OBJECTIVE:Social determinants of health influence maternal and perinatal outcomes, yet tools to operationalize these risks in clinical care remain scarce. We aimed to study social determinants in Brazilian pregnant women and develop a social vulnerability index (SVI) that could correlate with pregnancy and perinatal outcomes. METHODS:The present study was a secondary analysis of 1565 low-risk nulliparous women enrolled in two Brazilian cohort studies. We selected vulnerability indicators from sociodemographic data and tested the performance and risk association of multiple SVI models with any adverse outcome (preterm birth, gestational diabetes mellitus, pre-eclampsia, small or large for gestational age, low 5-min Apgar score, neonatal intubation, neonatal intensive care unit admission, fetal or neonatal death) using chi-square tests, logistic regression, and receiver operating characteristic analysis. RESULTS:Advanced maternal age, non-white ethnicity, and exclusive publicly funded antenatal care were the most consistent vulnerability predictors of adverse outcomes. The final three-variable SVI demonstrated a significant dose-response gradient, with maternal adverse outcomes increasing from 16.4% (no vulnerabilities) to 43.8% (3 vulnerabilities) and perinatal adverse outcomes rising from 22.1% to 35.6%. The model presented a sensitivity of 64.71%, a specificity of 42.56%, a positive predictive value of 47.46% and a negative predictive value of 60.07% for any adverse outcome. CONCLUSION:The three-variable SVI offers a simple, reproducible, and context-adapted screening tool for primary care. Either for individual or population screening, it can be easily combined with clinical risk assessment, targeting those who may benefit from equity-oriented maternal health strategies.

OBJECTIVE:To evaluate perinatal outcomes in women undergoing cervical cerclage for prevention of preterm birth in Brazilian maternity hospitals. METHODS:This retrospective cohort study included 1364 women with singleton pregnancies who underwent elective or rescue cervical cerclage between December 2003 and November 2025. Permanent cerclages were excluded. Primary outcomes included perinatal results and early (≤7 days) and late (>7 days) cerclage-related complications. Analyses were stratified by type of cerclage and use of vaginal progesterone. RESULTS:Elective cerclage was performed in 986 women and rescue cerclage in 378. Preterm birth was significantly less frequent in the elective group (35.7% vs 47.6%; P < 0.001). Cervical dilatation at the time of procedure influenced outcomes, with a longer latency period between cerclage and delivery when dilatation was <2 cm (21.26 ± 4.8 vs 14.71 ± 4.9 weeks). Early complications were uncommon (0.9% vs 2.9%; P = 0.006), while late complications were more frequent after rescue cerclage (22.5% vs 28.6%; P = 0.019), mainly preterm labor and preterm premature rupture of membranes. Adjuvant vaginal progesterone was not associated with a reduction in cerclage-related complications overall. However, in the rescue cerclage group, progesterone use was associated with higher rates of term birth and live birth, and lower rates of miscarriage and stillbirth. CONCLUSION:Both elective and rescue cerclages performed favorable perinatal outcomes and low rates of early complications. The benefit of adjuvant vaginal micronized progesterone in perinatal outcomes should be considered hypothesis-generating and warrants confirmation in prospective studies. Our findings highlight the importance of early identification of cervical insufficiency and timely intervention to optimize outcomes.

Objective:This study aimed to assess the incidence of small for gestational age (SGA) newborns in pregnant women infected with COVID-19 and examine the associated neonatal outcomes. Methods:This study involved a secondary analysis of the REBRACO Network, a prospective cohort study conducted in 15 maternity hospitals in Brazil before the introduction of COVID-19 vaccination (February 2020 to February 2021). Demographic data of pregnant women tested for COVID-19 were analyzed, and fetal outcomes were compared between women with positive and negative COVID-19 results who had SGA fetuses. Results:A total of 729 symptomatic pregnant women with COVID-19 were included in the study. However, there were 248 participants with missing information regarding childbirth or loss of follow-up, and 107 participants without confirmatory tests for COVID-19. Among the remaining participants, 198 had confirmed COVID-19 and 176 tested negative. The incidence of SGA among women with COVID-19 was 22.4%, whereas the incidence among women who tested negative for COVID-19 was 14.8%. SGA newborns born to COVID-19 positive pregnant women were 1.6 times more likely to experience adverse outcomes (such as prematurity, stillbirth, neonatal death, and admission to a neonatal ICU) compared to non-SGA newborns [OR = 1.655 (1.145 - 2.394); P=0.017]. In SGA newborns of pregnant women with confirmed COVID-19 infection, mechanical ventilation use was found to be associated with the infection [OR = 0.692 (0.562 - 0.853); P=0.002]. Conclusion:The higher incidence of SGA newborns and its stronger association with prematurity in pregnant women with confirmed COVID-19 infection suggest that COVID-19 infection is a significant factor contributing to neonatal morbidity and mortality.

