Association between the macroscopic characteristics of the umbilical cord, high-risk pregnancy and neonatal repercussions. / Associação entre as características macroscópicas do cordão umbilical, gestação de alto risco e repercussões neonatais.

OBJECTIVE: To verify the association between the macroscopic characteristics of the umbilical cord, high-risk pregnancy and neonatal repercussions. METHOD: A cross-sectional study carried out from January 2012 to January 2015 in a public maternity hospital in Goiânia/GO. The study population consisted of 126 recent puerperal women with diagnosis of high-risk pregnancy, and 139 clinically normal women (control group). Macroscopic features of the umbilical cord, maternal, fetal and neonatal diseases, gestational age, Apgar score, birth weight, head circumference and parity were evaluated. Data were descriptively analyzed. RESULTS: 265 puerperal women and their respective newborns participated in the study. The most frequent characteristics of the umbilical cord of those with high-risk pregnancy and those from the control group were the absence of true knots (97.6% and 2.4%, respectively), length between 35 and 70 centimeters and paracentral insertion (81.7% and 18.3%). A statistical difference was observed between the high-risk pregnancy group and extremes of maternal age (p=0.004). CONCLUSION: The analysis and description of the characteristics of the umbilical cord carried out by the nurse lend important information about the neonatal prognosis. This evaluation subsidizes clinical practice and seeks to ensure the safety of the (mother-baby) binomial throughout the perinatal period.

Influence of inflammatory infiltrate and alterations of the blood flow in the etiopathogenesis of the basement membrane of the amniotic epithelium (BMAE) thickening in patients with hypertensive syndromes in pregnancy.

PURPOSE: To evaluate the mechanisms involved in the etiology of the basement membrane of the amniotic epithelium (BMAE) thickening in patients with hypertensive syndromes in pregnancy (HSP). METHODS: Eighty placentas from patients presenting HSP were morphologically examined in staining through hematoxylin-eosin and periodic acid Schiff method. Placental morphological changes were classified into: diagnostic of low placental blood flow, characterized by a larger number of syncytial knots, fibrin deposits, and a larger number of vessels in terminal villi; and placentas with inflammation that presented inflammatory infiltrate in membranes or placental villi. Measurements of thickness were made with an automatic image analyzing software. RESULTS: BMAE thickness was higher in the group with HSP, particularly in cases with gestational hypertension and pre-eclampsia superimposed on chronic hypertension (PSCH). In the placentas of the HSP group, the thickness of the BMAE was higher in cases with inflammatory infiltrate. There was a positive and significant correlation between the BMAE thickness and the thickness of the amniotic epithelium. The BMAE thickening areas were associated with hyperplasia and edema of the amniotic epithelium. CONCLUSIONS: BMAE thickening in cases with HSP is more evident when there is an interaction between the severe effects of uteroplacental hypoxia, with consequent death and remodelling of the amniotic epithelium cells, as in PSCH, with local inflammatory processes that make this thickening much more evident.

Liver morphologic analysis in perinatal autopsies with intrauterine stress liver morphology in perinatal autopsies.

Quantify steatosis, fibrosis, and focuses of extramedullary erythropoiesis (ER) in the liver and report it to the causes of death in the perinatal. Morphologic analysis of steatosis', percentage of fibrosis, and ER of 467 perinatal autopsies. Cases with hypoxia/perinatal anoxia and ascending infection showed higher percentage of fibrosis. The number of ER was significantly higher among premature infants and in cases with infection. Our results contribute to a better quality of perinatal care through clinical demonstration of which injuries are associated with them, what may help in early diagnosis of these alterations in children who survive.

Foreskin analysis of circumcised boys with and without previous topical corticosteroid.

Problems with the foreskin are common reasons for pediatric surgery consultations. We collected the foreskin of 40 patients for 2 years and these samples were divided into groups with and without previous topical corticosteroid. We carried out histochemical hematoxylin & eosin and Picrosirius analyses of the foreskin. Collagen fibers and inflammatory infiltrate was higher in samples from patients who had complications related to phimosis. Fibrosis was higher in patients who used topical corticosteroid. A histopathologic study of the foreskin may provide an additional analysis of patients undergoing circumcision and it can also improve the accuracy of surgical indication.

