Performance of the first-trimester Fetal Medicine Foundation competing risks model for preeclampsia prediction: an external validation study in Brazil.

BACKGROUND: The current version of the Fetal Medicine Foundation competing risks model for preeclampsia prediction has not been previously validated in Brazil. OBJECTIVE: This study aimed (1) to validate the Fetal Medicine Foundation combined algorithm for the prediction of preterm preeclampsia in the Brazilian population and (2) to describe the accuracy and calibration of the Fetal Medicine Foundation algorithm when considering the prophylactic use of aspirin by clinical criteria. STUDY DESIGN: This was a cohort study, including consecutive singleton pregnancies undergoing preeclampsia screening at 11 to 14 weeks of gestation, examining maternal characteristics, medical history, and biophysical markers between October 2010 and December 2018 in a university hospital in Brazil. Risks were calculated using the 2018 version of the algorithm available on the Fetal Medicine Foundation website, and cases were classified as low or high risk using a cutoff of 1/100 to evaluate predictive performance. Expected and observed cases with preeclampsia according to the Fetal Medicine Foundation-estimated risk range (≥1 in 10; 1 in 11 to 1 in 50; 1 in 51 to 1 in 100; 1 in 101 to 1 in 150; and <1 in 150) were compared. After identifying high-risk pregnant women who used aspirin, the treatment effect of 62% reduction in preterm preeclampsia identified in the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention trial was used to evaluate the predictive performance adjusted for the effect of aspirin. The number of potentially unpreventable cases in the group without aspirin use was estimated. RESULTS: Among 2749 pregnancies, preterm preeclampsia occurred in 84 (3.1%). With a risk cutoff of 1/100, the screen-positive rate was 25.8%. The detection rate was 71.4%, with a false positive rate of 24.4%. The area under the curve was 0.818 (95% confidence interval, 0.773-0.863). In the risk range ≥1/10, there is an agreement between the number of expected cases and the number of observed cases, and in the other ranges, the predicted risk was lower than the observed rates. Accounting for the effect of aspirin resulted in an increase in detection rate and positive predictive values and a slight decrease in the false positive rate. With 27 cases of preterm preeclampsia in the high-risk group without aspirin use, we estimated that 16 of these cases of preterm preeclampsia would have been avoided if this group had received prophylaxis. CONCLUSION: In a high-prevalence setting, the Fetal Medicine Foundation algorithm can identify women who are more likely to develop preterm preeclampsia. Not accounting for the effect of aspirin underestimates the screening performance.

Application of 4 birthweight curves and local reference range at a University Hospital of Rio de Janeiro, Brazil.

BACKGROUND: Numerous fetal growth curves have been developed from various subpopulations and geographic locations worldwide. OBJECTIVE: To determine the birthweight standard at the Maternity School and compare it to currently used standards in the clinical practice services. STUDY DESIGN: Cross-sectional, observational, and descriptive study. Data from infants born between 2011 and 2016 were collected from the Maternity School Hospital of the Federal University of Rio de Janeiro to define the 10th, 25th, 50th, 75th, and 90th percentiles of the birthweight by gestational age. It was determined the performance of the INTERGROWTH-21st, Fenton, Alexander, and Lubchenco for the Maternity School standards. RESULTS: After the 33rd week of pregnancy, the INTERGROWTH standard was similar to the local standard for small-for-gestational-age infants and Fenton for large-for-gestational-age infants at Maternity School Hospital. The INTERGROWTH standard was found to be inadequate to classify small-for-gestational-age infants, which are babies at major risk for morbidity and mortality at the onset of the 33rd week of pregnancy. CONCLUSION: It was possible to define reference values for birthweight for the maternal school hospital considering at least 33 weeks of pregnancy with a 95% confidence interval. The comparison of the INTERGROWTH, Fenton, Alexander, and Lubchenko standards to the maternal school hospital curve showed that the Fenton curve was the most suitable for the diagnosis of small for gestational age.

