Interpregnancy interval and perinatal outcomes across Latin America from 1990 to 2009: a large multi-country study.

OBJECTIVE: To determine the relationship of interpregnancy interval with maternal and offspring outcomes. DESIGN: Retrospective study with data from the Perinatal Information System database of the Latin American Centre for Perinatology and Human Development, Uruguay. SETTING: Latin America, 1990-2009. POPULATION: A cohort of 894 476 women delivering singleton infants. METHODS: During 1990-2009 the Perinatal Information System database of the Latin American Centre for Perinatology identified 894 476 women with defined interpregnancy intervals: i.e. the time elapsed between the date of the previous delivery and the first day of the last normal menstrual period for the index pregnancy. Using the interval 12-23 months as the reference category, multiple logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) of the association between various interval lengths and maternal and offspring outcomes. MAIN OUTCOME MEASURES: Maternal death, pre-eclampsia, eclampsia, puerperal infection, fetal death, neonatal death, preterm birth, and low birthweight. RESULTS: In the reference interval there was 0.05% maternal death, 1.00% postpartum haemorrhage, 2.80% pre-eclampsia, 0.15% eclampsia, 0.28% puerperal infection, 3.45% fetal death, 0.68% neonatal death, 12.33% preterm birth, and 9.73% low birthweight. Longer intervals had increased odds of pre-eclampsia (>72 months), fetal death (>108-119 months), and low birthweight (96-107 months). Short intervals of <12 months had increased odds of pre-eclampsia (aOR 0.80; 95% CI 0.76-0.85), neonatal death (aOR 1.18; 95% CI 1.08-1.28), and preterm birth (aOR 1.16; 95% CI 1.11-1.21). Statistically, the interval had no relationship with maternal death, eclampsia, and puerperal infection. CONCLUSIONS: A short interpregnancy interval of <12 months is associated with pre-eclampsia, neonatal mortality, and preterm birth, but not with other maternal or offspring outcomes. Longer intervals of >72 months are associated with pre-eclampsia, fetal death, and low birthweight, but not with other maternal or offspring outcomes. TWEETABLE ABSTRACT: A short interpregnancy interval of <12 months is associated with neonatal mortality and preterm birth.

A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study.

OBJECTIVE: To generate a global reference for caesarean section (CS) rates at health facilities. DESIGN: Cross-sectional study. SETTING: Health facilities from 43 countries. POPULATION/SAMPLE: Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10,045,875 women giving birth from 43 countries for model testing. METHODS: We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. MAIN OUTCOME MEASURES: Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. RESULTS: According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/). CONCLUSIONS: This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. TWEETABLE ABSTRACT: The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems.

Status of national policy on companion of choice at birth in Latin America and the Caribbean: Gaps and challenges

The World Health Organization (WHO) recommends a companion of choice during labor and birth, to improve maternal and perinatal outcomes and women's satisfaction with health services. To better understand the status of companion of choice in Latin America and the Caribbean (LAC), an online survey was conducted with members of a midwifery virtual community of practice and with key informants, aiming to identify: 1) existing regulatory instruments related to companion of choice in the countries where the members are practicing; and, 2) key characteristics of implementation of companion of choice, where regulation exists. Responses (n = 112) were received from representatives of 20 of the 43 countries of LAC. Respondents reported existence of a national policy or legislation in seven countries, ministerial norms or institutional protocols in five countries, and no existing policy/protocol in eight countries. Respondents from the same country often provided contradictory responses. Responses differed from information provided by ministries of health in a WHO-led global policy survey in 11 instances. These variations may reflect that midwives were not always aware of the national policy/guideline in their country. We propose that a more robust effort should be undertaken to understand the status of companion of choice for labor and birth in LAC countries, at national, regional, and local level, in public and private facilities. It is important to know if policies exist, at what level of the system, and if key stakeholders, maternity-care health providers, and women are aware of their existence. Efforts should also be made to understand barriers to implementing companion of choice. (AU)

