Vulvovaginitis in pregnant women.

• The balanced vaginal microbiome is the main factor defending the vaginal environment against infections. Lactobacilli play a key role in this regard, maintaining the vaginal pH within the normal range (3.8 to 4.5). •Hormonal and immune adaptations resulting from pregnancy influence changes in the vaginal microbiome during pregnancy. •An altered vaginal microbiome predisposes to human immunodeficiency virus (HIV) infection. •Bacterial vaginosis is the main clinical expression of an imbalanced vaginal microbiome. •Vulvovaginal candidiasis depends more on the host's conditions than on the etiological agent. •Trichomonas vaginalis is a protozoan transmitted during sexual intercourse. •The use of probiotics is not approved for use in pregnant women.

Isolation and characterization of Toxoplasma gondii isolates from human congenital toxoplasmosis cases reveal a new virulent genotype in São Paulo, Brazil.

Toxoplasma gondii causes severe disease in congenitally infected fetuses. The severity of fetal infection is related to the gestational stage at the time of maternal infection, parasite burden, and genotypic characteristics. South America has a high incidence of congenital toxoplasmosis and has the highest genotypic diversity of the parasite. In Brazil, clinical toxoplasmosis in children is notorious, however there are very limited data regarding the strains recovered from congenital infections. In this study, T. gondii strains from two cases of severe congenital toxoplasmosis from the São Paulo metropolitan area were isolated (TgHumIMTBr2 and TgHumIMTBr3) and biologically and molecularly characterized using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and microsatellite analysis, revealing a new non-archetypal virulent genotype designated as #318. The other isolate, genotype #175, has already been described in domestic and wild animals in Brazil, but is now associated with acute toxoplasmosis in humans. These data reinforce the role of non-archetypal T. gondii genotypes in the severity of human congenital toxoplasmosis, highlighting the importance of studies focused on parasite isolation and genotyping for a better understanding of the virulence of isolates from human toxoplasmosis and contributing to the knowledge of the diversity of T. gondii in Brazil.

Desfechos da gestação em pacientes com dermatomiosite e polimiosite / Pregnancy outcomes in dermatomyositis and polymyositis patients

Introdução: Há poucos estudos que descrevem a gravidez em pacientes com dermatomiosite/polimiosite. São, em grande parte, limitados a relatos de casos ou estudos com amostras pequenas. Objetivos: Analisar a gestação em uma grande amostra de pacientes com dermatomiosite/polimiosite e os desfechos naquelas que engravidaram durante ou depois do início da doença. Métodos: Foram analisados 98 pacientes do sexo feminino com miopatias inflamatórias idiopáticas (60 com dermatomiosite e 38 com polimiosite). Elas foram entrevistadas entre junho de 2011 e junho de 2012 para coletar seus antecedentes obstétricos e dados demográficos. Resultados: Tinham antecedentes obstétricos 78 (79,6%) das 98 pacientes. Seis pacientes compolimiosite e nove com dermatomiosite engravidaram após o início da doença. O desfecho da gravidez nessas pacientes foi bom, exceto nos seguintes casos: um de reativação da doença, um de retardo do crescimento fetal, um de diabetes mellitus, um de hipertensão arterial, um de hipotireoidismo e dois de aborto (mesma paciente). Além disso, duas pacientes desenvolveram dermatomiosite durante a gravidez e quatro (duas polimiosite e duas dermatomiosite) durante o período pós-parto, com bom controle a seguir com glucocorticoidese terapia imunossupressora. Conclusões: Os eventos obstétricos adversos estiveram relacionados com as intercorrências clínicas e a gravidez não parece levar especificamente a um pior prognóstico na doença (por exemplo: recidiva). Além disso, a dermatomiosite ou polimiosite de início durante a gestaçãoou no período pós-parto apresentou boa evolução depois do tratamento farmacológico. .

