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1.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 70(8): e20240357, 2024. tab
文章 在 英语 | LILACS-Express | LILACS | ID: biblio-1569470

摘要

SUMMARY OBJECTIVE: The aim of this study was to compare the obstetric and perinatal complications in women who became pregnant with autologous oocytes and those who received donated oocytes (DO) in intracytoplasmic sperm injection cycles (ICSI). METHODS: A retrospective cohort study was carried out by collecting data from medical records between 2019 and 2022. Only patients who underwent ICSI in an induced cycle using their own or freshly DO, with male infertility factor and tubal factor, were included. RESULTS: A total of 120 patients were assessed, comprising 51 cases utilizing their own oocytes (control group) and 69 cases employing DO (study group). Patients receiving DO (n=69) exhibited a significantly higher mean age compared to those utilizing their own oocytes (n=51) (41.96±2.16 vs 38.54±1.42 years, p<0.001). There was no significant association between the source of oocytes and gestational age at delivery (p=0.296), birth weight (p=0.836), admission to neonatal intensive care unit (ICU) (p=0.120), or maternal admission to adult ICU (p=0.767). Additionally, the origin of oocytes did not demonstrate any significant association with the risk of pre-eclampsia (p=0.357), gestational diabetes mellitus (p=0.187), premature rupture of membranes (p=0.996), uterine atony (p=0.996), placenta previa (p=0.393), oligohydramnios (p=0.393), or gestational hypertension (p=0.393)." CONCLUSION: An increase in obstetric and perinatal complications was not observed in pregnancies with DO compared to pregnancies with autologous oocytes in women undergoing ICSI without prior comorbidities. Further studies with larger sample sizes are required to validate our findings.

2.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 70(9): e20240286, 2024. tab, graf
文章 在 英语 | LILACS-Express | LILACS | ID: biblio-1569478

摘要

SUMMARY OBJECTIVE: The aim of the study was to compare two labor induction regimens (4 and 6 h), to determine predictors of successful labor induction with intravaginal misoprostol 25 μg tablets, and to evaluate the association with adverse perinatal outcomes. METHODS: This was a retrospective cohort study that included singleton pregnancies undergoing induction of labor with an intravaginal misoprostol 25 μg tablet between 37 and 42 weeks of gestation. The pregnant women were divided into two groups: Group 1—intravaginal misoprostol 25 μg every 4 h and Group 2—intravaginal misoprostol 25 μg every 6 h. RESULTS: Pregnant women were divided into Group 1 (n=289) and Group 2 (n=278). Group 1 had a higher median number of intravaginal misoprostol 25 μg tablets (3.0 vs. 2.0 tablets, p<0.001), a lower prevalence of postpartum hemorrhage (7.6 vs. 32.7%, p<0.001), and a higher need for oxytocin (odds ratio [OR]: 2.1, 95%CI: 1.47-2.98, p<0.001) than Group 2. Models including intravaginal misoprostol 25 μg tablets every 4 and 6 h [x2(1)=23.7, OR: 4.35, p<0.0001], parity [x2(3)=39.4, OR: 0.59, p=0.031], and Bishop's score [x2(4)=10.8, OR: 0.77, p=0.019] were the best predictors of failure of labor induction. A statistically significant difference between groups was observed between the use of the first intravaginal misoprostol 25 μg tablet at the beginning (Breslow p<0.001) and the end of the active labor phase (Long Hank p=0.002). CONCLUSION: Pregnant women who used intravaginal misoprostol 25 μg every 4 h had a longer time from the labor induction to the beginning of the active phase of labor and higher rates of adverse perinatal outcomes than women who used intravaginal misoprostol 25 μg every 6 h.

3.
Rev. bras. ginecol. obstet ; 46: x-xx, 2024. tab, graf
文章 在 英语 | LILACS | ID: biblio-1565349

摘要

Abstract Objective To evaluate the risk factors for postpartum hemorrhage (PPH) according to the Robson Classification in a low-risk maternity hospital. Methods We conducted retrospective cohort study by analyzing the medical records of pregnant women attended in a low-risk maternity hospital, during from November 2019 to November 2021. Variables analyzed were: maternal age, type of delivery, birth weight, parity, Robson Classification, and causes of PPH. We compared the occurrence of PPH between pregnant women with spontaneous (Groups 1 and 3) and with induction of labor (2a and 4a). Chi-square and Student t-tests were performed. Variables were compared using binary logistic regression. Results There were 11,935 deliveries during the study period. According to Robson's Classification, 48.2% were classified as 1 and 3 (Group I: 5,750/11,935) and 26.1% as 2a and 4a (Group II: 3,124/11,935). Group II had higher prevalence of PPH than Group I (3.5 vs. 2.7%, p=0.028). Labor induction increased the occurrence of PPH by 18.8% (RR: 1.188, 95% CI: 1.02-1.36, p=0.030). Model including forceps delivery [x2(3)=10.6, OR: 7.26, 95%CI: 3.32-15.84, R2 Nagelkerke: 0.011, p<0.001] and birth weight [x2(4)=59.0, OR: 1.001, 95%CI:1.001-1.001, R2 Nagelkerke: 0.033, p<0.001] was the best for predicting PPH in patients classified as Robson 1, 3, 2a, and 4a. Birth weight was poor predictor of PPH (area under ROC curve: 0.612, p<0.001, 95%CI: 0.572-0.653). Conclusion Robson Classification 2a and 4a showed the highest rates of postpartum hemorrhage. The model including forceps delivery and birth weight was the best predictor for postpartum hemorrhage in Robson Classification 1, 3, 2a, and 4a.


