Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):548-553
DOI 10.1590/S0100-72032005000900008
PURPOSE: to study maternal mortality caused by hypertension during pregnancy, determining the mortality rate and the profile of those patients. METHODS: a retrospective study of maternal mortality caused by hypertension at the Maternidade Escola Assis Chateaubriand of the Universidade Federal do Ceará, from 1981 to 2003. General maternal mortality rate (MMR) and specific maternal mortality rate due to hypertension were evaluated, as well as these patients' epidemiological and clinical data. RESULTS: two hundred and ninety six cases of maternal death and 184,672 of live births were recorded, with a MMR of 160.28/100.000 live births. The most frequent cause of death was hypertension (41.2%); with 122 cases and an annual average of 5.3 deaths, and hypertension MMR of 60.10/100,000 live births. The women's age range varied from 13 to 42 years with an average of 26 years. Most of the patients came from the interior of the state. Deaths occurred predominantly in the first 24 hours after admission to the hospital (50.9%). Deaths were predominant in the first pregnancy (40.3%) and in women with 31 to 38 weeks gestational age (48.2%). Eclampsia occurred in 73 patients (64.1%) and was predominant along the gestational period (53.4%). There were 101 deaths in the puerperium. Cesarean section (62.3%) and general anesthesia (45.1%) prevailed. A high percentage of patients (61.4%) had no prenatal care. CONCLUSIONS: General MMR and hypertension MMR were high, the latter being the main cause of death in our maternity hospital.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(9):554-560
DOI 10.1590/S0100-72032005000900009
PURPOSE: to evaluate the performance of cytogenetic analysis, fluorescent in situ hybridization (FISH) and polymerase chain reaction (PCR) in the study of numerical chromosomal anomalies and in fetal sex determination of spontaneous abortion material. METHODS: cytogenetic analysis was performed on 219 spontaneous abortion specimens. Forty of these cases were also submitted to fetal sex determination using nested-PCR. Thirty-two of these cases were selected due to failed cytogenetic culture and the other eight were selected randomly. Twenty samples were submitted to the FISH technique, using probes for chromosomes 13, 18, 21, X and Y. Thirteen of these samples were selected due to failed cytogenetic culture and the other seven were randomly selected. The success rates of each technique were compared using the chi2 test and an established p<0.05 level of significance. The results of samples submitted to more than one test were evaluated for accuracy, using the cytogenetic result as the gold standard. RESULTS: cytogenetic analysis was successful in 84.9% of the samples and in 51.1% of them the results were abnormal: 65.2% trisomy, 17.9% triploidy, 9.4% tetraploidy, 4.2% chromosome X monosomy, and 1.1% each for double trisomy, tetrasomy and structural abnormality. The most frequent trisomy was that of chromosome 16 (39%). The success rate of FISH and PCR techniques (90%) did nod differ significantly from the cytogenetic analysis. In all cases submitted to more than one test, the results were identical to those obtained through cytogenetic analysis. Samples that failed to grow on cytogenetic test and that were submitted to other techniques of molecular biology had a success rate of 87.5 and 84.6% for PCR and FISH, respectively. CONCLUSION: cytogenetic analysis of spontaneous abortions had a high success rate and chromosomal anomalies were identified in over half of the cases. Molecular biology techniques (PCR and FISH) complemented the cytogenetic study and proved to be reliable in the detection of numerical chromosomal anomalies and in fetal sex determination.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(8):442-449
DOI 10.1590/S0100-72032005000800002
PURPOSE: to establish the frequency of acute toxoplasmosis in pregnant women, vertical transmission rate and the perinatal results of the infected fetuses and also to evaluate the relationship between the most used maternal-fetal diagnostic tests for toxoplasmosis during pregnancy and the relationship between age and acute toxoplasmosis infection during pregnancy. METHODS: longitudinal prospective study of 32,512 pregnant women attended by The Pregnancy Protection Program of the State of Mato Grosso do Sul - Brazil, from November 2002 to October 2003. ELISA (IgG and IgM) and IgG avidity test were performed for maternal diagnosis and amniotic fluid PCR for fetal investigation of the infection. The relationship between data was analyzed statistically by the chi2 or two-sided Fisher's exact test in contingency tables. RESULTS: a 0.42% frequency of acute Toxoplasma gondii infection among pregnant population was found, where 92% were previously exposed and 8% were susceptible. Among IgM-positive pregnant women, the age