Efeito de um treinamento de músculos pélvicos em grupo para mulheres com incontinência urinária: um ensaio clínico randomizado / Effect of a training of pelvic muscles in group for women with urinary incontinence: arandomized clinical test

Introdução: A incontinência urinária (IU) é um problema muitas vezes subestimado, não recebendo a devida atenção. Dentre as possibilidades de tratamento conservador da IU, o treinamento dos músculos do assoalho pélvico (TMAP) supervisionado deve ser recomendado como primeira linha de tratamento para as mulheres. O TMAP pode ser desenvolvido em grupos, individualmente e em casa. Objetivos: Ainda há poucos estudos na literatura envolvendo TMAP em grupo com protocolos definidos que possam ser facilmente compreendidos e reproduzidos pelos pacientes. O objetivo deste estudo é demonstrar a eficácia de um protocolo de TMAP em grupo comparado a um protocolo de TMAP domiciliar para mulheres com IU. Métodos: Este foi um estudo experimental controlado randomizado cego que seguiu as recomendações do CONSORT. Os instrumentos de avaliação foram a escala PERFECT, ICIQ-SF e PISQ-12. O principal resultado foi a melhora da função dos músculos do assoalho pélvico (MAP) e os resultados secundários foram a melhora da qualidade de vida (QV) e da função sexual (FS). Resultados: Com doze semanas de tratamento o protocolo do grupo TMAP apresentou-se como uma forma de tratamento mais eficaz para IU, pois apresentou melhora nos itens potência e QV. Ao observar a efetividade dos protocolos, após vinte e quatro semanas, ambos foram efetivos apenas no que se refere aos desfechos secundários, QV e FS. Conclusão: Pode-se supor que a intervenção em grupo, utilizada nesta amostra específica, constitui uma estratégia de intervenção fisioterapêutica factível e viável, capaz de beneficiar muitas mulheres com IU, além de ser uma ferramenta de fácil compreensão e acompanhamento pelos pacientes.

Single-dose antibiotic therapy for urinary infections during pregnancy: A systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: During pregnancy, urinary infections are an important cause of maternofetal morbidity and mortality and may lead to several complications. OBJECTIVE: To verify whether the use of antibiotic therapy in a single dose when compared with multiple doses in lower tract urinary infections during pregnancy is effective to obtain microbiologic cure. SEARCH STRATEGY: Online databases were searched. Keywords used were "single-drug dose", "antibiotic", "fosfomycin", "amoxicillin", "trimethoprim", "pregnancy", and "urinary tract infection". SELECTION CRITERIA: Studies were included if they were randomized controlled trials, the population was pregnant woman, microbiologic cure was attained, and one of the treatment groups received single-dose antibiotic therapy. DATA COLLECTION AND ANALYSIS: Preselected studies have been independently read by pairs, and data were extracted according to a predetermined sheet. The Cochrane tool was used for the risk of bias. MAIN RESULTS: A total of 1063 women from nine studies were included. The primary outcome was the microbiologic cure attested by urine culture. When compared with the multiple-day use of antibiotics, the single-dose treatment has shown statistically similar results in reaching culture cure (odds ratio 1.02, 95% confidence interval 0.73-1.44). CONCLUSION: The current study has shown that the use of single-dose treatment for lower tract urinary infections during pregnancy can be recommended, especially using fosfomycin. SYSTEMATIC REVIEW REGISTRATION: This review has not been registered.

Can the inability to contract the pelvic floor muscles influence the severity of urinary incontinence symptoms in females?

INTRODUCTION AND HYPOTHESIS: The objective was to analyze if the inability to perform a maximal voluntary contraction (MVC) of the pelvic floor muscles (PFMs) in a first assessment can influence the severity of urinary incontinence symptoms in women. METHODS: A cross-sectional study was carried out using the medical records of women with UI who were referred for pelvic floor physiotherapy after undergoing a gynecological evaluation between May 2013 and December 2019. Records included data referring to age, body mass index (BMI), obstetric history, Modified Oxford Scale (MOS), and the final score of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) from a baseline assessment. Data were divided into women who were unable and those who were able to voluntarily perform an MVC of the PFMs. Statistical analysis was conducted using SPSS version 21. RESULTS: A total of 498 medical records were analyzed and 36.3% of those women were not able to perform a PFM MVC after verbal command and digital stimulus. Homogeneity was observed among groups and no significant difference was found regarding the severity of UI symptoms when the groups were compared. CONCLUSIONS: No association was found between the inability to contract the PFMs and the severity of UI symptoms. Other studies should be developed to better understand why some women are incapable of performing a voluntary PFM contraction. Also, it would be relevant to compare women with PFM dysfunction who are not able to contract the PFMs with healthy women with the same PFM condition to analyze whether this muscle condition could be related to dysfunctions such as UI or pelvic organ prolapse.

