SUMMARY OBJECTIVE: This study aimed to evaluate cardiac contractility in fetuses from pregestational diabetes mellitus pregnancies by three-dimensional ultrasound using spatiotemporal image correlation in rendering mode. METHODS: A retrospective cross-sectional study was performed on 40 fetuses from nondiabetic pregnancies and 28 pregestational diabetic pregnancies between 20 and 33 weeks and 6 days. Cardiac contractility was assessed by measuring the ventricular myocardial area in diastole subtracted from the ventricular myocardial area in systole. RESULTS: Pregestational diabetic pregnancies had a lower maternal age than nondiabetic pregnancies (26.7 vs. 39.9 years, p=0.019). Cardiac contractility in fetuses from diabetic and nondiabetic pregnancies was similar (p=0.293). A moderately positive and significant correlation was observed between gestational age and cardiac contractility (r=0.46, p=0.0004). A 1-week increase in gestational age was responsible for a 0.1386 cm2 increase in cardiac contractility. CONCLUSION: Cardiac contractility as evaluated by three-dimensional ultrasound using spatiotemporal image correlation in rendering mode showed no significant differences across fetuses with and without pregestational diabetes. OBJECTIVE threedimensional three dimensional METHODS crosssectional cross sectional 4 2 3 days systole RESULTS 26.7 267 26 7 (26. vs 399 39 9 39. years p=0.019. p0019 p p=0.019 . 0 019 p=0.019) p=0.293. p0293 p=0.293 293 (p=0.293) r=0.46, r046 r 46 (r=0.46 p=0.0004. p00004 p=0.0004 0004 p=0.0004) 1week week 1 01386 1386 0.138 cm CONCLUSION 26. (26 p001 p=0.01 01 p029 p=0.29 29 (p=0.293 r=0.46 r04 (r=0.4 p0000 p=0.000 000 0138 138 0.13 (2 p00 p=0.0 p02 p=0.2 (p=0.29 r=0.4 r0 (r=0. p000 p=0.00 00 013 13 0.1 ( p0 p=0. (p=0.2 r=0. (r=0 0. p=0 (p=0. r=0 (r= p= (p=0 r= (r (p= (p

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: The aim of this study was to evaluate the success rate and predictors of labor induction using vaginal misoprostol in a low-risk pregnant women population. METHODS: A prospective cohort study was carried out with 196 pregnant women. Groups 2 and 4 of the Robson Classification admitted for induction of labor with vaginal misoprostol (25 μg tablets every 6 h, up to 4 tablets, for a maximum of 24 h). The success of labor induction was considered the achievement of vaginal delivery. Binary logistic regression was used to determine the best predictors of successful induction of labor with vaginal misoprostol. RESULTS: Of all the pregnant women analyzed, 140 (71.4%) were successful and 56 (28.6%) were unsuccessful. Pregnant women who achieved successful induction had a higher number of pregnancies (1.69 vs. 1.36, p=0.023), a higher number of deliveries (0.57 vs. 0.19, p<0.001), a higher Bishop score (2.0 vs. 1.38, p=0.002), and lower misoprostol 25 μg tablets (2.18 vs. 2.57, p=0.031). No previous deliveries [x2(1)=3.14, odds ratio (OR): 0.24, 95% confidence interval (CI): 0.10–0.57, R2 Nagelkerke: 0.91, p=0.001] and the presence of one previous delivery [x2(1)=6.0, OR: 3.40, 95% CI: 1.13–10.16, R2 Nagelkerke: 0.043, p=0.029] were significant predictors of successful induction of