Placental morphology findings in SARS-CoV-2 infection are considered nonspecific, although the role of trimester and severity of infection are underreported. Therefore, we aimed to investigate ...abnormal placental morphology, according to these two criteria.
This is an ancillary analysis of a prospective cohort study of pregnant women with suspected SARS-CoV-2 infection, managed in one maternity, from March 2020 to October 2021. Charting of clinical/obstetric history, trimester and severity of COVID-19 infection, and maternal/perinatal outcomes were done. Placental morphological findings were classified into maternal and fetal circulatory injury and acute/chronic inflammation. We further compared findings with women with suspected disease which tested negative for COVID-19. Diseases’ trimester of infection and clinical severity guided the analysis of confirmed COVID-19 cases.
Ninety-one placental discs from 85 women were eligible as a COVID-19 group, and 42 discs from 41 women in negative COVID-19 group. SARS-CoV-2 infection occurred in 68.2% during third trimester, and 6.6% during first; 16.5% were asymptomatic, 61.5% non-severe and 22.0% severe symptomatic (two maternal deaths). Preterm birth occurred in 33.0% (one fetal death). Global maternal vascular malperfusion (MVM) were significant in COVID-19 group whether compared with negative COVID-19 tests group; however, fetal vascular malperfusion lesions and low-grade chronic villitis were not. Three placentas had COVID-19 placentitis. Decidual arteriopathy was associated with infection in first/mid trimester, and chorangiosis in asymptomatic infections.
Placental abnormalities after an infection by COVID-19 were more frequent after first/mid-trimester infections. Extensive placental lesions are rare, although they may be more common upon underlying medical conditions.
•Placental morphological findings of SARS-CoV-2 infection are mostly considered nonspecific.•Placental abnormal morphological findings can occur post COVID-19 infection at any moment during pregnancy.•Placental abnormal morphological findings were more common in early infections, and extensive lesion is rare.•Extensive lesion may be more common in women with underlying medical conditions.
The objective of this study is to determine the incidence, socio-demographic and clinical risk factors for preeclampsia and associated maternal and perinatal adverse outcomes. This is a nested ...case-control derived from the multicentre cohort study Preterm SAMBA, in five different centres in Brazil, with nulliparous healthy pregnant women. Clinical data were prospectively collected, and risk factors were assessed comparatively between PE cases and controls using risk ratio (RR) (95% CI) plus multivariate analysis. Complete data were available for 1,165 participants. The incidence of preeclampsia was 7.5%. Body mass index determined at the first medical visit and diastolic blood pressure over 75 mmHg at 20 weeks of gestation were independently associated with the occurrence of preeclampsia. Women with preeclampsia sustained a higher incidence of adverse maternal outcomes, including C-section (3.5 fold), preterm birth below 34 weeks of gestation (3.9 fold) and hospital stay longer than 5 days (5.8 fold) than controls. They also had worse perinatal outcomes, including lower birthweight (a mean 379 g lower), small for gestational age babies (RR 2.45 1.52-3.95), 5-minute Apgar score less than 7 (RR 2.11 1.03-4.29), NICU admission (RR 3.34 1.61-6.9) and Neonatal Near Miss (3.65 1.78-7.49). Weight gain rate per week, obesity and diastolic blood pressure equal to or higher than 75 mmHg at 20 weeks of gestation were shown to be associated with preeclampsia. Preeclampsia also led to a higher number of C-sections and prolonged hospital admission, in addition to worse neonatal outcomes.
Objective
To describe maternal and perinatal outcomes for women with chronic hypertension, comparing those with superimposed pre‐eclampsia (SPE) with those without pre‐eclampsia (NPE).
Methods
In a ...retrospective cohort study in a tertiary hospital in Brazil, the records of women with chronic hypertension were reviewed between January 1, 2012, and May 31, 2017, in order to compare maternal and perinatal outcomes among those with and without SPE. Poisson regression was performed to investigate factors independently associated with severe pre‐eclampsia.
Results
Of 385 women with chronic hypertension included in the study, 167 were in the SPE group and 218 in the NPE group. The majority were white, overweight (body mass index ≥30 kg/m2), with mean age around 31 years. Adverse neonatal outcomes were significantly more prevalent among women with SPE, including small for gestational age (SPE 17.46% vs NPE 9.63%, P=0.01), low birth weight (SPE 2577 g ± 938 vs NPE 3128 g ± 723, P=0.003), neonatal intensive care unit admission (SPE 44.91% vs NPE 18.34%, P=0.08), and incidence of cesarean delivery (SPE 79.64% vs NPE 62.38%, P=0.003). Fetal growth restriction (PR prevalence ratio 2.62, 95% confidence interval CI 1.39–4.94) and previous pre‐eclampsia (PR 1.96, 95% CI 1.17–3.28) were associated with severe pre‐eclampsia.
