Pregnancy complications Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):153-159
DOI 10.1590/S0100-72032004000200011
Pustular psoriasis of pregnancy is a rare pustular dermatosis with eruptions that develop in groups of sterile pustules at the periphery of erythematous patches of the skin. Systemic symptoms include high fever, malaise, diarrhea, delirium, dehydration, tetany, and convulsions. Therapy with systemic corticosteroids, antibiotics, replacement of fluid and electrolytes is mandatory. In this report, we present the cases of two primigravidas, 23 and 28 years old, who presented pustular psoriasis of pregnancy at the 24th and 28th week of gestation. They were treated and, in the first case, a healthy 2,500-g female fetus was born vaginally, after labor induction with oxytocin at the 35th week of gestation; in the second patient, at the 37th week of gestation, after a moderate vaginal bleeding and no perception of fetal movements for 12 hours, a stillborn 2,700-g female was born after labor induction with prostaglandin.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):153-159
DOI 10.1590/S0100-72032004000200011
Pustular psoriasis of pregnancy is a rare pustular dermatosis with eruptions that develop in groups of sterile pustules at the periphery of erythematous patches of the skin. Systemic symptoms include high fever, malaise, diarrhea, delirium, dehydration, tetany, and convulsions. Therapy with systemic corticosteroids, antibiotics, replacement of fluid and electrolytes is mandatory. In this report, we present the cases of two primigravidas, 23 and 28 years old, who presented pustular psoriasis of pregnancy at the 24th and 28th week of gestation. They were treated and, in the first case, a healthy 2,500-g female fetus was born vaginally, after labor induction with oxytocin at the 35th week of gestation; in the second patient, at the 37th week of gestation, after a moderate vaginal bleeding and no perception of fetal movements for 12 hours, a stillborn 2,700-g female was born after labor induction with prostaglandin.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):745-748
DOI 10.1590/S0100-72032003001000008
Ehlers-Danlos syndrome is a connective tissue disease that is rarely associated with pregnancy, but with potentially fatal complications during pregnancy and puerperium, such as vascular and intestinal ruptures. It can also be associated with joint laxity and pain in women; during pregnancy there is a greater risk of prematurity, because of premature rupture of membranes and/or cervical insufficiency. Uterine rupture and inversion can also be associated with this syndrome. In the present study, we describe the case of a pregnant woman with Ehlers-Danlos syndrome, with a favorable evolution, without fetal complications and a good perinatal outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):745-748
DOI 10.1590/S0100-72032003001000008
Ehlers-Danlos syndrome is a connective tissue disease that is rarely associated with pregnancy, but with potentially fatal complications during pregnancy and puerperium, such as vascular and intestinal ruptures. It can also be associated with joint laxity and pain in women; during pregnancy there is a greater risk of prematurity, because of premature rupture of membranes and/or cervical insufficiency. Uterine rupture and inversion can also be associated with this syndrome. In the present study, we describe the case of a pregnant woman with Ehlers-Danlos syndrome, with a favorable evolution, without fetal complications and a good perinatal outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):381-384
DOI 10.1590/S0100-72032000000600009
Parkinson's disease is characterized by tremor, stiffness of the musculature, bradykinesia, and postural and march abnormalities. It attacks all ethnic groups, with no sex preference, frequently in the 45-50-year range. The diagnosis is essentially clinical. The association with pregnancy is rare. The experience with that association is scarse, some questions remaining without answer. The authors describe a case of Parkinson's disease and gestation with satisfactory evolution, in spite of the clinical worsening during pregnancy. The mother presented elevation of blood pressure levels, alterations of the hepatic enzymes, and oligohydramnios. She used, independently, selegiline until the third month, and, later on, amantadine. The newborn presented low weight, respiratory distress and jaundice, being discharged from the hospital, with no other complications, on the fourth day of life.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):381-384
DOI 10.1590/S0100-72032000000600009
Parkinson's disease is characterized by tremor, stiffness of the musculature, bradykinesia, and postural and march abnormalities. It attacks all ethnic groups, with no sex preference, frequently in the 45-50-year range. The diagnosis is essentially clinical. The association with pregnancy is rare. The experience with that association is scarse, some questions remaining without answer. The authors describe a case of Parkinson's disease and gestation with satisfactory evolution, in spite of the clinical worsening during pregnancy. The mother presented elevation of blood pressure levels, alterations of the hepatic enzymes, and oligohydramnios. She used, independently, selegiline until the third month, and, later on, amantadine. The newborn presented low weight, respiratory distress and jaundice, being discharged from the hospital, with no other complications, on the fourth day of life.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(3):149-154