Subject(s)
Humans , Female , Pregnancy , Risk Factors , Postpartum Period , Postpartum Hemorrhage , Hospitals, Maternity
4.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 70(7): e20240132, 2024. tab
文章 在 英语 | LILACS-Express | LILACS | ID: biblio-1565046

摘要

SUMMARY OBJECTIVE: The aim of this study was to evaluate the success rate and predictors of labor induction using vaginal misoprostol in a low-risk pregnant women population. METHODS: A prospective cohort study was carried out with 196 pregnant women. Groups 2 and 4 of the Robson Classification admitted for induction of labor with vaginal misoprostol (25 μg tablets every 6 h, up to 4 tablets, for a maximum of 24 h). The success of labor induction was considered the achievement of vaginal delivery. Binary logistic regression was used to determine the best predictors of successful induction of labor with vaginal misoprostol. RESULTS: Of all the pregnant women analyzed, 140 (71.4%) were successful and 56 (28.6%) were unsuccessful. Pregnant women who achieved successful induction had a higher number of pregnancies (1.69 vs. 1.36, p=0.023), a higher number of deliveries (0.57 vs. 0.19, p<0.001), a higher Bishop score (2.0 vs. 1.38, p=0.002), and lower misoprostol 25 μg tablets (2.18 vs. 2.57, p=0.031). No previous deliveries [x2(1)=3.14, odds ratio (OR): 0.24, 95% confidence interval (CI): 0.10-0.57, R2 Nagelkerke: 0.91, p=0.001] and the presence of one previous delivery [x2(1)=6.0, OR: 3.40, 95% CI: 1.13-10.16, R2 Nagelkerke: 0.043, p=0.029] were significant predictors of successful induction of labor with vaginal misoprostol. CONCLUSION: A high rate of labor induction success using vaginal misoprostol in a low-risk population was observed, mainly in multiparous and with gestational age>41 weeks. No previous delivery decreased the success of labor induction, while one previous delivery increased the success of labor induction.

5.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 70(7): e20231525, 2024. tab
文章 在 英语 | LILACS-Express | LILACS | ID: biblio-1565047

摘要

SUMMARY OBJECTIVE: The aim of this study was to evaluate the impact of therapeutic hypothermia on maternal and perinatal outcomes in newborns with Apgar score<7 at the 5th min. METHODS: A retrospective cohort study was carried out with 55 newborns who had an Apgar score<7 at the 5th min (35 without and 20 with therapeutic hypothermia) from low-risk pregnancies between 33 and 41 weeks gestation. The Apgar score was calculated through an objective assessment by a neonatologist in the delivery room. Therapeutic hypothermia was indicated by a neonatologist in the delivery room, according to the protocol established by the Brazilian Society of Pediatrics. The maternal and perinatal outcomes of both groups (without and with therapeutic hypothermia) were compared. RESULTS: A rate of Apgar score<7 at the 5th min was 1.02%. No statistical differences were observed between the two groups (without and with therapeutic hypothermia) regarding maternal/perinatal complications. The presence of maternal/perinatal complications did not increase the odds ratio of neonatal therapeutic hypothermia in newborns with Apgar score<7 at the 5th min. CONCLUSION: The rate of Apgar score<7 at the 5th min was low, and it was not associated with any maternal/perinatal complications. There was no significant difference in maternal/perinatal complications between newborns who received therapeutic hypothermia and those who did not.

