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Purpose The objective was to assess the continuation and satisfaction of women who had copper IUDs inserted during caesarean delivery, in addition to possible factors associated with device positioning. Materials and methods A prospective, observational study was carried out involving 158 women who underwent copper IUD insertion during caesarean delivery in Fortaleza, Brazil. The women were followed up 6 weeks and 6 months after insertion of the IUD, at which time they completed a satisfaction questionnaire. We performed speculum and ultrasound examination. Results IUD continuation rates after 6 weeks and 6 months were 92% and 71.5%, respectively. Approximately 85% and 76% of the women were satisfied with the method after 6 weeks and 6 months, respectively. The rate of poor positioning on ultrasound was 5% and the rate of visible thread after 6 weeks was 29.1%, both without association with age, parity, gestational age or active labour. There were 2 cases of infection (1.3%) and no cases of perforation or pregnancy. Conclusions There was a good rate of continuation and satisfaction with the immediate post-caesarean IUD. There was no association between IUD malpositioning and age, parity, gestational age or active labour.

Introduction: Gestational trophoblastic disease (DTG) comprises a heterogeneous group of cell proliferation originating from the trophoblastic epithelium. It is divided into complete, partial, and gestational trophoblastic neoplasms. The hydatidiform mole occurs around 1:200-400 gestations in Brazil. Objective: To emphasize the clinical factors related to the histopathological findings of GFR among women from the states of Ceará, Brazil. Methods: A retrospective quantitative, descriptive, cross-sectional study was performed by means of medical records, totaling 203 patients with confirmed histopathological diagnosis between 2012 and 2015. Clinical-epidemiological and laboratory data were evaluated for cases of complete hydatidiform mole (MHC) and partial hydatidiform mole (MHP). Results: 203 cases of gestational trophoblastic disease, 49.2% cases of MHC and 49.7% of MHP were identified. There was no statistically significant difference for age, parity, recurrence of bleeding, presence of hypertension, type of bleeding at admission, vesicle elimination, ovarian cytorutinic cysts and evolution for gestational trophoblastic neoplasia (GTN) among women with MHC and MHP. The presence of bleeding at the time of hospitalization was observed in 76.9% in MHC cases and 85.5% in MHP cases. 14.3% of MHC cases and 12.1% of MHP cases progressed to NTG. Conclusion: There was no statistically significant difference between clinical and epidemiological factors for women with MHC and MHP. Introdução: a doença trofoblástica gestacional (DTG) compreende um grupo heterogêneo de proliferação celular originada a partir do epitélio trofoblástico, dividindo-se em mola hidatiforme completa ou parcial e em neoplasias trofoblásticas gestacionais. A mola hidatiforme ocorre em torno de 1:200-400 gestações no Brasil. Objetivo: avaliar fatores clínicos e epidemiológicos relacionados aos achados histopatológicos de DTG entre mulheres do estado do Ceará, Brasil. Metodologia: pesquisa quantitativa, descritiva, transversal, do tipo retrospectivo, por meio de revisão de prontuários, totalizando 203 pacientes com diagnóstico histopatológico confirmado entre 2012 e 2015. Avaliou-se dados clínico-epidemiológicos e laboratoriais para os casos de mola hidatiforme completa (MHC) e de mola hidatiforme parcial (MHP). Resultados: foram identificados 203 casos de doença trofoblástica gestacional, 49,2% casos de MHC e 49,7% de MHP. Não houve diferença estatisticamente significante para idade, paridade, recidiva do sangramento, presença de hipertensão, tipo de sangramento à internação, eliminação de vesículas, cistos tecaluteínicos de ovário e evolução para neoplasias trofoblásticas gestacionais (NTG) entre mulheres com MHC e MHP. A presença de sangramento no momento da internação foi observada em 76,9% nos casos de MHC e em 85,5% nos de MHP. 14,3% dos casos de MHC e 12,1% dos casos de MHP evoluíram para NTG. Conclusão: não houve diferença estatisticamente significante entre fatores clínico-epidemiológicos para mulheres com MHC e MHP.

Made available in DSpace on 2021-06-25T10:56:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Objective: To assess the calorie intake and nutritional content of the maternal diet in regions with different culinary traditions and typical foods, and to understand the nutritional profile so as to provide information about the consumption of this population and promote maternal and perinatal health. Methods: From a cohort of 1145 pregnant women with diverse socio-backgrounds we analyzed the dietary characteristics profile according to three guidelines and compared the differences between regions of Brazil. Results: Women from the northeast had the lowest level of income, occupation, education, and age (P

Background Labor induction is defined as any procedure that stimulates uterine contractions before labor begins spontaneously. The vaginal and oral routes of administration of misoprostol are those most used for the induction of labor in routine practice, with the recommended dose being 25 μg. Nevertheless, the sublingual route may reduce the number of vaginal examinations required, increasing patient comfort and lowering the risk of maternal and fetal infection. Based on a previous systematic review, the objective of this study was to compare the frequency of tachysystole as the main outcome measure when misoprostol is administered sublingually at the dose of 12.5 μg versus vaginally at a dose of 25 μg to induce labor in a full-term pregnancy with a live fetus. Methods A randomized, placebo-controlled, triple-blind clinical trial was conducted at two maternity hospitals in northeastern Brazil. Two hundred patients with a full-term pregnancy, a live fetus, Bishop score ≤ 6 and an indication for induction of labor were included. Following randomization, one group received 12.5 μg misoprostol sublingually and a vaginal placebo, while the other group received a sublingual placebo and 25 μg misoprostol vaginally. The primary outcome was the frequency of tachysystole. Student’s t-test, the chi-square test of association and Fisher’s exact test were used, as appropriate. Risk ratios and their 95% confidence intervals were calculated. Results The frequency of tachysystole was lower in the group using 12.5 μg misoprostol sublingually compared to the group using 25 μg misoprostol vaginally (RR = 0.15; 95%CI: 0.02–0.97; p = 0.002). Failure to achieve vaginal delivery within 12 and 24 h was similar in both groups. Sublingual administration was preferred to vaginal administration by women in both groups; however, the difference was not statistically significant. Conclusion The effectiveness of labor induction with low-dose sublingual misoprostol was similar to that achieved with vaginal administration of the recommended dose; however, the rate of tachysystole was lower in the sublingual group, and this route of administration may prove a safe alternative. Trial registration Registration number: NCT01406392, ClinicalTrials.gov. Date of registration: August 1, 2011.

