Trabalhos Originais Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(1):59-64
DOI 10.1590/S0100-72032004000100009
PURPOSE: to carry out a molecular study (in situ hybridization) on patients who present intraepithelial lesions of the uterine cervix, and to assess the frequency and the physical state of the human papillomavirus (HPV). METHODS: histological sections of biopsies of the uterine cervix from 84 patients were evaluated by in situ hybridization, with a broad-spectrum probe, which allows the identification of the HPV types 6, 11, 16, 18, 31, 33, 35, 39, 42, 45, and 56 and with specific probes for HPV types 6, 11, 16, 18, 31, and 33. The physical patterns of HPV DNA found were: episomal, when the entire nucleus stains with biotin (brown); integrated - one or two brown points in the hybridized nucleus, or mixed, associating both patterns. Of the 84 patients evaluated, 31 (36.9%) had low-grade squamous intraepithelial lesions (LSIL), and 53 (63.1%) had high-grade squamous intraepithelial lesions (HSIL) on histological examination. Fisher's exact test was used for the statistical analysis. RESULTS: considering all the cases, 46 (54.7%) were positive for HPV DNA with the broad-spectrum probe. Regarding typing, HPV-16 was the most frequent in HSIL (12 cases - 22.6% - p<0.05). The frequencies of the other HPV types did not show statistically significant differences between the LSIL and HSIL cases. By physical condition assessment of the HPV DNA, the percentage of the episomal (most common in LSIL) and integrated patterns showed no significant differences between the two groups; the mixed HSIL type prevailed when compared to LSIL: 26.4 and 3.2%, respectively (p<0.01). The physical condition of the HPV DNA, integrated in the host cell, was more frequent in the most severe cases. CONCLUSIONS: HPV-16 was the most frequent in HSIL cases. The frequencies of the other HPV types did not show statistically significant differences between the LSIL and HSIL cases. The physical condition of the HPV DNA, integrated in the host cell, was more frequent in the more severe cases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(1):59-64
DOI 10.1590/S0100-72032004000100009
PURPOSE: to carry out a molecular study (in situ hybridization) on patients who present intraepithelial lesions of the uterine cervix, and to assess the frequency and the physical state of the human papillomavirus (HPV). METHODS: histological sections of biopsies of the uterine cervix from 84 patients were evaluated by in situ hybridization, with a broad-spectrum probe, which allows the identification of the HPV types 6, 11, 16, 18, 31, 33, 35, 39, 42, 45, and 56 and with specific probes for HPV types 6, 11, 16, 18, 31, and 33. The physical patterns of HPV DNA found were: episomal, when the entire nucleus stains with biotin (brown); integrated - one or two brown points in the hybridized nucleus, or mixed, associating both patterns. Of the 84 patients evaluated, 31 (36.9%) had low-grade squamous intraepithelial lesions (LSIL), and 53 (63.1%) had high-grade squamous intraepithelial lesions (HSIL) on histological examination. Fisher's exact test was used for the statistical analysis. RESULTS: considering all the cases, 46 (54.7%) were positive for HPV DNA with the broad-spectrum probe. Regarding typing, HPV-16 was the most frequent in HSIL (12 cases - 22.6% - p<0.05). The frequencies of the other HPV types did not show statistically significant differences between the LSIL and HSIL cases. By physical condition assessment of the HPV DNA, the percentage of the episomal (most common in LSIL) and integrated patterns showed no significant differences between the two groups; the mixed HSIL type prevailed when compared to LSIL: 26.4 and 3.2%, respectively (p<0.01). The physical condition of the HPV DNA, integrated in the host cell, was more frequent in the most severe cases. CONCLUSIONS: HPV-16 was the most frequent in HSIL cases. The frequencies of the other HPV types did not show statistically significant differences between the LSIL and HSIL cases. The physical condition of the HPV DNA, integrated in the host cell, was more frequent in the more severe cases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):739-744
DOI 10.1590/S0100-72032003001000007