ranged from 14 to 39 years, with a mean of 23±5.9 years. There was no statistically significant relationship between age and maternal acute T. gondii infection (p=0.73). The vertical transmission rate was 3.9%. A statistically significant relationship was shown (p=0.001) between a lower avidity IgG test (<30%) and the presence of fetal infection and a higher IgG avidity test (>60%) and the absence of fetal infection. There was a statistically significant association (p=0.001) between fetal infection (amniotic fluid PCR) and neonatal infection. CONCLUSIONS: maternal acute toxoplasmosis frequency was lower than the Brazilian national parameters, whereas vertical transmission rate did not differ from the rates found in other studies. The IgG avidity test, when associated with gestational age and the examination date, was useful to evaluate the therapeutical options and to consider the risk of vertical transmission when performed before 12 weeks. Positive PCR in amniotic fluid showed a positive relationship with the worst neonatal prognosis, being a specific method in diagnosing intrauterine fetal infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(8):450-455
DOI 10.1590/S0100-72032005000800003
PURPOSE: to test a new, noninvasive method for the diagnosis of fetal anemia in red blood cell isoimmunized pregnancies. METHODS: the index obtained by the ratio between the ultrasonographic measurement of the biventricular outer dimension (BVOD) and femur length (both in centimeters) was correlated with fetal hemoglobin values in a cross-sectional study. Fifty-nine fetuses of isoimmunized pregnancies selected for invasive treatment and submitted to 130 cordocenteses for the diagnosis and treatment of anemia were included in the study. The cardiofemoral index was obtained immediately before the cordocentesis and the fetal hemoglobin index was obtained from fetal blood samples. Linear regression was carried out to assess the correlation between the index and fetal hemoglobin; ROC curve was applied to determine the most accurate cutoff for the diagnosis of the fetal hemoglobin concentration below 10g/dl. RESULTS: BVOD measurement varied from 1.6 to 4.7 cm (average 2.5±1.3cm), and length of the femur, from 3.0 to 6.9 cm (average 4.3±0.9 cm). The cardiofemoral index varied from 0.4 to 1.0 (average 0.6±0.1). A significant inverse correlation between the cardiofemoral index and fetal hemoglobin (R²=0.37 and p<0.0001) was observed. The cutoff of 0.60 was the best to predict a level of fetal hemoglobin below or equal to 10.0g/dl: 80.85% sensitivity, 83.13% specificity, 73.8% positive predictive value, and 88.46% negative predictive value, in the diagnosis of fetuses anemia. CONCLUSION: the cardiofemoral index allows for good accuracy in the prediction of fetal hemoglobin concentration below 10g/dl in red blood cell isoimmunized pregnancies. It may thus be applied as a noninvasive method to the diagnosis of this pathology.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(8):456-460
DOI 10.1590/S0100-72032005000800004
PURPOSE: to analyze the effectiveness and safety of exclusive hospital parenteral antibiotic therapy to treat puerperal endometritis in a population of low socioeconomic level. METHODS: a prospective clinical trial evaluated 21 puerperae with a diagnosis of postpartum endometritis, whose deliveries occurred at a university hospital by cesarean section (52.4%) or normal delivery (47.6%). The sample was characterized by low socioeconomic and educational levels. The patients were submitted to a regimen of exclusive parenteral antibiotic, only during the hospitalization period (ATP-EX group). These results were compared with results obtained in a historical cohort in the same hospital (20 cases) submitted to a regimen of hospital parenteral antibiotic therapy complemented with ambulatory oral treatment (ATP+VO group). The patients were evaluated clinically on the occasion of periodic return visits in order to identify cases of recurrence and infectious complications. RESULTS: one patient from the ATP+VO group needed to be readmitted to the hospital on the 6th day after her discharge from the hospital with a diagnosis of endometritis recrudescence. No complications were observed among patients from ATP-EX group. CONCLUSION: for the treatment of puerperal endometritis, there was no additional advantage in using supplementary oral antibiotic therapy after patient discharge. The results using exclusive parenteral antibiotic treatment during hospitalization time indicate that it is effective and can be safely used in a population of low socioeconomic level.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(8):461-466
DOI 10.1590/S0100-72032005000800005