Made available in DSpace on 2020-12-12T02:05:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-05-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Bill and Melinda Gates Foundation Objective To assess the incidence and risk factors for hyperglycemia in pregnancy in a cohort of Brazilian nulliparous pregnant women. Materials and methods This is a secondary analysis of a multicenter cohort study that enrolled 1,008 nulliparous pregnant women at 19–21 weeks. Exclusion criteria included chronic exposure to corticosteroids and previous diabetes. Bivariate and multivariate analyses by Poisson regression were used to identify associated factors. Results The incidence of hyperglycemia in pregnancy was 14.9% (150/1,008), and 94.7% of these cases were gestational diabetes mellitus (142/150). Significant associated factors included a family history of diabetes mellitus, maternal overweight or obesity at enrollment, and previous maternal conditions (polycystic ovarian syndrome, thyroid dysfunctions and hypertensive disorders). A BMI ≥ 26.3Kg/m2 (RRadj 1.87 [1.66–2.10]) and a family history of diabetes mellitus (RRadj 1.71 [1.37–2.15]) at enrollment were independent risk factors for HIP. Conclusions A family history of diabetes mellitus and overweight or obesity (until 19–21 weeks of gestation) may be used as selective markers for HIP in Brazilian nulliparous women. Given the scarcity of results in nulliparous women, our findings may contribute to determine the optimal diagnostic approach in populations of similar socioeconomic characteristics. Department of Obstetrics and Gynecology Botucatu Medical School Unesp Department of Obstetrics and Gynecology University of Campinas (UNICAMP) School of Medical Sciences MEAC–Maternity School of the Federal University of Ceará Department of Maternal and Child Health Maternity of Clinic Hospital Federal University of Pernambuco Department of Obstetrics and Gynecology Maternity of the Clinic Hospital Federal University of RS Statistics Unit Jundiai School of Medicine Jundiaí College of Life Sciences University of Leicester Faculty of Health and Life Sciences Department of Women’s and Children’s Health Institute of Translational Medicine University of Liverpool Department of Obstetrics and Gynecology Botucatu Medical School Unesp CNPq: 401636/2013-5 Bill and Melinda Gates Foundation: OPP1107597

Made available in DSpace on 2019-10-06T16:40:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-07-02 The objective of this study is to determine the incidence, socio-demographic and clinical risk factors for preeclampsia and associated maternal and perinatal adverse outcomes. This is a nested case-control derived from the multicentre cohort study Preterm SAMBA, in five different centres in Brazil, with nulliparous healthy pregnant women. Clinical data were prospectively collected, and risk factors were assessed comparatively between PE cases and controls using risk ratio (RR) (95% CI) plus multivariate analysis. Complete data were available for 1,165 participants. The incidence of preeclampsia was 7.5%. Body mass index determined at the first medical visit and diastolic blood pressure over 75 mmHg at 20 weeks of gestation were independently associated with the occurrence of preeclampsia. Women with preeclampsia sustained a higher incidence of adverse maternal outcomes, including C-section (3.5 fold), preterm birth below 34 weeks of gestation (3.9 fold) and hospital stay longer than 5 days (5.8 fold) than controls. They also had worse perinatal outcomes, including lower birthweight (a mean 379 g lower), small for gestational age babies (RR 2.45 [1.52-3.95]), 5-minute Apgar score less than 7 (RR 2.11 [1.03-4.29]), NICU admission (RR 3.34 [1.61-6.9]) and Neonatal Near Miss (3.65 [1.78-7.49]). Weight gain rate per week, obesity and diastolic blood pressure equal to or higher than 75 mmHg at 20 weeks of gestation were shown to be associated with preeclampsia. Preeclampsia also led to a higher number of C-sections and prolonged hospital admission, in addition to worse neonatal outcomes. Department of Obstetrics and Gynaecology University of Campinas (UNICAMP) School of Medical Sciences MEAC - Maternity School of the Federal University of Ceará Department of Maternal and Child Health Maternity Hospital Federal University of Pernambuco Department of Obstetrics and Gynaecology Maternity Hospital Federal University of RS Department of Obstetrics and Gynaecology Botucatu School of Medicine Unesp Statistics Unit Jundiai School of Medicine College of Life Sciences Maurice Shock Building University of Leicester Department of Obstetrics and Gynaecology Botucatu School of Medicine Unesp

Although maternal nutrition has an impact on fetal development and gestational outcome, tracking maternal nutrition in outpatient practice is still complex and involves proper technical capacitation in this area. Nevertheless, the association between nutritional variables may broaden the ability to predict the occurrence of gestational disorders and prevention management. We aimed to identify factors that could indicate the probability of adverse outcomes in mid-pregnancy. From a cohort of 1165 nulliparous pregnant women without any previous disease, the nutritional status was assessed by body mass index (BMI) and mid-upper arm circumference (MUAC), associated with dietary patterns and sociodemographic characteristics. Two predictive models with nutritional status for screening the occurrence of adverse outcomes of preterm birth, gestational diabetes mellitus, small-for-gestational-age newborns and preeclampsia were developed. The odds of adverse outcomes were higher in non-white (p &lt, 0.05) obese women and with high protein consumption. There was no significant difference between the models, with an overall accuracy of 63% for both models and a probability of success in predicting adverse outcomes (BMI = 61%, MUAC = 52%). This study of Brazilian pregnant nulliparous women offers two possible options for early tracking of adverse gestational outcomes that should be further externally validated.

