SUMMARY OBJECTIVE: The aim of this study was to evaluate the association between maternal anxiety in the third trimester and changes in fetal and maternal circulation assessed by Doppler velocimetry. METHODS: This is a prospective, cross-sectional study. The inclusion criteria were good health, a singleton pregnancy, maternal age between 18 and 40 years, and gestational age between 34 and 40 weeks. Doppler measurements included mean uterine artery pulsatility index, fetal middle cerebral artery pulsatility index, peak of systolic velocity, umbilical artery, and umbilical vein. The Beck Anxiety Inventory questionnaire, validated for the Brazilian population, with 21 self-reported items, was applied. RESULTS: The study included 34 pregnant women, and 6 (17.7%) presented a total Beck Anxiety Inventory score showing moderate or severe maternal anxiety. The mean maternal age was 28.1 years (SD 5.7 years); the mean gestational age at interview was 36.5 weeks (SD 1.8 weeks), and the mean Beck Anxiety Inventory total score was 12.3 (SD 9.8). The group with moderate or severe anxiety, compared to the group with minimal or mild anxiety, presented an association with lower maternal age (median 21.5 vs. 29.5 years, p=0.019), lower fetal umbilical vein blood flow (median 189.4 vs. 249.5 mL/min, p=0.047), and lower umbilical vein-corrected blood flow (median 68.5 vs. 84.9 mL/kg/min, p=0.038). CONCLUSION: Maternal anxiety may affect fetal circulation patterns in late pregnancy and is associated with reduced blood flow in the fetal umbilical vein. The underlying physiopathology needs further investigation. OBJECTIVE velocimetry METHODS prospective crosssectional cross sectional health 1 4 3 index velocity questionnaire population 2 selfreported self reported items applied RESULTS women 17.7% 177 17 7 (17.7% 281 28 28. SD 57 5 5. years) 365 36 36. 8 1. weeks, , weeks) 123 12 12. 9.8. 98 9.8 . 9 9.8) median 215 21. vs 295 29 29. p=0.019, p0019 p p=0.019 0 019 p=0.019) 1894 189 189. 2495 249 249. mLmin mL min mL/min p=0.047, p0047 p=0.047 047 p=0.047) veincorrected corrected 685 68 68. 849 84 84. mLkgmin kg mL/kg/min p=0.038. p0038 p=0.038 038 p=0.038) CONCLUSION investigation 17.7 (17.7 9. p001 p=0.01 01 24 p004 p=0.04 04 p003 p=0.03 03 17. (17. p00 p=0.0 (17 p0 p=0. (1 p=0 ( p=

SUMMARY OBJECTIVE: The aim of this study was to assess fetal thymus size by ultrasound in growth-restricted fetuses due to placental insufficiency and compare to high-risk and low-risk pregnancy fetuses with normal placental function. METHODS: This is a nested case-control study of pregnant women followed up at a university hospital (July 2012 to July 2013). In all, 30 pregnant women presenting small fetuses for gestational age (estimated fetal weight <p10) due to placental insufficiency (umbilical artery Doppler >p95) were compared to 30 high-risk and 30 low-risk pregnancies presenting normal Doppler indices. The thymus transverse diameter and perimeter were converted into zeta score according to the normal values for gestational age. Head circumference and femur length were used to calculate ratios. RESULTS: Fetal thymus were significantly lower in pregnancies with placental insufficiency when compared to high-risk and low-risk pregnancies presenting, respectively, transverse diameter zeta score (-0.69±0.83 vs. 0.49±1.13 vs. 0.83±0.85, p<0.001) and P zeta score (-0.73±0.68 vs. 0.45±0.96 vs. 0.26±0.89, p<0.001). There was also a significant difference (p<0.05) in the ratios among the groups: pregnancies with placental insufficiency (TD/HC=0.10, P/FL=1.32, and P/HC=0.26), high-risk pregnancies (TD/HC=0.11, P/FL=1.40, and P/HC=0.30), and control group (DT/HC=0.11, P/FL=1.45, and P/HC=0.31). CONCLUSION: Fetal thymus size is reduced in growth-restricted fetuses due to placental insufficiency, suggesting fetal response as a consequence of the adverse environment. OBJECTIVE growthrestricted growth restricted highrisk high risk lowrisk low function METHODS casecontrol case 201 2013. 2013 . 2013) all 3 estimated <p10 p10 p umbilical >p95 p95 indices RESULTS respectively 0.69±0.83 069083 0 69 83 (-0.69±0.8 vs 049113 49 1 13 0.49±1.1 083085 85 0.83±0.85 p<0.001 p0001 001 0.73±0.68 073068 73 68 (-0.73±0.6 045096 45 96 0.45±0.9 026089 26 89 0.26±0.89 p<0.001. p<0.05 p005 05 (p<0.05 groups TD/HC=0.10, TDHC010 TDHC TD HC 10 (TD/HC=0.10 PFL132 PFL FL 32 P/FL=1.32 P/HC=0.26, PHC026 PHC P/HC=0.26 , P/HC=0.26) TD/HC=0.11, TDHC011 11 (TD/HC=0.11 PFL140 40 P/FL=1.40 P/HC=0.30, PHC030 P/HC=0.30 P/HC=0.30) DT/HC=0.11, DTHC011 DTHC DT (DT/HC=0.11 PFL145 P/FL=1.45 P/HC=0.31. PHC031 P/HC=0.31 31 P/HC=0.31) CONCLUSION environment 20 <p1 p1 >p9 p9 0.69±0.8 06908 6 8 (-0.69±0. 04911 4 0.49±1. 08308 0.83±0.8 p<0.00 p000 00 0.73±0.6 07306 7 (-0.73±0. 04509 9 0.45±0. 02608 2 0.26±0.8 p<0.0 p00 (p<0.0 TD/HC=0.10 TDHC01 (TD/HC=0.1 PFL13 P/FL=1.3 PHC02 P/HC=0.2 TD/HC=0.11 PFL14 P/FL=1.4 PHC03 P/HC=0.3 DT/HC=0.11 DTHC01 (DT/HC=0.1 <p >p 0.69±0. 0690 (-0.69±0 0491 0.49±1 0830 0.83±0. 0.73±0. 0730 (-0.73±0 0450 0.45±0 0260 0.26±0. p<0. p0 (p<0. TD/HC=0.1 TDHC0 (TD/HC=0. PFL1 P/FL=1. PHC0 P/HC=0. DT/HC=0.1 DTHC0 (DT/HC=0. 0.69±0 069 (-0.69± 049 0.49± 083 0.83±0 0.73±0 073 (-0.73± 045 0.45± 026 0.26±0 p<0 (p<0 TD/HC=0. (TD/HC=0 P/FL=1 P/HC=0 DT/HC=0. (DT/HC=0 0.69± 06 (-0.69 04 0.49 08 0.83± 0.73± 07 (-0.73 0.45 02 0.26± p< (p< TD/HC=0 (TD/HC= P/FL= P/HC= DT/HC=0 (DT/HC= 0.69 (-0.6 0.4 0.83 0.73 (-0.7 0.26 (p TD/HC= (TD/HC P/FL P/HC DT/HC= (DT/HC 0.6 (-0. 0. 0.8 0.7 0.2 TD/HC DT/HC (-0 (- (

