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Original Article07-29-2009
Risk factors for macrosomia in newborns at a school-maternity in northeast of Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(5):241-248
Abstract
Original ArticleRisk factors for macrosomia in newborns at a school-maternity in northeast of Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(5):241-248
DOI 10.1590/S0100-72032009000500007
Views163See moreOBJECTIVE: to determine the frequency of macrosomia in babies born alive at a reference obstetric service, and its association with maternal risk factors. METHODS: a transversal descriptive study, including 551 women at puerperium, hospitalized at Instituto de Saúde Elpídio de Almeida, in Campina Grande (PB), Brazil, from August to October, 2007. Women, whose deliveries had been assisted at the institution, with babies born alive from one single gestation and approached in the first postpartum day, were included in the study. The nutritional and sociodemographic maternal characteristics were analyzed, and the ratio of macrosomia (birth weight >4.000 g) and its association with maternal variables were determined. Macrosomia was classified as symmetric or asymmetric according to Rohrer's index. Statistical analysis has been done through Epi-Info 3.5 software; the prevalence ratio (PR) and the confidence interval at 95% (CI 95%) were calculated. The research protocol was approved by the local Ethics Committee and all the participants signed the informed consent. RESULTS: the mean maternal age was 24.7 years old, and the mean gestational age was 38.6 weeks. Excessive gestational weight gain was observed in 21.3% of the pregnant women, and 2.1% of the participants had a diagnosis of diabetes mellitus (gestational or clinic). A ratio of 5.4% of macrosomic newborns was found, 60 were asymmetric. There was no significant association between macrosomia, mother's age and parity. There was an association between macrosomia and overweight/obesity in the pre-gestational period (PR=2.9; CI 95%=1.0-7.8) and at the last medical appointment (PR=4.9; CI 95%=1.9-12.5), excessive weight gain (PR = 6.9; CI 95%:2.8-16.9), clinical or gestational diabetes (PR = 8.9; CI 95%:4.1-19.4) and hypertension (PR=2.9; CI 95%=1.1-7.9). The factors that persisted significantly associated with macrosomia in the multivariate analysis were the excessive weight gain during the gestation (RR=6.9; CI 95%=2.9-16.9) and the presence of diabetes mellitus (RR=8.9, CI 95%=4.1-19.4). CONCLUSIONS: considering that excessive gestational weight gain and diabetes mellitus were the factors more strongly associated with macrosomia, it is important that precocious detection measurements and adequate follow-up of such conditions be taken, aiming at preventing unfavorable perinatal outcomes.
Views163
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleRisk factors for macrosomia in newborns at a school-maternity in northeast of Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(5):241-248
DOI 10.1590/S0100-72032009000500007
Views163See moreOBJECTIVE: to determine the frequency of macrosomia in babies born alive at a reference obstetric service, and its association with maternal risk factors. METHODS: a transversal descriptive study, including 551 women at puerperium, hospitalized at Instituto de Saúde Elpídio de Almeida, in Campina Grande (PB), Brazil, from August to October, 2007. Women, whose deliveries had been assisted at the institution, with babies born alive from one single gestation and approached in the first postpartum day, were included in the study. The nutritional and sociodemographic maternal characteristics were analyzed, and the ratio of macrosomia (birth weight >4.000 g) and its association with maternal variables were determined. Macrosomia was classified as symmetric or asymmetric according to Rohrer's index. Statistical analysis has been done through Epi-Info 3.5 software; the prevalence ratio (PR) and the confidence interval at 95% (CI 95%) were calculated. The research protocol was approved by the local Ethics Committee and all the participants signed the informed consent. RESULTS: the mean maternal age was 24.7 years old, and the mean gestational age was 38.6 weeks. Excessive gestational weight gain was observed in 21.3% of the pregnant women, and 2.1% of the participants had a diagnosis of diabetes mellitus (gestational or clinic). A ratio of 5.4% of macrosomic newborns was found, 60 were asymmetric. There was no significant association between macrosomia, mother's age and parity. There was an association between macrosomia and overweight/obesity in the pre-gestational period (PR=2.9; CI 95%=1.0-7.8) and at the last medical appointment (PR=4.9; CI 95%=1.9-12.5), excessive weight gain (PR = 6.9; CI 95%:2.8-16.9), clinical or gestational diabetes (PR = 8.9; CI 95%:4.1-19.4) and hypertension (PR=2.9; CI 95%=1.1-7.9). The factors that persisted significantly associated with macrosomia in the multivariate analysis were the excessive weight gain during the gestation (RR=6.9; CI 95%=2.9-16.9) and the presence of diabetes mellitus (RR=8.9, CI 95%=4.1-19.4). CONCLUSIONS: considering that excessive gestational weight gain and diabetes mellitus were the factors more strongly associated with macrosomia, it is important that precocious detection measurements and adequate follow-up of such conditions be taken, aiming at preventing unfavorable perinatal outcomes.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article10-29-2007
