Infection Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(6):265-272
To evaluate maternal-fetal surveillance and follow-up of infants at risk for congenital syphilis (CS).
Retrospective cohort study in a Portuguese Tertiary Referral Hospital. The main inclusion criterion was a positive syphilis serology. The study included all pregnant women that delivered in our hospital between January 2004 and December 2013. The neonates were classified according to their probability of infection based on the Centers for Disease Control and Prevention guidelines.
Among the 27 pregnancies at risk for CS, 48.2% (n = 13) of the women had a diagnosis during the 1st trimester, and the median gestational age at the end of the treatment was 28 weeks. Inadequate treatment was noted in 44.4% (n = 12) of the women. Adverse pregnancy outcomes were observed in 30.8% of the cases (n = 8), 5 of which had been adequately treated. We found 2 (7.7%) cases with “proven or highly probable CS,” 10 (38.5%) with “possible CS,” 12 (46.1%) with “less likely CS,” and 2 (7.7%) with “unlikely CS.”Among the infants, the treatment was successful, except for 1 neurosyphilis case.
This study highlights many of the difficulties/concerns encountered in the maternal-neonatal management of syphilis. We highlight the importance of assuring the early detection of the infection as a way of guaranteeing the timely treatment, as well as a good compliance to the treatment and follow-up through a more efficient pregnant women surveillance network.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(6):265-272
To evaluate maternal-fetal surveillance and follow-up of infants at risk for congenital syphilis (CS).
Retrospective cohort study in a Portuguese Tertiary Referral Hospital. The main inclusion criterion was a positive syphilis serology. The study included all pregnant women that delivered in our hospital between January 2004 and December 2013. The neonates were classified according to their probability of infection based on the Centers for Disease Control and Prevention guidelines.
Among the 27 pregnancies at risk for CS, 48.2% (n = 13) of the women had a diagnosis during the 1st trimester, and the median gestational age at the end of the treatment was 28 weeks. Inadequate treatment was noted in 44.4% (n = 12) of the women. Adverse pregnancy outcomes were observed in 30.8% of the cases (n = 8), 5 of which had been adequately treated. We found 2 (7.7%) cases with “proven or highly probable CS,” 10 (38.5%) with “possible CS,” 12 (46.1%) with “less likely CS,” and 2 (7.7%) with “unlikely CS.”Among the infants, the treatment was successful, except for 1 neurosyphilis case.
This study highlights many of the difficulties/concerns encountered in the maternal-neonatal management of syphilis. We highlight the importance of assuring the early detection of the infection as a way of guaranteeing the timely treatment, as well as a good compliance to the treatment and follow-up through a more efficient pregnant women surveillance network.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(5):199-204
DOI 10.1590/S0100-72032013000500002
PURPOSE: To determine the prevalence and associated factors of the hospitalization of pregnant women for treatment of urinary tract infection and the repercussions on the health of the newborn, and the absence of a urine exam during the prenatal period. METHODS: A cross-sectional design, where were eligible all mothers of newborns with births occurring between January 1st and December 31, 2010 in Rio Grande (RS). Mothers were interviewed in the two maternity hospitals in the city. Information was collected regarding hospitalization for urinary tract infection, the prenatal assistance and sociodemographic conditions. Statistical analyses were performed by levels and controlled for confounding using Poisson regression. RESULTS: Of the 2,288 women eligible for the study, 2.9% were hospitalized for treatment of urinary tract infection and was higher, after adjustment, in woman with lowest economic status (3.1% the lowest and 2.1% the highest), younger (4.0% in adolescents and 1.8% in those over 30 years), had less education (3.1% had seven years or less of studying and 1.2% had 12 years or more) and did not live with a partner (4.3% living without partner and 2.6% living with partner). Pathologies of the newborn associated with hospitalization, were preterm birth (4.1% in pre-term and 2.7% in those at term) and low birth weight (6.4% in low and 2.6% in those in normal). Of the women who underwent prenatal care, 23.6% had not done the urine test as recommended and, after adjustment, and the risk for not done the test was higher among those with lower socioeconomic status (34.4% in lower and 14.4% in the highest level), less educated (32.3% with seven years or less of studying and 11.0% with 12 years or more) and not living with a partner (32.7% living without partner and 22.0% living with partner). CONCLUSIONS: The high rate of hospitalization reflects the lack of effectiveness of screening for urinary tract infection during pregnancy. The socioeconomic profile of women who required hospitalization and who did not undergo adequate screening of urinary tract infection in prenatal care, demonstrate the need of more careful attention to pregnant women with the features found.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(5):199-204
