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OBJECTIVE: To assess the incompleteness of the Robson Classification variables in the Live Birth Information System (Sistema de Informação sobre Nascidos Vivos - SINASC), in the state of Paraná, and its trend, 2014-2020. METHODS: This was a time-series study that analyzed six variables, according to health macro-regions. Incompleteness was classified (percentage of "ignored" and "blank fields") as follows: excellent (< 1.0%); good (1.0-2.9%); regular (3.0-6.9%); poor (≥ 7.0%). Prais-Winsten regression was used to estimate trends. RESULTS: A total of 1,089,116 births were evaluated. The variable "cesarean section before the onset of labor" was classified as poor in 2014 (39.4%) and 2015 (44.3%) in the state and in all macro-regions, but with a decreasing trend in incompleteness. The variables "gestational age" in the North and Northwest macro-regions, and "parity" and "number of fetuses" in the Northwest macro-region showed an increasing trend. CONCLUSION: Most of the variables evaluated showed low percentages of incompleteness with a decreasing trend, but there is a need to improve the completion of some variables.

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Abstract Objectives: to analyze the temporal trend in maternal, care and newborns characteristics, in the city of Guarapuava, Paraná, Brazil in the period of 2010 to 2019. Methods: ecological temporal tendency study is based on Sistema de Informações sobre Nascidos Vivos (Live Birth Information System). To verify changes on the topics, the Prais-Winsten generalized linear regression was applied. Results: data from 28,919 live births were analyzed in 2019, 15.9% of the pregnancies were adolescents, 49.8% were cesarean deliveries and 9.2% were premature childbirths. A reduction in teenage pregnancy was observed, with annual percentage variation (APV) for mothers aged ten to 14 being -0.14% (p=0.005) and 15 to 19 years old -0.82% (p=0.004); there was an increase in mothers' schooling, with an APV of 60.09% (p=0.026) for eight to 11 years of schooling and 11.27% (p<0.001) for 12 or more; there was an increase of 15.33% (p<0.001) for seven or more prenatal consultations and a decrease in the Apgar classifications considering the risk, with scores from zero to two in the 1st minute with an APV=-0.12 (p=0.010) and scores from three to five in the 5th minute with APV=-0.07 (p=0.011). Conclusions: The city of Guarapuava presents important decreased tendencies in early pregnancy and an increase in mothers' schooling, besides the changes regarding the conditions in which their children are born and how they are welcomed.

Resumo Objetivos: analisar a tendência temporal de características maternas, assistenciais e dos recém-nascidos do município de Guarapuava-PR no período de 2010 a 2019. Métodos: estudo ecológico de tendência temporal com dados do Sistema de Informações sobre Nascidos Vivos. Para verificar mudanças nas características avaliadas, utilizou-se regressão linear generalizada de Prais-Winsten. Resultados: analisaram-se dados de 28.919 nascidos vivos; em 2019, 15,9% das gestações foram de adolescentes, 49,8% dos partos cesáreos e 9,2% partos prematuros. Observou-se redução da gravidez na adolescência, com variação percentual anual (VPA) para mães com dez a 14 anos sendo -0,14% (p=0,005) e 15 a 19 anos -0,82% (p=0,004); aumento da escolaridade das mães, com VPA de 60,09% (p=0,026) para oito a 11 anos de estudo e 11,27% (p<0,001) para 12 ou mais; aumento de 15,33% (p<0,001) para sete ou mais consultas de pré-natal realizadas pelas gestantes e queda nas classificações de Apgar consideradas de risco, com notas zero a dois no 1º minuto com VPA=-0,12 (p=0,010) e notas três a cinco no 5º minuto com VPA=-0,07 (p=0,011). Conclusões: Guarapuava apresentou importantes tendências de redução da gravidez precoce e aumento de escolaridade das mães, além de mudanças sobre as condições em que nascem seus filhos e sobre como são acolhidos.

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This study aimed to evaluate the evolution of the completeness and consistency of the gastroschisis registry in the Brazilian Live Birth Information System (SINASC). It is a time-series study on the completeness of the variable "occurrence of congenital anomaly" and the consistency of gastroschisis diagnosis in SINASC, in biennia from 2005 to 2020, for federative units, region, and Brazil. The consistency was estimated by the ratio between deaths from gastroschisis registered in the Brazilian Mortality Information System (SIM) and the total number of cases recorded in SINASC. Temporal trend was analyzed by joinpoint regression. In the period, 46,574,995 live births and 10,024 cases of gastroschisis were recorded. A total of 5,632 infant deaths due to gastroschisis were identified. The percentage of incompleteness decreased from 6.52% to 1.87%, with an annual percentage variation (APV) of -14.5%, and completeness reached excellence (≤ 5% of incompleteness), except in the Central-West Region. Case/death ratios above 1 were found in the North and Northeast regions and in some federative units in the Central-West, but there was a decrease, approaching the mortality found in studies in the South and Southeast regions. Its reduction was more pronounced until 2009-2010 (APV = -10.7%) and smaller later (APV = -4.4%). The quality of the gastroschisis registry reflects regional differences in the overall quality of SINASC, constituting as a marker for malformations that require complex neonatal care.

