[Podocyturia in pregnant women with chronic hypertension may predict kidney injury?]. / Podocitúria em gestantes hipertensas crônicas pode predizer dano renal?

PURPOSE: To evaluate the presence of podocyturia in chronic hypertensive pregnant women in the third trimester of pregnancy and its possible association with renal disease. METHODS: This was an observational study of a convenience sample of 38 chronic hypertensive pregnant women. The podocytes were labeled by the indirect immunofluorescence technique with anti-podocin and diamidino-phenylindole (DAPI). The count was made on 30 random fields analyzed and corrected according to urinary creatinine (podocytes/mg creatinine). The patients were assigned to two groups: NG (normal glomerular function), up to 100 podocytes, and GP (probable glomerulopathy), more than 100 podocytes. Urinary creatinine was measured by the alkaline picrate method. The variables analyzed were body mass index, gestational age, and systolic and diastolic blood pressure at the time of sample collection. Data were analyzed using the SPSS - version 16.0 (IBM - USA). Statistical analysis was performed by the χ2 test, and significant differences were considered when p<0.05. RESULTS: The median podocyte count was 20.3 (0.0-98.1) for group GN, and 176.9 (109.1-490.6) for GP. The mean body mass index was 30.2 kg/m2 (SD=5.6), mean gestational age was 35.1 weeks (SD=2.5), median systolic blood pressure was 130.0 mmHg (100.0-160.0) and median diastolic blood pressure was 80.0 mmHg (60.0-110.0). There was no significant correlation between podocyturia and body mass index (p=0.305), gestational age (p=0.392), systolic blood pressure (p=0.540) or diastolic blood pressure (p=0.540). CONCLUSIONS: In this study, there was no podocyturia pattern consistent with the presence of active renal disease, although some of the women studied (15.8%) exhibited a significant loss. We believe that it is premature to recommend the inclusion of the determination of podocyturia in routine prenatal clinical practice in chronically hypertensive pregnant women.

Podocitúria em gestantes hipertensas crônicas pode predizer dano renal? / Podocyturia in pregnant women with chronic hypertension may predict kidney injury?

OBJETIVO: Avaliar a presença de podocitúria em gestantes hipertensas crônicas no terceiro trimestre da gestação e a associação com doença renal. MÉTODOS: Estudo observacional descritivo em uma amostra de conveniência de 38 gestantes hipertensas crônicas. Os podócitos foram marcados com técnica de imunofluorescência indireta com antipodocina e diamidino-fenilindol (DAPI). A contagem foi feita a partir de 30 campos analisados de forma aleatória, corrigida pela creatinina urinária (podócitos/mg de creatinina). Foram assumidos dois grupos: grupo GN (função glomerular normal), com até 100 podócitos, e grupo GP (provável glomerulopatia), com mais de 100 podócitos. A dosagem de creatinina foi realizada com uso da técnica do picrato alcalino. As variáveis de análise foram o índice de massa corpórea, a idade gestacional na coleta, a pressão arterial sistólica e a pressão arterial diastólica no momento da coleta. Para a análise dos dados, foi utilizado o programa SPSS - versão 16.0. (IBM - USA). Nas análises estatísticas, foi utilizado o teste do χ2, sendo consideradas diferenças significantes valores de p<0,05. RESULTADOS: A contagem de podócitos no grupo GN teve mediana de 20,3 (0,0 a 98,1), e no grupo GP, de 176,9 (109,1 a 490,6). A média do índice de massa corpórea foi 30,2 kg/m2 (DP=5,6), a média da idade gestacional foi de 35,1 semanas (DP=2,5), a mediana da pressão arterial sistólica foi de 130,0 mmHg (100,0-160,0) e a mediana da pressão arterial diastólica de 80,0 mmHg (60,0-110,0). Não houve correlação significativa entre podocitúria e índice de massa corpórea (p=0,305), idade gestacional na coleta (p=0,392), pressão arterial sistólica (p=0,540) e pressão arterial diastólica (p=0,540). CONCLUSÕES: Não foi identificado um padrão de podocitúria compatível com a presença de glomerulopatia ativa, ainda que algumas das gestantes (15,8%) tenham exibido perda podocitária expressiva. Consideramos ser prematuro recomendar para a prática ...

