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Soeiro RE, Souza RT, Bento SF, Cecatti JG, Surita FG, Freitas-Jesus JV, Pacagnella RC, Ribeiro-Do-Valle CC, Luz AG, Lajos GJ, Nobrega GM, Griggio TB, Charles CM, Silveira C, Miele MJ, Tedesco RP, Fernandes KG, Martins-Costa SH, Peret FJ, Feitosa FE, Traina E, Cunha Filho EV, Vettorazzi J, Haddad SM, Andreucci CB, Guida JP, Correa Junior MD, Dias MA, Oliveira LG, Melo Junior EF, Luz MGDA, Costa ML. The experience of pregnant women and their families who were infected with covid-19 before vaccination: A qualitative approach within a multicenter study in Brazil. Midwifery 2024; 135:104018. [PMID: 38729000 DOI: 10.1016/j.midw.2024.104018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 06/21/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Pregnant and postpartum women infected by COVID-19 are at increased risk of adverse outcomes, including negative effects on their mental health. Brazilian maternal mortality rate due to COVID-19 is 2.5 times higher than overall mortality rates. This study aimed to understand how pregnant/postpartum women experienced the COVID-19 suspicion/investigation or confirmed infection in different Brazilian cities, the pandemic's consequences to women and their families, and their needs to improve maternal health services during public health emergencies. METHODS We conducted a qualitative study with 27 women with COVID-19 and 6 of their family members, as part of a multicenter study among 15 maternity hospitals in Brazil. We applied in-depth interviews through telephone calls when women received the diagnostic or had a suspect infection and after 60 days. Another semi-structured interview was applied to their close family members. The interviews were considered through thematic analysis. RESULTS From the thematic content analysis three major themes emerged from the first and second interviews: (Cucinotta and Vanelli, 2020) assistance received by the woman and newborn in the medical services; (World Health Organization (WHO) 2021) stigma/fear of contamination from health workers and from family and friends reported by the women; (Allotey et al., 2020) the COVID-19 pandemic impact. CONCLUSION Before the availability of the COVID-19 vaccine, pregnant women experienced fear of death, hospitalization, quarantine, loss of family members, and financial repercussions, resulting in physical, psychological, and socioeconomic impacts on these women's lives.
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Affiliation(s)
- Rachel E Soeiro
- 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.
| | - Silvana F Bento
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Fernanda G Surita
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | | | - Rodolfo C Pacagnella
- 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
| | - Giuliane J Lajos
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Guilherme M Nobrega
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Thayna B Griggio
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Charles M Charles
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Carla Silveira
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Maria J Miele
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | | | | | | | | | | | - Evelyn Traina
- Federal University of São Paulo - UNIFESP/EPM, São Paulo, SP, Brazil
| | | | - Janete Vettorazzi
- Clinics Hospital of Porto Alegre, Porto Alegre, RS, Brazil; Moinhos de Vento Hospital - HMV, Porto Alegre, RS, Brazil
| | - Samira M Haddad
- Jorge Rossmann Regional Hospital - Sócrates Guanaes Institute, Itanhaém, SP, Brazil
| | | | | | | | - Marcos Ab Dias
- Fernandes Figueira Institute - IFF/Fiocruz, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Maria Laura Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
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Sardinha TG, Lajos GJ, Souza RT, Cecatti JG, Luz AG, Oppermann MLR, Pacagnella RC, Ribeiro-Do-Valle CC, Nobrega GM, Griggio TB, Charles CM, Silveira C, Miele MJ, Tedesco RP, Fernandes KG, Martins-Costa SH, Peret FJ, Feitosa FE, Traina E, Cunha Filho EV, Vettorazzi J, Haddad SM, Candreucci CB, Guida JP, Correa Junior MD, Dias MA, Oliveira LG, Melo Junior EF, Da Luz MG, Costa ML. The effect of body mass index on maternal and perinatal outcomes in COVID-19 infection during pregnancy and postpartum: Secondary analysis from the REBRACO cohort study. Int J Gynaecol Obstet 2024; 164:1019-1027. [PMID: 38009566 DOI: 10.1002/ijgo.15250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES To compare maternal and perinatal outcomes among women with obesity, overweight, and normal body mass index, associated with COVID-19 infection during pregnancy and postpartum. METHOD Prospective Cohort Study, within the REBRACO (Brazilian Network of COVID-19 in Pregnancy) multicenter initiative. Confirmed positive cases of SARS-CoV-2 were included, and women categorized into three groups according to their pre-pregnancy BMI: obesity (BMI ≥ 30), overweight (BMI <30 but >25), and normal BMI. Sociodemographic, clinical, and obstetric characteristics and different maternal and perinatal outcomes were compared, and a multiple regression analysis was performed to investigate factors independently associated with adverse maternal and perinatal outcomes. RESULTS Two hundred eighty-nine women positive for SARS-CoV-2 infection were considered, and 202 had available data on maternal BMI for the current analysis. Overall, 72 (35.6%)obese, 68 (33.6%) overweight, and 60 (29.7%) normal BMI. Obesity was associated with increased adverse clinical outcomes including sepsis (P = 0.02), acute respiratory distress syndrome (P = 0.002), and the need for mechanical ventilation (P = 0.044). Considering perinatal outcomes, a multiple regression model confirmed obesity as an independent factor associated with adverse results (adjusted odds ratio 3.73, 95% CI 1.54-9.08). CONCLUSION Obesity and overweight were associated with worse clinical outcomes, severe/critical COVID-19, and adverse perinatal outcomes.
