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  • Original Article

    Fetal Surveillance in Pregnancies Complicated by Diabetes: Analysis of Neonatal Outcome

    Rev Bras Ginecol Obstet. 2000;22(9):557-566

    Summary

    Original Article

    Fetal Surveillance in Pregnancies Complicated by Diabetes: Analysis of Neonatal Outcome

    Rev Bras Ginecol Obstet. 2000;22(9):557-566

    DOI 10.1590/S0100-72032000000900004

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    Purpose: to study the fetal well-being assessment in pregnancies complicated by diabetes, and to analyze the neonatal results. Methods: we studied 387 pregnant women with diabetes at the Fetal Surveillance Unit. The last examination (cardiotocography, fetal biophysical profile, amniotic fluid index and dopplervelocimetry) was correlated with the neonatal outcome. Results: the studied population included 46 (12%) type I diabetes, 45 (12%) type II and 296 (76%) gestational diabetes. Type I diabetes with abnormal or suspected cardiotocography was related to abnormal 1st minute Apgar (50 and 75%, p<0.05) and to the need for neonatal intensive care unit (50 and 75%, p<0.05). The abnormal biophysical profile in type II diabetic pregnancy was related to the need for neonatal intensive care (67%, p<0.05), and abnormal umbilical artery Doppler study was related to abnormal 1st minute Apgar (67%, p<0.05). Gestational diabetes with abnormal cardiotocography presented 36% abnormal 1st minute Apgar (p<0.05), 18% abnormal 5th minute Apgar (p<0.01) and 18% neonatal death (p<0.01). Abnormal amniotic fluid index was related to abnormal 5th minute Apgar (p<0.05) and need for neonatal intensive care unit (p<0.05). Gestational diabetes with abnormal umbilical artery Doppler was related (p<0.05) to: abnormal 1st and 5th minute Apgar, respectively, 25 and 8%, Need for neonatal intensive care in 17% and neonatal death in 8%. Conclusions: the fetal well-being examinations correlated with adverse perinatal outcome, showing the need for fetal surveillance in diabetic pregnant women.

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  • Review Article

    SARS-CoV-2 and Pregnancy: A Review of the Facts

    Rev Bras Ginecol Obstet. 2020;42(9):562-568

    Summary

    Review Article

    SARS-CoV-2 and Pregnancy: A Review of the Facts

    Rev Bras Ginecol Obstet. 2020;42(9):562-568

    DOI 10.1055/s-0040-1715137

    Views4

    Abstract

    Objective

    The present comprehensive review aims to show the full extent of what is known to date and provide a more thorough view on the effects of SARS-CoV2 in pregnancy.

    Methods

    Between March 29 and May, 2020, the words COVID-19, SARS-CoV2, COVID- 19 and pregnancy, SARS-CoV2 and pregnancy, and SARS and pregnancy were searched in the PubMed and Google Scholar databases; the guidelines from well-known societies and institutions (Royal College of Obstetricians and Gynaecologists [RCOG], American College of Obstetricians and Gynecologists [ACOG], International Society of Ultrasound in Obstetrics & Gynecology [ISUOG], Centers for Disease Control and Prevention [CDC], International Federation of Gynecology and Obstetrics [FIGO]) were also included.

    Conclusion

    The COVID-19 outbreak resulted in a pandemic with > 3.3 million cases and 230 thousand deaths until May 2nd. It is caused by the SARS-CoV2 virus and may lead to severe pulmonary infection and multi-organ failure. Past experiences show that unique characteristics in pregnancy make pregnant women more susceptible to complications from viral infections. Yet, this has not been reported with this new virus. There are risk factors that seem to increase morbidity in pregnancy, such as obesity (body mass index [BMI] > 35), asthma and cardiovascular disease. Current reports describe an increased rate of pretermbirth and C-section. Vertical transmission

