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You searched for:"Ernesto Antonio Figueiró-Filho"
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Rev Bras Ginecol Obstet. 2003;25(7):465-471
DOI 10.1590/S0100-72032003000700002
PURPOSE: to investigate the effect of antiretroviral drugs on carbohydrate metabolism in HIV-infected pregnant women and on fetal and neonatal prognosis. METHODS: a prospective study was conducted on 57 pregnant women. The women were divided into three groups: ZDV group, taking zidovudine (n=20), TT group, taking zidovudine + lamivudine + nelfinavir (n=25), and control group (n=12). Blood samples were obtained for the determination of the area under the curve (AUC) after a 75-g oral glucose test at four periods during pregnancy (1st=14-20 weeks, 2nd= 21-26 weeks, 3rd=27-32 weeks and 4th=33-38 weeks). Perinatal prognosis was based on prematurity rates, intrauterine growth restriction (IUGR), low birth weight, perinatal mortality, and vertical HIV-1 transmission. Data were analyzed statistically using the nonparametric c² test, Friedman test and Kruskal-Wallis test. RESULTS: the median values of the AUC were 11.685 mg/dL for the control group, 13.477 mg/dL for the ZDV Group, and 13.650 mg/dL for the TT group (p=0.049). The antiretroviral agents had no deleterious effects on prematurity, low birth weight, IUGR rates or on Apgar score. There was no case of vertical transmission of HIV-1. CONCLUSIONS: an association was detected between the use of triple therapy and the development of carbohydrate intolerance during pregnancy. This association was not shown with ZDV alone. The antiretroviral agents had no deleterious effects on perinatal prognosis.
Summary
Rev Bras Ginecol Obstet. 2003;25(7):465-471
DOI 10.1590/S0100-72032003000700002
PURPOSE: to investigate the effect of antiretroviral drugs on carbohydrate metabolism in HIV-infected pregnant women and on fetal and neonatal prognosis. METHODS: a prospective study was conducted on 57 pregnant women. The women were divided into three groups: ZDV group, taking zidovudine (n=20), TT group, taking zidovudine + lamivudine + nelfinavir (n=25), and control group (n=12). Blood samples were obtained for the determination of the area under the curve (AUC) after a 75-g oral glucose test at four periods during pregnancy (1st=14-20 weeks, 2nd= 21-26 weeks, 3rd=27-32 weeks and 4th=33-38 weeks). Perinatal prognosis was based on prematurity rates, intrauterine growth restriction (IUGR), low birth weight, perinatal mortality, and vertical HIV-1 transmission. Data were analyzed statistically using the nonparametric c² test, Friedman test and Kruskal-Wallis test. RESULTS: the median values of the AUC were 11.685 mg/dL for the control group, 13.477 mg/dL for the ZDV Group, and 13.650 mg/dL for the TT group (p=0.049). The antiretroviral agents had no deleterious effects on prematurity, low birth weight, IUGR rates or on Apgar score. There was no case of vertical transmission of HIV-1. CONCLUSIONS: an association was detected between the use of triple therapy and the development of carbohydrate intolerance during pregnancy. This association was not shown with ZDV alone. The antiretroviral agents had no deleterious effects on perinatal prognosis.
Summary
Rev Bras Ginecol Obstet. 2007;29(11):561-567
DOI 10.1590/S0100-72032007001100003
PURPOSE: to verify the association of abortion, recurrent fetal loss, miscarriage and severe pre-eclampsia with the presence of hereditary thrombophilias and antiphospholipid antibodies in pregnant women. METHODS: observational and transverse study of 48 pregnant women with past medical record of miscarriage, repeated abortion and fetal loss story (AB Group) and severe pre-eclampsia (PE Group), attended to in the High Risk Pregnancy Ambulatory of the Faculdade de Medicina (Famed) from the Universidade Federal de Mato Grosso do Sul (UFMS) from November 2006 to July 2007. The pregnant women of both groups were screened for the presence of antiphospholipid antibodies (anticardiolipin IgG and IgM, lupic anticoagulant and anti-beta2-glycoprotein I) and hereditary thrombophilias (protein C and S deficiency, antithrombin deficiency, hyperhomocysteinemia and factor V Leiden mutation). The laboratorial screening was performed during the pregnancy. The parametric data (maternal age and parity) were analyzed with Student’s tau test. The non-parametric data (presence/absence of hereditary thrombophilias and antiphospholipid antibodies, presence/absence of pre-eclampsia, fetal loss, miscarriage and repeated abortion) were analyzed with Fisher’s exact test in contingency tables. It was considered significant the association with p value <0.05. RESULTS: out of the 48 pregnant women, 31 (65%) were included in AB Group and 17 (35%) in PE Group. There was no significant difference between maternal age and parity within the groups. There was significant statistical association between recurrent fetal loss, recurrent abortions and previous miscarriages and maternal hereditary thrombophilias (p<0.05). There was no statistical association between the AB Group and the presence of antiphospholipid antibodies. Neither there were associations of the PE Group with maternal hereditary thrombophilias and the presence of antiphospholipid antibodies. CONCLUSIONS: the data obtained suggest routine laboratorial investigation for hereditary thrombophilias in pregnant women with previous obstetrical story of recurrent fetal loss, repeated abortion and miscarriage.
