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Original Article12-17-2021
Intraoperative Assessment of Endogenous Microbiota in the Breast
- Henrique Stachon,
- Vanessa Amoroso
, - Cicero Urban ,
- Pamela Bioni,
- Cleverton Spautz , [ ... ],
- Juliane Monteiro
Abstract
Original ArticleIntraoperative Assessment of Endogenous Microbiota in the Breast
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(10):759-764
- Henrique Stachon,
- Vanessa Amoroso ,
- Cicero Urban ,
- Pamela Bioni,
- Cleverton Spautz ,
- Rubens Silveira de Lima ,
- Karina Anselmi ,
- Flávia Kuroda ,
- Iris Rabinovich ,
- Thabata Alvarez ,
- Juliane Monteiro
Views227Abstract
Objective:
Breast surgery is considered a clean surgery; however, the rates of infection range between 3 and 15%. The objective of the present study was to intraoperatively investigate the presence of autochthonous microbiota in the breast.
Methods:
Pieces of breast tissue collected from 49 patients who underwent elective breast surgery (reconstructive, diagnostic, or oncologic) were cultured. The pieces of breast tissue were approximately 1 cm in diameter and were removed from the retroareolar area, medial quadrant, and lateral quadrant. Each piece of tissue was incubated in brain heart infusion (BHI) broth for 7 days at 37°C, and in cases in which the medium became turbid due to microorganism growth, the samples were placed in Petri dishes for culturing and isolating strains and for identifying species using an automated counter.
Results:
Microorganism growth was observed in the samples of 10 of the 49 patients (20.4%) and in 11 of the 218 pieces of tissue (5%). The detected species were Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus epidermidis, Sphingomonas paucimobilis, and Aeromonas salmonicida. No patient with positive samples had clinical infection postoperatively.
Conclusion:
The presence of these bacteria in breast tissue in approximately 20% of the patients in this series suggests that breast surgery should be considered a potential source of contamination that may have implications for adverse reactions to breast implants and should be studied in the near future for their oncological implications in breast implant-associated large-cell lymphoma etiology.
Key-words biofilmbreast conservative surgerycapsular contracturenipple-sparing mastectomysurgery infectionSee moreViews227
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleIntraoperative Assessment of Endogenous Microbiota in the Breast
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(10):759-764
- Henrique Stachon,
- Vanessa Amoroso ,
- Cicero Urban ,
- Pamela Bioni,
- Cleverton Spautz ,
- Rubens Silveira de Lima ,
- Karina Anselmi ,
- Flávia Kuroda ,
- Iris Rabinovich ,
- Thabata Alvarez ,
- Juliane Monteiro
Views227Abstract
Objective:
Breast surgery is considered a clean surgery; however, the rates of infection range between 3 and 15%. The objective of the present study was to intraoperatively investigate the presence of autochthonous microbiota in the breast.
Methods:
Pieces of breast tissue collected from 49 patients who underwent elective breast surgery (reconstructive, diagnostic, or oncologic) were cultured. The pieces of breast tissue were approximately 1 cm in diameter and were removed from the retroareolar area, medial quadrant, and lateral quadrant. Each piece of tissue was incubated in brain heart infusion (BHI) broth for 7 days at 37°C, and in cases in which the medium became turbid due to microorganism growth, the samples were placed in Petri dishes for culturing and isolating strains and for identifying species using an automated counter.
Results:
Microorganism growth was observed in the samples of 10 of the 49 patients (20.4%) and in 11 of the 218 pieces of tissue (5%). The detected species were Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus epidermidis, Sphingomonas paucimobilis, and Aeromonas salmonicida. No patient with positive samples had clinical infection postoperatively.
Conclusion:
The presence of these bacteria in breast tissue in approximately 20% of the patients in this series suggests that breast surgery should be considered a potential source of contamination that may have implications for adverse reactions to breast implants and should be studied in the near future for their oncological implications in breast implant-associated large-cell lymphoma etiology.
