Prevalência da infecção genital pelo vírus herpes simples tipo 1 e 2 em mulheres grávidas e não grávidas de Natal/RN

Herpes simplex is a virus that can be transmitted sexually and is potentially associated with vertical transmission. This study evaluated the prevalence of genital infection by herpes simplex virus (HSV) types 1 and 2 in pregnant and nonpregnant care in the city of Natal / RN, including a total of 222 women, 92 pregnant and 130 nonpregnant. The participants answered a questionnaire to obtain data and socio-demographic characteristics, as well as potential risk factors for sexually transmitted diseases. After the interview, we collected two cervical specimens, one for the Pap test and the other for DNA extraction and analyzed by polymerase chain reaction (PCR) to detect both virus serotypes. Then the women underwent a clinical examination by colposcopy. For statistical analysis, we used the chi-square and logistic regression by SSPS 17.0 Statistic. Most women were up to 30 years of age, nonwhite ethnicity, married, elementary education, family income below the poverty level; initiated sexual activity with age up to 18 years; had more than one sexual partner lifelong and was not pregnant, but has had at least one child. The HSV-1 showed a prevalence of 26.1% among pregnant women and 30.0% in non-pregnant women. While HSV-2 prevalence was found with 10.9% and 19.2% in pregnant and nonpregnant women, respectively. The largest proportion of morphological changes of the uterine cervix was detected among nonpregnant women, both in cytology and in colposcopy. The women were nonwhite ethnicity, married, became pregnant aged less than or equal to 18 years and who had one to two pregnancies had a lower risk of acquiring genital HSV infection. There was a high prevalence of genital HSV infection, HSV-1 is more prevalent than HSV-2. No association was found between morphological changes of the uterine cervix and the presence of the virus in pregnant and nonpregnant women, nor between genital HSV infection and the classic risk factors for sexually transmitted diseases

Prevalência da infecção por Chlamydia Trachomatis em mulheres atendidas no Programa de rastreamento do câncer de colo do útero

Genital infection with Chlamydia trachomatis is now recognized as one of the most prevalent sexually transmitted infections (STDs). Despite major advances in laboratory diagnosis techniques, primarily the character of asymptomatic chlamydial infection in both men and in women constitutes the basis for the formation of reservoirs that perpetuate transmission and acquisition of this and other STDs. The asymptomatic in women favors the rise of infection to the upper genital tract, causing injuries that can result in infertility. An examination of population screening for early detection and treatment of asymptomatic infections is the key step in combating this major public health problem. The present study aimed to evaluate the prevalence of infection by C. trachomatis in sexually active women attended the screening program for cervical cancer of the uterus in health facilities in municipalities in different regions of the State of Rio Grande do Norte, and identify factors that may contribute to the spread of this pathogen and its relationship with the lesions of the uterine cervix. It is a cross-sectional study aimed at detecting the presence of genital tract infection by C. trachomatis either in isolated form or in association with human papilloma virus (HPV) infection in asymptomatic women. Were included in this study, a total sample of 1,134 women aged 13-76, mean 34.4 years, from March 2008 to September 2012. Specimens containing exfoliated cells of the epithelium of the uterine cervix were analyzed by examining Pap cytology for the detection of possible injuries, and the polymerase chain reaction (PCR) for detection of plasmid DNA from C. trachomatis and HPV. Infection with C. trachomatis was detected with overall prevalence rate of 8.1% in the isolated form and 2.8% in co-infection with HPV. The infection was detected in 7.4% of women with normal cytology 11.5% of those with atypical cells of undetermined significance (ASC-US) and 16.7% of those with low-grade squamous intraepithelial lesion (LSIL). We observed an association between C. trachomatis and incidence of low-grade squamous intraepithelial lesion (LSIL). The genital tract infection by C. trachomatis alone was associated with education level, ethnicity and parity, revealing that women with higher education, those of non-white ethnicity and those who had three or more pregnancies were more likely to acquire infection. Levels very close to statistical significance were observed for chronological age, age at first sexual intercourse and first pregnancy. There was no association with marital status, number of sexual partners. Co-infection with C. trachomatis and HPV was detected in 2.3% of women with normal cytology, who had 5.1% in ASC-US and 10.4% in those with LSIL. No association was found between infection C. trachomatis and increased risk of HPV infection, but women with simultaneous infection by both pathogens showed greater risk for LSIL. Co-infection was more prevalent among single women, who had in the first sexual intercourse under 18 years and those who had two or more sexual partners over a lifetime