labor with vaginal misoprostol. CONCLUSION: A high rate of labor induction success using vaginal misoprostol in a low-risk population was observed, mainly in multiparous and with gestational age>41 weeks. No previous delivery decreased the success of labor induction, while one previous delivery increased the success of labor induction. OBJECTIVE lowrisk low risk METHODS 19 (2 h h. . h) RESULTS analyzed 14 71.4% 714 71 (71.4% 5 28.6% 286 28 (28.6% unsuccessful 1.69 169 1 69 (1.6 vs 136 36 1.36 p=0.023, p0023 p p=0.023 , 0 023 p=0.023) 0.57 057 57 (0.5 019 0.19 p<0.001, p0001 p<0.001 001 p<0.001) 2.0 20 (2. 138 38 1.38 p=0.002, p0002 p=0.002 002 p=0.002) 2.18 218 18 (2.1 257 2.57 p=0.031. p0031 p=0.031 031 p=0.031) x21=3.14, x21314 x x2 =3.14, 3 [x2(1)=3.14 OR (OR) 024 0.24 95 CI (CI) 010057 10 0.10–0.57 R Nagelkerke 091 91 0.91 p=0.001 x21=6.0, x2160 =6.0, [x2(1)=6.0 340 40 3.40 1131016 13 16 1.13–10.16 0043 043 0.043 p=0.029 p0029 029 CONCLUSION observed age41 age 41 age>4 weeks ( 71.4 7 (71.4 28.6 (28.6 1.6 (1. 1.3 p002 p=0.02 02 0.5 05 (0. 01 0.1 p000 p<0.00 00 2. p=0.00 2.1 21 2.5 p003 p=0.03 03 x21 x21=3.14 x2131 314 =3.14 [x2(1)=3.1 (OR 0.2 9 (CI 01005 0.10–0.5 09 0.9 x21=6.0 x216 60 =6.0 [x2(1)=6. 34 3.4 113101 1.13–10.1 004 04 0.04 age4 age> 71. (71. 28. (28. 1. (1 p00 p=0.0 0. (0 p<0.0 x21=3.1 x213 31 =3.1 [x2(1)=3. 0100 0.10–0. x21=6. =6. [x2(1)=6 3. 11310 1.13–10. 0.0 (71 (28 p0 p=0. p<0. x21=3. =3. [x2(1)=3 010 0.10–0 x21=6 =6 [x2(1)= 1131 1.13–10 (7 p=0 p<0 x21=3 =3 0.10– x21= = [x2(1) 113 1.13–1 p= p< 0.10 [x2(1 11 1.13– [x2( 1.13 [x2 1.1 [x

SUMMARY OBJECTIVE: The aim of this study was to evaluate the impact of therapeutic hypothermia on maternal and perinatal outcomes in newborns with Apgar score<7 at the 5th min. METHODS: A retrospective cohort study was carried out with 55 newborns who had an Apgar score<7 at the 5th min (35 without and 20 with therapeutic hypothermia) from low-risk pregnancies between 33 and 41 weeks gestation. The Apgar score was calculated through an objective assessment by a neonatologist in the delivery room. Therapeutic hypothermia was indicated by a neonatologist in the delivery room, according to the protocol established by the Brazilian Society of Pediatrics. The maternal and perinatal outcomes of both groups (without and with therapeutic hypothermia) were compared. RESULTS: A rate of Apgar score<7 at the 5th min was 1.02%. No statistical differences were observed between the two groups (without and with therapeutic hypothermia) regarding maternal/perinatal complications. The presence of maternal/perinatal complications did not increase the odds ratio of neonatal therapeutic hypothermia in newborns with Apgar score<7 at the 5th min. CONCLUSION: The rate of Apgar score<7 at the 5th min was low, and it was not associated with any maternal/perinatal complications. There was no significant difference in maternal/perinatal complications between newborns who received therapeutic hypothermia and those who did not. OBJECTIVE score7 7 score< th METHODS 5 35 (3 2 lowrisk low risk 3 4 gestation room Pediatrics compared RESULTS 102 1 02 1.02% maternalperinatal CONCLUSION ( 10 0 1.02 1.0 1.

