Articles - Revista Brasileira de Ginecologia e Obstetrícia

Abstract

The hypothesis of fetal origins to adult diseases proposes that metabolic chronic disorders, including cardiovascular diseases, diabetes, and hypertension originate in the developmental plasticity due to intrauterine insults. These processes involve an adaptative response by the fetus to changes in the environmental signals, which can promote the reset of hormones and of the metabolism to establish a “thrifty phenotype”. Metabolic alterations during intrauterine growth restriction can modify the fetal programming. The present nonsystematic review intended to summarize historical and current references that indicated that developmental origins of health and disease (DOHaD) occur as a consequence of altered maternal and fetal metabolic pathways. The purpose is to highlight the potential implications of growth factors and adipokines in “developmental programming”, which could interfere in the development by controlling fetal growth patterns. These changes affect the structure and the functional capacity of various organs, including the brain, the kidneys, and the pancreas. These investigations may improve the approach to optimizing antenatal as well as perinatal care aimed to protect newborns against long-termchronic diseases.

Abstract

Objective

The aim of the current review is to present a systematic evaluation of reported human placental findings in cases of zika virus (ZIKV) infection.

Data

sources We reviewed the EMBASE, PUBMED, and SCIELO databases until June 2019, without language restrictions. Selection of studies The search terms placenta AND zika virus were used. The inclusion criteria of the studies were studies that reported placental findings in humans. Experimental studies, reviews, notes or editorials were excluded. A total of 436 studies were retrieved; after duplicate exclusion, 243 articles had their titles screened, and 128 had their abstract read; of those, 32 were included in the final analysis (18 case reports, 10 case series, and 4 cohorts)

Data collection

We collected data concerning the author, year of publication, study design, number of participants, number of placental samples, onset of symptoms, perinatal outcomes, and main findings on histological analysis.

Data synthesis

The placental pathologic findings were described as mild and nonspecific, similar to those of other placental infections, including chronic placentitis, chronic villitis, increased Hofbauer cells, irregular fibrin deposits, increased mononuclear cells in the villus stroma, villous immaturity, edema, hypervascularization, stromal fibrosis, calcification, and focal necrosis of syncytiotrophoblasts.

Conclusion

Zika infection presents unspecific placental findings, similar to other infections in the toxoplasmosis, other agents, rubella, cytomegalovirus, and herpes (TORCH)group. Characterizing and standardizing placental findings after zika virus infection is key to understanding the mechanisms of congenital diseases.

Abstract

Objective

To evaluate the ability of the pubic arch angle (PAA) as measured by transperineal ultrasonography during labor to predict the delivery type and cephalic pole disengagement mode.

Methods

The present prospective cross-sectional study included 221 women in singleton-gestational labor ≥ 37 weeks with cephalic fetuses who underwent PAA measurement using transperineal ultrasonography. These measurements were correlated with the delivery type, cephalic pole disengagement mode, and fetal and maternal characteristics.

Results

Out of the subjects, 153 (69.2%) had spontaneous vaginal delivery, 7 (3.2%) gave birth by forceps, and 61 (27.6%) delivered by cesarean section. For the analysis, deliveries were divided into two groups: vaginal and surgical (forceps and cesarean). The mean PAA was 102 ± 7.5º (range, 79.3-117.7º). No statistically significant difference was observed in delivery type (102.6 ± 7.2º versus 100.8 ± 7.9º, p = 0.105). The occipitoanterior position was seen in 94.1% of the fetuses and the occipitoposterior position in 5.8%. A narrower PAA was found in the group of surgical deliveries (97.9 ± 9.6º versus 102.6 ± 7.3º, p = 0.049). Multivariate regression analysis showed that PAA was a predictive variable for the occurrence of head disengagement in occipital varieties after birth (odds ratio, 0.9; 95% confidence interval, 0.82-0.99; p = 0.026).

Conclusion

Ultrasonographic measurement of the PAA was not a predictor of delivery type, but was associated with the persistence of occipital varieties after birth.

Abstract

Objective

To reveal the changes in the quality of life reported by women with Human papillomavirus (HPV)-induced lesions.

Methods

This is a cross-sectional, descriptive-exploratory study of a qualitative approach performed from June to August 2016. Semi-structured face-to-face interviews based on five questions on the concept of quality of life were used. The data were submitted to thematic analysis. All ethical aspects have been contemplated.

