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OBJECTIVE: To determine stillbirth ratio and its association with maternal, perinatal, and delivery characteristics, as well as geographic differences in Latin American countries (LAC). METHODS: We analysed data from the Perinatal Information System of the Latin American Center for Perinatology and Human Development (CLAP) between January 2018 and June 2021 in 8 health facilities from five LAC countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic). Maternal, pregnancy, and delivery characteristics, in addition to pregnancy outcomes were reported. Estimates of association were tested using chi-square tests, and P < 0.05 was regarded as significant. Bivariate analysis was conducted to estimate stillbirth risk. Prevalence ratios (PR) with their 95% confidence intervals (CI) for each predictor were reported. RESULTS: In total, 101,852 childbirths comprised the SIP database. For this analysis, we included 99,712 childbirths. There were 762 stillbirths during the study period; the Stillbirth ratio of 7.7/1,000 live births (ranged from 3.8 to 18.2/1,000 live births across the different maternities); 586 (76.9%) were antepartum stillbirths, 150 (19.7%) were intrapartum stillbirths and 26 (3.4%) with an ignored time of death. Stillbirth was significantly associated with women with diabetes (PRadj 2.36; 95%CI [1.25-4.46]), preeclampsia (PRadj 2.01; 95%CI [1.26-3.19]), maternal age (PRadj 1.04; 95%CI [1.02-1.05]), any medical condition (PRadj 1.48; 95%CI [1.24-1.76, and severe maternal outcome (PRadj 3.27; 95%CI [3.27-11.66]). CONCLUSIONS: Pregnancy complications and maternal morbidity were significantly associated with stillbirths. The stillbirth ratios varied across the maternity hospitals, which highlights the importance for individual surveillance. Specialized antenatal and intrapartum care remains a priority, particularly for women who are at a higher risk of stillbirth.

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BACKGROUND: The burden of maternal morbidity in neonatal outcomes can vary with the adequacy of healthcare provision and tool implementation to improve monitoring. Such information is lacking in Latin American countries, where the decrease in severe maternal morbidity and maternal death remains challenging. OBJECTIVES: To determine neonatal outcomes according to maternal characteristics, including different degrees of maternal morbidity in Latin American health facilities. METHODS: This is a secondary cross-sectional analysis of the Perinatal Information System (SIP) database from eight health facilities in five Latin American and Caribbean countries. Participants were all women delivering from August 2018 to June 2021, excluding cases of abortion, multiple pregnancies and missing information on perinatal outcomes. As primary and secondary outcome measures, neonatal near miss and neonatal death were measured according to maternal/pregnancy characteristics and degrees of maternal morbidity. Estimated adjusted prevalence ratios (PRadj) with their respective 95% CIs were reported. RESULTS: In total 85,863 live births were included, with 1,250 neonatal near miss (NNM) cases and 695 identified neonatal deaths. NNM and neonatal mortality ratios were 14.6 and 8.1 per 1,000 live births, respectively. Conditions independently associated with a NNM or neonatal death were the need for neonatal resuscitation (PRadj 16.73, 95% CI [13.29-21.05]), being single (PRadj 1.45, 95% CI [1.32-1.59]), maternal near miss or death (PRadj 1.64, 95% CI [1.14-2.37]), preeclampsia (PRadj 3.02, 95% CI [1.70-5.35]), eclampsia/HELPP (PRadj 1.50, 95% CI [1.16-1.94]), maternal age (years) (PRadj 1.01, 95% CI [<1.01-1.02]), major congenital anomalies (PRadj 3.21, 95% CI [1.43-7.23]), diabetes (PRadj 1.49, 95% CI [1.11-1.98]) and cardiac disease (PRadj 1.65, 95% CI [1.14-2.37]). CONCLUSION: Maternal morbidity leads to worse neonatal outcomes, especially in women suffering maternal near miss or death. Based on SIP/PAHO database all these indicators may be helpful for routine situation monitoring in Latin America with the purpose of policy changes and improvement of maternal and neonatal health.

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BACKGROUND: Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. METHODS: Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. RESULTS: Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). CONCLUSION: Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR.

