Multiple pregnancy: epidemiology and association with maternal and perinatal morbidity

sem informaçãoTwin pregnancy accounts for 2 to 4% of total births, with a prevalence ranging from 0.9 to 2.4% in Brazil. It is associated with worse maternal and perinatal outcomes. Many conditions, such as severe maternal morbidity (SMM) (potentially life-threatening409554562sem informaçãosem informaçãosem informaçã

Approaching literature review for academic purposes: the literature review checklist

A sophisticated literature review (LR) can result in a robust dissertation/thesis by scrutinizing the main problem examined by the academic study; anticipating research hypotheses, methods and results; and maintaining the interest of the audience in how the dissertation/thesis will provide solutions for the current gaps in a particular field. Unfortunately, little guidance is available on elaborating LRs, and writing an LR chapter is not a linear process. An LR translates students' abilities in information literacy, the language domain, and critical writing. Students in postgraduate programs should be systematically trained in these skills. Therefore, this paper discusses the purposes of LRs in dissertations and theses. Second, the paper considers five steps for developing a review: defining the main topic, searching the literature, analyzing the results, writing the review and reflecting on the writing. Ultimately, this study proposes a twelve-item LR checklist. By clearly stating the desired achievements, this checklist allows Masters and Ph.D. students to continuously assess their own progress in elaborating an LR. Institutions aiming to strengthen students' necessary skills in critical academic writing should also use this tool7

Maternal health in Brazil: priorities and challenges

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Developing strategies to be added to the protocol for antenatal care: an exercise and birth preparation program

To describe the implementation process of a birth preparation program, the activities in the protocol for physical and birth preparation exercises, and the educational activities that have been evaluated regarding effectiveness and women's satisfaction. The birth preparation program described was developed with the following objectives: to prevent lumbopelvic pain, urinary incontinence and anxiety; to encourage the practice of physical activity during pregnancy and of positions and exercises for non-pharmacological pain relief during labor; and to discuss information that would help women to have autonomy during labor. The program comprised the following activities: supervised physical exercise, relaxation exercises, and educational activities (explanations of lumbopelvic pain prevention, pelvic floor function, labor and delivery, and which non-pharmacological pain relief to use during labor) provided regularly after prenatal consultations. These activities were held monthly, starting when the women joined the program at 18-24 weeks of pregnancy and continuing until 30 weeks of pregnancy, fortnightly thereafter from 31 to 36 weeks of pregnancy, and then weekly from the 37 th week until delivery. Information and printed materials regarding the physical exercises to be performed at home were provided. Clinicaltrials. gov: NCT01155804. The program was an innovative type of intervention that systematized birth preparation activities that were organized to encompass aspects related both to pregnancy and to labor and that included physical, educational and home-based activities. The detailed description of the protocol used may serve as a basis for further studies and also for the implementation of birth preparation programs within the healthcare system in different settings704231236COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPsem informação08/10392-

Developing strategies to be added to the protocol for antenatal care: An exercise and birth preparation program

OBJECTIVES: To describe the implementation process of a birth preparation program, the activities in the protocol for physical and birth preparation exercises, and the educational activities that have been evaluated regarding effectiveness and women's satisfaction. The birth preparation program described was developed with the following objectives: to prevent lumbopelvic pain, urinary incontinence and anxiety; to encourage the practice of physical activity during pregnancy and of positions and exercises for non-pharmacological pain relief during labor; and to discuss information that would help women to have autonomy during labor. METHODS: The program comprised the following activities: supervised physical exercise, relaxation exercises, and educational activities (explanations of lumbopelvic pain prevention, pelvic floor function, labor and delivery, and which non-pharmacological pain relief to use during labor) provided regularly after prenatal consultations. These activities were held monthly, starting when the women joined the program at 18–24 weeks of pregnancy and continuing until 30 weeks of pregnancy, fortnightly thereafter from 31 to 36 weeks of pregnancy, and then weekly from the 37th week until delivery. Information and printed materials regarding the physical exercises to be performed at home were provided. Clinicaltrials.gov: NCT01155804. RESULTS: The program was an innovative type of intervention that systematized birth preparation activities that were organized to encompass aspects related both to pregnancy and to labor and that included physical, educational and home-based activities. CONCLUSIONS: The detailed description of the protocol used may serve as a basis for further studies and also for the implementation of birth preparation programs within the healthcare system in different settings

