A decade of analysis describe of maternal and neonatal characteristics of live births in southern Brazil / Una década de descripción de las características maternas y neonatales de los nacidos vivos en el sur de Brasil

Introduction: Child health is conditioned by the circumstances of pregnancy, childbirth, and early life. Objective: To describe the maternal and neonatal characteristics of live births (LBs) in the Information System on Live Births of Santa Catarina (SC), Brazil. Materials and methods: A cross-sectional study describedthe maternal and neonatal characteristics of 940,059 LBs, from 2010 to 2019. Pearson's chi-square test and Fisher's exact test were conducted, with a statistical significance level of p < 0.05. Results: The mean values of maternal age, number of live children, and number of fetal deaths as well as abortions were 27.1 years, 0.9, and 0.2, respectively. The averages of the number of gestation weeks, number of prenatal consultations, the start date of the prenatal care, and birth weight were 38.5 weeks, 8.1 months, 2.5 monthsand 3,217.1 grams, respectively. Low birth weight (LBW) was prevalent among mothers without education (p < 0.001), including those without prenatal visits (p < 0.001). A higher prevalence of being underweight was observed among female neonates (p < 0.001) and with a maternal age of ≥ 40 years (10.8%; p < 0.001) compared to newborns with good vitality. Newborns with good vitality had a low prevalence of underweight (p < 0.001). The frequency of the variables studied increased, comparing the beginning and end of the period and whether the differences are statistically significant. Conclusions: The study draws attention to the need for interventions to improve the indicators that determine LBW(AU)

Introducción: La salud infantil está condicionada por las circunstancias del embarazo, parto y primeras etapas de la vida. Objetivo: Describir las características maternas y neonatales de los nacidos vivos en el Sistema de Información de Nacidos Vivos de Santa Catarina, Brasil. Materiales y métodos: Estudio transversal describiendo las características maternas y neonatales de 940.059 nacidos vivos entre 2010 y 2019. Se realizó la prueba de chi cuadrado de Pearson y exacta de Fisher y se estableció p < 0,05. Resultados: Los valores medios para la edad materna, el número de nacidos vivos y el número de mortinatos y abortos espontáneos fueron 27,1, 0,9 y 0,2, respectivamente. Las medias del número de semanas de gestación, el número de visitas prenatales, la fecha de inicio de la atención prenatal y el peso al nacer fueron 38,5 semanas (DE 2,2), 8,1 meses, 2,5 meses y 3 217,1 gramos, respectivamente. El bajo peso al nacer (BPN) fue prevalente entre las madres sin estudios (p < 0,001), incluidas las que no acudieron a una cita prenatal (p < 0,001). Hubo una mayor prevalencia de BPN en neonatos de sexo femenino (p < 0,001) con madres de edad ≥ 40 años (10,8%; p < 0,001). Los neonatos con buena vitalidad tuvieron una baja prevalencia de BPN (p < 0,001). La frecuencia de las variables estudiadas aumentó al comparar el inicio y el final del período y si las diferencias son estadísticamente significativas. Conclusiones: El estudio llama la atención sobre la necesidad de intervenciones para mejorar los indicadores que determinan el BPN(AU)

Two livebirths achieved in cases of hypergonadotropic hypogonadism nonobstructive azoospermia, treated with GnRH agonist and gonadotrophins: a case series and review of the literature.

Non-obstructive azoospermia (NOA) is the most severe form of male factor infertility. It results form from either primary or secondary testicular failure. Here, we report cases of two patients with NOA due to maturation arrest and increased serum FSH, treated with GnRH agonist and gonadotrophins. The two NOA patients underwent a pharmacological treatment consisting of pituitary desensibilization using a GnRH agonist and testicular stimulation using menotropin. Testicular stimulation started one month after the beginning of GnRH agonist treatment. The female partner underwent controlled ovarian stimulation (COS) followed by intracytoplasmic sperm injection (ICSI). On the third day of the cycle, menotropin daily doses was administered. When at least one follicle ≥14 mm was visualized, pituitary blockage was performed using GnRH antagonist ganirelix. When three or more follicles attained a mean diameter of ≥17 mm, triptorelin acetate was administered to trigger final follicular maturation. Oocyte retrieval was performed 35 hours later. After treatment, male partner blood levels of the FSH, LH, decreased and total testosterone were increased. Spermatozoa was observed after semen collection in both cases. After COS, oocytes were retrieved and ICSI was performed. Embryos were biopsied for preimplantation genetic testing (PGT) and those considered euploidy were transferred resulting in positive implantation, ongoing pregnancy, and livebirth on both cases. In this report we present a successful strategy for hypergonadotropic hypogonadism AOA men, as an alternative approach to the surgical testicular sperm recovery. Nevertheless, prospective randomized trials are needed to confirm our findings.

Double vitrification of embryos adversely affects clinical outcomes.

