prematurity Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2003;25(7):483-489
DOI 10.1590/S0100-72032003000700004
PURPOSE: to describe the pregnancy outcome of women submitted to cervical cerclage during pregnancy. METHODS: a series of 123 pregnancies in 116 women submitted to elective cervical cerclage by Espinosa-Bahamondes, Palmer and MacDonald techniques and followed at the High-Risk Antenatal Care Unit at CAISM/UNICAMP is described. Variables were analyzed through frequency, mean and standard deviation, comparisons were made using c² or Fisher exact tests. RESULTS: 73% had at least one previous abortion, 17.9% had had 3 prior abortions, and 48% had prior preterm deliveries. The mean gestational age at cerclage was 16 weeks. Cerclage by the Espinosa-Bahamondes technique predominated (94.3%). The overall complication rate was 69%, with preterm labor as the most frequent (31.7%), followed by vaginitis (26%), preterm premature rupture of membranes (10.5%) and fetal death (8.7%). Other clinical complications were less common and included urinary tract infections (5.6%), hypertensive disorders (4%) and gestational diabetes (2.4%). Fetal loss occurred in 8.9% of pregnancies (11 stillbirths). Premature deliveries were present in 18%. History of previous premature deliveries was associated with the occurrence of premature deliveries. CONCLUSION: Obstetrical history compatible with cervical incompetence was frequent, and prior preterm delivery was associated with a preterm delivery in the pregnancy under analysis. The use of cerclage by the Espinosa-Bahamondes technique resulted in 18% of premature newborns, and 104 per thousand rate of perinatal death. Prospective, controlled trials are needed to evaluate the real benefits of cervical cerclage performed during pregnancy.
Summary
Rev Bras Ginecol Obstet. 2003;25(7):483-489
DOI 10.1590/S0100-72032003000700004
PURPOSE: to describe the pregnancy outcome of women submitted to cervical cerclage during pregnancy. METHODS: a series of 123 pregnancies in 116 women submitted to elective cervical cerclage by Espinosa-Bahamondes, Palmer and MacDonald techniques and followed at the High-Risk Antenatal Care Unit at CAISM/UNICAMP is described. Variables were analyzed through frequency, mean and standard deviation, comparisons were made using c² or Fisher exact tests. RESULTS: 73% had at least one previous abortion, 17.9% had had 3 prior abortions, and 48% had prior preterm deliveries. The mean gestational age at cerclage was 16 weeks. Cerclage by the Espinosa-Bahamondes technique predominated (94.3%). The overall complication rate was 69%, with preterm labor as the most frequent (31.7%), followed by vaginitis (26%), preterm premature rupture of membranes (10.5%) and fetal death (8.7%). Other clinical complications were less common and included urinary tract infections (5.6%), hypertensive disorders (4%) and gestational diabetes (2.4%). Fetal loss occurred in 8.9% of pregnancies (11 stillbirths). Premature deliveries were present in 18%. History of previous premature deliveries was associated with the occurrence of premature deliveries. CONCLUSION: Obstetrical history compatible with cervical incompetence was frequent, and prior preterm delivery was associated with a preterm delivery in the pregnancy under analysis. The use of cerclage by the Espinosa-Bahamondes technique resulted in 18% of premature newborns, and 104 per thousand rate of perinatal death. Prospective, controlled trials are needed to evaluate the real benefits of cervical cerclage performed during pregnancy.
