High-risk Maternity Hospital Research Articles

Logical model of reception and risk classification for women with pre-eclampsia and eclampsia.

To describe the validation of the Logical Model of Reception and Risk Classification for women with pre-eclampsia/eclampsia in a high-risk maternity hospital. Evaluative research with a quantitative approach. The elaboration and validation of the Logical Model were systematized in stages related to the scope review, preparation of the document guided by the Donabedian model and validation by 12 stakeholders, aiming at the assessment of the Content Validation Index. The problem that gave rise to the intervention was elaborated, supporting the construction of the Logical Model. Agreement was reached on 24 items, reaching a Content Validation Index of 0.99. Stakeholders included contributions regarding correlations between elements of the structure and process. The document achieved high content validity and could contribute to decision-making by managers in the Reception and Risk Classification sectors for women with pre-eclampsia and/or eclampsia.

Osteopenia of prematurity and associated nutritional factors: case–control study

BackgroundPreterm newborn nutrition affects postnatal skeletal growth and bone mineralization, but studies have not yet fully concluded the relationship between nutrition and osteopenia. This study was intended to investigate the impact of nutritional factors on osteopenia in preterm newborns.MethodsThis is a case–control study with babies born with gestational age ≤ 32 weeks in a high-risk maternity hospital, between 2018 and 2019. The population consisted of 115 newborns, being 46 cases (40%) and 69 controls (60%). Disease outcome was based on serum alkaline phosphatase levels > 900UL/l and hypophosphatemia < 4 mg/dl. Gestational data at birth and clinical and nutritional follow-up data during 8 weeks postnatally were assessed. Variables were assessed using regressive logistic models.FindingsPreterm infants who were fed pasteurized fresh human milk with acidity ≥ 4 ºDornic are 5.36 times more likely to develop osteopenia (p = 0.035). Higher calcium intake, compared to controls, also increased the probability of disease occurrence [OR 1.05 (CI 1.006–1.1); p = 0.025], while the presence of a partner [OR 0.10 (CI 0.02–0.59); p = 0.038] and the shortest time using sedatives [OR 0.89 (CI 0.83–0.98); p = 0.010] were protective factors associated with osteopenia. Extremely low birth weight [OR 5.49 (CI 1.20–25.1); p = 0.028], sepsis [OR 5.71 (CI 1.35–24.2); p = 0.018] and invasive ventilatory support [OR 1.09 (CI 1.03–1.18); p = 0.007] were risk factors.ConclusionsAcidity and high calcium intake are the main nutritional factors associated with osteopenia of prematurity. Further studies on the use of human milk with lower acidity, recommendation and nutritional supplementation of calcium should be accomplished to guide prevention strategies in newborns at risk for osteopenia during hospital stay.

Socio-demographic profiles and obstetrics outcomes of pregnant women with epilepsy in a vulnerability State, Brazil.

IntroductionThe socio-demographic profile of pregnant women in low- and middle- income countries is characterized by low educational attainment and unemployment, leading to social and economic morbidity. characterized by limited opportunities for education, employment, and marriage, which are strongly related to the stigmatization of the disease. The study of the socio- profile and obstetric outcomes of pregnant women with epilepsy in Alagoas, Brazil, may help understand this scenario and facilitate the development of public policy strategies to reduce local morbidity.ObjectivesWe aimed to describe the sociodemographic profile of pregnant women with epilepsy and obstetric outcomes in Alagoas, Brazil.MethodsThis cohort study was based on medical records of pregnant women with epilepsy in Brazilian high-risk maternity hospitals from 2008 to 2020. The following data were collected: age, race, education, marital status, occupation, number of pregnancies, delivery, and abortion. The inclusion criteria were pregnant women with and without epilepsy (control group) aged < 40 years.ResultsThe prevalence of PWWE was 0.49% (n = 224/44,917). Cesarean delivery was more frequent in PWWE than in pregnant women without epilepsy (adjusted odds ratio [OR] = 22.0; 95% confidence interval [CI] = 14.35–33.73; p<0,01). Abortion was associated with PWWE (OR adjusted = 1.72; 95% CI = 1.13–2.61; p = 0.01). Pregnant women in the countryside were more likely to develop epilepsy than those born in the capital (OR = 1.55; 95% CI = 1.12–2.14; p <0.01).ConclusionThe PWWE socio-demographic profile of the Alagoas had a predominance of brown- colored skin, single status, homemakers, and illiteracy with a high proportion residing in the interior of the state. The obstetrics data show a higher incidence of cesarean deliveries and miscarriages.

