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BACKGROUND: Recognizing premature newborns and small-for-gestational-age (SGA) is essential for providing care and supporting public policies. This systematic review aims to identify the influence of the last menstrual period (LMP) compared to ultrasonography (USG) before 24 weeks of gestation references on prematurity and SGA proportions at birth. METHODS: Systematic review with meta-analysis followed the recommendations of the PRISMA Statement. PubMed, BVS, LILACS, Scopus-Elsevier, Embase-Elsevier, and Web-of-Science were searched (10-30-2022). The research question was: (P) newborns, (E) USG for estimating GA, (C) LMP for estimating GA, and (O) prematurity and SGA rates for both methods. Independent reviewers screened the articles and extracted the absolute number of preterm and SGA infants, reference standards, design, countries, and bias. Prematurity was birth before 37 weeks of gestation, and SGA was the birth weight below the p10 on the growth curve. The quality of the studies was assessed using the New-Castle-Ottawa Scale. The difference between proportions estimated the size effect in a meta-analysis of prevalence. RESULTS: Among the 642 articles, 20 were included for data extraction and synthesis. The prematurity proportions ranged from 1.8 to 33.6% by USG and varied from 3.4 to 16.5% by the LMP. The pooled risk difference of prematurity proportions revealed an overestimation of the preterm birth of 2% in favor of LMP, with low certainty: 0.02 (95%CI: 0.01 to 0.03); I2 97%). Subgroup analysis of USG biometry (eight articles) showed homogeneity for a null risk difference between prematurity proportions when crown-rump length was the reference: 0.00 (95%CI: -0.001 to 0.000; I2: 0%); for biparietal diameter, risk difference was 0.00 (95%CI: -0.001 to 0.000; I2: 41%). Only one report showed the SGA proportions of 32% by the USG and 38% by the LMP. CONCLUSIONS: LMP-based GA, compared to a USG reference, has little or no effect on prematurity proportions considering the high heterogeneity among studies. Few data (one study) remained unclear the influence of such references on SGA proportions. Results reinforced the importance of qualified GA to mitigate the impact on perinatal statistics. TRIAL REGISTRATION: Registration number PROSPERO: CRD42020184646.

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BACKGROUND: The assessment of clinical prognosis of pregnant COVID-19 patients at hospital presentation is challenging, due to physiological adaptations during pregnancy. Our aim was to assess the performance of the ABC2-SPH score to predict in-hospital mortality and mechanical ventilation support in pregnant patients with COVID-19, to assess the frequency of adverse pregnancy outcomes, and characteristics of pregnant women who died. METHODS: This multicenter cohort included consecutive pregnant patients with COVID-19 admitted to the participating hospitals, from April/2020 to March/2022. Primary outcomes were in-hospital mortality and the composite outcome of mechanical ventilation support and in-hospital mortality. Secondary endpoints were pregnancy outcomes. The overall discrimination of the model was presented as the area under the receiver operating characteristic curve (AUROC). Overall performance was assessed using the Brier score. RESULTS: From 350 pregnant patients (median age 30 [interquartile range (25.2, 35.0)] years-old]), 11.1% had hypertensive disorders, 19.7% required mechanical ventilation support and 6.0% died. The AUROC for in-hospital mortality and for the composite outcome were 0.809 (95% IC: 0.641-0.944) and 0.704 (95% IC: 0.617-0.792), respectively, with good overall performance (Brier = 0.0384 and 0.1610, respectively). Calibration was good for the prediction of in-hospital mortality, but poor for the composite outcome. Women who died had a median age 4 years-old higher, higher frequency of hypertensive disorders (38.1% vs. 9.4%, p < 0.001) and obesity (28.6% vs. 10.6%, p = 0.025) than those who were discharged alive, and their newborns had lower birth weight (2000 vs. 2813, p = 0.001) and five-minute Apgar score (3.0 vs. 8.0, p < 0.001). CONCLUSIONS: The ABC2-SPH score had good overall performance for in-hospital mortality and the composite outcome mechanical ventilation and in-hospital mortality. Calibration was good for the prediction of in-hospital mortality, but it was poor for the composite outcome. Therefore, the score may be useful to predict in-hospital mortality in pregnant patients with COVID-19, in addition to clinical judgment. Newborns from women who died had lower birth weight and Apgar score than those who were discharged alive.

