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Review Article
Expectant Versus Interventionist Care in the Management of Severe Preeclampsia Remote from Term: A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(8):627-637
11-15-2021
Summary
Review ArticleExpectant Versus Interventionist Care in the Management of Severe Preeclampsia Remote from Term: A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(8):627-637
11-15-2021Views149See moreAbstract
Objective
To compare the effects of expectant versus interventionist care in the management of pregnant women with severe preeclampsia remote from term.
Data sources
An electronic search was conducted in the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), Latin American and Caribbean Health Sciences Literature (LILACS, for its Spanish acronym), World Health Organization’s International Clinical Trials Registry Platform (WHO-ICTRP), and Open- Grey databases. The International Federation of Gynecology and Obstetrics (FIGO, for its French acronym), Royal College of Obstetricians and Gynaecologists (RCOG), American College of Obstetricians and Gynecologists (ACOG), and Colombian Journal of Obstetrics and Gynecology (CJOG) websites were searched for conference proceedings, without language restrictions, up to March 25, 2020.
Selection of studies
Randomized clinical trials (RCTs), and non-randomized controlled studies (NRSs) were included. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of the evidence.
Data collection
Studies were independently assessed for inclusion criteria, data extraction, and risk of bias. Disagreements were resolved by consensus.
Data synthesis
Four RCTs and six NRS were included. Low-quality evidence from the RCTs showed that expectant care may result in a lower incidence of appearance, pulse, grimace, activity, and respiration (Apgar) scores<7 at 5 minutes (risk ratio [RR]: 0.48; 95% confidence interval [95%CI]: 0.23%to 0.99) and a higher average birth weight (mean difference [MD]: 254.7 g; 95%CI: 98.5 g to 410.9 g). Very low quality evidence from the NRSs suggested that expectant care might decrease the rates of neonatal death (RR: 0.42; 95%CI 0.22 to 0.80), hyalinemembrane disease (RR: 0.59; 95%CI: 0.40 to 0.87), and admission to neonatal care (RR: 0.73; 95%CI: 0.54 to 0.99). Nomaternal or fetal differences were found for other perinatal outcomes.
Conclusion
Compared with interventionist management, expectant care may improve neonatal outcomes without increasing maternal morbidity and mortality.
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Review Article
Prenatal Ultrasound Diagnosis of Biometric changes in the Brain of Growth Restricted Fetuses. A Systematic Review of Literature
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(7):545-559
10-18-2021
Summary
Review ArticlePrenatal Ultrasound Diagnosis of Biometric changes in the Brain of Growth Restricted Fetuses. A Systematic Review of Literature
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(7):545-559
10-18-2021Views144See moreAbstract
Fetal growth restriction (FGR) occurswhen the fetus does not reach its intrauterine potential for growth and development as a result of compromise in placental function. It is a condition that affects 5 to 10% of pregnancies and is the second most common cause of perinatal morbidity and mortality. Children born with FGR are at risk of impaired neurological and cognitive development and cardiovascular or endocrine diseases in adulthood. The purpose of the present revision is to perform a literature search for evidence on the detection and assessment by ultrasound of brain injury linked to FGR during fetal life. Using a systematic approach and quantitative evaluation as study methodology, we reviewed ultrasound studies of the fetal brain structure of growth-restricted fetuses with objective quality measures. A total of eight studies were identified. High quality studies were identified for measurement of brain volumes; corpus callosum; brain fissure depth measurements, and cavum septi pellucidi width measurement. A low-quality study was available for transverse cerebellar diameter measurement in FGR. Further prospective randomized studies are needed to understand the changes that occur in the brain of fetuseswith restricted growth, as well as their correlation with the changes in cognitive development observed.
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Review Article
Placental Findings in Preterm and Term Preeclampsia: An Integrative Review of the Literature
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(7):560-569
10-18-2021
Summary
Review ArticlePlacental Findings in Preterm and Term Preeclampsia: An Integrative Review of the Literature
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(7):560-569
10-18-2021Views217Abstract
Introduction
Preeclampsia (PE) is a pregnancy complication associated with increased maternal and perinatal morbidity and mortality. The disease presents with recent onset hypertension (after 20 weeks of gestation) and proteinuria, and can progress to multiple organ dysfunction, with worse outcomes among early onset preeclampsia (EOP) cases (<34 weeks). The placenta is considered the root cause of PE; it represents the interface between the mother and the fetus, and acts as a macromembrane between the two circulations, due to its villous and vascular structures. Therefore, in pathological conditions, macroscopic and microscopic evaluation can provide clinically useful information that can confirm diagnosis and enlighten about outcomes and future therapeutic benefit.
Objective
To perform an integrative review of the literature on pathological placental findings associated to preeclampsia (comparing EOP and late onset preeclampsia [LOP]) and its impacts on clinical manifestations.
Results:
Cases of EOP presented worse maternal and perinatal outcomes, and pathophysiological and anatomopathological findings were different between EOP and LOP placentas, with less placental perfusion, greater placental pathological changes with less villous volume (villous hypoplasia), greater amount of trophoblastic debris, syncytial nodules, microcalcification, villous infarcts, decidual arteriolopathy in EOP placentas when compared with LOP placentas. Clinically, the use of low doses of aspirin has been shown to be effective in preventing PE, as well asmagnesium sulfate in preventing seizures in cases of severe features.