Recurrent vulvovaginal candidiasis (RVVC) presents challenges due to the adverse effects and resistance associated with prolonged antifungal therapy, highlighting the need for alternative treatments. This single-blind randomized trial evaluated intravaginal phototherapy with a 415 ± 13.7 nm blue LED as an adjunct to standard RVVC therapy. Participants were randomized to a control group (no light for 35 min) or experimental groups (light for 30 or 40 min) over three weekly sessions at 7 ± 3-day intervals. Clinical evaluations, microbiological analyses, and questionnaire assessments were conducted during the sessions and at 30 and 180 days, with symptom monitoring at 60, 90, 120, and 150 days. Thirteen women (mean age 28.92 years) were randomized into three groups: 30-minute (n = 5), 40-minute (n = 4), and control (n = 4). At 30 days, 61.5 % of participants showed a reduction of 50 % or more in the semiquantitative scores of signs and symptoms, rising to 76.9 % at 180 days, with the greatest improvements in the 30-minute and control groups. Significant symptom reduction was observed in the control group (p < 0.001). At 180 days, 53.8 % of participants had negative Candida cultures, predominantly in the 30-minute group. The therapy was well-tolerated, with high satisfaction scores in the control (5.00 ± 0.20) and 30-minute groups (4.20 ± 0.33). Phototherapy with a 415 ± 13.7 nm blue LED for 30 min demonstrated therapeutic potential as an adjunctive treatment for RVVC. Further studies with longer follow-up periods and larger sample sizes are needed to validate these findings and strengthen clinical evidence.

Objective:To compare maternal and perinatal outcomes in pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) infection among admissions in public and private maternity hospitals before COVID-19 vaccination. Methods:We performed a secondary analysis of the REBRACO (in Portuguese, the Brazilian Network of COVID-19 During Pregnancy) initiative, a national multicenter cohort study in Brazil, considering pregnant and postpartum women with suspected or confirmed SARS-CoV-2 infections (from February 2020 to February 2021) in 15 maternity centers (2 private and 13 public facilities). Sociodemographic and obstetric characteristics were compared according to the type of hospital care. The clinical and laboratory findings and maternal and perinatal outcomes were compared between the two groups. The prevalence ratio and its 95% confidence interval for each predictor and outcome were calculated. Results:Of the 559 symptomatic cases tested, 289 confirmed COVID-19 cases were included, with 213 (72.7%) and 76 (27.3%) women in public and private hospitals, respectively. The frequency of SARS-CoV-2 infection did not differ significantly between the groups. Women treated at public hospitals had lower education levels (p<0.001), and 50% declared that their pregnancy was unplanned. We recorded 13 maternal deaths among women treated at public hospitals and no maternal deaths among pregnant women treated at private hospitals (p=0.024). Pregnant women in public hospitals had higher rates of fever (p=0.041), tachypnea (p=0.003), abnormal laboratory findings of liver enzymes (p=0.005), and severe acute respiratory syndrome (SARS) (p=0.014), and their neonates presented with more neonatal respiratory distress (p=0.020). Conclusion:Adverse maternal and perinatal outcomes were worse in the public hospital group, with increased rates of SARS and neonatal respiratory distress. The alarming difference in the number of deaths between patients treated in the public and private sectors highlights the urgency of better understanding the social determinants of health and calls the attention of leaders and policymakers to take action in mitigating their impact.