PURPOSE: To evaluate the presence of podocyturia in chronic hypertensive pregnant women in the third trimester of pregnancy and its possible association with renal disease. METHODS: This was an observational study of a convenience sample of 38 chronic hypertensive pregnant women. The podocytes were labeled by the indirect immunofluorescence technique with anti-podocin and diamidino-phenylindole (DAPI). The count was made on 30 random fields analyzed and corrected according to urinary creatinine (podocytes/mg creatinine). The patients were assigned to two groups: NG (normal glomerular function), up to 100 podocytes, and GP (probable glomerulopathy), more than 100 podocytes. Urinary creatinine was measured by the alkaline picrate method. The variables analyzed were body mass index, gestational age, and systolic and diastolic blood pressure at the time of sample collection. Data were analyzed using the SPSS - version 16.0 (IBM - USA). Statistical analysis was performed by the χ2 test, and significant differences were considered when p<0.05. RESULTS: The median podocyte count was 20.3 (0.0-98.1) for group GN, and 176.9 (109.1-490.6) for GP. The mean body mass index was 30.2 kg/m2 (SD=5.6), mean gestational age was 35.1 weeks (SD=2.5), median systolic blood pressure was 130.0 mmHg (100.0-160.0) and median diastolic blood pressure was 80.0 mmHg (60.0-110.0). There was no significant correlation between podocyturia and body mass index (p=0.305), gestational age (p=0.392), systolic blood pressure (p=0.540) or diastolic blood pressure (p=0.540). CONCLUSIONS: In this study, there was no podocyturia pattern consistent with the presence of active renal disease, although some of the women studied (15.8%) exhibited a significant loss. We believe that it is premature to recommend the inclusion of the determination of podocyturia in routine prenatal clinical practice in chronically hypertensive pregnant women. .

[Maternal and perinatal outcomes in Bolivian pregnant women in the city of São Paulo: a cross-sectional case-control study]. / Desfechos maternos e perinatais em gestantes bolivianas no município de São Paulo: um estudo transversal caso-controle.

PURPOSE: to evaluate the characteristics regarding care of Bolivian pregnant women and their outcomes in Hospital Municipal Vereador José Storopolli. METHODS: a cross-sectional retrospective case-control study comparing two groups of pregnant women from 2003 to 2007. The Study Group included 312 Bolivian pregnant women and the Control Group, 314 Brazilian women. The groups were compared with respect to demographic variables, the presence of maternal complications and perinatal outcomes. Statistical analysis was performed by χ2 test and, when necessary, by applying Yates' correction. RESULTS: compared to Brazilian mothers, a smaller number of Bolivian women received prenatal care (16.4 versus 5.1%, p<0.001) and among those that did, the percentage of those who had less than five visits was higher (50 versus 19.3%, p<0.001). Compared to the Brazilian group, the Bolivian group had fewer unwed mothers (12.1 versus 25.4%, p<0.001) and a lower number of nulliparous women (34.1 versus 43.6%, p=0.017). Congenital syphilis had a higher incidence in the Bolivian group (2.9 versus 0.5%, p<0.05), as well as a higher number of newborns classified as large for gestational age (14.6 versus 5.8%, p <0.001). CONCLUSIONS: the failure to attend prenatal care or its completion with an inadequate number of consultations, and the higher number of cases of congenital syphilis observed among the Bolivian women show the great vulnerability of this ethnic minority group to health problems. Consequently, it is necessary a strategic planning of the sectors responsible for coordinating assistance in our country, in order to reduce this disparity, either through socio-economic improvements or by the implementation of health care tailored to the needs of this group.