Summary
Rev Bras Ginecol Obstet. 2007;29(11):561-567
DOI 10.1590/S0100-72032007001100003
PURPOSE: to verify the association of abortion, recurrent fetal loss, miscarriage and severe pre-eclampsia with the presence of hereditary thrombophilias and antiphospholipid antibodies in pregnant women. METHODS: observational and transverse study of 48 pregnant women with past medical record of miscarriage, repeated abortion and fetal loss story (AB Group) and severe pre-eclampsia (PE Group), attended to in the High Risk Pregnancy Ambulatory of the Faculdade de Medicina (Famed) from the Universidade Federal de Mato Grosso do Sul (UFMS) from November 2006 to July 2007. The pregnant women of both groups were screened for the presence of antiphospholipid antibodies (anticardiolipin IgG and IgM, lupic anticoagulant and anti-beta2-glycoprotein I) and hereditary thrombophilias (protein C and S deficiency, antithrombin deficiency, hyperhomocysteinemia and factor V Leiden mutation). The laboratorial screening was performed during the pregnancy. The parametric data (maternal age and parity) were analyzed with Student’s tau test. The non-parametric data (presence/absence of hereditary thrombophilias and antiphospholipid antibodies, presence/absence of pre-eclampsia, fetal loss, miscarriage and repeated abortion) were analyzed with Fisher’s exact test in contingency tables. It was considered significant the association with p value <0.05. RESULTS: out of the 48 pregnant women, 31 (65%) were included in AB Group and 17 (35%) in PE Group. There was no significant difference between maternal age and parity within the groups. There was significant statistical association between recurrent fetal loss, recurrent abortions and previous miscarriages and maternal hereditary thrombophilias (p<0.05). There was no statistical association between the AB Group and the presence of antiphospholipid antibodies. Neither there were associations of the PE Group with maternal hereditary thrombophilias and the presence of antiphospholipid antibodies. CONCLUSIONS: the data obtained suggest routine laboratorial investigation for hereditary thrombophilias in pregnant women with previous obstetrical story of recurrent fetal loss, repeated abortion and miscarriage.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):593-598
DOI 10.1590/S0100-72032003000800008
PURPOSE: to investigate the effect of antiretroviral drugs on the lipid metabolism in HIV-infected pregnant women. METHODS: a prospective study was conducted on 57 pregnant women. The women were divided into three groups: ZDV group, consisting of 20 HIV-infected women taking ZDV; TT group, consisting of 25 HIV-1-infected women on triple antiretroviral treatment (ZDV + 3TC + NFV), and control group, consisting of 12 pregnant women considered to be normal from a clinical and laboratory viewpoint. Demographic and anthropometric data were homogeneous. Patients with a personal and family history of hyperlipidemia were excluded. Blood samples were obtained for the determination of fasting lipids (total cholesterol, LDL and HDL, and triglycerides) at four periods during pregnancy (1st = 14-20 weeks; 2nd = 21-26 weeks; 3rd = 27-32 weeks and 4th = 33-38 weeks). Data were analyzed statistically using the nonparametric chi², Friedman and Kruskal-Wallis tests . RESULTS: the use of antiretroviral drugs during pregnancy induced no difference in total or HDL cholesterol but caused an increase from 76.5 and 84 mg/dL to 96 and 105 mg/dL in the concentration of the LDL fraction along gestation in ZDV and TT groups, respectively (p<0.01). A positive significant association was observed between triglycerides and viral burden in the ZDV group (r: 0.534; p=0.015). CONCLUSION: Antiretroviral agents during pregnancy increase serum LDL-colesterol levels. The risk of pregnancy regarding potentiation of long-term antiretroviral effects on lipid metabolism, remains to be established.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):593-598
DOI 10.1590/S0100-72032003000800008
PURPOSE: to investigate the effect of antiretroviral drugs on the lipid metabolism in HIV-infected pregnant women. METHODS: a prospective study was conducted on 57 pregnant women. The women were divided into three groups: ZDV group, consisting of 20 HIV-infected women taking ZDV; TT group, consisting of 25 HIV-1-infected women on triple antiretroviral treatment (ZDV + 3TC + NFV), and control group, consisting of 12 pregnant women considered to be normal from a clinical and laboratory viewpoint. Demographic and anthropometric data were homogeneous. Patients with a personal and family history of hyperlipidemia were excluded. Blood samples were obtained for the determination of fasting lipids (total cholesterol, LDL and HDL, and triglycerides) at four periods during pregnancy (1st = 14-20 weeks; 2nd = 21-26 weeks; 3rd = 27-32 weeks and 4th = 33-38 weeks). Data were analyzed statistically using the nonparametric chi², Friedman and Kruskal-Wallis tests . RESULTS: the use of antiretroviral drugs during pregnancy induced no difference in total or HDL cholesterol but caused an increase from 76.5 and 84 mg/dL to 96 and 105 mg/dL in the concentration of the LDL fraction along gestation in ZDV and TT groups, respectively (p<0.01). A positive significant association was observed between triglycerides and viral burden in the ZDV group (r: 0.534; p=0.015). CONCLUSION: Antiretroviral agents during pregnancy increase serum LDL-colesterol levels. The risk of pregnancy regarding potentiation of long-term antiretroviral effects on lipid metabolism, remains to be established.
