Estimates of avoided costs attributed to a short cervix screening program to prevent preterm birth from the perspective of the Unified Health System (SUS)

OBJECTIVE: To perform an economic cost analysis of the implementation of a short cervix screening program to reduce preterm birth in singleton pregnancies in a short-term time horizon. METHODS: We performed a cost-benefit economic analysis using the P5 trial database, a randomized multicenter clinical trial for prevention of preterm birth. Data collection was conducted from July 2015 to March 2019 in 17 different Brazilian hospitals. We conducted a cost analysis for universal cervical screening in singleton pregnancies between 18 weeks and 22 weeks plus 6 days. In subjects with a cervical length ≤ 25 mm, the analysis incorporated the costs of administering 200 mg/day of vaginal progesterone prophylactically until 36 weeks gestation. These findings were subsequently compared with the economic implications of forgoing cervical screening. The time horizon comprised from birth to 10 weeks postpartum. The outcome was measured monetarily in Brazilian real (R$) from the perspective of the Unified Health System. RESULTS: Among 7,844 women, 6.67$ 383,711.36, while non-screening generated an estimated additional cost of R$446,501.69 (related to the 29 non-screened preterm deliveries). Thus, screening and prophylaxis would generate a final cost reduction of R$ 62,790.33, constituting a possible cost-benefit strategy. CONCLUSION: Universal short cervix screening for preterm birth has lower costs compared to non-screening within a short-term time horizon, which suggests an interesting benefitcost ratio. Future studies should consider the cost-effectiveness of prophylactic treatment using sensitivity analyses in different scenarios within the Brazilian health system, as well as analyses that consider the long-term costs associated with preterm births, to robustly justify the implementation of a short cervix screening program.OBJETIVO: Realizar uma análise econômica de custo da implementação de um programa de rastreio de colo curto para redução da prematuridade em gestações únicas num horizonte temporal de curto prazo. MÉTODOS: Realizamos uma análise econômica do tipo custo-benefício utilizando o banco de dados do P5 trial, um ensaio clínico multicêntrico randomizado para prevenção da prematuridade. A coleta de dados ocorreu de julho de 2015 a março de 2019 em 17 diferentes hospitais do Brasil. Comparamos os custos do rastreamento universal em mulheres com gestação única de 18 a 22 semanas e 6 dias associado à progesterona vaginal profilática 200 mg/dia até 36 semanas naquelas com colo ≤ 25 mm com os do não rastreamento. O horizonte temporal foi do nascimento até 10 semanas após o parto. O desfecho foi medido monetariamente em real brasileiro (R$) na perspectiva do Sistema Único de Saúde. RESULTADOS: Entre 7.844 mulheres, 6,67$ 383.711,36, enquanto o não rastreamento gerou custo adicional estimado de R$446.501,69 (relacionado aos 29 partos prematuros não rastreados). Assim, o rastreamento mais a profilaxia geraria uma redução de custo final de R$ 62.790,33, apresentando-se como uma possível estratégia de custo-benefício. CONCLUSÃO: O rastreamento universal de colo curto para prematuridade apresenta menores custos em relação ao não rastreamento dentro de um horizonte temporal de curto prazo, o que sugere uma interessante relação de custo versus benefício. Novos estudos que considerem a custo-efetividade do tratamento profilático utilizando-se de análises de sensibilidade em diferentes cenários dentro do sistema de saúde brasileiro, assim como análises que considerem os custos de longo prazo atrelados ao nascimento prematuro, são necessários para justificar com robustez a implementação de um programa de rastreamento

