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Original Article
The Use of Mobile Educational Tools to Improve Antimicrobial Prescription for the Treatment of Acute Pyelonephritis in Pregnancy: A Retrospective Cross-sectional Study
- Vicente Sperb Antonello
, - Marjane Caroline Cunegatto,
- Elisa Tasca Rosin,
- Júlia Xavier Castilhos,
- Fabrícia Gamba Beduschi, [ ... ],
- Mirela Foresti Jimenez
02-01-2019
Summary
Original ArticleThe Use of Mobile Educational Tools to Improve Antimicrobial Prescription for the Treatment of Acute Pyelonephritis in Pregnancy: A Retrospective Cross-sectional Study
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(2):97-101
02-01-2019- Vicente Sperb Antonello ,
- Marjane Caroline Cunegatto,
- Elisa Tasca Rosin,
- Júlia Xavier Castilhos,
- Fabrícia Gamba Beduschi,
- Daniela Benzano Bumaguin,
- Ivan Carlos Ferreira Antonello,
- Mirela Foresti Jimenez
Views104See moreAbstract
Objective
To analyze the prescription of antimicrobial agents for pregnant women admitted into the obstetrics service who presented with acute pyelonephritis.
Methods
Three cross-sectional studies were performed comparing the prescription of antimicrobials for pyelonephritis in pregnant women in the time periods evaluated (2010-2011: 99 patients evaluated; 2013: 116 patients evaluated; 2015: 107 patients evaluated), at the Hospital Fêmina, Porto Alegre, in the state of Rio Grande do Sul, Brazil. The analysis was performed before and after the promotion of an institutional protocol for the treatment of pyelonephritis during pregnancy, and on a third occasion after the introduction of a smartphone-based mobile educational tool.
Results
The evaluation of the prescribing physicians and the adequacy of the prescriptions between the different periods studied revealed a significant increase in appropriate conduct for the choice of antimicrobial (2010: 83.8%; 2013: 95.7%; and 2015: 100%), route of administration (2010: 97%; 2013: 100%; and 2015: 100%), and interval (2010: 91.9%; 2013: 95.7%; and 2015: 100%), following the introduction of the protocol, and again after the implementation of the softwareapplicationwithorientationsontheantimicrobial treatment.
Conclusion
The use of specific mobile applications should be encouraged to attain a better quality and accuracy in prescriptions and to include strategies that not only reduce the risk of negative outcomes, but also improve the quality of care and treatment for maintaining the health both of the mother and of the baby.
Views104
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleThe Use of Mobile Educational Tools to Improve Antimicrobial Prescription for the Treatment of Acute Pyelonephritis in Pregnancy: A Retrospective Cross-sectional Study
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(2):97-101
02-01-2019- Vicente Sperb Antonello ,
- Marjane Caroline Cunegatto,
- Elisa Tasca Rosin,
- Júlia Xavier Castilhos,
- Fabrícia Gamba Beduschi,
- Daniela Benzano Bumaguin,
- Ivan Carlos Ferreira Antonello,
- Mirela Foresti Jimenez
Views104See moreAbstract
Objective
To analyze the prescription of antimicrobial agents for pregnant women admitted into the obstetrics service who presented with acute pyelonephritis.
Methods
Three cross-sectional studies were performed comparing the prescription of antimicrobials for pyelonephritis in pregnant women in the time periods evaluated (2010-2011: 99 patients evaluated; 2013: 116 patients evaluated; 2015: 107 patients evaluated), at the Hospital Fêmina, Porto Alegre, in the state of Rio Grande do Sul, Brazil. The analysis was performed before and after the promotion of an institutional protocol for the treatment of pyelonephritis during pregnancy, and on a third occasion after the introduction of a smartphone-based mobile educational tool.