OBJECTIVE: To evaluate the impact of double embryo vitrification on clinical outcomes. METHODS: This retrospective cohort study included data from January 2013 to March 2021. The study group included women aged 33.3±5.7 years with double-vitrified embryos (n=381), while the control group included women aged 32.1±6.7 years with embryos vitrified once (n=780), all transferred at the blastocyst stage. The primary endpoint was live birth rate (LBR), and secondary endpoints included percent positive ßHCG test, clinical/ongoing pregnancy rates, miscarriage/biochemical pregnancy rates and birthweight. RESULTS: LBR was significantly lower in double-vitrified embryos (30.2%) than in embryos vitrified once (45.6%, p<.05). Similarly, double-vitrified embryos were associated with significantly lower positive ßHCG tests (46% vs. 63.3%, p<.05) and clinical (34.9% vs. 52.2%, p<.05) and ongoing pregnancy (31.3% vs. 47.3%, p<.05) rates compared to embryos vitrified once. However, biochemical pregnancy (double vitrified: 24.1% vs. vitrified once: 17.9%, p>.05) and miscarriage rates (double vitrified: 10.2% vs. vitrified once: 9.4%, p>.05), as well as mean birthweight (double-vitrified embryos: 2950g vs. embryos vitrified once: 2837g, p>.05) did not differ significantly between two groups. On a secondary comparison, amongst double-vitrified embryos, the subgroup that was cultured for more than 24 hours between warming and second vitrification achieved significantly higher positive ßHCG tests (49%) and clinical pregnancy (38%) rates, compared to embryos re-vitrified on the same day of warming (31.8% and 20.5%, respectively, p<.05). Nevertheless, LBR did not differ significantly amongst these study-group embryos (embryos that remained in culture for more than 24 hours: 32.2% vs. embryos that were re-vitrified on warming day: 20.5%, p>.05). CONCLUSIONS: Double vitrification of embryos adversely affects clinical outcomes. However, it represents a valuable option concerning embryo wastage, with acceptable success rates.

Spatial patterns of prematurity and its determinants in the metropolitan region of São Paulo, Brazil, 2010-2019.

OBJECTIVE: To analyze spatial distribution of preterm births and their association with maternal, social, and health services indicators in the metropolitan region of São Paulo, Brazil, 2010-2019. METHODS: Ecological study using data on preterm newborns from 39 municipalities in the metropolitan region of São Paulo. Univariate global Moran's index (Im) was used to evaluate spatial association of prematurity, and univariate local Moran's index by using the cluster map (LISA) to identify spatial patterns and clusters. Bivariate global Moran's index was also used to analyze spatial autocorrelation with maternal, social, and health services indicators. RESULTS: A total of 3,103,898 live births were registered in period 2010-2019, of which 331,174 (10.7%) were preterm. The global Moran's index showed spatial independence (Im=0.05; p-value=0.233) of the proportion of preterm births between municipalities. However, in the local spatial analysis it was possible to identify a statistically significant spatial cluster between the municipalities of Biritiba Mirim, Guararema and Salesópolis, with high proportions of preterm births. In the bivariate analysis, a significant positive spatial association was identified with proportions of mothers under 20 years old (Im=0.17; p-value=0.024) and mothers with low schooling (Im=0.17; p-value=0.020), and a significant negative spatial association with HDI (Im=-0.14; p-value=0.039). CONCLUSIONS: The local spatial approach identified a spatial cluster located in the far east of the metropolitan region of São Paulo, where actions by health managers are needed to minimize occurrence of preterm births.

Trend of incompleteness of the Robson Classification variables in the Live Birth Information (SINASC) in the state of Paraná, Brazil, 2014-2020.

OBJECTIVE: To assess the incompleteness of the Robson Classification variables in the Live Birth Information System (Sistema de Informação sobre Nascidos Vivos - SINASC), in the state of Paraná, and its trend, 2014-2020. METHODS: This was a time-series study that analyzed six variables, according to health macro-regions. Incompleteness was classified (percentage of "ignored" and "blank fields") as follows: excellent (< 1.0%); good (1.0-2.9%); regular (3.0-6.9%); poor (≥ 7.0%). Prais-Winsten regression was used to estimate trends. RESULTS: A total of 1,089,116 births were evaluated. The variable "cesarean section before the onset of labor" was classified as poor in 2014 (39.4%) and 2015 (44.3%) in the state and in all macro-regions, but with a decreasing trend in incompleteness. The variables "gestational age" in the North and Northwest macro-regions, and "parity" and "number of fetuses" in the Northwest macro-region showed an increasing trend. CONCLUSION: Most of the variables evaluated showed low percentages of incompleteness with a decreasing trend, but there is a need to improve the completion of some variables.

Basal characteristics of patients who responded to Ovarian Fragmentation for Follicular Activation (OFFA) or In Vitro Activation (IVA): a systematic review and meta-analysis.

A systematic review and meta-analysis were performed to identify if there is a subset of patients with POI who are more likely to show follicular growth after ovarian fragmentation for follicular activation (OFFA) or in vitro activation (IVA). Five studies met inclusion criteria for meta-analysis with a total of 164 patients. Forty-three patients showed follicle development (26.21%). Of those, the pregnancy rate was 35.58% (11/43) and the live birth rate was 20.93% (9/43). Our meta-analysis showed that age was not associated with follicle growth. However, lower baseline FSH, lower duration of amenorrhea/diagnosis, and presence of follicles remaining in biopsy were statistically significant for follicle development. Patients with basal characteristics mentioned before may have more chances to show follicle growth after OFFA or IVA. Taking into account that approximately 20% of patients with follicle growth had live birth, these results are very promising. Given the overall certainty of evidence, future studies are needed to confirm said results.

