Prenatal care Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(3):148-155
DOI 10.1590/S0100-72032009000300008
Good prenatal care is essential to guarantee maternal and perinatal health. Nowadays, with the constant progress on the diagnostic methods and changes in diseases panorama, like increased frequency of diabetes and sexually transmitted diseases, several diagnostic procedures have been studied. These challenges difficult the selection of prenatal exams by the clinicians, in order to improve maternal and perinatal outcome. This review aimed to evaluate the main prenatal routine exams, according to the best current scientific evidences.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(3):148-155
DOI 10.1590/S0100-72032009000300008
Good prenatal care is essential to guarantee maternal and perinatal health. Nowadays, with the constant progress on the diagnostic methods and changes in diseases panorama, like increased frequency of diabetes and sexually transmitted diseases, several diagnostic procedures have been studied. These challenges difficult the selection of prenatal exams by the clinicians, in order to improve maternal and perinatal outcome. This review aimed to evaluate the main prenatal routine exams, according to the best current scientific evidences.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(9):445-451
DOI 10.1590/S0100-72032008000900004
PURPOSE: to determine the prevalence and risk factors associated to anemia in pregnant women from the semiarid region of Alagoas, Brazil. METHODS: transversal study comprising a sample (n=150) obtained taking into consideration the prevalence estimated by World Health Organization of 52%, an error of 8% and a confidence interval of 95%. Sampling has been done in three stages: 15 towns among the 38 in the region, four census sectors by town and 24 residences by sector. All the resident pregnant women were eligible, and their socio-economic, demographic, anthropometric and health data have been collected. Anemia was identified at the <11 g/dL hemoglobin level (Hemocue®), and its association with risk factors, tested by multiple linear regression analysis. RESULTS: anemia prevalence was 50%. Seventy eight per cent of the pregnant women were under pre-natal care. From those, 79.3% were in the second or third trimester of gestation. Nevertheless, only 21.2% of them were taking iron supplementation. Variables (p<0.05) independently associated with anemia (anemic versus not-anemic pregnant women) were: larger number of family members (4.5±2.3 versus 4,3±2.3; p=0.02), lower age group of the pregnant woman (23.9±6.3 versus 24.7±6.7; p=0.04), or of her partner (34.5±15.8 versus 36±17.5; p=0.03), no toilet in the house (30.7 versus 24%; p<0.001), history of child abortion and/or death (32.4 versus 16.4%; p<0.001), living in the country (60 versus 46.7%; p=0.03), average per capita income
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(9):445-451
DOI 10.1590/S0100-72032008000900004
PURPOSE: to determine the prevalence and risk factors associated to anemia in pregnant women from the semiarid region of Alagoas, Brazil. METHODS: transversal study comprising a sample (n=150) obtained taking into consideration the prevalence estimated by World Health Organization of 52%, an error of 8% and a confidence interval of 95%. Sampling has been done in three stages: 15 towns among the 38 in the region, four census sectors by town and 24 residences by sector. All the resident pregnant women were eligible, and their socio-economic, demographic, anthropometric and health data have been collected. Anemia was identified at the <11 g/dL hemoglobin level (Hemocue®), and its association with risk factors, tested by multiple linear regression analysis. RESULTS: anemia prevalence was 50%. Seventy eight per cent of the pregnant women were under pre-natal care. From those, 79.3% were in the second or third trimester of gestation. Nevertheless, only 21.2% of them were taking iron supplementation. Variables (p<0.05) independently associated with anemia (anemic versus not-anemic pregnant women) were: larger number of family members (4.5±2.3 versus 4,3±2.3; p=0.02), lower age group of the pregnant woman (23.9±6.3 versus 24.7±6.7; p=0.04), or of her partner (34.5±15.8 versus 36±17.5; p=0.03), no toilet in the house (30.7 versus 24%; p<0.001), history of child abortion and/or death (32.4 versus 16.4%; p<0.001), living in the country (60 versus 46.7%; p=0.03), average per capita income
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(1):12-18
DOI 10.1590/S0100-72032008000100003