Conclusion
The anatomopathological characteristics between EOP and LOP are significantly different, with large morphological changes in cases of EOP, such as
Key-words anatomopathological characteristicsmaternal mortality and morbidityPlacentapreeclampsia early onsetpreeclampsia late onsetSee more -
Review Article
Clinical Features and Maternal-fetal Results of Pregnant Women in COVID-19 Times
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(5):384-394
07-30-2021
Summary
Review ArticleClinical Features and Maternal-fetal Results of Pregnant Women in COVID-19 Times
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(5):384-394
07-30-2021Views239See moreAbstract
Objective
Coronavirus disease 2019 (COVID-19) is a disease caused by a newly discovered coronavirus, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), which usually leads to non-specific respiratory symptoms. Although pregnant women are considered at risk for respiratory infections by other viruses, such as SARS and Middle East respiratory syndrome (MERS), little is known about their vulnerability to SARS-CoV-2. Therefore, this study aims to identify and present the main studies on the topic, including the postpartum period.
Methods
In this narrative review, articles were searched in various databases, organizations, and health entities using keywords compatible with medical subject headings (MeSH), such as: COVID-19, pregnancy, vertical transmission, coronavirus 2019, and SARS-CoV-2.
Results
The review of the scientific literature on the subject revealed that pregnant women with COVID-19 did not present clinical manifestations significantly different from those of non-pregnant women; however, there are contraindicated therapies. Regarding fetuses, studies were identified that reported that infection by SARS-CoV-2 in pregnant women can cause fetal distress, breathing difficulties and premature birth, but there is no substantial evidence of vertical transmission.
Conclusion
Due to the lack of adequate information and the limitations of the analyzed studies, it is necessary to provide detailed clinical data on pregnant women infected with SARS-CoV-2 and on the maternal-fetal repercussions caused by this infection. Thus, this review may contribute to expand the knowledge of professionals working in the area as well as to guide more advanced studies on the risk related to pregnant women and their newborns. Meanwhile, monitoring of confirmed or suspected pregnant women with COVID-19 is essential, including in the postpartum period.
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Review Article
The Female Athlete Triad/Relative Energy Deficiency in Sports (RED-S)
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(5):395-402
07-30-2021
Summary
Review ArticleThe Female Athlete Triad/Relative Energy Deficiency in Sports (RED-S)
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(5):395-402
07-30-2021Views386See moreAbstract
In a healthy athlete, the caloric intake is sufficient for sports energy needs and body physiological functions, allowing a balance between energy availability, bone metabolism, andmenstrual cycle.Onthe other hand, an imbalance causedby low energy availability dueto a restrictive diet, eating disorders or long periods of energy expenditure leads to multisystemic deregulation favoring the essential functions of the body. This phenomenon, described as the female athlete triad, occurs in a considerable percentage of high-performance athletes, with harmful consequences for their future. The present review was carried out based on a critical analysis of themost recent publications available and aims to provide a global perception of the topic relative energy deficit in sport (RED-S). The objective is to promote theacquisition ofmore consolidated knowledgeon an undervaluedtheme, enabling the acquisition of preventive strategies, early diagnosis and/or appropriate treatment.
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Review Article
Interventions among Pregnant Women in the Field of Music Therapy: A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(5):403-413
07-30-2021
Summary
Review ArticleInterventions among Pregnant Women in the Field of Music Therapy: A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(5):403-413
07-30-2021Views352See moreAbstract
Objective
To investigate in the literature the studies on the benefits ofmusic therapy interventions among pregnant women in the prenatal, delivery and postpartum periods.
Data Sources
The search for articles was carried out in the following electronic databases: VHL, LILACS, SciELO, Portal CAPES, PsycINFO, ERIC, PubMed/Medline, and journals specialized in this field: Revista Brasileira de Musicoterapia (“Brazilian Journal of Music Therapy”) and Voices.
Study Selection
Descriptors in Portuguese (musicoterapia, gravidez, gestantes, revisão), English (music therapy, pregnancy, pregnant women, review) and Spanish (musicoterapia, embarazo, mujeres embarazadas, revisión) were used. The search was delimited between January 2009 and June 2019. The process of selection and evaluation of the articles was performed through peer review.
Data Collectio
n The following data were extracted: article title, year of publication, journal, author(s), database, country and date of collection, purpose of the study, sample size, type of care, intervention, instruments used, results, and conclusion. The data were organized in chronological order based on the year of publication of thestudy.
Summary of the Data
In total, 146 articles were identified, and only 23 studies were included in this systematic review. The articles found indicate among their results relaxation, decreased levels of anxiety, psychosocial stress and depression, decreased pain, increase in the maternal bond, improvement in the quality of sleep, control of the fetal heart rate and maternal blood pressure, and decreased intake of drugs in the postoperative period.
Conclusion
Music therapy during the prenatal, delivery and postpartum periods can provide benefits to pregnant women and newborns, thus justifying its importance in this field.
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Review Article
Morphology and Biochemistry of Ovulation Morfologia e bioquímica da ovulação
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(6):480-486
07-27-2021
Summary
Review ArticleMorphology and Biochemistry of Ovulation Morfologia e bioquímica da ovulação
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(6):480-486
07-27-2021Views242See moreAbstract
The process of ovulation involves multiple and iterrelated genetic, biochemical, and morphological events: cessation of the proliferation of granulosa cells, resumption of oocyte meiosis, expansion of cumulus cell-oocyte complexes, digestion of the follicle wall, and extrusion of the metaphase-II oocyte. The present narrative review examines these interrelated steps in detail. The combined or isolated roles of the folliclestimulating hormone (FSH) and luteinizing hormone (LH) are highlighted. Genes indiced by the FSH genes are relevant in the cumulus expansion, and LH-induced genes are critical for the resumption ofmeiosis and digestion of the follicle wall. A nonhuman model for follicle-wall digestion and oocyte release was provided.