Construct validity of a Portuguese version of the Female Sexual Function Index

Este trabalho teve como objetivos avaliar a validade de construto de uma versão do Female Sexual Function Index (FSFI). A versão foi inserida ao final de um questionário multidimensional e aplicada face a face em 235 mulheres esterilizadas. O índice de não resposta foi de 1,7%. A amostra apresentou-se bastante homogênea com baixa renda e nível educacional. Um coeficiente alfa de Cronbach de 0,948 indicou uma consistência interna muito alta. A análise fatorial demonstrou que o instrumento parece medir quatro fatores latentes: desejo/excitação, lubrificação, orgasmo/satisfação e dor. Isso pode referir-se a uma característica do próprio instrumento, às características da resposta sexual feminina ou ainda às peculiaridades culturais da amostra, o que pode interferir no entendimento das perguntas ou dos conceitos sobre os quais o instrumento versa. Assim aponta-se para necessidade de desenvolvimento de outros estudos na população geral para a definição do conjunto de propriedades do FSFI, como sua composição de fatores latentes e o estabelecimento de pontos de corte adequados à população brasileira.This study aimed to evaluate the construct validity of a version of the Female Sexual Function Index (FSFI). The version was inserted into a multidimensional questionnaire and applied face-to-face to 235 sterilized women. Non-response rate was 1.7%. The sample proved to be highly homogeneous, with low income and education. Cronbach's alpha of 0.948 indicated high internal consistency. Factor analysis showed that the instrument was measuring four factors: desire/arousal, lubrication, orgasm/satisfaction, and pain. This may reflect characteristics of the instrument itself, female sexual response, or even the sample's cultural peculiarities, which can affect understanding of the questions or concepts with which the instrument deals. This study emphasizes the need for further research in the general population to determine the psychometric properties of the FSFI, such as its factor composition and definition of appropriate cut-off points for the Brazilian population.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Shock index and heart rate standard reference values in the immediate postpartum period: a cohort study

To determine Shock Index (SI) reference values in the first two hours of the postpartum period after objectively measuring postpartum bleeding. Materials and methods A complementary analysis using data from a prospective cohort study at Women's Hospital of the University of Campinas, Brazil, between 1 February 2015 and 31 March 2016. It included women giving birth vaginally unless they had one of these conditions: gestational age below 34 weeks, hypertension, hypo-or hyperthyroidism without treatment, any cardiac disease, infections with fever or sepsis, history of coagulopathy or delivery by C-section. Blood loss was measured by adding the blood volume collected in the drape placed under the women's buttocks and the weight of gauzes and compresses used (excluding the dry weight). Vital signs were measured every 5-15 min after delivery. Exploratory data analysis was performed to assess the mean, standard deviation, median, and percentiles (5 th, 10th, 25th, 50th, 75th, 90th, 95th). To identify variation among the periods after delivery, the mean SI and heart rate (HR) values observed for the following intervals were used in the analysis: 0-20 min, 21-40 min, 41-60 min, 61-90 min and 91-120 min. Results One hundred eighty-six women were included. The mean age +/- SD was 24.9 +/- 6.1 years and the mean gestational age at birth was 39.2 +/- 1.8 weeks. At the puerperal period, the mean SI values ranged from 0.68 +/- 0.14 to 0.74 +/- 0.15. The percentile distribution ranged from 0.46 (5 th percentile) to 1.05 (95 th percentile). The mean HR values ranged from 80.8 +/- 12.7 bpm to 92.3 +/- 14.4 bpm. The percentile distribution ranged from 62.0 bpm (5th percentile) to 117 bpm (95 th percentile). Conclusion Reference ranges were established for SI and HR values which showed small variations throughout the postpartum period14

Cross-cultural adaptation of the Female Sexual Function Index

Ainda hoje pouco se conhece sobre a epidemiologia das disfunções sexuais femininas. O Female Sexual Function Index (FSFI) [Índice de Função Sexual Feminina] é um questionário breve, que pode ser auto-aplicado, e que se propõe avaliar a resposta sexual feminina. Este estudo teve por objetivo avaliar a adaptação transcultural da versão em português do FSFI. O processo envolveu cinco etapas: tradução, versão, apreciação formal de equivalência, revisão crítica por especialistas em sexualidade e pré-teste do instrumento. Após a identificação de problemas semânticos, concordâncias e discordâncias, foi possível propor uma versão sintética, escolhendo e incorporando itens de uma das duas versões em português. Algumas mudanças foram realizadas após o pré-teste do questionário, para tornar a versão em português mais coloquial e aceitável para a população-alvo ao utilizar termos mais corriqueiros, como opção ou complemento à linguagem científica. Ao se comparar mais de uma versão do instrumento, no processo de equivalência transcultural, foi possível detectar problemas e dificuldades na adaptação da linguagem que poderiam ter passado despercebidos, caso não se observassem todas as fases do processo.The epidemiology of female sexual dysfunctions is still not well known. The Female Sexual Function Index (FSFI) is a short questionnaire specially designed to assess female sexual response. This study aimed to evaluate the cross-cultural equivalence of the Portuguese version of the FSFI. The cross-cultural adaptation involved five steps: translation, back-translation, formal equivalence assessment, review by specialists in sexuality, and pre-testing. After identification of semantic problems, agreements, and disagreements, a brief version was proposed, selecting and incorporating items from one of the two Portuguese versions. Some changes were made after pre-testing the questionnaire, most of which to make the Portuguese version more readily comprehensible and acceptable for the target population, using ordinary words as options or to complement the scientific language. Comparing more than one version of the instrument in the process of cross-cultural equivalence allowed detecting problems and difficulties in adapting the language, which would not have been observed otherwise