DOI 10.1590/S0100-72032013000500002
PURPOSE: To determine the prevalence and associated factors of the hospitalization of pregnant women for treatment of urinary tract infection and the repercussions on the health of the newborn, and the absence of a urine exam during the prenatal period. METHODS: A cross-sectional design, where were eligible all mothers of newborns with births occurring between January 1st and December 31, 2010 in Rio Grande (RS). Mothers were interviewed in the two maternity hospitals in the city. Information was collected regarding hospitalization for urinary tract infection, the prenatal assistance and sociodemographic conditions. Statistical analyses were performed by levels and controlled for confounding using Poisson regression. RESULTS: Of the 2,288 women eligible for the study, 2.9% were hospitalized for treatment of urinary tract infection and was higher, after adjustment, in woman with lowest economic status (3.1% the lowest and 2.1% the highest), younger (4.0% in adolescents and 1.8% in those over 30 years), had less education (3.1% had seven years or less of studying and 1.2% had 12 years or more) and did not live with a partner (4.3% living without partner and 2.6% living with partner). Pathologies of the newborn associated with hospitalization, were preterm birth (4.1% in pre-term and 2.7% in those at term) and low birth weight (6.4% in low and 2.6% in those in normal). Of the women who underwent prenatal care, 23.6% had not done the urine test as recommended and, after adjustment, and the risk for not done the test was higher among those with lower socioeconomic status (34.4% in lower and 14.4% in the highest level), less educated (32.3% with seven years or less of studying and 11.0% with 12 years or more) and not living with a partner (32.7% living without partner and 22.0% living with partner). CONCLUSIONS: The high rate of hospitalization reflects the lack of effectiveness of screening for urinary tract infection during pregnancy. The socioeconomic profile of women who required hospitalization and who did not undergo adequate screening of urinary tract infection in prenatal care, demonstrate the need of more careful attention to pregnant women with the features found.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(4):158-163
DOI 10.1590/S0100-72032012000400004
PURPOSE: To verify cervical length using transvaginal ultrasonography in pregnant women between 28 and 34 weeks of gestation, correlating it with the latent period and the risk of maternal and neonatal infections. METHODS: 39 pregnant women were evaluated and divided into groups based on their cervical length, using 15, 20 and 25 mm as cut-off points. The latency periods evaluated were three and seven days. Included were pregnant women with live fetuses and gestational age between 28 and 34 weeks, with a confirmed diagnosis on admission of premature rupture of membranes. Patients with chorioamnionitis, multiple gestation, fetal abnormalities, uterine malformations (bicornus septate and didelphic uterus), history of previous surgery on the cervix (conization and cerclage) and cervical dilation greater than 2 cm in nulliparous women and 3 cm in multiparae were excluded from the study. RESULTS: A <15 mm cervical length was found to be highly related to a latency period of up to 72 hours (p=0.008). A <20 mm cervical length was also associated with a less than 72 hour latency period (p=0.04). A <25 mm cervical length was not found to be statistically associated with a 72 hour latency period (p=0,12). There was also no significant correlation between cervical length and latency period and maternal and neonatal infection. CONCLUSION: The presence of a short cervix (<15 mm) was found to be related to a latency period of less than 72 hours, but not to maternal or neonatal infections.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(4):158-163
DOI 10.1590/S0100-72032012000400004