SARS-CoV-2 infection in pregnant women assisted in a high-risk maternity hospital in Brazil: Clinical aspects and obstetric outcomes

BackgroundThe spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the possible development of serious illness, and the possibility of severe obstetric outcomes highlight the importance of addressing SARS-CoV-2 infection in obstetric management.Methods and findingsA cross-sectional study of pregnant women assisted in a high-risk maternity hospital in Brazil in 2020. All patients admitted for delivery or miscarriage care were tested for SARS-CoV-2 using polymerase chain reaction (PCR) and for immunoglobulin (I)gM, and/or IgG by immunochromatography. Clinical aspects and obstetric outcomes were analyzed. A total of 265 pregnant women were included in the study. There were 38 (14.4%) PCR positive cases during pregnancy, 12 (31.6%) on admission screening, and 71(27.2%) patients were IgM- and/or IgG-positive. Among the participants, 86 (32.4%) had at least one positive test during pregnancy. SARS-CoV-2 positive patients had greater contact with known positive patients (p = 0.005). The most frequently reported symptoms were runny nose, cough, loss of smell and taste, headache, and fever. There was also a 35% rate of asymptomatic infections and a 4.6% rate of severe or critical infections. Patients exposed or infected with SARS-CoV-2 had a higher incidence of preterm delivery, cesarean section, need for resuscitation in the delivery room, Apgar score <7 at 5 min, admission to the neonatal intensive care unit, and jaundice. Newborns with at least one positive test had a significantly greater need for phototherapy after delivery (p = 0.05). The results showed a high rate of positive tests among newborns (37.5%), which seems to be compatible with both neonatal and perinatal infection.ConclusionsIt is important to further investigate SARS-CoV-2 infection during pregnancy, including the clinical course and the possibility of adverse outcomes with impact on maternal and fetal health, regardless of the development of symptoms.

Non-invasive technologies in assisting high-risk parturient women: nurse-midwives’ perceptionss

Objective: to know nurse-midwives’ perceptions about factors related with the use of non-invasive care technologies in the care of high-risk parturient women. Methods: qualitative study, with 10 nurse-midwives from the obstetric center of a high-risk maternity hospital in a university hospital. Data were collected by semi-structured interviews and subjected to content analysis. Results: prenatal care with a focus on female autonomy, the availability of specific materials and the sector’s infrastructure are facilitating factors. Work overload, the devaluation of nurse-midwives’ knowledge by some medical professionals and the lack of institutional support for teamwork are limiting factors. Conclusion: the factors referred to show the need to boost collaborative work in assisting high obstetric risk, encourage the use of non-invasive care technologies and improve nurses’ working conditions.

USE OF OFF-LABEL MEDICATIONS IN A NEONATAL INTENSIVE CARE UNIT.

ABSTRACTObjective: This paper aims to analyze the use of off label (OL) medicines, according to the National Regulatory Agency, in a neonatal intensive care unit of a high-risk maternity hospital in Northeast Brazil.Methods: A cross-sectional study was carried out, using a convenience sample of newborns that used mechanical ventilation at the Intensive Care Unit. As a reference, OL medications were considered for those without an approval for newborn usage by the Brazilian Health Regulatory Agency (Agência Nacional de Vigilância Sanitária - ANVISA) and by the Food and Drugs Administration (FDA).Results: The sample consisted of 158 newborns, 58.3% male, 87.7% premature, and 70.2% of low or very low birth weight. According to ANVISA, 440 out of the 1,167 prescriptions analyzed were OL, with 98.1% of newborns exposed to at least one of these drugs. According to the FDA, 484 prescriptions were OL, with 75.8% of newborns exposed to at least one of them. Anti-infectives were the most prescribed OL medications. Neonates who presented respiratory failure and pneumonia used these drugs more often; and there was no relation between their use and the number of deaths.Conclusions: Nearly all newborns at the Intensive Care Units, mainly preterm infants, are exposed to at least one off-label (OL) medication during hospital stay, according to the national and international regulatory agencies. No association was found between off-label prescriptions and the frequency of complications or neonatal deaths.

