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You searched for:"Carlos Augusto Alencar Júnior"
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Rev Bras Ginecol Obstet. 2003;25(2):109-114
DOI 10.1590/S0100-72032003000200006
PURPOSE: to evaluate maternal and perinatal outcomes of premature rupture of membranes up to the 26th week of gestation. METHODS: retrospective analysis of the cases of premature rupture of membranes up to the 26th week of gestation, without signs of labor or treatment for this condition before admission, followed up at the Obstetric Pathology Infirmary of the "Maternidade Escola Assis Chateaubriand", Federal University of Ceará, from January 1994 to December 1999. The cases with gestational age less than 22 weeks and birth weight lower than 500 g were excluded. Premature rupture of membranes was confirmed by sterile speculum examination. In doubt, amniotic fluid crystallization test and pH determination were performed. All pregnant women underwent ultrasound examination to determine gestational age and amniotic fluid volume. Data concerning the result of gestation and consequences for the mother, fetus and neonate were analyzed. RESULTS: a total of 29 cases of premature rupture of membranes fulfilled inclusion criteria. The mean gestational age at rupture of membranes was 22 weeks. The mean duration of the latency period was 21.7 days. There Were 22 spontaneous vaginal and 3 induced deliveries, besides 4 cesarean sections. In six pregnant women there were signs of infection before labor. Antibiotics were administered in 37.9% of the cases and corticosteroids in 6.9%. No patient underwent tocolysis. There were 3 fetal and 25 neonatal deaths. Only one infant survived. This child remained at the neonatal care unit for 19 days due to infection and respiratory distress syndrome. There was no maternal death. CONCLUSION: the premature rupture of membranes up to the 26th week of gestation has been a fatal discase for fetuses and newborns in our institution.
Summary
Rev Bras Ginecol Obstet. 2003;25(2):109-114
DOI 10.1590/S0100-72032003000200006
PURPOSE: to evaluate maternal and perinatal outcomes of premature rupture of membranes up to the 26th week of gestation. METHODS: retrospective analysis of the cases of premature rupture of membranes up to the 26th week of gestation, without signs of labor or treatment for this condition before admission, followed up at the Obstetric Pathology Infirmary of the "Maternidade Escola Assis Chateaubriand", Federal University of Ceará, from January 1994 to December 1999. The cases with gestational age less than 22 weeks and birth weight lower than 500 g were excluded. Premature rupture of membranes was confirmed by sterile speculum examination. In doubt, amniotic fluid crystallization test and pH determination were performed. All pregnant women underwent ultrasound examination to determine gestational age and amniotic fluid volume. Data concerning the result of gestation and consequences for the mother, fetus and neonate were analyzed. RESULTS: a total of 29 cases of premature rupture of membranes fulfilled inclusion criteria. The mean gestational age at rupture of membranes was 22 weeks. The mean duration of the latency period was 21.7 days. There Were 22 spontaneous vaginal and 3 induced deliveries, besides 4 cesarean sections. In six pregnant women there were signs of infection before labor. Antibiotics were administered in 37.9% of the cases and corticosteroids in 6.9%. No patient underwent tocolysis. There were 3 fetal and 25 neonatal deaths. Only one infant survived. This child remained at the neonatal care unit for 19 days due to infection and respiratory distress syndrome. There was no maternal death. CONCLUSION: the premature rupture of membranes up to the 26th week of gestation has been a fatal discase for fetuses and newborns in our institution.
