Pregnancy complications Archives - Page 2 of 10 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(4):183-188
The purpose of this study was to evaluate the perinatal outcomes in pregnant women who use illicit drugs.
A retrospective observational study of patients who, at the time of delivery, were sent to or who spontaneously sought a public maternity hospital in the eastern area of São Paulo city. We compared the perinatal outcomes of two distinct groups of pregnant women - illicit drugs users and non-users - that gave birth in the same period and analyzed the obstetric and neonatal variables. We used Student's t-test to calculate the averages among the groups, and the Chi-square test or Fisher's exact test to compare categorical data from each group.
We analyzed 166 women (83 users and 83 non-users) in both groups with a mean of age of 26 years. Ninety-five percent of the drug users would use crack or pure cocaine alone or associated with other psychoactive substances during pregnancy. Approximately half of the users group made no prenatal visit, compared with 2.4% in the non-users group (p < 0.001). Low birth weight (2,620 g versus 3,333 g on average, p < 0.001) and maternal syphilis (15.7% versus 0%, p < 0.001) were associated with the use of these illicit drugs.
The use of illicit drugs, mainly crack cocaine, represents an important perinatal risk. Any medical intervention in this population should combine adherence to prenatal care with strategies for reducing maternal exposure to illicit drugs.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(4):183-188
The purpose of this study was to evaluate the perinatal outcomes in pregnant women who use illicit drugs.
A retrospective observational study of patients who, at the time of delivery, were sent to or who spontaneously sought a public maternity hospital in the eastern area of São Paulo city. We compared the perinatal outcomes of two distinct groups of pregnant women - illicit drugs users and non-users - that gave birth in the same period and analyzed the obstetric and neonatal variables. We used Student's t-test to calculate the averages among the groups, and the Chi-square test or Fisher's exact test to compare categorical data from each group.
We analyzed 166 women (83 users and 83 non-users) in both groups with a mean of age of 26 years. Ninety-five percent of the drug users would use crack or pure cocaine alone or associated with other psychoactive substances during pregnancy. Approximately half of the users group made no prenatal visit, compared with 2.4% in the non-users group (p < 0.001). Low birth weight (2,620 g versus 3,333 g on average, p < 0.001) and maternal syphilis (15.7% versus 0%, p < 0.001) were associated with the use of these illicit drugs.
The use of illicit drugs, mainly crack cocaine, represents an important perinatal risk. Any medical intervention in this population should combine adherence to prenatal care with strategies for reducing maternal exposure to illicit drugs.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(7):290-295
DOI 10.1590/SO100-720320140004892
To identify the major causes of maternal death in the State of Pará, Brazil.
A descriptive, observational and retrospective study was conducted using data from the Mortality Information System (SIM) of the State Department of Public Health of Pará. SIM information was obtained using the TabWin 3.2 software and recorded in a research protocol developed by the investigators. The sample included 383 maternal deaths of 10-49-year-old women, which occurred from 2006 to 2010. Data were analyzed using non-parametric tests (χ2 and G-tests). The BioStat(r) 5.0 software was used for statistical analysis and Microsoft(r) Excel 2007 for the preparation of database and tables.
The Maternal Mortality Ratio was 51.9 and did not decrease significantly during the period. Most deaths occurred during the postpartum period (up to 42 days) (51.7%), and some diagnostic confirmation was used. Direct obstetric causes were dominant (90.6%), mainly hypertension (34.6%), with emphasis on eclampsia (70%), and hemorrhage (22.2%). All of these maternal deaths were avoidable (100%).
Maternal death in Pará is characterized by occurring during the puerperium (up to 42 days), due mainly to direct obstetric causes, such as hypertension, with emphasis on eclampsia, and hemorrhage. This evidences the need for complete attention with good quality for pregnant women, from prenatal care to puerperium, in the state of Pará.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(7):290-295
DOI 10.1590/SO100-720320140004892
To identify the major causes of maternal death in the State of Pará, Brazil.
A descriptive, observational and retrospective study was conducted using data from the Mortality Information System (SIM) of the State Department of Public Health of Pará. SIM information was obtained using the TabWin 3.2 software and recorded in a research protocol developed by the investigators. The sample included 383 maternal deaths of 10-49-year-old women, which occurred from 2006 to 2010. Data were analyzed using non-parametric tests (χ2 and G-tests). The BioStat(r) 5.0 software was used for statistical analysis and Microsoft(r) Excel 2007 for the preparation of database and tables.
The Maternal Mortality Ratio was 51.9 and did not decrease significantly during the period. Most deaths occurred during the postpartum period (up to 42 days) (51.7%), and some diagnostic confirmation was used. Direct obstetric causes were dominant (90.6%), mainly hypertension (34.6%), with emphasis on eclampsia (70%), and hemorrhage (22.2%). All of these maternal deaths were avoidable (100%).