6.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 70(2): e20230700, 2024. tab, graf
文章 在 英语 | LILACS-Express | LILACS | ID: biblio-1535096

摘要

SUMMARY OBJECTIVE: This study aimed to evaluate cardiac contractility in fetuses from pregestational diabetes mellitus pregnancies by three-dimensional ultrasound using spatiotemporal image correlation in rendering mode. METHODS: A retrospective cross-sectional study was performed on 40 fetuses from nondiabetic pregnancies and 28 pregestational diabetic pregnancies between 20 and 33 weeks and 6 days. Cardiac contractility was assessed by measuring the ventricular myocardial area in diastole subtracted from the ventricular myocardial area in systole. RESULTS: Pregestational diabetic pregnancies had a lower maternal age than nondiabetic pregnancies (26.7 vs. 39.9 years, p=0.019). Cardiac contractility in fetuses from diabetic and nondiabetic pregnancies was similar (p=0.293). A moderately positive and significant correlation was observed between gestational age and cardiac contractility (r=0.46, p=0.0004). A 1-week increase in gestational age was responsible for a 0.1386 cm2 increase in cardiac contractility. CONCLUSION: Cardiac contractility as evaluated by three-dimensional ultrasound using spatiotemporal image correlation in rendering mode showed no significant differences across fetuses with and without pregestational diabetes.

7.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 70(1): e20230021, 2024. tab
文章 在 英语 | LILACS-Express | LILACS | ID: biblio-1529372

摘要

SUMMARY OBJECTIVE: The aim of this study was to evaluate the prevalence of early neonatal sepsis in pregnant women with a positive culture for group B beta-hemolytic Streptococcus in a middle-income city in Southeastern Brazil. METHODS: A retrospective cohort study was conducted, involving singleton low- and high-risk pregnancies in whom group B beta-hemolytic Streptococcus cultures were evaluated between 35 and 37 weeks of gestation using vaginal and anal swabs. A specific medium (Todd-Hewitt) was used for culturing. The pregnant women were divided into two groups based on positive (n==201) and negative (n==420) cultures for group B beta-hemolytic Streptococcus. RESULTS: The maternal colonization rate by group B beta-hemolytic Streptococcus was 32.3%. The prevalence of early neonatal sepsis was 1.0% (2/201) among patients with a positive group B beta-hemolytic Streptococcus culture and 1.9% (8/420) among patients with a negative culture. Among the patients who underwent adequate prophylaxis, crystalline penicillin G was used in 51.9% (54/104), followed by cefazolin in 43.3% (45/104), ampicillin in 3.8% (4/104), and clindamycin in 1.0% (1/104). A model that included prematurity (p==0.001) proved to be an independent risk predictor of early neonatal sepsis [χ2 (1)==15.0, odds ratio: 16.9, 95% confidence interval: 4.7-61.6, p<0.001, Nagelkerke R2==0.157]. CONCLUSION: The prevalence of a positive culture for group B beta-hemolytic Streptococcus was high. However, the prevalence of early neonatal sepsis was low in pregnant women with both positive and negative group B beta-hemolytic Streptococcus cultures and in pregnant women with a positive culture who underwent both adequate and inadequate antibiotic prophylaxis. Prematurity proved to be an independent predictor of early neonatal sepsis, considering the entire study population.

8.
Rev. bras. ginecol. obstet ; 45(3): 127-133, Mar. 2023. tab, graf
文章 在 英语 | LILACS | ID: biblio-1449712

摘要

Abstract Objective: To assess the maternal blood levels of fatty acids (FAs) in pregnancies with fetal growth restriction (FGR). Methods: This prospective cross-sectional study included pregnant women with gestational age between 26 and 37 + 6 weeks with FGR and appropriate for gestational age (AGA) fetuses. The levels of saturated, trans, monounsaturated, and polyunsaturated FAs were measured using centrifugation and liquid chromatography. The Student's t-test, Mann-Whitney test, and general linear model, with gestational age and maternal weight as covariants, were used to compare FA levels and the FGR and AGA groups. The Chi-square was used to evaluate the association between groups and studied variables. Results: Maternal blood sample was collected from 64 pregnant women, being 24 FGR and 40 AGA. A weak positive correlation was found between the palmitoleic acid level and maternal weight (r = 0.285, p = 0.036). A weak negative correlation was found between the gamma-linoleic acid level and gestational age (r = −0.277, p = 0.026). The median of the elaidic acid level (2.3 vs. 4.7ng/ml, p = 0.045) and gamma-linoleic acid (6.3 vs. 6.6ng/ml, p = 0.024) was significantly lower in the FGR than the AGA group. The palmitoleic acid level was significantly higher in the FGR than AGA group (50.5 vs. 47.6ng/ml, p = 0.033). Conclusion: Pregnant women with FGR had lower elaidic acid and gamma-linoleic acid levels and higher palmitoleic acid levels than AGA fetuses.