Summary
Rev Bras Ginecol Obstet. 2002;24(3):175-179
DOI 10.1590/S0100-72032002000300005
Purpose: to determine the presence of asymptomatic amniotic fluid infection in pregnant women, to identify the bacterial agents involved in the infection and to determine the antimicrobial susceptibility in vitro. Methods: amniotic fluid samples were obtained by amniocentesis from 81 pregnant women without labor signs and without suspucion of clinical infection, attended at Maternidade Escola Assis Chateaubriand from August 1997 to January 1999. The presence of aerobic bacteria, strict/facultative anaerobic bacteria and genital mycoplasmas was investigated. The anaerobic bacteria were identified by the ATB SystemÒ (Biolab Mérieux) and mycoplasmas by the IST MycoplasmaÒ kit (Biolab-Mérieux). Results: among the obtained samples, eight (9.8%) showed positive culture and in two samples two different strains were identified. The isolated pathogens were Ureaplasma urealyticum (7 cases, 8.6%), Mycoplasma hominis (1 case, 1.2%) and Peptostreptococcus sp (2 cases, 2.4%). The antimicrobial susceptibility was characterized by great mycoplasma resistance to erythromycin (37.5%) and no resistance to cyclins. Conclusions: the percentage of asymptomatic infections was high, and furthe research is necessary to evaluate the asymptomatic infection consequences in pregnant women and their newborns, involving methods that identify genital mycoplasmas, which were the most frequently isolated bacteria.
Summary
Rev Bras Ginecol Obstet. 2002;24(3):175-179
DOI 10.1590/S0100-72032002000300005
Purpose: to determine the presence of asymptomatic amniotic fluid infection in pregnant women, to identify the bacterial agents involved in the infection and to determine the antimicrobial susceptibility in vitro. Methods: amniotic fluid samples were obtained by amniocentesis from 81 pregnant women without labor signs and without suspucion of clinical infection, attended at Maternidade Escola Assis Chateaubriand from August 1997 to January 1999. The presence of aerobic bacteria, strict/facultative anaerobic bacteria and genital mycoplasmas was investigated. The anaerobic bacteria were identified by the ATB SystemÒ (Biolab Mérieux) and mycoplasmas by the IST MycoplasmaÒ kit (Biolab-Mérieux). Results: among the obtained samples, eight (9.8%) showed positive culture and in two samples two different strains were identified. The isolated pathogens were Ureaplasma urealyticum (7 cases, 8.6%), Mycoplasma hominis (1 case, 1.2%) and Peptostreptococcus sp (2 cases, 2.4%). The antimicrobial susceptibility was characterized by great mycoplasma resistance to erythromycin (37.5%) and no resistance to cyclins. Conclusions: the percentage of asymptomatic infections was high, and furthe research is necessary to evaluate the asymptomatic infection consequences in pregnant women and their newborns, involving methods that identify genital mycoplasmas, which were the most frequently isolated bacteria.
Summary
Rev Bras Ginecol Obstet. 2004;26(1):21-29
DOI 10.1590/S0100-72032004000100004
PURPOSE: to determine the main factors associated with vaginal delivery in high-risk pregnant women submitted to labor induction with vaginal misoprostol (50 µg). METHODS: this is a secondary analysis of an open nonrandomized clinical trial that included 61 high-risk pregnant women admitted at the "Maternidade-Escola Assis Chateaubriand", Fortaleza (Ceará). All women had singleton pregnancies with alive fetuses, gestational age >37 weeks and Bishop scores <7. Misoprostol was vaginally administered at doses of 50 µg every 6 h for a maximum of four doses. Univariate and multiple logistic regression analyses were performed to determine association between vaginal delivery (dependent variable) and independent variables (predictive), and receiver operating characteristic (ROC) curves were constructed for parity and Bishop scores. RESULTS: parity (one or more previous deliveries), Bishop scores >4 and interval induction to delivery <6 h were significantly associated with vaginal delivery, while tachysystole reduced the probability of vaginal delivery. A multivariate stepwise logistic regression was then performed to evaluate each of these as independent predictors. Parity (OR = 5.41, 95% CI = 4.18-6.64) and Bishop score >4 (OR = 3.30, 95% CI = 2.15-4.45) were significant independent predictors for vaginal delivery. In the ROC curve for parity and Bishop score, sensitivity of 63.2% and positive predictive value of 100% were found. The area under the ROC curve was 86.8%, significantly higher than 50% (p=0.023). CONCLUSIONS: the most important predictive factors for vaginal delivery after induction with misoprostol were parity and Bishop score. These characteristics should be considered when choosing schemes and doses of misoprostol for cervical ripening and labor induction.
