Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(2):65-71
DOI 10.1590/S0100-72032014000200004
To analyze the relationships among gestational risk, type of delivery and
immediate maternal and neonatal repercussions.
A retrospective cohort study based on secondary data was conducted in a
university maternity hospital. A total of 1606 births were analyzed over a 9-month
period. Epidemiological, clinical, obstetric and neonatal characteristics were
compared according to the route of delivery and the gestational risk characterized
on the basis of the eligibility criteria for high clinical risk. The occurrence of
maternal and neonatal complications during hospitalization was analyzed according
to gestational risk and cesarean section delivery using univariate and
multivariate logistic analysis.
The overall rate of cesarean sections was 38.3%. High gestational risk was
present in 50.2% of births, mainly represented by hypertensive disorders and fetal
malformations. The total incidence of cesarean section, planned cesarean section
or emergency cesarean section was more frequent in pregnant women at gestational
high risk (p<0.001). Cesarean section alone did not influence maternal outcome,
but was associated with poor neonatal outcome (OR 3.4; 95%CI 2.7-4.4). Gestational
high risk was associated with poor maternal and neonatal outcome (OR 3.8; 95%CI
1.3-8.7 and OR 17.5; 95%CI 11.6-26.3, respectively). In multivariate analysis, the
ratios were maintained, although the effect of gestational risk has determined a
reduction in the OR of the type of delivery alone from 3.4 (95%CI 2.7-4.4) to 1.99
(95%CI 1.5-2.6) for adverse neonatal outcome.
Gestational risk was the main factor associated with poor maternal and neonatal
outcome. Cesarean delivery was not directly associated with poor maternal outcome
but increased the chances of unfavorable neonatal outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(11):511-515
DOI 10.1590/S0100-72032013001100006
PURPOSE: To evaluate the incidence of maternal and fetal repercussions and glycemic control in women with Gestational Diabetes Mellitus (GDM) using a fasting glucose of 85 mg/dL in the first trimester as a cut-off point and to correlate it with risk factors. METHODS: The medical records of pregnant women followed in the outpatient antenatal high-risk service (PNAR) of HRAN from January 2011 to March 2012 were reviewed and those women diagnosed with GDM were selected for contact and for prenatal card verification. We collected data of age, parity, fasting glucose during the first quarter, the value of the Oral Glucose Tolerance Test (OGTT), Body Mass Index (BMI), mode of delivery, form of control, effects and fetal risk factors for GDM. Statistical analysis was performed using the PSPP 0.6.2 software and consisted of descriptive analysis of frequencies, χ2 test for categorical variables, Student's t-test for independent samples, and Pearson test for correlations, with the level of significance set at 5%. RESULTS: From 408 pregnant women enrolled, 105 were diagnosed with GDM and 71 had complete records or answered to the contact in order to provide the missing information. The GDM-fasting <85 (fasting glucose <85 mg/dL at the first prenatal visit, in the first trimester) group consisted of 29 (40.8%) women and the GDM-fasting >85 (fasting glucose >85 mg/dL at the first prenatal visit, in the first trimester) consisted of 42 (59.1%) women. It was observed that few patients (five in the GDM-fasting <85 group and three in the GDM-fasting >85 group) had no risk factors for GDM. There was a major need for control with insulin in patients of the GDM-fasting >85 group. There was no significant difference related to fetal impact or mode of delivery between the groups. CONCLUSIONS: The first trimester fasting glycemia, with a cut-off value of 85 mg/dL alone or associated with risk factors, does not seem to be a good single predictor of the maternal-fetal effects of GDM.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(11):497-502
DOI 10.1590/S0100-72032013001100004