Exercise-training reduced blood pressure and improve placental vascularization in pregnant spontaneously hypertensive rats--pilot study.

Assess the effects of exercise-training on resting arterial pressure and heart rate, placental fetuses morphologic alterations in pregnant spontaneously hypertensive rats (SHRs).Twenty SHRs and their respective control normotensive rats (WKY) were submitted or not to a swimming protocol during 9 weeks, resulting in four pregnant experimental groups: sedentary hypertensive (PSH), trained hypertensive (PTH), sedentary normotensive (PSN), and trained normotensive (PTN). Exercise-training by swimming attenuates arterial pressure in pregnant SHRs, and can contribute to an increase in the length of fetuses and the percentage of the vessels in the placenta.

Morphologic analysis of fetal stress organsin different causes of perinatal death.

Complications act as stress-inducers during pregnancy so the fetus can develop functional compensatory mechanisms or morphologic changes. The cases analyzed are with congenital malformations or acute stress; chronic included cases with ascending infection (AI) and perinatal hypoxia/anoxia (PHA). The hematoxylin-eosin (H&E) was done to analyze the vacuolization, and the immunohistochemistry to the phagocytosis. The discreet standard of vacuolization was observed in 52.6% of the cases, 22.1% moderate, and 25.3% severe. The number of macrophages was higher in PHA. Changes in these organs are closely related to the cause of death and to the period during which the harmful agent.

Morphological and morphometrical alterations of the osteochondral junction in perinatal necropsies.

Infants who die during the perinatal period could present the following upon examination of the ribs: alterations of the osteochondral junction (OCJ) that could be related to intrauterine growth restriction, placental alterations, maternal disorders, and congenital abnormalities. The aim of this study was to identify the morphological alterations of the OCJ in the autopsied infants and the factors associated with its pathogenesis. The OCJ from 254 infants were sequentially autopsied and analyzed. Hematoxylin-eosin and blue Masson's trichrome stains were used for examination. The expression in the chondrocytes of the cartilage oligomeric matrix protein (COMP) was measured using a polyclonal antibody. There were 199 (78.3%) cases with normal OCJ and 55 (22%) cases with alterations; among these, 38 (14.9%) cases have an increased cartilage matrix at the free bone marrow zone of the OCJ (ICM), 10 (3.9%) cases have a bizarre pattern (BZ), 5 (2%) cases have a bone tissue formation closing de growth channels (MCO) of the OCJ, and 2 (0.8%) cases have bone marrow cells encroaching the free bone marrow zone. The length of the proliferative zone was different in the groups with alterations of the OCJ (P < .001), being higher in the group of patients with MCO and ICM (P < .05). In the group with BZ, the length was smaller (P < .05). The analysis of the OCJ is important in the autopsies performed at the perinatal period, and this study contributes for a better understanding of the mechanisms related to the etiology of these alterations.

Immunological evaluation of vestibular folds in autopsies of patients with the acquired immunodeficiency syndrome.

UNLABELLED: Immune response cells are decreased in patients with the Acquired Immunodeficiency Syndrome. This alters the cell population in vestibular fold lymphoid follicles, leading to respiratory infections in these patients. Such infections are the main cause of mortality and morbidity in these patients. AIM: to characterize lymphoid follicle cell populations in the vestibular folds of adults with the Acquired Immunodeficiency Syndrome and associated or not respiratory infection. MATERIALS AND METHODS: A retrospective study was made of 64 adult larynges harvested during routine autopsies. Anti-B cell, Anti-CD3, Anti-CD68 and Anti-follicular dendritic cell antibodies were used for immunological testing. RESULTS: 46 (71.87%) of the sample patients had the Acquired Immunodeficiency Syndrome. In these patients, lymphoid follicle cellularity was lower compared to the control group. The cell number was decreased in patients with the Acquired Immunodeficiency Syndrome and associated respiratory tract infection. CONCLUSION: We demonstrated in this study that vestibular fold lymphoid follicles were affected by viral infections, and may be considered as a reliable marker of immunodepression in these patients.