Background: Currently, there are few studies that describe pregnancy in dermatomyositis/polymyositis patients, and they are largely limited to case reports or studies with few samples. Objectives: Therefore, we describe the pregnancy in a large sample of patients with dermatomyositis/polymyositis and to analyze the outcomes in those who became pregnant duringor after disease onset. Methods: The present single-center study analyzed 98 female patients with idiopathic inflammatory myopathies (60 dermatomyositis and 38 polymyositis patients). They wereinterviewed to obtain obstetric antecedent and demographic data from June 2011 to June 2012. Results: Seventy-eight (79.6%) of the 98 patients had obstetric histories. Six polymyositis and 9 dermatomyositis patients became pregnant after disease onset. The pregnancy outcomesin these cases were good, except in the following cases: 1 disease reactivation, 1 intrauterine growth retardation, 1 diabetes mellitus, 1 hypertension, 1 hypothyroidism, and 2 fetal losses (same patient). Moreover, 2 patients developed dermatomyositis during pregnancy and 4 (2 polymyositis and 2 dermatomyositis) during the postpartum period with good control after glucocorticoid and immunosuppressant therapy. Conclusions: The adverse obstetric events were related to clinical intercurrences and thepregnancy does not seem to carry a worse prognosis specifically in disease (for example:disease relapsing). Moreover, dermatomyositis or polymyositis onset during pregnancy orthe postpartum period had good outcome after drug therapy. .

Pregnancy outcomes in dermatomyositis and polymyositis patients.

BACKGROUND: Currently, there are few studies that describe pregnancy in dermatomyositis/polymyositis patients, and they are largely limited to case reports or studies with few samples. OBJECTIVES: Therefore, we describe the pregnancy in a large sample of patients with dermatomyositis/polymyositis and to analyze the outcomes in those who became pregnant during or after disease onset. METHODS: The present single-center study analyzed 98 female patients with idiopathic inflammatory myopathies (60 dermatomyositis and 38 polymyositis patients). They were interviewed to obtain obstetric antecedent and demographic data from June 2011 to June 2012. RESULTS: Seventy-eight (79.6%) of the 98 patients had obstetric histories. Six polymyositis and 9 dermatomyositis patients became pregnant after disease onset. The pregnancy outcomes in these cases were good, except in the following cases: 1 disease reactivation, 1 intrauterine growth retardation, 1 diabetes mellitus, 1 hypertension, 1 hypothyroidism, and 2 fetal losses (same patient). Moreover, 2 patients developed dermatomyositis during pregnancy and 4 (2 polymyositis and 2 dermatomyositis) during the postpartum period with good control after glucocorticoid and immunosuppressant therapy. CONCLUSIONS: The adverse obstetric events were related to clinical intercurrences and the pregnancy does not seem to carry a worse prognosis specifically in disease (for example: disease relapsing). Moreover, dermatomyositis or polymyositis onset during pregnancy or the postpartum period had good outcome after drug therapy.

Prenatal diagnosis of congenital rubella infection in São Paulo / Diagnóstico pré-natal de infecção congênita por rubéola, em São Paulo, Brasil

Objective: rubella during the early stages of pregnancy can lead to severe birth defects known as congenital rubella syndrome (CRS). Samples collected from pregnant women with symptoms and suspected of congenital rubella infection between 1996 and 2008 were analyzed. Methods: a total of 23 amniotic fluid samples, 16 fetal blood samples, 1 product of conception and 1 placenta were analyzed by serology and RT-PCR. Results: all patients presented positive serology for IgG / IgM antibodies to rubella virus. Among neonates, 16 were IgG-positive, 9 were IgM-positive and 4 were negative for both antibodies. Of the 25 samples analyzed in this study, 24 were positive by RT-PCR. Changes in ultrasound were found in 15 (60%) of 25 fetuses infected with rubella virus. Fetal death and miscarriage were reported in 10 (40%) of the 25 cases analyzed. The rubella virus was amplified by PCR in all fetuses with abnormal ultrasound compatible with rubella. Fetal death and abortion were reported in 10 of 25 cases analyzed. Conclusion: this study, based on primary maternal rubella infection definitely confirms the good sensitivity and specificity of RT-PCR using amniotic fluid and ultrasound. The results showed that molecular assays are important tools in the early diagnosis of rubella and congenital rubella syndrome. .