Temporal Evolution of Maternal Mortality: 1980-2019.

OBJECTIVE: To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution. METHODS: Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327). RESULTS: After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%). CONCLUSION: Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.

OBJETIVO: Determinar o perfil dos óbitos maternos ocorridos no período de 2000 a 2019 no Hospital de Clínicas de Porto Alegre (HCPA) e comparar com os óbitos maternos entre 1980 e 1999 na mesma instituição. MéTODOS: Estudo retrospectivo que analisou 2.400 prontuários de mulheres entre 10 e 49 anos que morreram entre 2000 e 2019. O presente estudo foi aprovado pelo Comitê de Ética (CAAE 78021417600005327). RESULTADOS: Após revisão de 2.481 prontuários de mulheres que morreram em idade reprodutiva, 43 mortes ocorreram durante a gravidez ou no período pós-parto. Destas, 28 foram considerados óbitos maternos. A taxa de mortalidade materna foi de 37.6 por 100.000 nascidos vivos. Em relação às causas, 16 óbitos (57.1%) estiveram diretamente associados à gravidez, 10 (35.1%) estiveram indiretamente associados e 2 (7.1%) não estiveram relacionados. A principal causa de morte foi hipertensão na gravidez (31.2%) seguida de esteatose hepática aguda da gravidez (25%). No estudo anterior, publicado em 2003 na mesma instituição4, a taxa de mortalidade foi de 129 por 100.000 nascidos vivos, e a maioria dos óbitos estava relacionada a causas obstétricas diretas (62%). As principais causas de óbito neste período foram por complicações hipertensivas (17.2%), seguidas de infecção pós-cesárea (16%). CONCLUSãO: Em comparação com os dados anteriores à década de 2000, houve uma redução importante das mortes maternas por causas infecciosas.

Temporal Evolution of Maternal Mortality: 1980-2019 / Evolução temporal da mortalidade materna: 1980-2019

Abstract Objective To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution. Methods Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327). Results After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%). Conclusion Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.

Resumo Objetivo Determinar o perfil dos óbitos maternos ocorridos no período de 2000 a 2019 no Hospital de Clínicas de Porto Alegre (HCPA) e comparar com os óbitos maternos entre 1980 e 1999 na mesma instituição. Métodos Estudo retrospectivo que analisou 2.400 prontuários de mulheres entre 10 e 49 anos que morreram entre 2000 e 2019. O presente estudo foi aprovado pelo Comitê de Ética (CAAE 78021417600005327). Resultados Após revisão de 2.481 prontuários de mulheres que morreram em idade reprodutiva, 43 mortes ocorreram durante a gravidez ou no período pós-parto. Destas, 28 foram considerados óbitos maternos. A taxa de mortalidade materna foi de 37.6 por 100.000 nascidos vivos. Em relação às causas, 16 óbitos (57.1%) estiveram diretamente associados à gravidez, 10 (35.1%) estiveram indiretamente associados e 2 (7.1%) não estiveram relacionados. A principal causa de morte foi hipertensão na gravidez (31.2%) seguida de esteatose hepática aguda da gravidez (25%). No estudo anterior, publicado em 2003 na mesma instituição4, a taxa de mortalidade foi de 129 por 100.000 nascidos vivos, e a maioria dos óbitos estava relacionada a causas obstétricas diretas (62%). As principais causas de óbito neste período foram por complicações hipertensivas (17.2%), seguidas de infecção pós-cesárea (16%). Conclusão Em comparação com os dados anteriores à década de 2000, houve uma redução importante das mortes maternas por causas infecciosas.

Peripartum Hysterectomies over a Fifteen-year Period.

