The impact of prior preeclampsia on the risk of superimposed preeclampsia and other adverse pregnancy outcomes in patients with chronic hypertension.

OBJECTIVE: We sought to compare the rates of superimposed preeclampsia and adverse outcomes in women with chronic hypertension with or without prior preeclampsia. STUDY DESIGN: We conducted secondary analysis of 369 women with chronic hypertension (104 with prior preeclampsia) enrolled at 12-19 weeks as part of a multisite trial of antioxidants to prevent preeclampsia (no reduction was found). Outcome measures were rates of superimposed preeclampsia and other adverse perinatal outcomes. RESULTS: Prepregnancy body mass index, blood pressure, and smoking status at enrollment were similar between groups. The rates of superimposed preeclampsia (17.3% vs 17.7%), abruptio placentae (1.0% vs 3.1%), perinatal death (6.7% vs 8.7%), and small for gestational age (18.4% vs 14.3%) were similar between groups, but preterm delivery <37 weeks was higher in the prior preeclampsia group (36.9% vs 27.1%; adjusted risk ratio, 1.46; 95% confidence interval, 1.05-2.03; P = .032). CONCLUSION: In women with chronic hypertension, a history of preeclampsia does not increase the rate of superimposed preeclampsia, but is associated with an increased rate of delivery at <37 weeks.

Exposure of pregnant women to indoor air pollution: a study from nine low and middle income countries.

OBJECTIVE: We studied exposure to solid fuel and second-hand tobacco smoke among pregnant women in south Asia, Africa and Latin America. DESIGN: Prospective cross-sectional survey. SETTING: Antenatal clinics in Argentina, Brazil, Ecuador, Guatemala, Uruguay, Democratic Republic of Congo, Zambia, India and Pakistan. SAMPLE: A total of 7,961 pregnant women in ten sites in nine countries were interviewed between October 2004 and September 2005. METHODS: A standardized questionnaire on exposure to indoor air pollution (IAP) and second-hand smoke was administered to pregnant women during antenatal care. MAIN OUTCOME MEASURES: Exposure to IAP and second-hand tobacco smoke. RESULTS: South Asian pregnant women commonly reported use of wood (49.1-89.7%), crop residue and animal dung as cooking and heating fuel. African pregnant women reported higher use of charcoal (85.4-93.5%). Latin American pregnant women had greater use of petroleum gas. Among south Asian women, solid fuel use and cooking on an open flame inside the home were common. There was a significant association between solid fuel use and allowing smoking within the home at the Asian sites and in Zambia (p < 0.05). CONCLUSIONS: Pregnant women from low/middle income countries were commonly exposed to IAP secondary to use of solid fuels. Among these populations, exposure to second-hand tobacco smoke was also common. This combination of exposures likely increases the risk of poor pregnancy outcomes among the most vulnerable women. Our study highlights the importance of further research on the combined impact of IAP and second-hand tobacco smoke exposures on adverse maternal and perinatal outcomes.

Antioxidant supplementation and premature rupture of the membranes: a planned secondary analysis.

OBJECTIVE: The purpose of this study was to determine if antioxidant supplementation during pregnancy reduces the incidence of premature rupture of the membranes (PROM). STUDY DESIGN: A placebo-controlled, double-blind trial was conducted. PROM and preterm PROM (PPROM) were planned secondary outcomes of the trial. Women between 12(0/7) and 19(6/7) weeks of gestation and diagnosed to have chronic hypertension or a prior history of preeclampsia were randomized to daily treatment with both vitamin C (1000 mg) and E (400 IU) or placebo. RESULTS: Outcome data for PROM were available for 697 of 739 patients. The rates of PROM (37/349 [10.6%] vs 19/348 [5.5%]; adjusted risk ratio [RR] 1.89 [95.42% CI, 1.11-3.23]; P = .015), and PPROM (16/349 [4.6%] vs 6/348 [1.7%]; RR 2.68 [1.07-6.71]; P = .025) were increased in the antioxidant group. CONCLUSION: Contrary to expectations, vitamins C and E supplementation in this dose combination may be associated with an increased risk of PROM and PPROM.