Ventricular-Peritoneal Shunt in Newborns in a High-Risk Maternity Unit: Case Series

Abstract Objective To identify factors related to ventricular-peritoneal shunt (VPS) complications in pediatric patients at a high-risk maternity hospital. Methods Prospective study, conducted between September/2018 and June/2019, with selected newborns without previous ventricular bypass who underwent neurosurgery for VPS placement in a high-risk maternity hospital in the state of Sergipe, Brazil. Diagnosis of hydrocephalus occurred by transfontanelle ultrasound. The variables were analyzed by Student t-test, adopting p &lt; 0.05 as statistical significance. Results Seven newborns participated in the study, 3 male and 4 female. Folic acid supplementation during pregnancy was considered a positive influencing factor in the 1st minute Apgar. Hydrocephalus secondary to premature hemorrhage was present in most newborns. Prematurity, 1st minute Apgar score &lt; 7, and birth weight &lt; 2,500 g did not represent a significant negative risk factor for prolonged hospitalization after neurosurgery. One newborn had cerebrospinal fluid infection and was the only one with heart disease. Conclusion This is the first scientific research that associates the benefits of maternal use of folic acid during pregnancy to better newborn Apgar scores. Only one newborn developed complications after neurosurgery, the only one with an associated comorbidity. Further studies are needed to provide more evidence on risk factors related to complications of VPS implantation in newborns. This neurosurgical procedure in a high-risk maternity contributed to the early management of hydrocephalus.

Adverse outcomes of childbirth in high-risk maternity hospitals

Abstract Objectives: to analyze adverse outcomes in teaching maternity hospitals in Maceió, Alagoas, Brazil. Methods: a cross-sectional, retrospective and analytical study was carried out with a random sample of 480 medical records of postpartum women in 2016 using the Adverse Outcome Index: in-hospital maternal death, neonatal in-hospital death&gt; 2500g and&gt; 37 weeks, uterine rupture, unplanned maternal admission to intensive care unit, delivery trauma to the newborn, return to the operating room, admission to an intensive neonatal unit with &gt;2500g and &gt; 37 weeks for more than one day, Apgar &lt;7 at the fifth minute, maternal hemotransfusion and fourth-degree perineal laceration. The data were analyzed using the Statistical Package for Social Sciences software version 22.0. Results: the results showed a 21% rate of adverse outcomes, at a rate of 26.4 for every 1,000 births, with a greater occurrence of neonatal intensive care admission with&gt;2500g and&gt;37 weeks for more than one day (52. 5%), maternal blood transfusion (20.8%) and unplanned maternal admission in intensive care (17.8%). Conclusions: the evaluation of adverse outcomes evidenced a high proportion of births with undesirable results, which allowed the analysis of the outlook of unfavorable outcomes related to safety in maternity wards through the use of indicators.

Hyperferritinemia worsens the perinatal outcomes of conceptions of pregnancies with preeclampsia.

