OBJECTIVE:To evaluate the quality of information registered on fetal death certifi cates. METHODS:Records were reviewed from 710 fetal deaths registered in the consolidated database of deaths from the State System for Data Analysis and the São Paulo State Secretary of Health, for deaths in São Paulo municipality (Southeastern Brazil) during the fi rst semester of 2008. Completeness was analyzed for variables on fetal death certifi cates issued by hospitals and autopsy service. The death certifi cates from a sub-sample of 212 fetal deaths in hospitals of the National Unifi ed Health System (public) were compared to medical records and to the records from Coroner's Offi ce. RESULTS:Among death certifi cates, 75% were issues by Coroner's Offi ce, with Coroner's greater frequency in public hospitals (78%). Completeness of variables on death certifi cates issued by hospitals was higher among nonpublic hospitals. There was greater completeness, agreement and sensitivity in death certifi cates issued by hospitals. There was low agreement and high specifi city for variables related to maternal characteristics. Increased reporting of gender, birth weight and gestational age was observed in certifi cates issued by Coroner's Offi ce. Autopsies did not result in improved ascertainment of cause of death, with 65.7% identifi ed as unspecifi ed fetal death as 24.3% as intrauterine hypoxia, while death certifi cates by hospitals reported 18.1% as unspecifi ed and 41.7% as intrauterine hypoxia. CONCLUSIONS:Completeness and the ascertainment of cause of fetal death need to be improved. The high proportion of autopsies did not improve information and ascertainment of cause of death. The quality of information generated by autopsies depends on access to hospital records.
It is known that the development of diabetic complications in human pregnancy is directly related to the severity and the duration of this pathology. In this study, we developed a model of long-term type 1 diabetes to investigate its effects on the cytoarchitecture, extracellular matrix and cell proliferation during the first adaptation phase of the myometrium for pregnancy. A single dose of alloxan was used to induce diabetes in mice prior to pregnancy. To identify the temporal effects of diabetes the mice were divided into two groups: Group D1 (females that became pregnant 90-100 days after alloxan); Group D2 (females that became pregnant 100-110 days after alloxan). Uterine samples were collected after 168 h of pregnancy and processed for light and electron microscopy. In both groups the histomorphometric evaluation showed that diabetes promoted narrowing of the myometrial muscle layers which was correlated with decreased cell proliferation demonstrated by PCNA immunodetection. In D1, diabetes increased the distance between muscle layers and promoted oedema. Contrarily, in D2 the distance between muscle layers decreased and, instead of oedema, there was a markedly deposition of collagen in the myometrium. Ultrastructural analysis showed that diabetes affects the organization of the smooth muscle cells and their myofilaments. Consistently, the immunoreaction for smooth muscle α-actin revealed clear disorganization of the contractile apparatus in both diabetic groups. In conclusion, the present model demonstrated that long-term diabetes promotes significant alterations in the myometrium in a time-sensitive manner. Together, these alterations indicate that diabetes impairs the first phenotypic adaptation phase of the pregnant myometrium.
The change in the distribution of gestational age in SP is related to the type of hospital and the proportion of cesarean sections in private hospitals.
BackgroundThere is a global growing trend of preterm births and a decline trend of fetal deaths. Is there an impact of the decline of fetal mortality on the increase of preterm live births in State of Sao Paulo, Brazil?MethodsThe time trends were evaluated by gestational age through exponential regression analysis. Data analyzed included the fetal mortality ratio, proportion of preterm live births, fertility rate of women 35 years and over, prenatal care, mother's education, multiple births and cesarean section deliveries. A survival analysis was carried out for 2000 and 2010.ResultsPreterm births showed the highest annual increase (3.2 %) in the less than 28 weeks of gestation group and fetal mortality ratio decreased (7.4 %) in the same gestational age group. There was an increase of cesarean section births and it was higher in the < 28 weeks group (6.1 %). There was a decreased annual trend of mothers with inadequate prenatal care (6.1 %) and low education (8.8 %) and an increased trend in multiple births and fertility rates of women of 35 years and over. The variables were highly correlated to which other over time. In 2000, 8.2 % of all pregnancies resulted in preterm births (0.9 % in fetal deaths and 7.3 % in live births). In 2010, the preterm birth increased to 9.4 % (0.8 % were preterm fetal deaths and 8.6 % preterm live births).ConclusionsThe results suggest that 45.2 % could be the maximum contribution of successful interventions to prevent a fetal death on the increase in preterm live births. This increasing trend is also related to changes of the women reproductive profile with the change of the women reproductive profile and access to prenatal care.
Introduction:The insatisfactory completeness of the variables in the Death Certificate (DC) makes it difficult to obtain specific perinatal mortality indicators. Objective: To assess the social representation of physicians about the perinatal DC. Methods: Twenty-five physicians were interviewed in 15 hospitals in the city of São Paulo, in 2009. Qualitative analysis was performed with the Collective Subject Discourse technique. Results: The DC is primarily considered according to its legal aspect. Physicians feel responsible for fulfilling the cause of death. The majority of them reported receiving help from other professionals to complete information on maternal characteristics and identification variables. There is lack of information on the mother's pre-natal conditions, which can make it difficult to identify the perinatal cause of death, mainly in the Unified Health System (SUS) hospitals. Some participants received specific DC training only when attending medical schools. Conclusions: The organization of medical work may affect the completion of the DC, especially in hospitals from SUS. Other professionals contributed to this task and their training can improve the quality of information.
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