Risco de doença cardiovascular em mulheres com história de distúrbio hipertensivo da gravidez

OBJECTIVE: Preeclampsia is a disease that can lead to a high maternal and infant morbidity. Worldwide, the incidence of this disease is highly variable and there is no data on this disorder in the Brazilian population. This study aimed at determining incidence and risk factors in the hypertensive disorders during pregnancy in a neighborhood of Natal, in addition to observing the evolution of these disorders one year and five years after delivery. METHODS: Prospective cohort study to assess the outcome of pregnancies of 242 women who became pregnant between 2004-2007 in the neighborhood of Bom Pastor in the city of Natal, state of RN, Brazil. Five years after delivery, there was an active search of thirty-nine (39) women who became pregnant and had a hypertensive disorder during pregnancy and/or pré-eclâmpsia, out of the total of 242 participants in the initial study. We administered a structured questionnaire to obtain basic information about the current clinical situation of patients and occurrences of subsequent pregnancy and presence of hypertensive disorders during pregnancy. We also searched for information on the use of hypotensive drugs and contraceptives. The following characteristics were checked and recorded: a) current weight, b) blood pressure c) body mass index - BMI, and we collected biological samples (blood and urine) for measurement of biochemical parameters and evaluation of microalbuminúria. Finally, we monitored the ambulatory blood pressure (ABP), which uses the method of automatic measurement of heart rate, systolic and diastolic blood pressure and an average of the two for the period of 24 hours. RESULTS: Out of 218 women who completed the study, the incidence of hypertensive disorders was of 16.9% (37 out of 218), while the incidence of preeclampsia was 13.8% (30 of 218). Women with preeclampsia had a BMI (body mass index) averaged of 25.3 (± 4.8) while this ratio in normotensive women was of 23.5 (± 3.7), p = 0.02. The risk of preeclampsia rises with age (OR 1084 p = 0.0034) and with a family history of hypertension (OR 2.6 p = 0.01). The follow-up one year after delivery revealed that 50% of women with hypertensive disorders in pregnancy remained hypertensive. High BMI was also observed after 5 years of delivery. CONCLUSIONS: an elevated BMI, age above 35 years and excessive weight gain during pregnancy were associated with hypertension in the long term in patients with prior preeclampsia. History of preeclampsia increases the risk of chronic hypertension

Aberrant expression of E-cadherin and beta-catenin proteins in placenta of bovine embryos derived from somatic cell nuclear transfer

Abnormal placental development is common in the bovine somatic cell nuclear transfer (SCNT)-derived fetus. In the present study, we characterised the expression of E-cadherin and beta-catenin, structural proteins of adherens junctions, in SCNT gestations as a model for impaired placentation. Cotyledonary tissues were separated from pregnant uteri of SCNT (n - 6) and control pregnancies (n - 8) obtained by artificial insemination. Samples were analysed by western blot, quantitative RT-PCR (qRT-PCR) and immunohistochemistry. Bovine trophectoderm cell lines derived from SCNT and control embryos were analysed to compare with the in utero condition. Although no differences in E-cadherin or beta-catenin mRNA abundance were observed in fetal tissues between the two groups, proteins encoded by these genes were markedly under-expressed in SCNT trophoblast cells. Immunohistochemistry revealed a different pattern of E-cadherin and total beta-catenin localisation in SCNT placentas compared with controls. No difference was observed in subcellular localisation of dephosphorylated active-beta-catenin protein in SCNT tissues compared with controls. However, qRT-PCR confirmed that the wingless (WNT)/beta-catenin signalling pathway target genes CCND1, CLDN1 and MSX1 were downregulated in SCNT placentas. No differences were detected between two groups of bovine trophectoderm cell lines. Our results suggest that impaired expression of E-cadherin and beta-catenin proteins, along with defective beta-catenin signalling during embryo attachment, specifically during placentation, is a molecular mechanism explaining insufficient placentation in the bovine SCNT-derived fetus.

