Pregnancy complications Archives - Page 11 of 11 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(2):50-55
DOI 10.1590/S0100-72032014000200002
To evaluate pregnancy outcome and thrombophilia frequency in women with recurrent
fetal death.
Evaluation of obstetric outcomes in a retrospective cohort of pregnant women with
recurrent stillbirth after the 20th week, from 2001 to 2013.
Antithrombin activity, protein C and S activity, factor V Leiden, prothrombin gene
mutation and antiphospholipid syndrome were analyzed.
We included 20 patients who had recurrent fetal death. Thrombophilia were found
in 11 of them, 7 diagnosed with antiphospholipid syndrome, 3 with protein S
deficiency and 1 with prothrombin gene mutation. All of them were treated with
subcutaneous heparin (unfractionated heparin or enoxaparina) and 14 of them with
acetylsalicylic acid (AAS) during pregnancy. Obstetric complications occurred in
15 patients and included: intrauterine fetal growth restriction (25%), placenta
previa (15%), reduced amniotic fluid index (25%), severe preeclampsia (10%), fetal
distress (5%), and stillbirth (5%). The mean gestational age at delivery was
35.8±3.7 weeks and newborn weight averaged 2,417.3±666.2 g.
Thrombophilia screening should be performed in all pregnant women with recurrent
fetal death after the 20th week as a way to identify possible causal
factors suitable for treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(2):50-55
DOI 10.1590/S0100-72032014000200002
To evaluate pregnancy outcome and thrombophilia frequency in women with recurrent
fetal death.
Evaluation of obstetric outcomes in a retrospective cohort of pregnant women with
recurrent stillbirth after the 20th week, from 2001 to 2013.
Antithrombin activity, protein C and S activity, factor V Leiden, prothrombin gene
mutation and antiphospholipid syndrome were analyzed.
We included 20 patients who had recurrent fetal death. Thrombophilia were found
in 11 of them, 7 diagnosed with antiphospholipid syndrome, 3 with protein S
deficiency and 1 with prothrombin gene mutation. All of them were treated with
subcutaneous heparin (unfractionated heparin or enoxaparina) and 14 of them with
acetylsalicylic acid (AAS) during pregnancy. Obstetric complications occurred in
15 patients and included: intrauterine fetal growth restriction (25%), placenta
previa (15%), reduced amniotic fluid index (25%), severe preeclampsia (10%), fetal
distress (5%), and stillbirth (5%). The mean gestational age at delivery was
35.8±3.7 weeks and newborn weight averaged 2,417.3±666.2 g.
Thrombophilia screening should be performed in all pregnant women with recurrent
fetal death after the 20th week as a way to identify possible causal
factors suitable for treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(11):523-529
DOI 10.1590/S0100-72032013001100008
PURPOSE: To evaluate the adequacy of gestational weight gain and to determine its association with maternal socioeconomic, demographic and nutritional factors and health care, to estimate the prevalence of low birth weight, macrosomia, preterm birth and cesarean delivery and to identify the association of these outcomes with the adequacy of weight gain. METHODS: A cross-sectional study was performed in 2009/2010 to obtain socioeconomic, demographic, nutritional, dietary and physical activity data of pregnant women assisted by primary health care in a municipality of the state of São Paulo. Subsequently, data were collected from the medical records to evaluate gestational weight gain. Type of delivery, birth weight and gestational age at delivery were obtained from the Livebirths Information System. Gestational weight gain was evaluated according to the recommendations of the Institute of Medicine (2009). Associations were investigated by comparing the frequencies and by logistic regression, with excessive weight gain (yes, no) and insufficient gain (yes, no) being the dependent variables. RESULTS: A total of 212 pregnant women were studied: 50.5% had excessive gain and 19.8% insufficient weight gain. Only prepregnancy nutritional status was associated with adequacy of weight gain: compared with normal weight, prepregnancy overweight women had a four-fold higher chance to gain excessive weight (OR 4.66, 95%CI 2.19-9.4). Nearly a third of babies were born by caesarian section, 5.7% were premature, 7.1% were underweight and 4.7% were macrosomic. There was no association between adequacy of gestational weight gain and these outcomes. CONCLUSION: The proportion of inadequate gestational weight gain was high. Overweight pregnant women have a four-fold higher chance to gain excessive weight, and priority should be given to actions promoting adequate prenatal weight gain.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(11):523-529
DOI 10.1590/S0100-72032013001100008
