p. 1-54 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-25T19:42:20Z No. of bitstreams: 3 Elsa%20Capas.pdf: 34075 bytes, checksum: ef49c4a459c9f8b972e86a5f5397d6fd (MD5) ELSA%20Parte%201.pdf: 87067 bytes, checksum: c17c80db8cdaa69e23fd49da75fdb9eb (MD5) Elsa%20Parte%202.pdf: 265809 bytes, checksum: b2fd70240e2015c603c0699cb4bf4491 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:21:35Z (GMT) No. of bitstreams: 3 Elsa%20Capas.pdf: 34075 bytes, checksum: ef49c4a459c9f8b972e86a5f5397d6fd (MD5) ELSA%20Parte%201.pdf: 87067 bytes, checksum: c17c80db8cdaa69e23fd49da75fdb9eb (MD5) Elsa%20Parte%202.pdf: 265809 bytes, checksum: b2fd70240e2015c603c0699cb4bf4491 (MD5) / Made available in DSpace on 2013-05-04T17:21:35Z (GMT). No. of bitstreams: 3 Elsa%20Capas.pdf: 34075 bytes, checksum: ef49c4a459c9f8b972e86a5f5397d6fd (MD5) ELSA%20Parte%201.pdf: 87067 bytes, checksum: c17c80db8cdaa69e23fd49da75fdb9eb (MD5) Elsa%20Parte%202.pdf: 265809 bytes, checksum: b2fd70240e2015c603c0699cb4bf4491 (MD5) Previous issue date: 2010 / Introdução: O alto nível de mortalidade perinatal é um grande desafio para a redução da mortalidade infantil, pois ela se relaciona não apenas com o desenvolvimento humano mas, sobretudo, com a qualidade da assistência obstétrica e neonatal. Objetivo: Descrever as características e a evolução da mortalidade perinatal no município de Salvador, Bahia de 1998 a 2007. Metodologia: Estudo descritivo de 11.080 casos de óbitos perinatais de mães residentes em Salvador, com tempo de gestação superior ou igual a 22 semanas e idade do recém-nascido até 7 dias. As fontes de dados foram o Sistema de Informações de Nascidos Vivos (SINASC) e o Sistema de Informações sobre Mortalidade (SIM) do Ministério da Saúde. Na análise utilizou-se o teste χ2 de Pearson e o cálculo das médias móveis. Os indicadores empregados foram as taxas de mortalidade. Resultados: A taxa de mortalidade perinatal mostrou tendência decrescente a partir do ano 2000, tendo decrescido em 22,1% de 33,1/1.000 nascimentos em 2000 para 25,8/1.000 em 2007, com a maior contribuição proveniente da taxa de mortalidade neonatal precoce em relação à fetal. A taxa de mortalidade fetal anteparto apresentou-se 34 vezes maior do que a intraparto. A análise dos dados constatou ainda que as principais causas de morte foram a prematuridade e a asfixia intraparto. Conclusão: As causas de óbito verificadas são sobejamente descritas como evitáveis; a identificação de seus fatores determinantes através de estudos específicos poderá servir de suporte ao planejamento de intervenções estratégicas, que diminuiriam a ocorrência de óbitos perinatais em Salvador. / Salvador

Resumo: Avaliar as causas mais freqüentes e fatores de risco associados com óbito perinatal em dois centros de diferentes níveis de atenção. Estudo caso-controle incluindo 299 casos de óbitos perinatais e 1161 recém-nascidos que sobreviveram ao período neonatal precoce (controles) entre 2001 e 2006 em dois hospitais de diferentes níveis de atenção (secundária e terciária) localizados em Botucatu/SP. Fatores maternos, gestacionais e neonatais associados com óbitos perinatais foram investigados. As causas básicas dos óbitos perinatais foram estratificadas dentro de 5 grupos de acordo com a classificação de Wigglesworth modificada. Correlações entre variáveis do estudo e óbito perinatal foram avaliadas pela análise univariada. Odds ratio foi calculado com intervalo de confiança a 95%. Análise de regressão logística múltipla foi realizada para obtenção de estimativas independentes para o risco de óbito perinatal. No centro de atenção terciária, fatores de risco independentes para óbito perinatal incluíram idade gestacional, primiparidade, gênero masculino e doença materna (hipertensão arterial, infecção intra-uterina). No centro de atenção secundária, nenhum fator de risco independente foi identificado ainda que Apgar de quinto minuto < 7, baixo peso ao nascer e hemorragia materna foram associados com óbito perinatal. As causas mais freqüentes de óbito perinatal no centro secundário foram asfixia e morte anteparto, enquanto no terciário prevaleceu malformação seguida por imaturidade e morte anteparto. Nossos resultados mostram que ambas, atenção obstétrica e neonatal, estão integradas num sistema hierarquizado, mas destacam a importância de melhorar a assistência pré-natal, ao parto e nascimento. / Abstract: To assess the most frequent causes and risk factors associated with perinatal death in two centers at different care levels. Case-control study including 299 perinatal death cases and 1161 infants