Fetal breathing movements in pregnancies complicated by pregestational diabetes mellitus
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(7):352-357
Abstract
Original ArticleFetal breathing movements in pregnancies complicated by pregestational diabetes mellitus
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(7):352-357
DOI 10.1590/S0100-72032007000700005
Views126PURPOSE: to analyze the pattern of fetal breathing movements (FBM) in diabetic pregnant women in the third trimester of pregnancy. METHODS: sixteen pregestational diabetic and 16 nondiabetic (control group) pregnant subjects were included fulfilling the following criteria: singleton, between 36-40 weeks of gestation, absence of other maternal diseases and absence of fetal anomalies. The fetal biophysical profile (FBP) was performed to evaluate the following parameters: fetal heart rate, FBM, fetal body movements, fetal tone and amniotic fluid index. The FBM was evaluated for 30 minutes, period when the examination was integrally recorded in VHS video for posterior analysis of the number of FBM episodes, the duration of each episode and the fetal breathing movements index (BMI). The BMI was calculated by the formula: (interval of time with FBM/total time of observation) x 100. At the beginning and in the end of the FBP maternal glucose levels were checked. The results were analyzed by the Mann-Whitney U-test and the Fisher exact test, adopting a level of significance of 5%. RESULTS: the glucose levels demonstrated significantly superior average in the diabetic group (113.3±35.3 g/dL) in relation to the normal group (78.2±14.8 g/dL, p<0.001). The average of the amniotic fluid index was higher in the group of the diabetic cases (15.5±6.4 cm) when compared with controls (10.6±2.0 cm; p=0.01). The average of the number of FBM episodes was superior in the diabetic ones (22.6±4.4) in relation to controls (14.8±2.3; p<0.0001). The average of the BMI in the diabetic patients (54.6±14.8%) was significantly higher than that in the control group (30.5±7.4%, p<0.0001). CONCLUSIONS: the elevated blood glucose levels can be associated with a different pattern in the FBM of diabetic mothers. The use of this parameter of the FBP, in the obstetric practice, must be considered with concern in diabetic pregnancies.
Key-words Amniotic fluidDiabetes mellitusFetal monitoringFetusPregnancy in diabeticsPregnancy, high riskRespirationUltrasonographySee moreViews126This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleFetal breathing movements in pregnancies complicated by pregestational diabetes mellitus
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(7):352-357
DOI 10.1590/S0100-72032007000700005
Views126PURPOSE: to analyze the pattern of fetal breathing movements (FBM) in diabetic pregnant women in the third trimester of pregnancy. METHODS: sixteen pregestational diabetic and 16 nondiabetic (control group) pregnant subjects were included fulfilling the following criteria: singleton, between 36-40 weeks of gestation, absence of other maternal diseases and absence of fetal anomalies. The fetal biophysical profile (FBP) was performed to evaluate the following parameters: fetal heart rate, FBM, fetal body movements, fetal tone and amniotic fluid index. The FBM was evaluated for 30 minutes, period when the examination was integrally recorded in VHS video for posterior analysis of the number of FBM episodes, the duration of each episode and the fetal breathing movements index (BMI). The BMI was calculated by the formula: (interval of time with FBM/total time of observation) x 100. At the beginning and in the end of the FBP maternal glucose levels were checked. The results were analyzed by the Mann-Whitney U-test and the Fisher exact test, adopting a level of significance of 5%. RESULTS: the glucose levels demonstrated significantly superior average in the diabetic group (113.3±35.3 g/dL) in relation to the normal group (78.2±14.8 g/dL, p<0.001). The average of the amniotic fluid index was higher in the group of the diabetic cases (15.5±6.4 cm) when compared with controls (10.6±2.0 cm; p=0.01). The average of the number of FBM episodes was superior in the diabetic ones (22.6±4.4) in relation to controls (14.8±2.3; p<0.0001). The average of the BMI in the diabetic patients (54.6±14.8%) was significantly higher than that in the control group (30.5±7.4%, p<0.0001). CONCLUSIONS: the elevated blood glucose levels can be associated with a different pattern in the FBM of diabetic mothers. The use of this parameter of the FBP, in the obstetric practice, must be considered with concern in diabetic pregnancies.
