pregnancy outcome Archives - Page 3 of 3 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(1):34-39
DOI 10.1590/S0100-72032012000100007
PURPOSE: To compare the maternal and perinatal outcomes of patients with placenta previa, after the adoption of a prolonged maternal hospital stay, to those of a 1991 series. METHODS: We performed a retrospective study comparing 108 cases of placenta previa hospitalized in the Maternity School Assis Chateaubriand, Universidade Federal do Ceará, during the period from 01/01/2006 to 12/31/2010, with those obtained in 1991, when 101 cases of the pathology were observed at our institution. The following maternal and perinatal data were collected: maternal age, parity, gestational age at delivery, mode of delivery, maternal stay length, Apgar scores at the 1st and 5th minutes, birth weight, adequacy of birth weight, neonatal length stay, maternal and neonatal morbidity and mortality rates (maternal, fetal, neonatal and perinatal). Statistical analysis was performed using the χ² and Fisher's exact tests. The results were considered significant when p<0.05. RESULTS: In 1991, placenta previa was found in 1.13% of cases (101/8900). In the present study, the prevalence was 0.43% (108/24726). No maternal death was observed in either series. Regarding the study of 1991, the current patients were significantly younger, with lower parity, were hospitalized longer, had better Apgar scores at 1st and 5th minutes, and had longer neonatal hospitalization. Also, we identified reduction of fetal, neonatal and perinatal mortality. CONCLUSIONS: Perinatal outcomes in patients with placenta previa were significantly improved between 1991 and the years 2006 and 2010. However, we can not say whether this improvement was due to the prolonged maternal hospital stay.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(1):34-39
DOI 10.1590/S0100-72032012000100007
PURPOSE: To compare the maternal and perinatal outcomes of patients with placenta previa, after the adoption of a prolonged maternal hospital stay, to those of a 1991 series. METHODS: We performed a retrospective study comparing 108 cases of placenta previa hospitalized in the Maternity School Assis Chateaubriand, Universidade Federal do Ceará, during the period from 01/01/2006 to 12/31/2010, with those obtained in 1991, when 101 cases of the pathology were observed at our institution. The following maternal and perinatal data were collected: maternal age, parity, gestational age at delivery, mode of delivery, maternal stay length, Apgar scores at the 1st and 5th minutes, birth weight, adequacy of birth weight, neonatal length stay, maternal and neonatal morbidity and mortality rates (maternal, fetal, neonatal and perinatal). Statistical analysis was performed using the χ² and Fisher's exact tests. The results were considered significant when p<0.05. RESULTS: In 1991, placenta previa was found in 1.13% of cases (101/8900). In the present study, the prevalence was 0.43% (108/24726). No maternal death was observed in either series. Regarding the study of 1991, the current patients were significantly younger, with lower parity, were hospitalized longer, had better Apgar scores at 1st and 5th minutes, and had longer neonatal hospitalization. Also, we identified reduction of fetal, neonatal and perinatal mortality. CONCLUSIONS: Perinatal outcomes in patients with placenta previa were significantly improved between 1991 and the years 2006 and 2010. However, we can not say whether this improvement was due to the prolonged maternal hospital stay.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(11):348-353
DOI 10.1590/S0100-72032011001100005
PURPOSE: To describe the obstetric outcome of women with overweight/obesity treated at the prenatal care clinic of a public maternity hospital in Rio de Janeiro. METHODS: A descriptive cross-sectional study which investigated 433 women (³20 years-old, without any chronic diseases) and their newborns treated at public hospitals in Rio de Janeiro. Information was collected from medical records and through interviews. The characteristics of mothers and newborns evaluated were divided into maternal (social habits, anthropometric measurements and clinical, obstetric, and prenatal care) and newborn groups (birth conditions). Data regarding the categories of nutritional status were analyzed using the odds ratio (OR) and 95% confidence interval (CI). RESULTS: The prevalence of overweight/obesity in this sample was 24.5% (n=106). There was an association between inadequate weight gain and the prevalence of overweight/obesity (OR 2.7, 95%CI 1.5-4.9, p<0.05). Overweight/obese women had an increased risk for preeclampsia (OR 3.3, 95%CI 1.1--9.9, p=0.03). Regarding birth conditions, mean birth weight was 3291.3 g (±455.2), with rates of low birth weight of 4.7% (n=5) and rates of macrosomia of 2.8% (n=3). CONCLUSIONS: There was an alarming prevalence of inadequate nutritional status before and during pregnancy, which may be associated with increased risk of perinatal morbidity and mortality. This suggests the need for nutritional monitoring of these pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(11):348-353