Results
The evaluation of the prescribing physicians and the adequacy of the prescriptions between the different periods studied revealed a significant increase in appropriate conduct for the choice of antimicrobial (2010: 83.8%; 2013: 95.7%; and 2015: 100%), route of administration (2010: 97%; 2013: 100%; and 2015: 100%), and interval (2010: 91.9%; 2013: 95.7%; and 2015: 100%), following the introduction of the protocol, and again after the implementation of the softwareapplicationwithorientationsontheantimicrobial treatment.
Conclusion
The use of specific mobile applications should be encouraged to attain a better quality and accuracy in prescriptions and to include strategies that not only reduce the risk of negative outcomes, but also improve the quality of care and treatment for maintaining the health both of the mother and of the baby.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Vicente Sperb Antonello
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Review Article
Effectiveness of Insulin Analogs Compared with Human Insulins in Pregnant Women with Diabetes Mellitus: Systematic Review and Meta-analysis
- Leyna Leite Santos ,
- Jamilly Leite Santos,
- Luciano Timbó Barbosa,
- Ivan do Nascimento da Silva,
- Célio Fernando de Sousa-Rodrigues, [ ... ],
- Fabiano Timbó Barbosa
02-01-2019
Summary
Review ArticleEffectiveness of Insulin Analogs Compared with Human Insulins in Pregnant Women with Diabetes Mellitus: Systematic Review and Meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(2):104-115
02-01-2019- Leyna Leite Santos ,
- Jamilly Leite Santos,
- Luciano Timbó Barbosa,
- Ivan do Nascimento da Silva,
- Célio Fernando de Sousa-Rodrigues,
- Fabiano Timbó Barbosa
Views130See moreAbstract
Diabetes during pregnancy has been linked to unfavorable maternal-fetal outcomes. Human insulins are the first drug of choice because of the proven safety in their use. However, there are still questions about the use of insulin analogs during pregnancy. The objective of the present study was to determine the effectiveness of insulin analogs compared withhuman insulin in the treatment of pregnant women with diabetes througha systematic review withmeta-analysis. The search comprised the period since the inception of each database until July 2017, and the following databases were used:MEDLINE, CINAHL, EMBASE, ISIWeb of Science, LILACS, Scopus, SIGLE andGoogle Scholar.We have selected 29 original articles: 11 were randomized clinical trials and 18 were observational studies.We have explored data from 6,382 participants. All of the articles were classified as having an intermediate to high risk of bias. The variable that showed favorable results for the use of insulin analogs was gestational age, with a mean difference of - 0.26 (95 % confidence interval [CI]: 0.03-0.49; p = 0.02), but with significant heterogeneity (Higgins test [I2] = 38%; chi-squared test [χ2] = 16.24; degree of freedom [DF] = 10; p = 0.09). This result, in the clinical practice, does not compromise the fetal well-being, since all babies were born at term. There was publication bias in the gestational age and neonatal weight variables. To date, the evidence analyzed has a moderate-to-high risk of bias and does not allow the conclusion that insulin analogs are more effective when compared with human insulin to treat diabetic pregnant women.
