Pregnancy complications Archives - Page 11 of 11 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(6):372-376
Parvovirus B19 has tropism for red line blood cells, causing immune hydrops during pregnancy. A positive anti-Kell Coombs reaction usually happens during pregnancy when there is production of antibodies that target Kell antigens, but cross reactions to other antigens may occur. A 24-year-old Gypsy primigravida, 0 Rhesus positive, presented with persistent isolated hyperthermia for 2 weeks and a positive indirect Coombs test result with anti-Kell antibodies at routine tests. She had a 19-week live fetus. The blood tests revealed bicytopenia with iron deficiency anemia, leucopoenia with neutropenia, and elevated C-reactive protein. She was medicated with imipenem, and had a slow clinical recovery. Blood, urine and sputum samples were taken to perform cultures and to exclude other systemic infections. Escherichia coli was isolated in the urine, which most probably caused a transient cross anti-Kell reaction. Haemophilus influenza in the sputum and seroconversion to parvovirus B19 was confirmed, causing unusual deficits in the white cells, culminating in febrile neutropenia. Despite the patient’s lack of compliance to the medical care, both maternal and fetal/neonatal outcomes were good. This a rare case report of 2 rare phenomena, a cross anti-Kell reaction to E. coli and parvovirus B19 infection with tropism for white cells causing febrile neutropenia, both events occurring simultaneously during pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(6):372-376
Parvovirus B19 has tropism for red line blood cells, causing immune hydrops during pregnancy. A positive anti-Kell Coombs reaction usually happens during pregnancy when there is production of antibodies that target Kell antigens, but cross reactions to other antigens may occur. A 24-year-old Gypsy primigravida, 0 Rhesus positive, presented with persistent isolated hyperthermia for 2 weeks and a positive indirect Coombs test result with anti-Kell antibodies at routine tests. She had a 19-week live fetus. The blood tests revealed bicytopenia with iron deficiency anemia, leucopoenia with neutropenia, and elevated C-reactive protein. She was medicated with imipenem, and had a slow clinical recovery. Blood, urine and sputum samples were taken to perform cultures and to exclude other systemic infections. Escherichia coli was isolated in the urine, which most probably caused a transient cross anti-Kell reaction. Haemophilus influenza in the sputum and seroconversion to parvovirus B19 was confirmed, causing unusual deficits in the white cells, culminating in febrile neutropenia. Despite the patient’s lack of compliance to the medical care, both maternal and fetal/neonatal outcomes were good. This a rare case report of 2 rare phenomena, a cross anti-Kell reaction to E. coli and parvovirus B19 infection with tropism for white cells causing febrile neutropenia, both events occurring simultaneously during pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(4):235-238
We report the case of a 33 year-old woman who complained of severe dysmenorrhea since menarche. From 2003 to 2009, she underwent 4 laparoscopies for the treatment of pain associated with endometriosis. After all four interventions, the pain recurred despite the use of gonadotropin-releasing hormone (GnRH) analogues and the insertion of a levonorgestrel intrauterine system (LNG-IUS). Finally, a colonoscopy performed in 2010 revealed rectosigmoid stenosis probably due to extrinsic compression. The patient was advised to get pregnant before treating the intestinal lesion. Spontaneous pregnancy occurred soon after LNG-IUS removal in 2011. In the 33rd week of pregnancy, the patient started to feel severe abdominal pain. No fever or sings of pelviperitonitis were present, but as the pain worsened, a cesarean section was performed, with the delivery of a premature healthy male, and an intestinal rupturewas identified. Severe peritoneal infection and sepsis ensued. A colostomy was performed, and the patient recovered after eight days in intensive care. Three months later, the colostomy was closed, and a new LNG-IUS was inserted. The patient then came to be treated by our multidisciplinary endometriosis team. The diagnostic evaluation revealed the presence of intestinal lesions with extrinsic compression of the rectum. She then underwent a laparoscopic excision of the endometriotic lesions, including an ovarian endometrioma, adhesiolysis and segmental colectomy in 2014. She is now fully recovered and planning a new pregnancy. A transvaginal ultrasound (TVUS) performed six months after surgery showed signs of pelvic adhesions, but no endometriotic lesions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(4):235-238