Key-words Amniotic fluidDiabetes mellitusFetal monitoringFetusPregnancy in diabeticsPregnancy, high riskRespirationUltrasonographySee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article10-05-2007
Insulinotherapy, maternal glycemic control and perinatal prognosis: difference between clinical and gestational diabetes
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):253-259
Abstract
Original ArticleInsulinotherapy, maternal glycemic control and perinatal prognosis: difference between clinical and gestational diabetes
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):253-259
DOI 10.1590/S0100-72032007000500006
Views135See morePURPOSE: to evaluate the insulin therapy protocol and its maternal and perinatal outcome in patients with clinical or gestational diabetes in a high risk reference service. METHODS: descriptive and prospective study including 103 pregnant women with gestational or clinical diabetes treated with insulin and attended by the reference service from October 2003 to December 2005. Gemellarity, miscarriages, unfinished prenatal care and deliveries not attended by the service were excluded. The gestational age at the beginning of the treatment, dosage, doses/day, increment of insulin (UI/kg), glycemic index (GI) and perinatal outcomes were compared. ANOVA, Fisher’s exact test and Goodman’s test considering p<0.05 were used. RESULTS: multiparity (92 versus 67.9%), pre-gestational body mass index (BMI) >25 kg/m² (88 versus 58.5%), weight gain (WG) <8 kg (36 versus 17%) and a high increment of insulin characterized the gestational diabetes. For the patients with clinical diabetes, despite the highest GI (120 mg/dL (39.2 versus 24%)) at the end of the gestational period, insulin therapy started earlier (47.2 versus 4%), lasted longer (56.6 versus 6%) and higher doses of insulin (92 versus 43 UI/day) were administered up to three times a day (54.7 versus 16%). Macrosomia was higher among newborns from the cohort of patients with gestational diabetes (16 versus 3.8%), being the only significant neonatal outcome. There were no neonatal deaths, except for one fetal death in the cohort of patients with clinical diabetes. There were no differences in the other neonatal complications in both cohorts, and most of the newborns were discharged from hospital up to seven days after delivery (46% versus 55.8%). CONCLUSIONS: the analysis of these two cohorts has shown differences in the insulin therapy protocol in quantity (UI/day), dosage (UI/kg weight) and number of doses/day, higher for the clinical diabetes cohort, and in the increment of insulin, higher for the gestational diabetes cohort. Indirectly, the quality of maternal glycemic control and the satisfactory perinatal outcome have proven that the treatment protocol was adequate and did not depend on the type of diabetes.