who survived the early neonatal period (controls) between 2001 and 2006 in two hospitals at different levels of care (secondary and tertiary) located in Botucatu/SP. Maternal, gestational and neonatal factors associated with perinatal death were investigated. The basic causes of perinatal death were stratified into 5 groups according to the modified Wigglesworth's classification system. Correlations between study variables and perinatal death were evaluated by univariate analysis. Odds ratio was calculated with a 95% confidence interval. Multiple logistic regression analysis was performed to estimate independent perinatal death risk. Results: In the tertiary care center, independent perinatal death risk factors included gestational age, primiparity, male gender and maternal disease (arterial hypertension, intrauterine infection). In the secondary care center, no independent risk factors were identified although five-minute Apgar score <7, low birthweight and maternal hemorrhage were associated with perinatal death. The most frequent causes of perinatal death in the secondary center were asphyxia and antepartum death while in the tertiary center they included malformation, imaturity and antepartum death. Our results show that both obstetric and neonatal care were integrated into a hierarchized system but highlight the importance of improving prenatal, delivery and birth care. / Orientador: Marilza Vieira Cunha Rudge / Coorientador: Izildinha Maestá / Banca: Antonio Prates Caldeira / Banca: José Carlos Peraçoli / Mestre

O comprometimento da saúde da criança, em decorrência de sua exposição aos poluentes do ar, em especial ao advindo do tráfego veicular, tem sido investigado sob diversos aspectos, entre eles, o baixo peso ao nascer e o nascimento pré-termo, os quais são importantes determinantes dos óbitos perinatais. Este estudo busca analisar a associação entre poluição do ar e mortalidade perinatal a partir da exposição das gestantes e dos recémnascidos aos poluentes atmosféricos na Região Sul do Município de São Paulo, estimados indiretamente a partir do tráfego de veículos próximos à residência materna. Um estudo caso-controle sobre a mortalidade perinatal na Região Sul do Município de São Paulo foi realizado entre os anos de 2000 e 2001. Utilizou -se fontes de dados primários e secundários para obtenção de diversas variáveis relacionadas ao recém-nascido, à mãe, à gestação e ao parto. As residências maternas (endereço) foram localizadas numa base cartográfica digital e foi delimitado um raio de cerca de 200 m ao redor das mesmas. Todas as vias contidas nesse raio foram selecionadas e as distâncias residência-via foram calculadas mediante técnicas avançadas de geoprocessamento. A partir desse procedimento, e utilizando a contagem média do fluxo de veículos nessas vias, gerou-se um indicador da exposição ao tráfego veicular, a densidade do tráfego ponderada pela distância (DTPD), que se baseia na curva de distribuição normal para caracterizar a dispersão dos poluentes a partir do centro das ruas. Análises descritivas e regressão logística (univariada e multivariada) foram realizadas. Observa-se que há um aumento no risco de ocorrência de óbito neonatal precoce entre aquelas mães expostas aos maiores valores de DTPD (OR= 2,34; IC 95% 0,89 6,18), embora esse resultado não tenha alcançado os níveis tradicionais de significância estatística. Os resultados sugerem que o componente neonatal precoce dos óbitos perinatais pode estar associado a maior exposição materna à poluição do ar, relacionado ao tráfego veicular próximo as suas residências. Quanto ao componente fetal dos óbitos perinatais, há ainda menos evidências dessa associação / The compromising of the health of children due to their exposure to air pollution, especially that originating from vehicle traffic, has been investigated from several aspects, such as low birth weight and premature birth, which are important determiners of perinatal deaths. This study seeks to analyze the association between air pollution and perinatal mortality from the exposure of pregnant women and of newborn children to the atmospheric pollutants in the Southern Region of the Municipality of São Paulo, estimated indirectly from the traffic of vehicles near their residences. A case-control study concerning perinatal mortality in the Southern Region of the Municipality of São Paulo was carried out during 2000 and 2001. Primary and secondary data sources were utilized for the obtainment of several variables related to the newborn child, to the mother, to the pregnancy, and to the childbirth. The mothers´ residences (addresses) were located on a digital cartographic base and were limited to within a radius of about 200 meters around those residences. All the streets contained in this radius were selected and the residence-to-street distances were calculated through advanced geoprocessing techniques. From this procedure, and utilizing the average flow-count of vehicles on those routes, an indicator was generated for the exposure to vehicle traffic, the distance-weighted traffic density (DWTD), which is based on the normal distribution curve to characterize the dispersion of pollutants from the centers of the streets. Descriptive analyses and logistic (univariate and multivariate) regression were performed. It was observed that there is an increase in the risk of early neonatal mortality among those mothers exposed to the highest values of DWTD (OR= 2.34; IC 95% 0.89 6.18), even though this result has not reached the traditional levels of statistical significance. The results suggest that the early neonatal component of the perinatal deaths may be associated to a higher maternal exposure to the air pollution related to the vehicle traffic near their residences. Concerning the fetal component of the perinatal deaths, there is even less evidence of this association

Orientador: Carlos Emilio Levy / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T23:13:59Z (GMT). No. of bitstreams: 1 Fiolo_Kateli_M.pdf: 2870883 bytes, checksum: 6e6dd0df208caa395482319a31dda8b1 (MD5) Previous issue date: 2011 / Resumo: Streptococcus agalactiae, conhecido como Estreptococo beta-hemolítico do grupo B (EGB), é classificado por diferenças capsulares que podem variar em dez sorotipos, alguns responsáveis por infecções materno-infantis sérias e debilitantes ou podendo ainda levar ao óbito. O EGB pode ocasionar também, infecções graves em adultos e idosos. OBJETIVO: Descrever e analisar o perfil epidemiológico dos sorotipos prevalentes de Streptococcus agalactiae, provenientes de infecção em recém-nascidos (RN), do Centro de Atenção Integral á Saúde da Mulher (CAISM /UNICAMP) e casos de infecção por EGB de diversos materiais do Hospital de Clínicas da Unicamp (HC UNICAMP) e de sete laboratórios que prestam serviços a outros hospitais maternidade na cidade de Campinas SP e região. MÉTODOS: Estudo transversal laboratorial realizado, no período de janeiro de 2007 a dezembro de 2010. As cepas de EGB foram triadas por provas laboratoriais manuais padronizadas, ou por automação microbiológica, Vitek®2 (BioMeriéux). A seguir foram tipadas por PCR, utilizando sucessivamente primers específicos para espécie e para nove sorotipos de Streptococcus agalactiae. RESULTADOS: Durante os anos de 2007 e 2008 o programa de triagem materna do CAISM coletou 2.022 amostras de secreção retovaginal com média de 20,5% de positividade. Entre janeiro de 2007 a dezembro de 2010, foram selecionadas 120 amostras de EGB, isoladas de pacientes do HC UNICAMP, de diferentes materiais: urina (72,5%), sangue (hemocultura) (15,8%), secreção de feridas e abscessos (4,1%), líquor (2,5%), secreção ferida cirúrgica (1,6%), outras secreções (3,3%). Foram também selecionados, entre setembro de 2008 a setembro de 2009, 383 amostras de EGB isolados por laboratórios que prestam serviço a hospitaismaternidade de Campinas e região em: urina (54,3%), secreção retovaginal (37,8%), esperma (3,4%), sangue (2,3%), secreções gerais (1,8%) e líquor (0,2%). Foram avaliados, por análise molecular os sorotipos de 70 destas amostras, sendo 22 isoladas de sangue, 5 de líquor e 43 de outros materiais clínicos, escolhidos aleatoriamente, revelando a predominância do sorotipo tipo V (61,4%), seguido pelo tipo Ia (24,3%), tipo III (10,0%), tipo Ib (2,8%) e o tipo IV (1,4%). Dentre as amostras analisadas apenas seis eram provenientes de processos infecciosos em RNs do CAISM, sendo 1, 2,1 e 2 casos, respectivamente para cada ano, de 2007 até 2010, estimando-se para este período uma incidência média 0,55 casos de EGB por 1.000 nascidos vivos. Apenas mais um caso de RN foi isolado no Hospital Estadual de Sumaré no ano de 2009. Entre esses sete casos de RN, em dois foram encontradas amostras pareadas de mãe-filho. Nas amostras de RNs houve predominância do sorotipo V com 42,8%, seguido pelo tipo III e Ia com 28,5% cada um, nas amostras das duas mães foram encontrados os mesmos sorotipos de seus recém-nascidos. CONCLUSÕES: O número de amostras obtidas de recém nascidos foi abaixo do esperado, possivelmente em conseqüência da eficiência do programa de triagem e profilaxia materna