[Treatment effectiveness of hypertension during pregnancy]. / Efetividade do tratamento de gestantes hipertensas.

OBJECTIVE: To compare the maternal-fetal clinical intercurrences and the effectiveness of treatment in the different clinical forms of hypertensive syndromes during pregnancy (HSP). METHODS: Medical records of 200 pregnant women with HSP were reviewed to appraise fetal intercurrences, classification of the hypertensive syndrome and use of antihypertensives. RESULTS: Of the 200 patients analyzed, 85 (42.5%) were controls; 32 (16%) presented gestational hypertension (GH), 67 (33.5%) had Pre-eclampsia (PE), 6 (3%) had chronic hypertension and 10 (5%) cases had PE superimposed chronic hypertension (PSCH). The lowest values for gestational age, weights of the newborn and for the Apgar index were observed in the patients with PE and PSCH. Treatment did not alter the Apgar index in relation to control and non-treated GH patients. Patients with PE presented the lowest gestational age and the smallest Apgar index when compared to controls. CONCLUSION: Introduction of an antihypertensive therapy during gestation was of fundamental importance for health improvement and pressure control of the pregnant woman with HSP. Nevertheless, it has been of little help for prevention of perinatal intercurrences. This was substantiated by the absence of improvement in the gestational conditions between the treated group when compared to the non-treated. Medication did not significantly improve the maternal-fetal blood flow and consequently in the birth condition of the child.

Morphometric study of the spleen in chronic Chagas' disease.

There is frequently an increase in spleen size in infectious systemic and chronic venous congestion. The aim of this report was to perform a comparative study of the spleen tissue of chagasic or nonchagasic autopsied patients with or without congestive heart failure. Evaluations were made of 111 cases. Connective tissue intensity, follicular density and area, and follicular arterioles wall area were determined through the morphometric study. The connective tissue was similar in all groups. The density of the lymphoid follicles was significantly less among the chagasic cases (P = 0.032). The follicular area was larger among the chagasic cases and in the chagasic group with congestive heart failure. The chagasic group without congestive heart failure presented a greater area of follicular arteriole walls. Therefore, the spleen modifications in chronic Chagas' disease could be a consequence not only of the heart failure but also of the Chagas infection itself.

[Infeccious diseases as causes of death in autopsied elderly]. / Doenças infecciosas como causas de morte em idosos autopsiados.

The population aging in Brazil was associated with the alterations in the morbimortality of the population. The aim of this study was to verify the causes of death and other pathological processes in autopsied elderly. The elderly with 60 years or more in the period from 1976 to 1998 represented 394 cases (24.4%). The age median was 69 years ranged from 60 to 120 years, being higher in the women (70.5 versus 68 yrs;p<0.05). The male gender (67.5%), white color (69.8%), and the cardiovascular (43.7%) and infectious (31%) causes of death were dominate. In the malnourished (76.2%) it had association of pneumonia and cystitis, (p<0.05). Arteriosclerosis (61.9%), and the chagasic (42.1%) and hypertensive cardiopathies (39.1%) were the most frequent processes. Therefore, it was observed an overlapping of chronic-degenerative and infectious causes of death. This study shows the necessity to value of follow up of body mass index and of risk factors for the development of illness in aging patients like pneumonia.

[Influence of cause of death on body and internal organs weight in perinatal autopsies]. / Influência da causa de morte no peso corporal e dos órgãos internos em autópsias perinatais.