La Organización Mundial de la Salud (OMS) recomienda un compañero de elección durante el trabajo de parto y el parto, para mejorar los resultados maternos y perinatales y la satisfacción de las mujeres con los servicios de salud. Para comprender mejor el estado del acompañante de elección en América Latina y el Caribe (ALC), se realizó una encuesta en línea con miembros de una comunidad virtual de práctica de partería y con informantes clave, con el objetivo de identificar: 1) los instrumentos regulatorios existentes relacionados con el acompañante de elección en los países donde los miembros están practicando; y, 2) características clave de la implementación del compañero de elección, cuando exista regulación. Respuestas ( n= 112) se recibieron de representantes de 20 de los 43 países de ALC. Los encuestados informaron sobre la existencia de una política o legislación nacional en siete países, normas ministeriales o protocolos institucionales en cinco países y ninguna política / protocolo existente en ocho países. Los encuestados del mismo país a menudo proporcionaron respuestas contradictorias. Las respuestas difieren de la información proporcionada por los ministerios de salud en una encuesta de política mundial dirigida por la OMS en 11 casos. Estas variaciones pueden reflejar que las parteras no siempre estaban al tanto de la política / directriz nacional de su país. Proponemos que se debe realizar un esfuerzo más robusto para comprender el estado de la compañera de elección para el trabajo de parto y el parto en los países de ALC, a nivel nacional, regional y local, en instalaciones públicas y privadas. Es importante saber si existen políticas, a qué nivel del sistema, y ​​si las partes interesadas clave, los proveedores de atención de salud de maternidad y las mujeres son conscientes de su existencia. También se deben hacer esfuerzos para comprender las barreras para implementar el compañero de elección. (AU)

COVID-19 and newborn health: systematic review

Objective: To describe perinatal and neonatal outcomes in newborns exposed to SARS-CoV-2. Methods: A systematic review was conducted by searching PubMed Central, LILACS, and Google Scholar using the keywords 'covid ' AND 'newborn' OR 'child' OR 'infant,' on 18 March 2020, and again on 17 April 2020. One researcher conducted the search and extracted data on demographics, maternal outcomes, diagnostic tests, imaging, and neonatal outcomes. Results: Of 256 publications identified, 20 met inclusion criteria and comprised neonatal outcome data for 222 newborns whose mothers were suspected or confirmed to be SARS-CoV-2 positive perinatally (17 studies) or of newborns referred to hospital with infection/pneumonia (3 studies). Most (12 studies) were case-series reports; all were from China, except three (Australia, Iran, and Spain). Of the 222 newborns, 13 were reported as positive for SARS-CoV-2; most of the studies reported no or mild symptoms and no adverse perinatal outcomes. Two papers among those from newborns who tested positive reported moderate or severe clinical characteristics. Five studies using data on umbilical cord blood, placenta, and/or amniotic fluid reported no positive results. Nine studies reported radiographic imaging, including 5 with images of pneumonia, increased lung marking, thickened texture, or high-density nodular shadow. Minor, non-specific changes in biochemical variables were reported. Studies that tested breast milk reported negative SARS-CoV-2 results. Conclusions: Given the paucity of studies at this time, vertical transmission cannot be confirmed or denied. Current literature does not support abstaining from breastfeeding nor separating mothers and newborns. Further evidence and data collection networks, particularly in the Americas, are needed for establishing definitive guidelines and recommendations.(AU)

