Pregnancy complications Archives - Page 11 of 11 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(7):370-375
DOI 10.1590/S0100-72032007000700008
Studies have shown possible risk relations among oral illnesses, mainly periodontal disease and adverse pregnancy outcomes, such as prematurity, low birth weight and preeclampsia. The explanation for this hypothesis is based on the fact that periodontal disease is an infectious state, which may increase maternal serum cytokines through the release of such agents directly from the periodontal pocket or by through the dissemination of pathogenic bacteria, inducing systemic production. This assumption is based on the knowledge that the physiopathology of the pregnancy complications cited above is associated with the presence of some cytokines in the maternal serum. The present study work has the objective to review literature in search of evidence to these alleged associations. Although a number of clinical studies have been found in this review, we noticed a lack of methodological standards, what limits the conclusions about this topic. On the other side, the fact that periodontal disease is not yet a confirmed risk factor for adverse pregnancy outcomes does not reduce the importance of oral health maintenance during pregnancy, since it is important to allow adequate feeding without pain and bleeding in order to maintain an adequate nutritional supply.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(7):370-375
DOI 10.1590/S0100-72032007000700008
Studies have shown possible risk relations among oral illnesses, mainly periodontal disease and adverse pregnancy outcomes, such as prematurity, low birth weight and preeclampsia. The explanation for this hypothesis is based on the fact that periodontal disease is an infectious state, which may increase maternal serum cytokines through the release of such agents directly from the periodontal pocket or by through the dissemination of pathogenic bacteria, inducing systemic production. This assumption is based on the knowledge that the physiopathology of the pregnancy complications cited above is associated with the presence of some cytokines in the maternal serum. The present study work has the objective to review literature in search of evidence to these alleged associations. Although a number of clinical studies have been found in this review, we noticed a lack of methodological standards, what limits the conclusions about this topic. On the other side, the fact that periodontal disease is not yet a confirmed risk factor for adverse pregnancy outcomes does not reduce the importance of oral health maintenance during pregnancy, since it is important to allow adequate feeding without pain and bleeding in order to maintain an adequate nutritional supply.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(1):19-24
DOI 10.1590/S0100-72031998000100004
Fetal and placental effects of insulin therapy on pregnancy of diabetic rats were studied. Alloxan was administered intravenously at the dose of 42 mg/kg of body weight. Five experimental groups were formed: control (G1, n=12), non-treated rats with moderate diabetes (G2, n=10), insulin-treated rats with moderate diabetes (G3, n=11),non-treated rats with severe diabetes (G4, n=12) and insulin-treated rats with severe diabetes (G5, n=10). Six hundred and thirty-four newborn rats and placentas wereprocured. The perinatal result of insulin therapy was directly related to the quality of glycemia control. Thus, inadequate control of moderate diabetes produced levels of moderate hyperglycemia, did not interfere with the newborn rats' body weight and decreased the proportion of LGA newborn rats. Adequate control of severe diabetes brought the newborn rat glycemia to normal levels, increased the newborn rats' body weight and decreased the proportion of SGA newborn rats. Adequate insulin therapy for severe diabetes diminished the weight of the placentas, but did not change the placental index.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(1):19-24
DOI 10.1590/S0100-72031998000100004
Fetal and placental effects of insulin therapy on pregnancy of diabetic rats were studied. Alloxan was administered intravenously at the dose of 42 mg/kg of body weight. Five experimental groups were formed: control (G1, n=12), non-treated rats with moderate diabetes (G2, n=10), insulin-treated rats with moderate diabetes (G3, n=11),non-treated rats with severe diabetes (G4, n=12) and insulin-treated rats with severe diabetes (G5, n=10). Six hundred and thirty-four newborn rats and placentas wereprocured. The perinatal result of insulin therapy was directly related to the quality of glycemia control. Thus, inadequate control of moderate diabetes produced levels of moderate hyperglycemia, did not interfere with the newborn rats' body weight and decreased the proportion of LGA newborn rats. Adequate control of severe diabetes brought the newborn rat glycemia to normal levels, increased the newborn rats' body weight and decreased the proportion of SGA newborn rats. Adequate insulin therapy for severe diabetes diminished the weight of the placentas, but did not change the placental index.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):181-185