PURPOSE: to verify the contribution of maternal age, parity, twin pregnancy, hypertensive syndrome, and premature rupture of membranes as risk factors for cesarean section. METHODS: after approval by the Ethics in Research Committee of the "Maternidade Professor Monteiro de Morais" - Recife, PE - Brazil, for a case control study, the authors analyzed data from 3919 pregnant women, without two or more prior cesarean sections, who gave birth to alive newborns with gestational age equal to or more than 28 weeks, weighing at least 1,000 g, on cephalic presentation, from September 1, 1999 to August 31, 2000. The case group included women submitted to cesarean section and the control group included women submitted to vaginal delivery. With the data collected from obstetric and neonatal reports, the authors performed multivariate analysis by logistic regression to determine a mathematical equation that associates cesarean probability due to more than one independent variable acting as risk factor, determining odds ratio with a confidence interval of 95% (95% CI), for the variables: maternal age, parity, twin pregnancy, hypertensive syndrome, and premature rupture of membranes. RESULTS: the chances for cesarean section significantly increased 8.3 times in twin pregnancy (OR = 8.3; 95% CI: 3.7-19.1), 3.4 in hypertensive syndrome (OR = 3.4; 95% CI: 2.9-4.0), 1.9 in primiparity (OR = 1.9; 95% CI: 1.8-2.0), 1.5 in maternal age over 34 years (OR = 1.5; 95% CI: 1.2-1.8), and 1.2 in the presence of premature rupture of membranes (OR = 1.2; 95 %CI: 1.0-1.4). CONCLUSIONS: the risk for cesarean section was greater in the presence of premature rupture of membranes, maternal age greater than 34 years, primiparity, hypertensive syndrome, and twin pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):739-744
DOI 10.1590/S0100-72032003001000007
PURPOSE: to verify the contribution of maternal age, parity, twin pregnancy, hypertensive syndrome, and premature rupture of membranes as risk factors for cesarean section. METHODS: after approval by the Ethics in Research Committee of the "Maternidade Professor Monteiro de Morais" - Recife, PE - Brazil, for a case control study, the authors analyzed data from 3919 pregnant women, without two or more prior cesarean sections, who gave birth to alive newborns with gestational age equal to or more than 28 weeks, weighing at least 1,000 g, on cephalic presentation, from September 1, 1999 to August 31, 2000. The case group included women submitted to cesarean section and the control group included women submitted to vaginal delivery. With the data collected from obstetric and neonatal reports, the authors performed multivariate analysis by logistic regression to determine a mathematical equation that associates cesarean probability due to more than one independent variable acting as risk factor, determining odds ratio with a confidence interval of 95% (95% CI), for the variables: maternal age, parity, twin pregnancy, hypertensive syndrome, and premature rupture of membranes. RESULTS: the chances for cesarean section significantly increased 8.3 times in twin pregnancy (OR = 8.3; 95% CI: 3.7-19.1), 3.4 in hypertensive syndrome (OR = 3.4; 95% CI: 2.9-4.0), 1.9 in primiparity (OR = 1.9; 95% CI: 1.8-2.0), 1.5 in maternal age over 34 years (OR = 1.5; 95% CI: 1.2-1.8), and 1.2 in the presence of premature rupture of membranes (OR = 1.2; 95 %CI: 1.0-1.4). CONCLUSIONS: the risk for cesarean section was greater in the presence of premature rupture of membranes, maternal age greater than 34 years, primiparity, hypertensive syndrome, and twin pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):731-738
DOI 10.1590/S0100-72032003001000006
PURPOSE: to evaluate, in pregnant adolescents, the incidence of iron deficiency, using the following blood tests: hemoglobin, ferritin, serum iron, transferrin saturation rate and serum transferrin receptor, and their relationships. METHODS: a total of 56 adolescents were included at the first prenatal evaluation between the 12th and the 20th week of gestation. The normal values for each test were: above 11 mg/dL for hemoglobin, 12 µg/dL for ferritin, 50 mg/L for serum iron, 16% for transferrin saturation rate and below 28.1 nmol/L for serum transferrin receptor. Each result was evaluated using percentages and the McNemar test was used to compare the results. RESULTS: incidence of anemia using the hemoglobin concentration test was 21.4%. All pregnant women presented mild anemia. In the present study, 21.4% of the patients had iron deficiency with a ferritin concentration <12 mug/dL. Serum iron concentration was reduced in 3.6% of the adolescents and transferrin saturation rate in 26.8% of the sample. The value obtained by the transferrin receptor test was unclear, due to the lack of international standardization regarding measure unit. Comparing the hemoglobin concentration test to the other iron deficiency tests, it was found that the latter do not show a better evaluation than the hemoglobin concentration test in patients with hypoferremia. CONCLUSIONS: the hemoglobin concentration test in patients with mild anemia was effective to identify iron deficiency.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):731-738
DOI 10.1590/S0100-72032003001000006