PURPOSE: To evaluate changes in body and internal organ weight of autopsied children in the perinatal period and their relationship with the cause of death. METHODS: One hundred and fifty three cases of perinatal autopsies performed at a university hospital in Southeastern Brazil ere included. Information about cause of perinatal death, date of autopsy, gestational age, perinatal weight and organ weight was obtained from the autopsy protocols and medical records of the mother and/or the newborn. Four groups of causes of death were defined: congenital malformations, perinatal hypoxia/anoxia, ascending infection and hyaline membrane. Brain, liver, lungs, heart, spleen, thymus and adrenals were analyzed. RESULTS: The weight of children with perinatal hypoxia/anoxi (1,834.6±1,090.1 g versus 1,488 g), hyaline membranes (1,607.2±820.1 g versus 1,125 g) and ascending infection (1,567.4±1,018.9 g versus 1,230 g) was higher than expected for the population. Lung weight was higher in cases with ascending infection (36.6±22.6 g versus 11 g) and lower in cases with congenital malformations (22.0±9.5 g versus 40 g). Spleen weight was higher in children with ascending infection (8.6±8.9 g versus 3.75 g ) and adrenal weight was lower in cases with congenital malformations (3.9±2.1 g versus 5.5 g). Thymus weight was lower in cases with miscellaneous causes (3.7±1.2 g versus 7.5 g) and spleen weight was lower in patients with lung immaturity (0.4±0.1 g versus 1.7 g). All results showed significant differences. CONCLUSIONS: This study demonstrates that variations in the weight of children and the weight of their organs are related to the types of cause of perinatal death. These data may contribute to a better interpretation of autopsy findings and their anatomical and clinical relationship.

Associação entre as características macroscópicas do cordão umbilical, gestação de alto risco e repercussões neonatais / Asociación entre las características macroscópicas del cordón umbilical, gestación de alto riesgo y repercusiones neonatales / Association between the macroscopic characteristics of the umbilical cord, high-risk pregnancy and neonatal repercussions

RESUMO Objetivo Verificar a associação entre as características macroscópicas do cordão umbilical, a gestação de alto risco e as repercussões neonatais. Método Estudo transversal, realizado no período de janeiro de 2012 a janeiro de 2015 em uma maternidade pública de Goiânia/GO. A população foi constituída de 126 puérperas com diagnóstico de gestação de alto risco e 139 clinicamente normais (grupo controle). Foram avaliadas características macroscópicas do cordão umbilical, doenças de base maternas, fetais e neonatais, idade gestacional, índice de Apgar, peso ao nascer, perímetro cefálico e paridade. Os dados foram analisados descritivamente. Resultados Participaram do estudo 265 puérperas e seus respectivos recém-nascidos. As características mais frequentes do cordão umbilical de puérperas com gestação de alto risco e grupo controle foram a ausência de nós verdadeiros (97,6% e 2,4%, respectivamente), comprimento entre 35 e 70 centímetros e inserção paracentral (81,7% e 18,3%). Houve diferença estatística entre o grupo gestação de alto risco e extremos de idade materna (p=0,004). Conclusão A análise e a descrição das características do cordão umbilical, realizadas pelo/a enfermeiro/a, trazem informações importantes sobre o prognóstico neonatal. Essa atribuição subsidia a prática clínica e visa à segurança ao binômio durante todo o período perinatal.

RESUMEN Objetivo Verificar la asociación entre las características macroscópicas del cordón umbilical, gestación de alto riesgo y repercusiones neonatales. Método Estudio transversal, realizado en el período de enero de 2012 a enero de 2015 en una maternidad pública de Goiânia/GO. La población estuvo constituida de 126 puérperas con diagnóstico de gestación de alto riesgo y 139 clínicamente normales (grupo control). Fueron evaluadas características macroscópicas del cordón umbilical, enfermedades de base maternas, fetales y neonatales, edad gestacional, índice de Apgar, peso al nacer, perímetro cefálico y paridad. Los datos fueron analizados descriptivamente. Resultados Participaron en el estudio 265 puérperas y sus respectivos recién nacidos. Las características más frecuentes del cordón umbilical de puérperas con gestación de alto riesgo y grupo control fueron la ausencia de nudos verdaderos (el 97,6% y el 2,4%, respectivamente), longitud entre 35 y 70 centímetros e inserción paracentral (el 81,7% y el 18,3%). Hubo diferencia estadística entre el grupo gestación de alto riesgo y extremos de edad materna (p=0,004). Conclusión El análisis y la descripción de las características del cordón umbilical, realizadas por el/la enfermero/a, brindan informaciones importantes acerca del pronóstico neonatal. Dicha atribución subsidia la práctica clínica y tiene como fin la seguridad del binomio durante todo el período perinatal.