DOI 10.1590/S0100-72031998000400002
With the purpose of identifying the social, demographic, pregnancy-related and medical care factors associated with maternal death, this study evaluated all deaths of women aged 10 to 49 years occurring in Recife, Pernambuco, Brazil, during 1992 and 1993. The data were obtained reviewing 1,013 death certificates, with 42 cases of identified maternal deaths. The data of these deaths were complemented with information from medical records, autopsies and also interviews with physicians from the hospitals where the death took place, and with the dead women's relatives. Almost two thirds (62%) of maternal deaths occurred among women aged 20 to 29 years and more than half of them were single. There was a higher number of deaths among caesarean deliveries than among vaginal ones. The majority of deaths occurred within the first three days of hospitalization and approximately 90% of hospital charges were sponsored by the National Health System (SUS).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):181-185
DOI 10.1590/S0100-72031998000400002
With the purpose of identifying the social, demographic, pregnancy-related and medical care factors associated with maternal death, this study evaluated all deaths of women aged 10 to 49 years occurring in Recife, Pernambuco, Brazil, during 1992 and 1993. The data were obtained reviewing 1,013 death certificates, with 42 cases of identified maternal deaths. The data of these deaths were complemented with information from medical records, autopsies and also interviews with physicians from the hospitals where the death took place, and with the dead women's relatives. Almost two thirds (62%) of maternal deaths occurred among women aged 20 to 29 years and more than half of them were single. There was a higher number of deaths among caesarean deliveries than among vaginal ones. The majority of deaths occurred within the first three days of hospitalization and approximately 90% of hospital charges were sponsored by the National Health System (SUS).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(5):237-243
DOI 10.1590/S0100-72031998000500002
We analyze prospectively the existence of a relationship between the mother's glycemic control, in the first half of pregnancy, and the occurrence of abnormal fetal cardiac abnormalities, in pregnant women with diabetes mellitus. In 127 pregnant women, the level of glycosylated hemoglobin was determined on the first visit during prenatal care. Nine patients had type I diabetes, 77 type II and 41 gestational diabetes mellitus (GDM). All mothers were submitted to detailed fetal echocardiography, during the 28th ± 4.127 week of gestation. In 31 (24.4%) of the 127 fetuses cardiac anomalies were detected. In 10 (7.87%) an isolated cardiac anomaly was identified. Mean HbA1c in the group of pregnant women without cardiac anomalies (5.64%) was statistically different from the group with anomalies (10.14%) (p<0.0001). The receiver-operator characteristic, representing the balance between sensitivity (92.83%) and specificity (98.92%) in the diagnosis of structural cardiac abnormalities, showed a cut-off point at the 7.5% HbA1c level. In nine of ten fetuses with structural cardiac anomalies, the maternal level of HbA1c was higher than 7.5%. The difference between means of the groups with and without myocardial hypertrophy diagnosed as isolated anomaly (MCHP) was not statistically significant, when considering both type II diabetes and GDM subgroups. In conclusion, levels of HbA1c higher than 7.5% were associated with most cases of echocardiographycally diagnosed structural cardiac anomalies. On the other hand, this test was not useful to discriminate conceptus with MCHP.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(5):237-243
DOI 10.1590/S0100-72031998000500002
