Indirect causes of severe maternal morbidity in Brasil : results from a national cross-section multicenter study

Orientadores: Fernanda Garanhani de Castro Surita, Maria Laura Costa do NascimentoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Introdução: A mortalidade e morbidade maternas podem ser classificadas segundo suas causas como direta, indireta e acidental (incidentais). As causas indiretas são definidas como condições pré-existentes ou recentemente adquiridas durante a gravidez e que não são causadas por condições obstétricas. Cerca de 27% das mortes maternas podem ser atribuídas às causas indiretas. Além disso, as causas indiretas possuem um potencial de aumento das complicações obstétricas e morbidade perinatal. Há uma dicotomia quando tentamos analisar as causas indiretas em países com alto índice de desenvolvimento e países em desenvolvimento. Em países com alto índice de desenvolvimento as causas indiretas de mortalidade materna são causas de difícil redução como cardiopatias, doenças cerebrovasculares e tromboembolismo. Já em países subdesenvolvidos refletem condições de saúde precárias na população geral, como doenças infecciosas.Objetivo: Identificar a prevalência, principais diagnósticos, resultados perinatais e fatores associados as causas indiretas de morbidade materna grave na Rede Brasileira de Vigilância da Morbidade Materna Grave. Métodos: Análise secundária de Estudo de corte transversal, multicêntrico, implantado em 27 hospitais de diversas regiões do país - Rede Nacional de Vigilância de Morbidade Materna Grave. Foram incluídas gestantes com morbidade materna grave. Definiram-se causas indiretas exclusivas como aquelas em que toda ou qualquer relação com as causas diretas foram excluídas. A partir disso, foram selecionados em 2 grupos para comparação dos dados. Foram definidas as variáveis sociodemográficas, obstétricas, condições clinicas e de manejo. Análise bivariada foi realizada para identificar fatores preditores associados, estimar razões de prevalência (RP) e seus respectivos intervalos de 95% de confiança (IC), ajustados para efeito cluster. Os resultados perinatais e o tipo de parto foram avaliados pela razão de prevalência. Foi realizada análise de regressão múltipla de Poisson. Foram identificados todos os casos de morte materna por causas indiretas. Os softwares utilizados para a análise foram SPSS versão 17 (SPSS, Chicago, IL, EUA) e Stata versão 7.0 (StataCorp, College Station, TX, EUA). Nível sig p 7dias(RP 2.57 [1.74 ¿ 3.81]). 37,8% das mulheres com causas indiretas permaneceram gravidas RP (95%CI) 7.93 [6.04-10.41]. Obesidade apareceu como fator protetor para causas indiretas exclusivas RP (95%CI) 0.45 [0.29 ¿ 0.69] enquanto baixo peso como fator de risco RP (95%CI) 3.23 [1.70 ¿ 6.14]. Número de consultas de pré natal menor que 6 e seguro saúde privado se apresentaram como fator de risco, respectivamente, RP (95%CI) 1.68 [1.36 ¿ 2.06], RP (95%CI) 2.04 [1.35 ¿ 3.08]. As causas indiretas mais prevalentes associadas à morte materna foram H1N1, Sepsis, Câncer e Doença Cardiovascular. Conclusão: A gravidade das causas indiretas exclusivas se evidencia nos indicadores de saúde, onde para cada 2.9 casos de Near Miss Materno ocorreu 1 morte. Mulheres com baixo peso, menor número de consultas de PN e PN fora do SUS apresentaram maior prevalência de Morbidade Materna Grave por causas indiretas exclusivas. O uso de drogas ilícitas aumentou o risco de quadros mais graves (NM+MM). Nos desfechos , permanecer gestante após uma internação por MMG e apgar de 5º minuto 7 days (RP 2.57 [1.74 - 3.81]). 37.8% of the women with indirect causes remained pregnant, presenting a PR (95% CI) 7.93 [6.04-10.41]. Obesity appeared as a protective factor for exclusive indirect causes PR (95% CI) 0.45 [0.29 - 0.69] while underweight as a risk factor PR (95% CI) 3.23 [1.70 - 6.14]. Number of pre-natal consultations less than 6 and private health insurance presented as a risk factor, respectively, PR (95% CI) 1.68 [1.36 - 2.06], PR (95% CI) 2.04 [1.35 - 3.08]. The most prevalent indirect causes associated with maternal death were H1N1, Sepsis, Cancer and Cardiovascular Disease. Conclusion: The severity of exclusive indirect causes is evident in the health indicators, where for each 2.9 cases of NMM there was 1 death among the exclusive indirect causes versus 7.4 cases of NMM for each MM among the other causes. Women with low weight, fewer PN and PN visits outside the SUS showed a higher prevalence of MMG due to exclusive indirect causes. The use of illicit drugs increased the risk of more severe conditions (NM + MM). In the outcomes of these women, remaining pregnant after admission for MMG and apgar of 5 m <7 were more prevalent among MMG due to exclusive indirect causes. The main causes of MM among the exclusive IC of MMg were infection of the H1N1 virus, sepsis, cancer and heart diseaseMestradoSaúde Materna e PerinatalMestra em Ciências da Saúd

