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In low and middle-income countries such as Brazil, most maternal deaths are related to hypertensive complications. Preeclampsia is the leading cause of maternal mortality and morbidity. Significant proportion is associated with the following factors: lack of identification of high-risk women, lack of adequate prevention, difficulty in maintaining a high-risk prenatal follow-up, delayed diagnosis, insecurity and low use of magnesium sulphate, delayed pregnancy interruption and lack of postpartum follow-up of these high-risk cases. Four major actions are proposed to minimize this alarming clinical picture and reduce the mortality rates due to preeclampsia, called the "4 P Rule" (Adequate Prevention - Vigilant Prenatal Care - Timely Delivery (Parturition) - Safe Postpartum). From this simple "rule" we can open a range of important processes and reminders that may help in the guidance of preeclampsia management., Competing Interests: Conflicts to interest: none to declare., (© 2024. Federação Brasileira de Ginecologia e Obstetrícia. All rights reserved.)

Competing Interests: None to declare.

Competing Interests: The authors have no conflict of interests to declare.

Competing Interests: None to declare.

Objective:  To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution., Methods:  Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327)., Results:  After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution 4 , the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%)., Conclusion:  Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes., Competing Interests: The authors have no conflict of interests to declare., (Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Objective:  To determine the indications and outcomes of peripartum hysterectomies performed at Hospital de Clínicas de Porto Alegre (a university hospital in Southern Brazil) during the past 15 years, and to analyze the clinical characteristics of the women submitted to this procedure., Methods:  A cross-sectional study of 47 peripartum hysterectomies from 2005 to 2019., Results:  The peripartum hysterectomies performed in our hospital were indicated mainly due to placenta accreta or suspicion thereof (44.7% of the cases), puerperal hemorrhage without placenta accreta (27.7%), and infection (25.5%). Total hysterectomies accounted for 63.8% of the cases, and we found no difference between total versus subtotal hysterectomies in the studied outcomes. Most hysterectomies were performed within 24 hours after delivery, and they were associated with placenta accreta, placenta previa, and older maternal age., Conclusion:  Most (66.0%) patients were admitted to the intensive care unit (ICU). Those who did not need it were significantly older, and had more placenta accreta, placenta previa, or previous Cesarean delivery., Competing Interests: The authors have no conflict of interests to declare., (Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Introduction: According to the International Urogynecological Association and International Continence Society people with normal pelvic floor muscle function should have the ability to voluntarily and involuntarily contract and relax these muscles. However, many women are unaware of their pelvic floor, and it is estimated that about 30-50% do not know how to actively contract these muscles. Within this context, therapeutic strategies to improve pelvic floor muscle strength and function are particularly relevant., Aims: To compare the use of an intravaginal vibratory stimulus (IVVS) versus intravaginal electrical stimulation (IVES) on pelvic floor muscle functionality in women with pelvic floor dysfunctions who cannot voluntarily contract these muscles., Materials and Methods: Randomized clinical trial performed at a tertiary care hospital from June 2016 to September 2017. The sample comprised adult women with pelvic floor dysfunction who were unable to contract their pelvic floor muscles voluntarily. Women with latex allergy or other allergies in the pelvic region, vaginal or urinary tract infection, gynecological cancer, significant pain on palpation, or pelvic floor training over the preceding 6 months were excluded. After baseline assessment, women that met the inclusion criteria were randomized to receive once-weekly 20-minute sessions of IVVS or IVES for 6 weeks., Results: Twenty-one women were randomly assigned to each group; 18 completed the IVVS and 17 completed the IVES protocols. The IVVS group presented a significant increase in PFM strength in relation to the IVES group (p = 0.026). There was a significant interaction between time and type of intervention for the same variable (p = 0.008) in the IVVS group., Conclusion: Both techniques were beneficial, but IVVS was significantly superior to IVES in improving pevic floor muscle strength. Additional studies are warranted to consolidate the utility of IVVS as a treatment modality for pelvic floor dysfunction.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Pre-eclampsia is a multifactorial and multisystemic disease specific to gestation. It is classically diagnosed by the presence of hypertension associated with proteinuria manifested in a previously normotensive pregnant woman after the 20 th week of gestation. Pre-eclampsia is also considered in the absence of proteinuria if there is target organ damage. The present review takes a general approach focused on aspects of practical interest in the clinical and obstetric care of these women. Thus, it explores the still unknown etiology, current aspects of pathophysiology and of the diagnosis, the approach to disease prediction, its adverse outcomes and prevention. Management is based on general principles, on nonpharmacological and on pharmacological clinical treatment of severe or nonsevere situations with emphasis on the hypertensive crisis and eclampsia. Obstetric management is based on preeclampsia without or with signs of clinical and/or laboratory deterioration, stratification of gestational age in < 24 weeks, between 24 and less than 34 weeks, and ≥ 34 weeks of gestation, and guidance on route of delivery. An immediate puerperium approach and repercussions in the future life of pregnant women who develop preeclampsia is also presented., Competing Interests: The present manuscript was prepared by members of the National Specialized Commission on Hypertension in the Gestation of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO, in the Portuguese acronym). The authors did not participate in the evaluation process, thereby respecting the evaluative ethical precepts of publication of scientific articles., (Thieme Publicações Ltda Rio de Janeiro, Brazil.)

The associations of Cesarean delivery with offspring metabolic and immune-mediated diseases are believed to derive from lack of mother-to-newborn transmission of specific microbes at birth. Bifidobacterium spp., in particular, has been hypothesized to play a health-promoting role, yet little is known about how delivery mode modifies colonization of the newborn by this group of microbes. The aim of this research was to examine the presence of Bifidobacterium in meconium and in the transitional stool, and to assess cytokine levels and hematological parameters in the venous cord blood of infants born by elective, pre-labor Cesarean section vs. vaginal delivery in Southern Brazil. We recruited 89 mother-newborn pairs (23 vaginal delivery and 66 elective cesarean delivery), obtained demographic information from a structured questionnaire and clinical information from medical records. We obtained umbilical cord venous blood and meconium samples following delivery and the transitional stool (the first defecation after meconium) before discharge. We determined plasma levels of IL-1β, IL-10, IL-6, GM-CSF, IL-5, IFN-γ, TNF-α, IL-2, IL-4 and IL-8 in the cord blood, and presence of stool Bifidobacterium by real time PCR. Compared to vaginally-delivered neonates, Cesarean-delivered neonates had a lower leukocyte count (p = 0.037), lower hemoglobin (p = 0.04), and lower levels of the cytokine GM-CSF (p = 0.009) in the cord blood. Moreover, Bifidobacterium was detected less often in the transitional stool of Cesarean-delivered neonates compared to vaginally-delivered neonates (p = 0.001). The results indicate that pre-labor Cesarean birth may be associated with microbial and hematological alterations in the neonate. The clinical significance of these findings remains to be determined in larger prospective birth cohort studies., Competing Interests: The authors have declared that no competing interests exist.

The authors review hypertensive disease during pregnancy with an academic and practical view, and using the best evidence available. This disease, which is the most important clinical disease in Brazilian pregnant women, may have its incidence reduced with prevention through the use of calcium and aspirin in pregnant women at risk. Previously, it was a disease that presented with hypertension with proteinuria, but it has now been classified with new clinical parameters besides proteinuria. Morbidity and mortality should be reduced in a continental country such as Brazil using protocols for the early treatment of complications by calculating severe outcomes in preeclampsia. The early treatment of acute hypertension, use of magnesium sulfate and early hospitalization in cases of preeclampsia are concepts to pursue the reduction of our pregnant women's mortality., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.)