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A vida sexual atualmente esta iniciando de forma mais precoce, em torno dos 10 aos 14 anos e nem sempre os adolescentes avaliam os riscos sobre a pratica. As sindromes hipertensivas especificas gestacionais (SHEG) sao a segunda causa de mortalidade materna em todo o mundo, superadas apenas pelas hemorragias. Somado a isso, podem culminar em encefalopatia, comprometimento cardiaco e renal, e coagulopatias. No Brasil, as SHEG sao consideradas a primeira causa de mortalidade materna, acarretando cerca de 5 a 17% das gestantes. Sendo assim, as pacientes jovens possuem um duplo fator de risco para o desenvolvimento da doenca as quais sao a primiparidade e a gravidez precoce. Este trabalho teve como objetivos identificar as repercussoes maternas e perinatais ocasionadas pelas sindromes hipertensivas especificas da gravidez em adolescentes, caracterizar os fatores de risco associados as SHEG nesse perfil de gestante e analisar os desfechos materno-fetais. O presente trabalho trata-se de uma revisao integrativa de literatura cuja bibliografia levantada ocorreu por meio da busca nas bases de dados Google Academico, Scientific Electronic Library Online- SCIELO e PubMed utilizando publicacoes entre 2013 a 2020 e com os seguintes descritores: “sindromes hipertensivas”, “hipertensao gestacional”, “gravidez na adolescencia”, “gestational hypertension”, “hypertensive disease” e “eclampsia”. A gestante adolescente ja e caracterizada como gestacao de alto risco a qual e imprescindivel uma assistencia medica de qualidade para que as complicacoes originadas pelas SHEG sejam minimizadas ou evitadas.

Background: In Brazil, the goal-based approach was named Project ACERTO and has obtained good results when applied in elective surgeries with shorter hospitalization time, earlier return to activities without increased morbidity and mortality. Aim: To analyze the impact of ACERTO on emergency surgery care. Methods: An intervention study was performed at a trauma hospital. Were compared 452 patients undergoing emergency surgery and followed up by the general surgery service from October to December 2018 (pre-ACERTO, n=243) and from March to June 2019 (post-ACERTO, n=209). Dietary reintroduction, volume of infused postoperative venous hydration, duration of use of catheters, probes and drains, postoperative analgesia, prevention of postoperative vomiting, early mobilization and physiotherapy were evaluated. Results: After the ACERTO implantation there was earlier reintroduction of the diet, the earlier optimal caloric intake, earlier venous hydration withdrawal, higher postoperative analgesia prescription, postoperative vomiting prophylaxis and higher physiotherapy and mobilization prescription were achieved early in all (p

Resumo O objetivo desta pesquisa foi analisar o conteúdo da assistência pré-natal em São Luís e os fatores associados com sua inadequação. Realizou-se estudo transversal baseado em dados da coorte de nascimento de São Luís em 2010. O conteúdo da assistência pré-natal foi classificado como inadequado quando não atendeu aos critérios do Programa de Humanização no Pré-Natal e Nascimento (PHPN) que estabelece o início precoce, o número mínimo de consultas, os exames laboratoriais básicos, a vacinação antitetânica e os procedimentos obstétricos. Regressão de Poisson foi utilizada para observar associações das variáveis com o desfecho. A taxa de inadequação foi de 60,2%. O pré-natal inadequado foi associado à classe econômica C (RP = 1,39; IC = 1,26-1,55), à D/E (RP = 1,60; IC = 1,43-1,79), à ocupação da mãe não qualificada/desempregada (RP = 1,24; IC = 1,11-1,37), à escolaridade de 5-8 anos (RP = 1,12; IC = 1,06-1,19) e de 0-4 anos (RP = 1,13; IC = 1,01-1,26), a não ter religião (RP = 1,10; IC = 1,04-1,17), ao uso de álcool durante a gestação (RP = 1,13; IC = 1,06-1,20) e ao atendimento no serviço público (RP = 1,75; IC = 1,54-2,00). Os resultados demonstraram inadequação e iniquidade da assistência pré-natal, evidenciando que mulheres de pior condição socioeconômica foram as que receberam assistência de menor qualidade.

