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COVID-19 pandemic has changed people's lives around the world due to restrictive measures adopted by governments. The impact of this change on female sexuality needs to be further investigated, particularly between female doctors who are more at risk as they are directly involved with health care services. An online survey has been filled out by female doctors. The questionnaire evaluates sexual function, depression, anxiety, burnout, sociodemographic and professional data, and it was answered during the peak of COVID-19 pandemic in Brazil. The main outcome is female doctors' sexual function during COVID-19 pandemic, which was evaluated by analyzing FSFI questionnaires. The secondary outcome is related to their mental health, assessed via depression, anxiety and burnout questionnaires. A sample of 388 female doctors filled out the questionnaire. The median age was 34.0 (29.0, 43.0) years old. The total FSFI median score was 23.8 [18.9, 26.8] with desire domain median of 5.0 [3.0, 7.0]. In our sample, 231 (59.5%) women had depression and/or anxiety, out of these, 191 (82.7%) had depression and 192 (83.2%), anxiety. From these samples of doctors with depression and/or anxiety, 183 (79.2%) had sexual dysfunction. This finding suggests that doctors are experiencing a high risk of sexual dysfunction and mental illness during the COVID-19 outbreak. A high index of depression and/or anxiety was shown in the studied population, with almost 80% of them reaching criteria for sexual dysfunction. Working in the frontline is related to worse mental health conditions. Depression and anxiety were found as potential mediators of burnout effect on sexual function.

Ambient temperature is associated with respiratory mortality, but evidence from tropical middle-income countries remains limited. We conducted a nationwide ecological time-series study to quantify associations between temperature and respiratory mortality across Brazil's diverse climates and to estimate the attributable burden. We analysed 1,087,094 respiratory deaths (ICD-10 J00–J99) from 646 municipalities (population ≥50,000) spanning all five Brazilian macroregions from 2010 to 2020. Daily temperature-mortality associations were estimated using distributed lag non-linear models (DLNM) with quasi-Poisson regression, adjusting for seasonality, long-term trends, and day of week. City-specific estimates were pooled using random-effects meta-analysis, and attributable fractions were calculated using the minimum mortality temperature (MMT) as reference. The pooled exposure-response curve showed a J-shaped relationship between temperature and respiratory mortality. The national MMT was 22.4°C, with low heterogeneity across municipalities (I² = 17.3%). Cumulative relative risks over lags 0–21 days were 1.29 (95% CI: 1.23–1.35) at the 1st temperature percentile (12.1°C) and 1.43 (95% CI: 1.36–1.50) at the 99th percentile (30.3°C). Overall, 6.08% of respiratory deaths were attributable to non-optimal temperatures, corresponding to 66,079 excess deaths during the study period. Regional patterns varied markedly: the North exhibited heat-dominant vulnerability (attributable fraction 12.5%), whereas the South showed cold-dominant effects (7.5%). Heat exposure accounted for a larger share of the national burden (4.27%) than cold (1.81%), reflecting Brazil's predominantly tropical climate. Temperature extremes substantially increase respiratory mortality across Brazil, with distinct regional vulnerability profiles. These findings support the implementation of region-specific early warning systems addressing both thermal extremes and inform climate adaptation strategies for tropical settings.

IntroductionPreterm birth is a leading cause of perinatal morbidity and mortality. During the COVID-19 pandemic, reduction in rates of preterm birth in women exposed to viral mitigation measures was reported by multiple studies. In addition, others and we observed a more pronounced reduction of preterm birth in women who had previously experienced a preterm birth. The aim of this pilot study is to establish the feasibility of a lifestyle intervention based on viral mitigation measures in high-risk pregnancies, with the ultimate aim to reduce the incidence of preterm birth.Methods and analysisOne hundred pregnant women, enrolled in antenatal clinics at two tertiary maternity centres in Melbourne, Australia, who have had a previous preterm birth between 22 and 34 weeks gestation will be recruited. This is a two-arm, parallel group, open-label randomised controlled feasibility trial: 50 women will be randomised to the intervention group, where they will be requested to comply with a set of lifestyle changes (similar to the viral mitigation measures observed during the pandemic). Another 50 women will be randomised to the control group, where they will undergo standard pregnancy care. The primary outcome of this trial is feasibility, which will be assessed by measuring patient eligibility rate, recruitment rate, compliance rate and data completion rate. Secondary outcomes include incidence of preterm birth, maternal satisfaction, maternal quality of life and other pregnancy outcomes. Standard methods in statistical analysis for randomised controlled trials on an intention to treat basis will be followed.Ethics and disseminationThis trial has been approved by the Monash Human Research Ethics Committee; approval reference number RES-22-0000-122A. Study findings will be reported and submitted to peer-reviewed journals for publication, and presentation at conferences.Trial registration numberACTRN12622000753752; Pre-results.