O objetivo deste estudo foi avaliar a evolução da completude e da consistência do registro de gastrosquise no Sistema de Informações sobre Nascidos Vivos (SINASC) no Brasil. Trata-se de estudo de série temporal sobre a completude da variável "ocorrência de anomalia congênita" e a consistência do diagnóstico de gastrosquise no SINASC, nos biênios entre 2005 e 2020, para Unidades da Federação, região e Brasil. A consistência foi estimada pela razão entre óbitos por gastrosquise registrados no Sistema de Informações sobre Mortalidade (SIM) e o total de casos registrados no SINASC. A tendência temporal foi analisada por regressão joinpoint. No período, havia registro de 46.574.995 nascidos vivos e 10.024 casos de gastrosquise entre eles. Identificamos 5.632 óbitos infantis por gastrosquise. O percentual de incompletude diminuiu de 6,52% para 1,87%, com variação percentual anual (VPA) de -14,5%, e a completude atingiu a excelência (≤ 5% de incompletude), exceto no Centro-oeste do país. Razão óbito/caso acima de 1 foi encontrada nas regiões Norte e Nordeste e em alguns estados do Centro-oeste, mas houve diminuição, aproximando-se da mortalidade encontrada em estudos no Sul e Sudeste. Sua redução foi mais acentuada até 2009-2010 (VPA = -10,7%) e menor posteriormente (VPA = -4,4%). A qualidade do registro de gastrosquise reflete as diferenças regionais da qualidade geral do SINASC, configurando-se uma condição marcadora para malformações que demandam atenção neonatal complexa.

El objetivo de este estudio fue evaluar la evolución de la completitud y consistencia del registro de la gastrosquisis en el Sistema de Información de los Nacidos Vivos (SINASC) en Brasil. Se trata de un estudio de serie temporal sobre la completitud de la variable "aparición de anomalía congénita" y la consistencia del diagnóstico de gastrosquisis en el SINASC, en los bienios entre 2005 y 2020, en estados, regiones y Brasil. La consistencia se estimó por la razón entre las defunciones por gastrosquisis registradas en el Sistema de Información de Mortalidad (SIM) y el total de casos inscritos en el SINASC. La tendencia temporal se analizó mediante regresión joinpoint. Durante el período, hubo 46.574.995 nacidos vivos y 10.024 casos de gastrosquisis entre ellos. Identificamos 5.632 muertes infantiles por gastrosquisis. El porcentaje de incompletitud disminuyó de 6,52% a 1,87%, con una variación porcentual anual (VPA) de -14,5%, y la completitud alcanzó la excelencia (≤ 5% de incompletitud), excepto en la región Centro-oeste del país. Se encontró una relación defunciones/caso superior a 1 en las regiones Norte y Nordeste y en algunos estados del Centro-oeste, pero hubo una disminución, acercándose a la mortalidad encontrada en estudios en el Sur y Sudeste. Su reducción fue más pronunciada hasta 2009-2010 (VPA = -10,7%) y después menor (VPA = -4,4%). La calidad del registro de gastrosquisis refleja diferencias regionales relacionadas con la calidad general del SINASC, configurando una condición manifiesta de malformaciones que demandan cuidados neonatales complejos.

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Objective: to analyze the trend of incompleteness of the maternal schooling and race/skin color variables held on the Brazilian Live Birth Information System (SINASC) between 2012 and 2020. Methods: this was an ecological time series study of the incompleteness of maternal schooling and race/skin color data for Brazil, its regions and Federative Units, by means of joinpoint regression and calculation of annual percentage change (APC) and average annual percentage change. Results: a total of 26,112,301 births were registered in Brazil in the period; incompleteness of maternal schooling data decreased for Brazil (APC = -8.1%) and the Southeast (APC = -19.5%) and Midwest (APC = -17.6%) regions; as for race/skin color, there was a downward trend for Brazil (APC = -8.2%) and all regions, except the Northeast region, while nine Federative Units and the Federal District showed a stationary trend. Conclusion: there was an improvement in filling out these variables on the SINASC, but with regional disparities, mainly for race/skin color.

Objetivo: analizar la tendencia de incompletitud de educación y raza/color de piel materna en el Sistema de Información de Nacidos Vivo (Sinasc), Brasil, entre 2012-2020. Métodos: estudio ecológico de serie temporal sobre la incompletitud de la educación y raza/color de piel materna para Brasil, regiones y Unidades de la Federación (UF), a través de regresión de joinpoint y cálculo de cambio porcentual anual (APC) y cambio porcentual anual promedio Resultados: se registraron 26.112.301 nacimientos en Brasil en el período. Brasil (APC = -8,1%) y regiones Sudeste (APC = -19,5%) y Centro-Oeste (APC = -17,6%) disminuirán la incompletud de la educación materna. En cuanto a raza/color de piel, hubo un descenso para Brasil (APC = -8,2%) y todas las regiones, excepto Nordeste, y nueve UF y Distrito Federal presentaron tendencia estacionaria. Conclusión: e llenado das variables en el Sinasc ha mejorado, pero con disparidades regionales, principalmente por raza/color de piel.

Objetivo: analisar a tendência da incompletude das variáveis escolaridade e raça/cor da pele da mãe no Sistema de Informações sobre Nascidos Vivos (Sinasc), Brasil, entre 2012 e 2020. Métodos: estudo ecológico de série temporal sobre a incompletude da escolaridade e da raça/cor da pele da mãe para o Brasil, suas macrorregiões e Unidades da Federação, pela regressão por joinpoint, e cálculo da variação percentual anual (VPA) e da variação percentual anual média. Resultados: foram registrados 26.112.301 nascimentos no Brasil, no período; no país (VPA = -8,1%) e em suas regiões Sudeste (VPA = -19,5%) e Centro-Oeste (VPA = -17,6%), houve redução da incompletude da escolaridade materna; quanto à raça/cor da pele da mãe, observou-se queda para o Brasil (VPA = -8,2%) e todas as suas regiões, exceto o Nordeste, e nove UFs e o Distrito Federal com tendência estável. Conclusão: o preenchimento das variáveis no Sinasc melhorou, porém com disparidades regionais, principalmente quanto à raça/cor da pele.