Summary
Rev Bras Ginecol Obstet. 2004;26(1):21-29
DOI 10.1590/S0100-72032004000100004
PURPOSE: to determine the main factors associated with vaginal delivery in high-risk pregnant women submitted to labor induction with vaginal misoprostol (50 µg). METHODS: this is a secondary analysis of an open nonrandomized clinical trial that included 61 high-risk pregnant women admitted at the "Maternidade-Escola Assis Chateaubriand", Fortaleza (Ceará). All women had singleton pregnancies with alive fetuses, gestational age >37 weeks and Bishop scores <7. Misoprostol was vaginally administered at doses of 50 µg every 6 h for a maximum of four doses. Univariate and multiple logistic regression analyses were performed to determine association between vaginal delivery (dependent variable) and independent variables (predictive), and receiver operating characteristic (ROC) curves were constructed for parity and Bishop scores. RESULTS: parity (one or more previous deliveries), Bishop scores >4 and interval induction to delivery <6 h were significantly associated with vaginal delivery, while tachysystole reduced the probability of vaginal delivery. A multivariate stepwise logistic regression was then performed to evaluate each of these as independent predictors. Parity (OR = 5.41, 95% CI = 4.18-6.64) and Bishop score >4 (OR = 3.30, 95% CI = 2.15-4.45) were significant independent predictors for vaginal delivery. In the ROC curve for parity and Bishop score, sensitivity of 63.2% and positive predictive value of 100% were found. The area under the ROC curve was 86.8%, significantly higher than 50% (p=0.023). CONCLUSIONS: the most important predictive factors for vaginal delivery after induction with misoprostol were parity and Bishop score. These characteristics should be considered when choosing schemes and doses of misoprostol for cervical ripening and labor induction.
Summary
Rev Bras Ginecol Obstet. 2000;22(5):257-263
DOI 10.1590/S0100-72032000000500002
Purpose: to evaluate the evolution of gestation, metabolic control and perinatal outcome of pregestational diabetic patients and to perform a comparative study of the results of patients with insulin-dependent diabetes (type I) and non-insulin-dependent diabetes (type II). Methods: retrospective analysis of 57 pregestational diabetic woman charts who began a prenatal follow-up in the Service of Maternofetal Medicine of the Maternidade-Escola Assis Chateaubriand of the Universidade Federal do Ceará, in the period from January 1995 to December 1998. The 57 pregnant women included in the study were divided into groups: the first, composed of 28 patients with insulin-dependent diabetes (type I), and the second with 29 pregnant women with non-insulin-dependent diabetes (type II), controlled with diet or with oral hypoglycemics before pregnancy. Results: there was no statistically significant difference between the two groups in relation to the need of hospitalization for glycemia control (39.2% x 27.5%) and maternal complications, such as: chronic arterial hypertension (14.2% x 27.5%), pregnancy-induced hypertension (14.2% x 17.2%), premature rupture of membranes (3.5% x 10.3%), urinary tract infection (10.7% x 6.8%), and preterm labor (3.5% x 6.8%). However, episodes of maternal hypoglycemia were more frequent among insulin-dependent patients (35.7% x 3.4%). The perinatal results were similar. We observed a great number of congenital anomalies and increased perinatal morbidity and mortality. Conclusion: there was no difference in the incidence of obstetric and clinical complications between insulin-dependent and non-insulin-dependent patients, except for maternal hypoglycemia.