PURPOSE: to study the use of medicines by pregnant women during prenatal care in clinics of the national public health system in the city of Natal, Brazil. METHODS: a total of 610 pregnant women between the first and the third trimesters of pregnancy were interviewed in the public clinics of the four sanitary districts of Natal, from May to July 2006. The data were collected by a structured questionnaire, based in use-oriented and medicine-oriented questions. The drugs were classified according to the Anatomical Therapeutic Chemical Classification System (ATC), in agreement with the gestation risk criteria from the Food and Drugs Administration (FDA). The statistical analysis was made by the chi2 test. RESULTS: a total of 1,505 drugs were used, with an average of 2.4 medications per woman. The use of at least one drug was found in 86.6% of the women. The most frequently used drugs were anti-anemics (35.6%), analgesics (24.9%), drugs for gastrointestinal disorders (9.1%) and vitamins (7%). According to the FDA classification, 42.7% belonged to category A risk, 27.1% to category B, 29.3% to category C, 0.3% to category D and none to category X. The use of medicines during the first trimester of pregnancy amounted to 43.6%. The rate of drug use increased with higher schooling level and family income. Self-medication was found in 12.2% of the drug intake and this rate was higher in the first trimester of gestation and with women with low education level and previous gestations. CONCLUSIONS: pregnant women from Natal are being exposed to a variety of medicines with uncertain safety in pregnancy. Therefore, more careful prescription is needed, to avoid possible fetal damage.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(1):12-18
DOI 10.1590/S0100-72032008000100003
PURPOSE: to study the use of medicines by pregnant women during prenatal care in clinics of the national public health system in the city of Natal, Brazil. METHODS: a total of 610 pregnant women between the first and the third trimesters of pregnancy were interviewed in the public clinics of the four sanitary districts of Natal, from May to July 2006. The data were collected by a structured questionnaire, based in use-oriented and medicine-oriented questions. The drugs were classified according to the Anatomical Therapeutic Chemical Classification System (ATC), in agreement with the gestation risk criteria from the Food and Drugs Administration (FDA). The statistical analysis was made by the chi2 test. RESULTS: a total of 1,505 drugs were used, with an average of 2.4 medications per woman. The use of at least one drug was found in 86.6% of the women. The most frequently used drugs were anti-anemics (35.6%), analgesics (24.9%), drugs for gastrointestinal disorders (9.1%) and vitamins (7%). According to the FDA classification, 42.7% belonged to category A risk, 27.1% to category B, 29.3% to category C, 0.3% to category D and none to category X. The use of medicines during the first trimester of pregnancy amounted to 43.6%. The rate of drug use increased with higher schooling level and family income. Self-medication was found in 12.2% of the drug intake and this rate was higher in the first trimester of gestation and with women with low education level and previous gestations. CONCLUSIONS: pregnant women from Natal are being exposed to a variety of medicines with uncertain safety in pregnancy. Therefore, more careful prescription is needed, to avoid possible fetal damage.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):267-275
DOI 10.1590/S0100-72032007000500008
Sweeteners are frequently used by women of reproductive age. This is a narrative review about the sweeteners currently sold in the Brazilian commerce. There is a few information on the use of saccharin and cyclamates in pregnancy and their effects on the fetus. Due to the limited information available and their carcinogenic potential in animal species, saccharin and cyclamates should be avoided during pregnancy (risk C). Aspartame has been extensively studied in animals and it is considered safe for use during pregnancy (risk B), except by women homozygous for phenylketonuria (risk C). Sucralose and acessulfame-K are not toxic, carcinogenic or mutagenic in animals, but there are no controlled studies in humans. However, since these two sweeteners are not metabolized, it is unlikely that their use during pregnancy could be harmful (risk B). Stevia, a substance extracted from a native Brazilian plant, is innocuous in animal pregnancies, but there are no controlled studies in humans (risk B). Body agents found in the composition of artificial sweeteners (mannitol, sorbitol, xylitol, erithrol, lactilol, isomalt, maltilol, lactose, fructose, maltodextrin, dextrin, and inverted sugar) are substances generally regarded as safe for human consumption. In conclusion, according to the currently available evidence, aspartame, sucralose, acessulfame-K and stevia can be safely used during pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):267-275
DOI 10.1590/S0100-72032007000500008
Sweeteners are frequently used by women of reproductive age. This is a narrative review about the sweeteners currently sold in the Brazilian commerce. There is a few information on the use of saccharin and cyclamates in pregnancy and their effects on the fetus. Due to the limited information available and their carcinogenic potential in animal species, saccharin and cyclamates should be avoided during pregnancy (risk C). Aspartame has been extensively studied in animals and it is considered safe for use during pregnancy (risk B), except by women homozygous for phenylketonuria (risk C). Sucralose and acessulfame-K are not toxic, carcinogenic or mutagenic in animals, but there are no controlled studies in humans. However, since these two sweeteners are not metabolized, it is unlikely that their use during pregnancy could be harmful (risk B). Stevia, a substance extracted from a native Brazilian plant, is innocuous in animal pregnancies, but there are no controlled studies in humans (risk B). Body agents found in the composition of artificial sweeteners (mannitol, sorbitol, xylitol, erithrol, lactilol, isomalt, maltilol, lactose, fructose, maltodextrin, dextrin, and inverted sugar) are substances generally regarded as safe for human consumption. In conclusion, according to the currently available evidence, aspartame, sucralose, acessulfame-K and stevia can be safely used during pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):71-75