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Objective: To describe the national by federal entity prevalence of the nutritional status of weight and length at birth. Materials and Methods: Cross-sectional descrip­tive study. Data from 1 907 341 alive newborns in 2017, registered in the Subsistema de Información sobre Nacimientos (Sinac), were analyzed. The percentiles for weight and length were estimated in the INTERGROWTH-21st platform. Results: The prevalence of small gestational age (SGA) and insufficient length (IL) was 7.4 and 4.8%, respectively. Differ­ences in the prevalence of IL, SGA and large for the gestational age (LGA) by sex were recorded (p <0.01). The entities with the highest prevalence of SGA were Estado de México and Yucatán (10.4%); Sonora (15.3%) and Baja California Sur (16.8%) of LGA. Conclusion: Sizing the nutritional status at birth allows the identification of entities that require targeted actions to reduce the risks associated with malnutrition.

Objetivo. Describir la prevalencia nacional por entidad federativa del estado de nutrición de peso y longitud al nacimiento. Material y métodos. Estudio transversal descriptivo. Se analizaron datos de 1 907 341 recién nacidos vivos en 2017, registrados en el Subsistema de Información sobre Nacimientos (Sinac). Los percentiles para peso y lon­gitud se estimaron en la plataforma INTERGROWTH-21st. Resultados. La prevalencia de pequeños para la edad ges­tacional (PEG) y longitud insuficiente (LI) fue de 7.4 y 4.8%, respectivamente. Se registraron diferencias por sexo en las prevalencias de LI, PEG y grandes para la edad gestacional (GEG) (p <0.01). Las entidades con mayores prevalencias de PEG (10.4%) fueron Estado de México y Yucatán. De GEG, fueron Sonora (16.8%) y Baja California Sur (15.3%). Conclu­sión. Dimensionar el estado de nutrición al nacer permite identificar entidades que requieren acciones focalizadas para disminuir los riesgos asociados con la malnutrición.

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BACKGROUND: Recent decreases in neonatal mortality have been slower than expected for most countries. This study aims to predict the risk of neonatal mortality using only data routinely available from birth records in the largest city of the Americas. METHODS: A probabilistic linkage of every birth record occurring in the municipality of São Paulo, Brazil, between 2012 e 2017 was performed with the death records from 2012 to 2018 (1,202,843 births and 447,687 deaths), and a total of 7282 neonatal deaths were identified (a neonatal mortality rate of 6.46 per 1000 live births). Births from 2012 and 2016 (N = 941,308; or 83.44% of the total) were used to train five different machine learning algorithms, while births occurring in 2017 (N = 186,854; or 16.56% of the total) were used to test their predictive performance on new unseen data. RESULTS: The best performance was obtained by the extreme gradient boosting trees (XGBoost) algorithm, with a very high AUC of 0.97 and F1-score of 0.55. The 5% births with the highest predicted risk of neonatal death included more than 90% of the actual neonatal deaths. On the other hand, there were no deaths among the 5% births with the lowest predicted risk. There were no significant differences in predictive performance for vulnerable subgroups. The use of a smaller number of variables (WHO's five minimum perinatal indicators) decreased overall performance but the results still remained high (AUC of 0.91). With the addition of only three more variables, we achieved the same predictive performance (AUC of 0.97) as using all the 23 variables originally available from the Brazilian birth records. CONCLUSION: Machine learning algorithms were able to identify with very high predictive performance the neonatal mortality risk of newborns using only routinely collected data.

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OBJECTIVE: To evaluate inadequacies in Certificates of Live Birth in a city in Southern Brazil between 2011 and 2015. METHODS: This is a retrospective quantitative study based on Certificates of Live Birth of mothers living in Itapema, Santa Catarina, issued from 2011 to 2015, using data from the Live Birth Information System. RESULTS: Among 3,537 certificates, we found no mistakes in the variables newborn's sex, birth weight, maternal age, type of pregnancy, and type of delivery. Concerning incompleteness, the variable "cesarean section was performed before the start of labor" had a mean rate considered poor, while occupation was classified as good (above 6%), neighborhood as excellent (between 0.8 and 4.5%), and induction also as excellent (0.7 to 2.9%). Inaccuracies were greater in the ethnicity (up to 0.7%) and neighborhood (up to 1.3%) variables, both considered excellent. In the comparison between sections, the pregnancy and childbirth section was the most incomplete. CONCLUSION: Data completeness in Certificates of Live Birth was considered excellent for most variables, and the classification of inaccuracies was excellent for all variables, evidencing the quality of the information found in these certificates.

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Objetivo: Identificar registros de anomalias congênitas com cobertura nacional existentes no mundo, destacando suas principais características históricas e operacionais. Métodos: Revisão documental, mediante busca na base Medline/Pubmed e consulta a dados provenientes de relatórios, documentos oficiais e sítios eletrônicos. Foram incluídos trabalhos com relato de pelo menos um registro nacional. Resultados: Foram identificados 40 registros nacionais de anomalias congênitas em 39 países diferentes. Todos os registros incluídos no estudo localizavam-se em países de renda alta ou média superior, com concentração na Europa. A maior parte dos registros foi de base populacional, de notificação compulsória e com tempo limite para notificação de até 1 ano de idade. O registro brasileiro apresentou a maior cobertura anual. Conclusão: Os registros discutidos apresentaram características diversas, relacionadas à realidade de cada país. Os resultados apresentados fornecem subsídios para a temática da vigilância das anomalias congênitas, sobretudo em locais onde se deseja implementar tal atividade.