ABSTRACT Objective: To evaluate the association between neck circumference (NC) measured during pregnancy and markers of glucose metabolism measured 2-6 months postpartum in women with overweight/obesity with and without gestational diabetes (GDM). Subjects and methods: This prospective study enrolled 100 pregnant women (including 50 with GDM) with pregestational body mass index (BMI) ≥ 25 kg and < 40 kg/m². The cohort was stratified according to NC tertiles during pregnancy. Glucose metabolism was assessed in the postpartum period. The association between NC during pregnancy and markers of glucose metabolism postpartum was tested using linear regression analysis. Results: Participants with NC in the third tertile, compared with those with NC in the second and first tertiles, had higher levels of glycated hemoglobin (HbA1c; 5.6 ± 0.4% versus 5.4 ± 0.3% versus 5.3 ± 0.2%, respectively, p = 0.006), fasting insulin (13.2 ± 6.6 µIU/mL versus 11.1 ± 5.8 µIU/mL versus 9.5 ± 4.9 µIU/mL, respectively, p = 0.035), homeostasis model for insulin resistance (HOMA-IR; 3.1 ± 1.7 versus 2.5 ± 1.3 versus 2.1 ± 1.2, respectively, p = 0.035) and triglyceride-glucose index (TyG; 4.6 ± 0.2 versus 4.5 ± 0.2 versus 4.5 ± 0.3, respectively, p = 0.010). In crude linear regression analysis, NC measured during pregnancy was significantly associated with levels of fasting plasma glucose, 2-hour glucose, HbA1c, log HOMA-IR, and TyG index. The association remained after adjustment for age, family history of diabetes, and number of pregnancies. When adjusted for pregestational BMI and gestational weight gain, NC remained independently associated with fasting plasma glucose and HbA1c levels. Conclusion: The NC measured during pregnancy was positively associated with worse glucose metabolic profile in the postpartum among women with obesity/overweight with and without GDM. The NC measurement may be a feasible tool for early identification of women at a higher risk of developing type 2 diabetes mellitus. Objective (NC 26 6 2- overweightobesity overweight obesity GDM . (GDM) methods 10 including 5 (BMI 4 kgm² kgm m² m kg/m² period analysis Results tertile HbAc HbA c (HbA1c 56 5. 04 0 0.4 54 03 3 0.3 53 02 0.2% respectively 0.006, 0006 0.006 , 006 0.006) 13.2 132 13 (13. 66 6. µIUmL µIU mL 111 11 1 11. 58 8 95 9 9. 49 4. 0.035, 0035 0.035 035 HOMAIR HOMA IR (HOMA-IR 31 3. 17 7 1. 2. 21 12 1.2 triglycerideglucose triglyceride (TyG 46 0. 45 0.010. 0010 0.010 010 0.010) 2hour hour HOMAIR, IR, HOMA-IR age pregnancies gain Conclusion obesityoverweight mellitus (GDM kg/m 000 0.00 00 13. (13 003 0.03 001 0.01 01 0.0 (1 (

Abstract Objective This study aims to create a new screening for preterm birth < 34 weeks after gestation with a cervical length (CL) ≤ 30 mm, based on clinical, demographic, and sonographic characteristics. Methods This is a post hoc analysis of a randomized clinical trial (RCT), which included pregnancies, in middle-gestation, screened with transvaginal ultrasound. After observing inclusion criteria, the patient was invited to compare pessary plus progesterone (PP) versus progesterone only (P) (1:1). The objective was to determine which variables were associated with severe preterm birth using logistic regression (LR). The area under the curve (AUC), sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) were calculated for both groups after applying LR, with a false positive rate (FPR) set at 10%. Results The RCT included 936 patients, 475 in PP and 461 in P. The LR selected: ethnics white, absence of previous curettage, previous preterm birth, singleton gestation, precocious identification of short cervix, CL < 14.7 mm, CL in curve > 21.0 mm. The AUC (CI95%), sensitivity, specificity, PPV, and PNV, with 10% of FPR, were respectively 0.978 (0.961-0.995), 83.4%, 98.1%, 83.4% and 98.1% for PP < 34 weeks; and 0.765 (0.665-0.864), 38.7%, 92.1%, 26.1% and 95.4%, for P < 28 weeks. Conclusion Logistic regression can be effective to screen preterm birth < 34 weeks in patients in the PP Group and all pregnancies with CL ≤ 30 mm. 3 (CL mm demographic characteristics RCT, , (RCT) middlegestation, middlegestation middle middle-gestation ultrasound criteria (PP (P 11. 