PURPOSE: to evaluate, in pregnant adolescents, the incidence of iron deficiency, using the following blood tests: hemoglobin, ferritin, serum iron, transferrin saturation rate and serum transferrin receptor, and their relationships. METHODS: a total of 56 adolescents were included at the first prenatal evaluation between the 12th and the 20th week of gestation. The normal values for each test were: above 11 mg/dL for hemoglobin, 12 µg/dL for ferritin, 50 mg/L for serum iron, 16% for transferrin saturation rate and below 28.1 nmol/L for serum transferrin receptor. Each result was evaluated using percentages and the McNemar test was used to compare the results. RESULTS: incidence of anemia using the hemoglobin concentration test was 21.4%. All pregnant women presented mild anemia. In the present study, 21.4% of the patients had iron deficiency with a ferritin concentration <12 mug/dL. Serum iron concentration was reduced in 3.6% of the adolescents and transferrin saturation rate in 26.8% of the sample. The value obtained by the transferrin receptor test was unclear, due to the lack of international standardization regarding measure unit. Comparing the hemoglobin concentration test to the other iron deficiency tests, it was found that the latter do not show a better evaluation than the hemoglobin concentration test in patients with hypoferremia. CONCLUSIONS: the hemoglobin concentration test in patients with mild anemia was effective to identify iron deficiency.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):725-730
DOI 10.1590/S0100-72032003001000005
PURPOSE: to evaluate the perinatal outcome of fetuses with congenital anomalies of the urinary tract. METHODS: we reviewed the perinatal outcome of 35 fetuses with congenital anomalies of the urinary tract. The following characteristics related to the uropathy were analyzed: type (hydronephrosis, dysplasia and renal agenesis), side of lesion (bilateral or unilateral), and level of the obstruction (high or low, in hydronephrosis). The perinatal outcome was evaluated according to these characteristics. The data were analyzed by the c² test and by the exact Fisher test. The level of significance was 0.05. RESULTS: the incidence of hydronephrosis was 68.6%. Half of the fetuses had unilateral hydronephrosis. Renal dysplasia occurred in 17.1% of the cases; 83.3% of these were bilateral and 16.7%, unilateral. The incidence of renal agenesis was 14.3%, all bilateral. The fetuses with dysplasia/agenesis had a 91% incidence of oligohydramnios, preterm birth, low birth weight, and death. In the group with bilateral disease the presence of oligohydramnios, preterm birth, low birth weight, death, urinary tract infections, and the need of hospitalization for a period greater than 7 days was significant when compared to the group with unilateral disease. The need of hospitalization for a period greater than 7 days in patients with low obstruction was significantly higher when compared to the patients with high obstruction. CONCLUSIONS: hydronephrosis, bilateral disease, and lower obstruction were the most frequent uropathies. The dysplasia/agenesis group had a worse prognosis when compared with the hydronephrosis group. Bilateral disease had a worse prognosis when compared with the unilateral disease group. In the low obstruction group, the need for a period of hospitalization greater than seven days was higher than in the high obstruction group.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):725-730
DOI 10.1590/S0100-72032003001000005
PURPOSE: to evaluate the perinatal outcome of fetuses with congenital anomalies of the urinary tract. METHODS: we reviewed the perinatal outcome of 35 fetuses with congenital anomalies of the urinary tract. The following characteristics related to the uropathy were analyzed: type (hydronephrosis, dysplasia and renal agenesis), side of lesion (bilateral or unilateral), and level of the obstruction (high or low, in hydronephrosis). The perinatal outcome was evaluated according to these characteristics. The data were analyzed by the c² test and by the exact Fisher test. The level of significance was 0.05. RESULTS: the incidence of hydronephrosis was 68.6%. Half of the fetuses had unilateral hydronephrosis. Renal dysplasia occurred in 17.1% of the cases; 83.3% of these were bilateral and 16.7%, unilateral. The incidence of renal agenesis was 14.3%, all bilateral. The fetuses with dysplasia/agenesis had a 91% incidence of oligohydramnios, preterm birth, low birth weight, and death. In the group with bilateral disease the presence of oligohydramnios, preterm birth, low birth weight, death, urinary tract infections, and the need of hospitalization for a period greater than 7 days was significant when compared to the group with unilateral disease. The need of hospitalization for a period greater than 7 days in patients with low obstruction was significantly higher when compared to the patients with high obstruction. CONCLUSIONS: hydronephrosis, bilateral disease, and lower obstruction were the most frequent uropathies. The dysplasia/agenesis group had a worse prognosis when compared with the hydronephrosis group. Bilateral disease had a worse prognosis when compared with the unilateral disease group. In the low obstruction group, the need for a period of hospitalization greater than seven days was higher than in the high obstruction group.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):717-724