Brazilian Doctor's Perspective On The Second Opinion Strategy Before A C-section

Objective: To describe the opinion of doctors who participated in the Latin American Study on Cesarean section in Brazil regarding the second opinion strategy when faced with the decision of performing a C-section. Methods: Seventy-two doctors from the hospitals where the study took place (where the second opinion was routinely sought) and 70 from the control group answered a pre-tested self-administered structured questionnaire. Descriptive tables were prepared based on the frequency of relevant variables on opinion of physicians regarding: effectiveness of the application of the second opinion strategy; on whether they would recommend implementation of this strategy and reasons for not recommending it in private institutions; feasibility of the strategy implementation and reasons for not considering this implementation feasible in private institutions. Results: Half of the doctors from the intervention hospitals (50%) and about two thirds of those in the control group (65%) evaluated the second opinion as being or having the potential of being effective/very effective in their institutions. The great majority of those interviewed from both intervention and control hospitals considered this strategy feasible in public (87% and 95% respectively) but not in private hospitals (64% and 70% respectively), mainly because in the latter the doctors would not accept interference from a colleague in their decision-making process. Conclusion: Although the second opinion strategy was perceived as effective in reducing C-section rates, doctors did not regard it feasible outside the public health system in Brazil. © 2006 Faculdade de Saúde Pública da Universidade de Sao Paulo.402233239Althabe, F., Belizan, J.M., Villar, J., Alexander, S., Bergel, E., Ramos, S., Mandatory second opinion to reduce rates of unnecessary caesarean sections in Latin America: A cluster randomised controlled trial (2004) Lancet, 363 (9425), pp. 1934-1940Belizan, J., Althabe, F., Barros, F.C., Alexander, S., Rates and implications of caesarean sections in Latin America: Ecological study (1999) BMJ, 319 (7222), pp. 1397-1402Chacham, A.S., Perpétuo, I.H.O., The incidence of caesarean deliveries in Belo Horizonte, Brazil: Social and economic determinants (1998) Reprod Health Matters, 6 (11), pp. 115-121Faúndes, A., Perpétuo, I.H.O., Cesárea por conveniência e a ética médica (2002) Ser Médico, 5 (19), pp. 32-34Faúndes, A., Pádua, K.S., Osis, M.J.D., Cecatti, J.G., Sousa, M.H., Opiniāo de mulheres e médicos brasileiros sobre a preferência pela via de parto (2004) Rev Saúde Pública, 38 (4), pp. 488-494Hopkins, K., Are brazilian women really choosing to deliver by cesarean? (2000) Soc Sci Med, 51 (5), pp. 725-740Mello e Souza, C., C-sections as ideal births: The cultural constructions of beneficence and patients' rights in Brazil (1994) Camb Q Healthc Ethics, 3 (3), pp. 358-366Moraes, M.S., Goldenberg, P., Cesáreas: Um perfil epidêmico (2001) Cad Saúde Pública, 17 (3), pp. 509-519Murray, S., Relation between private health insurance and high rates of caesarean section in Chile: Qualitative and quantitative study (2000) BMJ, 321 (7275), pp. 1501-1505Myers, S.A., Gleicher, N., A successful program to lower cesarean-section rates (1988) N Engl J Med, 319 (23), pp. 1511-1516(1998), 1. , Organización Panamericana de la Salud - OPAS. La salud en las Americas. Washington (DC)Osis, M.J.D., Pádua, K.S., Duarte, G.A., Souza, T.R., Faúndes, A., The opinion of brazilian women regarding vaginal labor and cesarean section (2001) Int J Gynaecol Obstet, 75 (SUPPL. 1), pp. S59-S66Penna, L., Arulkumaran, S., Cesarean section for non-medical reasons (2003) Int J Gynaecol Obstet, 82 (3), pp. 399-409Potter, J.E., Berquó, E., Perpétuo, I.H.O., Leal, O.F., Hopkins, K., Souza, M.R., Unwanted caesarean sections among public and private patients in Brazil: Prospective study (2001) BMJ, 323 (7322), pp. 1155-1158Rattner, D., Sobre a hipótese de estabilizaçāo das taxas de cesárea do estado de São Paulo, Brasil (1996) Rev Saúde Pública, 30 (1), pp. 19-33Schenker, J.G., Cain, J.M., FIGO committee report: FIGO committee for the ethical aspects of human reproduction and women's health (1999) Int J Gynaecol Obstet, 64 (3), pp. 317-322Sloan, N.L., Pinto, E., Calle, A., Langer, A., Winikoff, B., Fassihian, G., Reduction of cesarean delivery rate in Ecuador (2000) Int J Gynaecol Obstet, 69 (3), pp. 229-236Walker, R., Turnbull, D., Wilkinson, C., Strategies to address global cesarean section rates: A review of the evidence (2002) Birth, 29 (1), pp. 28-39Wolfe, S., Unnecessary cesarean sections: Curing a national epidemic (1994) Public Citiz Health Res Group, 10, pp. 1-

