SUMMARY OBJECTIVE: The aim of the study was to compare two labor induction regimens (4 and 6 h), to determine predictors of successful labor induction with intravaginal misoprostol 25 μg tablets, and to evaluate the association with adverse perinatal outcomes. METHODS: This was a retrospective cohort study that included singleton pregnancies undergoing induction of labor with an intravaginal misoprostol 25 μg tablet between 37 and 42 weeks of gestation. The pregnant women were divided into two groups: Group 1—intravaginal misoprostol 25 μg every 4 h and Group 2—intravaginal misoprostol 25 μg every 6 h. RESULTS: Pregnant women were divided into Group 1 (n=289) and Group 2 (n=278). Group 1 had a higher median number of intravaginal misoprostol 25 μg tablets (3.0 vs. 2.0 tablets, p<0.001), a lower prevalence of postpartum hemorrhage (7.6 vs. 32.7%, p<0.001), and a higher need for oxytocin (odds ratio [OR]: 2.1, 95%CI: 1.47–2.98, p<0.001) than Group 2. Models including intravaginal misoprostol 25 μg tablets every 4 and 6 h [x2(1)=23.7, OR: 4.35, p<0.0001], parity [x2(3)=39.4, OR: 0.59, p=0.031], and Bishop’s score [x2(4)=10.8, OR: 0.77, p=0.019] were the best predictors of failure of labor induction. A statistically significant difference between groups was observed between the use of the first intravaginal misoprostol 25 μg tablet at the beginning (Breslow p<0.001) and the end of the active labor phase (Long Hank p=0.002). CONCLUSION: Pregnant women who used intravaginal misoprostol 25 μg every 4 h had a longer time from the labor induction to the beginning of the active phase of labor and higher rates of adverse perinatal outcomes than women who used intravaginal misoprostol 25 μg every 6 h. OBJECTIVE ( h, , h) METHODS 3 gestation 1intravaginal 2intravaginal RESULTS n=289 n289 n 289 (n=289 n=278. n278 n=278 . 278 (n=278) 3.0 30 0 (3. vs 20 p<0.001, p0001 p p<0.001 001 7.6 76 7 (7. 327 32 32.7% odds OR [OR] 21 2.1 95%CI 95CI CI 95 147298 47 98 1.47–2.98 x21=23.7, x21237 x x2 =23.7, 23 [x2(1)=23.7 435 35 4.35 p<0.0001, p00001 p<0.0001 0001 p<0.0001] x23=39.4, x23394 =39.4, 39 [x2(3)=39.4 059 59 0.59 p=0.031, p0031 p=0.031 031 p=0.031] Bishops Bishop s x24=10.8, x24108 =10.8, 10 8 [x2(4)=10.8 077 77 0.77 p=0.019 p0019 019 Breslow Long p=0.002. p0002 p=0.002 002 p=0.002) CONCLUSION n=28 n28 28 (n=28 n27 n=27 27 (n=278 3. (3 p000 p<0.00 00 7. (7 32.7 [OR 9 14729 1.47–2.9 x21 x21=23.7 x2123 237 =23.7 [x2(1)=23. 43 4.3 p0000 p<0.000 000 x23 x23=39.4 x2339 394 =39.4 [x2(3)=39. 05 5 0.5 p003 p=0.03 03 x24 x24=10.8 x2410 108 =10.8 [x2(4)=10. 07 0.7 p=0.01 p001 01 p=0.00 n=2 n2 (n=2 (n=27 p00 p<0.0 32. 1472 1.47–2. x21=23. x212 =23. [x2(1)=23 4. x23=39. x233 =39. [x2(3)=39 0. p=0.0 x24=10. x241 =10. [x2(4)=10 n= (n= p0 p<0. 147 1.47–2 x21=23 =23 [x2(1)=2 x23=39 =39 [x2(3)=3 p=0. x24=10 =10 [x2(4)=1 (n p<0 14 1.47– x21=2 =2 [x2(1)= x23=3 =3 [x2(3)= p=0 x24=1 =1 [x2(4)= p< 1.47 x21= = [x2(1) x23= [x2(3) p= x24= [x2(4) 1.4 [x2(1 [x2(3 [x2(4 1. [x2( [x2 [x