RESUMO OBJETIVO Estimar a prevalência de gestação não planejada (GNP) em oito hospitais públicos universitários, distribuídos nas cinco regiões que compõem o Brasil. MÉTODOS Análise secundária de um estudo transversal multicêntrico nacional, realizado em oito hospitais universitários públicos, entre 1º de junho e 31 de agosto de 2020, no Brasil. Amostra por conveniência incluindo mulheres que deram à luz em período de sessenta dias consecutivos e atenderam aos seguintes critérios: maiores de 18 anos; idade gestacional acima de 36 semanas no parto; com recém-nascido único e vivo, sem malformações. RESULTADOS Amostra composta por 1.120 puérperas, das quais 756 (67,5%) declararam que a gravidez não tinha sido programada. A mediana da prevalência de GNP foi de 59,7%. Observou-se diferença significativa na prevalência de GNP entre os hospitais: Campinas (54,8%), Porto Alegre (58,2%), Florianópolis (59%), Teresina (61,2%), Brasília (64,3%), São Paulo (64,6%), Campo Grande (73,9%) e Manaus (95,3%) (p < 0,001). Foram fatores significativamente associados a GNP a idade materna, cor negra, menor renda familiar, maior número de filhos, maior número de pessoas convivendo em casa e não ter parceiro. CONCLUSÃO Na amostra estudada, cerca de dois terços das gestações foram declaradas como não programadas. A prevalência de gestação não planejada teve relação com fatores sociais e demográficos e variou significativamente entre os hospitais universitários avaliados.

ABSTRACT OBJECTIVE To estimate the prevalence of unplanned pregnancy in eight public university hospitals, distributed in the five regions that make up Brazil. METHODS A secondary analysis of a national multicenter cross-sectional study, carried out in eight public university hospitals between June 1 and August 31, 2020, in Brazil. Convenience sample including women who gave birth within sixty consecutive days and met the following criteria: over 18 years old; gestational age over 36 weeks at delivery; with a single and live newborn, without malformations. RESULTS Sample composed of 1,120 postpartum women, of whom 756 (67.5%) declared that the pregnancy had not been planned. The median prevalence of unplanned pregnancy was 59.7%. The prevalence of unplanned pregnancy across hospitals differed significantly: Campinas (54.8%), Porto Alegre (58.2%), Florianópolis (59%), Teresina (61.2%), Brasília (64.3%), São Paulo (64.6%), Campo Grande (73.9%) and Manaus (95.3%) (p < 0.001). Factors significantly associated with unplanned pregnancy were maternal age, black color, lower family income, greater number of children, greater number of people living in household, and not having a partner. CONCLUSION In the studied sample, about two thirds of the pregnancies were declared as unplanned. The prevalence of unplanned pregnancies was related to social and demographic factors and varied significantly across the university hospitals evaluated.

