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Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(1):12-18
, , , , , To assess the prevalence of gestational diabetes mellitus and the main associated risk factors in the population served by the Brazilian Unified Health System in the city of Caxias do Sul, state of Rio Grande do Sul.
A descriptive, cross-sectional and retrospective study was conducted. Maternal variables were collected from the medical records of all pregnant women treated at the basic health units in 2016. Hyperglycemia during pregnancy (pregestational diabetes, overt diabetes and gestational diabetes mellitus) was identified by analyzing the results of a 75-g oral glucose tolerance test, as recommended by the Brazilian Ministry of Health. Based on the data, the women were allocated into two groups: the gestational diabetes group and the no gestational diabetes group.
The estimated prevalence of gestational diabetes among 2,313 pregnant women was of 5.4% (95% confidence interval [95%CI]: 4.56-6.45). Pregnant women with 3 or more pregnancies had twice the odds of having gestational diabetes compared with primiparous women (odds ratio [OR]=2.19; 95%CI: 1.42-3.37; p<0.001). Pregnant women aged 35 years or older had three times the odds of having gestational diabetes when compared with younger women (OR=3.01; 95%CI: 1.97-4.61; p<0.001). Overweight pregnant women were 84% more likely to develop gestational diabetes than those with a body mass index lower than 25 kg/m2 (OR =1.84; 95%CI: 1.25-2.71; p=0.002). A multivariable regression analysis showed that being overweight and being 35 years old or older were independent variables.
In this population, the prevalence of gestational diabetes mellitus was of 5.4%. Age and being overweight were predictive factors for gestational diabetes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(1):12-18
, , , , , To assess the prevalence of gestational diabetes mellitus and the main associated risk factors in the population served by the Brazilian Unified Health System in the city of Caxias do Sul, state of Rio Grande do Sul.
A descriptive, cross-sectional and retrospective study was conducted. Maternal variables were collected from the medical records of all pregnant women treated at the basic health units in 2016. Hyperglycemia during pregnancy (pregestational diabetes, overt diabetes and gestational diabetes mellitus) was identified by analyzing the results of a 75-g oral glucose tolerance test, as recommended by the Brazilian Ministry of Health. Based on the data, the women were allocated into two groups: the gestational diabetes group and the no gestational diabetes group.
The estimated prevalence of gestational diabetes among 2,313 pregnant women was of 5.4% (95% confidence interval [95%CI]: 4.56-6.45). Pregnant women with 3 or more pregnancies had twice the odds of having gestational diabetes compared with primiparous women (odds ratio [OR]=2.19; 95%CI: 1.42-3.37; p<0.001). Pregnant women aged 35 years or older had three times the odds of having gestational diabetes when compared with younger women (OR=3.01; 95%CI: 1.97-4.61; p<0.001). Overweight pregnant women were 84% more likely to develop gestational diabetes than those with a body mass index lower than 25 kg/m2 (OR =1.84; 95%CI: 1.25-2.71; p=0.002). A multivariable regression analysis showed that being overweight and being 35 years old or older were independent variables.
In this population, the prevalence of gestational diabetes mellitus was of 5.4%. Age and being overweight were predictive factors for gestational diabetes.
, Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(5):352-356
, Pentalogy of Cantrell (PC) is a rare congenital anomaly characterized by changes in the mesodermal median structures and congenital heart disease, often with a poor prognosis. In 1958, Cantrell et al2 defined the full spectrum of the syndrome with the following anomalies: defects of the anterior diaphragm, of the lower part of the sternum, of the supraumbilical region and the abdominal wall, of the diaphragmatic pericardium, and various intracardiac congenital abnormalities. The present report describes a case of ectopia cordis associated with PC and the importance of the participation of a multidisciplinary team in the treatment of this condition.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(5):352-356
, Pentalogy of Cantrell (PC) is a rare congenital anomaly characterized by changes in the mesodermal median structures and congenital heart disease, often with a poor prognosis. In 1958, Cantrell et al2 defined the full spectrum of the syndrome with the following anomalies: defects of the anterior diaphragm, of the lower part of the sternum, of the supraumbilical region and the abdominal wall, of the diaphragmatic pericardium, and various intracardiac congenital abnormalities. The present report describes a case of ectopia cordis associated with PC and the importance of the participation of a multidisciplinary team in the treatment of this condition.
, Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(4):211-212
, Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(4):211-212
, Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(7):330-336
To assess the impact of pre-pregnancy obesity (body mass index [BMI] ≥30 kg/m2) on the gestational and perinatal outcomes.
Retrospective cohort study of 731 pregnant women with a BMI ≥30 kg/m2 at the first prenatal care visit, comparing them with 3,161 women with a BMI between 18.5 kg/m2 and 24.9 kg/m2. Maternal and neonatal variables were assessed. Statistical analyses reporting the demographic features of the pregnant women (obese and normal) were performed with descriptive statistics followed by two-sided independent Student’s t tests for the continuous variables, and the chi-squared (χ2) test, or Fisher’s exact test, for the categorical variables. We performed a multiple linear regression analysis of newborn body weight based on the mother’s BMI, adjusted by maternal age, hyperglycemic disorders, hypertensive disorders, and cesarean deliveries to analyze the relationships among these variables. All analyses were performed with the R (R Foundation for Statistical Computing, Vienna, Austria) for Windows software, version 3.1.0. A value of p < 0.05 was considered statistically significant.
Obesity was associated with older age [OR 9.8 (7.8-12.2); p < 0.01], hyperglycemic disorders [OR 6.5 (4.8-8.9); p < 0.01], hypertensive disorders [OR 7.6 (6.1-9.5); p < 0.01], caesarean deliveries [OR 2.5 (2.1-3.0); p < 0.01], fetal macrosomia [OR 2.9 (2.3-3.6); p < 0.01] and umbilical cord pH [OR 2.1 (1.4-2.9); p < 0.01). Conversely, no association was observed with the duration of labor, bleeding during labor, Apgar scores at 1 and 5 minutes after birth, gestational age, stillbirth and early neonatal mortality, congenital malformations, and maternal and fetal injury.
We observed that pre-pregnancy obesity was associated with maternal age, hyperglycemic disorders, hypertension syndrome, cesarean deliveries, fetal macrosomia, and fetal acidosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(7):330-336
To assess the impact of pre-pregnancy obesity (body mass index [BMI] ≥30 kg/m2) on the gestational and perinatal outcomes.
Retrospective cohort study of 731 pregnant women with a BMI ≥30 kg/m2 at the first prenatal care visit, comparing them with 3,161 women with a BMI between 18.5 kg/m2 and 24.9 kg/m2. Maternal and neonatal variables were assessed. Statistical analyses reporting the demographic features of the pregnant women (obese and normal) were performed with descriptive statistics followed by two-sided independent Student’s t tests for the continuous variables, and the chi-squared (χ2) test, or Fisher’s exact test, for the categorical variables. We performed a multiple linear regression analysis of newborn body weight based on the mother’s BMI, adjusted by maternal age, hyperglycemic disorders, hypertensive disorders, and cesarean deliveries to analyze the relationships among these variables. All analyses were performed with the R (R Foundation for Statistical Computing, Vienna, Austria) for Windows software, version 3.1.0. A value of p < 0.05 was considered statistically significant.
Obesity was associated with older age [OR 9.8 (7.8-12.2); p < 0.01], hyperglycemic disorders [OR 6.5 (4.8-8.9); p < 0.01], hypertensive disorders [OR 7.6 (6.1-9.5); p < 0.01], caesarean deliveries [OR 2.5 (2.1-3.0); p < 0.01], fetal macrosomia [OR 2.9 (2.3-3.6); p < 0.01] and umbilical cord pH [OR 2.1 (1.4-2.9); p < 0.01). Conversely, no association was observed with the duration of labor, bleeding during labor, Apgar scores at 1 and 5 minutes after birth, gestational age, stillbirth and early neonatal mortality, congenital malformations, and maternal and fetal injury.