Avoidability and temporal trend of neonatal mortality in Niteroi/RJ, 2012 to 2022 / Evitabilidade e tendência temporal da mortalidade neonatal em Niterói/RJ, 2012 a 2022

Abstract Objectives: to analyze neonatal deaths according to avoidability and to analyze the temporal trend of neonatal mortality rate (NMR) in Niterói/RJ, 2012-2022. Methods: ecological time series study. Data from Sistema de Informação sobre Nascidos Vivos and Sistema de Informação sobre Mortalidade. NMRs were calculated according to maternal and neonatal variables and trends were estimated using the joinpoint regression. Results: the annual number of live births (LB) fell, with a decreasing trend among adolescents and those with low education level. Of the 324 deaths, most occurred early (0-6 days), by preventable causes in 68.6%, predominating those reducible by adequate care during pregnancy. The overall NMR remained stable, ranging from 4.2 to 6/1,000 LB, being higher at the extremes of maternal age (12.7 and 8.6/1,000 LB in 2022, adolescents and over 35 years old, respectively), in low education level mothers (27.6/1,000 LB in 2022), in neonates <1,500g and <32 weeks (293.1 and 250/1,000 LB in 2022, respectively). NMR trend was upward in low schooling women, white-colored, adolescents and those ≥35 years, in babies weighing <1,500g and >2,500g, and for avoidable causes. Conclusions: the high proportion of preventable causes reveals the reduction potential. There was inequality in NMR and its trend, demanding more equitable health actions.

Resumo Objetivos: analisar os óbitos neonatais segundo evitabilidade e a tendência temporal da taxa de mortalidade neonatal (TMN) em Niterói/RJ, de 2012-2022. Métodos: estudo ecológico de série temporal. Dados provenientes do Sistema de Informações sobre Nascidos Vivos e Sistema de Informação sobre Mortalidade. As TMN foram calculadas segundo variáveis maternas e neonatais e as tendências estimadas pela regressão joinpoint. Resultados: o número anual de nascidos vivos (NV) diminuiu, com tendência decrescente entre mães adolescentes e de baixa escolaridade. Dos 324 óbitos, a maioria ocorreu precocemente, por causas evitáveis (68,6%), predominando aquelas reduzíveis por adequada atenção à gestação. A TMN global mostrou estabilidade, entre 4,2 e 6,0/1000NV, mais elevada nos extremos etários maternos (12,7 e 8,6/1.000 NV em 2022, adolescentes e maiores de 35 anos, respectivamente), nas mães com baixa escolaridade (27,6/1.000 NV em 2022), nos neonatos <1.500g e <32 semanas (293,1 e 250/1.000 NV em 2022, respectivamente). A tendência da TMN foi crescente entre mulheres de baixa escolaridade, brancas, adolescentes e ≥35 anos, nas faixas de peso <1.500g e >2.500g, e por causas evitáveis. Conclusões: a elevada proporção de causas evitáveis revela o potencial de redução. Houve desigualdade da TMN e sua tendência, demandando ações de saúde mais equânimes.

Epidemiological trends of isolated and non-isolated central nervous system congenital malformations in live births in a middle-income setting.

OBJECTIVES: This study aimed to analyze, in the São Paulo state of Brazil, time trends in prevalence, neonatal mortality, and neonatal lethality of central nervous system congenital malformations (CNS-CM) between 2004 and 2015. METHODS: Population-based study of all live births with gestational age ≥22 weeks and/or birthweight ≥400 g from mothers living in São Paulo State, during 2004-2015. CNS-CM was defined by the presence of International Classification Disease 10th edition codes Q00-Q07 in the death and/or live birth certificates. CNS-CM was classified as isolated (only Q00-Q07 codes), and non-isolated (with congenital anomalies codes nonrelated to CNS-CM). CNS-CM associated neonatal death was defined as death between 0 and 27 days after birth in infants with CNS-CM. CNS-CM prevalence, neonatal mortality, and lethality rates were calculated, and their annual trends were analyzed by Prais-Winsten Model. The annual percent change (APC) with 95% confidence interval (95%CI) was obtained. RESULTS: 7,237,628 live births were included in the study and CNS-CM were reported in 7526 (0.1%). CNS-CM associated neonatal deaths occurred in 2935 (39.0%). Isolated CNS-CM and non-isolated CNS-CM were found respectively in 5475 and 2051 livebirths, with 1525 (28%) and 1410 (69%) neonatal deaths. CNS-CM prevalence and neonatal lethality were stationary, however neonatal mortality decreased (APC -1.66; 95%CI -3.09 to -0.21) during the study. For isolated CNS-CM, prevalence, neonatal mortality, and lethality decreased over the period. For non-isolated CNS-CM, the prevalence increased, neonatal mortality was stationary, and lethality decreased during the period. The median time of CNS-CM associated neonatal deaths was 18 h after birth. CONCLUSIONS: During a 12-year period in São Paulo State, Brazil, neonatal mortality of infants with CNS-CM in general and with isolated CNS-CM showed a decreasing pattern. Nevertheless CNS-CM mortality remained elevated, mostly in the first day after birth.