Objective: The objective of this study was to assess the correlation between antenatal corticosteroids and peri-intraventricular haemorrhage (PIVH) using transfontanelle ultrasonography, as well as to evaluate the risk factors for its incidence. Methods: We performed a retrospective cohort study using medical records of preterm newborns. The protocol for maternal corticoid administration for foetal lung maturation included dexamethasone 4 mg (intramuscular) 8/8 hours per 48 hours, with one cycle per week. The diagnosis of periintraventricular haemorrhage was based on transfontanelle ultrasonography, using the Papile's classification. The following risk factors for peri-intraventricular haemorrhage were assessed: birth weight, gestational age at delivery, type of delivery, newborn's sex, surfactant administration, premature rupture of membranes and previous history of infection during the current pregnancy. The student's t-test and chi-square test were used for statistical analysis. Results: Our sample population included 184 preterm newborns. Transfontanelle ultrasonography revealed peri-intraventricular haemorrhage in 32 (74.4%) and periventricular leukomalacia in 11 (25.6%) newborns. Grade I haemorrhage was found in 20 (62.5%), grade II in five (15.6%), and grade III in seven (21.8%) newborns, as in accordance with Papile's classification. Vaginal delivery (p = 0.010), birth weight

To determine a predictive model for supporting decisions relating to the prognosis for women presenting with preterm labor and intact membranes.We conducted a prospective observational cohort study on 70 pregnant women at between 22 and 34 weeks of gestation. Transvaginal sonographic evaluation on the cervix was performed once on women who had completed a course of parenteral tocolysis. The sonographic parameters of cervical length measurement and presence of cervical glandular area were obtained. The outcome variable was occurrences of preterm delivery (35 weeks). Using a univariate logistic regression model, the coefficients of each independent variable were first estimated. To construct the predictive model, multivariate logistic regression containing all the selected variables that might be related to preterm delivery was used as the starting point. Accuracy, sensitivity, specificity and predictive values were used to measure associations of predicted probabilities and to check the ability of the model to predict outcomes. The predictive analyses were based on logistic regression models, with calculation of odds ratios and 95 % confidence intervals.The incidence of preterm delivery was 32.80 % (23/70). After validation, the predictive model proposed showed accuracy of 87.88 %, sensitivity of 78.26 % and specificity of 93.02 %.The model presented good accuracy with correspondence between predictions and observations, and has the capacity to become a useful tool for management of pregnant women with preterm labor and intact amniotic membranes.

Aneurism of the vein of Galen is a complex arteriovenous malformation which is of multiply communications between of the vein of Galen and the cerebral arteries. It represents less than 1% of the cerebral arteriovenous malformations. Few cases using three-dimensional (3D) power and color Doppler ultrasound have been reported in the literature. We present a case of an aneurysm of the vein of Galen diagnosed at 25th week of pregnancy. We demonstrate the main findings of 3D power and color Doppler ultrasonography in this anomaly. A 36-year-old pregnant woman, gravida 3, para 2 was referred to our institution because of a midline cystic mass diagnosed in a previous ultrasonography undertaken at 24 weeks' gestation. The ultrasonographic finding consisted of a male fetus with a midline cystic mass, with positive flow detection by color Doppler and ventriculomegaly due to the compressive effects of the malformation. The 3D color and power Doppler ultrasonography allowed us to reconstruct the architecture of the vascular malformation, and it showed the spatial relationships of aneurysm of the vein of Galen with the other structures of the brain. Pregnancy was interrupted at 29 weeks' gestation because of presence of cardiomegaly. A male newborn survived for 36 hours only. The 3D ultrasound can be used as advent image technique in prenatal diagnosis of aneurysm of the vein of Galen.

Sacrococcygeal teratoma accounts for half of all fetal tumors, with a prevalence of 1 : 40,000 births. It is believed to originate from pluripotent cells in Hensen's nodule. Although most are benign, they are associated with high morbidity and mortality rates because the fetus develops congestive heart failure and hydrops. Factors leading to poor prognosis include solid components in the mass, and hydrops diagnosed before the 30th week. A case of prenatal sacrococcygeal teratoma diagnosed using B-mode and color Doppler two-dimensional ultrasonography (2DUS) is described, in which three-dimensional ultrasonography (3DUS) enabled characterization of the extent of fetal lesions and allowed the parents to understand the pathological condition better. A 20-year-old primigravida was referred with a solid mass diagnosed in the lumbosacral spine. Examinations performed at our institution revealed pregnancy of 23 weeks and 4 days, with a female fetus presenting a bulky solid mass with cystic components and calcifications, measuring cm, starting from the sacral region, with internal flow seen on color Doppler. A new ultrasound confirmed fetal death at 25 weeks and 4 days. Postnatal findings confirmed the diagnosis of sacrococcygeal teratoma. 3DUS can be used in cases of sacrococcygeal teratoma to assess the development of tumor during the prenatal and to allow better understanding of this anomaly by the parents.