Objetivo: a rubéola, durante os primeiros estágios da gravidez, pode levar a graves defeitos congênitos, conhecidos como síndrome da rubéola congênita (SRC). Amostras de gestantes com sintomas e suspeitas da rubéola congênita foram coletadas entre 1996 e 2008. Métodos: um total de 23 amostras de fluido amniótico, 16 amostras de sangue fetal, um produto da concepção e uma placenta foram analisados por sorologia e PCR. Resultados: todas as gestantes apresentaram sorologia positiva para IgG/IgM para o vírus da rubéola. Entre os recém-nascidos, 14 apresentaram anticorpos IgG positivos e 11 foram os anticorpos IgM positivos. Das 25 amostras analisadas neste estudo, 24 eram positivas por RT-PCR. Alterações na ultrassonografia foram encontradas em 15 (60%) dos 25 fetos infectados com o vírus da rubéola. Morte fetal e aborto espontâneo foram reportados em 10 (40%) dos 25 casos analisados. O vírus da rubéola foi amplificado por PCR em todos os fetos que apresentaram alterações na ultrassonografia, compatíveis com a rubéola. Morte fetal e aborto foram relatados em 10 dos 25 casos analisados. Conclusão: os resultados mostraram que os ensaios moleculares são ferramentas importantes para o diagnóstico precoce da rubéola e da síndrome da rubéola congênita. .

Molecular epidemiology of rubella viruses involved in congenital rubella infections in São Paulo, Brazil, between 1996 and 2009.

Rubella virus (RV) infection during the early stages of pregnancy can lead to serious birth defects, known as congenital rubella syndrome (CRS). This retrospective study was conducted between 1996 and 2009 with surveillance specimens collected from patients suspected of congenital rubella infection (CRI) and CRS. The clinical samples (nine amminiotic fluid, eight urine, eight blood, one conception product, and one placenta) were sent for viral isolation and genotyping. Twenty-seven sequences were analysed and four genotypes (1a, 1B, 1G, and 2B) were identified in São Paulo that were involved in congenital infection. To our knowledge, this study is the first report that describes genetic diversity of the circulating rubella strains involved in CRI.

Rubella vaccination of unknowingly pregnant women: the São Paulo experience, 2001.

BACKGROUND: Rubella vaccination is contraindicated during pregnancy. During mass immunization of women of childbearing age against rubella, women unknowingly pregnant may be vaccinated. To evaluate the effects of rubella vaccination during pregnancy, the Brazilian state of São Paulo conducted a follow-up study of pregnant women vaccinated during a rubella campaign in 2001. METHODS: Women vaccinated during pregnancy were reported to a national surveillance system. In the state of São Paulo, follow-up of vaccinated women included household interviews. Serum samples from vaccinated women were tested for antirubella antibodies to classify susceptibility to rubella infection. Children born to susceptible mothers were tested for evidence of congenital rubella infection and evaluated for signs of congenital rubella syndrome. RESULTS: The São Paulo State Health Department received 6473 notifications of women vaccinated during pregnancy. Serology performed for 5580 women identified 811 (15%) that were previously susceptible. Incidence of spontaneous abortion or stillbirth among previously susceptible vaccinated women was similar to women with prior immunity. Twenty-seven (4.7%) of 580 newborns tested had evidence of congenital rubella infection; none had congenital rubella syndrome. CONCLUSIONS: Mass rubella vaccination of women of childbearing age was not associated with adverse birth outcomes or congenital rubella syndrome among children born to women vaccinated during pregnancy.