We report the case of a 33 year-old woman who complained of severe dysmenorrhea since menarche. From 2003 to 2009, she underwent 4 laparoscopies for the treatment of pain associated with endometriosis. After all four interventions, the pain recurred despite the use of gonadotropin-releasing hormone (GnRH) analogues and the insertion of a levonorgestrel intrauterine system (LNG-IUS). Finally, a colonoscopy performed in 2010 revealed rectosigmoid stenosis probably due to extrinsic compression. The patient was advised to get pregnant before treating the intestinal lesion. Spontaneous pregnancy occurred soon after LNG-IUS removal in 2011. In the 33rd week of pregnancy, the patient started to feel severe abdominal pain. No fever or sings of pelviperitonitis were present, but as the pain worsened, a cesarean section was performed, with the delivery of a premature healthy male, and an intestinal rupturewas identified. Severe peritoneal infection and sepsis ensued. A colostomy was performed, and the patient recovered after eight days in intensive care. Three months later, the colostomy was closed, and a new LNG-IUS was inserted. The patient then came to be treated by our multidisciplinary endometriosis team. The diagnostic evaluation revealed the presence of intestinal lesions with extrinsic compression of the rectum. She then underwent a laparoscopic excision of the endometriotic lesions, including an ovarian endometrioma, adhesiolysis and segmental colectomy in 2014. She is now fully recovered and planning a new pregnancy. A transvaginal ultrasound (TVUS) performed six months after surgery showed signs of pelvic adhesions, but no endometriotic lesions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(2):92-95
Nowadays, postpartum hemorrhage is the major cause of maternal mortality and morbidity worldwide. Uterine atony is its main cause; thus, prophylactic measures, as well as medical and surgical fast approaches, have been developed to manage it. The uterine compression sutures are a possible treatment that preserves the uterus and, consequently, the fertility potential. Bearing that in mind, we report two cases of postpartum hemorrhage after caesarean section, successfully treated with a new modification of Pereira suture - longitudinal and transverse uterine sutures were applied after no response was registered to the first-line therapies. Both women recovered, and the postpartum evaluation revealed a normal uterus with an adequate blood supply, suggesting potential fertility, as described in the literature regarding this kind of therapeutic approach.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(2):92-95
Nowadays, postpartum hemorrhage is the major cause of maternal mortality and morbidity worldwide. Uterine atony is its main cause; thus, prophylactic measures, as well as medical and surgical fast approaches, have been developed to manage it. The uterine compression sutures are a possible treatment that preserves the uterus and, consequently, the fertility potential. Bearing that in mind, we report two cases of postpartum hemorrhage after caesarean section, successfully treated with a new modification of Pereira suture - longitudinal and transverse uterine sutures were applied after no response was registered to the first-line therapies. Both women recovered, and the postpartum evaluation revealed a normal uterus with an adequate blood supply, suggesting potential fertility, as described in the literature regarding this kind of therapeutic approach.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(11):587-595
To identify the prevalence of maternal morbidity and its socioeconomic, demographic and health care associated factors in a city in Northeastern Brazil.
A cross-sectional and population-based study was conducted, with a design based on multi-stage complex sampling. A validated questionnaire was applied to 848 women aged between 15 and 49 years identified in 8,227 households from 60 census tracts of Natal, the capital of the state of Rio Grande do Norte (RN), Brazil. The main outcome measure was maternal morbidity. The Poisson regression analysis, with 5% significance, was used for the analysis of the associated factors.
The prevalence of maternal morbidity was of 21.2%. A bivariate analysis showed the following variables associated with an increased number of obstetric complications: non-white race (prevalence ratio [PR] =1.23; 95% confidence interval [95%CI]: 1.04-1.46); lower socioeconomic status (PR = 1.33; 95%CI: 1.12-1.58); prenatal care performed in public services (PR = 1.42; 95%CI: 1.16-1.72): women that were not advised during prenatal care about where they should deliver (PR = 1.24; 95%CI: 1.05-1.46); delivery in public services (PR = 1.63; 95%CI: 1.30-2.03); need to search for more than one hospital for delivery (PR = 1.22; 95%CI: 1.03-1.45); and no companion at all times of delivery care (PR = 1.25, 95%CI: 1.05-1.48). The place where the delivery occurred (public or private) and the socioeconomic status remained significant in the final model.
Women in a worse socioeconomic situation and whose delivery was performed in public services had a higher prevalence of maternal morbidity. Such an association reinforces the need to strengthen public policies to tackle health inequalities through actions focusing on these determinants.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(11):587-595
To identify the prevalence of maternal morbidity and its socioeconomic, demographic and health care associated factors in a city in Northeastern Brazil.
A cross-sectional and population-based study was conducted, with a design based on multi-stage complex sampling. A validated questionnaire was applied to 848 women aged between 15 and 49 years identified in 8,227 households from 60 census tracts of Natal, the capital of the state of Rio Grande do Norte (RN), Brazil. The main outcome measure was maternal morbidity. The Poisson regression analysis, with 5% significance, was used for the analysis of the associated factors.