Serum inhibin A and angiogenic factor levels in pregnancies with previous preeclampsia and/or chronic hypertension: are they useful markers for prediction of subsequent preeclampsia?

OBJECTIVE: Our objective was to determine whether measurement of placenta growth factor (PLGF), inhibin A, or soluble fms-like tyrosine kinase-1 (sFlt-1) at 2 times during pregnancy would usefully predict subsequent preeclampsia (PE) in women at high risk. STUDY DESIGN: We analyzed serum obtained at enrollment (12(0/7) to 19(6/7) weeks) and follow-up (24-28 weeks) from 704 patients with previous PE and/or chronic hypertension (CHTN) enrolled in a randomized trial for the prevention of PE. Logistic regression analysis assessed the association of log-transformed markers with subsequent PE; receiver operating characteristic analysis assessed predictive value. RESULTS: One hundred four developed preeclampsia: 27 at 37 weeks or longer and 77 at less than 37 weeks (9 at less than 27 weeks). None of the markers was associated with PE at 37 weeks or longer. Significant associations were observed between PE at less than 37 weeks and reduced PLGF levels at baseline (P = .022) and follow-up (P < .0001) and elevated inhibin A (P < .0001) and sFlt-1 (P = .0002) levels at follow-up; at 75% specificity, sensitivities ranged from 38% to 52%. Using changes in markers from baseline to follow-up, sensitivities were 52-55%. Associations were observed between baseline markers and PE less than 27 weeks (P < or = .0004 for all); sensitivities were 67-89%, but positive predictive values (PPVs) were only 3.4-4.5%. CONCLUSION: Inhibin A and circulating angiogenic factors levels obtained at 12(0/7) to 19(6/7) weeks have significant associations with onset of PE at less than 27 weeks, as do levels obtained at 24-28 weeks with onset of PE at less than 37 weeks. However, because the corresponding sensitivities and/or PPVs were low, these markers might not be clinically useful to predict PE in women with previous PE and/or CHTN.

Tobacco use and secondhand smoke exposure during pregnancy: an investigative survey of women in 9 developing nations.

OBJECTIVES: We examined pregnant women's use of cigarettes and other tobacco products and the exposure of pregnant women and their young children to secondhand smoke (SHS) in 9 nations in Latin America, Asia, and Africa. METHODS: Face-to-face surveys were administered to 7961 pregnant women (more than 700 per site) between October 2004 and September 2005. RESULTS: At all Latin American sites, pregnant women commonly reported that they had ever tried cigarette smoking (range: 78.3% [Uruguay] to 35.0% [Guatemala]). The highest levels of current smoking were found in Uruguay (18.3%), Argentina (10.3%), and Brazil (6.1%). Experimentation with smokeless tobacco occurred in the Democratic Republic of the Congo and India; one third of all respondents in Orissa, India, were current smokeless tobacco users. SHS exposure was common: between 91.6% (Pakistan) and 17.1% (Democratic Republic of the Congo) of pregnant women reported that smoking was permitted in their home. CONCLUSIONS: Pregnant women's tobacco use and SHS exposure are current or emerging problems in several low- and middle-income nations, jeopardizing ongoing efforts to improve maternal and child health.

Antioxidant therapy to prevent preeclampsia: a randomized controlled trial.

OBJECTIVE: To study whether antioxidant supplementation will reduce the incidence of preeclampsia among patients at increased risk. METHODS: A randomized, placebo-controlled, double-blind clinical trial was conducted at four Brazilian sites. Women between 12 0/7 weeks and 19 6/7 weeks of gestation and diagnosed to have chronic hypertension or a prior history of preeclampsia were randomly assigned to daily treatment with both vitamin C (1,000 mg) and vitamin E (400 International Units) or placebo. Analyses were adjusted for clinical site and risk group (prior preeclampsia, chronic hypertension, or both). A sample size of 734 would provide 80% power to detect a 40% reduction in the risk of preeclampsia, assuming a placebo group rate of 21% and alpha=.05. The alpha level for the final analysis, adjusted for interim looks, was 0.0458. RESULTS: Outcome data for 707 of 739 randomly assigned patients revealed no significant reduction in the rate of preeclampsia (study drug, 13.8% [49 of 355] compared with placebo, 15.6% [55 of 352], adjusted risk ratio 0.87 [95.42% confidence interval 0.61-1.25]). There were no differences in mean gestational age at delivery or rates of perinatal mortality, abruptio placentae, preterm delivery, and small for gestational age or low birth weight infants. Among patients without chronic hypertension, there was a slightly higher rate of severe preeclampsia in the study group (study drug, 6.5% [11 of 170] compared with placebo, 2.4% [4 of 168], exact P=.11, odds ratio 2.78, 95% confidence interval 0.79-12.62). CONCLUSION: This trial failed to demonstrate a benefit of antioxidant supplementation in reducing the rate of preeclampsia among patients with chronic hypertension and/or prior preeclampsia. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.ClinicalTrials.gov, NCT00097110 LEVEL OF EVIDENCE: I.