Views130This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Review ArticleEffectiveness of Insulin Analogs Compared with Human Insulins in Pregnant Women with Diabetes Mellitus: Systematic Review and Meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(2):104-115
02-01-2019- Leyna Leite Santos ,
- Jamilly Leite Santos,
- Luciano Timbó Barbosa,
- Ivan do Nascimento da Silva,
- Célio Fernando de Sousa-Rodrigues,
- Fabiano Timbó Barbosa
Views130See moreAbstract
Diabetes during pregnancy has been linked to unfavorable maternal-fetal outcomes. Human insulins are the first drug of choice because of the proven safety in their use. However, there are still questions about the use of insulin analogs during pregnancy. The objective of the present study was to determine the effectiveness of insulin analogs compared withhuman insulin in the treatment of pregnant women with diabetes througha systematic review withmeta-analysis. The search comprised the period since the inception of each database until July 2017, and the following databases were used:MEDLINE, CINAHL, EMBASE, ISIWeb of Science, LILACS, Scopus, SIGLE andGoogle Scholar.We have selected 29 original articles: 11 were randomized clinical trials and 18 were observational studies.We have explored data from 6,382 participants. All of the articles were classified as having an intermediate to high risk of bias. The variable that showed favorable results for the use of insulin analogs was gestational age, with a mean difference of - 0.26 (95 % confidence interval [CI]: 0.03-0.49; p = 0.02), but with significant heterogeneity (Higgins test [I2] = 38%; chi-squared test [χ2] = 16.24; degree of freedom [DF] = 10; p = 0.09). This result, in the clinical practice, does not compromise the fetal well-being, since all babies were born at term. There was publication bias in the gestational age and neonatal weight variables. To date, the evidence analyzed has a moderate-to-high risk of bias and does not allow the conclusion that insulin analogs are more effective when compared with human insulin to treat diabetic pregnant women.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Leyna Leite Santos
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Original Article
Association between Caffeine Consumption in Pregnancy and Low Birth Weight and Preterm Birth in the birth Cohort of Ribeirão Preto
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(12):749-756
12-01-2018
Summary
Original ArticleAssociation between Caffeine Consumption in Pregnancy and Low Birth Weight and Preterm Birth in the birth Cohort of Ribeirão Preto
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(12):749-756
12-01-2018Views235See moreAbstract
Objective
To describe caffeine consumption during pregnancy and its association with low birth weight (LBW) and preterm birth in the birth cohort of Ribeirão Preto, state of São Paulo, Brazil, in 2010.
Methods
Cohort study, with descriptive and analytical approach. Data included 7,607 women and their newborns in Ribeirão Preto, state of São Paulo, Brazil. The women answered standardized questionnaires about reproductive health, prenatal care, life habits, sociodemographic conditions, and information about coffee intake. The independent variable was high caffeine consumption (≥300 mg/day) from coffee during pregnancy, and the dependent variables were LBW (birth weight < 2,500 g) and preterm birth (< 37 weeks of gestational age). Four adjusted polytomous logistic regression models, relative risk (RR) and 95% confidence interval (CI) were fitted: biological and sociodemographic conditions; obstetric history; current gestational conditions; and all variables included in the previous models.
Results
A total of 4,908 (64.5%) mothers consumed caffeine, 143 (2.9%) of whom reported high consumption. High caffeine intake was significantly associated with reduced education and with the occupation of the head of the family, nonwhite skin color, not having a partner, higher parity, previous abortion and preterm birth, urinary tract infection, threatened abortion, alcohol consumption and smoking. No association was found between high caffeine consumption and LBW or preterm birth in both
Conclusion
In this cohort, high caffeine intake was lower than in other studies and no association with LBW or preterm birth was found.
Views235This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleAssociation between Caffeine Consumption in Pregnancy and Low Birth Weight and Preterm Birth in the birth Cohort of Ribeirão Preto
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(12):749-756
12-01-2018Views235See moreAbstract
Objective
To describe caffeine consumption during pregnancy and its association with low birth weight (LBW) and preterm birth in the birth cohort of Ribeirão Preto, state of São Paulo, Brazil, in 2010.
Methods
Cohort study, with descriptive and analytical approach. Data included 7,607 women and their newborns in Ribeirão Preto, state of São Paulo, Brazil. The women answered standardized questionnaires about reproductive health, prenatal care, life habits, sociodemographic conditions, and information about coffee intake. The independent variable was high caffeine consumption (≥300 mg/day) from coffee during pregnancy, and the dependent variables were LBW (birth weight < 2,500 g) and preterm birth (< 37 weeks of gestational age). Four adjusted polytomous logistic regression models, relative risk (RR) and 95% confidence interval (CI) were fitted: biological and sociodemographic conditions; obstetric history; current gestational conditions; and all variables included in the previous models.
