Gerardo Martínez

Small for Dates: Evaluation of Different Diagnostic Methods

Ninety‐four high‐risk pregnancies were studied weekly in a prospective and longitudinal study. Uterine height, biparietal diameter (BPD), cranial perimeter (CrP) and abdominal perimeter (AbP) were measured. Amniotic fluid volume (AFV) was assessed. Of the sample selected, 58 neonates were appropriate for gestational age and 36 were small‐for‐date (17 symmetrical and 19 asymmetrical). The sensitivity values in diagnosis of small‐for‐dates were: 67% for BPD, 42% for CrP, 94% for AbP, 56% for Uterine Height and 28% for AFV. The specificity for the five variables ranged from about 91% to 100%. If we consider symmetrical and asymmetrical retardation separately, the sensitivity values for the former were: 94%, 77%, 100%, 77% and 24% for BPD, CrP, AbP, Uterine Height and AFV respectively. For symmetrical retardation, the sensitivity values were: 43%, 11%, 90%, 37% and 32% for BPD, CrP, AbP, Uterine Height and AFV respectively. The fetal cranial measurements were the only ones to demostrate a different pattern of evolution in symmetrical and asymmetrical small‐for‐dates. This is therefore a useful measurement in making a differential diagnosis between both retardations. The earliest diagnoses were made in the symmetrical small‐for‐date group.

Suction patterns in preterm infants

The suction pattern for breast and bottle feeding in two groups of preterm infants is described. The time elapsed between birth and the moment of suction was longer in preterm neonates born at lower gestational ages for both groups studied, breast and bottle fed (figure 1). The evolution of suckling in breastfeeding was analyzed in a composite study (longitudinal and transverse) in a group of 16 neonates starting from 32 weeks of gestation. The velocity of milk extraction during suckling varied with gestational age. It was uniform at lower gestational ages, then it became faster in the first minutes and at the 36th week, it was very similar to that of mature neonates (figure 2 and table I). The evaluation of bottle feeding was performed in a transverse study in 46 preterm neonates which had been exclusively bottle fed during 1 or 2 weeks. All of them had previously been fed using an orogastric tube. Nourishing time was shorter than in breastfeeding; the average duration was 3.7 minutes (table II). The greatest volume was ingested in the first minute, 40% (range between 44 and 25%) (figure 3). The frequency of suction did not change the duration of feeding, but it was found that the efficiency of suction (number of suctions to ingest 1 cc) was significantly lower in the first minute (Anova, p < 0.05) (figure 4).

Gestational syphilis and stillbirth in Latin America and the Caribbean.

To measure the association between gestational syphilis and stillbirth in Latin America and the Caribbean.

Maternal and congenital syphilis in selected Latin America and Caribbean countries: a multi-country analysis using data from the Perinatal Information System.

UNLABELLED Background Maternal syphilis has an important impact on reproductive health. In 2010, World Health Organization (WHO)/Pan American Health Organization (PAHO) member countries approved the Strategy and Plan of Action for Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis in the Americas by 2015. This paper aims to describe epidemiological and programmatic characteristics related to maternal and congenital syphilis in selected countries of Latin America and Caribbean for the period 2010-12. METHODS The report is based on a multi-country, quantitative and qualitative analysis from data collected from several sources, representing a compilation of country reports from nine countries as part of the 2012 mid-term evaluation of the Strategy. Data was collected based on standardised procedures at country level. RESULTS Results are variable among countries. All countries have a strategic national plan to eliminate congenital syphilis, with some distinct characteristics for each country. Protocols and guidelines for the management and treatment of maternal and congenital syphilis in all countries were updated between 2011 and 2013. A high rate of missing information for all countries for some indicators was noticed. CONCLUSIONS The main limitation of the analyses is the huge amount of missing data. Countries must continue to be supported to build capacity for collecting high-quality data on intervention coverage and inequities, and to use it as a basis for decisions about how best to reach women and children with interventions. A high level political commitment is necessary to put into practice the Regional Initiative to Eliminate Congenital Syphilis, with the support of Health Ministries.