DOI 10.1590/S0100-72032011001100005
PURPOSE: To describe the obstetric outcome of women with overweight/obesity treated at the prenatal care clinic of a public maternity hospital in Rio de Janeiro. METHODS: A descriptive cross-sectional study which investigated 433 women (³20 years-old, without any chronic diseases) and their newborns treated at public hospitals in Rio de Janeiro. Information was collected from medical records and through interviews. The characteristics of mothers and newborns evaluated were divided into maternal (social habits, anthropometric measurements and clinical, obstetric, and prenatal care) and newborn groups (birth conditions). Data regarding the categories of nutritional status were analyzed using the odds ratio (OR) and 95% confidence interval (CI). RESULTS: The prevalence of overweight/obesity in this sample was 24.5% (n=106). There was an association between inadequate weight gain and the prevalence of overweight/obesity (OR 2.7, 95%CI 1.5-4.9, p<0.05). Overweight/obese women had an increased risk for preeclampsia (OR 3.3, 95%CI 1.1--9.9, p=0.03). Regarding birth conditions, mean birth weight was 3291.3 g (±455.2), with rates of low birth weight of 4.7% (n=5) and rates of macrosomia of 2.8% (n=3). CONCLUSIONS: There was an alarming prevalence of inadequate nutritional status before and during pregnancy, which may be associated with increased risk of perinatal morbidity and mortality. This suggests the need for nutritional monitoring of these pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(8):174-181
DOI 10.1590/S0100-72032011000800002
PURPOSE: To describe the maternal and perinatal outcomes of pregnant women diagnosed with leukemia who were followed up for prenatal care and delivery at a university hospital. METHODS: A retrospective study of the period from 2001 to 2011, which included 16 pregnant women with a diagnosis of leukemia followed by antenatal care specialists in hematological diseases and pregnancy. For acute leukemia diagnosed after the first trimester, the recommendation was to perform chemotherapy despite the current pregnancy. For chronic leukemia, patients who were controlled in hematological terms were maintained without medication during pregnancy, or chemotherapy was introduced after the first trimester. We analyzed the maternal and perinatal outcome. RESULTS: Acute lymphoblastic leukemia (ALL) was diagnosed in five cases (31.3%), acute myeloid leukemia (AML) in two cases (12.5%) and chronic myeloid leukemia (CML) in nine cases (56.3%). Of the cases of acute leukemia, two (28.6%) were diagnosed in the first trimester, two (28.6%) in the second and three (42.9%) in the third. Two patients with ALL diagnosed in the first trimester opted for therapeutic abortion. Four patients with acute leukemia received chemotherapy during pregnancy, with a diagnosis established after the 20th week. In one case of ALL with a late diagnosis (30 weeks), chemotherapy was started after delivery. All pregnant women with acute leukemia developed anemia and thrombocytopenia, and four (57.1%) developed febrile neutropenia. Of nine pregnant women with CML, four were treated with imatinib mesylate when they became pregnant, with treatment being interrupted in the first trimester in three of them and in the second trimester in one. During pregnancy, three patients (33.3%) required no chemotherapy after discontinuation of imatinib, and six (66.7%) were treated with the following drugs: interferon (n=5) and/or hydroxyurea (n=3 ). In the group of pregnant women with CML, anemia occurred in four (44.4%) cases and thrombocytopenia in one (11.1%). The perinatal outcomes of pregnancies complicated by acute leukemia were as follows: mean gestational age at delivery was 32 weeks (standard deviation - SD=4.4) and the mean birth weight was 1476 g (SD=657 g), there were 2 (40.0%) perinatal deaths (a fetal one and a neonatal one). In pregnancies complicated by CML, the mean gestational age at delivery was 37.6 weeks (SD=1.1) and the mean birth weight was 2870 g (SD=516 g). There was no perinatal death and no fetal abnormality was detected. CONCLUSIONS: Maternal and fetal morbidity is high in pregnancies complicated by acute leukemia. Whereas, in pregnancies complicated by CML, the maternal and fetal prognosis appears to be more favorable, with greater ease in management of complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(8):174-181