ABSTRACT Objective To verify the association between the macroscopic characteristics of the umbilical cord, high-risk pregnancy and neonatal repercussions. Method A cross-sectional study carried out from January 2012 to January 2015 in a public maternity hospital in Goiânia/GO. The study population consisted of 126 recent puerperal women with diagnosis of high-risk pregnancy, and 139 clinically normal women (control group). Macroscopic features of the umbilical cord, maternal, fetal and neonatal diseases, gestational age, Apgar score, birth weight, head circumference and parity were evaluated. Data were descriptively analyzed. Results 265 puerperal women and their respective newborns participated in the study. The most frequent characteristics of the umbilical cord of those with high-risk pregnancy and those from the control group were the absence of true knots (97.6% and 2.4%, respectively), length between 35 and 70 centimeters and paracentral insertion (81.7% and 18.3%). A statistical difference was observed between the high-risk pregnancy group and extremes of maternal age (p=0.004). Conclusion The analysis and description of the characteristics of the umbilical cord carried out by the nurse lend important information about the neonatal prognosis. This evaluation subsidizes clinical practice and seeks to ensure the safety of the (mother-baby) binomial throughout the perinatal period.

[Influence of maternal and fetal intercurrences on the different degrees of chorioamnionitis]. / Influência das intercorrências maternas e fetais nos diferentes graus de corioamnionite.

PURPOSE: To evaluate the influence of maternal complications, prematurity, fetal anthropometric parameters and conditions of the newborn on different degrees of chorioamnionitis. METHODS: We analyzed 90 placentas from deliveries performed at the General Hospital of Triângulo Mineiro Federal University with a diagnosis of inflammation in the anatomopathological exams. We reviewed the medical records to obtain relevant maternal and fetal information. The infections were classified as grade I - deciduitis; grade II - chorioamnionitis; grade III - chorioamnionitis and vasculitis; grade IV - neonatal sepsis and grade V - fetal death and pneumonitis. RESULTS: Among the pregnant women analyzed, 50.0% had no complications, 15.0% had ruptured membranes, 15.0% urinary tract infection, 7.5% hypertensive disorders, 7.5% transvaginal infection, 5.0% hematogenous infection, and 11.1% other complications. More than a half the neonates were males and 72.2% were born at term. Analysis of the degree of chorioamnionitis showed that 56.7% had grade I, 22.2% grade II, 4.4% grade III, 10.0% grade IV, and 6.7% grade V. Data were analyzed statistically by the Χ2 test for qualitative variables and by the Spearman test for correlation analysis. The higher grades of chorioamnionitis were observed in cases of maternal complications. We observed negative correlations between all parameters and the degree of fetal chorioamnionitis, which were significant regarding weight, length, thoracic circumference and Apgar score in the first and fifth minutes. CONCLUSIONS: The different patterns of chorioamnionitis were related to different maternal and fetal clinical features, affecting the life conditions of the newborn and the severity of morphological lesions found in stillbirths.

Comparison of the larynx-associated lymphoid tissue in the false vocal cords and subglottis in pediatric autopsies.

The aim this work was to compare the distribution of cellular phenotypes of the LF in the FVC to the ones in the subglottic region in pediatric autopsy, relating this distribution to age and different causes of death. We analyzed 60 larynges of newborns and children autopsied in the period from 1993 to 2003. The fragments were prepared in order to perform histochemical and immunohistochemical techniques. The morphological analysis showed cases that presented LF only in FVC (35%), LF only in the subglottic region (20%), lack of LF in FVC (30%) and lymphoid aggregates, which did not characterize an LF (15%). The cases of LF in the subglottic region were significantly younger compared to the ones that presented LF in the FVC (p=0.017). The LF in the subglottic region was bigger than the LF in the FVC (p=0.020). There was no significant difference between the cause of death and cellular phenotype for both FVC and the subglottic region. In conclusion, the cells that make up the LF in the FVC in newborns and children younger than one year have functional characteristics similar to LF cells in the subglottic region, suggesting that there are similarities with LALT.

Mucosa-associated lymphoid tissue in individuals with AIDS.