Conhecimento de adolescentes gestantes sobre o papilomavírus humano

To evaluate the level of information possessed by pregnant adolescents regarding the human papillomavirus (HPV). Methods Descriptive study developed in the adolescent prenatal outpatient clinic of a tertiary hospital from the state of 55o Paulo, Brazil. Data were collected between June and December 2017 following approval from the ethics and research committee (CAAE: 1.887.892/2017). Pregnant adolescents, <= 18 years old, who attended the abovementioned outpatient section, composed the sample. Those diagnosed with a psychiatric disorder and those with hearing or cognitive disabilities were excluded. After acceptance to participate in the present study, the pregnant adolescents signed an Informed Consent Form. Regarding the statistical analysis, the chi-squared test and the Fisher exact test were used. Results Regarding the knowledge about HPV, 123 (80.92%) of the participants had already heard about the subject; for 77 (50.66%), their schools had been the source of the information; 101 (66.45%) did not know how they could be infected by the virus. Age variation did not influence their knowledge on how to prevent themselves from HPV (p = 0.2562). The variable vaccine is associated with HPV prevention (p < 0.0001). Conclusion The pregnant adolescents composing the sample have shown to have knowledge about HPV. However, they do not prevent themselves from it appropriately, given that little more than half of the sample was vaccinated, had not reported an understanding that the use of preservatives and vaccination are effective means of prevention, and did not correlate HPV with uterine cervical cancer415291297Avaliar o nível de informação que as adolescentes gestantes possuem em relação ao papilomavírus humano (HPV). Métodos Estudo descritivo desenvolvido no ambulatório pré-natal adolescente de um hospital terciário do estado de São Paulo, Brasil. Os dados foram coletados entre junho e dezembro de 2017, após a aprovação do comitê de ética e pesquisa (CAAE: 1.887.892/2017). A amostra foi composta por adolescentes gestantes com 18 anos que frequentaram o ambulatório. Foram excluídas as com transtorno psiquiátrico diagnosticado e as portadoras de deficiência auditiva ou de cognição. Após aceitarem participar do presente estudo, as adolescentes grávidas assinaram o termo de assentimento e consentimento livre e esclarecido. Para as análises estatísticas, foram utilizados os testes de qui-quadrado e exato de Fisher. Resultados Em relação ao conhecimento sobre o HPV, 123 (80,92%) já tinham ouvido falar sobre o assunto; destas adolescentes, 77 (50,66%) receberam as informações que tinham através de suas escolas, e 101 (66,45%) pacientes não sabiam como poderiam contrair o vírus. A variação da idade das adolescentes entrevistadas não influenciou se estas sabiam ou não como se prevenir contra o HPV (p ¼ 0,2562). A variável vacina está associada à prevenção contra o HPV (p < 0,0001). Conclusão As gestantes avaliadas possuem conhecimento sobre o HPV, mas não fazem a prevenção adequada, visto que um pouco mais da metade se vacinaram, não relataram o preservativo e a vacina como métodos eficazes de prevenção, e não relacionaram o HPV com o câncer de colo de útero

Sexual Life And Dysfunction After Maternal Morbidity: A Systematic Review.