PURPOSE: To evaluate the adequacy of gestational weight gain and to determine its association with maternal socioeconomic, demographic and nutritional factors and health care, to estimate the prevalence of low birth weight, macrosomia, preterm birth and cesarean delivery and to identify the association of these outcomes with the adequacy of weight gain. METHODS: A cross-sectional study was performed in 2009/2010 to obtain socioeconomic, demographic, nutritional, dietary and physical activity data of pregnant women assisted by primary health care in a municipality of the state of São Paulo. Subsequently, data were collected from the medical records to evaluate gestational weight gain. Type of delivery, birth weight and gestational age at delivery were obtained from the Livebirths Information System. Gestational weight gain was evaluated according to the recommendations of the Institute of Medicine (2009). Associations were investigated by comparing the frequencies and by logistic regression, with excessive weight gain (yes, no) and insufficient gain (yes, no) being the dependent variables. RESULTS: A total of 212 pregnant women were studied: 50.5% had excessive gain and 19.8% insufficient weight gain. Only prepregnancy nutritional status was associated with adequacy of weight gain: compared with normal weight, prepregnancy overweight women had a four-fold higher chance to gain excessive weight (OR 4.66, 95%CI 2.19-9.4). Nearly a third of babies were born by caesarian section, 5.7% were premature, 7.1% were underweight and 4.7% were macrosomic. There was no association between adequacy of gestational weight gain and these outcomes. CONCLUSION: The proportion of inadequate gestational weight gain was high. Overweight pregnant women have a four-fold higher chance to gain excessive weight, and priority should be given to actions promoting adequate prenatal weight gain.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(10):442-446
DOI 10.1590/S0100-72032013001000003
PURPOSE: To measure fetal renal volume in normoglycemic and hyperglycemic pregnancies. METHODS: A longitudinal prospective study was conducted and included 92 hyperglycemic and 339 normoglycemic pregnant women attended at the prenatal service of a hospital from Rio de Janeiro State. Ultrasound examinations were performed to estimate gestational age at baseline and the kidney volume was estimated using the prolate ellipsoid volume equation. RESULTS: Fetal kidney volume growth between normoglycemic and hyperglycemic pregnancies are significantly different. The fetal kidney volume growth in pregnancy is positively correlated with gestational age explained by these predictor equations, by group: normal renal volume = exp (6.186+0.09×gestational week); hyperglycemic renal volume = exp (6.978+0.071×gestational week) and an excessive growth pattern for hyperglycemic pregnancies may be established according to gestational age. CONCLUSION: This is important for early detection of abnormalities in pregnancy, particularly in diabetic mothers.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(10):442-446
DOI 10.1590/S0100-72032013001000003
PURPOSE: To measure fetal renal volume in normoglycemic and hyperglycemic pregnancies. METHODS: A longitudinal prospective study was conducted and included 92 hyperglycemic and 339 normoglycemic pregnant women attended at the prenatal service of a hospital from Rio de Janeiro State. Ultrasound examinations were performed to estimate gestational age at baseline and the kidney volume was estimated using the prolate ellipsoid volume equation. RESULTS: Fetal kidney volume growth between normoglycemic and hyperglycemic pregnancies are significantly different. The fetal kidney volume growth in pregnancy is positively correlated with gestational age explained by these predictor equations, by group: normal renal volume = exp (6.186+0.09×gestational week); hyperglycemic renal volume = exp (6.978+0.071×gestational week) and an excessive growth pattern for hyperglycemic pregnancies may be established according to gestational age. CONCLUSION: This is important for early detection of abnormalities in pregnancy, particularly in diabetic mothers.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(8):368-372
DOI 10.1590/S0100-72032013000800006
PURPOSE: To compare the degree of peripheral facial palsy of pregnant women and puerperae at admission and at discharge and to evaluate related factors. METHODS: Retrospective, cross-sectional study, with analysis of medical records of pregnant and postpartum women with facial palsy, over a period of 12 months, with application of a standardized protocol for patient evaluation and of the House-Brackmann scale on the occasion of the first visit and at discharge. RESULTS: Six patients were identified, mean age of 22.6 years. Five cases were classified as stage IV and one as stage II on the House-Brackmann scale, being two of them puerperae and four pregnant. All showed improvement on the House-Brackmann scale. CONCLUSION: The Bell's palsy has a good prognosis even in pregnant and postpartum women, being important to perform the correct treatment to reduce the sequelae in this group identified as more susceptible to peripheral facial palsy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(8):368-372
DOI 10.1590/S0100-72032013000800006
