Urinary incontinence and vaginal squeeze pressure two years post-cesarean delivery in primiparous women with previous gestational diabetes mellitus

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Efeito da via de parto sobre a força muscular do assoalho pélvico

OBJETIVO: analisar a influência da via de parto sobre a força muscular do assoalho pélvico (FM-AP). MÉTODOS: estudo clínico de corte transversal, para avaliar a FM-AP pelo teste da avaliação da força do assoalho pélvico (AFA) e uso do perineômetro em primíparas, entre 20-30 anos de idade, 4-6 meses pós-parto. A contração, medida pelos dois testes, foi classificada em: zero - ausência, um - leve, dois - moderada e três - normal, sustentada por 6 segundos. Avaliaram-se 94 mulheres, entre 20 e 30 anos, divididas em três grupos: pós-parto vaginal (n=32); pós-cesárea (n=32) e nulíparas (n=30). A variável independente foi a via de parto e a dependente, a FM-AP. A comparação entre os graus de contração foi realizada pelo teste de Kruskal-Wallis e o teste de Dunn para comparações múltiplas; a influência da via de parto pelo teste chi2, o risco relativo (RR) para alteração da FM-AP e o coeficiente kappa para avaliar equivalência entre os testes. RESULTADOS: a mediana e 1º e 3º quartil da FM-AP foram menores (p=0,01) pós-parto vaginal (2,0;1-2) e intermediários pós-cesárea (2,0; 2-3) em relação às nulíparas (3,0;2-3), tanto analisadas pelo AFA como pelo perineômetro. Aumentou o RR de exame alterado pós-parto vaginal (RR=2,5; IC 95%: 1,3-5,0; p=0,002); (RR=2,3; IC 95%: 1,2-4,3; p=0,005) e pós-cesárea (RR=1,5; IC 95%: 0,94-2,57; p=0,12); (RR=1,3; IC 95%: 0,85-2,23; p=0,29) pelo PFSE e perineômetro, respectivamente. CONCLUSÕES: o parto vaginal diminuiu a força muscular do AP de primíparas quando comparado com os casos submetidos à cesárea e com as nulíparas.

Partial HELLP Syndrome: maternal and perinatal outcome

CONTEXTO: A síndrome HELLP é uma grave complicação da gestação caracterizada por hemólise, elevação das enzimas hepáticas e plaquetopenia. Algumas gestantes desenvolvem somente uma ou duas dessas características da síndrome HELLP. Esse quadro é denominado de síndrome HELLP parcial (SHP). OBJETIVO: O objetivo deste estudo foi avaliar as repercussões maternas e perinatais das mulheres que desenvolveram SHP e comparar os resultados com mulheres que tiveram hipertensão gestacional ou pré-eclâmpsia sem alterações dos exames laboratoriais para síndrome HELLP. TIPO DE ESTUDO: Observacional, retrospectivo e analítico. LOCAL: Maternidade do Hospital das Clínicas da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, São Paulo, Brasil. AMOSTRA: Foram selecionadas gestantes ou puérperas que tiveram elevação dos níveis pressóricos detectada pela primeira vez após a primeira metade da gestação com ou sem proteinúria entre janeiro/1990 a dezembro/1995. As mulheres foram divididas em dois grupos: Grupo SHP quando as mulheres com hipertensão arterial tinham pelo menos uma, mas não todas as alterações de exames que demonstravam hemólise, elevação das enzimas hepáticas ou plaquetopenia e Grupo Hipertensas pacientes com hipertensão sem alterações nos exames laboratoriais para síndrome HELLP. PRINCIPAIS VARIÁVEIS: Analisamos idade materna, raça, paridade, classificação da hipertensão, idade gestacional no diagnóstico da SHP, alterações nos exames laboratoriais para síndrome HELLP, tempo de permanência no hospital, complicações maternas, via de parto, incidência de prematuridade, restrição de crescimento intra-uterino, natimortos e neomortos. RESULTADOS: 318 mulheres foram selecionadas, das quais 41 (12,9%) tiveram SHP e 277 (87,1%) não desenvolveram alterações dos exames laboratoriais que compõem o diagnóstico da síndrome HELLP. A pré-eclâmpsia foi um tipo de hipertensão mais freqüente no grupo SHP que no grupo hipertensas. Não houve pacientes com hipertensão crônica isolada que desenvolveram SHP. A taxa de cesárea, eclâmpsia e de partos prematuros foi significativamente mais freqüente no grupo SHP que no grupo hipertensas. CONCLUSÃO: Observamos uma conduta agressiva nas pacientes com SHP, que resultou na interrupção imediata da gestação, com elevada taxa de cesárea e de recém-nascido pré-termo. Esta conduta deve ser revista para a redução desses índices.