Summary
Rev Bras Ginecol Obstet. 2005;27(12):719-725
DOI 10.1590/S0100-72032005001200003
PURPOSE: to evaluate the prevalence, epidemiological profile (age and origin) and vertical transmission rate of HTLV I/II infection in pregnant women screened by the Pregnant Protection Program of the State of Mato Grosso do Sul Brazil. METHODS: it is a descriptive and transversal study of 32,512 pregnant women submitted to a prenatal screening from November 2002 to October 2003. HTLV I/II infection was diagnosed in all pregnant women by ELISA, confirmed by Western blot and PCR. Congenital HTLV infection was investigated by ELISA test, Western blot and PCR performed on the child's blood sample. The associations between data (age, origin and HTLV infection) were statistically analyzed by the chi2 test considering p<0.05 to reject the null hypothesis. RESULTS: a prevalence of 0.1% (37) 0.1% HTLV I/II among 32,512 pregnant women was found. The mean age of the infected women was 25.4 ± 6.4 years, and 78.4% of them were from other areas than the capital. There was no association between maternal age and the patients' origin and infection. In all the eight evaluated newborns, which represented 21.6% of the sample, HTLV I/II serum antibodies were found. Only one newborn infant was breast-fed. CONCLUSIONS : HTLV I/II prevalence among pregnant women of the State of Mato Grosso do Sul Brazil was lower than the rates reported by endemic HTLV countries. This rate was almost the same as that described for non-endemic areas and in some Brazilian reports. The vertical transmission rate of HTLV I/II was 100%, in spite of breast-feeding having been proscribed. Improving the follow-up of the pregnant women and their newborns in the State is mandatory, since only a few infants were investigated.
Summary
Rev Bras Ginecol Obstet. 2005;27(12):719-725
DOI 10.1590/S0100-72032005001200003
PURPOSE: to evaluate the prevalence, epidemiological profile (age and origin) and vertical transmission rate of HTLV I/II infection in pregnant women screened by the Pregnant Protection Program of the State of Mato Grosso do Sul Brazil. METHODS: it is a descriptive and transversal study of 32,512 pregnant women submitted to a prenatal screening from November 2002 to October 2003. HTLV I/II infection was diagnosed in all pregnant women by ELISA, confirmed by Western blot and PCR. Congenital HTLV infection was investigated by ELISA test, Western blot and PCR performed on the child's blood sample. The associations between data (age, origin and HTLV infection) were statistically analyzed by the chi2 test considering p<0.05 to reject the null hypothesis. RESULTS: a prevalence of 0.1% (37) 0.1% HTLV I/II among 32,512 pregnant women was found. The mean age of the infected women was 25.4 ± 6.4 years, and 78.4% of them were from other areas than the capital. There was no association between maternal age and the patients' origin and infection. In all the eight evaluated newborns, which represented 21.6% of the sample, HTLV I/II serum antibodies were found. Only one newborn infant was breast-fed. CONCLUSIONS : HTLV I/II prevalence among pregnant women of the State of Mato Grosso do Sul Brazil was lower than the rates reported by endemic HTLV countries. This rate was almost the same as that described for non-endemic areas and in some Brazilian reports. The vertical transmission rate of HTLV I/II was 100%, in spite of breast-feeding having been proscribed. Improving the follow-up of the pregnant women and their newborns in the State is mandatory, since only a few infants were investigated.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):813-817
DOI 10.1590/S0100-72032004001000009
Maternal phenylketonuria is an aminoacid pathology characterized by elevated plasma levels of phenylalanine in the pregnant woman that may cause abnormalities in fetus development, and which is called maternal phenylketonuria syndrome. As the clinical manifestations are non-specific, the disease should be diagnosed by laboratory screening. We present a case of a second pregnancy in a woman with a history of psycho-cognitive development retardation without previous obstetric history, with diagnosis of phenylketonuria in the present gestation, treated with specific phenylalanine-free diet. The newborn did not present congenital defects. The previous gestation without maternal treatment resulted in a child with serious developmental disturbances, microcephalia and auditory-speaking deficits. Early diagnosis and treatment of hyperphenylalaninemia during pregnancy are essential, mainly because of the negative impact on fetal development. In the here reported case, there were fetal benefits from the maternal dietary treatment, which demonstrates the importance of the maternal diagnosis of phenylketonuria in women in reproductive age.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):813-817
