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OBJECTIVE: to analyze in-hospital maternal case fatality ratio in the postpartum period according to pregnancy risks and route of delivery, within the Brazilian National Health System, Brazil and macro-regions, 2010-2019. METHODS: this was an ecological time-series study, using data from the Hospital Information System; in-hospital maternal case fatality ratio in the postpartum period took into consideration maternal hospitalizations with outcome 'death' over the total number of hospitalizations per year, according to pregnancy risks and route of delivery, in the regions. RESULTS: there were 19,158,167 hospitalizations for childbirth and 5,110 deaths in the period analyzed; maternal case fatality ratio increased from 1.1 (2010) to 1.9 death/10,000 hospitalizations (2019), in usual-risk pregnancies after vaginal deliveries, and decreased from 10.5 (2010) to 7.0 deaths/10,000 hospitalizations (2019) in high-risk pregnancies after cesarean sections; the Midwest region presented the highest and the South region the lowest case fatality ratio for high-risk pregnancies. CONCLUSION: in-hospital case fatality ratio was higher for high-risk pregnancies, showing differences according to route of delivery and regions.

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Abstract Objective To assess the possible impact of the COVID-19 pandemic on maternal mortality among admissions for childbirth in 2020 in relation of the last 10 years. Methods An ecological study with pregnant women who underwent hospital births at the Brazilian unified public health service (SUS, in the Portuguese acronym) in Brazil from 2010 to 2020. The mortality among admissions for childbirth was obtained based on the number of admissions for childbirth with reported death as outcome divided by the total number of admissions. The underlying gestational risk and route of delivery were considered based on the national surveillance system. The average mortality for the period between 2010 and 2019 (baseline) was compared with the rate of deaths in 2020 (1st pandemic year); the rate ratio was interpreted as the risk of death in 2020 in relation to the average of the previous period (RR), with 95% confidence intervals (CIs). Results In 2020, the 1st year of the COVID-19 pandemic, 1,821,775 pregnant women were hospitalized for childbirth and 651 deaths were reported, which represents 8.7% of the total hospitalizations and 11.3% of maternal deaths between 2010 and 2020. There was an increase in maternal mortality after births in 2020 compared with the average for the period between 2010 and 2019, specially in low-risk pregnancies, both in vaginal (RR = 1.60; 95%CI:1.39-1.85) and cesarean births (RR = 1.18; 95%CI:1.04-1.34). Conclusion Maternal mortality among admissions for childbirth according to SUS data increased in 2020 compared with the average between 2010 and 2019, with an increment of 40% in low-risk pregnancies. The increase was of 18% after cesarean section and of 60% after vaginal delivery.

Resumo Objetivo Avaliar os possíveis impactos da pandemia de COVID-19 na mortalidade materna nas admissões para o parto em 2020 em relação ao histórico dos últimos 10 anos. Métodos Estudo ecológico com gestantes que realizaram parto hospitalar pelo Sistema Unificado de Saúde do Brasil (SUS) de 2010 a 2020. Para obter-se a taxa de mortalidade entre as admissões para o parto, foi utilizado o número de internações para parto que tiveram óbito como desfecho dividido pelo total de internações. O risco gestacional e o tipo de parto foram considerados a partir do sistema de vigilância nacional. A média de mortalidade no período de 2010 a 2019 (linha de base) foi comparada com a taxa de mortalidade pós-parto de 2020 (1° ano pandêmico); a razão das taxas foi interpretada como risco de óbito em 2020 em relação à média no período anterior (RR), com intervalo de confiança (IC) de 95%. Resultados Em 2020, 1° ano da pandemia de COVID-19, 1.821.775 gestantes foram internadas para o parto e 651 óbitos foram registrados, o que representa 8,7% do total de internações e 11,3% das mortes maternas entre 2010 e 2020. Houve aumento na mortalidade materna após partos em 2020 em relação à média do período entre 2010 e 2019, especialmente em gestações de baixo risco, tanto em partos normais (RR = 1.60; IC95%: 1.39-185) quanto em cesáreas (RR = 1.18; IC95%: 1.04-1.34). Conclusão A mortalidade entre as admissões para o parto pelo SUS aumentou em 2020 em relação à média de óbitos entre 2010 e 2019, com um incremento de 40% em mulheres de baixo risco gestacional. O aumento verificado foi de 18% após cesárea e de 60% após parto vaginal.

