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You searched for:"Ernesto Antonio Figueiró-Filho"
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Rev Bras Ginecol Obstet. 2014;36(1):10-16
DOI 10.1590/S0100-72032014000100004
To investigate the association of perinatal variables with the birth of very low birth weight (VLBW) preterm newborns.
It was a retrospective study of the medical records of infants born after spontaneous preterm labor with admission to a neonatal intensive care unit. Preterm infants were divided into two groups: very low birth weight (VLBW) group (weight <1,500 g) and low birth weight (LBW) group (weight ≥1,500 g and <2,500 g). Prenatal variables such as maternal complications during pregnancy and childbirth/postpartum, and fetal/neonatal complications were investigated. Statistical analysis was performed using the Fisher exact test or χ2 test, with calculation of relative risk (RR), and the Student t test for comparison of group means, with the level of significance set at p≤0.05.
Hemorrhagic comorbidities (p=0.006; RR=1.2) and hypertension (p=0.04; RR=1.5), surgical delivery (p=0.001; RR=0.5), gestational age <33 weeks (p< 0.001; RR=16.7) and Apgar score at 1st and 5th minute (p=0.006; RR=1.6; p=0.01; RR=1.9) were associated with the occurrence of VLBW. Infants with VLBW had a significant association with the occurrence of metabolic comorbidities (p=0.01; RR=1.8), neurological (p=0.01; RR=1.7) and infectious diseases (p=0.001; RR=1.9), hospitalization >4 weeks (p=0.02; RR=1.8) and early neonatal death (p=0.0001; RR=2.9).
Factors such as hypertension and bleeding comorbidities during delivery and management of gestational age of less than 33 weeks were associated with the birth of VLBW newborns. This group of infants also showed higher RR for the occurrence of early neonatal death.
Summary
Rev Bras Ginecol Obstet. 2014;36(1):10-16
DOI 10.1590/S0100-72032014000100004
To investigate the association of perinatal variables with the birth of very low birth weight (VLBW) preterm newborns.
It was a retrospective study of the medical records of infants born after spontaneous preterm labor with admission to a neonatal intensive care unit. Preterm infants were divided into two groups: very low birth weight (VLBW) group (weight <1,500 g) and low birth weight (LBW) group (weight ≥1,500 g and <2,500 g). Prenatal variables such as maternal complications during pregnancy and childbirth/postpartum, and fetal/neonatal complications were investigated. Statistical analysis was performed using the Fisher exact test or χ2 test, with calculation of relative risk (RR), and the Student t test for comparison of group means, with the level of significance set at p≤0.05.
Hemorrhagic comorbidities (p=0.006; RR=1.2) and hypertension (p=0.04; RR=1.5), surgical delivery (p=0.001; RR=0.5), gestational age <33 weeks (p< 0.001; RR=16.7) and Apgar score at 1st and 5th minute (p=0.006; RR=1.6; p=0.01; RR=1.9) were associated with the occurrence of VLBW. Infants with VLBW had a significant association with the occurrence of metabolic comorbidities (p=0.01; RR=1.8), neurological (p=0.01; RR=1.7) and infectious diseases (p=0.001; RR=1.9), hospitalization >4 weeks (p=0.02; RR=1.8) and early neonatal death (p=0.0001; RR=2.9).
Factors such as hypertension and bleeding comorbidities during delivery and management of gestational age of less than 33 weeks were associated with the birth of VLBW newborns. This group of infants also showed higher RR for the occurrence of early neonatal death.
Summary
Rev Bras Ginecol Obstet. 2004;26(3):241-245
DOI 10.1590/S0100-72032004000300011
The reduction of mother-to-child transmission (MTCT) of the HIV-1 using zidovudine (ZDV) represents a cornerstone in the prenatal and obstetrical care to these patients. The invasive fetal and obstetric procedures are proscribed in HIV-1 infected pregnant patients, to avoid the increased risk of MTCT of this virus. The authors present a case of an HIV-1 infected woman with recurrent polyhydramnios. Four ultrasound-guided amniotic punctures were performed in the 23rd, 26th, 27th and 29th weeks of gestation, each one draining the respective volumes of 1,800, 1,450, 1,700 and 1,960 ml of clear amniotic fluid. The patient started preterm labor with 30 weeks and 5 days resulting in vaginal delivery of a male neonate weighing 1,690g and measuring 43cm. The baby presented a post natal diagnosis of a sodium-losing nephropathy and was submitted to three negative polymerase chain reaction tests for HIV-1. The authors point out that the option to manage cases of HIV-1 infected pregnancies that could need invasive obstetric procedures should be to give the patient 2 mg//kg of ZDV endovenously before the procedure, in order to avoid MTCT of HIV-1, as it has demonstrated good results in this case.