Peso ao nascer e padrões de atendimento ao parto em município do Estado de São Paulo, Brasil, 1986

Foram estudados 4.776 recém-nascidos nos hospitais de Araraquara, SP (Brasil), durante o ano de 1986 para analisar sua distribuição quanto ao peso ao nascer, tipo de parto e categoria de internação. A incidência de baixo peso ao nascer foi de 9,2%. Quanto ao tipo de parto, a proporção de cesáreas foi a maior, com 76,0% do total de partos. Na associação do tipo de parto com a categoria de internação, a incidência de cesáreas entre as parturientes com assistência médica gratuita foi de 44,0% e entre as de assistência particular foi de 92,4%. A maior proporção de recém-nascidos com baixo peso ao nascer foi observada em parturientes com assistência gratuita, 10,8% seguida das previdenciárias, com 9,8% e particulares, 5,6%.

Randomized controlled trial on prevention of postcesarean infection using penicillin and cephalothin in Brazil

Background. There is a need to assess the effects of different antibiotic administration models on infectious complications among women from low-income populations who undergo cesarean delivery, and the cost benefit. Design. Randomized, blinded controlled clinical trial study of a single preoperative dose of cephalothin, versus a postcesarean scheme for infection prophylaxis, versus no antibiotics. Methods. The setting was a tertiary Brazilian center with 1,500 deliveries annually. Pregnant women (n = 600) with an indication for emergency or elective cesarean section were randomly allocated consecutively to one of three groups and treated as follows: Group 1 (n = 200), no antibiotics; Group 2 (n = 200), the standard antibiotics scheme followed at this center; Group 3 (n = 200), a single dose of intravenous cephalothin 2 g, intraoperatively. Main outcome measurements. Prevalences of wound infection, puerperal and postcesarean infections, and costs of antibiotics used. Results. Antibiotics reduced the incidence of puerperal infection, but did not change the percentages of wound and postcesarean infections and no use of antibiotics increased the puerperal infection risk sixfold. Cephalothin reduced the relative risk of puerperal infection by 89% (95% confidence interval: 7-87%). Penicillin reduced it by 78%, but this was not statistically significant. No deaths occurred. The costs of the two schemes were similar (almost US$1.00). Conclusions. Prophylactic cephalothin use was associated with decreased postcesarean puerperal infection and presented a cost benefit.

Bupivacaína, Ropivacaína e Levobupivacaína em Analgesia e Anestesia de Parto. Repercussões Materno-Fetais