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OBJECTIVE: To assess the possible impact of the COVID-19 pandemic on maternal mortality among admissions for childbirth in 2020 in relation of the last 10 years. METHODS: An ecological study with pregnant women who underwent hospital births at the Brazilian unified public health service (SUS, in the Portuguese acronym) in Brazil from 2010 to 2020. The mortality among admissions for childbirth was obtained based on the number of admissions for childbirth with reported death as outcome divided by the total number of admissions. The underlying gestational risk and route of delivery were considered based on the national surveillance system. The average mortality for the period between 2010 and 2019 (baseline) was compared with the rate of deaths in 2020 (1st pandemic year); the rate ratio was interpreted as the risk of death in 2020 in relation to the average of the previous period (RR), with 95% confidence intervals (CIs). RESULTS: In 2020, the 1st year of the COVID-19 pandemic, 1,821,775 pregnant women were hospitalized for childbirth and 651 deaths were reported, which represents 8.7% of the total hospitalizations and 11.3% of maternal deaths between 2010 and 2020. There was an increase in maternal mortality after births in 2020 compared with the average for the period between 2010 and 2019, specially in low-risk pregnancies, both in vaginal (RR = 1.60; 95%CI:1.39-1.85) and cesarean births (RR = 1.18; 95%CI:1.04-1.34). CONCLUSION: Maternal mortality among admissions for childbirth according to SUS data increased in 2020 compared with the average between 2010 and 2019, with an increment of 40% in low-risk pregnancies. The increase was of 18% after cesarean section and of 60% after vaginal delivery.

OBJETIVO: Avaliar os possíveis impactos da pandemia de COVID-19 na mortalidade materna nas admissões para o parto em 2020 em relação ao histórico dos últimos 10 anos. MéTODOS: Estudo ecológico com gestantes que realizaram parto hospitalar pelo Sistema Unificado de Saúde do Brasil (SUS) de 2010 a 2020. Para obter-se a taxa de mortalidade entre as admissões para o parto, foi utilizado o número de internações para parto que tiveram óbito como desfecho dividido pelo total de internações. O risco gestacional e o tipo de parto foram considerados a partir do sistema de vigilância nacional. A média de mortalidade no período de 2010 a 2019 (linha de base) foi comparada com a taxa de mortalidade pós-parto de 2020 (1° ano pandêmico); a razão das taxas foi interpretada como risco de óbito em 2020 em relação à média no período anterior (RR), com intervalo de confiança (IC) de 95%. RESULTADOS: Em 2020, 1° ano da pandemia de COVID-19, 1.821.775 gestantes foram internadas para o parto e 651 óbitos foram registrados, o que representa 8,7% do total de internações e 11,3% das mortes maternas entre 2010 e 2020. Houve aumento na mortalidade materna após partos em 2020 em relação à média do período entre 2010 e 2019, especialmente em gestações de baixo risco, tanto em partos normais (RR = 1.60; IC95%: 1.39­185) quanto em cesáreas (RR = 1.18; IC95%: 1.04­1.34). CONCLUSãO: A mortalidade entre as admissões para o parto pelo SUS aumentou em 2020 em relação à média de óbitos entre 2010 e 2019, com um incremento de 40% em mulheres de baixo risco gestacional. O aumento verificado foi de 18% após cesárea e de 60% após parto vaginal.

