Brazil Birth Research Articles

62 Maternal and neonatal outcomes associated with hypertensive disorders during pregnancy: Data from “Birth in Brazil” study

Objectives To describe outcomes associated with hypertensive disorders during pregnancy in Brazil. Introduction Hypertensive disorders represent the major maternal morbidity in middle-income countries, which can contribute to both maternal and neonatal adverse outcomes. “Birth in Brazil” study was the first national representative survey, offering the opportunity of evaluate this relationship in the country. Methods Birth in Brazil is a national hospital-based survey of postnatal women and newborns conducted between February 2011 and October 2012. We obtained data from hospital medical records and interviews of 23,894 women and their newborns in 266 hospitals with ⩾500 deliveries per year. This sample was stratified by Brazil’s five macro-regions, location (state capital or elsewhere) and type of hospital (private, public or mixed). We compared maternal and neonatal outcomes of women with and without hypertensive disorders using Chi-square Pearson test. Results The prevalence of hypertensive disorders during pregnancy was 12.5% ( n = 2999). Considering all women with hypertensive disorders, 63.7% ( n = 1910) had pre-eclampsia/gestational hypertension, 20.5% ( n = 614) superimposed pre-eclampsia, 11.4% ( n = 342) chronic hypertension and 0.4% ( n = 133) eclampsia. Women with hypertension during pregnancy were older (17.9% vs. 9.4% with ⩾35 years, p 11 years of schooling, p = 0.02) than women without hypertensive disorders. Also, women with hypertension during pregnancy had more previous cesarean (26.2% vs. 20.7%, p p = 0.002) and more pre-gestational diabetes (4.0% vs. 0.6%, p p p p p p p p Conclusions The prevalence of hypertensive disorders in Brazil seems to be slightly higher than other countries and had significant impact on maternal and neonatal outcomes. Public policies should emphasize the proper prenatal and intrapartum care in women with hypertension during pregnancy, avoiding delays in care.

Impact of maternal education level on risk of low Apgar score

ObjectiveTo investigate the association between 5-min Apgar score and socio-economic characteristics of pregnant women, particularly education level. Study designPopulation-based cross-sectional study. MethodsThis study used hospital records of live term singleton births in Brazil from 2004 to 2009, obtained from the Ministry of Health National Information System. Crude and adjusted odds ratios (ORs) were used to estimate the risk of a low 5-min Apgar score (≤6) associated with maternal education level, maternal age, marital status, primiparity, number of prenatal visits and mode of delivery (vaginal/caesarean section). ResultsNearly 12 million records were analysed. Births from mothers with 0, 1–3, 4–7 and 8–11 years of education resulted in crude ORs for low 5-min Apgar score of 3.1, 2.2, 1.8 and 1.3, respectively (reference: ≥12 years of education). The crude OR for mothers aged ≥41 years (reference 21–34 years) was 1.4, but no risk was detected for those with ≥12 years of education and those who gave birth by caesarean section (OR 1.0 [95% confidence interval 0.9–1.2]). Generally, the risk of a low 5-min Apgar score was found to increase as maternal age moved away from 21 to 34 years (OR 1.1–1.7), and for mothers with the same characteristics, the risk of a low 5-min Apgar score was found to decrease markedly as education level increased (adjusted OR decreased from 2.6 to 1.2). ConclusionMaternal education level is clearly associated with the risk of a low 5-min Apgar score.

Provider-Initiated Late Preterm Births in Brazil: Differences between Public and Private Health Services.