Background and Objectives - Bupivacaine has been a very useful local anesthetic in Obstetrics in spite of its potential cardiotoxicity. In obstetric analgesia, ropivacaine is preferred to bupivacaine, and levobupivacaine is less cardiotoxic than the racemic mixture. The aim of this study was to compare the maternal-fetal effects of bupivacaine, ropivacaine and levobupivacaine in obstetric analgesia and anesthesia. Methods - Participated in this study 33 term pregnant women, physical status ASA I and II submitted to epidural anesthesia who received 18.75 mg (in 15 ml completed with 9% saline) of: GI - bupivacaine, GII - ropivacaine, and GIII - levobupivacaine. Pain intensity, sensory block level, onset time, quality of analgesia, motor block intensity, analgesia duration and time for labor resolution were evaluated. For vaginal delivery, 40 mg (in 8 ml of saline) of the same local anesthetic were used; for cesarean delivery, the dose has been mg in 20 ml solution. Newborns of these mothers were evaluated through the Apgar score in minutes 1, 5 and 10, and through the Amiel-Tison method (neurologic and adaptative capacity score - NACS) at 30 min, 2 h, and 24 h. Results - There were no significant statistical differences among groups as to sensory block level, onset time, quality of analgesia, labor analgesia duration, time for labor resolution, and Apgar scores at minute 1. Ast to motor block, GIII > GII and GI was intermediary. In relation to pain intensity, there was a trend for GI > GIII. For Apgar scores in minute 5, GII > (GI = GIII), and in minute 10 (GI = GII) < GIII. NACS at 2 h showed, GII > GI > GIII, and at 24 h, GII > GIII > GI. Conclusions - Ropivacaine has relieved maternal pain with less motor block. Newborns of GII mothers (ropivacaine) showed the best Apgar and NACS scores.

Efeito da via de parto na força muscular do assoalho pélvico, em primíparas

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Influência da anestesia no desfecho perinatal de gestação de hipertensas obesas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Sobrepeso pré-gestacional associa-se a ganho ponderal excessivo na gestação

PURPOSE: To evaluate the adequacy of gestational weight gain and to determine its association with maternal socioeconomic, demographic and nutritional factors and health care, to estimate the prevalence of low birth weight, macrosomia, preterm birth and cesarean delivery and to identify the association of these outcomes with the adequacy of weight gain. METHODS: A cross-sectional study was performed in 2009/2010 to obtain socioeconomic, demographic, nutritional, dietary and physical activity data of pregnant women assisted by primary health care in a municipality of the state of São Paulo. Subsequently, data were collected from the medical records to evaluate gestational weight gain. Type of delivery, birth weight and gestational age at delivery were obtained from the Livebirths Information System. Gestational weight gain was evaluated according to the recommendations of the Institute of Medicine (2009). Associations were investigated by comparing the frequencies and by logistic regression, with excessive weight gain (yes, no) and insufficient gain (yes, no) being the dependent variables. RESULTS: A total of 212 pregnant women were studied: 50.5% had excessive gain and 19.8% insufficient weight gain. Only prepregnancy nutritional status was associated with adequacy of weight gain: compared with normal weight, prepregnancy overweight women had a four-fold higher chance to gain excessive weight (OR 4.66, 95%CI 2.19-9.4). Nearly a third of babies were born by caesarian section, 5.7% were premature, 7.1% were underweight and 4.7% were macrosomic. There was no association between adequacy of gestational weight gain and these outcomes. CONCLUSION: The proportion of inadequate gestational weight gain was high. Overweight pregnant women have a four-fold higher chance to gain excessive weight, and priority should be given to actions promoting adequate prenatal weight gain.

Frequência e perfil de gestantes com toxoplasmose em uma unidade de saúde de Matão - SP

Congenital toxoplasmosis is a serious public health case, for it causes irreversible damage to the embryo/fetus, which may cause its death. The identification and the care to pregnant women with suspect acute toxoplasmosis (IgM+) is performed in prenatal monitoring. This study aimed to measure the incidence and know the profile of positive pregnant women for toxoplasmosis in a Basic Health Unit (BHU) in Matão - SP, between the years 2011 to 2013. This is a retrospective descriptive study, from the medical records of pregnant women attended. The project was approved by the Municipal Departament of Health and BHU was chosen along the Municipal Epidemiological Surveillance. From 2011 to 2013, 189 women began prenatal care in the unit, an annual median of 71(±26.91), of which 17 (8.99%) were positive for the serological test indicative of acute phase (IgM+). The distribution over the trial period was: four cases in 2011, twelve cases in 2012 and one in 2013. Pregnant women IgM positive for toxoplasmosis attend by BHU were: age 24(±5.47) years; color: equally distributed among white, black and brown; as the number of pregnancies: multiparous (2±0.97), most of them with a cesarean delivery as obstetric history and possessed no other risk factors associated with pregnancy (94.12%); gave entrance at BHU with 13.65(±7.35) weeks of gestation and had a median of 5(±2.36) consultation on their prenatal care. The examination for toxoplasmosis was requested as recommended by the Health Ministry (HM) and the medication prescribed was Roxamicina® - spiramycin, as soon as the test results (IgM+) arrived. Of the 17 pregnant women, only 10 completed the pre-natal at BHU - attendance at the postpartum consult (58.8%). Of these, the deliveries were vaginal (55.55%), made preterm with 36.5 weeks of gestation at the Municipal Hospital. The babies were born alive (100%) with the weight of 2.68(±0.77) Kg and required special care hospital scope. From the ...