do EGB, não podendo ser excluída a possibilidade de limitações dos recursos laboratoriais utilizados. Os sorotipos encontrados são os mais prevalentes na literatura mundial e associados à maior virulência. A técnica de PCR revelou ser muito útil para estudos epidemiológicos e de elevada especificidade / Abstract: Streptococcus agalactiae, also known as beta-hemolytic streptococcus group B (GBS), is classified by capsular differences that can vary in ten serotypes, some responsible for maternal and infant debilitating or serious infections and can even lead to death. The GBS can also cause, serious infections in adults and elderly. OBJECTIVE: To describe and analyze the epidemiology of prevalent serotypes of Streptococcus agalactiae, isolated from newborns (NB), from the Center for Integral Attention to Women's Health (CAISM / UNICAMP) and cases of GBS infection of various materials from Hospital de Clinicas, Unicamp (HC UNICAMP) and seven laboratories that provide services to other maternity hospitals in Campinas, São Paulo, Brazil and region. Methods. It was a cross-sectional laboratory study conducted in the period from January 2007 to December 2010. GBS strains were screened by standard manual microbiological laboratory tests, or by automation by Vitek ® 2 (bioMérieux). Following, they were typed by PCR, using specific primers for species and nine serotypes of Streptococcus agalactiae. RESULTS: During the years of 2007 and 2008 the CAISM maternal screening program collected 2,022 rectovaginal secretion samples with an average of 20.5% positivity. From January 2007 to December 2010, were selected a total of 120 GBS strains isolated at the HC UNICAMP as follows: urine (72.5%) blood (15.8%), secretion from wounds and abscesses (4.1%), cerebrospinal fluid (2.5%), wound secretion (1.6%) and other secretions (3.3%). From September 2008 to September 2009, were also selected 383 samples of GBS isolated by laboratories that provide service for maternity hospitals of Campinas region as follows: urine (54.3%), rectovaginal secretion (37.8%), sperm (3.4%), blood (2.3%), general secretions (1.8%) and cerebrospinal fluid (0.2%). Of these samples 70 strains were evaluated by molecular typing analysis, 22 isolated from blood, 5 from cerebrospinal fluid and 43 randomly selected isolates from other clinical materials, revealing the predominance of serotype V (61.4%), followed by serotype Ia (24.3%), serotype III (10.0%), serotype Ib (2.8%) and serotype IV(1.4%). Among the 70 samples, six were from newborns of CAISM with infectious processes, with 1, 2, 1 and 2 cases occurred respectively in each year from 2007 to 2010. For this period were estimated an average incidence of 0.55 cases of GBS for 1,000 born alive. Only one additional case of NB infection was isolated in the Hospital Estadual de Sumaré in 2009. Among these seven cases of NB infections, for only two were found paired EGB isolates from mother and newborn. In the NB samples was found predominantly the serotype V ( 42.8%), followed by type Ia and III with 28.5% for each, and in two samples of mothers were found the same serotype of their newborns. CONCLUSIONS: The number of samples of newborns was lower than expected, possibly due to the efficiency of the maternal GBS screening program and prophylaxis, but can not be excluded the limitations of laboratory resources used. The founded serotypes are the most prevalent in the literature and associated with increased virulence. The PCR technique has proved to be very useful for epidemiological studies and a have a high specificity / Mestrado / Saude da Criança e do Adolescente / Mestre em Ciências

Abstract The aim of this study was to evaluate the treatment, course and outcome of pregnancy in Finland using two cohorts of diabetic women. The clinical cohort consisted of data from all 210 women with Type 1 diabetes and their 296 pregnancies managed between 1986 and 1995 in the two northernmost provinces of Finland. The register-based study population included all 1442 mothers with a singleton birth who had insulin treatment during pregnancy in 1991-1995 according to the Medical Birth Register. Of these mothers, 954 (66%) had pre-existing diabetes. Insulin-treated diabetes complicated 4.5/1000 births in Finland in 1991-1995, the prevalence of Type 1 diabetes being 2.9/1000 in the whole country and 3.3/1000 in Northern Finland. In the 1990's the care of these women shifted from tertiary level only to include the secondary level hospitals as well, and was more often carried out on an out-patient basis. This care policy in