Abstract Objective To evaluate the association between pain intensity in the active phase of the first stage of labor with the use or not of nonpharmacological methods for pain relief in a real-life scenario. Methods This was an observational cross-sectional study. The variables analyzed were obtained by a questionnaire with the mothers (up to 48 hours postpartum) to investigate the intensity of pain during labor using the visual analog scale (VAS). The nonpharmacological pain relief methods routinely used in obstetric practice were evaluated by consulting medical records. The patients were separated into two groups: Group I – patients who did not use nonpharmacological methods for pain relief and Group II –patients who used these methods. Results A total of 439 women who underwent vaginal delivery were included; 386 (87.9%) used at least 1 nonpharmacological method and 53 (12.1%) did not. The women who did not use nonpharmacological methods had significantly lower gestational age (37.2 versus 39.6 weeks, p < 0.001) and shorter duration of labor (24 versus 114 min, p < 0.001) than those who used the methods. There was no statistically significant difference in the pain scale score using the VAS between the group that used nonpharmacological methods and the group that did not (median 10 [minimum 2– maximum 10] versus 10 [minimum 6–maximum 10] p = 0.334). Conclusion In a real-life setting, there was no difference in labor pain intensity between the patients who used nonpharmacological methods and those who did not use them during the active phase of labor. reallife real life scenario crosssectional cross sectional study up 4 postpartum VAS. . (VAS) records groups 43 included 38 87.9% 879 87 9 (87.9% 5 12.1% 121 12 (12.1% 37.2 372 37 2 (37. 396 39 6 39. weeks 0.001 0001 0 001 24 (2 11 min median minimum 6maximum 0.334. 0334 0.334 334 0.334) setting (VAS 3 87.9 8 (87.9 12.1 (12.1 37. (37 0.00 000 00 ( 033 0.33 33 87. (87. 12. (12. (3 0.0 03 0.3 (87 (12 0. (8 (1

Resumo Objetivo Avaliar a associação da intensidade da dor na fase ativa da dilatação do parto em mulheres de acordo com a utilização ou não de métodos não farmacológicos para alívio da dor em cenário de vida real. Métodos Trata-se de um estudo observacional de corte transversal. As variáveis analisadas foram obtidas através de questionário com as puérperas (até 48 horas pós-parto) investigando a intensidade da dor no parto pela escala visual analógica (EVA). As medidas não farmacológicas de alívio da dor, utilizadas rotineiramente na prática obstétrica, foram avaliadas pela consulta aos prontuários. As pacientes foram separadas em dois grupos: Grupo I – pacientes que não utilizaram medidas não farmacológicas para alívio da dor e Grupo II - pacientes que utilizaram estas medidas. Resultados Foram incluídas 439 mulheres que tiveram parto vaginal, sendo que 386 (87,9%) utilizaram, pelo menos, uma medida não farmacológica e 53 (12,1%) não utilizaram. As mulheres que não utilizaram as medidas não farmacológicas apresentaram idade gestacional significativamente menor (37,2 versus 39,6 semanas, p < 0,001) e menor duração do trabalho de parto (24 versus 114 minutos, p < 0,001) quando comparadas às que utilizaram as medidas. Não houve diferença estatisticamente significativa na pontuação da escala da dor pela EVA de acordo com a categorização pelo uso ou não de métodos não farmacológicos (mediana 10 [mínimo 2–máximo 10] versus 10 (mínimo 6–máximo 10), p = 0,334]. Conclusão Em cenário de vida real, as pacientes submetidas aos métodos não farmacológicos não apresentaram diferença em relação à intensidade da dor quando comparadas às que não os utilizaram durante a fase ativa do trabalho de parto. real Tratase Trata se transversal até 4 pósparto pós pós-parto EVA. . (EVA) obstétrica prontuários grupos 43 vaginal 38 87,9% 879 87 9 (87,9% menos 5 12,1% 121 12 1 (12,1% 37,2 372 37 2 (37, 396 39 6 39, semanas 0,001 0001 0 001 24 (2 11 minutos mediana mínimo 2máximo máximo 6máximo 10, , 10) 0,334. 0334 0,334 334 0,334] (EVA 3 87,9 8 (87,9 12,1 (12,1 37, (37 0,00 000 00 ( 033 0,33 33 87, (87, 12, (12, (3 0,0 03 0,3 (87 (12 0, (8 (1

SUMMARY OBJECTIVE: The aim of this study was to evaluate the effects of obstetric simulation training on undergraduate medical students to improve their self-confidence. METHODS: Fifth-year undergraduate medical students were invited to a 2-week course of simulation in obstetrics during their clerkship. The sessions included were as follows: (1) care for the second and third periods of childbirth, (2) partograph analysis and pelvimetry, (3) premature rupture of membranes at term, and (4) diagnosis and management of third-trimester bleeding. Before the first session and at the end of the training period, a questionnaire about self-confidence in obstetric procedures and skills was applied. RESULTS: A total of 115 medical students were included, of whom 60 (52.2%) were male and 55 (47.8%) were female. Comparing initial and final scores, the median results of the subscales “comprehension and preparation” (18 vs. 22, p<0.001), “knowledge of procedures” (14 vs. 20, p<0.001), and “expectation” (22 vs. 23, p<0.01) were significantly higher at the end of the training period in all items of the questionnaire than in the beginning. Differences were found based on the students’ gender, i.e., female students had a significantly higher sum of scores than the male students in the initial subscale for “expectation” (median, 24 vs. 22, p<0.001) and “interest” (median, 23 vs. 21, p=0.032), and a higher sum of scores in the subscale for “expectation” (median, 23 vs. 21, p=0.010) in the final questionnaire. CONCLUSION: Obstetric simulation enhances the improvement of students’ self-confidence in understanding both the physiology of childbirth and the obstetric care procedures. Further studies are needed to understand the influence of gender on obstetric care. OBJECTIVE selfconfidence. selfconfidence self confidence. confidence METHODS Fifthyear Fifth year 2week week 2 clerkship follows 1 (1 (2 pelvimetry 3 (3 term 4 (4 thirdtrimester trimester bleeding applied RESULTS 11 6 52.2% 522 52 (52.2% 5 47.8% 478 47 8 (47.8% comprehension preparation 18 vs 22 p<0.001, p0001 p p<0.001 , 0 001 knowledge 14 20 expectation “expectation p<0.01 p001 01 beginning ie i e i.e. median, (median interest “interest 21 p=0.032, p0032 p=0.032 032 p=0.032) p=0.010 p0010 010 CONCLUSION ( 52.2 (52.2 47.8 (47.8 p000 p<0.00 00 p<0.0 p00 i.e p003 p=0.03 03 p=0.01 52. (52. 47. (47. p<0. p0 p=0.0 (52 (47 p<0 p=0. (5 p< p=0 p=