Progestogens for prevention of luteinising hormone (LH) surge in women undergoing controlled ovarian hyperstimulation as part of an assisted reproductive technology (ART) cycle.

BACKGROUND: Currently, gonadotrophin releasing hormone (GnRH) analogues are used to prevent premature ovulation in ART cycles. However, their costs remain high, the route of administration is invasive and has some adverse effects. Oral progestogens could be cheaper and effective to prevent a premature LH surge. OBJECTIVES: To evaluate the effectiveness and safety of using progestogens to avoid spontaneous ovulation in women undergoing controlled ovarian hyperstimulation (COH). SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility Group trials register, CENTRAL, MEDLINE, Embase and PsycINFO in Dec 2021. We contacted study authors and experts to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that included progestogens for ovulation inhibition in women undergoing controlled ovarian hyperstimulation (COH). DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane, including the risk of bias (RoB) assessment. The primary review outcomes were live birth rate (LBR) and oocyte pick-up cancellation rate (OPCR). Secondary outcomes were clinical pregnancy rate (CPR), cumulative pregnancy, miscarriage rate (MR), multiple pregnancies, LH surge, total and MII oocytes, days of stimulation, dose of gonadotropins, and moderate/severe ovarian hyperstimulation syndrome (OHSS) rate. The primary analyses were restricted to studies at overall low and some concerns RoB, and sensitivity analysis included all studies. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We included 14 RCTs (2643 subfertile women undergoing ART, 47 women used oocyte freezing for fertility preservation and 534 oocyte donors). Progestogens versus GnRH antagonists We are very uncertain of the effect of medroxyprogesterone acetate (MPA) 10 mg compared with cetrorelix on the LBR in poor responders (odds ratio (OR) 1.25, 95% confidence interval (CI) 0.73 to 2.13, one RCT, N = 340, very-low-certainty evidence), suggesting that if the chance of live birth following GnRH antagonists is assumed to be 18%, the chance following MPA would be 14% to 32%. There may be little or no difference in OPCR between progestogens and GnRH antagonists, but due to wide Cs (CIs), we are uncertain (OR 0.92, 95%CI 0.42 to 2.01, 3 RCTs, N = 648, I² = 0%, low-certainty evidence), changing the chance of OPCR from 4% with progestogens to 2% to 8%. Given the imprecision found, no conclusions can be retrieved on CPR and MR. Low-quality evidence suggested that using micronised progesterone in normo-responders may increase by 2 to 6 the MII oocytes in comparison to GnRH antagonists. There may be little or no differences in gonadotropin doses. Progestogens versus GnRH agonists Results were uncertain for all outcomes comparing progestogens with GnRH agonists. One progestogen versus another progestogen The analyses comparing one progestogen versus another progestogen for LBR did not meet our criteria for primary analyses. The OPCR was probably lower in the MPA 10 mg in comparison to MPA 4 mg (OR 2.27, 95%CI 0.90 to 5.74, one RCT, N = 300, moderate-certainty evidence), and MPA 4 mg may be lower than micronised progesterone 100 mg, but due to wide CI, we are uncertain of the effect (OR 0.81, 95%CI 0.43 to 1.53, one RCT, N = 300, low-certainty evidence), changing the chance of OPCR from 5% with MPA 4 mg to 5% to22%, and from 17% with micronised progesterone 100 mg to 8% to 24%. When comparing dydrogesterone 20 mg to MPA, the OPCR is probably lower in the dydrogesterone group in comparison to MPA 10 mg (OR 1.49, 95%CI 0.80 to 2.80, one RCT, N = 520, moderate-certainty evidence), and it may be lower in dydrogesterone group in comparison to MPA 4 mg but due to wide confidence interval, we are uncertain of the effect (OR 1.19, 95%CI 0.61 to 2.34, one RCT, N = 300, low-certainty evidence), changing the chance of OPCR from 7% with dydrogesterone 20 to 6-17%, and in MPA 4 mg from 12% to 8% to 24%. When comparing dydrogesterone 20 mg to micronised progesterone 100 mg, the OPCR is probably lower in the dydrogesterone group (OR 1.54, 95%CI 0.94 to 2.52, two RCTs, N=550, I² = 0%, moderate-certainty evidence), changing OPCR from 11% with dydrogesterone to 10% to 24%. We are very uncertain of the effect in normo-responders of micronised progesterone 100 mg compared with micronised progesterone 200 mg on the OPCR (OR 0.35, 95%CI 0.09 to 1.37, one RCT, N = 150, very-low-certainty evidence). There is probably little or no difference in CPR and MR between MPA 10 mg and dydrogesterone 20 mg. There may be little or no differences in MII oocytes and gonadotropins doses. No cases of moderate/severe OHSS were reported in most of the groups in any of the comparisons. AUTHORS' CONCLUSIONS: Little or no differences in LBR may exist when comparing MPA 4 mg with GnRH agonists in normo-responders. OPCR may be slightly increased in the MPA 4 mg group, but MPA 4 mg reduces the doses of gonadotropins in comparison to GnRH agonists. Little or no differences in OPCR may exist between progestogens and GnRH antagonists in normo-responders and donors. However, micronised progesterone could improve by 2 to 6 MII oocytes. When comparing one progestogen to another, dydrogesterone suggested slightly lower OPCR than MPA and micronised progesterone, and MPA suggested slightly lower OPCR than the micronised progesterone 100 mg. Finally, MPA 10 mg suggests a lower OPCR than MPA 4 mg. There is uncertainty regarding the rest of the outcomes due to imprecision and no solid conclusions can be drawn.

