Suicidality among pregnant women in Brazil: prevalence and risk factors.

Suicide is one of the major causes of preventable death. We evaluated suicidality among pregnant women who participated in prenatal care in Brazil. A total of 255 patients were assessed using semi-structured interviews as well as the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI), and Mini-International Neuropsychiatric Interview (MINI) Plus. Thereafter, Stata 12 was used to identify the significant predictors of current suicide risk (CSR) among participants using univariate and multivariate analyses (p < 0.05). According to MINI Plus module C, the lifetime suicide attempt rate was 12.55%. The overall CSR was 23.53%, distributed across risk levels of low (12.55%), moderate (1.18%), and high (9.80%). Our rates approximate those found in another Brazilian study (18.4%). Antenatal depression (AD), lifetime bipolar disorder, and any current anxiety disorder (as measured using the MINI) as well as BDI scores ≥15 and EPDS scores ≥11 were identified as positive risk factors in a univariate analysis (p < 0.001). These factors changed after a multivariate analysis was employed, and only years of education [odds ratio (OR) = 0.45; 95% confidence intervals (CIs) = 0.21-0.99], AD (OR = 3.42; 95% CIs = 1.37-8.53), and EPDS scores ≥11 (OR = 4.44; 95% CIs = 1.97-9.97) remained independent risk factors. AD and other psychiatric disorders were the primary risk factors for suicidality, although only the former remained an independent factor after a multivariate analysis. More than 10 years of education and EPDS scores ≥11 were also independent factors; the latter can be used as a screening tool for suicide risk.

Difference of endothelial function during pregnancies as a method to predict preeclampsia.

BACKGROUND: Systemic endothelial dysfunction has been identified as one of the main events in preeclampsia (PE). A nonhealthy vascular endothelium can be pointed out as the pathophysiological explanation of the clinical manifestations and complications of PE. Once normal pregnancy is characterized by a constant increase in endothelial function, a follow-up of this physiological event could be used as an early marker or a prediction tool to predict PE. OBJECTIVES: To perform a longitudinal assessment of endothelial function, using an ultrasound study of brachial artery flow Flow-mediated dilation (FMD), in normotensive and preeclamptic pregnancies, to evaluate the difference of FMD values along the second trimester of pregnancy to predict PE. PATIENTS AND METHODS: In a prospective cohort study, 91 pregnant women with a high risk of developing PE were subjected to FMD of the brachial artery. The difference in the FMD values, between 16(+0) and 19(+6) and 24(+0) and 27(+6) weeks of gestation were compared, taking PE development into consideration. Receiver operator characteristics (ROC) curves were created to determine the sensibility and specificity of FMD difference to predict PE. RESULTS: A total of 19 patients developed PE and the other 72 women remained normotensive until 1 week after delivery. When considering a cut off of +2.50 %, FMD difference, between the two evaluations, sensitivity for PE prediction was 87.5 % for early onset PE and 95.5 % for late PE. CONCLUSION: The difference of FMD values between the second trimester of pregnancy can be used for PE prediction for both, early and late forms of PE.

Assessment of endothelial function in pregnant women with preeclampsia and gestational diabetes mellitus by flow-mediated dilation of brachial artery.

PURPOSE: To compare endothelial function, as assessed by flow-mediated dilation (FMD) in pregnant women with preeclampsia (PE), gestational diabetes mellitus (GDM) and healthy pregnant women. METHODS: We conducted a cross-sectional study of eighty women who were selected and divided into three groups: Group A comprising 42 pregnant women with PE, Group B (control) consisting of 19 normotensive pregnant women with no comorbidities and Group C consisting of 19 pregnant women with GDM. The women underwent FMD and the results were compared between groups. The data were obtained from the Center for Fetal Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Brazil (CEMEFE-HC-UFMG) after approval by the Ethics and Research Committee on June 4, 2008 under no CAAE-0280.0.203.000-08. RESULTS: Nonparametric variance analysis showed no statistically significant difference between the characteristics of the three groups. The comparison between the results of the mean values of brachial artery FMD groups of pregnant women with preeclampsia (FMD = 5.36 ± 4.61 %), gestational diabetes (FMD = 9,18 ± 5.98 %) and pregnant women in the control group (FMD = 17.55 ± 8.35 %) showed that a statistically significant difference was found between groups using the Dunn test. The comparison between groups PE × GDM was not statistically significant. The group consisting of pregnant women with GDM associated with those with PE had significantly lower results for FMD (6.55 ± 5.33 %) than the control group (17.55 ± 8.35 %, p = 0.00). CONCLUSIONS: The group consisting of pregnant women with GDM or PE showed results for FMD significantly lower than the control group, suggesting possible endothelial injury in these patients.

