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Macías Saint-Gerons D, Castro JL, Colomar M, Rojas E, Sosa C, Ropero AM, Serruya SJ, Pastor D, Chiu M, Velandia-Gonzalez M, Abalos E, Durán P, Gomez Ponce de León R, Tomasso G, Mainero L, Rubino M, De Mucio B. Description of maternal and neonatal adverse events in pregnant people immunised with COVID-19 vaccines during pregnancy in the CLAP NETWORK of sentinel sites. Nested case-control analysis of the immunization-associated risk: A study protocol. BMJ Open 2024; 14:e073095. [PMID: 38286697 PMCID: PMC10826566 DOI: 10.1136/bmjopen-2023-073095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 11/01/2023] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION COVID-19 is associated with higher morbimortality in pregnant people compared with non-pregnant people. At present, the benefits of maternal immunisation are considered to outweigh the risks, and therefore, vaccination is recommended during pregnancy. However, additional information is needed on the safety of the vaccines in this population. METHODS AND ANALYSIS This a retrospective cohort nested case-control study in pregnant people who attended maternity hospitals from eight Latin American and Caribbean countries. A perinatal electronic clinical history database with neonatal and obstetric information will be used. The proportion of pregnant people immunised with COVID-19 vaccines of the following maternal and neonatal events will be described: preterm infant, small for gestational age, low birth weight, stillbirth, neonatal death, congenital malformations, maternal near miss and maternal death. Moreover, the risk of prematurity, small for gestational age and low birth weight associated with exposure to COVID-19 vaccines will be estimated. Each case will be matched with two groups of three randomly selected controls. Controls will be matched by hospital and mother's age (±3 years) with an additional matching by delivery date and conception time in the first and second control groups, respectively. The estimated required sample size for the main analysis (exposure to any vaccine) concerning 'non-use' is at least 1009 cases (3027 controls) to detect an increased probability of vaccine-associated event risk of 30% and at least 650 cases (1950 controls) to detect 30% protection. Sensitivity and secondary analyses considering country, type of vaccine, exposure windows and completeness of immunisation will be reported. ETHICS The study protocol was reviewed by the Ethical Review Committee on Research of the Pan American Health Organization. Patient informed consent was waived due to the retrospective design and the utilisation of anonymised data (Ref. No: PAHOERC.0546.01). Results will be disseminated in open access journals.
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Affiliation(s)
- Diego Macías Saint-Gerons
- Department of Medicine, University of Valencia, INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
| | - José Luis Castro
- Fundación para la innovación, la formación, la investigación y el desarrollo comunitario (FUNDEC), Santa Cruz de Tenerife, Spain
| | - Mercedes Colomar
- Unidad de Investigación Clínica y Epidemiológica Montevideo, Montevideo, Uruguay
- Deparment of Preventive and Social Medicine, School of Medicine, Montevideo, Uruguay
| | - Edgard Rojas
- Innovation, Access to Medicines and Health Technologies (IMT), PAHO, Washington, District of Columbia, USA
| | - Claudio Sosa
- Department of Obstetrics and Gynecology, Pereira Rossell Hospital, School of Medicine, Universidad de la Republica Uruguay, Montevideo, Uruguay
| | | | - Suzanne Jacob Serruya
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), PAHO, Montevideo, Uruguay
| | | | | | | | - Edgardo Abalos
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | - Pablo Durán
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), PAHO, Montevideo, Uruguay
| | | | - Giselle Tomasso
- Unidad de Investigación Clínica y Epidemiológica Montevideo, Montevideo, Uruguay
| | - Luis Mainero
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), PAHO, Montevideo, Uruguay
| | - Marcelo Rubino
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), PAHO, Montevideo, Uruguay
| | - Bremen De Mucio
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), PAHO, Montevideo, Uruguay
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de Mucio B, Sosa C, Colomar M, Mainero L, Cruz CM, Chévez LM, Lopez R, Carrillo G, Rizo U, Saint Hillaire EE, Arriaga WE, Guadalupe Flores RM, Ochoa C, Gonzalez F, Castro R, Stefan A, Moreno A, Metelus S, Souza RT, Costa ML, Luz AG, Sousa MH, Cecatti JG, Serruya SJ. The burden of stillbirths in low resource settings in Latin America: Evidence from a network using an electronic surveillance system. PLoS One 2023; 18:e0296002. [PMID: 38134193 PMCID: PMC10745214 DOI: 10.1371/journal.pone.0296002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To determine stillbirth ratio and its association with maternal, perinatal, and delivery characteristics, as well as geographic differences in Latin American countries (LAC). METHODS We analysed data from the Perinatal Information System of the Latin American Center for Perinatology and Human Development (CLAP) between January 2018 and June 2021 in 8 health facilities from five LAC countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic). Maternal, pregnancy, and delivery characteristics, in addition to pregnancy outcomes were reported. Estimates of association were tested using chi-square tests, and P < 0.05 was regarded as significant. Bivariate analysis was conducted to estimate stillbirth risk. Prevalence ratios (PR) with their 95% confidence intervals (CI) for each predictor were reported. RESULTS In total, 101,852 childbirths comprised the SIP database. For this analysis, we included 99,712 childbirths. There were 762 stillbirths during the study period; the Stillbirth ratio of 7.7/1,000 live births (ranged from 3.8 to 18.2/1,000 live births across the different maternities); 586 (76.9%) were antepartum stillbirths, 150 (19.7%) were intrapartum stillbirths and 26 (3.4%) with an ignored time of death. Stillbirth was significantly associated with women with diabetes (PRadj 2.36; 95%CI [1.25-4.46]), preeclampsia (PRadj 2.01; 95%CI [1.26-3.19]), maternal age (PRadj 1.04; 95%CI [1.02-1.05]), any medical condition (PRadj 1.48; 95%CI [1.24-1.76, and severe maternal outcome (PRadj 3.27; 95%CI [3.27-11.66]). CONCLUSIONS Pregnancy complications and maternal morbidity were significantly associated with stillbirths. The stillbirth ratios varied across the maternity hospitals, which highlights the importance for individual surveillance. Specialized antenatal and intrapartum care remains a priority, particularly for women who are at a higher risk of stillbirth.