Resumo Objetivo: Avaliar os níveis sanguíneos maternos de ácidos graxos (AGs) em gestações com restrição de crescimento fetal (RCF). Métodos: Este estudo prospectivo transversal incluiu gestantes com idade gestacional entre 26 e 37 semanas e 6 dias com RCF e fetos adequados para a idade gestacional (AIG). Os níveis de ácidos graxos saturados, trans, monoinsaturados e poliinsaturados foram medidos usando centrifugação e cromatografia líquida. O teste t-Student, o teste de Mann-Whitney e o modelo linear geral, com idade gestacional e peso materno como covariantes, foram utilizados para comparar os níveis de AGs e os grupos RCF e AIG. O teste Qui-quadrado foi utilizado para avaliar a associação entre os grupos e as variáveis estudadas. Resultados: Amostra de sangue materno foi coletada de 64 gestantes, sendo 24 RCF e 40 AIG. Uma correlação positiva fraca foi encontrada entre o nível de ácido palmitoleico e o peso materno (r = 0,285, p = 0,036). Uma correlação negativa fraca foi encontrada entre o nível de ácido gama-linoleico ea idade gestacional (r = −0,277, p = 0,026). A mediana do nível de ácido elaídico (2,3 vs. 4,7 ng/ml, p = 0,045) e ácido gama-linoleico (6,3 vs. 6,6 ng/ml, p = 0,024) foram significativamente menores no grupo RCF do que no grupo AIG. O nível de ácido palmitoleico foi significativamente maior no grupo RCF do que no grupo AIG (50,5 vs. 47,6 ng/ml, p = 0,033). Conclusão: Gestantes com RCF apresentaram níveis mais baixos de ácido elaídico e ácido gama-linoleico e níveis mais elevados de ácido palmitoleico do que os fetos AIG.


Subject(s)
Humans , Female , Pregnancy , Fatty Acids , Fetal Growth Retardation
9.
Femina ; 51(2): 105-113, 20230228. Ilus, Tab
文章 在 葡萄牙语 | LILACS | ID: biblio-1428706

摘要

No início do século 20, as altas taxas de mortalidade materna e infantil estimularam o desenvolvimento de um modelo de atendimento pré-natal que mantivesse características parecidas até os dias atuais. Nesse modelo, haveria maior concentração de visitas durante o final do terceiro trimestre de gestação, devido às maiores taxas de complicações nas fases finais da gestação e à dificuldade de prever a ocorrência de resultados adversos durante o primeiro trimestre. Atualmente, a avaliação clínica durante o primeiro trimestre, com auxílio da ultrassonografia e marcadores bioquímicos, pode prever uma série de complicações que acometem a gestação, incluindo cromossomopatias, pré-eclâmpsia, restrição de crescimento fetal, anomalias fetais e trabalho de parto pré-termo.


At the beginning of the 20th century, the high rates of maternal and infant mortality stimulated the development of a model of prenatal care that maintained similar characteristics until the present day. In this model, there would be a greater concentration of visits during the end of the third trimester of pregnancy, due to the higher rates of complications in the final stages of pregnancy and the difficulty in predicting the occurrence of adverse outcomes during the first trimester. Currently, clinical evaluation during the first trimester, with the aid of ultrasound and biochemical markers, can predict a series of complications that affect pregnancy, including chromosomal disorders, preeclampsia, fetal growth restriction, fetal anomalies and preterm labor.


Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia/diagnostic imaging , Ultrasonography, Prenatal , Aneuploidy , Trisomy/diagnosis , Biomarkers/chemistry , Infant Mortality , Maternal Mortality , Risk Assessment
11.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 69(1): 24-29, Jan. 2023. tab, graf
文章 在 英语 | LILACS-Express | LILACS | ID: biblio-1422610

摘要

SUMMARY OBJECTIVE: The aim of this study was to evaluate the association between antibiotic prophylaxis and adverse perinatal outcomes in premature rupture of membranes. METHODS: This retrospective cohort included pregnant women with premature rupture of membranes (between 24 and 33+6 weeks) who used or did not use prophylactic antibiotics. Pearson's chi-square (χ²) test, Student's t-test, and binary logistic regression were used for statistical analysis. RESULTS: A significant effect was observed in patients with premature rupture of membranes using prophylactic antibiotics regarding amniotic fluid index (p=0.007), deepest vertical pocket (p=0.049), duration of antibiotic therapy (p≤0.001), C-reactive protein level upon admission (p≤0.001), leukocyte count upon admission (p=0.007), and length of stay in neonatal intensive care (p=0.047). A significant association was observed between the abovementioned patients and surfactant use during the neonatal period (p=0.04). A higher prevalence of surfactant use was noted in these patients (20.0 vs. 8.7%; p=0.04). CONCLUSION: No association was found between antibiotic prophylaxis and the presence of adverse perinatal outcomes in pregnant women with premature rupture of membranes between 24 and 33+6 weeks of gestation.