UNLABELLED: Vestibular folds (VF) protect upper airways, but contain fewer immune cells in AIDS patients, which affects the structure of lymphoid follicles (LF). OBJECTIVE: To characterize fibrosis and immunoglobulin production in vestibular fold lymphoid tissues of AIDS patients with or with no infection and malnutrition. MATERIALS AND METHODS: A retrospective study of 71 adult vestibular fold autopsy specimens. The morphological analysis was done using the picrosirius staining method. Immunohistochemical methods consisted of anti-IgA, anti IgG, and anti IgM antibodies. RESULTS: Fibrosis was less intense in AIDS patients compared to subjects without AIDS; the same applied to patients with infection or malnutrition. IgA and IgG titers were higher in AIDS patients; IgM titers were higher in cases with infection. CONCLUSION: This study helps understand variations in lymphoid follicle components of AIDS patients; it also shows the influence of architectural changes and the effect of associated respiratory infection and malnutrition on lymphoid follicle function.

Prox-1 and VEGFR3 antibodies are superior to D2-40 in identifying endothelial cells of lymphatic malformations--a proposal of a new immunohistochemical panel to differentiate lymphatic from other vascular malformations.

We previously reported that D2-40 antibody identifies lymphatic endothelial cells (LECs) of lymphatic malformations (LM) with high specificity but only moderate sensitivity. The aim of this study was to compare the sensitivity and specificity of the markers Prospero-related homeobox gene-1 (Prox-1) and VEGFR3 to those of D2-40 for LECs in LM. Seventeen LM and 6 other vascular malformations with venous component (VM) were stained with D2-40, Prox-1, VEGFR3, CD31, and CD34 antibodies. The staining characteristics of vessels by each marker were assessed. Prox-1 and VEGFR3 specificity for LECs was examined by endothelial staining of VMs. Prox-1 and VEGFR3 stained substantially more large vessels than did D2-40 (15 of 17 cases). Small vessel staining was uniformly positive with all vascular markers except CD34, which did not stain lymphatic vessels. Eight cases had no or minimal D2-40 staining of large vessels, but the selected D2-40-vessels stained positive with VEGFR3, and 7 of 8 vessels were Prox-1 positive. Nine cases had variable D2-40 staining of large vessels; the selected D2-40 channels were all Prox-1 positive, and 8 of 9 were VEGFR3 positive. Two had rare vascular channels with no lymphatic marker stain but were positive for CD31 and CD34. Endothelial cells of VM had no Prox-1 but were VEGFR3/CD31/CD34 positive. VEGFR3 and Prox-1 antibodies have greater sensitivity for large lymphatic vessels than does D2-40. All lymphatic markers have high sensitivity for LECs of small lymphatic channels. Prox-1 has superior sensitivity and specificity to LECs. We recommend utilizing an immunohistochemical panel consisting of Prox-1, VEGFR3, CD31, and CD34 antibodies to differentiate lymphatic from venous malformations in pathologic practice.

Mucocele: a human model for lymphangiogenesis.

The mechanism of lymphangiogenesis is poorly understood, and controversy exists whether it is part of the inflammatory response to tissue injury. Utilizing markers specific to lymphatics, we aimed to study if lymphangiogenesis plays a role in the tissue response of mucoceles. Twenty-three extravasated mucoceles were selected. They were grouped by using widely accepted histologic criteria of wound healing into early-, intermediate-, and late-phase lesions. To identify lymphatic vessels we used lymphatic endothelium-specific antibodies (VEGFR3, Prospero-related homeobox gene-1 [Prox-1], and D2-40). To assess the proportion of lymphatic channels to all lesional vessels we used the panendothelial marker CD31. The presence, distribution, and proportion of lymphatic channels were assessed and compared among the groups. To investigate the involvement of lymphangiogenic signals, the expression of VEGFC was determined. To assess for proliferative activity of lymphatic endothelial cells we utilized Ki-67 antibody. Early-phase lesions (n = 6) were characterized by the presence of centrally located mucicarmine-positive material (mucin pools) with numerous inflammatory cells dominated by mucin-laden CD163-positive macrophages. Only scattered peripheral thin-walled large and small vessels were seen in the stroma surrounding the central mucin pool. Less than half of these vessels were of lymphatic nature as determined by Prox-1, VEGFR3, and D2-40 positivity. The histology of the intermediate-phase lesions (n = 6) was dominated by numerous lymphatics of varying size, not seen in the early phase. The histology of late-phase lesions (n = 11) resembled a "pseudo-cyst," with dense granulation tissue containing rare macrophages and rare lymphatic vessels. Although VEGFC was present in all phases, the highest expression was in the early phase. Low-grade proliferative lymphatic endothelium was noted in the intermediate lesions with a Ki-67 index of 4%. Early lymphangiogenesis and late lymphatic vessel regression were observed during mucocele evolution. The abundant newly formed ectatic lymphatic vessels seen in the intermediate phase may play a role in the clearance of extravasated material (mucin, edema, and lymph fluid) and in the initiation of the young fibroblast-rich granulation tissue. Mucocele appears to be an excellent human model for studying the factors that play a role in new lymphangiogenesis and regression.

