Carolina Machado Moreira

Objective: to identify, in the literature, which obstetric practices were used during the COVID-19 pandemic period. Method: this is a systematic literature review, which was conducted by searching the PubMed (MEDLINE) and Embase databases covering the period from 2020 to 2024, following the PRISMA guidelines. A total of 2,505 references were found in the initial search, and after screening, 14 studies were included in the narrative synthesis, using the Synthesis Without Meta-Analysis (SWiM) methodology. Results: The studies indicated that, during the pandemic, there was an increase in the implementation of recommended practices in parturition, such as providing diet and non-pharmacological methods for pain relief. Non-recommended interventions, such as the use of episiotomy and oxytocin, decreased significantly. However, cesarean section rates remained stable in most studies, with the exception of some cases in which there was an increase, justified by the search for increased safety for the mother-baby dyad. Conclusion: The COVID-19 pandemic significantly impacted the organization of care for pregnant women, parturients, and newborns. In several international contexts, obstetric interventions considered unnecessary were adopted. This reinforces the need for continuous awareness among professionals involved in obstetric and perinatal care. Therefore, it is essential to strengthen strategies that favor women’s autonomy and their active participation as central subjects in health care.

Objective To assess the factors associated with Postpartum Hemorrhage (PPH) in maternity hospitals in a Brazilian city during the COVID-19 pandemic. Methods This epidemiological, observational, and analytical study was nested in a prospective cohort and carried out with 1,257 parturients and their children, who were born vaginally, in three reference maternity hospitals in a city in southeastern Brazil in the three months of the highest incidence of the COVID-19 pandemic in the first half of 2020. The personal risk and obstetric antecedents related to hospitalization and maternal characteristics as well as the characteristics of newborns with the presence or absence of PPH were compared using the Pearson’s Chi-Square or Fisher’s Exact tests. To verify the magnitude of the association between the outcome variable (HPP) and its possible associated factors (independent variables), logistic regression models were constructed to estimate the Odds Ratio (OR). Results The prevalence of HPP was 4.14%. Parturients who presented COVID-19 infection, primiparous women, and who had a personal history of risk were associated with PPH. Higher proportions of newborns who were not breastfed and did not have skin-to-skin contact when their mothers had PPH were also observed. Concerning the final adjusted model and factors associated with the presence of PPH, women who had both clinical or obstetric complications and personal risk history in the current pregnancy had an increased chance of having PPH. Conclusion PPH was associated with primiparity and personal history of risk such as hypertensive syndromes during pregnancy and clinical and/or obstetric complications in the current pregnancy. Given the potential impact of PPH on maternal mortality, these findings reinforce the importance of early detection and identification of factors associated with PPH in addition to risk stratification.

Resumo Objetivo Avaliar os fatores associados à Hemorragia do Pós-Parto (HPP) em maternidades de uma metrópole brasileira durante a pandemia da COVID-19. Métodos Estudo epidemiológico, observacional, analítico, aninhado a uma coorte prospectiva, realizado com 1.257 parturientes e seus filhos nascidos por via vaginal em três maternidades de referência de uma metrópole do sudeste brasileiro, nos três meses de maior incidência da COVID-19 no primeiro semestre de 2020. Comparou-se, por meio do teste Qui-Quadrado de Pearson ou Exato de Fisher, os antecedentes pessoais de risco, obstétricos, relacionados à internação e às características maternas, bem como as características do recém-nascido com a presença ou ausência de HPP. A fim de verificar a magnitude da associação entre a variável desfecho (HPP) e seus possíveis fatores associados (variáveis independentes), foram construídos modelos de regressão logística para estimar a Odds Ratio (OR). Resultados A prevalência de HPP foi de 4,14%. Parturientes que apresentaram infecção por COVID-19, primíparas e que apresentaram antecedentes pessoais de risco associaram-se com HPP. Também se observou maiores proporções de recém-nascidos que não foram amamentados e que não tiveram contato pele a pele quando a mãe apresentou HPP. Em relação ao modelo ajustado final, com os fatores associados à presença de HPP, mulheres que apresentaram alguma intercorrência clínica ou obstétrica e apresentavam algum antecedente pessoal de risco na gestação atual aumentaram a chance de terem HPP. Conclusão A HPP associou-se à primiparidade, antecedentes pessoais de risco, como Síndromes hipertensivas na gestação, e intercorrências clínicas/obstétricas na gestação atual. Considerando o potencial impacto da HPP na mortalidade materna, tais achados reforçam a importância da detecção precoce e da identificação dos fatores associados a HPP, além da estratificação de risco.