Does microfluidic sperm selection improve clinical pregnancy and miscarriage outcomes in assisted reproductive treatments? A systematic review and meta-analysis.

BACKGROUND: The microfluidic sperm selection (MFSS) device has emerged as a promising adjunct in assisted reproduction treatments (ART). It employs mechanisms of biomimicry based on the microanatomy of the female reproductive tract through strategies like chemotaxis and rheotaxis. Numerous studies assert improvements in ART outcomes with the use of MFSS, often attributed to the theoretical reduction in sperm DNA damage compared to other techniques. However, these attributed benefits lack validation through large-scale clinical trials, and there is no significant evidence of enhanced assisted reproductive treatments (ART) outcomes. OBJECTIVE: To evaluate whether the utilization of MFSS enhances clinical pregnancy results and abortion outcomes in couples undergoing ART compared to standard sperm selection techniques for Intracytoplasmic Sperm Injection (ICSI). We also assessed laboratory outcomes as a supplementary analysis. SEARCH METHODS: We conducted searches across databases including PubMed, NIH, LILACS, CENTRAL, Crossref, Scopus, and OpenAlex. A total of 1,255 records were identified. From these, 284 duplicate records were eliminated, and an additional 895 records were excluded due to their association with patent applications, diagnostic tests, forensic analyses, or irrelevance to the research focus. Among the initially eligible 76 studies, 63 were excluded, encompassing abstracts, studies lacking adequate control groups, and ongoing clinical trials. Ultimately, 13 studies were selected for inclusion in the ensuing meta-analysis. RESULTS: Regarding clinical pregnancy, we assessed a total of 868 instances of clinical pregnancies out of 1,646 embryo transfers. Regarding miscarriage, we examined 95 cases of pregnancy loss among the 598 confirmed clinical pregnancies in these studies. CONCLUSION: The utilization of MFSS demonstrates marginal positive outcomes compared to standard sperm selection techniques, without statistical significance in any of the analyses. BROADER IMPLICATIONS: This study conducted the first meta-analysis to evaluate clinical pregnancy rates, miscarriage rates, and laboratory results associated with the use of MFSS compared to standard sperm selection techniques. We have also listed potentially eligible studies for future inclusion. It's important to emphasize the need for multicenter studies with standardized parameters to attain a more robust clarification of this issue.

Is endometrial receptivity affected in women with endometriosis? Results from a matched pair case-control study of assisted reproductive technology treatments.

RESEARCH QUESTION: Is endometriosis detrimental to embryo implantation? DESIGN: A retrospective matched case-control study of women with a surgical or ultrasound diagnosis of endometriosis at Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano between 2015 and 2021. Women with endometriosis who underwent a 'freeze-all' cycle during an IVF treatment were eligible to be included. They were matched to patients without the disease, who also underwent cryopreserved blastocyst transfer cycles, in a 1:1 ratio by age (±1 year), and number (=) and quality (±1 top versus low) of cryopreserved blastocysts. All women underwent single frozen embryo transfer, and assisted reproductive technology outcomes suggested by the Core Outcome Measure for Infertility Trials initiative were evaluated. The main outcome was the cumulative live birth rate per cycle. RESULTS: One hundred and one women with endometriosis and 101 matched unaffected women were included. Cumulative live birth rate per cycle did not vary between women with and without endometriosis (50% versus 58%, respectively; P = 0.32). On the basis of the Kaplan-Meier analysis, the predicted success rates over four embryos transferred were also similar (74% versus 82%, respectively; P = 0.67). CONCLUSION: In women with moderate or severe endometriosis, these retrospective results seem to indicate no or a limited effect of the disease on endometrial receptivity.

Live birth after single euploid frozen embryo transfer in a 39-year-old woman with high-grade mosaic Turner syndrome.

OBJECTIVE: To describe the reproductive and obstetric outcomes of an intracytoplasmic sperm injection cycle with preimplantation genetic testing for aneuploidy in an advanced reproductive-age woman with high-grade mosaic Turner syndrome. METHODS: Case report of a 39-year-old woman diagnosed with mosaic Turner Syndrome 45,X[90]/46,XX[10] karyotype who underwent in vitro fertilization treatment with blastocyst trophectoderm biopsy for preimplantation genetic testing using next-generation sequencing. RESULT(S): Two of the four blastocysts biopsied were euploid. The patient achieved ongoing pregnancy after the first single euploid frozen embryo transfer, followed by the birth of a healthy child. CONCLUSION: Autologous intracytoplasmic sperm injection cycles can be considered in a select group of advanced reproductive-age women diagnosed with high-grade mosaic Turner syndrome.

Epidemiologic profile and prevalence of live births with orofacial cleft in Brazil: a descriptive study.