Erratum: Effect of the Dietary Approaches to Stop Hypertension (DASH) diet on the development of preeclampsia and metabolic outcomes in pregnant women with pre-existing diabetes mellitus: a randomized, controlled, single-blind trial - CORRIGENDUM.

[This corrects the article DOI: 10.1017/jns.2023.54.].

Effect of the Dietary Approaches to Stop Hypertension (DASH) diet on the development of preeclampsia and metabolic outcomes in pregnant women with pre-existing diabetes mellitus: a randomised, controlled, single-blind trial.

Preeclampsia (PE) affects up to five times more women with pre-existing diabetes mellitus (PDM) than women without it. The present study aimed to identify the effect of the DASH diet on PE incidence (primary outcome) and blood pressure, glycated haemoglobin (GH), serum lipids, glutathione peroxidase (GP), C-reactive protein (CRP - secondary outcomes) in pregnant with PDM. This randomised, controlled, single-blind trial studied sixty-eight pregnant women with PDM throughout prenatal care until delivery (18 weeks) at a public maternity hospital, Brazil. The standard diet group (SDG) received a diet containing 45-65 % carbohydrates, 15-20 % protein and 25-30 % lipids. The DASH diet group (DDG) received the adapted DASH diet with a similar macronutrient distribution, but with a higher concentration of fibres, unsaturated fats, calcium, magnesium and potassium as well as lower saturated fat. Student's t, Mann-Whitney U and the Chi-square tests were used to compare outcomes. PE incidence was 22⋅9 % in the SDG and 12⋅1 % in the DDG (P = 0⋅25). GP levels significantly increased in the DDG (intra-group analysis; mean difference = 1588 [CI 181, 2994], P = 0⋅03) and tended to be different from the variation in the SDG (mean difference = -29⋅5 [CI -1305; 1⋅365]; v. DDG: 1588 [CI 181; 2994], P = 0⋅09). GH levels decreased significantly and similarly between groups (SDG: -0⋅61 [CI -0⋅26, -0⋅96], P = 0⋅00) v. DDG: -1⋅1 [CI -0⋅57, -1⋅62], P = 0⋅00). There was no evidence of a difference in PE incidence at the end of the intervention between the two diets. The DASH diet seems to favour PE-related biochemical markers.

The prevalence and perinatal repercussions of preeclampsia after the implementation of a prophylaxis protocol with aspirin.

OBJECTIVES: To evaluate the prevalence and perinatal repercussions of preeclampsia (PE) after the implementation of a prophylaxis protocol with aspirin in singleton pregnancy at Maternity School of Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (2015-2106). METHODOLOGY: PE prevalence according to gestational age (GA) and the prevalence ratio (PR) between PE and prematurity, small for gestational age (SGA), and fetal death were calculated in patients assisted during 2015 and 2016. RESULTS: PE occurred in 373(10.75%) of 3468 investigated cases, where PE < 37 weeks was of 2.79% and PE greater than 37 weeks was of 7.95%. A total of 413 (11.9%) prematurity cases, 320 SGA (9.22%), and 50 fetal deaths (1.44%) occurred. In the PE group, 97 premature newborns (PR 0.90) and 51 SGA (PR 1.16) were born, and two fetal deaths occurred (PR 7.46). Concerning PE < 37 weeks, 27 SGA cases (PR 1.42) and two fetal deaths (PR 2.62) were observed. Regarding PE greater than 37 weeks, 24 SGA (PR 1.09) were born, and no fetal deaths were observed. Our findings were compared to previously published results. CONCLUSIONS: PE was significantly associated with SGA newborns, especially premature PE. Prescribing aspirin for PE prophylaxis based only on clinical risk factors in a real-life scenario does not appear to be effective but resulted in a PE screening and prophylaxis protocol review and update at ME/UFRJ.

External validation of first trimester combined screening for pre-eclampsia in Brazil: An observational study.