Nutritional Status of Iodine in a Group of Pregnant Women from the State of Minas Gerais Correlated with Neonatal Thyroid Function.

OBJECTIVE: To evaluate the iodine sufficiency of pregnant women assisted in a University Hospital of Minas Gerais, and to correlate the urinary concentrations of maternal iodine with the fetal thyroid hormone levels at birth. METHODS: Urinary iodine concentrations from 30 pregnant women with a singleton pregnancy and gestational age lower than 20 weeks were analyzed. Occasional samples of the mothers' urine were collected for the urinary iodine concentration dosage, and these were correlated with the newborns' thyroid-stimulating hormone (TSH) levels. RESULTS: The median iodine urinary concentration of this study's pregnant women population was 216.73 mcg/l, which is proper for the group, following the World Health Organization (WHO). No cases of neonatal hypothyroidism were reported in the study, which corroborates the iodine sufficiency in this population sample. CONCLUSION: This study shows that despite the increased demand for iodine from pregnant women and the Brazilian Health Regulatory Agency (ANVISA) recommendation of 2013 for reduction of salt iodization levels, the population of pregnant women attended in the prenatal ambulatory of normal risk from the Federal University of Minas Gerais is considered sufficient in iodine. As a higher sample is necessary for the confirmation of these findings, it is too early to recommend the universal supplementation of iodine for Brazilian pregnant women, and more studies must be carried out, considering that iodine supplementation for pregnant women in an area of iodine sufficiency is associated to the risks of the fetus's excessive exposure to iodine.

OBJETIVO: Avaliar a suficiência iódica de gestantes atendidas em um Hospital Universitário de Minas Gerais e correlacionar as concentrações urinárias de iodo materno com os níveis de hormônios tireoidianos fetais ao nascimento. MéTODOS: Foi analisada a concentração urinária de iodo de 30 gestantes com gestação única e idade gestacional menor que 20 semanas. Foram coletadas amostras ocasionais de urina materna para dosagem da concentração urinária de iodo, e estas foram correlacionadas com os níveis de hormônio estimulante da tiroide (TSH) dos recém-nascidos. RESULTADOS: A mediana da concentração urinária de iodo das gestantes estudadas foi de 216,73 mcg/L, sendo adequada para o grupo segundo a Organização Mundial de Saúde (OMS). Não houve nenhum caso de hipotireoidismo neonatal no estudo, o que corrobora a suficiência de iodo nesta amostra populacional. CONCLUSãO: Esse estudo demonstra que apesar do aumento da demanda de iodo pelas gestantes e da recomendação da Agência Nacional de Vigilância Sanitária (ANVISA) de 2013 da redução dos níveis de iodação do sal, a população de gestantes atendidas no ambulatório de pré-natal de risco habitual da Universidade Federal de Minas Gerais é considerada suficiente em iodo. Apesar de uma maior amostragem ser necessária para a confirmação destes achados, é cedo para recomendar a suplementação universal de iodo para as gestantes brasileiras e mais estudos precisam ser realizados, levando-se em conta que a suplementação de iodo para gestantes em áreas suficientes em iodo está associada aos riscos da exposição excessiva de iodo ao feto.

Analysis of Variables that Influence the Success Rates of Induction of Labor with Misoprostol: A Retrospective Observational Study.

OBJECTIVE: Determine the predictive criteria for success in inducing labor for live fetuses using misoprostol in pregnant women. Secondarily, the objective is to determine the rates of vaginal or cesarean delivery, duration of induction, interval of administration of misoprostol, the main causes of induction of labor and indication for operative delivery. METHODS: Medical records of 873 pregnant women admitted for cervical maturation from January 2017 to December 2018 were reviewed in a descriptive observational study of retrospective analysis, considering the following response variables: age, parity, Bishop Index, doses of misoprostol, labor induction time. Logistic regression models were used to predict success with misoprostol in non-operative deliveries. RESULTS: Of the 873 patients evaluated, 72% evolved with vaginal delivery, 23% of the cases were cesarean, 5% forceps or vacuum-extractor. For non-operative delivery the predictive variables at admission were age, parity, gestational age and dilation. During hospitalization, fewer vaginal touches, amniotomy or amniorrhexis with clear fluid lead to a shorter induction time and a greater chance of non-operative delivery. False positives and false negatives of the model were always below 50% and correct answers above 65%. CONCLUSION: At admission, age less than 24 years, previous normal births, lower the gestational age and greater the dilation, were predictive of greater probability of non-operative delivery. During hospitalization, the less vaginal touches and occurrence of amniotomy/amniorrhexis with clear liquid indicate shorter induction time. Future studies with a prospective design and analysis of other factors are necessary to assess the replicability, generalization of these findings.