Summary
Rev Bras Ginecol Obstet. 2000;22(7):401-411
DOI 10.1590/S0100-72032000000700002
Purpose: to analyze the relationship between White's classification and the histopathological, changes occurring in the placentas of diabetic pregnant women, performing a qualitative comparison of histopathological changes in the placentas of nondiabetic pregnant women with those in diabetic ones (classes A and A/B), clinical, short duration (classes B and C), and clinical with vasculopathy (classes D to FRH), studying the influence of the quality of glycemic control and of gestational age on placental changes in the three groups of diabetic pregnant women. Patients and methods: specimens of placentas were collected from all diabetic pregnant women seen between 1991 and 1996 in the Maternity Section of the Hospital das Clínicas, Faculdade de Medicina de Botucatu, stained using the hematoxylin-eosin technique, and submitted to a histopathological examination. The quality of glycemic control was analyzed by the glycemia average of gestation and classified as adequate or inadequate, with a limit of 120 mg/dl. Gestational age was individualized as term and preterm. Results: forty-two newborns (43.3%) were born at term and the remaining were preterm (56.7%). The prematurity rate was higher for women with clinical diabetes (classes B and C; D to FRH). Some histopathological alterations were observed only in placentas from diabetic pregnant women: cystoid degeneration, chorial edema, intima edema, dysmaturity, Hofbauer cell hyperplasia, villitis, ghost cells, two vessels in the umbilical cord, and endarteritis. Conclusions: histopathological changes in the placentas of pregnant women with gestational diabetes (classes A and A/B), clinical, short duration (classes B and C), and clinical with vasculopathy (classes D to FRH) were similar to those in the nondiabetic ones, and, therefore, were independent of White's clinical classification. The histopathological changes in the placentas of pregnant women with gestational diabetes (classes A and A and B), clinical, short duration (classes B and C), and clinical with vasculopathy (classes D to FRH) were not related to gestational age at birth and to the quality of glycemic control of the mother. The comparison between histopathological changes and the increased number of preterm newborns in clinical diabetes, class D to FRH, suggest early placental ageing in clinical diabetes patients.
Summary
Rev Bras Ginecol Obstet. 2000;22(7):401-411
DOI 10.1590/S0100-72032000000700002
Purpose: to analyze the relationship between White's classification and the histopathological, changes occurring in the placentas of diabetic pregnant women, performing a qualitative comparison of histopathological changes in the placentas of nondiabetic pregnant women with those in diabetic ones (classes A and A/B), clinical, short duration (classes B and C), and clinical with vasculopathy (classes D to FRH), studying the influence of the quality of glycemic control and of gestational age on placental changes in the three groups of diabetic pregnant women. Patients and methods: specimens of placentas were collected from all diabetic pregnant women seen between 1991 and 1996 in the Maternity Section of the Hospital das Clínicas, Faculdade de Medicina de Botucatu, stained using the hematoxylin-eosin technique, and submitted to a histopathological examination. The quality of glycemic control was analyzed by the glycemia average of gestation and classified as adequate or inadequate, with a limit of 120 mg/dl. Gestational age was individualized as term and preterm. Results: forty-two newborns (43.3%) were born at term and the remaining were preterm (56.7%). The prematurity rate was higher for women with clinical diabetes (classes B and C; D to FRH). Some histopathological alterations were observed only in placentas from diabetic pregnant women: cystoid degeneration, chorial edema, intima edema, dysmaturity, Hofbauer cell hyperplasia, villitis, ghost cells, two vessels in the umbilical cord, and endarteritis. Conclusions: histopathological changes in the placentas of pregnant women with gestational diabetes (classes A and A/B), clinical, short duration (classes B and C), and clinical with vasculopathy (classes D to FRH) were similar to those in the nondiabetic ones, and, therefore, were independent of White's clinical classification. The histopathological changes in the placentas of pregnant women with gestational diabetes (classes A and A and B), clinical, short duration (classes B and C), and clinical with vasculopathy (classes D to FRH) were not related to gestational age at birth and to the quality of glycemic control of the mother. The comparison between histopathological changes and the increased number of preterm newborns in clinical diabetes, class D to FRH, suggest early placental ageing in clinical diabetes patients.
Summary
Rev Bras Ginecol Obstet. 2000;22(8):519-523
DOI 10.1590/S0100-72032000000800008
Purpose: to evaluate the results of assistance to breech deliveries. Methods: this was a descriptive study where 160 pregnant women with breech presentation and live newborns were analyzed. They were divided into two groups according to the route of delivery. Clinical data concerning labor, delivery and newborns were studied. For statistical analysis vaginal deliveries were compared with cesarean sections using mean and standard deviation estimates, Student's t, Mann-Whitney and chi² tests. Results: the global cesarean section rate was 81.2%. The gestational age and the weight of the newborns were significantly lower in the vaginal delivery group. Prematurity and low birth weight were significantly associated with vaginal delivery. Only 14 newborns had an Apgar score below 7 at the fifth minute, almost 60% of them in the vaginal delivery group. Conclusions: this population presented a high cesarean section rate and also high perinatal morbidity, prematurity and low birth weight in the vaginal delivery group. These findings do not allow conclusions regarding the real relationships among breech presentation, route of delivery and perinatal outcomes. The control regarding gestational age and parity, besides a random decision on the route of delivery, is necessary for future conclusions.