PURPOSE: To verify cervical length using transvaginal ultrasonography in pregnant women between 28 and 34 weeks of gestation, correlating it with the latent period and the risk of maternal and neonatal infections. METHODS: 39 pregnant women were evaluated and divided into groups based on their cervical length, using 15, 20 and 25 mm as cut-off points. The latency periods evaluated were three and seven days. Included were pregnant women with live fetuses and gestational age between 28 and 34 weeks, with a confirmed diagnosis on admission of premature rupture of membranes. Patients with chorioamnionitis, multiple gestation, fetal abnormalities, uterine malformations (bicornus septate and didelphic uterus), history of previous surgery on the cervix (conization and cerclage) and cervical dilation greater than 2 cm in nulliparous women and 3 cm in multiparae were excluded from the study. RESULTS: A <15 mm cervical length was found to be highly related to a latency period of up to 72 hours (p=0.008). A <20 mm cervical length was also associated with a less than 72 hour latency period (p=0.04). A <25 mm cervical length was not found to be statistically associated with a 72 hour latency period (p=0,12). There was also no significant correlation between cervical length and latency period and maternal and neonatal infection. CONCLUSION: The presence of a short cervix (<15 mm) was found to be related to a latency period of less than 72 hours, but not to maternal or neonatal infections.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):221-224
DOI 10.1590/S0100-72031998000400008
A case of postsurgical necrotizing fasciitis is presented. A 68-year-old female patient was submitted to a lumpectomy for a big breast lipoma. After surgen there was an aggressive local infection, with extensive necrosis of the breast tissue, including the superficial and deep fasciae and also the skin over the breast. The gravity of the disease and the difficulties in its diagnosis due to the late skin necrosis are emphasized. Under such circunstances an early and aggressive approach is necessary.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):221-224
DOI 10.1590/S0100-72031998000400008
A case of postsurgical necrotizing fasciitis is presented. A 68-year-old female patient was submitted to a lumpectomy for a big breast lipoma. After surgen there was an aggressive local infection, with extensive necrosis of the breast tissue, including the superficial and deep fasciae and also the skin over the breast. The gravity of the disease and the difficulties in its diagnosis due to the late skin necrosis are emphasized. Under such circunstances an early and aggressive approach is necessary.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(8):442-449
DOI 10.1590/S0100-72032005000800002
PURPOSE: to establish the frequency of acute toxoplasmosis in pregnant women, vertical transmission rate and the perinatal results of the infected fetuses and also to evaluate the relationship between the most used maternal-fetal diagnostic tests for toxoplasmosis during pregnancy and the relationship between age and acute toxoplasmosis infection during pregnancy. METHODS: longitudinal prospective study of 32,512 pregnant women attended by The Pregnancy Protection Program of the State of Mato Grosso do Sul - Brazil, from November 2002 to October 2003. ELISA (IgG and IgM) and IgG avidity test were performed for maternal diagnosis and amniotic fluid PCR for fetal investigation of the infection. The relationship between data was analyzed statistically by the chi2 or two-sided Fisher's exact test in contingency tables. RESULTS: a 0.42% frequency of acute Toxoplasma gondii infection among pregnant population was found, where 92% were previously exposed and 8% were susceptible. Among IgM-positive pregnant women, the age ranged from 14 to 39 years, with a mean of 23±5.9 years. There was no statistically significant relationship between age and maternal acute T. gondii infection (p=0.73). The vertical transmission rate was 3.9%. A statistically significant relationship was shown (p=0.001) between a lower avidity IgG test (<30%) and the presence of fetal infection and a higher IgG avidity test (>60%) and the absence of fetal infection. There was a statistically significant association (p=0.001) between fetal infection (amniotic fluid PCR) and neonatal infection. CONCLUSIONS: maternal acute toxoplasmosis frequency was lower than the Brazilian national parameters, whereas vertical transmission rate did not differ from the rates found in other studies. The IgG avidity test, when associated with gestational age and the examination date, was useful to evaluate the therapeutical options and to consider the risk of vertical transmission when performed before 12 weeks. Positive PCR in amniotic fluid showed a positive relationship with the worst neonatal prognosis, being a specific method in diagnosing intrauterine fetal infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(8):442-449
DOI 10.1590/S0100-72032005000800002