BACKGROUND:Radiotherapy for cervical cancer can lead to genitourinary syndrome (GUS), which negatively impacts sexual function and the quality of life among female cancer survivors. OBJECTIVE:To evaluate the efficacy of promestriene and non-ablative radiofrequency (NARF) in treating GUS and its effects on sexual function in women who have undergone radiotherapy for cervical cancer (CC). METHOD:In this pilot randomized clinical trial included 24 women who had received radiotherapy and/or brachytherapy for CC within the past five years. Participants were randomized to receive treatment with promestriene cream or intravaginal (NARF). Sexual function was assessed pre- and post-treatment using the Female Sexual Function Index (FSFI). Vaginal symptoms were evaluated using a visual analog scale (VAS), and histological analyses of vaginal biopsies were performed before and after the intervention. OUTCOMES:The main outcomes measured were improvements in sexual function and reductions in vaginal symptoms. RESULTS:Significant improvements in FSFI scores and reductions in vaginal symptom intensity were observed in both treatment groups. The median FSFI score increased from 13.0 to 23.1 after treatment. Histological analysis demonstrated a significant increase in epithelial thickness and an improvement in stromal quality in both groups. No significant differences were noted between the promestriene and (NARF) groups concerning sexual function improvements or symptom reduction. CLINICAL IMPLICATIONS:Both promestriene and (NARF) proved effective and safe enhancing sexual function and reducing vaginal symptoms in post-radiotherapy CC survivors. STRENGTHS AND LIMITATIONS:The study's strengths include its randomized design and comprehensive assessment of subjective and objective outcomes. However, the small sample size and limited follow-up period limit the generalization and long-term applicability of the findings. CONCLUSION:Both promestriene and (NARF) significantly improve sexual function and alleviate vaginal symptoms in women treated with radiotherapy for CC, presenting viable options for managing GUS in this patient population.

Objective: The current study aimed to describe risk factors for adverse perinatal outcomes (APOs) among pregnant women nonvaccinated for COVID-19 who had respiratory symptoms. Methods: A nested case-control study was performed within the REBRACO (in Portuguese, the Brazilian Network of COVID-19 During Pregnancy) initiative. Women were recruited during pregnancy in 15 maternity hospitals in Brazil from February 1, 2020, to February 28, 2021, while seeking medical care for respiratory symptoms, and were followed up until childbirth regardless of confirmation of COVID-19. For this analysis, women were divided into two groups: (1) those with APOs, defined as the occurrence of fetal or neonatal death, preterm delivery, 5-min Apgar score <7, neonatal respiratory distress, neonatal mechanical ventilation, admission to the neonatal intensive care unit, small-for-gestational-age newborn, or any neonatal morbidity; and (2) those without APOs. Results: The total number of women included in this analysis was 481, with 210 having APOs (43.7%). The characteristics independently associated with APOs were a composite outcome of severe acute respiratory syndrome, maternal admission at the intensive care unit, or maternal death (relative risk [RR], 3.30 [95% confidence interval (CI), 1.38-7.89]), living in the North and Northeastern regions of Brazil (RR, 3.09 [95% CI, 1.13-8.41]), and pre-eclampsia (RR, 2.77 [95% CI, 1.19-6.43]). Conclusion: Severe maternal illness was strongly associated with APO regardless of COVID-19 confirmation. It is essential to provide sufficient and timely health care for women who have respiratory symptoms compatible with COVID-19.

OBJECTIVE:The current study aimed to describe risk factors for adverse perinatal outcomes (APOs) among pregnant women nonvaccinated for COVID-19 who had respiratory symptoms. METHODS:A nested case-control study was performed within the REBRACO (in Portuguese, the Brazilian Network of COVID-19 During Pregnancy) initiative. Women were recruited during pregnancy in 15 maternity hospitals in Brazil from February 1, 2020, to February 28, 2021, while seeking medical care for respiratory symptoms, and were followed up until childbirth regardless of confirmation of COVID-19. For this analysis, women were divided into two groups: (1) those with APOs, defined as the occurrence of fetal or neonatal death, preterm delivery, 5-min Apgar score <7, neonatal respiratory distress, neonatal mechanical ventilation, admission to the neonatal intensive care unit, small-for-gestational-age newborn, or any neonatal morbidity; and (2) those without APOs. RESULTS:The total number of women included in this analysis was 481, with 210 having APOs (43.7%). The characteristics independently associated with APOs were a composite outcome of severe acute respiratory syndrome, maternal admission at the intensive care unit, or maternal death (relative risk [RR], 3.30 [95% confidence interval (CI), 1.38-7.89]), living in the North and Northeastern regions of Brazil (RR, 3.09 [95% CI, 1.13-8.41]), and pre-eclampsia (RR, 2.77 [95% CI, 1.19-6.43]). CONCLUSION:Severe maternal illness was strongly associated with APO regardless of COVID-19 confirmation. It is essential to provide sufficient and timely health care for women who have respiratory symptoms compatible with COVID-19.

