morbidity Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(6):303-309
DOI 10.1590/S0100-72032005000600003
PURPOSE: to diagnose intrauterine growth restriction (IGR) and its connection with early neonatal morbidity and mortality, through Roher's ponderal index (PI). METHODS: this was a retrospective, descriptive study of transversal cohort, in which 2741 newborns (NB) were included, 2053 of them from healthy pregnant women, 228 from women with mild pregnancy-related hypertension, 52 from those with severe pregnancy-related hypertension, 25 from those with mild pregnancy-related hypertension that evolved to eclampsia, 136 from those with premature membrane rupture, and 247 from women who smoked along gestation. Roher's PI was calculated by the equation: PI = weight/height ³ x 100 and the values 2.25 and 3.10 of Lubchenco's 10 and 90 percentiles were used to classify the types of IGR. IGR was classified as asymmetric for NB with PI < 2.25 and weight lower than percentile 10, as symmetric, with PI from 2.25 to 3.10 and weight lower than percentile 10, and adequate for gestational age with PI from 2.25 to 3.10, and weight from 10 to 90 percentiles. Statistical analysis was performed using the non-paired t test, the non-parametric chi2 test and Fisher's exact test, with significance set at a value of p<0.05. RESULTS: low birth weight (< 2,500 g) was present in 3.6% (100/2741) of the cases, while the rate of IGR diagnosed through PI was 15.7% (430/2741), 14.0% being asymmetric and 1.7% symmetric. The most frequent complication among the asymmetric IGRNB was transient tachypnea (8.3%), followed by asphyxia (5.7%) and infection (2.6%). Transient tachypnea was present in 6.5% of symmetric IGRNB, followed by asphyxia (4.3%), meconium aspiration syndrome (2.2%), hypoglycemia (2.2%) and infection (2.2%). Early neonatal death was similar for NB with restricted IGR and adequate IGR for gestational age, both groups reaching a rate of 0.3%. CONCLUSIONS: Rohrer's PI was able to diagnose the different IGR patterns, which would not be known if the birth weight had been calculated in terms of gestational age. The asymmetric NB presented a higher incidence of transient tachypnea and asphyxia, without statistical significance in relation the other IGR patterns. The frequency of early neonatal death was similar for the asymmetric and adequate for gestational age NB groups.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(6):303-309
DOI 10.1590/S0100-72032005000600003
PURPOSE: to diagnose intrauterine growth restriction (IGR) and its connection with early neonatal morbidity and mortality, through Roher's ponderal index (PI). METHODS: this was a retrospective, descriptive study of transversal cohort, in which 2741 newborns (NB) were included, 2053 of them from healthy pregnant women, 228 from women with mild pregnancy-related hypertension, 52 from those with severe pregnancy-related hypertension, 25 from those with mild pregnancy-related hypertension that evolved to eclampsia, 136 from those with premature membrane rupture, and 247 from women who smoked along gestation. Roher's PI was calculated by the equation: PI = weight/height ³ x 100 and the values 2.25 and 3.10 of Lubchenco's 10 and 90 percentiles were used to classify the types of IGR. IGR was classified as asymmetric for NB with PI < 2.25 and weight lower than percentile 10, as symmetric, with PI from 2.25 to 3.10 and weight lower than percentile 10, and adequate for gestational age with PI from 2.25 to 3.10, and weight from 10 to 90 percentiles. Statistical analysis was performed using the non-paired t test, the non-parametric chi2 test and Fisher's exact test, with significance set at a value of p<0.05. RESULTS: low birth weight (< 2,500 g) was present in 3.6% (100/2741) of the cases, while the rate of IGR diagnosed through PI was 15.7% (430/2741), 14.0% being asymmetric and 1.7% symmetric. The most frequent complication among the asymmetric IGRNB was transient tachypnea (8.3%), followed by asphyxia (5.7%) and infection (2.6%). Transient tachypnea was present in 6.5% of symmetric IGRNB, followed by asphyxia (4.3%), meconium aspiration syndrome (2.2%), hypoglycemia (2.2%) and infection (2.2%). Early neonatal death was similar for NB with restricted IGR and adequate IGR for gestational age, both groups reaching a rate of 0.3%. CONCLUSIONS: Rohrer's PI was able to diagnose the different IGR patterns, which would not be known if the birth weight had been calculated in terms of gestational age. The asymmetric NB presented a higher incidence of transient tachypnea and asphyxia, without statistical significance in relation the other IGR patterns. The frequency of early neonatal death was similar for the asymmetric and adequate for gestational age NB groups.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(4):197-203
DOI 10.1590/S0100-72032005000400006
PURPOSE: to apply a severity score to cases of severe maternal morbidity (SMM) and to compare the classification criteria. METHODS: a control-case study was performed as a secondary analysis of cases of SMM in a tertiary level maternity unit for a period of 12-month. A specific score for assessing the degree of severity was applied to cases identified as SMM. Twenty cases of near miss maternal morbidity (higher severity) were compared to 104 control cases (lower severity) of other severe morbidities, regarding risk factors, primary determinants and assistance requirements. Analyses were performed with means and proportions, using Student's t, Wilcoxon and chi2 statistical tests, and estimations of OR and 95% CI. RESULTS: the higher severity (near miss) was identified in 16.1% of cases and the history of abortion was the only factor statistically associated with it (OR=3.41, 95% CI 1.08-10.79). In fact, the indices of assistance complexity were more frequent in the near-miss morbidity group, which also presented less hypertension (30% against 62.5%) and more hemorrhage (35.5% against 10.6%) as primary determinant factors of severe morbidity. CONCLUSIONS: the higher severity of maternal morbidity was associated with a history of abortion and with hemorrhage as a cause. The applied score was able to identify a higher severity subgroup (near miss), which needs more complex professional and institutional care in order to avoid the occurrence of death.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(4):197-203
DOI 10.1590/S0100-72032005000400006
PURPOSE: to apply a severity score to cases of severe maternal morbidity (SMM) and to compare the classification criteria. METHODS: a control-case study was performed as a secondary analysis of cases of SMM in a tertiary level maternity unit for a period of 12-month. A specific score for assessing the degree of severity was applied to cases identified as SMM. Twenty cases of near miss maternal morbidity (higher severity) were compared to 104 control cases (lower severity) of other severe morbidities, regarding risk factors, primary determinants and assistance requirements. Analyses were performed with means and proportions, using Student's t, Wilcoxon and chi2 statistical tests, and estimations of OR and 95% CI. RESULTS: the higher severity (near miss) was identified in 16.1% of cases and the history of abortion was the only factor statistically associated with it (OR=3.41, 95% CI 1.08-10.79). In fact, the indices of assistance complexity were more frequent in the near-miss morbidity group, which also presented less hypertension (30% against 62.5%) and more hemorrhage (35.5% against 10.6%) as primary determinant factors of severe morbidity. CONCLUSIONS: the higher severity of maternal morbidity was associated with a history of abortion and with hemorrhage as a cause. The applied score was able to identify a higher severity subgroup (near miss), which needs more complex professional and institutional care in order to avoid the occurrence of death.