Building a network of sentinel centres for the care of women in an abortion situation: advances in Latin America and the Caribbean

León, Rodolfo Gómez Ponce de; Baccaro, Luiz Francisco; Schweizer, Gonzalo Rubio; Bahamondes, Valeria; Messina, Analia; Francisco, Luis Andrés de; Jacob, Suzanne Serruya

doi:10.1136/bmjgh-2022-010059

Cited by 8 publications

(11 citation statements)

References 23 publications

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“…The CLAP MUSA-Network is a multicenter network with international cooperation created by the Latin American Centre of Perinatology (CLAP) in 2015, with the aim of encouraging good practices in the care of women in abortion situations in Latin America and the Caribbean (9). Participating hospitals are called sentinel centers, and the network currently has 29 sentinel centers located in 13 countries.…”

Section: Methodsmentioning

confidence: 99%

“…All data is kept confidential and anonymized. Details on the network's operating scheme were recently published (9).…”

Section: Methodsmentioning

confidence: 99%

“…The CLAP MUSA-Network 5 is made up of several health institutions in Latin America and the Caribbean that aim to strengthen epidemiological surveillance and develop a critical mass of trained professionals in sexual and reproductive health (9). The COVID-19 pandemic caused changes in the flow of care for women in an abortion situation in the hospitals that make up the network, both externally and internally.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of the impact of COVID-19 pandemic on women´s care in an abortion situation in Latin America and the Caribbean

De Leon,

Baccaro,

Schweizer

et al. 2024

Cad. Ibero Am. Direito Sanit.

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Objective: to understand the influence of the COVID-19 pandemic on aspects of quality of care provided to women in abortion situations in sentinel centers of the CLAP MUSA-Network (a multicenter network with international cooperation with the aim of encouraging good practices in Latin America and the Caribbean). Methods: cross-sectional study between January/2017 and December/2021 with women of any age admitted for abortion or miscarriage. We analyzed the total number of cases and the proportion of legal abortions. The dependent variables were complications and use of contraceptives after abortion. The independent variables were COVID-19 pandemic, clinical and sociodemographic data. Statistical analysis was carried out using linear regression, multiple Poisson regression, Cochran-Armitage, chi-square, Mann-Whitney and Cohen tests. Results: we analyzed data from 93689 women assisted in 12 sentinel centers of the CLAP MUSA-Network, 64.55% in the pre-pandemic period (NP) and 35.45% in the pandemic period (PP) (22.73% received post-abortion care and 77.27% legal abortion). We found no differences in the number of cases over the period, regardless of the legal context. We observed a significant increase in the proportion of legal abortions in liberal and moderate contexts. In NP, 46.46% of women underwent medical abortion, while 62.18% of women underwent medical abortion in PP (h-Cohen 0.32). We found no increase in the number of complications during PP. In NP, 79.12% started contraceptives after abortion, while in PP, 70.39% started contraceptives after abortion (h-Cohen 0.20). Conclusion: the COVID-19 pandemic was not associated with a decrease in the number of cases, a decrease in the proportion of legal interruptions, or an increase in complications in sentinel centers of the CLAP MUSA-Network. Submission: 30/04/23|Review: 08/11/23|Approval: 09/11/23

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Section: Methodsmentioning

confidence: 99%

“…All data is kept confidential and anonymized. Details on the network's operating scheme were recently published (9).…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Analysis of the impact of COVID-19 pandemic on women´s care in an abortion situation in Latin America and the Caribbean

De Leon,

Baccaro,

Schweizer

et al. 2024

Cad. Ibero Am. Direito Sanit.

Self Cite

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“…Valuable information on current challenges is provided when health indicators, such as stillbirth ratios, are monitored in different countries of the region. It can contribute to direct actions to decrease this burden and improve the quality of perinatal health [13,14]. Therefore, this study aimed to determine stillbirth ratios according to maternal and pregnancy characteristics, along with associated factors in some Latin American countries over the last few years.…”

Section: Plos Onementioning

confidence: 99%

The burden of stillbirths in low resource settings in Latin America: Evidence from a network using an electronic surveillance system