Results
A total of 4,908 (64.5%) mothers consumed caffeine, 143 (2.9%) of whom reported high consumption. High caffeine intake was significantly associated with reduced education and with the occupation of the head of the family, nonwhite skin color, not having a partner, higher parity, previous abortion and preterm birth, urinary tract infection, threatened abortion, alcohol consumption and smoking. No association was found between high caffeine consumption and LBW or preterm birth in both
Conclusion
In this cohort, high caffeine intake was lower than in other studies and no association with LBW or preterm birth was found.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Review Articles
Evaluation of Preeclampsia Results after Use of Metformin in Gestation: Systematic Review and Meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(11):713-721
11-01-2018
Summary
Review ArticlesEvaluation of Preeclampsia Results after Use of Metformin in Gestation: Systematic Review and Meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(11):713-721
11-01-2018Views183See moreAbstract
Objective
Does the use of metformin have an influence on the outcomes of preeclampsia (PE)?
Sources of Data
The descriptors pregnancy, metformin, treatment, and preeclampsia associated with the Boolean operators AND and OR were found in the MEDLINE, LILACS, Embase and Cochrane databases. A flowchart with exclusion criteria and inclusion strategy using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, and eligibility criteria was used. Data were extracted regarding the type of study, the applied dosage, treatment time, segment, bias risks, and the Patient, Intervention, Comparison and Outcome (PICO) strategy to identify the quality of the study.
Selection of Studies
Total number of journals in the initial search (n= 824); exclusions from repeated articles on different search engines (n= 253); exclusions after reading the titles, when the title had no correlations with the proposed theme (n= 164); exclusions due to incompatibility with the criteria established in the methodological analysis (n= 185), exclusion of articles with lower correlation with the objective of the present study (n= 187); and final bibliographic selection (n= 35).
Data Collection
At first, a systematic review of the literature was performed. Subsequently, from the main selection, randomized and non-randomized trials with metformin that presented their results in absolute and relative numbers of PE outcomes were selected. The variables were treated statistically in the meta-analysis with the Review Manager software (RevMan), version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration. Denmark in the Hovedistaden region.
Synthesis of Data
The study showed that metmorfin presented greater preventive effects for pregnancy-induced hypertension and was less effective for PE.
Conclusion
Metformin may gain place in preventive treatments for PE, once the dosages, the gestational age, and treatment time are particularly evaluated. A methodological strategy with an improved perspective of innovative and/or carefully progressive dosages during pregnancy to avoid side effects and the possibility of maternal-fetal risks is suggested.
Views183This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Review ArticlesEvaluation of Preeclampsia Results after Use of Metformin in Gestation: Systematic Review and Meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(11):713-721
11-01-2018Views183See moreAbstract
Objective
Does the use of metformin have an influence on the outcomes of preeclampsia (PE)?
Sources of Data
The descriptors pregnancy, metformin, treatment, and preeclampsia associated with the Boolean operators AND and OR were found in the MEDLINE, LILACS, Embase and Cochrane databases. A flowchart with exclusion criteria and inclusion strategy using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, and eligibility criteria was used. Data were extracted regarding the type of study, the applied dosage, treatment time, segment, bias risks, and the Patient, Intervention, Comparison and Outcome (PICO) strategy to identify the quality of the study.
Selection of Studies
Total number of journals in the initial search (n= 824); exclusions from repeated articles on different search engines (n= 253); exclusions after reading the titles, when the title had no correlations with the proposed theme (n= 164); exclusions due to incompatibility with the criteria established in the methodological analysis (n= 185), exclusion of articles with lower correlation with the objective of the present study (n= 187); and final bibliographic selection (n= 35).
Data Collection
At first, a systematic review of the literature was performed. Subsequently, from the main selection, randomized and non-randomized trials with metformin that presented their results in absolute and relative numbers of PE outcomes were selected. The variables were treated statistically in the meta-analysis with the Review Manager software (RevMan), version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration. Denmark in the Hovedistaden region.
Synthesis of Data
The study showed that metmorfin presented greater preventive effects for pregnancy-induced hypertension and was less effective for PE.
