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Summary
Rev Bras Ginecol Obstet. 2019;41(1):11-16
To evaluate the accuracy of the diagnosis of fetal heart diseases obtained through ultrasound examinations performed during the prenatal period compared with the postnatal evaluation.
A retrospective cohort study with 96 pregnant women who were attended at the Echocardiography Service and whose deliveries occurred at the Complexo Hospitalar Santa Casa de Porto Alegre, in the state of Rio Grande do Sul, Brazil. Risk factor assessment plus sensitivity and specificity analysis were used, comparing the accuracy of the screening for congenital heart disease by means of obstetrical ultrasound and morphological evaluation and fetal echocardiography, considering p < 0.05 as significant. The present study was approved by the Research Ethics Committee of the Institution.
The analysis of risk factors shows that 31.3% of the fetuses with congenital heart disease could be identified by anamnesis. The antepartum echocardiography demonstrated a sensitivity of 97.7%, a specificity of 88.9%, and accuracy of 93% in the diagnosis of congenital heart disease. A sensitivity of 29.3% was found for the obstetric ultrasound, of 54.3% for themorphological ultrasound, and of 97.7% for the fetal echocardiography. The fetal echocardiography detected fetal heart disease in 67.7% of the cases, the morphological ultrasound in 16.7%, and the obstetric ultrasound in 11.5% of the cases.
There is a high proportion of congenital heart disease in pregnancies with no risk factors for this outcome. Faced with the disappointing results of obstetric ultrasound for the detection of congenital heart diseases and the current unfeasibility of universal screening of congenital heart diseases through fetal echocardiography, the importance of the fetal morphological ultrasound and its performance by qualified professionals is reinforced for a more appropriate management of these pregnancies.
Summary
Rev Bras Ginecol Obstet. 2019;41(1):11-16
To evaluate the accuracy of the diagnosis of fetal heart diseases obtained through ultrasound examinations performed during the prenatal period compared with the postnatal evaluation.
A retrospective cohort study with 96 pregnant women who were attended at the Echocardiography Service and whose deliveries occurred at the Complexo Hospitalar Santa Casa de Porto Alegre, in the state of Rio Grande do Sul, Brazil. Risk factor assessment plus sensitivity and specificity analysis were used, comparing the accuracy of the screening for congenital heart disease by means of obstetrical ultrasound and morphological evaluation and fetal echocardiography, considering p < 0.05 as significant. The present study was approved by the Research Ethics Committee of the Institution.
The analysis of risk factors shows that 31.3% of the fetuses with congenital heart disease could be identified by anamnesis. The antepartum echocardiography demonstrated a sensitivity of 97.7%, a specificity of 88.9%, and accuracy of 93% in the diagnosis of congenital heart disease. A sensitivity of 29.3% was found for the obstetric ultrasound, of 54.3% for themorphological ultrasound, and of 97.7% for the fetal echocardiography. The fetal echocardiography detected fetal heart disease in 67.7% of the cases, the morphological ultrasound in 16.7%, and the obstetric ultrasound in 11.5% of the cases.
There is a high proportion of congenital heart disease in pregnancies with no risk factors for this outcome. Faced with the disappointing results of obstetric ultrasound for the detection of congenital heart diseases and the current unfeasibility of universal screening of congenital heart diseases through fetal echocardiography, the importance of the fetal morphological ultrasound and its performance by qualified professionals is reinforced for a more appropriate management of these pregnancies.
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. 1998;20(1):25-32
DOI 10.1590/S0100-72031998000100005
It is universally accepted that prenatal care has a beneficial impact on perinatal outcome. However, it is unclear whether access to early and frequent prenatal care influences the impact of pregnancy complications on birth weight. The objective of the present study was to determine the effectiveness of prenatal care, concerning antenatal visits (number and time of the first one), on gestational age and fetal weight at birth. We assessed prospectively the effect of the antenatal care in a group of 648 infants born consecutively at the University Hospital of Santa Maria, weighing from <1000 to >4000 g, and from <28 to >40 weeks of gestational age. Preterm delivery (<37 weeks) accounted for 17.7% of all deliveries, low birth-weight infants (<2500 g) for 20.5%, and very low birth-weight infants (<1000 g) for 2.8%. When the first antenatal visit was performed before the 12th week, only 5.1% of the babies were born with <37 weeks of gestational age or weight at birth of <2500 g. However, when the first visit was after the 28th week, the percentage of preterm delivery was 41.3% and of birth weight <2500 g was 43.5%. A significant association between higher frequency of antenatal visits, early care and decrease in preterm delivery frequency and low birth-weight infants was noted (p <0.001). We conclude that increase in the number of antenatal visits and early care can reduce the preterm delivery and low-birth weight infant rates.