DOI 10.1590/S0100-72032004001000009
Maternal phenylketonuria is an aminoacid pathology characterized by elevated plasma levels of phenylalanine in the pregnant woman that may cause abnormalities in fetus development, and which is called maternal phenylketonuria syndrome. As the clinical manifestations are non-specific, the disease should be diagnosed by laboratory screening. We present a case of a second pregnancy in a woman with a history of psycho-cognitive development retardation without previous obstetric history, with diagnosis of phenylketonuria in the present gestation, treated with specific phenylalanine-free diet. The newborn did not present congenital defects. The previous gestation without maternal treatment resulted in a child with serious developmental disturbances, microcephalia and auditory-speaking deficits. Early diagnosis and treatment of hyperphenylalaninemia during pregnancy are essential, mainly because of the negative impact on fetal development. In the here reported case, there were fetal benefits from the maternal dietary treatment, which demonstrates the importance of the maternal diagnosis of phenylketonuria in women in reproductive age.
Summary
Rev Bras Ginecol Obstet. 2021;43(11):820-825
To compare maternal and perinatal risk factors associated with complete uterine rupture and uterine dehiscence.
Cross-sectional study of patients with uterine rupture/dehiscence from January 1998 to December 2017 (30 years) admitted at the Labor and Delivery Unit of a tertiary teaching hospital in Canada.
There were 174 (0.1%) cases of uterine disruption (29 ruptures and 145 cases of dehiscence) out of 169,356 deliveries. There were associations between dehiscence and multiparity (odds ratio [OR]: 3.2; p=0.02), elevated maternal body mass index (BMI; OR: 3.4; p=0.02), attempt of vaginal birth after a cesarian section (OR: 2.9; p=0.05) and 5-minute low Apgar score (OR: 5.9; p<0.001). Uterine rupture was associated with preterm deliveries (36.5 ± 4.9 versus 38.2 ± 2.9; p=0.006), postpartum hemorrhage (OR: 13.9; p<0.001), hysterectomy (OR: 23.0; p=0.002), and stillbirth (OR: 8.2; p<0.001). There were no associations between uterine rupture and maternal age, gestational age, onset of labor, spontaneous or artificial rupture of membranes, use of oxytocin, type of uterine incision, and birthweight.
This large cohort demonstrated that there are different risk factors associated with either uterine rupture or dehiscence. Uterine rupture still represents a great threat to fetal-maternal health and, differently from the common belief, uterine dehiscence can also compromise perinatal outcomes.
Summary
Rev Bras Ginecol Obstet. 2021;43(11):820-825
To compare maternal and perinatal risk factors associated with complete uterine rupture and uterine dehiscence.
Cross-sectional study of patients with uterine rupture/dehiscence from January 1998 to December 2017 (30 years) admitted at the Labor and Delivery Unit of a tertiary teaching hospital in Canada.
There were 174 (0.1%) cases of uterine disruption (29 ruptures and 145 cases of dehiscence) out of 169,356 deliveries. There were associations between dehiscence and multiparity (odds ratio [OR]: 3.2; p=0.02), elevated maternal body mass index (BMI; OR: 3.4; p=0.02), attempt of vaginal birth after a cesarian section (OR: 2.9; p=0.05) and 5-minute low Apgar score (OR: 5.9; p<0.001). Uterine rupture was associated with preterm deliveries (36.5 ± 4.9 versus 38.2 ± 2.9; p=0.006), postpartum hemorrhage (OR: 13.9; p<0.001), hysterectomy (OR: 23.0; p=0.002), and stillbirth (OR: 8.2; p<0.001). There were no associations between uterine rupture and maternal age, gestational age, onset of labor, spontaneous or artificial rupture of membranes, use of oxytocin, type of uterine incision, and birthweight.
This large cohort demonstrated that there are different risk factors associated with either uterine rupture or dehiscence. Uterine rupture still represents a great threat to fetal-maternal health and, differently from the common belief, uterine dehiscence can also compromise perinatal outcomes.