DOI 10.1590/S0100-72032003000300002
PURPOSE: to describe the frequency of clinical and laboratorial findings in pregnant women with malaria. METHODS: a descriptive study was performed including 445 pregnant women with a positive diagnosis of malaria of the Maternity and women's Clinic Bárbara Heliodora (Rio Branco, Acre State), from January 1996 to December 2001. These cases were reviewed and the pregant women with malaria were selected. RESULTS: a total of 33,420 patients were hospitalized in that period. Of these, 445 pregnant women (1.4%) were included. Among these, the frequency of the infection with Plasmodium vivax was 52.8% (n=235), with P. falciparum, 43.8% (n=195), and 3.4% (n=15) with both plasmodia. The most frequent clinical and laboratorial alterations (p<0.05) were observed in the patients with P. falciparum: pale mucosa, jaundice hemoglobin and hematocrit decrease, hypoglycemia and increase in serum aminotransferase, urea, creatinine and in bilirubin levels. Only one patient (1/445), a pregnant woman infected with P. falciparum died. Abortions, premature birth and low birth weight were detected in 1.3, 1.1 and 1.1% of the cases, respectively. CONCLUSIONS: these findings reflect the repercussion of malaria during pregnancy, and justify the existence of qualified medical care in obstetric units for diagnosis and treatment of these cases, especially in the Amazon region.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(3):149-154
DOI 10.1590/S0100-72032003000300002
PURPOSE: to describe the frequency of clinical and laboratorial findings in pregnant women with malaria. METHODS: a descriptive study was performed including 445 pregnant women with a positive diagnosis of malaria of the Maternity and women's Clinic Bárbara Heliodora (Rio Branco, Acre State), from January 1996 to December 2001. These cases were reviewed and the pregant women with malaria were selected. RESULTS: a total of 33,420 patients were hospitalized in that period. Of these, 445 pregnant women (1.4%) were included. Among these, the frequency of the infection with Plasmodium vivax was 52.8% (n=235), with P. falciparum, 43.8% (n=195), and 3.4% (n=15) with both plasmodia. The most frequent clinical and laboratorial alterations (p<0.05) were observed in the patients with P. falciparum: pale mucosa, jaundice hemoglobin and hematocrit decrease, hypoglycemia and increase in serum aminotransferase, urea, creatinine and in bilirubin levels. Only one patient (1/445), a pregnant woman infected with P. falciparum died. Abortions, premature birth and low birth weight were detected in 1.3, 1.1 and 1.1% of the cases, respectively. CONCLUSIONS: these findings reflect the repercussion of malaria during pregnancy, and justify the existence of qualified medical care in obstetric units for diagnosis and treatment of these cases, especially in the Amazon region.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):329-332
DOI 10.1590/S0100-72032001000500009
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):329-332
DOI 10.1590/S0100-72032001000500009
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(3):159-165
DOI 10.1590/S0100-72032001000300005
Purpose: to evaluate the diagnostic difficulties, treatment and outcome in cases of acute liver failure of pregnancy. Methods: seven patients with acute liver failure of pregnancy, managed during the past 4 years, were studied with emphasis on presenting symptoms, laboratory findings, clinical course, maternal complications and fetal outcome. Results: the mean age was 25.8 years (two were primigravidas), and the mean gestational age at onset was 30.1 weeks. The final diagnosis was acute fatty liver of pregnancy in four cases and intrahepatic cholestasis of pregnancy in three cases. Anorexia, nausea, abdominal pain, jaundice and encephalopathy were the main clinical findings. Two maternal deaths occurred: one due to hepatic failure, while waiting for transplantation, and another due to hepatic failure associated with coagulopathy and major intra-abdominal bleeding after liver biopsy. One patient with acute fatty liver of pregnancy underwent a successful liver transplantation one year ago (after chronification of her disease). The remaining four cases had complete resolution of the disorders after delivery and supportive measures. Maternal and fetal mortalities were 28.6% and 57.1%, respectively. Conclusion: from this initial experience, we conclude that acute liver failure of pregnancy is a serious disease, with high maternal-fetal mortality, and that early recognition of this illness, referral to tertiary liver centers, and prompt interruption of gestation are, together, very important for the success of the treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(3):159-165
DOI 10.1590/S0100-72032001000300005