DOI 10.1590/S0100-72032003001000004
PURPOSE: to evaluate the adequacy of the prenatal care process offered to users of the Unified Health Care System (SUS) in Juiz de Fora-MG and to compare the municipal services. METHODS: a transversal study with auditing was carried out on the records of 370 pregnant women, selected by systematic sampling among women who carried their pregnancies to term and gave birth using SUS services in the first semester of 2002, with prenatal care given in Juiz de Fora. For statistical analysis the c² test was used to compare the municipal services (level of significance: 5%). The evaluation followed a three-tiered complementary sequence, using: the utilization of prenatal care (Kessner index: beginning and frequency of care) at level 1; the utilization of prenatal care and basic laboratory tests, according to the Humanization Program of Prenatal Care and Birth (ABO-Rh, hemoglobin/hematocrit, VDRL, glycemia and urinalysis), at level 2; and the utilization of prenatal care, the basic laboratory tests and the obligatory clinical-obstetric procedures during a prenatal visit (assessment of blood pressure, weight, edema, uterine fundal height, gestational age, fetal heart rate and fetal presentation), at level 3. RESULTS: the observed adequacy of the process was only 26.7% (level 1), 1.9% (level 2) and 1.1% (level 3). We also observed a prenatal coverage of 99.04%, an average of 6.4 visits per pregnant woman, and an average gestational age of 17.4 weeks at the time of the first prenatal visit. There were no significant differences between the municipal services. CONCLUSIONS: prenatal care offered to SUS users in Juiz de Fora should be reviewed from a qualitative standpoint, and periodic evaluations as necessary instruments of improvement are recommendable. Managers and professionals should undertake actions aimed at increasing compliance with norms/routines of the program - principally the request/recording of basic complementary tests - and which guarantee increased utilization of prenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):717-724
DOI 10.1590/S0100-72032003001000004
PURPOSE: to evaluate the adequacy of the prenatal care process offered to users of the Unified Health Care System (SUS) in Juiz de Fora-MG and to compare the municipal services. METHODS: a transversal study with auditing was carried out on the records of 370 pregnant women, selected by systematic sampling among women who carried their pregnancies to term and gave birth using SUS services in the first semester of 2002, with prenatal care given in Juiz de Fora. For statistical analysis the c² test was used to compare the municipal services (level of significance: 5%). The evaluation followed a three-tiered complementary sequence, using: the utilization of prenatal care (Kessner index: beginning and frequency of care) at level 1; the utilization of prenatal care and basic laboratory tests, according to the Humanization Program of Prenatal Care and Birth (ABO-Rh, hemoglobin/hematocrit, VDRL, glycemia and urinalysis), at level 2; and the utilization of prenatal care, the basic laboratory tests and the obligatory clinical-obstetric procedures during a prenatal visit (assessment of blood pressure, weight, edema, uterine fundal height, gestational age, fetal heart rate and fetal presentation), at level 3. RESULTS: the observed adequacy of the process was only 26.7% (level 1), 1.9% (level 2) and 1.1% (level 3). We also observed a prenatal coverage of 99.04%, an average of 6.4 visits per pregnant woman, and an average gestational age of 17.4 weeks at the time of the first prenatal visit. There were no significant differences between the municipal services. CONCLUSIONS: prenatal care offered to SUS users in Juiz de Fora should be reviewed from a qualitative standpoint, and periodic evaluations as necessary instruments of improvement are recommendable. Managers and professionals should undertake actions aimed at increasing compliance with norms/routines of the program - principally the request/recording of basic complementary tests - and which guarantee increased utilization of prenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):711-715
DOI 10.1590/S0100-72032003001000003