OBJECTIVE: To determine the indications and outcomes of peripartum hysterectomies performed at Hospital de Clínicas de Porto Alegre (a university hospital in Southern Brazil) during the past 15 years, and to analyze the clinical characteristics of the women submitted to this procedure. METHODS: A cross-sectional study of 47 peripartum hysterectomies from 2005 to 2019. RESULTS: The peripartum hysterectomies performed in our hospital were indicated mainly due to placenta accreta or suspicion thereof (44.7% of the cases), puerperal hemorrhage without placenta accreta (27.7%), and infection (25.5%). Total hysterectomies accounted for 63.8% of the cases, and we found no difference between total versus subtotal hysterectomies in the studied outcomes. Most hysterectomies were performed within 24 hours after delivery, and they were associated with placenta accreta, placenta previa, and older maternal age. CONCLUSION: Most (66.0%) patients were admitted to the intensive care unit (ICU). Those who did not need it were significantly older, and had more placenta accreta, placenta previa, or previous Cesarean delivery.

OBJETIVO: Determinar as indicações e os desfechos das histerectomias periparto realizadas no Hospital de Clínicas de Porto Alegre nos últimos 15 anos, bem como analisar as características clínicas das mulheres submetidas a esse procedimento. MéTODOS: Estudo transversal de 47 histerectomias periparto realizadas no período de 2005 a 2019. RESULTADOS: Em nosso hospital, as histerectomias periparto foram indicadas principalmente por acretismo placentário ou sua suspeita (44,7% dos casos), hemorragia puerperal sem acretismo placentário (27,7%), e infecção (25,5%). Histerectomias totais corresponderam a 63,8% dos casos, e não encontramos diferença entre histerectomia total e subtotal para os desfechos estudados. A maioria das histerectomias foi realizada dentro de 24 horas após o parto, o que estava associado a acretismo placentário, placenta prévia, e idade materna mais avançada. CONCLUSãO: A maioria (66,0%) das mulheres necessitou de internação em unidade de terapia intensiva (UTI); aquelas que não necessitaram eram significativamente mais velhas, e tinham mais acretismo placentário, placenta prévia, ou cesárea prévia.

Peripartum Hysterectomies over a Fifteen-year Period / Histerectomias periparto ao longo de um período de quinze anos

Abstract Objective To determine the indications and outcomes of peripartum hysterectomies performed at Hospital de Clínicas de Porto Alegre (a university hospital in Southern Brazil) during the past 15 years, and to analyze the clinical characteristics of the women submitted to this procedure. Methods A cross-sectional study of 47 peripartum hysterectomies from 2005 to 2019. Results The peripartum hysterectomies performed in our hospital were indicated mainly due to placenta accreta or suspicion thereof (44.7% of the cases), puerperal hemorrhage without placenta accreta (27.7%), and infection (25.5%). Total hysterectomies accounted for 63.8% of the cases, andwefound no differencebetween total versus subtotal hysterectomies in the studied outcomes. Most hysterectomies were performed within 24 hours after delivery, and they were associated with placenta accreta, placenta previa, and older maternal age. Conclusion Most (66.0%) patients were admitted to the intensive care unit (ICU). Those who did not need it were significantly older, and had more placenta accreta, placenta previa, or previous Cesarean delivery.

Resumo Objetivo Determinar as indicações e os desfechos das histerectomias periparto realizadas no Hospital de Clínicas de Porto Alegre nos últimos 15 anos, bem como analisar as características clínicas das mulheres submetidas a esse procedimento. Métodos Estudo transversal de 47 histerectomias periparto realizadas no período de 2005 a 2019. Resultados Em nosso hospital, as histerectomias periparto foram indicadas principalmente por acretismo placentário ou sua suspeita (44,7% dos casos), hemorragia puerperal sem acretismo placentário (27,7%), e infecção (25,5%). Histerectomias totais corresponderam a 63,8% dos casos, e não encontramos diferença entre histerectomia total e subtotal para os desfechos estudados. Amaioria das histerectomias foi realizada dentro de 24 horas após o parto, o que estava associado a acretismo placentário, placenta prévia, e idade materna mais avançada. Conclusão A maioria (66,0%) das mulheres necessitou de internação em unidade de terapia intensiva (UTI); aquelas que não necessitaram eram significativamente mais velhas, e tinham mais acretismo placentário, placenta prévia, ou cesárea prévia.

Increased of the carotid intima media thickness in preeclampsia.