Objetivo: Identificar registros de anomalías congénitas con cobertura nacional existentes en el mundo, destacando sus principales características históricas y operativas. Métodos: Revisión documental de literatura en la base de datos Medline/Pubmed y datos de informes, documentos oficiales y sitios web. Se incluyeron trabajos con informes de al menos un registro nacional. Resultados: Se identificaron 40 registros nacionales de anomalías congénitas en 39 países diferentes. Todos los registros incluidos se ubicaron en países de ingresos altos y medianos altos, con una concentración en Europa. La mayoría de los registros eran de base poblacional, con notificación obligatoria y un límite de tiempo de notificación de hasta 1 año. El registro brasileño presentá la cobertura anual más alta. Conclusión: Los registros discutidos presentaban características diferentes y relacionadas con la realidad de cada país. Los resultados presentados proporcionan subsidios para la vigilancia de anomalías congénitas, especialmente en lugares que deseen implementar dicha actividad.

Objective: To identify registers of congenital anomalies with national coverage currently available around the world, highlighting their main historical and operational characteristics. Methods: This was a documentary study by means of a Medline database search (via PubMed) and searches involving reports, official documents and websites. Studies reporting at least one national registry were included. Results: 40 registers of national congenital anomalies were identified in 39 different countries. All registers included in the study were concentrated in upper-middle or high-income countries located in Europe. Most of the registers were population-based, compulsory notification and with a time limit for notification of up to 1 year of age. The Brazilian register showed the highest annual coverage. Conclusion: The registers analyzed showed different characteristics, related to the reality of each country. The results presented provide support for the theme of congenital anomalies surveillance, especially in places where such activity is intended to be implemented.

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Objetivos: Describir variables epidemiológicas clave durante el año 2020 (pandemia de COVID-19) con respecto a la prevención de la transmisión perinatal (TP) del VIH en Ciudad de Buenos Aires (CABA), comparando con períodos previos.Métodos: Análisis retrospectivo de los datos agregados de TP de las principales maternidades de CABA. El año pandémico (2020) se comparó con los años no pandémicos 2018 y 2019.Resultados: Se observó una reducción del total de nacimientos en 2020 en comparación con 2019 y 2018 (11.640 vs. 14.031 y 15,978, respectivamente). La proporción de nacidos vivos en madres VIH+ (MEV) fue 0,88% en 2020, sin diferencia con 2019 y 2018 (0,94% y 0,93%), p> 0,05 para todas las comparaciones. Entre las MEV, el diagnóstico intraparto fue del 2,9% para 2020, sin diferencias con 2019 (2,25%) y 2018 (9,3%), p> 0,05 (todas las comparaciones); el 8,8% comenzó el tratamiento antirretroviral con > 28 semanas de edad gestacional en 2020 frente al 16% y el 18,05% en 2018 y 2019 (p> 0,05, todas las comparaciones). La prevalencia de la carga viral indetectable en el momento del parto fue del 67% en 2020 frente al 64% en 2018 y del 65,4% en 2019 (p> 0,05, todas las comparaciones). La transmisión perinatal fue 0% en 2020 vs. 1,33% en 2018 y 2,25% 2019 (p> 0,05, todas las comparaciones).Conclusiones: En la primera ola de la pandemia de COVID-19 no se observaron cambios en la proporción de MEV asistidas, diagnóstico intraparto de VIH, inicio tardío del TARV y TP en CABA

Background: To describe key epidemiological variables in 2020 (COVID-19 pandemic) regarding prevention of mother-to-child transmission (MTCT) in Buenos Aires city (CABA) in comparison with previous periods. Methods: Retrospective analysis of aggregated MTCT data was gathered from six principal maternity hospitals in Buenos Aires city. Pandemic year (2020) was compared to non-pandemic years 2018-19 individually considering key epidemiological variables. Results: A reduction of total births was observed in 2020 compared to 2019 and 2018 (11640 vs. 14031 and 15978, respectively). Proportion of live births in HIV-infected women (HPW) was 0.88% in 2020 without difference with 2019 and 2018 (0.94% and 0.93%), p> 0.05 for all comparisons. Among HPW, intrapartum diagnosis was 2.9% for 2020, with no difference between 2019 (2.25%) and 2018 (9.3%), p>0.05 (all comparisons); 8.8% had antiretroviral therapy (ART) started > 28 weeks of gestational age in 2020 vs. 16% and 18.05% in 2018 and 2019 (p> 0.05, all comparisons). Prevalence of undetectable viral load at delivery was 67% in 2020 vs 64% in 2018 and 65.4% in 2019 (p> 0.05, all comparisons). Perinatal transmission was 0% in 2020 vs 1.33% in 2018 and 2.25% 2019 (p> 0.05, all comparisons) Conclusions: In first wave of COVID 19 pandemic no changes in the proportion of HPW assisted, HIV intrapartum diagnosis, late ART initiation and MTCT-rate was observed in CABA

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ABSTRACT: Objective: To evaluate inadequacies in Certificates of Live Birth in a city in Southern Brazil between 2011 and 2015. Methods: This is a retrospective quantitative study based on Certificates of Live Birth of mothers living in Itapema, Santa Catarina, issued from 2011 to 2015, using data from the Live Birth Information System. Results: Among 3,537 certificates, we found no mistakes in the variables newborn's sex, birth weight, maternal age, type of pregnancy, and type of delivery. Concerning incompleteness, the variable "cesarean section was performed before the start of labor" had a mean rate considered poor, while occupation was classified as good (above 6%), neighborhood as excellent (between 0.8 and 4.5%), and induction also as excellent (0.7 to 2.9%). Inaccuracies were greater in the ethnicity (up to 0.7%) and neighborhood (up to 1.3%) variables, both considered excellent. In the comparison between sections, the pregnancy and childbirth section was the most incomplete. Conclusion: Data completeness in Certificates of Live Birth was considered excellent for most variables, and the classification of inaccuracies was excellent for all variables, evidencing the quality of the information found in these certificates.