Conclusion
Metformin may gain place in preventive treatments for PE, once the dosages, the gestational age, and treatment time are particularly evaluated. A methodological strategy with an improved perspective of innovative and/or carefully progressive dosages during pregnancy to avoid side effects and the possibility of maternal-fetal risks is suggested.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 
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Original Article
Systemic Lupus Erythematosus and Pregnancy: A Single-Center Observational Study of 69 Pregnancies
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):587-592
10-01-2018
Summary
Original ArticleSystemic Lupus Erythematosus and Pregnancy: A Single-Center Observational Study of 69 Pregnancies
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):587-592
10-01-2018Views166See moreAbstract
Objective
To evaluate the effects of pregnancy in systemic lupus erythematosus (SLE) patients.
Methods
The present article is a retrospective cohort study. Datawere collected from medical records of pregnant women with SLE from January 2002 to December 2012 at Universidade Estadual de Campinas, in the city of Campinas, state of São Paulo, Brazil. Systemic lupus erythematosus and disease activity were defined according to the American College of Rheumatology and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) criteria respectively. The means, standard deviations (SDs), percentages and correlations were performed using the SAS software, version 9.4 (SAS Institute Inc., Cary, NC, US).
Results
We obtained data from 69 pregnancies in 58 women. During pregnancy, a new flare was observed in 39.2% (n = 27). The manifestations were most common in patients with prior kidney disease, and mainly occurred during the third quarter and the puerperium. Renal activity occurred in 24.6% (n = 17), and serious activity, in 16% (n = 11). Of all deliveries, 75% (n = 48) were by cesarean section. Twomaternal deaths occurred (3%). Preterm birth was themain complication in the newborns. The abortion rate was 8.7%. Severe SLEDAI during pregnancy was associated with prematurity (100%) and perinatal death (54%).
Conclusion
Thematernal-fetal outcome is worse in SLE when thewomen experience a flare during pregnancy. The best maternal-fetal outcomes occur when the disease is in remission for at least 6 months before the pregnancy.
Views166This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleSystemic Lupus Erythematosus and Pregnancy: A Single-Center Observational Study of 69 Pregnancies
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(10):587-592
10-01-2018Views166See moreAbstract
Objective
To evaluate the effects of pregnancy in systemic lupus erythematosus (SLE) patients.
Methods
The present article is a retrospective cohort study. Datawere collected from medical records of pregnant women with SLE from January 2002 to December 2012 at Universidade Estadual de Campinas, in the city of Campinas, state of São Paulo, Brazil. Systemic lupus erythematosus and disease activity were defined according to the American College of Rheumatology and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) criteria respectively. The means, standard deviations (SDs), percentages and correlations were performed using the SAS software, version 9.4 (SAS Institute Inc., Cary, NC, US).
Results
We obtained data from 69 pregnancies in 58 women. During pregnancy, a new flare was observed in 39.2% (n = 27). The manifestations were most common in patients with prior kidney disease, and mainly occurred during the third quarter and the puerperium. Renal activity occurred in 24.6% (n = 17), and serious activity, in 16% (n = 11). Of all deliveries, 75% (n = 48) were by cesarean section. Twomaternal deaths occurred (3%). Preterm birth was themain complication in the newborns. The abortion rate was 8.7%. Severe SLEDAI during pregnancy was associated with prematurity (100%) and perinatal death (54%).
Conclusion
Thematernal-fetal outcome is worse in SLE when thewomen experience a flare during pregnancy. The best maternal-fetal outcomes occur when the disease is in remission for at least 6 months before the pregnancy.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Articles
Risk Assessment for Preterm Delivery using the Fetal Fibronectin Test Associated with the Measurement of Uterine Cervix Length in Symptomatic Pregnant Women
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(9):507-512
09-01-2018
Summary
Original ArticlesRisk Assessment for Preterm Delivery using the Fetal Fibronectin Test Associated with the Measurement of Uterine Cervix Length in Symptomatic Pregnant Women
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(9):507-512
09-01-2018Views108See moreAbstract
Objective
To analyze the use of the measurement of uterine cervix length (MUCL) and the fetal fibronectin (fFN) rapid test as predictors of preterm delivery (PTD) in symptomatic pregnant women assisted at the Santa Casa de Misericórdia de Sobral Maternity Hospital.