OBJECTIVE: To validate a combined algorithm for early prediction of pre-eclampsia (PE) in the Brazilian population. STUDY DESIGN: This is an unplanned secondary analysis of a cohort study. Consecutive singleton pregnancies undergoing first-trimester screening for PE involving examination of maternal characteristics, medical history, and biophysical markers were considered eligible. Women were classified as low-or high-risk using a cutoff of 1/200, but the individual risk was not used to dictate management, as aspirin prophylaxis was given to women based solely on clinical risk factors. Receiver-operating characteristics (ROC) curves for PE, preterm PE(PE < 37) and early 34(PE < 34) were constructed and detection rates(DR) and false-positive rates(FPR) were calculated, adjusting for the effect of aspirin. Propensity score analysis was utilized to account for possible confounding by indication. MAIN OUTCOME MEASURES: Screening performance and PE rates. RESULTS: Among 1695 women, 323(19.1%) were classified as high-risk for PE and 1372(80.9%) were considered low-risk. Aspirin use was registered in 62(3.7%) in the high-risk group and 33(1.9%) in the low-risk group. There were 164(9.7%) women who developed PE, including 41(2.4%) with PE < 37 and 18(1.1%) PE < 34.Subgroups with aspirin had higher incidence of PE, suggest confounding by indication. The algorithm had an AUC of 0.87, DR of 72% for PE < 34; an AUC of 0.8, DR of 59% for PE < 37, both with FPR of 18%. Accounting for effect of aspirin, we observed an improvement in DR of PE < 37 to 67%. CONCLUSION: Using combined predictive algorithm for preterm PE prediction is feasible in clinical practice in low/middle-income countries. Aspirin use needs to be accounted for when evaluating the performance of screening.

Evaluation of fetal medicine foundation algorithm in predicting small-for-gestational-age neonates.

OBJECTIVES: To examine the performance of the Fetal Medicine Foundation (FMF) 2012 predictive model and of isolated biophysical markers (uterine artery pulsatility index and mean arterial pressure) for small-for-gestational-age (SGA), in patients from Rio de Janeiro, Brazil. METHODS: For this cross-sectional study, SGA was diagnosed when a newborn presented birth weight below the fifth percentile for gestational age. FMF2012 algorithm sensitivity and specificity, positive (PPV) and negative (NPV) predictive value, positive likelihood ratio (LR +) and area under the ROC curve (AUC) were calculated to predict total and preterm SGA (SGA < 37). The performance of isolated biophysical markers - mean arterial pressure (MAP) and mean uterine artery pulsatility index (UtAPI) were studied. RESULTS: The final sample consisted of 1480 cases: 69 (4.6%) developed SGA, including 12 patients (0.8%) who were SGA < 37. The AUC showed that the performances of the FMF2012 combined model for SGA prediction was 0.687 and for preterm SGA was 0.824. With risk cutoff of 1:150, SGA screening yielded the following: sensitivity, 47%; specificity, 75%; LR +, 1.88; PPV, 8.66%; NPV, 96.72%. When screening for preterm SGA, we found sensitivity 66.6%, specificity 74.59%, LR +: 2.58, PPV 2%, and NPV 99.63%. CONCLUSIONS: Performance of the FMF2012 algorithm in predicting SGA in our population was similar to that obtained in the reference population, according to sensitivity, but our false positive rate is significantly higher than the reference population.

Performance of Fetal Medicine Foundation Software for Pre-Eclampsia Prediction Upon Marker Customization: Cross-Sectional Study.