OBJETIVO: Analisar a associação da gravidez na adolescência com prematuridade. MÉTODOS: Foram incluídas todas as pacientes que pariram num hospital terciário universitário do Maranhão, no período de julho a dezembro de 2006, alocando-as em dois grupos: adolescentes (10 a 19 anos de idade) e adultas (20 a 34 anos). As variáveis estudadas foram: escolaridade, situação conjugal, número de consultas no pré-natal, idade gestacional no início do pré-natal, duração da gestação, tipo de parto e peso ao nascer. Os dados foram processados no programa Epi-Info, versão 3.4.1, e foram analisadas as associações entre as variáveis pela razão dos produtos cruzados, a odds ratio (OR), com intervalo de confiança (IC) de 95%; utilizaram-se também modelos de regressão logística. O nível de significância adotado foi de 0,05. RESULTADOS: Foram avaliadas 1.978 pacientes. Verificou-se frequência de 25,4% de partos em adolescentes, que apresentaram baixa escolaridade, ausência de companheiro, menor número de consultas no pré-natal, início tardio do pré-natal, baixo peso ao nascer (BPN) e prematuridade. Realizando a análise, tendo como variável desfecho a prematuridade, verificou-se nítida associação com baixo número de consultas do pré-natal (OR 3,0; IC95% 2,2-4,0) e início tardio do pré-natal (OR 1,9; IC95% 1,3-2,6), baixa escolaridade (OR 1,9; IC95% 1,4-2,5) em relação com a adolescência (OR 1,5; IC95% 1,1-1,9). As adolescentes tiveram menor incidência de cesárea (33,3%) que as adultas (49,4%), com diferença significativa, além de menor associação com pré-eclâmpsia e desproporção cefalopélvica. CONCLUSÕES: A gravidez na adolescência esteve associada a início tardio do pré-natal e baixo número de consultas pré-natal, além de baixa escolaridade, BPN, prematuridade e menor incidência de desproporção cefalopélvica e pré-eclâmpsia.

