Cristine Kolling Konopka

Clinical and epidemiological profile of HIV-infected pregnant women in a service in south Brazil

PURPOSE to analyze the clinical and epidemiological profile, the outcome of pregnancy and the vertical transmission of human immunodeficiency virus (HIV)-infected pregnant women receiving prenatal care at the University Hospital of Santa Maria (HUSM). METHODS A prospective study was conducted on 139 HIV-infected pregnant women attended at the High-Risk Prenatal Care Outpatient Clinic of HUSM, during the period from August 2002 to August 2007, with at least two prenatal visits in this service. Data were collected by an interview and by filling out a research protocol during a prenatal visit. The protocol was attached to the medical records of the patient and kept until the outcome of gestation. Descriptive analysis of quantitative variables was performed using the SPSS software, version 15.0. RESULTS The mean age of the 139 pregnant women studied was 25.6 years (+/-5.8), 79 (56.8%) were white, 81 (58.5%) were married or lived in a stable union, and 90 (65.0%) had less than eight years of schooling. Fifty-one percent of the pregnant women already had two or more children, with a number of children higher than the mean for the state. The infection was diagnosed during the present or a previous pregnancy in more than 70.0% cases. Sexual exposure occurred in 97.0%, and in 59.6% of cases the partner was known to be infected. During the study period, among the cases properly monitored, only one newborn (0.7%) was infected with HIV. CONCLUSIONS Young women in a socioeconomic situation of vulnerability, with low schooling and multiparous represent the majority of HIV-positive pregnant women attended at the service. Evaluations performed during the prenatal period were relevant for the diagnosis of infection in most cases. An early diagnosis associated with proper clinical, obstetrical and psychological monitoring and with nursing care is important to provide appropriate treatment compliance and a reduction of the rates of vertical transmission.

Resultados de dois esquemas de tratamento da pielonefrite durante a gravidez e correlação com o desfecho da gestação

PURPOSE To determine the epidemiological profile of women admitted for urinary tract infection as well as to verify the most prevalent agents and response to antibiotic therapy. METHODS A retrospective study of 106 pregnant women admitted to a university hospital for urinary tract infection treatment during the period between January 2007 to December 2010. The evaluation was based on analysis of the medical records of these pregnant women, with the observation of hospitalization and pregnancy data, as well as its outcome. Statistical analysis was performed using Statistical Package for the Social Science, version 15.0. The bilateral Fisher exact test and Students t test were used for data analysis, as well as descriptive statistical methods. RESULTS Positive urine cultures were observed in 60.5% of pregnant women admitted due to urinary tract infection. The most frequent infectious agent was Escherichia coli and no difference in resistance, recurrence or complications was observed between the most frequent etiologic agents. Pregnant women with previous UTI had a higher recurrence risk (OR=10.8; p<0.05). The antibiotics most commonly used during hospitalization were ampicillin and cefazolin. Change of therapeutic agent due to bacterial resistance occurred in 11.9% of patients who took cefazolin and in 20% of patients who took ampicillin (OR=5.5; p<0.05). The rate of gestational complications was the same for both treatments. There was no difference in mean number of days of hospitalization between the treatments. CONCLUSION In the studied population ampicillin showed a higher rate of bacterial resistance than cefazolin, requiring a larger number of treatment regimen exchanges, without resulting in differences in clinical outcome or time of hospitalization.PURPOSE: To determine the epidemiological profile of women admitted for urinary tract infection as well as to verify the most prevalent agents and response to antibiotic therapy. METHODS: A retrospective study of 106 pregnant women admitted to a university hospital for urinary tract infection treatment during the period between January 2007 to December 2010. The evaluation was based on analysis of the medical records of these pregnant women, with the observation of hospitalization and pregnancy data, as well as its outcome. Statistical analysis was performed using Statistical Package for the Social Science, version 15.0. The bilateral Fisher exact test and Students t test were used for data analysis, as well as descriptive statistical methods. RESULTS: Positive urine cultures were observed in 60.5% of pregnant women admitted due to urinary tract infection. The most frequent infectious agent was Escherichia coli and no difference in resistance, recurrence or complications was observed between the most frequent etiologic agents. Pregnant women with previous UTI had a higher recurrence risk (OR=10.8; p<0.05). The antibiotics most commonly used during hospitalization were ampicillin and cefazolin. Change of therapeutic agent due to bacterial resistance occurred in 11.9% of patients who took cefazolin and in 20% of patients who took ampicillin (OR=5.5; p<0.05). The rate of gestational complications was the same for both treatments. There was no difference in mean number of days of hospitalization between the treatments. CONCLUSION: In the studied population ampicillin showed a higher rate of bacterial resistance than cefazolin, requiring a larger number of treatment regimen exchanges, without resulting in differences in clinical outcome or time of hospitalization.