Results

A total of 20 women aged between 25 and 59 years old were interviewed. From the analysis of the data, the following thematic units emerged: physical and emotional changes, especially complaints of pruritus, discharge and pain, worry, fear, shame and sadness; changes in sexual and affective relationships with decreased libido, dyspareunia and interruption of sexual activity; changes in social relationships resulting in absenteeism at work.

Conclusion

Human papillomavirus infection impairs the quality of life of women as it significantly affects sexual, affective, physical, emotional, and everyday habits. Therefore, HPV infection can lead to exponential changes in the quality of life of women, which can be mitigated by the availability of sources of support such as family, friends and the multi-professional team, helping to improve knowledge and cope with HPV.

Abstract

Objective

The present study aimed to understand patient perception of the adverse effects of contraceptives to improve health care and adherence to treatment.

Methods

An online questionnaire was available for women in Brazil to respond to assess their perception of adverse effects and their relationship with contraceptive methods.

Results

Of all 536 women who responded, 346 (64.6%) reported current contraceptive use. One hundred and twenty-two (122-34.8%) women reported having already stopped using contraception because of the adverse effects. As for the contraceptive method used, the most frequent was the combined oral contraceptive (212-39.6%). When we calculated the relative risk for headache, there was a relative risk of 2.1282 (1.3425-3.3739; 95% CI), suggesting that the use of pills increases the risk of headache, as well as edema, in which a relative risk of 1.4435 (1.0177-2.0474; 95% CI) was observed. For low libido, the use of oral hormonal contraceptives was also shown to be a risk factor since its relative risk was 1.8805 (1.3527-2.6142; 95% CI). As for acne, the use of hormonal contraceptives proved to be a protective factor, with a relative risk of 0.3015 (0.1789-0.5082; 95% CI).

Conclusion

The choice of a contraceptive method must always be individualized, and the patients must be equal participants in the process knowing the expected benefits and harms of each method and hormone, when present.

Abstract

Objective

Pregnancy after bariatric surgery is a reality of the 21^st century and therefore is essential that all obstetricians know how to manage it. The most prevalent nutritional deficiency is iron deficiency and, consequently, anemia. Although bariatric surgery and pregnancy are already risk factors for anemia, we evaluated in our study if there were any other risk factors and actions to improve hemoglobin levels in this population.

Methods

We performed a retrospective cohort study, and performed frequency measurements and analyzes of odds ratio, X² and Fisher exact test to evaluate the risk factors.

Results

We evaluated 44 pregnancies after bariatric surgery, with an incidence of anemia of 62%, and the only identifiable risk factor for anemia was being black. As for the treatment, the iron salt used for oral supplementation did not associate with anemia risk, and in 27% of the patients, the adjustment of the oral dosage was enough for improvement in hemoglobin levels, but in 36% supplementation with intravenous iron was necessary.

Conclusion

Being black is a risk factor for anemia. The type of iron salt does not correlate with the incidence of anemia, and for the treatment and improvement of iron dosages, it seems an effective increase in iron intake.

Abstract

Objective

The study was conducted to determine the quality of life and depression of women with gestational diabetes during pregnancy and the postpartum period.

Methods

100 pregnant women with gestational diabetes and 100 healthy pregnant women were included in the present study. Data were obtained from pregnant women in their third trimester who agreed to take part in the study. The data was collected during the third trimester and six to eight weeks after the baby was born. The data were obtained by socio-demographic characteristics form, postpartum data collection form, the MOS 36 Item Short Form Health Survey and Center for Epidemiologic Studies Depression Scale (CESD).

Results

The mean age of pregnant women with gestational diabetes in the study was the same as the average age of healthy pregnant women. The CESD score of pregnant women with gestational diabetes was 26,77 ± 4,85 while the corresponding score was 25,19 ± 4,43 for healthy women. Additionally, the score in the postpartum period was 32.47 ± 5.94 for pregnant women with gestational diabetes and 35.47 ± 8.33 for healthy pregnant women. CESD scores were found to be higher than the cut-off score of 16 in both groups, and the mean scores increased during the postpartum period.

Conclusion

During the postpartum period, the quality of life of pregnant women with gestational diabetes was affected more negatively than healthy pregnant women. Depressive symptoms of women with both gestational diabetes and healthy pregnancy were found to be high in pregnancy and postpartum periods.