OBJECTIVES: Evidence suggests that infection or inflammation is a major contributor to early spontaneous preterm birth (sPTB). Therefore, this study aimed to investigate the development and causes of maternal infection associated with maternal and neonatal outcomes in women with sPTB. METHODS: This was a secondary analysis of a multicenter cross-sectional study with a nested case–control component, the Brazilian Multicentre Study on Preterm Birth (EMIP), conducted from April 2011 to July 2012 in 20 Brazilian referral obstetric hospitals. Women with preterm birth (PTB) and their neonates were enrolled. In this analysis, 2,682 women undergoing spontaneous preterm labor and premature pre-labor rupture of membranes were included. Two groups were identified based on self-reports or prenatal or hospital records: women with at least one infection factor and women without any maternal infection (vulvovaginitis, urinary tract infection, or dental infection). A bivariate analysis was performed to identify potential individual risk factors for PTB. The odds ratios (ORs) with their respective 95% confidence intervals were calculated. RESULTS: The majority of women with sPTB fulfilled at least one criterion for the identification of maternal infection (65.9%), and more than half reported having urinary tract infection during pregnancy. Approximately 9.6% of women with PTB and maternal infection were classified as having periodontal infection only. Apart from the presence of a partner, which was more common among women with infectious diseases (p=0.026; OR, 1.28 [1.03-1.59]), other variables did not show any significant difference between groups. CONCLUSION: Maternal infection was highly prevalent in all cases of sPTBs, although it was not clearly associated with the type of PTB, gestational age, or any adverse neonatal outcomes.

A sophisticated literature review (LR) can result in a robust dissertation/thesis by scrutinizing the main problem examined by the academic study; anticipating research hypotheses, methods and results; and maintaining the interest of the audience in how the dissertation/thesis will provide solutions for the current gaps in a particular field. Unfortunately, little guidance is available on elaborating LRs, and writing an LR chapter is not a linear process. An LR translates students’ abilities in information literacy, the language domain, and critical writing. Students in postgraduate programs should be systematically trained in these skills. Therefore, this paper discusses the purposes of LRs in dissertations and theses. Second, the paper considers five steps for developing a review: defining the main topic, searching the literature, analyzing the results, writing the review and reflecting on the writing. Ultimately, this study proposes a twelve-item LR checklist. By clearly stating the desired achievements, this checklist allows Masters and Ph.D. students to continuously assess their own progress in elaborating an LR. Institutions aiming to strengthen students’ necessary skills in critical academic writing should also use this tool.

OBJECTIVE: To evaluate the occurrence of Post-Traumatic Stress Disorder among women experiencing a severe maternal morbidity event and associated factors in comparison with those without maternal morbidity. METHODS: In a retrospective cohort study, 803 women with or without severe maternal morbidity were evaluated at 6 months to 5 years postpartum for the presence of Post-Traumatic Stress Disorder. Interviews were conducted by telephone and electronic data was stored. Data analysis was carried out by using χ2, Fisher’s Exact test, and logistic regression analysis. RESULTS: There was no significant change in the prevalence of Post-Traumatic Stress Disorder related to a previous severe maternal morbidity experience. There were also no differences in diagnostic criteria for severe maternal morbidity (hypertensive syndromes, hemorrhage, surgical intervention or intensive care unit admission required, among other management criteria). Low parity (2.5-fold risk) and increasing age were factors associated with Post-Traumatic Stress Disorder. CONCLUSIONS: A severe maternal morbidity episode is not associated with Post-Traumatic Stress Disorder symptoms within five years of the severe maternal morbidity event and birth. However, a more advanced maternal age and primiparity increased the risk of Post-Traumatic Stress Disorder. This does not imply that women who had experienced a severe maternal morbidity event did not suffer or need differentiated care.