Objetivo: Describir los resultados perinatales y neonatales en recién nacidos expuestos al SARS-CoV-2. Métodos: Se realizó una revisión sistemática mediante la búsqueda en PubMed Central, LILACS y Google Scholar utilizando las palabras clave 'covid' Y 'recién nacido' O 'niño' O 'infante', el 18 de marzo de 2020 y nuevamente el 17 de abril de 2020. Un investigador realizó la búsqueda y extrajo datos sobre demografía, resultados maternos, pruebas de diagnóstico, imágenes y resultados neonatales. Resultados: De 256 publicaciones identificadas, 20 cumplieron los criterios de inclusión y comprendieron datos de resultados neonatales de 222 recién nacidos cuyas madres se sospechaba o se había confirmado que eran positivas para el SRAS-CoV-2 perinatalmente (17 estudios) o de recién nacidos remitidos al hospital con infección / neumonía (3 estudios) . La mayoría (12 estudios) fueron informes de series de casos; todos eran de China, excepto tres (Australia, Irán y España). De los 222 recién nacidos, 13 fueron reportados como positivos para SARS-CoV-2; la mayoría de los estudios informaron síntomas leves o nulos y sin resultados perinatales adversos. Dos artículos entre los de recién nacidos que dieron positivo informaron características clínicas moderadas o graves. Cinco estudios que utilizaron datos sobre sangre del cordón umbilical, placenta o líquido amniótico no informaron resultados positivos. Nueve estudios informaron imágenes radiográficas, incluidos cinco con imágenes de neumonía, aumento de la marcación de los pulmones, textura engrosada o sombra nodular de alta densidad. Se informaron cambios menores no específicos en las variables bioquímicas. Los estudios que probaron la leche materna informaron resultados negativos de SARS-CoV-2. Conclusiones: Dada la escasez de estudios en este momento, la transmisión vertical no se puede confirmar ni negar. La literatura actual no apoya la abstinencia de la lactancia materna ni la separación de madres y recién nacidos. Se necesitan más evidencias y redes de recolección de datos, particularmente en las Américas, para establecer pautas y recomendaciones definitivas.(AU)

Objetivo. Descrever os resultados perinatais e neonatais dos recém-nascidos expostos à SARS-CoV-2. Métodos. Uma revisão sistemática com pesquisa bibliográfica em PubMed Central, LILACS e Google Scholar foi realizada utilizando as palavras-chave 'covid' E ('newborn' OU 'child' OU 'infant') em 18 de março de 2020, e novamente em 17 de abril de 2020 por um pesquisador. Foram analisados dados sobre demografia, resultados maternos, testes de diagnóstico, técnicas de imagem e resultados neonatais. Resultados. Das 256 publicações identificadas, 20 preenchiam os critérios de inclusão e incluíam dados de resultados neonatais de 222 recém-nascidos cujas mães eram suspeitas ou positivas para a SARSCoV-2 no período perinatal (17 estudos) ou recém-nascidos internados no hospital com infecção/pneumonia (3 estudos). A maioria (12 estudos) eram relatos de séries de casos; todos, exceto três (Austrália, Irão e Espanha), eram provenientes da China. Dos 222 recém-nascidos, 13 eram positivos para SARS-CoV-2; a maioria dos estudos relatou que os recém-nascidos eram assintomáticos ou tinham sintomas leves e que não foram observados resultados perinatais adversos. Entre os estudos com recém-nascidos positivos, dois descreviam características clínicas moderadas ou graves. O sangue do cordão umbilical, a placenta ou o líquido amniótico foram analisados em cinco estudos, não tendo sido relatados resultados positivos. Imagens radiográficas foram descritas em nove estudos, incluindo cinco com imagens de pneumonia, aumento da trama pulmonar, espessamento da textura ou opacidades nodulares de alta densidade. Foram relatadas alterações menores e não específicas dos parâmetros bioquímicos. Estudos que analisaram leite materno mostraram resultados negativos para SARS-CoV-2. Conclusões. Dada a escassez de estudos, neste momento a transmissão vertical não pode ser confirmada ou excluída. A literatura atual não apoia a abstenção da amamentação ou a separação dos recém-nascidos das suas mães. São necessárias mais provas e mais dados, especialmente na Região das Américas, para estabelecer orientações e recomendações definitivas.(AU)