11 1 . (1:1) LR. (LR) AUC, (AUC) sensitivity specificity PPV (PPV NPV (NPV FPR (FPR 10 93 47 46 selected white curettage cervix 147 14 7 14. 210 21 0 21. CI95%, CI95 CI CI95% (CI95%) PNV 0978 978 0.97 0.9610.995, 09610995 0.961 0.995 961 995 (0.961-0.995) 834 83 4 981 98 83.4 98.1 0765 765 0.76 0.6650.864, 06650864 0.665 0.864 665 864 (0.665-0.864) 387 38 38.7% 921 92 92.1% 261 26 26.1 954 95 95.4% 2 (RCT (1:1 (LR (AUC 9 CI9 (CI95% 097 97 0.9 9610 0.9610.995 0961099 0961 0.96 0995 0.99 96 99 (0.961-0.995 8 83. 98. 076 76 0.7 6650 0.6650.864 0665086 0665 0.66 0864 0.86 66 86 (0.665-0.864 38.7 92.1 26. 95.4 (1: (CI95 09 0. 0.9610.99 096109 096 099 (0.961-0.99 07 0.6650.86 066508 066 0.6 086 0.8 6 (0.665-0.86 38. 92. 95. (1 (CI9 0.9610.9 09610 (0.961-0.9 0.6650.8 06650 06 08 (0.665-0.8 ( (CI 0.9610. (0.961-0. 0.6650. (0.665-0. 0.9610 (0.961-0 0.6650 (0.665-0 (0.961- (0.665- (0.961 (0.665 (0.96 (0.66 (0.9 (0.6 (0. (0

Resumo Objetivo Lúpus eritematoso sistêmico (LES) pode causar danos irreversíveis aos órgãos. A gravidez com LES pode ter riscos para condições ameaçadoras à vida. O presente estudo teve como objetivo determinar a prevalência de MMG em pacientes com LES e analisar os parâmetros que contribuíram para os casos de maior gravidade. Métodos Trata-se de um estudo transversal retrospectivo a partir da análise de dados obtidos de prontuários de gestantes com LES atendidas em um Hospital Universitário no Brasil. As gestantes foram divididas em grupo controle sem intercorrências, grupo com condições potencialmente ameaçadoras a vida (CPAV) e grupo com near miss materno (NMM). Resultados A taxa de NMM foi de 112,9 por 1.000 nascidos vivos. A maioria dos casos de CPAV (83,9%) e NMM (92,9%) teve partos prematuros com risco aumentado estatisticamente significativo em comparação com o grupo controle (p = 0,0042; odds ratio [OR]: 12,05; intervalo de confiança [IC]: 1,5–96,6 para o grupo NMM e p = 0,0001; OR: 4,84; IC95%: 2,2–10,8 para o grupo CPAV). MMG aumenta o risco de maior tempo de internação (p < 0,0001; OR: 18,8; IC95%: 7,0–50,6 e p < 0,0001; OR: 158,17; IC95%: 17,6–1424,2 para os grupos CPAV e NMM, respectivamente), recémnascidos com baixo peso (p = 0,0006; OR: 3,67; IC95%: 1,7–7,9 e p = 0,0009; OR: 17,68; IC95%: 2–153,6 para os grupos CPAV e NMM, respectivamente), bem como doenças renais (CPAV: 58,9%; 33/56; p = 0,0069 e NMM: 78,6%; 11/14; p = 0,0026)]. Os casos de NMM apresentaram risco aumentado para óbito neonatal (p = 0,0128; OR: 38,4; IC95%: 3,3–440,3), natimorto e aborto espontâneo (p = 0,0011; OR: 7,68; IC95%: 2,2–26,3). Conclusão Lúpus eritematoso sistêmico foi significativamente associado à morbidade materna grave, internações mais longas e risco aumentado de desfechos obstétricos e neonatais ruins. (LES órgãos gravidade Tratase Trata se Brasil intercorrências (CPAV NMM. . (NMM) 1129 112 9 112, 1000 1 000 1.00 vivos 83,9% 839 83 (83,9% 92,9% 929 92 (92,9% 0,0042 00042 0 0042 OR [OR] 12,05 1205 12 05 IC [IC] 15966 5 96 6 1,5–96, 0,0001 00001 0001 4,84 484 4 84 IC95% IC95 22108 2 10 8 2,2–10, CPAV. CPAV) 18,8 188 18 70506 7 50 7,0–50, 158,17 15817 158 17 17614242 1424 17,6–1424, respectivamente, respectivamente , respectivamente) 0,0006 00006 0006 3,67 367 3 67 1779 1,7–7, 0,0009 00009 0009 17,68 1768 68 21536 153 2–153, 58,9% 589 58 33/56 3356 33 56 00069 0069 0,006 78,6% 786 78 11/14 1114 11 14 0,0026. 00026 0,0026 0026 0,0026)] 0,0128 00128 0128 38,4 384 38 3,3–440,3, 334403 3,3–440,3 440 3,3–440,3) 0,0011 00011 0011 7,68 768 2,2–26,3. 