Maternal and fetal outcome in abruptio placentae at a tertiary care centre: a retrospective analysis

Background: Placental abruption is a major obstetric complication leading to increased risk of maternal and neonatal morbidity and mortality globally. Placental abruption is traditionally defined as premature separation of a normally implanted placenta after 20 weeks of gestation and before delivery of the fetus. Early recognition of the risk factors, timely diagnosis and early intervention can significantly reduce maternal and fetal morbidity and mortality. This study was aimed to identify the associated risk factors with abruptio placenta and to analyse the maternal and perinatal outcome in abruptio placenta.Methods: This was a retrospective observational study, from Jan 2016 to Dec 2019 at M.S. Ramaiah medical college and hospitals, Bangalore.Results: In our study, the incidence of abruptio placenta was 0.95%. Majority of our patients were between 20-24 years (41.5%). Primigravidae accounted for 46.15% of the cases. The unbooked cases were 92%. The commonest risk factor was hypertension complicating pregnancy which accounted for 26% .The live births were 64%. Postpartum haemorrhage was one of the major complications in our study. There was no maternal mortality, probably due to early intervention and availability of blood and blood products.Conclusions: Timely diagnosis and appropriate intervention preferably in tertiary care centre will significantly reduce mortality and morbidity in both mother and fetus.

Utilization of Big Data In E-Commerce Business

In this day and age with the internet brings revolution to the way all fields work, especially in the field of business. With the internet technology data became big and known as "Big Data". The development of big data has increased significantly so that it can be utilized in various fields, especially in business areas that have been implemented with internet technology. This electronic buying and selling media have a wide range such as from small to large stores that can utilize media or with a site. This makes users always need this technology, so an E-commerce can also be said to be the largest data-producing media. This study addresses the problem of the extent to which big data generated from E-commerce can affect business and provide benefits for business organizations such as expanding the scope of transactions, supporting decision-making, and others. The research method used in compiling this research is to collect data and information and then conduct processing and analysis of the data. So it is expected from the results of utilization of big data in this E-commerce business that has been processed can provide support especially in making decisions with cluster results that have been obtained for example such as to know the most sales patterns in order to be able to add stock to certain goods and determine promotions based on future sales. The study concluded that based on gift shop sales data, the average item purchased by the store's customers is found in items that are included in cluster group 0 so that the gift shop can increase the stock of items contained in cluster group 0

Serum lactate dehydrogenase level in pre-eclampsia and its correlation with maternal and fetal outcome

Background: Hypertensive disorders are the most common medical disorders during pregnancy. It increases maternal and perinatal morbidity and mortality. The incidence is 7 to 10%. Identifying high risk patients and close monitoring can reduce the complications. Lactate dehydrogenase is a useful biochemical marker and can be used to evaluate maternal complications like Disseminated intravascular coagulation (DIC), HELLP syndrome (Haemolysis, elevated liver enzymes and lowered platelets), pulmonary edema, renal failure and fetal complications like Fetal growth restriction (FGR) APGAR score ≤7 at 5 min and Neonatal intensive care unit (NICU) admissions. The objective of this study was to estimate serum Lactate dehydrogenase levels (LDH) in pre-eclampsia patients and study the correlation between increased LDH levels and maternal and fetal outcome.Methods: It was a prospective study from October 2015 to May 2017 at M. S. Ramaiah medical college and hospitals, Bangalore.Results: The incidence of maternal and foetal complications was increased with higher serum LDH levels. With serum LDH >than 600 IU/l the incidence of HELLP syndrome, DIC, pulmonary edema was statistically significant. It also correlated with increased creatinine levels and decreased platelets with p value<0.001. The foetal complications including FGR NICU admission and Apgar score <7 at 5 min was statistically significant. The liver enzymes and serum creatinine correlated with increased LDH levels.Conclusions: Maternal and foetal complications are increased with raised LDH levels, and it can be used as a biochemical marker to achieve a better outcome

Clinicopathological study of postmenopausal bleeding in a tertiary hospital: a retrospective analysis