DOI 10.1590/S0100-72032011000800002
PURPOSE: To describe the maternal and perinatal outcomes of pregnant women diagnosed with leukemia who were followed up for prenatal care and delivery at a university hospital. METHODS: A retrospective study of the period from 2001 to 2011, which included 16 pregnant women with a diagnosis of leukemia followed by antenatal care specialists in hematological diseases and pregnancy. For acute leukemia diagnosed after the first trimester, the recommendation was to perform chemotherapy despite the current pregnancy. For chronic leukemia, patients who were controlled in hematological terms were maintained without medication during pregnancy, or chemotherapy was introduced after the first trimester. We analyzed the maternal and perinatal outcome. RESULTS: Acute lymphoblastic leukemia (ALL) was diagnosed in five cases (31.3%), acute myeloid leukemia (AML) in two cases (12.5%) and chronic myeloid leukemia (CML) in nine cases (56.3%). Of the cases of acute leukemia, two (28.6%) were diagnosed in the first trimester, two (28.6%) in the second and three (42.9%) in the third. Two patients with ALL diagnosed in the first trimester opted for therapeutic abortion. Four patients with acute leukemia received chemotherapy during pregnancy, with a diagnosis established after the 20th week. In one case of ALL with a late diagnosis (30 weeks), chemotherapy was started after delivery. All pregnant women with acute leukemia developed anemia and thrombocytopenia, and four (57.1%) developed febrile neutropenia. Of nine pregnant women with CML, four were treated with imatinib mesylate when they became pregnant, with treatment being interrupted in the first trimester in three of them and in the second trimester in one. During pregnancy, three patients (33.3%) required no chemotherapy after discontinuation of imatinib, and six (66.7%) were treated with the following drugs: interferon (n=5) and/or hydroxyurea (n=3 ). In the group of pregnant women with CML, anemia occurred in four (44.4%) cases and thrombocytopenia in one (11.1%). The perinatal outcomes of pregnancies complicated by acute leukemia were as follows: mean gestational age at delivery was 32 weeks (standard deviation - SD=4.4) and the mean birth weight was 1476 g (SD=657 g), there were 2 (40.0%) perinatal deaths (a fetal one and a neonatal one). In pregnancies complicated by CML, the mean gestational age at delivery was 37.6 weeks (SD=1.1) and the mean birth weight was 2870 g (SD=516 g). There was no perinatal death and no fetal abnormality was detected. CONCLUSIONS: Maternal and fetal morbidity is high in pregnancies complicated by acute leukemia. Whereas, in pregnancies complicated by CML, the maternal and fetal prognosis appears to be more favorable, with greater ease in management of complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(5):222-228
DOI 10.1590/S0100-72032010000500004
PURPOSE: to compare two screening tests for diabetes and their results to pregnancy outcomes. METHODS: in total, 279 pregnant women were submitted to two screening tests for gestational diabetes - fasting glycemia plus risk factors (FG + RF) and to the simplified glucose tolerance test (GTT50g). Screening by FG + RF consisted of the determination of fasting glycemia and anamnesis for the identification of risk factors on the occasion of the first prenatal visit. The GTT50g was performed between the 24th and the 28th week of pregnancy and consisted of the determination of plasma glycemia under fasting conditions and one hour after an oral overload with 50 g glucose. Positive and negative results were compared to pregnancy outcome. The dependent variables were: type of delivery, gestational age, weight and ponderal index at birth, Apgar indexes <7 in the 1st and 5th minutes, need for admission to the Intensive Care Unit (ICU), duration of hospitalization, and neonatal death. Data were analyzed statistically through the Students t-test, and the level of significance was set at 5%. RESULTS: only two of the perinatal variables studied were distinguished by the tests. An abnormal GTT50g was associated with a greater proportion of cesarean deliveries (58.7 versus 34.3%) and a positive FG + RF association was related to a higher rate of premature births (15.4 versus 5.4%). The other dependent variables did not differ among patients with positive and negative results of the two screening tests. CONCLUSIONS: despite the relation between prematurity and a positive FG + RF association, the increase of caesarean sections and the abnormal GTT50g, it would be a critical failure to accept these associations as definitive. Among others explanations, multiple intercurrent factors and the characteristics of the screening tests themselves should be considered.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(5):222-228