IMPORTÂNCIA DO RASTREAMENTO SOROLÓGICO DA TOXOPLASMOSE EM GESTANTES ATENDIDAS EM AMBULATÓRIO DE PRÉ-NATAL DE ALTO RISCO

Estudo transversal, retrospectivo, de 408 gestantes imunocompetentes, atendidas em Ambulatorio de Pre-Natal de Alto Risco, entre janeiro de 2005 a dezembro de 2006 para verificar a relevância da triagem sorologica da infeccao por Toxoplasma gondii, nesta populacao. Foram analisados os perfis sorologicos, para pesquisa de anticorpos especificos IgM, IgG e avidez de IgG, atraves de metodos imunologicos ELFA® e MEIA®. Foram identificadas, 271 (66,42) imunes, 121 (29,6%) suscetiveis, seis (1,47%) com provavel doenca aguda e 10 (2,45%) casos com teste da avidez de IgG foi realizado apos o quarto mes de gestacao, alem do tempo estabelecido como ideal para pesquisa deste parâmetro laboratorial. A realizacao do teste de avidez de IgG, em tempo adequado, permitiu definir um maior numero de casos passiveis de tratamento. O encontro de 29,6% de gestantes suscetiveis a infeccao por T. gondii mostrou a importância da triagem sorologica na prevencao de casos de toxoplasmose aguda . Palavras-chave: toxoplasmose; gestantes; IgG; IgM; cuidado pre-natal Transversal retrospective study of serological test to T. gondii infection for 408 immunocompetent pregnant women attended in The High Risk Prenatal Ambulatory, among January, 2005 to December, 2006 to determinate the importance of screening for Toxoplasma gondii ( T. gondii ) infection in this population. Serological profile for specific IgM, IgG and IgG avidity done by ELFA® e MEIA® methodology were analyzed. There were found 271(66,42%) out of 408 pregnant women immune to T.gondii infection, 41 (29,3%) susceptible, six (1,47%) with probable acute disease and ten (2,45%) with avidity test realized after the adequate period established like optimal for research. The accomplishment of the IgG avidity test during the correct time allows the detection of a higher number of acute diseases. The data for 29,6% of pregnant women susceptible to infection by T. gondii shows the importance of serological screening for toxoplasmosis in order to prevent cases of acute toxoplasmosis in the population studied. Keywords: Toxoplasmosis, Pregnant, IgG, IgM, Prenatal Care.

Aspiração manual intrauterina no tratamento do abortamento incompleto até 12 semanas gestacionais: uma alternativa à curetagem uterina

PURPOSE To analyze the effectiveness and occurrence of complications, in addition to hospitalization time and blood losses. METHODS Thirty patients were assigned alternatively and consecutively to one of two groups (15 to the Curettage Group and 15 to the Manual Vacuum Aspiration Group). The following variables were analyzed: effectiveness of the method, occurrence of complications, time before the procedure, time of execution of the procedure, time after the procedure, and total time of hospital permanence, in addition to hematocrit and hemoglobin, which were measured before and after the procedure. Patients were evaluated clinically 10 to 14 days after the procedure. Parametric and nonparametric tests were used for statistical analysis, with the level of significance set at p>0.05. RESULTS Both methods were efficient and no complications were recorded. Blood losses were similar in the two groups, but the hospitalization time was significantly shorter for the Manual Vacuum Aspiration Group (p=0.03). CONCLUSION Manual vacuum aspiration is as efficient and safe as uterine curettage, with the advantage of requiring shorter hospitalization, which increases the resolution of the method, improving the quality of care for these patients.

Pregnancy in Non-Communicating Unicornuate Uterus: Diagnosis Difficulty and Outcomes – a Case Report

Approximately 1 in every 76,000 pregnancies develops within a unicornuate uterus with a rudimentary horn. Müllerian uterus anomalies are often asymptomatic, thus, the diagnosis is a challenge, and it is usually made during the gestation or due to its complications, such as uterine rupture, pregnancy-induced hypertension, antepartum, postpartum bleeding and intrauterine growth restriction (IUGR). In order to avoid unnecessary cesarean sections and the risks they involve, the physicians should consider the several approaches and for how long it is feasible to perform labor induction in suspected cases of pregnancy in a unicornuate uterus with a rudimentary horn, despite the rarity of the anomaly. This report describes a case of a unicornuate uterus in which a pregnancy developed in the non-communicating rudimentary horn and the consequences of the delayed diagnosis.

