Pregnancy complications, infections Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(2):56-62
DOI 10.1590/S0100-72032012000200003
PURPOSE: To describe the characteristics of pregnancies complicated by maternal syphilis and fetal death. METHODS: Retrospective descriptive study performed by reviewing the medical records of 48 pregnant women with maternal syphilis and fetal death outcome admitted to Hospital Geral de Nova Iguaçu, Baixada Fluminense, State of Rio de Janeiro, during the period from 2005 to 2008. Birth weight >500 g and fetal death documented by Death Certificate were the inclusion criteria. The following aspects were analyzed: sociodemographic factors, reproductive history, aspects of the current pregnancy, prenatal care, Venereal Disease Research Laboratory (VDRL) testing, and other gestational conditions, in addition to syphilis. The fetal deaths were classified as maternal, placental or fetal. Percentage, mean, standard deviation (SD), maximum and minimum values were reported. RESULTS: The mean maternal age was 22.7 years (SD=0.9 years), and at least 50% of the patients had low educational level. At hospital admission, 68.8% of the subjects were in the third trimester, with a mean gestational age of 29.2 weeks (SD=0.5), and more than 50% were in labor. The vast majority of fetal deaths (93%) occurred before maternal hospitalization. Among the patients who received prenatal care (54.2%), 30.8% had no VDRL test, 30.8 and 15.4% had a reactive and non-reactive result, respectively, and none had more than one prenatal VDRL test. At the time of childbirth, most of the mothers (95.8%) carried out VDRL testing. Overall, the VDRL titers varied from 1:1 to 1:512, with predominant values >1:4 (91.7%). In 23% of cases other clinical conditions related to fetal death, in addition to syphilis, were found. CONCLUSIONS: The infection was the main clinically identified cause of fetal death in this patient series. Fetal death occurred during the preterm period and in the presence of high titers of maternal infection, suggesting recent syphilis infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(2):56-62
DOI 10.1590/S0100-72032012000200003
PURPOSE: To describe the characteristics of pregnancies complicated by maternal syphilis and fetal death. METHODS: Retrospective descriptive study performed by reviewing the medical records of 48 pregnant women with maternal syphilis and fetal death outcome admitted to Hospital Geral de Nova Iguaçu, Baixada Fluminense, State of Rio de Janeiro, during the period from 2005 to 2008. Birth weight >500 g and fetal death documented by Death Certificate were the inclusion criteria. The following aspects were analyzed: sociodemographic factors, reproductive history, aspects of the current pregnancy, prenatal care, Venereal Disease Research Laboratory (VDRL) testing, and other gestational conditions, in addition to syphilis. The fetal deaths were classified as maternal, placental or fetal. Percentage, mean, standard deviation (SD), maximum and minimum values were reported. RESULTS: The mean maternal age was 22.7 years (SD=0.9 years), and at least 50% of the patients had low educational level. At hospital admission, 68.8% of the subjects were in the third trimester, with a mean gestational age of 29.2 weeks (SD=0.5), and more than 50% were in labor. The vast majority of fetal deaths (93%) occurred before maternal hospitalization. Among the patients who received prenatal care (54.2%), 30.8% had no VDRL test, 30.8 and 15.4% had a reactive and non-reactive result, respectively, and none had more than one prenatal VDRL test. At the time of childbirth, most of the mothers (95.8%) carried out VDRL testing. Overall, the VDRL titers varied from 1:1 to 1:512, with predominant values >1:4 (91.7%). In 23% of cases other clinical conditions related to fetal death, in addition to syphilis, were found. CONCLUSIONS: The infection was the main clinically identified cause of fetal death in this patient series. Fetal death occurred during the preterm period and in the presence of high titers of maternal infection, suggesting recent syphilis infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(3):143-148
DOI 10.1590/S0100-72032005000300008
