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Introduction:: There was a left-shift on the distribution curve of gestational age (GA) and a reduction of the proportion of live births of 40 weeks, when compared to the expected standard in many countries., Objective:: To study the distribution of gestational age births in São Paulo city (SP) and its relationship with the type of hospital and delivery., Methods:: Data were extracted from Live Birth Information System (SINASC) linked to the National Database of Health Establishments (CNES) in 2013 and 2014. Data are presented according to birth in public (SUS) and private (non SUS) hospitals, type of delivery and gestational age, standardized according to the mother's age., Results:: There was a left-shift in GA curve for total births which was more pronounced among cesarean births and private hospitals. The median GA of public hospitals was 39 weeks, while in the private hospitals, 38 weeks. The proportion of preterm births (9,5%) was similar in public and private hospitals, but among public hospital there was a higher proportion of very preterm births (<32 weeks), while (34-36) in private hospitals late preterm and early term were more frequent., Conclusions:: The change in the distribution of gestational age in SP is related to the type of hospital and the proportion of cesarean sections in private hospitals.

Background: There is a global growing trend of preterm births and a decline trend of fetal deaths. Is there an impact of the decline of fetal mortality on the increase of preterm live births in State of Sao Paulo, Brazil?, Methods: The time trends were evaluated by gestational age through exponential regression analysis. Data analyzed included the fetal mortality ratio, proportion of preterm live births, fertility rate of women 35 years and over, prenatal care, mother's education, multiple births and cesarean section deliveries. A survival analysis was carried out for 2000 and 2010., Results: Preterm births showed the highest annual increase (3.2%) in the less than 28 weeks of gestation group and fetal mortality ratio decreased (7.4%) in the same gestational age group. There was an increase of cesarean section births and it was higher in the < 28 weeks group (6.1%). There was a decreased annual trend of mothers with inadequate prenatal care (6.1%) and low education (8.8%) and an increased trend in multiple births and fertility rates of women of 35 years and over. The variables were highly correlated to which other over time. In 2000, 8.2% of all pregnancies resulted in preterm births (0.9% in fetal deaths and 7.3% in live births). In 2010, the preterm birth increased to 9.4% (0.8% were preterm fetal deaths and 8.6% preterm live births)., Conclusions: The results suggest that 45.2% could be the maximum contribution of successful interventions to prevent a fetal death on the increase in preterm live births. This increasing trend is also related to changes of the women reproductive profile with the change of the women reproductive profile and access to prenatal care.

Introduction: We have previously shown that long-term type 1 diabetes affects the structural organization, contractile apparatus and extracellular matrix (ECM) of the myometrium during early pregnancy in mice., Objective: This study aimed to identify which myometrial ECM components are affected by diabetes, including fibril-forming collagen types I, III and V, as well as proteoglycans, decorin, lumican, fibromodulin and biglycan., Methods: Alloxan-induced type 1 diabetic female mice were divided into subgroups D1 and D2, formed by females that bred 90-100 and 100-110 days after diabetes induction, respectively. The deposition of ECM components in the myometrium was evaluated by immunohistochemistry/immunofluorescence., Results: The subgroup D1 showed decreased deposition of collagen types I and III in the external muscle layer (EML) and decreased collagen types III and V in the internal muscle layer (IML). Collagen types I and III were decreased in both muscle layers of the subgroup D2. In addition, increased deposition of collagen types I and III and lumican as well as decreased collagen type V were observed in the connective tissue between muscle layers of D2. Lumican was decreased in the EML of the subgroups D1 and D2. Fibromodulin was repressed in the IML and EML of both D1 and D2. In contrast, decorin deposition diminished only in muscle layers of D2. No changes were noticed for biglycan., Conclusions: Subgroups D1 and D2 showed distinct stages of progression of diabetic complications in the myometrium, characterized by both common and specific sets of changes in the ECM composition.

