Emotional and Clinical Aspects Observed in Women with Gestational Trophoblastic Disease: A Multidisciplinary Action.

OBJECTIVE: To evaluate the emotional and clinical aspects observed in women with gestational trophoblastic disease (GTD) followed-up in a reference center (RC) by a multidisciplinary team. METHODS: Retrospective cohort study of the clinical records of 186 women with GTD and of the emotional aspects (EA) observed in these women by a team of psychologists and reported by the 389 support groups conducted from 2014 to 2018. RESULTS: The women were young (mean age: 31.2 years), 47% had no living child, 60% had planned the pregnancy, and 50% participated in two or more SG. Most women (n = 137; 73.6%) reached spontaneous remission of molar gestation in a median time of 10 weeks and had a total follow-up time of seven months. In the group of 49 women (26.3%) who progressed to gestational trophoblastic neoplasia (GTN), time to remission after chemotherapy was 18 weeks, and total follow-up time was 36 months. EA included different levels of anxiety and depression, more evident in 9.1% of the women; these symptoms tended to occur more frequently in women older than 40 years (p = 0.067), less educated (p = 0.054), and whose disease progressed to GTN (p = 0.018), as well as in those who had to undergo multi-agent chemotherapy (p = 0.028) or hysterectomy (p = 0.001) adjuvant to clinical treatment. CONCLUSION: This study found several EA in association with all types of GTD. It also highlights the importance of specialized care only found in a RC, essential to support the recovery of the mental health of these women.

OBJETIVO: Avaliar aspectos emocionais e clínicos observados em mulheres com doença trofoblástica gestacional (DTG) acompanhadas em um centro de referência (CR), por equipe multiprofissional. MéTODO: Estudo de coorte retrospectivo nos prontuários clínicos de 186 mulheres com DTG, e dos aspectos emocionais (AE) observados nessas mulheres pela equipe de psicólogas e registrados nos 389 grupos de apoio (GAs), ocorridos de 2014 a 2018. RESULTADOS: As pacientes eram jovens (idade média 31,2 anos), 47% sem filhos vivos, 60% tinham desejado ou planejado esta gravidez e 50% delas participaram de dois ou mais GAs. A maioria (n = 137­73,6%) apresentou remissão espontânea da gestação molar com mediana de 10 semanas e um tempo total de seguimento de 7 meses. Quarenta e nove mulheres (26,3%) evoluíram para neoplasia trofoblástica gestacional (NTG); a mediana para atingir a remissão após tratamento com quimioterapia foi de 19 semanas e o tempo total de seguimento foi de 36 meses. Os AE incluíram variados graus de ansiedade e depressão, mais evidentes em 9,1% das nossas pacientes; tais AE tenderam a ocorrer mais em mulheres com idade acima de 40 anos (p = 0,067), com menor escolaridade (p = 0,054), com evolução para NTG (p = 0,018), e nas que necessitaram de tratamento quimioterápico com regime de múltiplos agentes (p = 0,028), ou de histerectomia complementar ao tratamento clínico (p = 0,001). CONCLUSãO: Este estudo mostrou presença de vários AE associados em todos os tipos de DTG. Destaca também a importância de um atendimento psicológico especializado, somente encontrado nos CR, que é essencial para ajudar na recuperação da saúde mental dessas mulheres.

Evaluation of Angiogenic Factors (PlGF and sFlt-1) in Pre-eclampsia Diagnosis.

OBJECTIVE: Recent observations support the hypothesis that an imbalance between angiogenic factors has a fundamental role in the pathogenesis of pre-eclampsia and is responsible for the clinical manifestations of the disease. The goal of the present study was to evaluate the sensitivity, specificity, and the best accuracy level of Soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and sFlt-1/PlGF ratio in maternal serum and protein/creatinine ratio in urine sample to define the best cutoff point of these tests to discriminate between the patients with gestational hypertension and the patients with pre-eclampsia, to evaluate the possibility of using them as diagnostic methods. METHODS: A prospective longitudinal study was performed, and blood samples were collected from 95 pregnant patients with hypertension to measure serum concentrations of biomarkers sFlt-1 and PlGF. Urine samples were collected for protein screening. Significance was set as p < 0.05. RESULTS: The sFlt-1/PlGF ratio demonstrated a sensitivity of 57.5% and a specificity of 60% using 50.4 as a cutoff point. The test that showed the best accuracy in the diagnosis of pre-eclampsia was protein/creatinine ratio, with a sensitivity of 78.9% and a specificity of 70% using 0.4 as a cutoff point and showing an area under the receiver operating characteristic curve of 0.80 (p < 0.001). CONCLUSION: No studied laboratory test proved to be fairly accurate for the diagnosis of pre-eclampsia, except for the protein/creatinine ratio. The evidence is insufficient to recommend biomarkers sFlt-1 and PlGF to be used for the diagnosis of pre-eclampsia.