OBJECTIVES: To evaluate the association between self-reported maternal near miss and adverse nutritional status in children under one year of age. METHODS: This study is a secondary analysis of a study in which women who took their children under one year of age to the national vaccine campaign were interviewed. The self-reported condition of maternal near miss used the criteria of Intensive Care Unit admission; eclampsia; blood transfusion and hysterectomy; and their potential associations with any type of nutritional disorder in children, including deficits in weight-for-age, deficits in height-for-age, obesity and breastfeeding. The rates of near miss for the country, regions and states were initially estimated. The relative risks of infant adverse nutritional status according to near miss and maternal/childbirth characteristics were estimated with their 95% CIs using bivariate and multiple analyses. RESULTS: The overall prevalence of near miss was 2.9% and was slightly higher for the Legal Amazon than for other regions. No significant associations were found with nutritional disorders in children. Only a 12% decrease in overall maternal breastfeeding was associated with near miss. Living in the countryside and child over 6 months of age increased the risk of altered nutritional status by approximately 15%, while female child gender decreased this risk by 30%. Maternal near miss was not associated with an increased risk of any alteration in infant nutritional status. CONCLUSIONS: There was no association between maternal near miss and altered nutritional status in children up to one year of age. The risk of infant adverse nutritional status was greater in women living in the countryside, for children over 6 months of age and for male gender.

In Latin American, there is currently a regional action with the main purposes of putting the concept of severe neonatal morbidity in practice and formulating proposals for interventions. A general overview of neonatal health conditions, including morbidity and mortality, is provided to update regional knowledge on the topic. An example of the development and implementation of the concept of maternal near miss is also provided, followed by results from a systematic review covering all previously published studies on Neonatal Near Miss. Finally, some proposals for building a common concept on the topic and for launching a prospective surveillance study are presented. A Neonatal Near Miss is a neonate who had a severe morbidity (organ dysfunction or failure) but who survived this condition within the first 27 days of life. The pragmatic criteria recommended to be used are as follows: birth weight below 1700 g, Apgar score below 7 at 5 minutes of life and gestational age below 33 weeks. As a proxy for organ dysfunction, the following management criteria are also confirmed: parenteral therapeutic antibiotics; nasal continuous positive airway pressure; any intubation during the first 27 days of life; phototherapy within the first 24 h of life; cardiopulmonary resuscitation; the use of vasoactive drugs, anticonvulsants, surfactants, blood products and steroids for refractory hypoglycemia and any surgical procedure. Although this study starts from a regional perspective, this topic is clearly globally relevant. All nations, especially low and middle-income countries, could benefit from the proposed standardization.

OBJECTIVE: To assess the prevalence of pregnancy complications identified as maternal near miss (MNM) and associated factors among women using the public health care system in the Amazon and Northeast regions of Brazil. METHODS: A secondary analysis of a population-based survey conducted in 2010 was performed focusing on women self-reporting maternal complications. The main outcome was MNM, pragmatically defined as intensive care unit admission, eclampsia, hysterectomy, or blood transfusion. In addition, the risk of MNM was estimated for certain sociodemographics and characteristics of care received. Poisson regression was performed, generating adjusted prevalence ratios (PRadj) with 95% confidence intervals (95%CI). RESULTS: A total of 13 044 women (77%) who had given birth during the prior year using the public health system were interviewed. At least one complication was reported by 37.5%, with hemorrhage (28.4%) and infection (8.3%) being the most frequent. The overall MNM ratio was 31.5 per 1 000 live births, higher for the Amazon region than for the Northeast. Factors with a higher risk for developing MNM were: indigenous ethnicity (PRadj 2.77; 95% CI: 1.50-5.14), more than one hour to reach the hospital (PRadj 1.55; 95%CI: 1.06-2.25), being refused by a full hospital and having to find another one (PRadj 1.49; 95%CI: 1.03-2.16), cesarean section (PRadj 2.56; 95%CI: 1.90-3.44), and public prenatal care (PRadj 1.95; 95%CI: 1.06-3.61). CONCLUSIONS: Users of public health system in the Amazon and Northeast regions of Brazil have high MNM rates. Some characteristics of the women and of the care they received represent inequalities associated with higher risk for MNM. Specific actions are required to improve maternal health programs in these expansive areas of the country.

