Host and viral mechanisms of congenital Zika syndrome

In 2015-2016, in the Americas, and especially in northeast Brazil, a significant number of cases of microcephaly and other congenital brain abnormalities were linked with an outbreak of Zika virus (ZIKV) infection in pregnant women. While maternal symptoms of ZIKV are generally mild and self-limiting, clinical presentation in fetuses and newborns infected is extensive and includes microcephaly, decreased cortical development, atrophy and hypoplasia of the cerebellum and cerebellar vermis, arthrogryposis, and polyhydramnios. The term congenital ZIKV syndrome (CZS) was introduced to describe the range of findings associated with maternal-fetal ZIKV transmission. ZIKV is primarily transmitted b

Maternal near miss – understanding and applying the concept

A morte materna é o evento mais raro e dramático, de uma cadeia de acontecimentos que pode acometer qualquer mulher durante o ciclo gravídico-puerperal. Esta cadeia de eventos inicia-se quando uma mulher apresenta alguma das diversas condições potencialmente ameaçadoras da vida (CPAV). Quando não adequadamente tratada, ela pode evoluir para condições ameaçadoras da vida, em que há disfunção ou falência orgânica e que se definem a partir de critérios clínicos, laboratoriais ou de manejo. Mulheres que sobrevivem a tais eventos graves serão classificadas como near miss materno. O conceito de near miss materno permite avaliação da qualidade da assistência obstétrica, representando uma ferramenta a ser utilizada na prática obstétrica rotineira, ao identificar mulheres que estejam sob maior risco de evolução para quadros graves, permitindo a rápida implementação de medidas de tratamento e suporte. O objetivo do presente artigo é revisar a construção histórica do conceito de near miss, apresentar os atuais parâmetros validados para a sua utilização e propor seu uso de forma rotineira, na prática clínica e no currículo dos cursos médicos e de especialização em Obstetrícia.Maternal death is the most rare and dramatic event among a sequence of events that may affect any woman during pregnancy or up to 40 days post-partum. This sequence of events begins when a woman presents any of the potentially life-threatening conditions (PLTC). These conditions, when not properly treated, can evolve to life-threatening conditions when organ dysfunction of failure appear, which are defined using some clinical, laboratory, or management criteria. Women who survive such serious events will be classified as maternal near miss. The concept of maternal near miss allows the assessment of the quality of obstetric care, representing a tool to be used in the routine obstetric practice, for identifying women with higher risk of developing more severe conditions and allowing the rapid implementation of treatment and support measures. The objective of the current article is to review the historical construction of the concept of maternal near miss, to present the current validated parameters for use of this concept and to propose the routine use of maternal near miss in clinical practice and in the curriculum of medical schools and courses of specialization in Obstetrics

Placental sampling for understanding viral infections - A simplified protocol for the COVID-19 pandemic

OBJECTIVE:  The coronavirus disease 2019 (COVID-19) is a pandemic viral disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The impact of the disease among the obstetric population remains unclear, and the study of the placenta can provide valuable information. Adequate sampling of the placental tissue can help characterize the pathways of viral infections. METHODS:  A protocol of placental sampling is proposed, aiming at guaranteeing representativity of the placenta and describing the adequate conservation of samples and their integrity for future analysis. The protocol is presented in its complete and simplified versions, allowing its implementation in different complexity settings. RESULTS:  Sampling with the minimum possible interval from childbirth is the key for adequate sampling and storage. This protocol has already been implemented during the Zika virus outbreak. CONCLUSION:  A protocol for adequate sampling and storage of placental tissue is fundamental for adequate evaluation of viral infections on the placenta. During the COVID-19 pandemic, implementation of this protocol may help to elucidate critical aspects of the SARS-CoV-2 infection

Sexual and reproductive health (SRH) needs for forcibly displaced adolescent girls and young women (10–24 years old) in humanitarian settings: a mixed-methods systematic review