BackgroundA large proportion of the rise in prematurity worldwide is owing to late preterm births, which may be due to the expansion of obstetric interventions, especially pre-labour caesarean section. Late preterm births pose similar risks to overall prematurity, making this trend a concern. In this study, we describe factors associated with provider-initiated late preterm birth and verify differences in provider-initiated late preterm birth rates between public and private health services according to obstetric risk.MethodsThis is a sub-analysis of a national population-based survey of postpartum women entitled “Birth in Brazil”, performed between 2011 and 2012. We included 23,472 singleton live births. We performed non-conditional multiple logistic regressions assessing associated factors and analysing differences between public and private health services.ResultsProvider-initiated births accounted for 38% of late preterm births; 32% in public health services and 61% in private health services. They were associated with previous preterm birth(s) and maternal pathologies for women receiving both public and private services and with maternal age ≥35 years for women receiving public services. Women receiving private health services had higher rates of provider-initiated late preterm birth (rate of 4.8%) when compared to the ones receiving public services (rate of 2.4%), regardless of obstetric risk–adjusted OR of 2.3 (CI 1.5–3.6) for women of low obstetric risk and adjusted OR of 1.6 (CI 1.1–2.3) for women of high obstetric risk.ConclusionThe high rates of provider-initiated late preterm birth suggests a considerable potential for reduction, as such prematurity can be avoided, especially in women of low obstetric risk. To promote healthy births, we advise introducing policies with incentives for the adoption of new models of birth care.

The Burden of Provider-Initiated Preterm Birth and Associated Factors: Evidence from the Brazilian Multicenter Study on Preterm Birth (EMIP).

BackgroundAbout 15 million children are born under 37 weeks of gestation worldwide. Prematurity is the leading cause of neonatal deaths and short/long term morbidities, entailing consequences not only for the individual, but also their family, health agencies, facilities and all community. The provider-initiated preterm birth is currently one of the most important obstetric conditions related to preterm births, particularly in middle and high income countries, thus decreasing the need for therapeutic preterm birth is essential to reduce global prematurity. Therefore detailed knowledge on the factors associated with provider-initiated preterm birth is essential for the efforts to reduce preterm birth rates and its consequences. In this current analysis we aimed to assess the proportion of provider-initiated (pi-PTB) among preterm births in Brazil and identify associated factors.Methods and FindingsThis is an analysis of a multicenter cross-sectional study with a nested case-control component called Brazilian Multicenter Study on Preterm Birth (EMIP). EMIP was conducted in 20 referral obstetric hospitals located in the three most populated of the five Brazilian regions. We analysed data of women with pi-PTB, defined as childbirth occurring at less than 37 weeks, medically indicated for maternal/fetal compromise or both; and women with term birth, childbirth at or after 37 weeks. Maternal, sociodemographic, obstetric, prenatal care, delivery, and postnatal characteristics were assessed as possible factors associated with pi-PTB, compared to term births. The overall prevalence of preterm births was 12.3%. Of these, approximately one-third of cases were initiated by the provider. Hypertensive disorders, placental abruption, and diabetes were the main maternal conditions leading to pi-PTB. Caesarean section was the most common mode of delivery. Chronic hypertension (OR 7.47; 95%CI 4.02–13.88), preeclampsia/eclampsia/HELLP syndrome (OR 15.35; 6.57–35.88), multiple pregnancy (OR 12.49; 4.86–32.05), and chronic diabetes (OR 5.24; 2.68–10.25) were the most significant factors independently associated with pi-PTB.Conclusionspi-PTB is responsible for about one-third of all preterm births, requiring special attention. The decision-making process relative to the choice of provider-initiated birth is complex, and many factors should be elucidated to improve strategies for its prevention, including evidence-based guidelines on proper management of the corresponding clinical conditions.

Relationship Between The Obstetric Profile Of Mothers And The Need For Newborn Resuscitation

In most cases, the births in Brazil take place in a quiet way. However, as a transitional period susceptible to complications, the newborn may unexpectedly require resuscitation. Therefore, the presence of at least one trained professional in case of need to perform resuscitation is necessary. This study aimed to correlate the obstetric profile of mothers with neonatal resuscitation. The quantitative approach was used. Data were collected between February and March 2016, in a referral hospital in obstetrics, in a city of Cariri Region. To collect the data, we used a form that included questions related to the purpose of the study. After collection, the data were analyzed, and organized in Excel 2010 spreadsheets program, and presented through tables and graphs built in Word and Excel 2010 programs. We performed a Pearson correlation test with SPSS 22.0 program. With this study, it was concluded that there is a great relationship between the need for resuscitation maneuver and diseases during pregnancy, stock time and type of delivery. Also, deserves due attention to the statistical relationship between death and use of medication and meconium. The obstetric patient profile is important and must be considered in the clinical evolution of the newborn. Many of these factors can be identified even during pregnancy, during prenatal care, thus enabling the implementation of interventions in a timely manner.