OBJETIVO: Pesquisas recentes sustentam a hipótese de que um desequilíbrio entre fatores angiogênicos desempenhe um papel fundamental na patogênese da pré-eclâmpsia e seja responsável pelas manifestações clínicas da doença. O objetivo do presente estudo foi avaliar a sensibilidade, a especificidade e o nível de melhor acurácia do Fator semelhante a tirosina quinase 1 (sFlt-1), Fator de crescimento placentário (PlGF), e relação sFlt-1/PlGF no soro materno e relação proteína/creatinina em amostra de urina e definir o melhor ponto de corte desses testes para distinguir pacientes com hipertensão gestacional daquelas com pré-eclâmpsia, a fim de avaliar a possibilidade de utilizá-los como métodos diagnósticos. MéTODOS: Foi realizado um estudo prospectivo longitudinal e foram coletadas amostras de sangue de 95 gestantes com hipertensão arterial para dosar as concentrações séricas dos biomarcadores sFlt-1 e PlGF. Amostras de urina foram coletadas para pesquisa de proteinúria. Foram consideradas significativas as diferenças com p < 0,05. RESULTADOS: A relação sFlt-1/PlGF demonstrou sensibilidade de 57,5% e especificidade de 60% utilizando 50,4 como ponto de corte. O teste que apresentou a melhor acurácia no diagnóstico de pré-eclâmpsia foi a relação proteína/creatinina, com sensibilidade de 78,9% e especificidade de 70%, utilizando 0,4 como ponto de corte e demostrando uma área sob a curva receiver operating characteristic (ROC, na sigla em inglês) de 0,80 (p < 0,001). CONCLUSãO: Nenhum método de rastreamento isolado se mostrou com boa acurácia para o diagnóstico de pré-eclâmpsia, exceto a relação proteína/creatinina. As evidências são insuficientes para recomendar os biomarcadores sFlt-1 e PlGF como diagnóstico de pré-eclâmpsia.

Accuracy of Prenatal Diagnosis of Congenital Cardiac MalformationsAcurácia do diagnóstico pré-natal de cardiopatias congênitas.

OBJECTIVE: To evaluate the accuracy of the diagnosis of fetal heart diseases obtained through ultrasound examinations performed during the prenatal period compared with the postnatal evaluation. METHODS: A retrospective cohort study with 96 pregnant women who were attended at the Echocardiography Service and whose deliveries occurred at the Complexo Hospitalar Santa Casa de Porto Alegre, in the state of Rio Grande do Sul, Brazil. Risk factor assessment plus sensitivity and specificity analysis were used, comparing the accuracy of the screening for congenital heart disease by means of obstetrical ultrasound and morphological evaluation and fetal echocardiography, considering p < 0.05 as significant. The present study was approved by the Research Ethics Committee of the Institution. RESULTS: The analysis of risk factors shows that 31.3% of the fetuses with congenital heart disease could be identified by anamnesis. The antepartum echocardiography demonstrated a sensitivity of 97.7%, a specificity of 88.9%, and accuracy of 93% in the diagnosis of congenital heart disease. A sensitivity of 29.3% was found for the obstetric ultrasound, of 54.3% for the morphological ultrasound, and of 97.7% for the fetal echocardiography. The fetal echocardiography detected fetal heart disease in 67.7% of the cases, the morphological ultrasound in 16.7%, and the obstetric ultrasound in 11.5% of the cases. CONCLUSION: There is a high proportion of congenital heart disease in pregnancies with no risk factors for this outcome. Faced with the disappointing results of obstetric ultrasound for the detection of congenital heart diseases and the current unfeasibility of universal screening of congenital heart diseases through fetal echocardiography, the importance of the fetal morphological ultrasound and its performance by qualified professionals is reinforced for a more appropriate management of these pregnancies.