Fetal cardiac troponin T as a marker of poor prognosis in nonimmune hydrops fetalis.

OBJECTIVE: Severe fetal anemia and cardiac compromise are important causes of nonimmune hydrops fetalis, and fetal recovery also depends on the degree of fetal heart compromise. The aim of this study was to report the fetal cardiac troponin T (cTnT) levels in cases of nonimmune fetal hydrops. METHODS: Fetal cTnT was analyzed on 7 occasions in 5 cases of nonimmune fetal hydrops (twice in 2 cases). RESULTS: In 3 of 4 fetuses in which intrauterine death occurred, fetal cTnT levels were increased. The only fetus that survived in this series showed decreased levels of cTnT before birth. CONCLUSION: Fetal cTnT levels may be a marker of fetal prognosis in cases of fetal hydrops.

Atividade lúpica durante a gestação / Systemic lupus erythematosus activity during pregnancy

O lúpus eritematoso sistêmico é uma doença inflamatória crônica, de natureza autoimune, caracterizada pela presença de diversos autoanticorpos, com manifestações clínicas polimórficas e com períodos de exacerbações e remissões. O desenvolvimento da doença está ligado à predisposição genética e a fatores ambientais, como a luz ultravioleta e a alguns medicamentos. As mulheres portadoras de lúpus cursam com gestações de alto risco, pois apresentam maiores taxas de abortamento, partos prematuros, restrição do crescimento fetal, mortalidade perinatal e, ainda, a Síndrome do Lúpus Neonatal. Estudos mostram que a taxa de abortamento, nesses casos, varia de 20 a 22 porcento. A pesquisa de anticorpos antifosfolípides nessas pacientes é positiva em 27 porcento das análises, implicando em maiores taxas de abortamentos, óbito fetal, prematuridade e restrição do crescimento fetal. É uma doença de várias faces e deve ser questionada como diagnóstico diferencial em situações clínicas na gestação. O início do quadro durante a gravidez é raro, sendo uma situação grave tanto para a mãe como para o feto. O momento para a concepção deve ser programado em período fora de atividade da doença, quando a paciente, possivelmente, estará utilizando pequenas doses de corticosteroide. A gestação deve ser desaconselhada quando a doença está em atividade, principalmente se associada a fatores de gravidade, como nefrite lúpica, hipertensão arterial crônica e síndrome dos anticorpos antifosfolípides. O pré-natal dessas gestantes deve ser realizado por uma equipe multidisciplinar em centro de referência.

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease, which is characterized by the presence of different autoantibodies and polymorphic clinical manifestations, with periods of exacerbation and remission. The development of the disease is related to a genetic predisposition and to environmental factors such as ultraviolet light and some drugs. Women with SLE are subject to high-risk pregnancies since they present higher rates of abortion, premature delivery, fetal growth retardation, perinatal mortality, and even neonatal lupus. Studies have shown that abortion may occur in 20 to 22 percent of the cases. In these patients, the investigation of antiphospholipid antibodies is positive in 27 percent of the tests, implying higher rates of abortion, fetal death, prematurity and fetal growth retardation. SLE is a disease of many facets and should be considered as a differential diagnosis in clinical situations during pregnancy. The onset of manifestations during pregnancy is rare but may occur, and represents a serious situation for both the mother and fetus. The time of conception should be programmed during a period without disease activity, when the patient is possibly using small doses of corticosteroids. The patient should be counseled not to become pregnant when the disease is active, especially when associated with severity fators such as lupus nephritis and involvement of the central nervous system. The prenatal follow-up of these women should be performed by a multidisciplinary team at a referral center.