OBJECTIVE: To describe the epidemiological profile and prevalence of live births with orofacial clefts in Brazil between 1999 and 2020. METHODS: Descriptive study. The population corresponded to live births with isolated orofacial clefts in Brazil registered in the Live Birth Information System between 1999 and 2020. Descriptive variables were selected according to their availability and grouped into socioeconomic and demographic, maternal and child health care, and biological variables. Data were submitted to a descriptive analysis using the Software for Statistics and Data Science (STATA). RESULTS: During the period, 33,699 children were born with orofacial clefts, and 82.1% (27,677) of them were isolated clefts. Regarding these cases, the majority were cleft lip and palate (9,619 or 34.7%), followed by cleft palate (9,442 or 34.1%), and by cleft lip (8,616 or 31.3%). CONCLUSIONS: Live births with orofacial clefts in Brazil were male, white, with birthweight ≥2,500 g and gestational age ≥37 weeks, born by cesarean section, and with Apgar scores ≥7. The cases were more frequent among mothers who were in their first and single pregnancy and had seven or more prenatal appointments. The mothers were 20 and 29 years old, had eight to ten years of study, and were single. The national prevalence of clefts was 4.24/10,000. The South and Southeast regions of Brazil had the highest prevalence, while the lowest prevalence was recorded in the Northeast and North regions. For the Federative Units, the highest and lowest prevalences were found, respectively, in Paraná and Acre.

Saúde em Dados / Health in data

O Boletim CEInfo "Saúde em Dados" é uma publicação em formato eletrônico com periodicidade anual e de livre acesso editado pela Coordenação de Epidemiologia e Informação (CEInfo) da Secretaria Municipal da Saúde de São Paulo (SMS-SP). O documento é apresentado em dois formatos: uma versão em PDF para consulta e download e outra em formato aberto com conteúdo das diferentes unidades territoriais/administrativas do Município de São Paulo ­ Coordenadoria Regional de Saúde/Supervisão Técnica de Saúde e Subprefeitura. O "Saúde em Dados" foi criado para promover a disseminação de dados sobre nascimentos, mortes e adoecimento da população paulistana, além da estrutura de estabelecimentos/serviços da rede SUS e sua produção assistencial com o objetivo de contribuir com a organização das ações de saúde no Município. Desde 2021, são apresentados os registros de síndrome gripal (SG), síndrome respiratória aguda grave (SRAG) e óbitos decorrentes da pandemia de Covid-19. Na sua 22ª edição, foram incluídos a proporção de nascidos vivos com anomalias congênitas prioritárias segundo definição do Ministério da Saúde, além de alguns agravos de notificação compulsória: doenças e agravos relacionados ao trabalho (DART), acidentes e violências. Os coeficientes foram calculados com a projeção da população residente em 2022 e padronizados por idade com base na população residente de 2020 do Município de São Paulo. Como destaque e a partir desta edição, são apresentados indicadores de mortalidade segundo sexo biológico para as doenças isquêmicas do coração, doenças cerebrovasculares, diabetes mellitus, câncer de pulmão e câncer colorretal. As informações podem ser utilizadas na produção de análises sobre a situação de saúde e de apoio aos gestores, trabalhadores e demais interessados em discutir as ações e políticas de saúde na cidade de São Paulo. Assim qualquer pessoa pode acessar estes conteúdos e utilizá-los com diferentes finalidades e formatos, sendo necessária apenas a preservação da sua origem e citação da fonte. Espera-se que esta publicação cumpra sua finalidade como mais um instrumento público de divulgação de informações de saúde, de apoio aos gestores e à participação social do SUS na cidade de São Paulo.

[Evolution of the completeness and consistency of the gastroschisis registry in the Brazilian Live Birth Information System, from 2005 to 2020]. / Evolução da completude e consistência do registro de gastrosquise no Sistema de Informações sobre Nascidos Vivos no Brasil, de 2005 a 2020.

This study aimed to evaluate the evolution of the completeness and consistency of the gastroschisis registry in the Brazilian Live Birth Information System (SINASC). It is a time-series study on the completeness of the variable "occurrence of congenital anomaly" and the consistency of gastroschisis diagnosis in SINASC, in biennia from 2005 to 2020, for federative units, region, and Brazil. The consistency was estimated by the ratio between deaths from gastroschisis registered in the Brazilian Mortality Information System (SIM) and the total number of cases recorded in SINASC. Temporal trend was analyzed by joinpoint regression. In the period, 46,574,995 live births and 10,024 cases of gastroschisis were recorded. A total of 5,632 infant deaths due to gastroschisis were identified. The percentage of incompleteness decreased from 6.52% to 1.87%, with an annual percentage variation (APV) of -14.5%, and completeness reached excellence (≤ 5% of incompleteness), except in the Central-West Region. Case/death ratios above 1 were found in the North and Northeast regions and in some federative units in the Central-West, but there was a decrease, approaching the mortality found in studies in the South and Southeast regions. Its reduction was more pronounced until 2009-2010 (APV = -10.7%) and smaller later (APV = -4.4%). The quality of the gastroschisis registry reflects regional differences in the overall quality of SINASC, constituting as a marker for malformations that require complex neonatal care.