Estágio menopausal e níveis hormonais no desenvolvimento muscular e funcional em mulheres de meia idade: um estudo transversal

Introduction: Hypoestrogenism is the main characteristic of female aging. It promotes significant changes in body composition, both in fat mass as in lean body mass, leading to a decrease in muscle strength and physical performance. Objective: The aim of this study was to test whether menopausal status and hormone levels are associated with muscular strength and physical performance in middle-aged women. Methods: In a cross-sectional study it was collected sociodemographic data, gynecological history, anthropometric and biochemical measures in women aged 40 to 65 years in Parnamirim-RN. The menopause status (pre, peri and post menopause) was determined by menstrual history. All women underwent three dimensions of physical performance assessment: handgrip dynamometry, gait speed and chair stands test - Short Physical Performance Battery (SPPB). Categorical data were presented as absolute and relative frequencies. Quantitative data were showed as mean and standard deviation and the normality of distribution was verified with Kolmogorov-Smirnov (KS) test. Biochemical measures of estradiol and follicle-stimulating hormone (FSH) were transformed to log10. ANOVA with Tukey post-test for comparison of variables between the groups pre, peri and post-menopausal was performed and then multiple linear regression analyzes. Results: Two hundred and seventy eight women aged 50.2 (±5.58) years composed this study, being 50 women in premenopausal status (18%), 122 in perimenopausal (43.9%), and 106 postmenopausal stage (38.1%). The groups were different in age (p=0.001), marital relationship duration (p <0.001), number of pregnancies (p=0.001) and parity (p=0.001). Differences in biochemical measures were observed among the groups: estradiol (p<0.001), FSH (p<0.001), total cholesterol (p=0.001). There were no differences in gait velocity between menopausal status. Values in mean of grip strength decreased by postmenopausal women to perimenopausal and premenopausal ones (24.5 ± 5.1, 25.6 ± 5.4, 26.9 ± 4.9 for post-stage, pre and peri menopausas, respectively, p = 0.02) and the performance of chair stands test was better in premenopausal women compared with that in peri and postmenopausal status (p = 0.02). In multiple linear regression for muscle strength, the variables that remained were: age, estradiol and somatic symptoms measured by Menopause Rating Scale-MRS (R2=0.15). While for the xiv chair-stands test the predictors were number of births and FSH values (R2=0.04). Conclusion: There is a relationship between the stages of menopause and muscle performance in measures of grip strength and sit-up test and these are influenced by the fall of estrogens levels. Data suggest that the decrease in muscle strength and physical performance already appear in the transition to menopause stage, pointing to the need for more research in this area and appropriate preventive interventions

Interação entre a analgesia de parto e o seu resultado: avaliação pelo peso e índice de Apgar do recém-nascido

JUSTIFICATIVA E OBJETIVOS: Existem controvérsias quanto à possibilidade de a analgesia de parto interferir no andamento do trabalho de parto e na vitalidade do recém-nascido. O objetivo deste estudo foi a interação entre analgesia do parto pelas técnicas peridural contínua e duplo bloqueio, com pequena dose de anestésico local, e o tipo de parto ocorrido, pela análise do peso e índice de Apgar do recém-nascido. MÉTODO: Analisaram-se, prospectivamente, os resultados de 168 analgesias de parto (janeiro de 2002 a janeiro de 2003), divididas em quatro grupos: G1 (n = 58) peridural contínua e evolução para parto vaginal; G2 (n = 69) duplo bloqueio e evolução para parto vaginal; G3 (n = 25) peridural contínua e evolução para cesariana; G4 (n = 16) duplo bloqueio e evolução para cesariana. Para G1 foi administrada ropivacaína a 0,125% (12 a 15 mL), para G2, bupivacaína a 0,5% (0,5 a 1 mL), sufentanil (10 mg), por via subaracnóidea. Administrou-se ropivacaína a 0,5%, por via peridural, para o parto vaginal (8 mL) e para cesariana (20 mL). Avaliaram-se idade, peso, altura, índice de massa corpórea (IMC), idade gestacional (IG), paridade e complicações (hipotensão arterial, bradicardia e hipóxia), e, do recém-nascido, peso e índice de Apgar (1º, 5º e 10º min). RESULTADOS: A maioria das parturientes era primigesta, com gestação de termo (uma IG de 28 semanas e nenhum pós-datismo), com peso, G2 < G4, e, IMC, G2 £ G4. Para o peso do RN, G1 < G3 e G2 < G4, e o Apgar do 1º min, G1 > G3. CONCLUSÕES: As técnicas de analgesia, peridural contínua e duplo bloqueio, com pequenas doses de anestésico local, não apresentaram interação com o resultado do parto, se a análise estiver focalizada no peso e no índice de Apgar do recém-nascido.