Detection of human parvovirus B19 in cases of hydrops fetalis in São Paulo, Brazil / Detecção de parvovírus humano B19 em casos de hydropsia fetal em São Paulo, Brasil

Human parvovirus B19 infection is known to be one of the causes of hydrops fetalis. The maternal infection caused by the virus may be symptomatic or asymptomatic. In this study, 40 pregnant women with gestational age of approximately 25 weeks, prenatal diagnosis of non immune hydrops fetalis and suspected of human parvovirus B19 infection were studied between January 1999 and December 2005. Serology results and detection of DNA in the maternal serum, foetal serum and amniotic fluid confirmed that 20 pregnant women had been infected by human parvovirus B19. The ultrasound examination demonstrated foetal hydrops, anaemia, hepatosplenomegaly, ascites, cardiopathy and amniotic fluid disorders. Among the positive cases, there were three fatal losses, one by miscarriage and two by intrauterine foetal death.

A infecção por parvovírus humano B19 é um dos responsáveis pela hidropsia fetal. A infecção materna causada pelo vírus pode ser sintomática ou assintomática. Neste estudo 40 mulheres com idade gestacional de aproximadamente 25 semanas, diagnóstico pré-natal de hidropsia fetal e suspeita de infecção por parvovírus humano B19 foram avaliadas durante o período de janeiro de 1999 a dezembro de 2005. Os resultados de sorologia e detecção de DNA no soro materno, fetal e fluido amniótico confirmaram 20 mulheres grávidas com infecção por parvovírus humano B19. A análise de ultra-som demonstrou hidropsia fetal, anemia, hepatosplenomegalia, ascite, cardiopatia e desordens amnióticas. Entre os casos positivos, ocorreram três perdas fetais: uma por aborto e duas por morte fetal intra-uterina.

Rubella in pregnancy: intrauterine transmission and perinatal outcome during a Brazilian epidemic.

Sixty pregnant women with clinical signs of rubella and specific rubella antibodies were studied between January 1999 and December 2002 in order to determine the intrauterine rubella transmission rate and the presence of the virus in amniotic fluid and fetal tissues by nested PCR. Thirty-three patients presented rubella before 12 weeks of gestation and 27 after 12 weeks. Gestational age at the time of acute rubella was determined on the basis of the date of last menstruation and the first trimester ultrasound scan. Thirteen patients with clinical features of rubella before 12 weeks of gestation were submitted to amniocentesis. Three products of conception were analyzed. The presence of the rubella virus was determined by nested PCR. IgM and IgG antibodies were analyzed in neonatal samples at birth and at 3 months of age using a capture immunoassay. Newborn follow-up was based on the presence of congenital rubella syndrome-compatible defects, anti-rubella antibodies, echocardiographic alterations, brainstem evoked response audiometry, and ophthalmological pathology. Five miscarriages and four fetal deaths were observed in the group of patients presenting clinical features before 12 weeks of gestation. IgM antibodies were detected in seven neonates at birth and at 3 months of age. Deafness was observed in three cases and pigmentary retinopathy in one case. Fourteen of the 16 samples (13 amniotic fluid and 3 fetal tissue samples) submitted to virological analysis tested positive. Four fetal deaths, five miscarriages (one with negative virology) and seven newborns with anti-rubella IgM at birth and/or at 3 months age were observed in the group with rubella before 12 weeks of gestation. There were three cases in which virological analysis of the amniotic fluid samples was positive (infected) while the newborn showed no signs of congenital rubella syndrome and anti-rubella IgM were absent. When maternal rubella occurred after 12 weeks of gestation, no fetal or neonatal rubella signs were observed. Eradication of congenital rubella syndrome is possible since vaccination campaigns continue and all services related to the health care of children, adolescents and women have become aware of the significance of the problem and are collaborating. All pregnant women in Brazil should be screened for the rubella antibody and the susceptible group should be vaccinated after giving birth.

Auditory brainstem response and otoacoustic emission assessment of hearing-impaired children of mothers who contracted rubella during pregnancy.