association with the self-monitoring of blood glucose levels contributed to an obvious improvement in glycaemic control during pregnancy. Despite that, the high proportion (73%) of women entering pregnancy with unsatisfactory glycaemic control did not decrease during the study period. Retinopathy complicated 134 (45.3%) diabetic pregnancies, while clinical nephropathy was found in 23 (7.8%) cases. Although retinopathy was more often aggravated during the first pregnancy, the occurrence of retinopathy or its severe form was not increased at the beginning of consecutive pregnancies. Of the mothers, 50 (16.9%) had pre-eclampsia during pregnancy, and in 28% of these cases it was classified as superimposed. It was found more often among primiparous than multiparous (25.6% vs. 11.0%, respectively), and its occurrence rose with the severity of diabetes. In both cohorts, the rates of preterm deliveries, Caesarean sections and large for gestational age (LGA) infants were significantly (p &lt; 0.001) higher in Type 1 diabetic pregnancies than in the background population. The rates of congenital anomalies (CA) were 540-629/10000 in two study populations, both being 2-3-fold as compared to the background population. Cardiac malformations were most common, with anomalies in the genitourinary tract and the musculoskeletal organs being next in frequency. Sixty-three percent of malformed infants were boys. Though pregnancy itself was not found to worsen the prognosis of diabetes, at least in the short term, pregnancy in diabetic women still remains a high risk state with an increased rate of prematurity, operative deliveries, CAs and peri- and neonatal mortality. In order to decrease the mortality rate in diabetic births, attention should be directed at both the prevention of CA and at identifying the foetuses at risk for intrauterine death. The postneonatal mortality rate is also high, reflecting a shift in the deaths from the early neonatal period to a later age. Therefore, a combined mortality, including induced abortions, stillborns and infant deaths, would give a more realistic idea of the outcomes in diabetic pregnancies.

Orientador: José Guilherme Cecatti / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T18:48:20Z (GMT). No. of bitstreams: 1 Souza_RenatoTeixeira_M.pdf: 10640708 bytes, checksum: 93bc984ddc636a415fed23ea6ca3a333 (MD5) Previous issue date: 2015 / Resumo: Introdução: Mais de 15 milhões de bebês nascem prematuros anualmente no mundo, sendo a prematuridade a maior causa de óbitos no período neonatal. A prematuridade terapêutica tem papel importante nesse contexto, pois se estima que 20 a 40% dos partos prematuros ocorrem por indicação dos provedores de assistência obstétrica. Dessa forma, a redução dos partos prematuros terapêuticos adquire cada vez mais importância para o controle da taxa de prematuridade e da morbimortalidade neonatais. O conhecimento dos fatores relacionados ao parto prematuro terapêutico é ponto fundamental para atingir essa redução. Objetivos: Avaliar a ocorrência do parto prematuro terapêutico e seus fatores associados na população do Estudo Multicêntrico de Investigação em Prematuridade (EMIP). Métodos: Análise secundária do EMIP, um estudo brasileiro de caso-controle aninhado a um corte transversal multicêntrico. O estudo ocorreu em 20 hospitais de referência em 3 regiões do Brasil de abril de 2011 a julho de 2012 e realizou a vigilância de 33.740 partos nesse período. O principal desfecho a ser avaliado é a ocorrência de parto prematuro terapêutico, definido como o parto que ocorreu antes de 37 semanas e que foi indicado pela equipe de assistência devido uma condição materna ou fetal. O grupo controle foi composto pelas mulheres com parto a termo. Os partos prematuros foram categorizados, conforme recomendações da Organização Mundial da Saúde, em prematuro extremo, muito prematuros e pretermo moderado Uma quarta categoria de idade gestacional, contemplando apenas os prematuros tardios, também foi analisada. Variáveis relacionadas a características sociodemográficas, pôndero-estaturais e de estilo de vida maternos, características da assistência ao pré-natal e ao parto e sobre a presença de morbidade ou complicação durante a gravidez, parto ou puerpério foram avaliadas na análise de risco para parto prematuro terapêutico. Foi realizada uma análise bivariada para estimar o risco de parto prematuro terapêutico para cada e uma análise multivariada com regressão logística não condicional para obter os fatores independentemente associados ao desfecho. Resultados: O parto prematuro