22263 2,2–26,3 26 2,2–26,3) grave ruins (NMM 100 00 1.0 83,9 (83,9 92,9 (92,9 0,004 0004 004 [OR 12,0 120 [IC 1596 1,5–96 0,000 0000 4,8 48 IC9 2210 2,2–10 18, 7050 7,0–50 158,1 1581 15 1761424 142 17,6–1424 3,6 36 177 1,7–7 17,6 176 2153 2–153 58,9 33/5 335 006 0,00 78,6 11/1 111 0002 0,002 002 0,0026) 0,012 0012 012 38, 33440 3,3–440, 44 0,001 001 7,6 76 2226 2,2–26, 1. 83, (83, 92, (92, 12, 159 1,5–9 4, 221 2,2–1 705 7,0–5 158, 176142 17,6–142 3, 1,7– 17, 215 2–15 58, 33/ 0,0 78, 11/ 0,01 01 3344 3,3–440 7, 222 2,2–26 (83 (92 1,5– 22 2,2– 70 7,0– 17614 17,6–14 1,7 21 2–1 0, 334 3,3–44 2,2–2 (8 (9 1,5 2,2 7,0 1761 17,6–1 1, 2– 3,3–4 ( 2, 17,6– 3,3– 3,3

Abstract Objective Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with SLE may have severe life-threatening risks. The present study aimed to determine the prevalence of severe maternal morbidity (SMM) in patients with SLE and analyze the parameters that contributed to cases of greater severity. Methods This is a cross-sectional retrospective study from analysis of data retrieved from medical records of pregnant women with SLE treated at a University Hospital in Brazil. The pregnant women were divided in a control group without complications, a group with potentially life-threatening conditions (PLTC), and a group with maternal near miss (MNM). Results The maternal near miss rate was 112.9 per 1,000 live births. The majority of PLTC (83.9%) and MNM (92.9%) cases had preterm deliveries with statistically significant increased risk compared with the control group (p = 0.0042; odds ratio [OR]: 12.05; 95% confidence interval [CI]: 1.5–96.6 for the MNM group and p = 0.0001; OR: 4.84; 95%CI: 2.2–10.8 for the PLTC group). Severe maternal morbidity increases the risk of longer hospitalization (p < 0.0001; OR: 18.8; 95%CI: 7.0–50.6 and p < 0.0001; OR: 158.17; 95%CI: 17.6–1424,2 for the PLTC and MNM groups, respectively), newborns with low birthweight (p = 0.0006; OR: 3.67; 95%CI: 1.7–7.9 and p = 0.0009; OR: 17.68; 95%CI: 2–153.6) for the PLTC and MNM groups, respectively] as well as renal diseases (PLTC [8.9%; 33/56; p = 0.0069] and MNM [78.6%; 11/14; p = 0.0026]). Maternal near miss cases presented increased risk for neonatal death (p = 0.0128; OR: 38.4; 95%CI: 3.3–440.3]), and stillbirth and miscarriage (p = 0.0011; OR: 7.68; 95%CI: 2.2–26.3]). Conclusion Systemic lupus erythematosus was significantly associated with severe maternal morbidity, longer hospitalizations, and increased risk of poor obstetric and neonatal outcomes. (SLE damage lifethreatening life threatening risks SMM (SMM severity crosssectional cross sectional Brazil complications PLTC, , (PLTC) MNM. . (MNM) 1129 112 9 112. 1000 1 000 1,00 births 83.9% 839 83 (83.9% 92.9% 929 92 (92.9% 0.0042 00042 0 0042 OR [OR] 12.05 1205 12 05 95 CI [CI] 15966 5 96 6 1.5–96. 0.0001 00001 0001 4.84 484 4 84 95%CI 95CI 22108 2 10 8 2.2–10. group. group) 18.8 188 18 70506 7 50 7.0–50. 158.17 15817 158 17 17614242 1424 17.6–1424, groups respectively, respectively respectively) 0.0006 00006 0006 3.67 367 3 67 1779 1.7–7. 0.0009 00009 0009 17.68 1768 68 2–153.6 21536 153 8.9% 89 [8.9% 33/56 3356 33 56 0.0069 00069 0069 78.6% 786 78 [78.6% 11/14 1114 11 14 0.0026. 00026 0.0026 0026 0.0026]) 0.0128 00128 0128 38.4 384 38 3.3–440.3, 334403 3.3–440.3 440 3.3–440.3]) 0.0011 00011 0011 7.68 768 2.2–26.3. 22263 2.2–26.3 26 2.2–26.3]) hospitalizations outcomes (MNM 100 00 1,0 83.9 (83.9 92.9 (92.9 0.004 0004 004 [OR 12.0 120 [CI 1596 1.5–96 0.000 0000 4.8 48 2210 2.2–10 18. 7050 7.0–50 158.1 1581 15 1761424 142 17.6–1424 3.6 36 177 1.7–7 17.6 176 2–153. 2153 8.9 [8.9 33/5 335 0.006 006 78.6 [78.6 11/1 111 0002 0.002 002 0.0026] 0.012 0012 012 38. 33440 3.3–440. 44 3.3–440.3] 0.001 001 7.6 76 2226 2.2–26. 2.2–26.3] 1, 83. (83. 92. (92. 0.00 12. 159 1.5–9 4. 221 2.2–1 705 7.0–5 158. 176142 17.6–142 3. 1.7– 17. 2–153 215 8. [8. 33/ 78. [78. 11/ 0.01 01 3344 3.3–440 7. 222 2.2–26 (83 (92 0.0 1.5– 22 2.2– 70 7.0– 17614 17.6–14 1.7 2–15 21 [8 [78 334 3.3–44 2.2–2 (8 (9 0. 1.5 2.2 7.0 1761 17.6–1 1. 2–1 [ [7 3.3–4 ( 2. 17.6– 2– 3.3– 3.3