O objetivo deste estudo foi avaliar a evolução da completude e da consistência do registro de gastrosquise no Sistema de Informações sobre Nascidos Vivos (SINASC) no Brasil. Trata-se de estudo de série temporal sobre a completude da variável "ocorrência de anomalia congênita" e a consistência do diagnóstico de gastrosquise no SINASC, nos biênios entre 2005 e 2020, para Unidades da Federação, região e Brasil. A consistência foi estimada pela razão entre óbitos por gastrosquise registrados no Sistema de Informações sobre Mortalidade (SIM) e o total de casos registrados no SINASC. A tendência temporal foi analisada por regressão joinpoint. No período, havia registro de 46.574.995 nascidos vivos e 10.024 casos de gastrosquise entre eles. Identificamos 5.632 óbitos infantis por gastrosquise. O percentual de incompletude diminuiu de 6,52% para 1,87%, com variação percentual anual (VPA) de -14,5%, e a completude atingiu a excelência (≤ 5% de incompletude), exceto no Centro-oeste do país. Razão óbito/caso acima de 1 foi encontrada nas regiões Norte e Nordeste e em alguns estados do Centro-oeste, mas houve diminuição, aproximando-se da mortalidade encontrada em estudos no Sul e Sudeste. Sua redução foi mais acentuada até 2009-2010 (VPA = -10,7%) e menor posteriormente (VPA = -4,4%). A qualidade do registro de gastrosquise reflete as diferenças regionais da qualidade geral do SINASC, configurando-se uma condição marcadora para malformações que demandam atenção neonatal complexa.

El objetivo de este estudio fue evaluar la evolución de la completitud y consistencia del registro de la gastrosquisis en el Sistema de Información de los Nacidos Vivos (SINASC) en Brasil. Se trata de un estudio de serie temporal sobre la completitud de la variable "aparición de anomalía congénita" y la consistencia del diagnóstico de gastrosquisis en el SINASC, en los bienios entre 2005 y 2020, en estados, regiones y Brasil. La consistencia se estimó por la razón entre las defunciones por gastrosquisis registradas en el Sistema de Información de Mortalidad (SIM) y el total de casos inscritos en el SINASC. La tendencia temporal se analizó mediante regresión joinpoint. Durante el período, hubo 46.574.995 nacidos vivos y 10.024 casos de gastrosquisis entre ellos. Identificamos 5.632 muertes infantiles por gastrosquisis. El porcentaje de incompletitud disminuyó de 6,52% a 1,87%, con una variación porcentual anual (VPA) de -14,5%, y la completitud alcanzó la excelencia (≤ 5% de incompletitud), excepto en la región Centro-oeste del país. Se encontró una relación defunciones/caso superior a 1 en las regiones Norte y Nordeste y en algunos estados del Centro-oeste, pero hubo una disminución, acercándose a la mortalidad encontrada en estudios en el Sur y Sudeste. Su reducción fue más pronunciada hasta 2009-2010 (VPA = -10,7%) y después menor (VPA = -4,4%). La calidad del registro de gastrosquisis refleja diferencias regionales relacionadas con la calidad general del SINASC, configurando una condición manifiesta de malformaciones que demandan cuidados neonatales complejos.

Detección temprana y seguimiento de la parálisis cerebral / Early detection and follow-up of cerebral palsy

La parálisis cerebral es la discapacidad física más común en la niñez y ocurre en 1 de cada 500 nacidos vivos. Históricamente, el diagnóstico se ha realizado entre los 12 y los 24 meses de edad, aunque actualmente se puede realizar antes de los 6 meses de edad corregida. El diagnóstico temprano comienza con un cuidadoso historial médico e implica la utilización de neuroimágenes, evaluaciones neurológicas y motoras estandarizadas que indican hallazgos indicativos de parálisis cerebral. Para ello, en la presente revisión se desarrolla un procedimiento que ha sido propuesto en la literatura. El seguimiento y el control de la evolución de la condición se deben hacer desde múltiples especialidades. Los médicos deben comprender la importancia de la pronta derivación a una intervención temprana específica de diagnóstico y del seguimiento adecuado de la condición para optimizar la plasticidad motora y cognitiva del niño, prevenir complicaciones secundarias y mejorar el bienestar del paciente y entorno familiar(AU)

Cerebral palsy is the most common physical disability in childhood, occurring in 1 of 500 live births. historically, the diagnosis has been made between 12 and 24 months of age, but now it can be made before 6 months of corrected age. Early diagnosis begins with a judicious medical history and involves neuroimaging, standardized neurological, and motor assessments that indicate abnormal findings indicative of cerebral palsy. In the present review, the authors propose a process widely developed in the medical literature. Monitoring during growth and control of the condition must be done from multiple specialties. Clinicians should understand the importance of prompt referral to an early diagnostic-specific intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being(AU)

Personalized embryo transfer guided by endometrial receptivity analysis: a systematic review with meta-analysis.