Summary
Rev Bras Ginecol Obstet. 1998;20(1):25-32
DOI 10.1590/S0100-72031998000100005
It is universally accepted that prenatal care has a beneficial impact on perinatal outcome. However, it is unclear whether access to early and frequent prenatal care influences the impact of pregnancy complications on birth weight. The objective of the present study was to determine the effectiveness of prenatal care, concerning antenatal visits (number and time of the first one), on gestational age and fetal weight at birth. We assessed prospectively the effect of the antenatal care in a group of 648 infants born consecutively at the University Hospital of Santa Maria, weighing from <1000 to >4000 g, and from <28 to >40 weeks of gestational age. Preterm delivery (<37 weeks) accounted for 17.7% of all deliveries, low birth-weight infants (<2500 g) for 20.5%, and very low birth-weight infants (<1000 g) for 2.8%. When the first antenatal visit was performed before the 12th week, only 5.1% of the babies were born with <37 weeks of gestational age or weight at birth of <2500 g. However, when the first visit was after the 28th week, the percentage of preterm delivery was 41.3% and of birth weight <2500 g was 43.5%. A significant association between higher frequency of antenatal visits, early care and decrease in preterm delivery frequency and low birth-weight infants was noted (p <0.001). We conclude that increase in the number of antenatal visits and early care can reduce the preterm delivery and low-birth weight infant rates.
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.
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Rev Bras Ginecol Obstet. 2022;44(4):343-351
, , , , , , To evaluate the emotional and clinical aspects observed in women with gestational trophoblastic disease (GTD) followed-up in a reference center (RC) by a multidisciplinary team.
Retrospective cohort study of the clinical records of 186 women with GTD and of the emotional aspects (EA) observed in these women by a teamof psychologists and reported by the 389 support groups conducted from 2014 to 2018.
The women were young (mean age: 31.2 years), 47% had no living child, 60% had planned the pregnancy, and 50% participated in two or more SG. Most women (n=137; 73.6%) reached spontaneous remission ofmolar gestation in a median time of 10 weeks and had a total follow-up time of seven months. In the group of 49 women (26.3%) who progressed to gestational trophoblastic neoplasia (GTN), time to remission after chemotherapy was 18 weeks, and total follow-up time was 36 months. EA included different levels of anxiety and depression,more evident in 9.1% of the women; these symptoms tended to occur more frequently in women older than 40 years (p=0.067), less educated (p=0.054), and whose disease progressed to GTN (p=0.018), as well as in those who had to undergo multi-agent chemotherapy (p=0.028) or hysterectomy (p=0.001) adjuvant to clinical treatment.
This study found several EA in association with all types of GTD. It also highlights the importance of specialized care only found in a RC, essential to support the recovery of the mental health of these women.
Summary
Rev Bras Ginecol Obstet. 2022;44(4):343-351
, , , , , , To evaluate the emotional and clinical aspects observed in women with gestational trophoblastic disease (GTD) followed-up in a reference center (RC) by a multidisciplinary team.
Retrospective cohort study of the clinical records of 186 women with GTD and of the emotional aspects (EA) observed in these women by a teamof psychologists and reported by the 389 support groups conducted from 2014 to 2018.
The women were young (mean age: 31.2 years), 47% had no living child, 60% had planned the pregnancy, and 50% participated in two or more SG. Most women (n=137; 73.6%) reached spontaneous remission ofmolar gestation in a median time of 10 weeks and had a total follow-up time of seven months. In the group of 49 women (26.3%) who progressed to gestational trophoblastic neoplasia (GTN), time to remission after chemotherapy was 18 weeks, and total follow-up time was 36 months. EA included different levels of anxiety and depression,more evident in 9.1% of the women; these symptoms tended to occur more frequently in women older than 40 years (p=0.067), less educated (p=0.054), and whose disease progressed to GTN (p=0.018), as well as in those who had to undergo multi-agent chemotherapy (p=0.028) or hysterectomy (p=0.001) adjuvant to clinical treatment.
This study found several EA in association with all types of GTD. It also highlights the importance of specialized care only found in a RC, essential to support the recovery of the mental health of these women.