RESUMO: Objetivo: Avaliar inadequações nas declarações de nascidos de um município do Sul do Brasil entre 2011 e 2015. Métodos: Quantitativo retrospectivo a partir das Declarações de Nascidos Vivos de mães com residência em Itapema, Santa Catarina, no período de 2011 a 2015, utilizando os dados do Sistema de Informação de Nascidos Vivos. Resultados: Em 3.537 declarações, não foram encontradas falhas nas variáveis sexo e peso do recém-nascido, idade da mãe, tipo de gravidez e tipo de parto. Sobre incompletudes, a variável "cesárea ocorreu antes do trabalho de parto iniciar" teve classificação média como ruim; ocupação, como bom (acima 6%); bairro (entre 0,8 e 4,5%), como excelente; e indução (0,7 a 2,9%), também como excelente. As incorreções apresentadas foram maiores nas variáveis raça/cor (até 0,7%) e bairro (até 1,3%), ambas classificadas como excelente. Na comparação entre seções, gestação e parto apresentaram maiores incompletudes. Conclusão: A completude dos dados das Declarações de Nascidos Vivos foi considerada excelente na maior parte das variáveis, e a classificação das incorreções resultou em excelente para todas as variáveis, evidenciando a qualidade das informações dessas declarações.

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Estudio descriptivo sobre la prevalencia e incidencia de Síndrome de Down en los Certificados Médicos Oficiales firmados en nuestro servicio en el período comprendido entre los años 2017- 2019, la prevalencia de cardiopatías congénitas en los mismos y la prevalencia de nacimientos con esta anomalía genética en nuestro hospital. Comparación con estadística nacional e internacional

Descriptive study on prevalence and incidence in Down Syndrome in the Official Medical Certificates signed by our service between years 2017-2019, the prevalence of con genital heart disease on these and the prevalence of birth with this genetic anomaly on our hospital. National and International comparison of statistics

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This study aimed to assess agreement between antenatal estimates of gestational age by ultrasound and clinical records at birth in the Brazilian Amazon. Ultrasound examinations were scheduled during the second trimester for 578 pregnant women prospectively screened at primary health care units, following a standardized protocol for image quality control. A multistage algorithm was used to assess the best estimate of gestational age during the antenatal period, considering reliability of last menstrual period (LMP) and acceptable differences in relation to ultrasound estimates derived from fetal biparietal diameter and femur length. Agreement of antenatal estimates of gestational age confirmed by ultrasound and clinical records at birth was analyzed with Bland-Altman plots and kappa coefficients (preterm and postterm births). Overall, ultrasound examinations presented high quality (>90% of satisfactory images), and were adopted as the best estimate of gestational age among 83.4% of pregnant women, confirming reliable LMP in the remaining proportion. On average, difference in gestational age between antenatal estimates and clinical records was 0.43 week (95% CI: 0.32, 0.53). Classification of preterm births had a good agreement (kappa: 0.82, p<0.001), but a poor performance was observed for postterm births (kappa: -0.06, p = 0.92). Higher differences in gestational age were noted for participants with >11 years of education and cases of caesarean deliveries. In conclusion, high-quality ultrasound images from the second trimester of pregnancy based the assessment of gestational age, while reliability of LMP was limited. Information from clinical records at birth presented an acceptable agreement on average and for classification of preterm births, which is relevant for properly interpreting perinatal outcomes. Discrepancies in caesarean deliveries may warrant further investigation.

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OBJECTIVE: To estimate maternal mortality ratio according to occupation in Brazil. METHODS: This is a mortality study conducted with national data from the Mortality Information System (SIM) and the Live Birth Information System (SINASC) in 2015. Maternal mortality ratios were estimated according to the occupation recorded in death certificates, using the Brazilian Classification of Occupation (CBO), version 2002. RESULTS: A total of 1,738 maternal deaths records were found, corresponding to a maternal mortality ratio of 57.6/100,000 live births. It varied among occupational groups, with higher estimates among service and agricultural workers, particularly for domestic workers (123.2/100,000 live births), followed by general agricultural workers (88.3/100,000 live births). Manicurists and nursing technicians also presented high maternal mortality ratio. Maternal occupation was not reported in 17.0% of SIM registers and in 13.2% of SINASC data. Inconsistent records of occupation were found."Housewife" prevailed in SIM (35.5%) and SINASC (39.1%). CONCLUSIONS: Maternal mortality ratio differs by occupation, suggesting a work contribution, which requires further research focusing occupational risk factors. Socioeconomic factors are closely related to occupation, and their combination with work exposures and the poor access to health services need to be also addressed.

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ABSTRACT OBJECTIVE To estimate maternal mortality ratio according to occupation in Brazil. METHODS This is a mortality study conducted with national data from the Mortality Information System (SIM) and the Live Birth Information System (SINASC) in 2015. Maternal mortality ratios were estimated according to the occupation recorded in death certificates, using the Brazilian Classification of Occupation (CBO), version 2002. RESULTS A total of 1,738 maternal deaths records were found, corresponding to a maternal mortality ratio of 57.6/100,000 live births. It varied among occupational groups, with higher estimates among service and agricultural workers, particularly for domestic workers (123.2/100,000 live births), followed by general agricultural workers (88.3/100,000 live births). Manicurists and nursing technicians also presented high maternal mortality ratio. Maternal occupation was not reported in 17.0% of SIM registers and in 13.2% of SINASC data. Inconsistent records of occupation were found."Housewife" prevailed in SIM (35.5%) and SINASC (39.1%). CONCLUSIONS Maternal mortality ratio differs by occupation, suggesting a work contribution, which requires further research focusing occupational risk factors. Socioeconomic factors are closely related to occupation, and their combination with work exposures and the poor access to health services need to be also addressed.