DOI 10.1590/S0100-72031998000200003
Fetal death may not be considered an unusual event and, in developing countries, the most prevalent causes could be possibly controlled and/or treated. The purpose of the present study was to investigate causes of fetal death in a Brazilian population. This is a descriptive study performed at the Hospital Maternidade Leonor Mendes de Barros in São Paulo. The study subjects were 122 pregnant women with diagnosis of fetal death and gestation age of 20 or more weeks. The statistical procedures used were means and standard deviation. The main causes of the fetal death were hypertensive disorders and infections and, for a quarter of the cases, they were not identified at all. It is concluded that an important percentage of fetal deaths would have been prevented and that there was a significant number of unidentified causes. Results of the present study might be useful to orientate a primary prevention health program, specially concerning antenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):71-75
DOI 10.1590/S0100-72031998000200003
Fetal death may not be considered an unusual event and, in developing countries, the most prevalent causes could be possibly controlled and/or treated. The purpose of the present study was to investigate causes of fetal death in a Brazilian population. This is a descriptive study performed at the Hospital Maternidade Leonor Mendes de Barros in São Paulo. The study subjects were 122 pregnant women with diagnosis of fetal death and gestation age of 20 or more weeks. The statistical procedures used were means and standard deviation. The main causes of the fetal death were hypertensive disorders and infections and, for a quarter of the cases, they were not identified at all. It is concluded that an important percentage of fetal deaths would have been prevented and that there was a significant number of unidentified causes. Results of the present study might be useful to orientate a primary prevention health program, specially concerning antenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):193-198
DOI 10.1590/S0100-72031998000400004
The patients who do not adjust to the metabolic changes of pregnancy and those with previous alterations in carbohydrate metabolism show a significant increase in perinatal morbidity and mortality. In order to contribute to a better prenatal management of diabetic patients, the authors reviewed 60 cases of diabetes during pregnancy, assisted at the Department of Obstetrics and Gynecology, Faculty of Medicine of Ribeirão Preto, University of São Paulo. The sample was divided into two groups: one with prenatal care according to the Department protocol, and referred to this center for pregnancy resolution, and the other without appropriate prenatal care. In the group with prenatal care according to the Department protocol the complications observed were related to prematurity. The group without appropriate care showed 3 cases of congenital malformations, 3 cases of prematurity, 1 case of severe neonatal hypoglycemia, 1 case of macrossomia, 1 case of intrauterine growth retardation and 1 neonatal death. Comparing the groups, it became clear that the appropriate prenatal care is essential for the diabetic pregnant patient, but also that a reference center, such as this Obstetrical and Gynecological Department, must be fully integrated with the regional health centers, in order to offer assistance before and during gestation to the diabetic patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(4):193-198
DOI 10.1590/S0100-72031998000400004
The patients who do not adjust to the metabolic changes of pregnancy and those with previous alterations in carbohydrate metabolism show a significant increase in perinatal morbidity and mortality. In order to contribute to a better prenatal management of diabetic patients, the authors reviewed 60 cases of diabetes during pregnancy, assisted at the Department of Obstetrics and Gynecology, Faculty of Medicine of Ribeirão Preto, University of São Paulo. The sample was divided into two groups: one with prenatal care according to the Department protocol, and referred to this center for pregnancy resolution, and the other without appropriate prenatal care. In the group with prenatal care according to the Department protocol the complications observed were related to prematurity. The group without appropriate care showed 3 cases of congenital malformations, 3 cases of prematurity, 1 case of severe neonatal hypoglycemia, 1 case of macrossomia, 1 case of intrauterine growth retardation and 1 neonatal death. Comparing the groups, it became clear that the appropriate prenatal care is essential for the diabetic pregnant patient, but also that a reference center, such as this Obstetrical and Gynecological Department, must be fully integrated with the regional health centers, in order to offer assistance before and during gestation to the diabetic patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(8):449-453