Objectives The aim of the study was to determine carotid intima-media thickness (CIMT) values in patients who developed and did not develop preeclampsia (PE), and to determine whether CIMT values could be predictors of PE development. Methods The study included pregnant women who were examined by regular ultrasound examination at the Materno-Infantil Presidente Vargas Hospital (HMIPV) in Porto Alegre, Brazil, from April 2016 to September 2017. The examinations were performed every three months. Patients were divided into two groups. The first group included patients diagnosed with PE (n=21) and second group included patients who did not have PE (n=199). A high frequency ultrasound device (12 MHz) with a semi-automatic method was used to estimate CIMT. Results CIMT was significantly higher in pregnant women with PE than in women without PE (55±0.11 vs. 0.44±0.06, respectively; p<0.001). Using a cut-off value of 0.51 mm, CIMT had a specificity of 77.9% and sensitivity of 81% in the diagnosis of PE. With CIMT ≥0.6 mm, the probability of a patient developing PE was 44.4%; with CIMT >0.42 mm, the probability was only 4.2%. Conclusions An increase in CIMT was associated with the onset of PE. CIMT values were significantly higher in patients who develop PE.

Pre-eclampsia/Eclampsia.

Pre-eclampsia is a multifactorial and multisystemic disease specific to gestation. It is classically diagnosed by the presence of hypertension associated with proteinuria manifested in a previously normotensive pregnant woman after the 20th week of gestation. Pre-eclampsia is also considered in the absence of proteinuria if there is target organ damage. The present review takes a general approach focused on aspects of practical interest in the clinical and obstetric care of these women. Thus, it explores the still unknown etiology, current aspects of pathophysiology and of the diagnosis, the approach to disease prediction, its adverse outcomes and prevention. Management is based on general principles, on nonpharmacological and on pharmacological clinical treatment of severe or nonsevere situations with emphasis on the hypertensive crisis and eclampsia. Obstetric management is based on preeclampsia without or with signs of clinical and/or laboratory deterioration, stratification of gestational age in < 24 weeks, between 24 and less than 34 weeks, and ≥ 34 weeks of gestation, and guidance on route of delivery. An immediate puerperium approach and repercussions in the future life of pregnant women who develop preeclampsia is also presented.

A pré-eclâmpsia é uma doença multifatorial e multissistêmica específica da gestação. É classicamente diagnosticada pela presença de hipertensão arterial associada à proteinúria em gestante previamente normotensa após a 20a semana de gestação. A pré-eclâmpsia também é considerada na ausência de proteinúria se houver lesão de órgão-alvo. A presente revisão tem uma abordagem geral focada em aspectos de interesse prático na assistência clínica e obstétrica dessas mulheres. Assim, explora a etiologia ainda desconhecida, aspectos atuais da fisiopatologia e do diagnóstico e diagnóstico diferencial de convulsões, a abordagem da predição da doença, seus resultados adversos e prevenção. A conduta baseia-se em princípios gerais, tratamento clínico não farmacológico e farmacológico de situações graves ou não graves, com ênfase na crise hipertensiva e eclâmpsia. O controle obstétrico se fundamenta na pré-eclâmpsia sem ou com sinais de deterioração clínica e/ou laboratorial, estratificação da idade gestacional abaixo de 24 semanas, entre 24 e menos de 34 semanas e 34 ou mais semanas de gestação e orientação na via de parto. Uma abordagem imediata do puerpério e repercussões na vida futura de gestantes que desenvolvem pré-eclâmpsia também foram apresentadas.

Pré-eclâmpsia/eclâmpsia / Pre-Eclampsia/Eclampsia

A pré-eclâmpsia é uma doença multifatorial e multissistêmica específica da gestação. É classicamente diagnosticada pela presença de hipertensão arterial associada à proteinúria em gestante previamente normotensa após a 20a semana de gestação. A pré-eclâmpsia também é considerada na ausência de proteinúria se houver lesão de órgão-alvo. A presente revisão tem uma abordagem geral focada em aspectos de interesse prático na assistência clínica e obstétrica dessas mulheres. Assim, explora a etiologia ainda desconhecida, aspectos atuais da fisiopatologia e do diagnóstico e diagnóstico diferencial de convulsões, a abordagem da predição da doença, seus resultados adversos e prevenção. A conduta baseia-se em princípios gerais, tratamento clínico não farmacológico e farmacológico de situações graves ou não graves, com ênfase na crise hipertensiva e eclâmpsia. O controle obstétrico se fundamenta na pré-eclâmpsia sem ou com sinais de deterioração clínica e/ou laboratorial, estratificação da idade gestacional abaixo de 24 semanas, entre 24 e menos de 34 semanas e 34 ou mais semanas de gestação e orientação na via de parto. Uma abordagem imediata do puerpério e repercussões na vida futura de gestantes que desenvolvem pré-eclâmpsia também foram apresentadas.(AU)