Adverse events associated with the use of recommended vaccines during pregnancy: an overview of systematic reviews

Introduction: Maternal immunization is aimed at reducing morbidity and mortality in pregnant women and their newborns. Updated evidence synthesis of maternal-fetal outcomes is constantly needed to ensure that the risk-benefit of vaccination during pregnancy remains positive. Methods: An overview of systematic reviews (OoSRs) was performed. We searched The Cochrane Library, MEDLINE and EMBASE for SRs including recommended vaccines for maternal immunization reporting the following: abortion, stillbirth, chorioamnionitis, congenital anomalies, microcephaly, neonatal death, neonatal infection, preterm birth (PTB), low birth weight (LBW), maternal death and small for gestational age (SGA) from 2010 to April 2019. Quality and overlap of SRs was assessed. Results: Seventeen SRs were identified, eight of them included meta-analysis; quality was high in three SRs, moderate in six SRs, low in two SRs, and critically low in six SRs. Stillbirth and PTB were the most frequently reported outcomes by 15 and 13 SRs, respectively, followed by abortion (9 SRs), congenital anomalies (9 SRs), SGA (8 SRs), neonatal death (8 SRs), LBW (4 SRs), chorioamnionitis (3 SRs), maternal death (1 SR). SRs included mainly observational evidence for influenza and Tdap vaccines (11 SRs and 4 SRs, respectively); limited evidence was found for hepatitis (1 SR), yellow fever (1 SR), and meningococcal (1 SR) vaccines. Most of the SRs found no effect. Eight SRs found benefit/protection of influenza vaccine (for stillbirth, neonatal death, preterm birth, LBW), or Tdap vaccine (for preterm birth and SGA); one found a probable risk (chorioamnionitis/Tdap). The SRs for Hepatitis B, meningococcal and yellow fever vaccines were inconclusive. Conclusions: Definite risks were not identified for any vaccine and outcome; however better evidence is needed for all outcomes and vaccines. The available evidence in the SRs to support vaccine safety was based mainly on observational data. More RCTs with adequate reporting of maternal-fetal outcomes and larger high-quality observational studies are needed. (AU)

EviSIP: using evidence to change practice through mentorship - an innovative experience for reproductive health in the Latin American and Caribbean regions

Maternal mortality is unacceptably high in our region. In 2015, the Latin American Center for Perinatology and Women´s Reproductive Health (CLAP) created a regional network of institutions including 16 countries, committed to improving epidemiological surveillance and healthcare of women in a situation of abortion or near miss event, using a common platform, the Perinatal Information System (SIP). The objective of the current pilot project was to test a new method of study called EviSIP (Evidence from SIP), a method of generating information on maternal near miss and abortion for the region. We describe the implementation of this initiative in reproductive healthcare facilities using SIP. Junior researchers/clinicians from these countries were included, along with expert researchers in reproductive health from across the world. Articles were produced with data on maternal near miss and abortion gathered from the SIP of each participating sentinel center; and recommendations from experts. EviSIP was the first joint workspace to discuss patient outcomes after treatment of abortion or near miss cases, with data analysis of each Sentinel Center; discuss and analyze data among centers, at a country and regional level; discuss the main outcomes and their impact on changing procedures and policies; strengthen the operational research capacity of the centers; develop and encourage the publication of scientific articles. The EviSIP initiative also promoted training of healthcare professionals in research. EviSIP provided a unique opportunity to train for research and mentorship and was pivotal to the production of scientific knowledge of reproductive health in the region. (AU)