OBJETIVO: Avaliar o valor prognóstico da proteinúria nas gestantes com síndromes hipertensivas nos desfechos maternos e perinatais. MÉTODOS: Estudo transversal retrospectivo de 334 gestantes com síndromes hipertensivas que pariram no Hospital São Paulo na disciplina de Obstetrícia da UNIFESP/EPM, no período de 1º de janeiro de 1999 a 31 de dezembro de 2002. RESULTADOS: Após a revisão dos prontuários, as pacientes foram divididas em quatro grupos: I sem proteinúria (n-203), II com proteinúria de 0,3 a 1g (n-39), III de 1 a 2g (n-45) e grupo IV de 2g ou mais (n-47). Na ausência da proteinúria houve um caso de descolamento prematuro da placenta. Com proteinúria observou-se desfechos maternos adversos, com a presença das complicações, proporcional à elevação da proteinúria, sendo a síndrome HELLP a mais freqüente com 30,5% (40/131) seguida da eclâmpsia com 3,8% (5/131), DPP 3,01% (4/131) e insuficiência renal 0,7% (1/131). Foi constatado um óbito materno nesse grupo, perfazendo-se o CMM de 763100.000/n.v. Em relação aos desfechos perinatais, no grupo sem proteinúria não houve elevação dos efeitos adversos. Na presença da proteinúria e a elevação dos seus níveis observou-se pior prognóstico perinatal com os seguintes indicadores: aumento da prematuridade (62,2% vs 11,5%), recém-nascidos com peso < 2500g (6,5% vs 1,5%), Apgar < 7 no 5º minuto (30,4% vs 3,5%), restrição de crescimento intra-útero (41,9% vs 6,5%), cuidados intensivos na unidade neonatal (59,8% vs 15,5%), natimortos (14,4% vs 1,4%), e óbitos neonatais (6,1% vs 0,98%). O coeficiente de mortalidade perinatal foi maior com proteinúria (175 vs 19,7) e, quando > 2g (297,8 vs 19,7). CONCLUSÕES: A presença da proteinúria e a elevação dos seus níveis, aumentaram as complicações maternas, principalmente a síndrome HELLP e eclâmpsia. Observou-se incidência de complicações perinatais com elevação significativamente maior da prematuridade, recém-nascidos com Apgar < 7, peso < 2500g, CIUR, natimortos e óbitos neonatais. AIM: The purpose of this study was to determine the role of proteinuria on pregnancy outcome in hypertensive syndrome with singleon pregnancies. METHODS: Transversal study with retrospective data of 334 pregnancies complicated by hypertensive syndromes who were delivered in the Department of Obstetrics of UNIFESP/EPM from January 1, 1999 to December 31, 2002. RESULTS: The patients were divided into four groups: (I) without proteinuria (n-203); (II) with proteinuria of 0.3 to 1.0g (n-39); (III) 1.0 to 2.0g (n-45); and (IV) 2.0g or more. Without proteinuria there was one case of placental abruption. The presence of proteinuria predicted adverse maternal outcome with increase of complications proportional to his elevation; among them, HELLP syndrome was the most frequent with 30.5% (40/131) followed by eclampsia with 3.8% (5/131), DPP 3.1% (4/131) and renal insufficiency with 0.7% (1/131). It was confirmed one maternal death in that group, when Maternal Mortality of 763/100.000nv was added up. As to the perinatal effects there was not increase of adverse effects without proteinuria. In the presence of proteinuria and its levels was observed the worst perinatal outcome with the elevation of the following indicatives: increase prematurety (62.2% vs 11.5%), newborn with weight < 2500g (6.5% vs 1.5%), newborn with Apgar < 7 in the 5th minute (30.4% vs 3.5%), concepts with growing restriction of intrauterine (41.9% vs 6.5%), newborn interned in the neonatal undid, (59.8% vs 15.5%) stillborn (14.4% vs 1.4%), neonatal deaths (6.1% vs 0.98%). The Perinatal Mortality was greater with proteinúria (175 vs 19,7) and, when = 2.0g (297.8 vs 19.6). CONCLUSIONS: The presence of proteinuria in the hipertensives syndromes during gestation and the elevation of their levels increase the risks of maternal complications, especially HELLP syndromes and eclampsia. Besides, it was observed a significative incidence of premature birth, newborn with Apgar < 7, weight < 2500g, IUGR, stillborn and neonatal deaths.

Bronchogenic cysts arise from abnormal buds from the primitive esophagus and tracheobronchial tree, which do not extend to the site where alveolar differentiation occurs. Bronchogenic cysts are typically unilocular mucus field lesions arising from posterior membranous wall of the air way. The prenatal diagnosis usually is realized by two-dimensional ultrasound showing the large unilocular cystic image in the chest fetus. The prenatal percutaneous aspiration can reduce the risk of heart compression and permit better respiratory conditions to newborn. We present a case of a primiparous pregnant 23 year-old-woman prenatal ultrasound showed a large unilocular cyst in the left hemithorax with compression of the normal left lung tissue and contralateral mediastinal shift. This cyst was percutaneously aspirated without subsequent reaccumulation of fluid. The newborn did not have respiratory distress and the computed tomography scan confirmed the finding of a fluid-filled cyst in the left chest. The chest X-ray showed the displacement of the heart and the mediastinum from the left to the right. The prenatal diagnosis of bronchogenic cyst is very important to assess the degree of the compression of the normal lung and the mediastinum shift. Furthermore, the prenatal diagnosis permits planning delivery in the tertiary hospital with multidisciplinary team because of the risk of respiratory distress.