Summary
Rev Bras Ginecol Obstet. 2000;22(5):257-263
DOI 10.1590/S0100-72032000000500002
Purpose: to evaluate the evolution of gestation, metabolic control and perinatal outcome of pregestational diabetic patients and to perform a comparative study of the results of patients with insulin-dependent diabetes (type I) and non-insulin-dependent diabetes (type II). Methods: retrospective analysis of 57 pregestational diabetic woman charts who began a prenatal follow-up in the Service of Maternofetal Medicine of the Maternidade-Escola Assis Chateaubriand of the Universidade Federal do Ceará, in the period from January 1995 to December 1998. The 57 pregnant women included in the study were divided into groups: the first, composed of 28 patients with insulin-dependent diabetes (type I), and the second with 29 pregnant women with non-insulin-dependent diabetes (type II), controlled with diet or with oral hypoglycemics before pregnancy. Results: there was no statistically significant difference between the two groups in relation to the need of hospitalization for glycemia control (39.2% x 27.5%) and maternal complications, such as: chronic arterial hypertension (14.2% x 27.5%), pregnancy-induced hypertension (14.2% x 17.2%), premature rupture of membranes (3.5% x 10.3%), urinary tract infection (10.7% x 6.8%), and preterm labor (3.5% x 6.8%). However, episodes of maternal hypoglycemia were more frequent among insulin-dependent patients (35.7% x 3.4%). The perinatal results were similar. We observed a great number of congenital anomalies and increased perinatal morbidity and mortality. Conclusion: there was no difference in the incidence of obstetric and clinical complications between insulin-dependent and non-insulin-dependent patients, except for maternal hypoglycemia.
Summary
Rev Bras Ginecol Obstet. 2001;23(5):329-332
DOI 10.1590/S0100-72032001000500009
Wilson's disease (hepatolenticular degeneration) is a rare autosomal recessive disorder that usually occurs between the first and third decades. The condition is characterized by excessive deposition of copper in the liver and brain. It is fatal if the diagnosis and treatment are not performed early in life. The authors describe one case of pregnancy and Wilson's disease, showing the good evolution of the patient, who used D-penicillamine until the seventh week of gestation, discontinuing thereafter until the 20th week of gestation. The mother evolved with no signs of clinic and obstetric problems. The newborn did not present any problem and was healthy in his first year of life.
Summary
Rev Bras Ginecol Obstet. 2001;23(5):329-332
DOI 10.1590/S0100-72032001000500009
Wilson's disease (hepatolenticular degeneration) is a rare autosomal recessive disorder that usually occurs between the first and third decades. The condition is characterized by excessive deposition of copper in the liver and brain. It is fatal if the diagnosis and treatment are not performed early in life. The authors describe one case of pregnancy and Wilson's disease, showing the good evolution of the patient, who used D-penicillamine until the seventh week of gestation, discontinuing thereafter until the 20th week of gestation. The mother evolved with no signs of clinic and obstetric problems. The newborn did not present any problem and was healthy in his first year of life.
Summary
Rev Bras Ginecol Obstet. 2012;34(1):34-39
DOI 10.1590/S0100-72032012000100007
PURPOSE: To compare the maternal and perinatal outcomes of patients with placenta previa, after the adoption of a prolonged maternal hospital stay, to those of a 1991 series. METHODS: We performed a retrospective study comparing 108 cases of placenta previa hospitalized in the Maternity School Assis Chateaubriand, Universidade Federal do Ceará, during the period from 01/01/2006 to 12/31/2010, with those obtained in 1991, when 101 cases of the pathology were observed at our institution. The following maternal and perinatal data were collected: maternal age, parity, gestational age at delivery, mode of delivery, maternal stay length, Apgar scores at the 1st and 5th minutes, birth weight, adequacy of birth weight, neonatal length stay, maternal and neonatal morbidity and mortality rates (maternal, fetal, neonatal and perinatal). Statistical analysis was performed using the χ² and Fisher's exact tests. The results were considered significant when p<0.05. RESULTS: In 1991, placenta previa was found in 1.13% of cases (101/8900). In the present study, the prevalence was 0.43% (108/24726). No maternal death was observed in either series. Regarding the study of 1991, the current patients were significantly younger, with lower parity, were hospitalized longer, had better Apgar scores at 1st and 5th minutes, and had longer neonatal hospitalization. Also, we identified reduction of fetal, neonatal and perinatal mortality. CONCLUSIONS: Perinatal outcomes in patients with placenta previa were significantly improved between 1991 and the years 2006 and 2010. However, we can not say whether this improvement was due to the prolonged maternal hospital stay.