PURPOSE: to compare the characteristics of human semen preserved at +4ºC and at -196ºC for 24 h and to determine which technique is indicated for use in specific procedures. METHODS: semen samples of 24 voluntaries were analyzed after collection and divided into two aliquots, one of them cooled (+4ºC) and the other frozen (-196ºC). Samples were kept at low temperatures for 24 h and then at room temperature for 30 minutes (T1), capacitated (T2) and kept at +37ºC for 90 minutes (T3), being analyzed regarding count and progressive motility at T1, T2 and T3. The General Linear Model was used to analyze results obtained with different techniques, while Wilcoxon's test was used to compare results obtained in two different moments using the same technique (a = 5% e p<0,05). RESULTS: data were missed in one fresh semen sample, in one sample after preservation, in five samples after capacitation and in two samples after incubation. The average number of total motile sperm/mL (NTMS) in fresh semen was 39.7 million (1.3-104.0). After preservation, the average NTMS in cooled semen was 9.6 million (0-37.4) and in frozen semen 8.7 million (0-41.2). After capacitation, the average NTMS was 5.4 million either in cooled (0-21.7), or in frozen semen (0-28). After incubation, the average NTMS in cooled semen was 9.8 million (0-40.5) and in frozen 4.4 million (0-25.6). Concerning count, progressive motility and NTMS, there was no significant difference (p>0,05) between techniques in the three moments of observation. In cooled samples, there was no difference between variables after capacitation and after incubation, but, in frozen semen, count was significantly greater after capacitation. CONCLUSIONS: although there has been no significant difference between semen count and progressive motility in both techniques, the use of cooled semen is recommended for specific procedures within a short time period due to its simplicity and low cost. When frozen semen is necessary, we recommend its use soon after capacitation in order to avoid loss in quality.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):711-715
DOI 10.1590/S0100-72032003001000003
PURPOSE: to compare the characteristics of human semen preserved at +4ºC and at -196ºC for 24 h and to determine which technique is indicated for use in specific procedures. METHODS: semen samples of 24 voluntaries were analyzed after collection and divided into two aliquots, one of them cooled (+4ºC) and the other frozen (-196ºC). Samples were kept at low temperatures for 24 h and then at room temperature for 30 minutes (T1), capacitated (T2) and kept at +37ºC for 90 minutes (T3), being analyzed regarding count and progressive motility at T1, T2 and T3. The General Linear Model was used to analyze results obtained with different techniques, while Wilcoxon's test was used to compare results obtained in two different moments using the same technique (a = 5% e p<0,05). RESULTS: data were missed in one fresh semen sample, in one sample after preservation, in five samples after capacitation and in two samples after incubation. The average number of total motile sperm/mL (NTMS) in fresh semen was 39.7 million (1.3-104.0). After preservation, the average NTMS in cooled semen was 9.6 million (0-37.4) and in frozen semen 8.7 million (0-41.2). After capacitation, the average NTMS was 5.4 million either in cooled (0-21.7), or in frozen semen (0-28). After incubation, the average NTMS in cooled semen was 9.8 million (0-40.5) and in frozen 4.4 million (0-25.6). Concerning count, progressive motility and NTMS, there was no significant difference (p>0,05) between techniques in the three moments of observation. In cooled samples, there was no difference between variables after capacitation and after incubation, but, in frozen semen, count was significantly greater after capacitation. CONCLUSIONS: although there has been no significant difference between semen count and progressive motility in both techniques, the use of cooled semen is recommended for specific procedures within a short time period due to its simplicity and low cost. When frozen semen is necessary, we recommend its use soon after capacitation in order to avoid loss in quality.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):639-646
DOI 10.1590/S0100-72032003000900004
PURPOSE: to evaluate the association between the variability of amniotic fluid index (AFI) values with gestational age and some sociodemographic and obstetric variables among low-risk pregnant women. METHOD: a comparative study was carried out including 2868 low-risk pregnant women who had routine obstetric ultrasound examination, including fetal biometry and the measurement of AFI, from 20 to 42 weeks of gestation. The data were analyzed using Student's t test, analysis of variance of mean AFI values along gestational ages, according to other control variables, and also by multiple linear regression analysis. RESULTS: there was no significant variation of mean AFI values during the time of pregnancy neither when separately evaluating its association with maternal age, color, education, smoking habit, parity, and the presence of previous cesarean section scars, nor when the evaluation was performed through multivariate analysis. In this situation only the increase in gestational age showed to be associated with the decrease of AFI. Generally speaking, the mean AFI values fluctuated between 140 and 180 mm between the 20th and the 36th week, then showing values below 140 mm in a progressive decrease after this limit of gestational age. CONCLUSIONS: AFI values do not show a significant variation during pregnancy regarding the studied sociodemographic and obstetric variables.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):639-646