Objective: To evaluate factors associated with maternal death among women experiencing life-threatening conditions during pregnancy, childbirth, or within 42 days of termination of pregnancy. Methods: A secondary analysis of data prospectively collected in a Brazilian multicenter cross-sectional study between July 2009 and June 2010 was conducted. Women were identified who delivered at a hospital in Ceará and who had potentially life-threatening conditions. Stepwise logistic regression was used to identify factors associated with maternal death. Results: Overall, 941 women were identified and 11 died. Among criteria for severe maternal morbidity, eclampsia (adjusted odds ratio [aOR] 203.70, 95% CI 5.03 to 8254.20; P=0.005) and intensive care unit (ICU) admission (aOR 69.30, 95% CI 6.63– 724.26; P

To determine maternal and perinatal outcomes according to the mode of delivery in normotensive and hypertensive women bearing a live, full-term fetus, who were submitted to labor induction with misoprostol.Retrospective cohort study. The endpoints were tachysystole, uterine hyperstimulation, indications for cesarean section, severe maternal morbidity, side effects, maternal death, 1st/5th minute Apgar, neonatal death, requirement for neonatal intensive care, and birth weight (grams). The chi-square or Fisher's exact test was applied at a significance level of 5%. Risk ratios (RRs) and their 95% confidence intervals (95% CI) were calculated.No significant differences were found in maternal outcome as a function of mode of delivery. First-minute Apgar score7 was less common with vaginal deliveries in normotensive women (RR = 0.41; 95% CI: 0.18-0.90), this being the only significant difference in perinatal outcome.Maternal and perinatal outcomes were similar in hypertensive and normotensive women submitted to labor induction with misoprostol.

To assess the prediction of delivery within 7 days in pregnant women who showed symptoms of spontaneous preterm birth (PB) by means of fetal adrenal gland biometry and to compare these predictions with the cervical length (CL) measurement.We performed a prospective cross-sectional study with 53 pregnant women between 24 and 36 weeks of gestation. An ultrasound exam was performed for each participant to obtain the CL measurement (transvaginal route) and fetal adrenal gland biometry on day 1 of their hospital admission because of symptoms of spontaneous PB. The main outcome measure was the time between the ultrasound exam and delivery, which was classified into two groups: delivery ≤7 days and delivery 7 days. A receiver operating characteristics (ROC) curve was performed to define the cutoffs for sensitivity and specificity.The prevalence of delivery within 7 days was 35.8%, which showed a statistically significant difference from the depth of the central zone of the fetal adrenal gland (p = 0.036). The cutoff for the depth of the central zone of the fetal adrenal gland was 7.2 mm (sensitivity 66.7%, specificity 61.8% and accuracy 63.5%). These values were not significantly different than the cutoffs for cervical length measurement: 20 mm (p = 0.267) and 9 mm (p = 0.118).The biometry for the central zone of the fetal adrenal gland predicted delivery within 7 days in pregnant women with spontaneous PB and had a predictive accuracy similar to that of CL measurement.

The objective of this study was identify the association between delays in the care provided to pregnant women and the fetal death outcome, in a tertiary reference maternity hospital in the Northeastern Brazil. A case-control study, with 72 cases of fetal death and 144 controls (live births) in women admitted to the Obstetrics Service of the Assis Chateaubriand Teaching Maternity Hospital, in Fortaleza, Ceara´ . Controls were matched (2:1) by the approximate gestational age of the case. The groups were compared using the three delays model of obstetric care. The Pearson’s Chi-square test and the Fisher’s exact test were used to compare the groups. P 6 consultations: 27.8% in cases, 40.3% in controls, p = 0.003), less risk classification of pregnancy (41.7% vs 55.9%, p = 0.048), less guidance about the health facility for delivery (44.5% vs 64%, p = 0.009), lower frequency of cesarean sections (25.4% vs 65.7%) and higher frequency of hemorrhagic syndromes (33.3% vs 19.4%, p = 0.024) and syphilis (15.3% vs 4.2%, p = 0�004). Variables that persisted significantly associated with fetal death in the logistic regression were: Refusal of assistance (OR = 4.07, IC 95%: 1.08–15.3), Absence or inadequacy of prenatal care (OR = 2.69, IC 95%: 1.07–6.75), Delay in diagnosis (OR = 10.3, IC 95%: 2.58–41.4) and Inadequate patient conduct (OR = 4.88; IC 95%: 1.43–16.6). Despite of having a higher frequency of obstetric complications, gestations with fetal death are more prone to delays in obstetric care.