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  • Original Article

    Fetal blood gas changes in red-cell transfusion in alloimmunization

    Rev Bras Ginecol Obstet. 2003;25(8):599-603

    Summary

    Original Article

    Fetal blood gas changes in red-cell transfusion in alloimmunization

    Rev Bras Ginecol Obstet. 2003;25(8):599-603

    DOI 10.1590/S0100-72032003000800009

    Views1

    PURPOSE: the aim was to study Rh-alloimmunized pregnant women and describe the gasometric abnormalities and the fetal acid-base changes before and after intrauterine transfusion. METHODS: between June 2001 and October 2001, before and after intrauterine transfusion in the alloimunized fetuses, gasometric data and acid-base parameters were prospectively studied in the umbilical vein blood. The measurements were performed in 8 samples of 5 fetuses. The fetal blood was obtained by cordocentesis before and after the intrauterine transfusion. The results were compared to the volemic expansion, the gestational age at procedure, the estimated fetal weight and the hemoglobin values (g/dL). RESULTS: all the cases showed pH value reduction, mean of 0.09 (SD=0.02). The fetal hemoglobin value showed a mean improvement of 8.4 g/dL (SD=2.9 g/dL). The pO2 and HCO3- concentrations showed negative variation (mean deltapO2 = -1.28 mmHg, mean deltaHCO3- = -2.25 mEq/L). pCO2 showed improvement (mean deltapCO2 = 3.2 mmHg) and reduced values of base excess occurred (mean = -3.75). CONCLUSION: the gasometric analysis allows to conclude that intrauterine transfusion is followed by pH reduction in the umbilical vein, with relative fetal acidemia after the procedure.

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  • Original Article

    Effects of maternal anemia on computerized cardiotocography and fetal biophysical profile

    Rev Bras Ginecol Obstet. 2009;31(12):615-620

    Summary

    Original Article

    Effects of maternal anemia on computerized cardiotocography and fetal biophysical profile

    Rev Bras Ginecol Obstet. 2009;31(12):615-620

    DOI 10.1590/S0100-72032009001200007

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    PURPOSES: to evaluate the influence of maternal hemoglobin (Hb) levels in the patterns of fetal heart rate (FHR) and in the fetal biophysical profile (FBP) in term gestations. METHODS: pregnant women with anemia (Hb<11.0 g/dL) were prospectively evaluated between the 36th and the 40th week of gestation, from January 2008 to March 2009. The Control Group was composed of term and healthy pregnant women, with normal values of hemoglobin (Hb>11,0 g/dL). Cases of anomalies or fetal growing restrictions were excluded. The FHR evaluation was performed by computerized cardiotocography (8002 System-Sonicaid), and by record analysis during 30 minutes of exam. The FBP was done in all the patients. Student's, χ2 and Fisher's exact tests were used, with 0.05 significance level. RESULTS: The average of maternal Hb in the group with anemia (n=18) was 9.4 g/dL (DP=1.4 g/dL), and in the control group, 12.4g/dL (DP=1.3 g/dL). There has been no significant mean differences between groups concerning the cardiotocography parameters, respectively: basal FHR(131.3 versus 133.7 bpm, p=0.5), FHR accelerations > 10b pm (7.9 versus 8.2, p=0.866), FHR accelerations > 15 bpm (5.2 versus. 5.4, p=0.9), episodes of high variation of the FHR (17.1 versus 15.5 min, p=0,5), episodes of variation of the FHR (4.4 versus 3.6 min, p=06), and short term variation (10.5 versus 10.9 ms, p=0.5). In both groups, all patients presented normal FBP. CONCLUSIONS: this study suggests that light or moderate maternal anemia, without other maternal or fetal comorbidity, is not associated with abnormalities in the parameters of fetal biophysical profile and of the FHR analyzed by computerized cardiotocography.

