinatal , Morte FetalRESUMO
OBJECTIVE: The multiple effects of the COVID-19 pandemic are beginning to be seen from the alteration of vital statistics figures. This is summarized in changes in the usual causes of death and excess attributable mortality, which can finally be seen in structural changes in the populations of the countries. For this reason, this research was created with the objective of determining the impact of the COVID-19 pandemic on maternal, perinatal and neonatal mortality in four locations in Bogotá D.C. (Colombia). METHODS: A retrospective longitudinal investigation was carried out in which 217,419 mortality data were analyzed in the towns of Kennedy, Fontibón, Bosa and Puente Aranda in the city of Bogotá - Colombia that occurred between the years 2018 to 2021, of which maternal (54), perinatal (1,370) and neonatal (483) deaths in order to identify a history of SARS-CoV-2 infection that could be related to the excess mortality associated with COVID-19. The data were collected from the open records of vital statistics of the National Statistics Department (DANE), where they were analyzed from frequency measures or central tendency and dispersion according to the types of variables. The specific mortality indicators related to maternal, perinatal and neonatal death events were calculated. RESULTS: A decrease in perinatal and neonatal mortality was evidenced since 2020, which was associated with the progressive decrease in pregnancies in those same years; Additionally, a considerable increase in maternal deaths was observed for 2021 compared to the other years analyzed. The proportion of maternal deaths in 2020 and 2021 by 10% and 17%, respectively, were attributed to COVID-19. CONCLUSIONS: It is observed that the trend of maternal mortality is related to the increase in mortality from COVID-19, maternal deaths associated with COVID-19 occurred specifically in the zonal planning units that registered more than 160 cases of COVID-19 for the year 2021.
OBJETIVO: Los múltiples efectos de la pandemia por la COVID-19 se empiezan a ver a partir de la alteración de las cifras de estadísticas vitales. Esto se resume en cambios en las causas de muertes habituales y el exceso de mortalidad atribuible, lo que finalmente se puede ver en modificaciones estructurales de las poblaciones de los países. Por esta razón se crea esta investigación que tuvo como objetivo determinar el impacto de la pandemia de COVID-19 sobre la mortalidad materna, perinatal y neonatal en cuatro localidades de Bogotá D.C. (Colombia). METODOS: Se realizó una investigación de tipo longitudinal retrospectiva en el que se analizaron 217.419 datos de mortalidades las localidades de Kennedy, Fontibón, Bosa y Puente Aranda de la ciudad de Bogotá - Colombia ocurridas entre los años 2018 a 2021, de los cuales se determinaron las muertes maternas (54), perinatales (1.370) y neonatales (483) a fin de identificar antecedente de infección por SARS-CoV-2 que pudiera estar relacionada con el exceso de mortalidad asociada a la COVID-19. Los datos fueron recopilados de los registros abiertos de estadísticas vitales del Departamento Nacional de Estadística (DANE), en donde fueron analizados a partir de medidas de frecuencias o tendencia central y dispersión de acuerdo con los tipos de variables. Se calcularon los indicadores de mortalidad específicos relacionados con los eventos de muerte materna, perinatal y neonatal. RESULTADOS: Se evidenció una disminución en la mortalidad perinatal y neonatal desde el año 2020, la cual estuvo asociada a la disminución progresiva de embarazos en esos mismos años; de forma adicional se observó un aumento considerable de las muertes maternas para 2021 con respecto a los demás años analizados. La proporción de las muertes maternas en 2020 y 2021 en un 10% y 17%, respectivamente, se atribuyeron a la COVID-19. CONCLUSIONES: Se observa que la tendencia de la mortalidad materna está relacionada con el aumento de la mortalidad por la COVID-19, las muertes maternas asociadas a COVID-19 se presentaron específicamente en las unidades de planeación zonal que registraron más de 160 casos de COVID-19 para el año 2021.
