Impact of pregestational obesity on perinatal complications: update in a Latin American cohort.

OBJECTIVES: While the association between pregestational obesity and perinatal complications has been established, it is necessary to update the current understanding of its impact on maternal and foetal health due to its growing prevalence. Thus, this study aimed to investigate the association between pregestational obesity with the leading perinatal complications during the last 6 years. STUDY DESIGN: A cross-sectional study was performed in San Felipe, Chile. Anonymised data of 11,197 deliveries that occurred between 2015 and 2021 were included. METHODS: Pregestational body mass index was defined according to the World Health Organisation during the first trimester of pregnancy. The association between pregestational obesity and perinatal complications was analysed by calculating the odds ratio (OR), which was adjusted for confounding variables. Statistical differences were considered with a P-value of <0.05. RESULTS: The prevalence of pregestational obesity was 30.1%. Pregestational obesity was related to a high incidence of perinatal complications (≥3 complications; P < 0.0001). The main perinatal complications were caesarean section, large for gestational age (LGA), gestational diabetes (GD), macrosomia, hypertensive disorders of pregnancy (HDP), premature rupture of membranes (PROM), intrauterine growth restriction, and failed induction. Pregestational obesity was shown to be a risk factor for macrosomia (OR: 2.3 [95% confidence interval {95% CI}: 2.0-2.8]), GD (OR: 1.9 [95% CI: 1.6-2.1]), HDP (OR: 1.8 [95% CI: 1.5-2.1]), LGA (OR: 1.6 [95% CI: 1.5-1.8]), failed induction (OR: 1.4 [95% CI: 1.0-1.8]), PROM (OR: 1.3 [95% CI: 1.1-1.6]), and caesarean section (OR: 1.3 [95% CI: 1.2-1.4]). CONCLUSIONS: Pregestational obesity has been shown to be a critical risk factor for the main perinatal complications in the study population. Pregestational advice is imperative not only in preventing pregestational obesity but also in the mitigation of critical perinatal complications once they arise.

Incidência da mola hidatiforme na Escola Paulista de Medicina / Incidence of hydatidiform mole at the Escola Paulista de Medicina

No período de janeiro de 1980 a dezembro de 1989 foram atendidas na Escola Paulista de Medicina, um centro de referência, 75 pacientes com mola hidatiforme, das quais 65 se submeteram a esvaziamento em nosso serviço, e dez em outros. Para o cálculo da freqüência da mola hidatiforme utilizamos somente as 65 pacientes cujo esvaziamento molar se procedeu na Escola Paulista de Medicina em relaçäo a 13.986 gravidezes (partos, abortos e gravidezes sectópicas) ocorridas no período estudado. Deste modo, a freqüência da mola hidatiforme foi de 1:215 gravidezes, valor comparável aos países asiáticos e africanos

[Incidence of hydatidiform mole at the Paulista Medical School]. / Incidência da mola hidatiforme na Escola Paulista de Medicina.

Between January 1980 and December 1989, at Escola Paulista de Medicina, a referral centre, 75 patients with hydatiform mole were assisted. The frequency of the hydatiform mole was calculated in 65 patients, whose treatment was performed in our Hospital, out of 13,986 pregnancies, which had occurred in this period of study. Thus, the incidence was 1:215 pregnancies, similar to that found in Asian and African countries.

[Relationship between hypertensive states and perinatal prognosis in abruptio placentae]. / Relação entre os estados hipertensivos e o prognóstico perinatal no descolamento prematuro da placenta.

Ninety-one occurrences of abruptio placentae were analyzed by the Department of Obstetrics of the São Paulo School of Medicine in São Paulo, Brazil during a ten-year period, from 1979 to 1988. The purpose was to analyze perinatal prognosis and its relation to hypertensive states. The authors observed that arterial hypertension was present in 75% of the cases, most of which chronic arterial hypertension; they also observed that perinatal mortality increased in the presence of high arterial blood pressure.

Incidence and etiology of postcesarean section morbity

In view of the different concepts found in the literature regarding puerperal febrile morbidity we performed a prospective study in order to observe the incidence of postcesarean section febrile morbidity in the Hospital Säo Paulo, Escola Paulista de Medicina, as well as to identify the puerperal febrile pathologies involved. Postcesarean section febrile morbidity was observed in 13.07 per cent on the puerperae. Infection of the surgical wound, present in 67.1 per cent of the febrile cases, was the most frequent pathology. Puerperal infection was the second most common cause (24.3 per cent)

Incidence of postcesarian febrile morbidity as related to prenatal care and nutritional state before pregnancy

Two hundred and eight-three patients were studied regarding prenatal care and nutritional state as related to incidence of postcesarean febrile morbidity. Regarding place of prenatal care, the results showed a statistically higler incidence in patients not attended at the Service of the Hospital Säo Paulo, Escola Paulista de Medicina. No difference of postecesarean febrile morbidity could be observed between patients attended at the Hospital Säo Paulo and those attende elsewhere regarding number of medical examinations during prenatal care. In regard to the nutritional state before pregnancy, obese and undernourished patients presented a statistically higher incidence when compared to eutrophic patients

[Acquired immunodeficiency syndrome (AIDS)]. / Sindrome da imunodeficiencia adquirida (AIDS).

PIP: Although not as common as for males, 4-7% of AIDS reports are in females, therefore allowing the possibility of perinatal transmission. Some routes of transmission are suspected: 1) intrauterine transmission, 2) during delivery, 3) breastfeeding, 4) direct contact between parents and infant. Some studies suggest that pregnancy increases the likelihood for disease development. The HTLV-III virus has been identified in breast milk, therefore breastfeeding is not recommended to mothers with AIDS. The HIV test is recommended to pregnant women with evidence of infections or that have been using IV drugs, women from high incidence areas, prostitutes, and those with high risk group partners.^ieng

Anestesia com quetamina. Estudo comparativo entre tiopental sodico e diazepam na prevencao de seus efeitos psicotomimeticos e circulatorios. / Ketamine anesthesia. A comparative study of sodic thiopental and diazepam in prevention of psucotomimetic and circulatory effects

Estudo de 150 pacientes submetidos a anestesia pela quetamina, avaliando com analise "duplo-cego", a eficiencia de duas medicacoes pre-anestesicas - pentotal sodico e diazepam - na prevencao dos efeitos psicotomimeticos e circulatorios deste tipo de anestesia. Com ambas as medicacoes pre-anestesicas obteve-se consideravel reducao das manifestacoes psiquicas. Da mesma forma observou-se reducao da taquicardia provocada pela quetamina, embora nao tenha havido protecao contra a hipertensao arterial