Views135This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleInsulinotherapy, maternal glycemic control and perinatal prognosis: difference between clinical and gestational diabetes
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):253-259
DOI 10.1590/S0100-72032007000500006
Views135See morePURPOSE: to evaluate the insulin therapy protocol and its maternal and perinatal outcome in patients with clinical or gestational diabetes in a high risk reference service. METHODS: descriptive and prospective study including 103 pregnant women with gestational or clinical diabetes treated with insulin and attended by the reference service from October 2003 to December 2005. Gemellarity, miscarriages, unfinished prenatal care and deliveries not attended by the service were excluded. The gestational age at the beginning of the treatment, dosage, doses/day, increment of insulin (UI/kg), glycemic index (GI) and perinatal outcomes were compared. ANOVA, Fisher’s exact test and Goodman’s test considering p<0.05 were used. RESULTS: multiparity (92 versus 67.9%), pre-gestational body mass index (BMI) >25 kg/m² (88 versus 58.5%), weight gain (WG) <8 kg (36 versus 17%) and a high increment of insulin characterized the gestational diabetes. For the patients with clinical diabetes, despite the highest GI (120 mg/dL (39.2 versus 24%)) at the end of the gestational period, insulin therapy started earlier (47.2 versus 4%), lasted longer (56.6 versus 6%) and higher doses of insulin (92 versus 43 UI/day) were administered up to three times a day (54.7 versus 16%). Macrosomia was higher among newborns from the cohort of patients with gestational diabetes (16 versus 3.8%), being the only significant neonatal outcome. There were no neonatal deaths, except for one fetal death in the cohort of patients with clinical diabetes. There were no differences in the other neonatal complications in both cohorts, and most of the newborns were discharged from hospital up to seven days after delivery (46% versus 55.8%). CONCLUSIONS: the analysis of these two cohorts has shown differences in the insulin therapy protocol in quantity (UI/day), dosage (UI/kg weight) and number of doses/day, higher for the clinical diabetes cohort, and in the increment of insulin, higher for the gestational diabetes cohort. Indirectly, the quality of maternal glycemic control and the satisfactory perinatal outcome have proven that the treatment protocol was adequate and did not depend on the type of diabetes.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article06-21-2007
beta-cell function evaluation in patients with polycystic ovary syndrome using HOMA model: a comparison between obeses e nonobeses
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(3):141-146
Abstract
Original Articlebeta-cell function evaluation in patients with polycystic ovary syndrome using HOMA model: a comparison between obeses e nonobeses
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(3):141-146
DOI 10.1590/S0100-72032007000300005
Views151PURPOSE: to evaluate the effect of obesity on beta-cell function in patients with polycystic ovary syndrome (PCOS). METHODS: this cross-section study evaluated 82 patients with PCOS selected consecutively, at the moment of the diagnosis. We compared 31 PCOS obese women (BMI >30 kg/m²) to 51 age-matched PCOS nonobese patients (BMI <30 kg/m²). Using fasting glucose and insulin levels, homeostatic model assessment values for insulin resistance (HOMA-IR and QUICKI) and percent beta-cell function (HOMA-%beta-cell) were calculated. As secondary variables, the age at PCOS diagnosis, age of menarche, hormonal levels (testosterone, prolactin, FSH and LH), total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol were also analyzed. RESULTS: menarche was significantly earlier in obese PCOS patients (11.7±1.8 years) than in nonobese patients (12.67±1.86 years) (p<0.05). Obese patients presented lower LH levels (7.9±5 mIU/mL) than did nonobese patients (10.6±6 mIU/mL) (p<0.05). Both groups presented mean HDL cholesterol levels below 50 mg/dL. Obese patients presented significantly higher baseline insulin levels (32.5±25.2 mIU/mL) and fasting blood glucose levels (115.9±40.7 mg/dL) than did nonobese patients (8.8±6.6 mIU/mL and 90.2±8.9 mg/dL, respectively) (p<0.01). Of the obese PCOS patients, 93% presented insulin resistance versus 25% of nonobese PCOS patients (p<0.01). Eighty-six perecent of the obese women had hyperfunction of beta-cell versus 41% of nonobese with PCOS (p<0.0001). CONCLUSIONS: obese PCOS patients presented higher prevalence of insulin resistance and hyperfunction of beta-cell than did nonobese PCOS patients.