OBJETIVO: Determinar os critérios preditivos para o sucesso na indução do trabalho de parto para fetos vivos utilizando misoprostol em gestantes. Em segundo lugar, o objetivo é determinar as taxas de parto vaginal ou cesáreo, duração da indução, intervalo de administração de misoprostol, as principais causas de indução do trabalho de parto e indicação para parto operatório. MéTODOS: Foram revisados os prontuários de 873 gestantes internadas para amadurecimento cervical entre janeiro de 2017 e dezembro de 2018 em um estudo descritivo observacional de análise retrospectiva, considerando as variáveis-resposta: idade, paridade, Índice de Bishop, doses de misoprostol, tempo de indução do trabalho de parto. Modelos de regressão logística foram utilizados para prever o sucesso com misoprostol em partos não operatórios. RESULTADOS: Dos 873 pacientes avaliados, 72% evoluíram com parto vaginal, 23% dos casos foram cesáreos, 5% fórceps ou vácuo-extrator. Para o parto não operatório as variáveis preditivas na internação foram idade, paridade, idade gestacional e dilatação. Durante a internação, um menor número de toques vaginais, amniotomia ou amniorrexe com líquido claro, levam a menor tempo de indução e maior chance de parto não operatório. Falsos positivos e falsos negativos do modelo sempre foram inferiores a 50% e respostas corretas acima de 65%. CONCLUSãO: Na internação, idade menor que 24 anos, ocorrência de partos normais anteriores, menor idade gestacional e maior dilatação, foram preditivos de maior probabilidade de parto não-operatório. Durante a internação, o menor número de toques vaginais, amniotomia/amniorrexe com líquido claro indicam menor tempo de indução. Estudos futuros com design prospectivo e análise de outros fatores são necessários para avaliar a replicabilidade, generalização desses achados.

Cystatin C as an indicator of renal damage in pre-eclampsia.

OBJECTIVE: To assess the predictive abilities of serum and urinary cystatin C levels for glomerular lesions in pregnant women with pre-eclampsia. METHODS: In this study, kidney function markers were compared between38 pregnant women with pre-eclampsia and 22 healthy pregnant women. RESULTS: The serum and urine levels of cystatin C and urea were significantly higher in the pre-eclampsia group than in the control group. Receiver operating characteristic curve analysis demonstrated that the serum cystatin C level (91.7%) had a superior diagnostic accuracy for pre-eclampsia than the other markers. CONCLUSION: Serum cystatin C level maybe a significant marker of pre-eclampsia.

Relationship between Cardiofemoral Index and the plasma concentration of brain natriuretic peptide in anemic fetuses associated with Rh alloimmunization.

BACKGROUND: Fetal anemia is a common result of alloimmunization and is an important cause of fetal congestive heart failure resulting in heart dilation. Fetuses suspected of having heart failure present a higher Cardiofemoral Index and an increase in plasma BNP levels, because the cardiac hormonal system is activated by increased heart wall stretch due to increased left ventricular volume and pressure overload. METHODS: Our group studied 33 pregnant women (22-31 weeks' gestation at the first cordocentesis) referred for intrauterine fetal transfusion due to severe red blood cells isoimmunization. Up to 6 h prior to each cordocentesis, all fetuses were submitted to ultrasonography measurements where the Cardiofemoral Index was calculated. Samples of blood from the umbilical vein were collected for hemoglobin concentration and blood gas measurements. Plasma levels of BNP were determined with the use of plasma that had previously been frozen and thawed once. Plasma BNP was measured by radioimmunoassay. Pearson's correlation test and regression analysis were used to determine the association between the plasma concentration of BNP and the Cardiofemoral Index of the anemic fetuses with RH alloimmunization. RESULTS: Anemia was severe in 17 (50%) fetuses, mild in 9 (26.47%) and in 8 patients (23.53%) the fetuses were not anemic; hemoglobin ranged from 3.10 to 15.70 g/dl. The Cardiofemoral Index ranged from 0.43 to 0.87 and it was altered (>or=0.59) in 23 fetuses. A significant positive correlation was observed between BNP plasma fetal concentration and Cardiofemoral Index (Pearson r=0.61, P<0.0001). CONCLUSIONS: These results suggest that fetal plasma concentration of BNP may increase in fetuses with heart dilation leading to a positive association between Cardiofemoral Index and plasma concentration of BNP.

