Análise do impacto da pandemia de COVID-19 sobre a atenção a mulheres em situação de aborto na América Latina e Caribe

Objective: to understand the influence of the COVID-19 pandemic on aspects of quality of care provided to women in abortion situations in sentinel centers of the CLAP MUSA-Network (a multicenter network with international cooperation with the aim of encouraging good practices in Latin America and the Caribbean). Methods: cross-sectional study between January/2017 and December/2021 with women of any age admitted for abortion or miscarriage. We analyzed the total number of cases and the proportion of legal abortions. The dependent variables were complications and use of contraceptives after abortion. The independent variables were COVID-19 pandemic, clinical and sociodemographic data. Statistical analysis was carried out using linear regression, multiple Poisson regression, Cochran-Armitage, chi-square, Mann-Whitney and Cohen tests. Results: we analyzed data from 93689 women assisted in 12 sentinel centers of the CLAP MUSA-Network, 64.55% in the pre-pandemic period (NP) and 35.45% in the pandemic period (PP) (22.73% received post-abortion care and 77.27% legal abortion). We found no differences in the number of cases over the period, regardless of the legal context. We observed a significant increase in the proportion of legal abortions in liberal and moderate contexts. In NP, 46.46% of women underwent medical abortion, while 62.18% of women underwent medical abortion in PP (h-Cohen 0.32). We found no increase in the number of complications during PP. In NP, 79.12% started contraceptives after abortion, while in PP, 70.39% started contraceptives after abortion (h-Cohen 0.20). Conclusion: the COVID-19 pandemic was not associated with a decrease in the number of cases, a decrease in the proportion of legal interruptions, or an increase in complications in sentinel centers of the CLAP MUSA-Network. Submission: 30/04/23|Review: 08/11/23|Approval: 09/11/23Objetivo: comprender la influencia de la pandemia de COVID-19 en aspectos de la calidad de la atención brindada a las mujeres en situación de aborto en los centros centinela de la Red CLAP-MUSA (una red multicéntrica de cooperación internacional con el objetivo de fomentar buenas prácticas en América Latina y el Caribe). Metodología: estudio transversal entre enero/2017 y diciembre/2021 con mujeres de cualquier edad ingresadas para abortos espontáneos o inducidos. Se analizó el número total de casos y la proporción de abortos legales. Las variables dependientes fueron las complicaciones y el uso de anticonceptivos después del aborto. Las variables independientes fueron pandemia de COVID-19, datos clínicos y sociodemográficos. El análisis estadístico se realizó mediante regresión lineal, regresión múltiple de Poisson, pruebas de Cochran-Armitage, chi-cuadrado, Mann-Whitney y Cohen. Resultados: se analizaron datos de 93689 mujeres atendidas en 12 centros centinela de la Red CLAP-MUSA, 64,55% en el período prepandemia (NP) y 35,45% en el período pandemia (PP) (22,73% recibieron atención postaborto y 77,27% aborto legal). No encontramos diferencias en el número de casos durante el período, independientemente del contexto legal. Observamos un aumento significativo en la proporción de abortos legales en contextos liberales y moderados. En NP, el 46,46% de las mujeres se sometieron al aborto con medicamentos, mientras que el 62,18% de las mujeres se sometieron al aborto con medicamentos en PP (h-Cohen 0,32). No encontramos aumento en el número de complicaciones durante el PP. En NP, 79,12% inició anticonceptivos después del aborto, mientras que en PP, 70,39% inició anticonceptivos después del aborto (h-Cohen 0,20). Conclusión: la pandemia de COVID-19 no se asoció con una disminución en el número de casos, una disminución en la proporción de interrupciones legales o un aumento en las complicaciones en los centros centinela de la Red CLAP-MUSA. Acceptación: 30/04/23|Revisión: 08/11/23|Aprobación: 09/11/23Objetivo: compreender a influência da pandemia de COVID-19 nos aspectos da qualidade da assistência prestada às mulheres em situação de abortamento nos centros sentinela da Rede CLAP-MUSA, uma rede multicêntrica com cooperação internacional visando encorajar boas práticas na América Latina e no Caribe. Metodologia: estudo transversal entre janeiro/2017 e dezembro/2021 com mulheres de qualquer idade admitidas por abortamentos espontâneos ou induzidos. Analisamos o número total de casos e a proporção de abortos legais. As variáveis dependentes foram complicações e uso de anticoncepcionais após o aborto. As variáveis independentes foram a pandemia de COVID-19, dados clínicos e sociodemográficos. A análise estatística foi realizada por meio de regressão linear, regressão múltipla de Poisson, testes de Cochran-Armitage, qui-quadrado, Mann-Whitney e Cohen. Resultados: foram analisados dados de 93.689 mulheres, atendidas em 12 centros sentinelas da Rede CLAP-MUSA, 64,55% no período pré-pandêmico (NP) e 35,45% no período pandêmico (PP) (22,73% receberam atendimento pós-aborto e 77,27%, aborto legal). Não encontramos diferenças no número de casos ao longo do período, independentemente do contexto legal. Observamos um aumento significativo na proporção de abortos legais em contextos liberais e moderados. No NP, 46,46% das mulheres realizaram aborto medicamentoso, enquanto 62,18% das mulheres realizaram aborto medicamentoso no PP (h-Cohen 0,32). Não encontramos aumento no número de complicações durante o PP. No NP, 79,12% iniciaram anticoncepcionais após o aborto, enquanto no PP, 70,39% iniciaram anticoncepcionais após o aborto (h-Cohen 0,20). Conclusão: a pandemia de COVID-19 não se associou à diminuição do número de casos, à diminuição da proporção de interrupções legais ou ao aumento de complicações nos centros sentinelas da Rede CLAP-MUSA. Submissão: 30/04/23|Revisão: 08/11/23|Aprovação: 09/11/2

