Congenital defects Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(9):553-558
DOI 10.1590/S0100-72032001000900002
Purpose: to evaluate the role of routine obstetrical ultrasound scan in suspecting the presence of fetal congenital heart diseases and severe arrhythmias, as well as the factors involved in its accuracy. Methods: the sample was made up of 77 neonates and infants hospitalized at the Institute of Cardiology of Rio Grande do Sul from May to October of 2000, with confirmed postnatal diagnosis of structural heart disease or severe arrhythmia, whose mothers had been submitted to at least one obstetrical ultrasound scan after 18 weeks of gestation. After informed consent, a customized standard questionnaire was used. Categorical variables were compared using chi² test or Fisher's exact test and a logistic regression model was used to determine independent variables possibly involved in the prenatal suspicion of cardiac abnormalities. Results: in 19 patients (24.6%), obstetrical ultrasound was able to rise prenatal suspicion of structural or rhythm abnormalities. Considering only congenital heart diseases, this prevalence was 19.2% (14/73). In 73.7% of these cases, the cardiac disorder was accessible by the four-chamber view alone. Arrhythmias during obstetrical scan were observed in 26.3 of the babies with prenatal suspicion of a heart abnormality, while only 3.4% of the patients without prenatal suspicion showed a rhythm alteration (p=0.009). Significant differences between the groups with and without prenatal suspicion of cardiac abnormalities were observed in relation to parity (p=0.029), delivery by cesarean section (p=0.006), need for intensive care (p=0.046) and school education level of the father (p=0.014). At multivariate analysis, only the presence of a rhythm alteration during ultrasound scan was shown to be an independent variable associated with prenatal suspicion of cardiac abnormalities. Conclusions: routine obstetrical ultrasound has been underused in prenatal screening of congenital heart diseases. Adequate training and making obstetricians and the population a ware of the problem may be instruments for increasing the efficacy of routine obstetrical ultrasound in rising the suspicion of fetal cardiac abnormalities.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(9):553-558
DOI 10.1590/S0100-72032001000900002
Purpose: to evaluate the role of routine obstetrical ultrasound scan in suspecting the presence of fetal congenital heart diseases and severe arrhythmias, as well as the factors involved in its accuracy. Methods: the sample was made up of 77 neonates and infants hospitalized at the Institute of Cardiology of Rio Grande do Sul from May to October of 2000, with confirmed postnatal diagnosis of structural heart disease or severe arrhythmia, whose mothers had been submitted to at least one obstetrical ultrasound scan after 18 weeks of gestation. After informed consent, a customized standard questionnaire was used. Categorical variables were compared using chi² test or Fisher's exact test and a logistic regression model was used to determine independent variables possibly involved in the prenatal suspicion of cardiac abnormalities. Results: in 19 patients (24.6%), obstetrical ultrasound was able to rise prenatal suspicion of structural or rhythm abnormalities. Considering only congenital heart diseases, this prevalence was 19.2% (14/73). In 73.7% of these cases, the cardiac disorder was accessible by the four-chamber view alone. Arrhythmias during obstetrical scan were observed in 26.3 of the babies with prenatal suspicion of a heart abnormality, while only 3.4% of the patients without prenatal suspicion showed a rhythm alteration (p=0.009). Significant differences between the groups with and without prenatal suspicion of cardiac abnormalities were observed in relation to parity (p=0.029), delivery by cesarean section (p=0.006), need for intensive care (p=0.046) and school education level of the father (p=0.014). At multivariate analysis, only the presence of a rhythm alteration during ultrasound scan was shown to be an independent variable associated with prenatal suspicion of cardiac abnormalities. Conclusions: routine obstetrical ultrasound has been underused in prenatal screening of congenital heart diseases. Adequate training and making obstetricians and the population a ware of the problem may be instruments for increasing the efficacy of routine obstetrical ultrasound in rising the suspicion of fetal cardiac abnormalities.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(8):517-521
DOI 10.1590/S0100-72032001000800006
Purpose: to verify the association of the use of abortifacient drugs during the first 3 months of gestation with the occurrence of congenital malformations in live births. Patients and Methods: population-based case-control study through selection of the first six live births on a day, over the period of a year, at a public maternity in Salvador, Bahia, with a total of 800 cases. Studies were performed through investigation of birth records in the search of congenital malformation data, observation of selected malformed newborns, followed by interview with the mothers for collection of anamnesis data, by application of a questionnaire. Later on data were statistically evaluated by Epi-Info 5.0 software. Results: puerperae came from a low socialeconomic class (74.8%), without any or almost any schooling (61.1%). The general percentage of birth defects was estimated at 4.7%. Out of 800 puerperae, 16% reported abortifacient drug intake during the first 3 months of gestation and 10.9% of them had malformed babies. This incidence was 3.6% in children whose mothers denied the intake of any abortifacient drugs. Agents most commonly taken in those unsuccessful abortive attempts were misoprostol (Cytotec) and herbs, specially "alumã" (Vermonia baiensis Tol) and "espinho cheiroso" (Kanthoxilum shifolium Lam), which, according to the literature, do not really have any abortive effect. Conclusion: the study revealed the extension of intentional miscarriage in a low income population and showed that the occurrence of birth defects could be related to gestational exposure to misoprostol and herbal medicine intake.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(8):517-521
DOI 10.1590/S0100-72032001000800006
Purpose: to verify the association of the use of abortifacient drugs during the first 3 months of gestation with the occurrence of congenital malformations in live births. Patients and Methods: population-based case-control study through selection of the first six live births on a day, over the period of a year, at a public maternity in Salvador, Bahia, with a total of 800 cases. Studies were performed through investigation of birth records in the search of congenital malformation data, observation of selected malformed newborns, followed by interview with the mothers for collection of anamnesis data, by application of a questionnaire. Later on data were statistically evaluated by Epi-Info 5.0 software. Results: puerperae came from a low socialeconomic class (74.8%), without any or almost any schooling (61.1%). The general percentage of birth defects was estimated at 4.7%. Out of 800 puerperae, 16% reported abortifacient drug intake during the first 3 months of gestation and 10.9% of them had malformed babies. This incidence was 3.6% in children whose mothers denied the intake of any abortifacient drugs. Agents most commonly taken in those unsuccessful abortive attempts were misoprostol (Cytotec) and herbs, specially "alumã" (Vermonia baiensis Tol) and "espinho cheiroso" (Kanthoxilum shifolium Lam), which, according to the literature, do not really have any abortive effect. Conclusion: the study revealed the extension of intentional miscarriage in a low income population and showed that the occurrence of birth defects could be related to gestational exposure to misoprostol and herbal medicine intake.