[Isolation, differentiation and biochemical aspects of amniotic fluid stem cell]. / Isolamento, diferenciação e aspectos bioquímicos de células-tronco de líquido amniótico.

UNLABELLED: The mesenchymals stem cells (MSCs) are cells with the great potential of differentiation are being introduced in the clinic for treatment of several diseases. Mesenchymal stem cells have several advantages including the stability of their phenotype in vitro. BACKGROUND: isolation of MSCs in amniotic fluid, its expansion and the demonstration of the capacity of these cells to differentiate in adipogenic and myogenic cells, without to change the chromosomal stability of the MSCs in culture. METHODS: in order to evaluate the functional change of these cells, were gotten values of the differentiated adipogenic cells and not differentiated through the dosage of triglycerides. The myogenic nature of the differentiated cells was analyzed comparing the creatine kinase--CK, lactic dehydrogenase--LDH and aldolase produced by the cells. RESULTS: the values of triglycerides were significantly higher in differentiated cells, showing intracytoplasmatic granule form after differentiation. All the biochemical characters were significantly higher in differentiated myogenic cells. CONCLUSIONS: this study suggests that the standardized protocol of differentiation can be used in the attainment of cells with characteristics of adipogenic and muscular cells, from amniotic fluid.

Photodynamic therapy as a new approach to Trichomonas vaginalis inactivation.

The emergence of nitroimidazole resistant isolates has been an aggravating factor in the treatment of trichomoniasis, the most common non-viral sexually transmitted disease in the world. This highlights the importance of new technologies that are safe, effective, and have minor side effects or resistance. Hence, we evaluated the effectiveness of photodynamic therapy on the inactivation of Trichomonas vaginalis in vitro. We used methylene blue as a photosensitizing substance, and a light-emitting diode (LED) for irradiation of metronidazole sensitive and resistant strains. Our results showed that only the presence of light did not interfere with parasite growth; however, methylene blue isolated or associated with light inhibited 31.78% ±â€¯7.18 and 80.21% ±â€¯7.11 of the sensitive strain, respectively, and 31.17% ±â€¯4.23 and 91.13% ±â€¯2.31 of the resistant strain, respectively. The high trichomonicidal activity of the photodynamic therapy, associated with low cost and ease of application, signalize its great therapeutic potential not only when conventional treatment fails, but also routinely in women with trichomoniasis.

Longitudinal evaluation of uterine perfusion, endothelial function and central blood flow in early onset pre-eclampsia.

OBJECTIVES: Physiopathological mechanisms that trigger clinical manifestations in pre-eclampsia (PE) remain unclear, and management is still a challenge. The identification of tools to predict the onset of the disease and prevent its complications is of great interest in medical practice. The present study aims to evaluate uterine perfusion, endothelial function and central nervous system blood flow in pregnant women with high-risk factors for PE, for comparison of the results between the group of patients who developed early onset PE and those who remained normotensive throughout pregnancy. STUDY DESIGN: Sixty-two patients were recruited from our high-risk prenatal service, and followed throughout gestation. Patients were submitted to flow-mediated dilation, Dopplervelocimetry of uterine arteries and Dopplervelocimetry of ophthalmic arteries at three distinct moments of pregnancy: between 16+0 and 19+6weeks, between 24+0 and 27+6weeks and at hospital admission to delivery. MAIN OUTCOME MEASURES: Pulsatility index of uterine arteries, flow-mediated dilation and ophthalmic arteries resistance index were evaluated and compared between the two groups of patients. RESULTS: Ten pregnancies were complicated by early onset PE, and these patients presented a significantly higher pulsatility index of uterine arteries between 16+0 and 19+6weeks of gestation, compared with the normotensive group (p=0,016). Both flow-mediated dilation and ophthalmic arteries resistance index values were lower in affected patients at 24+0 to 27+6weeks (p=0,001), and by the time of delivery (p<0,002). CONCLUSIONS: Those findings suggest that impaired placental perfusion, endothelial dysfunction and central hyperperfusion temporarily precede the clinical manifestations of early onset pre-eclampsia.