terapêutico foi responsável por 35,4% dos partos prematuros na amostra estudada. As síndromes hipertensivas, o descolamento prematuro de placenta e a diabetes foram as condições que mais frequentemente motivaram a resolução prematura da gravidez. A idade materna avançada, a hipertensão crônica, a obesidade e a gravidez múltipla foram as principais condições maternas relacionadas à ocorrência de parto prematuro terapêutico. Houve uma tentativa de tratamento da condição materna que motivou a resolução em mais de 50% dos casos e 74,5% das mulheres com parto entre 28 e 31 semanas receberam corticoterapia. A cesariana foi a via de parto mais frequente. A proporção de mortalidade neonatal, do Apgar do quinto minuto menor que sete e da admissão em unidade intensiva neonatal foi muito maior nos prematuros terapêuticos do que no termo, mesmo considerando os prematuros tardios. Conclusões: Os resultados do estudo corroboram com a crescente importância do parto prematuro terapêutico, devido sua prevalência e impacto nos resultados perinatais. A gravidez múltipla, idade materna avançada, a obesidade e a presença de morbidades pré-gestacionais são os fatores que requerem especial atenção nas estratégias de prevenção da prematuridade terapêutica / Abstract: Background: More than 15 million babies are born prematurely each year worldwide and its the leading cause of deaths in the neonatal period. Provider-initiated preterm birth (piPTB) plays an important role in this context because it is estimated that 20-40% of preterm births occur by indication of obstetric care providers. Thus, the reduction in piPTB rate acquires more importance to decrease the rate of prematurity and neonatal morbidity and mortality. Knowledge of the factors related to piPTB is a key factor to achieve this reduction. Objectives: To evaluate the occurrence of provider-initiated preterm birth and the associated factors in the Multicenter Study on Preterm Birth in Brazil (EMIP) population. Methods: Secondary analysis of EMIP, a Brazilian multicenter cross-sectional study plus a nested case-control. The study took place in 20 referral hospitals in 3 regions of Brazil from April 2011 to March 2012 and conducted surveillance of 33,740 deliveries in this period. The primary outcome to be evaluated is the occurrence of provider-initiated preterm birth, defined as birth that occurred before 37 weeks and was medically indicated due to maternal or foetal condition. The control group was composed of women with term delivery. Preterm birth was categorized into extremely premature, very premature and moderate preterm, according to the World Health Organization. Another category that includes only the late preterm was also evaluated. Maternal, socio-demographic, obstetrical, prenatal care, delivery and postnatal characteristics were assessed as factors associated with piPTB. A bivariate analysis to estimate the risk for piPTB and a multivariate analysis using unconditional logistic regression for the factors independently associated with piPTB was performed. Results: The therapeutic preterm labor accounted for 35.4% of premature births in the sample. Hypertensive disorders, placental abruption and diabetes were the main conditions related to pi-PTB indications. Advanced maternal age, chronic hypertension, obesity and multiple pregnancy were the main maternal conditions related to pi-PTB. There was an attempt to treat maternal condition that led to the resolution in over 50% of cases and 74.5% of women with birth between 28 and 31 weeks received corticosteroid therapy. Cesarean section was the most frequent mode of delivery. The proportion of neonatal mortality, Apgar score<7 at 5 minutes and NICU admission were much higher in provider-initiated preterm newborns than in term newborns, even considering the late preterms. Conclusions: The results of our study corroborate the increasing notability of provider-initiated preterm birth, due to its prevalence and impact on perinatal outcomes. Multiple pregnancies, advanced maternal age, obesity and the presence of pre-gestational morbidities are the main factors that require special attention in prematurity prevention strategies / Mestrado / Saúde Materna e Perinatal / Mestre em Ciências da Saúde

Master of Public Health - MPH / South Africa had a stillbirth rate of 16.4/1000 in 2019. Umbiflow is a sophisticated portable continuous wave Doppler device with bidirectional indication of blood flow velocity in the umbilical cord. Umbiflow clinical trial results have indicated that several stillbirths were avoided by screening pregnant women classed as low risk. The study aimed to describe the perceptions of health professionals on the Umbiflow screening tool. The objectives were to explore the health professionals’ perceptions on the usability, acceptability and the perceived challenges with implementation of Umbiflow