Key-words biofilmbreast conservative surgerycapsular contracturenipple-sparing mastectomysurgery infectionSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article11-29-2021
Psychological Problems Experienced by Patients with Bowel Endometriosis Awaiting Surgery
- Helizabet Salomão Abdalla Ayroza Ribeiro ,
- Andresa Maria Felipe de Paiva ,
- Beatriz da Costa Porto Taliberti ,
- Anna Luiza Lobão Gonçalves ,
- Renata Pereira Condes , [ ... ],
- Paulo Augusto Galvão Ayroza Ribeiro
Abstract
Original ArticlePsychological Problems Experienced by Patients with Bowel Endometriosis Awaiting Surgery
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):676-681
- Helizabet Salomão Abdalla Ayroza Ribeiro ,
- Andresa Maria Felipe de Paiva ,
- Beatriz da Costa Porto Taliberti ,
- Anna Luiza Lobão Gonçalves ,
- Renata Pereira Condes ,
- Paulo Augusto Galvão Ayroza Ribeiro
Views224Abstract
Objective
To assess the most common psychological disturbances in women with deep endometriosis and bowel involvement who are waiting surgical treatment and to evaluate what forms of coping are used to solve the problem.
Methods
This was a cross-sectional observational study of 40 women diagnosed with deep endometriosis and intestinal symptoms. They completed two questionnaires: one for anxiety and depression (Hospital Anxiety and Depression Scale [ HADS]) and the Scale of Mode of Confronting Problems (EMEP, in the Portuguese acronym).
Results
We found that 77.1% of the patients had anxiety and depression, with anxiety being the most prevalent (87.5% of the patients); 90% of the patients used problem focused and religious introspection as their main modes of confronting problems.
Conclusion
In the use of the HADS questionary, two psychological aspects were the most present in women with deep endometriosis awaiting surgical treatment: anxiety and depression. The most used forms of coping to solve the problem were problem coping and religious practices.
Key-words anxiety disordersCross-sectional studiesdepressive disordersEndometriosispsychological adaptationSee moreViews224This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticlePsychological Problems Experienced by Patients with Bowel Endometriosis Awaiting Surgery
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):676-681
- Helizabet Salomão Abdalla Ayroza Ribeiro ,
- Andresa Maria Felipe de Paiva ,
- Beatriz da Costa Porto Taliberti ,
- Anna Luiza Lobão Gonçalves ,
- Renata Pereira Condes ,
- Paulo Augusto Galvão Ayroza Ribeiro
Views224Abstract
Objective
To assess the most common psychological disturbances in women with deep endometriosis and bowel involvement who are waiting surgical treatment and to evaluate what forms of coping are used to solve the problem.
Methods
This was a cross-sectional observational study of 40 women diagnosed with deep endometriosis and intestinal symptoms. They completed two questionnaires: one for anxiety and depression (Hospital Anxiety and Depression Scale [ HADS]) and the Scale of Mode of Confronting Problems (EMEP, in the Portuguese acronym).
Results
We found that 77.1% of the patients had anxiety and depression, with anxiety being the most prevalent (87.5% of the patients); 90% of the patients used problem focused and religious introspection as their main modes of confronting problems.
Conclusion
In the use of the HADS questionary, two psychological aspects were the most present in women with deep endometriosis awaiting surgical treatment: anxiety and depression. The most used forms of coping to solve the problem were problem coping and religious practices.
Key-words anxiety disordersCross-sectional studiesdepressive disordersEndometriosispsychological adaptationSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Helizabet Salomão Abdalla Ayroza Ribeiro
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Original Article11-29-2021
Pathways of IFN-alpha Activation in Patients with Cervical Intraepithelial Neoplasia (CIN)
- Nelson Ranieri Tirone ,
- Carolina Guissoni Campos ,
- Kézia Jesus Aguiar Ferreira ,
- Léticia Montes Stark ,
- Jéssica Ferreira Vieira , [ ... ],
- Márcia Antoniazi Michelin
Abstract
Original ArticlePathways of IFN-alpha Activation in Patients with Cervical Intraepithelial Neoplasia (CIN)
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):682-689
- Nelson Ranieri Tirone ,
- Carolina Guissoni Campos ,
- Kézia Jesus Aguiar Ferreira ,
- Léticia Montes Stark ,
- Jéssica Ferreira Vieira ,
- Eddie Fernando Cândido Murta ,
- Márcia Antoniazi Michelin
Views212See moreAbstract
Objective
The aim of the present study was to compare the local and systemic expression of the factors linked to the interferon alpha (IFN-α) activation pathway in different degrees of cervical intraepithelial neoplasia (CIN) and cervical cancer.