Methods
This was a prospective and analytic study involving 53 parturients assisted between September of 2015 and July of 2016; the participants were between 24 and 34 weeks of gestational age (GA) and presented complaints related to preterm labor (PTL) prodromes. Vaginal secretion was collected for fFN testing, and the MUCL was obtained via transvaginal ultrasonography.
Results
A total of 58.49% of the subjects showed MUCL < 25 mm, and 41.51% were positive in the fFNrapid test.Atotal of 48 patients were followed-up until their delivery date, and 54.17% resulted in PTL. The relative risk (RR) for PTD in patients with MUCL < 25 mm was 1.83 (p = 0.09, 0.99-3.36, 95% confidence interval [CI]), with a mean time before delivery of 2.98 weeks. Based on fFN positive results, the RR was 3.50 (p = 0.002, 1.39- 8.79, 95%CI) and themean time until delivery was 1.94weeks. The RRwas 2.70 (p = 0.002, 1.08-6.72, 95%CI) when both tests were used. The RR of PTD within 48 hours, and 7 and 14 days were, respectively, 1.30 (p = 0.11, 95% CI 1.02-1.67), 1.43 (p = 0.12, 95% CI % 0.99-2.06), and 2.03 (p = 0.008, 95% CI 1.26-3.27), when based on the MUCL, and 1.75 (p = 0.0006, 95% CI 1.20-2.53), 2.88 (p = 0.0001, 95% CI, 1.57-5.31), and 3.57 (p = 0.0002, 95% CI 1.63-7.81) when based on positive fFN results. The RR at 48 hours and 7 and 14 days considering both tests was 1.74 (p = 0.0001, 95% CI 1.14-2.64), 2.22 (p = 0.0001, 95% CI 1.22-4.04), and 2.76 (p = 0.0002, 95% CI 1.27-5.96), respectively.
Conclusion
In symptomatic pregnant women, we concluded that the MUCL < 25 mm associated with positive fFN rapid test indicate increased the risk for PTD. Further studies with larger sample sizes could contribute in supporting the results presented in the current study.
Views108This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticlesRisk Assessment for Preterm Delivery using the Fetal Fibronectin Test Associated with the Measurement of Uterine Cervix Length in Symptomatic Pregnant Women
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(9):507-512
09-01-2018Views108See moreAbstract
Objective
To analyze the use of the measurement of uterine cervix length (MUCL) and the fetal fibronectin (fFN) rapid test as predictors of preterm delivery (PTD) in symptomatic pregnant women assisted at the Santa Casa de Misericórdia de Sobral Maternity Hospital.
Methods
This was a prospective and analytic study involving 53 parturients assisted between September of 2015 and July of 2016; the participants were between 24 and 34 weeks of gestational age (GA) and presented complaints related to preterm labor (PTL) prodromes. Vaginal secretion was collected for fFN testing, and the MUCL was obtained via transvaginal ultrasonography.
Results
A total of 58.49% of the subjects showed MUCL < 25 mm, and 41.51% were positive in the fFNrapid test.Atotal of 48 patients were followed-up until their delivery date, and 54.17% resulted in PTL. The relative risk (RR) for PTD in patients with MUCL < 25 mm was 1.83 (p = 0.09, 0.99-3.36, 95% confidence interval [CI]), with a mean time before delivery of 2.98 weeks. Based on fFN positive results, the RR was 3.50 (p = 0.002, 1.39- 8.79, 95%CI) and themean time until delivery was 1.94weeks. The RRwas 2.70 (p = 0.002, 1.08-6.72, 95%CI) when both tests were used. The RR of PTD within 48 hours, and 7 and 14 days were, respectively, 1.30 (p = 0.11, 95% CI 1.02-1.67), 1.43 (p = 0.12, 95% CI % 0.99-2.06), and 2.03 (p = 0.008, 95% CI 1.26-3.27), when based on the MUCL, and 1.75 (p = 0.0006, 95% CI 1.20-2.53), 2.88 (p = 0.0001, 95% CI, 1.57-5.31), and 3.57 (p = 0.0002, 95% CI 1.63-7.81) when based on positive fFN results. The RR at 48 hours and 7 and 14 days considering both tests was 1.74 (p = 0.0001, 95% CI 1.14-2.64), 2.22 (p = 0.0001, 95% CI 1.22-4.04), and 2.76 (p = 0.0002, 95% CI 1.27-5.96), respectively.