BACKGROUND: FMF2012 is an algorithm developed by the Fetal Medicine Foundation (FMF) to predict pre-eclampsia on the basis of maternal characteristics combined with biophysical and biochemical markers. Afro-Caribbean ethnicity is the second risk factor, in magnitude, found in populations tested by FMF, which was not confirmed in a Brazilian setting. OBJECTIVE: This study aimed to analyze the performance of pre-eclampsia prediction software by customization of maternal ethnicity. METHODS: This was a cross-sectional observational study, with secondary evaluation of data from FMF first trimester screening tests of singleton pregnancies. Risk scores were calculated from maternal characteristics and biophysical markers, and they were presented as the risk for early pre-eclampsia (PE34) and preterm pre-eclampsia (PE37). The following steps were followed: (1) identification of women characterized as black ethnicity; (2) calculation of early and preterm pre-eclampsia risk, reclassifying them as white, which generated a new score; (3) comparison of the proportions of women categorized as high risk between the original and new scores; (4) construction of the receiver operator characteristic curve; (5) calculation of the area under the curve, sensitivity, and false positive rate; and (6) comparison of the area under the curve, sensitivity, and false positive rate of the original with the new risk by chi-square test. RESULTS: A total of 1531 cases were included in the final sample, with 219 out of 1531 cases (14.30; 95% CI 12.5-16.0) and 182 out of 1531 cases (11.88%; 95% CI 10.3-13.5) classified as high risk for pre-eclampsia development, originally and after recalculating the new risk, respectively. The comparison of FMF2012 predictive model performance between the originally estimated risks and the estimated new risks showed that the difference was not significant for sensitivity and area under the curve, but it was significant for false positive rate. CONCLUSIONS: We conclude that black ethnicity classification of Brazilian pregnant women by the FMF2012 algorithm increases the false positive rate. Suppressing ethnicity effect did not improve the test sensitivity. By modifying demographic characteristics, it is possible to improve some performance aspects of clinical prediction tests.

How do maternal factors impact preeclampsia prediction in Brazilian population?

Objective: To evaluate the impacts of maternal risk factors described by the Fetal Medicine Foundation's 2012 algorithm (FMF2012) in a Brazilian population. Methods: All singleton pregnancies submitted to first-trimester preeclampsia (PE) screening using the FMF2012 algorithm were considered for study inclusion. Maternal factors, recorded via a patient questionnaire, were described and compared between PE outcome groups. A Gaussian regression model was derived to measure the effects of maternal factors, and to identify factors that contributed significantly (p < .05) to the alteration of gestational age at delivery, in pregnancies with PE. Results: Of the 1934 cases considered for study inclusion, the final sample consisted of 1531 cases. The sample included 120 (7.8%) cases of PE, of which 26 (1.7%) were preterm PE (PE < 37 weeks) and 11 (0.72%) were early PE (PE < 34 weeks). The PE rate did not differ according to ethnicity, smoking, family history of PE, or use of assisted reproductive technology. Significant differences (p < .05) between the normal and PE groups in maternal age, maternal weight, previous history of PE, chronic hypertension, and types 1 and 2 diabetes were detected. Conclusions: The significance and magnitude of associations of maternal factors in our sample differed from those incorporated in the FMF2012 model, implying the need to derive a fitted model for our population.

Streptococcus agalactiae carriage among pregnant women living in Rio de Janeiro, Brazil, over a period of eight years.

Group B Streptococcus (GBS) carriage by pregnant women is the primary risk factor for early-onset GBS neonatal sepsis. Intrapartum antibiotic prophylaxis (IAP) can prevent this transmission route, and two main approaches are recommended to base the selection of pregnant women to be submitted to IAP: the risk-based and the culture-based strategies. In Brazil, compliance to such recommendations is poor, and not much is known about GBS carriage. In the present study, 3,647 pregnant women living in Rio de Janeiro State, Brazil, were screened for GBS anogenital colonization, over a period of 8 years (2008-2015). GBS was detected in 956 (26.2%) of them, and presence of vaginal discharge was the only trait associated with a higher risk for GBS colonization. Serotypes Ia (257; 37.3%) and II (137; 19.9%) were the most frequent among 689 (72.1% of the total) GBS isolates evaluated, followed by NT isolates (84; 12.1%), serotype Ib (77; 11.1%), V (63; 9.1%), III (47; 6.8%) and IV (24; 3.5%). Estimated coverage of major serotype-based GBS vaccines currently under clinical trials would vary from 65.2% to 84.3%. All 689 isolates tested were susceptible to ampicillin and vancomycin. Resistance to chloramphenicol, clindamycin, erythromycin, levofloxacin, and tetracycline was observed in 5% (35), 2% (14), 14% (97), 5% (35) and 86% (592) of the isolates, respectively. No significant fluctuations in colonization rates, serotype distribution and antimicrobial susceptibility profiles were observed throughout the period of time investigated. The culture-based approach for IAP recommendation showed to be the best choice for the population investigated when compared to the risk-based, since the first did not increase the number of pregnant women submitted to antibiotic therapy and covered a larger number of women who were actually colonized by GBS. The fact the not all isolates were available for additional characterization, and serotype IX antiserum was not available for testing represent limitations of this study. Nevertheless, to the best of our knowledge, this is the largest investigation on GBS carriage among pregnant women in Brazil up to date, and results are useful for improving GBS prevention and treatment strategies.