Summary
Rev Bras Ginecol Obstet. 2000;22(8):519-523
DOI 10.1590/S0100-72032000000800008
Purpose: to evaluate the results of assistance to breech deliveries. Methods: this was a descriptive study where 160 pregnant women with breech presentation and live newborns were analyzed. They were divided into two groups according to the route of delivery. Clinical data concerning labor, delivery and newborns were studied. For statistical analysis vaginal deliveries were compared with cesarean sections using mean and standard deviation estimates, Student's t, Mann-Whitney and chi² tests. Results: the global cesarean section rate was 81.2%. The gestational age and the weight of the newborns were significantly lower in the vaginal delivery group. Prematurity and low birth weight were significantly associated with vaginal delivery. Only 14 newborns had an Apgar score below 7 at the fifth minute, almost 60% of them in the vaginal delivery group. Conclusions: this population presented a high cesarean section rate and also high perinatal morbidity, prematurity and low birth weight in the vaginal delivery group. These findings do not allow conclusions regarding the real relationships among breech presentation, route of delivery and perinatal outcomes. The control regarding gestational age and parity, besides a random decision on the route of delivery, is necessary for future conclusions.
Summary
Rev Bras Ginecol Obstet. 2003;25(2):109-114
DOI 10.1590/S0100-72032003000200006
PURPOSE: to evaluate maternal and perinatal outcomes of premature rupture of membranes up to the 26th week of gestation. METHODS: retrospective analysis of the cases of premature rupture of membranes up to the 26th week of gestation, without signs of labor or treatment for this condition before admission, followed up at the Obstetric Pathology Infirmary of the "Maternidade Escola Assis Chateaubriand", Federal University of Ceará, from January 1994 to December 1999. The cases with gestational age less than 22 weeks and birth weight lower than 500 g were excluded. Premature rupture of membranes was confirmed by sterile speculum examination. In doubt, amniotic fluid crystallization test and pH determination were performed. All pregnant women underwent ultrasound examination to determine gestational age and amniotic fluid volume. Data concerning the result of gestation and consequences for the mother, fetus and neonate were analyzed. RESULTS: a total of 29 cases of premature rupture of membranes fulfilled inclusion criteria. The mean gestational age at rupture of membranes was 22 weeks. The mean duration of the latency period was 21.7 days. There Were 22 spontaneous vaginal and 3 induced deliveries, besides 4 cesarean sections. In six pregnant women there were signs of infection before labor. Antibiotics were administered in 37.9% of the cases and corticosteroids in 6.9%. No patient underwent tocolysis. There were 3 fetal and 25 neonatal deaths. Only one infant survived. This child remained at the neonatal care unit for 19 days due to infection and respiratory distress syndrome. There was no maternal death. CONCLUSION: the premature rupture of membranes up to the 26th week of gestation has been a fatal discase for fetuses and newborns in our institution.
Summary
Rev Bras Ginecol Obstet. 2003;25(2):109-114
DOI 10.1590/S0100-72032003000200006
PURPOSE: to evaluate maternal and perinatal outcomes of premature rupture of membranes up to the 26th week of gestation. METHODS: retrospective analysis of the cases of premature rupture of membranes up to the 26th week of gestation, without signs of labor or treatment for this condition before admission, followed up at the Obstetric Pathology Infirmary of the "Maternidade Escola Assis Chateaubriand", Federal University of Ceará, from January 1994 to December 1999. The cases with gestational age less than 22 weeks and birth weight lower than 500 g were excluded. Premature rupture of membranes was confirmed by sterile speculum examination. In doubt, amniotic fluid crystallization test and pH determination were performed. All pregnant women underwent ultrasound examination to determine gestational age and amniotic fluid volume. Data concerning the result of gestation and consequences for the mother, fetus and neonate were analyzed. RESULTS: a total of 29 cases of premature rupture of membranes fulfilled inclusion criteria. The mean gestational age at rupture of membranes was 22 weeks. The mean duration of the latency period was 21.7 days. There Were 22 spontaneous vaginal and 3 induced deliveries, besides 4 cesarean sections. In six pregnant women there were signs of infection before labor. Antibiotics were administered in 37.9% of the cases and corticosteroids in 6.9%. No patient underwent tocolysis. There were 3 fetal and 25 neonatal deaths. Only one infant survived. This child remained at the neonatal care unit for 19 days due to infection and respiratory distress syndrome. There was no maternal death. CONCLUSION: the premature rupture of membranes up to the 26th week of gestation has been a fatal discase for fetuses and newborns in our institution.