Conclusion
In symptomatic pregnant women, we concluded that the MUCL < 25 mm associated with positive fFN rapid test indicate increased the risk for PTD. Further studies with larger sample sizes could contribute in supporting the results presented in the current study.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Articles
Drug Use during Pregnancy and its Consequences: A Nested Case Control Study on Severe Maternal Morbidity
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(9):518-526
09-01-2018
Summary
Original ArticlesDrug Use during Pregnancy and its Consequences: A Nested Case Control Study on Severe Maternal Morbidity
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(9):518-526
09-01-2018Views231See moreAbstract
Objective
To assess the relationship between the use of psychoactive substances during pregnancy and the occurrence of severe maternal morbidity (SMM), perinatal outcomes and repercussions on the neuropsychomotor development of exposed children.
Methods
A case-control study nested within a cohort of severe maternal morbidity (COMMAG) was performed. Women with SMM were considered cases. Controls were thosewith low-risk pregnancy,without SMMand admitted during the same time period as the cases. Cohort data were collected retrospectively in hospital records for childbirth. A face-to-face interview was also performed with 638 women (323 without SMM and 315 with SMM) and their children of the index pregnancy between 6 months and 5 years after childbirth. During the interview, substance abuse during pregnancy was assessed by a modified question from the Alcohol, Smoking and Substance Involvement Screening Test 2.0 (ASSIST) and the neuropsychomotor development in the children was assessed by the Denver Developmental Screening Test, 2nd edition.
Results
The prevalence of licit or illicit drug use during pregnancy was ~ 17%. Among drug users, 63.9% used alcohol, 58.3% used tobacco, 9.2% used cocaine/crack and 4.6% used marijuana. There was no association between drug use during pregnancy and SMM, although tobacco use during pregnancy was associated with bleeding, presence of near-miss clinical criteria (NMCC) and alteration in infant development; alcohol use was associated with neonatal asphyxia; and cocaine/crack use was associated with the occurrence of some clinical complications during pregnancy.
Conclusion
The use of psychoactive substances during pregnancy is frequent and associated with worse maternal, perinatal and child development outcomes.
Views231This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticlesDrug Use during Pregnancy and its Consequences: A Nested Case Control Study on Severe Maternal Morbidity
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(9):518-526
09-01-2018Views231See moreAbstract
Objective
To assess the relationship between the use of psychoactive substances during pregnancy and the occurrence of severe maternal morbidity (SMM), perinatal outcomes and repercussions on the neuropsychomotor development of exposed children.
Methods
A case-control study nested within a cohort of severe maternal morbidity (COMMAG) was performed. Women with SMM were considered cases. Controls were thosewith low-risk pregnancy,without SMMand admitted during the same time period as the cases. Cohort data were collected retrospectively in hospital records for childbirth. A face-to-face interview was also performed with 638 women (323 without SMM and 315 with SMM) and their children of the index pregnancy between 6 months and 5 years after childbirth. During the interview, substance abuse during pregnancy was assessed by a modified question from the Alcohol, Smoking and Substance Involvement Screening Test 2.0 (ASSIST) and the neuropsychomotor development in the children was assessed by the Denver Developmental Screening Test, 2nd edition.