STUDY QUESTION: Does a personalized embryo transfer (pET) guided by tests for endometrial receptivity (TER) increase the effectiveness of ART procedures? SUMMARY ANSWER: The use of TER-guided pET is not supported by current published evidence in women without repeated implantation failure (RIF), while in women with RIF more research is needed to assess a potential benefit. WHAT IS KNOWN ALREADY: Implantation rates are still far from ideal, especially in some patients that have RIF with good-quality embryos. As a potential solution, a wide range of diverse TER use different sets of genes to identify displacements of the window of implantation to adjust the individual length of progesterone exposure in a pET. STUDY DESIGN, SIZE, DURATION: A systematic review with meta-analysis was performed. Search terms included endometrial receptivity analysis, ERA, personalized embryo transfer. CENTRAL, PubMed, Embase, reference lists, clinical trials registers, and conference proceedings (search date October 2022) were searched, with no language restrictions. PARTICIPANTS/MATERIALS, SETTING, METHODS: Randomized controlled trials (RCTs) and cohort studies comparing a pET guided by TER vs standard embryo transfer (sET) in different subgroups that undergo ART were identified. We also investigated pET in non-receptive-TER vs sET in receptive-TER, and pET in a specific population vs sET in a general population. Risk of bias (RoB) was assessed with the Cochrane tool and ROBINS-I. Only those with low/moderate RoB underwent meta-analysis. The GRADE approach was used to evaluate the certainty of evidence (CoE). MAIN RESULTS AND THE ROLE OF CHANCE: We screened 2136 studies and included 35 (85% used ERA and 15% used other TER). Two studies were RCTs comparing endometrial receptivity analysis (ERA)-guided pET vs sET in women with no history of RIF. In women without RIF, no important differences (moderate-CoE) were found in live birth rates and clinical pregnancy rates (CPR). We also performed a meta-analysis of four cohort studies that were adjusted for confounding. In agreement with the RCTs, no benefits were found in women without RIF. However, in women with RIF, low CoE suggests that pET might improve the CPR (OR 2.50, 95% CI 1.42-4.40). LIMITATIONS, REASONS FOR CAUTION: We found few studies with low RoB. Only two RCTs in women without RIF were published, and none in women with RIF. Furthermore, the heterogeneity observed in populations, interventions, co-interventions, outcomes, comparisons, and procedures limited the pooling of many of the included studies. WIDER IMPLICATIONS OF THE FINDINGS: In the population of women without RIF, in agreement with previously published reviews, pET did not prove to be more effective than sET and, therefore, it precludes the routine use of this strategy in this population until more evidence is available. However, more research is advisable in women with RIF as low-certainty evidence from observational studies adjusted for confounders suggests that the CPR might be higher with pET guided by TER in this population. Although this review presents the best available evidence, it is still insufficient to change current policies. STUDY FUNDING/COMPETING INTEREST(S): No specific funding was obtained for this study. There are no conflicts of interest to declare. REGISTRATION NUMBER: PROSPERO CRD42022299827.

Experiences of patients undergoing IVF treatment during the COVID-19 pandemic.

OBJECTIVE: To assess the willingness of patients with infertility to continue with their in vitro fertilization (IVF) treatment during the COVID-19 pandemic. METHODS: This cross-sectional survey was conducted in the reproductive, endocrine, and infertility medicine department (REIMD) at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia. Patients that were planned to undergo IVF treatment at REIMD were contacted and asked about whether they would like to start IVF treatment during the COVID-19 pandemic from August 2020 to August 2021. Data was analyzed using the SPSS version 24. Statistics obtained as means and standard deviations from continuous variables correlated with the Chi-square test and results were considered significant at p≤0.05. RESULTS: Of the 400 participants, 245 (61.25%) were between the ages of 30-39 years. About 42.75% (n=171) of the patients had 6-10 years of infertility, and 18% (n=72) had at least one pregnancy but no living children. While 64.7% (n=259) of the participants responded on the first call, 83% (n=332) agreed to continue their treatment. Of those, 13% (n=43) preferred to book appointments as soon as possible; 29.8% (n=99) preferred booking within three months; while 57.2% (n=190) chose to book after three months. From our sample, 86.8% (n=59) were afraid to contract the virus and the choice to delay the IVF treatment correlated with the patient's age (p<0.001) and duration of infertility (p=0.007). CONCLUSIONS: The COVID-19 pandemic affected IVF treatment courses, and many patients were afraid to be infected during this pandemic.

Trend of incompleteness of maternal schooling and race/skin color variables held on the Brazilian Live Birth Information System, 2012-2020.

OBJECTIVE: to analyze the trend of incompleteness of the maternal schooling and race/skin color variables held on the Brazilian Live Birth Information System (SINASC) between 2012 and 2020. METHODS: this was an ecological time series study of the incompleteness of maternal schooling and race/skin color data for Brazil, its regions and Federative Units, by means of joinpoint regression and calculation of annual percentage change (APC) and average annual percentage change. RESULTS: a total of 26,112,301 births were registered in Brazil in the period; incompleteness of maternal schooling data decreased for Brazil (APC = -8.1%) and the Southeast (APC = -19.5%) and Midwest (APC = -17.6%) regions; as for race/skin color, there was a downward trend for Brazil (APC = -8.2%) and all regions, except the Northeast region, while nine Federative Units and the Federal District showed a stationary trend. CONCLUSION: there was an improvement in filling out these variables on the SINASC, but with regional disparities, mainly for race/skin color.