Adverse Perinatal Outcomes among Adolescent Pregnant Women Living with HIV: A Propensity-Score-Matched Study.

HIV infection and adolescent pregnancy are known to increase the risk of adverse perinatal outcomes. However, data are limited concerning the outcomes of pregnancies among adolescent girls living with HIV. This retrospective propensity-score matched study aimed to compare adverse perinatal outcomes in adolescent pregnant women living with HIV (APW-HIV-positive) with HIV-negative adolescent pregnant women (APW-HIV-negative) and adult pregnant women with HIV (PW-HIV). APW-HIV-positive were propensity-score matched with APW-HIV-negative and PW-HIV. The primary endpoint was a composite endpoint of adverse perinatal outcomes, comprising preterm birth and low birth weight. There were 15 APW-HIV-positive and 45 women in each control group. The APW-HIV-positive were aged 16 (13-17) years and had had HIV for 15.5 (4-17) years, with 86.7% having perinatally acquired HIV. The APW-HIV-positive had higher rates of perinatally acquired HIV infection (86.7 vs. 24.4%, p < 0.001), a longer HIV infection time (p = 0.021), and longer exposure to antiretroviral therapy (p = 0.034) compared with the PW-HIV controls. The APW-HIV-positive had an almost five-fold increased risk of adverse perinatal outcomes compared with healthy controls (42.9% vs. 13.3%, p = 0.026; OR 4.9, 95% CI 1.2-19.1). The APW-HIV-positive and APW-HIV-negative groups had similar perinatal outcomes.

Prevalence of oncogenic human papillomavirus in pregnant adolescents, association with colpocytological changes, risk factors and obstetric outcomes.

PURPOSE: The authors aim to carry out an investigation on the impact of cervical oncogenic Human Papillomavirus (HPV) detection in pregnant adolescents, to clarify the prevalence and risk factors, considering the importance and lack of data on this topic in Brazil. METHODS: A cross-sectional study was conducted with adolescents receiving prenatal care in a tertiary hospital in São Paulo, Brazil, with routine Pap smear and oncogenic HPV detection test in the uterine cervix. The authors sought to associate the results of these tests with demographic and obstetric variables. RESULTS: A total of 303 pregnant adolescents whose mean age was 15.30 ± 1.22 years comprised the study subjects. The frequency of high-risk HPV cervical detection was 50.50%. Multivariate analysis revealed that a large number of partners in their lifetime (OR = 1.27) and having a religion (OR = 2.05) were risk factors for cervical detection of oncogenic HPV, while schooling appeared as a protective factor (OR = 0.85). There was an association between this detection and colpocytological alterations, reaching almost 30% of patients, but without association with obstetric and neonatal outcomes. CONCLUSION: The prevalence found is one of the highest in Brazil and worldwide. A greater number of partners during their lifetime and having religion were detected as possible factors associated with cervical HPV detection. Detection of cervical HPV-DNA did not influence obstetric and neonatal outcomes. The findings of this study reinforce the need to implement educational measures capable of modifying the incidence of sexually transmitted infections in this population and capable of promoting adherence to HPV vaccination programs.

Prevalence of oncogenic human papillomavirus in pregnant adolescents, association with colpocytological changes, risk factors and obstetric outcomes

Abstract Purpose The authors aim to carry out an investigation on the impact of cervical oncogenic Human Papillomavirus (HPV) detection in pregnant adolescents, to clarify the prevalence and risk factors, considering the importance and lack of data on this topic in Brazil. Methods A cross-sectional study was conducted with adolescents receiving prenatal care in a tertiary hospital in São Paulo, Brazil, with routine Pap smear and oncogenic HPV detection test in the uterine cervix. The authors sought to associate the results of these tests with demographic and obstetric variables. Results A total of 303 pregnant adolescents whose mean age was 15.30 ± 1.22 years comprised the study subjects. The frequency of high-risk HPV cervical detection was 50.50%. Multivariate analysis revealed that a large number of partners in their lifetime (OR = 1.27) and having a religion (OR = 2.05) were risk factors for cervical detection of oncogenic HPV, while schooling appeared as a protective factor (OR = 0.85). There was an association between this detection and colpocytological alterations, reaching almost 30% of patients, but without association with obstetric and neonatal outcomes. Conclusion The prevalence found is one of the highest in Brazil and worldwide. A greater number of partners during their lifetime and having religion were detected as possible factors associated with cervical HPV detection. Detection of cervical HPV-DNA did not influence obstetric and neonatal outcomes. The findings of this study reinforce the need to implement educational measures capable of modifying the incidence of sexually transmitted infections in this population and capable of promoting adherence to HPV vaccination programs.

Resultados maternos e perinatais em pacientes com disfunção sistólica grave / Maternal and perinatal outcome in patients with severe systolic dysfunction