Objective:To ascertain how screening for preterm birth is performed among obstetricians working in public and private practice in a middle-income country.Methods:Cross-sectional study of 265 obstetrician-gynecologists employed at public and private facilities. An online questionnaire was administered, with items designed to collect data on prematurity screening and prevention practices.Results:The mean age of respondents was 44.5 years; 78.5% were female, and 97.7% had completed a medical residency program. Universal screening (i.e., by ultrasound measurement of cervical length) was carried out by only 11.3% of respondents in public practice; 43% request transvaginal ultrasound if the manual exam is abnormal, and 74.6% request it in pregnant women with risk factors for preterm birth. Conversely, 60.7% of respondents in private practice performed universal screening. This difference in screening practices between public and private practice was highly significant (p < 0.001). Nearly all respondents (90.6%) reported prescribing vaginal progesterone for short cervix.Conclusion:In the setting of this study, universal ultrasound screening to prevent preterm birth was used by just over half of doctors in private practice. In public facilities, screening was even less common. Use of vaginal progesterone in cervical shortening was highly prevalent. There is an unmet need for formal protocols for screening and prevention of preterm birth in middle-income settings.

OBJECTIVES:To compare maternal and perinatal outcomes among women with obesity, overweight, and normal body mass index, associated with COVID-19 infection during pregnancy and postpartum. METHOD:Prospective Cohort Study, within the REBRACO (Brazilian Network of COVID-19 in Pregnancy) multicenter initiative. Confirmed positive cases of SARS-CoV-2 were included, and women categorized into three groups according to their pre-pregnancy BMI: obesity (BMI ≥ 30), overweight (BMI <30 but >25), and normal BMI. Sociodemographic, clinical, and obstetric characteristics and different maternal and perinatal outcomes were compared, and a multiple regression analysis was performed to investigate factors independently associated with adverse maternal and perinatal outcomes. RESULTS:Two hundred eighty-nine women positive for SARS-CoV-2 infection were considered, and 202 had available data on maternal BMI for the current analysis. Overall, 72 (35.6%)obese, 68 (33.6%) overweight, and 60 (29.7%) normal BMI. Obesity was associated with increased adverse clinical outcomes including sepsis (P = 0.02), acute respiratory distress syndrome (P = 0.002), and the need for mechanical ventilation (P = 0.044). Considering perinatal outcomes, a multiple regression model confirmed obesity as an independent factor associated with adverse results (adjusted odds ratio 3.73, 95% CI 1.54-9.08). CONCLUSION:Obesity and overweight were associated with worse clinical outcomes, severe/critical COVID-19, and adverse perinatal outcomes.

Objective: Compare the number of puerperal women submitted to blood transfusion before and after the implementation of a care protocol for postpartum hemorrhage (PPH) with multidisciplinary team training. Methods: Cross-sectional study in a university hospital, analyzing births from 2015 to 2019, compared the use of blood products before and after the adoption of a PPH protocol with multidisciplinary training. Results: Between 2015 and 2019, there were 17,731 births, with 299 (1.7%) postpartum women receiving blood products and 278 postpartum women were considered for this analysis, 128 (0.7%) at Time 1 and 150 (0.8%) at Time 2. After the multiprofessional team training (T2), there was a difference in the complete use of the PPH protocol (use of oxytocin, misoprostol and tranexamic acid) (T1 = 5.1% x T2 = 49.5%, p <= 0.0001). An individual categorized analysis revealed that, in the T2 period, there was lower use of blood component units per patient compared to T1 (Mann-Whitney, p=0.006). It should be noted that at T1 and T2, 54% and 24% respectively received two units of blood products. It is important to highlight that after the multidisciplinary team training for the PPH protocol, the goal of zero maternal death due to hemorrhage was reached. Conclusion: The adoption of a specific protocol for PPH, combined with the training of a multidisciplinary team, had an impact on the ability to identify women at high risk of hemorrhage, resulting in a decrease in the use of blood components.