Validação de instrumento para histórico de enfermagem materno-infantil utilizando Horta: estudo metodológico / Validation of an instrument for the history of maternal and child nursing using Horta: a methodological study / Validación de instrumento para histórico de enfermería materno-infantil utilizando Horta: estudio metodológico

OBJETIVO: elaborar um instrumento para a etapa de histórico de enfermagem voltado ao serviço materno-infantil. MÉTODO: estudo metodológico, com validação de conteúdo de um instrumento para o histórico de enfermagem para o serviço materno-infantil, com base no referencial de Wanda Horta. RESULTADOS: o formulário contém as informações: identificação; sinais vitais,glicemia e dados antropométricos; dados clínicos e exames laboratoriais; entrevista e observação da paciente; exame físico e necessidades humanas básicas; impressões. Foram agregadas outras necessidades relacionadas à área (reprodução/crescimento e desenvolvimento) não previstas pela teoria de base que fundamentou o estudo. Verificou-se um índice de validade de conteúdo global de 0,81 para clareza, 0,85 para pertinência, 0,92 para abrangência e 0,81 para organização. CONCLUSÃO: instrumento construído e validado com base na teoria de Wanda Horta, voltado para clientela materno-infantil, fornecendo um instrumento importante para documentar a primeira etapa do processo de enfermagem

AIM: to elaborate an instrument for the nursing history stage focused on maternal and child health service. METHOD: methodological study, with validation of content of an instrument for the nursing history for maternal and child service, based on the reference of Wanda Horta. RESULTS: the form contains the following information: identification; vital signs, blood glucose and anthropometric data; clinical data and laboratory tests; interview and observation of the patient; physical examination and basic human needs; printouts. Other needs related to the area (reproduction/growth and development) not provided for by the underlying theory that gave grounds for the study were added. There was an overall content validity index of 0.81 for clarity, 0.85 for relevance, 0.92 for comprehensiveness, and 0.81 for organization. CONCLUSION: instrument built and validated based on Wanda Horta's theory, aimed at the maternal and child clientele, providing an important instrument to document the first stage of the nursing process

OBJETIVO: elaborar un instrumento para la etapa de histórico de enfermería direccionado al servicio materno-infantil. MÉTODO: estudio metodológico, con validación de contenido de un instrumento para el histórico de enfermería para el servicio materno-infantil, basado en el referencial de Wanda Horta. RESULTADOS: el formulario contiene las informaciones: identificación; signos vitales, glucemia y datos antropométricos; datos clínicos y exámenes de laboratorios; entrevista y observación de la paciente; examen físico y necesidades humanas básicas; impresiones. Fueron agregadas otras necesidades relacionadas al área (reproducción/crecimiento y desarrollo) no previstas por la teoría de base que fundamentó el estudio. Se verificó un índice de validad de contenido global de 0,81 para clareza, 0,85 para pertinencia, 0,92 para alcance y 0,81 para organización. CONCLUSIÓN: instrumento construido y validado con base en la teoría de Wanda Horta, direccionado a la clientela materno-infantil, forneciendo un instrumento importante para documentar la primera etapa del proceso de enfermería

Hypertensive disorders of pregnancy in women with gestational diabetes mellitus from Rio de Janeiro, Brazil.

Pregnant women with Gestational Diabetes Mellitus (GDM) have a greater chance of developing Hypertensive Disorders of Pregnancy (HDP) by the effect of insulin resistance in nitric oxide action.This study aims to describe factors associated with the development of HDP in pregnant women with GDM, assisted in a public maternity hospital in Rio de Janeiro, Brazil. This is a cross-sectional study including 292 pregnant adult women with GDM assisted at Maternidade Escola of the Universidade Federal do Rio de Janeiro. The women were examined during pregnancy and postpartum. Data were collected between 2011 and 2014 from medical records and through in-person interviews. The Student t-test and the chi-square test were applied; additionally, the magnitude of the association between independents variables and HDP was estimated by logistic regression models. The occurrence of HDP was observed in 19.5% (n=57) of the evaluated women: 9.2% had pregnancy hypertension and 10.3% had preeclampsia. The chance of HDP was higher among women with GDM in a previous pregnancy (Odds Ratio-OR=3.8; Confidence Interval of 95%-95% CI: 1.1; 12.8) and among those who were 35 years old or older (OR 3.3; 95% CI: 1.2; 8.7) after controlling the effects of pre-gestational weight and dietary ingestion of calcium, riboflavin, thiamine, vitamin A and protein. Women that had any alteration in blood pressure in a previous pregnancy and those over 35 years old were under higher risk of HDP. The findings may help in the design of interventions aiming to prevent HDP in adult women.

Preeclampsia: Prevalence and perinatal repercussions in a University Hospital in Rio de Janeiro, Brazil.

Preeclampsia (PE) prevalence studies in Brazil are both scarce and not divided in accordance with gestational age at delivery. We accessed PE prevalence according to delivery before 34, 37 and 42weeks in a cross-sectional study including 4464 single deliveries. PE was diagnosed in 301 cases (6.74%); Prevalence of PE was 0.78%; 1.92% and 6.74% according to deliveries before 34, 37 and 42weeks. PE was associated with fetal death, prematurity and small for gestational age newborns.

Streptococcus agalactiae in Brazil: serotype distribution, virulence determinants and antimicrobial susceptibility.

BACKGROUND: Group B Streptococcus (GBS) remains a major cause of neonatal sepsis and is also associated with invasive and noninvasive infections in pregnant women and non-pregnant adults, elderly and patients with underlying medical conditions. Ten capsular serotypes have been recognized, and determination of their distribution within a specific population or geographical region is important as they are major targets for the development of vaccine strategies. We have evaluated the characteristics of GBS isolates recovered from individuals with infections or colonization by this microorganism, living in different geographic regions of Brazil. METHODS: A total of 434 isolates were identified and serotyped by conventional phenotypic tests. The determination of antimicrobial susceptibility was performed by the disk diffusion method. Genes associated with resistance to erythromycin (ermA, ermB, mefA) and tetracycline (tetK, tetL, tetM, tetO) as well as virulence-associated genes (bac, bca, lmb, scpB) were investigated using PCR. Pulsed-field gel electrophoresis (PFGE) was used to examine the genetic diversity of macrolide-resistant and of a number of selected macrolide-susceptible isolates. RESULTS: Overall, serotypes Ia (27.6%), II (19.1%), Ib (18.7%) and V (13.6%) were the most predominant, followed by serotypes IV (8.1%) and III (6.7%). All the isolates were susceptible to the beta-lactam antimicrobials tested and 97% were resistant to tetracycline. Resistance to erythromycin and clindamycin were found in 4.1% and 3% of the isolates, respectively. Among the resistance genes investigated, tetM (99.3%) and tetO (1.8%) were detected among tetracycline-resistant isolates and ermA (39%) and ermB (27.6%) were found among macrolide-resistant isolates. The lmb and scpB virulence genes were detected in all isolates, while bac and bca were detected in 57 (13.1%) and 237 (54.6%) isolates, respectively. Molecular typing by PFGE showed that resistance to erythromycin was associated with a variety of clones. CONCLUSION: These findings indicate that GBS isolates circulating in Brazil have a variety of phenotypic and genotypic characteristics, and suggest that macrolide-resistant isolates may arise by both clonal spread and independent acquisition of resistance genes.