P09.41 Chlamydia trachomatisscreening among preterm births in brazil: an experience from a university hospital

Background Premature birth (PPT) is a major determinant of neonatal morbimortality with adverse consequences for health. The causes are multifactorial, with intrauterine infection probably explains most of these outcomes. It is believed that infection with Chlamydia trachomatis (CT) is also involved in PPT and premature rupture of membranes. Our goal was to study the prevalence of CT in pregnant women and associated factors related to cases of PPT attended in an University Hospital in Vitoria, Brazil. Methods A cross-sectional study performed among parturient who have preterm birth in a University Hospital from June 2012 to August 2013. Participants answered a questionnaire including demographic, behavioural, and clinical data. A sample of urine was collected and screened for CT using polymerase chain reaction. Results The prevalence of PPT in the hospital during the period of the study was 26%. A total of 378 cases of PPT were registered, among them 323 women participated and were tested for CT, forty-five (13.9%) had a positive result. 31.6% was up to 24 years old and women infected by CT were younger than the others (p = 0.022). A total of 76.2% were married/living together, and CT was more frequent among the single ones (p = 0.018); 16.7% of women had their first sexual activity under 14 years old. The causes of prematurity were maternal-fetal in 40.9%, rupture of the membranes in 29.7% and premature labour in 29.4%. In multivariate analysis, being married was a protective factor for infection [OR = 12:48 (95% CI: 0.24–0.97)]. None of the other characteristics were associated with CT infection. Conclusions This study shows a high prevalence of preterm birth and CT infection among parturient who have preterm birth. This high prevalence increases the need for defining screening strategies and assistance during the prenatal period. Disclosure of interest statement There is no conflict of interest

Prematuridade e fatores associados em Santa Catarina, Brasil: análise após alteração do campo idade gestacional na Declaração de Nascidos Vivos

Objetivos:estimar a prevalência de prematuridade e os fatores associados, após a alteração do campo idade gestacional na Declaração de Nascidos Vivos, no Estado de Santa Catarina, Brasil, em 2012.Métodos:estudo seccional com base nos dados do Sistema de Informações de Nascidos Vivos (SINASC). Razões de Prevalência (RP) de prematuridade, brutas e ajustadas, por Regressão de Cox Robusta para o ano de 2012, foram calculadas e os resultados comparados aqueles reportados para 2005.Resultados:as taxas de prematuridade aumentaram de 6,1%, em 2005, para 10,6% em 2012. Ao se comparar os dois anos, maiores diferenças foram encontradas entre as mulheres com menor número de consultas pré-natal, menor nível de escolaridade e de cor não branca. Após o ajuste pelos fatores de confusão, as taxas de prematuridade se mostraram associadas à menor frequência de consultas de pré-natal (RP=2,64; IC95%: 2,58-3,28), menor escolaridade (RP= 1,65; IC95%: 1,11-2,45), idade materna <20 anos (RP= 1,24; IC95%: 1,17-1,31) e maior que 39 anos (RP= 1,32; IC95%: 1,17-1,49) e de cor não branca (RP=1,14; IC95%: 1,07-1,21.)Conclusões:mudanças no campo idade gesta-cional, agora preenchido como semanas completas de gestação, resultaram em medidas mais confiáveis das taxas de prematuridade no Brasil.