ABSTRACT Objective: Pregnant women with type 1 diabetes (T1D) have an increased risk of maternal-fetal complications. Regarding treatment, continuous subcutaneous insulin infusion (CSII) has advantages compared to multiple daily injections (MDI), but data about the best option during pregnancy are limited. This study's aim was to compare maternal-fetal outcomes among T1D patients treated with CSII or MDI during pregnancy. Subjects and methods: This study evaluated 174 pregnancies of T1D patients. Variables of interest were compared between the groups (CSII versus MDI), and logistic regression analysis was performed (p < 0.05). Results: Of the 174 included pregnancies, CSII was used in 21.3% (37) and MDI were used in 78.7% (137). HbA1c values improved throughout gestation in both groups, with no difference in the first and third trimesters. The frequency of cesarean section was significantly higher in the CSII group [94.1 vs. 75.4%, p = 0.017], but there was no significant difference in the frequency of other complications, such as miscarriage, premature delivery and preeclampsia. The mean birth weight and occurrence of neonatal complications were also similar, except for the proportion of congenital malformations, which was significantly lower in the CSII group [2.9 vs. 15.6%, p = 0.048]. In regression analysis, the association of CSII with cesarean section and malformations lost significance after adjusting for HbA1c and other covariates of interest. Conclusion: In this study, we observed a higher frequency of cesarean section and a lower occurrence of congenital malformations in the CSII group, but the adjusted results might indicate that these associations are influenced by glycemic control. Objective TD T D (T1D maternalfetal maternal fetal treatment MDI, , (MDI) limited studys s methods 17 MDI) 0.05. 005 0.05 . 0 05 0.05) Results 213 21 3 21.3 37 (37 787 78 7 78.7 137. 137 (137) HbAc HbA c trimesters 94.1 941 94 [94. vs 754 75 4 75.4% 0.017, 0017 0.017 017 0.017] miscarriage preeclampsia similar 2.9 29 2 9 [2. 156 15 6 15.6% 0.048. 0048 0.048 048 0.048] Conclusion control (MDI 00 0.0 21. (3 78. 13 (137 94. [94 75.4 001 0.01 01 2. [2 15.6 004 0.04 04 0. ( (13 [9 75. [ 15. (1

Resumo Objetivo Comparar a eficácia do bloqueio do quadrado lombar (QL) e da morfina intratecal (M) na analgesia pós-cesariana. Métodos Trinta e uma gestantes com ≥ 37 semanas de gestação submetidas a cesariana eletiva foram incluídas no estudo. Eles foram alocados aleatoriamente no grupo QL (12,5 mg de bupivacaína a 0,5% para raquianestesia e 0,3 ml/kg de bupivacaína a 0,2% para bloqueio de QL) ou no grupo M (12,5 mg de bupivacaína a 0,5% e 100 mcg de morfina na raquianestesia). A escala visual analógica de dor, consumo de morfina e tramadol para alívio da dor em 48 horas e efeitos colaterais foram registrados. Resultados A mediana do escore de dor e/ou variação da dor foi maior no grupo morfina do que no grupo QL (p = 0,02). Não houve diferença significativa no consumo de morfina ou tramadol entre os grupos ao longo do tempo. Efeitos colaterais como prurido, náuseas e vômitos foram observados apenas no grupo morfina. Conclusão O bloqueio QL e a morfina intratecal são eficazes para analgesia após cesariana. Os pacientes submetidos ao bloqueio do QL apresentaram menores escores de dor pós-operatória sem os efeitos colaterais indesejáveis dos opioides, como náuseas, vômitos e prurido. (QL (M póscesariana. póscesariana pós pós-cesariana 3 estudo 12,5 125 12 5 (12, 05 0 0,5 03 0, mlkg ml kg 02 2 0,2 10 raquianestesia. . raquianestesia) 4 registrados eou p 0,02. 002 0,02 0,02) tempo prurido pósoperatória operatória opioides 12, 1 (12 00 0,0 (1 (