Summary
Rev Bras Ginecol Obstet. 2012;34(1):34-39
DOI 10.1590/S0100-72032012000100007
PURPOSE: To compare the maternal and perinatal outcomes of patients with placenta previa, after the adoption of a prolonged maternal hospital stay, to those of a 1991 series. METHODS: We performed a retrospective study comparing 108 cases of placenta previa hospitalized in the Maternity School Assis Chateaubriand, Universidade Federal do Ceará, during the period from 01/01/2006 to 12/31/2010, with those obtained in 1991, when 101 cases of the pathology were observed at our institution. The following maternal and perinatal data were collected: maternal age, parity, gestational age at delivery, mode of delivery, maternal stay length, Apgar scores at the 1st and 5th minutes, birth weight, adequacy of birth weight, neonatal length stay, maternal and neonatal morbidity and mortality rates (maternal, fetal, neonatal and perinatal). Statistical analysis was performed using the χ² and Fisher's exact tests. The results were considered significant when p<0.05. RESULTS: In 1991, placenta previa was found in 1.13% of cases (101/8900). In the present study, the prevalence was 0.43% (108/24726). No maternal death was observed in either series. Regarding the study of 1991, the current patients were significantly younger, with lower parity, were hospitalized longer, had better Apgar scores at 1st and 5th minutes, and had longer neonatal hospitalization. Also, we identified reduction of fetal, neonatal and perinatal mortality. CONCLUSIONS: Perinatal outcomes in patients with placenta previa were significantly improved between 1991 and the years 2006 and 2010. However, we can not say whether this improvement was due to the prolonged maternal hospital stay.
Summary
Rev Bras Ginecol Obstet. 2002;24(5):343-346
DOI 10.1590/S0100-72032002000500009
Aplastic anemia is characterized by a circulating pancytopenia, hypocellularity, and fatty replacement of cellular marrow elements, without evidence of malignant transformation or myeloproliferative disease. It usually affects young and senior adults, without any sexual preference. Most cases of aplastic anemia are acquired, but the disease may also be inherited due to a molecular disorder (Fanconi's anemia). Aplastic anemia in pregnancy is an extremely rare condition with high maternal and fetal morbidity and mortality rates. The authors describe a case of a patient with previously diagnosed aplastic anemia, whose pregnancy was complicated with urinary tract infection, preeclampsia and fetal growth restriction, with elective preterm birth. In spite of the adverse conditions in pregnancy and delivery, mother and newborn had a satisfactory clinical evolution.
Summary
Rev Bras Ginecol Obstet. 2002;24(5):343-346
DOI 10.1590/S0100-72032002000500009
Aplastic anemia is characterized by a circulating pancytopenia, hypocellularity, and fatty replacement of cellular marrow elements, without evidence of malignant transformation or myeloproliferative disease. It usually affects young and senior adults, without any sexual preference. Most cases of aplastic anemia are acquired, but the disease may also be inherited due to a molecular disorder (Fanconi's anemia). Aplastic anemia in pregnancy is an extremely rare condition with high maternal and fetal morbidity and mortality rates. The authors describe a case of a patient with previously diagnosed aplastic anemia, whose pregnancy was complicated with urinary tract infection, preeclampsia and fetal growth restriction, with elective preterm birth. In spite of the adverse conditions in pregnancy and delivery, mother and newborn had a satisfactory clinical evolution.
