Calciuria and preeclampsia: a case-control study.

AIM: Calciuria has been reported to decrease in preeclampsia. We compared calciuria among groups of normal, hypertensive and preeclamptic pregnant women, and assessed its correlation with the severity of the disease. MATERIAL AND METHODS: We conducted a case-control study of mild and severe preeclampsia, chronic hypertension, and normal pregnancy, with 14 patients in each group. The groups were analyzed by one-way anova (variance analysis) for symmetrical distribution and Kruskal-Wallis test for asymmetrical distribution when comparing quantitative variables, and by crossed tables when comparing qualitative variables. RESULTS: There were statistically significant differences between the groups when comparing severe preeclampsia with chronic hypertension, and severe preeclampsia with the control group (P < 0.0001). The calciuria medians were 81.5 mg/24 h for severe preeclampsia, 118 mg/24 h for mild preeclampsia, 226 mg/24 h for chronic hypertension, and 272 mg/24 h for the control group. In a ROC (receiver operating characteristic) curve analysis, the best cutoff point for preeclampsia diagnosis was 167 mg/24 h, with a sensitivity of 75% and a specificity of 85%. The outcomes were more severe as the level of calciuria dropped. CONCLUSION: Measurement of calciuria can differentiate between severe preeclampsia and chronic hypertension, and hypocalciuria is also a marker for disease severity.

The COVID-19 pandemic in Brazilian pregnant and postpartum women: results from the REBRACO prospective cohort study.

Brazil presented a very high number of maternal deaths and evident delays in healthcare. We aimed at evaluating the characteristics of SARS-CoV-2 infection and associated outcomes in the obstetric population. We conducted a prospective cohort study in 15 Brazilian centers including symptomatic pregnant or postpartum women with suspected COVID-19 from Feb/2020 to Feb/2021. Women were followed from suspected infection until the end of pregnancy. We analyzed maternal characteristics and pregnancy outcomes associated with confirmed COVID-19 infection and SARS, determining unadjusted risk ratios. In total, 729 symptomatic women with suspected COVID-19 were initially included. Among those investigated for COVID-19, 51.3% (n = 289) were confirmed COVID-19 and 48% (n = 270) were negative. Initially (before May 15th), only 52.9% of the suspected cases were tested and it was the period with the highest proportion of ICU admission and maternal deaths. Non-white ethnicity (RR 1.78 [1.04-3.04]), primary schooling or less (RR 2.16 [1.21-3.87]), being overweight (RR 4.34 [1.04-19.01]) or obese (RR 6.55 [1.57-27.37]), having public prenatal care (RR 2.16 [1.01-4.68]), planned pregnancies (RR 2.09 [1.15-3.78]), onset of infection in postpartum period (RR 6.00 [1.37-26.26]), chronic hypertension (RR 2.15 [1.37-4.10]), pre-existing diabetes (RR 3.20 [1.37-7.46]), asthma (RR 2.22 [1.14-4.34]), and anaemia (RR 3.15 [1.14-8.71]) were associated with higher risk for SARS. The availability of tests and maternal outcomes varied throughout the pandemic period of the study; the beginning was the most challenging period, with worse outcomes. Socially vulnerable, postpartum and previously ill women were more likely to present SARS related to COVID-19.

Preeclampsia among women with COVID-19 during pregnancy and its impact on maternal and perinatal outcomes: Results from a national multicenter study on COVID in Brazil, the REBRACO initiative.