The prevalence of maternal morbidity was of 21.2%. A bivariate analysis showed the following variables associated with an increased number of obstetric complications: non-white race (prevalence ratio [PR] =1.23; 95% confidence interval [95%CI]: 1.04-1.46); lower socioeconomic status (PR = 1.33; 95%CI: 1.12-1.58); prenatal care performed in public services (PR = 1.42; 95%CI: 1.16-1.72): women that were not advised during prenatal care about where they should deliver (PR = 1.24; 95%CI: 1.05-1.46); delivery in public services (PR = 1.63; 95%CI: 1.30-2.03); need to search for more than one hospital for delivery (PR = 1.22; 95%CI: 1.03-1.45); and no companion at all times of delivery care (PR = 1.25, 95%CI: 1.05-1.48). The place where the delivery occurred (public or private) and the socioeconomic status remained significant in the final model.
Women in a worse socioeconomic situation and whose delivery was performed in public services had a higher prevalence of maternal morbidity. Such an association reinforces the need to strengthen public policies to tackle health inequalities through actions focusing on these determinants.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(11):640-644
Approximately 1 in every 76,000 pregnancies develops within a unicornuate uterus with a rudimentary horn.Müllerian uterus anomalies are often asymptomatic, thus, the diagnosis is a challenge, and it is usually made during the gestation or due to its complications, such as uterine rupture, pregnancy-induced hypertension, antepartum, postpartum bleeding and intrauterine growth restriction (IUGR). In order to avoid unnecessary cesarean sections and the risks they involve, the physicians should consider the several approaches and for how long it is feasible to perform labor induction in suspected cases of pregnancy in a unicornuate uterus with a rudimentary horn, despite the rarity of the anomaly. This report describes a case of a unicornuate uterus in which a pregnancy developed in the non-communicating rudimentary horn and the consequences of the delayed diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(11):640-644
Approximately 1 in every 76,000 pregnancies develops within a unicornuate uterus with a rudimentary horn.Müllerian uterus anomalies are often asymptomatic, thus, the diagnosis is a challenge, and it is usually made during the gestation or due to its complications, such as uterine rupture, pregnancy-induced hypertension, antepartum, postpartum bleeding and intrauterine growth restriction (IUGR). In order to avoid unnecessary cesarean sections and the risks they involve, the physicians should consider the several approaches and for how long it is feasible to perform labor induction in suspected cases of pregnancy in a unicornuate uterus with a rudimentary horn, despite the rarity of the anomaly. This report describes a case of a unicornuate uterus in which a pregnancy developed in the non-communicating rudimentary horn and the consequences of the delayed diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):496-512
The authors review hypertensive disease during pregnancy with an academic and practical view, and using the best evidence available. This disease, which is the most important clinical disease in Brazilian pregnant women, may have its incidence reduced with prevention through the use of calcium and aspirin in pregnant women at risk. Previously, it was a disease that presented with hypertension with proteinuria, but it has now been classified with new clinical parameters besides proteinuria. Morbidity and mortality should be reduced in a continental country such as Brazil using protocols for the early treatment of complications by calculating severe outcomes in preeclampsia. The early treatment of acute hypertension, use of magnesium sulfate and early hospitalization in cases of preeclampsia are concepts to pursue the reduction of our pregnant women’s mortality.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):496-512
The authors review hypertensive disease during pregnancy with an academic and practical view, and using the best evidence available. This disease, which is the most important clinical disease in Brazilian pregnant women, may have its incidence reduced with prevention through the use of calcium and aspirin in pregnant women at risk. Previously, it was a disease that presented with hypertension with proteinuria, but it has now been classified with new clinical parameters besides proteinuria. Morbidity and mortality should be reduced in a continental country such as Brazil using protocols for the early treatment of complications by calculating severe outcomes in preeclampsia. The early treatment of acute hypertension, use of magnesium sulfate and early hospitalization in cases of preeclampsia are concepts to pursue the reduction of our pregnant women’s mortality.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(7):317-321
This study aimed to evaluate and validate the qualitative human chorionic gonadotropin β subunit (β-hCG) test of the vaginal fluid washings of pregnant women with premature rupture of fetal membranes (PROM).
Cross-sectional study of pregnant women between gestational weeks 24 and 39 who underwent consultations in one of our institutions. They were divided into two groups: group A (pregnant women clinically diagnosed with PROM) and group B (pregnant women without loss of amniotic liquid). The patients were subjected to a vaginal fluid washing with 3 mL of saline solution, which was aspirated subsequently with the same syringe. The solution was immediately sent to the laboratory to perform the vaginal β-hCG test with cut-off points of 10 mIU/mL (β-hCG-10) and/or 25 mIU/mL (β-hCG-25).