Abstract Objective To compare the efficacy of quadratus lumborum (QL) block and intrathecal morphine (M) for postcesarean delivery analgesia. Methods Thirty-one pregnant women with ≥ 37 weeks of gestation submitted to elective cesarean section were included in the study. They were randomly allocated to either the QL group (12.5 mg 0.5% bupivacaine for spinal anesthesia and 0.3 ml/kg 0.2% bupivacaine for QL block) or the M group (12.5 mg bupivacaine 0.5% and 100 mcg of morphine in spinal anesthesia). The visual analog scale of pain, consumption of morphine and tramadol for pain relief in 48 hours, and side effects were recorded. Results Median pain score and/or pain variation were higher in the morphine group than in the QL group (p = 0.02). There was no significant difference in the consumption of morphine or tramadol between groups over time. Side effects such as pruritus, nausea, and vomiting were observed only in the morphine group. Conclusion Quadratus lumborum block and intrathecal morphine are effective for analgesia after cesarean section. Patients undergoing QL block had lower postoperative pain scores without the undesirable side effects of opioids such as nausea, vomiting, and pruritus. (QL (M Thirtyone Thirty one 3 study 12.5 125 12 5 (12. 05 0 0.5 03 0. mlkg ml kg 02 2 0.2 10 anesthesia. . anesthesia) 4 hours recorded andor p 0.02. 002 0.02 0.02) time pruritus nausea 12. 1 (12 00 0.0 (1 (

Key points Pregnancy places a metabolic overload on the maternal thyroid, especially in the first trimester, mainly because of the demand imposed by the conceptus. The fetal thyroid becomes functionally mature only around pregnancy week 20. Until then, the fetus depends on the transfer of maternal thyroid hormones (THs). Thyroid hormones are essential for the adequate fetal neurofunctional and cognitive development. Hypothyroidism brings higher risks of obstetric and fetal complications, namely, first-trimester miscarriage, preeclampsia and gestational hypertension, placental abruption, prematurity, low birth weight, and higher perinatal morbidity and mortality. Primary hypothyroidism (involvement of the gland with difficulty in producing and/or releasing TH) is the most common form of disease presentation, with the main etiology of Hashimoto's thyroiditis of autoimmune origin. In about 85%-90% of cases of Hashimoto's thyroiditis, antithyroid antibodies are present; the antithyroperoxidase (ATPO) is the most frequent. Positivity for ATPO is determined when circulating values exceed the upper limit of the laboratory reference. It implies greater risks of adverse maternal-fetal outcomes. Such a correlation occurs even in ranges of maternal euthyroidism. The critical point for the diagnosis of hypothyroidism during pregnancy is an elevation of thyroid-stimulating hormone (TSH). The measurement of free thyroxine (FT4) differentiates between subclinical and overt hypothyroidism. In subclinical hypothyroidism, FT4 is within the normal range, whereas in overt hypothyroidism, FT4 values are below the lower limit of the laboratory reference. Treatment of hypothyroidism is performed with levothyroxine (LT4) replacement with the aim of achieving adequate TSH levels for pregnancy. Some women have a previous diagnosis of hypothyroidism, and may or may not be compensated at the beginning of pregnancy. Even in compensated cases, the increase in LT4 dose is necessary as soon as possible. In the postpartum period, adjustment of the LT4 dose depends on the condition of previous disease, on the positivity for ATPO, and also on the value of LT4 in use at the end of pregnancy. Recommendations In places with full technical and financial conditions, TSH testing should be