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Affiliation(s)
- Thais G Sardinha
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Giuliane J Lajos
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Adriana G Luz
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Carolina C Ribeiro-Do-Valle
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Guilherme M Nobrega
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Thayna B Griggio
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Charles M Charles
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Carla Silveira
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Maria J Miele
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | | | | | | | | | - Evelyn Traina
- Federal University of São Paulo-UNIFESP/EPM, São Paulo, São Paulo, Brazil
| | | | - Janete Vettorazzi
- Clinics Hospital of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Moinhos de Vento Hospital-HMV, Porto Alegre, Brazil
| | - Samira M Haddad
- Jorge Rossmann Regional Hospital-Sócrates Guanaes Institute, Itanhaém, São Paulo, Brazil
| | | | - José P Guida
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Sumaré State Hospital-HES, Sumaré, São Paulo, Brazil
| | | | - Marcos Ab Dias
- Fernandes Figueira Institute-IFF/Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leandro G Oliveira
- São Paulo State University School of Medicine, Botucatu, São Paulo, Brazil
| | | | | | - Maria Laura Costa
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Guida JP, Cecatti JG, Souza RT, Pacagnella RC, Ribeiro-do-Valle CC, Luz AG, Lajos GJ, Surita FG, Nobrega GM, Griggio TB, Charles CM, Miele MJ, Ferreira SB, Tedesco RP, Fernandes KG, Martins-Costa SH, Ramos JG, Peret FJ, Feitosa FE, Traina E, Cunha Filho EV, Vettorazzi J, Haddad SM, Andreucci CB, Correa Junior MD, Mayrink J, Dias MA, Oliveira LG, Melo Junior EF, da Luz MG, Costa ML. Preeclampsia among women with COVID-19 during pregnancy and its impact on maternal and perinatal outcomes: results from a national multicenter study on COVID in brazil, the REBRACO initiative. Pregnancy Hypertens 2022; 28:168-173. [PMID: 35568019 PMCID: PMC9085347 DOI: 10.1016/j.preghy.2022.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 04/09/2022] [Accepted: 05/05/2022] [Indexed: 12/31/2022]
Abstract
Objective To evaluate the prevalence of preeclampsia among cases of COVID-19 infection during pregnancy and the association between both conditions, in a multicenter cohort of Brazilian women with respiratory symptoms. Study design Ancillary analysis of the Brazilian Network of COVID-19 in Obstetrics (REBRACO) study. We performed a nested case-control analysis selecting all women with COVID-19 and compared outcomes between women with and without PE. Main outcomes Maternal, gestational, and clinical characteristics and perinatal outcomes. Measures Prevalence ratio (PR) and its 95%CI for each of the predictors and outcomes. Results A total of 203 women were included: 21 (10.3%) in PE group and 182 (89.7%) in non-PE group. Preeclampsia was not different among women with and without COVID-19 (10.3% vs 13.1%, p-value = 0.41), neither complication such as eclampsia and HELLP syndrome. Chronic hypertension (33.4%) (p < 0.01) and obesity (60.0%) (p = 0.03) were the most frequent comorbidities in PE group, and they were significantly more frequent in this group. Women with PE had more cesarean section (RR 5.54 [1.33 – 23.14]) and their neonates were more frequently admitted to neonatal intensive care unit (PR 2.46[1.06 – 5.69]), most likely due to preterm-birth-related complications. Conclusion The prevalence of PE among women with COVID-19 infection during pregnancy was around 10%; women with COVID-19 and a history of chronic hypertension or obesity are more likely to have preeclampsia. Cesarean section is increased among women with PE and COVID-19, with increased rates of neonatal admission to intensive care units, mostly due to prematurity.