Abstract Background Globally, there are 42 million women and girls estimated to be forcibly displaced. Adolescent girls and young women in humanitarian settings have their sexual and reproductive health (SRH) neglected. This systematic review aimed to describe SRH obstacles that adolescent girls and young women (10–24 years old) face in humanitarian settings in line with the Sustainable Development Goals. Methods We conducted a mixed-methods systematic review in six databases, focusing on migrant women ages 10 – 24and their SRH outcomes. The mixed-methods appraisal tool was used to evaluate the quality of the studies. This review follows PRISMA and the Systematic Review Guidelines from the Centre for Reviews and Dissemination recommendations. Results Among the 1290 studies screened by abstracts, 32 met the eligibility criteria: 15 were qualitative, 10 were quantitative and seven were mixed-methods studies. Most studies were performed in the last four years, in African countries. They discussed the increased frequency of adolescent pregnancies (16–23%), lack of contraceptive use and access (8–32%), poor menstrual hygiene management (lack of water, shortage of menstrual hygiene supplies), ignorance and stigma about sexually transmitted infections and HIV, a higher number of child, early and forced marriage or partnership and sexual and gender-based violence, challenging to obtain SRH information/knowledge/access, and unmet SRH needs. Conclusion Migration is a current issue. Although there is a growing number of studies on adolescent girls and young women’s SRH in humanitarian settings, this population remains overlooked, and face several challenges in SRH. There is a need for targeting interventions on SRH

Preterm Preeclampsia and Timing of Delivery: A Systematic Literature Review

<div><p>Abstract Introduction Preeclampsia, a multifactorial disease with pathophysiology not yet fully understood, is a major cause of maternal and perinatal morbidity and mortality, especially when preterm. The diagnosis is performed when there is an association between arterial hypertension and proteinuria or evidence of severity. There are unanswered questions in the literature considering the timing of delivery once preterm preeclampsia has been diagnosed, given the risk of developingmaternal complications versus the risk of adverse perinatal outcomes associated with prematurity. The objective of this systematic review is to determine the best timing of delivery for women diagnosed with preeclampsia before 37 weeks of gestation. Methods Systematic literature review, performed in the PubMed database, using the terms preeclampsia, parturition and timing of delivery to look for studies conducted between 2014 and 2017. Studies that compared the maternal and perinatal outcomes of women who underwent immediate delivery or delayed delivery, in the absence of evidence of severe preeclampsia, were selected. Results A total of 629 studies were initially retrieved. After reading the titles, 78 were selected, and their abstracts, evaluated; 16 were then evaluated in full and, in the end, 6 studies (2 randomized clinical trials and 4 observational studies) met the inclusion criteria. The results were presented according to gestational age range (< 34 weeks and between 34 and 37 weeks) and by maternal and perinatal outcomes, according to the timing of delivery, considering immediate delivery or expectant management. Before 34 weeks, thematernal outcomeswere similar, but the perinatal outcomes were significantly worse when immediate delivery occurred. Between 34 and 37 weeks, the progression to severe maternal disease was slightly higher among women undergoing expectant management, however, with better perinatal outcomes. Conclusions When there is no evidence of severe preeclampsia or impaired fetal wellbeing, especially before 34 weeks, the pregnancy should be carefully surveilled, and the delivery, postponed, aiming at improving the perinatal outcomes. Between 34 and 37 weeks, the decision on the timing of delivery should be shared with the pregnant woman and her family, after providing information regarding the risks of adverse outcomes associated with preeclampsia and prematurity.</p></div

Additional file 1 of Sexual and reproductive health (SRH) needs for forcibly displaced adolescent girls and young women (10–24 years old) in humanitarian settings: a mixed-methods systematic review

Additional file 1. Search strategy

Microperforated hymen: a case of delayed diagnosis

Although the incidence of microperforated hymen (MH) is unclear, this hymenal subocclusive anomaly is considered a rare entity. Differently from imperforated hymen, MH may be asymptomatic until puberty when the women’s quality of life is jeopardized. Depending on the size of the microperforation, MH’s clinical features me be very similar to those found in imperforated hymen cases. However, MH may present infectious complications since the accumulated secretion retained in the vaginal canal has contact with the external environment and therefore represents a source of entry for infectious agents. The authors report a case of a 28-year-old woman who sought the gynecologist complaining of inability to have vaginal intercourse. She referred normal menses, but in fact, although regular, bleeding was filiform and was exteriorized only through the right side of the vagina. Physical examination and imaging disclosed a microperforation of the hymenal membrane at 10 o’clock position. Hymenotomy under general anesthesia was undertaken. Outcome was favorable and the patient could thenceforth have a normal life. We conclude that this anomaly may be overlooked, interfering on its incidence determination. The delayed onset of symptoms and psychological embarrassing aspects, which postpone gynecological consultation, may contribute for misdiagnoses. We call attention to a mandatory detailed anamnesis and thorough physical examination to diagnose this anomaly before the puberty, when complications are less frequent and treatment is advisable