We analyze prospectively the existence of a relationship between the mother's glycemic control, in the first half of pregnancy, and the occurrence of abnormal fetal cardiac abnormalities, in pregnant women with diabetes mellitus. In 127 pregnant women, the level of glycosylated hemoglobin was determined on the first visit during prenatal care. Nine patients had type I diabetes, 77 type II and 41 gestational diabetes mellitus (GDM). All mothers were submitted to detailed fetal echocardiography, during the 28th ± 4.127 week of gestation. In 31 (24.4%) of the 127 fetuses cardiac anomalies were detected. In 10 (7.87%) an isolated cardiac anomaly was identified. Mean HbA1c in the group of pregnant women without cardiac anomalies (5.64%) was statistically different from the group with anomalies (10.14%) (p<0.0001). The receiver-operator characteristic, representing the balance between sensitivity (92.83%) and specificity (98.92%) in the diagnosis of structural cardiac abnormalities, showed a cut-off point at the 7.5% HbA1c level. In nine of ten fetuses with structural cardiac anomalies, the maternal level of HbA1c was higher than 7.5%. The difference between means of the groups with and without myocardial hypertrophy diagnosed as isolated anomaly (MCHP) was not statistically significant, when considering both type II diabetes and GDM subgroups. In conclusion, levels of HbA1c higher than 7.5% were associated with most cases of echocardiographycally diagnosed structural cardiac anomalies. On the other hand, this test was not useful to discriminate conceptus with MCHP.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):165-167
DOI 10.1590/S0100-72031998000300008
HELLP syndrome is a severe complication of preeclampsia that increases maternal and perinatal morbidity and mortality. Two cases of recurrent HELLP syndrome are described, maternal death occurring in one of the cases. This study is a warning about the increased risk of HELLP syndrome in the next pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):165-167
DOI 10.1590/S0100-72031998000300008
HELLP syndrome is a severe complication of preeclampsia that increases maternal and perinatal morbidity and mortality. Two cases of recurrent HELLP syndrome are described, maternal death occurring in one of the cases. This study is a warning about the increased risk of HELLP syndrome in the next pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):395-403
DOI 10.1590/S0100-72031998000700005
Purpose: to establish a list of diseases promoting maternal death according to frequency. Methods: In 1996, 65,406 deaths were recorded in the City of São Paulo, 26,778 of which were of women. Of these, 4591 were within the 10-49 year age bracket. We analyzed the latter group, regarding at the field "Cause of Death" in the Death Certificate, trying to establish some correlation between the described pathology, and the pregnancy-puerperium cycle. We separated for a further study 293 Death Certificates, from which we selected, after hospital survey and/or home visits, a total of 119 positive cases for maternal death. The positive cases for maternal death were then tabulated, grouped and analyzed according to age and pathology, using the great medical care groups. Results: as regards the 119 positive cases for maternal death, we did not find any reference to the pregnancy-puerperium state in 53 of them (that is, 40.54% subnotifying). The cases were grouped according to pathology, where we found a predominance of eclampsia/pre-eclampsia cases (18.02%), followed by cases resulting from hemorrhagic complications in the third quarter and puerperium (12.61%), abortion complications (12.61%), puerperal infection (9.91%) and cardiopathies (9.91%). Conclusions: for the first time, we are publishing the Late Maternal Mortality Coefficient for the City of São Paulo, which was 51.33/100,000 born alive. However, we used for the official publication the Maternal Mortality Coefficient for death within up to 42 days of puerperium, which was, 48.03/100,000 born alive for the city of São Paulo. We should bear in mind that no correction factor should be applied to these figures since we have made an active search of cases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):395-403
DOI 10.1590/S0100-72031998000700005
Purpose: to establish a list of diseases promoting maternal death according to frequency. Methods: In 1996, 65,406 deaths were recorded in the City of São Paulo, 26,778 of which were of women. Of these, 4591 were within the 10-49 year age bracket. We analyzed the latter group, regarding at the field "Cause of Death" in the Death Certificate, trying to establish some correlation between the described pathology, and the pregnancy-puerperium cycle. We separated for a further study 293 Death Certificates, from which we selected, after hospital survey and/or home visits, a total of 119 positive cases for maternal death. The positive cases for maternal death were then tabulated, grouped and analyzed according to age and pathology, using the great medical care groups. Results: as regards the 119 positive cases for maternal death, we did not find any reference to the pregnancy-puerperium state in 53 of them (that is, 40.54% subnotifying). The cases were grouped according to pathology, where we found a predominance of eclampsia/pre-eclampsia cases (18.02%), followed by cases resulting from hemorrhagic complications in the third quarter and puerperium (12.61%), abortion complications (12.61%), puerperal infection (9.91%) and cardiopathies (9.91%). Conclusions: for the first time, we are publishing the Late Maternal Mortality Coefficient for the City of São Paulo, which was 51.33/100,000 born alive. However, we used for the official publication the Maternal Mortality Coefficient for death within up to 42 days of puerperium, which was, 48.03/100,000 born alive for the city of São Paulo. We should bear in mind that no correction factor should be applied to these figures since we have made an active search of cases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):415-419