DOI 10.1590/S0100-72032010000500004
PURPOSE: to compare two screening tests for diabetes and their results to pregnancy outcomes. METHODS: in total, 279 pregnant women were submitted to two screening tests for gestational diabetes - fasting glycemia plus risk factors (FG + RF) and to the simplified glucose tolerance test (GTT50g). Screening by FG + RF consisted of the determination of fasting glycemia and anamnesis for the identification of risk factors on the occasion of the first prenatal visit. The GTT50g was performed between the 24th and the 28th week of pregnancy and consisted of the determination of plasma glycemia under fasting conditions and one hour after an oral overload with 50 g glucose. Positive and negative results were compared to pregnancy outcome. The dependent variables were: type of delivery, gestational age, weight and ponderal index at birth, Apgar indexes <7 in the 1st and 5th minutes, need for admission to the Intensive Care Unit (ICU), duration of hospitalization, and neonatal death. Data were analyzed statistically through the Students t-test, and the level of significance was set at 5%. RESULTS: only two of the perinatal variables studied were distinguished by the tests. An abnormal GTT50g was associated with a greater proportion of cesarean deliveries (58.7 versus 34.3%) and a positive FG + RF association was related to a higher rate of premature births (15.4 versus 5.4%). The other dependent variables did not differ among patients with positive and negative results of the two screening tests. CONCLUSIONS: despite the relation between prematurity and a positive FG + RF association, the increase of caesarean sections and the abnormal GTT50g, it would be a critical failure to accept these associations as definitive. Among others explanations, multiple intercurrent factors and the characteristics of the screening tests themselves should be considered.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(1):11-18
DOI 10.1590/S0100-72032010000100003
PURPOSE: to describe adverse perinatal outcomes in patients with fetal blood flow centralization, using the relationship between the pulsatility indexes of the middle cerebral and umbilical arteries (MCAPI/UAPI), and between the resistance indexes of the middle cerebral and umbilical arteries (MCARI/UARI), as well as to compare both diagnostic indexes. METHODS: 151 pregnant women with diagnosis of blood flow centralization, attended to at the maternity hospital of Universidade Estadual de Campinas, whose delivery occurred up to 15 days after the ultrasonographic diagnosis, were included. It was considered as adverse perinatal outcomes: Apgar index lower than 7 at the fifth minute, permanence in neonatal ICU, small fetus for the gestational age, severe fetal suffering, perinatal death, hypoglycemia, polycythemia, necrotizing enterocolitis, brain hemorrhage, lung hemorrhage, anemia, septicemia, hyaline membrane disease, convulsive syndromes, hyperreflexia syndrome and kidney insufficiency. Rates of the perinatal adverse outcomes (PAO) for the brain-placentary ratios have been compared, using Fisher's exact or Pearson's χ2 tests, at 5% significance level. Adverse perinatal outcomes according to the gestational age have been evaluated using the Cochrane-Armitage test for trend. RESULTS: the adverse perinatal outcomes for the group with the two indexes altered were: 62.5% of the newborns needed to be placed in an ICU, 75.2% were small for the gestational age (SGA), 35.3% were under severe fetal suffering, 84.4% had hypoglycemia, 8.3% polycythemia, 4.2% necrotizing enterocolitis, and 2.1% brain hemorrhage. There has been significant association between the MCAPI/UAPI and MCARI/UARI ratios along the gestational age, and the need for neonatal intensive care, small fetuses for the gestational age, septicemia, necrotizing enterocolitis, kidney insufficiency, hyaline membrane disease, and anemia. There has been no significant difference between the two indexes of adverse perinatal outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(1):11-18
DOI 10.1590/S0100-72032010000100003