OBJETIVO: Evaluar la prevalencia de las complicaciones del embarazo establecidas como morbilidad materna extremadamente grave (MMEG), y los factores asociados, entre las usuarias del sistema de atención de salud pública en las zonas amazónica y noreste del Brasil. MÉTODOS:Se realizó un análisis secundario de una encuesta poblacional llevada a cabo en el 2010 y centrado en las mujeres que autonotificaban complicaciones obstétricas. El principal resultado fue la MMEG, definida a efectos prácticos como ingreso en una unidad de cuidados intensivos, eclampsia, histerectomía o transfusión de sangre. Se calculó además el riesgo de MMEG para determinadas características sociodemográficas y de la atención recibida. Se llevó a cabo una regresión de Poisson y se generaron las razones de prevalencia ajustadas (RPa) con intervalos de confianza de 95% (IC 95%). RESULTADOS:Se entrevistó a un total de 13 044 mujeres (77%) que habían dado a luz durante el año previo en el sistema de salud pública. Un 37,5% notificó como mínimo una complicación; la hemorragia (28,4%) y la infección (8,3%) fueron las más frecuentes. El índice general de MMEG fue de 31,5 por 1 000 nacidos vivos, más elevado en la región amazónica que en la noreste. Los factores que comportaron un riesgo mayor de MMEG fueron la etnicidad autóctona (RPa 2,77; IC 95% = 1,50-5,14), precisar más de una hora para llegar al hospital (RPa 1,55; IC 95% = 1,06-2,25), no ser admitida en un hospital por estar completo y tener que encontrar otro (RPa 1,49; IC 95% = 1,03-2,16), la cesárea (RPa 2,56; IC 95% = 1,90-3,44), y la asistencia prenatal pública (RPa 1,95; IC 95% = 1,06-3,61). CONCLUSIONES: Las usuarias del sistema de salud pública en las regiones amazónica y noreste del Brasil muestran tasas elevadas de morbilidad materna extremadamente grave. Algunas características de las mujeres y de la atención recibida comportan desigualdades asociadas con un riesgo mayor de morbilidad materna extremadamente grave. Se requieren acciones específicas que mejoren los programas de salud materna en estas amplias zonas del país.

OBJECTIVE: To evaluate the long-term reproductive consequences that affect women who have experienced potentially life-threatening or life-threatening (near-miss) maternal complications. INTRODUCTION: Although advances have been made in reducing maternal death, few studies have investigated the long-term repercussions of significant events such as severe maternal morbidity and maternal near-misses. These repercussions may be long-lasting and negatively affect quality of life. METHODS: A total of 382 women who had experienced a potentially life-threatening pregnancy-related condition within the last five years were analyzed in this retrospective cohort study. A control group of 188 women who gave birth without complications was also included. Trained interviewers contacted the subjects by telephone and completed a pre-coded, structured questionnaire on reproductive health. Data were analyzed using odds ratios adjusted for age. The main outcome measures were occurrence and outcome of subsequent pregnancies. RESULTS: The estimated risk of becoming infertile as a result of tubal ligation or hysterectomy was 3.5 times higher in women who experienced a maternal near-miss or severe maternal morbidity during the index pregnancy as compared to controls. Likewise, the risk of complications in subsequent pregnancies was five times greater in women who had experienced severe maternal morbidity. However, no differences were found in the occurrence or number of subsequent pregnancies or perinatal outcome. CONCLUSION: The occurrence of a life-threatening or potentially life-threatening maternal condition reduces future reproductive potential and increases the risk of complications in subsequent pregnancies.