DOI 10.1590/S0100-72031998000700008
Twin pregnancy in which a normal fetus and a complete mole develop at the same time is a rare event. Clinical complications and malignancy are frequent in this type of disease.This report is about a case of a late diagnosis due to the presence of the fetus. The diagnosis was made when the pregnancy was interrupted and then confirmed by histopathological study and flow cytometry. The pregnancy was terminated transpelvically due to massive uterine hemorrhage. The post-molar follow-up showed the persistence of high levels of bhCG. The patient's complete recovery was achieved after the administration of methotrexate. The diagnosis, natural history, and procedures for this rare disease are discussed in view of this case.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):415-419
DOI 10.1590/S0100-72031998000700008
Twin pregnancy in which a normal fetus and a complete mole develop at the same time is a rare event. Clinical complications and malignancy are frequent in this type of disease.This report is about a case of a late diagnosis due to the presence of the fetus. The diagnosis was made when the pregnancy was interrupted and then confirmed by histopathological study and flow cytometry. The pregnancy was terminated transpelvically due to massive uterine hemorrhage. The post-molar follow-up showed the persistence of high levels of bhCG. The patient's complete recovery was achieved after the administration of methotrexate. The diagnosis, natural history, and procedures for this rare disease are discussed in view of this case.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(8):437-441
DOI 10.1590/S0100-72031998000800002
Purpose:to compare the incidence of preterm labor and birth, premature rupture of membranes (PROM) and low birth-weight newborns (< 2,500 g) between two groups of pregnant women (with or without BV). To verify the adequacy of including a regular prenatal BV investigation. Methods:a total of 217 women between 28 and 32 weeks of pregnancy (35 with BV and 182 without BV) were studied. The diagnosis of BV was established according to Amsel's criteria. The data were analyzed by the chi² test, Fisher's test, Mann-Whitney test and the relative risk. Results:the incidence of preterm labor, preterm birth, PROM and low birth-weight was statistically higher in the group of women with BV than in the control group (29.4% vs. 3.8%; 28.6% vs. 3.3%; 22.9% vs. 10.4%; 20.0% vs. 3.3%; respectively). The means of gestational age and birth-weight were significantly lower in the newborns from mothers with BV (265.8 days vs. 279.9 days; 2,958 g vs. 3,294 g, respectively). Conclusion:all perinatal complications studied were significantly associated with the presence of untreated BV during pregnancy. Therefore, the diagnosis and adequate treatment should be included in the routine prenatal assistance at Brazilian Obstetrics Services. Such measure may be effective in the reduction of these perinatal complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(8):437-441
DOI 10.1590/S0100-72031998000800002
Purpose:to compare the incidence of preterm labor and birth, premature rupture of membranes (PROM) and low birth-weight newborns (< 2,500 g) between two groups of pregnant women (with or without BV). To verify the adequacy of including a regular prenatal BV investigation. Methods:a total of 217 women between 28 and 32 weeks of pregnancy (35 with BV and 182 without BV) were studied. The diagnosis of BV was established according to Amsel's criteria. The data were analyzed by the chi² test, Fisher's test, Mann-Whitney test and the relative risk. Results:the incidence of preterm labor, preterm birth, PROM and low birth-weight was statistically higher in the group of women with BV than in the control group (29.4% vs. 3.8%; 28.6% vs. 3.3%; 22.9% vs. 10.4%; 20.0% vs. 3.3%; respectively). The means of gestational age and birth-weight were significantly lower in the newborns from mothers with BV (265.8 days vs. 279.9 days; 2,958 g vs. 3,294 g, respectively). Conclusion:all perinatal complications studied were significantly associated with the presence of untreated BV during pregnancy. Therefore, the diagnosis and adequate treatment should be included in the routine prenatal assistance at Brazilian Obstetrics Services. Such measure may be effective in the reduction of these perinatal complications.