Fatores associados à realização seletiva de episotomia em hospital universitário / Factors associated with the seletive practice of episotomy in a university hospital

Objetivo: avaliar a prevalência de episiotomia em hospital universitário quando da implantação da norma de episiotomia seletiva e fatores associados a esse procedimento. Estudo de corte transversal realizado em uma amostra de 323 mulheres submetidas a parto normal, com feto vivo, durante o período de junho a agosto de 2000. As variáveis maternas (idade, procedência e paridade), do recém-nascido (peso, idade gestacional e escore de Apgar) e relacionadas ao procedimento (profissional responsável e horário) foram obtidas por meio de entrevistas com as mães e consultas aos prontuários. Para a análise estatística foi realizada a distribuição das categorias das variáveis entre os grupos com e sem episiotomia, com a diferença avaliada pelo teste do x2, e estimada a Razão de Prevalência (RP e IC95) para cada possível fator associado. A prevalência de episiotomia na amostra estudada foi de 37,8

A doençã periodontal como fator de risco em gestantes com bebês prematuros de baixo peso ao nascer / The periodontal disease as a risk factor in preagnants with premature childbird and low birth weight

O presente estudo teve como objetivo estimar aprevalência de doença periodontal materna e avaliar ainfluência dessa doença sobre a ocorrência de nascimento decrianças prematuras com baixo peso ao nascer. Método: Foirealizado um estudo seccional em mulheres no puerpérioimediato, mães de recém nascidos vivos, internadas naMaternidade do Hospital das Clínicas da Universidade Federalde Pernambuco, no período de 1 de abril a 30 de novembro de2004. Os recém nascidos foram classificados segundo o statusdo peso ao nascer (baixo peso ou peso normal) e o status daexposição (mãe com doença periodontal presente ou ausente).As pacientes foram selecionadas através de critérios deexclusão, tais como, diabetes mellitus, tabagismo, uso dedrogas, cardiopatias prévias e infecções, sendo coletadosdados sobre a história obstétrica através de questionários eprontuários. O exame periodontal foi realizado através do índiceperiodontal comunitário. Resultados: Os resultadosdemonstraram que 91,2 porcento das puérperas avaliadasapresentavam prevalência de doença periodontal, sendo amesma classificada segundo os níveis: leve (38,8 porcento), moderado(37,5 porcento) e grave (14,9 porcento) e, dentre estas, apenas 11 porcento tiveramparto prematuro com crianças de baixo peso ao nascer.Conclusão: Baseado nos resultados, foi possível concluir quenão existiu associação significativa entre doença periodontal ecrianças prematuras de baixo peso ao nascer

Diffusion imaging may predict reversible brain lesions in eclampsia and severe preeclampsia: initial experience.

OBJECTIVE: The purpose of this study was to validate diffusion-weighted magnetic resonance imaging in the prediction of the evolutive course of brain edema and to establish its pathophysiologic presence in patients with eclampsia/severe preeclampsia. STUDY DESIGN: Seventeen patients with a clinical diagnosis of severe eclampsia/preeclampsia and T2 hyperintense brain lesions on routine magnetic resonance imaging were evaluated at hospital admission and 8 weeks later. RESULTS: Brain edema was reversible in 13 patients and irreversible in 4 patients, as indicated on follow-up magnetic resonance imaging. Sixteen of 17 patients were differentiated accurately into reversible and irreversible groups on the basis of diffusion imaging on hospital admission. Diffusion-weighted magnetic resonance imaging demonstrated a significant increase in water mobility in abnormal regions compared with normal-appearing brains in patients in the reversible group (1.34+/-0.10 mm(2) vs 0.79+/-0.08 mm(2)/s x 10(-3), P<.001). In the irreversible group, restricted water diffusion was present, which was consistent with cytotoxic edema and early brain infarction in 3 of 4 patients. CONCLUSION: Diffusion-weighted magnetic resonance imaging can predict successfully the evolutive course of brain edema in an acute setting in these patients. Our findings indicate that brain edema is vasogenic, although ischemic/cytotoxic edema was observed less commonly.