Summary
Rev Bras Ginecol Obstet. 2004;26(3):241-245
DOI 10.1590/S0100-72032004000300011
The reduction of mother-to-child transmission (MTCT) of the HIV-1 using zidovudine (ZDV) represents a cornerstone in the prenatal and obstetrical care to these patients. The invasive fetal and obstetric procedures are proscribed in HIV-1 infected pregnant patients, to avoid the increased risk of MTCT of this virus. The authors present a case of an HIV-1 infected woman with recurrent polyhydramnios. Four ultrasound-guided amniotic punctures were performed in the 23rd, 26th, 27th and 29th weeks of gestation, each one draining the respective volumes of 1,800, 1,450, 1,700 and 1,960 ml of clear amniotic fluid. The patient started preterm labor with 30 weeks and 5 days resulting in vaginal delivery of a male neonate weighing 1,690g and measuring 43cm. The baby presented a post natal diagnosis of a sodium-losing nephropathy and was submitted to three negative polymerase chain reaction tests for HIV-1. The authors point out that the option to manage cases of HIV-1 infected pregnancies that could need invasive obstetric procedures should be to give the patient 2 mg//kg of ZDV endovenously before the procedure, in order to avoid MTCT of HIV-1, as it has demonstrated good results in this case.
Summary
Rev Bras Ginecol Obstet. 2004;26(3):249-249
Summary
Rev Bras Ginecol Obstet. 2004;26(3):249-249
Summary
Rev Bras Ginecol Obstet. 2004;26(1):31-36
DOI 10.1590/S0100-72032004000100005
PURPOSE: to experimentally evaluate the diabetogenic effects of antiretroviral drugs on pregnant Wistar rats and the perinatal effects on the offspring. METHODS: adult female pregnant Wistar rats weighing 200-230 g were used. The antiretroviral drugs zidovudine (ZDV), lamivudine (3TC) and nelfinavir (NFV) were used alone and in association at daily doses of ten times the dose normally used in pregnant women, proportionally to the animal's body weight. Seven groups were studied, including the control. The experiment started on day 0 of pregnancy and the pregnant animals were sacrificed on day 21. The fetuses were counted and weighed. Blood determinations of glucose, insulin, glucagon and lactate were performed on day 21. The retroperitoneal adipose tissue was weighed. Data were analyzed statistically by Student's t-test. RESULTS: the groups treated with 3TC, ZDV + 3TC and ZDV + 3TC + NFV showed decreasing values of maternal daily body weight gain, retroperitoneal adipose tissue weight and weight of fetuses (control group: 6.2 g; 3TC group variation: 4.1-5.6 g). The serum lactate levels were also decreased when compared to the control in these groups (control group: 5.8 mmol/mL; 3TC group variations: 3.2-3.7 mmol/mL). All antiretroviral-treated groups showed a decreasing number of fetuses when compared to the control (control group: 14.7; drug group variation: 11.1-12.7). All treated groups also showed decreasing serum values of insulin (control group: 6.2 µIU/mL; drug group variation: 2.1 to 2.7 µIU/mL) and increasing serum levels of glucagon when compared to the control (control group: 88.2 pg/mL; drug group variation: 99.7 to 120.7 pg/mL). There was no statistical significance of glucose levels when comparing treated groups to the control. CONCLUSIONS: the antiretroviral drugs interfered in carbohydrate metabolism of pregnant rats and reduced the number of fetuses. 3TC caused less maternal body weight gain, decreased fetus weight and lactate and insulin levels and increased serum glucagon.