A sociodemographic, clinical study of patients with venous ulcer

Background Venous ulcer is the most serious consequence of chronic venous insufficiency and is responsible for almost 70% of chronic leg ulcers. The main purpose of this research was to describe social, demographic and clinical characteristics of patients with venous ulcers and to identify some professional repercussions of this pathology.Subjects and methods We evaluated patients with a clinical picture compatible with venous ulcer. The sociodemographic characteristics of the patients, and the clinical characteristics and professional repercussions of the pathology were studied. We used the ankle-brachial index to identify associated arterial disease. The body mass index (BMI) was used for the classification of the nutritional condition of the patients.Results A total of 120 patients were included in the study (90 females and 30 males; 80.8% White; 44.2% > 60 years old). Ninety-one per cent of the patients had been in education for less than 4 years, and 89.7% were on the poverty line. Thirty-five per cent were retired, 2.5% were receiving government help due to disease and 4.2% were unemployed. About 16% of patients were out of work due to the disease, and 49.2% presented some degree of disability in terms of work tasks. The ulcer area was less than 30 cm(2) in 69.1% of patients. The first ulcer episode occurred in 13.4 years on average, and 64.2% of patients had recurrent episodes. Females presented on average 5.65 pregnancies, and 75.4% of patients were overweight.Conclusion Venous ulcer occurred mainly in the low-income population, who presented with little formal education. Generally, the ulcers were present for a long time and were recurrent, with repercussions for the capabilities of patients to work.

Resultados Perinatais de Gêmeos com Pesos Discordantes ao Nascer

Objetivo: estudar as influências da diferença de pesos entre gêmeos, no nascimento, sobre o resultado perinatal. Métodos: analisaram-se, retrospectivamente, as informações referentes aos partos gemelares ocorridos na Maternidade do Hospital Regional de Clínicas de Sorocaba, SP, de julho de 1997 a junho de 1998. A amostragem foi composta de 89 mães e seus gêmeos, divididos em três classes de diferença de pesos ao nascer: com concordância (diferença <15%), discordância leve (de 15 a 25%) e discordância grave (>25%). As variáveis independentes analisadas foram essas três classes e as dependentes foram: baixo peso ao nascer, índice de Apgar menor que 7 no primeiro e quinto minuto, nascimentos pré-termo, tempo médio de internação do recém-nascido no berçário e coeficiente de mortalidade perinatal I. Para análise estatística utilizaram-se o teste de Kruskal-Wallis, complementado pelo teste de Hollander, e o teste de Blackwell. Resultados: a incidência de discordância de pesos entre pares de gêmeos foi de 30,3%, sendo 19,1% de discordância leve e 11,2% de discordância grave. Observamos nas classes, respectivamente, os números de gestações (62, 17 e 10) e de nascimentos pré-termo (32, 9 e 7). Para o primeiro e o segundo gêmeo, observamos: baixo peso ao nascer (39/41, 13/12 e 8/9), Apgar <7 no primeiro minuto (16/13, 3/7 e 2/3), Apgar menor que 7 no quinto minuto (4/4, 0/2 e 1/2), tempo médio (dias) de internação no berçário (3,7/3,7, 4,6/6,0 e 7,3/8,7) e coeficiente de mortalidade perinatal I (22,4/16,8, 0/16,8 e 5,6/5,6). Conclusões: o baixo peso ao nascer e nascimentos pré-termo foram mais freqüentes nos gêmeos da classe com discordância grave. Houve tendência ao agravamento progressivo do resultado perinatal, respectivamente, nas classes com concordância, discordância leve e discordância grave.