de Mucio,

Sosa,

Colomar

et al. 2023

PLoS ONE

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Objective To determine stillbirth ratio and its association with maternal, perinatal, and delivery characteristics, as well as geographic differences in Latin American countries (LAC). Methods We analysed data from the Perinatal Information System of the Latin American Center for Perinatology and Human Development (CLAP) between January 2018 and June 2021 in 8 health facilities from five LAC countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic). Maternal, pregnancy, and delivery characteristics, in addition to pregnancy outcomes were reported. Estimates of association were tested using chi-square tests, and P < 0.05 was regarded as significant. Bivariate analysis was conducted to estimate stillbirth risk. Prevalence ratios (PR) with their 95% confidence intervals (CI) for each predictor were reported. Results In total, 101,852 childbirths comprised the SIP database. For this analysis, we included 99,712 childbirths. There were 762 stillbirths during the study period; the Stillbirth ratio of 7.7/1,000 live births (ranged from 3.8 to 18.2/1,000 live births across the different maternities); 586 (76.9%) were antepartum stillbirths, 150 (19.7%) were intrapartum stillbirths and 26 (3.4%) with an ignored time of death. Stillbirth was significantly associated with women with diabetes (PRadj 2.36; 95%CI [1.25–4.46]), preeclampsia (PRadj 2.01; 95%CI [1.26–3.19]), maternal age (PRadj 1.04; 95%CI [1.02–1.05]), any medical condition (PRadj 1.48; 95%CI [1.24–1.76, and severe maternal outcome (PRadj 3.27; 95%CI [3.27–11.66]). Conclusions Pregnancy complications and maternal morbidity were significantly associated with stillbirths. The stillbirth ratios varied across the maternity hospitals, which highlights the importance for individual surveillance. Specialized antenatal and intrapartum care remains a priority, particularly for women who are at a higher risk of stillbirth.

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“…It is a healthcare database of perinatal electronic medical records that centralises the demographic, diagnostic, obstetric and neonatal clinical data of mothers and their offspring. In addition, it incorporates the systematic collection of information on the use of vaccines (tetanus/diphtheria, Tdap, influenza, rubella, hepatitis B, hepatitis A), as well as information on dosage, date of vaccination and time of vaccination (before or during pregnancy, or after delivery) 37. In response to the outbreak of the COVID-19 pandemic, CLAP developed a specific SIP form to monitor COVID vaccination of pregnant people, along with other related variables, such as COVID-19 history, which have become part of the routine follow-up of pregnant people (online supplemental material 2).…”

Section: Introductionmentioning

confidence: 99%

Description of maternal and neonatal adverse events in pregnant people immunised with COVID-19 vaccines during pregnancy in the CLAP NETWORK of sentinel sites: nested case–control analysis of the immunization-associated risk – a study protocol

Macías Saint-Gerons,

Castro,

Colomar

et al. 2024

BMJ Open

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IntroductionCOVID-19 is associated with higher morbimortality in pregnant people compared with non-pregnant people. At present, the benefits of maternal immunisation are considered to outweigh the risks, and therefore, vaccination is recommended during pregnancy. However, additional information is needed on the safety of the vaccines in this population.Methods and analysisThis a retrospective cohort nested case–control study in pregnant people who attended maternity hospitals from eight Latin American and Caribbean countries. A perinatal electronic clinical history database with neonatal and obstetric information will be used. The proportion of pregnant people immunised with COVID-19 vaccines of the following maternal and neonatal events will be described: preterm infant, small for gestational age, low birth weight, stillbirth, neonatal death, congenital malformations, maternal near miss and maternal death. Moreover, the risk of prematurity, small for gestational age and low birth weight associated with exposure to COVID-19 vaccines will be estimated. Each case will be matched with two groups of three randomly selected controls. Controls will be matched by hospital and mother’s age (±3 years) with an additional matching by delivery date and conception time in the first and second control groups, respectively. The estimated required sample size for the main analysis (exposure to any vaccine) concerning ‘non-use’ is at least 1009 cases (3027 controls) to detect an increased probability of vaccine-associated event risk of 30% and at least 650 cases (1950 controls) to detect 30% protection. Sensitivity and secondary analyses considering country, type of vaccine, exposure windows and completeness of immunisation will be reported.EthicsThe study protocol was reviewed by the Ethical Review Committee on Research of the Pan American Health Organization. Patient informed consent was waived due to the retrospective design and the utilisation of anonymised data (Ref. No: PAHOERC.0546.01). Results will be disseminated in open access journals.

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Building a network of sentinel centres for the care of women in an abortion situation: advances in Latin America and the Caribbean

Cited by 8 publications

References 23 publications

Analysis of the impact of COVID-19 pandemic on women´s care in an abortion situation in Latin America and the Caribbean

Analysis of the impact of COVID-19 pandemic on women´s care in an abortion situation in Latin America and the Caribbean

The burden of stillbirths in low resource settings in Latin America: Evidence from a network using an electronic surveillance system

Description of maternal and neonatal adverse events in pregnant people immunised with COVID-19 vaccines during pregnancy in the CLAP NETWORK of sentinel sites: nested case–control analysis of the immunization-associated risk – a study protocol

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