Maternal mortality in Campinas: evolution, under-registration and avoidanc

CONTEXT: Up until a few years ago, maternal mortality did not merit much attention as a worldwide public health issue. The health and social development indicator almost exclusively used was infant death.OBJECTIVE: To study the number, characteristics, basic causes and avoidance of maternal mortality (MM) among women living in the city of Campinas, which occurred between 1985 and 1991, identified from all death certificates of women aged 10 through 49 years. DESIGN: Retrospective and descriptive population-based study. SETTING: University Referal Center.SAMPLES: All eligible death certificates classified as declared and presumed maternal deaths according to the Laurenti criteria for the cause of death were selected and complementary studies of the clinical records were performed. MAIN MEASURES: Day of the week and place of occurrence of death; period of occurrence; transfer from another hospital; number of days from delivery/abortion to death; blood transfusion; opportunity for transfusion; complications; autopsy; basic cause of death.RESULTS: Initially 39 declared maternal deaths were identified and a total of 62 were confirmed by the end of the study. This corresponds to an under-registration rate of 37.1% and to an MM ratio of 45.5 per 100,000 live births. Around three-fourths of these maternal deaths were due to a direct obstetrical cause and were considered avoidable.CONCLUSION: Maternal mortality still is high in the municipality of Campinas, although lower than the mean estimated for Brazil. The predominance of direct obstetric causes and avoidable deaths reinforces the need for public health interventions directed towards avoiding themOBJETIVOS: Estudar o número e as características das mortes maternas, suas causas e evitabilidade, entre mulheres residentes no município de Campinas no período de 1985 a 1991, identificadas entre todas as declarações de óbito de mulheres com idade entre 10 e 49 anos. TIPO DE ESTUDO: Estudo descritivo de base populacional, retrospectivo. MÉTODO: Selecionaram-se, dentre todas as D.O. elegíveis ao estudo, as classificadas quanto à causa básica do óbito como mortes maternas declaradas e presumíveis, segundo os critérios de Laurenti, que foram complementarmente estudadas através de seus prontuários clínicos. RESULTADOS: Identificaram-se 39 mortes maternas declaradas e um total de 62 confirmadas ao fim do estudo, correspondendo a uma subenumeração de 37,1% e a uma RMM de 45,5 por 100.000 NV. Cerca de três quartos dos óbitos maternos aconteceram por uma causa obstétrica direta e foram considerados evitáveis. CONCLUSÃO:A mortalidade materna ainda é elevada no município de Campinas, embora bem menor que a média estimada para o Brasil. O predomínio de causas obstétricas diretas e de óbitos evitáveis reforça a necessidade de medidas de saúde pública para evitá-los.51