The objective of this study was identify the association between delays in the care provided to pregnant women and the fetal death outcome, in a tertiary reference maternity hospital in the Northeastern Brazil. A case-control study, with 72 cases of fetal death and 144 controls (live births) in women admitted to the Obstetrics Service of the Assis Chateaubriand Teaching Maternity Hospital, in Fortaleza, Ceará. Controls were matched (2:1) by the approximate gestational age of the case. The groups were compared using the three delays model of obstetric care. The Pearson's Chi-square test and the Fisher's exact test were used to compare the groups. P <0.05 was considered statistically significant. The Group with fetal death had a smaller number of prenatal consultations (> 6 consultations: 27.8% in cases, 40.3% in controls, p = 0.003), less risk classification of pregnancy (41.7% vs 55.9%, p = 0.048), less guidance about the health facility for delivery (44.5% vs 64%, p = 0.009), lower frequency of cesarean sections (25.4% vs 65.7%) and higher frequency of hemorrhagic syndromes (33.3% vs 19.4%, p = 0.024) and syphilis (15.3% vs 4.2%, p = 0·004). Variables that persisted significantly associated with fetal death in the logistic regression were: Refusal of assistance (OR = 4.07, IC 95%: 1.08-15.3), Absence or inadequacy of prenatal care (OR = 2.69, IC 95%: 1.07-6.75), Delay in diagnosis (OR = 10.3, IC 95%: 2.58-41.4) and Inadequate patient conduct (OR = 4.88; IC 95%: 1.43-16.6). Despite of having a higher frequency of obstetric complications, gestations with fetal death are more prone to delays in obstetric care.

Objective: This study assessed the efficacy of the cervical pessary combined with progesterone to prevent preterm birth in pregnant women with short cervix and previous preterm birth. Methods: This post hoc analysis of the randomized, multicenter P5 trial examined the efficacy of the cervical pessary associated with vaginal progesterone versus progesterone alone for preventing recurrent preterm birth in 155 pregnant women with cervical length ≤30 mm and prior spontaneous preterm birth (sPPTB) (main subgroup), and in 85 women with cervical length ≤25 mm and sPPTB (higher-risk population). The primary outcome was spontaneous preterm birth (sPTB) before 34 weeks; secondary outcomes included sPTB rates before 37, 32, and 28 weeks, analyzed using Odds Ratio (OR) and Kaplan–Meier curves. A secondary objective was to identify predictive factors for sPTB recurrence in the cohort with prior preterm birth (n = 479), irrespective of treatment allocation. Results: Demographic profiles were balanced between groups. The addition of a cervical pessary to progesterone did not result in a significant reduction in sPTB before 34 weeks: to cervix ≤30 mm, OR 1.169 (95% CI 0.524–2.609; p = 0.703) and 1.167 (95% CI 0.466–2.921; p = 0.742) for ≤25 mm; similar null findings were observed across all gestational age thresholds. Kaplan–Meier survival curves demonstrated no significant differences between groups (p > 0.05). Secondary analysis (n = 479) identified principal predictors of sPTB recurrence, regardless of the cervical length: higher education (OR 2.37; 95% CI 0.99–5.63; p = 0.024), previous cervical conization (OR 4.78; 95% CI 1.08–21.19; p = 0.039) previous low birth weight < 2.5 kg (OR 2.43; 95% CI 1.22–4.85; p = 0.051), prior miscarriages (OR 1.36; 95% CI 1.10–1.69; p = 0.005), current twin pregnancy (OR 14.86; 95% CI 4.35–50.68; p < 0.001) and cervical funneling (OR 3.60; 95% CI 1.79–7.24; p < 0.001). Predictive models achieved an AUC of 0.719, with 87.0% sensitivity and 58.8% specificity. Conclusions: These findings do not support the routine use of cervical pessary combined with progesterone in women with dual risk factors. In this Brazilian population, specific clinical and obstetric characteristics—including higher education, cervical funneling, prior low birth weight delivery, previous conization, current twin gestation, and prior miscarriage—could identify women at increased risk for recurrent preterm birth.

This systematic review examines the relationship between blood loss and clinical signs and explores its use to trigger clinical interventions in the management of obstetric haemorrhage. A systematic review of the literature was carried out using a comprehensive search strategy to identify studies presenting data on the relationship of clinical signs & symptoms and blood loss. Methodological quality was assessed using the STROBE checklist and the general guidelines of MOOSE. 30 studies were included and five were performed in women with pregnancy-related haemorrhage (other studies were carried in non-obstetric populations). Heart rate (HR), systolic blood pressure (SBP) and shock index were the parameters most frequently studied. An association between blood loss and HR changes was observed in 22 out of 24 studies, and between blood loss and SBP was observed in 17 out of 23 studies. An association was found in all papers reporting on the relationship of shock index and blood loss. Seven studies have used Receiver Operating Characteristic Curves to determine the accuracy of clinical signs in predicting blood loss. In those studies the AUC ranged from 0.56 to 0.74 for HR, from 0.56 to 0.79 for SBP and from 0.77 to 0.84 for shock index. In some studies, HR, SBP and shock index were associated with increased mortality. We found a substantial variability in the relationship between blood loss and clinical signs, making it difficult to establish specific cut-off points for clinical signs that could be used as triggers for clinical interventions. However, the shock index can be an accurate indicator of compensatory changes in the cardiovascular system due to blood loss. Considering that most of the evidence included in this systematic review is derived from studies in non-obstetric populations, further research on the use of the shock index in obstetric populations is needed.