PURPOSE: to describe adverse perinatal outcomes in patients with fetal blood flow centralization, using the relationship between the pulsatility indexes of the middle cerebral and umbilical arteries (MCAPI/UAPI), and between the resistance indexes of the middle cerebral and umbilical arteries (MCARI/UARI), as well as to compare both diagnostic indexes. METHODS: 151 pregnant women with diagnosis of blood flow centralization, attended to at the maternity hospital of Universidade Estadual de Campinas, whose delivery occurred up to 15 days after the ultrasonographic diagnosis, were included. It was considered as adverse perinatal outcomes: Apgar index lower than 7 at the fifth minute, permanence in neonatal ICU, small fetus for the gestational age, severe fetal suffering, perinatal death, hypoglycemia, polycythemia, necrotizing enterocolitis, brain hemorrhage, lung hemorrhage, anemia, septicemia, hyaline membrane disease, convulsive syndromes, hyperreflexia syndrome and kidney insufficiency. Rates of the perinatal adverse outcomes (PAO) for the brain-placentary ratios have been compared, using Fisher's exact or Pearson's χ2 tests, at 5% significance level. Adverse perinatal outcomes according to the gestational age have been evaluated using the Cochrane-Armitage test for trend. RESULTS: the adverse perinatal outcomes for the group with the two indexes altered were: 62.5% of the newborns needed to be placed in an ICU, 75.2% were small for the gestational age (SGA), 35.3% were under severe fetal suffering, 84.4% had hypoglycemia, 8.3% polycythemia, 4.2% necrotizing enterocolitis, and 2.1% brain hemorrhage. There has been significant association between the MCAPI/UAPI and MCARI/UARI ratios along the gestational age, and the need for neonatal intensive care, small fetuses for the gestational age, septicemia, necrotizing enterocolitis, kidney insufficiency, hyaline membrane disease, and anemia. There has been no significant difference between the two indexes of adverse perinatal outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(7):326-334
DOI 10.1590/S0100-72032009000700002
PURPOSE: to analyze the association of the mother's age, the perinatal outcome and the delivery route. METHODS: information about all the patients attended at the Service of Obstetrics and Gynecology of a tertiary university hospital in Maranhão, from July to December 2006, was analyzed. Patients have been allocated in three groups: adolescents (10 to 19 years old), adults (20 to 34 years old), and aged women (>35 years old). Variables studied were: skin color, schooling, marital status, family income, parity, number of appointments during pre-natal care, gestational age at the onset of pre-natal care, delivery route, Apgar index at the fifth minute and birth weight. Data were processed by the Epi-info program, version 3.4.1, and the association among the variables was analyzed by the Odds Ratio (OR) or the cross product ratio, with confidence intervals (CI) of 95%. The significance level was 0.05. RESULTS: among 2,196 patients, 25% of deliveries occurred in adolescents, 69% in adults and 6% in aged women. Among the adolescents, there was higher risk of prematurity (OR=1.46; CI95%=1.14-1.88), and low birth weight (OR=1.47; CI95%=1.13- 1.90), higher incidence of normal delivery as compared to the other groups (65.2%), besides the association with late onset of pre-natal care (OR=1.86; CI95%=1.43-2.43), lower number of appointments (OR=2.03; CI95%=1.57-2.63), and use of abortive procedures at the onset of gestation (OR=2.34; CI95%=1.38-3.98). Among aged women, there was strong association with diabetes mellitus (OR=9.00; CI95%=3.18-25.19), pre-eclampsia (OR=4.38; CI95%=3.02-6.34), premature membrane rupture (OR=5.81; CI95%=3.08-10.89), besides a higher chance of presenting Apgar index lower than seven at the fifth minute (OR=2.90; CI95%=1.37-6.01), and higher ratio of cesarean section (60.3%). CONCLUSIONS: pregnancy in adolescence is associated to late onset of pre-natal care and few appointments along it, use of abortive procedures at the onset of gestation, low schooling, no mates, low birth weight, prematurity, and lower incidence of cephalo pelvic disproportion and pre-eclampsia. Among aged pregnant women, there was association with diabetes, pre-eclampsia, premature membrane rupture, Apgar index lower than seven at the fifth minute and higher ratio of cesarean section.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(7):326-334
DOI 10.1590/S0100-72032009000700002