DOI 10.1590/S0100-72032003000900004
PURPOSE: to evaluate the association between the variability of amniotic fluid index (AFI) values with gestational age and some sociodemographic and obstetric variables among low-risk pregnant women. METHOD: a comparative study was carried out including 2868 low-risk pregnant women who had routine obstetric ultrasound examination, including fetal biometry and the measurement of AFI, from 20 to 42 weeks of gestation. The data were analyzed using Student's t test, analysis of variance of mean AFI values along gestational ages, according to other control variables, and also by multiple linear regression analysis. RESULTS: there was no significant variation of mean AFI values during the time of pregnancy neither when separately evaluating its association with maternal age, color, education, smoking habit, parity, and the presence of previous cesarean section scars, nor when the evaluation was performed through multivariate analysis. In this situation only the increase in gestational age showed to be associated with the decrease of AFI. Generally speaking, the mean AFI values fluctuated between 140 and 180 mm between the 20th and the 36th week, then showing values below 140 mm in a progressive decrease after this limit of gestational age. CONCLUSIONS: AFI values do not show a significant variation during pregnancy regarding the studied sociodemographic and obstetric variables.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):631-635
DOI 10.1590/S0100-72032003000900003
PURPOSE: to evaluate maternal age of 40 and older as an independent risk factor for pregnancy-induced hypertension (PIH). METHOD: we conducted a retrospective cohort study involving analysis of medical records of 2047 women in labor, divided into groups of 298 aged 40 and older and 1749 aged under 40. A multiple logistic regression was done to evaluate the association of maternal age with the occurrence of PIH adjusted by parity, chronic arterial hypertension, diabetes and twin pregnancy. RESULTS: the incidence of PIH in patients aged 40 and over was 22.1% (66/298), higher than in patients aged under 40 (16%, 286/1463). PIH was diagnosed in 27.2% of primiparous (174/640), 47.6% of chronic hypertensive (30/66) and 27.1% of diabetic patients (13/48). Advancing maternal age, primiparity and chronic arterial hypertension were associated with the occurrence of PIH in univariate analysis (OR = 1.46, 2.58 and 4.69, respectively). There was no significant association with diabetes. After the adjustment we observed an increase in the strength of the association between maternal age and PIH (adjusted OR = 1.69), as well as parity and chronic arterial hypertension. CONCLUSION: maternal age of 40 and older was a risk factor for the occurrence of PIH independent of parity, chronic arterial hypertension and diabetes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(9):631-635
DOI 10.1590/S0100-72032003000900003
PURPOSE: to evaluate maternal age of 40 and older as an independent risk factor for pregnancy-induced hypertension (PIH). METHOD: we conducted a retrospective cohort study involving analysis of medical records of 2047 women in labor, divided into groups of 298 aged 40 and older and 1749 aged under 40. A multiple logistic regression was done to evaluate the association of maternal age with the occurrence of PIH adjusted by parity, chronic arterial hypertension, diabetes and twin pregnancy. RESULTS: the incidence of PIH in patients aged 40 and over was 22.1% (66/298), higher than in patients aged under 40 (16%, 286/1463). PIH was diagnosed in 27.2% of primiparous (174/640), 47.6% of chronic hypertensive (30/66) and 27.1% of diabetic patients (13/48). Advancing maternal age, primiparity and chronic arterial hypertension were associated with the occurrence of PIH in univariate analysis (OR = 1.46, 2.58 and 4.69, respectively). There was no significant association with diabetes. After the adjustment we observed an increase in the strength of the association between maternal age and PIH (adjusted OR = 1.69), as well as parity and chronic arterial hypertension. CONCLUSION: maternal age of 40 and older was a risk factor for the occurrence of PIH independent of parity, chronic arterial hypertension and diabetes.