Histerectomia no ciclo gravidico-puerperal: estudo retrospectivo de 12 anos / Hysterectomy in pregnancy and puerperium: a retrospective study of 12 years

Estudo retrospectivo de 74 histerectomias realizadas na Maternidade do Hospital das Clinicas da UFPE de junho de 1983 a dezembro de 1995, com o objetivo de analisar esta cirurgia, observando-se qual o tipo de histerectomia e melhor indicada no periodo puerperal. Analisou-se a indicaçäo que mais predominou, tempo cirurgico, tempo de hospitalizacao, relaparotomias por complicaçöes infecciosas e óbitos

Esferocitose hereditaria na gravidez / Hereditary spherocytosis in pregnancy

O presente trabalho descreve 2 casos de esferocitose hereditaria na gravidez, situaçäo rara com esplemomegalia e ictericia. Säo discutidas as condutas adequadas

Gestante portadora de cifoescoliose acentuada associada a pelve raquitica e sequela de poliomelite: apresentaçäo de um caso e revisäo da literatura / Pregnant carrier of pronounced kyphoscoliosis, associated to rachitic pelvis and sequel of polyomyelitis: report of a case and review of the literature

O presente caso diz respeito a uma paciente portadora de cifoescoliose acentuada associada a pelve raquitica e sequela de poliomelite, contraida aos 11 meses de idade e pré eclampsia leve

Repercussöes do tratamento da pré-eclâmpsia com sulfato de magnésio com início no pré-parto ou no pós-parto / Repercussions of preeclampsia treatment with magnesium sulphate, begining in the prepartum or in the postpartum

Com o objetivo de avaliar as repercussöes do tratamento da pré-eclâmpsia com sulfato de magnésio com início pré-parto ou pós-parto, foram estudados 628 gestantes e seus recém-nascidos, atendidas no Servi;o de Obstetrícia do Hospital da Clínicas da Universidade Federal de Pernambuco, no período de Janeiro de 1992 a Setembro de 1996, subdivididas em dois grupos terapêutica com sulfato de magnésio no pré-parto e 301, no pós-parto. A pesquisa teve desenho de ensaio clínico, prospectivo, controlado, randomizado com critérios de inclusäo ser gestante, com feto vivo, em trabalho de parto ou com indicaçäo de interrupçäo de gravidez, apresentando tensäo arterial diastólica>90mmHg e <110mmHg e sistólica>140mmHg e <160mmHg, acompanhadas da presença, isolada pu associada, de cefaléia; escótomas; dor em hipocôndrio direito; oligúria<400m/24h; plaquetometria onferior a 100.000 plaquetas/mm3, anemia hemolítica microangiopática; icterícia; elevaçäo das provas de funçäo hepática e/ou presença de feto com crescimento intra-uterino retardado, ou tensäo arterial diastólica>110mmHg e sistólica>160mmHg em presença de proteinúria de uma cruz ou mais, detectada através de fita reativa; excluídas as gestantes com miastenia gravis: insuficiência renal: diabetes melitus descompensada: cardiopatia grau IV segundo critério da New York Heart Association; gemelidade; presença de malformaçöes fetais incompatíveis com a vida. Todas as pacientes foram tratadas com soluçäo de sulfato de magnésio, segundo esquema endovenoso de Zuspan. Aguardou-se o parto pela via transvaginal pelo período de duas horas após dose de ataque, findo o qual procedeu-se à resoluçäo por via alta. Os casos em que a TA...