Nager syndrome or acrofacial dysostosis is a rare and complex malformation characterized by ear anomalies, micrognathia, radial limb hypoplasia, and absence of the thumb or other fingers. Since the original description of the syndrome in 1948, there have only been four reports of prenatal diagnoses in the literature, all during the second trimester, and only two of them had anatomopathological correlations. We describe a case of Nager syndrome that was suspected in the third trimester of gestation and confirmed postnatally through pathology. The mother was white, 27 years old, and G5P2A2, with a family history of a brother with a harelip. She was referred to our service at 33 weeks of pregnancy with an ultrasound fetal diagnosis of musculoskeletal dysplasia associated with severe micrognathia and severe polyhydramnios. Birth was by means of cesarean section because of suspected fetal distress, which resulted in extraction of a live male fetus with Apgar 1/4, weight of 1,505 g, severe mandibular hypoplasia, low-set ears, severe upper-limb shortening, and absent left thumb. Death occurred 4 h after birth. Anatomopathological examination confirmed the diagnosis of Nager syndrome.

Conjoined twins are rare variants of monozygotic twins, which result from an incomplete division of the embryonic disk. Cephalothoracopagus is a rare twin pregnancy described as imperfect fusion of the head and chest, but separated columns, limbs, and pelvis. They occur with incidence rates that range from 1 per 50,000 to 1 per 100,000 births; however, the incidence of the cephalothoracopagus variety is 1 per 58 conjoined twins. In the case of identical and symmetric faces caused by the orientations of the 2 notochordal axes that are perfectly ventroventral, they are called janiceps disymmetros. We present a prenatal diagnosis of a typical case of cephalothoracopagus janiceps disymmetros and the diagnostic confirmation by image and pathology exams.

Os lipomas espinhais são raros, respondendo por 1% de todos os tumores espinhais, estando associados ao disrafismo espinhal oculto em mais de 99% dos casos. Estão divididos em três tipos principais: lipomielomeningocele, lipoma intradural e fibrolipoma do filo terminal. Este relato descreve um caso de lipoma lombossacral congênito associado a estigma cutâneo do tipo seio dérmico lombar congênito.

To evaluate the perinatal results from epileptic women using antiepileptic drugs during prenatal care.This was a retrospective longitudinal study assessing the perinatal results of women exposed to antiepileptic drugs during pregnancy, and we compared these results with those of pregnant women who were not exposed. The development of pregnancy, gestational age at delivery, Apgar scores, biometric data, morbidity, stillbirths and neonatal mortality were analyzed. The chi-square test and Fisher's exact test were used for the categorical variables, while Student's t-test was used for independent numerical variables.Over a 10-year period, 12 790 singleton gestations were analyzed, among which 104 (0.8%) consisted of epileptic pregnant women. From this total, 82 evolved to childbirth and their neonatal data were compared with those of 316 newborns from non-epileptic women. The most-used antiepileptic drug was phenobarbital in 70% of the cases. There was greater neonatal mortality (p = 0.006), occurrence of neonatal hemorrhagic disorders (p = 0.005), and occurrence of minor congenital anomalies (p = 0.03) among the children of women exposed to antiepileptic drugs.The antenatal exposure to antiepileptic drugs is associated mainly with occurrences of hemorrhagic complications during the neonatal period; furthermore, great prevalence of newborns presenting minor congenital anomalies and elevated risk of neonatal mortality.

Made available in DSpace on 2022-04-28T19:01:09Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-01-01 Consiglio Nazionale delle Ricerche Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care. Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), R. Alexander Fleming 101, P.O. Box 6030 Centre for Research on Reproductive Health of Campinas (Cemicamp), R. Vital Brasil 200 Federal University of Amazonas CISAM, School of Medical Sciences Federal University of Ceará Federal University of Bahia Hospital Geral Cesar Cals Hospital Geral de Fortaleza Maternidade Odete Valadares Hospital Materno Infantil IMIP Federal University of Pernambuco Federal University of Campina Grande Federal University of Maranhão Federal University of Paraná Federal University of Paraíba Hospital Maternidade Fernando Magalhães Federal University of Rio Grande Do sul Hospital Maternidade Celso Pierro Instituto Fernandes Figueira Hospital Israelita Albert Einstein University of the State of São Paulo Jundiaí School of Medicine University of São Paulo Santa Casa de Limeira Santa Casa de São Carlos Maternidade Leonor Mendes de Barros Federal University of São Paulo Consiglio Nazionale delle Ricerche: 402702/2008-5