Severe maternal morbidity (near miss) as a sentinel event of maternal death. An attempt to use routine data for surveillance

<p>Abstract</p> <p>Background</p> <p>To identify all the records within the Brazilian Hospital Information System (HIS) that contained information suggestive of severe maternal morbidity (near miss); to describe the diagnoses and procedures used; to identify variables associated with maternal death.</p> <p>Methods</p> <p>A descriptive population study with data from the HIS and Mortality Information System (MIS) files of records of women during pregnancy, delivery and in the postpartum period in all the capital cities of the Brazilian states in 2002. Initially, records of women between 10 and 49 years of age were selected; next, those records with at least one criterion suggestive of near miss were selected. For the linkage of HIS with MIS and HIS with itself, a blocking strategy consisting of three independent steps was established. In the data analysis, near miss ratios were calculated with corresponding 95% confidence interval and the diagnoses and procedures were described; a multiple logistic regression model was adjusted. Primary and secondary diagnoses and the requested and performed procedures during hospitalization were the main outcome measures.</p> <p>Results</p> <p>The overall maternal near miss ratio was 44.3/1,000 live births. Among the records indicating near miss, 154 maternal deaths were identified. The criteria of severity most frequently found were infection, preeclampsia and hemorrhage. Logistic regression analysis resulted in 12 variables, including four significant interactions.</p> <p>Conclusion</p> <p>Although some limitations, the perspective of routinely using this information system for surveillance of near miss and implementing measures to avoid maternal death is promising.</p

Women's health in the Region of the Americas

Sem informação374-519920

The scenario of pre-natal care in Brazil and the Humanizing of Prenatal Care and Childbirth Program

The purpose of this article was to contextualize historically the advent of the Brazilian Ministry of Health's Prenatal and Birth Humanization Program. Its conceptual, philosophical and operational aspects were pointed out through situation and documental analysis. The Program, launched in June 2000, has as its main strategy to guarantee better access, coverage and quality in prenatal care, birth and puerperal care to pregnant women and newborns from a citizen's rights perspective. The Program is based on the right to humanization of obstetric and neonatal care as the first prerequisite for adequate follow-up, besides establishing criteria for classification of care and promotion of a bond between outpatient care and the moment of delivery, integrated and with interventions that had strong evidence of being effective. The article presents the Brazilian scenario of prenatal care at the end of nineties, discuss the principles of humanization as requirement for the quality of care, reconstitutes the design and launch of the Program, besides commenting practical aspects of its initial evaluation and challenges for the future.O objetivo deste artigo foi contextualizar historicamente a implantação do Programa de Humanização do Pré-Natal e Nascimento do Ministério da Saúde no Brasil, resgatando, através de análise documental e situacional, seus aspectos conceituais, filosófico e operacional. O Programa, lançado em junho de 2000, tem como principal estratégia assegurar a melhoria do acesso, da cobertura e da qualidade do acompanhamento pré-natal, da assistência ao parto e puerpério das gestantes e ao recém-nascido, na perspectiva dos direitos de cidadania. O Programa fundamenta-se no direito à humanização da assistência obstétrica e neonatal como condição primeira para adequado acompanhamento, além de estabelecer critérios para qualificar a assistência e promover o vínculo entre a assistência ambulatorial e o momento do parto, integrados e com intervenções que tivessem fortes evidências de que são efetivas. O artigo apresenta o panorama da assistência pré-natal no Brasil no fim da década de 90, discute os princípios da humanização como requisito para a qualidade da atenção, reconstitui o delineamento e lançamento do Programa, bem como comenta aspectos práticos de sua avaliação inicial e desafios para o futuro.26927