Summary
Rev Bras Ginecol Obstet. 2004;26(1):31-36
DOI 10.1590/S0100-72032004000100005
PURPOSE: to experimentally evaluate the diabetogenic effects of antiretroviral drugs on pregnant Wistar rats and the perinatal effects on the offspring. METHODS: adult female pregnant Wistar rats weighing 200-230 g were used. The antiretroviral drugs zidovudine (ZDV), lamivudine (3TC) and nelfinavir (NFV) were used alone and in association at daily doses of ten times the dose normally used in pregnant women, proportionally to the animal's body weight. Seven groups were studied, including the control. The experiment started on day 0 of pregnancy and the pregnant animals were sacrificed on day 21. The fetuses were counted and weighed. Blood determinations of glucose, insulin, glucagon and lactate were performed on day 21. The retroperitoneal adipose tissue was weighed. Data were analyzed statistically by Student's t-test. RESULTS: the groups treated with 3TC, ZDV + 3TC and ZDV + 3TC + NFV showed decreasing values of maternal daily body weight gain, retroperitoneal adipose tissue weight and weight of fetuses (control group: 6.2 g; 3TC group variation: 4.1-5.6 g). The serum lactate levels were also decreased when compared to the control in these groups (control group: 5.8 mmol/mL; 3TC group variations: 3.2-3.7 mmol/mL). All antiretroviral-treated groups showed a decreasing number of fetuses when compared to the control (control group: 14.7; drug group variation: 11.1-12.7). All treated groups also showed decreasing serum values of insulin (control group: 6.2 µIU/mL; drug group variation: 2.1 to 2.7 µIU/mL) and increasing serum levels of glucagon when compared to the control (control group: 88.2 pg/mL; drug group variation: 99.7 to 120.7 pg/mL). There was no statistical significance of glucose levels when comparing treated groups to the control. CONCLUSIONS: the antiretroviral drugs interfered in carbohydrate metabolism of pregnant rats and reduced the number of fetuses. 3TC caused less maternal body weight gain, decreased fetus weight and lactate and insulin levels and increased serum glucagon.
Summary
Rev Bras Ginecol Obstet. 2004;26(5):369-375
DOI 10.1590/S0100-72032004000500005
OBJECTIVE: to assess the action of antiretroviral drugs on glycid metabolism and on the pancreas of pregnant Wistar rats. METHODS: adult pregnant Wistar rats weighing 200-230g were used. Azidothymidine, lamivudine and nelfinavir were administered to the animals at doses 10 times higher than those administered to pregnant women. The animals were divided into seven groups of 10 animals, including a control group. The animals were sacrificed on the 21st day of pregnancy and glycemia, insulinemia, glucagonemia, free fatty acids (FFA) and hepatic glycogen were measured. Direct counts of the number of immunohistochemically labeled insulin- and glucagon-producing cells were used to determine pancreatic damage. Data were analyzed statistically by the Student's t-test comparing each treated group with the control group. RESULTS: increased serum glucagon (control group: 88.2 pg/ml; treated groups: 99.7-120.7 pg/ml) and reduced insulin (control group: 6.2 muIU/ml; treated groups: 2.1-2.7 muIU/ml) were observed in all groups treated with antiretroviral drugs after 21 days of pregnancy. There was no significant difference between the experimental groups and the control in glycemia, plasma FFA or hepatic glycogen. Also, there was no significant difference in number of insulin- and glucagon-producing cells between the treated groups and the control. CONCLUSION: treatment of noninfected rats with antiretroviral drugs during pregnancy altered maternal glycid metabolism causing insulin decrease and glucagon elevation, with normal glycemia and unchanged number of pancreatic cells.
Summary
Rev Bras Ginecol Obstet. 2004;26(5):369-375
DOI 10.1590/S0100-72032004000500005
OBJECTIVE: to assess the action of antiretroviral drugs on glycid metabolism and on the pancreas of pregnant Wistar rats. METHODS: adult pregnant Wistar rats weighing 200-230g were used. Azidothymidine, lamivudine and nelfinavir were administered to the animals at doses 10 times higher than those administered to pregnant women. The animals were divided into seven groups of 10 animals, including a control group. The animals were sacrificed on the 21st day of pregnancy and glycemia, insulinemia, glucagonemia, free fatty acids (FFA) and hepatic glycogen were measured. Direct counts of the number of immunohistochemically labeled insulin- and glucagon-producing cells were used to determine pancreatic damage. Data were analyzed statistically by the Student's t-test comparing each treated group with the control group. RESULTS: increased serum glucagon (control group: 88.2 pg/ml; treated groups: 99.7-120.7 pg/ml) and reduced insulin (control group: 6.2 muIU/ml; treated groups: 2.1-2.7 muIU/ml) were observed in all groups treated with antiretroviral drugs after 21 days of pregnancy. There was no significant difference between the experimental groups and the control in glycemia, plasma FFA or hepatic glycogen. Also, there was no significant difference in number of insulin- and glucagon-producing cells between the treated groups and the control. CONCLUSION: treatment of noninfected rats with antiretroviral drugs during pregnancy altered maternal glycid metabolism causing insulin decrease and glucagon elevation, with normal glycemia and unchanged number of pancreatic cells.