BackgroundPregnant and postpartum women infected by COVID-19 are at increased risk of adverse outcomes, including negative effects on their mental health. Brazilian maternal mortality rate due to COVID-19 is 2.5 times higher than overall mortality rates. This study aimed to understand how pregnant/postpartum women experienced the COVID-19 suspicion/investigation or confirmed infection in different Brazilian cities, the pandemic's consequences to women and their families, and their needs to improve maternal health services during public health emergencies.MethodsWe conducted a qualitative study with 27 women with COVID-19 and 6 of their family members, as part of a multicenter study among 15 maternity hospitals in Brazil. We applied in-depth interviews through telephone calls when women received the diagnostic or had a suspect infection and after 60 days. Another semi-structured interview was applied to their close family members. The interviews were considered through thematic analysis.ResultsFrom the thematic content analysis three major themes emerged from the first and second interviews: (Cucinotta and Vanelli, 2020) assistance received by the woman and newborn in the medical services; (World Health Organization (WHO) 2021) stigma/fear of contamination from health workers and from family and friends reported by the women; (Allotey et al., 2020) the COVID-19 pandemic impact.ConclusionBefore the availability of the COVID-19 vaccine, pregnant women experienced fear of death, hospitalization, quarantine, loss of family members, and financial repercussions, resulting in physical, psychological, and socioeconomic impacts on these women's lives.

Background COVID-19 pandemic has changed people’s lives around the world due to restrictive measures adopted by governments. The impact of this change on female sexuality needs to be further investigated, particularly between female doctors who are more at risk as they are directly involved with health care services. Methods An online survey has been filled out by female doctors. The questionnaire evaluates sexual function, depression, anxiety, burnout, sociodemographic and professional data, and it was answered during the peak of COVID-19 pandemic in Brazil. The main outcome is female doctors’ sexual function during COVID-19 pandemic, which was evaluated by analyzing FSFI questionnaires. The secondary outcome is related to their mental health, assessed via depression, anxiety and burnout questionnaires. Results A sample of 388 female doctors filled out the questionnaire. The median age was 34.0 (29.0, 43.0) years old. The total FSFI median score was 23.8 [18.9, 26.8] with desire domain median of 5.0 [3.0, 7.0]. In our sample, 231 (59.5%) women had depression and/or anxiety, out of these, 191 (82.7%) had depression and 192 (83.2%), anxiety. From these samples of doctors with depression and/or anxiety, 183 (79.2%) had sexual dysfunction. Conclusion This finding suggests that doctors are experiencing a high risk of sexual dysfunction and mental illness during the COVID-19 outbreak. A high index of depression and/or anxiety was shown in the studied population, with almost 80% of them reaching criteria for sexual dysfunction. Working in the frontline is related to worse mental health conditions. Depression and anxiety were found as potential mediators of burnout effect on sexual function.

Objective The purpose of this study is to evaluate the diagnostic performance of MRI parameters to predict adverse maternal peripartum outcomes in pregnant females at high-risk for placenta accreta spectrum (PAS) disorder. Methods and materials This retrospective study evaluated 60 pregnant females who underwent MRI for placental assessment. MRI studies were reviewed by a radiologist blinded to all clinical data. MRI parameters were compared with five maternal outcomes: severe bleeding, cesarean hysterectomy, prolonged operation time, need for blood transfusion, and need for intensive care unit (ICU) admission. The MRI findings were associated with pathologic and/or intraoperative findings for PAS. Results The study identified 46 cases of PAS disorder and 16 cases of placenta percreta. The agreement between the radiologist impression of PAS disorder and the intraoperative/histological findings was substantial (0.67, p < 0.001), and almost perfect for the presence of placenta percreta (0.87, p < 0.001). The presence of a placental bulge was highly associated with placenta percreta, with sensitivity of 87.5% and specificity of 90.9%. The MRI signs that associated with more maternal outcomes were myometrial thinning, with significant odds ratio for severe blood loss (20.2), hysterectomy (4.0), need for blood transfusion (4.8) and prolonged surgery time (4.9), and uterine bulging, with significant odds ratio for severe blood loss (11.9), hysterectomy (34.0), ICU admission (5.0), and need for blood transfusion (4.8). Conclusion MRI signs significantly correlated with invasive placenta and were independently associated with adverse maternal outcomes. The presence of a placental bulge was highly accurate in predicting placenta percreta. Advances in knowledge First study to evaluate the strength of the association between individual MRI signs and five adverse maternal outcomes. Conclusions support published MRI signs associated with placental invasion, especially regarding the value placental bulging in predicting placenta percreta.