12.
Einstein (Säo Paulo) ; 21: eAO0230, 2023. tab, graf
文章 在 英语 | LILACS-Express | LILACS | ID: biblio-1430291

摘要

ABSTRACT Objective To assess the effects of enfuvirtide on pregnancy in albino rats and their fetuses. Methods Forty pregnant EPM 1 Wistar rats were randomly allocated into four groups: control (E) (distilled water twice/day), G1 (4mg/kg/day enfuvirtide), G2 (12mg/kg/day enfuvirtide), and G3 (36mg/kg/day enfuvirtide) groups. On the 20th day of gestation, the rats were anesthetized and subjected to cesarean section. Their blood was collected for laboratory analysis, and they were sacrificed. The offspring's fragments of their kidneys, liver, and placentas and the maternal rats' fragments of their lungs, kidneys, and liver were separated in the immediate postpartum period for light microscopy analysis. Results No maternal deaths occurred. In the second week at the end of pregnancy, the mean weight of the G3 Group was significantly lower than that of the G2 Group (p=0.029 and p=0.028, respectively). Analyzing blood laboratory parameters, the G1 Group had the lowest mean amylase level, and the G2 Group had the lowest mean hemoglobin level and the highest mean platelet count. In the morphological analysis, there were no changes in organs, such as the kidneys and liver, in both the maternal rats and offspring. Three maternal rats in the G3 Group had pulmonary inflammation in the lungs. Conclusion Enfuvirtide has no significant adverse effects on pregnancy, conceptual products, or functional alterations in maternal rats.

13.
Radiol. bras ; 56(4): 179-186, 2023. tab
文章 在 英语 | LILACS-Express | LILACS | ID: biblio-1514660

摘要

Abstract Objective: To evaluate the capacity of fetal Doppler, maternal, and obstetric characteristics for the prediction of cesarean section due to intrapartum fetal compromise (IFC), a 5-min Apgar score < 7, and an adverse perinatal outcome (APO), in a high-risk population. Materials and Methods: This was a prospective cohort study involving 613 singleton pregnant women, admitted for labor induction or at the beginning of spontaneous labor, who underwent Doppler ultrasound within the last 72 h before delivery. The outcome measures were cesarean section due to IFC, a 5-min Apgar score < 7, and any APO. Results: We found that maternal characteristics were neither associated with nor predictors of an APO. Abnormal umbilical artery (UA) resistance index (RI) and the need for intrauterine resuscitation were found to be significant risk factors for cesarean section due to IFC (p = 0.03 and p < 0.0001, respectively). A UA RI > the 95th percentile and a cerebroplacental ratio (CPR) < 0.98 were also found to be predictors of cesarean section due to IFC. Gestational age and a UA RI > 0.84 were found to be predictors of a 5-min Apgar score < 7 for newborns at < 29 and ≥ 29 weeks, respectively. The UA RI and CPR presented moderate accuracy in predicting an APO, with areas under the ROC curve of 0.76 and 0.72, respectively. Conclusion: A high UA RI appears to be a significant predictor of an APO. The CPR seems to be predictive of cesarean section due to IFC and of an APO in late preterm and term newborns.


Resumo Objetivo: Avaliar a capacidade do Doppler fetal e características materno-obstétricas na predição de cesariana por comprometimento fetal intraparto (CFI), índice de Apgar de 5º min < 7 e desfecho perinatal adverso (DPA) em uma população de alto risco. Materiais e Métodos: Estudo de coorte prospectivo envolvendo 613 parturientes admitidas para indução ou em início de trabalho de parto espontâneo que realizaram ultrassonografia Doppler nas 72 horas anteriores ao parto. Os desfechos foram cesariana por CFI, índice de Apgar de 5º min < 7 e DPA. Resultados: As características maternas não foram associadas nem preditoras de DPA. Índice de resistência (IR) da artéria umbilical anormal (p = 0,03) e necessidade de medidas de ressuscitação intrauterina (p < 0,0001) permaneceram como fatores de risco significativos para cesariana por CFI. IR AU > 95º e razão cerebroplacentária (RCP) < 0,98 foram preditores de cesariana. Idade gestacional e IR AU > 0,84 foram os preditores de índice de Apgar de 5º min < 7 para recém-nascidos < 29 e ≥ 29 semanas, respectivamente. IR AU e RCP apresentaram acurácia moderada na predição de DPA (área sob a curva ROC de 0,76 e 0,72, respectivamente). Conclusão: IR UA mostrou-se preditor significativo de DPA. RCP revelou-se possível preditora de cesariana por CFI e DPA em recémnascidos prematuros tardios e a termo.