Analysis of Variables that Influence the Success Rates of Induction of Labor with Misoprostol: A Retrospective Observational Study / Análise de variáveis que influenciam na taxa de sucesso da indução do parto com misoprostol: Um estudo observacional retrospectivo

Abstract Objective Determine the predictive criteria for success in inducing labor for live fetuses using misoprostol in pregnant women. Secondarily, the objective is to determine the rates of vaginal or cesarean delivery, duration of induction, interval of administration of misoprostol, the main causes of induction of labor and indication for operative delivery. Methods Medical records of 873 pregnant women admitted for cervical maturation from January 2017 to December 2018 were reviewed in a descriptive observational study of retrospective analysis, considering the following response variables: age, parity, Bishop Index, doses of misoprostol, labor induction time. Logistic regression models were used to predict success with misoprostol in non-operative deliveries. Results Of the 873 patients evaluated, 72% evolved with vaginal delivery, 23% of the cases were cesarean, 5% forceps or vacuum-extractor. For non-operative delivery the predictive variables at admission were age, parity, gestational age and dilation. During hospitalization, fewer vaginal touches,amniotomy or amniorrhexis with clear fluid lead to a shorter induction time and a greater chance of non-operative delivery. False positives and false negatives of the model were always below 50% and correct answers above 65%. Conclusion At admission, age less than 24 years, previous normal births, lower the gestational age and greater the dilation, were predictive of greater probability of nonoperative delivery. During hospitalization, the less vaginal touches and occurrence of amniotomy/amniorrhexis with clear liquid indicate shorter induction time. Future studies with a prospective design and analysis of other factors are necessary to assess the replicability, generalization of these findings.

Resumo Objetivo Determinar os critérios preditivos para o sucesso na indução do trabalho de parto para fetos vivos utilizando misoprostol em gestantes. Em segundo lugar, o objetivo é determinar as taxas de parto vaginal ou cesáreo, duração da indução, intervalo de administração de misoprostol, as principais causas de indução do trabalho de parto e indicação para parto operatório. Métodos Foram revisados os prontuários de 873 gestantes internadas para amadurecimento cervical entre janeiro de 2017 e dezembro de 2018 em um estudo descritivo observacional de análise retrospectiva, considerando as variáveis-resposta: idade, paridade, Índice de Bishop, doses de misoprostol, tempo de indução do trabalho de parto. Modelos de regressão logística foram utilizados para prever o sucesso com misoprostol em partos não operatórios. Resultados Dos 873 pacientes avaliados, 72% evoluíram com parto vaginal, 23% dos casos foram cesáreos, 5% fórceps ou vácuo-extrator. Para o parto não operatório as variáveis preditivas na internação foram idade, paridade, idade gestacional e dilatação. Durante a internação, um menor número de toques vaginais, amniotomia ou amniorrexe com líquido claro, levam a menor tempo de indução e maior chance de parto não operatório. Falsos positivos e falsos negativos do modelo sempre foram inferiores a 50% e respostas corretas acima de 65%. Conclusão Na internação, idade menor que 24 anos, ocorrência de partos normais anteriores, menor idade gestacional e maior dilatação, foram preditivos de maior probabilidade de parto não-operatório. Durante a internação, o menor número de toques vaginais, amniotomia/amniorrexe com líquido claro indicam menor tempo de indução. Estudos futuros com design prospectivo e análise de outros fatores são necessários para avaliar a replicabilidade, generalização desses achados.

Nutritional Status of Iodine in a Group of Pregnant Women from the State of Minas Gerais Correlated with Neonatal Thyroid Function / Status nutricional de iodo em um grupo de gestantes mineiras correlacionado com função tireoidiana neonatal

Abstract Objective To evaluate the iodine sufficiency of pregnant women assisted in a University Hospital of Minas Gerais, and to correlate the urinary concentrations of maternal iodine with the fetal thyroid hormone levels at birth. Methods Urinary iodine concentrations from 30 pregnant women with a singleton pregnancy and gestational age lower than 20 weeks were analyzed. Occasional samples of the mothers' urine were collected for the urinary iodine concentration dosage, and these were correlated with the newborns' thyroid-stimulating hormone (TSH) levels. Results The median iodine urinary concentration of this study's pregnant women population was 216.73 mcg/l, which is proper for the group, following the World Health Organization (WHO). No cases of neonatal hypothyroidism were reported in the study, which corroborates the iodine sufficiency in this population sample. Conclusion This study shows that despite the increased demand for iodine from pregnant women and the Brazilian Health Regulatory Agency (ANVISA) recommendation of 2013 for reduction of salt iodization levels, the population of pregnant women attended in the prenatal ambulatory of normal risk from the Federal University of Minas Gerais is considered sufficient in iodine. As a higher sample is necessary for the confirmation of these findings, it is too early to recommend the universal supplementation of iodine for Brazilian pregnant women, and more studies must be carried out, considering that iodine supplementation for pregnant women in an area of iodine sufficiency is associated to the risks of the fetus's excessive exposure to iodine.