CONCLUSIONS: Based on the auditory brainstem response (ABR) results obtained in this study, the incidence of deafness in children whose mothers had rubella during pregnancy is high (29.5%), and deafness is profound in most cases (80%). Vaccinating women of childbearing age against rubella is essential to reduce the number of cases of childhood sensorineural hearing loss caused by gestational rubella. OBJECTIVE: It has been shown in the literature that, in Brazil, gestational rubella is responsible for approximately 21% of cases of deafness in children. The purpose of this study was to assess the incidence of deafness in children whose mothers had rubella during pregnancy. MATERIAL AND METHODS: Between February and July 2001, we conducted a prospective study assessing hearing status in 17 children (mean age 6 months). The mothers had serologically (ELISA) confirmed gestational rubella. We recorded ABRs and analysed distortion product otoacoustic emissions (DPOAEs). RESULTS: In 5 children (29.5%), ABRs revealed sensorineural hearing loss, which was moderate to severe in 1 (20%) and profound in 4 (80%). The hearing loss was bilateral in 3 children (60%) and asymmetrical in 4 (80%). Regarding DPOAEs, 7 children (41%) presented no response, and this occurred bilaterally in 4 (57%). All children with abnormal ABRs also presented abnormal DPOAEs. Two children with normal ABRs presented abnormal DPOAEs.

Gravidez em adolescentes com dermatomiosite juvenil ( DMJ ) / Pregnancy in adolescents with juvenile dermatomyositis ( JDM )

Com a melhora do prognóstico nos pacientes com dermatomiosite juvenil (DMJ), as criancas tornam-se adolescentes com possibilidade de início da vida sexual e risco de engravidar. No período entre 1983 e 2004, 4.638 pacientes foram seguidos em nosso servico, entre os quais 117 (86/74 por cento do sexo feminino) apresentaram o diagnóstico de DMJ. Entre as pacientes com DMJ, três engravidaram durante o acompanhamento. A idade da primeira atividade sexual variou entre 15 (caso 1) e 14 anos (casos 2 e 3). As gestacões, todas não planejadas, ocorreram aos 16 anos e 3 meses (caso 1), 15 anos e 4 meses (caso 2) e 14 anos e 7 meses (caso 3). A paciente 1 apresentava-se em atividade cutânea da DMJ no início da gravidez, mas evoluiu com completa remissão no 6º mês da gestacão; foram mantidos gamaglobulina endovenosa (2g/kg/mês) nos primeiros 5 meses e prednisona (5mg/dia) durante toda a gestacão; o pré-natal foi sem intercorrências; o parto foi fórcipe; o recém-nascido (RN) nasceu sem intercorrências. As pacientes 2 e 3 estavam em remissão no início da gravidez e também não apresentaram intercorrências no período pré-natal. O parto da paciente 2 foi vaginal e o RN nasceu bem, de termo e adequado para idade gestacional. No caso 3, o parto foi cesariano por reducão do líquido amniótico e o RN nasceu prematuro (36 semanas), mas bem e adequado para a idade gestacional. Em nenhuma das pacientes observou-se reativacão da DMJ no período pós-natal. A atividade sexual precoce e o aumento da gravidez em adolescentes com DMJ são assuntos que devem ser considerados na rotina do atendimento desses pacientes.

Rubéola na gestação: transmissão vertical avaliada por PCR e resultados perinatais / Rubella in pregnancy: evaluation of vertical transmission by PCR and perinatal outcome

Realizou-se estudo prospectivo em 80 pacientes com rubéola durante a gestação com o objetivo de avaliar os resultados perinatais, a taxa de transmissão vertical e a pesquisa viral utilizando-se da técnica do RT-PCR. A amniocentese foi oferecida às pacientes que apresentaram quadro clínico até 11 semanas e 6 dias de gestação. Ocorreram 5 abortamentos e 4 óbitos fetais e sete recém-nascidos apresentaram IgM positiva. A avaliação auditiva estava alterada em 3 casos e o fundo de olho em 2./ We performed a prospective study with 80 patients with rubella, during the gestational period, with the aim of evaluating perinatal outcome, vertical transmission rate and viral detection by the use of RT-PCR technique. Patients who presented the clinical features until 12 weeks and 6 days of gestation were submitted to amniocentesis...