PURPOSE: To analyze the prevalence of and factors associated with fragility fractures in Brazilian women aged 50 years and older. METHODS: This cross-sectional population survey, conducted between May 10 and October 31, 2011, included 622 women aged >50 years living in a city in southeastern Brazil. A questionnaire was administered to each woman by a trained interviewer. The associations between the occurrence of a fragility fracture after age 50 years and sociodemographic data, health-related habits and problems, self-perception of health and evaluation of functional capacity were determined by the χ2 test and Poisson regression using the backward selection criteria. RESULTS: The mean age of the 622 women was 64.1 years. The prevalence of fragility fractures was 10.8%, with 1.8% reporting hip fracture. In the final statistical model, a longer time since menopause (PR 1.03; 95%CI 1.01-1.05; p<0.01) and osteoporosis (PR 1.97; 95%CI 1.27-3.08; p<0.01) were associated with a higher prevalence of fractures. CONCLUSIONS: These findings may provide a better understanding of the risk factors associated with fragility fractures in Brazilian women and emphasize the importance of performing bone densitometry.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(11):490-496
DOI 10.1590/S0100-72032013001100003
PURPOSE: It was to evaluate the frequency and the risk factors of falls in early postmenopausal women. METHODS: A cross-sectional study was conducted on 358 women (age: 45-65 years and amenorrhea >12 months) with time since menopause <10 years. Exclusion criteria were: neurological or musculoskeletal disorders, vestibulopathies, uncorrected visual deficit, uncontrolled hypertension and postural hypotension, or drug use (sedative and hypnotic agents). A fall was identified as an unexpected unintentional change in position which causes an individual to remain in a lower level in relation to the initial position. The history of self-reported falls during the previous 24 months, and clinical and anthropometric data (body mass index (BMI) and waist circumference (WC)) and bone densitometric measures were analyzed. For statistical analysis, c² trend test and the logistic regression method (odds ratio (OR)) were used for the comparison between groups of women with and without falls. RESULTS: Of the 358 women, 48.0% (172/358) had a history of falls and 17.4% (30/172) had fractures. The fall occurred indoors (at home) in 58.7% (101/172). The mean age was 53.7±6.5 years, time since menopause 5.8±3.5 years, BMI 28.3±4.6 kg/m² and WC 89.0±11.4 cm. There were differences as the occurrence of smoking and diabetes, with greater frequency among fallers vs. non-fallers, 25.6 versus 16.1% and 12.8 versus 5.9%, respectively (p<0.05). By evaluating the risk of falls in the presence of influential variables, it was observed that risk increased with current smoking status (OR 1.93; 95%CI 1.01-3.71), whereas other clinical and anthropometric variables did not influence this risk. CONCLUSIONS: In early postmenopausal women there was higher frequency of falls. Current smoking was clinical indicators of risk for falls. With the recognition of factors for falling, preventive measures become important, as the orientation of abolishing smoking.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(1):29-34
DOI 10.1590/S0100-72032014000100007
To evaluate the maternal risk factors that require newborn assistance in neonatal Intensive Care Units (ICU).
A prospective observational case-control study was conducted on 222 pregnant women (1:1 case-control ratio) attended at a public maternity. The following variables were analyzed in the puerperae: age at menarche, age at first sexual intercourse, history of chronic diseases, habits, prenatal care, obstetric history, clinical complications during pregnancy and childbirth, and sociodemographic variables. The variables of the newborns were: Apgar scores, gestational age, birth weight, presence or absence of malformation, need for resuscitation, and complications during the first 24 hours. Proportions were compared using the Fisher exact test or the Person γ2 test. Multivariable models were developed by logistic regression analysis using adjusted Odds Ratio with a 95% confidence interval (CI).
Regarding reproductive history, ≥3 pregnancies and 2 or 3 previous cesareans were sytatistically significant (p=0.0 and 0.0, respectively). Among the complications that required assistance in the neonatal ICU, prematurity was responsible for 61 cases (55.5%), followed by risk of intrapartum infection in 46 cases (41.8%). Regarding the maternal history, the presence of hypertensive disease showed statistical significance (p=0.0). Premature rupture of membranes was strongly associated with the need for the neonatal ICU (Odds Ratio - OR=6.1, 95%CI 2.6-14.4).