SUMMARY OBJECTIVE: Fetal thymus involvement in prematurity has been studied, and this study aimed to evaluate its relationship with short cervix and amniotic fluid sludge in the second trimester of pregnancy. METHODS: In this prospective cross-sectional study, 79 pregnant women (19+0 to 24+6 weeks) were included, and cervical length and the presence or absence of amniotic fluid sludge were evaluated. In the three-vessel view of the fetal thorax, the thymus was identified, and its perimeter and transverse diameter were measured and transformed to a zeta score based on gestational age. RESULTS: Data from 22 women with short cervix (<25 mm) and 57 patients with normal cervix (≥25 mm) were analyzed. The transverse diameter of the fetal thymus was significantly greater in the short cervix group compared to that of the normal cervix group (z-score 2.708 vs. −0.043, p=0.003). There were no significant differences in the perimeter (z-score −0.039 vs. −0.071, p=0.890) or the transverse diameter (z-score 1.297 vs. −0.004, p=0.091) of the fetal thymus associated with the presence (n=21) or absence of sludge (n=58). CONCLUSION: A short cervix is associated with an increased transverse diameter of the fetal thymus during the second trimester of gestation. OBJECTIVE studied pregnancy METHODS crosssectional cross sectional 7 19+0 190 19 0 (19+ 246 24 6 24+ weeks included evaluated threevessel three vessel thorax identified age RESULTS 2 <25 25 (<2 mm 5 ≥25 (≥2 analyzed zscore z 2708 708 2.70 vs 0043 043 −0.043 p=0.003. p0003 p p=0.003 . 003 p=0.003) 0039 039 −0.03 0071 071 −0.071 p=0.890 p0890 890 1297 1 297 1.29 0004 004 −0.004 p=0.091 p0091 091 n=21 n21 n 21 (n=21 n=58. n58 n=58 58 (n=58) CONCLUSION gestation 19+ (19 <2 (< ≥2 (≥ 270 70 2.7 04 −0.04 p000 p=0.00 00 03 −0.0 007 07 −0.07 p=0.89 p089 89 129 29 1.2 000 −0.00 p=0.09 p009 09 n=2 n2 (n=2 n5 n=5 (n=58 (1 < ( ≥ 27 2. p00 p=0.0 −0. p=0.8 p08 8 12 1. n= (n= (n=5 p0 p=0. −0 (n p=0 − p=

ABSTRACT OBJECTIVE To estimate the prevalence of unplanned pregnancy in eight public university hospitals, distributed in the five regions that make up Brazil. METHODS A secondary analysis of a national multicenter cross-sectional study, carried out in eight public university hospitals between June 1 and August 31, 2020, in Brazil. Convenience sample including women who gave birth within sixty consecutive days and met the following criteria: over 18 years old; gestational age over 36 weeks at delivery; with a single and live newborn, without malformations. RESULTS Sample composed of 1,120 postpartum women, of whom 756 (67.5%) declared that the pregnancy had not been planned. The median prevalence of unplanned pregnancy was 59.7%. The prevalence of unplanned pregnancy across hospitals differed significantly: Campinas (54.8%), Porto Alegre (58.2%), Florianópolis (59%), Teresina (61.2%), Brasília (64.3%), São Paulo (64.6%), Campo Grande (73.9%) and Manaus (95.3%) (p < 0.001). Factors significantly associated with unplanned pregnancy were maternal age, black color, lower family income, greater number of children, greater number of people living in household, and not having a partner. CONCLUSION In the studied sample, about two thirds of the pregnancies were declared as unplanned. The prevalence of unplanned pregnancies was related to social and demographic factors and varied significantly across the university hospitals evaluated. Brazil crosssectional cross sectional study 31 2020 criteria old 3 delivery newborn malformations 1120 120 1,12 75 67.5% 675 67 5 (67.5% planned 597 59 7 59.7% 54.8%, 548 54.8% , 54 8 (54.8%) 58.2%, 582 58.2% 58 2 (58.2%) 59%, 59% (59%) 61.2%, 612 61.2% 61 (61.2%) 64.3%, 643 64.3% 64 (64.3%) 64.6%, 646 64.6% 6 (64.6%) 73.9% 739 73 9 (73.9% 95.3% 953 95 (95.3% p 0.001. 0001 0.001 . 0 001 0.001) color income children household partner evaluated 202 112 12 1,1 67.5 (67.5 59.7 54.8 (54.8% 58.2 (58.2% (59% 61.2 (61.2% 64.3 (64.3% 64.6 (64.6% 73.9 (73.9 95.3 (95.3 000 0.00 00 20 11 1, 67. (67. 59. 54. (54.8 58. (58.2 (59 61. (61.2 64. (64.3 (64.6 73. (73. 95. (95. 0.0 (67 (54. (58. (5 (61. (64. (73 (95 0. (6 (54 (58 ( (61 (64 (7 (9