RESUMO Objetivos: avaliar os perfis de intervenções obstétricas durante a pandemia da COVID-19 em hospitais públicos de Belo Horizonte, Minas Gerais, Brasil. Métodos: estudo observacional, com delineamento transversal, aninhado a uma coorte, incluindo 1.717 puérperas. Para identificar os perfis das práticas obstétricas, procedeu-se à técnica de Análise de Componentes Principais. Resultados: geraram-se perfis divergentes de coexistência de intervenções obstétricas em mulheres com perfis obstétricos análogos. Tendo em vista que as mulheres pertencentes aos perfis formados tenderam a receber o mesmo conjunto de intervenções, concluiu-se que os resultados formaram três tipos de perfil, os quais podem ter sido influenciados pelo contexto da COVID-19. Conclusões: os achados deste estudo demonstram a necessidade de melhorar a assistência ao trabalho de parto e ao nascimento, visando à promoção da autonomia, do protagonismo e do bem-estar das parturientes. Tal procedimento pode ser determinante nos desfechos materno-infantis monitorados pelo programa Objetivos de Desenvolvimento Sustentável.

Objectives: to assess the profiles of obstetric interventions during the COVID-19 pandemic in public hospitals in Belo Horizonte, Minas Gerais, Brazil. Methods: an observational study, with a cross-sectional design, nested in a cohort, including 1,717 postpartum women. To identify the profiles of obstetric practices, the Principal Component Analysis technique was used. Results: divergent profiles of coexistence of obstetric interventions were generated in women with similar obstetric profiles. Given that women belonging to the profiles formed tended to receive the same set of interventions, it was concluded that the results formed three types of profile, which may have been influenced by the context of COVID-19. Conclusions: the findings of this study demonstrate the need to improve care during labor and birth, aiming to promote autonomy, leading role and well-being of postpartum women. Such a procedure can be decisive in maternal and child outcomes monitored by the Sustainable Development Goals.

RESUMO Objetivo: Avaliar o impacto do projeto estadual de pesquisa-ação nas coberturas vacinais em crianças menores de dois anos no estado de Minas Gerais, segundo o porte dos municípios, comparando os anos de 2021 e 2022. Métodos: Estudo aninhado ao projeto estadual de pesquisa-ação, um ensaio clínico comunitário, do tipo antes-depois, realizado em 212 municípios do estado de Minas Gerais. Utilizou-se, neste estudo, dados secundários de Cobertura Vacinal (CV), Homogeneidade das Vacinas (HCV) e Proporção de Abandono (PA). Após a classificação de municípios por porte, e as taxas de cobertura vacinal serem classificadas de maneira equânime, foi realizada uma análise de dados secundários de 12 imunobiológicos indicados para a faixa etária em questão e de suas PAs. Resultados: Observou-se aumento na proporção de municípios classificados como de pequeno porte que atingiram a meta da cobertura vacinal estabelecida pelo Programa Nacional de Imunização (PNI), após a realização do projeto de pesquisa-ação. Houve aumento na proporção de municípios de pequeno porte classificados como de baixa PA para a vacina Rotavírus, na homogeneidade adequada da CV e na classificação de risco para risco muito baixo e risco baixo e médio, todos com diferença estatisticamente significativa. Conclusão: Houve influência do porte municipal na efetividade das ações aplicadas para aumento de cobertura vacinal, explicitando que a proposição de ações individualizadas para cada município é imprescindível para melhorar a cobertura vacinal.

Objective: To evaluate the impact of the state action-research project on vaccination coverage in children under two years of age in the state of Minas Gerais, according to the size of the municipalities, comparing the years 2021 and 2022. Methods: This is a study nested within the state action-research project, a before-after community clinical trial carried out in 212 municipalities in the state of Minas Gerais. This study used secondary data on Vaccination Coverage (VC), Homogeneity of Vaccines (HVC) and Abandonment rate of multi-dose vaccines. After classifying municipalities by size and vaccination coverage rates were equitably classified, an analysis of secondary data on 12 immunobiologicals indicated for the age group in question and their abandonment rate of multi-dose vaccines was carried out. Results: There was an increase in the proportion of municipalities classified as small that reached the vaccination coverage target set by the National Immunization Program (PNI) after the action-research project was carried out. There was an increase in the proportion of small municipalities classified as having a low abandonment rate for the rotavirus vaccine, in the adequate homogeneity of vaccination coverage and in the classification of risk as very low risk and low and medium risk, all with a statistically significant difference. Conclusion: There was an influence of municipal size on the effectiveness of the actions applied to increase vaccination coverage, explaining that proposing individualized actions for each municipality is essential to improve vaccination coverage.