Maternal death in Pará is characterized by occurring during the puerperium (up to 42 days), due mainly to direct obstetric causes, such as hypertension, with emphasis on eclampsia, and hemorrhage. This evidences the need for complete attention with good quality for pregnant women, from prenatal care to puerperium, in the state of Pará.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(6):259-263
DOI 10.1590/S0100-720320140004812
To analyze the factors related to route of delivery in patients with pre-eclampsia.
A retrospective analytical study was conducted from January 2009 to January 2011, during which 250 medical records of patients diagnosed with pre-eclampsia who gave birth to live fetuses with a gestational age of 28 weeks or more were selected. The variables evaluated were: maternal age (19 years, 20−34 years and over 35 full years), gestational age at delivery (28−37 weeks and more than 37 weeks), parity (primiparous or multiparous), previous cesarean section, history of pre-eclampsia or chronic hypertension, current diagnosis of mild or severe pre-eclampsia, and birth weight of the newborn. The information was transcribed to a questionnaire based on the variables being investigated. The chi-square test was applied to identify the relationship between the variables, with the level of significance set at p<0.05, and the Odds Ratio (OR) was calculated only for the variables showing a statistically significant difference in order to determine the odds for the patient to be submitted to a cesarean section.
In this study, we observed a 78.4% rate of cesarean delivery, with 54.1% of the patients submitted to the procedure having a gestational age of 28 to 37 weeks (OR=3.1; p<0.01). Patients with a history of pre-eclampsia were 2.5 times more likely to have cesarean delivery (OR=2.5; p<0.02). All patients who had had a previous cesarean were submitted to cesarean delivery in the current pregnancy (p<0.01). Pregnant women with severe pre-eclampsia were 3.3 times more likely to progress to cesarean delivery than those with mild pre-eclampsia (OR=3.3; p<0.01).
After individual analysis, only gestational age and a diagnosis of severe pre-eclampsia showed significant differences, representing risk factors for this type of delivery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(6):259-263
DOI 10.1590/S0100-720320140004812
To analyze the factors related to route of delivery in patients with pre-eclampsia.
A retrospective analytical study was conducted from January 2009 to January 2011, during which 250 medical records of patients diagnosed with pre-eclampsia who gave birth to live fetuses with a gestational age of 28 weeks or more were selected. The variables evaluated were: maternal age (19 years, 20−34 years and over 35 full years), gestational age at delivery (28−37 weeks and more than 37 weeks), parity (primiparous or multiparous), previous cesarean section, history of pre-eclampsia or chronic hypertension, current diagnosis of mild or severe pre-eclampsia, and birth weight of the newborn. The information was transcribed to a questionnaire based on the variables being investigated. The chi-square test was applied to identify the relationship between the variables, with the level of significance set at p<0.05, and the Odds Ratio (OR) was calculated only for the variables showing a statistically significant difference in order to determine the odds for the patient to be submitted to a cesarean section.
In this study, we observed a 78.4% rate of cesarean delivery, with 54.1% of the patients submitted to the procedure having a gestational age of 28 to 37 weeks (OR=3.1; p<0.01). Patients with a history of pre-eclampsia were 2.5 times more likely to have cesarean delivery (OR=2.5; p<0.02). All patients who had had a previous cesarean were submitted to cesarean delivery in the current pregnancy (p<0.01). Pregnant women with severe pre-eclampsia were 3.3 times more likely to progress to cesarean delivery than those with mild pre-eclampsia (OR=3.3; p<0.01).