Conclusion
SPE is associated with prematurity and higher rates of admission to neonatal intensive care unit. Fetal growth restriction and previous pre‐eclampsia are factors associated with severe complications of pre‐eclampsia.
Superimposed pre‐eclampsia affects almost half of women with chronic hypertension, and fetal growth restriction and previous pre‐eclampsia are among the risk factors for severe pre‐eclampsia.
Objective
To validate the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) 12‐item tool against the 36‐item version for measuring functioning and disability associated with pregnancy and the ...occurrence of maternal morbidity.
Methods
This is a secondary analysis of the Brazilian retrospective cohort study on long‐term repercussions of severe maternal morbidity (SMM) among women who delivered at a tertiary facility (COMMAG study). We compared WHODAS‐12 and WHODAS‐36 scores of women with and without SMM using measures of central tendency and variability, tests for instruments’ agreement (Bland‐Altman plot), confirmatory factor analysis (CFA), and Cronbach alpha coefficient for internal consistency.
Results
The COMMAG study enrolled 638 women up to 5 years postpartum. Although the median WHODAS‐36 and ‐12 scores for all women were statistically different (13.04 and 11.76, respectively; P<0.001), there was a strong linear correlation between them. Furthermore, the mean difference and the differences in variance analyses demonstrated agreement of total scores between the two versions. CFA demonstrated how the WHODAS‐12 questions are divided into six previously defined factors and Cronbach alpha showed good internal consistency.
Conclusion
WHODAS‐12 demonstrated agreement with WHODAS‐36 for total score and was a good instrument for screening functioning and disability among postpartum women, with and without SMM.
WHODAS‐12 demonstrated agreement with WHODAS‐36 and was good for screening functioning and disability among women who experienced pregnancy with or without severe maternal morbidity.
Objective
To assess the impact of proteinuria on pregnancy outcomes among women with pre‐eclampsia.
Methods
The present retrospective cohort study included patients with pre‐eclampsia who delivered ...at a referral maternity hospital in Brazil between January 1, 2009, and December 31, 2013. Patients were stratified into three groups based on 24‐hour urinary protein excretion during pregnancy: mild (0.3–<2.0 g), severe (2.0–<5.0 g), and massive (≥5.0 g).
Results
There were 293 patients included in the study; 88, 129, and 76 had mild, severe, and massive proteinuria, respectively. Chronic hypertension was the most frequent pre‐existing condition among all women (86 29.4%). The mean pregnancy duration at the onset of maternal pre‐eclampsia was longest in the mild group compared and decreased with increasing proteinuria severity (P<0.001). Preterm delivery was recorded among 205 of 293 (70.0%) neonates; there were 66 (22.5%) neonates that were preterm and in the massive proteinuria group. The incidence of severe pre‐eclampsia was lowest in the mild proteinuria group (P=0.002) and tended to occur at 34 weeks. Cesarean delivery rates exceeded 80.0% in all groups. Most patients assessed at 40–60 days postpartum remained proteinuric (40/6166%).
Conclusions
Quantifying the severity of proteinuria could identify a subgroup of women with pre‐eclampsia at increased risk of adverse outcomes.
Proteinuria was not necessary to diagnose pre‐eclampsia; however, its presence identified women and neonates with an increased risk of adverse outcomes.
This article includes a Portuguese translation of the , available in the Supporting Information section.
Abstract
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.
Objective
To assess the scores of postpartum women using the WHO Disability Assessment Schedule 2.0 36‐item tool (WHODAS‐36), considering different morbidities.
Methods
Secondary analysis of a ...retrospective cohort of women who delivered at a referral maternity in Brazil and were classified with and without severe maternal morbidity (SMM). WHODAS‐36 was used to assess functioning in postpartum women. Percentile distribution of total WHODAS score was compared across three groups: Percentile (P)<10, 10<P<90, and P>90. Cases of SMM were categorized and WHODAS‐36 score was assessed according to hypertension, hemorrhage, or other conditions.
Results
A total of 638 women were enrolled: 64 had mean scores below P<10 (1.09) and 66 were above P>90 (41.3). Of women scoring above P>90, those with morbidity had a higher mean score than those without (44.6% vs 36.8%, P=0.879). Women with higher WHODAS‐36 scores presented more complications during pregnancy, especially hypertension (47.0% vs 37.5%, P=0.09). Mean scores among women with any complication were higher than those with no morbidity (19.0 vs 14.2, P=0.01). WHODAS‐36 scores were higher among women with hypertensive complications (19.9 vs 16.0, P=0.004), but lower among those with hemorrhagic complications (13.8 vs 17.7, P=0.09).
Conclusions
Complications during pregnancy, childbirth, and the puerperium increase long‐term WHODAS‐36 scores, demonstrating a persistent impact on functioning among women, up to 5 years postpartum.