RESUMO OBJETIVO Estimar a prevalência de gestação não planejada (GNP) em oito hospitais públicos universitários, distribuídos nas cinco regiões que compõem o Brasil. MÉTODOS Análise secundária de um estudo transversal multicêntrico nacional, realizado em oito hospitais universitários públicos, entre 1º de junho e 31 de agosto de 2020, no Brasil. Amostra por conveniência incluindo mulheres que deram à luz em período de sessenta dias consecutivos e atenderam aos seguintes critérios: maiores de 18 anos; idade gestacional acima de 36 semanas no parto; com recém-nascido único e vivo, sem malformações. RESULTADOS Amostra composta por 1.120 puérperas, das quais 756 (67,5%) declararam que a gravidez não tinha sido programada. A mediana da prevalência de GNP foi de 59,7%. Observou-se diferença significativa na prevalência de GNP entre os hospitais: Campinas (54,8%), Porto Alegre (58,2%), Florianópolis (59%), Teresina (61,2%), Brasília (64,3%), São Paulo (64,6%), Campo Grande (73,9%) e Manaus (95,3%) (p < 0,001). Foram fatores significativamente associados a GNP a idade materna, cor negra, menor renda familiar, maior número de filhos, maior número de pessoas convivendo em casa e não ter parceiro. CONCLUSÃO Na amostra estudada, cerca de dois terços das gestações foram declaradas como não programadas. A prevalência de gestação não planejada teve relação com fatores sociais e demográficos e variou significativamente entre os hospitais universitários avaliados. (GNP Brasil nacional º 3 2020 critérios 1 anos parto recémnascido recém nascido vivo malformações 1120 120 1.12 puérperas 75 67,5% 675 67 5 (67,5% programada 597 59 7 59,7% Observouse Observou se 54,8%, 548 54,8% , 54 8 (54,8%) 58,2%, 582 58,2% 58 2 (58,2%) 59%, 59% (59%) 61,2%, 612 61,2% 61 (61,2%) 64,3%, 643 64,3% 64 (64,3%) 64,6%, 646 64,6% 6 (64,6%) 73,9% 739 73 9 (73,9% 95,3% 953 95 (95,3% p 0,001. 0001 0,001 . 0 001 0,001) materna negra familiar filhos parceiro estudada programadas avaliados 202 112 12 1.1 67,5 (67,5 59,7 54,8 (54,8% 58,2 (58,2% (59% 61,2 (61,2% 64,3 (64,3% 64,6 (64,6% 73,9 (73,9 95,3 (95,3 000 0,00 00 20 11 1. 67, (67, 59, 54, (54,8 58, (58,2 (59 61, (61,2 64, (64,3 (64,6 73, (73, 95, (95, 0,0 (67 (54, (58, (5 (61, (64, (73 (95 0, (6 (54 (58 ( (61 (64 (7 (9

SUMMARY OBJECTIVE: The objective of this study was to compare the nutritional status and dietary intake of pregnant women with sickle cell disease (SS hemoglobinopathy and SC hemoglobinopathy) to healthy controls and report the maternal and perinatal outcomes. METHODS: This is a prospective, longitudinal cohort study. Pregnant women with a diagnosis of sickle cell disease and control group were recruited in an outpatient clinic of a tertiary care hospital in São Paulo, Brazil. Maternal anthropometric data and dietary intake data were collected at the second and third trimesters. RESULTS: A total of 49 pregnancies complicated by sickle cell disease were included. Prepregnancy body mass index was significantly lower in the SS hemoglobinopathy group (n=26, median 20.3 kg/m2) than the SC hemoglobinopathy group (n=23, 22.7 kg/m2) or control group (n=33, 23.2 kg/m2, p<0.05). The prepregnancy nutritional status revealed significantly more women classified as underweight in the SS hemoglobinopathy group (15.4%) than in the SC hemoglobinopathy group (4.4%) and control group (1.6%, p=0.009). In the second trimester, maternal protein intake was significantly lower in SS hemoglobinopathy (73.2 g/day) and SC hemoglobinopathy (68.8 g/day) than in the control group (95.7 g/day, p=0.004). In the third trimester, only SS hemoglobinopathy mothers showed dietary intake of protein significantly lower than that of the controls (67.5 g/day vs. 92.8 g/day, p=0.02). Vitamin A and E consumption was also reduced in the third trimester in the SS hemoglobinopathy group (p<0.05). CONCLUSION: The nutritional status of pregnant women with SS hemoglobinopathy is characterized by a state of undernutrition. The lower protein intake in the second and third trimesters of pregnant women with SS hemoglobinopathy may contribute to this condition. Undernourishment is a serious complication of sickle cell disease, primarily during pregnancy, and it should be addressed during the prenatal period. OBJECTIVE outcomes METHODS prospective Paulo Brazil RESULTS 4 included n=26, n26 n 26 (n=26 203 20 3 20. kg/m2 kgm2 kgm kg m2 m n=23, n23 23 (n=23 227 22 7 22. n=33, n33 33 (n=33 232 2 23. p<0.05. p005 p p<0.05 . 0 05 p<0.05) 15.4% 154 15 (15.4% 4.4% 44 (4.4% 1.6%, 16 1 6 (1.6% p=0.009. p0009 p=0.009 009 p=0.009) 73.2 732 73 (73. gday g day 68.8 688 68 8 (68. 95.7 957 95 (95. p=0.004. p0004 p=0.004 004 p=0.004) 67.5 675 67 5 (67. vs 928 92 92. p=0.02. p002 p=0.02 02 p=0.02) (p<0.05) CONCLUSION undernutrition condition pregnancy period n=26 n2 (n=2 kg/m n=23 n=33 n3 (n=3 p00 p<0.0 15.4 (15.4 4.4 (4.4 1.6% (1.6 p000 p=0.00 00 73. (73 68. (68 95. 9 (95 67. (67 p=0.0 (p<0.05 n=2 (n= n=3 p0 p<0. 15. (15. 4. (4. 1.6 (1. (7 (6 (9 p=0. (p<0.0 n= (n p<0 (15 (4 1. (1 ( p=0 (p<0. p< p= (p<0 (p< (p