Key-words Diabetes mellitusInsulinInsulin resistanceIslets of LangerhansObesityPolycystic ovary syndromeSee moreViews151This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original Articlebeta-cell function evaluation in patients with polycystic ovary syndrome using HOMA model: a comparison between obeses e nonobeses
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(3):141-146
DOI 10.1590/S0100-72032007000300005
Views151PURPOSE: to evaluate the effect of obesity on beta-cell function in patients with polycystic ovary syndrome (PCOS). METHODS: this cross-section study evaluated 82 patients with PCOS selected consecutively, at the moment of the diagnosis. We compared 31 PCOS obese women (BMI >30 kg/m²) to 51 age-matched PCOS nonobese patients (BMI <30 kg/m²). Using fasting glucose and insulin levels, homeostatic model assessment values for insulin resistance (HOMA-IR and QUICKI) and percent beta-cell function (HOMA-%beta-cell) were calculated. As secondary variables, the age at PCOS diagnosis, age of menarche, hormonal levels (testosterone, prolactin, FSH and LH), total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol were also analyzed. RESULTS: menarche was significantly earlier in obese PCOS patients (11.7±1.8 years) than in nonobese patients (12.67±1.86 years) (p<0.05). Obese patients presented lower LH levels (7.9±5 mIU/mL) than did nonobese patients (10.6±6 mIU/mL) (p<0.05). Both groups presented mean HDL cholesterol levels below 50 mg/dL. Obese patients presented significantly higher baseline insulin levels (32.5±25.2 mIU/mL) and fasting blood glucose levels (115.9±40.7 mg/dL) than did nonobese patients (8.8±6.6 mIU/mL and 90.2±8.9 mg/dL, respectively) (p<0.01). Of the obese PCOS patients, 93% presented insulin resistance versus 25% of nonobese PCOS patients (p<0.01). Eighty-six perecent of the obese women had hyperfunction of beta-cell versus 41% of nonobese with PCOS (p<0.0001). CONCLUSIONS: obese PCOS patients presented higher prevalence of insulin resistance and hyperfunction of beta-cell than did nonobese PCOS patients.
Key-words Diabetes mellitusInsulinInsulin resistanceIslets of LangerhansObesityPolycystic ovary syndromeSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article04-12-1998
Glycosylated hemoglobin levels and cardiac abnormalities in fetuses of diabetic mothers
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(5):237-243
Abstract
Original ArticleGlycosylated hemoglobin levels and cardiac abnormalities in fetuses of diabetic mothers
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(5):237-243
DOI 10.1590/S0100-72031998000500002
Views95We analyze prospectively the existence of a relationship between the mother's glycemic control, in the first half of pregnancy, and the occurrence of abnormal fetal cardiac abnormalities, in pregnant women with diabetes mellitus. In 127 pregnant women, the level of glycosylated hemoglobin was determined on the first visit during prenatal care. Nine patients had type I diabetes, 77 type II and 41 gestational diabetes mellitus (GDM). All mothers were submitted to detailed fetal echocardiography, during the 28th ± 4.127 week of gestation. In 31 (24.4%) of the 127 fetuses cardiac anomalies were detected. In 10 (7.87%) an isolated cardiac anomaly was identified. Mean HbA1c in the group of pregnant women without cardiac anomalies (5.64%) was statistically different from the group with anomalies (10.14%) (p<0.0001). The receiver-operator characteristic, representing the balance between sensitivity (92.83%) and specificity (98.92%) in the diagnosis of structural cardiac abnormalities, showed a cut-off point at the 7.5% HbA1c level. In nine of ten fetuses with structural cardiac anomalies, the maternal level of HbA1c was higher than 7.5%. The difference between means of the groups with and without myocardial hypertrophy diagnosed as isolated anomaly (MCHP) was not statistically significant, when considering both type II diabetes and GDM subgroups. In conclusion, levels of HbA1c higher than 7.5% were associated with most cases of echocardiographycally diagnosed structural cardiac anomalies. On the other hand, this test was not useful to discriminate conceptus with MCHP.