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This study characterises maternal mortality in southern Brazil and verifies its trends between 2000 and 2018. It is an ecological time-series study, analysing secondary data from the Department of Informatics of the Unified Health System. The trend of the maternal mortality ratio (MMR) was calculated using generalised linear regression, and the ratios of the rates according to women's characteristics, with a confidence interval (CI) of 95%. The MMR in the South region went from 53.4 to 36.8 deaths per 100,000 live births from 2000 to 2018, a reduction trend of 1.2 percentage points per year. Mortality was directly related to increasing age (p < .001) and inversely related to schooling (p < .001) and predominated in non-white women (p < .001). The main cause of death was direct causes, including hypertensive disorders. Despite the reduction trend in maternal mortality in southern Brazil, the MMR observed is constantly above the recommended by the World Health Organisation.Impact StatementWhat is already known on this subject? The Maternal Mortality Ratio (MMR) is an indicator that allows an analysis of women's health in relation to the socio-economic and care characteristics of the region where they live. Between 2000 and 2015, Brazil had presented a high MMR, with around 50 deaths per 100,000 live births, while WHO considers a reasonably adequate MMR of fewer than 20 deaths per 100,000 live births.What do the results of this study add? This study updates data about MMR in the Southern Region of Brazil, the one which has the lowest rates in the country, but with variable values between the states. There was a reduction in MMR in southern Brazil between 2000 and 2018 but higher rates for women over 30 years old and in a situation of social vulnerability, as low-income and non-white women. Santa Catarina State presented stable values in the period and remained below the RMM averages of the other states during all years.What are the implications of these findings for clinical practice and/or further research? Comparing previous and current Maternal Mortality Rates in the regional context is important to adapt public health policies for the most affected population. Maternal death is still a reality for single and low-income women, who have greater difficulty in access to health care. Strategies in the Unified Health System are needed to tackle this problem.

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The microstructural characteristics of biodegradable Mg alloys determine their performance and appropriateness for orthopedic fixation applications. In this work, the effect of the annealing treatment of a Mg-0.7Zn-0.6Ca (ZX11) alloy on the mechanical integrity, corrosive behavior, and biocompatibility-osteoinduction was studied considering two annealing temperatures, 350 and 450 °C. The microstructure showed a recrystallized structure, with a lower number of precipitates, grain size, and stronger basal texture for the ZX11-350 condition than the ZX11-450. The characteristics mentioned above induce a higher long-term degradation rate for the ZX11-450 than the ZX11-350 on days 7th and 15th of immersion. In consequence, the mechanical integrity changes within this period. The increased degradation rate of the ZX11-450 condition reduces 40% the elongation at failure, in contrast with the 16% reduction for the ZX11-350 condition. After that period, the mechanical integrity remained unchanged. No cytotoxic effects were observed for both treatments and significant differentiation of mesenchymal stem cells into the osteoblast phenotype was observed.

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OBJECTIVE: To analyze the temporal trend of hospitalizations caused by abortion in Brazil between 2008-2018, according to region and federal units (FU). METHODS: Ecological study concerning hospitalizations due to abortion of women of childbearing age, from Hospital Information System data. The rates were calculated according the characteristics of women. The trend was assessed by Prais-Winsten generalized linear regression. RESULTS: The 2,258,104 hospitalizations due to abortion represent 5% of all hospitalizations in women of childbearing age. Hospitalizations for abortions in Brazil reduced 0.76 in the period; this trend occurred in 19 Brazilian FUs and all regions, except the South (stable). There was a significant reduction (p<0.001) in hospitalizations for spontaneous abortion and in admissions for abortion in women aged 20 to 39 years. CONCLUSION: A temporal trend of reduction in the hospitalizations due to abortion in Brazil was found, variating according to characteristics of the woman, FU and region of residence.