Water Aerobics In Pregnancy: Cardiovascular Response, Labor And Neonatal Outcomes

Background. To evaluate the association between water aerobics, maternal cardiovascular capacity during pregnancy, labor and neonatal outcomes. Methods. A randomized, controlled clinical trial was carried out in which 34 pregnant women were allocated to a water aerobics group and 37 to a control group. All women were submitted to submaximal ergometric tests on a treadmill at 19, 25 and 35 weeks of pregnancy and were followed up until delivery. Oxygen consumption (VO 2 max), cardiac output (CO), physical fitness, skin temperature, data on labor and delivery, and neonate outcomes were evaluated. Frequency distributions of the baseline variables of both groups were initially performed and then analysis of the outcomes was carried out. Categorical data were compared using the chi-square test, and numerical using Student's t or Mann-Whitney tests. Wilk's Lambda or Friedman's analysis of repeat measurements were applied for comparison of physical capacity, cardiovascular outcomes and maternal temperature. Results. VO 2 max and physical fitness were higher in both groups in the second trimester, returning to basal levels in the third trimester. In both groups, CO increased as pregnancy progressed and peak exercise temperature was higher than resting temperature, increasing further after five minutes of recovery and remaining at this level until 15 minutes after exercise completion. There was no difference between the two groups regarding duration (457.9 ± SD 249.6 vs 428.9 ± SD 203.2 minutes) or type of delivery. Labor analgesia was requested by significantly fewer women in the water aerobics group (27% vs 65%; RR = 0.42 95%CI 0.23-0.77). Neonatal results were similar in both groups. Conclusion. The regular practice of moderate water aerobics by sedentary and low risk pregnant women was not detrimental to the health of the mother or the child. There was no influence on maternal cardiovascular capacity, duration of labor or type of delivery; however, there were fewer requests for analgesia during labor in the water aerobics group. © 2008 Baciuk et al; licensee BioMed Central Ltd.51Artal, R., O'Toole, M., Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period (2003) Br J Sports Med, 37, pp. 6-12. , 12547738. 10.1136/bjsm.37.1.6Davies, G.A.L., Wolfe, L.A., Mottola, M.F., MacKinnon, C., Joint SOGC/CSEP Clinical Practice Guideline: Exercise in Pregnancy and the Postpartum Period (2003) Can J Appl Physiol, 28 (3), pp. 330-341. , 12955862Katz, V.L., Exercise in water during pregnancy (2003) Clin Obstet Gynecol, 469 (2), pp. 432-441. , 10.1097/00003081-200306000-00022College Of Obstetricians, A., Gynecologists, ACOG Committee Opinion. Exercise during pregnancy and the postpartum period. Number 267, January 2002 (2002) Int J Gynecol Obstet, 77, pp. 79-81. , 