Artigo original Resumo OBJETIVOS: avaliar a evolução da adequação do processo de atendimento às gestantes usuárias do Sistema Único de Saúde (SUS) e consolidar metodologia para monitoramento da assistência pré-natal. MÉTODOS: estudo de séries temporais múltiplas, com auditoria em cartões de gestantes que realizaram pré-natal em município do Sudeste brasileiro (Juiz de Fora, Minas Gerais) nos semestres iniciais de 2002 e 2004 (370 e 1.200 cartões, respectivamente) e utilizaram o SUS no atendimento ao parto a termo (p ≤ 0,05). Obedeceu-se a uma sequência em três níveis complementares: utilização do pré-natal (início e número de atendimentos) no nível 1; utilização do pré-natal e procedimentos clínicoobstétricos obrigatórios em uma consulta pré-natal [aferições de pressão arterial (PA), peso, altura uterina (AU), idade gestacional (IG), batimentos cardiofetais (BCFs) e apresentação fetal] no nível 2; e utilização, procedimentos clínico-obstétricos obrigatórios e exames laboratoriais básicos, segundo o Programa de Humanização no Pré-natal e Nascimento/PHPN [tipagem ABO/Rh, hemoglobina/hematócrito (Hb/Htc), VDRL, glicemia e exame comum de urina] no nível 3. RESULTADOS: confirmou-se a alta cobertura pré-natal (99%), aumento da média de consultas/gestante (6,4 versus 7,2%) e decréscimo da idade gestacional na primeira consulta (17,4 versus 15,7 semanas). Aumentaram significativamente os registros adequados dos procedimentos e exames (exceções: apresentação fetal e tipagem sanguínea):
To evaluate the incidence of and risk factors for hypertensive disorders in a cohort of HIV-infected pregnant women.
Hypertensive disorders (HD) including preeclampsia/eclampsia (PE/E) and pregnancy-induced hypertension, and risk factors were evaluated in a cohort of HIV-infected pregnant women from Latin America and the Caribbean enrolled between 2002-2009. Only pregnant women enrolled for the first time in the study and delivered at ≥ 20 weeks gestation were analyzed.
HD were diagnosed in 73 (4.8%, 95%CI: 3.8%-6.0%) of 1513 patients; 35(47.9%) had PE/E. HD was significantly increased among women with a gestational age-adjusted body mass index (gBMI) ≥ 25 kg/m2 (OR=3.1; 95%CI: 1.9-5.0), hemoglobin (Hg) ≥11 g/dL at delivery (OR=2.1; 95%CI: 1.2-3.6) and age ≥35 years (OR=1.8; 95%CI: 1.1-3.2). PE/E was increased among women with a gBMI ≥25 kg/m2 (OR=3.0; 95%CI: 1.5-6.0) and Hg ≥11 g/dL at delivery (OR=2.8; 95%CI: 1.2-6.5). A previous history of PE/E increased the risk of PE/E 6.7 fold (95%CI: 1.8-25.5). HAART before conception was associated with PE/E (OR=2.3; 95%CI: 1.1-4.9)
HIV-infected women, with a previous history of PE/E, a gBMI ≥25 kg/m2, Hg at delivery ≥11 g/dL and in use of HAART before conception are at an increased risk of developing PE/E during pregnancy.
Objective To define the prevalence of adverse outcomes of maternal infection in a large cohort of ZIKV-infected Brazilian women and their infants. Design Prospective population-based cohort study. Setting Ribeirão Preto's region's private and public health facilities. Population Symptomatic ZIKV-infected mothers and their infants. Methods Prenatal/early neonatal data were obtained for all mother-child pairs. A subgroup of infants had cranial ultrasonography, eye fundoscopy, hearing and neurological examinations and Bayley III screening tests within 3 months of age. Conclusions This prospective population-based study represents the largest Brazilian cohort study of ZIKV in pregnancy. Congenital anomalies potentially associated with CZS are less frequent than previously thought. There is a strong association between the gestational age of infection (≤11 weeks) and a poorer early infant prognosis. A notable proportion of apparently asymptomatic newborns can present with subclinical findings within 3 months of age.
To examine maternal characteristics associated with adverse pregnancy outcomes (APOs) among HIV-infected women.
Prospective cohort study
Multiple sites in Latin America and the Caribbean
First on-study pregnancy among HIV-1-infected women enrolled in NISDI (Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) International Site Development Initiative) Perinatal (2002–2007) and LILAC (2008–2012) studies.
Frequencies of APOs assessed among pregnancies. Risk factors investigated by logistic regression analysis.
Main Outcome measures
APOs including preterm delivery (PT), low birth weight (LBW), small for gestational age (SGA), stillbirth (SB) and neonatal death.
Among 1512 women, 1.9% (95% confidence interval [CI] 1.3–2.7%) of singleton pregnancies resulted in a stillbirth and 32.9% (30.6–35.4%) had at least one APO. Of 1483 singleton live births, 19.8% (17.8–21.9%) were PT, 14.2% (12.5–16.1%) were LBW, 12.6% (10.9–14.4%) were SGA, and 0.4% (0.2–0.9%) of infants died within 28 days after birth. Multivariable logistic regression modeling indicated that the following risk factors increased the probability of having one or more APOs: lower maternal body mass index (odds ratio [OR]=2.2; 95% CI: 1.4–3.5) at delivery, hospitalization during pregnancy (OR=3.3; 95% CI: 2.0–5.3), hypertension during pregnancy (OR=2.7; 95% CI: 1.5–4.8), antiretroviral use at conception (OR=1.4; 95% CI: 1.0–1.9) and tobacco use during pregnancy (OR=1.7; 95% CI: 1.3–2.2). Results of fitting multivariable logistic regression models for PT, LBW, SGA and SB are also reported.
HIV-infected women had relatively high occurrence of APOs and some maternal risk factors were associated with these APOs. Interventions targeting modifiable risk factors should be evaluated further.
We report 2 fatal cases of congenital Zika virus (ZIKV) infection. Brain anomalies, including atrophy of the cerebral cortex and brainstem, and cerebellar aplasia were observed. The spinal cord showed architectural distortion, severe neuronal loss, and microcalcifications. The ZIKV proteins and flavivirus-like particles were detected in cytoplasm of spinal neurons, and spinal cord samples were positive for ZIKV RNA.
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What are the novel findings of this work? Routine contingent screening for placenta accreta spectrum disorders based on the finding of placenta previa and previous uterine surgery is effective in a public healthcare setting. What are the clinical implications of this work? A contingent screening strategy for placenta accreta spectrum disorders is feasible in an ultrasound service where placenta localization is routinely performed. When linked to a placenta accreta diagnostic and surgical management service, adoption of such a screening strategy has the potential to significantly reduce the maternal morbidity and mortality associated with this condition.
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