Dopplervelocimetria dos compartimentos arterial e venoso da circulaçäo fetal e umbilical em gestaçäo de alto-risco: análise dos resultados perinatais / Dopplervelocimetry of the arterial and venous compartments of the fetal and umbilical circulation in high-risk pregnancy: perinatal results

Objetivos: estudar o perfil hemodinâmico fetal em gestantes de alto risco e avaliar a relaçäo das suas alteraçöes com os resultados perinatais. Métodos: realizou-se estudo prospectivo transversal em 108 gestantes atendidas no ambulatório de pré-natal da Clínica Obstétrica do HCFMUSP. Tais gestantes foram encaminhadas ao Setor de Avaliaçäo de Vitalidade Fetal, onde foram submetidas à dopplervelocimetria das artérias umbilicais, cerebral média, aorta, ducto venoso e veia cava inferior. Os critérios de inclusäo foram gestantes que apresentavam qualquer doença ou intercorrência na gravidez encaminhadas para avaliaçäo da vitalidade fetal, nas quais a resoluçäo da gestaçäo ocorreu nas próximas 24 horas após os exames. Foram excluídas as pacientes com gestaçäo gemelar ou com malformaçäo fetal. Resultados: as repercussöes hemodinâmicas na circulaçäo fetal foram demonstradas pela observaçäo de alteraçöes na dopplervelocimetria das artérias umbilicais, aorta, artéria cerebral média, ducto venoso e veia cava inferior. Valores alterados do índice de pulsatilidade (IP) da artéria umbilical foram observados em 25,9 por cento dos casos, da aorta em 24,0 por cento e da artéria cerebral média em 34,2 por cento. O IPV do ducto venoso estava alterado em 18,2 por cento dos casos e o da veia cava inferior em 46,6 por cento. Os segmentos da circulaçäo fetal que melhor se correlacionaram com os resultados perinatais foram a artéria umbilical e o ducto venoso. O IP alterado da artéria umbilical correlacionou-se significativamente com índices de Apgar de 1º minuto inferior a 7 em 42,8 por cento e com necessidade de UTI neonatal em 50,0 por cento dos casos. O IPV (indice de pulsatilidade para veias) do ducto venoso alterado apresentou associaçäo significativa com o índice de Apgar de 1º minuto inferior a 7 (52,6 por cento), Apgar de 5º minuto inferior a 7 (15,7 por cento), acidemia no nascimento (60,0 por cento), necessidade de UTI neonatal (52,6 por cento) e óbito neonatal (21,1 por cento). Os valores de prediçäo da alteraçäo do IPV do ducto venoso para o diagnóstico de acidemia foram: sensibilidade de 39,1; especificidade de 90,4; valor preditivo positivo de 60,0 e valor preditivo negativo de 80,2. Conclusäo: a dopplervelocimetria permite avaliar a hemodinâmica fetal nas mais variadas situaçöes e o estudo do ducto venoso constitui exame importante na avaliaçäo das alteraçöes hemodinâmicas decorrentes da hipoxia fetal

Controversias no uso de tocoliticos / Controversies in the use of tocolytics agents

Durante muitos anos acreditou-se que o problema da inibicao do trabalho de parto prematuro estava resolvido. Entretanto, ainda hoje, existem muitas duvidas sobre os riscos e beneficios dos agentes tocoliticos. Uma revisao sobre o assunto demonstra que a eficacia dos agentes tocoliticos e limitada em 24 a 48 horas de terapia. Muitos autores nao acreditam que a manutencao da terapia oral apos a inibicao das contracoes com medicacao endovenosa reduza a incidencia de recorrencias...