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Introducción. Las funciones del Comité de Ética Clínica (CEC) son educativas, normativas, consultivas, mediadoras y reflexivas. Como cualquier servicio de salud, las consultas de casos a un CEC deben ser sujetas a revisión y mejora de la calidad. Los objetivos fueron evaluar la factibilidad, la efectividad y la satisfacción de las recomendaciones ético-asistenciales dadas por el CEC, y evaluar su impacto en el equipo tratante y en la familia. Población y métodos. Estudio descriptivo, retrospectivo, cualicuantitativo, de casos clínicos presentados en el Comité de Ética Clínica del hospital desde el 1 de enero de 2013 hasta el 31 de diciembre de 2017, según datos del libro de actas, historias clínicas, registros de la Oficina de Comunicación a Distancia y entrevistas semiestructuradas al equipo de salud. Resultados. Se analizaron 108 casos (106 pacientes), 73 casos con encuesta y registros, y 35 solamente con registros. Los motivos principales más frecuentes de consulta fueron los siguientes: adecuación del esfuerzo terapéutico (46/42,6 %), compromiso neurológico grave (15/13,9 %), calidad de vida del paciente (11/10,2 %), conflictos entre el paciente, la familia y el sistema de salud (7/6,5 %), y rechazo del tratamiento por la familia (6/5,6 %). Se hallaron niveles altos de satisfacción (> 95 %) y niveles moderados de factibilidad (> 74 %) y efectividad (> 85 %). Solo en 50/108 casos (46,3 %) quedó registro en la historia clínica de la consulta al CEC y el 44 % de los profesionales opinó que la consulta tuvo un impacto positivo en la familia y en el paciente. Conclusiones. Los resultados contribuyeron a descubrir oportunidades de mejora, especialmente en la documentación y en la comunicación en el proceso de consulta.

Introduction. A clinical ethics committee (CEC) has educational, regulatory, advisory, mediation, and reflexive functions. As any health care service, the consults with the CEC should be subjected to review and quality improvement. The study objectives were to assess the feasibility, effectiveness, and satisfaction with the bioethical recommendations made by the CEC and assess their impact on the treating team and the patient's family. Population and methods. Descriptive, retrospective, qualitative, and quantitative study of clinical cases submitted to the hospital's CEC between January 1 st, 2013 and December 31, 2017 using data from the CEC minute book, medical records, registries from the Office for Remote Communication, and semi-structured interviews with health care team members. Results. A total of 108 cases (106 patients) were analyzed: 73 cases with survey and registries and 35 with registries only. The main most frequent reasons for consultation were adequacy of therapeutic effort (46/42.6%), severe neurological involvement (15/13.9%), patient's quality of life (11/10.2%), patient-family-health system conflict (7/6.5%), and family's refusal of treatment (6/5.6%). High levels of satisfaction (> 95%) and moderate levels of feasibility (> 74%) and effectiveness (> 85%) were observed. In only 50/108 cases (46.3%), the consultation with the CEC was registered in the medical record, 44% of health care providers stated that the consultation had a positive impact on the patient and their family. Conclusions. Results helped to establish improvement opportunities, especially in terms of documentation and communication in the consultation process.

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INTRODUCTION: A clinical ethics committee (CEC) has educational, regulatory, advisory, mediation, and reflexive functions. As any health care service, the consults with the CEC should be subjected to review and quality improvement. The study objectives were to assess the feasibility, effectiveness, and satisfaction with the bioethical recommendations made by the CEC and assess their impact on the treating team and the patient's family. POPULATION AND METHODS: Descriptive, retrospective, qualitative, and quantitative study of clinical cases submitted to the hospital's CEC between January 1st, 2013 and December 31st, 2017 using data from the CEC minute book, medical records, registries from the Office for Remote Communication, and semi-structured interviews with health care team members. RESULTS: A total of 108 cases (106 patients) were analyzed: 73 cases with survey and registries and 35 with registries only. The main most frequent reasons for consultation were adequacy of therapeutic effort (46/42.6%), severe neurological involvement (15/13.9%), patient's quality of life (11/10.2%), patient-family-health system conflict (7/6.5%), and family's refusal of treatment (6/5.6%). High levels of satisfaction (> 95%) and moderate levels of feasibility (> 74%) and effectiveness (> 85%) were observed. In only 50/108 cases (46.3%), the consultation with the CEC was registered in the medical record, 44% of health care providers stated that the consultation had a positive impact on the patient and their family. CONCLUSIONS: Results helped to establish improvement opportunities, especially in terms of documentation and communication in the consultation process.