Resumo Objetivo Estudar a ansiedade materna em gestantes sem comorbidades no contexto do surto de COVID-19 no Brasil e estudar o conhecimento e as preocupações maternas sobre a pandemia. Métodos Trata-se de análise secundária de um estudo transversal multicêntrico nacional realizado em 10 cidades, de junho a agosto de 2020, no Brasil. Mulheres no pós-parto entrevistadas, sem comorbidades médicas ou obstétricas, foram incluídas nesta subanálise. Foram aplicados um questionário estruturado e o Inventário de Ansiedade de Beck (BAI, na sigla em inglês). Resultados Das 1.662 mulheres, 763 (45,9%) atenderam aos critérios da análise atual e 16,1% apresentaram ansiedade materna moderada e 11,5% ansiedade materna grave. A ansiedade materna moderada ou grave foi associada à escolaridade no ensino médio (odds ratio [OR]: 1,58; intervalo de confiança [IC] 95%: 1,04–2,40). O fator protetor foi coabitar com companheiro (OR: 0,46; IC95%: 0,29–0,73). Houve correlação positiva entre a pontuação total do BAI e o recebimento de informações sobre cuidados na pandemia (rparcial 0,15; p < 0,001); preocupação com a transmissão vertical de COVID-19 (rparcial 0,10; p = 0,01); receber informações sobre amamentação (rparcial 0,08; p = 0,03); preocupações sobre cuidados pré-natais (rparcial 0,10; p = 0,01) e preocupações sobre o bebê contrair COVID-19 (rparcial 0,11; p = 0,004). A correlação foi negativa com os seguintes aspectos: ter autoconfiança para se proteger (rparcial 0,08; p = 0,04), aprender (rparcial 0,09; p = 0,01) e ter autoconfiança para amamentar (rparcial 0,22; p < 0,001) no contexto da pandemia. Conclusão A ansiedade de gestantes sem comorbidades médicas ou obstétricas esteve associada à escolaridade no ensino médio e não morar com companheiro durante a pandemia de COVID-19. A autoconfiança na proteção contra COVID-19 e o conhecimento sobre os cuidados com a amamentação durante a pandemia reduziram a ansiedade materna.

Abstract Objective To study maternal anxiety in pregnant women without comorbidities in the context of the COVID-19 outbreak in Brazil and to study maternal knowledge and concerns about the pandemic. Methods This is a secondary analysis from a national multicenter cross-sectional study performed in 10 cities, from June to August, 2020, in Brazil. Interviewed postpartum women, without medical or obstetrical comorbidities, were included in the present subanalysis. A structured questionnaire and the Beck Anxiety Inventory (BAI) were applied. Results Out of the 1,662 women, 763 (45.9%) met the criteria for the current analysis and 16.1% presented with moderate and 11.5% with severe maternal anxiety. Moderate or severe maternal anxiety was associated with high school education (odds ratio [OR]:1.58; 95% confidence interval [CI]:1.04–2.40). The protective factor was cohabiting with a partner (OR: 0.46; 95%CI: 0.29–0.73). There was a positive correlation between the total BAI score and receiving information about care in the pandemic (rpartial 0.15; p < 0.001); concern about vertical transmission of COVID-19 (rpartial 0.10; p = 0.01); receiving information about breastfeeding (rpartial 0.08; p = 0.03); concerns about prenatal care (rpartial 0.10; p = 0.01), and concerns about the baby contracting COVID-19 (rpartial 0.11; p = 0.004). The correlation was negative in the following aspects: self-confidence in protecting from COVID-19 (rpartial 0.08; p = 0.04), having learned (rpartial 0.09; p = 0.01) and self-confidence in breastfeeding (rpartial 0.22; p < 0.001) in the context of the pandemic. Conclusion The anxiety of pregnant women without medical or obstetrical comorbidities was associated to high school educational level and not living with a partner during the COVID-19 pandemic. Self-confidence in protecting against COVID-19 and knowledge about breastfeeding care during the pandemic reduced maternal anxiety.