La mortalidad materna es inaceptablemente alta en nuestra región. En 2015, el Centro Latinoamericano de Perinatología y Salud Reproductiva de la Mujer (CLAP) creó una red regional de instituciones que incluye 16 países, comprometidas con mejorar la vigilancia epidemiológica y la atención de la salud de las mujeres en situación de aborto o cuasi accidente, utilizando un método común. plataforma, el Sistema de Información Perinatal (SIP). El objetivo del proyecto piloto actual era probar un nuevo método de estudio llamado EviSIP (Evidence from SIP), un método para generar información sobre el cuasi accidente y el aborto materno en la región. Describimos la implementación de esta iniciativa en instalaciones de salud reproductiva utilizando SIP. Se incluyeron investigadores / médicos jóvenes de estos países, junto con investigadores expertos en salud reproductiva de todo el mundo. Se elaboraron artículos con datos sobre casi accidentes maternos y abortos recopilados del SIP de cada centro centinela participante; y recomendaciones de expertos. EviSIP fue el primer espacio de trabajo conjunto para discutir los resultados de los pacientes después del tratamiento de un aborto o casos de casi accidentes, con análisis de datos de cada Centro Sentinel; discutir y analizar datos entre centros, a nivel nacional y regional; discutir los principales resultados y su impacto en el cambio de procedimientos y políticas; fortalecer la capacidad de investigación operativa de los centros; Desarrollar y fomentar la publicación de artículos científicos. La iniciativa EviSIP también promovió la formación de los profesionales sanitarios en investigación. EviSIP brindó una oportunidad única para capacitarse en investigación y tutoría y fue fundamental para la producción de conocimiento científico sobre salud reproductiva en la región. (AU)

A systematic review and meta-analysis of cesarean delivery and other uterine surgery as risk factors for placenta accreta

Background: The incidence of placenta accreta has increased in recent years and it has been suggested that the rising trend in cesarean delivery and other uterine surgery is the underlying cause. Objective: To explore the magnitude of the effect of performing single and repeat cesarean deliveries or other uterine surgery on the incidence of placenta accreta. Search strategy: Relevant databases were searched for papers published before August 1, 2018, using terms including "accreta" and "cesarean." Selection criteria: Cohort studies assessing the risk of placenta accreta according to women's history of uterine surgery. Data collection and analysis: Meta-analyses were performed to assess the risks associated between uterine surgery and placenta accreta, hysterectomy, and uterine rupture. The I2 statistic was used to examine between-study heterogeneity. Main results: The risk of placenta accreta in a second pregnancy increased for women who had undergone a cesarean in their first pregnancy compared with vaginal delivery (OR 3.02; 95% CI, 1.50-6.08). Absolute risk of placenta accreta increased with the number of previous cesareans. The risk of uterine rupture and hysterectomy was also associated with the number of cesareans. Conclusions: Risk of placenta accreta, hysterectomy, and uterine rupture increases with the number of previous cesarean deliveries. (AU)

Antecedentes: la incidencia de placenta accreta ha aumentado en los últimos años y se ha sugerido que la tendencia al alza en el parto por cesárea y otras cirugías uterinas es la causa subyacente. Objetivo: explorar la magnitud del efecto de realizar cesáreas únicas y repetidas u otra cirugía uterina sobre la incidencia de placenta accreta. Estrategia de búsqueda: se realizaron búsquedas en las bases de datos relevantes de artículos publicados antes del 1 de agosto de 2018, utilizando términos como "accreta" y "cesárea". Criterios de selección: estudios de cohortes que evalúan el riesgo de placenta accreta según los antecedentes de cirugía uterina de las mujeres. Recopilación y análisis de datos: se realizaron metanálisis para evaluar los riesgos asociados entre la cirugía uterina y la placenta accreta, la histerectomía y la rotura uterina. La estadística I 2 se utilizó para examinar la heterogeneidad entre estudios. Resultados principales: El riesgo de placenta accreta en un segundo embarazo aumentó para las mujeres que se habían sometido a una cesárea en su primer embarazo en comparación con el parto vaginal (OR 3,02; IC del 95%, 1,50-6,08). El riesgo absoluto de placenta accreta aumentó con el número de cesáreas previas. El riesgo de rotura uterina e histerectomía también se asoció con el número de cesáreas. Conclusiones: El riesgo de placenta accreta, histerectomía y rotura uterina aumenta con el número de cesáreas previas. (AU)