Purpose: to evaluate the diagnostic difficulties, treatment and outcome in cases of acute liver failure of pregnancy. Methods: seven patients with acute liver failure of pregnancy, managed during the past 4 years, were studied with emphasis on presenting symptoms, laboratory findings, clinical course, maternal complications and fetal outcome. Results: the mean age was 25.8 years (two were primigravidas), and the mean gestational age at onset was 30.1 weeks. The final diagnosis was acute fatty liver of pregnancy in four cases and intrahepatic cholestasis of pregnancy in three cases. Anorexia, nausea, abdominal pain, jaundice and encephalopathy were the main clinical findings. Two maternal deaths occurred: one due to hepatic failure, while waiting for transplantation, and another due to hepatic failure associated with coagulopathy and major intra-abdominal bleeding after liver biopsy. One patient with acute fatty liver of pregnancy underwent a successful liver transplantation one year ago (after chronification of her disease). The remaining four cases had complete resolution of the disorders after delivery and supportive measures. Maternal and fetal mortalities were 28.6% and 57.1%, respectively. Conclusion: from this initial experience, we conclude that acute liver failure of pregnancy is a serious disease, with high maternal-fetal mortality, and that early recognition of this illness, referral to tertiary liver centers, and prompt interruption of gestation are, together, very important for the success of the treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(9):609-614
DOI 10.1590/S0100-72032002000900007
Purpose: the objective of the present study was to determine the number and type of deliveries, category of admission to the hospital, occupation and obstetrical diagnosis for adolescents from the municipality of Ribeirão Preto, from January 1992 to December 1996. Methods: the information obtained from hospital discharge forms was analyzed at the Hospital Data Processing Center. The 6.04a-text processor Epi-Info System, a data bank and statistics for epidemiology produced by the Centers of Disease Control and Prevention (Atlanta, GA, USA), and Dbase IV were used to process the information. The association between variables was tested by the chi² test, with the level of significance set at 5%. The analyzed parameters were: number and type of delivery, category of hospital admission, occupation and obstetric diagnosis. Results: a total of 42,969 deliveries occurred during the study period, among which 7,134 (16.6%) corresponded to adolescent deliveries. An increase in the number of deliveries by girls in this age range occurred over the years, from 1,225 in 1992 to 1,538 in 1996. Deliveries were reported starting from 12 years of age, with a gradual increase in this number, especially after 14 years of age, when a 104.2% increase occurred for deliveries at this age, followed by 48.8% at 15 years, 36.1% at 16 years, 14.0% at 17 years, 52.8% at 18 years, and with practically no increase among 19-year-old girls. The highest number of deliveries (5,709) was recorded for the unified health system category of admission, followed by 1,277 deliveries for the prepaid category and 148 deliveries for the private category. With respect to occupation, 14.1% of the patients belonged to the economically active population, while 85.8% did not. Of the total deliveries, 59.2% were normal, 5.6% were forceps deliveries, and 35.2% were cesarean sections. The most frequent obstetrical diagnoses were: problems of fetus or placenta affecting maternal management (7.9%), fetus-pelvis disproportion (6.0%), problems with the amniotic cavity and membranes (5.0%), hypertension complicating delivery and puerperium (3.5%), and premature or false labor (3.4%). Conclusions: most deliveries were normal and occurred more frequently at the end of adolescence, especially among girls belonging to the unified health system. There was a predominance of adolescents not belonging to the economically active population. Some obstetrical complications were diagnosed at the time of resolution of pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(9):609-614
DOI 10.1590/S0100-72032002000900007
Purpose: the objective of the present study was to determine the number and type of deliveries, category of admission to the hospital, occupation and obstetrical diagnosis for adolescents from the municipality of Ribeirão Preto, from January 1992 to December 1996. Methods: the information obtained from hospital discharge forms was analyzed at the Hospital Data Processing Center. The 6.04a-text processor Epi-Info System, a data bank and statistics for epidemiology produced by the Centers of Disease Control and Prevention (Atlanta, GA, USA), and Dbase IV were used to process the information. The association between variables was tested by the chi² test, with the level of significance set at 5%. The analyzed parameters were: number and type of delivery, category of hospital admission, occupation and obstetric diagnosis. Results: a total of 42,969 deliveries occurred during the study period, among which 7,134 (16.6%) corresponded to adolescent deliveries. An increase in the number of deliveries by girls in this age range occurred over the years, from 1,225 in 1992 to 1,538 in 1996. Deliveries were reported starting from 12 years of age, with a gradual increase in this number, especially after 14 years of age, when a 104.2% increase occurred for deliveries at this age, followed by 48.8% at 15 years, 36.1% at 16 years, 14.0% at 17 years, 52.8% at 18 years, and with practically no increase among 19-year-old girls. The highest number of deliveries (5,709) was recorded for the unified health system category of admission, followed by 1,277 deliveries for the prepaid category and 148 deliveries for the private category. With respect to occupation, 14.1% of the patients