The new epidemic of Zika virus infection raises grave concerns, especially with the increasingly-recognized link between emerging cases of microcephaly and this infectious disease. Besides small cranial dimensions, there are striking morphologic anomalies in the fetal brain. Key anomalies include cortical developmental malformations and a peculiar distribution of pathologic calcifications. These potentially indicate a new pattern of congenital central nervous system infection. Methods: Eight women underwent fetal MRI. Four infants also underwent postnatal CT. Five of the women underwent amniocentesis. Results: All neonates were born with microcephaly. On fetal MRI, ventriculomegaly, marked reduction of white matter thickness, severe sylvian fissure simplification, abnormal sulcation, and diffuse volumetric loss of cerebellar hemispheres were consistently seen. On postnatal CT, diffuse subcortical and basal ganglia calcifications were observed. The Zika virus was detected in two amniocenteses by polymerase chain reaction assays. Conclusion: We hope to assist the medical community in recognizing the spectrum of encephalic changes related to congenital Zika virus infection. RESUMO Os novos casos epidêmicos de infecção pelo vírus Zika suscitam grande preocupação, sobretudo com o crescente reconhecimento da ligação entre casos emergentes de microcefalia e esta doença infecciosa. Além da cabeça de pequenas dimensões, existem profundas alterações morfológicas no encéfalo fetal. Anomalias mais típicas incluem malformações do desenvolvimento cortical e uma distribuição peculiar de calcificações patológicas. Estes dados potencialmente indicam um novo padrão de infecção congênita do sistema nervoso central. Métodos: Oito mulheres foram submetidas a RM fetal. Quatro crianças também realizaram TC pós-natal. Cinco mulheres foram submetidas a amniocentese. Resultados: Todos os neonatos nasceram com microcefalia. Na RM fetal, ventriculomegalia, acentuada redução da espessura da substância branca, acentuada simplificação da fissura sylviana, sulcação anormal e redução volumétrica difusa dos hemisférios cerebelares foram constantes. Na TC pós-natal, calcificações difusas subcorticais e nos núcleos da base foram observadas. O vírus Zika foi detectado por PCR em duas amniocenteses. Conclusão: Esperamos dar suporte à comunidade médica em reconhecer este padrão de imagem potencialmente específico.

Aim: To assess the accuracy of delivery date predictions made using fetal adrenal artery Doppler velocimetry in pregnant women with spontaneous preterm birth (PB) and to compare these predictions with cervical length (CL) measurements.Material and methods: A prospective study was performed with 51 pregnant women whose gestational lengths were between 24 and 36 weeks. The main outcome was the time between the Doppler velocimetry examination and delivery, categorized as delivery within 7 days or 7 days later after the examination. A receiver operating characteristics curve was performed to define the cutoffs among deliveries within 7 days for fetal adrenal artery Doppler velocimetry parameters and CL measurements.Results: The incidence of delivery within 7 days was 37.3%, with a statistically significant difference for the pulsatility index (PI; p=0.045) and resistance index (RI; p=0.030) of the fetal adrenal artery. The best cutoff values of PI and RI for predicting deliveries within 7 days were 1.65 and 0.78, respectively. The sensitivity and specificity of PI, RI, and CL (20 mm) were 73.7% (95% CI: 51.9–95.5) and 56.3% (95% CI: 38.1–74.4); 68.4% (95% CI: 45.4–91.4) and 62.5% (95% CI: 44.8–80.2); and 76.5% (95% CI: 54.0–99.0) and 78.1% (95%: CI 71.1–97.7), respectively.Conclusion: Fetal adrenal artery Doppler velocimetry can predict delivery within 7 days among pregnant women in cases of spontaneous PB and this prediction is similar to the predictions made using CL measurements.

Objectives: To better understand the etiologic factors that can influence preeclampsia, we inves- tigated hereditary factors for thrombosis, FV Leiden, F II 20210A mutation and the polymorphism C677T of the MTHFR, as singly and as in association, in a group of women from Ceara state-Northeast Brazil with severe preeclampsia. Material and Methods: We conducted a case-control study. 101 cases of severe preeclampsia were recruited from School Maternity Assis Chateaubriand, a reference Maternity of State of Ceara, Brazil, from December 2009 to December 2010. For clinical correlations, women were interrogated about fetal low weight (less than2500 grams) and fetal loss in previous pregnancies. Low weight, fetal loss and necessity of neonatal intensive care unit (neonatal ICU) related to current pregnancy were registered. 245 healthy voluntary women were recruited from the blood bank donors to verify the frequency of FV Leiden, FII and MTHFR as a control group. The study was approved by the Committee on Ethics in Human Research of Maternidade Escola Assis Chateubriand and all individuals gave their informed consent to participate in the study. Standard veinipuncture, with EDTA as anticoagulant, was used to collect blood samples. Genomic DNA was extracted, soon after, using a salting out method. Agarose gel electrophoresis with ethidium bromide staining was performed to ensure the quality of DNA extraction. Results: The frequencies of FV Leiden and FII mutation carrier were 0.99% (1/101) for both factors in the preeclampsia patients and 1.86% (4/214) and 0.93% (2/214), respectively, in control group. All mutates were heterozygous and concomitance of both mutations was not found. The genotype distribution of the MTHFR C677T in the patients and controls frequencies was in Hardy-Weinberg equilibrium (p ≤ 0.05). No statistical difference was observed between cases and controls in MTHFR genotypes or alleles. Conclusions: The FV Leiden, FII G20210A mutation and MTHFR C677T were not risks for preeclampsia development. FV Leiden and FII G20210A mutations had low frequency in the population studied, which may justify the absence of association.