Características clínicas e laboratoriais de gestantes com pré-eclâmpsia versus hipertensão gestacional

Purpose: To compare clinical and laboratory characteristics, obstetric and perinatal outcomes of patients with pre-eclampsia versus gestational hypertension. Methods: A retrospective study was carried out to analyze medical records of patients diagnosed with pre-eclampsia and gestational hypertension whose pregnancies were resolved within a period of 5 years, for a total of 419 cases. We collected clinical and laboratory data, obstetric and perinatal outcomes. Comparisons between groups were performed using the test suitable for the variable analyzed: unpaired t test, Mann-Whitney U test or χ2test, with the level of significance set at p<0.05. Results: Were evaluated 199 patients in the gestational hypertension group (GH) and 220 patients in the pre-eclampsia group (PE). Mean body mass index was 34.6 kg/m2 in the GH group and 32.7 kg/m2 in the PE group, with a significant difference between groups. The PE group showed higher systolic and diastolic blood pressure and higher rates of abnormal values in the laboratory tests, although the mean values were within the normal range. Cesarean section was performed in 59.1% of cases of PE and in 47.5% of the GH group; and perinatal outcomes in terms of gestational age and birth weight were significantly lower in the PE group. Conclusion: Women with gestational hypertension exhibit epidemiological characteristics of patients at risk for chronic diseases. Patients with pre-eclampsia present clinical and laboratory parameters of greater severity, higher rates of cesarean delivery and worse maternal and perinatal outcomes.

Clinical and laboratory characteristics of pregnant women with preeclampsia versus gestational hypertension

To compare clinical and laboratory characteristics, obstetric and perinatal outcomes of patients with pre-eclampsia versus gestational hypertension. A retrospective study was carried out to analyze medical records of patients diagnosed with pre-eclampsia and gestational hypertension whose pregnancies were resolved within a period of 5 years, for a total of 419 cases. We collected clinical and laboratory data, obstetric and perinatal outcomes. Comparisons between groups were performed using the test suitable for the variable analyzed: unpaired t test, Mann-Whitney U test or χ2 test, with the level of significance set at p<0.05. Were evaluated 199 patients in the gestational hypertension group (GH) and 220 patients in the pre-eclampsia group (PE). Mean body mass index was 34.6 kg/m2 in the GH group and 32.7 kg/m2 in the PE group, with a significant difference between groups. The PE group showed higher systolic and diastolic blood pressure and higher rates of abnormal values in the laboratory tests, although the mean values were within the normal range. Cesarean section was performed in 59.1% of cases of PE and in 47.5% of the GH group; and perinatal outcomes in terms of gestational age and birth weight were significantly lower in the PE group. Women with gestational hypertension exhibit epidemiological characteristics of patients at risk for chronic diseases. Patients with pre-eclampsia present clinical and laboratory parameters of greater severity, higher rates of cesarean delivery and worse maternal and perinatal outcomes.

Pré-eclâmpsia e risco de alterações no ultrassom de crânio de recém-nascidos prematuros

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Binômio mãe-filho: estudo epidemiológico e de base populacional desenvolvido em maternidades de baixo e alto risco

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliação dos protocolos de diagnóstico e de controle da hiperglicemia materna: impacto na prevalência de Diabetes Melito Gestacional (DMG) e de Hiperglicemia Gestacional Leve (HGL) e nos resultados perinatais

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB