RESUMO
BACKGROUND: Uric acid has strong antioxidant activity, whereas its oxidative damage is closely related to many diseases. We assessed the association between serum uric acid (SUA) levels and premature rupture of membranes (PROM) in pregnant women with gestational diabetes (GDM) in China. METHODS: In this cross-sectional study, a total of 456 pregnant women were enrolled. Anthropometric parameters for pregnant women were collected within 12 weeks of gestation. Weight gain during pregnancy was obtained from the patients' records. GDM was diagnosed according to 75-g oral glucose tolerance tests at the 24-28th week of gestation, and SUA was determined simultaneously. PROM was identified as the natural rupture of foetal membranes before the first stage of labour. Logistic models were fitted to identify the presence of PROM using clinical characteristics with (Model 2) or without serum uric acid (Model 1). RESULTS: There were differences in BMI, haemoglobin A1c, fasting blood glucose, 1-h postprandial glucose (PG), 2-h PG, insulin levels, triglycerides,weight gain during pregnancy, the rate of macrosomia, fetus birth weight and PROM between women with and without GDM (all P < 0.05). Furthermore, GDM women with PROM had lower levels of SUA compared to those without PROM (P = 0.030). The odds ratio of PROM decreased with increasing SUA levels. The area under the receiver operating characteristic curves for PROM based on Model 2 was larger than that in Model 1 (0.86 versus 0.71, P < 0.05). CONCLUSION: Relatively elevated SUA levels at the 24-28th weeks of gestation were associated with a lower risk of PROM in women with GDM. Therefore, SUA may be a protective factor for PROM in GDM patients. The optimal concentration of uric acid in different diseases and different populations needs to be further studied.
Assuntos
Diabetes Gestacional/sangue , Ruptura Prematura de Membranas Fetais/sangue , Ácido Úrico/sangue , Adulto , Estudos Transversais , Feminino , Humanos , GravidezRESUMO
Premature rupture of the membranes (PROM) occurs in about 8-10% of pregnancies and its most important complication is chorioamnionitis, so labour induction has an important role in this situation. This study was performed to compare oxytocin and sublingual Misoprostol for labour induction in PROM cases with term pregnancy. A total of 270 pregnant women who had spontaneous rupture of membrane and unripe cervix were enrolled. The first group underwent Oxytocin infusion according to low-dose standard protocol and the second group received 25 µg sublingual Misoprostol every 4 h. Time interval from induction to the beginning of active phase of labour was similar in both groups. Second stage of labour was significantly shorter in misoprostol group (p < .05). Although, some maternal side-effects were significantly higher in misoprostol group (p < .001), but 5 minute Apgar score was significantly better in this group. In conclusion, sublingual misoprostol was associated with better neonatal outcomes was more effective than oxytocin for labour induction in PROM cases. Impact statement What is already known on this subject: PROM occurs in about 8-10% of pregnancies; about 60% of these cases are term pregnancies. Most experts recommend early induction of labour in term PROM cases with an eye towards avoiding increased morbidity and mortality. Oxytocin is the most frequently used agent that is administered intravenously for the purpose of labour induction. Misoprostol is an alternative to oxytocin and is simpler to use, as it is administered via the oral, buccal, sublingual, rectal and vaginal routes rather than intravenously. What do the results of this study add: Time interval from induction to the beginning of active phase of labour was similar in both groups. Second stage of labour was significantly shorter in the misoprostol group. Although, some maternal side-effects were significantly higher in misoprostol group, the 5 minute Apgar score was significantly better in this group. What are the implications of these finding for clinical practice and/or further research: Sublingual misoprostol for induction of labour in PROM cases is more effective than oxytocin and its neonatal outcomes are better. Due to its easy prescription and better labour outcomes, sub lingual misoprostol may be a better choice for labour induction in PROM cases.
Assuntos
Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Trabalho de Parto Induzido/métodos , Misoprostol/administração & dosagem , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Administração Intravenosa , Administração Sublingual , Adulto , Índice de Apgar , Feminino , Humanos , Segunda Fase do Trabalho de Parto/efeitos dos fármacos , Gravidez , Nascimento a Termo , Fatores de Tempo , Adulto JovemRESUMO
Realizar recomendaciones para la atención del embarazo con ruptura prematura de membranas como parte integral de la Guía de Práctica Clínica (GPC) para la prevención, detección temprana y tratamiento de las complicaciones del embarazo en Colombia.Materiales y métodos: el grupo desarrollador de la Guía (GDG) elaboró esta GPC durante 2011-2012, acorde con la Guía Metodológica para la elaboración de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud Colombiano, basándose en la evidencia científica disponible y sumando la participación activa de grupos de pacientes, sociedades científicas y grupos de interés. En particular, la evidencia de esta sección fue adaptada de la GPC "Preterm prelabour rupture of membranes" (Royal College of Obstetricians and Gynaecologists-2006) y actualizada por medio de procedimientos sistemáticos, tanto para la búsqueda y valoración de la evidencia como para la generación de recomendaciones. El nivel de evidencia y la fuerza de las recomendaciones fueron expresadas por medio del sistema del Scottish Intercollegiate Guidelines Network (SIGN).Resultados: se presentan las recomendaciones para la atención de los embarazos con ruptura prematura de membranas. Estas incluyen cambios en la conducta del personal de salud y las instituciones para aumentar la probabilidad de obtener un resultado materno fetal exitoso en las gestaciones con esta complicación.Conclusiones: se presenta una versión resumida de las recomendaciones y evidencia de esta sección, que se espera sea adoptada por los profesionales de salud encargados de la atención del embarazo en el país para disminuir la morbilidad y mortalidad asociada a la gestación...
Realizar recomendaciones para la atención del embarazo con ruptura prematura de membranas como parte integral de la Guía de Práctica Clínica (GPC) para la prevención, detección temprana y tratamiento de las complicaciones del embarazo en Colombia.Materiales y métodos: el grupo desarrollador de la Guía (GDG) elaboró esta GPC durante 2011-2012, acorde con la Guía Metodológica para la elaboración de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud Colombiano, basándose en la evidencia científica disponible y sumando la participación activa de grupos de pacientes, sociedades científicas y grupos de interés. En particular, la evidencia de esta sección fue adaptada de la GPC "Preterm prelabour rupture of membranes" (Royal College of Obstetricians and Gynaecologists-2006) y actualizada por medio de procedimientos sistemáticos, tanto para la búsqueda y valoración de la evidencia como para la generación de recomendaciones. El nivel de evidencia y la fuerza de las recomendaciones fueron expresadas por medio del sistema del Scottish Intercollegiate Guidelines Network (SIGN).Resultados: se presentan las recomendaciones para la atención de los embarazos con ruptura prematura de membranas. Estas incluyen cambios en la conducta del personal de salud y las instituciones para aumentar la probabilidad de obtener un resultado materno fetal exitoso en las gestaciones con esta complicación.Conclusiones: se presenta una versión resumida de las recomendaciones y evidencia de esta sección, que se espera sea adoptada por los profesionales de salud encargados de la atención del embarazo en el país para disminuir la morbilidad y mortalidad asociada a la gestación...