PURPOSE: to analyze the association of the mother's age, the perinatal outcome and the delivery route. METHODS: information about all the patients attended at the Service of Obstetrics and Gynecology of a tertiary university hospital in Maranhão, from July to December 2006, was analyzed. Patients have been allocated in three groups: adolescents (10 to 19 years old), adults (20 to 34 years old), and aged women (>35 years old). Variables studied were: skin color, schooling, marital status, family income, parity, number of appointments during pre-natal care, gestational age at the onset of pre-natal care, delivery route, Apgar index at the fifth minute and birth weight. Data were processed by the Epi-info program, version 3.4.1, and the association among the variables was analyzed by the Odds Ratio (OR) or the cross product ratio, with confidence intervals (CI) of 95%. The significance level was 0.05. RESULTS: among 2,196 patients, 25% of deliveries occurred in adolescents, 69% in adults and 6% in aged women. Among the adolescents, there was higher risk of prematurity (OR=1.46; CI95%=1.14-1.88), and low birth weight (OR=1.47; CI95%=1.13- 1.90), higher incidence of normal delivery as compared to the other groups (65.2%), besides the association with late onset of pre-natal care (OR=1.86; CI95%=1.43-2.43), lower number of appointments (OR=2.03; CI95%=1.57-2.63), and use of abortive procedures at the onset of gestation (OR=2.34; CI95%=1.38-3.98). Among aged women, there was strong association with diabetes mellitus (OR=9.00; CI95%=3.18-25.19), pre-eclampsia (OR=4.38; CI95%=3.02-6.34), premature membrane rupture (OR=5.81; CI95%=3.08-10.89), besides a higher chance of presenting Apgar index lower than seven at the fifth minute (OR=2.90; CI95%=1.37-6.01), and higher ratio of cesarean section (60.3%). CONCLUSIONS: pregnancy in adolescence is associated to late onset of pre-natal care and few appointments along it, use of abortive procedures at the onset of gestation, low schooling, no mates, low birth weight, prematurity, and lower incidence of cephalo pelvic disproportion and pre-eclampsia. Among aged pregnant women, there was association with diabetes, pre-eclampsia, premature membrane rupture, Apgar index lower than seven at the fifth minute and higher ratio of cesarean section.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(11):555-560
DOI 10.1590/S0100-72032007001100002
PURPOSE: to identify the factors related to successful gestational diabetes mellitus (GDM) management with glyburide and to evaluate perinatal outcomes. METHODS: prospective longitudinal study including 50 pregnant women with GDM who required complementary treatment to diet and physical activity, whose fetus presented normal abdominal circumference (AC) to ultrasound (pct<75). Study period was August 2005 to July 2006. Ultrasonography was carried out monthly. Glyburide was used until delivery, as long as glucose control was obtained and fetal AC was normal, being thus considered therapeutically successful. In case there was no glucose control or alteration in AC, management was switched to insulin therapy, being thus considered therapeutically unsuccessful. Pregnant women were divided into two groups: one therapeutically successful (n=29) and another therapeutically unsuccessful (n=21). The results evaluated were: therapeutic success, maternal characteristics and perinatal outcome. RESULTS: fifty-eight percent of the cases were successfully managed with glyburide. No difference was found (p>0.05) in either group, with regards to maternal age, glucose values at OGTT75g, maternal body mass index (BMI), number of pre-natal consultations, number of previous pregnancies. According to the logistic model of regression used, therapeutically successful pregnant patients had had a later diagnosis (p=0.02) and lower weight gain during gestation (p<0.01). Perinatal outcome did not differ in either group. CONCLUSIONS: patients with later diagnosis and lower weight gain are more likely to have successful GDM management with glyburide. Unsuccessful management with glyburide did not alter the perinatal outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(11):555-560
DOI 10.1590/S0100-72032007001100002
PURPOSE: to identify the factors related to successful gestational diabetes mellitus (GDM) management with glyburide and to evaluate perinatal outcomes. METHODS: prospective longitudinal study including 50 pregnant women with GDM who required complementary treatment to diet and physical activity, whose fetus presented normal abdominal circumference (AC) to ultrasound (pct<75). Study period was August 2005 to July 2006. Ultrasonography was carried out monthly. Glyburide was used until delivery, as long as glucose control was obtained and fetal AC was normal, being thus considered therapeutically successful. In case there was no glucose control or alteration in AC, management was switched to insulin therapy, being thus considered therapeutically unsuccessful. Pregnant women were divided into two groups: one therapeutically successful (n=29) and another therapeutically unsuccessful (n=21). The results evaluated were: therapeutic success, maternal characteristics and perinatal outcome. RESULTS: fifty-eight percent of the cases were successfully managed with glyburide. No difference was found (p>0.05) in either group, with regards to maternal age, glucose values at OGTT75g, maternal body mass index (BMI), number of pre-natal consultations, number of previous pregnancies. According to the logistic model of regression used, therapeutically successful pregnant patients had had a later diagnosis (p=0.02) and lower weight gain during gestation (p<0.01). Perinatal outcome did not differ in either group. CONCLUSIONS: patients with later diagnosis and lower weight gain are more likely to have successful GDM management with glyburide. Unsuccessful management with glyburide did not alter the perinatal outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):497-505