To analyze the prevalence of hyperferritinemia in pregnant women with preeclampsia and its association with adverse perinatal outcomes. A cross-sectional study carried out in 2017 with a convenience sample of pregnant women with preeclampsia attended at a high-risk maternity hospital in Alagoas, Brazil. Socioeconomic, lifestyle, clinical and biochemical data were collected through a structured questionnaire. Type of delivery, gestational age, weight and length at birth, and Apgar score were analyzed as outcome variables. Women were dichotomized according to the serum ferritin level (150ng/mL). Poisson regression models were used to analyze the effect of hyperferritinemia on the outcome variables. Estimates were presented as prevalence ratio with 95% confidence intervals (PR [95% CI]). Based on the Fisher's exact statistical teste and in the proportions of the neonatal outcome (birth weight), with a statistical significance of 5%, the statistical power of the sample studied was 83%. Two hundred six pregnant women with preeclampsia were recruited, which 8.74% presented hyperferritinemia. Except for ferritin level, there were no differences in C-reactive protein (CRP), hemoglobin, Glutamate Oxaloacetate Transaminase (GOT) and Pyruvic Glutamic Transaminase (PGT) levels between women with or without hyperferritinemia. After adjusting for potential confounders, hyperferritinemia was associated with low birth weight (2.19 [2.13-3.89 95%CI]), low birth length (7.76 [2.52-23.8 95% CI]) and being born small for gestational age (3.14 [1.36-7.28 95% CI]). In the presence of hyperferritinemia, preeclampsia patients were associated with a higher rate of unfavorable neonatal outcomes.

Maternal near miss determinants at a maternity hospital for high-risk pregnancy in northeastern Brazil: a prospective study

BackgroundTo investigate the association between sociodemographic and obstetric variables and delays in care with maternal near misses (MNMs) and their health indicators.MethodsA prospective cohort study was conducted at a high-risk maternity hospital in northeastern Brazil from June 2015 to May 2016 that included all pregnant women seen at the maternity hospital during the data collection period and excluded those who had not been discharged at the end of the study or whom we were unable to contact after the 42nd postpartum day for MNM control. We used the MNM criteria recommended by the WHO. Risk ratios (RRs) and their 95% confidence intervals (CIs) were calculated. Hierarchical multiple logistic regression analysis was performed. The p values of all tests were two-tailed, and the significance level was set to 5%.ResultsA total of 1094 pregnant women were studied. We identified 682 (62.4%) women without adverse maternal outcomes (WOAMOs) and 412 (37.6%) with adverse maternal outcomes (WAMOs), of whom 352 had potentially life-threatening conditions (PLTCs) (85.4%), including 55 MNM cases (13.3%) and five maternal deaths (1.2%). During the study period, 1002 live births (LBs) were recorded at the maternity hospital, resulting in an MNM ratio of 54.8/1000 LB. The MNM distribution by clinical condition identified hypertension in pregnancy (67.2%), hemorrhage (42.2%) and sepsis (12.7%). In the multivariate analysis, the factors significantly associated with an increased risk of MNM were fewer than six prenatal visits (OR: 3.13; 95% CI: 1.74–5.64) and cesarean section in the current pregnancy (OR: 2.91; 95% CI: 1.45–5.82).ConclusionsThe factors significantly associated with the occurrence of MNM were fewer than six prenatal visits and cesarean section in the current pregnancy. These findings highlight the need for improved quality, an increased number of prenatal visits and the identification of innovative and viable models of labor and delivery care that value normal delivery and decrease the percentage of unnecessary cesarean sections.

Maternal Near Miss Determinants at a High-Risk Maternity Hospital in Northeastern Brazil: A Prospective Study [26N

INTRODUCTION: To investigate the association between sociodemographic and obstetric variables and delays in care with maternal near misses (MNMs) and their health indicators. METHODS: A prospective cohort study approved by the Ethics Committee (CAAE n. 37977014.0.0000.5011) was conducted at a high-risk maternity hospital in northeastern Brazil from June 2015 to May 2016, including all pregnant women, after informed consent, and excluded those not discharged at the end of the study or those unable to contact after the 42nd postpartum day. We used the MNM criteria recommended by WHO. Risk ratios (RRs) and their 95% confidence intervals (CIs) were calculated. Hierarchical multiple logistic regression analysis was performed, p values were two-tailed, and significance level was 5%. RESULTS: 1,094 pregnant women were studied, 682 (62.4%) without adverse maternal outcomes and 412 (37.6%) with those outcomes, 352 potentially life-threatening conditions (85.4%), including 55 MNM cases (13.3%) and five maternal deaths (1.2%). During the study period, 1,002 live births were recorded at the maternity hospital, resulting in an MNM ratio of 54.8/1,000 LB. The MNM distribution by clinical condition identified hypertension in pregnancy (67.2%), hemorrhage (42.2%) and sepsis (12.7%). In the multivariate analysis, the factors significantly associated with an increased risk of MNM were fewer than six prenatal visits and cesarean section in the current pregnancy. CONCLUSION: These findings highlight the need for improved quality, an increased number of prenatal visits and the identification of innovative and viable models of labor and delivery care that value normal delivery and decrease the percentage of unnecessary cesarean sections.