OBJETIVO: Avaliar a acurácia do diagnóstico de cardiopatias congênitas obtidos por meio das ecografias realizadas durante o pré-natal comparativamente à avaliação pós-natal. MéTODOS: Estudo de coorte retrospectivo com 96 gestantes atendidas no Serviço de Ecocardiografia cujos partos ocorreram no Complexo Hospitalar Santa Casa de Porto Alegre, RS, Brasil. Utilizou-se a avaliação de fatores de risco e a análise de sensibilidade e especificidade, comparando-se a acurácia do rastreamento de cardiopatia congênita por meio da ecografia obstétrica, da avaliação morfológica e da ecocardiografia fetal, considerando-se como significativo um p < 0,05. O referido estudo foi aprovado pelo Comitê de Ética em Pesquisa da Instituição. RESULTADOS: A análise de fatores de risco demonstra que 31,3% dos fetos com cardiopatia congênita poderiam ser identificados pela anamnese. As ecografias anteparto possuem sensibilidade de 97,7%, especificidade de 88,9% e acurácia de 93,0% no diagnóstico da cardiopatia congênita. Ao se analisar cada tipo de ecografia separadamente, encontrou-se sensibilidade de 29,3% para a ecografia obstétrica, de 54,3% para ecografia morfológica, e de 97,7% para ecocardiografia fetal. A ecocardiografia fetal definiu a cardiopatia fetal em 67,7% dos casos, a ecografia morfológica em 16,7%, e a ecografia obstétrica em 11,5%. CONCLUSãO: Demonstra-se uma elevada proporção de cardiopatia congênita em gestações sem fatores de risco para esse desfecho. Frente aos resultados desanimadores da ecografia obstétrica para a detecção de cardiopatias congênitas e na atual inviabilidade de rastreamento universal de cardiopatias congênitas por meio da ecocardiografia fetal, reforça-se a importância da ecografia morfológica fetal e sua realização por profissionais qualificados para esse fim de forma a permitir o manejo mais adequado destas gestações.

Metabolic safety of the etonogestrel contraceptive implant in healthy women over a 3-year period.

OBJECTIVE: To ascertain whether placement of the etonogestrel contraceptive implant induces significant changes in carbohydrate and lipid metabolism, as reflected by metabolic parameters, in healthy women. STUDY DESIGN: Prospective cohort study of 213 healthy patients who received etonogestrel implants. Weight, BMI, blood pressure and a comprehensive metabolic profile were assessed at baseline, 1, 2 and 3 years. In 21 of the 213 participants, AUC for glucose levels, fasting insulin levels at baseline and year 3 (immediately before implant removal), HOMA-IR score, and the QUICK index were assessed. Parameters were expressed as median and interquartile range. The Wilcoxon test and ANOVA were used for comparison of measurements after implant placement (significance level p<0.05). RESULTS: Median age was 26 years (range, 22-31.5). Results showed a trend toward increase of the variables weight (63.3-66.1) and BMI (24.7-25.7) and a decrease in TC (172-161.5), TG (75-69.5), and LDL (100.5-98.5) (p>0.05). Of the metabolic variables, FBG (85-88) and HDL (53-46) had significant differences (p<0.002). In the subgroup of 21 patients, there were reductions in insulin levels (9.65 vs. 8.4mU/dL, p=0.03), HOMA scores (2.06 vs. 1.75, p=0.02), QUICK index (0.34 vs. 0.35, p=0.03), TC (178 vs. 160mg/dL, p=0.001), HDL (51 vs. 46mg/dL, p=0.009), and LDL (110 vs. 100mg/dL, p=0.035). CONCLUSION: These results provide evidence of the metabolic safety of the ENG implant in healthy women over a 3-year period. Indeed, implant placement induces changes consistent with a lower risk of insulin resistance and dyslipidemia.

Maternal physical activity, cervical length and its relation to spontaneous vaginal birth at term.