Introduction: The insatisfactory completeness of the variables in the Death Certificate (DC) makes it difficult to obtain specific perinatal mortality indicators., Objective: To assess the social representation of physicians about the perinatal DC., Methods: Twenty-five physicians were interviewed in 15 hospitals in the city of São Paulo, in 2009. Qualitative analysis was performed with the Collective Subject Discourse technique., Results: The DC is primarily considered according to its legal aspect. Physicians feel responsible for fulfilling the cause of death. The majority of them reported receiving help from other professionals to complete information on maternal characteristics and identification variables. There is lack of information on the mother's pre-natal conditions, which can make it difficult to identify the perinatal cause of death, mainly in the Unified Health System (SUS) hospitals. Some participants received specific DC training only when attending medical schools., Conclusions: The organization of medical work may affect the completion of the DC, especially in hospitals from SUS. Other professionals contributed to this task and their training can improve the quality of information.

Few studies have analyzed the SINASC (Live Birth Information System) and MIS (Mortality Information System) applying qualitative methodology seeking to understand data production processes and contexts. This article aims to study the social representation of health professionals about Live Birth Certificates (LBC) and perinatal Death Certificates (DC). A total of 24 interviews were conducted with nurses and other professionals of 16 Unified Health System (SUS) and non-SUS hospitals of the city of São Paulo in 2009. Qualitative methodology was adopted along with the Collective Subject Discourse technique. Professionals acknowledged that they are an integral part of the information production process of SINASC and their reports indicate that they incorporate it in their work routine. They also perceive that training activities are a tool to understand the information produced by them and are aware of the utility of LBC information. Although physicians are legally responsible for the DC, other professionals frequently provide some of the information to complete it. The professionals see themselves as participants of the SINASC. Despite providing information to complete the DC, they do not see themselves as participants of the MIS operation.

Objective: To evaluate the quality of information registered on fetal death certificates., Methods: Records were reviewed from 710 fetal deaths registered in the consolidated database of deaths from the State System for Data Analysis and the São Paulo State Secretary of Health, for deaths in São Paulo municipality (Southeastern Brazil) during the first semester of 2008. Completeness was analyzed for variables on fetal death certificates issued by hospitals and autopsy service. The death certificates from a sub-sample of 212 fetal deaths in hospitals of the National Unified Health System (public) were compared to medical records and to the records from Coroners Office., Results: Among death certificates, 75% were issues by Coroners Office, with a greater frequency in public hospitals (78%). Completeness of variables on death certificates issued by hospitals was higher among non-public hospitals. There was greater completeness, agreement and sensitivity in death certificates issued by hospitals. There was low agreement and high specificity for variables related to maternal characteristics. Increased reporting of gender, birth weight and gestational age was observed in certificates issued by Coroners Office. Autopsies did not result in improved ascertainment of cause of death, with 65.7% identified as unspecified fetal death as 24.3% as intrauterine hypoxia, while death certificates by hospitals reported 18.1% as unspecified and 41.7% as intrauterine hypoxia., Conclusions: Completeness and the ascertainment of cause of fetal death need to be improved. The high proportion of autopsies did not improve information and ascertainment of cause of death. The quality of information generated by autopsies depends on access to hospital records.

It is known that the development of diabetic complications in human pregnancy is directly related to the severity and the duration of this pathology. In this study, we developed a model of long-term type 1 diabetes to investigate its effects on the cytoarchitecture, extracellular matrix and cell proliferation during the first adaptation phase of the myometrium for pregnancy. A single dose of alloxan was used to induce diabetes in mice prior to pregnancy. To identify the temporal effects of diabetes the mice were divided into two groups: Group D1 (females that became pregnant 90-100 days after alloxan); Group D2 (females that became pregnant 100-110 days after alloxan). Uterine samples were collected after 168 h of pregnancy and processed for light and electron microscopy. In both groups the histomorphometric evaluation showed that diabetes promoted narrowing of the myometrial muscle layers which was correlated with decreased cell proliferation demonstrated by PCNA immunodetection. In D1, diabetes increased the distance between muscle layers and promoted oedema. Contrarily, in D2 the distance between muscle layers decreased and, instead of oedema, there was a markedly deposition of collagen in the myometrium. Ultrastructural analysis showed that diabetes affects the organization of the smooth muscle cells and their myofilaments. Consistently, the immunoreaction for smooth muscle α-actin revealed clear disorganization of the contractile apparatus in both diabetic groups. In conclusion, the present model demonstrated that long-term diabetes promotes significant alterations in the myometrium in a time-sensitive manner. Together, these alterations indicate that diabetes impairs the first phenotypic adaptation phase of the pregnant myometrium., (© 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.)