Premature rupture of membranes and hypertensive disease should receive special attention in prenatal care due to their strong association with newborns requiring assistance in the neonatal ICU.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(9):413-420
DOI 10.1590/S0100-72032013000900006
PURPOSE: To characterize and compare clinical, anthropometric and biochemical-metabolic variables in patients with polycystic ovary syndrome (PCOS), stratified according to body mass index (BMI). METHODS: A cross-sectional study conducted on 78 women aged 18 to 45 years with a clinical diagnosis of PCOS by the Rotterdam criteria. Patients were stratified according to BMI. The variables analyzed were: age, marital status, physical inactivity, menstrual irregularity, blood pressure (BP), anthropometric measurements, lipid profile, fasting glucose, and hormone measurements. To compare the variables between the different BMI values we used analysis of variance and the Kruskal-Wallis test. The level of significance was set at 5% for all tests. RESULTS: The patients had a mean age of 26.3 years, 79.5% of them were sedentary and 68% had hyperandrogenism. Waist circumference, waist/hip ratio, waist/height ratio and percentage of body fat were higher in the obese group. The markers of cardiovascular risk (CVR - fasting glucose, systolic and diastolic BP and LDL-cholesterol) were directly proportional to BMI, whereas HDL-cholesterol and SHBG were inversely related to BMI. CONCLUSION: The presence of markers of CVR factors increased proportionally to BMI, indicating that the metabolic profile of obese women with PCOS is more unfavorable than that of non-obese patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(8):379-383
DOI 10.1590/S0100-72032013000800008
PURPOSE: It was to determine the prevalence of Chlamydia trachomatis and the risk factors associated with infection in endocervical specimens from women seen in outpatient Obstetrics and Gynecology. METHODS: Samples of endocervical secretion of 200 women treated at the University Hospital of the Federal University of Rio Grande were analyzed for the presence of C. trachomatis by polymerase chain reaction (PCR) using primers that amplify CT05/CT06 281 base pairs of the main outer membrane protein of C. trachomatis. All participants completed a pre-coded and self-report questionnaire. Data were analyzed with the SPSS 17.0 software; for multivariate analysis it was used Poisson regression. RESULTS: Of the 200 women who were included in the study, the prevalence of infection with C. trachomatis was 11% (22 patients) and these 55 (27.5%) were positive for HPV. Risk factors associated with infection by C. trachomatis were: 8 years or less of schooling (p<0.001), family income below the poverty level (p=0.005), first intercourse at age 15 or less (p=0.04) and being a carrier of the virus HIV (p<0.001). After multivariate analysis, only the variables of schooling or less than eight years (PR 6.0; 95%CI 1.26 - 29.0; p=0.02) and presence of HIV (RP 14.1; 95%CI 3.4 - 57.5; p<0.001) remained statistically significant. CONCLUSIONS: The prevalence of C. trachomatis in endocervical specimens by PCR was 11%. The factors associated with a higher infection by C. trachomatis were lower education and being HIV positive.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(5):226-232
DOI 10.1590/S0100-72032013000500007
PURPOSE: To determine the HPV prevalence and genotypes and to identify factors associated with infection in pregnant and non-pregnant women with positive or negative HIV-1, treated in Gynecology and Obstetrics Ambulatories and in Health Primary Units, in Rio Grande, Rio Grande do Sul State, Brazil. METHODS: Cervical cells samples from 302 patients were analyzed for HPV presence and genotypes were determined by nested and sequencing polymerase chain reaction. We calculated prevalence ratios associated with the studied variables by Fisher's exact or χ² tests, and Poisson's regression. Women with insufficient material were excluded from the study. RESULTS: HPV was detected in 55 of the 302 women included in the study (18.2%); of these, 31 were pregnant, showing a significant association for HPV (p=0.04) when compared to non-pregnant ones. Risk factors for the infection were: patients aged <20 years-old (p=0.04), early initiation of sexual life (p=0.04), absence of cytological test (p=0.01), diagnosis of altered cytology (p=0.001), and counting <349 cells/mm³ (p=0.05). However, multi-parity was found to be a protective factor for the infection (p=0.01). Multivariate analysis showed that age <20 years-old (PR=2.8; 95%CI 1.0 - 7.7, p=0.04) and an altered cytological result (PR=11.1; 95%CI 3.0 - 4.1, p=0.001) were significantly associated with infection. HPV genotype was determined in 47 samples (85.4%) presenting one genotype per infection: eight HPV 16 and 58; six HPV 6; four HPV 18 and 33; three HPV 53 and 82; two HPV 83 and 61; one HPV 31, 35, 45, 64, 68, 71 and 85. CONCLUSIONS: The prevalence of HPV detection was 18.2%, the most frequent genotypes were 16 and 58, and sociodemographic and gynecological factors were associated with viral infection.