Resumo Objetivo A presente revisão detalhada busca fornecer dados objetivos para avaliar o que se sabe até o momento e possibilitar uma visãomais ampla dos efeitos do SARSCoV2 na gravidez. Métodos Entre 29 demarço e 2 de maio de 2020, foi realizada uma busca nos bancos de dados PubMed e Google Scholar com as palavras COVID-19, SARS-CoV2, COVID-19 e gravidez, SARS-CoV2 e gravidez, e SARS e gravidez. As recomendações dos principais órgãos sobre o tema também foram acessadas. Conclusão O surto de COVID-19 resultou em uma pandemia com> 3.3 milhões de casos e 230 mil mortes até 2 de maio. É uma condição causada pelo vírus SARS-CoV2 e pode levar ao acometimento pulmonar difuso e à falência de múltiplos órgãos. Características únicas da gestante tornam essa população mais propensas a complicações de infecções virais. Até o momento, essa tendência não foi observada para esse novo vírus. Os fatores que parecem estar associados à maior morbidade materno-fetal são obesidade (índice demassa corporal [IMC] > 35), asma e doença cardiovascular. Há descrição de aumento de parto prematuro e parto cesáreo. Não se pode descartar a possibilidade de transmissão vertical da doença, devido a relatos de positividade de reação em cadeia de polimerase (RT-PCR) de swab nasal, RT-PCR de líquido amniótico e imunoglobulina M (IgM) de recém-nascidos. Tratamentos devem ser analisados caso a caso, dada a falta de qualidade de estudos que comprovem a sua eficácia e segurança na gravidez. O corpo clínico deve utilizar equipamentos de proteção individual (EPI) ao manusear pacientes suspeitos ou confirmados e ficar atento aos sinais de descompensação respiratória.

Abstract Objective The present comprehensive review aims to show the full extent of what is known to date and provide a more thorough view on the effects of SARS-CoV2 in pregnancy. Methods Between March 29 and May, 2020, the words COVID-19, SARS-CoV2, COVID- 19 and pregnancy, SARS-CoV2 and pregnancy, and SARS and pregnancy were searched in the PubMed and Google Scholar databases; the guidelines from well-known societies and institutions (Royal College of Obstetricians and Gynaecologists [RCOG], American College of Obstetricians and Gynecologists [ACOG], International Society of Ultrasound in Obstetrics & Gynecology [ISUOG], Centers for Disease Control and Prevention [CDC], International Federation of Gynecology and Obstetrics [FIGO]) were also included. Conclusion The COVID-19 outbreak resulted in a pandemic with > 3.3 million cases and 230 thousand deaths until May 2nd. It is caused by the SARS-CoV2 virus and may lead to severe pulmonary infection and multi-organ failure. Past experiences show that unique characteristics in pregnancy make pregnant women more susceptible to complications from viral infections. Yet, this has not been reported with this new virus. There are risk factors that seem to increase morbidity in pregnancy, such as obesity (body mass index [BMI] > 35), asthma and cardiovascular disease. Current reports describe an increased rate of pretermbirth and C-section. Vertical transmission

Resumo Objetivo O objetivo deste estudo foi determinar a validação de face e conteúdo da Escala Mackey de Avaliação da Satisfação com o Parto (MCSRS, na sigla em inglês), transculturalmente adaptada para o português brasileiro. Métodos O MCSRS é um questionário com 34 itens relacionados à satisfação com o parto. As versões traduzida e retrotraduzida foram comparadas com o material original, e 10 especialistas analisaram cada item de acordo com os seguintes critérios: clareza, equivalência semântica, pertinência e relevância cultural. A versão final foi apresentada a 10 mães para validação de face, para garantir que o questionário fosse adequado à população-alvo. Resultados O total de 34 itens avaliados por especialistas para clareza, equivalência semântica, pertinência e relevância apresentou concordância positiva de 0,85, 0,92, 0,97 e 0,97; concordância negativa de 0,13, 0,09, 0,04 e 0,04; e concordância total de 0,75; 0,85, 0,94 e 0,94, respectivamente. A modelagem linear multinível foi aplicada com efeitos aleatórios cruzados e com efeitos aleatórios aninhados para cada juiz. A intercepção de cada critério foi a seguinte: clareza, 0,87; equivalência semântica, 0,92; pertinência, 0,96; e relevância cultural, 0,96. A média geral de concordância foi de 92,8%. A mensuração da validade de face foi 80% de concordância nos itens, todos claramente entendidos. Conclusão A versão final do questionário MCSRS do português brasileiro teve validade de face e conteúdo confirmada. Este instrumento de avaliação da satisfação materna durante o parto foi validado para ser aplicado na população femininabrasileira.

Abstract Objective The aim of this study was to determine the content and face validity of the Mackey Childbirth Satisfaction Rating Scale (MCSRS) questionnaire cross-culturally adapted to Brazilian Portuguese. Methods The MCSRS is a questionnaire with 34 items related to childbirth satisfaction. The forward- and back-translated versions were compared with the original material, and 10 experts analyzed each item according to the following criteria: clarity, semantic equivalence, appropriateness, and cultural relevance. The final version was presented to 10 mothers for face validation to ensure the questionnaire would suit the target population. Results The total of 34 items assessed by experts for clarity, semantic equivalence, appropriateness, and relevance showed positive agreement of 0.85, 0.92, 0.97 and 0.97; negative agreement of 0.13, 0.09, 0.04 and 0.04; and total agreement of 0.75; 0.85, 0.94 and 0.94, respectively. Multilevel linear modeling was applied with crossed random effects and with nested random effects for each judge. The intercept of each criterion was as follows: clarity, 0.87; semantic equivalence, 0.92; appropriateness, 0.96; and cultural relevance, 0.96. The overall mean of agreement was 92.8%. The face validity measurement yielded 80% of agreement on the items, all of them clearly understood. Conclusion The final version of the Brazilian Portuguese MCSRS questionnaire had face and content validity confirmed. This instrument of evaluation of maternal satisfaction during childbirth was validated to be applied in the Brazilian female population.