Non-invasive care technologies: nurses' contributions to the demedicalization of health care in a high-risk maternity hospital

ABSTRACT Objective: to discuss the use of non-invasive care technologies by nurse-midwives in a high-risk maternity hospital. Method: a descriptive and qualitative study with ten nurse-midwives who work at the obstetric center of a high-risk maternity at a university hospital in Rio de Janeiro City. Data collection took place in June and July 2017, through a semi-structured interview. The material was submitted to content analysis. Results: The participants use non-invasive care technologies from the perspective of health work technologies and demedicalization, setting up a care process centered on sensitive work and soft technologies. Thus, they shift the focus away from interventionist procedures and develop a care based on human relationships, integrality and female protagonism. Conclusion: with these technologies, nurse-midwives perform a new way of caring in high-risk maternity hospitals, contributing to the humanization of care and rearrangement of these fields. Implications for the practice: the use of these technologies drives the change of the care model by focusing on sensitive work and soft technologies instead of rough work and procedural hegemony.

PREVALÊNCIA E FATORES ASSOCIADOS À VIOLÊNCIA DOMÉSTICA: ESTUDO EM UMA MATERNIDADE DE ALTO RISCO

RESUMO Objetivo: descrever as prevalências dos tipos de violência doméstica entre puérperas atendidas em uma maternidade de alto risco e examinar a associação desses agravos com variáveis demográficas, socioeconômicas e reprodutivas. Método: estudo transversal, realizado com 302 puérperas. Os dados foram coletados por meio de entrevistas a partir de roteiro estruturado com questões acerca da caracterização das participantes e instrumento para identificação de violência Abuse Assessment Screen. Resultados: entre as entrevistadas, 43% relataram ter vivenciado situações de maus-tratos ao longo da vida, 7,6% foram vítimas de violência física no último ano e 4,6% estiveram em situação de violência física durante a gestação. Mulheres com idade entre 31-43 anos (RP: 1,5; 1,1-2,1), com três ou mais gestações (RP: 1,8; IC95%: 1,2-2,7) e evangélicas (RP: 1,6 IC95%: 1,1-2,3) vivenciaram mais frequentemente maus-tratos na vida. A ausência de companheiro esteve associada à história de violência física no último ano e na gestação (p&lt; 0,05). Conclusão: este estudo reafirma que a violência constitui um fenômeno presente na vida da mulher, inclusive no período gestacional, e se mostrou associado à condição demográfica e obstétrica da mulher.

Entre o nascer e o morrer: cuidados paliativos na experiência dos profissionais de saúde

Objective: To understand how the health professionals of a neonatal intensive care unit (NICU) in a high-risk maternity hospital experience neonatal palliative care. Methods: Qualitative study carried out using the critical phenomenological method and with the unstructured interview as instrument, performed from October to December 2015, with participation of eight health professionals of the said NICU. Four categories arose: Experiencing palliative care; Giving meaning to the baby with no prognosis; The families of the babies and the affectation of professionals; and Traversing death in the lived experience of the professionals. Results: The main findings of the study indicate that palliative care for the professionals can be portrayed from different aspects. For them, looking and caring for babies without prognosis are intertwined with the onset of affective involvement; the experience of contact with the family also appears as a way of being affected, as feelings that had not emerged before arise; and the moment of the baby`s death is a challenge full of difficulties to face. Conclusion: It is perceived that, even without the palliative care program at the institution, there is the initiative to perform a practice that approaches that kind of care, especially with regard to seeking comfort for the baby and greater inclusion of the family, what already demonstrates that they are sensitized awareness to this perspective.