RESUMO OBJETIVO Estimar a razão de mortalidade materna segundo a ocupação no Brasil. MÉTODOS Trata-se de estudo de mortalidade realizado com dados nacionais do Sistema de Informação sobre Mortalidade (SIM) e do Sistema de Informação sobre Nascidos Vivos (Sinasc) no ano de 2015. Foram estimadas as razões de mortalidade materna de acordo com a ocupação registrada em declarações de óbito, utilizando a Classificação Brasileira de Ocupações, versão 2002. RESULTADOS Foram encontrados 1.738 registros de óbitos maternos, correspondendo a uma razão de mortalidade materna de 57,6/100.000 nascidos vivos. Esse índice variou entre as categorias ocupacionais, sendo maior entre as trabalhadoras dos serviços e da agropecuária, particularmente para as empregadas domésticas (123,2/100.000 nascidos vivos), seguidas pelas trabalhadoras agropecuárias em geral (88,3/100.000 nascidos vivos). Também apresentaram elevada razão de mortalidade materna as manicures e técnicas de enfermagem. A ocupação materna não foi informada em 17,0% dos casos do SIM e em 13,2% do Sinasc. Foram encontrados registros inconsistentes, como "dona de casa", o mais frequente no SIM (35,5%) e no Sinasc (39,1%). CONCLUSÕES A razão de mortalidade materna difere de acordo com a ocupação, sugerindo uma contribuição do trabalho, o que requer pesquisas adicionais para identificar os fatores de risco ocupacionais. Fatores socioeconômicos estão intimamente relacionados à ocupação, e sua combinação com exposições no trabalho e acesso a serviços de saúde precisa ser abordada.

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Our principal Regional hospital take his name in honor to his profesional outstanding performance as a surgeon and director of it establishment, but existing controversiesas for the date and place of his born and marriage. We present exclusively his baptism and marriage certificate that clarifies this doubts

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This study is a quantitative and qualitative assessment of data from the Brazilian Information System on Live Births (SINASC) in Brazil. Coverage of the data by municipality was estimated as the ratio between reported and estimated live births. Data quality in the SINASC was assessed via probabilistic linkage with the database from the Birth in Brazil study, 2011-2012, and kappa coefficients of agreement were calculated. In 2013, data coverage was high and homogeneous in all states of Brazil. However, the analysis according to municipalities (counties) showed greater spatial heterogeneity. As for completeness of information in SINASC, kappa coefficients were statistically different from zero for all the tested variables (p < 0.001), and marginal distributions of all the variables were similar in the two databases. Gestational age was the variable with the worst agreement, with a kappa value of 0.461. The indicator that describes the inconsistencies, measured by the sum of the square of the differences between the reported and expected prematurity rates by birthweight bracket, showed the highest value in the North of Brazil and the lowest in the South, pointing to geographic inequalities in measurement of gestational age.

Neste trabalho, avaliam-se quantitativa e qualitativamente as informações do Sistema de Informações sobre Nascidos Vivos (SINASC). A cobertura das informações por município foi estimada pela razão entre nascidos vivos informados e estimados. Para avaliação da qualidade das informações do SINASC, relacionou-se o sistema à base de dados do estudo Nascer no Brasil, 2011-2012, e foram estimados coeficientes kappa de concordância. Em 2013, a cobertura das informações foi alta e homogênea em todas as Unidades da Federação. Entretanto, a análise por município brasileiro apresentou maior heterogeneidade espacial. Quanto à qualidade de preenchimento das informações do SINASC, os coeficientes kappa de concordância foram estatisticamente diferentes de zero para todas as variáveis testadas (p < 0,001), e as distribuições marginais para todas as variáveis consideradas foram semelhantes nas duas bases de dados. A idade gestacional foi a variável que mostrou pior concordância, com valor de kappa de 0,461. O indicador que descreve as inconsistências, medido pela soma do quadrado das diferenças entre os percentuais de prematuridade informados e esperados por faixa de peso ao nascer, teve o valor mais alto na Região Norte e o menor na Região Sul, apontando para desigualdades geográficas na mensuração da idade gestacional.

En este trabajo, se evalúa cuantitativa y cualitativamente la información del Sistema de Información sobre Nacidos Vivos (SINASC) de Brasil. La cobertura de la información por municipio se estimó por la razón entre nacidos vivos informados y estimados. Para la evaluación de la calidad de la información del SINASC, se efectuó la relación del sistema con la base de datos del estudio Nacer no Brasil, 2011-2012 y se estimaron los coeficientes kappa de concordancia. En 2013, la cobertura de la información fue alta y homogénea en todas las unidades de la Federación. No obstante, el análisis por municipio brasileño presentó mayor heterogeneidad espacial. En cuanto a la calidad de cumplimentación de la información del SINASC, los coeficientes kappa de concordancia fueron estadísticamente diferentes de cero para todas las variables probadas (p < 0,001) y las distribuciones marginales para todas las variables consideradas fueron semejantes en las dos bases de datos. La edad gestacional fue la variable que mostró peor concordancia, con valor de kappa de 0,461. El indicador que describe las inconsistencias, medido por la suma del cuadrado de las diferencias entre los porcentajes de prematuridad informados y esperados por franja de peso al nacer, tuvo el valor más alto en la región Norte y el menor en la Sur, apuntando desigualdades geográficas en la medición de la edad gestacional.