Sexo fetal: identificação ultra-sonográfica precoce / Fetal sex: early ultrasonographic identification

Objetivo: Verificar a incidência de acerto na identificação ultra-sonográfica precoce do sexo fetal. Método: Foram estudados prospectivamente 1.931 fetos, por meio de exames ultra-sonográficos transvaginais e complementados por exames transabdominais, em gestações entre nove e 12 semanas, na Clínica Obstétrica da Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ) e na Clínica de Ultra-Sonografia Fórum. O falo (tubérculo genital) foi determinado como horizontal no sexo feminino e vertical no sexo masculino, através da imagem em plano sagital ao corpo fetal, e correlacionado ao sexo quando do exame morfológico realizado aós a 18ª semana de gestação. Resultados: O sexo fetal determinado pela avaliação ultra-sonográfica precoce coincidiu com o sexo avaliado em 81,7 por cento dos casos em gestações com nove semanas, em 95,5 por cento nas gestações com 10 semanas, em 92,9 por cento naquelas com 11 semanas e em 99,8 por cento nas gestações com 12 semanas. O sucesso da identificação aumenta com o progredir da gestação, obtendo-se a média global de 94,2 por cento de acerto no período estudado. O acerto no diagnóstico do sexo fetal aumenta com a experiência do operador. Conclusão: A determinação ultra-sonográfica do posicionamento do falo genital pode predizer o sexo fetal precocemente.

Purpose: To establish the percentage of correct early diagnosis of fetal gender. Methods: A prospective study was developed in a University Federal of Rio de Janeiro, Departament of Obstetrics an Gynecology and Clinic of Ultrasonographic Forum. 1,931 women underwent transvaginal and transabdominal sonography at 9-12 weeks gestation. Fetal gender was identified according to genital falo position (vertical-men or horizontal-female) at sagittal plane and confirmed after 18 weeks pregnancy, morphologic, karyotyping analysis or after birth. Results: The overall accuracy of correctly assigning fetal gender was 94,2 per cent. The sucess of identification increased with gestational age, being 81,7 per cent, 95,5 per cent, 92,9 per cent and 99,8 per cent at nine, 10, 11 and 12 weeks, respectively. The accuracy of correctly identifying fetal sex significantly changed with operator training. Conclusion: Early ultrasound can accurately determine fetal gender.

Síndromes hipertensivas da gestação e repercussões perinatais / Hypertensive syndromes during pregnancy and perinatal outcomes

OBJETIVOS: avaliar repercussões perinatais nas síndromes hipertensivas em gestações. MÉTODOS: estudo observacional e retrospectivo, realizado em hospital terciário, entre janeiro de 1996 e outubro de 2003. Um total de 12.272 gestações preencheu critérios de inclusão. Dois tipos de hipertensão foram considerados: hipertensão gestacional (HG) e hipertensão arterial crônica (HAC). Variáveis estudadas: fetos pequenos para idade gestacional (PIG), Apgar baixo no 1° e 5° minutos, infecção neonatal, síndrome de aspiração meconial (SAM), prematuridade, síndrome de angústia respiratória (SAR). RESULTADOS: 1259 (10,26 por cento) gestantes tinham hipertensão; 344 (2,80 por cento) foram classificadas como HG, 915 (7,45 por cento) como HAC, havendo 11.013 (89,74 por cento) gestantes normotensas. HG constituiu risco elevado para: PIG, Apgar baixo no 1° e 5° minutos, infecção neonatal e prematuridade, mas não para SAM e SAR. HAC constituiu risco elevado para: PIG, Apgar baixo no 1° minuto, SAM, prematuridade e SAR, mas não para Apgar baixo no 5° minuto e infecção neonatal. Quando comparamos os riscos relativos dos grupos de HAC e HG, houve maior risco de prematuridade no grupo de HAC. CONCLUSÕES: dados sugerem que tanto HAC quanto HG aumentaram risco para PIG, Apgar baixo no 1° e 5° minutos, infecção neonatal, SAM, prematuridade e SAR. HAC apresentou maior risco relativo para prematuridade.