OBJECTIVE: Physical activity during pregnancy is known to be beneficial, however there are controversies about the risk of preterm labor, and there is no published data to assess the association between cervical length and maternal physical activity during pregnancy. Therefore, the objective of the study was to describe the cervical length in the second and third trimesters, correlating with physical activity, anthropometric characteristics, and obstetric results. METHODS: Prospective cohort with 56 pregnant women, allocated in two groups according to the answers obtained by a validating questionnaire on physical activity. It was considered significant p < 0.05. RESULTS: The length of the uterine cervix was similar between active and sedentary women, from the 22nd to the 24th week of pregnancy (p = 0.58), and from the 32nd to the 34th week (p = 0.59). Gestational age at delivery was lower among active women than among sedentary ones, although without clinical repercussion, 38.2 ± 1.2 vs. 39.1 ± 1.2 weeks, respectively (p = 0.02). Among active women, 33 (89.1 %) had natural labor, while among sedentary ones, only 13 (68.4 %) (p = 0.05). The Apgar score was higher among children of active mothers (p = 0.04). CONCLUSION: Despite being the data still to small to allow final conclusions, maternal physical activity, cervical length and its relation to spontaneous vaginal birth at term is a relevant topic for the information of women in early pregnancy. More investigations directly after specific activities such as riding, walking, and biking are needed to answer the questions we receive from our pregnant patients.

Tratamento do condiloma vulvar: relato de caso / Treatment of vulvar condyloma: case report

As lesões associadas ao papilomavírus humano (HPV), excluídas as neoplasias intraepiteliais cervicais, são mais prevalentes nas mulheres portadoras do vírus da imunodeficiência humana tipo 1 (HIV-1). Apesar de opiniões radicais a favor do tratamento cirúrgico para a maioria das lesões, a conduta terapêutica mais adequada deve ser individualizada. Relato de Caso: mulher de 25 anos, portadora do HIV-1, com extensa lesão condilomatosa vulvar, com 10 cm em seu maior diâmetro e um ano de evolução. Optou-se por realizar a exérese da lesão com cirurgia por ondas de radiofrequência. À avaliação, 90 dias após a cirurgia, não havia sinais de recidiva e não foram vistas lesões em vagina ou colo uterino. O exame anatomopatológico confirmou a hipótese diagnóstica de condiloma acuminado. Discussão: o tratamento cirúrgico de condilomas em mulheres imunodeprimidas constitui-se em opção de escolha para diminuir a transmissibilidade da infecção pelo HPV e o risco de carcinoma vulvar, aparentemente aumentado para essas pacientes. Além disso, pretende eliminar os sintomas, amenizar a carga psicológica decorrente do estigma social e melhorar o aspecto estético da paciente.

Lesions associated with human papilomavirus (HPV), excluding intraepithelial cervical neoplasias, are more prevalent among women infected with type 1 human immunodeficiency virus (HIV-1). Despite the radical opinions favoring surgical treatment for most of these lesions, the most adequate therapeutic conduct should be planned on an individual basis. Case report: A 25-year-old HIV-infected woman with an extensive vulvar condylomatous lesion of one year duration measuring 10 cm in its widest diameter was investigated. Exeresis of the lesion was performed by radio frequency waves surgery. Evaluation 90 days after surgery showed no signs of recurrence, and no lesions were observed in the vagina or uterine cervix. Anatomopathological examination confirmed the diagnostic hypothesis of condyloma acuminatum. Discussion: surgical treatment of condylomata in immunodepressed women is an option of choice in order to reduce the transmissibility of HPV infection and the risk of vulvar carcinoma, which is apparently increased in these patients. In addition, the aim of surgery is to eliminate symptoms, relieve the psychological burden due to the social stigma and improve the aesthetic appearance of the patient.

Outcomes for pregnant women infected with the influenza A (H1N1) virus during the 2009 pandemic in Porto Alegre, Brazil.