Impact of homicide and traffic crashes on life expectancy in the largest Latin American country

Brazil and Canada are on opposite poles of the spectrum for life expectancy in America. We identified factors underlying Brazil's lower life expectancy relative to Canada, with emphasis on the role of injury compared with other major causes. We computed life expectancy at birth in Brazil and Canada in 2010 and identified the ages and causes of death responsible for the gap between both countries. The main outcome measure was the contribution of homicide and traffic accidents to the gap, compared with other causes of death. Relative to Canada, life expectancy was lower in Brazil by 8.2 years (men) and 5.2 years (women). Injury lowered life expectancy of men in Brazil by 2.2 years, or more than a quarter of the gap, mainly due to homicide and traffic accidents between ages 20 and 64 years. Homicide and traffic accidents contributed more than all circulatory diseases combined. In women, circulatory disease was the most important cause of lower life expectancy. In 2010, homicides and traffic accidents were the principal cause for short life expectancy of men in Brazil. Improving life expectancy in Brazil requires addressing the root causes of inequalities that drive illicit drug trade, violence and accidents.

Nascer no Brasil: o retrato do nascimento na voz das mulheres

Nascer no Brasil conta a história de mulheres que enfrentam constrangimentos, em diferentes situações de parto, experimentando sentimentos de não acolhimento e de negligência em diversos hospitais e maternidades. Todas são protagonistas com suas histórias de expectativas, esperanças, alegria com o nascimento do bebê e, paradoxalmente, de sofrimento, sentimento de abandono, violência, incluindo a prevalência da intervenção desnecessária de procedimentos técnicos sobre a naturalidade da vida. O vídeo baseou-se na pesquisa Nascer no Brasil: Inquérito nacional sobre parto e nascimento, que envolveu pesquisadores de várias instituições científicas do país, sob a coordenação da Fundação Oswaldo Cruz (Fiocruz). Ele integra a série Nascer no Brasil que, como importante veículo audiovisual de divulgação científica, contribui para sensibilizar e informar os profissionais de saúde e o público em geral sobre os fatores fundamentais que devem ser considerados no acompanhamento dos partos.

Neonatal care in Brazil: hospital structure and adequacy according to newborn obstetric risk

Background:In Brazil, hospital birth care is available to all, but there are important differences between hospitals in the public and private sectors, geographical regions and capitals/inland cities, resulting in inequalities of infant health.Aims:To assess the hospital structure for birth care in Brazil and analyze hospital adequacy to care for newborns according to levels of risk.Methods:Data were collected as part of a nationwide hospital-based cohort study, ‘Birth in Brazil’. The hospitals were classified according to whether they had a neonatal intensive care unit and divided into two models of governance: public and private financing. Three structure domains were assessed: human resources, medications and equipment for post-natal women and newborn emergency care. Newborns were classified according to the obstetric risk.Results:There are more NICUs in private hospitals and they cater mostly for low obstetric risk newborns; the public sector serves 50% of at-risk patients in hospitals without an NICU. The differences between hospital service structures according to geographic region and capital/inland cities were evident. Hospitals in less developed regions and inland cities had poorer adequacy in the three domains.Conclusion:The distribution of neonatal care to Brazilian infants varied between the public and private sectors. The public sector offered less complex services for newborns at risk, and infants without obstetric risk were born in facilities with an NICU, creating the possibility of unnecessary intervention, especially in the private sector.

Prenatal testing and prevalence of HIV infection during pregnancy: data from the "Birth in Brazil" study, a national hospital-based study.