10.1016/S0020-7292(02)80004-2Kramer, M.S., McDonald, S.W., Aerobic exercise for women during pregnancy (2006) Cochrane Database Syst Rev, 3, p. 000180. , 16855953Prevedel, T.T.S., Calderon, I.M.P., Deconti, M.H., Consonni, E.B., Rudge, M.V.C., [Maternal and perinatal outcomes from hydrotherapy during pregnancy] (2003) Rev Bras Ginecol Obstet, 25 (1), pp. 53-59. , 10.1590/S0100-72032003000100008Sibley, L., Ruhling, R.O., Cameron-Foster, J., Christensen, C., Bolen, T., Swimming and physical fitness during pregnancy (1981) J Nurse Midwif, 26, pp. 3-12. , 10.1016/0091-2182(81)90169-5Barakat, R., Stirling, J.R., Lucia, A., Does exercise training during pregnancy affect gestational age? a randomized controlled trial (2008) Br J Sports Med, 42, pp. 674-678. , 10.1136/bjsm.2008.047837. 18552370Bruce, R.A., Methods of exercise testing: Step test, bicycle, treadmill, isometrics (1977) Exercise in Cardiovascular Health and Disease, pp. 149-160. , New York, NY: York Medical Books Amsterdam EA, Wilmore JH, DeMaria ANBristol, D.R., Sample sizes for constructing confidence intervals and testing hypotheses (1989) Stat Med, 8, pp. 803-811. , 10.1002/sim.4780080705. 2772440Friendly, M., (1995) From SAS System for Statistical Graphics, , Copyright (c) by SAS Institute Inc., Cary, NC, USA - version 1.2 FirstWolfe, L.A., Heenan, A.P., Bonen, A., Aerobic conditioning effects on substrate responses during graded cycling in pregnancy (2003) Can J Physiol Pharmacol, 81, pp. 696-703. , 10.1139/y03-059. 12897817Santos, I.A., Stein, R., Fuchs, S.C., Duncan, B.B., Ribeiro, J.P., Kroeff, L.R., Carballo, M.T., Schmidt, M.I., Aerobic exercise and submaximal functional capacity in overweight pregnant women: A randomized trial (2005) Obstet Gynecol, 106 (2), pp. 243-249. , 16055571Avery, N.D., Wolfe, L.A., Amara, C.E., Davies, G.A., McGrath, M.J., Effects of human pregnancy on cardiac autonomic function above and below the ventilatory threshold (2001) J Appl Physiol, 90, pp. 321-328. , 11133925Wolfe, L.A., Davies, G.A., Canadian Guidelines for exercise in pregnancy (2003) Clin Obstet Gynecol, 46 (2), pp. 488-495. , 10.1097/00003081-200306000-00027. 12808398Hermida, R.C., Ayala, D.E., Mojón, A., Fernandez, J.R., Alonso, I., Silva, I., Ucieda, R., Iglesias, M., Blood pressure patterns in normal pregnancy, gestational hypertension, and preeclampsia (2000) Hypertension, 36, pp. 149-158. , 10948070Lotgering, F.K., Van Doorn, M.B., Struijk, P.C., Pool, J., Wallenburg, H.C., Maximal aerobic exercise in pregnant women: Heart rate, O2 consumption, CO2 production, and ventilation (1991) J Appl Physiol, 70 (3), pp. 1016-1023. , 1903379O'Toole, M., Physiologic aspects of exercise in pregnancy (2003) Clin Obstet Gynecol, 46 (2), pp. 379-389. , 10.1097/00003081-200306000-00017. 