DOI 10.1590/S0100-72032007001000002
PURPOSE: to evaluate fetal structural and/or functional abnormalities by ultrasound examination and fetal echocardiography, in pregnant women positive for human immunodeficiency virus (HIV). METHODS: we analyzed prospectively 109 HIV positive pregnant women under antiretroviral therapy (Study Group) and 200 low risk pregnant patients (Control Group). All of them were submitted to ultrasound scan and fetal and neonatal echocardiography once a month. The amniotic fluid volume, fetal growth, fetal structural and functional alteration and the perinatal outcome were evaluated. RESULTS: there were eight (7.3%) cases of fetal structural abnormality in the Study Group and two (1%) in the Control Group (p=0.616). There were four cases of congenital heart disease and four cases of hydronephrosis in the Study Group, with statistic significance (p=0.015) for the cardiac abnormalities. There were eight cases (7.3%) of oligohydramnios and 11 cases (10%) of polyhydramnios in the Study Group against two cases (1%) of oligohydramnios and none of polyhydramnios in the Control Group (p=0.004 and p<0.001). Eleven (10%) newborn babies were too small for their gestation age in the Study Group, against three (2.7%) in the Control Group (p=0,002). The incidence of preterm delivery was 8.7 and 2.5% in the Study and Control Groups respectively (p=0.041). It was observed six cases (5.5%) of fetal death in the Study Group and none in the Control Group (p=0.002). CONCLUSIONS: in the present study, we have observed higher prevalence of amniotic fluid volume and congenital heart abnormalities in the Study Group as compared to the Control Group. Statistical significance was found in both situations. The high fetal death rate found in the Study Group was probably due to fetal malformation, whereas the high prematurity rate and the prevalence of small size for the gestational age of the newborn babies were probably related to antiretroviral therapy, smoking and drug abuse.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(10):497-505
DOI 10.1590/S0100-72032007001000002
PURPOSE: to evaluate fetal structural and/or functional abnormalities by ultrasound examination and fetal echocardiography, in pregnant women positive for human immunodeficiency virus (HIV). METHODS: we analyzed prospectively 109 HIV positive pregnant women under antiretroviral therapy (Study Group) and 200 low risk pregnant patients (Control Group). All of them were submitted to ultrasound scan and fetal and neonatal echocardiography once a month. The amniotic fluid volume, fetal growth, fetal structural and functional alteration and the perinatal outcome were evaluated. RESULTS: there were eight (7.3%) cases of fetal structural abnormality in the Study Group and two (1%) in the Control Group (p=0.616). There were four cases of congenital heart disease and four cases of hydronephrosis in the Study Group, with statistic significance (p=0.015) for the cardiac abnormalities. There were eight cases (7.3%) of oligohydramnios and 11 cases (10%) of polyhydramnios in the Study Group against two cases (1%) of oligohydramnios and none of polyhydramnios in the Control Group (p=0.004 and p<0.001). Eleven (10%) newborn babies were too small for their gestation age in the Study Group, against three (2.7%) in the Control Group (p=0,002). The incidence of preterm delivery was 8.7 and 2.5% in the Study and Control Groups respectively (p=0.041). It was observed six cases (5.5%) of fetal death in the Study Group and none in the Control Group (p=0.002). CONCLUSIONS: in the present study, we have observed higher prevalence of amniotic fluid volume and congenital heart abnormalities in the Study Group as compared to the Control Group. Statistical significance was found in both situations. The high fetal death rate found in the Study Group was probably due to fetal malformation, whereas the high prematurity rate and the prevalence of small size for the gestational age of the newborn babies were probably related to antiretroviral therapy, smoking and drug abuse.