The objective of this study is to analyze the knowledge, attitudes and practices (KAP) of physicians regarding abortion care in Brazil. We conducted a nationwide, hospital-based, cross-sectional study between 2021 and 2025 with 1,276 physicians working in public and private maternity hospitals. The KAP were assessed using a self-administered, anonymous questionnaire. Differences in proportions among the Brazilian regions were detected using the chi-square test, with a significance level of 0·05. One third of physicians were unfamiliar with Brazilian guidelines, only 25% had adequate knowledge about the non-hospital use of misoprostol and almost 40% reported that Manual Vacuum Aspiration (MVA) was never available in the service. Professionals in all regions reported very low agreement with permissions that would extend the legal termination of pregnancy in the country; the existence of prejudice and a lack of empathy toward women who likely terminated their pregnancies; and a high reliance on conscientious objection to not providing care to legal abortion. The results reinforce the need for training of medical professionals addressing women’s sexual and reproductive rights beyond biological and clinical management aspects of abortion care, the involvement of other health professionals in clinical abortion care, and the guarantee of supplies for MVA.

To determine Shock Index (SI) reference values in the first two hours of the postpartum period after objectively measuring postpartum bleeding. A complementary analysis using data from a prospective cohort study at Women's Hospital of the University of Campinas, Brazil, between 1 February 2015 and 31 March 2016. It included women giving birth vaginally unless they had one of these conditions: gestational age below 34 weeks, hypertension, hypo- or hyperthyroidism without treatment, any cardiac disease, infections with fever or sepsis, history of coagulopathy or delivery by C-section. Blood loss was measured by adding the blood volume collected in the drape placed under the women's buttocks and the weight of gauzes and compresses used (excluding the dry weight). Vital signs were measured every 5-15 min after delivery. Exploratory data analysis was performed to assess the mean, standard deviation, median, and percentiles (5th, 10th, 25th, 50th, 75th, 90th, 95th). To identify variation among the periods after delivery, the mean SI and heart rate (HR) values observed for the following intervals were used in the analysis: 0-20 min, 21-40 min, 41-60 min, 61-90 min and 91-120 min. One hundred eighty-six women were included. The mean age ± SD was 24.9 ± 6.1 years and the mean gestational age at birth was 39.2 ± 1.8 weeks. At the puerperal period, the mean SI values ranged from 0.68 ± 0.14 to 0.74 ± 0.15. The percentile distribution ranged from 0.46 (5th percentile) to 1.05 (95th percentile). The mean HR values ranged from 80.8 ± 12.7 bpm to 92.3 ± 14.4 bpm. The percentile distribution ranged from 62.0 bpm (5th percentile) to 117 bpm (95th percentile). Reference ranges were established for SI and HR values which showed small variations throughout the postpartum period.

The SARS-CoV-2 (COVID-19) pandemic impacted the health systems between and within countries, and in the course of the pandemic sexual and reproductive health services were the most disrupted. Findings from high-income settings have reported significant changes in preterm birth prevalence during the pandemic period. To understand the possible effects of the COVID-19 pandemic on preterm birth numbers at the Brazilian national level. We compare the number of preterm deliveries during the COVID-19 pandemic period (2020 and 2021) with previous years. We conducted a population-based cross-sectional study taking the period from January 2017 to December 2021 to account. We use individual-level live births data from the Brazilian Live Birth Information System (SINASC), and we estimate the odds ratio (OR) of preterm deliveries using propensity score weighting analysis in Brazil and its regions. During the study period (from 2017 to 2021), about 2.7 million live births were recorded per year, and the missing value for gestational age at delivery was less than 1.5%. The preterm birth prevalence slightly increased during the COVID-19 pandemic compared to the pre-pandemic period (11.32% in 2021 vs 11.09% in 2019, p-value < 0.0001). After adjusting for sociodemographic variables, the OR of preterm births in Brazil has significantly increased, 4% in 2020 (OR: 1.04 [1.03–1.05] 95% CI, p-value < 0.001), and 2% in 2021(OR: 1.02 [1.01–1.03] 95% CI, p-value < 0.001), compared to 2019. At the regional level, the preterm birth pattern in the South, Southeast and Northeast regions show a similar pattern. The highest odds ratio was observed in the South region (2020 vs 2019, OR: 1.07 [1.05–1.10] 95% CI; 2021 vs 2019, OR: 1.03 [1.01–1.06] 95% CI). However, we also observed a significant reduction in the ORs of preterm births in the northern region during the COVID-19 pandemic (2020 vs 2019, OR: 0.96 [0.94–0.98] 95% CI) and (2021 vs 2019, OR: 0.97 [0.95–0.99] 95% CI). Our analysis shows that the pandemic has increased regional variation in the number of preterm births in Brazil in 2020 and 2021 compared to the pre-pandemic years.

[This corrects the article DOI: 10.1371/journal.pone.0217907.].