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COVID-19 , Morte Materna , Gravidez , Recém-Nascido , Feminino , Humanos , Pandemias , Colômbia/epidemiologia , Estudos Retrospectivos , SARS-CoV-2 , Espanha , Mortalidade InfantilRESUMO
Objetivo: identificar desigualdades en salud asociadas a la mortalidad perinatal durante el Plan Decenal de Salud Pública 2012-2021 en los 42 municipios del Departamento de Cauca Colombia. Métodos: estudio ecológico que abordó el periodo 2012-2021 a partir de datos de fuentes secundarias procedentes del Departamento Administrativo Nacional de Estadística. La población de estudio fueron mujeres entre los 12 y 49 años residentes en Cauca. Se calcularon desigualdades por rangos y modelos de regresión de acuerdo con el Índice de Desigualdad de la Pendiente, el Índice de Desigualdad Relativa y el Índice de Concentración. Resultados: 42 municipios reportaron 3 110 muertes perinatales. La edad media de las mujeres afectadas fue de 25,3 años con predominio del grupo de 20 a 24 años. La región Pacifico reportó la mayor tasa de mortalidad. La pertenencia étnica, el analfabetismo y el Índice de Pobreza Multidimensional, se asociaron estadísticamente con la mortalidad. Se observó una desigualdad más pronunciada en la tasa de mortalidad perinatal en los municipios con condiciones socioeconómicas más desfavorables. Conclusiones: a pesar de la operacionalización del Plan Decenal de Salud Pública, la mortalidad perinatal en el Cauca continúa siendo un reto en el proceso salud/enfermedad. Existe disparidad en la mortalidad perinatal en relación con el nivel socioeconómico; aunque se ha observado disminución en la desigualdad en el transcurso de los años, aún persisten brechas significativas. Los hallazgos subrayan la necesidad de monitorear y dar cuenta de las desigualdades en salud al diseñar, implementar y evaluar las políticas públicas de prevención de la mortalidad perinatal.
Objective: to identify health inequalities associated with perinatal mortality during the Ten-Year Public Health Plan 2012-2021 in the 42 municipalities of the Department of Cauca, Colombia. Methods: ecological study that addressed the period 2012 - 2021 based on data from secondary sources from the National Administrative Department of Statistics. The study population was women between 12 and 49 years of age residing in Cauca. Rank inequalities and regression models were calculated according to the Slope Inequality Index, the Relative Inequality Index and the Concentration Index. Results: 42 municipalities reported 3 110 perinatal deaths. The mean age of the affected women was 25,3 years with a predominance of the 20-24 years age group. The Pacific region reported the highest mortality rate. Ethnicity, illiteracy and the Multidimensional Poverty Index were statistically associated with mortality. There was greater inequality in perinatal mortality in municipalities with worse socioeconomic status. Conclusions: despite the operationalization of the Ten-Year Public Health Plan, perinatal mortality in Cauca continues to be a challenge in the health/disease process. There is disparity in perinatal mortality in relation to socioeconomic level, and although a decrease in inequality has been observed over the years, significant gaps still persist. The findings underscore the need to monitor and account for health inequalities in the design, implementation and evaluation of public policies to prevent perinatal mortality.
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Resumen ANTECEDENTES: La coexistencia de hiperglucemia y embarazo se asocia con morbilidad, mortalidad y riesgo cardiometabólico para la madre y su hijo. En el año 2010, la International Association of the Diabetes and Pregnancy Study Groups (IADPSG) estableció una clasificación, aceptada por la Organización Mundial de la Salud (OMS) y la International Federation of Gynecologt and Obstetrics (FIGO) en el 2013, en la que se consideran las semanas de gestación al diagnóstico de hiperglucemia y las concentraciones séricas de glucosa en diferentes escenarios. OBJETIVO: Actualizar los escenarios de clasificación de la hiperglucemia en la embarazada y documentar, de acuerdo con lo soportado en la evidencia, su repercusión clínica. METODOLOGÍA: Búsqueda bibliográfica en las bases de datos PubMed, Google Académico y Clinicalkey de artículos publicados entre los años 2008 a 2022, que contuvieran las palabras clave (MESH): "gestational diabetes" e "hyperglycemia in pregnancy" que posteriormente se filtraron conforme a su contenido específico definido en los criterios de inclusión (estudios epidemiológicos, de diagnóstico y clasificación de la hiperglucemia en el embarazo y de desenlaces maternos y perinatales en coexistencia con hiperglucemia en el embarazo). RESULTADOS: Se identificaron 25,886 artículos, de los que solo 24 cumplieron con los criterios de inclusión (8 observacionales descriptivos, 2 de revisión sistemática y metanálisis, 13 revisiones de la bibliografía y consensos globales, y 1 ensayo clínico aleatorizado). CONCLUSIÓN: Clasificar a la hiperglucemia en diferentes escenarios clínicos es importante para su debido diagnóstico, orientación clínica, estudios adicionales y tratamiento temprano.