<p><i>Objectives: </i>To study indicators specifically reflecting the reproductive health of Ukrainian women and to analyse factors behind the indicators. </p><p><i>Methods:</i> Induced abortion and maternal mortality were studied in some countries/regions of the former Soviet Union, using official statistics. Abortion rates, contraceptive practices and intentions in Ukrainian women were analysed by a large self-completion survey in 1996, and by a classroom questionnaire to first year medical students in 1999 in Donetsk, Ukraine. Totally, 1694 women and 689 students participated. Perinatal mortality was studied, applying the Nordic-Baltic perinatal death classification to all cases in the Donetsk region in 1997-98 (n=1126) and in Denmark in 1996 (n=540). Clinical guidelines, use of technology and rates of interventions in the two regions were analysed. </p><p><i>Results:</i> Abortion remains a major method of fertility control and abortion-related mortality contributes to maternal deaths. Perinatal mortality rate is twice as high in the Donetsk region as in Denmark. A substantial proportion of sexually active women do not practice contraception. Modern methods of contraception are not widely used. There is a lack of knowledge in reproductive health issues and negative attitude to OCs. There is a positive attitude towards abortion as an acceptable fertility control method and of having abortion instead of using OCs or IUD. Poor economy is an obstacle to the use of contraceptive methods associated with a cost. Lack of experience with contraception reduces the intention to use any method in the future. Being single, younger than 19 years, living with parents, having a positive attitude towards abortion as fertility control method, having a history of previous childbirth and/or abortion are important factors associated with pregnancy termination. Antepartum deaths of growth-retarded fetuses, intrapartum and neonatal deaths associated with asphyxia are more common in Ukraine than in Denmark, particularly among premature infants. Lack of evidence-based clinical guidelines and adequate resources for fetal monitoring during pregnancy and labour, together with negative attitudes towards, and limited resources for, instrumental delivery, contribute to high perinatal mortality.</p><p><i>Conclusion:</i> Better reproductive education/information of all strata of society is needed. Implementation of evidence-based guidelines in perinatal medicine, where international collaboration can be of great value, should be a matter of high priority. </p>

Objectives: To study indicators specifically reflecting the reproductive health of Ukrainian women and to analyse factors behind the indicators. Methods: Induced abortion and maternal mortality were studied in some countries/regions of the former Soviet Union, using official statistics. Abortion rates, contraceptive practices and intentions in Ukrainian women were analysed by a large self-completion survey in 1996, and by a classroom questionnaire to first year medical students in 1999 in Donetsk, Ukraine. Totally, 1694 women and 689 students participated. Perinatal mortality was studied, applying the Nordic-Baltic perinatal death classification to all cases in the Donetsk region in 1997-98 (n=1126) and in Denmark in 1996 (n=540). Clinical guidelines, use of technology and rates of interventions in the two regions were analysed. Results: Abortion remains a major method of fertility control and abortion-related mortality contributes to maternal deaths. Perinatal mortality rate is twice as high in the Donetsk region as in Denmark. A substantial proportion of sexually active women do not practice contraception. Modern methods of contraception are not widely used. There is a lack of knowledge in reproductive health issues and negative attitude to OCs. There is a positive attitude towards abortion as an acceptable fertility control method and of having abortion instead of using OCs or IUD. Poor economy is an obstacle to the use of contraceptive methods associated with a cost. Lack of experience with contraception reduces the intention to use any method in the future. Being single, younger than 19 years, living with parents, having a positive attitude towards abortion as fertility control