performed for all pregnant women (universal screening) as early as possible, ideally at the beginning of the first trimester or even in preconception planning. In places with less access to laboratory tests, screening is reserved for cases with greater risk factors for decompensation, namely: previous thyroidectomy or radioiodine therapy, type 1 diabetes mellitus or other autoimmune diseases, presence of goiter, previous history of hypo or hyperthyroidism or previous ATPO positivity. The TSH dosage should be repeated throughout pregnancy only in these cases. The diagnosis of hypothyroidism is made from the TSH value > 4.0 mIU/L. Pregnant women with previous hypothyroidism, overt hypothyroidism diagnosed during pregnancy or those with the above-mentioned higher risk factors for decompensation should be referred for risk antenatal care, preferably in conjunction with the endocrinologist. Overt hypothyroidism in pregnancy is identified when TSH > 10 mIU/L, and treatment with LT4 is readily recommended at an initial dose of 2 mcg/kg/day. TSH values > 4.0 mUI/L and ≤ 10.0 mUI/L require FT4 measurement with two diagnostic possibilities: overt hypothyroidism when FT4 levels are below the lower limit of the laboratory reference, or subclinical hypothyroidism when FT4 levels are normal. The treatment for subclinical hypothyroidism is LT4 at an initial dose of 1 mcg/kg/day, and the dose should be doubled upon diagnosis of overt hypothyroidism. In cases of TSH > 2.5 and ≤ 4.0 mIU/L, if there are complete conditions, ATPO should be measured. If positive (above the upper limit of normal), treatment with LT4 at a dose of 50 mcg/day is indicated. If conditions are not complete, the repetition of the TSH dosage should be done only for cases at higher risk. In these cases, treatment with LT4 will be established when TSH > 4.0 mIU/L at a dose of 1 mcg/kg/day; if needed, the dose can be adjusted after FT4 evaluation. Women with previous hypothyroidism should have their LT4 dose adjusted to achieve TSH < 2.5 mIU/L at preconception. As soon as they become pregnant, they need a 30% increase in LT4 as early as possible. In practice, they should double the usual dose on two days a week. Levothyroxine should be given 30-60 minutes before breakfast or three hours or more after the last meal. Concomitant intake with ferrous sulfate, calcium carbonate, aluminum hydroxide and sucralfate should be avoided. The target of LT4 therapy during pregnancy is to achieve a TSH value < 2.5 mIU/L. Once the therapy is started, monthly control must be performed until the mentioned goal is reached. In the postpartum period, women with previous disease should resume the preconception dose. Cases diagnosed during pregnancy in use of LT4 ≤ 50 mcg/day may have the medication suspended. The others should reduce the current dose by 25% to 50% and repeat the TSH measurement in six weeks. Cases of ATPO positivity are at higher risk of developing postpartum thyroiditis and de-escalation of LT4 should be performed as explained. conceptus 20 then THs. THs . (THs) development complications namely firsttrimester miscarriage hypertension abruption prematurity weight mortality involvement andor TH presentation Hashimotos Hashimoto s origin 85%90% 8590 85% 90% 85 90 85%-90 present (ATPO frequent reference maternalfetal outcomes euthyroidism thyroidstimulating stimulating TSH. (TSH) FT (FT4 range LT (LT4 possible period universal planning tests diseases goiter 40 4 0 4. mIUL mIU L abovementioned above care endocrinologist mcgkgday mcg kg day mcg/kg/day mUIL mUI 100 10. possibilities 25 5 2. measured normal, , normal) mcgday indicated needed evaluation 30 practice 3060 60 30-6 meal sulfate carbonate avoided started reached suspended weeks deescalation de escalation explained (THs 85%90 859 8 9 85%-9 (TSH (FT (LT 3 306 6 30- 85%9 85%-