BackgroundThe rate of vertical HIV transmission has decreased in Brazil, but regional inequalities suggest problems in implementing control measures during pregnancy and delivery. The aims of this study were to ascertain the coverage of HIV testing during prenatal care and estimate the prevalence of HIV infection during pregnancy in Brazil.MethodsThis was a national hospital-based study of 23,894 women that was conducted in 2011–2012. The data came from interviews with mothers during postpartum hospitalization, from hospital medical files and from prenatal cards. All the pregnant women with reactive serological results for HIV infection marked on their cards or with diagnoses of HIV infection during the hospital stay for delivery were considered cases of HIV infection. Univariate and multivariable logistic regression were performed to investigate factors associated with the prevalence of HIV infection and with performing at least one HIV test during pregnancy.ResultsAmong participating women, the coverage of testing for HIV infection was 81.7% among those who presented with prenatal card and the prevalence of HIV infection among pregnant women was 0.4% (95% CI: 0.32-0.51%). In the adjusted analysis, there was higher coverage of testing among women living in the South and Southeast regions; of women aged 35 years and over; with greater schooling levels; who self-reported as white; with prenatal care provided in private services; with an early start to prenatal care; and with an adequate number of consultations, defined as a minimum of six for a term pregnancy. In the adjusted analyses there was a greater odds ratio of HIV infection among women living in the South region, aged 35 years and over, with schooling of less than 8 years, who self-reported race as black, without a partner, with syphilis coinfection and who were attended by public services.ConclusionsThe prevalence of HIV infection among pregnant women in Brazil remains below 1% and the coverage of testing for HIV infection is over 80%. However, the regional and social inequalities in access to healthcare services and the missed opportunities for diagnoses of HIV infection indicate the importance of strengthening HIV infection control programs during pregnancy.

Methodological issues on planning and running the Brazilian Multicenter Study on Preterm Birth.

Objectives. Assuming that the occurrence of preterm births and their maternal and neonatal associated conditions in Brazil are not completely known, a multicenter study was proposed. The purpose of this paper is to describe the methods used, its processes, achievements, and challenges. Study Design. A multicenter cross-sectional study on preterm births in Brazilian facilities plus a nested case-control study to assess their associated factors. A description of all steps of planning and implementing such a nationwide study, including strategies for dealing with problems arising during the process, is presented. Results. 20 referral hospitals in different regions of Brazil participated in the study. A detailed questionnaire for data collection, an electronic platform for data transcription and monitoring, research materials, and specific monitoring tools were developed; then data management and analyses were performed. Finally, we got information on 4,150 preterm births and 1,146 term births. Conclusions. This study represented the first step of a planned comprehensive assessment of preterm birth in Brazil, with detailed information that will lead to several analyses and further studies, bringing the knowledge to improve screening, diagnosis, and treatment practices in maternal and perinatal health with the final purpose of reducing the burden of this condition in the country.

Process of decision-making regarding the mode of birth in Brazil: from the initial preference of women to the final mode of birth.

The purpose of this article is to describe the factors cited for the preference for type of birth in early pregnancy and reconstruct the decision process by type of birth in Brazil. Data from a national hospital-based cohort with 23,940 postpartum women, held in 2011-2012, were analyzed according to source of funding for birth and parity, using the χ2 test. The initial preference for cesarean delivery was 27.6%, ranging from 15.4% (primiparous public sector) to 73.2% (multiparous women with previous cesarean private sector). The main reason for the choice of vaginal delivery was the best recovery of this type of birth (68.5%) and for the choice of cesarean, the fear of pain (46.6%). Positive experience with vaginal delivery (28.7%), cesarean delivery (24.5%) and perform female sterilization (32.3%) were cited by multiparous. Women from private sector presented 87.5% caesarean, with increased decision for cesarean birth in end of gestation, independent of diagnosis of complications. In both sectors, the proportion of caesarean section was much higher than desired by women.

Birth in Brazil "in time": a matter of hierarchy in birthcare interventions?