14.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 69(11): e20230511, 2023. tab
文章 在 英语 | LILACS-Express | LILACS | ID: biblio-1514715

摘要

SUMMARY OBJECTIVE: The aim of this study was to evaluate the accuracy of intrapartum cardiotocography in identifying acidemia at birth by umbilical cord blood gasometry in high-risk pregnancies. METHODS: This was a retrospective cohort study of singleton high-risk parturients using intrapartum cardiotocography categories I, II, and III. The presence of fetal acidemia at birth was identified by the analysis of umbilical cord arterial blood pH (<7.1). Associations between variables were determined using the chi-square test and Kruskal-Wallis tests. RESULTS: We included 105 cases of cardiotocography category I, 20 cases of cardiotocography category II, and 10 cases of cardiotocography category III. cardiotocography category III had a higher prevalence of cesarean sections compared to cardiotocography category I (90.0 vs. 42.9%, p<0.006). Venous pH was higher in patients with cardiotocography category I compared to cardiotocography category III (7.32 vs. 7.23, p=0.036). Prevalence of neonatal intensive care unit (NICU) admission was lower in neonates of patients with cardiotocography category I compared to cardiotocography category III (3.8 vs. 30.0%, p=0.014). Prevalence of composite adverse outcomes was lower in neonates of patients with cardiotocography category I compared to cardiotocography category II (9.5 vs. 30.0%, p=0.022) and cardiotocography category III (9.5 vs. 60.0%, p=0.0004). cardiotocography categories II and III had low sensitivity (0.05 and 0.00, respectively) and high negative predictive value (NPV) (0.84 and 0.91, respectively) for identifying fetal acidemia at birth. The three categories of intrapartum cardiotocography showed high specificities (96.0, 99.0, and 99.0%, respectively). CONCLUSION: All three categories of intrapartum cardiotocography showed low sensitivity and high specificity for identifying acidemia at birth.

15.
Rev. bras. ginecol. obstet ; 45(1): 3-10, 2023. tab, graf
文章 在 英语 | LILACS | ID: biblio-1431621

摘要

Abstract Objective To evaluate the association between pain intensity in the active phase of the first stage of labor with the use or not of nonpharmacological methods for pain relief in a real-life scenario. Methods This was an observational cross-sectional study. The variables analyzed were obtained by a questionnaire with the mothers (up to 48 hours postpartum) to investigate the intensity of pain during labor using the visual analog scale (VAS). The nonpharmacological pain relief methods routinely used in obstetric practice were evaluated by consulting medical records. The patients were separated into two groups: Group I - patients who did not use nonpharmacological methods for pain relief and Group II -patients who used these methods. Results A total of 439 women who underwent vaginal delivery were included; 386 (87.9%) used at least 1 nonpharmacological method and 53 (12.1%) did not. The women who did not use nonpharmacological methods had significantly lower gestational age (37.2 versus 39.6 weeks, p < 0.001) and shorter duration of labor (24 versus 114 min, p < 0.001) than those who used the methods. There was no statistically significant difference in the pain scale score using the VAS between the group that used nonpharmacological methods and the group that did not (median 10 [minimum 2- maximum 10] versus 10 [minimum 6-maximum 10] p = 0.334). Conclusion In a real-life setting, there was no difference in labor pain intensity between the patients who used nonpharmacological methods and those who did not use them during the active phase of labor.


Resumo Objetivo Avaliar a associação da intensidade da dor na fase ativa da dilatação do parto em mulheres de acordo com a utilização ou não de métodos não farmacológicos para alívio da dor em cenário de vida real. Métodos Trata-se de um estudo observacional de corte transversal. As variáveis analisadas foram obtidas através de questionário com as puérperas (até 48 horas pós-parto) investigando a intensidade da dor no parto pela escala visual analógica (EVA). As medidas não farmacológicas de alívio da dor, utilizadas rotineiramente na prática obstétrica, foram avaliadas pela consulta aos prontuários. As pacientes foram separadas em dois grupos: Grupo I - pacientes que não utilizaram medidas não farmacológicas para alívio da dor e Grupo II - pacientes que utilizaram estas medidas. Resultados Foram incluídas 439 mulheres que tiveram parto vaginal, sendo que 386 (87,9%) utilizaram, pelo menos, uma medida não farmacológica e 53 (12,1%) não utilizaram. As mulheres que não utilizaram as medidas não farmacológicas apresentaram idade gestacional significativamente menor (37,2 versus 39,6 semanas, p < 0,001) e menor duração do trabalho de parto (24 versus 114 minutos, p < 0,001) quando comparadas às que utilizaram as medidas. Não houve diferença estatisticamente significativa na pontuação da escala da dor pela EVA de acordo com a categorização pelo uso ou não de métodos não farmacológicos (mediana 10 [mínimo 2-máximo 10] versus 10 (mínimo 6-máximo 10), p = 0,334]. Conclusão Em cenário de vida real, as pacientes submetidas aos métodos não farmacológicos não apresentaram diferença em relação à intensidade da dor quando comparadas às que não os utilizaram durante a fase ativa do trabalho de parto.