Desfechos maternos e perinatais em gestantes bolivianas no município de São Paulo: um estudo transversal caso-controle / Maternal and perinatal outcomes in Bolivian pregnant women in the city of São Paulo: a cross-sectional case-control study

OBJETIVO: avaliar as características relativas ao atendimento de parturientes bolivianas e seus desfechos em um hospital do município de São Paulo. MÉTODOS: estudo transversal retrospectivo tipo caso-controle, entre dois grupos de gestantes, atendidas no período de 2003 a 2007. O Grupo Estudo incluiu 312 gestantes bolivianas e o Grupo Controle, 314 gestantes brasileiras. Os grupos foram comparados em relação às variáveis demográficas, à ocorrência de intercorrências maternas e às variáveis perinatais. A análise estatística foi feita com o uso do teste do χ2 e, quando necessário, foi aplicada a correção de Yates. RESULTADOS: comparado às parturientes brasileiras, o número de bolivianas que frequentaram o pré-natal foi menor (16,4 versus 5,1 por cento; p < 0,001) e, dentre as que o fizeram, foi maior a porcentagem das que compareceram a menos do que cinco consultas (50 versus 19,3 por cento; p<0,001). Foi observado menor número de mães bolivianas solteiras (12,1 versus 25,4 por cento; p<0,001) e menor número de gestantes nulíparas (34,1 versus 43,6 por cento; p=0,017). A incidência de sífilis congênita foi maior entre as bolivianas (2,9 versus 0,5 por cento; p<0,05), assim como o número de recém-nascidos classificados como grande para a idade gestacional (14,6 versus 5,8 por cento; p<0,001). CONCLUSÕES: o não comparecimento ao pré-natal, ou o número inadequado de consultas, e o número mais elevado de casos de sífilis congênita observado entre as bolivianas mostram a grande vulnerabilidade desse grupo étnico minoritário frente aos agravos da saúde. Consequentemente, faz-se necessário um planejamento estratégico dos setores responsáveis pela coordenação da assistência em nosso município, com o intuito de reduzir essa disparidade, seja por meio de melhorias socioeconômicas ou da implementação da assistência à saúde, particularizada para esse grupo.

PURPOSE: to evaluate the characteristics regarding care of Bolivian pregnant women and their outcomes in Hospital Municipal Vereador José Storopolli. METHODS: a cross-sectional retrospective case-control study comparing two groups of pregnant women from 2003 to 2007. The Study Group included 312 Bolivian pregnant women and the Control Group, 314 Brazilian women. The groups were compared with respect to demographic variables, the presence of maternal complications and perinatal outcomes. Statistical analysis was performed by χ2 test and, when necessary, by applying Yates' correction. RESULTS: compared to Brazilian mothers, a smaller number of Bolivian women received prenatal care (16.4 versus 5.1 percent, p<0.001) and among those that did, the percentage of those who had less than five visits was higher (50 versus 19.3 percent, p<0.001). Compared to the Brazilian group, the Bolivian group had fewer unwed mothers (12.1 versus 25.4 percent, p<0.001) and a lower number of nulliparous women (34.1 versus 43.6 percent, p=0.017). Congenital syphilis had a higher incidence in the Bolivian group (2.9 versus 0.5 percent, p<0.05), as well as a higher number of newborns classified as large for gestational age (14.6 versus 5.8 percent, p <0.001). CONCLUSIONS: the failure to attend prenatal care or its completion with an inadequate number of consultations, and the higher number of cases of congenital syphilis observed among the Bolivian women show the great vulnerability of this ethnic minority group to health problems. Consequently, it is necessary a strategic planning of the sectors responsible for coordinating assistance in our country, in order to reduce this disparity, either through socio-economic improvements or by the implementation of health care tailored to the needs of this group.

Clinical formulas, mother's opinion and ultrasound in predicting birth weight.

CONTEXT AND OBJECTIVE: Accurate fetal weight estimation is important for labor and delivery management. So far, there has not been any conclusive evidence to indicate that any technique for fetal weight estimation is superior to any other. Clinical formulas for fetal weight estimation are easy to use but have not been extensively studied in the literature. This study aimed to evaluate the accuracy of clinical formulas for fetal weight estimation compared to maternal and ultrasound estimates. DESIGN AND SETTING: Prospective study involving 100 full-term, cephalic, singleton pregnancies delivered within three days of fetal weight estimation. The setting was a tertiary public teaching hospital in São Paulo, Brazil. METHODS: Upon admission, the mother's opinion about fetal weight was recorded. Symphyseal-fundal height and abdominal girth were measured and two formulas were used to calculate fetal weight. An ultrasound scan was then performed by a specialist to estimate fetal weight. The four estimates were compared with the birth weight. The accuracy of the estimates was assessed by calculating the percentage that was within 10% of actual birth weight for each method. The chi-squared test was used for comparisons and p < 0.05 was considered significant. RESULTS: The birth weight was correctly estimated (+/- 10%) in 59%, 57%, 61%, and 65% of the cases using the mother's estimate, two clinical formulas, and ultrasound estimate, respectively. The accuracy of the four methods did not differ significantly. CONCLUSION: Clinical formulas for fetal weight prediction are as accurate as maternal and ultrasound estimates.