Summary
Rev Bras Ginecol Obstet. 2012;34(1):40-46
DOI 10.1590/S0100-72032012000100008
PURPOSE: To determine the frequency and the association of serum markers for inherited and acquired thrombophilias in pregnant women with a history of severe pre-eclampsia in previous pregnancies. METHODS: Case-control study consisting of 81 pregnant women with a history of severe pre-eclampsia in previous pregnancies (study group) and 32 women with no history of severe pre-eclampsia in previous pregnancies (control group). The presence of inherited thrombophilia and antiphospholipid antibodies was screened in both groups. We used the chi-square test with Yates correction to assess associations and calculate the relative risks. RESULTS: The presence of thrombophilia was detected in 60.0% of patients with a previous history of pre-eclampsia and in 6.0% of the control patients. A significant association was found between pre-eclampsia in a previous pregnancy and the presence of markers for hereditary thrombophilia/antiphospholipid antibodies (p<0.05). The relative risk to develop pre-eclampsia was found to be 1.57 (1.34
Summary
Rev Bras Ginecol Obstet. 2012;34(1):40-46
DOI 10.1590/S0100-72032012000100008
PURPOSE: To determine the frequency and the association of serum markers for inherited and acquired thrombophilias in pregnant women with a history of severe pre-eclampsia in previous pregnancies. METHODS: Case-control study consisting of 81 pregnant women with a history of severe pre-eclampsia in previous pregnancies (study group) and 32 women with no history of severe pre-eclampsia in previous pregnancies (control group). The presence of inherited thrombophilia and antiphospholipid antibodies was screened in both groups. We used the chi-square test with Yates correction to assess associations and calculate the relative risks. RESULTS: The presence of thrombophilia was detected in 60.0% of patients with a previous history of pre-eclampsia and in 6.0% of the control patients. A significant association was found between pre-eclampsia in a previous pregnancy and the presence of markers for hereditary thrombophilia/antiphospholipid antibodies (p<0.05). The relative risk to develop pre-eclampsia was found to be 1.57 (1.34
Summary
Rev Bras Ginecol Obstet. 2005;27(8):442-449
DOI 10.1590/S0100-72032005000800002
PURPOSE: to establish the frequency of acute toxoplasmosis in pregnant women, vertical transmission rate and the perinatal results of the infected fetuses and also to evaluate the relationship between the most used maternal-fetal diagnostic tests for toxoplasmosis during pregnancy and the relationship between age and acute toxoplasmosis infection during pregnancy. METHODS: longitudinal prospective study of 32,512 pregnant women attended by The Pregnancy Protection Program of the State of Mato Grosso do Sul - Brazil, from November 2002 to October 2003. ELISA (IgG and IgM) and IgG avidity test were performed for maternal diagnosis and amniotic fluid PCR for fetal investigation of the infection. The relationship between data was analyzed statistically by the chi2 or two-sided Fisher's exact test in contingency tables. RESULTS: a 0.42% frequency of acute Toxoplasma gondii infection among pregnant population was found, where 92% were previously exposed and 8% were susceptible. Among IgM-positive pregnant women, the age ranged from 14 to 39 years, with a mean of 23±5.9 years. There was no statistically significant relationship between age and maternal acute T. gondii infection (p=0.73). The vertical transmission rate was 3.9%. A statistically significant relationship was shown (p=0.001) between a lower avidity IgG test (<30%) and the presence of fetal infection and a higher IgG avidity test (>60%) and the absence of fetal infection. There was a statistically significant association (p=0.001) between fetal infection (amniotic fluid PCR) and neonatal infection. CONCLUSIONS: maternal acute toxoplasmosis frequency was lower than the Brazilian national parameters, whereas vertical transmission rate did not differ from the rates found in other studies. The IgG avidity test, when associated with gestational age and the examination date, was useful to evaluate the therapeutical options and to consider the risk of vertical transmission when performed before 12 weeks. Positive PCR in amniotic fluid showed a positive relationship with the worst neonatal prognosis, being a specific method in diagnosing intrauterine fetal infection.