Resumo Objetivo Avaliar a suficiência iódica de gestantes atendidas em um Hospital Universitário de Minas Gerais e correlacionar as concentrações urinárias de iodo materno com os níveis de hormônios tireoidianos fetais ao nascimento. Métodos Foi analisada a concentração urinária de iodo de 30 gestantes com gestação única e idade gestacional menor que 20 semanas. Foram coletadas amostras ocasionais de urina materna para dosagem da concentração urinária de iodo, e estas foram correlacionadas com os níveis de hormônio estimulante da tiroide (TSH) dos recémnascidos. Resultados A mediana da concentração urinária de iodo das gestantes estudadas foi de 216,73 mcg/L, sendo adequada para o grupo segundo a Organização Mundial de Saúde (OMS). Não houve nenhum caso de hipotireoidismo neonatal no estudo, o que corrobora a suficiência de iodo nesta amostra populacional. Conclusão Esse estudo demonstra que apesar do aumento da demanda de iodo pelas gestantes e da recomendação da Agência Nacional de Vigilância Sanitária (ANVISA) de 2013 da redução dos níveis de iodação do sal, a população de gestantes atendidas no ambulatório de pré-natal de risco habitual da Universidade Federal de Minas Gerais é considerada suficiente em iodo. Apesar de uma maior amostragem ser necessária para a confirmação destes achados, é cedo para recomendar a suplementação universal de iodo para as gestantes brasileiras e mais estudos precisam ser realizados, levando-se em conta que a suplementação de iodo para gestantes em áreas suficientes em iodo está associada aos riscos da exposição excessiva de iodo ao feto.

Immunocytochemistry Improving the Diagnosis of Trichomonas vaginalis Infections.

The aim of this study was to evaluate the immunocytochemistry (ICC) to diagnose trichomoniasis, particularly asymptomatic infections. By culture serial dilutions, ICC was able to detect 1 trophozoite/mL, while the culture was positive up to 100 trophozoites/mL. The ICC in vivo detection capability was assessed in vaginal secretions of mice experimentally infected and in vaginal swabs from asymptomatic HIV-positive pregnant women compared with culture. All vaginal secretion samples from mice were positive according to both methods. Swabs from fifty-five asymptomatic women were positive in four (7.27%) of them by culture. Beyond these four, another ten (25.45%) women were positive by immunocytochemistry, proving their higher sensitivity (p = 0.002), noticing 3.5 times more positives. ICC had better performance in both successive dilutions as in asymptomatic women, showing higher sensitivity and specificity. In this way, its facility of execution and cost-effectiveness support its practicality, as a routine procedure to diagnose trichomoniasis not only when the parasite load is lower but probably in all clinical scenarios.

[Assess flow velocity in the ductus venosus and inferior vena cava in fetuses in isoimmunized pregnancies]. / Fluxo no ducto venoso e na veia cava inferior dos fetos em gestações isoimunizadas.

OBJECTIVE: Ductus venosus and inferior vena cava flow velocity was assessed in fetuses in isoimmunized pregnancies. METHODS: Examination of 61 fetuses aged 27 to 35 weeks from Rh-erythrocyte antigen isoimmunized women was carried out from June 1999 to June 2004. All fetuses were submitted to the examination of ductus venosus and inferior vena cava flow velocity. Blood samples were collected to determine hemoglobin values and hemoglobin concentration deficits. Accordingly, fetuses were grouped as follows: non-anemic; mildly anemic; moderately anemic and severely anemic fetuses. Comparison of the variation of average flow velocity in the inferior vena cava and ductus venosus across the four groups was carried out using the chi-square test. RESULTS: Inferior vena cava flow velocity was found to be altered in 3.8% of non-anemic fetuses; in 3.1% of the mildly anemic, in 40.0% of those moderately anemic; and in 76.0% of the severely anemic ones. Alteration in ductus venosus flow velocity, in turn, was identified in 7.7% of non-anemic fetuses; 3.1% of mildly anemic; 32.5% of moderately anemic and 68.0% of those severely anemic. Results were statistically significant with p < 0.001. CONCLUSION: The study shows that alteration of flow velocity in the inferior vena cava and ductus venosus increased with the severity of anemia.