The Brazilian Ministry of Health's Program for Humanization of Prenatal and Childbirth Care: preliminary results

This article evaluates the implementation of the Brazilian Ministry of Health's Program for Humanization of Prenatal and Childbirth Care using data generated by the SISPRENATAL/DATASUS database from the Unified National Health System. From its beginning in June 2000 until December 2002, 3,983 municipalities joined the Program, and 71% of participating municipalities (3,183) reported their health care activities, constituting a database with 720,871 women. Nearly 20% of the women had six or more prenatal visits, and approximately half of them had the postpartum follow-up visit and required lab tests performed in 2002. In addition, 41% of the women had been vaccinated against tetanus. The number of HIV antibody tests was twice that of syphilis during the two-year period. Only a small percentage of women (2% in 2001 and 5% in 2002) received the entire set of prenatal and childbirth care services. The low percentages attest to the need for permanent evaluation aimed at improving quality of care and guaranteeing both high-quality maternal and perinatal results and the inalienable right of women to safe care and well-being during pregnancy and delivery.Avalia-se a experiência da implantação do Programa de Humanização no Pré-natal e Nascimento do Ministério da Saúde, no Brasil, a partir dos dados gerados pelo SISPRENATAL/DATASUS. De sua instituição em junho de 2000 até dezembro de 2002, 3.983 municípios aderiram, e 71% desses (3.183) registraram procedimentos no âmbito do programa, constituindo um banco de dados com 720.871 mulheres. Cerca de 20% das mulheres realizaram seis ou mais consultas de pré-natal, e cerca da metade delas realizou também a consulta puerperal e os exames obrigatórios em 2002, e 41% das mulheres foram imunizadas com a vacina antitetânica. A realização de exames para a detecção de HIV foi o dobro em relação à sífilis, nos dois anos em análise. O conjunto das atividades assistenciais recomendado foi recebido apenas por um pequeno percentual de mulheres, 2% em 2001 e 5% em 2002. Os baixos percentuais registrados ratificam a necessidade de permanentes avaliações com o objetivo de melhorar a qualidade dessa atenção, garantindo, além de melhores resultados maternos e perinatais, o direito inalienável de cada mulher de gestar e parir com segurança e bem-estar.1281128

Neonatal Near Miss: A Systematic Review.

The concept of neonatal near miss has been proposed as a tool for assessment of quality of care in neonates who suffered any life-threatening condition. However, there are no internationally agreed concepts or criteria for defining or identifying neonatal near miss. The purpose of this study was to perform a systematic review of studies and markers that are able to identify neonatal near miss cases and predict neonatal mortality. Electronic searches were performed in the Medline, Embase and Scielo databases, with no time or language restriction, until December 2014. The term neonatal near miss was used alone or in combination with terms related to neonatal morbidity/mortality and neonatal severity scores. Study selection criteria involved three steps: title, abstract and full text of the articles. Two researchers performed study selection and data extraction independently. Heterogeneity of study results did not permit the performance of meta-analysis. Following the inclusion and exclusion criteria adopted, only four articles were selected. Preterm and perinatal asphyxia were used as near miss markers in all studies. Health indicators on neonatal morbidity and mortality were extracted or estimated. The neonatal near miss rate was 2.6 to 8 times higher than the neonatal mortality rate. Pragmatic and management criteria are used to help develop the neonatal near miss concept. The most severe cases are identified and mortality is predicted with these criteria. Furthermore, the near miss concept can be used as a tool for evaluating neonatal care. It is the first step in building management strategies to reduce mortality and long-term sequelae.1532

[probabilistic Record Linkage: An Application To Severe Maternal Morbidity (near Miss) And Maternal Mortality].

This article presents an experience with record linkage from the Brazilian Hospital Information System (SIH) with the Mortality Information System (SIM), and the SIH with itself, applied to severe maternal morbidity (near miss) and maternal mortality. This was an empirical study using Brazilian data for the state capitals and Federal District in 2002. For the two linkages separately applied in each capital, a three simple step blocking strategy was established, plus related multiple steps and also two clerical review strategies. From the total number of true pairs found after the two linkages, simple steps failed to find fewer than 8%, while the multiple step strategy failed to find only 0.7%. This approach allowed exploring the issue of severe maternal morbidity and mortality in these databases. The number of pairs found and reviewed under the multiple steps strategy was lower than the sum of pairs obtained with the three simple steps, and fewer pairs were lost. However, for the record linkage of the SIH with itself, both strategies are suggested.24653-6