method, having a history of previous childbirth and/or abortion are important factors associated with pregnancy termination. Antepartum deaths of growth-retarded fetuses, intrapartum and neonatal deaths associated with asphyxia are more common in Ukraine than in Denmark, particularly among premature infants. Lack of evidence-based clinical guidelines and adequate resources for fetal monitoring during pregnancy and labour, together with negative attitudes towards, and limited resources for, instrumental delivery, contribute to high perinatal mortality. Conclusion: Better reproductive education/information of all strata of society is needed. Implementation of evidence-based guidelines in perinatal medicine, where international collaboration can be of great value, should be a matter of high priority.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-06-27T14:27:56Z No. of bitstreams: 1 analuizapossanipaiva.pdf: 1296783 bytes, checksum: afd1057e1bb9a7e569e3d6ed64784eca (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-06-28T12:57:28Z (GMT) No. of bitstreams: 1 analuizapossanipaiva.pdf: 1296783 bytes, checksum: afd1057e1bb9a7e569e3d6ed64784eca (MD5) / Made available in DSpace on 2016-06-28T12:57:28Z (GMT). No. of bitstreams: 1 analuizapossanipaiva.pdf: 1296783 bytes, checksum: afd1057e1bb9a7e569e3d6ed64784eca (MD5) Previous issue date: 2012-04-27 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A taxa de mortalidade infantil tem diminuído a cada ano no Brasil, porém ainda se mantém em níveis elevados, tendo como principal componente a mortalidade perinatal. Cerca de 80% do óbitos infantis ocorrem por causas perinatais, consideradas preveníveis por meio do manejo adequado da assistência. O objetivo deste estudo foi descrever a mortalidade perinatal em Cataguases-MG, pelas características do recém-nascido e da mãe, classificando os óbitos quanto ao potencial de evitabilidade. Foram analisados pelos sistemas de informação, SIM e SINASC, 2972 nascimentos e 45 óbitos perinatais ocorridos nos anos de 2008 a 2011. Foram investigados 11 casos de 2011, pelos registros dos prontuários de atenção primária, secundária e terciária, documentos da gestante e entrevista. Os resultados encontrados foram: divergência entre os registros do banco de dados e dos prontuários, dados perdidos no banco de óbitos e nos prontuários, dificuldade de acesso aos documentos e alto índice de óbitos fetais, 58% dos óbitos perinatais. No decorrer dos anos, ocorreu aumento dos casos de asfixia ao nascimento no primeiro e quinto minutos. No ano de 2011 o baixo peso atingiu 9%, 10% dos nascimentos foram prematuros, e ocorreram as taxas de mortalidade mais altas dos últimos quatro anos: infantil (21,7/1000), perinatal (22,7/1000) e pós-neonatal (9,0/1000). A classificação da evitabilidade do óbito revelou possíveis falhas nos três níveis de atenção. Na atenção primária as falhas foram relacionadas ao acesso às informações e identificação do risco gestacional. Na atenção secundária foi identificada falha no atendimento oportuno em relação ao parto, e na atenção terciária, dificuldade no acesso a atendimento de alto risco. / The infant mortality rate has decreased every year in Brazil but still remains at high levels, having perinatal mortality as main component. About 80% of infant deaths occur by perinatal causes, considered preventable through proper management of assistance. The aim of this study was to describe perinatal mortality in Cataguases-MG, by newborn and mother characteristics, classifying deaths as avoidance potential. Were analyzed by information systems, SIM and SINASC, 2972 births and 45 perinatal deaths occurred in the year 2008 to 2011. Eleven cases in 2011 had the reports investigated by primary care, secondary care, tertiary care, pregnant documents and interview. The results were: divergence between records in database and patient records, lost data on deaths and patient records, difficulty to access documents and high levels of fetal deaths, 58% of perinatal deaths. Over the years, cases of asphyxia have increased in the first and fifth minutes. In 2011 low weight reached 9%, 10% of premature births, and there were higher mortality rates in four years: infant (21.7/1000), perinatal (22.7/1000) and post-neonatal (9.0/1000). The classification of the death avoidance revealed possible failures in three levels of care. Failures were related in primary care to access information and to identify the gestational risk. In secondary care has been identified service failed timely in childbirth, and difficulty in access high risk care.