Bases para el desarrollo e implementación de un modelo de información en salud de la mujer y perinatal orientado a la gestión en Latinoamérica

RESUMEN Objetivo El Sistema Informático Perinatal (SIP) ha marcado un hito en el uso de información sistematizada en la Región de las Américas. Lo que se ha aprendido ha contribuido al desarrollo de un modelo basado en un conjunto mínimo de indicadores (CMI). El objetivo del estudio fue describir el proceso histórico y metodológico de desarrollo, implementación y escalamiento territorial de un CMI para monitorizar y evaluar políticas, programas y servicios de salud de la mujer y perinatal orientado a la gestión (SIP-GESTIÓN). Métodos El estudio se llevó a cabo en dos etapas: 1) validación en cuatro fases de un CMI en una red de hospitales: a) construcción del modelo teórico de indicadores, b) implementación de la investigación operativa, c) selección final de indicadores, y d) definición de patrones de referencia, y 2) escalamiento territorial. Resultados Se identificaron 17 modelos de indicadores. El modelo inicial incluyó 177 indicadores agrupados en siete dimensiones (contexto, hábitos, accesibilidad, uso de servicios, calidad de cuidados, impacto materno-fetal, e impacto materno-neonatal) que se redujeron a 21 tras tres rondas Delphi. El modelo final (SIP-GESTIÓN) incluyó 40 indicadores. Se analizaron 240 021 partos (79,1%) de un total de 303 559 atendidos en las 122 maternidades seleccionadas en 24 Jurisdicciones (100%) de Argentina. La información se presenta a nivel nacional y desagregada por región sanitaria, provincia y hospital. Conclusiones Este modelo permitió alcanzar altos niveles de cobertura y calidad de la información y escalamiento territorial y es útil para la gestión, la investigación y la reorientación de programas y políticas.Objective The Perinatal Information System (SIP) represents a milestone in the use of systematized information in the Region of the Americas. What has been learned from the system has contributed to the development of a model based on a set of core indicators (SCI). The objective of the study was to describe the historical and methodological process involved in the development, implementation, and territorial scaling-up of an SCI to monitor and evaluate womens and perinatal health policies, programs, and services geared to management (SIP-GESTIÓN). Methods The study was conducted in two stages: 1) a four-phase validation of an SCI in a hospital network: a) construction of the theoretical indicator model, b) operations research, c) final selection of the indicators, and d) the definition of reference standards; and 2) territorial scaling-up. Results A total of 17 indicator models were identified. The initial model included 177 indicators divided into seven dimensions (context, habits, accessibility, use of services, quality of care, maternal and fetal impact, and maternal and neonatal impact), with 21 indicators remaining after three Delphi rounds. The final model (SIP-GESTIÓN), which included 40 indicators, was then used to study 240,021 (79.1%) of the 303,559 deliveries attended in 122 selected maternity facilities in 24 jurisdictions (100%) in Argentina. The information is presented in national terms and by health region, province, and hospital. Conclusions This model has made it possible to achieve high levels of information coverage and quality and territorial scaling-up and is useful for management, research, and the reorientation of programs and policies.

Exploring the Concept of Degrees of Maternal Morbidity as a Tool for Surveillance of Maternal Health in Latin American and Caribbean Settings

Objectives To assess a birth registry to explore maternal mortality and morbidity and their association with other factors. Study Design Exploratory multicentre cross-sectional analysis with over 700 thousand childbirths from twelve Latin American and Caribbean countries between 2009 and 2012. The WHO criteria for maternal morbidity were employed to split women, following a gradient of severity of conditions, into (1) maternal death (MD); (2) maternal near miss (MNM); (3) potentially life-threatening conditions (PLTC); (4) less severe maternal morbidity (LSMM); (5) any maternal morbidity; and (6) women with no maternal morbidity. Their prevalence and estimated risks of adverse maternal outcomes were assessed. Results 712,081 childbirths had a prevalence of MD and MNM of 0.14% and 3.1%, respectively, while 38% of women had experienced morbidity. Previous maternal morbidity was associated with higher risk of adverse maternal outcomes and also the extremes of reproductive ages, nonwhite ethnicity, no stable partner, no prenatal care, smoking, drug and alcohol use, elective C-section, or induction of labour. Poorer perinatal outcomes were proportional to the severity of maternal outcomes. Conclusions The findings corroborate WHO concept regarding continuum of maternal morbidity, reinforcing its importance in preventing adverse maternal outcomes and improving maternal healthcare in different settings.