Interpregnancy interval and perinatal outcomes across Latin America from 1990 to 2009: a large multi-country study

Objective: To determine the relationship of interpregnancy interval with maternal and offspring outcomes. Design: Retrospective study with data from the Perinatal Information System database of the Latin American Centre for Perinatology and Human Development, Uruguay. Setting: Latin America, 1990-2009. Population: A cohort of 894 476 women delivering singleton infants. Methods: During 1990-2009 the Perinatal Information System database of the Latin American Centre for Perinatology identified 894 476 women with defined interpregnancy intervals: i.e. the time elapsed between the date of the previous delivery and the first day of the last normal menstrual period for the index pregnancy. Using the interval 12-23 months as the reference category, multiple logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) of the association between various interval lengths and maternal and offspring outcomes. Main outcome measures: Maternal death, pre-eclampsia, eclampsia, puerperal infection, fetal death, neonatal death, preterm birth, and low birthweight. Results: In the reference interval there was 0.05% maternal death, 1.00% postpartum haemorrhage, 2.80% pre-eclampsia, 0.15% eclampsia, 0.28% puerperal infection, 3.45% fetal death, 0.68% neonatal death, 12.33% preterm birth, and 9.73% low birthweight. Longer intervals had increased odds of pre-eclampsia (>72 months), fetal death (>108-119 months), and low birthweight (96-107 months). Short intervals of <12 months had increased odds of pre-eclampsia (aOR 0.80; 95% CI 0.76-0.85), neonatal death (aOR 1.18; 95% CI 1.08-1.28), and preterm birth (aOR 1.16; 95% CI 1.11-1.21). Statistically, the interval had no relationship with maternal death, eclampsia, and puerperal infection. Conclusions: A short interpregnancy interval of <12 months is associated with pre-eclampsia, neonatal mortality, and preterm birth, but not with other maternal or offspring outcomes. Longer intervals of >72 months are associated with pre-eclampsia, fetal death, and low birthweight, but not with other maternal or offspring outcomes. (AU)

A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study

Objective: To generate a global reference for caesarean section (CS) rates at health facilities. Design: Cross-sectional study. Setting: Health facilities from 43 countries. Population/sample: Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10,045,875 women giving birth from 43 countries for model testing. Methods: We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. Main outcome measures: Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. Results: According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/). Conclusions: This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. (AU)

Neonatal Near Miss: the need for a standard definition and appropriate criteria and the rationale for a prospective surveillance system

In Latin American, there is currently a regional action with the main purposes of putting the concept of severe neonatal morbidity in practice and formulating proposals for interventions. A general overview of neonatal health conditions, including morbidity and mortality, is provided to update regional knowledge on the topic. An example of the development and implementation of the concept of maternal near miss is also provided, followed by results from a systematic review covering all previously published studies on Neonatal Near Miss. Finally, some proposals for building a common concept on the topic and for launching a prospective surveillance study are presented. A Neonatal Near Miss is a neonate who had a severe morbidity (organ dysfunction or failure) but who survived this condition within the first 27 days of life. The pragmatic criteria recommended to be used are as follows: birth weight below 1700 g, Apgar score below 7 at 5 minutes of life and gestational age below 33 weeks. As a proxy for organ dysfunction, the following management criteria are also confirmed: parenteral therapeutic antibiotics; nasal continuous positive airway pressure; any intubation during the first 27 days of life; phototherapy within the first 24 h of life; cardiopulmonary resuscitation; the use of vasoactive drugs, anticonvulsants, surfactants, blood products and steroids for refractory hypoglycemia and any surgical procedure. Although this study starts from a regional perspective, this topic is clearly globally relevant. All nations, especially low and middle-income countries, could benefit from the proposed standardization. (AU)