PURPOSE: to establish the frequency of acute toxoplasmosis in pregnant women, vertical transmission rate and the perinatal results of the infected fetuses and also to evaluate the relationship between the most used maternal-fetal diagnostic tests for toxoplasmosis during pregnancy and the relationship between age and acute toxoplasmosis infection during pregnancy. METHODS: longitudinal prospective study of 32,512 pregnant women attended by The Pregnancy Protection Program of the State of Mato Grosso do Sul - Brazil, from November 2002 to October 2003. ELISA (IgG and IgM) and IgG avidity test were performed for maternal diagnosis and amniotic fluid PCR for fetal investigation of the infection. The relationship between data was analyzed statistically by the chi2 or two-sided Fisher's exact test in contingency tables. RESULTS: a 0.42% frequency of acute Toxoplasma gondii infection among pregnant population was found, where 92% were previously exposed and 8% were susceptible. Among IgM-positive pregnant women, the age ranged from 14 to 39 years, with a mean of 23±5.9 years. There was no statistically significant relationship between age and maternal acute T. gondii infection (p=0.73). The vertical transmission rate was 3.9%. A statistically significant relationship was shown (p=0.001) between a lower avidity IgG test (<30%) and the presence of fetal infection and a higher IgG avidity test (>60%) and the absence of fetal infection. There was a statistically significant association (p=0.001) between fetal infection (amniotic fluid PCR) and neonatal infection. CONCLUSIONS: maternal acute toxoplasmosis frequency was lower than the Brazilian national parameters, whereas vertical transmission rate did not differ from the rates found in other studies. The IgG avidity test, when associated with gestational age and the examination date, was useful to evaluate the therapeutical options and to consider the risk of vertical transmission when performed before 12 weeks. Positive PCR in amniotic fluid showed a positive relationship with the worst neonatal prognosis, being a specific method in diagnosing intrauterine fetal infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(7):443-448
DOI 10.1590/S0100-72032000000700007
Purpose: to determine the main factors associated with the occurrence of surgical site infection in patients submitted to total abdominal hysterectomy at the Instituto Materno ¾ Infantil de Pernambuco (iMIP). Methods: a cross-sectional study was conducted, enrolling patients submitted to total abdominal hysterectomy at IMIP who returned to postsurgical consultation for infection control, between January, 1995 and December, 1998 (n = 414). The frequency of surgical site infection (defined according to the CDC criteria, 1998) was 10% (42 cases). Prevalence risk (PR) of infection (dependent variable) and its 95% confidence interval (CI) were calculated for independent variables: age, obesity, hypertension, diabetes, malignant pathology, type of incision, duration of surgery and antibiotic prophylaxis. Multiple logistic regression analysis was used to determine adjusted risk of infection. Results: a significantly increased risk of infection was found for the following variables: age >60 years (PR = 2.39, 95% CI = 1.15-4.94), obesity (PR = 3.2, 95% CI = 1.83-5.59), duration of surgery >2 hours (PR = 2.35, 95% CI = 1.32-4.21) and diabetes (PR = 6.0, 95% CI = 3.41-10.57). On the other hand, risk of infection was significantly reduced when antibiotic prophylaxis was administered (PR = 0.38, 95% CI = 0.21-0.68). Type of incision, malignant disease and hypertension were not associated with infection. Conclusions: the factors associated with increased risk of surgical site infection after total abdominal hysterectomy at IMIP were: age >60 years, obesity, diabetes and surgical duration >2 hours. Antibiotic prophylaxis showed a protective effect with reduction of risk of infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(7):443-448
DOI 10.1590/S0100-72032000000700007
Purpose: to determine the main factors associated with the occurrence of surgical site infection in patients submitted to total abdominal hysterectomy at the Instituto Materno ¾ Infantil de Pernambuco (iMIP). Methods: a cross-sectional study was conducted, enrolling patients submitted to total abdominal hysterectomy at IMIP who returned to postsurgical consultation for infection control, between January, 1995 and December, 1998 (n = 414). The frequency of surgical site infection (defined according to the CDC criteria, 1998) was 10% (42 cases). Prevalence risk (PR) of infection (dependent variable) and its 95% confidence interval (CI) were calculated for independent variables: age, obesity, hypertension, diabetes, malignant pathology, type of incision, duration of surgery and antibiotic prophylaxis. Multiple logistic regression analysis was used to determine adjusted risk of infection. Results: a significantly increased risk of infection was found for the following variables: age >60 years (PR = 2.39, 95% CI = 1.15-4.94), obesity (PR = 3.2, 95% CI = 1.83-5.59), duration of surgery >2 hours (PR = 2.35, 95% CI = 1.32-4.21) and diabetes (PR = 6.0, 95% CI = 3.41-10.57). On the other hand, risk of infection was significantly reduced when antibiotic prophylaxis was administered (PR = 0.38, 95% CI = 0.21-0.68). Type of incision, malignant disease and hypertension were not associated with infection. Conclusions: the factors associated with increased risk of surgical site infection after total abdominal hysterectomy at IMIP were: age >60 years, obesity, diabetes and surgical duration >2 hours. Antibiotic prophylaxis showed a protective effect with reduction of risk of infection.