OBJECTIVE: To study the epidemiologic characteristics and underlying conditions that place pregnant women infected with H1N1 virus at increased risk for being admitted to the intensive care unit (ICU). METHODS: In this cross-sectional study conducted in Porto Alegre, Brazil, with 57 pregnant women hospitalized with the H1N1 influenza during the 2009 pandemic, we collected epidemiologic characteristics and assessed the rates of ICU admission according to pregnancy duration and the presence or absence of comorbidities. RESULTS: The median (range) of maternal age was 26 years (15-41 years), the pregnancy duration at the time of infection was 29 weeks (8-41 weeks), and the birth weight was 3180 g (740-3900 g). Five patients (8.8%) were in the first, 22 (38.6%) in the second, and 30 (52.6%) in the third trimester, and (22.8%) had comorbidities. Antiviral drugs were administered to all, and 46 (80.7%) patients received an early treatment. There were no maternal, fetal, or neonatal deaths. Eight patients (14%) required ICU admission and 15 (50%) of the patients who gave birth during their hospitalization underwent a cesarean delivery. The risk of being treated at the ICU did not increase for patients with comorbidities (P=0.22) or an advanced pregnancy (P=0.31). The study revealed a relationship between early initiation of an antiviral treatment and a lower mortality rate. CONCLUSION: Neither an advanced pregnancy nor comorbidities increased the risk of being admitted to the ICU but, compared with the results of other studies, a prompt treatment lowered mortality.

High Prevalence of Human Papillomavirus Infection among Brazilian Pregnant Women with and without Human Immunodeficiency Virus Type 1.

Objective. To estimate HPV prevalence among pregnant women from Ribeirão Preto, Brazil, and the possible influence of HIV-1 infection on this prevalence. Methods. A cross-sectional study with 44 HIV-positive and 53 HIV-negative pregnant women was conducted. Cervicovaginal specimens were obtained from all women during gynecologic exam. HPV DNA, low and high risk HPV types, was detected using conventional PCR. Statistical analysis used Student's t-test, Mann-Whitney test, Fischer's Exact test, and prevalence ratios with 95% confidence interval. Results. HIV-positive pregnant women had higher proportion of HPV infection than HIV-negative pregnant women (79.5% versus 58.5%; P < .05). HPV positivity prevalence ratio for HIV-positive women was 1.36 (95% CI 1.04-1.8; P = .03). There was significant association between HIV viral load levels and HPV positivity (P < .05). Conclusions. Our results demonstrate higher HPV positivity in HIV-infected pregnant women. Higher values of HIV viral load were associated with HPV positivity.

Profilaxia da transmissão vertical do vírus da imunodifeciência humana tipo 1 / Prophylaxis of vertical transmission human immunodeficiency virus type 1

O conhecimento progressivo dos fatores ou situações que influenciam a transmissão vertical (TV) do vírus da imunodeficiência humana tipo 1 (HIV-1) possibilitou a adoção de estratégias profiláticas com redução notável de suas taxas ao longo dos anos. Dos primeiros relatos indicando 35 por cento de TV desse vírus, observam-se taxas menores que 1 por cento na atualidade. Dentre as intervenções pré-natais de maior impacto sobre a transmissão perinatal do HIV-1 sobressai a utilização de antirretrovirais (ARV), o controle das infecções gerais e genitais, evitar condutas invasivas sobre o feto assim como sexo sem preservativos e afastar-se do uso de drogas lícitas e ilícitas. Atualmente, os esquemas de ARV consideram a Highly Active Anti-Retroviral Therapy (HAART), independete de sua finalidade terapêutica (materna) ou profilática (TV do HIV-1). O esquema HAART mais utilizado contempla a associação de inibidores da transcriptase reversa (zidovudina e lamivudina) com inibidores da protease (lopinavir e ritonavir). Completando o ciclo das estratégias obstétricas de maior impacto na redução da TV do HIV-1 está a cesárea eletiva, cuja efetividade está ligada à observação dos critérios de sua indicação (carga viral > 1.000 cópias/ml, gestação >38 semanas, membranas íntegras e fora de trabalho de parto). Sempre que possível deve-se evitar corioamniorrexe prolongada, manobras invasivas sobre o feto, parto instrumentalizado e episiotomia. Das intervenções pós-natais consideradas importantes para a redução da TV do HIV-1 são apontadas a recepção pediátrica de boa qualidade, utilização da zidovudina neonatal e a amamentação artificial.