Abstract Objective To evaluate the risk factors for postpartum hemorrhage (PPH) according to the Robson Classification in a low-risk maternity hospital. Methods We conducted retrospective cohort study by analyzing the medical records of pregnant women attended in a low-risk maternity hospital, during from November 2019 to November 2021. Variables analyzed were: maternal age, type of delivery, birth weight, parity, Robson Classification, and causes of PPH. We compared the occurrence of PPH between pregnant women with spontaneous (Groups 1 and 3) and with induction of labor (2a and 4a). Chi-square and Student t-tests were performed. Variables were compared using binary logistic regression. Results There were 11,935 deliveries during the study period. According to Robson’s Classification, 48.2% were classified as 1 and 3 (Group I: 5,750/11,935) and 26.1% as 2a and 4a (Group II: 3,124/11,935). Group II had higher prevalence of PPH than Group I (3.5 vs. 2.7%, p=0.028). Labor induction increased the occurrence of PPH by 18.8% (RR: 1.188, 95% CI: 1.02-1.36, p=0.030). Model including forceps delivery [x2(3)=10.6, OR: 7.26, 95%CI: 3.32-15.84, R2 Nagelkerke: 0.011, p<0.001] and birth weight [x2(4)=59.0, OR: 1.001, 95%CI:1.001-1.001, R2 Nagelkerke: 0.033, p<0.001] was the best for predicting PPH in patients classified as Robson 1, 3, 2a, and 4a. Birth weight was poor predictor of PPH (area under ROC curve: 0.612, p<0.001, 95%CI: 0.572-0.653). Conclusion Robson Classification 2a and 4a showed the highest rates of postpartum hemorrhage. The model including forceps delivery and birth weight was the best predictor for postpartum hemorrhage in Robson Classification 1, 3, 2a, and 4a. (PPH lowrisk low hospital 201 2021 age parity Groups . 4a) Chisquare Chi square ttests t tests performed regression 11935 11 935 11,93 period Robsons s 482 48 2 48.2 5,750/11,935 575011935 5 750 261 26 26.1 3,124/11,935. 312411935 3,124/11,935 124 3,124/11,935) 3.5 35 (3. vs 27 7 2.7% p=0.028. p0028 p p=0.028 0 028 p=0.028) 188 18 8 18.8 RR (RR 1188 1.188 95 CI 1.021.36, 102136 1.02 1.36, 02 36 1.02-1.36 p=0.030. p0030 p=0.030 030 p=0.030) x23=10.6, x23106 x x2 =10.6, 10 6 [x2(3)=10.6 OR 726 7.26 95%CI 95CI 3.3215.84, 3321584 3.32 15.84, 32 15 84 3.32-15.84 R Nagelkerke 0011 011 0.011 p<0.001 p0001 001 x24=59.0, x24590 4 =59.0, 59 [x2(4)=59.0 1001 1.001 95%CI1.0011.001, 95CI10011001 95%CI:1.001-1.001 0033 033 0.033 area curve 0612 612 0.612 0.5720.653. 05720653 0.572 0.653 572 653 0.572-0.653) 20 202 1193 93 11,9 48. 5,750/11,93 57501193 75 26. 31241193 3,124/11,93 12 3. (3 2.7 p002 p=0.02 18. 118 1.18 9 021 1.021.36 10213 102 1.0 136 1.36 1.02-1.3 p003 p=0.03 03 x23 x23=10.6 x2310 106 =10.6 [x2(3)=10. 72 7.2 3215 3.3215.84 332158 332 3.3 1584 15.84 3.32-15.8 01 0.01 p<0.00 p000 00 x24 x24=59.0 x2459 590 =59.0 [x2(4)=59. 100 1.00 CI1 95%CI1.0011.001 95CI1001100 95%CI:1.001-1.00 003 0.03 061 61 0.61 5720 0.5720.653 0572065 0572 0.57 0653 0.65 57 65 0.572-0.653 119 11, 5,750/11,9 5750119 3124119 3,124/11,9 ( 2. p00 p=0.0 1.1 1.021.3 1021 1. 13 1.3 1.02-1. x23=10. x231 =10. [x2(3)=10 7. 321 3.3215.8 33215 33 158 15.8 3.32-15. 0.0 p<0.0 x24=59. x245 =59. [x2(4)=59 95%CI1.0011.00 95CI100110 95%CI:1.001-1.0 06 0.6 0.5720.65 057206 057 0.5 065 0.572-0.65 5,750/11, 575011 312411 3,124/11, p0 p=0. 1.021. 1.02-1 x23=10 =10 [x2(3)=1 3.3215. 3321 15. 3.32-15 0. p<0. x24=59 =59 [x2(4)=5 95%CI1.0011.0 95CI10011 95%CI:1.001-1. 0.5720.6 05720 05 0.572-0.6 5,750/11 57501 31241 3,124/11 p=0 1.021 1.02- x23=1 =1 [x2(3)= 3.3215 3.32-1 p<0 x24=5 =5 [x2(4)= 95%CI1.0011. 95CI1001 95%CI:1.001-1 0.5720. 0.572-0. 5,750/1 5750 3124 3,124/1 p= x23= = [x2(3) 3.321 3.32- p< x24= [x2(4) 95%CI1.0011 95CI100 95%CI:1.001- 0.5720 0.572-0 5,750/ 575 312 3,124/ [x2(3 [x2(4 95%CI1.001 95CI10 95%CI:1.001 0.572- 5,750 31 3,124 [x2( 95%CI1.00 95CI1 95%CI:1.00 5,75 3,12 [x2 95%CI1.0 95%CI:1.0 5,7 3,1 [x 95%CI1. 95%CI:1. 5, 95%CI1 95%CI:1