Dysglycemias in pregnancy: from diagnosis to treatment. Brazilian consensus statement

There is an urgent need to find consensus on screening, diagnosing and treating all degrees of DYSGLYCEMIA that may occur during pregnancies in Brazil, considering that many cases of DYSGLYCEMIA in pregnant women are currently not diagnosed, leading to maternal and fetal complications. For this reason the Brazilian Diabetes Society (SBD) and the Brazilian Federation of Gynecology and Obstetrics Societies (FEBRASGO), got together to introduce this proposal. We present here a joint consensus regarding the standardization of clinical management for pregnant women with any degree of Dysglycemia, on the basis of current information, to improve medical assistance and to avoid related complications of Dysglycemia in pregnancy to the mother and the fetus. This consensus aims to standardize the diagnosis among general practitioners, endocrinologists and obstetricians allowing the dissemination of information in basic health units, public and private services, that are responsible for screening, diagnosing and treating disglycemic pregnant patients.

Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária

OBJETIVO: identificar fatores de risco para a macrossomia fetal na população de gestantes portadoras de diabete ou hiperglicemia diária. MÉTODOS: estudo retrospectivo, tipo caso-controle, incluindo 803 pares de mães e recém-nascidos desta população específica, distribuídos em dois grupos: macrossômicos (casos, n=242) e não macrossômicos (controles, n=561). Foram comparadas variáveis relativas à idade, paridade, peso e índice de massa corporal (IMC), ganho de peso (GP), antecedentes de diabete, hipertensão arterial e tabagismo, tipo e classificação do diabete e indicadores do controle glicêmico no terceiro trimestre. As médias foram avaliadas pelo teste F e as variáveis categorizadas foram submetidas à análise univariada, utilizando-se o teste do chi². Os resultados significativos foram incluídos no modelo de regressão múltipla, para identificação do risco independente de macrossomia, considerando-se OR, IC 95% e valor de p. Para todas as análises foi estabelecido o limite de significância estatística de 5% (p<0,05). RESULTADOS: observou-se associação significativa entre macrossomia e GP maior que 16 kg, IMC >25 kg/m², antecedentes pessoais, obstétricos e, especificamente, o de macrossomia, classificação nos grupos de Rudge (IB e IIA + IIB), média glicêmica (MG) >120 mg/dL e média de glicemia pós-prandial >130 mg/dL no terceiro trimestre. Na análise de regressão múltipla, o GP >16 kg (OR=1,79; IC 95%: 1,23-1,60), o IMC >25 kg/m² (OR=1,83; IC 95%: 1,27-2,64), o antecedente pessoal de diabete (OR=1,56; IC 95%: 1,05-2,31) e de macrossomia (OR=2,37; IC 95%: 1,60-3,50) e a MG >120 mg/dL no terceiro trimestre (OR=1,78; IC 95%: 1,13-2,80) confirmaram risco independente para macrossomia nestas gestações de risco. CONCLUSÃO: o GP superior a 16 kg, o IMC maior ou igual a 25 kg/m², a MG superior a 120 mg/dL no terceiro trimestre e a presença de antecedentes pessoais de diabete ou de macrossomia foram identificados como fatores de risco para macrossomia fetal em gestantes portadoras de diabete ou de hiperglicemia diária.

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.

Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil

CONTEXTO E OBJETIVO: Gestações complicadas pelo diabetes estão associadas com aumento de complicações maternas e neonatais. Os custos hospitalares aumentam de acordo com a assistência prestada. O objetivo foi calcular o custo-benefício e a taxa de rentabilidade social da hospitalização comparada ao atendimento ambulatorial em gestantes com diabetes ou com hiperglicemia leve. DESENHO do ESTUDO: Estudo prospectivo, observacional, quantitativo, realizado em hospital universitário, sendo incluídas todas as gestantes com diabetes pregestacional e gestacional ou com hiperglicemia leve que não desenvolveram intercorrências clínicas na gestação e que tiveram parto no Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (HC-FMB-Unesp). MÉTODOS: Trinta gestantes tratadas com dieta foram acompanhadas em ambulatório e 20 tratadas com dieta e insulina foram abordadas com hospitalizações curtas e frequentes. Foram obtidos custos diretos (pessoal, material e exames) e indiretos (despesas gerais) a partir de dados contidos no prontuário e no sistema de custo por absorção do hospital e posteriormente calculado o custo-benefício. RESULTADOS: O sucesso do tratamento das gestantes diabéticas evitou o gasto de US$ 1.517,97 e US$ 1.127,43 para pacientes hospitalizadas e ambulatoriais, respectivamente. O custo-benefício da atenção hospitalizada foi US$ 143.719,16 e ambulatorial, US$ 253.267,22, com rentabilidade social 1,87 e 5,35 respectivamente. CONCLUSÃO: A análise árvore de decisão confirma que o sucesso dos tratamentos elimina custos no hospital. A relação custo-benefício indicou que o tratamento ambulatorial é economicamente mais vantajoso do que a hospitalização. A rentabilidade social de ambos os tratamentos foi maior que 1, indicando que ambos os tipos de atendimento à gestante diabética têm benefício positivo.