Pre-eclampsia is a multifactorial and multisystemic disease specific to gestation. It is classically diagnosed by the presence of hypertension associated with proteinuria manifested in a previously normotensive pregnant woman after the 20th week of gestation. Pre-eclampsia is also considered in the absence of proteinuria if there is target organ damage. The present review takes a general approach focused on aspects of practical interest in the clinical and obstetric care of these women. Thus, it explores the still unknown etiology, current aspects of pathophysiology and of the diagnosis, the approach to disease prediction, its adverse outcomes and prevention. Management is based on general principles, on nonpharmacological and on pharmacological clinical treatment of severe or nonsevere situations with emphasis on the hypertensive crisis and eclampsia. Obstetric management is based on preeclampsia without or with signs of clinical and/or laboratory deterioration, stratification of gestational age in < 24 weeks, between 24 and less than 34 weeks, and ≥ 34 weeks of gestation, and guidance on route of delivery. An immediate puerperium approach and repercussions in the future life of pregnant women who develop preeclampsia is also presented.(AU)

Depression, lower urinary tract symptoms and quality of life in women with multiple sclerosis: a descriptive and correlational study

Introduction: Among the most ordinary clinical manifestations of Multiple Sclerosis (MS) are depression and the presence of Lower Urinary Tract Symptoms (LUTS). Both can compromise a person's quality of life. The objective of this research was to identify the major urinary symptoms and correlate them with quality of life and with depressive symptoms in women with MS. Methods: This was an observatory, descriptive and correlational study, with nonprobabilistic sampling by convenience. This research included women over 18 years old who displayed LUT symptoms and who had been diagnosed with Relapsing-Remitting MS. Assessment consisted of an anamnesis card, the Kurtzke Expanded Disability Status Scale (EDSS), the Incontinence Impact Questionnaire-7 (IIQ-7-BR), the Urogenital Distress Inventory-6 (UDI-6-BR), the Beck Depression Inventory-2 (BDI-II) and the Multiple Sclerosis Quality of Life Questionnaire - Portuguese version (MSQOL-54). Results: 41 women participated in the study, with average age of 50.1 (± 9.45) and average of 4.11 in the EDSS. The most common urinary symptom was urinary urgency (78%). There was no correlation between the severity of the urinary symptom and quality of life. Moderate and significant negative correlation (r = -0.561 p < 0.001) was found between depression and the physical component of quality of life and strong negative correlation (r = -0.729 p < 0.001) was found between depression and the mental component. Conclusions: The most prevalent urinary symptom was urinary urgency. A strong correlation was found between symptoms of depression and quality of life and there was no correlation between urinary symptoms and quality of life.

Associations of birth mode with cord blood cytokines, white blood cells, and newborn intestinal bifidobacteria.

The associations of Cesarean delivery with offspring metabolic and immune-mediated diseases are believed to derive from lack of mother-to-newborn transmission of specific microbes at birth. Bifidobacterium spp., in particular, has been hypothesized to play a health-promoting role, yet little is known about how delivery mode modifies colonization of the newborn by this group of microbes. The aim of this research was to examine the presence of Bifidobacterium in meconium and in the transitional stool, and to assess cytokine levels and hematological parameters in the venous cord blood of infants born by elective, pre-labor Cesarean section vs. vaginal delivery in Southern Brazil. We recruited 89 mother-newborn pairs (23 vaginal delivery and 66 elective cesarean delivery), obtained demographic information from a structured questionnaire and clinical information from medical records. We obtained umbilical cord venous blood and meconium samples following delivery and the transitional stool (the first defecation after meconium) before discharge. We determined plasma levels of IL-1ß, IL-10, IL-6, GM-CSF, IL-5, IFN-γ, TNF-α, IL-2, IL-4 and IL-8 in the cord blood, and presence of stool Bifidobacterium by real time PCR. Compared to vaginally-delivered neonates, Cesarean-delivered neonates had a lower leukocyte count (p = 0.037), lower hemoglobin (p = 0.04), and lower levels of the cytokine GM-CSF (p = 0.009) in the cord blood. Moreover, Bifidobacterium was detected less often in the transitional stool of Cesarean-delivered neonates compared to vaginally-delivered neonates (p = 0.001). The results indicate that pre-labor Cesarean birth may be associated with microbial and hematological alterations in the neonate. The clinical significance of these findings remains to be determined in larger prospective birth cohort studies.