Summary
Rev Bras Ginecol Obstet. 2005;27(8):442-449
DOI 10.1590/S0100-72032005000800002
PURPOSE: to establish the frequency of acute toxoplasmosis in pregnant women, vertical transmission rate and the perinatal results of the infected fetuses and also to evaluate the relationship between the most used maternal-fetal diagnostic tests for toxoplasmosis during pregnancy and the relationship between age and acute toxoplasmosis infection during pregnancy. METHODS: longitudinal prospective study of 32,512 pregnant women attended by The Pregnancy Protection Program of the State of Mato Grosso do Sul - Brazil, from November 2002 to October 2003. ELISA (IgG and IgM) and IgG avidity test were performed for maternal diagnosis and amniotic fluid PCR for fetal investigation of the infection. The relationship between data was analyzed statistically by the chi2 or two-sided Fisher's exact test in contingency tables. RESULTS: a 0.42% frequency of acute Toxoplasma gondii infection among pregnant population was found, where 92% were previously exposed and 8% were susceptible. Among IgM-positive pregnant women, the age ranged from 14 to 39 years, with a mean of 23±5.9 years. There was no statistically significant relationship between age and maternal acute T. gondii infection (p=0.73). The vertical transmission rate was 3.9%. A statistically significant relationship was shown (p=0.001) between a lower avidity IgG test (<30%) and the presence of fetal infection and a higher IgG avidity test (>60%) and the absence of fetal infection. There was a statistically significant association (p=0.001) between fetal infection (amniotic fluid PCR) and neonatal infection. CONCLUSIONS: maternal acute toxoplasmosis frequency was lower than the Brazilian national parameters, whereas vertical transmission rate did not differ from the rates found in other studies. The IgG avidity test, when associated with gestational age and the examination date, was useful to evaluate the therapeutical options and to consider the risk of vertical transmission when performed before 12 weeks. Positive PCR in amniotic fluid showed a positive relationship with the worst neonatal prognosis, being a specific method in diagnosing intrauterine fetal infection.
Summary
Rev Bras Ginecol Obstet. 2012;34(10):459-465
DOI 10.1590/S0100-72032012001000005
PURPOSES: To assess whether an enoxaparin-based intervention using a score system was effective in improving perinatal outcome in women with thrombophilia. METHODS: Study Design: Prospective, not randomized, uncontrolled, performed at a Clinic of High-Risk Pregnancy from November 2009 to November 2011. We included women with a diagnosis and therapeutic intervention for thrombophilia acquired and/or inherited in the current pregnancy. The obstetric and perinatal outcomes of pregnant women before the intervention were compared with outcomes after the intervention, and statistically analyzed using the χ2 test with Yates correction, considered significant when p<0.05. The initial dose of low-molecular-weight Heparin (LMWH) was guided by a scoring system based on the clinical and gestational history of the patients and screening tests for acquired and/or inherited thrombophilia. RESULTS: We included 84 pregnant women with 175 pregnancies before diagnosis, 20.0% of which resulted in fetal ou perinatal death, 40.0% resulted in abortion, 17.7% developed preeclampsia/eclampsia, 10.3% resulted in full-term births, and 29.7% in premature births. In the 84 pregnancies after intervention, 6.0% resulted in fetal ou perinatal death, 1.2% in abortion, 4.8% developed preeclampsia/eclampsia, 22.6% resulted in premature birth, and 70.2% in full-term birth. A significant reduction in the rate of stillbirths/perinatal death (p<0.05) and abortion (p<0.0001) and a significant increase (p<0.05) in the number of live births were observed after intervention. CONCLUSION: Enoxaparin-based intervention using a score system in pregnant women with thrombophilia is effective in improving perinatal outcome.
Summary
Rev Bras Ginecol Obstet. 2012;34(10):459-465
DOI 10.1590/S0100-72032012001000005
PURPOSES: To assess whether an enoxaparin-based intervention using a score system was effective in improving perinatal outcome in women with thrombophilia. METHODS: Study Design: Prospective, not randomized, uncontrolled, performed at a Clinic of High-Risk Pregnancy from November 2009 to November 2011. We included women with a diagnosis and therapeutic intervention for thrombophilia acquired and/or inherited in the current pregnancy. The obstetric and perinatal outcomes of pregnant women before the intervention were compared with outcomes after the intervention, and statistically analyzed using the χ2 test with Yates correction, considered significant when p<0.05. The initial dose of low-molecular-weight Heparin (LMWH) was guided by a scoring system based on the clinical and gestational history of the patients and screening tests for acquired and/or inherited thrombophilia. RESULTS: We included 84 pregnant women with 175 pregnancies before diagnosis, 20.0% of which resulted in fetal ou perinatal death, 40.0% resulted in abortion, 17.7% developed preeclampsia/eclampsia, 10.3% resulted in full-term births, and 29.7% in premature births. In the 84 pregnancies after intervention, 6.0% resulted in fetal ou perinatal death, 1.2% in abortion, 4.8% developed preeclampsia/eclampsia, 22.6% resulted in premature birth, and 70.2% in full-term birth. A significant reduction in the rate of stillbirths/perinatal death (p<0.05) and abortion (p<0.0001) and a significant increase (p<0.05) in the number of live births were observed after intervention. CONCLUSION: Enoxaparin-based intervention using a score system in pregnant women with thrombophilia is effective in improving perinatal outcome.