Abstract BACKGROUND: Hyperglycemia in pregnancy is associated with perinatal maternal morbidity and mortality and cardiometabolic risk for the mother and her offspring. In 2010, the International Diabetes and Pregnancy Study Group (IADPSG) established a classification, accepted by the World Health Organization (WHO) and the International Federation of Gynecology and Obstetrics (FIGO) in 2013, considering gestational age. diagnosis and serum glucose levels to be classified in different scenarios. OBJECTIVE: To update the classification scenarios of hyperglycemia in pregnant women and to document, in accordance with what is supported by the evidence, its clinical impact. MATERIALS AND METHODS: The PubMed, Google Scholar, and Clinicalkey databases were searched with the MESH terms ("gestational diabetes," "hyperglycemia in pregnancy"), subsequently filtered according to specific content, defined in the inclusion criteria (studies on epidemiology, diagnosis and classification of hyperglycemia in pregnancy and studies on maternal and perinatal outcomes in hyperglycemia in pregnancy) all articles published between 2008 and 2022. RESULTS: 25,886 articles were identified, 24 of these met the inclusion criteria; eight were descriptive observational, two systematic reviews and meta-analyses, thirteen reviews of the literature and global consensus, and one randomized clinical trial. CONCLUSION: Classifying hyperglycemia within the different clinical scenarios is important for its approach, clinical orientation, additional studies if required, and early management interventions.
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SUMMARY OBJECTIVE: This study aimed to assess adverse maternal and perinatal outcomes in parturients undergoing labor analgesia. METHODS: This was a retrospective cohort study in parturients who underwent labor analgesia. Parturients were categorized into three groups: Group 1 (n=83)—analgesia performed with cervical dilatation ≤4.0 cm; Group 2 (n=82)—analgesia performed with cervical dilatation between 5.0 and 8.0 cm; and Group 3 (n=83)—analgesia performed with cervical dilatation ≥9.0 cm. RESULTS: Analgesia in parturients with cervical dilatation ≥9.0 cm showed a higher prevalence and a 3.86-fold increase (OR 3.86; 95%CI 1.50-9.87; p=0.009) in the risk of forceps delivery. Analgesia in parturients with cervical dilatation ≤4.0 cm showed a higher prevalence and a 3.31-fold increase (OR 3.31; 95%CI 1.62-6.77; p=0.0016) in the risk of cesarean section. Analgesia in parturients with cervical dilatation ≥9.0 cm was associated with a higher prevalence of fetal bradycardia (20.7%), a need for neonatal oxygen therapy (6.1%), and a need for admission to a neonatal intensive care unit (4.9%). Analgesia in parturients with cervical dilatation ≤4 cm was associated with a higher prevalence of Apgar score <7 at 1st minute (44.6%). CONCLUSION: Performing labor analgesia in parturients with cervical dilatation ≤4.0 or ≥9.0 cm was associated with a higher prevalence of adverse maternal and perinatal outcomes.
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Antecedentes: En Chile, la mitad de los casos de mortalidad perinatal son atribuibles a anomalías congénitas, y un tercio de estas corresponde a cardiopatías congénitas. Aproximadamente un 35% de estos últimos requerirán cirugía antes del año de vida, por lo que la pesquisa prenatal impacta profundamente en el pronóstico. Objetivo: Dar a conocer los resultados perinatales de pacientes con diagnóstico prenatal de canal atrio-ventricular controlados en el Centro de Referencia Perinatal Oriente (CERPO) entre los años 2003 y 2021, su asociación a otras anomalías, características demográficas y pronóstico a un año. Métodos: En este estudio se puede apreciar que tanto el pronóstico como el plan terapéutico posnatal dependerán de la presencia de otras alteraciones morfológicas y del estudio genético. De los factores estudiados, se puede concluir que tanto la presencia de anomalías cardiacas asociadas, como el grado de insuficiencia valvular y el tipo de canal no son predictores de la sobrevida perinatal. Conclusiones: Finalmente, en relación con la sobrevida posnatal, en este estudio, la sobrevida a un año de los recién nacidos vivos fue de un 52%, pero al desglosarlo en los niños con cariotipo euploide y trisomía 21, estos valores se tornan muy distintos, 44 y 81% respectivamente.