Surveillance of surgical site infection after cesarean section and time of notification.

BACKGROUND: Cesarean section is a surgical procedure the main complication of which is surgical site infection (SSI), which is related to maternal morbidity and mortality. OBJECTIVE: To evaluate active monitoring by telephone to identify infection and time of SSI report in postpartum women and associated risk factors. METHODS: We conducted a prospective observational study from 2013-2014, at a referral service for high-risk pregnancies. Surveillance was conducted via telephone at least 30 days after cesarean delivery. Incidence ratio and time of infection occurrence (days) was analyzed. Survival analysis was conducted to assess the temporal distribution of the development of infection. RESULTS: Of a total of 353 patients, 14 (4%) cases of SSI were reported, and 10 (7.4%) of the reported cases occurred within 15 days after cesarean and average time of infection was12.21 days. American Society of Anesthesiologists score was the only risk factor associated with SSI after cesarean section. CONCLUSIONS: The prevalence of SSI after cesarean section via telephone is similar to several services with different methods of surveillance, considering it could be used by services with limited resources. Superficial incisional SSI was the most common type of infection, time of infection report was mainly before the 15th day postprocedure, and American Society of Anesthesiologists score of 2 or less was protective against SSI. Telephone calls can be a viable method to identify women with infection briefly after discharge, particularly at-risk patients.

Comunicando más notícias sobre malformações congênitas: reflexões bioéticas e jurídicas / Communicating bad news about congenital abnormalities: bioethical and legal considerations / Comunicacíon de malas noticias relativas a malformaciones congénitas: reflexiones bioéticas y jurídicas

Resumo A constatação de que o feto é portador de malformação congênita enquadra-se como má notícia, e sua comunicação à gestante envolve conflitos éticos relativos à medicina fetal e neonatologia. A quebra de expectativas dos pais quanto ao filho idealizado desperta sentimentos antagônicos, e o modo de processar a notícia e até mesmo a eventual decisão de interromper a gestação podem ser diretamente influenciados pela forma como o fato é comunicado pela equipe. Para os casos em que a criança nasce com vida, a decisão de iniciar cuidados paliativos também deve ser compartilhada, viabilizando o exercício da parentalidade responsável. Contudo, é comum que a família solicite distanásia e obstinação terapêutica, quando não adequadamente esclarecida sobre o prognóstico da doença. São discutidos no estudo aspectos relacionados à adequada comunicação na relação médico-paciente, fundamental ao exercício da autonomia e ao dever de informar, cuja violação é passível de responsabilização nas esferas cível e ético-profissional.

Abstract The communication to the pregnant woman that her fetus has congenital abnormality is framed by what is meant by bad news, surrounded by ethical conflicts experienced in fetal medicine and neonatology. The couple's breach of expectations about their idealized child arouses antagonistic feelings; The manner of elaboration of the news and even the eventual decision to terminate the pregnancy will be directly influenced as the fact was communicated by the team. For cases in which the child is born alive, the decision to adopt Palliative Care should also be shared, providing the exercise of responsible parenting. It is common, however, the request by the family of practices that configure dysthanasia and therapeutic obstinacy, when not adequately clarified about the prognosis of the disease. Aspects related to proper communication in the physician-patient relationship are discussed, fundamental to the exercise of autonomy and the duty to inform, whose violation leads to liability in the civil and ethical-professional spheres.

Resumen La constatación de que el feto sufre una malformación congénita se enmarca en lo que se entiende por malas noticias, y su comunicación a la gestante implica conflictos éticos relativos a la medicina fetal y a la neonatología. La frustración de las expectativas de la pareja sobre su hijo idealizado despierta sentimientos antagónicos, y la manera de procesar la noticia e incluso la eventual decisión de interrumpir el embarazo pueden ser directamente influenciadas por la manera en que el equipo comunica el hecho. Para los casos en que el niño nace con vida, la decisión de adoptar cuidados paliativos también debe compartirse, para hacer viable el ejercicio de la parentalidad responsable. Sin embargo, es común que la familia solicite la distanasia y la obstinación terapéutica, cuando no se le aclara adecuadamente sobre el pronóstico de la enfermedad. En este estudio se discuten aspectos relacionados con la comunicación adecuada en la relación médico-paciente, fundamental al ejercicio de la autonomía y al deber de informar, cuya violación es pasible de responsabilidad civil y ético-profesional.