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  • Perception influence of professionals regarding unsafe in attention to women’s health

    Rev Bras Ginecol Obstet. 2012;34(2):69-73

    Summary

    Perception influence of professionals regarding unsafe in attention to women’s health

    Rev Bras Ginecol Obstet. 2012;34(2):69-73

    DOI 10.1590/S0100-72032012000200005

    Views3

    PURPOSE: To identify the knowledge and awareness of health professionals regarding the Brazilian legislation on induced abortion. METHODS: Unidentified sealed envelopes containing the questionnaires were sent to all professionals (n=149) working in the Obstetrics Department of a university hospital and public hospital at the periphery of São Paulo (SP), Brazil. A total of 119 professionals responded to the questionnaire. The 0.05 confidence interval and the Fisher exact test and χ² test were used for data analysis. RESULTS: Of the respondents, 48.7% were physicians, 33.6% were nursing professionals and 17.6% were professionals from other fields (psychologists, nutritionists, physiotherapists, laboratory technicians and administrators). There was a significant difference (p=0.01) in the proportion of professionals who believe that abortion for non-lethal fetal malformation and due to unplanned pregnancies should be included in the Brazilian legislation. It was observed that the knowledge about the law and the description of the circumstances allowed by law on abortion was significantly different when comparing health professionals (p=0.01). When asked about the situations in which Brazilian law allows abortion, 32.7% of physicians, 97.5% of nursing professionals and 90.5% of other professionals were unaware of the law. CONCLUSION: This study demonstrated the lack of of knowledge of Brazilian law among health professionals, to a lesser extent among obstetricians and a to a greater extent among nursing professionals. Attitudes of discrimination and prejudice were observed regarding the care provided to women who induce an abortion.

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  • Original Article

    Previous cesarean section as a risk factor for abruptio placentae

    Rev Bras Ginecol Obstet. 2004;26(9):709-714

    Summary

    Original Article

    Previous cesarean section as a risk factor for abruptio placentae

    Rev Bras Ginecol Obstet. 2004;26(9):709-714

    DOI 10.1590/S0100-72032004000900006

    Views0

    PURPOSE: to study the relationship between previous cesarean section and abruptio placentae. METHODS: a retrospective study reviewed 6495 deliveries between April 2001 and January 2004. The adopted inclusion criteria were: clinical diagnosis of abruptio placentae confirmed by placental examination after delivery, single pregnancy, birth weight >500 g, gestational age >22 weeks and no history of abdominal trauma. Five controls were selected for each abruptio placentae case and were matched for the following parameters: parity, gestational age (< or > 30 weeks), maternal arterial hypertension during pregnancy, presence of nonobstetrical uterine scar, premature rupture of membranes and polyhydramnios. Statistical analysis of continuous variables was perfomed by Student's t test. Statistical significance of the comparisons of categorical variables was evaluated by the chi2 test or by the Fisher exact test. p values <0.05 were considered to be significant. RESULTS: thirty-four cases of abruptio placentae were included (incidence 0.52%). The control group included 170 cases that fulfilled the matching criteria. The incidence of previous cesarean section in the abruptio placentae group was 26.5% (9 cases) and in the control group it was 21.2% (36 cases). No significant difference was found between the groups (p=0.65, OR=1.34, CI 95%=0.53-3.34). CONCLUSION: the present study was not able to demonstrate association between abruptio placentae and previous cesarean section.

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  • Original Article

    Computerized cardiotocography in pregnancies complicated by pregestational diabetes mellitus: heart rate patterns in large for gestational age fetuses

    Rev Bras Ginecol Obstet. 2005;27(12):712-718

    Summary

    Original Article

    Computerized cardiotocography in pregnancies complicated by pregestational diabetes mellitus: heart rate patterns in large for gestational age fetuses