The progressive knowledge about the factors or situations that influence the vertical transmission (VT) of human immunodeficiency type 1 (HIV-1) has led to the implementation of strategies which have promoted a remarkable decline along the years. From the first results showing 35 percent, it is possible to observe less than 1 percent nowadays. Among the prenatal interventions with higher impact on the HIV-1 VT the most evident are the use of antiretrovirals (ARV), the control of general and genital infections, and to avoid fetal invasion. Additionally, we recognize the importance of protected sex with condom and to avoid licit and illicit drugs. The modern schemes of ARV drugs during pregnancy consider the Highly Active Antiretroviral Therapy (HAART) as a rule, independently if indication is therapeutic (for mothers) or prophylactic (to avoid VT of HIV-1). The most used HAART schema among pregnant women considers the association of reverse transcriptase inhibitors (zidovudine and lamivudine) with protease inhibitors (lopinavir and ritonavir). Completing the cycle of obstetrical strategies for greater impact on reduction of VT of HIV-1, we point that the elective cesarean section has its positive role linked to the criteria of its indication (viral load higher than 1,000 copies/ml, pregnancy with more than 38 weeks, integrity of membranes, and before start the uterine contractions). If possible, we need to avoid prolonged rupture of membranes, invasive fetal management, forceps and episiotomy. Among the postnatal interventions considered important to reduce VT of HIV-1 we point that the good quality of neonatal reception, use of neonatal zidovudine, and bottle-feeding are the best.

Evaluation of IGF-2/ApaI polymorphism in pregnant women infected with human immunodeficiency virus type 1 taking antiretroviral drugs.

OBJECTIVE: Studies carried out to assess the effects of antiretroviral drugs (ARV) in HIV-1 infected pregnant women have demonstrated carbohydrate intolerance. Some reports also refer to the effect of disturbances in the expression of the insulin-like growth factor (IGF) system on pancreas beta-cell function in humans and IGF-2/ApaI polymorphisms have been associated with obesity and features of the metabolic syndromes. In the present study, we tested the association between IGF-2/ApaI genotype and hyperglycemia in HIV-1 infected pregnant women receiving ARV. DESIGN: We studied IGF-2/ApaI polymorphism in 87 healthy pregnant women, 43 HIV-1 infected pregnant women taking ARV with hyperglycemia during pregnancy, and 43 HIV-1-negative pregnant women with gestational diabetes. Blood samples were obtained for DNA extraction, PCR and genotyping. Data were analyzed statistically by the Kolmogorov-Smirnov normality, ANOVA and chi-square tests. RESULTS: There were no significant differences in genotype frequency among the three groups analyzed. Considering the HIV-1-infected pregnant women, there were no significant differences in genotype frequency between the zidovudine group and the triple antiretroviral treatment group. There were no significant differences in allele frequencies among the groups evaluated. Non-white pregnant women tended to present the GG genotypes compared to white pregnant women. CONCLUSION: These results contribute to a better understanding of metabolic glycemic disorders in HIV-1-infected pregnant women using ARV, showing that IGF-2/ApaI polymorphisms are not responsible as a single causative factor of glycemic alterations. These data indicate that other variables should be studied in order to explain these glycemic abnormalities.

Chlamydia trachomatis e gestação / Chlamydia trachomatis and pregnancy

A infecção pela Chlamydia trachomatis é uma das mais freqüentes e curáveis doenças bacterianas de transmissão sexual, constatação que traz consigo sérias conseqüências para a saúde reprodutiva da mulher. A prevalência da infecção do trato genital inferior pela C. trachomatis varia, conforme dados obtidos na literatura, entre 2 e 25 porcento, sendo mais prevalente em adultos jovens. A infecção é assintomática em 75 porcento das mulheres e em pelo menos 50 porcento dos homens, portanto, a infecção do trato genital inferior por esse agente permanece indetectável em sua grande maioria. Essa infecção situa-se entre as causas mais comuns de doença inflamatória pélvica (DIP), gravidez ectópica e infertilidade. Há aumento de evidências de que a infecção por C. trachomatis pode acarretar desfechos adversos na gestação, como abortamento, infecção intra-uterina, natimorto, prematuridade e ruptura prematura e membranas. Essa atualização focalizará a epidemiologia, características clínicas, fisiopatologia e seqüelas reprodutivas da infecção por esse agente, abordando de modo geral os métodos de triagem e o tratamento clínico preconizado.