Summary
Rev Bras Ginecol Obstet. 2001;23(2):93-97
DOI 10.1590/S0100-72032001000200006
Purpose: to analyze the effect of betamethasone on the pregnancy of rats. Methods: thirty pregnant rats were divided into three groups of ten animals each. Group I -- the animals received betamethasone IM (1 mg/kg body weight, in 0.5 ml distilled water) on the 11th, 12th, 18th and 19th day of pregnancy. Group II -- the rats received distilled water (0.5 ml) IM on the 11th, 12th, 18th and 19th day of pregnancy. Group III - the rats did not receive any drug or vehicle. The animals were weighed on days 0, 7, 14 and on the 20th of pregnancy, and on the last day of weighing, the animals were sacrificed. The number of implantations, resorptions, fetuses, placentas, malformations, maternal and fetal mortality as well as the weight of the fetuses and placentas were obtained and analyzed. Results: our results show that the rats treated with betamethasone gained significantly less weight. Their fetuses had an average weight of 3.2 g compared with 3.75 g in the control group. The results regarding placental weight were 0.36 g vs 0.48 g, respectively. All these differences were statistically significant. Conclusions: betamethasone had a negative effect on the gain of weight of matrices, fetuses and placentas when administered repeatedly and continuousy after the second half of pregnancy.
Summary
Rev Bras Ginecol Obstet. 2001;23(2):93-97
DOI 10.1590/S0100-72032001000200006
Purpose: to analyze the effect of betamethasone on the pregnancy of rats. Methods: thirty pregnant rats were divided into three groups of ten animals each. Group I -- the animals received betamethasone IM (1 mg/kg body weight, in 0.5 ml distilled water) on the 11th, 12th, 18th and 19th day of pregnancy. Group II -- the rats received distilled water (0.5 ml) IM on the 11th, 12th, 18th and 19th day of pregnancy. Group III - the rats did not receive any drug or vehicle. The animals were weighed on days 0, 7, 14 and on the 20th of pregnancy, and on the last day of weighing, the animals were sacrificed. The number of implantations, resorptions, fetuses, placentas, malformations, maternal and fetal mortality as well as the weight of the fetuses and placentas were obtained and analyzed. Results: our results show that the rats treated with betamethasone gained significantly less weight. Their fetuses had an average weight of 3.2 g compared with 3.75 g in the control group. The results regarding placental weight were 0.36 g vs 0.48 g, respectively. All these differences were statistically significant. Conclusions: betamethasone had a negative effect on the gain of weight of matrices, fetuses and placentas when administered repeatedly and continuousy after the second half of pregnancy.
Summary
Rev Bras Ginecol Obstet. 2001;23(7):423-427
DOI 10.1590/S0100-72032001000700003
Purpose: to evaluate the impact of birth time interval between twins in relation to the morbidity and mortality of the second newborn twin. Methods: this is a retrospective study of 50 women with twin pregnancy at the `Maternidade Pró-Matre de Vitória' who gave birth to 100 alive newborns through the vaginal canal, weighing each over 500 g and not having any major malformations. The newborns were separated into two groups: G1 (first twin) and G2 (second twin). The following criteria were considered to be indicative of newborn morbidity: asphyxia at birth, characterized by Apgar index lower than 7 in the first minute of life; respiratory distress syndrome detected by clinical and radiological findings, and hospitalization period longer than 4 days. In-hospital mortality was analyzed as well. Cut off was at every 5 minutes, up to 35 minutes, to study the time interval between the twin (deltat) delivery. A time-span (deltat) analysis was also carried out up to 5 minutes: 6-10, 11-15, 16-20, and 21-150 minutes. Results: there were no statistically significant differences between the second twin's morbidity/mortality in relation to the first, considering the aforesaid cutoff and time-span levels. Conclusion: delivery time interval between G1 and G2 did not influence the second twin's morbidity and mortality; however, in the assistance of the second twin's delivery, it is absolutely necessary to individualize the characteristics of each case, not allowing any anxiety to set in through untimely and potentially damaging procedures.