Clinical formulas, mother's opinion and ultrasound in predicting birth weight / Fórmulas clínicas, opinião materna e ultra-sonografia na predição do peso ao nascer

CONTEXT AND OBJECTIVE: Accurate fetal weight estimation is important for labor and delivery management. So far, there has not been any conclusive evidence to indicate that any technique for fetal weight estimation is superior to any other. Clinical formulas for fetal weight estimation are easy to use but have not been extensively studied in the literature. This study aimed to evaluate the accuracy of clinical formulas for fetal weight estimation compared to maternal and ultrasound estimates. DESIGN AND SETTING: Prospective study involving 100 full-term, cephalic, singleton pregnancies delivered within three days of fetal weight estimation. The setting was a tertiary public teaching hospital in São Paulo, Brazil. METHODS: Upon admission, the mother's opinion about fetal weight was recorded. Symphyseal-fundal height and abdominal girth were measured and two formulas were used to calculate fetal weight. An ultrasound scan was then performed by a specialist to estimate fetal weight. The four estimates were compared with the birth weight. The accuracy of the estimates was assessed by calculating the percentage that was within 10 percent of actual birth weight for each method. The chi-squared test was used for comparisons and p < 0.05 was considered significant. RESULTS: The birth weight was correctly estimated (± 10 percent) in 59 percent, 57 percent, 61 percent, and 65 percent of the cases using the mother's estimate, two clinical formulas, and ultrasound estimate, respectively. The accuracy of the four methods did not differ significantly. CONCLUSION: Clinical formulas for fetal weight prediction are as accurate as maternal and ultrasound estimates.

CONTEXTO E OBJETIVO: A avaliação correta do peso fetal é importante na assistência ao trabalho de parto. Até o presente, não existe evidência conclusiva que aponte que algum método de estimar o peso fetal seja superior aos outros. As fórmulas clínicas usadas para estimar o peso fetal são de fácil realização, porém não têm sido extensivamente estudadas na literatura. Este estudo visou avaliar a acurácia das fórmulas clínicas na predição do peso fetal, comparadas ao peso estimado através da opinião materna e da ultra-sonografia e ao peso ao nascer. TIPO DE ESTUDO E LOCAL: Estudo prospectivo envolvendo 100 gestantes de termo, com feto único e cefálico, que tiveram seus partos dentro de três dias da estimativa do peso fetal. O estudo foi realizado em maternidade ensino, pública e terciária, na cidade de São Paulo, Brasil. MÉTODOS: Ao ser internada, a opinião da gestante acerca do peso fetal foi registrada. Mediu-se a altura uterina e a circunferência abdominal maternas e esses números foram usados em duas fórmulas clínicas para se estimar o peso fetal. Um especialista realizou então uma ultra-sonografia para estimativa do peso fetal. As quatro estimativas foram comparadas com o peso ao nascer e a acurácia de cada método foi avaliada comparando-se a porcentagem de estimativas dentro de 10 por cento do peso ao nascimento. O teste do χ2 foi usado para comparações e p < 0,05 considerado significante. RESULTADOS: O peso ao nascer foi corretamente estimado (± 10 por cento) em 59 por cento, 57 por cento, 61 por cento e 65 por cento das vezes através da opinião materna, das duas fórmulas clínicas e da ultra-sonografia, respectivamente. Não houve diferença significante na acurácia dos quatro métodos. CONCLUSÕES: As fórmulas clínicas são tão precisas na avaliação do peso fetal quanto a opinião materna e a ultra-sonografia.