The β-hCG-10 test of the vaginal secretion was performed in 128 cases. The chi-squared test with Yates’ correction showed a statistically significant difference between the 2 groups (p = 0.0225). The sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy parameters were 77.1%, 43.6%, 52.3%; 70.4%; and 58.6% respectively. The β-hCG-25 test of the vaginal washing was performed in 49 cases. The analysis by Fisher’s exact test showed a statistically significant difference between the groups (p = 0.0175). The sensibility, specificity, PPV, NPV, and accuracy parameters were 44.4%, 87.1%, 66.6%; 72.9%; and 71.4% respectively.
The β-hCG-25 test showed better accuracy for the diagnosis of PROM, and can corroborate the early diagnosis of PROM because it is a simple and quick exam.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(7):317-321
This study aimed to evaluate and validate the qualitative human chorionic gonadotropin β subunit (β-hCG) test of the vaginal fluid washings of pregnant women with premature rupture of fetal membranes (PROM).
Cross-sectional study of pregnant women between gestational weeks 24 and 39 who underwent consultations in one of our institutions. They were divided into two groups: group A (pregnant women clinically diagnosed with PROM) and group B (pregnant women without loss of amniotic liquid). The patients were subjected to a vaginal fluid washing with 3 mL of saline solution, which was aspirated subsequently with the same syringe. The solution was immediately sent to the laboratory to perform the vaginal β-hCG test with cut-off points of 10 mIU/mL (β-hCG-10) and/or 25 mIU/mL (β-hCG-25).
The β-hCG-10 test of the vaginal secretion was performed in 128 cases. The chi-squared test with Yates’ correction showed a statistically significant difference between the 2 groups (p = 0.0225). The sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy parameters were 77.1%, 43.6%, 52.3%; 70.4%; and 58.6% respectively. The β-hCG-25 test of the vaginal washing was performed in 49 cases. The analysis by Fisher’s exact test showed a statistically significant difference between the groups (p = 0.0175). The sensibility, specificity, PPV, NPV, and accuracy parameters were 44.4%, 87.1%, 66.6%; 72.9%; and 71.4% respectively.
The β-hCG-25 test showed better accuracy for the diagnosis of PROM, and can corroborate the early diagnosis of PROM because it is a simple and quick exam.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(5):209-216
In 2013, it was estimated that 289,000 maternal deaths occurred worldwide. The maternal mortality ratio has decreased in many countries in the past decades, due to early identification and treatment of obstetric complications, despite the dissimilarities observed in diverse locations and populations. Black women, for instance, have always been more susceptible to the occurrence of maternal mortality and severe morbidity. Therefore, the objective of this study is to assess skin color as a predictive factor for maternal near miss (MNM) in a sample of Brazilian women interviewed in the Brazilian National Demographic and Health Survey (DHS) of 2006.
A secondary analysis of the DHS database, a population-based crosssectional nationally representative study was conducted. This database is of public domain. The risk of maternal complications according to ethnic group and the associated sociodemographic characteristics were evaluated. For the data analysis, the odds ratios and respective 95% confidence intervals were calculated.
In the sample interviewed, 59% of women were black or brown (mixed-race). Approximately 23% of women had some complication, and 2% of these women had at least one MNM pragmatic criterion. The MNM rate was 31 per 1,000 live births, and its occurrence was not statistically different among the ethnic groups. The only factors identified that were considered to be associated with the occurrence of MNM were maternal age above 40 and women not currently attending school, but only among white women.
The 2006 DHS results did not show a higher occurrence of maternal complications, and specifically of MNM associated with black/brown skin color.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(5):209-216
In 2013, it was estimated that 289,000 maternal deaths occurred worldwide. The maternal mortality ratio has decreased in many countries in the past decades, due to early identification and treatment of obstetric complications, despite the dissimilarities observed in diverse locations and populations. Black women, for instance, have always been more susceptible to the occurrence of maternal mortality and severe morbidity. Therefore, the objective of this study is to assess skin color as a predictive factor for maternal near miss (MNM) in a sample of Brazilian women interviewed in the Brazilian National Demographic and Health Survey (DHS) of 2006.
A secondary analysis of the DHS database, a population-based crosssectional nationally representative study was conducted. This database is of public domain. The risk of maternal complications according to ethnic group and the associated sociodemographic characteristics were evaluated. For the data analysis, the odds ratios and respective 95% confidence intervals were calculated.
In the sample interviewed, 59% of women were black or brown (mixed-race). Approximately 23% of women had some complication, and 2% of these women had at least one MNM pragmatic criterion. The MNM rate was 31 per 1,000 live births, and its occurrence was not statistically different among the ethnic groups. The only factors identified that were considered to be associated with the occurrence of MNM were maternal age above 40 and women not currently attending school, but only among white women.
The 2006 DHS results did not show a higher occurrence of maternal complications, and specifically of MNM associated with black/brown skin color.