Vitamin A is a crucial micronutrient for pregnant women and their fetuses. In addition to being essential for morphological and functional development and for ocular integrity, vitamin A exerts systemic effects on several fetal organs and on the fetal skeleton. Vitamin A requirements during pregnancy are therefore greater. Vitamin A deficiency (VAD) remains the leading cause of preventable blindness in the world. VAD in pregnant women is a public health issue in most developing countries. In contrast, in some developed countries, excessive vitamin A intake during pregnancy can be a concern since, when in excess, this micronutrient may exert teratogenic effects in the first 60 days following conception. Routine prenatal vitamin A supplementation for the prevention of maternal and infant morbidity and mortality is not recommended; however, in regions where VAD is a public health issue, vitamin A supplementation is recommended to prevent night blindness. Given the importance of this topic and the lack of a complete, up-to-date review on vitamin A and pregnancy, an extensive review of the literature was conducted to identify conflicting or incomplete data on the topic as well as any gaps in existing data.

BackgroundMaternal mortality remains a major public health issue worldwide, with persistent high rates prevailing principally in underdeveloped countries. The objective of this study was to determine the risk factors for severe maternal morbidity and near miss (SMM/NM) in pregnant and postpartum women at the maternity ward of the Dom Malan Hospital, Petrolina, in northeastern Brazil.MethodsA retrospective, cohort study was conducted to evaluate the sociodemographic and obstetric characteristics of the women. Patients who remained hospitalized at the end of the study period were excluded. Risk ratios (RR) and their respective 95% confidence intervals (95% CI) were calculated as a measure of relative risk. Hierarchical multiple logistic regression was also performed. Two-tailed p-values were used for all the tests and the significance level adopted was 5%.ResultsA total of 2,291 pregnant or postpartum women receiving care between May and August, 2011 were included. The frequencies of severe maternal morbidity and near miss were 17.5% and 1.0%, respectively. Following multivariate analysis, the factors that remained significantly associated with an increased risk of SMM/NM were a Cesarean section in the current pregnancy (OR: 2.6; 95% CI: 2.0 – 3.3), clinical comorbidities (OR: 3.4; 95% CI: 2.5 – 4.4), having attended fewer than six prenatal visits (OR: 1.1; 95% CI: 1.01 – 1.69) and the presence of the third delay (i.e. delay in receiving care at the health facility) (OR: 13.3; 95% CI: 6.7 – 26.4).ConclusionsThe risk of SMM/NM was greater in women who had been submitted to a Cesarean section in the current pregnancy, in the presence of clinical comorbidities, fewer prenatal visits and when the third delay was present. All these factors could be minimized by initiating a broad debate on healthcare policies, introducing preventive measures and improving the training of the professionals and services providing obstetric care.

IntroductionThe incidence of cancer is increasing worldwide and with it the prevalence of malnutrition, which is responsible for the death of almost 20 % of cancer patients. The objective of this study was to identify the factors associated with malnutrition in hospitalized cancer patients.MethodsCross-sectional study conducted with 277 hospitalized patients in the Institute of Integrative Medicine Prof. Fernando Figueira from March to November 2013. The nutritional status was classified as well-nourished and moderate/severe malnutrition, according to the Patient-Generated Subjective Global Assessment. The association between moderate/severe malnutrition and demographic, behavioral, socioeconomic, clinical, therapeutic and nutritional variables was investigated through univariate regression and hierarchical Poisson models, with a 5 % significance level.ResultsThe prevalence of malnutrition was 71.1 %, being classified as moderate in 35.4 % and severe in 35.7 %. After multivariate analysis, smokers/ex-smokers low socioeconomic status, performance status ≥2 and age ≥60 years were associated with increased risk of malnutrition.ConclusionThere was observed a high prevalence of moderate/severe malnutrition in cancer patients, with the increased risk of malnutrition associated with the presence of factors that can be assessed during hospital admission suggesting a higher alert of the medical and health care staff about the need for nutritional assessment and intervention.

SARS-CoV-2, the new coronavirus of severe acute respiratory syndrome, which causes a predominantly respiratory disease called COVID-19, quickly caused a pandemic, due to its high transmissibility, leaving a trail of deaths around the world. Initially, the pregnancy puerperal cycle was not associated with complications and mortality, only later was recognized as a risk group. As the disease progressed, the maternal mortality rate by COVID-19 increased, Brazil is responsible for an important portion. This rate may be even higher due to underreporting, difficulties in performing laboratorial tests and possible false negative results and depends on the health policies adopted by each region or country. It is important to carry out studies on maternal mortality so that the prognostic factors can be recognized and so avoid them.

Objectives To evaluate Doppler velocimetry (resistance index (RI) and peak systolic velocity (PSV)) in the maternal-fetal circulation before and 5 and 24 h after tocolysis with oral nifedipine. Methods

Background The induction of full-term labour in women with a live fetus remains a major challenge in modern obstetrics.Objectives To determine, using the best level of evidence available, the efficacy and safety of sublingual administration of misoprostol compared with vaginal misoprostol in the third trimester of pregnancy for the induction of labour, according to initial doses, in women with a live, full-term fetus and an unripe cervix.Search strategy Pubmed/Medline, Lilacs and Scielo databases were consulted, as well as clinical trials registered in the Cochrane Register from January 1996 to February 2008, using the keywords 'misoprostol', 'labour, obstetric', 'delivery, obstetric', 'induced labour' and 'parturition' with the search limits of 'clinical trials' and 'randomised clinical trials'.Selection criteria This review contains randomised clinical trials in which the sublingual and vaginal routes of administration of misoprostol were compared. Participants were pregnant women with an indication for induction of labour and a live fetus more than 37 weeks of gestational age.Data collection and analysis The primary analysis compared sublingual and vaginal routes of administration of misoprostol. Secondary analyses compared different routes and initial doses of misoprostol. Statistical analysis included odds ratios and their respective 95% CI. To evaluate the heterogeneity of the studies, the I-squared test was used, studies being considered heterogeneous when I 2 was greater than 50%.Main results Five good quality clinical trials involving a total of 740 women were eligible, and all were included. No statistically significant difference was found between the sublingual and the vaginal misoprostol groups with respect to the rate of vaginal delivery not achieved within 24 hours (OR 1.27, 95% CI 0.87-1.84), uterine hyperstimulation syndrome (OR 1.20, 95% CI 0.61-2.33) or caesarean section (OR 1.33, 95% CI 0.96-1.85). An increased risk of uterine tachysystole was found in the sublingual misoprostol group (OR 1.70, 95% CI 1.02-2.83). When the studies were grouped according to the initial dose of misoprostol, no significant difference was found between sublingual or vaginal groups.Author's conclusions The sublingual route of administration is as effective as the vaginal route in inducing labour in full-term pregnancies with live fetuses. However, the safety, adverse effects, optimal dose and perinatal outcome related to this route of administration remain to be established, and it cannot be recommended for routine use in obstetric practice.

None.

No abstract