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. 2005;27(7):387-392
DOI 10.1590/S0100-72032005000700004
PURPOSE: to assess peak systolic velocity (PSV) and the resistance index (RI) in the middle cerebral artery (MCA), suprarenal aorta (SRA) and infrarenal aorta (IRA) of the fetus and in the umbilical artery (UA) between the 22nd and 38th week of gestation. METHODS: a prospective study which evaluated the parameters of 33 normal fetuses in the 22nd, 26th, 30th, and 38th week of gestation. Pregnant women with a singleton fetus with no diseases or complications and who agreed to participate were included in the study. Exclusion criteria were fetal malformations, discontinuation of prenatal care visits and mothers who smoked, used alcohol or illicit drugs. Ultrasound examinations were performed by a single observer. For the acquisition of the Doppler velocimetry tracing in the MCA, SRA, IRA and UA, the sample volume was 1 to 2 mm, placed in the center of the arteries. The insonation angle was 5º to 19º in the MCA, below 45º in the SRA and IRA, and less than 60º in the UA. We used a wall filter of 50-100 Hz. The parameters were calculated automatically with the frozen image, three measurements being made. The final result was obtained by the arithmetic mean of the three values. Data were analyzed by analysis of variance (ANOVA), post hoc Bonferroni test, Pearson's correlation, and regression analysis. The level of significance was set at p<0.05 in all analyses. RESULTS: PSV increased from 26.3 to 57.7 cm/s in the MCA between the 22nd and the 38th week of gestation (p<0.05). In the SRA and in the IRA, PSV increased between the 22nd and 34th week of gestation, from 74.6 and 59.0 cm/s to 106.0 and 86.6 cm/s, respectively (p<0.05). In the UA, PSV increased between the 22nd and the 34th week of gestation, but decreased from 55.5 to 46.2 cm/s between the 34th and the 38th week of gestation. In the MCA, the RI was lower in the 22nd (0.81) and 38th week of gestation (0.75) and higher (0.85) in the 26th week (p<0.05). In the SRA, the RI values were stable in all weeks and in the IRA they were stable in most weeks (p>0.05). In the UA, RI decreased from 0.69 to 0.56 between the 22nd and 38th week of gestation (p<0.05). CONCLUSION: in normal fetuses, in the second half of gestation PSV increased in the MCA, SRA and IRA, decreasing in the UA between the 34th and 38th week of gestation. RI was lower in the 22nd and 38th weeks of gestation in the MCA, decreased between the 22nd and the 38th week in the UA, and was constant in most of the gestational weeks in the SRA and IRA.
Summary
Rev Bras Ginecol Obstet. 2005;27(7):387-392
DOI 10.1590/S0100-72032005000700004
PURPOSE: to assess peak systolic velocity (PSV) and the resistance index (RI) in the middle cerebral artery (MCA), suprarenal aorta (SRA) and infrarenal aorta (IRA) of the fetus and in the umbilical artery (UA) between the 22nd and 38th week of gestation. METHODS: a prospective study which evaluated the parameters of 33 normal fetuses in the 22nd, 26th, 30th, and 38th week of gestation. Pregnant women with a singleton fetus with no diseases or complications and who agreed to participate were included in the study. Exclusion criteria were fetal malformations, discontinuation of prenatal care visits and mothers who smoked, used alcohol or illicit drugs. Ultrasound examinations were performed by a single observer. For the acquisition of the Doppler velocimetry tracing in the MCA, SRA, IRA and UA, the sample volume was 1 to 2 mm, placed in the center of the arteries. The insonation angle was 5º to 19º in the MCA, below 45º in the SRA and IRA, and less than 60º in the UA. We used a wall filter of 50-100 Hz. The parameters were calculated automatically with the frozen image, three measurements being made. The final result was obtained by the arithmetic mean of the three values. Data were analyzed by analysis of variance (ANOVA), post hoc Bonferroni test, Pearson's correlation, and regression analysis. The level of significance was set at p<0.05 in all analyses. RESULTS: PSV increased from 26.3 to 57.7 cm/s in the MCA between the 22nd and the 38th week of gestation (p<0.05). In the SRA and in the IRA, PSV increased between the 22nd and 34th week of gestation, from 74.6 and 59.0 cm/s to 106.0 and 86.6 cm/s, respectively (p<0.05). In the UA, PSV increased between the 22nd and the 34th week of gestation, but decreased from 55.5 to 46.2 cm/s between the 34th and the 38th week of gestation. In the MCA, the RI was lower in the 22nd (0.81) and 38th week of gestation (0.75) and higher (0.85) in the 26th week (p<0.05). In the SRA, the RI values were stable in all weeks and in the IRA they were stable in most weeks (p>0.05). In the UA, RI decreased from 0.69 to 0.56 between the 22nd and 38th week of gestation (p<0.05). CONCLUSION: in normal fetuses, in the second half of gestation PSV increased in the MCA, SRA and IRA, decreasing in the UA between the 34th and 38th week of gestation. RI was lower in the 22nd and 38th weeks of gestation in the MCA, decreased between the 22nd and the 38th week in the UA, and was constant in most of the gestational weeks in the SRA and IRA.