Cloacal malformation is an extremely rare fetal pathological condition that presents as a variety of defects. It predominantly affects females, with prevalence of 1 in 50,000 births. Prenatal ultrasonography on a 20-year-old caucasian woman (G4P1A2) at 33 weeks of pregnancy showed the fetus having a large cystic mass in the lower abdomen with a single septum, bilateral hydronephrosis, ambiguous genitalia, and a single umbilical artery. The pregnancy developed accentuated oligohydramnios, and presence of a fetal brain-sparing effect was diagnosed using arterial Doppler velocimetry. The newborn showed abdominal distension, ambiguous genitalia, and rectal atresia, with a single perineal opening. Pelvic ultrasound done on the first day after delivery revealed the presence of a large retrovesical septated cystic mass of dense content in the fetal abdomen, and bilateral hydronephrosis. Hysterotomy was performed, and 70 mL of dense liquid was drained through an abdominal colostomy. The infant died on the 27th day of life as a result of infectious complications. Prenatal diagnosing of female urogenital anomalies is usually difficult because of their rarity, different types of manifestation, and lack of characteristic ultrasound signs. Presence of a septated cyst with dense content in the fetal abdomen confirms the finding of hydrometrocolpos, thus raising clinical suspicion of a cloacal anomaly.

The EEC syndrome is a genetic anomaly characterized by the triad: ectodermal dysplasia (development of anomalies of the structures derived from the embryonic ectodermal layer), ectrodactyly (extremities, hands and feet malformations) and cleft lip and/or palate; these malformations can be seen together or in isolation. The prenatal diagnosis can be made by two-dimensional ultrasonography (2DUS) that identifies the facial and/or limb anomalies, most characteristic being the “lobster-claw” hands. The three-dimensional ultrasonography (3DUS) provides a better analysis of the malformations than the 2DUS. A 25-year-old primigravida, had her first transvaginal ultrasonography that showed an unique fetus with crow-rump length of 47 mm with poorly defined hands and feet,. She was suspected of having sporadic form of EEC syndrome. The 2DUS performed at 19 weeks confirmed the EEC syndrome, showing a fetus with lobster-claw hands (absence of the 2nd and 3rd fingers), left foot with the absence of the 3rd toe and the right foot with syndactyly, and presence of cleft lip/palate. The 3DUS defined the anomalies much better than 2DUS including the lobster-claw hands.

