Premature rupture of membranes before 28 weeks managed expectantly: maternal and perinatal outcomes in a developing country.

This study aimed to assess outcomes of expectant management for early preterm premature rupture of membranes (PPROM). This retrospective cohort involved 66 women with PPROM <28 weeks managed in a single hospital (1999-2006). Main outcomes were chorioamnionitis, severe maternal morbidity (maternal sepsis, haemorrhage/blood transfusion, hysterectomy or admission to intensive care unit), maternal mortality, low birth weight, preterm birth, neonatal infection and perinatal mortality. Mean gestational ages at PPROM and delivery were 21.7 ± 4.2 and 28.4 ± 5.9 weeks, respectively. Chorioamnionitis was diagnosed in 47%; no cases of severe maternal morbidity or mortality occurred. Stillbirth rate was 25.7% and >80% of infants were delivered before 34 weeks. Neonatal infection was diagnosed in 42.9% of the 49 live-births. Overall survival rate was 57.6%. Expectant management of PPROM <28 weeks resulted in high rates of chorioamnionitis and preterm deliveries but in over half of the cases, a live infant was discharged home.

Association between mode of delivery and neonatal deaths and complications in term pregnancy: a cohort study in Brazil.

AIM: Aim of the study was analyzing the association between mode of delivery and neonatal mortality/ morbidity in term pregnancy. METHODS: Cohort study with births of liveborn normally formed fetuses from single term pregnancies in a public teaching hospital in São Paulo, Brazil, from January 2003 to March 2004 (total of 1471 births). Data were collected from medical records. We defined 'elective caesareans' as those performed before labor. Four analyses were made: caesarean vs. vaginal, elective vs. non elective caesarean, elective caesarean vs. trial of labor, elective caesarean vs. women in labor. Outcomes studied were: neonatal deaths, jaundice, low Apgar score at 5 minutes, prolonged mechanical ventilation, convulsions, meconium aspiration syndrome, obstetrical trauma and late discharge. Adjustments were made for possible confounders. The chi square test was used along with logistic regression for the analyses. A significance level of 5% was assumed. RESULTS: A significant negative association between elective caesareans and neonatal death was found, neonatal complications taken as a whole and neonatal complications plus deaths. For example, elective caesarean versus women in labor for the outcome any neonatal complication, adjusted odds ratio 0.59; confidence interval 0.31-0.89. CONCLUSION: The study highlights a significant negative association of elective caesarean and neonatal mortality and morbidity in term pregnancy.

Avaliacao do teste de tolerancia a glicose oral (TTGO) em gestantes de risco para diabetes gestacional / Evaluation of tolerance test of the oral GTT in the risk group for gestational diabetes

O presente estudo teve a finalidade de avaliar se o teste de tolerancia a glicose oral (TTGO) era capaz de discriminar em gestantes de risco, aquelas com alteracoes metabolicas suficientes para provocarem agravos ao produto da concepcao. Estudamos 38 gestantes com os seguintes estigmas: obesidade, macrossomia anterior e antecedentes familiares de diabetes. A amostra foi dividida em dois grupos, um com TTGO alterado e o outro, onde o TTGO nao permitiu o diagnostico de DG, grupo com potencial intolerancia a glicose. Avaliamos os pesos e insulinemia dos recem-nascidos. Observamos que os dois grupos nao diferiram estatisticamente em relacao aos parametros estudados e que em ambos encontramos resultados denotando influencia das alteracoes metabolicas maternas sobre o produto da concepcao, caracterizado por hiperinsulinismo, e peso maior que o esperado....