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Trabalhos Originais
Impact of antenatal corticosteroid therapy for the acceleration of fetal lung maturation in neonates at a teaching hospital in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(10):655-661
03-18-2002
Summary
Trabalhos OriginaisImpact of antenatal corticosteroid therapy for the acceleration of fetal lung maturation in neonates at a teaching hospital in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(10):655-661
03-18-2002DOI 10.1590/S0100-72032002001000004
Views43See morePURPOSE: 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.
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Trabalhos Originais
Risk assessment for spontaneous preterm delivery according to cervical length in the first and second trimesters of pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):463-468
11-06-2002
Summary
Trabalhos OriginaisRisk assessment for spontaneous preterm delivery according to cervical length in the first and second trimesters of pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):463-468
11-06-2002DOI 10.1590/S0100-72032002000700006
Views73See morePurpose: to evaluate, in the first and second trimesters of pregnancy, the correlation between cervical length and spontaneous preterm delivery. Methods: cervical length was evaluated in 641 pregnant women between 11-16 weeks' and 23-24 weeks' gestation. Cervical assessment was performed by a transvaginal scan with the patient with empty bladder in a gynecological position. Cervical length was measured from the internal to the external os. The gestational age at delivery was correlated with the length of the cervix. To compare the means in groups of pregnant women who had a term or preterm delivery, we used Student's t test. Sensitivity, specificity, false-positive and false-negative rates, and accuracy were calculated for cervical length of 20 mm or less, 25 mm or less and 30 mm or less in the prediction of preterm delivery. Results: the measurement of cervical length, between 11 and 16 weeks of pregnancy, did not show any statistically significant difference on comparing women who had preterm and term delivery (40.6 mm and 42.7 mm, respectively, p=0.2459). However, the difference between the two groups at 23 to 24 weeks was significant (37.3 mm in the group who delivered prematurely and 26.7 mm in the term group, p=0.0001, Student's t test). Conclusion: there was no significant difference in cervical length, at 11 to 16 weeks, between pregnant women who had a preterm and term delivery. However, at 23 to 24 weeks, cervical length was significantly different between the two groups, and this measurement might be used as a predictor for prematurity.
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Trabalhos Originais
Longitudinal Assessment of Cervix Length in Twin Gestation
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):377-381
09-23-2002
Summary
Trabalhos OriginaisLongitudinal Assessment of Cervix Length in Twin Gestation
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):377-381
09-23-2002DOI 10.1590/S0100-72032002000600004
Views53See morePurpose: to establish a reference range for cervical length measurement throughout gestation in twin pregnancies and to correlate cervical length with gestational age at delivery. Methods: retrospective analysis of prospectively collected data between 1994 and 2000, involving 149 twin pregnancies undergoing transvaginal ultrasound examination every four weeks for measurement of cervical length. Results: one hundred and twenty-seven women (85.2%) delivered after 34 weeks, 20 (13.4%) between 24 and 33 weeks and two pregnancies resulted in fetal loss before 24 weeks. The mean gestational age at delivery was 36.3 weeks. A total of 497 ultrasound examinations with cervical length measurement were performed in 127 patients with twin pregnancies who delivered after 34 weeks (mean = 4 examinations per patient). All scans were carried out between 9 and 39 weeks (mean = 29.4 weeks). There was an inverse correlation between cervical length measurement and gestational age at the scan in twin pregnancies (r=-0.44; p < 0.0001). The mean value was 44 mm at 10 weeks and 28 mm at 36 weeks. The corresponding fifth percentile values of these gestations were 28 mm and 12 mm, respectively. Cervical length measurement changes were more pronounced in the second half of the pregnancy (Kruskal-Wallis test, p=0.0006). Mean cervical length measurement and 90% prediction interval values were established throughout gestation by regression analysis. Twenty-six cases delivered before 34 weeks, nine of these cases (34.6%) had at least one cervical length measurement below the 5th percentile. Conclusions: cervical length shortens gradually throughout gestation in twin pregnancies but changes are more significant in the second half of the pregnancy. Approximately one-third of the pregnancies that delivered before 34 weeks had at least one cervical length measurement below the 5th percentile for the gestational age.
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Trabalhos Originais
Prognosis of Pregnancy with Threatened Abortion between 6 and 13 weeks Presenting Embryo/Fetus Alive at Ultrasound Scan
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):301-306
07-24-2002
Summary
Trabalhos OriginaisPrognosis of Pregnancy with Threatened Abortion between 6 and 13 weeks Presenting Embryo/Fetus Alive at Ultrasound Scan
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):301-306
07-24-2002DOI 10.1590/S0100-72032002000500003
Views51See morePurpose: to compare the outcome of pregnancies with and without threatened abortion presenting alive embryo/fetus between 6 and 13 weeks at sonographic evaluation. Method: this was a retrospective case-control study, carried out from February 1998 to December 1999. Criteria for inclusion were: topic and single pregnancy; embryo/fetus cardiac activity present in the ultrasound scan; gestational age between 6 weeks and 13 weeks and 6 days, absence of fetal anomalies, absence of attempt of abortion by drugs or manipulation, absence of maternal disease, known pregnancy result. A total of 1531 pregnancies were examined, of which 258 with threatened abortion (case group) and 1273 without threatened abortion (control group). The two groups were compared regarding outcome such as: abortion, stillbirth, prematurity and intrauterine growth restriction. Results: the percentage of abortion (11,7%) and prematurity (17,8%) were higher in the group with threatened abortion (p<0.001 and p=0.026, respectively). The frequency of stillbirth and intrauterine growth restriction did not differ significantly between the groups.Conclusion: threatened abortion with alive embryo/fetus in 6- to 13- week gestation presented a higher abortion risk and subsequent prematurity.