PURPOSE: to describe etiology, evolution and prevalence of hydrops fetalis in a cohort of pregnant women during a period of ten years (1992 to 2002) in a tertiary maternity. METHODS: a retrospective study was carried out in patients referred to the maternity of the Fernandes Figueira Institute, with diagnosis of hydrops fetalis, detected by ultrasonography, during the period from 1992 to 2002. The cases were selected according to etiology (immune or nonimmune) and evolution, performed invasive procedures and survival were compared between both groups. Analysis of variables was performed by Epi-Info 6.0 and a p value less than 0.05 was considered to be statistical significant. RESULTS: in ten years of follow-up, 80 patients with an initial diagnosis of hydrops were attended. The frequency of hydrops in this population was 1 in 157 live births. Rh immunization (immune group) was detected in 13 cases (16.2%), and for 67 cases (83.8%) nonimmune causes (nonimmune group) were considered. Major causes of nonimmune hydrops fetalis were idiopathic (40.2%), genetic (20.8%), infectious diseases (20.7%), and cardiopathy (7.4%). A difference was found in relation to maternal age in the immune group (mean = 32.8 years) when compared with the nonimmune group (mean = 28.7 years) (p=0.03), but gestational age at delivery was similar in both groups (mean = 33.6 weeks in the immune group and 33.1 weeks in the nonimmune group) (p=0.66). Amniocentesis and blood transfusion in utero were carried out more frequently in the immune group (p<0.001) and perinatal mortality was 53.8% in the immune group and 68.6% in the nonimmune group (p=0.47). Complementary research of IgG anti-parvovirus B19 antibodies was carried out in 41 of 67 cases of nonimmune hydrops, with 16 being positive for the presence of anti-B19 IgG antibodies. CONCLUSION: nonimmune etiology was the most common form of presentation of hydrops fetalis in our study. Perinatal mortality of this entity is still high and a substantial number of cases had no identified cause. Characterization of fetal karyotype and performance of specific parvovirus B19 serology could increase causal identification of nonimmune hydrops classified as idiopathic.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(3):143-148
DOI 10.1590/S0100-72032005000300008
PURPOSE: to describe etiology, evolution and prevalence of hydrops fetalis in a cohort of pregnant women during a period of ten years (1992 to 2002) in a tertiary maternity. METHODS: a retrospective study was carried out in patients referred to the maternity of the Fernandes Figueira Institute, with diagnosis of hydrops fetalis, detected by ultrasonography, during the period from 1992 to 2002. The cases were selected according to etiology (immune or nonimmune) and evolution, performed invasive procedures and survival were compared between both groups. Analysis of variables was performed by Epi-Info 6.0 and a p value less than 0.05 was considered to be statistical significant. RESULTS: in ten years of follow-up, 80 patients with an initial diagnosis of hydrops were attended. The frequency of hydrops in this population was 1 in 157 live births. Rh immunization (immune group) was detected in 13 cases (16.2%), and for 67 cases (83.8%) nonimmune causes (nonimmune group) were considered. Major causes of nonimmune hydrops fetalis were idiopathic (40.2%), genetic (20.8%), infectious diseases (20.7%), and cardiopathy (7.4%). A difference was found in relation to maternal age in the immune group (mean = 32.8 years) when compared with the nonimmune group (mean = 28.7 years) (p=0.03), but gestational age at delivery was similar in both groups (mean = 33.6 weeks in the immune group and 33.1 weeks in the nonimmune group) (p=0.66). Amniocentesis and blood transfusion in utero were carried out more frequently in the immune group (p<0.001) and perinatal mortality was 53.8% in the immune group and 68.6% in the nonimmune group (p=0.47). Complementary research of IgG anti-parvovirus B19 antibodies was carried out in 41 of 67 cases of nonimmune hydrops, with 16 being positive for the presence of anti-B19 IgG antibodies. CONCLUSION: nonimmune etiology was the most common form of presentation of hydrops fetalis in our study. Perinatal mortality of this entity is still high and a substantial number of cases had no identified cause. Characterization of fetal karyotype and performance of specific parvovirus B19 serology could increase causal identification of nonimmune hydrops classified as idiopathic.