SUMMARY OBJECTIVE: This study aimed to assess the perinatal outcomes of pregnancies with a prenatal diagnosis of congenital cystic adenomatoid malformation. METHODS: We conducted a retrospective cohort study based on information contained in the medical records of pregnant women whose fetuses had been prenatally diagnosed with congenital cystic adenomatoid malformation by ultrasonography. RESULTS: Sample analysis was based on 21 singleton pregnancies with confirmed isolated fetal congenital cystic adenomatoid malformations. The mean maternal±standard deviation age was 28±7.7 years. Types I, II, and III congenital cystic adenomatoid malformation were detected in 19% (4/21), 52.4% (11/21), and 28.6% (6/21), respectively. All fetuses presented with unilateral congenital cystic adenomatoid malformation (21/21) without associated anomalies, and 52.3% (11/21) were in the right lung. In total, 33.3% (7/21) of fetuses presented a “congenital cystic adenomatoid malformation volume ratio” >1.6 and were managed with maternal betamethasone administration. The mean gestational age at the time of steroid administration was 28.5±0.9 weeks, with a reduction in the lesion dimensions of 9.5% (2/21) (Types I and III of congenital cystic adenomatoid malformation). The mean gestational age at delivery was 38.7±2.4 weeks, and a cesarean section was performed in 76.2% (16/21) cases. Postsurgical resection was necessary for 23.8% (5/21) of the patients, and 4.7% (1/21) of them died because of respiratory complications after surgery. Pulmonary hypoplasia occurred in 9.5% (2/21) of the patients, and 4.7% (1/21) of them died because of respiratory insufficiency. The survival rate was 90.5% (19/21), and 57.2% (12/21) remained asymptomatic. CONCLUSION: Despite the isolated prenatal diagnosis of congenital cystic adenomatoid malformation, which showed good survival, congenital cystic adenomatoid malformation is associated with significant perinatal morbidity. Maternal betamethasone administration did not significantly reduce fetal lung lesion dimensions.

ABSTRACT There are few data on the impact of COVID-19 in pregnancy, however, analyzing these data is important to guide the clinical practice, covering the early prevention, detection, patients’ isolation, epidemiological investigation, diagnosis and early treatment. This is a report of three cases of COVID-19 confirmed by real-time reverse transcription – polymerase chain reaction (RT-PCR) of nasopharyngeal secretions collected in swabs from pregnant women in the city of Vitoria, Espirito Santo State, Brazil. In the three cases, all the patients presented with fever, one had shortness of breath, one had diarrhea, two of them reported abdominal pain and two of them had cough. The three patients progressed with a severe clinical evolution of COVID-19. The permanence in the intensive care unit (ICU) was more than 10 days. Two of them recovered and one remained in the ICU with irreversible refractory shock, multiple organ failure and died. The mode of delivery was individualized and based on the obstetric indication and severity of the maternal infection, and the cesarean section was indicated in the two severe maternal COVID-19 cases that evolved favorably. These newborns were premature and tested negative for COVID-19 by RT-PCR.