Background: Postmenopausal bleeding is bleeding from the genital tract one year after menopause. The incidence is 4-11%. It is one of the cardinal signs of endometrial carcinoma. There is 10% risk of genital cancer and 10% risk of significant pathology and needs evaluation. In majority of them, it is due to benign condition such as endometrial atrophy or polyp. The aim of the present study was to evaluate the endometrial thickness by transvaginal ultrasound and to correlate with the histopathological pattern of the material obtained by hysteroscopic guided biopsy or curettage.Methods: A retrospective analysis of all the patients attending the outpatient department from January 2017 to December 2019 was done. This study was undertaken at M.S. Ramaiah Medical College and Hospitals. All patients with postmenopausal bleeding were evaluated clinically, then they underwent PAP smear, transvaginal ultrasound for endometrial thickness. This was followed by hysteroscopic guided biopsy and curettage. The material obtained was sent for histopathological examination as it is the gold standard for further management.Results: A total of 89 patients were enrolled for the study. The final results revealed atrophic endometrium in 35.95%, hyperplasia without atypia in 20.2%, polyps in 11.2% and endometrial carcinoma in 6.7%.Conclusions: In postmenopausal bleeding assessing endometrial thickness by transvaginal ultrasound is ideal. Hysteroscopy is a simple technique to evaluate the uterine cavity and take biopsy for histopathological examination, which is the gold standard

Correlation of placental laterality and uterine artery Doppler in pre-eclampsia

Background: Pre-eclampsia is a complex condition associated with maternal and fetal mortality and morbidity. Various screening tests have been proposed for the prediction of pre-eclampsia with varying results. Non-invasive doppler velocimetry studies of uterine arteries in second trimester with abnormal forms can predict the occurrence of pre-eclampsia. This abnormal wave forms indicate defective uterine perfusion and is consequence of placental implantation laterally. The objective of this study was to correlate placental laterality and uterine artery doppler in pre-eclampsia. Methods: It was prospective study from November 2019 to March 2021 at M S Ramaiah medical college and hospitals, Bangalore. Results: In the present study, preeclampsia was seen in 36.5 % with lateral location of placenta, 19.3% with posterior location of placenta and 15.9% with anterior location of placenta. This was statistically significant with p&lt;0.001. Uterine artery doppler, the pulsatality index (PI) was &lt;95th centile in 88.1% and 11.9% had &gt;95th centile The subjects with PI &gt;95th centile, 65.5% developed preeclampsia and &lt;95th centile, 13.1% developed pre-eclampsia. This was statistically significant. In this study, with PI at 1.68, the sensitivity was 53.19%, specificity was 92.86%, positive predictive value (PPV) of 64.1% and negative predictive value (NPV) was 89.2%. Conclusions: USG is a simple, non-invasive, easy to perform and cost-effective method to locate the placenta. Every attempt should be made to do Uterine artery doppler at the same sitting. Both these are non-invasive and can predict the occurrence of pre-eclampsia. These patients can be managed as high risk and monitored more carefully. Surveillance will help in decreasing maternal and perinatal mortality and morbidity

The backpacker’s identity and emotional experience: a systematic literature review with bibliometric analysis

Backpacking tourism is increasingly attracting the attention of young people and adults, and especially researchers. Therefore, this study aims to analyse and identify what the literature has addressed about backpackers’ identity and emotional experience through a systematic literature review according to the PRISMA method, followed by bibliometric analysis. For this purpose, a search was made in the Scopus and Web of Science databases, obtaining a total of 173 articles published up to June 2021. But after applying the inclusion and exclusion and eligibility criteria, that has left 27 articles related to the purpose of this study. The data analysis performed by the PRISMA method resulted in the following categories: (i) conceptualization and evolution of backpacking tourism; (ii) social identity of the backpacker; (iii) emotional experience of the backpacker; (iv) factors influencing backpacker satisfaction. The results obtained show that the subject has been growing in the number of publications and that there is still the possibility of further researches. Furthermore, there was a predominance of qualitative methodologies in the empirical studies developed. In addition, the paper allowed us to conceptualize and analyse the evolution of backpacking tourism, as well as the social identity of the backpacker and the positive impacts that emotional experience has on satisfaction.info:eu-repo/semantics/publishedVersio

Influence of Gender on Disaster Volunteers: an Exploratory Study of Mennonite Disaster Service

There is a substantial amount of literature concerning volunteerism, particularly the relationship between volunteerism and women. Researchers theorize that volunteerism, gender, and faith are positively correlated. Much remains to be discovered about the roles of women within faith-based volunteer organizations like Mennonite Disaster Service (MDS). This study examines the evolution of changing gender roles within MDS using archival data and an extensively deployed survey (n=852). Data from the 2010 MDS survey is used in OLS regression and binary logistics regression models to examine the association between volunteerism and gender. Overall, survey data and archival evidence support the notion that women's roles in MDS have evolved considerably over time, albeit unevenly. It appears that when controlling for socio-demographic variables, level of orthodoxy, and importance of faith, the effect of being female does significantly influence the number of times volunteered. Furthermore, being female does significantly influence holding a leadership position on a MDS project site. Historically, women were not able to volunteer as much as men because of domestic duties and today women still volunteer significantly fewer times than do men. Furthermore, while women historically have permeated some leadership roles such as committee members; today, they are still significantly less likely than are men to hold a leadership position on MDS project sites.Department of Sociolog