49 Keypoints • Preeclampsia (PE) is an important cause of maternal and perinatal mortality worldwide, accounts for 10% to 15% of direct maternal deaths, and 99% of these deaths are in low-income countries. • Preeclampsia is defined as systolic blood pressure of ≥140 mmHg and/or diastolic blood pressure of ≥90 mmHg on at least two occasions, measured four hours apart in previously normotensive women, and is accompanied by one or more of the following new-onset conditions after 20 weeks’ gestation: (1) proteinuria, (2) evidence of other maternal organ dysfunction, or (3) uteroplacental dysfunction. • Preeclampsia is classified into: (1) early PE (delivery < 34+0 weeks’ gestation); (2) preterm PE (delivery < 37+0 weeks’ gestation); (3) late-onset PE (delivery ≥ 34+0 weeks’ gestation); (4) term PE (delivery ≥ 37+0 weeks’ gestation). • In Brazil, the incidence of PE varies from 1.5% to 7%; of preterm PE is 2% and of eclampsia is 0.6%. However, these statistics are likely to be underestimated and vary according to the region studied. • Screening strategies for PE vary depending on the parameters used, pre-test risk, outcome stratification, and the gestational age at which screening is performed. However, there is consensus in the literature that no single-parameter screening test has been shown to adjust the preexisting maternal risk for PE with sufficient specificity and sensitivity for clinical use.
Unplanned pregnancy continues to be a public health problem in Brazil, particularly for the most vulnerable segment of the population. According to data from the Birth in Brazil study, 55% of pregnancies are unplanned, a proportion that reaches 65.3% among adolescents. Although the copper IUD is a highly effective long-term contraceptive method, it is still little used in Brazil for several reasons, including access barriers in outpatient clinics. The offer of IUD insertion immediately after childbirth or abortion is a window of opportunity to avoid unplanned pregnancies.
Abstract Objective The present study aims to establish a risk profile for high-grade cervical lesions and cervical cancer (CIN2 + ) in women undergoing colposcopy at the Hospital do Câncer de Barretos, through the analysis of Human Papillomavirus (HPV) infection, cervical cytology, and patient's age. Methods Retrospective cross-sectional study based on a computerized database of women aged ≥ 18 years old who underwent colposcopy at the Prevention Department of the Hospital do Câncer de Barretos from 2017 to 2019. Results A total of 3,411 women were included, 58.0% were positive for high-risk-HPV test, with a higher prevalence of CIN2+ for HPV16 (30.3%) and other HPV (45.0%). Cytological findings that suggest invasive cervical cancer (squamous cells or adenocarcinoma), regardless of the status of HPV test, showed 100% diagnosis of CIN2 + , while atypias that suggest high-grade lesions, HSIL and ASC-H, positive for HPV test, showed in 86 and 55.2%, respectively, diagnosis of CIN2 + . ASC-H cytological results among women aged > 40 years old and negative HPV were mainly associated with benign findings. We observed that ≤ CIN1 has a higher prevalence among older women with negative HPV, while for high-grade lesions there is an increase among young women HPV16- and/or 18-positive. In cancer diagnosis, we observed a predominance of HPV 16/18 regardless of the age group. Conclusion The highest risks of precursor lesions and cervical cancer were found among women with positive HPV 16/18 tests and severe cytological atypia in population screening tests. In addition, cytological findings of ASC-H HPV negative in women > 40 years old usually represent benign findings in histological investigation.
The Latin American Center for Perinatology-PAHO aims to strengthen healthcare since 1970. For timely surveillance of maternal health, a perinatal information system (SIP) was implemented to enable monitoring trends of severe morbidity/mortality. It is time for integrated interventions to translate surveillance into health policies to address preventable maternal/perinatal deaths.