PURPOSE: To compare the degree of peripheral facial palsy of pregnant women and puerperae at admission and at discharge and to evaluate related factors. METHODS: Retrospective, cross-sectional study, with analysis of medical records of pregnant and postpartum women with facial palsy, over a period of 12 months, with application of a standardized protocol for patient evaluation and of the House-Brackmann scale on the occasion of the first visit and at discharge. RESULTS: Six patients were identified, mean age of 22.6 years. Five cases were classified as stage IV and one as stage II on the House-Brackmann scale, being two of them puerperae and four pregnant. All showed improvement on the House-Brackmann scale. CONCLUSION: The Bell's palsy has a good prognosis even in pregnant and postpartum women, being important to perform the correct treatment to reduce the sequelae in this group identified as more susceptible to peripheral facial palsy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(3):130-135
DOI 10.1590/S0100-72032013000300007
PURPOSE: It was to determine the prevalence of depressive symptoms in a sample of puerperal women from Brasília, Brazil, distinguishing cases with onset after delivery from those already present during pregnancy. METHODS: A prospective cohort study with convenience sampling of patients submitted to elective cesarean section at two private hospitals. As an instrument for assessing depressive symptoms, the Edinburgh Postnatal Depression Scale with cutoff >13 was applied shortly before delivery and four to eight weeks after childbirth. RESULTS: Among the 107 women who completed the study, 11 (10.3%) had significant depressive symptoms during pregnancy and 12 (11.2%) during the postpartum period. Among the 12 patients with postpartum symptoms, 6 had symptoms during pregnancy, so that 5.6% of the sample had postpartum onset of depression. The higher overall frequency of depression was significantly among single women than among married women (p=0.04), a fact mainly due to a higher frequency of single women experiencing persistent depressive symptoms both before and after delivery (p=0.002). The risk of depression was not influenced by age, parity or educational level. CONCLUSION: Women with depression identified during the postpartum period comprise a heterogeneous group, in which symptoms may have started before pregnancy, during pregnancy or after childbirth. In this sample, half of the postpartum depression cases already presented symptoms during late pregnancy. Since depression can arise before and after childbirth, it may have different etiologies and, therefore, a different response to treatment, a possibility that should be considered by clinicians and researchers.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(3):130-135
DOI 10.1590/S0100-72032013000300007
PURPOSE: It was to determine the prevalence of depressive symptoms in a sample of puerperal women from Brasília, Brazil, distinguishing cases with onset after delivery from those already present during pregnancy. METHODS: A prospective cohort study with convenience sampling of patients submitted to elective cesarean section at two private hospitals. As an instrument for assessing depressive symptoms, the Edinburgh Postnatal Depression Scale with cutoff >13 was applied shortly before delivery and four to eight weeks after childbirth. RESULTS: Among the 107 women who completed the study, 11 (10.3%) had significant depressive symptoms during pregnancy and 12 (11.2%) during the postpartum period. Among the 12 patients with postpartum symptoms, 6 had symptoms during pregnancy, so that 5.6% of the sample had postpartum onset of depression. The higher overall frequency of depression was significantly among single women than among married women (p=0.04), a fact mainly due to a higher frequency of single women experiencing persistent depressive symptoms both before and after delivery (p=0.002). The risk of depression was not influenced by age, parity or educational level. CONCLUSION: Women with depression identified during the postpartum period comprise a heterogeneous group, in which symptoms may have started before pregnancy, during pregnancy or after childbirth. In this sample, half of the postpartum depression cases already presented symptoms during late pregnancy. Since depression can arise before and after childbirth, it may have different etiologies and, therefore, a different response to treatment, a possibility that should be considered by clinicians and researchers.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(10):459-465
DOI 10.1590/S0100-72032012001000005