OBJETIVO: O objetivo deste trabalho é avaliar os resultados maternos e perinatais em gestantes com disfunção sistólica grave de ventrículo esquerdo acompanhadas em hospital terciário durante a gestação, parto e puerpério imediato. MÉTODOS: Doze pacientes com disfunção ventricular grave, definida por fração de ejeção <40 por cento em ecocardiograma realizado durante a gestação, foram avaliadas retrospectivamente. Os dados incluíram ocorrência de complicações clínicas e obstétricas, características do parto e resultados neonatais. As complicações clínicas consideradas foram aparecimento ou piora da dispnéia, arritmia, acidente vascular cerebral, tromboembolismo pulmonar, edema agudo de pulmão, parada cardíaca e morte. RESULTADOS: A média da fração de ejeção das pacientes foi 28,9+-6,47 por cento (mediana: 30 por cento). Quatro pacientes iniciaram o pré-natal em classe funcional III e oito com classe I ou II. Dez pacientes apresentaram piora da dispnéia durante a gravidez. A complicação clínica mais comum foi edema agudo de pulmão (Três pacientes). Três das quatro pacientes que iniciaram o pré-natal em classe funcional III apresentaram boa evolução da gravidez; a outra apresentou parto prematuro devido à piora dos sintomas. Houve dois partos vaginais e 10 cesáreas. Dez dos 13 recém-nascidos foram pequenos para idade gestacional. Uma paciente, que já tinha indicação de transplante cardíaco antes da gestação, apresentou descompensação clínica durante a gravidez e evoluiu para edema agudo de pulmão e choque cardiogênico, realizando o transplante dois meses após o parto. Não houve morte materna ou neonatal. CONCLUSÕES: Embora o número de gestações avaliadas tenha sido pequeno, deve-se rever a indicação de abortamento terapêutico em gestantes com disfunção ventricular esquerda grave, uma vez que todas as gestações evoluíram até a viabilidade. Os recém-nascidos destas mães apresentaram grande incidência de restrição do crescimento intra-uterino...

OBJECTIVE: The objective of this study was to evaluate maternal and fetal outcome in patients with severe left ventricle systolic dysfunction followed in a terciary-care hospital. METHODS: We retrospectively evaluated 12 pregnant women with severe systolic dysfunction, defined as a ejection fraction <40 percent. Follow-up data included functional class evaluation, ocurrency of cardiac and obstetric events, labor data and neonatal outcome. Cardiac events were defined as new onset of arrhythmias, stroke, pulmonary thrombosis, pulmonary edema, cardiac arrest, and death. RESULTS: The mean ejection fraction was 28,9±6,47 percent. Four patients were in the NYHA class III, and 8 in class I or II on presentation. Ten patients had deteriorated during pregnancy. The most common cardiac event was pulmonary edema (3 patients). Three of the four patients with class III on presentation had a good evolution during pregnancy, and the other one had preterm delivery due to worsening symptons. There were 2 vaginal espontaneous deliveries and 10 cesarean sections. Small-for-gestational-age birthweigth ocurred in 10 pregnancies. There was no maternal or neonatal death. CONCLUSIONS: Pregnancy in patients with severe left ventricle systolic dysfunction increases the risk of maternal complications and compromises fetal growth. It is important to follow this women in a tertiary-care hospital.

[Maternal and perinatal outcome in patients with severe systolic dysfunction]. / Resultados maternos e perinatais em pacientes com disfunção sistólica grave.

OBJECTIVE: The objective of this study was to evaluate maternal and fetal outcome in patients with severe left ventricle systolic dysfunction followed in a tertiary-care hospital. METHODS: We retrospectively evaluated 12 pregnant women with severe systolic dysfunction, defined as a ejection fraction<40%. Follow-up data included functional class evaluation, occurrence of cardiac and obstetric events, labor data and neonatal outcome. Cardiac events were defined as new onset of arrhythmias, stroke, pulmonary thrombosis, pulmonary edema, cardiac arrest, and death. RESULTS: The mean ejection fraction was 28.9+/-6.47%. Four patients were in the NYHA class III, and 8 in class I or II on presentation. Ten patients had deteriorated during pregnancy. The most common cardiac event was pulmonary edema (3 patients). Three of the four patients with class III on presentation had a good evolution during pregnancy, and the other one had preterm delivery due to worsening symptoms. There were 2 vaginal spontaneous deliveries and 10 cesarean sections. Small-for-gestational-age birthweight occurred in 10 pregnancies. There was no maternal or neonatal death. CONCLUSIONS: Pregnancy in patients with severe left ventricle systolic dysfunction increases the risk of maternal complications and compromises fetal growth. It is important to follow this women in a tertiary-care hospital.

Análise dos fatores associados à recorrência de gravidez na adolescência / Analysis of factors associated to recurrence in adolescent pregnancy

Estudou-se um grupo de 106 gestantes adolescentes multigestas, comparando-as com 510 adolescentes primigestas da clínica obstétrica do HC-FMUSP com referência a variáveis demográficas, obstétricas e psicossociais. Entre janeiro de 2000 a janeiro de 2006. As pacientes tinham até 18 anos. Diferenças estatísticas fora encontradas em relação: idade, escolaridade, situação conjugal, dependência financeira, idade dos companheiros e reação dos pais frente à gestação. Detectou-se que as multigestas planejam mais as gestações, tem atividade sexual mais cedo, conhecem e usam mais métodos contraceptivos. Ainda essas apresentam mais partos prematuros, recém-nascidos de pré-termo e menos aplicação de fórcipe nos seus partos...

This research studied a group of 106 adolescents patients with more than pregnancies and compared them to 510 with first pregnancy considering the demographics, obstetrics and psychosocial variables. The patients were recruited in the ambulatory service of obstetrics in the clinic of adolescent pregnancy of the HC-FMUSP from January 2000 to January 2006. The oldest patients were 18. Significant statistical differences were observed between the patients relation to: age, education, union and financial dependence on their partners, fathers and mothers reaction when faced with the news of pregnancy. Adolescents patients with more than pregnancies planned better their gestations, began their sexual activities earlier, knew and used contraceptive methods. This patients had more frequent premature labor, higher frequency of pre-term births and during labor the use of forcips...