We observed that pre-pregnancy obesity was associated with maternal age, hyperglycemic disorders, hypertension syndrome, cesarean deliveries, fetal macrosomia, and fetal acidosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(11):516-522
DOI 10.1590/S0100-72032013001100007
PURPOSE: To analyze the impact of vaginal delivery after a previous cesarean section on perinatal outcomes. METHODS: Case-control study with selection of incident cases and consecutive controls. Maternal and perinatal variables were analyzed. We compared secundiparas who had a vaginal delivery after a previous cesarean delivery (VBAC) (n=375) with secundiparas who had a second cesarean section (CS) (n=375). Inclusion criteria were: secundiparas who underwent a cesarean section in the previous pregnancy; singleton and term pregnancy; fetus in vertex presentation, with no congenital malformation; absence of placenta previa or any kind of bleeding in the third quarter of pregnancy. RESULTS: The rate of vaginal delivery was 45.6%, and 20 (5.3%) women had forceps deliveries. We found a significant association between VBAC and mothers younger than 19 years (p<0.01), Caucasian ethnicity (p<0.05), mean number of prenatal care visits (p<0.001), time of premature rupture of membranes (p<0.01), labor duration shorter than 12 hours (p<0.04), Apgar score lower than seven at 5th minute (p<0.05), fetal birth trauma (p<0.01), and anoxia (p<0.006). In the group of newborns delivered by cesarean section, we found a higher frequency of transient tachypnea (p<0.014), respiratory disorders (p<0.048), and longer time of stay in the neonatal intensive care unit (p<0.016). There was only one case of uterine rupture in the VBAC group. The rate of neonatal mortality was similar in both groups. CONCLUSIONS: Vaginal delivery in secundiparas who had previous cesarean sections was associated with a significant increase in neonatal morbidity. Further studies are needed to develop strategies aimed at improving perinatal results and professional guidelines, so that health care professionals will be able to provide their patients with better counseling regarding the choice of the most appropriate route of delivery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(11):516-522
DOI 10.1590/S0100-72032013001100007
PURPOSE: To analyze the impact of vaginal delivery after a previous cesarean section on perinatal outcomes. METHODS: Case-control study with selection of incident cases and consecutive controls. Maternal and perinatal variables were analyzed. We compared secundiparas who had a vaginal delivery after a previous cesarean delivery (VBAC) (n=375) with secundiparas who had a second cesarean section (CS) (n=375). Inclusion criteria were: secundiparas who underwent a cesarean section in the previous pregnancy; singleton and term pregnancy; fetus in vertex presentation, with no congenital malformation; absence of placenta previa or any kind of bleeding in the third quarter of pregnancy. RESULTS: The rate of vaginal delivery was 45.6%, and 20 (5.3%) women had forceps deliveries. We found a significant association between VBAC and mothers younger than 19 years (p<0.01), Caucasian ethnicity (p<0.05), mean number of prenatal care visits (p<0.001), time of premature rupture of membranes (p<0.01), labor duration shorter than 12 hours (p<0.04), Apgar score lower than seven at 5th minute (p<0.05), fetal birth trauma (p<0.01), and anoxia (p<0.006). In the group of newborns delivered by cesarean section, we found a higher frequency of transient tachypnea (p<0.014), respiratory disorders (p<0.048), and longer time of stay in the neonatal intensive care unit (p<0.016). There was only one case of uterine rupture in the VBAC group. The rate of neonatal mortality was similar in both groups. CONCLUSIONS: Vaginal delivery in secundiparas who had previous cesarean sections was associated with a significant increase in neonatal morbidity. Further studies are needed to develop strategies aimed at improving perinatal results and professional guidelines, so that health care professionals will be able to provide their patients with better counseling regarding the choice of the most appropriate route of delivery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(8):381-385
DOI 10.1590/S0100-72032012000800007