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Costa ML, Souza RT, Pacagnella RC, Bento SF, Ribeiro-do-Valle CC, Luz AG, Lajos GJ, Mazon SB, Bahamondes L, Surita FG, Nobrega GM, Griggio TB, Charles CM, Miele MJ, Tedesco RP, Fernandes KG, Martins-Costa S, Peret FJ, Feitosa FE, Mattar R, Traina E, Cunha Filho EV, Vettorazzi J, Haddad SM, Andreucci CB, Guida JP, Correa Junior MD, Dias MAB, Oliveira LG, Melo Junior EF, Menezes CA, Luz MG, Cecatti JG. Brazilian network of COVID-19 during pregnancy (REBRACO: a multicentre study protocol). BMJ Open 2021; 11:e051284. [PMID: 34921076 PMCID: PMC8685531 DOI: 10.1136/bmjopen-2021-051284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the clinical, epidemiological and laboratory aspects of SARS-CoV-2 infection during pregnancy and postpartum in 16 maternity hospitals. METHODS AND ANALYSIS A prospective multicentre study, with five axes. First, the prevalence of SARS-CoV-2 infection among women admitted for childbirth will be described in a cross-sectional study. Second, maternal and perinatal outcomes will be assessed in a prospective cohort study including pregnant or postpartum women with suspected COVID-19. Third, a cohort of positive COVID-19 cases with sampling of a variety of biological material. Histopathological and viral analysis of biological maternal and neonatal samples will be performed, and the assessment of nutritional variables to evaluate the association between vitamin D and severity of infection. Fourth, a monitoring and evaluation committee to collect relevant healthcare information and plan actions in centres facing the pandemic. Furthermore, qualitative studies will be performed to study pregnant women, their families and health professionals. Fifth, an ecological study will monitor the number of live births, stillbirths and other outcomes to explore any trend among the periods before, during and after the pandemic. Data will systematically be collected in an electronic platform following standardised operational procedures. For quantitative study components, an appropriate statistical approach will be used for each analysis. For qualitative data, in-depth interviews recorded in audio will be transcribed, checking the text obtained with the recording. Subsequently, thematic analysis with the aid of the NVivo programme will be performed. ETHICS AND DISSEMINATION Ethical approval was obtained (letters of approval numbers 4.047.168, 4.179.679 and 4.083.988). All women will be fully informed to sign the consent form before enrolment in the study. Findings will be disseminated through peer-reviewed journals and scientific conferences.
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Affiliation(s)
- Maria Laura Costa
- School of Medical Sciences. Department of Obstetrics and Gynaecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynaecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynaecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Silvana F Bento
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Carolina C Ribeiro-do-Valle
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Adriana G Luz
- Obstetrics and Gineacology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Giuliane J Lajos
- Obstetrics and Gineacology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Silvia B Mazon
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Fernanda G Surita
- Obstetrics and Gyneacology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Guilherme M Nobrega
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Thayna B Griggio
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Charles M'poca Charles
- Department of Obstetrics and Gynaecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Maria J Miele
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Ricardo P Tedesco
- Department of Obstetrics and Gynecology, Faculdade de Medicina de Jundiai, Jundiai, Brazil
| | - Karayna G Fernandes
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
- Department of Obstetrics and Gynecology, Faculdade de Medicina de Jundiai, Jundiai, Brazil
| | - Sergio Martins-Costa
- Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Frederico Ja Peret
- Department of Obstetrics and Gynecology, Unimed Belo Horizonte, Belo Horizonte, Brazil
| | - Francisco E Feitosa
- Department of Obstetrics and Gynecology, Sociedade de Assistencia a Maternidade Escola Assis Chateaubriand, Fortaleza, Brazil
| | - Rosiane Mattar
- Department of Obstetrics and Gynecology, UNIFESP, Sao Paulo, Brazil
| | - Evelyn Traina
- Department of Obstetrics and Gynecology, UNIFESP, Sao Paulo, Brazil
| | - Edson V Cunha Filho
- Department of Obstetrics and Gynecology, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Janete Vettorazzi
- Department of Obstetrics and Gynecology, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Samira M Haddad
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | | | - José Paulo Guida
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | | | | | - Leandro G Oliveira
- Department of Obstetrics and Gynecology, UNESP Campus de Botucatu, Botucatu, Brazil
| | | | - Carlos As Menezes