OBJETIVO:Validar questionário para conhecer e descrever a percepção dos médicos especialistas em ginecologia e obstetrícia quanto à vivência e autoconfiança no atendimento de emergências no parto vaginal.MÉTODOS:Estudo prospectivo de validação de instrumento constituído por afirmativas sobre atendimento nas emergências: parto pélvico (n=23), distocia de ombros (n=20), hemorragia pós-parto (n=24), parto fórcipe (n=32) e vácuo extrator (n=5). Os participantes opinaram sobre cada item segundo escala de Likert (0=discordo plenamente, 1=discordo parcialmente, 2=indiferente, 3=concordo parcialmente e 4=concordo plenamente). O questionário foi aplicado a 12 especialistas em ginecologia e obstetrícia esperando-se encontrar nível de compreensão superior a 80%. Uma escala de cinco pontos foi empregada para avaliar a compreensão de cada questão (de 0=não entendi nada a 5=entendi perfeitamente e não tenho dúvidas). Valores acima de 4 foram considerados indicadores de compreensão suficiente. O instrumento utilizado foi especialmente elaborado para atender às especificidades demandadas. A análise da confiabilidade interna foi pelo coeficiente alfa de Cronbach. Para a validação externa foram calculadas a proporção de itens com plena compreensão, por cada grupo. Para fins de investigação, o alfa deve ser maior do que 0,7.RESULTADOS:Os participantes apresentavam média de idade de 33,3 anos, com desvio padrão (DP) de 5,0 anos, e tempo de formado médio de 5,8 anos (DP=1,3anos). Todos eram especialistas com residência médica em Ginecologia e Obstetrícia. A média da proporção de participantes que compreenderam plenamente os itens de cada emergência estudada foi: parto pélvico 97,3%, distocia de ombros 96,7%, hemorragia pós-parto 99,7%, parto fórcipe 97,4%, e vácuo extrator 98,3%. Os resultados do alfa de Cronbach, para os itens de cada emergência estudada, foram: parto pélvico 0,85, sendo o limite inferior do intervalo de confiança de 95% (IC95%) 0,72, distocia de ombros 0,74 (limite inferior do IC95%=0,51), hemorragia pós-parto 0,79 (limite inferior do IC95%=0,61), parto fórcipe 0,96 (limite inferior do IC95%=0,92), e vácuo extrator 0,90 (limite inferior do IC95%=0,79).CONCLUSÃO:O questionário validado é instrumento útil para conhecer e descrever a percepção do médico quanto à vivência e autoconfiança no atendimento de emergências na assistência ao parto vaginal.

PURPOSE:To validate a questionnaire to be applied in order to learn and describe the perceptions of specialists in obstetrics and gynecology about their experience and self-confidence in the emergency care for vaginal delivery.METHODS:This was a prospective study for the validation of an instrument that contains statements about emergency obstetrical care: breech delivery (n=23), shoulder dystocia (n=20), postpartum haemorrhage (n=24), forceps delivery (n=32), and vacuum extractor (n=5). Participants gave their opinions on each item by applying the Likert scale (0=strongly disagree, 1=partially disagree, 2=indifferent, 3=partially agree and 4=strongly agree). The questionnaire was applied to 12 specialists in obstetrics and gynecology and it was expected to be found a level of comprehension exceeding 80%. A five-point scale was used to assess the understanding of each question (from 0=did not understand anything to 5=understood perfectly and I have no doubt). A score above 4 was considered to indicate sufficient understanding. The instrument used was specially designed to suit the specific demands. The analysis of internal reliability was done using the Cronbach alpha coefficient. For external validation, we calculated the proportion of items with full understanding for each subscale. For research purposes, the alpha should be greater than 0.7.RESULTS:Participants had a mean age of 33.3 years, with 5.0 standard deviation (SD), and an average interval time since graduation from medical school of 5.8 years (SD=1.3 years). All were specialists with residency in obstetrics and gynecology. The mean proportion of participants who fully understood the items in each emergency was 97.3% for breech delivery, 96.7% for shoulder dystocia, 99.7% for postpartum hemorrhage, 97.4% for forceps delivery, and 98.3% for the use of a vacuum extractor. The results of Cronbach's alpha for the items in each emergency studied were: 0.85 for breech delivery, with 0.72 lower limit of 95% confidence interval ((%%CI), 0.74 for shoulder dystocia (lower limit of 95%CI=0.51), 0.79 for postpartum hemorrhage (lower limit of 95%CI=0.61), 0.96 for forceps delivery (lower limit of 95%CI=0.92), and 0.90 for the vacuum extractor (lower limit of 95%CI=0.79).CONCLUSION:The validated questionnaire is useful for learning and describing the perception of physicians about their experience and self-confidence in emergency care for vaginal births.