OBJETIVOS: Explorar o uso do conceito de near miss neonatal como uma ferramenta para a avaliação da qualidade do atendimento neonatal, já que 3 milhões de óbitos neonatais precoces ocorrem a cada ano em todo o mundo. A maioria desses óbitos é evitável e ocorre em países em desenvolvimento. MÉTODOS: Esta é uma análise secundária do 2005 WHO Global Survey on Maternal and Perinatal Health, um estudo transversal. Nossa análise incluiu dados de 19 hospitais brasileiros selecionados aleatoriamente. Uma definição pragmática de near miss neonatal foi desenvolvida e testada. Os indicadores de near miss foram calculados. RESULTADOS: Entre os 15.169 nascidos vivos incluídos nesta análise, 424 apresentaram pelo menos uma das seguintes condições: muito baixo peso ao nascer, menos de 30 semanas de gestação ao nascer ou escore de Apgar aos 5 minutos de vida menor que 7. De acordo com a definição operacional, esses sobreviventes de condições com risco de vida foram considerados casos de near miss. A taxa de mortalidade neonatal precoce foi de 8,2/1.000 nascidos vivos, e a taxa de near miss neonatal foi de 21,4 casos/1.000 nascidos vivos. Variações substanciais na mortalidade entre recém-nascidos com condições com risco de vida ao nascer foram observadas, o que sugere a existência de questões relacionadas à qualidade do atendimento intra-hospitalar. CONCLUSÃO: O conceito de near miss e os indicadores forneceram informações que poderiam ser úteis para avaliar a qualidade do atendimento e para estabelecer prioridades para outras avaliações e para a melhoria da atenção à saúde dos recém-nascidos.

OBJECTIVES: To explore the use of the neonatal near miss concept as a tool to evaluate the quality of neonatal care, as 3 million early neonatal deaths occur every year around the world and the majority of these deaths are avoidable and take place in developing countries. METHODS: This is a secondary analysis of the 2005 WHO Global Survey on Maternal and Perinatal Health, a cross-sectional study, using data from 19 randomly selected Brazilian hospitals. A pragmatic definition of neonatal near miss was developed and tested. Near miss indicators were calculated. RESULTS: Among the 15,169 live born infants included in this analysis, 424 presented at least one of the following conditions: very low birth weight, less than 30 gestational weeks at birth or an Apgar score at the 5th minute of life less than 7. According to the operational definition, these survivors from life-threatening conditions were considered neonatal near miss cases. The early neonatal mortality rate was 8.2/1,000 live births, the neonatal near miss rate was 21.4 neonatal near miss cases/1,000 live births. Substantial variations in the mortality among neonates with life-threatening conditions at birth were observed suggesting intra-hospital quality of care issues. CONCLUSION:The near miss concept and indicators provided information that could be useful to evaluate the quality of care and set priorities for further assessments and health care improvement for newborn infants.

OBJETIVO: avaliar a correlação entre o peso fetal estimado (PFE) por ultrassonografia e o peso neonatal (PN), bem como a capacidade do PFE predizer as alterações do PN entre gestantes de João Pessoa (PB). MÉTODOS: estudo de validação diagnóstica incluindo 122 gestantes que tiveram o PFE calculado por ultrassonografia até sete dias antes do parto e o PN determinado imediatamente após o nascimento, com balança específica para recém-nascidos. A correlação entre o PFE e o PN foi avaliada pelo coeficiente de correlação de Pearson entre as duas medidas e pela média das diferenças entre elas. O PFE e o PN foram classificados em: pequeno para idade gestacional (PIG), adequado para a idade gestacional (AIG) e grande para a idade gestacional (GIG), de acordo com os percentis 10 e 90 das respectivas curvas de referência. O diagnóstico de desvios do PFE foi validado utilizando a curva de valores de referência de peso neonatal de Alexander como padrão-ouro, estimando-se a sensibilidade, especificidade, valores preditivos positivo e negativo. RESULTADOS: houve uma elevada correlação linear entre o PFE e o PN (R=0,96) e a diferença entre eles variou entre -474 g e +480 g, com média de +3 g. A maioria das máximas variações percentuais da estimativa de peso esteve entre 10 e 15%. O PFE teve sensibilidade de 85,7% e especificidade de 100% para detecção de PIG, e de 100 e 77,2%, respectivamente, para GIG. CONCLUSÕES: o PFE é capaz de predizer adequadamente o PN, e a curva de PFE de referência testada teve bom desempenho no rastreamento dos desvios do crescimento fetal, quando utilizada nessa população.