Key-words Diabetes mellitusFetusGlysosylated hemoglobin AMalformationsPregnancy complicationsUltrasonographySee moreViews95This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleGlycosylated hemoglobin levels and cardiac abnormalities in fetuses of diabetic mothers
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(5):237-243
DOI 10.1590/S0100-72031998000500002
Views95We analyze prospectively the existence of a relationship between the mother's glycemic control, in the first half of pregnancy, and the occurrence of abnormal fetal cardiac abnormalities, in pregnant women with diabetes mellitus. In 127 pregnant women, the level of glycosylated hemoglobin was determined on the first visit during prenatal care. Nine patients had type I diabetes, 77 type II and 41 gestational diabetes mellitus (GDM). All mothers were submitted to detailed fetal echocardiography, during the 28th ± 4.127 week of gestation. In 31 (24.4%) of the 127 fetuses cardiac anomalies were detected. In 10 (7.87%) an isolated cardiac anomaly was identified. Mean HbA1c in the group of pregnant women without cardiac anomalies (5.64%) was statistically different from the group with anomalies (10.14%) (p<0.0001). The receiver-operator characteristic, representing the balance between sensitivity (92.83%) and specificity (98.92%) in the diagnosis of structural cardiac abnormalities, showed a cut-off point at the 7.5% HbA1c level. In nine of ten fetuses with structural cardiac anomalies, the maternal level of HbA1c was higher than 7.5%. The difference between means of the groups with and without myocardial hypertrophy diagnosed as isolated anomaly (MCHP) was not statistically significant, when considering both type II diabetes and GDM subgroups. In conclusion, levels of HbA1c higher than 7.5% were associated with most cases of echocardiographycally diagnosed structural cardiac anomalies. On the other hand, this test was not useful to discriminate conceptus with MCHP.
Key-words Diabetes mellitusFetusGlysosylated hemoglobin AMalformationsPregnancy complicationsUltrasonographySee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article12-05-2006
Lamellar body count versus the shake test in the assessment of fetal lung maturity in diabetics
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(8):460-466
Abstract
Original ArticleLamellar body count versus the shake test in the assessment of fetal lung maturity in diabetics
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(8):460-466
DOI 10.1590/S0100-72032006000800004
Views161PURPOSE: to assess the performance of lamellar body count compared to the shake (Clements) test in the prediction of fetal lung maturity in diabetics. METHODS: prospective study of 62 patients who underwent amniocentesis between the 26th and 39th week of pregnancy. Immediately after collection, the amniotic fluid sample was submitted to the shake test and lamellar body count. Deliveries occurred within three days of amniocentesis. Immature test results (absence of a complete bubble ring in the third tube for the shake test and less than 50,000 lamellar bodies) were confronted with the occurrence of pulmonary immaturity in the neonate (respiratory distress syndrome). The performance of both tests was compared using the chi2 test and p<0.05 was considered to be significant. RESULTS: seven infants had respiratory distress syndrome (11.3%). The lamellar body count and shake test were similar regarding sensitivity (100 vs 71.4%, respectively) and negative predictive value (100 vs 93.5%). Lamellar body count was superior as regards specificity (87.3 vs 52.7%, p=0.0001), positive predictive value (50 vs 16.1%, p=0.017), and accuracy (88.7 vs 54.8%, p<0.001). CONCLUSIONS: lamellar body count is a simple and accurate method of assessing fetal lung maturity. It performs slightly better than the shake test in terms of specificity, positive predictive value and accuracy, with the advantage of not requiring manipulation or reagents. Similar to the shake test, lamellar body count has a high-negative predictive value: mature results (50,000 or more) indicate thar the infant will not have hyaline membrane.
Key-words Amniotic fluidDiabetes mellitusFetal organ maturityLungNewbornPregnancy in diabeticsRespiratory distress syndromeSee moreViews161This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleLamellar body count versus the shake test in the assessment of fetal lung maturity in diabetics
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(8):460-466
DOI 10.1590/S0100-72032006000800004
Views161PURPOSE: to assess the performance of lamellar body count compared to the shake (Clements) test in the prediction of fetal lung maturity in diabetics. METHODS: prospective study of 62 patients who underwent amniocentesis between the 26th and 39th week of pregnancy. Immediately after collection, the amniotic fluid sample was submitted to the shake test and lamellar body count. Deliveries occurred within three days of amniocentesis. Immature test results (absence of a complete bubble ring in the third tube for the shake test and less than 50,000 lamellar bodies) were confronted with the occurrence of pulmonary immaturity in the neonate (respiratory distress syndrome). The performance of both tests was compared using the chi2 test and p<0.05 was considered to be significant. RESULTS: seven infants had respiratory distress syndrome (11.3%). The lamellar body count and shake test were similar regarding sensitivity (100 vs 71.4%, respectively) and negative predictive value (100 vs 93.5%). Lamellar body count was superior as regards specificity (87.3 vs 52.7%, p=0.0001), positive predictive value (50 vs 16.1%, p=0.017), and accuracy (88.7 vs 54.8%, p<0.001). CONCLUSIONS: lamellar body count is a simple and accurate method of assessing fetal lung maturity. It performs slightly better than the shake test in terms of specificity, positive predictive value and accuracy, with the advantage of not requiring manipulation or reagents. Similar to the shake test, lamellar body count has a high-negative predictive value: mature results (50,000 or more) indicate thar the infant will not have hyaline membrane.