Purpose To evaluate blood loss during misoprostol-induced vaginal births and during cesarean sections after attempted misoprostol induction. Methods We conducted a prospective observational study in 101 pregnant women indicated for labor induction; pre- and postpartum hemoglobin levels were measured to estimate blood loss during delivery. Labor was induced by administering 25 μg vaginal misoprostol every 6 hours (with a maximum of 6 doses). The control group included 30 patients who spontaneously entered labor, and 30 patients who underwent elective cesarean section. Pre- and postpartum hemoglobin levels were evaluated using the analysis of variance for repeated measurements, showing the effects of time (pre- and postpartum) and of the group (with and withoutmisoprostol administration). Results Therewere significant differences between pre- and postpartum hemoglobin levels (p < 0.0001) with regard to misoprostol-induced vaginal deliveries (1.6 ± 1.4 mg/dL), non-induced vaginal deliveries (1.4 ± 1.0 mg/dL), cesarean sections after attempted misoprostol induction (1.5 ± 1.0 mg/dL), and elective cesarean deliveries (1.8 ± 1.1 mg/dL). However, the differences were proportional between the groups with and without misoprostol administration, for both cesarean (p = 0.6845) and vaginal deliveries (p = 0.2694). Conclusions Labor induction using misoprostol did not affect blood loss during delivery. Resumo Objetivo Avaliar a perda sanguínea em partos vaginais induzidos com misoprostol, e em cesáreas com tentativa prévia de indução do parto com misoprostol. Métodos Realizou-se estudo prospectivo observacional com 101 gestantes com indicação para indução do trabalho de parto, as quais foram avaliadas pela dosagem de hemoglobina pré e pós-parto para estimativa da perda sanguínea no parto. Procedeu-se à indução do trabalho de parto com misoprostol 25 μg, via vaginal, a cada 6 horas, em um número máximo de 6 doses. O grupo controle foi composto por 30 pacientes que entraram emtrabalho de parto espontaneamente, e por 30 pacientes que se submeteram a cesárea eletiva. O estudo da hemoglobina, antes e depois do parto, foi avaliado por ANOVA paramedidas repetidas, no qual foi verificado o efeito do tempo (pré e pós-parto) e o efeito do grupo (com e sem uso do misoprostol). Resultados Existem diferenças significativas entre os níveis de hemoglobina pré e pós-parto (p < 0,0001) nos partos vaginais induzidos pelo misoprostol (1,6 ± 1,4 mg/ dL), nos partos vaginais não induzidos (1,4 ± 1,0 mg/dL), nas cesáreas com tentativa prévia de indução (1,5 ± 1,0mg/dL), e nas cesáreas eletivas (1,8 ± 1,1mg/dL). Porém, as diferenças foram proporcionais em ambos os grupos, ou seja, ocorreu diferença tanto no grupo que fez uso do misoprostol quanto no grupo que não fez uso do medicamento, tanto na cesárea (p = 0,6845) quanto no parto vaginal (p = 0,2694). Conclusões A indução do parto com misoprostol não alterou a perda sanguínea durante o parto.

Pathophysiological mechanisms of peripartum cardiomyopathy are not yet completely defined, although there is a strong association with various factors that are already known, including pre-eclampsia. Peripartum cardiomyopathy treatment follows the same recommendations as heart failure with systolic dysfunction. Clinical and experimental studies suggest that products of prolactin degradation can induce this cardiomyopathy. The pharmacological suppression of prolactin production by D2 dopamine receptor agonists bromocriptine and cabergoline has demonstrated satisfactory results in the therapeutic response to the treatment. Here we present a case of an adolescent patient in her first gestation with peripartum cardiomyopathy that evolved to the normalized left ventricular function after cabergoline administration, which was used as an adjuvant in cardiac dysfunction treatment. Subsequently, despite a short interval between pregnancies, the patient exhibited satisfactory progress throughout the entire gestation or puerperium in a new pregnancy without any cardiac alterations. Dopamine agonists that are orally used and are affordable in most tertiary centers, particularly in developing countries, should be considered when treating peripartum cardiomyopathy cases.

Interstitial pregnancy sometimes is mistakenly referred to as cornual pregnancy and is frequently confused with angular pregnancy. A strict distinction among these three conditions is clinically important because their findings, management and outcomes are different. We report an unusual case of pregnancy where interstitial pregnancy was diagnosed at 6 weeks of pregnancy, located close to the right cornual portion of the uterus. Prenatal monitoring was carried out until birth at 36 weeks' gestation with uterine conservation. Ultrasound scan and magnetic resonance imaging were realized to confirm the diagnosis and to monitor the evolution.

Background The induction of full-term labour in women with a live fetus remains a major challenge in modern obstetrics. Objectives To determine, using the best level of evidence available, the efficacy and safety of sublingual administration of misoprostol compared with vaginal misoprostol in the third trimester of pregnancy for the induction of labour, according to initial doses, in women with a live, full-term fetus and an unripe cervix. Search strategy Pubmed/Medline, Lilacs and Scielo databases were consulted, as well as clinical trials registered in the Cochrane Register from January 1996 to February 2008, using the keywords ‘misoprostol’, ‘labour, obstetric’, ‘delivery, obstetric’, ‘induced labour’ and ‘parturition’ with the search limits of ‘clinical trials’ and ‘randomised clinical trials’. Selection criteria This review contains randomised clinical trials in which the sublingual and vaginal routes of administration of misoprostol were compared. Participants were pregnant women with an indication for induction of labour and a live fetus more than 37 weeks of gestational age. Data collection and analysis The primary analysis compared sublingual and vaginal routes of administration of misoprostol. Secondary analyses compared different routes and initial doses of misoprostol. Statistical analysis included odds ratios and their respective 95% CI. To evaluate the heterogeneity of the studies, the I-squared test was used, studies being considered heterogeneous when I2 was greater than 50%. Main results Five good quality clinical trials involving a total of 740 women were eligible, and all were included. No statistically significant difference was found between the sublingual and the vaginal misoprostol groups with respect to the rate of vaginal delivery not achieved within 24 hours (OR 1.27, 95% CI 0.87–1.84), uterine hyperstimulation syndrome (OR 1.20, 95% CI 0.61–2.33) or caesarean section (OR 1.33, 95% CI 0.96–1.85). An increased risk of uterine tachysystole was found in the sublingual misoprostol group (OR 1.70, 95% CI 1.02–2.83). When the studies were grouped according to the initial dose of misoprostol, no significant difference was found between sublingual or vaginal groups. Author’s conclusions The sublingual route of administration is as effective as the vaginal route in inducing labour in full-term pregnancies with live fetuses. However, the safety, adverse effects, optimal dose and perinatal outcome related to this route of administration remain to be established, and it cannot be recommended for routine use in obstetric practice.