Women who experienced severe maternal morbidity are at risk of disabilities in the postpartum period, as measured by the WHODAS 2.0 36‐item tool.
Prediction of preeclampsia is a challenge to overcome. The vast majority of prospective studies in large general obstetric populations have failed in the purpose of obtain a useful and effective ...model of prediction, sometimes based on complex tools unavaible in areas where the incidence of preeclampsia is the highest. The goal of this study was to assess mean arterial blood pressure (MAP) levels at 19-21, 27-29 and 37-39 weeks of gestation and performance of screening by MAP for the prediction of preeclampsia in a Brazilian cohort of healthy nulliparous pregnant women.
This was a cohort approach to a secondary analysis of the Preterm SAMBA study. Mean arterial blood pressure was evaluated at three different time periods during pregnancy. Groups with early-onset preeclampsia, late-onset preeclampsia and normotension were compared. Increments in mean arterial blood pressure between 20 and 27 weeks and 20 and 37 weeks of gestation were also calculated for the three groups studied. The accuracy of mean arterial blood pressure in the prediction of preeclampsia was determined by ROC curves.
Of the 1373 participants enrolled, complete data were available for 1165. The incidence of preeclampsia was 7.5%. Women with early-onset preeclampsia had higher mean arterial blood pressure levels at 20 weeks of gestation, compared to the normotensive group. Women with late-onset preeclampsia had higher mean arterial blood pressure levels at 37 weeks of gestation, than the normotensive groups and higher increases in this marker between 20 and 37 weeks of gestation. Based on ROC curves, the predictive performance of mean arterial blood pressure was higher at 37 weeks of gestation, with an area under the curve of 0.771.
As an isolated marker for the prediction of preeclampsia, the performance of mean arterial blood pressure was low in a healthy nulliparous pregnant women group. Considering that early-onset preeclampsia cases had higher mean arterial blood pressure levels at 20 weeks of gestation, future studies with larger cohorts that combine multiple markers are needed for the development of a preeclampsia prediction model.
Objectives
To compare scores on the 36‐item WHO Disability Assessment Schedule 2.0 tool (WHODAS‐36) for postpartum women across a continuum of morbidity and to validate the 12‐item version ...(WHODAS‐12).
Methods
This is a secondary analysis of the Brazilian retrospective cohort study on long‐term repercussions of severe maternal morbidity. We determined mean, median, and percentile values for WHODAS‐36 total score and for each domain, and percentile values for WHODAS‐12 total score in postpartum women divided into three groups: “no,” “nonsevere,” and “severe” morbidities.
Results
The WHODAS‐36 mean total scores were 11.58, 18.31, and 19.19, respectively for no, nonsevere, and severe morbidity. There was a dose‐dependent effect on scores for each domain of WHODAS‐36 according to the presence and severity of morbidity. The diagnostic validity of WHODAS‐12 was determined by comparing it with WHODAS‐36 as a “gold standard.” The best cut‐off point for diagnosing dysfunctionality was the 95th percentile.
Conclusion
The upward trend of WHODAS‐36 total mean value scores of women with no morbidity compared with those with morbidity along a severity continuum may reflect the impact of morbidity on postpartum functioning.
WHODAS total mean scores among postpartum women showed an upward trend in women with no morbidity compared with those with morbidity along a severity continuum.
Aim. To evaluate the use of analgesia for vaginal birth, in women with and without severe maternal morbidity (SMM) and to describe sociodemographic, clinical, and obstetric characteristics and ...maternal and perinatal outcomes associated with labor analgesia. Methods. Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHO-MCS), a global cross-sectional study performed between May 2010 and December 2011 in 29 countries. Women who delivered vaginally and had an SMM were included in this analysis and were then divided into two groups: those who received and those who did not receive analgesia for labor/delivery. We further compared maternal characteristics and maternal and perinatal outcomes between these two groups. Results. From 314,623 women originally included in WHO-MCS, 9,788 developed SMM and delivered vaginally, 601 (6.1%) with analgesia and 9,187 (93.9%) without analgesia. Women with SMM were more likely to receive analgesia than those who did not experience SMM. Global distribution of SMM was similar; however, the use of analgesia was less prevalent in Africa. Higher maternal education, previous cesarean section, and nulliparity were factors associated with analgesia use. Analgesia was not an independent factor associated with an increase of severe maternal outcome (Maternal Near Miss + Maternal Death). Conclusions. The overall use of analgesia for vaginal delivery is low but women with SMM are more likely to receive analgesia during labor. Social conditions are closely linked with the likelihood of having analgesia during delivery and such a procedure is not associated with increased adverse maternal outcomes. Expanding the availability of analgesia in different levels of care should be a concern worldwide.
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