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Rev Bras Ginecol Obstet. 2023;45(6):347-355
, , , , , , To review the literature and synthesize evidence on pathophysiological interactions attributed to the simultaneous occurrence of COVID-19 and preeclampsia.
A systematic review was conducted from November (2021) to January (2022) to retrieve observational studies published on the PubMed, LILACS, SciELO Brazil and Google Scholar databases. The search was based on the descriptors [(eclampsia OR preeclampsia) AND (COVID-19)]. Quantitative studies that pointed to pathophysiological interactions were included. Literature reviews, studies with HIV participants, or with clinical approach only were excluded. The selection of studies was standardized and the evaluation was performed by pairs of researchers.
In this review, 155 publications were retrieved; 16 met the inclusion criteria. In summary, the physiological expression of angiotensin-converting enzyme-2 (ACE-2) receptors is physiologically increased in pregnant women, especially at the placental site. Studies suggest that the coronavirus binds to ACE-2 to enter the human cell, causing deregulation of the renin-angiotensin-aldosterone system and in the ratio between angiotensin-II and angiotensin-1-7, inducing manifestations suggestive of preeclampsia. Furthermore, the cytokine storm leads to endothelial dysfunction, vasculopathy and thrombus formation, also present in preeclampsia.
The studies retrieved in this review suggest that there is a possible overlap of pathophysiological interactions between COVID-19 and preeclampsia, which mainly involve ACE-2 and endothelial dysfunction. Given that preeclampsia courses with progressive clinical and laboratory alterations, a highly quality prenatal care may be able to detect specific clinical and laboratory parameters to differentiate a true preeclampsia superimposed by covid-19, as well as cases with hypertensive manifestations resulting from viral infection.
Summary
Rev Bras Ginecol Obstet. 2023;45(6):347-355
, , , , , , To review the literature and synthesize evidence on pathophysiological interactions attributed to the simultaneous occurrence of COVID-19 and preeclampsia.
A systematic review was conducted from November (2021) to January (2022) to retrieve observational studies published on the PubMed, LILACS, SciELO Brazil and Google Scholar databases. The search was based on the descriptors [(eclampsia OR preeclampsia) AND (COVID-19)]. Quantitative studies that pointed to pathophysiological interactions were included. Literature reviews, studies with HIV participants, or with clinical approach only were excluded. The selection of studies was standardized and the evaluation was performed by pairs of researchers.
In this review, 155 publications were retrieved; 16 met the inclusion criteria. In summary, the physiological expression of angiotensin-converting enzyme-2 (ACE-2) receptors is physiologically increased in pregnant women, especially at the placental site. Studies suggest that the coronavirus binds to ACE-2 to enter the human cell, causing deregulation of the renin-angiotensin-aldosterone system and in the ratio between angiotensin-II and angiotensin-1-7, inducing manifestations suggestive of preeclampsia. Furthermore, the cytokine storm leads to endothelial dysfunction, vasculopathy and thrombus formation, also present in preeclampsia.
The studies retrieved in this review suggest that there is a possible overlap of pathophysiological interactions between COVID-19 and preeclampsia, which mainly involve ACE-2 and endothelial dysfunction. Given that preeclampsia courses with progressive clinical and laboratory alterations, a highly quality prenatal care may be able to detect specific clinical and laboratory parameters to differentiate a true preeclampsia superimposed by covid-19, as well as cases with hypertensive manifestations resulting from viral infection.
Summary
Rev Bras Ginecol Obstet. 2017;39(8):376-383
To describe the trends in the prevalence of macrosomia (birth weight ± 4,000 g) according to gestational age in Brazil in the periods of 2001-2010 and 2012-2014.
Ecological study with data from the Brazilian Live Birth Information System (SINASC, in the Portuguese acronym) regarding singleton live newborns born from 22 gestational weeks. The trends in Brazil as a whole and in each of its five regions were analyzed according to preterm (22-36 gestational weeks) and term (37-42 gestational weeks) strata. Annual Percent Changes (APCs) based on the Prais-Winsten method and their respective 95% confidence intervals (CIs) were used to verify statistically significant changes in 2001-2010.
In Brazil, the prevalence of macrosomic births was of 5.3% (2001-2010) and 5.1% (2012-2014). The rates were systematically higher in the North and Northeast Regions both in the preterm and in term strata. In the preterm stratum, the North Region presented the highest variation in the prevalence of macrosomia (+137.5%) when comparing 2001 (0.8%) to 2010 (1.9%). In the term stratum, downward trends were observed in Brazil as a whole and in every region. The trends for 2012-2014 were more heterogeneous, with the prevalence systematically higher than that observed for 2001-2010. The APC in the preterm stratum (2001-2010) showed a statistically significant trend change in the North (APC: 15.4%; 95%CI: 0.6-32.3) and South (APC: 13.5%; 95%CI: 4.8-22.9) regions. In the term stratum, the change occurred only in the North region (APC:-1.5%; 95%CI: -2.5--0.5).
The prevalence of macrosomic births in Brazil was higher than 5.0%. Macrosomia has potentially negative health implications for both children and adults, and deserves close attention in the public health agenda in Brazil, as well as further support for investigation and intervention.
Summary
Rev Bras Ginecol Obstet. 2017;39(8):376-383
To describe the trends in the prevalence of macrosomia (birth weight ± 4,000 g) according to gestational age in Brazil in the periods of 2001-2010 and 2012-2014.
Ecological study with data from the Brazilian Live Birth Information System (SINASC, in the Portuguese acronym) regarding singleton live newborns born from 22 gestational weeks. The trends in Brazil as a whole and in each of its five regions were analyzed according to preterm (22-36 gestational weeks) and term (37-42 gestational weeks) strata. Annual Percent Changes (APCs) based on the Prais-Winsten method and their respective 95% confidence intervals (CIs) were used to verify statistically significant changes in 2001-2010.
In Brazil, the prevalence of macrosomic births was of 5.3% (2001-2010) and 5.1% (2012-2014). The rates were systematically higher in the North and Northeast Regions both in the preterm and in term strata. In the preterm stratum, the North Region presented the highest variation in the prevalence of macrosomia (+137.5%) when comparing 2001 (0.8%) to 2010 (1.9%). In the term stratum, downward trends were observed in Brazil as a whole and in every region. The trends for 2012-2014 were more heterogeneous, with the prevalence systematically higher than that observed for 2001-2010. The APC in the preterm stratum (2001-2010) showed a statistically significant trend change in the North (APC: 15.4%; 95%CI: 0.6-32.3) and South (APC: 13.5%; 95%CI: 4.8-22.9) regions. In the term stratum, the change occurred only in the North region (APC:-1.5%; 95%CI: -2.5--0.5).
The prevalence of macrosomic births in Brazil was higher than 5.0%. Macrosomia has potentially negative health implications for both children and adults, and deserves close attention in the public health agenda in Brazil, as well as further support for investigation and intervention.
Summary
Rev Bras Ginecol Obstet. 2015;37(8):381-387
DOI 10.1590/SO100-720320150005393
To evaluate the waiting times before obtaining the first colposcopic examination for women with abnormal Papanicolaou smears.
Retrospective cohort study conducted on patients who required a colposcopic examination to clarify an abnormal pap test, between 2002 January and 2008 August, in a metropolitan region of Brazil. The waiting times were defined as: Total Waiting Time (interval between the date of the pap test result and the date of the first colposcopic examination); Partial A Waiting Time (interval between the date of the pap test result and the date of referral); Partial B Waiting Time (interval between the date of referral and the date of the first colposcopic examination). Means, medians, relative and absolute frequencies were calculated. The Kruskal-Wallis test and Pearson's chi-square test were used to determine statistical significance.
A total of 1,544 women with mean of age of 34 years (SD=12.6 years) were analyzed. Most of them had access to colposcopic examination within 30 days (65.8%) or 60 days (92.8%) from referral. Mean Total Waiting Time, Partial A Waiting Time, and Partial B Waiting Time were 94.5 days (SD=96.8 days), 67.8 days (SD=95.3 days) and 29.2 days (SD=35.1 days), respectively.
A large part of the women studied had access to colposcopic examination within 60 days after referral, but Total waiting time was long. Measures to reduce the waiting time for obtaining the first colposcopic examination can help to improve the quality of care in the context of cervical cancer control in the region, and ought to be addressed at the phase between the date of the pap test results and the date of referral to the teaching hospital.
Summary
Rev Bras Ginecol Obstet. 2015;37(8):381-387
DOI 10.1590/SO100-720320150005393
To evaluate the waiting times before obtaining the first colposcopic examination for women with abnormal Papanicolaou smears.
Retrospective cohort study conducted on patients who required a colposcopic examination to clarify an abnormal pap test, between 2002 January and 2008 August, in a metropolitan region of Brazil. The waiting times were defined as: Total Waiting Time (interval between the date of the pap test result and the date of the first colposcopic examination); Partial A Waiting Time (interval between the date of the pap test result and the date of referral); Partial B Waiting Time (interval between the date of referral and the date of the first colposcopic examination). Means, medians, relative and absolute frequencies were calculated. The Kruskal-Wallis test and Pearson's chi-square test were used to determine statistical significance.
A total of 1,544 women with mean of age of 34 years (SD=12.6 years) were analyzed. Most of them had access to colposcopic examination within 30 days (65.8%) or 60 days (92.8%) from referral. Mean Total Waiting Time, Partial A Waiting Time, and Partial B Waiting Time were 94.5 days (SD=96.8 days), 67.8 days (SD=95.3 days) and 29.2 days (SD=35.1 days), respectively.
A large part of the women studied had access to colposcopic examination within 60 days after referral, but Total waiting time was long. Measures to reduce the waiting time for obtaining the first colposcopic examination can help to improve the quality of care in the context of cervical cancer control in the region, and ought to be addressed at the phase between the date of the pap test results and the date of referral to the teaching hospital.
Summary
Rev Bras Ginecol Obstet. 2014;36(1):40-45
DOI 10.1590/S0100-72032014000100009
To analyze the cytological findings of women with cervical adenocarcinoma, taking
into account the patient's history in the year prior to diagnosis and the
histopathological aspects of the lesions.
A retrospective comparative study was conducted using data from women with
cervical adenocarcinoma or squamous carcinoma detected between 2002 and 2008. The
cytological reports were synthesized according to the Bethesda System revised in
2001 and were compared to the histopathological findings of cervical
adenocarcinoma and squamous carcinoma. The distributions of cytological findings
were calculated, as well as the global agreement and chance-corrected agreement
using the Cohen's Kappa Coefficient. For this purpose, the cytological findings
were grouped according to the epithelial origin, forming the glandular cell and
squamous cell groups, with the histopathologically confirmed tumor types
(adenocarcinoma versus squamous carcinoma) being used as the gold
standard.
A total of 284 cases of cervical cancer were diagnosed during the study period.
The effectively studied cases were 27 and 54 patients with adenocarcinoma and
squamous carcinoma, respectively. The adenocarcinoma group represented 9.5% of the
total cases diagnosed, and 56.0% of the women in this group were younger than 50
years. Cervical cytology was collected on average 92 days before the cancer
diagnosis (range: 19 days to 310 days). In 41.6% of cases the cytological results
were consistent with glandular alterations such as adenocarcinoma cells or
atypical glandular cells. The global agreement and Cohen's Kappa Coefficient were
73.7 and 48.7%, suggesting substantial and moderate agreement, respectively.
In this population, the cytological smears had an important role in screening
women with adenocarcinoma, although some of them were referred to clarify the
clinical symptoms. The agreement between cytological and histopathological
findings was moderate.
Summary
Rev Bras Ginecol Obstet. 2014;36(1):40-45
DOI 10.1590/S0100-72032014000100009
To analyze the cytological findings of women with cervical adenocarcinoma, taking
into account the patient's history in the year prior to diagnosis and the
histopathological aspects of the lesions.
A retrospective comparative study was conducted using data from women with
cervical adenocarcinoma or squamous carcinoma detected between 2002 and 2008. The
cytological reports were synthesized according to the Bethesda System revised in
2001 and were compared to the histopathological findings of cervical
adenocarcinoma and squamous carcinoma. The distributions of cytological findings
were calculated, as well as the global agreement and chance-corrected agreement
using the Cohen's Kappa Coefficient. For this purpose, the cytological findings
were grouped according to the epithelial origin, forming the glandular cell and
squamous cell groups, with the histopathologically confirmed tumor types
(adenocarcinoma versus squamous carcinoma) being used as the gold
standard.