Objective To evaluate the impact of the race (Black versus non-Black) on maternal and perinatal outcomes of pregnant women with COVID-19 in Brazil.Methods This is a subanalysis of REBRACO, a Brazilian multicenter cohort study designed to evaluate the impact of COVID-19 on pregnant women. From February 2020 until February 2021, 15 maternity hospitals in Brazil collected data on women with respiratory symptoms. We selected all women with a positive test for COVID-19; then, we divided them into two groups: Black and non-Black women. Finally, we compared, between groups, sociodemographic, maternal, and perinatal outcomes. We obtained the frequency of events in each group and compared them using X2 test; p-values < 0.05 were considered significant. We also estimated the odds ratio (OR) and confidence intervals (CI).Results 729 symptomatic women were included in the study; of those, 285 were positive for COVID-19, 120 (42.1%) were Black, and 165 (57.9%) were non-Black. Black women had worse education (p = 0.037). The timing of access to the health system was similar between both groups, with 26.3% being included with seven or more days of symptoms. Severe acute respiratory syndrome (OR 2.22 CI 1.17-4.21), intensive care unit admission (OR 2.00 CI 1.07-3.74), and desaturation at admission (OR 3.72 CI 1.41-9.84) were more likely to occur among Black women. Maternal death was higher among Black women (7.8% vs. 2.6%, p = 0.048). Perinatal outcomes were similar between both groups.Conclusion Brazilian Black women were more likely to die due to the consequences of COVID-19.

Abstract Purpose Placenta accreta spectrum disorder (PAS) is a pathological condition in which placenta abnormally adheres to or invades the myometrium. PAS has a high risk of complications, especially peripartum bleeding, which can be associated with several maternal and neonatal adverse outcomes. Our goal is to determine maternal and fetal outcomes in cases of PAS managed by a multidisciplinary team (MDT). Methods This is a retrospective cohort study that included all cases of PAS managed by a MDT between January 2016 and December 2022. Maternal and neonatal outcomes were analyzed for each case. Results There were 102 cases of PAS managed by a MDT during the study period. Maternal age average was 35.5 years, 75.4% had at least one prior cesarean section and 55.8% had placenta previa. 54.9% were diagnosed with placenta accreta, 20.5% with placenta increta and 24.5% with placenta percreta. Hysterectomy was performed in 55.8% of the cases, and in 87.7% of them placenta was left in situ. Blood products transfusion was necessary in 24.5% of the cases, with a mean number of 2 red blood cells concentrates. Intensive care unit admission rate after surgery was 8.8% and no maternal death occurred. Conclusions Although PAS is a condition associated with high morbidity and mortality, this study demonstrates lower rates of maternal complications than reported in literature. PAS management should be based in protocols, and pregnancy interruption should be performed in centers of excellence with an experienced and trained MDT, making it possible to reduce maternal morbidity and mortality.

A infecção pelo HPV é extremamente prevalente e transformou-se em queixa freqüente tanto na prática ginecológica como em outras especialidades, como dermatologia, urologia e proctologia. O objetivo deste trabalho é esclarecer sobre este agente viral. A compreensão de sua importância é fundamental tanto para o controle e erradicação de outras doenças sexualmente transmissíveis, entre as quais a infecção pelo HIV, quanto para o controle do câncer de colo uterino, uma neoplasiaa freqüente, principalmente em países em desenvolvimento, como é o caso do Brasil.