Assistência prestada à adolescente no momento do parto em uma maternidade de alto risco

Objective: To examine the obstetric practices carried out in parturient adolescents seen in a high-risk maternity hospital. Methods: Observational, cross-sectional, documental, and descriptive study, performed through search in 157 medical records of parturient adolescents seen in a high-risk maternity in Maceio, AL, Brazil, in the period from January to June 2013. Socioeconomic variables and the obstetric and clinic practices were evaluated, and the results were presented in simple frequency. Results: Among the parturient adolescents, age ranged from 14 to 19 years, and 96 (61.1%) were in a stable relationship. Regarding the obstetric data, 125 (79.6%) were primigravidae, and 73 attended between 4 and 6 prenatal visits. In 107 (68.1%) medical records, the partogram was not found. Of the childbirths, in 75 (47.8%) the professionals did not perform episiotomy, in 110 (70.1%) active management of the 3rd stage of labour was practiced, and 146 (86.6%) adolescents did not have complications during childbirth. Conclusion: The study evidenced that some obstetric practices recommended by the Ministry of Health are being performed with the parturient adolescents, but are not enough for quality care.

Prevalence and Factors Associated at Presence of Central Nervous System Congenital Malformations

Introduction: Congenital malformations are currently an important cause of morbidity and mortality in many countries, though in most cases their etiology is unknown. The central nervous system (CNS) is involved in many of these defects. Original Research Article Porto et al.; BJMMR, 6(10): 956-964, 2015; Article no.BJMMR.2015.272 957 Objective: To study the factors associated with CNS congenital malformations and their prevalence in infants born at a high risk maternity hospital in Northeastern Brazil. Materials and Methods: A case-control study performed from January 2010 to December 2011, with data from The Latin American Collaborative Study of Congenital Malformations. Results: Among the 8.405 registered births, 187 were malformed newborns (2.2%). Nervous system malformations were diagnosed in 61 patients (32.6% (CI = 95% 27.5 to 38.0)), the most frequent being neural tube defects and congenital hydrocephaly. Previous history of miscarriage and/or stillbirth (p = 0.008), family history of malformations (p < 0.001) and parental consanguinity (p = 0.028) are associated with CNS malformation. Environmental factors such as maternal chronic diseases, smoking, exposure to teratogenic drugs and alcohol presented no statistically significant differences. Conclusions: The genetic component was an important contributing factor to the etiology of the malformations studied.

Ruído no alojamento conjunto: percepção das usuárias e dos profissionais de enfermagem

OBJETIVO: mensurar os níveis de ruído e levantar a percepção dos profissionais de enfermagem e usuárias de Alojamento Conjunto em uma maternidade de referência para gestação de alto risco em Curitiba-PR. MÉTODOS: estudo transversal, quantitativo, realizado em alojamento conjunto de um hospital público, no qual a percepção foi levantada por meio de entrevistas com 19 profissionais e 77 usuárias, e o ruído foi avaliado por meio de Medidor Integrador marca Bruel e Kjaer tipo 2230 calibrado na compensação "A". RESULTADOS: os níveis de ruído em todas as áreas do Alojamento Conjunto estão acima do recomendado pela literatura (35 a 45 dB(A) para ambiente hospitalar). Os valores mais expressivos foram de 67,7dB(A) no posto de enfermagem e 65,3 dB(A) na sala de visitas. Usuárias e profissionais de enfermagem estão expostos a fontes de ruído advindos do processo de trabalho da equipe de saúde, do comportamento dos usuários, dos funcionários e de ruído externo da maternidade. Estratégias para diminuir o ruído e melhorar a ambiência do AC estão voltadas para ações relacionadas ao processo de trabalho da equipe de saúde, a confortabilidade e a gestão. CONCLUSÃO: o ruído do Alojamento Conjunto está acima do preconizado. Profissionais de enfermagem percebem mais o ruído externo, enquanto as usuárias mais o ruído interno. Constatou-se que o ruído elevado interfere na ambiência do AC e afeta as atividades diárias dos profissionais e pacientes.