OBJECTIVE: To evaluate the prevalence of preeclampsia among cases of COVID-19 infection during pregnancy and the association between both conditions, in a multicenter cohort of Brazilian women with respiratory symptoms. STUDY DESIGN: Ancillary analysis of the Brazilian Network of COVID-19 in Obstetrics (REBRACO) study. We performed a nested case-control analysis selecting all women with COVID-19 and compared outcomes between women with and without PE. MAIN OUTCOMES: Maternal, gestational, and clinical characteristics and perinatal outcomes. MEASURES: Prevalence ratio (PR) and its 95%CI for each of the predictors and outcomes. RESULTS: A total of 203 women were included: 21 (10.3%) in PE group and 182 (89.7%) in non-PE group. Preeclampsia was not different among women with and without COVID-19 (10.3% vs 13.1%, p-value = 0.41), neither complication such as eclampsia and HELLP syndrome. Chronic hypertension (33.4%) (p < 0.01) and obesity (60.0%) (p = 0.03) were the most frequent comorbidities in PE group, and they were significantly more frequent in this group. Women with PE had more cesarean section (RR 5.54 [1.33 - 23.14]) and their neonates were more frequently admitted to neonatal intensive care unit (PR 2.46[1.06 - 5.69]), most likely due to preterm-birth-related complications. CONCLUSION: The prevalence of PE among women with COVID-19 infection during pregnancy was around 10%; women with COVID-19 and a history of chronic hypertension or obesity are more likely to have preeclampsia. Cesarean section is increased among women with PE and COVID-19, with increased rates of neonatal admission to intensive care units, mostly due to prematurity.

Facing the COVID-19 pandemic inside maternities in Brazil: A mixed-method study within the REBRACO initiative.

INTRODUCTION: COVID-19 pandemic posed major challenges in obstetric health care services. Preparedness, development, and implementation of new protocols were part of the needed response. This study aims to describe the strategies implemented and the perspectives of health managers on the challenges to face the pandemic in 16 different maternity hospitals that comprise a multicenter study in Brazil, called REBRACO (Brazilian network of COVID-19 during pregnancy). METHODS: Mixed-method study, with quantitative and qualitative approaches. Quantitative data on the infrastructure of the units, maternal and perinatal health indicators, modifications on staff and human resources, from January to July/2020. Also, information on total number of cases, and availability for COVID-19 testing. A qualitative study by purposeful and saturation sampling was undertaken with healthcare managers, to understand perspectives on local challenges in facing the pandemic. RESULTS: Most maternities early implemented their contingency plan. REBRACO centers reported 338 confirmed COVID-19 cases among pregnant and post-partum women up to July 2020. There were 29 maternal deaths and 15 (51.8%) attributed to COVID-19. All maternities performed relocation of beds designated to labor ward, most (75%) acquired mechanical ventilators, only the minority (25%) installed new negative air pressure rooms. Considering human resources, around 40% hired extra health professionals and increased weekly workload and the majority (68.7%) also suspended annual leaves. Only one center implemented universal screening for childbirth and 6 (37.5%) implemented COVID-19 testing for all suspected cases, while around 60% of the centers only tested moderate/severe cases with hospital admission. Qualitative results showed that main challenges experienced were related to the fear of the virus, concerns about reliability of evidence and lack of resources, with a clear need for mental health support among health professionals. CONCLUSION: Study findings suggest that maternities of the REBRACO initiative underwent major changes in facing the pandemic, with limitations on testing, difficulties in infrastructure and human resources. Leadership, continuous training, implementation of evidence-based protocols and collaborative initiatives are key to transpose the fear of the virus and ascertain adequate healthcare inside maternities, especially in low and middle-income settings. Policy makers need to address the specificities in considering reproductive health and childbirth during the COVID-19 pandemic and prioritize research and timely testing availability.

Reported calcium intake is reduced in women with preeclampsia.

OBJECTIVE: The purpose of this trial is to investigate the relationship between dietary calcium content and incidence of preeclampsia, comparing diet calcium content in normotensive and preeclampsia patients. Dietary calcium was measured by a dietary interview conducted at the day after delivery. METHODS: This is a prospective cross-sectional study involving 1092 patients who delivered at Hospital de Clínicas de Porto Alegre - Brazil. RESULTS: The average diet calcium content in the studied population was 1038 mg. The average calcium intake in the normotensive group was 1057 mg, in chronic hypertension group was 962 mg, in transient hypertension group was 963 mg, in mild preeclampsia was 902 mg and in severe preeclampsia group was 755 mg. The results of this study show that pregnant women who develop severe preeclampsia have a significant lower diet calcium intake when compared to normotensive women (P = 0.018). CONCLUSION: The results of the present study can provide the foundations for prospective trials, including randomised clinical trials involving only patients with a low content of calcium in their diet.