Initially, I should say of my satisfaction and sense of responsibility for commenting on an article drawn from the national survey Birth in Brazil. This survey is a milestone in the production of knowledge about birthcare models in the country, given its relevance, comprehensiveness and uniqueness. Except for c-section, episiotomy and painrelief in normal vaginal delivery, the other data presented on the article are unique. I had not known of information about the other obstetric practices and interventions during childbirth – nutrition, mobility, use of a partogram, use of peripheral intravenous line, oxytocin infusion, amniotomy, lithotomy position in labor, Kristeller maneuver (uterine fundal pressure during expulsion of fetus), and normal vaginal delivery without interventions –, other than in partial or limited studies. In addition, as commentator, I have the freedom-of-interpretation privilege without having to stick to the “immanence” of the results. It is probable that the “idea of safety” regarding birthcare, with timely interventions to prevent morbid outcomes is mixed up with the goals of swiftness and opportunism, in detriment of the “idea of physiology” of the birth. The c-section is a way to swiftly resolve delivery to low-risk (45.5%) and other pregnant women (60.3%). For women considered as being of low risk, another way to shorten delivery is to perform interventions that prompt, expedite, hasten, or quicken the care-provision process. The interventions that, successfully or not, accelerate the vaginal delivery include: amniotomy and oxytocin infusion for cervical dilation; Kristeller and episiotomy for fetus expulsion. For the women of the investigation, the mainstay of health-care delivery is centered in the clinic and the practitioner, rather than on the woman and the childbirth process. Thus, some of the results observed in the study include a higher exposure of nulliparous women to oxytocin infusion, Kristeller maneuver and episiotomy; higher chance of poorly educated women undergo amniotomy and receive oxytocin when giving birth in public health facilities; also for those who give birth in the Central region of the country, in addition to Kristeller maneuver and episiotomy. Even in birth centers where only low-risk women are attended, some unnecessary interventions are highly performed. Amniotomy and oxytocin infusion rates reach 75.1% and 46.3%, Maria Luiza Gonzalez Riesco

Percepções maternas no Método Canguru: contato pele a pele, amamentação e autoeficácia

O número crescente de nascimentos prematuros no Brasil e no mundo constitui um problema de saúde pública. Diante disso, surgiram modelos de assistência neonatal, como o Método Canguru (MC), que foi adotado no Brasil como política pública para recém-nascidos pré-termo de baixo peso (RNPB). É composto de três etapas - duas hospitalares e uma ambulatorial - e o período pós-natal é um tempo de adaptação e de aprendizagem para a mãe no contexto da prematuridade. O estudo objetivou descrever a realização da posição canguru e as práticas de amamentação, bem como avaliar a percepção de autoeficácia quanto aos cuidados e à interação com o neonato, ao longo das três etapas do MC, de puérperas de RNPB. Participaram dez mães de neonatos internados em uma unidade de referência do MC do Distrito Federal. Os instrumentos foram roteiros de entrevista e uma escala para avaliação de autoeficácia materna, aplicados nas três etapas. Os resultados referentes à posição canguru apontaram relação entre a frequência desse posicionamento no hospital e a prática do MC no domicílio. Sobre a amamentação, os dados indicaram a prevalência do aleitamento materno após a alta. Os dados evidenciaram que as etapas hospitalares do MC contribuíram para a aquisição de autoeficácia das mães em relação aos cuidados com seus filhos e à interação com eles. Com base na percepção de mães que vivenciaram o MC foi possível descrever aspectos relevantes do método ao longo de suas etapas, o que pode contribuir para a qualificação de intervenções da equipe multiprofissional.