Background: In Chile, half of the perinatal mortality cases are attributable to congenital anomalies, and one third of these correspond to congenital heart disease. Approximately 35% of the later will require surgery before one year of life, so prenatal screening has a profound impact on the prognosis. Objective: To present the perinatal results of patients with a prenatal diagnosis of atrio-ventricular canal controlled at Centro de Referencia Perinatal Oriente CERPO) between 2003 and 2021, its association with other anomalies, demographic characteristics, and 1-year prognosis. Methods: In this study it can be seen that both the prognosis and the postnatal therapeutic plan will depend on the presence of other morphological alterations and the genetic study. From the factors studied, it can be concluded that the presence of associated cardiac anomalies, the degree of valvular insufficiency, and the type of canal are not predictors of perinatal survival. Conclusions: Finally, in relation to postnatal survival, in this study, the 1-year survival of live newborns was 52%, but when broken down into children with euploid karyotype and trisomy 21, these values become very different, 44 and 81% respectively.
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Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Adulto , Comunicação Atrioventricular/diagnóstico , Comunicação Atrioventricular/mortalidade , Diagnóstico Pré-Natal , Resultado da Gravidez , Análise de Sobrevida , Chile/epidemiologia , Estudos Retrospectivos , Mortalidade Perinatal , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/mortalidadeRESUMO
SUMMARY OBJECTIVE: This study aimed to assess the perinatal outcomes of pregnancies with a prenatal diagnosis of congenital cystic adenomatoid malformation. METHODS: We conducted a retrospective cohort study based on information contained in the medical records of pregnant women whose fetuses had been prenatally diagnosed with congenital cystic adenomatoid malformation by ultrasonography. RESULTS: Sample analysis was based on 21 singleton pregnancies with confirmed isolated fetal congenital cystic adenomatoid malformations. The mean maternal±standard deviation age was 28±7.7 years. Types I, II, and III congenital cystic adenomatoid malformation were detected in 19% (4/21), 52.4% (11/21), and 28.6% (6/21), respectively. All fetuses presented with unilateral congenital cystic adenomatoid malformation (21/21) without associated anomalies, and 52.3% (11/21) were in the right lung. In total, 33.3% (7/21) of fetuses presented a "congenital cystic adenomatoid malformation volume ratio" >1.6 and were managed with maternal betamethasone administration. The mean gestational age at the time of steroid administration was 28.5±0.9 weeks, with a reduction in the lesion dimensions of 9.5% (2/21) (Types I and III of congenital cystic adenomatoid malformation). The mean gestational age at delivery was 38.7±2.4 weeks, and a cesarean section was performed in 76.2% (16/21) cases. Postsurgical resection was necessary for 23.8% (5/21) of the patients, and 4.7% (1/21) of them died because of respiratory complications after surgery. Pulmonary hypoplasia occurred in 9.5% (2/21) of the patients, and 4.7% (1/21) of them died because of respiratory insufficiency. The survival rate was 90.5% (19/21), and 57.2% (12/21) remained asymptomatic. CONCLUSION: Despite the isolated prenatal diagnosis of congenital cystic adenomatoid malformation, which showed good survival, congenital cystic adenomatoid malformation is associated with significant perinatal morbidity. Maternal betamethasone administration did not significantly reduce fetal lung lesion dimensions.
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INTRODUCTION: Placental alterations caused by severe acute respiratory coronavirus-2 (SARS-CoV-2) infection have already been described, but most studies used small sample groups and the difference according to the severity of the disease has not been verified. Our objective was to describe placental alterations in patients with coronavirus disease 2019 (COVID-19) and analyze the association of pathological placental findings with the clinical parameters of COVID-19 and perinatal results. METHODS: This was a nested study within a prospective cohort study involving 109 symptomatic pregnant women with COVID-19. The prevalence of observed placental alterations was described, and the associations of pathological findings with the clinical parameters of COVID-19 severity and with perinatal outcomes were assessed. RESULTS: The frequency of types of placental features was poor maternal vascular perfusion in 45% of cases, poor fetal vascular perfusion in 33.9%, hematogenous origin infection in 32.1%, and morphological changes corresponding to ascending infection in 21.1%. Hematogenous infection differed significantly according to COVID-19 severity (p = 0.008), with a prevalence ratio (PR) of 1.74 (95% confidence interval, 1.02-2.98) in the moderate COVID-19 group compared to the mild COVID-19 group. Among the perinatal outcomes, there was an unexpected inverse association between prematurity and placental infection of hematogenous origin, with lower rates of prematurity among cases with inflammation of hematogenous origin (p = 0.029). DISCUSSION: Moderate SARS-Cov-2 infection presented a higher prevalence of placental pathological findings. There was no association of placental findings with adverse perinatal outcomes.