12808388Veille, J.C., Hellerstein, H.K., Cherry, B., Bacevice Jr., A.E., Maternal left ventricular performance during bicycle exercise (1994) Am J Cardiol, 73, pp. 609-610. , 10.1016/0002-9149(94)90345-X. 8147311Rowell, L.B., Human cardiovascular adjustments to exercise and thermal stress (1974) Physiol Rev, 54 (1), pp. 75-159. , 4587247Van Doorn, M.B., Lotgering, F.K., Struijk, P.C., Pool, J., Wallenburg, H.C., Maternal and fetal cardiovascular responses to strenuous bicycle exercise (1992) Am J Obstet Gynecol, 166 (3), pp. 854-859. , 1550154Veille, J.C., Hohimer, A.R., Burry, R.N., Speroff, L., The effect of exercise on uterine activity in the last eight weeks of pregnancy (1985) Am J Obstet Gynecol, 151 (6), pp. 727-730. , 3976780Carpenter, M.W., Sady, S.P., Hoegsberg, B., Sady, M.A., Haydon, B., Cullinane, E.M., Coustan, D.R., Thompson, P.D., Fetal heart rate response to maternal exertion (1988) JAMA, 259 (20), pp. 3006-3009. , 10.1001/jama.259.20.3006. 3285041Soultanakis-Aligianni, H.N., Thermoregulation during exercise in pregnancy (2003) Clin Obstet Gynecol, 46 (2), pp. 442-455. , 10.1097/00003081-200306000-00023. 12808394Larsson, L., Lindqvist, P.G., Low-impact exercise during pregnancy - A study of safety (2005) Acta Obstet Gynecol Scand, 84, pp. 34-38. , 10.1111/j.0001-6349.2005.00696.x. 15603564Lindqvist, P.G., Marsal, K., Merlo, J., Pirhonen, J.P., Thermal response to submaximal exercise before, during and after pregnancy: A longitudinal study (2003) J Matern Fetal Neonatal Med, 13 (3), pp. 152-6. , 10.1080/713605828. 12820836Duncombe, D., Wertheim, E.H., Skouteris, H., Paxton, S.J., Kelly, L., Factors related to exercise over the course of pregnancy including women's beliefs about the safety of exercise during pregnancy Midwifery, , 18063253Clapp III, J.F., The course of labor after endurance exercise during pregnancy (1990) Am J Obstet Gynecol, 163 (6), pp. 1799-1804. , 2256485Ver Dye, T., Fernandez, I.D., Rains, A., Fershteyn, Z., Recent Studies in the epidemiologic assessment of physical activity, fetal growth, and preterm delivery: A narrative review (2003) Clin Obstet Gynecol, 46 (2), pp. 415-422. , 10.1097/00003081-200306000-00020. 12808391Bell, R.J., Palma, S.M., Lumley, J.M., The effect of vigorous exercise during pregnancy on birth-weight (1995) Aust NZ J Obstet Gynaecol, 35 (1), pp. 46-51. , 10.1111/j.1479-828X.1995.tb01829.xMisra, D.P., Strobino, D.M., Stashinko, E.E., Nagey, D.A., Nanda, J., Effects of physical activity on preterm birth (1998) Am J Epidemiol, 147 (7), pp. 628-635. , 9554601Clapp III, J.F., Kim, H., Burciu, B., Lopez, B., Beginning regular exercise in early pregnancy: Effect on fetoplacental growth (2000) Am J Obstet Gynecol, 183 (6), pp. 1484-1488. , 10.1067/mob.2000.107096. 11120515Campbell, M.K., Mottola, M.F., Recreational exercise and occupational activity during pregnancy and birth weight: A case-control study (2001) Am J Obstet Gynecol, 184, pp. 404-408. , 10.1067/mob.2001.10939