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Background: Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. Methods: Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. Results: Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). Conclusion: Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR. (AU)

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Las enfermedades cardiometabólicas son de alta prevalencia en edades donde existe una mayor productividad. Esta condición representa un problema público que implica su análisis en el ámbito de las políticas públicas localizadas en contextos específicos como el caso del Municipio Maracaibo del Estado Zulia en Venezuela. El estudio propone elaborar el diseño de una política pública relativa a la educación nutricional, mediante la gestión de proyectos estratégicos para prevenir, educar y controlar las referidas enfermedades. El estudio fue desarrollado durante el período 2019-2020. En lo metodológico se fundamentó en el enfoque de marco lógico que permiten cuestionar y analizar la realidad estudiada, a través de la organización de un diseño de investigación estructurado en un nivel prospectivo-estratégico que implica la sistematización del problema público. El resultado plantea un proyecto didáctico de intervención comunitaria orientado a disminuir la prevalencia de enfermedades cardiometabólicas en esta región del país, mediante un programa de educación nutricional para promocionar estilos de vida saludables. Se concluye que la definición de las enfermedades cardiometabólicas como problema estructurado en el ámbito social, es un prerrequisito para el diseño de una política pública, asociado a proyectos de educación nutricional que contribuyan a atenuar esta condición en la población(AU)

Cardiometabolic diseases are highly prevalent at ages where there is greater productivity. This condition represents a public problem that implies its analysis in the field of public policies located in specific contexts, such as the Maracaibo Municipality of the Zulia State - Venezuela. The study proposes to develop the design of a public policy related to nutritional education, through the management of strategic projects to prevent, educate and control the referred diseases. The study was developed during the 2019- 2020 period. Methodologically, it was based on the logical framework approach that allows questioning and analyzing the reality studied, through the organization of a structured research design at one level; prospective - strategic, and implies the systematization of the public problem. The result proposes a didactic community intervention project aimed at reducing the prevalence of cardiometabolic diseases in this region of the country, through a nutritional education program to promote healthy lifestyles. It is concluded that the definition of cardiometabolic diseases as a structured problem in the social sphere is a prerequisite for the design of a public policy, associated with nutritional education projects that contribute to mitigating this condition in the population(AU)

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Introducción: Concepción interdisciplinaria de la gestión del sistema de salud en el contexto latinoamericano, de acuerdo con lo establecido por la Organización Mundial de la Salud/ Organización Panamericana de la Salud. El artículo propone una estrategia prospectiva de desarrollo social en la Costa Atlántica de Colombia, para afianzar el funcionamiento, desde lo preventivo y asistencial, del Sistema General de Seguridad Social y Salud colombiano. Objetivo: Definir, desde una visión prospectiva para el desarrollo social colectivo, los retos del Sistema General de Seguridad Social y Salud colombiano. Método: Estudio exploratorio, fundamentado en el análisis teórico conceptual que permite derivar el sistema de relaciones de las categorías: gerencia del sistema de salud y desarrollo social colectivo. Se aplica la prospectiva estratégica, mediante el componente empírico-analítico, a través del cual se visualizan escenarios futuros que direccionen el desarrollo del sistema de salud a partir de la interacción entre sus actores representativos. Resultados: Se determinaron debilidades relacionadas con la gestión integral del Sistema General de Seguridad Social y Salud colombiano, específicamente en la Costa Atlántica. En esta región del país el escaso uso de técnicas prospectivas debilita la estrategia gerencial y minimiza la posibilidad de asumir retos y prever incertidumbres en uno de los sistemas que, a través de la efectividad de servicios de salud y calidad de vida, supone un indicador de desarrollo social colectivo. Conclusiones: Necesidad de visionar retos y escenarios para modelar la gestión del Sistema General de Seguridad Social y Salud en la Costa Atlántica de Colombia para afianzar la equidad, la inclusión y la calidad de vida e incrementar los estándares de gestión de la salud en colectivos y comunidades vulneradas(AU)

Introduction: There is an interdisciplinary basis conceived for the management of the health system in the Latin American context, in accordance with the provisions of WHO/PAHO and that is linked with related disciplines, such as management and education. This article proposes a prospective strategy of social development in the Atlantic Coast of Colombia to consolidate its functioning from the preventive and welfare perspectives in the Colombian's General System of Social Security and Health (SGSSS, by its acronym in Spanish). Objective: To define the challenges of the SGSSS from a prospective point of view for the collective social development. Method: An exploratory study, based on the conceptual, theoretical analysis to derive the relations´ system of the following categories: management of the health system, and collective social development. Strategic prospective is used by the empirical-analytical component to visualize future scenarios of probable occurrence that address the development of the health system from the interaction between its representative actors. Results: The weaknesses identified were related to the comprehensive management of the Colombian SGSSS, specifically on the Atlantic Coast, where the limited use of prospective techniques weakens the management strategy and minimizes the possibility of assuming challenges and anticipating uncertainties in one of the systems that through the effectiveness of health services and quality of life warrants responding to collective social development. Conclusions: There is a need to view challenges and scenarios for modeling the management of the SGSSS on the Atlantic Coast of Colombia to strengthen the equity, inclusion and quality of life, and to increase the standards of health management in vulnerable groups and communities(AU)