A total of 284 cases of cervical cancer were diagnosed during the study period.
The effectively studied cases were 27 and 54 patients with adenocarcinoma and
squamous carcinoma, respectively. The adenocarcinoma group represented 9.5% of the
total cases diagnosed, and 56.0% of the women in this group were younger than 50
years. Cervical cytology was collected on average 92 days before the cancer
diagnosis (range: 19 days to 310 days). In 41.6% of cases the cytological results
were consistent with glandular alterations such as adenocarcinoma cells or
atypical glandular cells. The global agreement and Cohen's Kappa Coefficient were
73.7 and 48.7%, suggesting substantial and moderate agreement, respectively.
In this population, the cytological smears had an important role in screening
women with adenocarcinoma, although some of them were referred to clarify the
clinical symptoms. The agreement between cytological and histopathological
findings was moderate.
Summary
Rev Bras Ginecol Obstet. 2012;34(2):56-62
DOI 10.1590/S0100-72032012000200003
PURPOSE: To describe the characteristics of pregnancies complicated by maternal syphilis and fetal death. METHODS: Retrospective descriptive study performed by reviewing the medical records of 48 pregnant women with maternal syphilis and fetal death outcome admitted to Hospital Geral de Nova Iguaçu, Baixada Fluminense, State of Rio de Janeiro, during the period from 2005 to 2008. Birth weight >500 g and fetal death documented by Death Certificate were the inclusion criteria. The following aspects were analyzed: sociodemographic factors, reproductive history, aspects of the current pregnancy, prenatal care, Venereal Disease Research Laboratory (VDRL) testing, and other gestational conditions, in addition to syphilis. The fetal deaths were classified as maternal, placental or fetal. Percentage, mean, standard deviation (SD), maximum and minimum values were reported. RESULTS: The mean maternal age was 22.7 years (SD=0.9 years), and at least 50% of the patients had low educational level. At hospital admission, 68.8% of the subjects were in the third trimester, with a mean gestational age of 29.2 weeks (SD=0.5), and more than 50% were in labor. The vast majority of fetal deaths (93%) occurred before maternal hospitalization. Among the patients who received prenatal care (54.2%), 30.8% had no VDRL test, 30.8 and 15.4% had a reactive and non-reactive result, respectively, and none had more than one prenatal VDRL test. At the time of childbirth, most of the mothers (95.8%) carried out VDRL testing. Overall, the VDRL titers varied from 1:1 to 1:512, with predominant values >1:4 (91.7%). In 23% of cases other clinical conditions related to fetal death, in addition to syphilis, were found. CONCLUSIONS: The infection was the main clinically identified cause of fetal death in this patient series. Fetal death occurred during the preterm period and in the presence of high titers of maternal infection, suggesting recent syphilis infection.
Summary
Rev Bras Ginecol Obstet. 2012;34(2):56-62
DOI 10.1590/S0100-72032012000200003
PURPOSE: To describe the characteristics of pregnancies complicated by maternal syphilis and fetal death. METHODS: Retrospective descriptive study performed by reviewing the medical records of 48 pregnant women with maternal syphilis and fetal death outcome admitted to Hospital Geral de Nova Iguaçu, Baixada Fluminense, State of Rio de Janeiro, during the period from 2005 to 2008. Birth weight >500 g and fetal death documented by Death Certificate were the inclusion criteria. The following aspects were analyzed: sociodemographic factors, reproductive history, aspects of the current pregnancy, prenatal care, Venereal Disease Research Laboratory (VDRL) testing, and other gestational conditions, in addition to syphilis. The fetal deaths were classified as maternal, placental or fetal. Percentage, mean, standard deviation (SD), maximum and minimum values were reported. RESULTS: The mean maternal age was 22.7 years (SD=0.9 years), and at least 50% of the patients had low educational level. At hospital admission, 68.8% of the subjects were in the third trimester, with a mean gestational age of 29.2 weeks (SD=0.5), and more than 50% were in labor. The vast majority of fetal deaths (93%) occurred before maternal hospitalization. Among the patients who received prenatal care (54.2%), 30.8% had no VDRL test, 30.8 and 15.4% had a reactive and non-reactive result, respectively, and none had more than one prenatal VDRL test. At the time of childbirth, most of the mothers (95.8%) carried out VDRL testing. Overall, the VDRL titers varied from 1:1 to 1:512, with predominant values >1:4 (91.7%). In 23% of cases other clinical conditions related to fetal death, in addition to syphilis, were found. CONCLUSIONS: The infection was the main clinically identified cause of fetal death in this patient series. Fetal death occurred during the preterm period and in the presence of high titers of maternal infection, suggesting recent syphilis infection.
Summary
Rev Bras Ginecol Obstet. 2005;27(10):619-626
DOI 10.1590/S0100-72032005001000009
PURPOSE: to evaluate the prevalence of cytologic, colposcopic and histopathologic alterations observed in the uterine cervix of adolescents with suspected cervical neoplasia and to compare it with young adult women. METHODS: a cross-sectional, retrospective study that analyzed 366 medical records of females referred to clarify diagnosis of the suspected cervical neoplasia. The patients had been classified into two groups defined by age. The Adolescent group was composed of 129 females between 13 and 19 years and the Adult group was composed of 237 females between 20 and 24 years. Data were analyzed statistically by the prevalence ratio (PR), respective confidence intervals (CI) at 95% for each variable, chi2 test, or Fisher exact test used to compare proportion. RESULTS: the first sexual intercourse coitarche occurred on average at 15.0 years in the Adolescent group and 16.6 years in the Adult group. The possibility of diagnosis of cytological alterations in the first Papanicolaou smears (PR=2.61; CI 95%: 2.0-3,4), the condition of non-clarified cervical intraepithelial neoplasia (CIN) (PR=1.78; CI 95%: 1.26-2,52), and the colposcopic impressions of low grade (PR=1.42; CI 95%: 1.08-1.86) were statistically significant in the Adolescent group. The histopathologic analysis did not show differences at any grade of CIN. However, two cases of microinvasive carcinoma, one in each group, and three cases of clinical invasive carcinoma in the Adult group were identified. CONCLUSION: our study suggests that cervical cancer is rare among adolescents, but we verified that alterations associated with it occurred even in younger women. The evaluation of cervical intraepithelial neoplasia with the careful application of the same tools used for adult women was appropriate also in adolescence.
Summary
Rev Bras Ginecol Obstet. 2005;27(10):619-626
DOI 10.1590/S0100-72032005001000009
PURPOSE: to evaluate the prevalence of cytologic, colposcopic and histopathologic alterations observed in the uterine cervix of adolescents with suspected cervical neoplasia and to compare it with young adult women. METHODS: a cross-sectional, retrospective study that analyzed 366 medical records of females referred to clarify diagnosis of the suspected cervical neoplasia. The patients had been classified into two groups defined by age. The Adolescent group was composed of 129 females between 13 and 19 years and the Adult group was composed of 237 females between 20 and 24 years. Data were analyzed statistically by the prevalence ratio (PR), respective confidence intervals (CI) at 95% for each variable, chi2 test, or Fisher exact test used to compare proportion. RESULTS: the first sexual intercourse coitarche occurred on average at 15.0 years in the Adolescent group and 16.6 years in the Adult group. The possibility of diagnosis of cytological alterations in the first Papanicolaou smears (PR=2.61; CI 95%: 2.0-3,4), the condition of non-clarified cervical intraepithelial neoplasia (CIN) (PR=1.78; CI 95%: 1.26-2,52), and the colposcopic impressions of low grade (PR=1.42; CI 95%: 1.08-1.86) were statistically significant in the Adolescent group. The histopathologic analysis did not show differences at any grade of CIN. However, two cases of microinvasive carcinoma, one in each group, and three cases of clinical invasive carcinoma in the Adult group were identified. CONCLUSION: our study suggests that cervical cancer is rare among adolescents, but we verified that alterations associated with it occurred even in younger women. The evaluation of cervical intraepithelial neoplasia with the careful application of the same tools used for adult women was appropriate also in adolescence.