Introducción. Las funciones del Comité de Ética Clínica (CEC) son educativas, normativas, consultivas, mediadoras y reflexivas. Como cualquier servicio de salud, las consultas de casos a un CEC deben ser sujetas a revisión y mejora de la calidad. Los objetivos fueron evaluar la factibilidad, la efectividad y la satisfacción de las recomendaciones ético-asistenciales dadas por el CEC, y evaluar su impacto en el equipo tratante y en la familia. Población y métodos. Estudio descriptivo, retrospectivo, cualicuantitativo, de casos clínicos presentados en el Comité de Ética Clínica del hospital desde el 1 de enero de 2013 hasta el 31 de diciembre de 2017, según datos del libro de actas, historias clínicas, registros de la Oficina de Comunicación a Distancia y entrevistas semiestructuradas al equipo de salud. Resultados. Se analizaron 108 casos (106 pacientes), 73 casos con encuesta y registros, y 35 solamente con registros. Los motivos principales más frecuentes de consulta fueron los siguientes: adecuación del esfuerzo terapéutico (46/42,6 %), compromiso neurológico grave (15/13,9 %), calidad de vida del paciente (11/10,2 %), conflictos entre el paciente, la familia y el sistema de salud (7/6,5 %), y rechazo del tratamiento por la familia (6/5,6 %). Se hallaron niveles altos de satisfacción (> 95 %) y niveles moderados de factibilidad (> 74 %) y efectividad (> 85 %). Solo en 50/108 casos (46,3 %) quedó registro en la historia clínica de la consulta al CEC y el 44 % de los profesionales opinó que la consulta tuvo un impacto positivo en la familia y en el paciente. Conclusiones. Los resultados contribuyeron a descubrir oportunidades de mejora, especialmente en la documentación y en la comunicación en el proceso de consulta.

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Objetivo: Analisar a tendência temporal das internações por aborto no Brasil, de 2008 a 2018, segundo região e Unidades da Federação (UFs). Métodos: Estudo ecológico, com dados de internações por aborto de mulheres em idade fértil registrados no Sistema de Informações Hospitalares/Sistema Único de Saúde (SIH/SUS). As taxas foram calculadas segundo características da mulher; e a tendência, avaliada por regressão linear generalizada de Prais-Winsten. Resultados: As 2.258.104 internações por aborto representaram 5% de todas as internações de mulheres em idade fértil. Houve redução significativa, de 0,76 pontos percentuais ao ano, no período. Essa tendência ocorreu em 19 UFs brasileiras e em todas as regiões, exceto a Sul (estável). Houve redução significativa (p-valor<0,001) nas internações por aborto espontâneo e nas internações de mulheres de 20 a 39 anos. Conclusão: Observou-se tendência de redução das internações por aborto no país, com variações segundo características da mulher, UF e região de residência.

Objetivo: Analizar la tendencia temporal de las hospitalizaciones por aborto en Brasil de 2008-2018, según región y unidad federativas (UF). Métodos: Estudio ecológico con datos sobre hospitalizaciones por aborto de mujeres en edad fértil del Sistema de Información Hospitalaria/ Sistema Único de Salud (SIH/SUS). Las tasas se calcularon según las características de la mujer y la tendencia se evaluó mediante regresión lineal generalizada de Prais-Winsten. Resultados: Las 2.258.104 hospitalizaciones por aborto representan el 5% de todas las hospitalizaciones en mujeres en edad fértil. Hubo una reducción significativa de 0,76 puntos porcentuales por año; esta tendencia ocurrió en 19 UFs brasileñas y en todas las regiones, excepto en el Sur (estable). Hubo una reducción significativa (p<0,001) en las hospitalizaciones por aborto espontáneo y en mujeres de 20 a 39 años. Conclusión: El estudio mostró una tendencia a reducir las hospitalizaciones por aborto en Brasil, con variaciones según características de la mujer, UF y región de residencia.