Dornase alpha use in patients with cystic fibrosis

Cystic Fibrosis (FC) is an autosomal recessive disorder with an estimated incidence of one in 7,500 live births in Brazil, varying in different states( 1 ). The gene in question encodes a protein called cystic fibrosis transmembrane conductance regulator (CFTR), involved in the transepithelial transport of ions and water. It affects, thus, the epithelial organs whose secretions are thick, with consequent obstruction and development of classical clinical changes. In the bronchial tubes, thickened secretions predispose to the onset of infection, which leads to a vicious cycle of increased clogging and tendency of recurrent infections. About 10% of sputum in these patients is made up of DNA, primarily from leukocytes that migrate into the bronchial lumen to fight infection( 2 ). Within this perspective, the use of effective mucolytics was always sought for a better management of CF, aiming at improving the quality of life and reducing the associated morbidity. From about two decades ago, dornase alfa has been recommended for use in patients with CF. Its action, cleaving DNA, dilutes secretions, being effective in reducing the decline in lung function and decreasing the number of pulmonary exacerbations, according to a randomized clinical trial published in 1994( 3 ). Later, other studies showed that the drug was effective in reducing pulmonary exacerbations and improving other functional outcomes, even in patients with incipient pulmonary disease, still with normal functional parameters( 4 - 9 ). The proven effectiveness of dornase alfa in such conditions led to its inclusion in consensus guidelines on the management of CF lung disease for children over 6 years of age( 10 , 11 ). In this issue of Revista Paulista de Pediatria, Rozov et al present an elegant study, in which they aggregate evidence for the use of dornase alfa in children and adolescents with CF( 12 ). The Brazilian multicenter study evaluated patients over 5 years of age who had not received the drug. CF is a genetic disorder whose development is influenced by environmental factors. Therefore, the merit of this study lies in the fact that it demonstrates the benefits of dornase alfa in Brazilian patients, regarding the reduction of visits to the emergency room, an outcome associated with quality of life. Previously, the authors had already published results of quality of life for these patients, showing improvements in many areas after the introduction of this medication( 13 ). A limitation of the study that should be mentioned is its uncontrolled design. There are inherent limitations to studies with a design of before and after. Patients monitored in surveys tend to be more compliant and subject to the placebo effect. However, ethical constraints absolve the authors as to the choice of the design, since there was already evidence of the benefit of the drug in children older than 6 years, a fact that advised against a control group with placebo.

PIH22 - Systematic Literature Review and Cost-effectiveness Analysis of Fetal Fibronectin Test for Predicting Preterm in Brazil

Brazil is among the countries with the highest incidence of preterm births. Incorporation of diagnostic tests to predict a preterm birth could improve the efficiency of the clinical practice reducing hospital expenses related to maternal hospitalization. The aim of this study was to compare the cost-effectiveness of fibronectin testing (FN) vs cervical length (CL) measurement in women with symptomatic preterm labor. Systematic review of the literature of the diagnostic tests and development of a decision analytic model using the accuracy of the diagnostic tests to predict preterm birth and project the results in terms of effectiveness and cost. The analysis was performed for a hypothetical cohort of 10,000 patients, for each test, with symptomatic preterm labor between 24 and 34 weeks of gestation. The primary perspective of the study was of the Brazilian Health system (SUS). Data sources were the medical literature, SUS official published prices for medicines and DATASUS (SUS database). Costs are in 2012 Brazilian Reais. A total of 14 studies were included. There was a wide variation concerning the accuracy of the tests among the studies, particularly with respect to gestational age at testing/delivering and definition of the CL test threshold. The values obtained were LR+ 3,98/LR- 0,33 (FN) and LR+ 2,22/LR- 0,54 (CL). For the whole hypothetical cohort the total costs of the FN and CL were 2,3 billion and 890 million, respectively. The difference of avoided hospitalizations between the tests was 244 for FN. ICER was BRL 5,834,35. Both diagnostic tests are important alternatives for the detection of premature birth in Brazil. Studies of prediction of preterm delivery using CL have important limitations beyond the fact that CL measure is an operator/machine dependent procedure. In women with symptomatic preterm labor FN is a cost-effective test strategy for prediction of preterm births.

Helicobacter pylori Infection in Infants and Toddlers in South America: Concordance between [ 13 C]Urea Breath Test and Monoclonal H. pylori Stool Antigen Test