belonged to the economically active population, while 85.8% did not. Of the total deliveries, 59.2% were normal, 5.6% were forceps deliveries, and 35.2% were cesarean sections. The most frequent obstetrical diagnoses were: problems of fetus or placenta affecting maternal management (7.9%), fetus-pelvis disproportion (6.0%), problems with the amniotic cavity and membranes (5.0%), hypertension complicating delivery and puerperium (3.5%), and premature or false labor (3.4%). Conclusions: most deliveries were normal and occurred more frequently at the end of adolescence, especially among girls belonging to the unified health system. There was a predominance of adolescents not belonging to the economically active population. Some obstetrical complications were diagnosed at the time of resolution of pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(9):585-591
DOI 10.1590/S0100-72032002000900004
Purpose: to report 15 breast cancer cases associated with pregnancy and to compare to a control group with breast ductal infiltrating carcinoma, evaluating clinical staging, metastatic axillary lymph node involvement, histopathologic aspects related to nuclear grade, histology grade and estrogen and progesterone hormonal receptors. Method: a retrospective study of 15 cases of patients with breast cancer associated with pregnancy, attended at Mastology Department in the Woman Health Reference Center, Pérola Byington Hospital, São Paulo, was done between September 1996 and April 2001. The evaluation of clinical staging, time of diagnosis and involved axillary lymph nodes was the main study basis. Also age, parity, histologic type, applied treatment, histologic characteristics regarding nuclear grade and histologic grade and the presence of hormonal receptors in the tumors were analyzed. Results: we observed that 7 patients (46.7%) presented a locally advanced breast cancer (clinical stage IIIA and IIIB) and that 3 patients (20%) presented a disseminated disease at the moment of diagnosis. The patients presented on average 2.4 involved axillary lymph nodes and in only one patient the lymph nodes were free of disease (6.6%). Regarding time of diagnosis, 40% of the tumors were diagnosed during the lactational period, 46.7% during the second trimester and 13.3% during the third trimester. The pregnant patients were compared to a control group of non-pregnant patients in the same age range, all of them with infiltrating breast carcinoma, and clinical staging, axillary lymph node involvement, nuclear grade, histologic grade and estrogen and progesterone hormonal receptors were evaluated. There was a statistically significant difference (p=0.0022) regarding clinical staging and axillary lymph node involvement (p=0.0017), and no statistically significant difference as concerns the remaining parameters. Conclusion: breast cancer associated with pregnancy is a neoplasia with a bad prognosis. There is no difference when comparing pregnant patients with non-pregnant patients in the same age range, the advanced clinical staging at the moment of diagnosis being the determinant factor for survival.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(9):585-591
DOI 10.1590/S0100-72032002000900004
Purpose: to report 15 breast cancer cases associated with pregnancy and to compare to a control group with breast ductal infiltrating carcinoma, evaluating clinical staging, metastatic axillary lymph node involvement, histopathologic aspects related to nuclear grade, histology grade and estrogen and progesterone hormonal receptors. Method: a retrospective study of 15 cases of patients with breast cancer associated with pregnancy, attended at Mastology Department in the Woman Health Reference Center, Pérola Byington Hospital, São Paulo, was done between September 1996 and April 2001. The evaluation of clinical staging, time of diagnosis and involved axillary lymph nodes was the main study basis. Also age, parity, histologic type, applied treatment, histologic characteristics regarding nuclear grade and histologic grade and the presence of hormonal receptors in the tumors were analyzed. Results: we observed that 7 patients (46.7%) presented a locally advanced breast cancer (clinical stage IIIA and IIIB) and that 3 patients (20%) presented a disseminated disease at the moment of diagnosis. The patients presented on average 2.4 involved axillary lymph nodes and in only one patient the lymph nodes were free of disease (6.6%). Regarding time of diagnosis, 40% of the tumors were diagnosed during the lactational period, 46.7% during the second trimester and 13.3% during the third trimester. The pregnant patients were compared to a control group of non-pregnant patients in the same age range, all of them with infiltrating breast carcinoma, and clinical staging, axillary lymph node involvement, nuclear grade, histologic grade and estrogen and progesterone hormonal receptors were evaluated. There was a statistically significant difference (p=0.0022) regarding clinical staging and axillary lymph node involvement (p=0.0017), and no statistically significant difference as concerns the remaining parameters. Conclusion: breast cancer associated with pregnancy is a neoplasia with a bad prognosis. There is no difference when comparing pregnant patients with non-pregnant patients in the same age range, the advanced clinical staging at the moment of diagnosis being the determinant factor for survival.