Transvaginal ultrasonographic assessment of the expulsion rate of intrauterine devices inserted in the immediate postpartum period: a pilot study.

OBJECTIVE: To compare the expulsion rates of intrauterine devices (IUDs) inserted in the immediate postpartum after vaginal birth and cesarean section. METHODS: Nineteen patients who had a vaginal birth and 19 patients who had a cesarean section at Hospital de Clínicas de Porto Alegre, Brazil, were selected for copper T 380A IUD insertion. With the aim of detecting clinically unnoticed dislodged devices, ultrasound examinations were performed at 1 month and between 3 and 12 months after delivery. The IUDs were considered completely expelled when found outside the endometrial cavity (e.g., in the cervical canal) or outside the uterus (in the vagina). RESULTS: Expulsion rates were statistically different between the two groups: after a vaginal birth, 50% (ultrasound only) + 27.8% (clinical examination); and post-cesarean section, 0% (p < .001; OR 5.75, 95% CI 2.36-14.01). CONCLUSION: Considering that the contraceptive efficacy of IUDs is associated with their intrauterine location, the high expulsion rates seen when they are inserted immediately after vaginal delivery contraindicate their use in this setting. The use of IUDs immediately after a cesarean section is still a reasonable alternative because its expulsion rate was zero. Ultrasound assessment of IUD positioning performed better than clinical examination, which failed to detect expulsion after postpartum insertion in 75% of the cases (9 from 12 cases).

Variation in the urinary protein/creatinine ratio at four different periods of the day in hypertensive pregnant women.

OBJECTIVE: To assess the urine protein/creatinine ratio in urine samples of pregnant women with hypertension in regard to: 1) the presence of significant variation at different periods of the day; 2) the differences if they exist, to identify the most reliable period of the day for sampling; and 3) whether the first sample, obtained when the patient arrives at the clinic, correlates with the same accuracy, with the 24-hour proteinuria. DESIGN: Cross-sectional study. PLACE: Obstetrics Emergency Department, Hospital de Clínicas de Porto Alegre, a teaching hospital in Porto Alegre, Brazil. POPULATION: Seventy-five women with hypertension with 20-week gestation or over. METHODS: Urine samples for determination of the protein/creatinine ratio were obtained on arrival (first specimen) and every 6 hours thereafter, totaling four samples in 24 hours. Four sampling periods were established: 1) from 8 am to 2 pm, 2) from 2 pm to 8 pm, 3) from 8 pm to 2 am, and 4) from 2 am to 8 am. The protein/creatinine ratio in the four different day periods were compared with the 24-hour proteinuria obtained simultaneously. The results were analyzed by the Spearman correlation and the receiver-operator characteristic (ROC) curve. RESULTS: The urine protein/creatinine ratio is strongly correlated (Spearman correlation equal to 0.8 or greater) with the 24-hour proteinuria at all four periods of the day (p<0.001), as well as the first sample obtained on arrival (p=0.003). These findings were corroborated by the ROC curve in which the values of four day periods and that of the first sample were equal to or greater than 0.930. CONCLUSION: In hypertensive pregnant women, the single voided urine sample protein/creatinine ratio, irrespective of sampling time, is strongly correlated with the 24-hour proteinuria, as is the sample obtained on arrival.