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OBJECTIVE: to analyze the incompleteness of variables retrieved from the Live Birth Information System (SINASC) and the Mortality Information System (SIM), in the State of Rio de Janeiro, in the time series 1999 to 2014. METHODS: this was a time series study of SINASC and SIM; the Romero & Cunha score was used to analyze incompleteness; Joinpoint regression was used to analyze temporal trend; in 2014, deaths were evaluated separately according to investigation. RESULTS: regarding SINASC variables, in 1999 marital status (37.40%), number of stillborn children (31.30%), and race/skin color (24.63%) had the highest incompleteness percentages; in 2014, no variable exceeded 5% incompleteness, except occupation; regarding SIM variables, in 1999 five variables exceeded 20%, and missing data for previous stillborn children was over 60%; in 2014, only one variable exceeded 20% incompleteness; investigated deaths had better completeness. CONCLUSION: both systems were found to have improved; the quality of SINASC completeness remained superior to that of SIM.

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Caesarean delivery rates in Mexico are among the highest in the world. Given heightened public and professional awareness of this problem and the updated 2014 national guidelines to reduce the frequency of caesarean delivery, we analysed trends in caesarean delivery by type of facility in Mexico from 2008 to 2017. We obtained birth-certificate data from the Mexican General Directorate for Health Information and grouped the total number of vaginal and caesarean deliveries into five categories of facility: health-ministry hospitals; private hospitals; government employment-based insurance hospitals; military hospitals; and other facilities. Delivery rates were calculated for each category nationally and for each state. On average, 2 114 630 (95% confidence interval, CI: 2 061 487-2 167 773) live births occurred nationally each year between 2008 and 2017. Of these births, 53.5% (1 130 570; 95% CI: 1 108 068-1 153 072) were vaginal deliveries, and 45.3% (957 105; 95% CI: 922 936-991 274) were caesarean deliveries, with little variation over time. During the study period, the number of live births increased by 4.4% (from 1 978 380 to 2 064 507). The vaginal delivery rate decreased from 54.8% (1 083 331/1 978 380) to 52.9% (1 091 958/2 064 507), giving a relative percentage decrease in the rate of 3.5%. The caesarean delivery rate increased from 43.9% (869 018/1 978 380) to 45.5% (940 206/2 064 507), giving a relative percentage increase in the rate of 3.7%. The biggest change in delivery rates was in private-sector hospitals. Since 2014, rates of caesarean delivery have fallen slightly in all sectors, but they remain high at 45.5%. Policies with appropriate interventions are needed to reduce the caesarean delivery rate in Mexico, particularly in private-sector hospitals.

Les taux d'accouchements par césarienne au Mexique sont parmi les plus élevés au monde. Au vu de la sensibilisation accrue de la population et des professionnels à ce problème et de la mise à jour des directives nationales de 2014 visant à diminuer la fréquence des accouchements par césarienne, nous avons analysé l'évolution des accouchements par césarienne selon le type d'établissement entre 2008 et 2017 au Mexique. Nous avons obtenu des données issues d'actes de naissance auprès de la Direction générale mexicaine des informations sur la santé et regroupé le nombre total d'accouchements par voie basse et par césarienne en cinq catégories d'établissement: hôpitaux relevant du ministère de la Santé, hôpitaux publics, hôpitaux relevant de l'assurance liée à l'emploi public, hôpitaux militaires et autres établissements. Les taux d'accouchements ont été calculés pour chaque catégorie à l'échelle nationale et pour chaque État. En moyenne, 2 114 630 (intervalle de confiance, IC, à 95%: 2 061 487-2 167 773) naissances vivantes ont eu lieu chaque année entre 2008 et 2017 à l'échelle nationale. Parmi ces naissances, 53,5% (1 130 570; IC à 95%: 1 108 068-1 153 072) étaient des accouchements par voie basse, et 45,3% (957 105; IC à 95%: 922 936-991 274) étaient des accouchements par césarienne, avec peu de variations dans le temps. Au cours de la période étudiée, le nombre de naissances vivantes a augmenté de 4,4% (de 1 978 380 à 2 064 507). Le taux d'accouchements par voie basse est passé de 54,8% (1 083 331/1 978 380) à 52,9% (1 091 958/2 064 507), ce qui correspond à une diminution relative du taux de 3,5%. Le taux d'accouchements par césarienne est passé de 43,9% (869 018/1 978 380) à 45,5% (940 206/2 064 507), ce qui correspond à une augmentation relative du taux de 3,7%. Le changement le plus important concernant les taux d'accouchements a été constaté dans les hôpitaux du secteur privé. Depuis 2014, les taux d'accouchements par césarienne ont légèrement diminué dans tous les secteurs, mais demeurent élevés (45,5%). Des politiques et des interventions appropriées sont nécessaires pour réduire le taux d'accouchements par césarienne aux Mexique, en particulier dans les hôpitaux de secteur privé.