A microlitíase alveolar pulmonar (MAP) é uma doença rara que atinge ambos os pulmões, caracterizada pela presença de pequenos cálculos (fosfato de cálcio) nos espaços alveolares. Relatamos o caso de uma paciente do sexo feminino, de 26 anos, cujo diagnóstico foi confirmado com base nos achados marcantes na radiografia de tórax e tomografia computadorizada de alta resolução. A paciente, gestante de 28 semanas, retornou ao hospital 10 meses após o diagnóstico apresentando insuficiência respiratória hipoxêmica e com distúrbio ventilatório restritivo grave à espirometria. Após completadas 32 semanas e 4 dias de gestação, foi submetida aparto cesariano, com sucesso para mãe e filha. A MAP tem evolução clínica variável. Tem provável caráter autossômico recessivo e associação com história familiar positiva. A etiologia é incerta, e muitos autores especulam que haja um defeito enzimático local responsável pelo acúmulo intra-alveolar de cálcio. Relatos de pacientes com MAP que engravidaram são excepcionais, sendo o presente caso o primeiro descrito no Brasil. O curso dessa doença costuma ser lentamente progressivo, e os pacientes geralmente falecem devido à insuficiência cardiorrespiratória. O presente caso ilustra a necessidade de se oferecer aconselhamento genético e orientações sobre o risco de gravidez às pacientes, especialmente em casos de doença avançada. Atualmente, a única terapia efetiva é o transplante pulmonar.

Objective: To compare the results of maternal and perinatal pregnancies of obese women after bariatric surgery. Methods: A retrospective cross-sectional study was carried out on 63 women who had undergone bariatric surgery and 73 obese women (control). Demographic data, the characteristics of the bariatric surgery, and the maternal and perinatal results were evaluated. The Student's t-test and chi-square test (χ2) were used to compare the groups. The gestational complications of the prevalence of gestational diabetes mellitus, anemia, and preeclampsia were analyzed using simple and multivariate logistical regression and odd ratios (OD) with their respective confidence intervals (CI) of 95%. Results: The average body mass index (BMI) at the 1st prenatal appointment of the control group was 34.6±3.3 kg/m2 and that of the post-surgical group was 26.5±4.2 kg/m2. The Roux-en-Y Gastric Bypass was used in 100% of cases; no complications were observed during or after the surgeries. The average weight loss in patients with a prior bariatric surgery was statistically significant (P=0.000). The average weight at birth of the control group was significantly higher than in the post-bariatric surgery group (P=0.017). The women who had a prior bariatric surgery had a higher chance of anemia (OR=3.5; CI 95%: 1.5-8.3) and a reduced chance of macrosomia (OR=0.2; CI 95%:0.1-0.5), and prematurity (OR=0.3; CI 95%:0.1-0.7). Conclusion: Those women who had been submitted to bariatric surgery presented better maternal and perinatal results when compared to obese women.

OBJETIVO: Testar a efetividade e segurança do comprimido sublingual de misoprostol, na dose de 25 mcg a cada seis horas, para indução do parto em gestantes de alto risco internadas em dois hospitais-escola do Nordeste do Brasil. MÉTODOS: Realizou-se um ensaio clínico aberto, não randomizado, incluindo 40 gestantes de alto risco internadas nas Enfermarias de Patologia Obstétrica da Maternidade-Escola Assis Chateaubriand e Instituto Materno-Infantil de Pernambuco. Todas tinham idade gestacional maior que 37 semanas, feto único com boa vitalidade e escores de Bishop menores ou iguais a 7. Utilizou-se o comprimido de 25 mcg de misoprostol via sublingual, repetindo-se a cada seis horas, até no máximo de quatro doses. A análise estatística foi realizada no programa de domínio público Epi-Info 3.2.2. RESULTADOS: O trabalho de parto foi desencadeado em todas as gestantes. O intervalo entre a primeira dose e o início das contrações foi de 4,8±3,8 horas. O intervalo entre a primeira dose e o parto variou de 8 a 31 horas, com 95% dos partos ocorrendo nas primeiras 24 horas, sendo 75% por via vaginal. Houve necessidade de mais de uma dose de misoprostol em 60% dos casos. A taquissistolia ocorreu em 12,5% das gestantes. Não ocorreram complicações neonatais. CONCLUSÃO: O comprimido sublingual de 25 mcg de misoprostol foi efetivo para desencadeamento do trabalho de parto em gestantes de alto-risco. A eficácia desta nova via deve ser comparada à da via vaginal em futuros estudos clínicos randomizados.

The aim of this study was to highlight the importance of knowledge of idiopathic dilated cardiomyopathy (IDC) in pregnancy and its complications, with the order to establish early diagnosis and treatment. We report the case of a primigravida aged 17, previously healthy, 18 weeks of gestation with dyspnea at rest, which started 2 weeks ago. During the investigation, the echocardiogram (ECO) showed left ventricle (LV) dilation with impaired systolic and diastolic function, LV ejection fraction of 20%. We did not identify a cause for the patient’s clinical condition, being diagnosed with IDC. The patient remained in obstetrics and cardiology monitoring for up to 23 weeks of gestation, when it was decided by the interruption of pregnancy by caesarean section due to hemodynamic instability. The newborn came to death four days after the procedure. The patient evolved to clinical improvement, 16 days after the resolution of gestation, was discharged for outpatient monitoring.