Key-words Amniotic fluidDiabetes mellitusFetal organ maturityLungNewbornPregnancy in diabeticsRespiratory distress syndromeSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article12-05-2006
Fetal heart rate and umbilical artery Dopplervelocimetry between the 18th and 20th weeks of gestation in pregnancies complicated by pregestational diabetes mellitus
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(8):453-459
Abstract
Original ArticleFetal heart rate and umbilical artery Dopplervelocimetry between the 18th and 20th weeks of gestation in pregnancies complicated by pregestational diabetes mellitus
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(8):453-459
DOI 10.1590/S0100-72032006000800003
Views95PURPOSE: to analyze the fetal heart rate (FHR) and umbilical artery Dopplervelocimetry between 18th and 20th weeks of gestation in pregnant women complicated by pregestational diabetes mellitus. METHODS: twenty-eight pregnancies with pregestational diabetes and 27 normal pregnant women were analyzed prospectively, in a cross-sectional and case-control study. The inclusion criteria were the following: singleton pregnancy between 18 and 29 weeks, no other associated maternal diseases and no fetal abnormality. Ultrasonography was performed and FHR was calculated by the interval between the beginnings of two consecutive cardiac cycles, in the three umbilical artery Doppler sonograms, obtained in the umbilical cord near to the placental insertion, using color Doppler. Five consecutive FHR cycles from each sonogram were measured, to analyze mean FHR and its variation. The following Doppler indices were studied: systolic/diastolic ratio, pulsatility index (PI) and resistance index (RI). Student's t test and Mann-Whitney Utest were applied to comparative study. p values were considered significant when p<0.05. Results: no significant difference was observed in mean FHR between the studied groups (diabetic group: 149.2 bpm, control group: 147.2 bpm; p = 0.12). FHR variation revealed similar results between the groups (diabetic group: 5.3 bpm; control group: 5.3 bpm; p=0.50). No significant difference was found in the Doppler indices S/D (p=0.79), PI (p=0.25) and RI (p=0.71) between the groups. CONCLUSIONS: the absence of differences in FHR characteristics between the 18th and 20th gestational weeks indicates similar neurological maturation of FHR regulatory systems in this period, between fetuses of diabetic mothers and controls. Abnormalities in the uteroplacental resistance were not identified in the studied period, in pregnancies complicated by pregestational diabetes.
Key-words Diabetes mellitusDopplerfetalHeart rateLaser-doppler flowmetryUltrasonographyUmbilical arteriesSee moreViews95This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleFetal heart rate and umbilical artery Dopplervelocimetry between the 18th and 20th weeks of gestation in pregnancies complicated by pregestational diabetes mellitus
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(8):453-459
DOI 10.1590/S0100-72032006000800003
Views95PURPOSE: to analyze the fetal heart rate (FHR) and umbilical artery Dopplervelocimetry between 18th and 20th weeks of gestation in pregnant women complicated by pregestational diabetes mellitus. METHODS: twenty-eight pregnancies with pregestational diabetes and 27 normal pregnant women were analyzed prospectively, in a cross-sectional and case-control study. The inclusion criteria were the following: singleton pregnancy between 18 and 29 weeks, no other associated maternal diseases and no fetal abnormality. Ultrasonography was performed and FHR was calculated by the interval between the beginnings of two consecutive cardiac cycles, in the three umbilical artery Doppler sonograms, obtained in the umbilical cord near to the placental insertion, using color Doppler. Five consecutive FHR cycles from each sonogram were measured, to analyze mean FHR and its variation. The following Doppler indices were studied: systolic/diastolic ratio, pulsatility index (PI) and resistance index (RI). Student's t test and Mann-Whitney Utest were applied to comparative study. p values were considered significant when p<0.05. Results: no significant difference was observed in mean FHR between the studied groups (diabetic group: 149.2 bpm, control group: 147.2 bpm; p = 0.12). FHR variation revealed similar results between the groups (diabetic group: 5.3 bpm; control group: 5.3 bpm; p=0.50). No significant difference was found in the Doppler indices S/D (p=0.79), PI (p=0.25) and RI (p=0.71) between the groups. CONCLUSIONS: the absence of differences in FHR characteristics between the 18th and 20th gestational weeks indicates similar neurological maturation of FHR regulatory systems in this period, between fetuses of diabetic mothers and controls. Abnormalities in the uteroplacental resistance were not identified in the studied period, in pregnancies complicated by pregestational diabetes.