Chlamydia trachomatis is the most common and curable bacterial disease sexually transmitted, in many countries, a fact that has serious consequences for the reproductive women's health. The prevalence of the lower tract infection with C. trachomatis varies from 2 percent to 25 percent and is higher among young people. The infection is asymptomatic in 75 percent of women and at least 50 percent of men, thus the lower genital tract infection remains largely undetected. It is a major cause of pelvic inflammatory disease (PID), which in turn is a major cause of infertility and ectopic pregnancy. It has been also demonstrated that the infection for C. trachomatis can cause adverse outcomes for the pregnancy, as abortion, intrauterine infection, stillborn, prematurity and premature rupture of membranes. This updating highlights the epidemiology, pathophysiology, clinical features and reproductive sequelae of the infection. Current screening and management methods are outlined.(au)

Visceral leishmaniasis and pregnancy: analysis of cases reported in a central-western region of Brazil.

OBJECTIVES: Because of the large number of cases of visceral leishmaniasis (VL) recorded in Brazil over the last few years, this disease has been showing characteristics different from previously known ones. We report cases of pregnant women treated for VL, describing their course and outcome and the chemotherapeutic medication used according to the clinical signs and symptoms of each patient. STUDY DESIGN: We report five cases of pregnant women treated for VL in a central-western region of Brazil. RESULTS: No case of vertical transmission was observed, even in patients who were treated after delivery. One of the patients with a late diagnosis made after the onset of symptoms died. Thus, the treatment of VL during pregnancy reduces maternal mortality and the rate of vertical transmission of the disease, being safe and effective as long as the disease is diagnosed early. CONCLUSION: At present, amphotericin B and its derivatives appear to be the best therapeutic option for the mother-child binomial.

Effects of antiretroviral agents during pregnancy on liver enzymes and amylase in HIV-exposed, uninfected newborn infants.

This study assessed the effect of antiretroviral drugs administered to pregnant women on amylase and liver enzymes of the neonate. A prospective study was conducted on 52 neonates divided into three groups: infants born to HIV-infected mothers taking zidovudine (ZDV group, n = 18), infants born to mothers taking zidovudine + lamivudine + nelfinavir (TT group, n = 22) and infants born to normal women (control group, n = 12). Umbilical cord blood from the newborn infant was used to determine liver transaminases and amylase. Data were analyzed statistically by nonparametric tests, with the level of significance set at p<0.05. The median levels for TT group newborns were 33.3 U/L for oxaloacetic transaminase, 21.5 U/L for pyruvic transaminase, 1.9 mg/dL for total bilirubin, 153 mg/dL for alkaline phosphatase, and 9.6 U/L for amylase. These results did not differ from those obtained for Control newborns or newborns exposed to ZDV alone. No association was observed between the use of antiretroviral drugs during pregnancy and adverse effects on neonatal amylase and hepatic parameters at birth.

Effects of antiretroviral agents during pregnancy on liver enzymes and amylase in HIV-exposed, uninfected newborn infants

This study assessed the effect of antiretroviral drugs administered to pregnant women on amylase and liver enzymes of the neonate. A prospective study was conducted on 52 neonates divided into three groups: infants born to HIV-infected mothers taking zidovudine (ZDV group, n = 18), infants born to mothers taking zidovudine + lamivudine + nelfinavir (TT group, n = 22) and infants born to normal women (control group, n = 12). Umbilical cord blood from the newborn infant was used to determine liver transaminases and amylase. Data were analyzed statistically by nonparametric tests, with the level of significance set at p<0.05. The median levels for TT group newborns were 33.3 U/L for oxaloacetic transaminase, 21.5 U/L for pyruvic transaminase, 1.9 mg/dL for total bilirubin, 153 mg/dL for alkaline phosphatase, and 9.6 U/L for amylase. These results did not differ from those obtained for Control newborns or newborns exposed to ZDV alone. No association was observed between the use of antiretroviral drugs during pregnancy and adverse effects on neonatal amylase and hepatic parameters at birth.