PURPOSE: To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7,0. METHODS: Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Student's t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR). The level of significance was set at p<0.05. RESULTS: Of a total of 15,495 consecutive births, 25 term neonates (0.16%) had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005), cesarean section (OR=3.5, p<0.01) and modified intrapartum cardiotocography (OR=7.8, p<0.02) presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001), need for resuscitation (OR=12.2, p <0.0001) and base deficit were associated with the event (15.0 versus -4.5, p<0.0001). CONCLUSION: Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(8):381-385
DOI 10.1590/S0100-72032012000800007
PURPOSE: To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7,0. METHODS: Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Student's t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR). The level of significance was set at p<0.05. RESULTS: Of a total of 15,495 consecutive births, 25 term neonates (0.16%) had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005), cesarean section (OR=3.5, p<0.01) and modified intrapartum cardiotocography (OR=7.8, p<0.02) presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001), need for resuscitation (OR=12.2, p <0.0001) and base deficit were associated with the event (15.0 versus -4.5, p<0.0001). CONCLUSION: Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(1):10-16
DOI 10.1590/S0100-72032009000100003
PURPOSE: to determine the prevalence of histopathological changes, in human placentas, related to hypertensive syndromes. METHODS: a transversal study that compares histopathological changes identified in 43 placentae from hypertensive pregnant women (HypPr), with the ones from 33 placentae from normotensive pregnant women (NorPr). The weight, volume and macroscopic and microscopic occurrence of infarctions, clots, hematomas, atherosis (partial obliteration, thickness of layers and presence of blood vessels hyalinization) and Tenney-Parker changes (absent, discreet and prominent), as well as the locating of infarctions and clots (central, peripheral or the association of both) have been analyzed. The χ2 and t Student tests have been used for the statistical analysis, as well as medians, standard deviations and ratios. It has been considered as significant, p<0.05. RESULTS: the macroscopic study of HypPr placentae have presented lower weight (461.1 versus 572.1 g) and volume (437.4 versus 542.0 cm³), higher infarction (51.2 versus 45.5%; p<0.05: OR=1.15) and clots (51.2 versus 15.1%; p<0.05; OR=5.4) ratios, as compared to the NorPr's. In the HypPr and NorPr, microscopic clots have occurred in 83.7 versus 45.5% (p<0.05; OR=4.3), respectively. Atherosis and Tenney-Parker changes have been statistically associated to the hypertensive syndromes (p<0.05). CONCLUSIONS: the obtained data allow us to associate lower placentary weight and volume, higher ratio of macro and microscopic infarction, clots, atherosis and Tenney-Parker changes to placentae of gestations occurring with hypertensive syndromes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(1):10-16
DOI 10.1590/S0100-72032009000100003
PURPOSE: to determine the prevalence of histopathological changes, in human placentas, related to hypertensive syndromes. METHODS: a transversal study that compares histopathological changes identified in 43 placentae from hypertensive pregnant women (HypPr), with the ones from 33 placentae from normotensive pregnant women (NorPr). The weight, volume and macroscopic and microscopic occurrence of infarctions, clots, hematomas, atherosis (partial obliteration, thickness of layers and presence of blood vessels hyalinization) and Tenney-Parker changes (absent, discreet and prominent), as well as the locating of infarctions and clots (central, peripheral or the association of both) have been analyzed. The χ2 and t Student tests have been used for the statistical analysis, as well as medians, standard deviations and ratios. It has been considered as significant, p<0.05. RESULTS: the macroscopic study of HypPr placentae have presented lower weight (461.1 versus 572.1 g) and volume (437.4 versus 542.0 cm³), higher infarction (51.2 versus 45.5%; p<0.05: OR=1.15) and clots (51.2 versus 15.1%; p<0.05; OR=5.4) ratios, as compared to the NorPr's. In the HypPr and NorPr, microscopic clots have occurred in 83.7 versus 45.5% (p<0.05; OR=4.3), respectively. Atherosis and Tenney-Parker changes have been statistically associated to the hypertensive syndromes (p<0.05). CONCLUSIONS: the obtained data allow us to associate lower placentary weight and volume, higher ratio of macro and microscopic infarction, clots, atherosis and Tenney-Parker changes to placentae of gestations occurring with hypertensive syndromes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(4):232-237
