Labor interventions in low- and high-risk parturients in a university hospital.

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.

Labor interventions in low- and high-risk parturients in a university hospital

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.

Intrauterine Zika virus infection: review of the current findings with emphasis in the prenatal and postnatal brain imaging diagnostic methods.

Zika virus (ZIKV) is a widespread flavivirus transmitted to humans through the bite of Aedes mosquitoes. The number of ZIKV cases increased significantly between 2015 and 2016, and Brazil was the first to report autochthonous transmission of infection. The main neurological disorder related to ZIKV infection is microcephaly. Fetal magnetic resonance imaging (MRI) is the gold standard examination for the analysis of fetal brain infection, followed by obstetric ultrasonography. Cerebral atrophy, intracranial calcifications, ventriculomegaly, cerebellar, and brain gyrus abnormalities are some of the most common findings. Postnatal MRI shows high sensitivity and specificity. Corpus callosum abnormalities, cerebellar hypoplasia, and choroid plexus dilation can be also observed. We present a review of congenital ZIKV infection with emphasis on pre and postnatal brain findings using ultrasonography, MRI, computed tomography, and three-dimensional reconstruction models.

Metástase extensa para o seio maxilar como primeira manifestação de carcinoma tireoidiano / Extensive metastasis to the maxillary sinus as the first manifestation of thyroid carcinoma

Introdução: A incidência do câncer de tireoide vem crescendo de maneira considerável, sendo o sexo feminino mais acometido. O carcinoma da tireoide pode ser classificado em bem diferenciado, pouco diferenciado, medular e anaplásico. Metástases em seio maxilar raramente são encontradas, com um número reduzido de casos na literatura. Relato do caso: Paciente do sexo feminino, 78 anos, sem queixas iniciais, trazida ao ambulatório de Cirurgia de Cabeça e Pescoço do Hospital Estadual Mario Covas por familiares, que notaram, há dois meses, protrusão de olho esquerdo associada à diminuição da acuidade visual do mesmo. Ao exame físico se notou uma tireoide cinco vezes aumentada, endurecida, heterogênea e aparentemente multinodular; assimetria de hemiface esquerda com parestesia; e proptose de órbita esquerda. O tratamento da paciente consistiu em tireoidectomia total e radioterapia adjuvante. Paciente foi a óbito no 29º pós-operatório por pneumonia nosocomial e edema agudo de pulmão. Conclusões: Paciente possuía carcinoma pouco diferenciado de tireoide, uma variante incomum de câncer tireoidiano, com metástase rara para seio maxilar. Trata-se de uma manifestação agressiva do carcinoma tireoidiano, resultando em prognóstico ruim e taxa de mortalidade alta.