Results
The prevalence of licit or illicit drug use during pregnancy was ~ 17%. Among drug users, 63.9% used alcohol, 58.3% used tobacco, 9.2% used cocaine/crack and 4.6% used marijuana. There was no association between drug use during pregnancy and SMM, although tobacco use during pregnancy was associated with bleeding, presence of near-miss clinical criteria (NMCC) and alteration in infant development; alcohol use was associated with neonatal asphyxia; and cocaine/crack use was associated with the occurrence of some clinical complications during pregnancy.
Conclusion
The use of psychoactive substances during pregnancy is frequent and associated with worse maternal, perinatal and child development outcomes.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 
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Original Article
Hazards of Repeat Pregnancy during Adolescence: A Case-control Study
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(8):437-443
08-01-2018
Summary
Original ArticleHazards of Repeat Pregnancy during Adolescence: A Case-control Study
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(8):437-443
08-01-2018Views150See moreAbstract
Objective
To evaluate the social, obstetric and psychological risk factors related to repeat pregnancy in teenagers.
Methods
A case control study conducted at Centro de Atenção à Saúde Integral da Mulher (Caism, in the Portuguese acronym), in Campinas, Brazil, from 2015 to 2017. Three groups were selected: a case-group of adolescents who had repeat pregnancy and two control-groups, one consisting of adolescents who had delivered at first time and another one of adult women with more than one deliveries. Participants were asked about habits, socio-demographics characteristics, reproductive and obstetric history and assessed psychological issues.
Results
Ninety women were enrolled, 30 in each study group. Adolescents with repeat pregnancy have lower self-esteem scores and more ineffective contraceptive use. When compared with teens at first delivery, they had less schooling level (odds ratio [OR] 4.03 [1.37-11.8]), more school abandon (OR 8.16 [2.36-28.2]) and drugs use (OR 4.97[1.39-17.8]). Non-white skin color (OR 6.2 [1.15-41.0]), drugs use (OR 17.5 [2.62-116.6]) and first sexual intercourse under 15y (OR 18.0[2.82-115.0]) were found as higher risk factors for repeat pregnancy when comparing adolescents and adults.Moreover, adolescents withmore than one gestation had lower self-esteem and greater susceptibility to unplanned pregnancy.
Conclusion
There was an association between repeat pregnancy among adolescents and lower education, early onset of sexual activity, non-white skin color, low use of contraception and increased use of drugs.
Views150This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleHazards of Repeat Pregnancy during Adolescence: A Case-control Study
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(8):437-443
08-01-2018Views150See moreAbstract
Objective
To evaluate the social, obstetric and psychological risk factors related to repeat pregnancy in teenagers.
Methods
A case control study conducted at Centro de Atenção à Saúde Integral da Mulher (Caism, in the Portuguese acronym), in Campinas, Brazil, from 2015 to 2017. Three groups were selected: a case-group of adolescents who had repeat pregnancy and two control-groups, one consisting of adolescents who had delivered at first time and another one of adult women with more than one deliveries. Participants were asked about habits, socio-demographics characteristics, reproductive and obstetric history and assessed psychological issues.
Results
Ninety women were enrolled, 30 in each study group. Adolescents with repeat pregnancy have lower self-esteem scores and more ineffective contraceptive use. When compared with teens at first delivery, they had less schooling level (odds ratio [OR] 4.03 [1.37-11.8]), more school abandon (OR 8.16 [2.36-28.2]) and drugs use (OR 4.97[1.39-17.8]). Non-white skin color (OR 6.2 [1.15-41.0]), drugs use (OR 17.5 [2.62-116.6]) and first sexual intercourse under 15y (OR 18.0[2.82-115.0]) were found as higher risk factors for repeat pregnancy when comparing adolescents and adults.Moreover, adolescents withmore than one gestation had lower self-esteem and greater susceptibility to unplanned pregnancy.
Conclusion
There was an association between repeat pregnancy among adolescents and lower education, early onset of sexual activity, non-white skin color, low use of contraception and increased use of drugs.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Pregnancy Archives - Page 5 of 26 - Revista Brasileira de Ginecologia e Obstetrícia