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La diabetes mellitus gestacional (DMG) es uno de los trastornos metabólicos más frecuentes que pueden afectar el embarazo. Su prevalencia aumenta en la misma proporción que la epidemia de obesidad y sobrepeso. Reconocer y tratar cualquier grado de alteración de la glucemia que afecte la gestación conduce a la disminución de complicaciones maternas y fetales, inmediatas y a largo plazo. A pesar de un cúmulo de investigación básica y clínica, aun no existe un enfoque único para diagnosticar y tratar la diabetes durante el embarazo. Lo deseable para nuestro país es buscar la uniformidad de criterios en la pesquisa y el diagnóstico de la DMG, y de esa manera, poder tener nuestra propia casuística. Es por ello que la Sociedad Venezolana de Endocrinología y Metabolismo ha concebido la idea de elaborar este Manual de Diabetes Gestacional, con la colaboración de la Sociedad de Obstetricia y Ginecología de Venezuela, la Sociedad Venezolana de Medicina Interna y Especialistas que integran el equipo multidisciplinario de atención a la embarazada de alto riesgo conformado por endocrinólogos, internistas, obstetras, nutricionistas, deportólogos y/o biólogos del ejercicio y neonatólogos, para que pueda ser utilizado tanto a nivel primario como en áreas de especialización. Este manual se enfocará en la prevención, la pesquisa, el diagnóstico, el tratamiento y seguimiento de la Diabetes Mellitus Gestacional, pudiendo servir de base para la integración del equipo de salud que se constituya para atender a nuestra paciente.

Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders that can affect pregnancy. Its prevalence increases in the same proportion as the epidemic of obesity and overweight. Recognize and treat any degree of impaired glucose affecting pregnancy leads to decreased maternal and fetal, immediate and long-term complications. Despite a wealth of basic and clinical research, there is no single approach to diagnose and treat diabetes during pregnancy. Desirable for our country is to seek uniformity of criteria in the screening and diagnosis of GDM and thus able to have our own casuistry. That is why the Venezuelan Society of Endocrinology and Metabolism has conceived the idea of a Manual of Gestational Diabetes, in collaboration with the Society of Obstetrics and Gynecology of Venezuela, the Venezuelan Society of Internal Medicine and specialists who make up the multidisciplinary care team high-risk pregnant formed with endocrinologists, internists, obstetricians, nutritionists, exercise physiologists and/or biologists exercise and neonatologist so that it can be used both at the primary level and areas of expertise. This manual will focus on prevention, screening, diagnosis, treatment and monitoring of Gestational Diabetes Mellitus and can serve as a basis for integrating health team to serve our patient.

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Introducción: La inclusión de drogas que revierten efectivamente el bloqueo de la placa neuromuscular mejora el perfil de uso de los medicamentos que la relajan, y más aún si estos carecen de efectos adversos de importancia clínica y se pueden emplear en neonatos. Objetivos: Este artículo describe el caso de 2 pacientes pediátricos en quienes se aplicó sugammadex para la reversión de la relajación neuromuscular. Metodología: Estudio observacional descriptivo retrospectivo con un diseño de reporte de casos. Resultados: Se describe el uso exitoso de sugammadex para la reversión del bloqueo neuromuscular inducido por rocuronio en 2 pacientes neonatos y la ausencia de eventos adversos. Discusión: La literatura para el uso de sugammadex en pacientes recién nacidos es poca y controvertida, lo cual no apoya su amplia prescripción en neonatología debido a la falta de estudios que aseguren su efectividad y la ausencia de efectos adversos. No existen dosis recomendadas por grupo etario y una lista de efectos adversos esperables que contraindiquen su administración. Aun así, es ideal poder disponer de medicamentos que reviertan la relajación derivada del uso de bloqueadores neuromusculares en cualquier edad, lo cual incluye a los pacientes neonatos. Conclusiones: Tras una dosis de sugammadex se describe la reversión del bloqueo neuromuscular en 2 pacientes neonatos, siendo esta efectiva para la restauración funcional de la placa neuromuscular. Para poder recomendar su amplio uso en recién nacidos es ideal la realización de estudios experimentales controlados.