After individual analysis, only gestational age and a diagnosis of severe pre-eclampsia showed significant differences, representing risk factors for this type of delivery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(3):102-106
DOI 10.1590/S0100-72032014000300002
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(3):102-106
DOI 10.1590/S0100-72032014000300002
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(12):541-548
DOI 10.1590/S0100-72032013001200003
PURPOSE: To determine the prevalence of low back pain in pregnant women and to describe its characteristics and associated factors. METHODS: The participants were 269 pregnant women in the first to the third trimester of pregnancy, seen at the obstetrics outpatient clinic of a University Hospital in the Brazilian Northeast. We applied a questionnaire in order to obtain data regarding socio-demographic variables, obstetric history and characteristics of low back pain, as well as the Oswestry and Rolland Morris questionnaires to assess disability and a visual analog pain scale to measure pain intensity. RESULTS: The prevalence of low back pain was 73%, with the following characteristics: stabbing (62/31.6%), irradiation (162/82.6%), of daily frequency (105/53.5%), usually starting at night (83/42.3%) when it was also more intense (122/62.2%), and lasting about 1 hour in 118 women (60.2%). Pain improved with rest (100/51%), worsened when the women stood or sat for a long time (86/43.9%) and when they did housework (85/43.4%). The level of disability ranged from "mild" to "moderate" in most cases. Urinary tract infection (p=0.02) and the scores of the Oswestry and Rolland Morris questionnaires showed significant association with the visual analogue pain scale. CONCLUSION: The prevalence of back pain among pregnant women is high, with varying characteristics. The degree of disability is usually moderate and the presence of urinary infection and higher disability scores were associated with greater intensity of low back pain.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(12):541-548
DOI 10.1590/S0100-72032013001200003
PURPOSE: To determine the prevalence of low back pain in pregnant women and to describe its characteristics and associated factors. METHODS: The participants were 269 pregnant women in the first to the third trimester of pregnancy, seen at the obstetrics outpatient clinic of a University Hospital in the Brazilian Northeast. We applied a questionnaire in order to obtain data regarding socio-demographic variables, obstetric history and characteristics of low back pain, as well as the Oswestry and Rolland Morris questionnaires to assess disability and a visual analog pain scale to measure pain intensity. RESULTS: The prevalence of low back pain was 73%, with the following characteristics: stabbing (62/31.6%), irradiation (162/82.6%), of daily frequency (105/53.5%), usually starting at night (83/42.3%) when it was also more intense (122/62.2%), and lasting about 1 hour in 118 women (60.2%). Pain improved with rest (100/51%), worsened when the women stood or sat for a long time (86/43.9%) and when they did housework (85/43.4%). The level of disability ranged from "mild" to "moderate" in most cases. Urinary tract infection (p=0.02) and the scores of the Oswestry and Rolland Morris questionnaires showed significant association with the visual analogue pain scale. CONCLUSION: The prevalence of back pain among pregnant women is high, with varying characteristics. The degree of disability is usually moderate and the presence of urinary infection and higher disability scores were associated with greater intensity of low back pain.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(12):536-540
DOI 10.1590/S0100-72032013001200002
PURPOSE: To evaluate weight retention 12 months postpartum and factors associated among women who had received prenatal care at Health Care Centers in Porto Alegre, southern Brazil. METHODS: Pregnant women in the last trimester were identified at 20 Health Care Centers. Socioeconomic, demographic and anthropometrics data were obtained. Six and 12 months after delivery, the women received home visits for anthropometric measures. The gestational weight gain was defined by pre-pregnancy Body Mass Index (BMI). Weight retention was defined as the difference between pre-gestational weight and weight at postpartum. Data were analyzed using McNemar's Test, ANOVA with Bonferroni correction and multiple linear regression. RESULTS: Of the 715 pregnant women recruited, 545 were assessed 12 months after delivery. Women were more likely to be overweight 12 months postpartum compared to the pre-pregnancy period (52.9 versus 36.7%) and weight retention during the 12 months postpartum was more than 10 kg in 30.7% of the women. Weight retention in the postpartum period was higher among women who were overweight (9.9±7.7 kg) compared to those who were of normal weight during the pre-pregnancy period (7.6±6.2 kg). Pre-pregnancy BMI, gestational weight gain, and maternal age were associated with gestational weight retention 12 months postpartum (p<0.001). CONCLUSION: Adequate prenatal care is necessary to minimize the adverse effects of excessive weight gain during pregnancy on women's health.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(12):536-540
DOI 10.1590/S0100-72032013001200002
PURPOSE: To evaluate weight retention 12 months postpartum and factors associated among women who had received prenatal care at Health Care Centers in Porto Alegre, southern Brazil. METHODS: Pregnant women in the last trimester were identified at 20 Health Care Centers. Socioeconomic, demographic and anthropometrics data were obtained. Six and 12 months after delivery, the women received home visits for anthropometric measures. The gestational weight gain was defined by pre-pregnancy Body Mass Index (BMI). Weight retention was defined as the difference between pre-gestational weight and weight at postpartum. Data were analyzed using McNemar's Test, ANOVA with Bonferroni correction and multiple linear regression. RESULTS: Of the 715 pregnant women recruited, 545 were assessed 12 months after delivery. Women were more likely to be overweight 12 months postpartum compared to the pre-pregnancy period (52.9 versus 36.7%) and weight retention during the 12 months postpartum was more than 10 kg in 30.7% of the women. Weight retention in the postpartum period was higher among women who were overweight (9.9±7.7 kg) compared to those who were of normal weight during the pre-pregnancy period (7.6±6.2 kg). Pre-pregnancy BMI, gestational weight gain, and maternal age were associated with gestational weight retention 12 months postpartum (p<0.001). CONCLUSION: Adequate prenatal care is necessary to minimize the adverse effects of excessive weight gain during pregnancy on women's health.
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.