PURPOSES: To assess whether an enoxaparin-based intervention using a score system was effective in improving perinatal outcome in women with thrombophilia. METHODS: Study Design: Prospective, not randomized, uncontrolled, performed at a Clinic of High-Risk Pregnancy from November 2009 to November 2011. We included women with a diagnosis and therapeutic intervention for thrombophilia acquired and/or inherited in the current pregnancy. The obstetric and perinatal outcomes of pregnant women before the intervention were compared with outcomes after the intervention, and statistically analyzed using the χ2 test with Yates correction, considered significant when p<0.05. The initial dose of low-molecular-weight Heparin (LMWH) was guided by a scoring system based on the clinical and gestational history of the patients and screening tests for acquired and/or inherited thrombophilia. RESULTS: We included 84 pregnant women with 175 pregnancies before diagnosis, 20.0% of which resulted in fetal ou perinatal death, 40.0% resulted in abortion, 17.7% developed preeclampsia/eclampsia, 10.3% resulted in full-term births, and 29.7% in premature births. In the 84 pregnancies after intervention, 6.0% resulted in fetal ou perinatal death, 1.2% in abortion, 4.8% developed preeclampsia/eclampsia, 22.6% resulted in premature birth, and 70.2% in full-term birth. A significant reduction in the rate of stillbirths/perinatal death (p<0.05) and abortion (p<0.0001) and a significant increase (p<0.05) in the number of live births were observed after intervention. CONCLUSION: Enoxaparin-based intervention using a score system in pregnant women with thrombophilia is effective in improving perinatal outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(10):459-465
DOI 10.1590/S0100-72032012001000005
PURPOSES: To assess whether an enoxaparin-based intervention using a score system was effective in improving perinatal outcome in women with thrombophilia. METHODS: Study Design: Prospective, not randomized, uncontrolled, performed at a Clinic of High-Risk Pregnancy from November 2009 to November 2011. We included women with a diagnosis and therapeutic intervention for thrombophilia acquired and/or inherited in the current pregnancy. The obstetric and perinatal outcomes of pregnant women before the intervention were compared with outcomes after the intervention, and statistically analyzed using the χ2 test with Yates correction, considered significant when p<0.05. The initial dose of low-molecular-weight Heparin (LMWH) was guided by a scoring system based on the clinical and gestational history of the patients and screening tests for acquired and/or inherited thrombophilia. RESULTS: We included 84 pregnant women with 175 pregnancies before diagnosis, 20.0% of which resulted in fetal ou perinatal death, 40.0% resulted in abortion, 17.7% developed preeclampsia/eclampsia, 10.3% resulted in full-term births, and 29.7% in premature births. In the 84 pregnancies after intervention, 6.0% resulted in fetal ou perinatal death, 1.2% in abortion, 4.8% developed preeclampsia/eclampsia, 22.6% resulted in premature birth, and 70.2% in full-term birth. A significant reduction in the rate of stillbirths/perinatal death (p<0.05) and abortion (p<0.0001) and a significant increase (p<0.05) in the number of live births were observed after intervention. CONCLUSION: Enoxaparin-based intervention using a score system in pregnant women with thrombophilia is effective in improving perinatal outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(11):494-498
DOI 10.1590/S0100-72032012001100003
PURPOSE: To describe trends in prevalence, indicators of care and pregnancy outcomes for women with pre-existing type I or type II diabetes. METHODS: Cohort study of all consecutive singleton pregnancies complicated by pre-existing type I or type II diabetes followed from 2004 to 2011 at a tertiary perinatal care centre (n=194). We collected data from the medical records and described trends in demographics, clinical history, indicators of care before or during pregnancy and glycaemic control. We also studied perinatal outcomes, including gestational age at delivery, mode of delivery, and birthweight. RESULTS: The overall incidence of pregestational diabetes was 4.4 per 1000, with no significant changes throughout the study period. The number of type 2 diabetes cases also remained constant. In 67% of cases delivery occurred after 37 weeks (maximum 80% in 2010 - 11). During this period there was a significant reduction in rates of elective caesarean section (p=0.03) and in the incidence of large infants for gestational age (p=0.04). Indicators of glycaemic control were favorable throughout pregnancy, with no significant trends detected during the study period. However, preconceptional care indicators were substandard, with no significant improvement. CONCLUSIONS: A multidisciplinary approach to diabetic management and obstetric practice contributed to adequate glycaemic control throughout pregnancy and to improved pregnancy outcomes. Preconceptional care remains a key challenge.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(11):494-498
DOI 10.1590/S0100-72032012001100003