Key-words Diabetes mellitusDopplerfetalHeart rateLaser-doppler flowmetryUltrasonographyUmbilical arteriesSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article08-25-2006
Antiphospholipid antibodies in gestational and pregestational diabetic women
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(3):179-183
Abstract
Original ArticleAntiphospholipid antibodies in gestational and pregestational diabetic women
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(3):179-183
DOI 10.1590/S0100-72032006000300007
Views131PURPOSE: to diagnose and treat diabetic pregnant women with antiphospholipid antibodies and to describe the gestational and perinatal results. METHODS: we evaluated 56 gestational and pregestational diabetic women who were attended at one specialized prenatal care unit, between July 2003 and March 2004. All of them had a blood test to quantify antiphospholipid antibodies. If positive, they were treated with heparin and aspirin at low doses and the usual treatment for diabetes. We calculated the prevalence and 95% confidence interval for all and also those for the pregestational ones. The characteristics of the pregnancies and the newborns are described. RESULTS: antiphospholipid antibodies prevalence among the diabetic pregnant women was 7% (95% CI - 0.1 to 13.9). Among pregestational diabetic women it was 12% (95% CI - 0.2 to 23.3). Among the diabetic women with antiphospholipid antibodies the duration of disease was five years or more. Maternal age in positive antiphospholipid antibodies diabetics ranged from 27 to 38 years; one was primiparous, another was secundiparous and two were multiparous. CONCLUSION: antiphospholipid antibodies prevalence in diabetic pregnant women was similar to that in the general population and lower than that of the pregestational diabetic women.
Key-words Antibodies, antiphospolipidAntiphospholipid syndromeDiabetes mellitusHigh risk pregnancyPregnancy in diabetesSee moreViews131This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleAntiphospholipid antibodies in gestational and pregestational diabetic women
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(3):179-183
DOI 10.1590/S0100-72032006000300007
Views131PURPOSE: to diagnose and treat diabetic pregnant women with antiphospholipid antibodies and to describe the gestational and perinatal results. METHODS: we evaluated 56 gestational and pregestational diabetic women who were attended at one specialized prenatal care unit, between July 2003 and March 2004. All of them had a blood test to quantify antiphospholipid antibodies. If positive, they were treated with heparin and aspirin at low doses and the usual treatment for diabetes. We calculated the prevalence and 95% confidence interval for all and also those for the pregestational ones. The characteristics of the pregnancies and the newborns are described. RESULTS: antiphospholipid antibodies prevalence among the diabetic pregnant women was 7% (95% CI - 0.1 to 13.9). Among pregestational diabetic women it was 12% (95% CI - 0.2 to 23.3). Among the diabetic women with antiphospholipid antibodies the duration of disease was five years or more. Maternal age in positive antiphospholipid antibodies diabetics ranged from 27 to 38 years; one was primiparous, another was secundiparous and two were multiparous. CONCLUSION: antiphospholipid antibodies prevalence in diabetic pregnant women was similar to that in the general population and lower than that of the pregestational diabetic women.
Key-words Antibodies, antiphospolipidAntiphospholipid syndromeDiabetes mellitusHigh risk pregnancyPregnancy in diabetesSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Diabetes mellitus Archives - Page 2 of 4 - Revista Brasileira de Ginecologia e Obstetrícia