Objective: To analyze the temporal trend of hospitalizations caused by abortion in Brazil between 2008-2018, according to region and federal units (FU). Methods: Ecological study concerning hospitalizations due to abortion of women of childbearing age, from Hospital Information System data. The rates were calculated according the characteristics of women. The trend was assessed by Prais-Winsten generalized linear regression. Results: The 2,258,104 hospitalizations due to abortion represent 5% of all hospitalizations in women of childbearing age. Hospitalizations for abortions in Brazil reduced 0.76 in the period; this trend occurred in 19 Brazilian FUs and all regions, except the South (stable). There was a significant reduction (p<0.001) in hospitalizations for spontaneous abortion and in admissions for abortion in women aged 20 to 39 years. Conclusion: A temporal trend of reduction in the hospitalizations due to abortion in Brazil was found, variating according to characteristics of the woman, FU and region of residence.

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Objetivo: analisar a letalidade materna hospitalar pós-parto segundo risco gestacional e via de parto, no Sistema Único de Saúde, Brasil e macrorregiões, 2010-2019. Métodos: estudo ecológico de série temporal, com dados do Sistema de Informações Hospitalares; a letalidade materna hospitalar pós-parto considerou internações maternas com desfecho "óbito" sobre o total de internações/ano, segundo risco gestacional e via de parto, nas regiões. Resultados: houve 19.158.167 internações para parto e 5.110 óbitos no período analisado; a letalidade materna subiu de 1,1 (2010) para 1,9 óbito/10 mil internações (2019), em gestações de risco habitual após partos vaginais, e reduziu-se de 10,5 (2010) para 7,0 óbitos/10 mil internações (2019) em gestações de alto risco após cesarianas; o Centro-Oeste expressou a maior e o Sul a menor letalidade para gestações de alto risco. Conclusão: a letalidade hospitalar foi maior em gestações de alto risco, com diferenças segundo via de parto e regiões.

Objetivo: analizar la letalidad materna hospitalaria posparto según riesgo gestacional y modalidad de parto por el Sistema Único de Salud en Brasil y regiones entre 2010-2019. Métodos: estudio de serie temporal ecológico con datos del Sistema de Información Hospitalario; la letalidad materna hospitalaria posparto consideró las hospitalizaciones maternas con resultado de óbito, por el total de hospitalizaciones por año. Resultados: hubo 19.158.167 admisiones por parto y 5.110 óbitos en el período; la letalidad materna aumentó de 1,10 (2010) a 1,9 muerte/10.000 (2019) en embarazos de riesgo habitual posparto vaginal y disminuyó de 10,5 a 7,0 muertes/10.000 en embarazos de alto riesgo después de cesáreas; el Centro-Oeste expresó la letalidad más alta y el Sur la más baja para embarazos de alto riesgo. Conclusión: la letalidad hospitalaria fue mayor en los embarazos de alto riesgo, con diferencias según el modo de parto y las regiones de Brasil.

Objective: to analyze in-hospital maternal case fatality ratio in the postpartum period according to pregnancy risks and route of delivery, within the Brazilian National Health System, Brazil and macro-regions, 2010-2019. Methods: this was an ecological time-series study, using data from the Hospital Information System; in-hospital maternal case fatality ratio in the postpartum period took into consideration maternal hospitalizations with outcome 'death' over the total number of hospitalizations per year, according to pregnancy risks and route of delivery, in the regions. Results: there were 19,158,167 hospitalizations for childbirth and 5,110 deaths in the period analyzed; maternal case fatality ratio increased from 1.1 (2010) to 1.9 death/10,000 hospitalizations (2019), in usual-risk pregnancies after vaginal deliveries, and decreased from 10.5 (2010) to 7.0 deaths/10,000 hospitalizations (2019) in high-risk pregnancies after cesarean sections; the Midwest region presented the highest and the South region the lowest case fatality ratio for high-risk pregnancies. Conclusion: in-hospital case fatality ratio was higher for high-risk pregnancies, showing differences according to route of delivery and regions.

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