Influencia da causa de morte no peso corporal e dos orgaos internos em autopsias perinatais / Influence of cause of death on body and internal organs weight in perinatal autopsies

OBJETIVO: Avaliar as variações do peso corporal e dos órgãos internos de crianças autopsiadas no período perinatal e sua relação com a causa de morte. MÉTODOS: Foram incluídos 153 casos de autópsias perinatais realizadas em um hospital universitário do Sudeste do Brasil. Informações sobre causa de morte perinatal, data da autópsia, idade gestacional, peso perinatal e dos órgãos foram recuperadas dos protocolos de autópsia e do prontuário da mãe e/ou do recém-nascido. Foram definidos quatro grupos de causa de morte: malformações congênitas, hipóxia/anóxia perinatal, infecção ascendente e membrana hialina. Encéfalo, fígado, pulmões, coração, baço, timo e suprarrenais foram analisados. RESULTADOS: O peso das crianças com hipóxia/anóxia perinatal (1.834,6±1.090,1 g versus 1.488 g), membrana hialina (1.607,2±820,1 g versus 1.125 g) e infecção ascendente (1.567,4±1.018,9 g versus 1.230 g) foi maior do que o esperado para a idade gestacional. O peso dos pulmões foi maior nos casos com infecção ascendente (36,6±22,6 g versus 11 g) e menor nos casos com malformação congênita (22,0±9,5 g versus 40 g). O peso do baço foi maior nos casos que apresentaram infecção ascendente (8,6±8,9 g versus 3,75 g ). O peso das suprarrenais foi menor nos casos com malformação congênita (3,9±2,1 g versus 5,5 g), o do timo foi menor nos casos com miscelânea (3,7±1,2 g versus 7,5 g) e o do baço foi menor nos casos com imaturidade pulmonar (0,4±0,1 g versus 1,7 g). Todos esses resultados apresentaram diferenças significativas. CONCLUSÕES: Este estudo demonstra que as variações do peso das crianças e de seus órgãos ...

PURPOSE: To evaluate changes in body and internal organ weight of autopsied children in the perinatal period and their relationship with the cause of death. METHODS: One hundred and fifty three cases of perinatal autopsies performed at a university hospital in Southeastern Brazil ere included. Information about cause of perinatal death, date of autopsy, gestational age, perinatal weight and organ weight was obtained from the autopsy protocols and medical records of the mother and/or the newborn. Four groups of causes of death were defined: congenital malformations, perinatal hypoxia/anoxia, ascending infection and hyaline membrane. Brain, liver, lungs, heart, spleen, thymus and adrenals were analyzed. RESULTS: The weight of children with perinatal hypoxia/anoxi (1,834.6±1,090.1 g versus 1,488 g), hyaline membranes (1,607.2±820.1 g versus 1,125 g) and ascending infection (1,567.4±1,018.9 g versus 1,230 g) was higher than expected for the population. Lung weight was higher in cases with ascending infection (36.6±22.6 g versus 11 g) and lower in cases with congenital malformations (22.0±9.5 g versus 40 g). Spleen weight was higher in children with ascending infection (8.6±8.9 g versus 3.75 g ) and adrenal weight was lower in cases with congenital malformations (3.9±2.1 g versus 5.5 g). Thymus weight was lower in cases with miscellaneous causes (3.7±1.2 g versus 7.5 g) and spleen weight was lower in patients with lung immaturity (0.4±0.1 g versus 1.7 g). All results showed significant differences. CONCLUSIONS: This study demonstrates that variations in the weight of children and the weight of their organs are related to the types of cause of perinatal death. These data may contribute to a better interpretation of autopsy findings and their anatomical and clinical relationship. .