    Rev Bras Ginecol Obstet. 2005;27(12):712-718

    DOI 10.1590/S0100-72032005001200002

    Views2

    PURPOSE: to verify the fetal heart rate (FHR) patterns of large for gestational age (LGA) fetuses in pregnancies at term complicated by pregestational diabetes. METHODS: fetal surveillance was performed weekly in 64 fetuses of mothers with pregestational diabetes. Inclusion criteria were: diagnosis of pregestational diabetes mellitus, single pregnancy, alive fetus, absence of fetal anomalies, and computerized cardiotocography performed at the 37th week of gestation. Exclusion criteria included: postnatal diagnosis of fetal anomalies and delivery not performed at the local hospital. The FHR patterns were studied with computerized cardiotocography and the parameters were analyzed according to a fetal weight as LGA (birth weight above percentile 90). The cardiotocography parameters included: basal FHR, episodes of high variation, episodes of low variation, and short-term variation. RESULTS: forty-two patients fulfilled the proposed criteria. Ten (23.8%) newborns were LGA. Normal criteria were met in all performed examinations. FHR accelerations (above 15 bpm) were present in 7 (70%) LGA cases and in 29 (90.6%) non-LGA (p=0.135). Accelerations were more frequent in the non-LGA group (1.5±1.3 accelerations/10 min) when compared to LGA group (0.8±0.9 accelerations/10min, p=0.04, Mann-Whitney test). The high variation episodes were detected in all cases. The mean FHR variation in these episodes was different in the LGA group (16.2±2.5 bpm) when compared to the non-LGA group (19.7±4.2 bpm, p=0.02, Mann-Whitney test). CONCLUSION: the FHR patterns of non-LGA (higher frequency of accelerations and higher FHR variation in the high variation episodes) reflect parameters commonly analyzed by traditional cardiotocography of a healthy fetus. This fact appears to confirm the patterns of better oxygen supply to the fetuses less compromised by diabetes in pregnancy.

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  • Original Article

    Dietary intake of pregnant women and maternal weight gain after nutritional counseling

    Rev Bras Ginecol Obstet. 2011;33(2):87-92

    Summary

    Original Article

    Dietary intake of pregnant women and maternal weight gain after nutritional counseling

    Rev Bras Ginecol Obstet. 2011;33(2):87-92

    DOI 10.1590/S0100-72032011000200006

    Views5

    PURPOSE: to determine the dietary consumption of pregnant women, by assessing the intake of macronutrients and micronutrients, and to verify the maternal weight gain during pregnancy. METHODS: a retrospective study conducted from June 2002 to June 2008 with pregnant women who received nutritional counseling during prenatal care at a university hospital, grouped according to anthropometric nutritional status classified by pregestational body mass index (BMI). The dietary intake was analyzed according to the information obtained in food frequency interviews, performed at the first evaluation of pregnant women in the service of nutrition to obtain data about eating habits, and the intake of macronutrients and micronutrients was calculated. The pregnant women received nutritional counseling, and the maternal weight gain was investigated. RESULTS: a total of 187 pregnant women who received nutritional counseling were analyzed. Twenty-three (12.2%) were underweight, 84 (45.0%) normal weight, 37 (19.8%) overweight, and 43 (23.0%) obese. The underweight pregnant women had lower consumption of lipids when compared to the normal weight group (101.4 versus 137.3 g; p=0.043). The average iron intake was higher in normal weight pregnant women (14.6 mg/d) compared to the overweight (12.2 mg/d) or obese (10.9 mg/d; p<0.001) groups. The average intake of folate was higher in normal weight pregnant women compared to obese ones (336.5 µg/d versus 234.5 µg/d; p=0.002). Excessive maternal weight gain was significantly (p=0.009) more frequent in overweight (56.7%) and obese (39.5%) pregnant women compared to underweight (17.4%) and normal weight (31.0%) women. CONCLUSIONS: The maternal weight gain above recommended levels was associated with overweight and obesity. The dietary intake of pregnant women differs according to maternal anthropometric nutritional status, with a lower daily intake of iron in overweight and obese women and a lower intake of folate in obese ones, a fact that reinforces the importance of prenatal vitamin supplementation.

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