OBJETIVO: analisar a associação da gravidez na adolescência com o baixo peso ao nascer (BPN). MÉTODOS: foram incluídas todas as pacientes que tiveram parto num hospital terciário universitário do Maranhão no período de julho a dezembro de 2006, alocando-as em dois grupos: adolescentes (dez a 19 anos de idade) e adultas (20 a 34 anos). As variáveis estudadas foram: cor, escolaridade, situação conjugal, renda familiar, número de consultas no pré-natal, idade gestacional no início do pré-natal, local do pré-natal, duração da gestação, tipo de parto e peso ao nascer. Os dados foram processados no programa Epi-Info, versão 3.4.1, e foram analisadas as associações entre as variáveis pela razão dos produtos cruzados, a Odds Ratio (OR), com intervalo de confiança (IC) de 95%; utilizaram-se também modelos de regressão logística. O nível de significância adotado foi de 0,05. RESULTADOS: foram avaliadas 1.978 pacientes. Verificou-se freqüência de 25,4% de partos em adolescentes, que apresentaram baixa escolaridade, ausência de companheiro, menor número de consultas no pré-natal, início tardio do pré-natal, BPN e prematuridade. Realizando a análise, tendo como variável desfecho o BPN e associação com prematuridade (OR=29,0), verificou-se nítida associação com baixo número de consultas do pré-natal (OR=2,98; IC95%= 2,23-4,00) e início tardio do pré-natal (OR=1,91; IC95%=1,3-2,6), baixa escolaridade (OR=1,95; IC95%=1,4-2,5) em relação com a adolescência (OR=1,50; IC95%=1,1-1,9). Obtiveram-se resultados similares quando se excluiu a variável prematuridade. As adolescentes tiveram menor incidência de cesárea (33,3%) que as adultas (49,4%), com diferença significativa, além de menor associação com pré-eclâmpsia e desproporção céfalo-pélvica. CONCLUSÕES: a gravidez na adolescência esteve associada a início tardio do pré-natal e baixo número de consultas pré-natal, além de baixa escolaridade, BPN e menor incidência de desproporção céfalo-pélvica e pré-eclâmpsia. PURPOSE: to analyze the association of pregnancy in adolescence with low birth weight (LBW). METHODS: all the patients who gave birth in a teaching Hospital at Maranhão State from July to December 2006 were included in the study and were split in two groups: adolescents (ten to 19 years old) and adults (20 to 34 years old). The variables studied were: skin color, schooling, marital status, family income, number of pre-natal appointments, gestational age at the onset of pre-natal assistance, place where they spend that period, gestation duration, delivery route and birth weight. Data were processed by the Epi-Info program, 3.4.1 version, and the associations between variables were analyzed by the Odds Ratio (OR), with a confidence interval (CI) of 95%. Models of logistic regression were also used. The significance level adopted was 0.05. RESULTS: 1,978 patients were evaluated. A ratio of 25.4% of deliveries in adolescents was observed; they presented low level of schooling, no mates, low number of pre-natal appointments, late onset of pre-natal assistance, low birth weight and prematurity. In the analysis of LBW as end variable, associated to prematurity (OR=29.0), it was clear the association with low number of pre-natal appointments (OR=2.98; 95%CI=2.23-4.00), pre-natal late onset (OR=1.91; 95%CI=1.3-2.6) and low schooling (OR=1.95; 95%CI=1.4-2.5) related to adolescence (OR=1.50; 95%CI=1.1-1.9). Similar results were obtained when the prematurity variable was excluded. Adolescents showed lower incidence of caesarean section (33.3%) than adults (49.4%), a significant difference, besides lower association with pre-eclampsia and cephalo-pelvic disproportion. CONLUSIONS: pregnancy in adolescence was associated to pre-natal late onset and low number of appointments, besides low schooling, low birth weight and a lower incidence of cephalo pelvic disproportion and pre-eclampsia.

OBJETIVOS: avaliar a utilidade do comprimento cervical ultra-sonográfico para a predição do parto em gestantes com contrações uterinas persistentes e bolsa íntegra. MÉTODOS: realizou-se estudo observacional, prospectivo, do tipo coorte no qual foram incluídas 45 gestantes internadas em nossa instituição entre a 22ª e a 34ª semana. Ultra-sonografia transvaginal do colo foi realizada uma única vez, após completado um ciclo de tocólise endovenosa, com aferição do comprimento, conforme critérios descritos previamente. Os achados ultra-sonográficos não foram utilizados para o diagnóstico ou conduta obstétrica. O desfecho estudado foi a ocorrência de parto pré-termo (

Rânula congênita uma rara malformação cística visualizada na cavidade oral. É um pseudocisto habitualmente localizado no espaço sublingual entre o músculo milo-hioideo e a mucosa da língua. Relata-se um caso de gestante de 24 anos, G3P2, com idade gestacional de 29 semanas, encaminhada por conta de polidrâmnio e grande massa de cavidade oral de natureza cística.

Acalvaria é uma malformação congênita rara de patogênese desconhecida, na qual os ossos da abóbada craniana, a dura-máter e a musculatura associada estão ausentes, mas o sistema nervoso central costuma estar preservado. A teoria fisiopatogênica mais aceita sugere um defeito pós-neurulação, com disposição normal do ectoderma embrionário. O objetivo deste relato é descrever os achados de imagem neonatais da acalvaria primária.

Schizencephaly is a brain-destructive lesion relating to clefts in the fetal brain that usually communicate with the ventricular system, subarachnoid space, or both. It presents as two types: Type I (closed) and Type II (open). During pregnancy, it may be suspected in the course of ultrasonography, which highlights ventricular dilatation and brain abnormalities. Usually, the diagnosis is confirmed postnatally using trans-fontanel ultrasonography. The etiology of schizencephaly is still unknown, but it may be derived from a primary disorder of brain development or from bilateral middle cerebral artery occlusion. Many causative agents including vascular insult, infections, toxins, and medications have been associated with this malformation. We present a pictorial essay of six cases of schizencephaly that were suspected on prenatal ultrasound scans and confirmed postnatally by trans-fontanel, two-dimensional and three-dimensional ultrasonography.