Influência das intercorrências maternas e fetais nos diferentes graus de corioamnionite / Influence of maternal and fetal intercurrences on the different degrees of chorioamnionitis

OBJETIVO: Avaliar a influência das complicações maternas, da prematuridade, dos parâmetros antropométricos do feto e de condições do recém-nascido nos diferentes graus de corioamnionite. MÉTODOS: Foram analisadas 90 placentas provenientes de partos realizados no Hospital de Clinicas da Universidade Federal do Triângulo Mineiro com diagnóstico de inflamação no exame anatomopatológico. A revisão dos prontuários foi realizada para adquirir informações materno-fetais relevantes. A infecção foi classificada em: grau I - deciduíte; grau II - corioamnionite; grau III - corioamnionite e vasculite; grau IV - sepse neonatal; e grau V - morte fetal e pneumonite. RESULTADOS: Dentre as gestantes analisadas, 50,0% não apresentaram intercorrências, 15,0% apresentaram amniorrexe prematura, 15,0% infecção do trato urinário, 7,5% síndromes hipertensivas, 7,5% infecção transvaginal, 5,0% infecção hematogênica e 11,1% outras complicações. Mais da metade dos neonatos eram do sexo masculino e 72,2% a termo. Analisando o grau de corioamnionite, 56,7% apresentaram o grau I, 22,2 % grau II, 4,4% grau III, 10,0% grau IV e 6,7% grau V. Na análise estatística foi utilizado o Teste Χ2 para a análise de variáveis qualitativas e o Teste de Spearman para a análise das correlações. Os graus mais elevados de corioamnionite foram observados nos casos que apresentaram intercorrências maternas. Foram observadas correlações negativas entre todos os parâmetros fetais e o grau de corioamnionite, sendo significativa em relação ao peso, ao comprimento, à circunferência torácica e ao Apgar no primeiro e quinto minuto. CONCLUSÕES: Os diferentes padrões de corioamnionite estão relacionados a diferentes manifestações clínicas materno-fetais, influenciando nas condições de vida do recém-nascido e na gravidade de lesões morfológicas encontradas em natimortos.

PURPOSE: To evaluate the influence of maternal complications, prematurity, fetal anthropometric parameters and conditions of the newborn on different degrees of chorioamnionitis. METHODS: We analyzed 90 placentas from deliveries performed at the General Hospital of Triângulo Mineiro Federal University with a diagnosis of inflammation in the anatomopathological exams. We reviewed the medical records to obtain relevant maternal and fetal information. The infections were classified as grade I - deciduitis; grade II - chorioamnionitis; grade III - chorioamnionitis and vasculitis; grade IV - neonatal sepsis and grade V - fetal death and pneumonitis. RESULTS: Among the pregnant women analyzed, 50.0% had no complications, 15.0% had ruptured membranes, 15.0% urinary tract infection, 7.5% hypertensive disorders, 7.5% transvaginal infection, 5.0% hematogenous infection, and 11.1% other complications. More than a half the neonates were males and 72.2% were born at term. Analysis of the degree of chorioamnionitis showed that 56.7% had grade I, 22.2% grade II, 4.4% grade III, 10.0% grade IV, and 6.7% grade V. Data were analyzed statistically by the Χ2 test for qualitative variables and by the Spearman test for correlation analysis. The higher grades of chorioamnionitis were observed in cases of maternal complications. We observed negative correlations between all parameters and the degree of fetal chorioamnionitis, which were significant regarding weight, length, thoracic circumference and Apgar score in the first and fifth minutes. CONCLUSIONS: The different patterns of chorioamnionitis were related to different maternal and fetal clinical features, affecting the life conditions of the newborn and the severity of morphological lesions found in stillbirths.