Summary
Rev Bras Ginecol Obstet. 2001;23(7):423-427
DOI 10.1590/S0100-72032001000700003
Purpose: to evaluate the impact of birth time interval between twins in relation to the morbidity and mortality of the second newborn twin. Methods: this is a retrospective study of 50 women with twin pregnancy at the `Maternidade Pró-Matre de Vitória' who gave birth to 100 alive newborns through the vaginal canal, weighing each over 500 g and not having any major malformations. The newborns were separated into two groups: G1 (first twin) and G2 (second twin). The following criteria were considered to be indicative of newborn morbidity: asphyxia at birth, characterized by Apgar index lower than 7 in the first minute of life; respiratory distress syndrome detected by clinical and radiological findings, and hospitalization period longer than 4 days. In-hospital mortality was analyzed as well. Cut off was at every 5 minutes, up to 35 minutes, to study the time interval between the twin (deltat) delivery. A time-span (deltat) analysis was also carried out up to 5 minutes: 6-10, 11-15, 16-20, and 21-150 minutes. Results: there were no statistically significant differences between the second twin's morbidity/mortality in relation to the first, considering the aforesaid cutoff and time-span levels. Conclusion: delivery time interval between G1 and G2 did not influence the second twin's morbidity and mortality; however, in the assistance of the second twin's delivery, it is absolutely necessary to individualize the characteristics of each case, not allowing any anxiety to set in through untimely and potentially damaging procedures.
Summary
Rev Bras Ginecol Obstet. 2003;25(1):29-34
DOI 10.1590/S0100-72032003000100005
PURPOSE: to identify characteristics common to women who suffer from cervical incompetence (CI) allowing their early identification and helping in the follow-up of the gestational-postdelivery cycle. PATIENTS AND METHODS: fifty pregnant women suffering from CI and submitted to uterine cerclage according to modified McDonald's technique were analyzed in an observational descriptive study. The following variables of the medical records were evaluated: age, preceding obstetrical aspects, time of CI diagnosis, cerclage-related aspects and preterm delivery incidence. RESULTS: the average age of the mothers was 29.28 years and mean number of previous gestations was 3.76. As to the preceding obstetrical aspects, 189 gestations with a CI diagnosis were reported and cerclage had been applied to 18 of them, resulting in 18 babies who were born alive (8 preterm deliveries and 10 term deliveries). Of the 171 previous pregnancies in which CI diagnosis was not reported, 90 progressed to abortion, 68 were preterm and 13 were term deliveries. In 30 (60%) patients, CI was diagnosed during the intergestational interval, and 20 (40%) during gestation. The average gestational period in which patients were submitted to cerclage was 18.29 weeks; 40% of the cerclages were emergency procedures and 60% were elective. The incidence of prematurity was 30% (15/50). CONCLUSION: careful obstetrical evaluation of multiparous women, presenting recurrent miscarriages, during the intergestational interval and/or during the first trimester of pregnancy, may allow the early diagnosis and adequate treatment of CI, avoiding prematurity.