PURPOSE: to compare the effectiveness of glibenclamide and acarbose with that of insulin for the treatment of gestational diabetes mellitus (GDM), in regard to maternal glucose levels, newborn (NB) weight and neonatal hypoglycemia. METHODS: an open, randomized prospective study was carried out. Fifty-seven patients diagnosed with GDM were included. These patients required dietary control and additional therapy. Pregnant women were randomly alloted to one of three groups with different therapies: a control group making use of insulin therapy, a study group making use of glibenclamide and a study group making use of acarbose. The study took seven months (from October 1st 2003 to May 1st 2004). Assessed outcomes were maternal glucose levels in the prenatal period, the need for replacing therapy to achieve glucose level control, NB weight and neonatal hypoglycemia. Statistical analysis was determined by ANOVA with the level of significance set at 5%. RESULTS: maternal characteristics were similar in all the three groups. Glucose level control was not obtained in three of the patients who used glibenclamide (15%) and in seven (38.8%) of the patients who used acarbose. Regarding fasting and postprandial glucose level rates and average NB weight no difference between the three groups was observed. No statistical difference was found for fasting or postprandial glucose levels and average NB weight in any of the three groups. The rate of large for gestational age fetuses was 5.2, 31.5 and 11.1% for the groups treated with insulin, glibenclamide and acarbose, respectively. Neonatal hypoglycemia was observed in six NB. Four of these were from the glibenclamide group (21.0%). CONCLUSIONS: glibenclamide was more effective for glucose level control than acarbose but neither were more efficient than insulin. NB children whose mothers had been alloted to the glibenclamide group showed a higher rate of macrosomia and neonatal hypoglycemia when compared to those newborns whose mothers were subjected to other therapies.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(8):467-472
DOI 10.1590/S0100-72032005000800006
PURPOSE: to evaluate the prevalence of subclinical hypothyroidism and its effects on lipidic profile and bone mineral density (BMD) in postmenopausal women. METHODS: a cross-sectional study with survey of data from medical records of patients attended at a climacteric outpatient clinic. Inclusion criteria: postmenopausal women with measured thyroid-stimulating hormone (TSH) and free thyroxin (T4-L). Exclusion criteria: hyperthyroidism and thyroid cancer. Values of TSH >5.0 mIU/ml and normal T4-L were considered to be subclinical hypothyroidism. The 329 selected women (55.2±6.4 years) were divided into three groups: normal thyroid function (control) (n=208), subclinical hypothyroidism (n=53) and clinical hypothyroidism under treatment (n=59). Clinical data, hormonal therapy use, body mass index (BMI=kg/m²), lipid profile (total cholesterol, HDL, LDL, triglycerides) and BMD of lumbar column and femur were obtained. RESULTS: subclinical hypothyroidism was diagnosed in 16.1% of the cases. The groups were homogeneous regarding clinical features, BMI or lipidic profile. BMD in lumbar column and femur was lower in subclinical and clinical hypothyroidism than in euthyroidism (p<0.001). There was a negative correlation between values of TSH and BMD of lumbar column and femur (p<0.001). There was no correlation between TSH values and age, menopause time, BMI, and lipid profile. The total of hormonal therapy users was 65.1%, mean duration of 3.43±2.42 years, not differing between the groups. CONCLUSION: subclinical hypothyroidism with prevalence of 16.1% in postmenopausal women was associated with lower BMD, with no effects on lipid profile.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(8):473-478
DOI 10.1590/S0100-72032005000800007
PURPOSE: to analyze the correlation between PROGINS polymorphism and breast cancer. METHODS: a case-control study was carried out from April to October 2004. The genotypes of 50 women with breast cancer and 49 healthy women were analyzed. The 306-base pair Alu insertion polymorphism in the G intron of progesterone receptor gene was detected by polymerase chain reaction and analyzed on 2% agarose gel stained with ethidium bromide. The control and experimental groups were compared regarding genotypes using the statistical Epi-Info 6.0 program and for frequencies the exact Fisher test or chi2 test were used. p value smaller p than 5% was considered to be significant. RESULTS: in relation to PROGINS we found in the studied population a prevalence of 62 (62.6%) wild homozygous, 35 (35.3%) heterozygous individuals and two (2.1%) cases with the presence of the mutation. Regarding PROGINS polymorphism, significance was not evidenced when cases and controls were compared, as related to homozygosis (62 vs 65.3%), heterozygosis (36 vs 34,6%) or the mutation (2.0 vs 2.1%), with p=0.920 (OR=1.01), 0.891 (OR=1.06), and 0.988 (OR=1.10), respectively. CONCLUSIONS: the results show that single-gene PROGINS polymorphism does not confer a substantial risk of breast cancer to its carriers.