Sexualidade e puerpério: uma revisão daliteratura / Sexuality and the postpartum period: aliterature review

As disfunções sexuais femininas estão presentes nas várias etapas da vida da mulher. Estudos brasileiros apontam 53% de disfunção sexual entre as mulheres e índices acima de 70% de dificuldades sexuais na gestação e puerpério. Nos primeiros seis meses após o parto, as principais queixas sexuais são dispareunia e diminuição do desejo sexual. Esta revisão da literatura tem como objetivo estudar as disfunções sexuais no puerpério e os principais fatores associados. Também apresenta uma revisão mais detalhada da associação entre função sexual e amamentação, depressão e via de parto. A partir da revisão dos dados da literatura, podemos concluir que inúmeros fatores interferem na função sexual, sendo essencial a sua avaliação antes, durante e após a gestação. O casal deve ser orientado sobre as inúmeras mudanças que ocorrem nesse período. É fundamental que a equipe de saúde esteja preparada para auxiliar o casal em cada momento e na retomada da intimidade, possibilitando uma melhor qualidade da atividade sexual no puerpério.

Female sexual dysfunctions are present in various stages of women’s lives. Brazilian studies indicate 53% of sexual dysfunction among women and more than 70% of sexual difficulties during pregnancy and the postpartum period. In the first six months after delivery, the main complaints are sexual dyspareunia and decreased sexual desire. The objective of this literature review is to study sexual dysfunction in the postpartum period and the main associated factors. It also presents a more detailed review of the association between breastfeeding and sexual function, depression and mode of delivery. From the review of the literature, we can conclude that many factors interfere with sexual functioning and it is essential to evaluate them before, during and after pregnancy. The couple should be advised on the many changes that occur during this period. It is fundamental that the health staff is prepared to assist the couple in every moment and in the resumption of intimacy, enabling them a better quality of sexual activity in the postpartum period.

Uso de fármacos na gestaçåo / Use of pharmaceuticals in pregnancy

Os autores realizaram um estudo epidemiológico (586 pacientes) sobre o uso de fármacos na gestaçåo e fatores associados (incluindo estratificaçåo trimestral). O estudo foi realizado durante o 1§ semestre de 1992 na Maternidade do Hospital de Clínicas de Porto Alegre. Foi analisada, também, a prevalência de variáveis secundárias, como prescriçåo de fármacos no trabalho de parto, prescriçåo de fármacos no puerpério imediato, uso de agentes abortivos no 1§ trimestre, tabagismo, alcoolismo, drogadiçåo, uso casiro de inseticidas e exposiçåo à radiaçåo na gravidez. Foram analisadas duas investigaçöes paralelas; na primeira (investigaçåo A), foram incluídos, durante a gestaçåo, os antianêmicos/vitaminas e, no puerpério imediato, os antianêmicos/vitaminas e os analgésicos; na segunda (investigaçåo B), foram excluídos esses fármacos por serem de uso rotineiro. Detectou-se, na investigaçåo A, 89 por cento de uso de fármacos na gestaçåo, com 62 por cento de uso no 1§ trimestre, enquanto na investigaçåo B estes percentuais foram de 71 e 37 por cento, respectivamente. No trabalho de partohouve prevalência de 56 por centode uso de drogas em ambas as investigaçöes. No puerpério imediato, 100 por cento das pacientes usaram fármacos na investigaçåo A, enquanto na investigaçåo B detectaram-se 39 por cento de medicalizaçåo. Os grupos farmacológicos de maior prevalência na gestaçåo foram os antianêmicos/vitaminas (58 por cento), os analgésicos (38 por cento) e os antimicrobianos (21 por cento). O grupo de maior prevalência no trabalho de parto foi o dos analgésicos (37 por cento). Já no puerpério imediato, os analgésicos (100 por cento), os antianêmicos (92 por cento) e os ocitócicos (16,5 por cento) foram os fármacos mais utilizados. Três percentuais dos fármacos usados na gravidez eram da categoria X (FDA). O índice de automedicaçåo foi 18 por cento. As gestantes que tiveram cuidados pré-natais mostraram, quando comparadas aquelas sem assistência pré-natal, maior prevalência de uso de fármacos na gravidez (p<0,01)