Maternal morbidity after implementation of a postpartum hemorrhage protocol including use of misoprostol

Objective: To compare maternal morbidity before and after implementation of a postpartum hemorrhage (PPH) protocol that included misoprostol. Methods: A retrospective analysis was performed using data from 34 631 deliveries recorded at a Spanish hospital between January 1, 2007, and December 31, 2014. The PPH protocol was implemented in 2009 and included use of misoprostol and the Bakri balloon. Results: The pre-implementation and post-implementation groups comprised 9394 and 25 237 women, respectively. Women in the pre-implementation group tended to have lower hemoglobin levels than did those in the post-implementation group: 811 (8.6%) versus 1349 (5.3%) for levels less than 90 g/L, and 272 (2.9%) versus 497 (2.0%) for levels less than 80 g/L (both P<0.001). Implementation of the PPH protocol was also associated with a decrease in the frequency of postpartum hysterectomies owing to uterine atony (0.11 cases per 1000 deliveries vs 0.53 cases per 1000 deliveries for the pre-implementation group; P=0.063). Pregnancy length, maternal age, neonatal weight at delivery, multiple pregnancy, previous cesarean delivery, parity, operative vaginal delivery, induced labor, cesarean delivery, and not using the PPH protocol were found to predict postpartum anemia in the multivariate analysis (all P<0.001). Conclusion: Implementation of the PPH protocol decreased rates of postpartum anemia and postpartum hysterectomy owing to uterine atony. (AU)

Sistema Informático Perinatal (SIP): programas utilitarios y diagrama de redes: instrucciones de configuración del sistema

Las nuevas versiones de los programas del Sistema Informático Perinatal han sido preparadas para funcionar conformando una red hospitalaria, regional o nacional según diferentes modelos de complejidad. Esta nueva posibilidad facilita el flujo de información entre niveles para la major atención de la gestante y recién nacido, así como también para la gestión del sector, permitiendo centralizar bases de datos con información actualizada para evaluación y toma de decisiones de manera oportuna...

Saúde Sexual e Reprodutiva: Guias para a Atenção Continuada da Mulher e do Recém-Nascido focalizadas na APS

[Extraído do Prólogo]. "O presente manual tem como antecedente o livro “Atendimento Pré-natal e Parto de Baixo Risco”, que foi publicado pelo CLAP em 1995, sendo atualizado em todos os assuntos e com o seu enfoque ampliado, aprofundando os conteúdos dos cuidados pré-gestacionais com um critério de promoção e de prevenção que procura melhorar o estado de saúde da mulher, do seu parceiro e do seu filho/a, com medidas relativamente simples. Incorpora também novos aspectos sobre planejamento familiar com um enfoque de direitos, onde é incluída a anticoncepção de emergência e o conceito de atendimento integral para evitar as oportunidades perdidas e melhorar a eficiência dos contatos do pessoal de saúde com a mulher e seu filho/a" .

Sistema informático perinatal (SIP): historia clínica perinatal: formulario complementario para mujeres en situación de aborto: instrucciones de llenado y definición de términos

En este manual se describe en detalle la forma de llenado y la definición e interpretación de cada una de las variables que presenta la Historia Clínica Perinatal y del sector correspondiente a Mujeres en Situación de Aborto. La Historia Clínica deberá facilitar la atención, el monitoreo y la supervisión del cumplimiento de las normas, de tal manera que el sistema de salud cuente con información precisa y oportuna para la toma de decisiones. La riqueza de datos contenidos en la Historia Clínica Perinatal y sus formularios complementarios permiten constituir el banco de datos más valioso con que cuenta el equipo de salud, ya sea para conocer las características de la población prestataria, evaluar los resultados de la atención brindada, identificar los problemas prioritarios, monitorizar indicadores claves y realizar investigaciones operacionales y epidemiológicas.