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Affiliation(s)
- Bremen de Mucio
- Latin American Center of Perinatology (CLAP-PAHO), Montevideo, Uruguay
| | - Claudio Sosa
- Latin American Center of Perinatology (CLAP-PAHO), Montevideo, Uruguay
| | - Mercedes Colomar
- Latin American Center of Perinatology (CLAP-PAHO), Montevideo, Uruguay
| | - Luis Mainero
- Latin American Center of Perinatology (CLAP-PAHO), Montevideo, Uruguay
| | | | | | - Rita Lopez
- Hospital Berta Calderon Roque, Managua, Nicaragua
| | | | | | | | | | | | | | | | | | - Allan Stefan
- Hospital Leonardo Martinez Valenzuela, San Pedro Sula, Honduras
| | | | - Sherly Metelus
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Renato T. Souza
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Maria L. Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Adriana G. Luz
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | | | - José G. Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
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Veiga-Junior NN, Eugeni C, Kajiura BD, F. Dantas PB, Trabach CB, Junqueira AA, Nunes CC, Baccaro LF. Analysis of uterine evacuation methods in postabortion care after implementation of a surveillance network (CLAP MUSA-Network) at a university hospital. PLoS One 2023; 18:e0296009. [PMID: 38100497 PMCID: PMC10723722 DOI: 10.1371/journal.pone.0296009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Management of uterine evacuation is essential for increasing safe abortion care. Monitoring through surveillance systems tracks changes in clinical practice and provides information to improve equity in abortion care quality. OBJECTIVE This study aimed to evaluate the frequency of manual vacuum aspiration (MVA) and medical abortion (MA), and identify the factors associated with each uterine evacuation method after surveillance network installation at a Brazilian hospital. METHODS This cross-sectional study included women admitted for abortion or miscarriage to the University of Campinas Women's Hospital, Brazil, between July 2017 and November 2020. The dependent variables were the use of MVA and MA with misoprostol. The independent variables were the patients' clinical and sociodemographic data. The Cochran-Armitage, chi-square, and Mann-Whitney U tests, as well as multiple logistic regression analysis, were used to compare uterine evacuation methods. RESULTS We enrolled 474 women in the study, 91.35% of whom underwent uterine evacuation via uterine curettage (78.75%), MVA (9.46%), or MA (11.54%). MVA use increased during the study period (Z = 9.85, p < 0.001). Admission in 2020 (odds ratio [OR] 64.22; 95% confidence interval [CI] 3.79-1086.69) and lower gestational age (OR 0.837; 95% CI 0.724-0.967) were independently associated with MVA, whereas the only factor independently associated with MA was a higher education level (OR 2.66; 95% CI 1.30-5.46). CONCLUSION MVA use increased following the installation of a surveillance network for good clinical practice. Being part of a network that encourages the use of evidence-based methods provides an opportunity for healthcare facilities to increase access to safe abortions.
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Affiliation(s)
- Nelio N. Veiga-Junior
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
| | - Caroline Eugeni
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
| | - Beatriz D. Kajiura
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
| | - Priscilla B. F. Dantas
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
| | - Caroline B. Trabach
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
| | - Aline A. Junqueira
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
| | - Carina C. Nunes
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
| | - Luiz F. Baccaro
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
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Fonseca SC. Do we still need to talk about maternal morbidity and near miss? CAD SAUDE PUBLICA 2023; 39:e00185223. [PMID: 37970944 PMCID: PMC10644974 DOI: 10.1590/0102-311xpt185223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 11/19/2023] Open
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Sosa C, de Mucio B, Colomar M, Mainero L, Costa ML, Guida JP, Souza RT, Luz AG, Cecatti JG, Sousa MH, Cruz CM, Chevez LM, Lopez R, Carrillo G, Rizo U, Saint Hillaire EE, Arriaga WE, Guadalupe RM, Ochoa C, Gonzalez F, Castro R, Stefan A, Moreno A, Serruya SJ. The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson's Ten Group Classification System. BMC Pregnancy Childbirth 2023; 23:605. [PMID: 37620835 PMCID: PMC10464484 DOI: 10.1186/s12884-023-05937-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. METHODS Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. RESULTS Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). CONCLUSION Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR.
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Affiliation(s)
- Claudio Sosa
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), Montevideo, Uruguay
| | - Bremen de Mucio
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), Montevideo, Uruguay
| | - Mercedes Colomar
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), Montevideo, Uruguay
| | - Luis Mainero
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), Montevideo, Uruguay
| | - Maria L Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Jose P Guida
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Adriana G Luz
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - José G Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil.
| | - Maria H Sousa
- Jundiaí School of Medicine - HU/FMJ, Jundiaí, SP, Brazil
| | | | - Luz M Chevez
- Hospital Berta Calderon Roque, Managua, Nicaragua
| | - Rita Lopez
- Hospital Berta Calderon Roque, Managua, Nicaragua
| | | | | | | | | | | | | | | | | | - Allan Stefan
- Hospital Leonardo Martinez Valenzuela, San Pedro Sula, Honduras
| | | | - Suzanne J Serruya
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WR), Montevideo, Uruguay
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