DOI 10.1590/S0100-72031998000800004
Purpose: to determine folate, vitamin B12 and ferritin levels in patients whose fetuses presented neural-tube defects (NTD). Blood folate and vitamin B12 act as cofactors of enzymes involved in DNA biosynthesis. Interruption of this process may block neural-tube closing. Vitamin supplementation with folate may reduce occurrence rates and recurrence of NTD, although there is concern about the fact that this prevention may mask vitamin B12 deficiency. Methods: vitamin B12 and ferritin determinations by enzyme immunoassay with microparticles and folic acid determination using the ion capture method (IMx ABBOTT). Results: the percentage of pregnant women with vitamin B12 deficirncy (serum levels < 150 pg/ml) was 11.8%. There was no case of folate deficiency (serum levels < 3.0 ng/ml) and prevalence of pregnant women with iron store deficiency was 47.1% (serum levels < ng/mg). Conclusions: occording to the results obtained in this study (prevalence of 11.8% of vitamin B12 and 0% of folate deficient pregnant women) we suggest that supplementation should be administered after serum vitamin B12 determination.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(8):449-453
DOI 10.1590/S0100-72031998000800004
Purpose: to determine folate, vitamin B12 and ferritin levels in patients whose fetuses presented neural-tube defects (NTD). Blood folate and vitamin B12 act as cofactors of enzymes involved in DNA biosynthesis. Interruption of this process may block neural-tube closing. Vitamin supplementation with folate may reduce occurrence rates and recurrence of NTD, although there is concern about the fact that this prevention may mask vitamin B12 deficiency. Methods: vitamin B12 and ferritin determinations by enzyme immunoassay with microparticles and folic acid determination using the ion capture method (IMx ABBOTT). Results: the percentage of pregnant women with vitamin B12 deficirncy (serum levels < 150 pg/ml) was 11.8%. There was no case of folate deficiency (serum levels < 3.0 ng/ml) and prevalence of pregnant women with iron store deficiency was 47.1% (serum levels < ng/mg). Conclusions: occording to the results obtained in this study (prevalence of 11.8% of vitamin B12 and 0% of folate deficient pregnant women) we suggest that supplementation should be administered after serum vitamin B12 determination.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(2):105-108
DOI 10.1590/S0100-72031999000200008
Purpose: to evaluate the effects of acetaminophen on the pregnancy of female albino rats. Methods: forty pregnant rats were separated into four groups. All the animals received daily by gavage 1 ml of acetaminophen solution from the first day (day zero) until the 20th day of pregnancy: group I - only distilled water (control); groups II, III and IV, respectively, 125, 500 and 1,500 mg/kg body weight of acetaminophen dissolved in distilled water. The animals were weighed on days 0, 7, 15 and 20 of pregnancy. Results: our results showed that the rats that received the medication presented a reduction in weight when compared to the control group. The incidence of reabsorption of the embryos was 2.0, 3.5 and 7.0 times higher than in the control, in groups II, III and IV, respectively. Groups GII and GIV showed a clear reduction in the weight of the concepts. In GIV there was a 50% reduction in weight increase of fetuses and placentas when compared to the control, and 15.7% of external malformations were also found. Conclusions: the continuous use of acetaminophen should be avoided at doses higher than 70 mg/kg per during pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(2):105-108
DOI 10.1590/S0100-72031999000200008
Purpose: to evaluate the effects of acetaminophen on the pregnancy of female albino rats. Methods: forty pregnant rats were separated into four groups. All the animals received daily by gavage 1 ml of acetaminophen solution from the first day (day zero) until the 20th day of pregnancy: group I - only distilled water (control); groups II, III and IV, respectively, 125, 500 and 1,500 mg/kg body weight of acetaminophen dissolved in distilled water. The animals were weighed on days 0, 7, 15 and 20 of pregnancy. Results: our results showed that the rats that received the medication presented a reduction in weight when compared to the control group. The incidence of reabsorption of the embryos was 2.0, 3.5 and 7.0 times higher than in the control, in groups II, III and IV, respectively. Groups GII and GIV showed a clear reduction in the weight of the concepts. In GIV there was a 50% reduction in weight increase of fetuses and placentas when compared to the control, and 15.7% of external malformations were also found. Conclusions: the continuous use of acetaminophen should be avoided at doses higher than 70 mg/kg per during pregnancy.