Subject(s)
Humans , Female , Pregnancy , Pain Measurement , Labor Pain
16.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 69(7): e20230500, 2023. tab, graf
文章 在 英语 | LILACS-Express | LILACS | ID: biblio-1449087

摘要

SUMMARY OBJECTIVE: This study aimed to assess adverse maternal and perinatal outcomes in parturients undergoing labor analgesia. METHODS: This was a retrospective cohort study in parturients who underwent labor analgesia. Parturients were categorized into three groups: Group 1 (n=83)—analgesia performed with cervical dilatation ≤4.0 cm; Group 2 (n=82)—analgesia performed with cervical dilatation between 5.0 and 8.0 cm; and Group 3 (n=83)—analgesia performed with cervical dilatation ≥9.0 cm. RESULTS: Analgesia in parturients with cervical dilatation ≥9.0 cm showed a higher prevalence and a 3.86-fold increase (OR 3.86; 95%CI 1.50-9.87; p=0.009) in the risk of forceps delivery. Analgesia in parturients with cervical dilatation ≤4.0 cm showed a higher prevalence and a 3.31-fold increase (OR 3.31; 95%CI 1.62-6.77; p=0.0016) in the risk of cesarean section. Analgesia in parturients with cervical dilatation ≥9.0 cm was associated with a higher prevalence of fetal bradycardia (20.7%), a need for neonatal oxygen therapy (6.1%), and a need for admission to a neonatal intensive care unit (4.9%). Analgesia in parturients with cervical dilatation ≤4 cm was associated with a higher prevalence of Apgar score <7 at 1st minute (44.6%). CONCLUSION: Performing labor analgesia in parturients with cervical dilatation ≤4.0 or ≥9.0 cm was associated with a higher prevalence of adverse maternal and perinatal outcomes.

17.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 69(6): e20221182, 2023. tab
文章 在 英语 | LILACS-Express | LILACS | ID: biblio-1440889

摘要

SUMMARY OBJECTIVE: The aim of this study was to evaluate the accuracy of intrapartum cardiotocography in identifying fetal acidemia by umbilical cord blood analysis in low-risk pregnancies. METHODS: This is a retrospective cohort study of low-risk singleton pregnancies in labor after performing intrapartum cardiotocography categories I, II, and III. The presence of fetal acidemia at birth was identified by analyzing the pH of umbilical cord arterial blood (pH<7.1). RESULTS: No significant effect of the cardiotocography category on the arterial (p=0.543) and venous (p=0.770) pH of umbilical cord blood was observed. No significant association was observed between the cardiotocography category and the presence of fetal acidemia (p=0.706), 1-min Apgar score <7 (p=0.260), hospitalization in the neonatal intensive care unit (p=0.605), newborn death within the first 48 h, need for neonatal resuscitation (p=0.637), and adverse perinatal outcomes (p=0.373). Sensitivities of 62, 31, and 6.0%; positive predictive values of 11.0, 16.0, and 10.0%; and negative predictive values of 85, 89.0, and 87.0% were observed for cardiotocography categories I, II, and III, respectively. CONCLUSION: The three categories of intrapartum cardiotocography presented low sensitivities and high negative predictive values to identify fetal acidemia at birth in low-risk pregnancies.

18.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 68(4): 530-535, Apr. 2022. tab
文章 在 英语 | LILACS-Express | LILACS | ID: biblio-1376149

摘要

SUMMARY OBJECTIVE: The main aim of this study was to evaluate the impact of using interventions in low- and high-risk parturients on maternal and perinatal adverse outcomes during labor. METHODS: This is a prospective study. The analyzed variables were obtained through a questionnaire with puerperal women (between 1- and 48-h postpartum) and through medical record searches. The study population was divided into two groups as follows: Group I included parturients who underwent at least one type of obstetric intervention and Group II included parturients who did not undergo any type of obstetric intervention. RESULTS: Most parturients (75.3%) underwent at least one type of intervention, with oxytocin being the most prevalent intervention (49.5%), followed by misoprostol use (28.7%), elective cesarean section at the request of the patient (23.0%), amniotomy (21.2%), and episiotomy (21.0%). Regarding the adverse perinatal outcomes related to low-risk pregnancies, the prevalence of the second- or third-degree perineal tears (17.8% vs. 36.7%, p=0.001) was lower in Group I than in Group II. Moreover, in high-risk pregnancies, the prevalence of hospitalization in the neonatal intensive care unit (2.8% vs. 16.7%, p<0.001), adult intensive care unit admission (0.8% vs. 3.9%, p=0.004), and the need for oxygen therapy (26.8% vs. 40.4%, p<0.001) was lower in Group I than in Group II. CONCLUSIONS: In low-risk parturients, the interventions performed were associated with lower prevalence of second- or third-degree perineal tears. There was a lower prevalence of neonatal and adult intensive care unit admissions, the need for oxygen therapy, intracranial hemorrhage, and neonatal infection among high-risk parturients.