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OBJECTIVE: This study aims to investigate the presence of Cytomegalovirus (CMV), herpes virus simplex (HSV), and parvovirus B19 (PVB19) in the placental tissue of patients who underwent abortions without an otherwise-defined aetiology. STUDY DESIGN: This cross-sectional study was conducted in a high-risk obstetric maternity facility at a University Hospital in Belo Horizonte, Brazil, from January 2013 to December 2015. We included placenta samples obtained from spontaneous abortions of unknown aetiology. Seventy placenta samples were identified and were classified according to histopathological characteristics. All samples were analysed using immunohistochemistry and polymerase chain reaction for CMV, PVB19, and HSV. The clinical variables were collected from the medical records of patients to verify the association of infection with villitis. The patients were divided into the following groups: I) with villitis (n = 28) and II) without villitis (n = 42). METHODS: Immunohistochemistry used monoclonal anti-CMV antibody (NCL-CMVpp65, Leica Biosystems, Wetzlar, Germany), anti-PVB19 antibody (NCL-PARVO, Leica Biosystems, Wetzlar, Germany), and anti-HSV1/HSV2 antibodies (NCL-HSV-1 and HSV2, Leica Biosystems, Wetzlar, Germany). The data were analysed using the Statistical Package for Social Sciences (SPSS Inc, Chicago, IL) 19.0. RESULTS: Viral agents were detected in five patients (7.14%) in the villitis group. Three patients were positive for CMV, one for PVB19, and one for HSV type 2. Foetal and maternal complications were significantly higher in the group with villitis compared with those in the group without villitis (p = .002). CONCLUSIONS: The prevalence of transplacental viral infections as a cause of spontaneous abortion should be considered high in the placenta with villitis. Thus, this study highlights the need for developing diagnostic tests to clarify the aetiology of abortion and foetal loss.

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Objetivo: analisar criticamente dados sobre o nascimento e intercorrências clínico-obstétricas dos sumários de alta obstétrica, visando à troca de informações para continuidade do cuidado materno e neonatal. Pacientes e métodos: estudo observacional retrospectivo em base de dados secundários. Foram consultados 102 sumários de alta obstétrica da maternidade do Hospital das Clínicas da UFMG, entre julho e dezembro de 2013. Para se avaliar a pertinência da proposição de um modelo estruturado para o documento eletrônico, as situações de alta obstétrica e os conteúdos clínicos documentados pelos médicos foram comparados entre internações anteparto e pós-parto, empregando-se o teste qui-quadrado de Pearson. Resultados: em 48 (49,5%) dos 97 documentos selecionados, a condição gestacional era de elevado risco. Os campos já estruturados no formulário em uso tiveram alta frequência de preenchimento. Observou-se semelhança entre o conteúdo dos registros clínicos das altas anteparto e pós-parto, a não ser pelos resultadosde exames, mais frequentes no primeiro e pelos dados sobre o nascimento, no segundo. Dados sobre o concepto e orientações para após a alta tiveram frequência aquém do esperado. Conclusões: o sumário de alta obstétrica em um discurso livre sobre os fatos ocorridos durante o nascimento pode falhar em prover dados de qualidade para a continuidadedo cuidado na rede de atenção materno-infantil. Acredita-se que a proposição de um padrão estruturado, contendo um conjunto mínimo de dados possa oferecer subsídios para aprimorar a troca de informações maternas e neonatais.

Objective: to critically analyze data on birth, and clinical and obstetric complications in the content of obstetric discharge reports aiming at exchanging information for the continuity of maternal and neonatal care. Patients and methods: this was a retrospective observational study in a database of secondary data. A total of 102 obstetric discharge reports were consulted from the UFMG General Hospital maternity between July and December of 2013. The obstetric discharge situations and clinical contents documented by physicians were compared between antepartum and postpartum hospitalizations using the chi-square test of Pearson to evaluate the relevance of the proposition of a structuredmodel for electronic documentation. Results: in 48 (49.5%) out of the 97 selected documents, the gestational condition was of high risk. The s already structured in the form in use were filled in high frequency. The similarity between the content of antepartum and postpartum clinical records was observed, except for results of tests, which were morefrequent in the first, and birth data in the second. Data on the newborn and guidance after discharge were often lower than expected. Conclusions:the content in the obstetric discharge report about the events that occurred during birth may fail to provide quality data for the continuity of care in the maternal and child care. It is believed that the proposition of a structured pattern, containing a minimum set of data can provide subsidies to improve the exchange of maternal and neonatal information.

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OBJECTIVE: To evaluate complications in pregnant women with sickle cell disease, especially those leading to maternal death or near miss (severe obstetric complications). METHODS: A prospective cohort of 104 pregnant women registered in the Blood Center of Belo Horizonte (Hemominas Foundation) was followed up at high-risk prenatal units. They belonged to Group I (51 hemoglobin SS and three hemoglobin S/ß0-thalassemia) or Group II (49 hemoglobin SC and one hemoglobin S/ß+-thalassemia). Both groups had similar median ages. Predictive factors for 'near miss' or maternal death with p-value = 0.25 in the univariate analysis were included in a multivariate logistic model (significance set for p-value = 0.05). RESULTS: Group I had more frequent episodes of vaso-occlusive crises, more transfusions in the antepartum and postpartum, and higher percentage of preterm deliveries than Group II. Infections and painful crises during the postpartum period were similar in both the groups. The mortality rate was 4.8%: three deaths in Group I and two in Group II. One-third of the women in both the groups experienced near miss. The most frequent event was pneumonia/acute chest syndrome. Alpha-thalassemia co-inheritance and ß-gene haplotypes were not associated with near miss or maternal death. In multivariate analysis predictors of near miss or death were parity above one and baseline red blood cell macrocytosis. In Group I, baseline hypoxemia (saturation < 94%) was also predictive of near miss or death. CONCLUSION: One-third of pregnant women had near miss and 4.8% died. Both hemoglobin SS and SC pregnant women shared the same risk of death or of severe complications, especially pulmonary events...

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