Complicações perinatais em gestantes infectadas pelo vírus da imunodeficiência humana / Perinatal complications in infected pregnancy women by the human immunodeficiency virus

OBJETIVOS: analisar as complicações perinatais em gestantes infectadas pelo HIV. MÉTODOS: estudo do tipo coorte, realizado em centro perinatal terciário, no período de 1 de janeiro de 1996 a 31 de março de 2003. Foram selecionadas para o estudo 7698 gestações, cujos critérios de inclusão foram: gestação única e idade gestacional superior a 22 semanas. A infecção pelo HIV foi confirmada pelos testes ELISA e Western Blot. Estudou-se a associação entre a presença da infecção pelo HIV e as seguintes variáveis: ruptura prematura de membranas, parto prematuro, muito baixo peso ao nascimento, infecção puerperal, Apgar baixo no primeiro e quinto minutos, crescimento intra-uterino restrito (CIUR) e pequeno para a idade gestacional (PIG). RESULTADOS: do total de gestantes estudadas, 228 (2,96 por cento) estavam infectadas pelo HIV. Os resultados dos testes estatísticos indicam que a infecção pelo HIV não é fator de risco para a ruptura prematura de membranas (RR = 0,48, p <0,01), parto prematuro (RR = 0,92, p = 0,01), muito baixo peso ao nascimento (RR = 0,69, p = 0,54), infecção puerperal (RR = 0,00, p = 0,31), Apgar menor do que sete no primeiro minuto (RR = 0,81, p = 0,40) e no quinto minuto (RR = 0,36, p = 0.19). Entre as variáveis estudadas, a hipótese de homogeneidade das proporções foi rejeitada para crescimento intra-uterino restrito (RR = 5,27, p <0,01) e pequeno para a idade gestacional (RR = 1,73, p < 0,01). CONCLUSÕES: a ocorrência de complicações maternas e fetais em gestantes infectadas pelo HIV não é diferente da observada em mulheres não infectadas, com exceção CIUR e PIG.

Sífilis e gravidez: avaliaçäo da prevalência e fatores de risco nas gestantes atendidas na maternidade de Escola UFRJ / Syphilis and pregnancy: estimate of ocurrence and risk factors in pregnant women under the care of Maternidade Escola UFRJ

A sífilis é uma infecçäo sexualmente transmitida que, na gestaçäo, pode trazer efeitos desastrosos para o feto. Sua prevalência é estimada pela Secretaria Municipal de Saúde do Rio de Janeiro em 5 por cento. Este conhecimento permite melhor abordagem no seu diagnóstico e tratamento. Objetiva determinar a prevalência de sífilis e fatores de risco no período de janeiro de 1994 a dezembro de 1999, na Maternidade Escola da UFRJ. Foram incluídas no estudo 5.519 mulheres que tiveram seus partos em nosso serviço. Foi considerada como portadora da infecçäo, toda paciente com o teste näo treponêmico - VDRL - positivo, em qualquer momento da gestaçäo, e com qualquer titulaçäo. A positividade do VDRL foi correlacionada com a ocorrência de óbito neonatal, a idade materna, o estado civil da mäe, grau de instruçäo materno, assim como o número de consultas de pré-natal. A escolaridade da mäe e a qualidade do atendimento pré-natal säo fatores de risco para a infecçäo sifilítica durante a gestaçäo