The 4G/4G polymorphism of the plasminogen activator inhibitor-1 (PAI-1) gene as an independent risk factor for placental insufficiency, which triggers fetal hemodynamic centralization.

OBJECTIVE: To describe a case report of 4G/4G polymorphism of the plasminogen activator inhibitor-1 (PAI-1) gene as an independent risk factor for placental insufficiency. DESIGN: Case report. SETTING: Department of Public Health, State University of Ceará (UECE), Fortaleza-CE, Brazil. CASE REPORT: Hereditary hypofibrinolysis, which is mediated by 4G/4G homozygosity for the PAI-1 gene, is an independent risk factor for pregnancy complications, probably acting through thrombotic induction of placental insufficiency. We report a case of a low risk pregnancy, which separately presented placental insufficiency and fetal centralization at the beginning of the third trimester, without any other clinical manifestations during pregnancy. However, immediately after childbirth, the patient had a deep vein thrombosis of a lower limb. The anatomopathological examination of the placenta showed old and recent placental infarcts. Homozygosity for the 4G allele of PAI-1 gene was subsequently diagnosed as the sole probable causal factor.

Translation and cross-cultural adaptation of the Pregnancy Physical Activity Questionnaire (PPAQ) to the Brazilian population.

OBJECTIVE: To evaluate the total activity performed by women with low-risk pregnancy as well as translate and pursue a cross-cultural adaptation of the Pregnancy Physical Activity Questionnaire (PPAQ) to the Brazilian reality. DESIGN: We conducted a cross-sectional quantitative study including 305 women between 16 and 40 years of age with low-risk pregnancies. SETTING: The Department of Public Health, State University of Ceará, Fortaleza, Brazil. METHODS: We applied an adapted version of PPAQ to assess the levels of physical activity and the intensity in the metabolic equivalent task (MET), which could be distinguished as follows: sedentary (< 1.5 METs), light (1.5-3.0 METs), moderate activity (3.0-6.0 METs), and vigorous activity (>6.0 METs). The Kruskal-Wallis test was used to compare energy expenditure (MET) with socio-demographic variables. RESULTS: More than half of the participants performed activities that were classified as light (51.4%). If we group the activities that were categorized as sedentary and light, this value increases to 74.7%, showing a high prevalence of insufficiently active pregnant women. Lower energy expenditure was observed in the third gestational trimester among pregnant women with lower educational level, single women, and mixed-race women (p < 0.05). CONCLUSION: There is a prevalence of physical inactivity during the three trimesters of pregnancy. The results validate PPAQ for the Brazilian population to serve as a basis for future public policies focused on combating the health problems of mother-infant pairs.

Tuberculosis in pregnancy:a challenging differential diagnosisfor inflammatory bowel disease.

OBJECTIVE: To describe a case of tuberculosis with intestinal variant in a pregnant woman in the 17th week of pregnancy. DESIGN: Case report. SETTING: Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo-SP, Brazil. CONCLUSION: Tuberculosis is a public health problem that concerns many countries in the world. It was declareda public emergency by the World Health Organization in 2005. Its presence during pregnancy brings maternal risk and fetal impairment if not treated quickly and properly. The intestinal variant is not the most common form of the disease and may be confused with inflammatory bowel diseases, especially Crohns disease. Knowledge of the specific characteristics, combined with a detailed medical history and appropriate diagnostic methods can make all the difference in gestational prognosis. We report the case of a pregnant woman who wrongly underwent treatment for inflammatory bowel disease at another service. After admission to our university hospital, fruitful diagnostic clarification was achieved and the patient was diagnosed and treated for tuberculosis. We describe the details of the investigation and, in particular, review the main characteristics in the literature for differentiating the two diseases.