Objective To analyze which of the maternal risk factors for PE is more predictive unfavorable perinatal outcomes between women diagnosed with Severe PE. Methods Over a period of twelve months, (2014–2015), 208 cases of severe preeclampsia were included in a observational and retrospective cohort study. This study was conducted at the Maternity School Assis Chateaubriand in Fortaleza, State of Ceara, Brazil. The maternal risk factors were analized by the Student ’T’ test and logistic regression Results Of the 208 patients analyzed obtained in perinatal outcomes 39 (18%) cases of SGA, 17 (8.17%) cases of intrapartum anoxia and 10 (4.8%) cases of fetal death. Early- and late-onset severe preeclampsia differed from each other remarkably. The increased arterial systolic and diastolic pressure early in the prenatal care was the most important predictive factor to unfavorable perinatal outcomes (OR = 1.13, CI- 1.00 to 1.06; p = 0,03) Conclusion women with Hypertension in the beginning of prenatal care was an important risk factor to early preeclampsia and unfavorable perinatal outcomes; therefore, the Primiparity was protector parameter.

PURPOSE: to investigate whether rectally administered misoprostol is an effective method for induction of labor in patients with premature ruptured membranes at term. METHODS: a pilot trial was conducted, enrolling 32 women with alive, singleton, cephalic fetus and ruptured membranes between 36 and 41 weeks of pregnancy, with Bishop score 18 h received antibiotics (crystalline penicillin) for prophylaxis of streptococcal infeccion. Outcomes included time from induction to labor and induction to delivery, incidence of tachysystole, mode of delivery, incidence of chorioamnionitis and neonatal outcome. Statistical analysis was performed using the public domain software Epi-Info 2002. Means and standard deviations were calculated, as well as frequency distributions. Survival analysis was performed to determine percent of deliveries according to time (hours) since the administration of the first tablet. RESULTS: the mean (±SD) induction-to-labor and induction-to-delivery intervals were 299.8±199.9 and 681±340.5 min, respectively. The frequency of tachysystole was 9.4%. About 72% of patients achieved vaginal delivery. Chorioamnionitis was diagnosed in 12.5% of the patients. Median Apgar scores at 1st and 5th min were 8 and 9, respectively. There was no case of Apgar

Objective: To investigate the occurrence and characterization of metabolic syndrome (MetS) in the long term after pregnancies with preeclampsia. Design: Retrospective cohort study. Setting: Assis Chateaubriand Maternity Teaching Hospital - Federal University of Ceara, Fortaleza, Ceara, Brazil. Sample: 68 patients who gave birth between 1992 and 2002 at the Maternity, 34 patients with a history of preeclampsia and 34 with no history of obstetric complications. Methods: Blood pressure and body compositional indices were recorded. Fasting blood samples were tested for glucose, total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol and triglycerides. A questionnaire was used to collect demographic data including family history of diseases associated with cardiovascular diseases. Criteria for metabolic syndrome were defined by International Diabetes Federation 2005 (IDF). Main outcome measures: Occurrence and characterization of MetS. Results: There were 18 (52.9%) diagnoses of MetS in the group of women without a history of obstetric complications and 28 (82.3%) in the group of women with a history of preeclampsia, p=0.01 with a RR of 4.1 (CI 95% 1.4 - 12.2, p=0.009). The number of components to characterize MetS were, respectively, 2.7 ( ± 1.3) and 3.3 ( ± 1.3), p=0.05. Conclusions: Women with a history of preeclampsia have a higher prevalence of MetS 14 years after gestation.

OBJETIVO: Comparar os resultados maternos e perinatais de pacientes portadoras de placenta prévia, após adoção do internamento materno prolongado, com os de uma série histórica ocorrida em 1991. MÉTODOS: Estudo retrospectivo comparando 108 casos da doença - em pacientes hospitalizadas em uma instituição de ensino do estado do Ceará, nordeste do Brasil, no período de primeiro de janeiro de 2006 a 31 de dezembro de 2010 - com 101 casos ocorridos em 1991, na mesma instituição. Os seguintes dados maternos e perinatais foram coletados: idade materna, paridade, idade gestacional no momento do parto, via de parto, tempo de internamento materno, escores de Apgar ao primeiro e quinto minutos, peso ao nascimento, adequação do peso ao nascer, tempo de hospitalização neonatal, morbidade materna e neonatal e mortalidades (materna, fetal, neonatal e perinatal). As variáveis categóricas foram analisadas utilizando-se os testes do χ² de associação e exato de Fischer. Os resultados foram considerados significativos quando p

Objectives: It was the aim of this study to evaluate differences in the prognosis of fetuses with absent (AED) and reverse end-diastolic (RED) flow in the umbilical artery based on neonatal outcomes. Methods: We performed a cross-sectional study based on the records of 143 patients attending at Assis Chateaubriand Teaching Maternity between 1 January 1999 and 31 December 2005. Patients were classified according to diagnosis as having either fetal centralization (FC), AED or RED. Obstetrical findings and perinatal outcomes were compared for the 3 groups and between AED and RED by Fisher’s exact test. Perinatal outcomes were analyzed quantitatively with logistic or multinomial regression. Odds ratios were calculated for significant risk factors. Results: There was a statistically significant difference in gestational age at diagnosis, Apgar scores at 1 and 5 min, Capurro score, use of surfactant and mechanical ventilation, admission to the neonatal intensive care unit, perinatal and neonatal death. When comparing RED with AED, the odds of neonatal intensive care unit admission, mechanical ventilation, use of surfactant, neonatal mortality and perinatal mortality were 3.2, 1.4, 1.0, 5.1 and 5.3 times higher for RED. Only perinatal mortality kept statistically significant with odds of 5.2 (p = 0.043) when adjusted by gestational age (multivariate analysis). Conclusion: The incidence of perinatal mortality was observed to increase with the severity of Doppler findings, with significant differences between the AED and RED groups.