Introduction: The inclusion of drugs that effectively reverse the neuromuscular junction blockade enhances the profile of drugs used for relaxation of the neuromuscular junction; better yet if these agents are free from any clinically important adverse effects and amenable to use in neonates. Objectives: This article describes a case of two pediatric patients who received Sugammadex to reverse neuromuscular relaxation. Methodology: Retrospective, descriptive, observational study designed as a case report. Results: This is a description of a Sugammadex successful reversal of Rocuronium-induced neuromuscular blockade in two neonates with no adverse events. Discussion: The literature on the use of Sugammadex in newborn patients is scarce and controversial which does not contribute to a broad prescription of the drug in neonatology settings due to the shortage of studies attesting to its effectiveness and absence of adverse effects. There are no recommended doses per age group and a list of expected adverse effects to contraindícate its administration. However, the idea is to have available drugs that reverse the relaxation resulting from the use of neuromuscular blockers at any age, including neonates. Conclusions: Following the administration of a dose of Sugammadex the reversal of neuromuscular blockade in neonate patients is described with effective functional recovery of the neuromuscular junction. Further experimental controlled trials are needed to recommend the use of Sugammadex in newborn babies.

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Describir los hallazgos ecográficos detectados en los fetos y su relación con el cariotipo anormal obtenido en las amniocentesis genéticas realizadas en el segundo trimestre. Se revisaron todos los informes de los estudios ecográficos realizados previamente a la amniocentesis de los fetos que resultaron con cromosomopatías durante el año 2006. Centro Nacional de Genética Humana y Experimental. Universidad Central de Venezuela. Caracas. En 1786 amniocentesis, se obtuvieron 32 fetos (1,79 por ciento) con cromosomopatías, siendo la trisomía 21 la más frecuente (47 por ciento). De todos los casos con alteraciones cromosómicas 15 fetos (46,9 por ciento) tuvieron uno o más marcadores ecográficos. Los hallazgos ecográficos encontrados en el grupo general fueron pliegue nucal engrosado en 40 por ciento, higroma quístico en 19,5 por ciento, ectasia pielocalicial en 12,5 por ciento, e intestino hiperecogénico, ausencia de hueso nasal, foco ecogénico intracardíaco y pie equino varo, cada uno en un 7 por ciento. Un 53 por ciento de los fetos con trisomía 21 presentaron algún tipo de hallazgo ecográfico anormal, así mismo un 67 por ciento de los fetos con trisomía 18 y 100 por ciento de los fetos que tenían monosomía X, trisomía 22 y triploidía. El ultrasonido juega un papel muy importante en el diagnóstico prenatal. El diagnóstico apropiado de las anomalías estructurales y hallazgos menores, incrementa la sospecha de alguna alteración cromosómica y puede sugerir la realización de procedimientos invasivos de diagnóstico prenatal

To describe the abnormalities detected by detailed second trimester ultrasonography among the fetuses with abnormal karyotype after amniocentesis. Ultrasound studies belonging to fetuses with diagnosed chromosomal anomalies in 2006 were reviewed. Centro Nacional de Genética Humana y Experimental. Universidad Central de Venezuela. Caracas. A total of 1,786 patients underwent amniocentesis with a result of 32 (1.79 percent) fetuses detected with an abnormal karyotype, trisomy 21 (47 percent). Out of all cases with chromosomal anormalies 15 fetuses (46.9 percent) had one or more sonographic markers. Ultrasound markers were: increased nucal fold 40 percent , cystic hygroma (19.5 percent) , pyelectasis 12.5 percent, and echogenic bowel, absent nasal bone, echogenic intracardiac foci and club foot (7 percent) each one. A 53 percent of fetuses with trisomy 21 had some adnormal sonographic marker, as well as 67 percent of trisomy 18 and 100 percent of fetuses with X0, trisomy 22 and triploidy. The second trimester ultrasound plays an important role in prenatal diagnosis. The appropriate detection of structural anomalies and sonographic markers increase the diagnosis of aneuploidies and can suggest the necessity to practice an invasive study

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El tratamiento del ataque cerebrovascular isquémico (ACV) agudo cambió desde la publicación, en 1995, de los resultados del estudio NINDS (National Institute of Neurological Disorders and Stroke Trial) con activador tisular del plasminógeno. En este artículo se hace una revisión de la fisiopatología del ACV isquémico agudo, la generación del edema, la evaluación clínica, las pruebas diagnósticas, los estudios clínicos, y los criterios de inclusión y de exclusión para la trombólisis intravenosa al cabo de tres horas del inicio de los síntomas.

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