Accurate noninvasive tests for diagnosing Helicobacter pylori infection in very young children are strongly required. We investigated the agreement between the [(13)C]urea breath test ([(13)C]UBT) and a monoclonal ELISA (HpSA) for detection of H. pylori antigen in stool. From October 2007 to July 2011, we enrolled 414 infants (123 from Brazil and 291 from Peru) of ages 6 to 30 months. Breath and stool samples were obtained at intervals of at least 3 months from Brazilian (n = 415) and Peruvian (n = 908) infants. [(13)C]UBT and stool test results concurred with each other in 1,255 (94.86%) cases (kappa coefficient = 0.90; 95% confidence interval [CI] = 0.87 to 0.92). In the H. pylori-positive group, delta-over-baseline (DOB) and optical density (OD) values were positively correlated (r = 0.62; P < 0.001). The positivity of the tests was higher (P < 0.001; odds ratio [OR] = 6.01; 95% CI = 4.50 to 8.04) in Peru (546/878; 62.2%) than in Brazil (81/377; 21.5%) and increased with increasing age in Brazil (P = 0.02), whereas in Peru it decreased with increasing age (P < 0.001). The disagreement between the test results was associated with birth in Brazil and female gender but not with age and diarrhea. Our results suggest that both [(13)C]UBT and the stool monoclonal test are reliable for diagnosing H. pylori infection in very young children, which will facilitate robust epidemiological studies in infants and toddlers.

O391 SOCIOECONOMIC INEQUALITIES, BIRTH COMPANION AND MOTHER-BABY CONTACT AT BIRTH IN BRAZIL

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S399-S399 Free communication (oral) presentations O391 SOCIOECONOMIC INEQUALITIES, BIRTH COMPANION AND MOTHER-BABY CONTACT AT BIRTH IN BRAZIL A.P.E. Pereira, A.P.E. PereiraSearch for more papers by this authorM.H. da S. Bastos, M.H. da S. BastosSearch for more papers by this authorM.M. Theme, M.M. ThemeSearch for more papers by this authorM. do C. Leal, M. do C. LealSearch for more papers by this author A.P.E. Pereira, A.P.E. PereiraSearch for more papers by this authorM.H. da S. Bastos, M.H. da S. BastosSearch for more papers by this authorM.M. Theme, M.M. ThemeSearch for more papers by this authorM. do C. Leal, M. do C. LealSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)60821-2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S399-S399 RelatedInformation

Birth in Brazil: national survey into labour and birth

BackgroundCaesarean section rates in Brazil have been steadily increasing. In 2009, for the first time, the number of children born by this type of procedure was greater than the number of vaginal births. Caesarean section is associated with a series of adverse effects on the women and newborn, and recent evidence suggests that the increasing rates of prematurity and low birth weight in Brazil are associated to the increasing rates of Caesarean section and labour induction.MethodsNationwide hospital-based cohort study of postnatal women and their offspring with follow-up at 45 to 60 days after birth. The sample was stratified by geographic macro-region, type of the municipality and by type of hospital governance. The number of postnatal women sampled was 23,940, distributed in 191 municipalities throughout Brazil. Two electronic questionnaires were applied to the postnatal women, one baseline face-to-face and one follow-up telephone interview. Two other questionnaires were filled with information on patients’ medical records and to assess hospital facilities. The primary outcome was the percentage of Caesarean sections (total, elective and according to Robson’s groups). Secondary outcomes were: post-partum pain; breastfeeding initiation; severe/near miss maternal morbidity; reasons for maternal mortality; prematurity; low birth weight; use of oxygen use after birth and mechanical ventilation; admission to neonatal ICU; stillbirths; neonatal mortality; readmission in hospital; use of surfactant; asphyxia; severe/near miss neonatal morbidity. The association between variables were investigated using bivariate, stratified and multivariate model analyses. Statistical tests were applied according to data distribution and homogeneity of variances of groups to be compared. All analyses were taken into consideration for the complex sample design.DiscussionThis study, for the first time, depicts a national panorama of labour and birth outcomes in Brazil. Regardless of the socioeconomic level, demand for Caesarean section appears to be based on the belief that the quality of obstetric care is closely associated to the technology used in labour and birth. Within this context, it was justified to conduct a nationwide study to understand the reasons that lead pregnant women to submit to Caesarean sections and to verify any association between this type of birth and it’s consequences on postnatal health.