Factors associated with mother‐to‐child transmission of the human immunodeficiency virus in Pernambuco, Brazil, 2000–2009

To identify risk factors associated with mother-to-child transmission of HIV in the Brazilian state of Pernambuco. Retrospective cohort study with 1200 HIV-exposed children born in Pernambuco, registered up to the age of 2months in a public programme to prevent vertical transmission. Univariate and multivariate logistic regression analyses were conducted for maternal and peripartum characteristics and prophylactic interventions, to identify risk factors for mother-to-child transmission of HIV. The transmission rate was 9.16% (95% CI: 7.4-10.9). The following risk factors were independently associated with transmission: non-use of antiretroviral during pregnancy (OR: 7.8; 95% CI: 4.1-15); vaginal delivery (OR: 2.02; 95% CI: 1.2-3.4); prematurity (OR: 2.5; 95% CI: 1.3-4.7); and breastfeeding (OR: 2.6; 95% CI: 1.4-4.6). This mother-to-child transmission rate is unacceptably high, as prophylactic interventions such as antiretroviral therapy and infant feeding formula are free of charge. Absence of antiretroviral therapy during pregnancy was the main risk factor. Therefore, early identification of exposed mothers and initiating prophylactic interventions are the main challenges for controlling transmission.

Incidence and main causes of severe maternal morbidity in São Luís, Maranhão, Brazil: a longitudinal study.

Evaluation of severe maternal morbidity has been used in monitoring of maternal health. The objective of this study was to estimate its incidence and main causes in São Luís, Maranhão, Brazil. Prospective longitudinal study, carried out in two public high-risk maternity hospitals and two public intensive care units (ICUs) for referral of obstetric cases from the municipality. Between March 1, 2009, and February 28,2010, all cases of severe maternal morbidity according to the Mantel and Waterstone criteria were identified. The sociodemographic and healthcare characteristics of the extremely severe cases were compared with the less severe cases, using the Fisher, χ(2), Student t and Mann-Whitney tests, with a significance level of < 0.05. 127 cases of severe maternal morbidity were identified among 8,493 deliveries, i.e. an incidence of 15.0/1000 deliveries. Out of 122 cases interviewed, 121 cases were within the Waterstone criteria and 29 were within the Mantel criteria, corresponding to incidences of 14.1/1000 and 3.4/1000 deliveries, respectively. These rates were lower than those described in the literature, possibly due to case loss. The main causes were hypertension during pregnancy, which was more frequent in less severe cases (P = 0.001) and obstetric hemorrhage, which was more common among extremely severe cases (P = 0.01). Direct obstetric disorders were the main causes of severe maternal morbidity in São Luís, Maranhão. Investigation and monitoring of severe morbidity may contribute towards improving obstetric care in the municipality.

Rapid HIV testing and prevention of perinatal HIV transmission in high-risk maternity hospitals in St. Petersburg, Russia

The purpose of this study was to evaluate the effectiveness of a human immunodeficiency virus (HIV) rapid testing (RT) program. From April 13, 2004, to April 13, 2005, pregnant women at 2 high-risk maternity hospitals with no or incomplete HIV testing results (negative tests at <34 weeks, none thereafter) were offered point-of-care RT, with antiretroviral prophylaxis for RT-positive women and their infants. Overall, 89.2% of eligible women (3671/4117) underwent RT, of whom 90.4% received results before delivery. HIV seroprevalence among all women who underwent RT was 2.7% (100/3671 women); among previously untested women, seroprevalence was 6.5% (90/1375 women); the incidence of HIV seroconversion among women with previous negative tests during pregnancy was 0.4% (10/2296 women). After adjustment, the main predictor of receiving RT results after delivery was late admission. Among HIV-exposed infants, 97.9% (92/94) received prophylaxis; 61.7% (58/94) had available follow-up data, and 8.6% (5/58) met criteria for definitive or presumptive HIV infection. The RT program achieved timely detection of HIV-infected women in labor with unknown HIV status and effectively prevented perinatal HIV transmission.