Summary
Rev Bras Ginecol Obstet. 2010;32(7):352-358
DOI 10.1590/S0100-72032010000700008
PURPOSE: to evaluate the antenatal and postnatal risk factors of neonatal death in pregnancies with absent (DZ) or reverse (DR) end-diastolic flow in the umbilical artery. METHODS: a cross-sectional retrospective study based on data from 48 medical records of singleton pregnancies with DZ or DR, and gestational age of 24 to 34 weeks, at a maternity in the Brazilian Northeast. Mean age was 27.3 (SD: 7.9) years. Twenty (41.7%) patients were primiparas. Hypertensive disorders were found in 44 (91.7%) cases. Thirty-five women (72.9%) had DZ and 13 (27.1%) had DR. Univariate analysis was firstly done (Student's t-test and Fisher's exact test) correlating the parameters with the assessed outcome (neonatal death). Variables that showed significant association were included in the logistic regression model (Wald statistics). The level of significance was set at 5%. RESULTS: The perinatal mortality rate was 64.6% (31/48). There were five stillbirths and 26 neonatal deaths. The mean gestational age at diagnosis was 27.9 (SD: 2.8) weeks. Deliveries before 24 hours after diagnosis occurred in 52.1% of the cases. Cesarean section was performed in 85.4% of the sample. The newborns weighed 975.9 g on average (SD: 457.5). Twenty-four (57.1%) presented Apgar scores below 7 in the first minute and 21.4% in the fifth minute. Gestational age at diagnosis, birth weight and Apgar of the first minute proved to be variables significantly related to neonatal death (p values were: 0.008, 0.004, and 0.020, respectively). The Odds Ratio was 6.6, 25.3 and 13.8 for neonatal death, when the diagnosis was established at the 28th week, weight was <1000 g and first minute Apgar score was <7, respectively. CONCLUSIONS: gestational age at diagnosis, birth weight and Apgar score at the first minute were factors that could predict neonatal death in pregnancies with DV or DR determined by umbilical artery Doppler velocimetry.
Summary
Rev Bras Ginecol Obstet. 2010;32(7):352-358
DOI 10.1590/S0100-72032010000700008
PURPOSE: to evaluate the antenatal and postnatal risk factors of neonatal death in pregnancies with absent (DZ) or reverse (DR) end-diastolic flow in the umbilical artery. METHODS: a cross-sectional retrospective study based on data from 48 medical records of singleton pregnancies with DZ or DR, and gestational age of 24 to 34 weeks, at a maternity in the Brazilian Northeast. Mean age was 27.3 (SD: 7.9) years. Twenty (41.7%) patients were primiparas. Hypertensive disorders were found in 44 (91.7%) cases. Thirty-five women (72.9%) had DZ and 13 (27.1%) had DR. Univariate analysis was firstly done (Student's t-test and Fisher's exact test) correlating the parameters with the assessed outcome (neonatal death). Variables that showed significant association were included in the logistic regression model (Wald statistics). The level of significance was set at 5%. RESULTS: The perinatal mortality rate was 64.6% (31/48). There were five stillbirths and 26 neonatal deaths. The mean gestational age at diagnosis was 27.9 (SD: 2.8) weeks. Deliveries before 24 hours after diagnosis occurred in 52.1% of the cases. Cesarean section was performed in 85.4% of the sample. The newborns weighed 975.9 g on average (SD: 457.5). Twenty-four (57.1%) presented Apgar scores below 7 in the first minute and 21.4% in the fifth minute. Gestational age at diagnosis, birth weight and Apgar of the first minute proved to be variables significantly related to neonatal death (p values were: 0.008, 0.004, and 0.020, respectively). The Odds Ratio was 6.6, 25.3 and 13.8 for neonatal death, when the diagnosis was established at the 28th week, weight was <1000 g and first minute Apgar score was <7, respectively. CONCLUSIONS: gestational age at diagnosis, birth weight and Apgar score at the first minute were factors that could predict neonatal death in pregnancies with DV or DR determined by umbilical artery Doppler velocimetry.