Methods
A total of 128 patients with CIN I, CIN II, CIN III and cervical cancer was evaluated. The real-time polymerase chain reaction (RT-PCR) technique was used to evaluate the gene expression of IFNR1, IFNR2, IFN-α, oligoadenylate synthase (2’5′OAS), cytokine signal suppressor 1 (SOCS) 1, SOCS3, signal transducer and transcription activator 1 (STAT1), and IRF9 from 128 biopsies. A total of 46 out of 128 samples were evaluated by flow cytometry for IFNAR1, IFNAR2, STAT1, IRF7 and IFN-α in peripheral blood cells.
Results
Patients with CIN II and III (63 samples) had a low local expression of IFNR1, but not IFNR2. Patients with some degree of injury showed high expression of SOCS1 and SOCS3. Systemically, patients with CIN II and III (20 samples) had a significant increase in IFNR1, IFNR2, STAT1, IRF7, and IFN-α in helper, cytotoxic T lymphocytes, and in monocytes.
Conclusion
Patients with high-grade lesions have increased systemic expression of IFN-α and its activation pathways in helper and cytotoxic T lymphocytes, as well as in monocytes due to an exacerbation of the immune response in these patients. This phenomenon is not accompanied by resolution of the lesion due to a defect in the IFN-α activation pathway that revealed by low local IFNAR1 expression and high local expression of SOCS1 and SOCS3.
Views212This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticlePathways of IFN-alpha Activation in Patients with Cervical Intraepithelial Neoplasia (CIN)
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):682-689
- Nelson Ranieri Tirone ,
- Carolina Guissoni Campos ,
- Kézia Jesus Aguiar Ferreira ,
- Léticia Montes Stark ,
- Jéssica Ferreira Vieira ,
- Eddie Fernando Cândido Murta ,
- Márcia Antoniazi Michelin
Views212See moreAbstract
Objective
The aim of the present study was to compare the local and systemic expression of the factors linked to the interferon alpha (IFN-α) activation pathway in different degrees of cervical intraepithelial neoplasia (CIN) and cervical cancer.
Methods
A total of 128 patients with CIN I, CIN II, CIN III and cervical cancer was evaluated. The real-time polymerase chain reaction (RT-PCR) technique was used to evaluate the gene expression of IFNR1, IFNR2, IFN-α, oligoadenylate synthase (2’5′OAS), cytokine signal suppressor 1 (SOCS) 1, SOCS3, signal transducer and transcription activator 1 (STAT1), and IRF9 from 128 biopsies. A total of 46 out of 128 samples were evaluated by flow cytometry for IFNAR1, IFNAR2, STAT1, IRF7 and IFN-α in peripheral blood cells.
Results
Patients with CIN II and III (63 samples) had a low local expression of IFNR1, but not IFNR2. Patients with some degree of injury showed high expression of SOCS1 and SOCS3. Systemically, patients with CIN II and III (20 samples) had a significant increase in IFNR1, IFNR2, STAT1, IRF7, and IFN-α in helper, cytotoxic T lymphocytes, and in monocytes.
Conclusion
Patients with high-grade lesions have increased systemic expression of IFN-α and its activation pathways in helper and cytotoxic T lymphocytes, as well as in monocytes due to an exacerbation of the immune response in these patients. This phenomenon is not accompanied by resolution of the lesion due to a defect in the IFN-α activation pathway that revealed by low local IFNAR1 expression and high local expression of SOCS1 and SOCS3.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Nelson Ranieri Tirone
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Original Article11-29-2021
Exposed Implant after Immediate Breast Reconstruction – Presentation and Analysis of a Clinical Management Protocol
- Rafael Amin Menezes Hassan ,
- Cícero de Andrade Urban ,
- Maíra Teixeira Dória ,
- Cleverton Cesar Spautz ,
- Iris Rabinovich , [ ... ],
- Rubens Silveira de Lima
Abstract
Original ArticleExposed Implant after Immediate Breast Reconstruction – Presentation and Analysis of a Clinical Management Protocol
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):690-698
- Rafael Amin Menezes Hassan ,
- Cícero de Andrade Urban ,
- Maíra Teixeira Dória ,
- Cleverton Cesar Spautz ,
- Iris Rabinovich ,
- Karina Furlan Anselmi ,
- Eduardo Schunemann Jr ,
- Flávia Kuroda ,
- Bernardo Passos Sobreiro ,
- Rubens Silveira de Lima
Views223See moreAbstract
Objective
Infection and exposure of the implant are some of the most common and concerning complications after implant-based breast reconstruction. Currently, there is no consensus on the management of these complications. The aim of the present study was to review our cases and to present a clinical protocol.