PURPOSE: to evaluate the correlation between the estimated fetal weight (EFW) by ultrasonography and the neonatal weight (NW), as well as the EFW's capacity to predict changes in NW among pregnant women in João Pessoa, Paraíba, Brazil. METHODS: a diagnostic validation study, including 122 pregnant women who have had the EFW calculated by ultrasonography up to seven days before delivery and the NW established immediately after birth, with a specific newborn's scale. The correlation between EFW and NW measurements was assessed by Pearson's correlation coefficient and by the mean difference between them. EFW and NW were classified as: low for the gestational age (LGA), adequate for the gestational age (AGA) and high for the gestational age (HGA), according to the percentiles 10 and 90 of the respective reference curves. The diagnosis of EFW deviation has been validated using the values of the Alexander's NW reference curve as gold-standard, by estimating the sensitivity, specificity, and positive and negative predictive values. RESULTS: there has been a high linear correlation between the EFW and NW (R=0.96), and the difference between them has varied from -474 g to +480 g, with an average of +3 g. Most of the highest percent weight estimate variations were between 10 and 15%. EFW has had 85.7% of sensitivity and 100% of specificity for the detection of LGA, and 100 and 77.2%, respectively, for the detection of HGA. CONCLUSIONS: EFW is able to predict NW adequately, and the reference EFW tested has had a good performance in the screening of fetal growth deviation, in the population studied.

Objetivo: identificar o efeito da idade sobre os resultados maternos e perinatais das gestações ocorridas em mulheres com 40 anos ou mais. Métodos: comparamos 494 gestantes com mais de 40 anos, com 988 gestantes com idade entre 20 e 29 anos, pareando-as por paridade. Após controlar possíveis variáveis confundidoras pela análise multivariada, a idade materna avançada manteve associação com a maior prevalência de hipertensão arterial, apresentação anômala, parto por cesária, hemorragia puerperal, índice de Apgar baixo, morte perinatal, natimortalidade e sofrimento fetal intraparto. Resultados: a idade materna avançada esteve isoladamente associada à hipertensão arterial, apresentação anômala, diagnóstico de sofrimento fetal intraparto, parto por cesária e hemorragia puerperal. Com relação aos resultados neonatais, a idade materna avançada estava associada independentemente apenas ao baixo índice de Apgar, morte perinatal e óbito fetal. Conclusões: esses achados mostram a necessidade de assistência obstétrica adequada com atenção especial a esses fatores para procurar melhorar os resultados maternos e perinatais das gestantes com idade avançada.

Most authors agree on the negative impact of pregnancy in women with advanced maternal age on maternal and perinatal outcome. However, it is not usual to evaluate if some considered risk factors are only confounders because they are present in women over forty years. In order to identify the isolated effect of age on maternal and perinatal outcome of pregnancies in women over forty, 494 pregnancies from this age group were compared to 988 pregnancies among women aged 20 to 29 years, matched by parity. After controlling possible confounding variables through multivariate analysis, advanced maternal age maintained its association with a higher prevalence of hypertension, malpresentation, cesarean section, postpartum hemorrhage, low Apgar score, perinatal death, late fetal death and intrapartum fetal distress. These findings show the need for adequate obstetrical care with special attention to those factors in order to improve maternal and perinatal outcome of pregnancies in women with advanced age.