Because there is a lack of knowledge on the long-term consequences of maternal morbidity/near miss episodes on women´s sexual life and function we conducted a systematic review with the purpose of identifying the available evidence on any sexual impairment associated with complications from pregnancy and childbirth. Systematic review on aspects of women sexual life after any maternal morbidity and/or maternal near miss, during different time periods after delivery. The search was carried out until May 22(nd), 2015 including studies published from 1995 to 2015. No language or study design restrictions were applied. Maternal morbidity as exposure was split into general or severe/near miss. Female sexual outcomes evaluated were dyspareunia, Female Sexual Function Index (FSFI) scores and time to resume sexual activity after childbirth. Qualitative syntheses for outcomes were provided whenever possible. A total of 2,573 studies were initially identified, and 14 were included for analysis after standard selection procedures for systematic review. General morbidity was mainly related to major perineal injury (3(rd) or 4(th) degree laceration, 12 studies). A clear pattern for severity evaluation of maternal morbidity could not be distinguished, unless when a maternal near miss concept was used. Women experiencing maternal morbidity had more frequently dyspareunia and resumed sexual activity later, when compared to women without morbidity. There were no differences in FSFI scores between groups. Meta-analysis could not be performed, since included studies were too heterogeneous regarding study design, evaluation of exposure and/or outcome and time span. Investigation of long-term repercussions on women's sexual life aspects after maternal morbidity has been scarcely performed, however indicating worse outcomes for those experiencing morbidity. Further standardized evaluation of these conditions among maternal morbidity survivors may provide relevant information for clinical follow-up and reproductive planning for women.1530

Subsequent reproductive outcome in women who have experienced a potentially life-threatening condition or a maternal near-miss during pregnancy

OBJECTIVE: To evaluate the long-term reproductive consequences that affect women who have experienced potentially life-threatening or life-threatening (near-miss) maternal complications. INTRODUCTION: Although advances have been made in reducing maternal death, few studies have investigated the long-term repercussions of significant events such as severe maternal morbidity and maternal near-misses. These repercussions may be long-lasting and negatively affect quality of life. METHODS: A total of 382 women who had experienced a potentially life-threatening pregnancy-related condition within the last five years were analyzed in this retrospective cohort study. A control group of 188 women who gave birth without complications was also included. Trained interviewers contacted the subjects by telephone and completed a pre-coded, structured questionnaire on reproductive health. Data were analyzed using odds ratios adjusted for age. The main outcome measures were occurrence and outcome of subsequent pregnancies. RESULTS: The estimated risk of becoming infertile as a result of tubal ligation or hysterectomy was 3.5 times higher in women who experienced a maternal near-miss or severe maternal morbidity during the index pregnancy as compared to controls. Likewise, the risk of complications in subsequent pregnancies was five times greater in women who had experienced severe maternal morbidity. However, no differences were found in the occurrence or number of subsequent pregnancies or perinatal outcome. CONCLUSION: The occurrence of a life-threatening or potentially life-threatening maternal condition reduces future reproductive potential and increases the risk of complications in subsequent pregnancies

The Use of Mid-Pregnancy Cervical Length to Predict Preterm Birth in Brazilian Asymptomatic Twin Gestations

Funding Information: This work was supported by Bill & Melinda Gates Foundation [OPP1107597], the Brazilian Ministry of Health, and the Brazilian National Council for Scientific and Technological Development (CNPq) [401615/20138]. The funders had no role in the design, development of the study, analysis, interpretation of data, writing the manuscript and in the decision to submit the article for publication. Publisher Copyright: © 2022 Georg Thieme Verlag. All rights reserved.Peer reviewedPublisher PD

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

Computer-assisted Telephone Interviewing (cati): Using The Telephone For Obtaining Information On Reproductive Health.

The objective of this study was to evaluate the feasibility of using computer assisted telephone interviewing (CATI) as a method for obtaining information on reproductive health in Brazil. A total of 998 eligible women for the study were selected to answer a questionnaire through computer- assisted telephone interviewing undertaken by trained interviewers. The outcomes of each telephone contact attempt were described. Differences between groups were assessed using the χ(2) test. Phone contact was made in 60.3% of the attempts and 57.5% of the interviews were completed. The success rate improved with the decrease in time from hospitalization to interview and with the higher numbers of telephones available. A total of 2,170 calls were made, comprising of one to sixteen attempts per woman. The majority of situations where extra calls were necessary were due to the number being busy or to the fact that the woman was not available at the time of the call. CATI can prove be a valuable procedure for obtaining information on reproductive health among Brazilian women, particularly for relatively recent events and when more than one alternative telephone number is available.271801-