Relationship between legacy and emerging organic pollutants in Antarctic seabirds and their foraging ecology as shown by δ13C and δ15N

Foraging ecology and the marine regions exploited by Antarctic seabirds outside of breeding strongly influence their exposure to persistent organic pollutants (POPs). However, relationships between them are largely unknown, an important knowledge gap given that many species are capital breeders and POPs may be deleterious to seabirds. This study investigates the relationship between Antarctic seabird foraging ecology (measured by δC and δN) and POPs accumulated in their eggs prior to breeding. Organochlorinated pesticides, polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), and dechlorane plus (DP) were measured in eggs of chinstrap, Adélie, and gentoo penguins (Pygoscelis antarctica, P. adeliae, P. papua), as well as south polar skua (Catharacta maccormicki), sampled on King George Island. Total POP levels were as follows: skua (3210 ± 3330 ng/g lipid weight) > chinstrap (338 ± 128 ng/g) > Adélie (287 ± 43.3 ng/g) > gentoo (252 ± 49.4 ng/g). Trophic position and pre-breeding foraging sites were important in explaining POP accumulation patterns across species. The most recalcitrant compounds were preferentially accumulated in skuas, occupying one trophic level above penguins. In contrast, their Antarctic endemism, coupled with influence from cold condensation of pollutants, likely contributed to penguins exhibiting higher concentrations of more volatile compounds (e.g., hexachlorobenzene, PCB-28 and − 52) than skuas. Regional differences in penguin pre-breeding foraging areas did not significantly affect their POP burdens, whereas the trans-equatorial migration and foraging sites of skuas were strongly reflected in their pollutant profiles, especially for PBDEs and DPs. Overall, our results provide new insights on migratory birds as biovectors of POPs, including non-globally regulated compounds such as DP, from northern regions to Antarctica.This study is part of the project:“Estudos bioecológicos em Pingüins(Pygoscelis antarctica,P. papuaeP. adeliae) e skuas (CatharactamaccormickiieC. lonnbergii): determinação de micropoluentes e níveisde estresse através de métodos de amostragem não invasivos,”spon-sored by CNPq/MCT 557049/2009-1 and FAPERJ (E-26/111.505/2010).The authors are indebted to the Brazilian Navy, which provided logisti-cal support in Antarctica through the“Secretaria da Comissão Intermin-isterial para os Recursos do Mar”(SECIRM). Chemical and stableisotopes analysis were performed in partnership with researchersfrom the Department of Instrumental Analysis and EnvironmentalChemistry of the Institute of Organic Chemistry (IQOG-CSIC), Spain.CSIC and MAGRAMA (Projects EG042010,14CAES001) are acknowl-edged forfinancialsupport.JLR acknowledgeshis contract under project14CAES001. For their assistance with the collection of eggshell samples,the authors thank Juliana Bell, Adriana Pessôa, and Moacir Silva. Forother important contributions, the authors thank Larissa Cunha, GabrielOliveira, Petrus Galvão, Izidro Ferreira,Valéria Vasconcelos, andJaqueline Guida

Diabetes among women with preterm births: outcomes of a Brazilian multicenter study

ABSTRACT Objective The objective was to compare the maternal and perinatal characteristics and outcomes between women with and without diabetes in a Brazilian cohort of women with preterm births. Methods This was an ancillary analysis of the Brazilian Multicenter Study on Preterm Birth, which included 4,150 preterm births. This analysis divided preterm births into two groups according to the presence of diabetes; pregestational and gestational diabetes were clustered in the same Diabetes Group. Differences between both groups were assessed using χ 2 or Student’s t tests. Results Preterm births of 133 and 4,017 women with and without diabetes, respectively, were included. The prevalence of diabetes was 3.2%. Pregnant women aged ≥35 years were more common in the Diabetes Group (31.6% versus 14.0% non-diabetic women, respectively). The rate of cesarean section among patients with diabetes was 68.2% versus 52.3% in non-diabetic cases), with a gestational age at birth between 34 and 36 weeks in 78.9% of the cases and 62.1% of the controls. Large-for-gestational-age babies were 7 times more common in the Diabetes Group. Conclusion Preterm birth among Brazilian women with diabetes was more than twice as prevalent; these women were older and had regular late preterm deliveries, usually by cesarean section. They also had a greater frequency of fetal morbidities, such as malformations and polyhydramnios, and a higher proportion of large-for-gestational-age and macrosomic neonates