Las tasas de parto por cesárea en México están entre las más altas del mundo. Dada la creciente concienciación pública y profesional sobre este problema y las directrices nacionales actualizadas de 2014 para reducir la frecuencia de los partos por cesárea, se analizaron las tendencias de los partos por cesárea según el tipo de establecimiento en México entre 2008 y 2017. Se obtuvieron datos de los certificados de nacimiento de la Dirección General de Información Sanitaria de México y se agrupó el número total de partos vaginales y por cesárea en cinco categorías de establecimientos: hospitales del ministerio de salud pública, hospitales privados, hospitales gubernamentales para asegurados por empleo, hospitales militares y otras instalaciones. Se calcularon los índices de partos para cada categoría a nivel nacional y según cada estado. De media, 2 114 630 (intervalo de confianza, IC, del 95 %: 2 061 487­2 167 773) nacimientos vivos se produjeron a nivel nacional al año entre 2008 y 2017. De estos nacimientos, el 53,5 % (1 130 570; IC del 95 %: 1 108 068­1 153 072) fueron partos vaginales y el 45,3 % (957 105; IC del 95 %: 922 936­991 274) fueron partos por cesárea, con poca variación a lo largo del tiempo. Durante el periodo de estudio, el número de nacidos vivos aumentó un 4,4 % (de 1 978 380 a 2 064 507). La tasa de partos vaginales disminuyó del 54,8 % (1 083 331/1 978 380) al 52,9 % (1 091 958/2 064 507), lo que supone una disminución porcentual relativa de la tasa del 3,5 %. La tasa de partos por cesárea aumentó del 43,9 % (869 018/1 978 380) al 45,5 % (940 206/2 064 507), lo que representa un aumento porcentual relativo de la tasa del 3,7 %. El mayor cambio en las tasas de partos se produjo en los hospitales del sector privado. Desde 2014, las tasas de parto por cesárea se han reducido ligeramente en todos los sectores, pero siguen siendo elevadas (45,5 %). Se necesitan políticas con intervenciones apropiadas para reducir la tasa de partos por cesárea en México, especialmente en los hospitales del sector privado.

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This study assesses the quality of the SIM and SINASC information systems in coverage, incompleteness and consistency aspects, as well as the contribution of the linkage for data retrieval. It includes all live births and infant deaths in Rio Grande do Sul from 2000 to 2014. The records were paired by deterministic linkage through the DNV number and, in its absence, by probabilistic linkage. SINASC's coverage rose from 72.2% in 2000 to 98.9%, namely a 37% increase in the number of matched records. All variables in SINASC presented excellent incompleteness throughout the period, except for the number of dead children and maternal occupation. SIM presented poor or very poor incompleteness for most of the variables until 2003. Although it improved, in 2014, six variables still presented regular or poor incompleteness. The linkage procedure greatly reduced the incompleteness for most variables. There was a great variability in terms of consistency: while for gender this percentage was over 97% throughout the period, for another five variables it was still less than 75% in 2014. SINASC presented high coverage level and excellent incompleteness. Problems related to consistency persist. This study shows the linkage technic efficiency to retrieve missing information.

O estudo avalia a qualidade do SIM e do SINASC nos aspectos cobertura, incompletitude e consistência, bem como a contribuição do "linkage" para a recuperação de dados. Foram analisados nascimentos e óbitos de menores de um ano ocorridos no Rio Grande do Sul entre 2000 e 2014. Os registros foram pareados por "linkage" determinístico através do número da DNV e, na ausência deste, por "linkage" probabilístico. A cobertura do SINASC aumentou 37%, passando de 72,2% em 2000 para 98,9%. O grau de incompletitude do SINASC foi excelente para todas as variáveis, exceto quantidade de filhos mortos e ocupação materna. No SIM, até 2003 a maioria das variáveis apresentou preenchimento ruim ou muito ruim. Apesar da melhoria, seis delas ainda possuíam preenchimento regular ou ruim em 2014. Após o "linkage", a incompletitude reduziu-se para grande parte das variáveis. Houve alta variabilidade quanto à consistência: sexo apresentou percentual superior a 97% em todo período, enquanto para outras cinco variáveis essa fração segue inferior a 75% em 2014. Destaca-se a alta cobertura e a excelente incompletitude do SINASC. Persistem problemas relacionados à consistência de informações. Evidencia-se a relevância do "linkage" como método para recuperar informações.

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Resumo O estudo avalia a qualidade do SIM e do SINASC nos aspectos cobertura, incompletitude e consistência, bem como a contribuição do "linkage" para a recuperação de dados. Foram analisados nascimentos e óbitos de menores de um ano ocorridos no Rio Grande do Sul entre 2000 e 2014. Os registros foram pareados por "linkage" determinístico através do número da DNV e, na ausência deste, por "linkage" probabilístico. A cobertura do SINASC aumentou 37%, passando de 72,2% em 2000 para 98,9%. O grau de incompletitude do SINASC foi excelente para todas as variáveis, exceto quantidade de filhos mortos e ocupação materna. No SIM, até 2003 a maioria das variáveis apresentou preenchimento ruim ou muito ruim. Apesar da melhoria, seis delas ainda possuíam preenchimento regular ou ruim em 2014. Após o "linkage", a incompletitude reduziu-se para grande parte das variáveis. Houve alta variabilidade quanto à consistência: sexo apresentou percentual superior a 97% em todo período, enquanto para outras cinco variáveis essa fração segue inferior a 75% em 2014. Destaca-se a alta cobertura e a excelente incompletitude do SINASC. Persistem problemas relacionados à consistência de informações. Evidencia-se a relevância do "linkage" como método para recuperar informações.

Abstract This study assesses the quality of the SIM and SINASC information systems in coverage, incompleteness and consistency aspects, as well as the contribution of the linkage for data retrieval. It includes all live births and infant deaths in Rio Grande do Sul from 2000 to 2014. The records were paired by deterministic linkage through the DNV number and, in its absence, by probabilistic linkage. SINASC's coverage rose from 72.2% in 2000 to 98.9%, namely a 37% increase in the number of matched records. All variables in SINASC presented excellent incompleteness throughout the period, except for the number of dead children and maternal occupation. SIM presented poor or very poor incompleteness for most of the variables until 2003. Although it improved, in 2014, six variables still presented regular or poor incompleteness. The linkage procedure greatly reduced the incompleteness for most variables. There was a great variability in terms of consistency: while for gender this percentage was over 97% throughout the period, for another five variables it was still less than 75% in 2014. SINASC presented high coverage level and excellent incompleteness. Problems related to consistency persist. This study shows the linkage technic efficiency to retrieve missing information.

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