Postpartum depression: A systematic review of the genetics involved.

Postpartum depression is one of the most prevalent psychopathologies. Its prevalence is estimated to be between 10% and 15%. Despite its multifactorial etiology, it is known that genetics play an important role in the genesis of this disorder. This paper reviews epidemiological evidence supporting the role of genetics in postpartum depression (PPD). The main objectives of this review are to determine which genes and polymorphisms are associated with PPD and discuss how this association may occur. In addition, this paper explores whether these genes are somehow related to or even the same as those linked to Major Depression (MD). To identify gaps in the current knowledge that require investigation, a systematic review was conducted in the electronic databases PubMed, LILACS and SciELO using the index terms "postpartum depression" and "genetics". Literature searches for articles in peer-reviewed journals were made until April 2014. PPD was indexed 56 times with genetics. The inclusion criteria were articles in Portuguese, Spanish or English that were available by institutional means or sent by authors upon request; this search resulted in 20 papers. Genes and polymorphisms traditionally related to MD, which are those involved in the serotonin, catecholamine, brain-derived neurotrophic factor and tryptophan metabolism, have been the most studied, and some have been related to PPD. The results are conflicting and some depend on epigenetics, which makes the data incipient. Further studies are required to determine the genes that are involved in PPD and establish the nature of the relationship between these genes and PPD.

Ultrastructural aspects of mucosas in endemic pemphigus foliaceus.

OBJECTIVE: To investigate whether ultrastructural changes present in clinically normal oral mucosa could occur in the mucosas of patients with endemic pemphigus foliaceus (EPF) or fogo selvagem (wildfire). PATIENTS: Surgical biopsy specimens were taken from the foreskin of 8 patients with EPF and 3 control subjects, the uterine cervix and vaginal wall of 9 patients with EPF and 2 controls, and the oral mucosa of 5 patients with EPF and 4 controls. The patients received a clinical and histopathologic diagnosis of EPF and all had clinically normal oral and genital mucosas. RESULTS: In the patients with EPF, widening of the intercellular spaces and distended, elongated cytoplasmic projections, the tips of which contained desmosomes and were sometimes disassembled, were evident in all 4 regions studied. At the periphery of the spinous cells, cytoplasmic vesicles apparently containing intact or fragments of desmosomes or half-desmosomes were seen. CONCLUSIONS: The ultrastructural lesions found in the mucosas studied are similar to those previously described in the literature for the oral mucosa of patients with EPF. In the cases of EPF, even though the desmosomal changes occurred in all epithelial layers, blisters did not occur in the mucosas by possible coexpression of desmoglein 1 and desmoglein 3.

Doppler flowmetry of ophthalmic arteries for prediction of pre-eclampsia.

BACKGROUND: central nervous system (CNS) hyperperfusion is one of the events that constitute the pathophysiological basis for the clinical manifestations and complications of pre-eclampsia (PE). Detecting the increased flow in the CNS through Doppler flowmetry of the ophthalmic artery might precede the clinical onset of PE and could be used as a marker for subsequent development of PE. OBJECTIVE: to evaluate the ophthalmic artery resistive index (OARI) values in the second trimester of pregnancy for prediction of the clinical manifestations of PE. OBJECTIVE: to evaluate the ophthalmic artery resistive index (OARI) values in the second trimester of pregnancy for prediction of the clinical manifestations of PE. METHODS: a total of 73 patients with risk factors for the development of PE were selected from the prenatal service at the HC-UFMG. They were submitted to ophthalmic artery Doppler flowmetry between 24 and 28 weeks of pregnancy and monitored until the end of the pregnancy to verify the occurrence of PE. ROC curves were created to determine the predictive characteristics of the OARI. RESULTS: fourteen of the patients selected developed PE and 59 remained normotensive until the postpartum period. Patients with subsequent development of PE presented OARI values lower than patients that remained normotensive (0.682 ± 0.028 X 0.700 ± 0.029, p = 0.044). Considering the development of PE as an outcome, the area under the OARI curve was 0.694 (CI 0.543 to 0.845), with no points obtaining good values of sensitivity or specificity. CONCLUSION: Doppler flowmetry of ophthalmic arteries between 24 and 28 weeks of pregnancy did not present itself as a good exam for predicting PE.