Influence of glycemic control on fetal lung maturity in gestations affected by diabetes or mild hyperglycemia

Objective. To evaluate the influence of glycemic control on fetal lung maturity in pregnancies affected by diabetes or mild hyperglycemia. Design. Cross-sectional study. Setting. Level III maternity center. Population. A total of 187 pregnant women were submitted to routine amniocentesis for the assessment of fetal lung maturity up to 72 hours before delivery. Methods. Fetal lung maturity thresholds were: Clements-positive at a dilution of 0.5; OD(650) nm >= 0.15; and lamellar body count (LBC) >= 32,000/mu l. The relation of test results with adequate (<= 6.7 mmol/l) or poor (> 6.7 mmol/l) glycemic mean (GM) at term and at preterm was evaluated. Main outcome measure. Delay in fetal lung maturity when glycemic control was poor. Results. Glycemic control was adequate in 146 (78.1%) women. Clements maturity rates were higher at term (91.9%) than at preterm (64.7%) when GM <= 6.7 mmol/l (p < 0.001), but not when control was inadequate. LBC median was higher at term (99.0; 62.0-154.0) than at preterm (66.5; 40.5-108.25) (p = 0.009) when GM <= 6.7 mmol/l, while GM > 6.7 mmol/l did not lead to any difference between these rates at term or preterm. When glycemic control was adequate, OD(650) nm medians at term and at preterm were similar. However, when GM > 6.7 mmol/l, OD(650) nm median at term (0.29; 0.22-0.40) was higher than that observed at preterm (0.15; 0.12-0.18) (p < 0.001). Conclusions. Our results suggest that in term pregnancies routine amniocentesis for the assessment of fetal lung maturity should be abandoned. In preterm pregnancies, or when glycemic control is inadequate it is recommended.

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)

Hydatidiform Mole in Ectopic Pregnancy Clinical, Imaging, Pathological and Immunohistochemical Characteristics

OBJECTIVE: To determine the clinical, pathological, immunohistochemical and imaging characteristics of hydatidiform mole in ectopic pregnancy (HMEP) in all the cases admitted to the Department of Obstetrics and Gynecology, University Hospital of Caracas (HUC), Central University of Venezuela.STUDY DESIGN: Retrospective and comparative study, based on clinical records review of 2 groups: 10 cases with a diagnosis of HMEP and 20 cases with intrauterine hydatidiform mole (IUHM) admitted to the Obstetrics and Gynecology Department of HUC from 1996 to 2010. Clinical, pathological, immunohistochemical and imaging features were analyzed.RESULTS: The prevalence of HMEP in this study was 0.14:1,000 pregnancies; in this group the mean age was 28.8 years, and the mean gestational age at admission was 8.6 weeks. Both groups (HMEP and IUHM) were comparable in these last variables. Abdominal pain and genital bleeding were the most common clinical symptoms in the HMEP group, while it was vaginal bleeding in the IUHM group. Ultrasound findings were similar to those traditionally described in nonmolar ectopic pregnancy. Histology and immunohistochemistry showed that all cases of HMEP were partial mole.CONCLUSION: Although in this study the prevalence of HMEP was high, the size of the sample limits definitive conclusions. This study concludes that all cases of HMEP are partial mole. (J Reprod Med 2012;57:329-332)