Methods
We conducted a retrospective review of consecutive patients submitted to implant-based breast reconstruction between 2014 and 2016. All patients were managed according to a specific and structured protocol.
Results
Implant exposure occurred in 33 out of 277 (11.9%) implant-based reconstructions. Among these, two patients had history of radiotherapy and had their implant removed; Delayed reconstruction with a myocutaneous flap was performed in both cases. Signs of severe local infection were observed in 12 patients, and another 5 presented with extensive tissue necrosis, and they were all submitted to implant removal; of them, 8 underwent reconstruction with a tissue expander, and 2, with a myocutaneous flap. The remaining 14 patients had no signs of severe infection, previous irradiation or extensive tissue necrosis, and were submitted to primary suture as an attempt to salvage the implant. Of these, 8 cases (57.1%) managed to keep the
Conclusion
Our clinical protocol is based on three key points: history of radiotherapy, severe infection, and extensive tissue necrosis. It is a practical and potentially-reproducible method of managing one of the most common complications of implant-based breast reconstruction.
Views223This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleExposed Implant after Immediate Breast Reconstruction – Presentation and Analysis of a Clinical Management Protocol
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):690-698
- Rafael Amin Menezes Hassan ,
- Cícero de Andrade Urban ,
- Maíra Teixeira Dória ,
- Cleverton Cesar Spautz ,
- Iris Rabinovich ,
- Karina Furlan Anselmi ,
- Eduardo Schunemann Jr ,
- Flávia Kuroda ,
- Bernardo Passos Sobreiro ,
- Rubens Silveira de Lima
Views223See moreAbstract
Objective
Infection and exposure of the implant are some of the most common and concerning complications after implant-based breast reconstruction. Currently, there is no consensus on the management of these complications. The aim of the present study was to review our cases and to present a clinical protocol.
Methods
We conducted a retrospective review of consecutive patients submitted to implant-based breast reconstruction between 2014 and 2016. All patients were managed according to a specific and structured protocol.
Results
Implant exposure occurred in 33 out of 277 (11.9%) implant-based reconstructions. Among these, two patients had history of radiotherapy and had their implant removed; Delayed reconstruction with a myocutaneous flap was performed in both cases. Signs of severe local infection were observed in 12 patients, and another 5 presented with extensive tissue necrosis, and they were all submitted to implant removal; of them, 8 underwent reconstruction with a tissue expander, and 2, with a myocutaneous flap. The remaining 14 patients had no signs of severe infection, previous irradiation or extensive tissue necrosis, and were submitted to primary suture as an attempt to salvage the implant. Of these, 8 cases (57.1%) managed to keep the
Conclusion
Our clinical protocol is based on three key points: history of radiotherapy, severe infection, and extensive tissue necrosis. It is a practical and potentially-reproducible method of managing one of the most common complications of implant-based breast reconstruction.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Rafael Amin Menezes Hassan
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Original Article11-29-2021
Understanding How Health Providers Identify Women with Postpartum Hemorrhage: A Qualitative Study
- Silvana Ferreira Bento ,
- Anderson Borovac-Pinheiro ,
- Erika Zambrano Tanaka ,
- Carla Silveira ,
- Rodolfo Carvalho Pacagnella
Abstract
Original ArticleUnderstanding How Health Providers Identify Women with Postpartum Hemorrhage: A Qualitative Study
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):648-654
- Silvana Ferreira Bento ,
- Anderson Borovac-Pinheiro ,
- Erika Zambrano Tanaka ,
- Carla Silveira ,
- Rodolfo Carvalho Pacagnella
Views215See moreAbstract
Objective
To identify how health providers recognize postpartum hemorrhage early and the difficulties involved in it.
Methods
An exploratory, descriptive study using a qualitative approach through a semi-structured interview technique. In total, 27 health professionals (nursing tech nicians, nurses, medical residents in Gynecology and Obstetrics, hired medical doctors, and medicine professors) working in a tertiary-level hospital of reference in women’s health care in the State of São Paulo, Brazil, participated in the study through an invitation. After they accepted the invitation, they signed the free and informed consent form. All interviews were recorded and transcribed, and a thematic analysis was conducted. We found three analysis categories: a) perception of the severity: “there is something wrong with the women”; b) difficulties in the early diagnosis of postpartum hemorrhage; and c) the process to improve obstetrical care.
Results
Caregivers believe teamwork and communication should be improved. Besides the visual estimation of blood loss, the nursing team is attentive to behavioral symptoms like irritability, while the medical staff follow protocols and look for objective signs, such as altered vital signs.
Conclusion
Besides the objective evaluations, the subjective perceptions of the providers are involved in the clinical judgement regarding the diagnosis of postpartum hemorrhage, and this should be included in a broader diagnosis strategy.
Views215This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleUnderstanding How Health Providers Identify Women with Postpartum Hemorrhage: A Qualitative Study
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):648-654
- Silvana Ferreira Bento ,
- Anderson Borovac-Pinheiro ,
- Erika Zambrano Tanaka ,
- Carla Silveira ,
- Rodolfo Carvalho Pacagnella
Views215See moreAbstract
Objective
To identify how health providers recognize postpartum hemorrhage early and the difficulties involved in it.
Methods
An exploratory, descriptive study using a qualitative approach through a semi-structured interview technique. In total, 27 health professionals (nursing tech nicians, nurses, medical residents in Gynecology and Obstetrics, hired medical doctors, and medicine professors) working in a tertiary-level hospital of reference in women’s health care in the State of São Paulo, Brazil, participated in the study through an invitation. After they accepted the invitation, they signed the free and informed consent form. All interviews were recorded and transcribed, and a thematic analysis was conducted. We found three analysis categories: a) perception of the severity: “there is something wrong with the women”; b) difficulties in the early diagnosis of postpartum hemorrhage; and c) the process to improve obstetrical care.
Results
Caregivers believe teamwork and communication should be improved. Besides the visual estimation of blood loss, the nursing team is attentive to behavioral symptoms like irritability, while the medical staff follow protocols and look for objective signs, such as altered vital signs.
Conclusion
Besides the objective evaluations, the subjective perceptions of the providers are involved in the clinical judgement regarding the diagnosis of postpartum hemorrhage, and this should be included in a broader diagnosis strategy.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Silvana Ferreira Bento
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Original Article11-29-2021
Clinical Experience Over 15 Years with the B-Lynch Compression Suture Technique in the Management of Postpartum Hemorrhage
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):655-661
Abstract
Original ArticleClinical Experience Over 15 Years with the B-Lynch Compression Suture Technique in the Management of Postpartum Hemorrhage
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):655-661
Views228See moreAbstract
Objective
To describe the clinical experience with the B-Lynch technique in the management of postpartum hemorrhage as well as the factors related to the indication of the technique and to present the success rates of the application of the B-Lynch technique.
Methods
Observational, retrospective, cross-sectional, and analytical study. Patient data was obtained through the study of medical records. The study population comprised of patients who underwent hemostatic suture using the B-Lynch technique, including 104 patients within the period from January 1, 2005, to December 31, 2019.
Results
Of the total of 104 patients, 82.7% did not present any complications. Blood transfusion and intensive care unit admission were the most prevalent complications, with 13.5% and 15.4%, respectively. Only 1% of the patients had puerperal and surgical site infections. The factors most related to the application of the technique were the presence of previous cesarean section (30.8%), use of oxytocin (16.3%), and pre-eclampsia (11.6%). Puerperal hysterectomy was performed in 4.8% of the patients due to failure of the method.
Conclusion
The clinical experience with the B-Lynch technique was satisfactory since it presented few complications, with excellent results in hemorrhagic control. Previous cesarean section, the use of oxytocin, and preeclampsia stood out as factors related to the indication of the application of the technique, and the success rate in controlling postpartum hemorrhage was 95.2%.
Views228This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleClinical Experience Over 15 Years with the B-Lynch Compression Suture Technique in the Management of Postpartum Hemorrhage
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):655-661
Views228See moreAbstract
Objective
To describe the clinical experience with the B-Lynch technique in the management of postpartum hemorrhage as well as the factors related to the indication of the technique and to present the success rates of the application of the B-Lynch technique.
Methods
Observational, retrospective, cross-sectional, and analytical study. Patient data was obtained through the study of medical records. The study population comprised of patients who underwent hemostatic suture using the B-Lynch technique, including 104 patients within the period from January 1, 2005, to December 31, 2019.
Results
Of the total of 104 patients, 82.7% did not present any complications. Blood transfusion and intensive care unit admission were the most prevalent complications, with 13.5% and 15.4%, respectively. Only 1% of the patients had puerperal and surgical site infections. The factors most related to the application of the technique were the presence of previous cesarean section (30.8%), use of oxytocin (16.3%), and pre-eclampsia (11.6%). Puerperal hysterectomy was performed in 4.8% of the patients due to failure of the method.
Conclusion
The clinical experience with the B-Lynch technique was satisfactory since it presented few complications, with excellent results in hemorrhagic control. Previous cesarean section, the use of oxytocin, and preeclampsia stood out as factors related to the indication of the application of the technique, and the success rate in controlling postpartum hemorrhage was 95.2%.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article11-29-2021
Temporal Evolution of Maternal Mortality: 1980-2019
- Janete Vettorazzi ,
- Edimárlei Gonsales Valério ,
- Maria Alexandrina Zanatta ,
- Mariana Hollmann Scheffler ,
- Sergio Hofmeister de Almeida Martins Costa , [ ... ],
- José Geraldo Lopes Ramos
Abstract
Original ArticleTemporal Evolution of Maternal Mortality: 1980-2019
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):662-668
- Janete Vettorazzi ,
- Edimárlei Gonsales Valério ,
- Maria Alexandrina Zanatta ,
- Mariana Hollmann Scheffler ,
- Sergio Hofmeister de Almeida Martins Costa ,
- José Geraldo Lopes Ramos
Views218Abstract
Objective
To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution.
Methods
Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327).
Results
After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%).
Conclusion
Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.
Key-words acute fatty liver of pregnancyMaternal mortalitymaternal mortality ratiopostcesarean infectionpregnancy hypertensionpregnancy-related deathSeptic abortionsevere maternal morbiditySee moreViews218This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleTemporal Evolution of Maternal Mortality: 1980-2019
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):662-668
- Janete Vettorazzi ,
- Edimárlei Gonsales Valério ,
- Maria Alexandrina Zanatta ,
- Mariana Hollmann Scheffler ,
- Sergio Hofmeister de Almeida Martins Costa ,
- José Geraldo Lopes Ramos
Views218Abstract
Objective
To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution.
Methods
Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327).
Results
After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%).
Conclusion
Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.
Key-words acute fatty liver of pregnancyMaternal mortalitymaternal mortality ratiopostcesarean infectionpregnancy hypertensionpregnancy-related deathSeptic abortionsevere maternal morbiditySee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Janete Vettorazzi
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Original Article11-29-2021
Association between Adverse Maternal Clinical Outcomes and Imbalance of Cytokines and Angiogenic Factors in Preterm Preeclampsia
- Priscila Rezeck Nunes ,
- Mariana Romao-Veiga ,
- Vera Therezinha Medeiros Borges ,
- Mariana Leticia Matias ,
- Vanessa Rocha Ribeiro , [ ... ],
- Jose Carlos Peracoli
Abstract
Original ArticleAssociation between Adverse Maternal Clinical Outcomes and Imbalance of Cytokines and Angiogenic Factors in Preterm Preeclampsia
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):669-675
- Priscila Rezeck Nunes ,
- Mariana Romao-Veiga ,
- Vera Therezinha Medeiros Borges ,
- Mariana Leticia Matias ,
- Vanessa Rocha Ribeiro ,
- Roberto Antonio Araujo Costa ,
- Maria Terezinha Serrao Peracoli ,
- Jose Carlos Peracoli
Views140See moreAbstract
Objective
Preeclampsia (PE) is a pregnancy-specific syndrome characterized by abnormal levels of cytokines and angiogenic factors, playing a role in the disease development. The present study evaluated whether immunological markers are associated with the gestational age and with the disease severity in preeclamptic women.
Methods
Ninety-five women who developed PE were stratified for gestational age as preterm PE (< 37 weeks) and term PE (≥ 37 weeks of gestation) and compared for disease severity as well as plasma concentration of angiogenic factors and cytokines. The concentrations of placental growth factor (PlGF), vascular endothelial growth factor (VEGF), Fms-like soluble tyrosine kinase (sFlt-1) and soluble endoglin (sEng), as well as the cytokines, tumor necrosis factor-α (TNF-α) and interleukin 10 (IL-10), were determined by enzyme-linked immunosorbent assay (ELISA).
Results
The comparison between preeclamptic groups showed a higher percentage of severe cases in preterm PE (82.1%) than in term PE (35.9%). Similarly, the concentrations of TNF-α, sFlt-1, and sEng, as well as TNF-α/IL-10 and sFlt-1/PlGF ratios were significantly higher in the preterm PE group. In contrast, concentrations of PlGF, VEGF, and IL-10 were significantly lower in women with preterm PE. Negative correlations between TNF-α and IL-10 (r = 0.5232) and between PlGF and sFlt1 (r = 0.4158) were detected in the preterm PE.
Conclusion
In pregnant women with preterm PE, there is an imbalance between immunological markers, with the predominance of anti-angiogenic factors and TNF-α, associated with adverse maternal clinical outcomes.
Views140This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleAssociation between Adverse Maternal Clinical Outcomes and Imbalance of Cytokines and Angiogenic Factors in Preterm Preeclampsia
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):669-675
- Priscila Rezeck Nunes ,
- Mariana Romao-Veiga ,
- Vera Therezinha Medeiros Borges ,
- Mariana Leticia Matias ,
- Vanessa Rocha Ribeiro ,
- Roberto Antonio Araujo Costa ,
- Maria Terezinha Serrao Peracoli ,
- Jose Carlos Peracoli
Views140See moreAbstract
Objective
Preeclampsia (PE) is a pregnancy-specific syndrome characterized by abnormal levels of cytokines and angiogenic factors, playing a role in the disease development. The present study evaluated whether immunological markers are associated with the gestational age and with the disease severity in preeclamptic women.
Methods
Ninety-five women who developed PE were stratified for gestational age as preterm PE (< 37 weeks) and term PE (≥ 37 weeks of gestation) and compared for disease severity as well as plasma concentration of angiogenic factors and cytokines. The concentrations of placental growth factor (PlGF), vascular endothelial growth factor (VEGF), Fms-like soluble tyrosine kinase (sFlt-1) and soluble endoglin (sEng), as well as the cytokines, tumor necrosis factor-α (TNF-α) and interleukin 10 (IL-10), were determined by enzyme-linked immunosorbent assay (ELISA).
Results
The comparison between preeclamptic groups showed a higher percentage of severe cases in preterm PE (82.1%) than in term PE (35.9%). Similarly, the concentrations of TNF-α, sFlt-1, and sEng, as well as TNF-α/IL-10 and sFlt-1/PlGF ratios were significantly higher in the preterm PE group. In contrast, concentrations of PlGF, VEGF, and IL-10 were significantly lower in women with preterm PE. Negative correlations between TNF-α and IL-10 (r = 0.5232) and between PlGF and sFlt1 (r = 0.4158) were detected in the preterm PE.
Conclusion
In pregnant women with preterm PE, there is an imbalance between immunological markers, with the predominance of anti-angiogenic factors and TNF-α, associated with adverse maternal clinical outcomes.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Priscila Rezeck Nunes
Original Article Archives - Revista Brasileira de Ginecologia e Obstetrícia