Summary
Rev Bras Ginecol Obstet. 2003;25(1):29-34
DOI 10.1590/S0100-72032003000100005
PURPOSE: to identify characteristics common to women who suffer from cervical incompetence (CI) allowing their early identification and helping in the follow-up of the gestational-postdelivery cycle. PATIENTS AND METHODS: fifty pregnant women suffering from CI and submitted to uterine cerclage according to modified McDonald's technique were analyzed in an observational descriptive study. The following variables of the medical records were evaluated: age, preceding obstetrical aspects, time of CI diagnosis, cerclage-related aspects and preterm delivery incidence. RESULTS: the average age of the mothers was 29.28 years and mean number of previous gestations was 3.76. As to the preceding obstetrical aspects, 189 gestations with a CI diagnosis were reported and cerclage had been applied to 18 of them, resulting in 18 babies who were born alive (8 preterm deliveries and 10 term deliveries). Of the 171 previous pregnancies in which CI diagnosis was not reported, 90 progressed to abortion, 68 were preterm and 13 were term deliveries. In 30 (60%) patients, CI was diagnosed during the intergestational interval, and 20 (40%) during gestation. The average gestational period in which patients were submitted to cerclage was 18.29 weeks; 40% of the cerclages were emergency procedures and 60% were elective. The incidence of prematurity was 30% (15/50). CONCLUSION: careful obstetrical evaluation of multiparous women, presenting recurrent miscarriages, during the intergestational interval and/or during the first trimester of pregnancy, may allow the early diagnosis and adequate treatment of CI, avoiding prematurity.
Summary
Rev Bras Ginecol Obstet. 2002;24(10):655-661
DOI 10.1590/S0100-72032002001000004
PURPOSE: to evaluate the effects of antenatal corticosteroid treatment on the incidence of respiratory distress syndrome (RDS), neonatal morbidities, and mortality in preterm babies assisted at IMIP, a teaching hospital in Brazil. METHODS: this was an observational, analytical, cohort study which included 155 newborns from women who delivered prematurely. The study was conducted between February and November 2001 and included 78 women in the corticosteroid-treated group and 77 in the nontreated group. The study design included the incidence of RDS, assessment of morbidities related to prematurity and tabulation of neonatal mortality. The risk ratio and its 95% confidence interval were determined for estimation of the relative risk for RDS and neonatal outcome (dependent variables) according to antenatal corticoid therapy administration (independent variable). RESULTS: corticosteroid treatment was administered to 50.3% of the patients (64% of the women received the full treatment course, while 36% of the same group received a partial course of treatment). The incidence of RDS was significantly lower in the corticosteroid treated group (37.2%) compared with the nontreated group (63.6%). There was no observable decrease in the risk for morbidities associated with prematurity. There was a decrease in mortality and in the frequency of supplemental oxygen therapy in the corticosteroid group (37%). On multiple logical regression analysis, there was a 72% reduction in the risk for RDS in the corticosteroid group, and approximately a seven times greater risk for RDS in babies of gestational age below 32 weeks. CONCLUSIONS: a favorable impact of antenatal corticosteroid administration was observed, with significant reduction of the risk for RDS in patients with gestational age between 26 and 35 weeks. Although no effect on the other morbidities was observed, this can be explained by the small size of the sample.
Summary
Rev Bras Ginecol Obstet. 2002;24(10):655-661
DOI 10.1590/S0100-72032002001000004
PURPOSE: to evaluate the effects of antenatal corticosteroid treatment on the incidence of respiratory distress syndrome (RDS), neonatal morbidities, and mortality in preterm babies assisted at IMIP, a teaching hospital in Brazil. METHODS: this was an observational, analytical, cohort study which included 155 newborns from women who delivered prematurely. The study was conducted between February and November 2001 and included 78 women in the corticosteroid-treated group and 77 in the nontreated group. The study design included the incidence of RDS, assessment of morbidities related to prematurity and tabulation of neonatal mortality. The risk ratio and its 95% confidence interval were determined for estimation of the relative risk for RDS and neonatal outcome (dependent variables) according to antenatal corticoid therapy administration (independent variable). RESULTS: corticosteroid treatment was administered to 50.3% of the patients (64% of the women received the full treatment course, while 36% of the same group received a partial course of treatment). The incidence of RDS was significantly lower in the corticosteroid treated group (37.2%) compared with the nontreated group (63.6%). There was no observable decrease in the risk for morbidities associated with prematurity. There was a decrease in mortality and in the frequency of supplemental oxygen therapy in the corticosteroid group (37%). On multiple logical regression analysis, there was a 72% reduction in the risk for RDS in the corticosteroid group, and approximately a seven times greater risk for RDS in babies of gestational age below 32 weeks. CONCLUSIONS: a favorable impact of antenatal corticosteroid administration was observed, with significant reduction of the risk for RDS in patients with gestational age between 26 and 35 weeks. Although no effect on the other morbidities was observed, this can be explained by the small size of the sample.