- Obstetrics and Gyneacology, Salvador University, Salvador, BA, Brazil
| | | | - Jose Guilherme Cecatti
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
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V Cunha Filho E, Picolli JF, Miotto R, Barth MB, Silva Neto P, Antônio P Soares J, Raupp GS, Paula S Goulart A, de Sá CN, Arlindo EM. P-083. Aortic Dissection during pregnancy: A case report. Pregnancy Hypertens 2021. [DOI: 10.1016/j.preghy.2021.07.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Costa ML, Souza RT, Pacagnella RC, Bento SF, Ribeiro-do-Valle CC, Luz AG, Lajos GJ, Nobrega GM, Griggio TB, Charles CM, Tedesco RP, Fernandes KG, Martins-Costa SHA, Peret FJA, Feitosa FE, Mattar R, Cunha Filho EV, Vetorazzi J, Haddad SM, Andreucci CB, Guida JP, Correa Junior MD, Dias MAB, Oliveira LG, Melo Junior EF, Menezes CAS, Luz MGQ, Cecatti JG. Facing the COVID-19 pandemic inside maternities in Brazil: A mixed-method study within the REBRACO initiative. PLoS One 2021; 16:e0254977. [PMID: 34297740 PMCID: PMC8301675 DOI: 10.1371/journal.pone.0254977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 07/07/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION COVID-19 pandemic posed major challenges in obstetric health care services. Preparedness, development, and implementation of new protocols were part of the needed response. This study aims to describe the strategies implemented and the perspectives of health managers on the challenges to face the pandemic in 16 different maternity hospitals that comprise a multicenter study in Brazil, called REBRACO (Brazilian network of COVID-19 during pregnancy). METHODS Mixed-method study, with quantitative and qualitative approaches. Quantitative data on the infrastructure of the units, maternal and perinatal health indicators, modifications on staff and human resources, from January to July/2020. Also, information on total number of cases, and availability for COVID-19 testing. A qualitative study by purposeful and saturation sampling was undertaken with healthcare managers, to understand perspectives on local challenges in facing the pandemic. RESULTS Most maternities early implemented their contingency plan. REBRACO centers reported 338 confirmed COVID-19 cases among pregnant and post-partum women up to July 2020. There were 29 maternal deaths and 15 (51.8%) attributed to COVID-19. All maternities performed relocation of beds designated to labor ward, most (75%) acquired mechanical ventilators, only the minority (25%) installed new negative air pressure rooms. Considering human resources, around 40% hired extra health professionals and increased weekly workload and the majority (68.7%) also suspended annual leaves. Only one center implemented universal screening for childbirth and 6 (37.5%) implemented COVID-19 testing for all suspected cases, while around 60% of the centers only tested moderate/severe cases with hospital admission. Qualitative results showed that main challenges experienced were related to the fear of the virus, concerns about reliability of evidence and lack of resources, with a clear need for mental health support among health professionals. CONCLUSION Study findings suggest that maternities of the REBRACO initiative underwent major changes in facing the pandemic, with limitations on testing, difficulties in infrastructure and human resources. Leadership, continuous training, implementation of evidence-based protocols and collaborative initiatives are key to transpose the fear of the virus and ascertain adequate healthcare inside maternities, especially in low and middle-income settings. Policy makers need to address the specificities in considering reproductive health and childbirth during the COVID-19 pandemic and prioritize research and timely testing availability.
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Affiliation(s)
- Maria Laura Costa
- 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
| | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
| | - Silvana F Bento
- 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
| | - Giuliane J Lajos
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
| | - Guilherme M Nobrega
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
| | - Thayna B Griggio
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
| | - Charles M Charles
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
| | | | | | | | | | | | - Rosiane Mattar
- Universidade Federal de São Paulo UNIFESP/EPM, São Paulo/SP, Brazil
| | | | - Janete Vetorazzi
- Hospital das Clínicas de Porto Alegre, Porto Alegre/RS, Brazil
- Hospital Moinhos de Vento-HMV, Porto Alegre/R, Brazil
| | - Samira M Haddad
- Hospital Regional Jorge Rossmann Instituto Sócrates Guanaes, Itanhaém/SP, Brazil
| | | | | | | | - Marcos A B Dias
- Instituto Fernandes Figueira IFF/Fiocruz, Rio de Janeiro/RJ, Brazil
| | - Leandro G Oliveira
- Faculdade de Medicina da Universidade Estadual de São Paulo, Botucatu/SP, Brazil
| | | | | | | | - Jose G Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
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