ABSTRACT BACKGROUND: Racial disparities are differences among distinct subgroups of the human species; biologically, there are no scientifically proven reasons for them to exist. OBJECTIVE: To assess the impact of racism or racial discrimination on obstetric outcomes. DESIGN AND SETTING: Systematic review conducted at a tertiary/academic hospital. METHODS: The Cochrane Library, SCOPUS/EMBASE, PubMed, Web of Science and ClinicalTrials.gov databases were searched from inception to June 2020. Studies presenting any type of racial discrimination, or any manifestation of racism that was perceived by women of any age in an obstetric scenario were included. Studies that only assessed racial disparities without including direct racism were excluded. The secondary outcomes evaluated included quality of antenatal care, intra and postpartum care, preterm birth and birthweight. The Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I) scale was used to assess the quality of evidence from non-randomized studies. RESULTS: A total of 508 records were retrieved and 29 were selected for qualitative synthesis. No meta-analysis could be performed due to the high heterogeneity across studies. Perceived racism was associated as a risk factor in 7/10 studies focusing on pregnancy and postpartum maternal outcomes, five studies on preterm birth, one study on small for gestational age and two studies on low birthweight. Overall, among the 29 studies, the risk of bias was classified as moderate. CONCLUSIONS: Perceived racism presented an association with poor obstetric outcomes. Anti-racist measures are needed in order to address the problems that are causing patients to perceive or experience racism. SYSTEMATIC REVIEW REGISTRATION: PROSPERO database, CRD42020194382

RESUMO Existe informação não organizada sobre a avaliação do assoalho pélvico de mulheres com endocrinopatias ginecológicas (ex. síndrome dos ovários policísticos - SOP, hiperplasia adrenal congênita - HAC, insuficiência ovariana prematura - IOP). Dessa forma, objetivamos realizar uma revisão sistemática foi realizada nas bases Pubmed, Scopus, Google Scholar, Scielo e PEDro sobre as endocrinopatias ginecológicas (SOP, HAC, IOP e hiperprolactinemia (HPL) desde a origem a abril de 2020. A avaliação da qualidade de dados foi real-izada pela escala de Newcastle-Ottawa Scale (NOS) adaptada para estudos transversais. De 4,272 resultados encontrados em todas as databases, após exclusão por duplicatas, triando por título e resumos, nove estudos foram selecionados para análise quantitativa. Sete estudos foram realizados para mulheres com SOP e dois estudos com IOP. Em suma, mulheres com SOP apresentados uma alta prevalência de incontinência urinária (IU) em mulheres obesas, alta espessura do músculo elevador do ânus, altos níveis de atividade muscular aferida por eletromiografia de superfície quando comparadas com mulheres do grupo controle. Sobre a IOP, esta não foi associada com IU, IF e POP. A escala NOS evidenciou que a qualidade dos estudos selecionados variou de 5 a 8. Concluímos que uma alta atividade e volume muscular foi encontrada em mulheres com SOP, com estudos posteriores sendo necessários para confirmar estes achados. Literatura foi escassa para IOP, HAC e HPL.

SUMMARY There is no pooled information about pelvic floor parameters (muscle assessment, disorders) of women with gynecologicaL endocrinopathies (eg. polycystic ovary syndrome, congenital adrenal hyperplasia, premature ovarian insufficiency). Given that, a systematic review was performed on the Pubmed, Scopus, Google Scholar, Scielo and PEDro databases regarding the main gynecological endocrinopathies [polycystic ovary syndrome (PCOS), premature ovarian insufficiency (POI), congenital adrenal hyperplasia (CAH) and hyperprolactinemia (HPL)] since their inception to April 2020. Data quality assessment was made by the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. A total of 4,272 results were retrieved from all databases. After excluding duplicate results and screening by title and abstract, nine studies were selected for quantitative analysis. Seven studies were performed with women with PCOS and two studies with POI. Women with PCOS presented a higher prevalence of urinary incontinence (UI) among obese women, a higher thickness of the levator ani muscle, and higher levels of muscle activity measured by surface electromyograph when compared to the control women. Regarding POI, there was no association with UI, FI, and POP. NOS found that the quality assessment for these selected studies ranged from 5 to 8. We concluded that higher pelvic muscle activity and volume were found in women with PCOS, with further studies needed to confirm this data. Literature was scant about POI, CAH, and HPL.

Resumo Objetivo Avaliar a associação entre as posições maternas verticais e supinas ao nascimento e a taxa de incidência de lesões obstétricas do esfíncter anal (LOEAs). Métodos Estudo coorte retrospectivo que analisou os dados de 1.728 gestantes que tiveram parto vaginal cefálico simples com peso ao nascer de 2.500 g. Análises de regressão múltipla foram usadas para investigar o efeito de posições supinas ou verticais sobre a taxa de incidência de LOEAs após o ajuste para fatores de risco e intervenções obstétricas. Resultados No total, 239 (13,8%) nascimentos ocorreram nas posições verticais, e 1,489 (86,2%), nas posições supinas. Lacerações graves de grau III ocorreram em 43 (2,5%) pacientes, e de grau IV, em 3 (0,2%) mulheres. As posições supinas tiveram um efeito protetor significativo contra lacerações graves, razão de probabilidades [Intervalo de Confiança de 95%]: 0,47 [0.22-0.99], ajustado para o uso de Fórceps 4.80 [2.15-10.70], nuliparidade 2.86 [1.44-5.69], e peso ao nascer 3.30 [1.56-7.00]. Anestesia (p<0.070), aumento de ocitocina (p<0.228), distocia de ombro (p<0.670), e episiotomia (p<0.559) não estiveram associados à incidência de laceração grave. Conclusão As posições de parto verticais não estiveram associadas a uma menor taxa de ruptura perineal. A interpretação dos achados referentes a essas posições levantou dúvidas sobre a proteção perineal que ainda aguardam respostas.

Abstract Objective To evaluate the association between the upright and supine maternal positions for birth and the incidence of obstetric anal sphincter injuries (OASIs). Methods Retrospective cohort study analyzed the data of 1,728 pregnant women who vaginally delivered live single cephalic newborns with a birth weight of 2,500 g. Multiple regression analyses were used to investigate the effect of the supine and upright positions on the incidence of OASIs after adjusting for risk factors and obstetric interventions. Results In total, 239 (13.8%) births occurred in upright positions, and 1,489 (86.2%) in supine positions. Grade-III lacerations occurred in 43 (2.5%) patients, and grade-IV lacerations occurred in 3 (0.2%) women. Supine positions had a significant protective effect against severe lacerations, odds ratio [95% confidence interval]: 0,47 [0.22- 0.99], adjusted for the use of forceps 4.80 [2.15-10.70], nulliparity 2.86 [1.44-5.69], and birth weight 3.30 [1.56-7.00]. Anesthesia (p<0.070), oxytocin augmentation (p<0.228), shoulder dystocia (p<0.670), and episiotomy (p<0.559) were not associated with the incidence of severe lacerations. Conclusion Upright birth positions were not associated with a lower rate of perineal tears. The interpretation of the findings regarding these positions raised doubts about perineal protection that are still unanswered.