Abstract Background Small-for-gestational-age neonates (SGA) are at increased risk of neonatal morbidity. Nulliparity represents a risk factor for SGA; birthweight charts may perform differently for the detection of SGA among nulliparas. This study aimed at describing the prevalence of SGA in nulliparas according to different birthweight charts and evaluating the diagnostic performance of these charts to maternal and perinatal outcomes. Methods This is a secondary analysis of a Brazilian cohort of nulliparas named Preterm SAMBA study. Birthweight centiles were calculated using the Intergrowth-21st, WHO-Fetal Growth Charts, Birth in Brazil population chart and GROW-customised chart. The risks of outcomes among SGA neonates and their mothers in comparison to neonates with birthweights between the 40th-60th centiles were calculated, according to each chart. ROC curves were used to detect neonatal morbidity in neonates with birth weights below different cutoff centiles for each chart. Results A sample of 997 nulliparas was assessed. The rate of SGA infants varied between 7.0–11.6%. All charts showed a significantly lower risk of caesarean sections in women delivering SGA neonates compared to those delivering adequate-for-gestational-age neonates (OR 0.55–0.64, p < .05). The charts had poor performance (AUC 0.492 – 0.522) for the detection of neonatal morbidity related to SGA born at term. Conclusion The populational and customised birthweight charts detected different prevalence of small-for-gestational-age neonates and showed similar and poor performance to identify related neonatal adverse outcomes in this population.

OBJETIVO: Comparar duas modalidades de screening de câncer de colo uterino por exame citopatológico (CP) desenvolvidas no Estado do Rio Grande do Sul: uma, sazonal e isolada, promovida pelo Ministério da Saúde em 1998; outra, regular, promovida pela Secretaria da Saúde do Estado do Rio Grande do Sul no período de 1991 a 1996. MATERIAIS E MÉTODOS: avaliou-se retrospectivamente os resultados obtidos com a coleta de exames citopatológicos de colo uterino da campanha do Ministério da Saúde e do programa regular da Secretaria da Saúde do Estado do Rio Grande do Sul. RESULTADOS: Comparando-se o percentual de alterações nos exames coletados pela Secretaria da Saúde em 1996 com os exames coletados pelo Ministério da Saúde em 1998, obteve-se, respectivamente: NIC I - 0,55% / 0,29%; NIC II - 0,25% / 0,15%; NIC III - 0,16% / 0,14%; carcinoma - 0,04% / 0,04%. Quanto aos exames coletados pela Secretaria da Saúde no período 1991-1996, 58,64% não eram representativos da junção escamo-colunar (JEC). Sobre estes, somente 13,74% das lesões de alto grau encontravam-se em CPs não representativos da JEC, enquanto 85,22% das lesões de alto grau encontravam-se nos CPs representativos da JEC (1,04% dos resultados ignorados). CONCLUSÕES: A campanha sazonal do Ministério da Saúde no Rio Grande do Sul apresentou desempenho desfavorável quando comparada ao programa regular da Secretaria da Saúde, sugerindo que rastreamentos isolados tenham eficácia menor que rastreamentos planejados e contínuos. O próprio rastreamento regular possui falhas que devem ser corrigidas, como a baixa representatividade da junção escamo-colunar.

Background: Recently, late umbilical cord clamping is generally recommended, which decreases neonatal anemia; however, it may also increase neonatal jaundice and some other poor outcomes. Objectives: We here attempted to determine whether late clamping actually increases the incidence of phototherapy for jaundice and other poor outcomes of the term “low-risk newborns”. Methods: With the approval of the Brazilian Registry of Clinical Trials (REBEC), a total of 357 low-risk newborns (singleton, uncomplicated pregnancy/delivery, in a Brazilian public institution) were randomized into two groups: group I (n = 114): cord clamping 1 minute (early clamping) or group II (n = 243): cord clamping between 1 - 3 minutes (late clamping). Statistics were used appropriately (i.e., measures of central tendency, dispersion for continuous variables, Shapiro-Wilk, Mann-Whitney test, or Chi-square test). Results: Phototherapy was performed in 5.3% in both groups. Also, there were no statistical differences in the occurrence of secondary outcomes, such as sepsis, neonatal ICU admission, and transient tachypnea of the newborns: i.e., 0.9%, 15.8%, and 3.5%, respectively for group I versus 1.2%, 15.6%, and 5.8%, respectively for group II. Conclusion: Late umbilical cord clamping does not increase the need for phototherapy in low-risk neonates. This result corroborates the current recommendation of late cord clamping, whenever appropriate.