19.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 68(2): 256-260, Feb. 2022. tab, graf
文章 在 英语 | LILACS | ID: biblio-1365340

摘要

SUMMARY OBJECTIVE: The objective of this study was to analyze the relationship between the number of prenatal care visits and the occurrence of adverse perinatal outcomes in an average city in the state of Minas Gerais, Brazil. METHODS: This was a prospective and observational study. The variables analyzed were obtained through a questionnaire administered to postpartum women (between 1 and 48 h postpartum) and information contained in prenatal cards. The pregnant women were classified into three groups: Group I, <3 prenatal care visits; Group II, 3-5 prenatal care visits; and Group III, ≥6 prenatal care visits. RESULTS: Group I had a lower median weight (57.0 vs. 64.0 kg, p<0.001), body mass index (22.1 vs. 24.3 kg/m2, p<0.001), and weight gain (9.0 vs. 12 kg, p=0.002) than Group III. The prevalence of admission to the neonatal intensive care unit (11.6 vs. 4.2%, p=0.02) and the newborn mortality rate within the first 72 h of life (2.3 vs. 0%, p<0.001) were higher in Group I than in Group III. Group II had a higher prevalence of admission to the adult intensive care unit (5.7 vs. 0.6%, p<0.001) and a higher newborn mortality rate within the first 72 h of life (1.6% vs. 0%, p<0.001) than Group III. CONCLUSIONS: Having ≥6 prenatal care visits was associated with lower rates of admission to the neonatal and adult intensive care unit, as well as a lower newborn mortality rate within the first 72 h of life.


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Prenatal Care , Pregnancy Outcome/epidemiology , Weight Gain , Prospective Studies , Postpartum Period
20.
Rev. bras. ginecol. obstet ; 43(10): 743-748, Oct. 2021. tab, graf
文章 在 英语 | LILACS | ID: biblio-1357058

摘要

Abstract Objective To assess maternal serum levels of vitamin D in fetuses appropriate for gestational age (AGA), small for gestational age (SGA), and with fetal growth restriction (FGR) according to estimated fetal weight (EFW). Methods This cross-sectional study included 87 pregnant women between 26 and 36 weeks of gestation: 38 in the AGA group, 24 in the SGA group, and 25 in the FGR group. Maternal serum vitamin D levels were assessed using the chemiluminescence method. The Fisher exact test was used to compare the results between the groups. Results The mean ± standard deviation (SD) of maternal age (years) and body mass index (kg/m2) in the AGA, SGA, and FGR groups were 25.26 8.40 / 26.57 ± 4.37; 25.04 ± 8.44 / 26.09 ± 3.94; and 25.48 ± 7.52 / 26.24 ± 4.66, respectively (p > 0.05). The maternal serum vitamin D levels (mean ± SD) of the AGA, SGA, and FGR groups were 22.47 ± 8.35 ng/mL, 24.80 ± 10.76 ng/mL, and 23.61 ± 9.98 ng/mL, respectively, but without significant differences between the groups (p = 0.672). Conclusion Maternal serum vitamin D levels did not present significant differences among pregnant women with AGA, SGA, or FGR fetuses between 26 and 36 weeks of gestation according to EFW.


Resumo Objetivo Avaliar o nível sérico materno de vitamina D em fetos adequados para idade gestacional (AIG), pequenos para idade gestacional (PIG) e com restrição de crescimento (RCF) de acordo com a estimativa de peso fetal (EPF). Métodos Realizou-se um estudo transversal envolvendo 87 gestantes entre 26 e 36 semanas, sendo: 38 do grupo AIG, 24 do grupo PIG e 25 do grupo RCF. A dosagem sérica materna de vitamina D foi realizada pelo método de quimiluminescência. Para as comparações entre os grupos, utilizou-se o teste exato de Fisher. Resultados A média ± desvio-padrão (DP) da idade materna (anos) e do índice de massa corporal (kg/m2) nos grupos AIG, PIG e RCF foram 25,26 ± 8,40 / 26,57 ± 4,37; 25,04 ± 8,44 / 26,09 ± 3,94; e 25,48 ± 7,52 / 26,24 ± 4,66, respectivamente (p>0,05). A concentração sérica materna de vitamina D (médias ± desvios-padrão) dos grupos AIG, PG e RCF foram 22,47±8,35 ng/ml; 24,80_10,76 ng/ml; e 23,61 ± 9,98 ng/ml, respectivamente, contudo, sem diferenças significativas entre os grupos (p=0,672). Conclusão A concentração sérica materna de vitamina D não apresentou diferenças significantes entre gestantes com fetos AIG, PIG ou RCF entre 26 e 36 semanas de acordo com a EPF.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Pregnant Women , Fetal Growth Retardation , Vitamin D , Infant, Small for Gestational Age , Cross-Sectional Studies , Ultrasonography, Prenatal , Gestational Age
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