DOI 10.1590/S0100-72032006000400005
PURPOSE: to identify maternal and perinatal factors related to neonates with birthweight >4,000 g. METHODS: cross-section cohort study with 411 consecutive cases of fetal macrosomia (FM) which occurred from March 1998 to March 2005. Data were compared to 7,349 cases of fetal birthweight >2,500 and <3,999 g which occurred in the same period. Maternal variables (maternal age, parity, diabetes, previous cesarean section, meconium-stained amniotic fluid, cephalopelvic disproportion, main cesarean section indications) and perinatal variables (birth injury, <7 1-min and 5-min Apgar score, fetal and early neonatal mortality range, need of neonatal intensive care unit) were analyzed. For statistical analysis the chi2 test with Yates correction and Student's t test were used with the level of significance set at 5%. RESULTS: FM was significantly associated with older mothers, more parous and <7 1-min Apgar score (p<0.05; OR=1.8; 95% CI: 1,4-2.5) and <7 5-min Apgar score (p<0,05; OR=2.3; 95% CI: 1.3-4,1), diabetes mellitus (p<0.05; OR=4.2; 95% CI: 2.7-6.4), meconium-stained amniotic fluid (p<0.02; OR=1.3; 95% CI: 1.0-1.7), need of neonatal intensive care unit (p<0,05; OR=2.0; 95% CI: 1.5-2.7), early neonatal mortality (p<0,05; OR = 2.7; 95% CI: 1.0-6.7), cesarean section (p < 0.05; OR = 2.03; 95% CI: 1,6-2,5) and cephalopelvic disproportion (p < 0.05;OR = 2.8; 95% CI: 1.6-4,8). There was no statistical difference between birth injury and fetal mortality range. In the FM group the main cesarean section indications were repeat cesarean sections (11.9%) and cephalopelvic disproportion (8.6%); in the normal birthweight group, repeat cesareans (8.3%) and fetal distress during labor (3.9%). CONCLUSIONS: in spite of the characteristic limitations of a retrospective evaluation, the analysis demonstrated which complications were associated with large fetal size, being useful in obstetric handling of patients with a diagnosis of extreme fetal growth. FM remains an obstetric problem of difficult solution, associated with important maternal and perinatal health problems, due to the significant observed rates of maternal and perinatal morbidity and mortality in developed and developing countries.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(4):232-237
DOI 10.1590/S0100-72032006000400005
PURPOSE: to identify maternal and perinatal factors related to neonates with birthweight >4,000 g. METHODS: cross-section cohort study with 411 consecutive cases of fetal macrosomia (FM) which occurred from March 1998 to March 2005. Data were compared to 7,349 cases of fetal birthweight >2,500 and <3,999 g which occurred in the same period. Maternal variables (maternal age, parity, diabetes, previous cesarean section, meconium-stained amniotic fluid, cephalopelvic disproportion, main cesarean section indications) and perinatal variables (birth injury, <7 1-min and 5-min Apgar score, fetal and early neonatal mortality range, need of neonatal intensive care unit) were analyzed. For statistical analysis the chi2 test with Yates correction and Student's t test were used with the level of significance set at 5%. RESULTS: FM was significantly associated with older mothers, more parous and <7 1-min Apgar score (p<0.05; OR=1.8; 95% CI: 1,4-2.5) and <7 5-min Apgar score (p<0,05; OR=2.3; 95% CI: 1.3-4,1), diabetes mellitus (p<0.05; OR=4.2; 95% CI: 2.7-6.4), meconium-stained amniotic fluid (p<0.02; OR=1.3; 95% CI: 1.0-1.7), need of neonatal intensive care unit (p<0,05; OR=2.0; 95% CI: 1.5-2.7), early neonatal mortality (p<0,05; OR = 2.7; 95% CI: 1.0-6.7), cesarean section (p < 0.05; OR = 2.03; 95% CI: 1,6-2,5) and cephalopelvic disproportion (p < 0.05;OR = 2.8; 95% CI: 1.6-4,8). There was no statistical difference between birth injury and fetal mortality range. In the FM group the main cesarean section indications were repeat cesarean sections (11.9%) and cephalopelvic disproportion (8.6%); in the normal birthweight group, repeat cesareans (8.3%) and fetal distress during labor (3.9%). CONCLUSIONS: in spite of the characteristic limitations of a retrospective evaluation, the analysis demonstrated which complications were associated with large fetal size, being useful in obstetric handling of patients with a diagnosis of extreme fetal growth. FM remains an obstetric problem of difficult solution, associated with important maternal and perinatal health problems, due to the significant observed rates of maternal and perinatal morbidity and mortality in developed and developing countries.