Perinatal outcome of hypertensive pregnant women is related to the severity of preeclampsia

Introduction: Hypertension in pregnancy plays a key role in perinatal morbidity and mortality. This study aims to analyze maternal and perinatal outcomes associated with hypertension in pregnant women. Methods: A prospective longitudinal study was conducted at the University Hospital of Santa Maria, RS, Brazil, involving hypertensive pregnant women admitted for delivery. The results were analyzed using the chi-square test and the Mann-Whitney test. Results: Of the 162 hypertensive pregnant women studied, 61.1% were diagnosed with preeclampsia. Cesarean section was the most frequent mode of delivery (79.6%). Overall, 46.2% of newborns were premature; of these, 23.4% required intensive neonatal care. Preeclampsia and severe preeclampsia were associated with prematurity in 56.2% of cases (p = 0.011) and 75.7% of cases (p = 0.004), respectively. Severe preeclampsia was associated with neonatal complications (45.9%), and no neonatal complications were associated with mild preeclampsia in 78% (p = 0.014) and gestational hypertension in 96% (p = 0.001). Neonatal deaths occurred in 11.1% of cases admitted to the neonatal intensive care unit, corresponding to a neonatal mortality rate of 24 per 1,000 live births. Conclusions: The association of severe preeclampsia with prematurity and adverse perinatal outcomes corroborates the need for care of these laboring women in referral centers with specialized neonatal care. Keywords: Hypertension; pregnancy; pre-eclampsia; perinatal outcome; neonatal complications

Misoprostol modulates the gene expression prostaglandin E2 and oxidative stress markers in myometrial cells.

Misoprostol, prostaglandin E1 analogue, used for labour induction. However, one-third of patients who have labour induced with prostaglandins do not reach vaginal delivery. The differential expression of prostaglandin receptors in myometrial cells could account for this differential response. Since delivery physiology also involves modulation of oxidative metabolism that can be potentially affected by pharmacological drugs, in the present investigation the role of misoprostol on expression of prostaglandin receptors, and oxidative markers of myometrial cells was evaluated. Samples of myometrial tissues procured from women with spontaneous (SL) and nonspontaneous (NSL) labours were cultured in vitro and exposed to different concentrations of misoprostol. Gene expression was evaluated by qRT-PCR and oxidative biomarkers were evaluated by spectrophotometric and fluorometric analysis. Cells from SL women presented greater responsiveness to misoprostol, since an upregulation of genes related to increased muscle contraction was observed. Otherwise, cells from NSL women had low responsiveness to misoprostol exposure or even a suppressive effect on the expression of these genes. Oxidative biomarkers that previously have been related to labour physiology were affected by misoprostol treatment: lipoperoxidation and protein carbonylation (PC). However, a decrease in lipoperoxidation was observed only in SL cells treated with low concentrations of misoprostol, whereas a decrease of PC occurred in all samples treated with different misoprostol concentrations. The results suggest a pharmacogenetic effect of misoprostol in labour induction involving differential regulation of EP receptor genes, as well as some minor differential modulation of oxidative metabolism in myometrial cells.

Level of reactivity of IgM anticardiolipin antibodies in preeclampsia: a likely early serologic marker

The purpose of this study was to measure the level of anticardiolipin antibodies in preeclamptic pregnant women to verify a possible association between the presence of these antibodies and the development of the syndrome. A total of 36 pregnant women with preeclampsia and 19 women with normal pregnancy were evaluated. Anticardiolipin antibodies were determined by enzyme immunoassay. The reactivity level of anticardiolipin antibodies was significantly higher in the preeclamptic group, with a significance level of 95%. The results can mean the participation of anticardiolipin antibodies in the pathogenesis of preeclampsia. Future studies may confirm this parameter as an early marker for the development of this disease.

Ocorrência de toxoplasmose recente em gestantes: importância da correta interpretação dos testes sorológicos

Tendo em vista a gravidade da primo - infeccao por Toxoplasma gondii durante a gestacao, e de grande valor o conhecimento do perfil sorologico apresentado pelas gestantes no inicio da gravidez. Avaliando os indices de anticorpos IgC e IgM presentes no soro de gestantes sensibilizadas, foi possivel estimar a frequencia com que encontramos pacientes apresentando possivel fase aguda da doenca. Metodos: A populacao estudada foi composta por gestantes atendidas no ambulatorio de pre-natal do HUSM. Foram analisados os resultados registrados em prontuarios medicos das gestantes que apresentam sorologia sugestiva de toxoplasmose aguda. A prevalencia sorologica de Toxoplasmose aguda nas gestantes estudadas foi de 2,37%. Foi realizado acompanhamento sorologico para analise dos titulos de anticorpos IgC e IgM, sendo que a maior parte das gestantes manteve os niveis de anticorpos determinados na primeira amostra analisada. A maioria das gestantes estudadas realizaram a primeira pesquisa sorologica para determinacao de anticorpos anti- T. gondii entre os dois primeiros trimestres de gestacao. Conclusao: A soroprevalencia de toxoplasmose aguda nas gestantes estudadas encontra-se dentro das estimativas citadas na literatura. Atraves do levantamento da idade gestacional em que estas pacientes realizaram os testes sorologicos, foi detectada a importância da solicitacao do teste de gravidez de IgC parar excluir a possibilidade da fase aguda da doencano inicio da gestacao.