PURPOSE: To describe trends in prevalence, indicators of care and pregnancy outcomes for women with pre-existing type I or type II diabetes. METHODS: Cohort study of all consecutive singleton pregnancies complicated by pre-existing type I or type II diabetes followed from 2004 to 2011 at a tertiary perinatal care centre (n=194). We collected data from the medical records and described trends in demographics, clinical history, indicators of care before or during pregnancy and glycaemic control. We also studied perinatal outcomes, including gestational age at delivery, mode of delivery, and birthweight. RESULTS: The overall incidence of pregestational diabetes was 4.4 per 1000, with no significant changes throughout the study period. The number of type 2 diabetes cases also remained constant. In 67% of cases delivery occurred after 37 weeks (maximum 80% in 2010 - 11). During this period there was a significant reduction in rates of elective caesarean section (p=0.03) and in the incidence of large infants for gestational age (p=0.04). Indicators of glycaemic control were favorable throughout pregnancy, with no significant trends detected during the study period. However, preconceptional care indicators were substandard, with no significant improvement. CONCLUSIONS: A multidisciplinary approach to diabetic management and obstetric practice contributed to adequate glycaemic control throughout pregnancy and to improved pregnancy outcomes. Preconceptional care remains a key challenge.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(7):310-315
DOI 10.1590/S0100-72032012000700004
PURPOSE: To identify the etiology of nonimmune hydrops fetalis cases in pregnant women diagnosed and referred for prenatal care. METHODS: Retrospective analysis of cases with nonimmune hydrops fetalis that were monitored between March 1992 and December 2011. Diagnosis was confirmed by the presence of fetal subcutaneous edema (≥5 mm) with effusion in at least one serous cavity using obstetric ultrasound, and etiological investigation was conducted with cytogenetic (karyotype), infectious (syphilis, parvovirus B19, toxoplasmosis, rubella, cytomegalovirus, adenovirus and herpes simplex), hematologic and metabolic (inborn errors) analysis and fetal echocardiography. Twin pregnancies were excluded. Statistical analysis was performed using the χ² test for adhesion (software R 2.11.1). RESULTS: We included 116 patients with nonimmune hydrops fetalis; the etiology was elucidated in 91 cases (78.5%), while 25 cases (21.5%) were classified as idiopathic. Most cases had a chromosomal etiology, for a total of 26 cases (22.4%), followed by lymphatic etiology with 15 cases (12.9% with 11 cases of cystic hygroma), and cardiovascular and infectious etiology with 14 cases each (12.1%). In the remaining cases, the etiology was thoracic in 6.9% (eight cases), malformation syndromes in 4.3% (five cases), extrathoracic tumors in 3.4% (four cases), metabolic in 1.7% (two cases), and hematologic, gastrointestinal and genitourinary in 0.9% (one case each). During the postnatal period, 104 cases were followed up until the 40th day of life, and 12 cases had intrauterine fetal death. The survival rate of these 104 newborns was 23.1% (24 survived). CONCLUSION: An attempt should be made to clarify the etiology of hydrops diagnosed during pregnancy since the condition is associated with a wide spectrum of diseases. It is especially important to determine whether a potentially treatable condition is present and to identify disease at risk for recurrence in future pregnancies for adequate pre-conception counseling.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(7):310-315
DOI 10.1590/S0100-72032012000700004
PURPOSE: To identify the etiology of nonimmune hydrops fetalis cases in pregnant women diagnosed and referred for prenatal care. METHODS: Retrospective analysis of cases with nonimmune hydrops fetalis that were monitored between March 1992 and December 2011. Diagnosis was confirmed by the presence of fetal subcutaneous edema (≥5 mm) with effusion in at least one serous cavity using obstetric ultrasound, and etiological investigation was conducted with cytogenetic (karyotype), infectious (syphilis, parvovirus B19, toxoplasmosis, rubella, cytomegalovirus, adenovirus and herpes simplex), hematologic and metabolic (inborn errors) analysis and fetal echocardiography. Twin pregnancies were excluded. Statistical analysis was performed using the χ² test for adhesion (software R 2.11.1). RESULTS: We included 116 patients with nonimmune hydrops fetalis; the etiology was elucidated in 91 cases (78.5%), while 25 cases (21.5%) were classified as idiopathic. Most cases had a chromosomal etiology, for a total of 26 cases (22.4%), followed by lymphatic etiology with 15 cases (12.9% with 11 cases of cystic hygroma), and cardiovascular and infectious etiology with 14 cases each (12.1%). In the remaining cases, the etiology was thoracic in 6.9% (eight cases), malformation syndromes in 4.3% (five cases), extrathoracic tumors in 3.4% (four cases), metabolic in 1.7% (two cases), and hematologic, gastrointestinal and genitourinary in 0.9% (one case each). During the postnatal period, 104 cases were followed up until the 40th day of life, and 12 cases had intrauterine fetal death. The survival rate of these 104 newborns was 23.1% (24 survived). CONCLUSION: An attempt should be made to clarify the etiology of hydrops diagnosed during pregnancy since the condition is associated with a wide spectrum of diseases. It is especially important to determine whether a potentially treatable condition is present and to identify disease at risk for recurrence in future pregnancies for adequate pre-conception counseling.