Púrpura trombocitopênica auto-imune e gravidez: relato de um caso / Autoimmune thrombocytopenic purpura and pregnancy: a case report

The authors studed one case of autoimmune thrombocytopenic purpura in a 25 years old pregnant woman, with 38 weeks of pregnancy. The conduct was rest and sedatives. The preference was the vaginal delivery, because ther was no concordance in our Service that the cesarean section avoids hemorrhage in the newborns of pregnant women bearing ATP. In the 99 day of treatment, it was performed a cesarean section after diagnosis of acute fetal distress, the newborn presenting an Apgar score of 1 and 3, with good evolution and absence of petechiae or purpura. The patient had puerperal infection, but it was not found in the literature any association between this pathology and thrombocytopenic purpura

Gravidez abdominal tardia interrompida por episódio de sangramento intracavitário / Late abdominal pregnancy interrupted by intracavitary bleeding

Versa o estudo sobre um caso de gravidez abdominal tardia onde säo focalizados aspectos clínicos, tática cirúrgica e resultados perinatais

Estudo comparativo com pindolol e metildopa em gestantes com hipertensäo arterial crônica / Comparative study with pindolol and methyldopa in pregnant women with chronic hypertension

Foram tratadas 40 gestantes com hipertensäo arterial crônica, 20 consecutivas com a metildopa e 20 com pindolol. A dose inicial da metildopa foi de 250 mg duas vezes ao dia, até o máximo de 2.000 mg. Principiou-se com o pindolol, na dose de 10 mg, até o máximo de 30 mg. Prescreveram-se hipotensores a partir de uma pressäo arterial diastólica de 95 mmHg. No grupo do pindolol houve diminuiçäo significativa da pressäo arterial, pelo teste t de Student para grupos pareados, p<0,01 (pressäo arterial média pré-tratamento 153,25 + ou - 6,34 x 104,25 + ou - 4,94 mmHg e pressäo arterial média pós-tratamento 143,75 + ou - 9,44 x 93,25 + ou - 9,63 mmHg). A necessidade de associaçäo com outros fármacos (nifedipina e hidralazina) foi significativamente menor no grupo do pindolol, 4/20, de que no grupo da metildopa, 9/20, p<0,05, pelo teste do X2. O aparecimento de pré-eclâmpsia superposta e os resultados neonatais (peso, índice de Apgar e neomortos) näo apresentaram diferenças estatisticamente significativas nos dois grupos, p>0,05, pelos testes t para grupos independentes, do X2 e exato de Fischer

Diabetes e gravidez: consulta e resultados em 138 casos / Diabetes and pregnancy: management and out come in 138 cases

Cento e trinta e oito pacientes säo tratadas no período de 1§ de janeiro de 1980 a 31 de dezembro de 1986. A classe dominante é o diabetes gestacional (71,74%). Utilizam-se as curvas de O'Sullivan e Mestman para diagnostica-lo. Avaliaçäo clínica (ênfase na contagem dos movimentos fetais), cardiotocografia basal e o perfil biofísico fetal säo as provas de vitalidade fetal usadas; em algumas vezes, a amniocentese. Como meios de aquilatar a maturidade fetal, realizam-se avaliaçäo clínica, ultrassonografia e, em casos selecionados, estudo do líquido amniótico (teste de Clements, Brossens-Gordon, dosagem de creatinina). O rígido controle metabólico é o principal objetivo na conduta. Efetua-se cesariana em 80,43% dos casos. O peso médio dos recém-nascidos é 3442,75 ñ 565,41g. Registra-se mortalidade fetal de 5,07%

Gravidez ectópica: estudo de 76 casos / Ectopic pregnancy: study of 76 cases

Em cinco anos, de 1980 a 1984 ocorreram 76 casos de prenhez ectópica na Clínica Obstétrica do Hospital Baräo de Lucena. O sintoma mais freqüente foi a dor abdominal que esteve presente em todas as pacientes e o menos assíduo foi a "massa abdominal" que foi registrada em 9% do total investigado. A culdocentese foi empreendida em mais de 50% dos casos e quando resultou positiva houve concordância absoluta com o diagnóstico firmado na laparotomia. A anestesia mais utilizada foi a geral que representou mais de 60% de todas as anestesias realizadas. Näo houve registro de óbito materno