Approaching literature review for academic purposes: The Literature Review Checklist

A sophisticated literature review (LR) can result in a robust dissertation/thesis by scrutinizing the main problem examined by the academic study; anticipating research hypotheses, methods and results; and maintaining the interest of the audience in how the dissertation/thesis will provide solutions for the current gaps in a particular field. Unfortunately, little guidance is available on elaborating LRs, and writing an LR chapter is not a linear process. An LR translates students’ abilities in information literacy, the language domain, and critical writing. Students in postgraduate programs should be systematically trained in these skills. Therefore, this paper discusses the purposes of LRs in dissertations and theses. Second, the paper considers five steps for developing a review: defining the main topic, searching the literature, analyzing the results, writing the review and reflecting on the writing. Ultimately, this study proposes a twelve-item LR checklist. By clearly stating the desired achievements, this checklist allows Masters and Ph.D. students to continuously assess their own progress in elaborating an LR. Institutions aiming to strengthen students’ necessary skills in critical academic writing should also use this tool

Curva de altura uterina por idade gestacional e diagnóstico de desvios do crescimento fetal

OBJECTIVE: To validate a new symphysis-fundal curve for screening fetal growth deviations and to compare its performance with the standard curve adopted by the Brazilian Ministry of Health. METHODS: Observational study including a total of 753 low-risk pregnant women with gestational age above 27 weeks between March to October 2006 in the city of João Pessoa, Northeastern Brazil. Symphisys-fundal was measured using a standard technique recommended by the Brazilian Ministry of Health. Estimated fetal weight assessed through ultrasound using the Brazilian fetal weight chart for gestational age was the gold standard. A subsample of 122 women with neonatal weight measurements was taken up to seven days after estimated fetal weight measurements and symphisys-fundal classification was compared with Lubchenco growth reference curve as gold standard. Sensitivity, specificity, positive and negative predictive values were calculated. The McNemar χ2 test was used for comparing sensitivity of both symphisys-fundal curves studied. RESULTS: The sensitivity of the new curve for detecting small for gestational age fetuses was 51.6% while that of the Brazilian Ministry of Health reference curve was significantly lower (12.5%). In the subsample using neonatal weight as gold standard, the sensitivity of the new reference curve was 85.7% while that of the Brazilian Ministry of Health was 42.9% for detecting small for gestational age. CONCLUSIONS: The diagnostic performance of the new curve for detecting small for gestational age fetuses was significantly higher than that of the Brazilian Ministry of Health reference curve.OBJETIVO: Validar la curva de referencia de altura uterina por edad de gestación para el rastreo de desvíos del crecimiento fetal y comparar su performance con la curva estándar adoptada por el Ministerio de la Salud de Brasil. MÉTODOS: Estudio observacional que envolvió 753 gestantes de bajo riesgo de Joao Pessoa, Noreste de Brasil, entre marzo y octubre de 2006, con edad de gestación por encima de 27 semanas. La altura uterina fue medida de acuerdo con técnica recomendada por el Ministerio de la Salud. El patrón-oro fue el peso fetal, estimado por el ultrasonido con base en la curva de referencia brasilera por edad de gestación. Una sub-muestra de 122 casos con pesos neonatales obtenidos hasta siete días después de la estimación del peso fetal, la clasificación de la altura uterina fue comparada con la curva de Lubchenco como estándar-oro. La sensibilidad, la especificidad y los valores predictivos positivo y negativo fueron calculados. Para comparar el desempeño de la sensibilidad entre ambas curvas de altura uterina, se utilizó la prueba chi-cuadrado de McNemar. RESULTADOS: La sensibilidad de la nueva curva para la detección de fetos pequeños para la edad de gestación fue de 51,6%, mientras que la curva del patrón-oro fue significativamente menor (12,5%). En la sub-muestra que tuvo el peso neonatal como estándar-oro, la sensibilidad de la nueva curva de referencia fue de 87,7%, mientras que la del Ministerio de la Salud exhibió 42,9% de sensibilidad para la detección de fetos pequeños para la edad de gestación. CONCLUSIONES: La capacidad diagnóstica de la nueva curva de referencia para detectar fetos pequeños para la edad de gestación fue significativamente mejor que la curva recomendada por el Ministerio de la Salud.OBJETIVO: Validar curva de referência de altura uterina por idade gestacional para o rastreamento de desvios do crescimento fetal e comparar sua performance com a curva-padrão adotada pelo Ministério da Saúde do Brasil. MÉTODOS: Estudo observacional que envolveu 753 gestantes de baixo risco de João Pessoa, PB, entre março e outubro de 2006, com idade gestacional acima de 27 semanas. A altura uterina foi medida de acordo com técnica preconizada pelo Ministério da Saúde. O padrão-ouro foi o peso fetal, estimado pelo ultrassom com base na curva de referência brasileira por idade gestacional. Uma subamostra de 122 casos com pesos neonatais obtidos até sete dias depois da estimativa do peso fetal, a classificação da altura uterina foi comparada com a curva de Lubchenco como padrão-ouro. A sensibilidade, a especificidade e os valores preditivos positivo e negativo foram calculados. Para comparar o desempenho da sensibilidade entre ambas as curvas de altura uterina, utilizou-se o teste χ2 de McNemar. RESULTADOS: A sensibilidade da nova curva para a detecção de fetos pequenos para a idade gestacional foi de 51,6%, enquanto a da curva do padrão-ouro foi significativamente menor (12,5%). Na subamostra que teve o peso neonatal como padrão-ouro, a sensibilidade da nova curva de referência foi de 85,7%, enquanto a do Ministério da Saúde exibiu 42,9% de sensibilidade para a detecção de fetos pequenos para a idade gestacional. CONCLUSÕES: A capacidade diagnóstica da nova curva de referência para detectar fetos pequenos para a idade gestacional foi significativamente melhor do que a da curva recomendada pelo Ministério da Saúde