The accurate analysis of the fetal heart rate (FHR) and its correlation with uterine contractions (UC) allows the diagnostic and the anticipation of many problems related to fetal distress and the preservation of his life. This paper presents the results of an hibrid system based on a set of deterministic rules and fuzzy inference system developed to analyze FHR and UC signals collected by cardiotocography (CTG) exams. The studied variables are basal FHR, short and long term FHR variability, transitory accelerations and decelerations, these lasts classified by their type and number of ocurrencies. The system output is a first level diagnostic based on those input variables. The system is developed using the Matlab version 7 script language. The project also supports a multi-institutional agreement between Brazil and Germany, among the UFC - Universidade Federal do Ceara, the TUM - Technische Universitat Munchen, and the Trium Analysis Online GmbH. The system validation methodology was based on the knowledge of Brazilian and German obstetricians. The results achieved low false positive rates, classifying a high percentage of normal exams as normal and none suspicious or pathological exams as normal ones. These results allow the projection of the refinement of the proposed system with new input variables and further analysis of other obstetricians.

Objective: To compare sublingual with vaginal misoprostol for the induction of labor. Methods: This double-blind clinical trial randomized 150 women to receive every 6 h 25 μg of sublingual misoprostol and vaginal placebo or 25 μg of vaginal misoprostol and sublingual placebo. Maternal and neonatal outcomes were analyzed and risk ratios (RRs) with 95% confidence intervals (CIs) calculated. The significance level was 5%. Results: Vaginal delivery rates were 57% in the sublingual group and 69% in the vaginal group (RR, 0.8; 95% CI, 0.6–1.1). There were 11 cases of fetal distress in the sublingual group and 4 cases in the vaginal group (RR, 2.7; 95% CI, 0.9–8.2). There were no significant differences in the number of doses needed, interval between first dose and delivery, incidence of contractility disturbances, or neonatal results. Conclusion: The administration of misoprostol 25 μg by the sublingual route was neither more effective nor safer than the same dose administered vaginally.

Objetivos: avaliar sensibilidade, especificidade, valor preditivo positivo e negativo e razão de probabilidade da ultra-sonografia transvaginal e da histeroscopia quando comparadas com o exame histopatológico do endométrio em mulheres com câncer de mama tratadas com tamoxifeno. Método: estudo transversal, com trinta mulheres, em que se avaliou a ecogenicidade do eco endometrial e a sua espessura por meio de ultra-sonografia transvaginal. Realizou-se histeroscopia que foi descrita como normal (endométrio normal ou atrófico) ou anormal (espessamento, pólipo, mioma, sinéquia). Mediante biópsia endometrial foi obtido material para exame histopatológico e os resultados foram considerados normais (endométrio de maturação irregular e/ou atrofia) ou anormais (pólipos, hiperplasia simples ou complexa, miomas ou carcinoma endometrial). Resultados: a prevalência geral de alterações endometriais foi de 36,6%. Os achados mais freqüentes foram a atrofia cística (46,6%) e os pólipos (26,6%). Por meio de curva ROC determinou-se que o melhor ponto de corte da medida da espessura do endométrio foi 8 mm. Esta medida apresentou sensibilidade de 72,7%, especificidade de 78,9%, valor preditivo positivo de 66,6%, valor preditivo negativo de 83,3% e razão de probabilidade de 3,4. A histeroscopia apresentou sensibilidade de 90,9%, especificidade de 68,4%, valor preditivo positivo de 62,5%, valor preditivo negativo de 92,8% e razão de probabilidade de 2.8. Conclusão: os achados mais freqüentes foram a atrofia cística e os pólipos. A ultra-sonografia transvaginal apresentou maior taxa de falso-positivo (42,1%), utilizando ponto de corte da espessura do endométrio de 5 mm, porém melhorou-se a acurácia quando se utilizou a medida de 8 mm obtido pela confecção de curva ROC.

Objetivo: avaliar os parâmetros ultra-sonográficos associados ao incremento da mortalidade perinatal em casos de hidrocefalia fetal. Métodos: foram avaliados 45 casos de hidrocefalia acompanhados entre janeiro/1996 e dezembro/1999. A hidrocefalia foi diagnosticada quando a relação entre a mensuração dos ventrículos laterais e os hemisférios cerebrais correspondentes foi superior a 0,35 ou quando a medida do átrio dos ventrículos laterais foi superior a 10 mm. Em todos os exames definiu-se o tipo, gravidade, simetria, evolução e época do diagnóstico da hidrocefalia. As pacientes foram submetidas a ultra-som morfológico na busca de outras alterações anatômicas. O índice de líquido amniótico e os óbitos fetais foram registrados. Os principais achados ultra-sonográficos foram correlacionados à mortalidade perinatal. Utilizaram-se, para análise estatística, o teste do chi² e o teste exato de Fisher. O valor de p

SUMMARY In Brasil, abortion is legal in cases of rape, when there is a risk of maternal death, and in cases of fetal anencephaly. However, the literature reports that some doctors refuse to care for women with such demands or come to perform it in a discriminatory manner. OBJECTIVE: Pretest, test and evaluate the measurement properties of the “Mosaic of Opinions on Induced Abortion,” a questionnaire developed to investigate the perspectives of Brazilian healthcare professionals about the morality of abortion. METHODS: Firstly, the questionnaire was pretested in an intentional sample of specialists. Secondly, it was tested in a randomized sample of 32 healthcare professionals. Finally, we conducted a multi-center study in seven university hospitals to evaluate the measurement properties of the questionnaire. RESULTS: Combined samples of the three phases totalized 430 individuals. In pretest and test, all the evaluated aspects obtained satisfactory results. In the multicenter phase, confirmatory factorial analysis led to an important reduction of the questionnaire, which also obtained good indicators of reliability, beyond the validation of construct and criteria. CONCLUSION: Questionnaire has been validated and is suitable for use in other surveys in Brasil.