Edimárlei Gonsales Valério

Tei index to assess fetal cardiac performance in fetuses at risk for fetal inflammatory response syndrome

To examine, in patients with premature rupture of the amniotic membranes (PROM) at < 34 weeks of gestation, the relationship between fetal myocardial performance measured by the Tei index and fetal inflammatory response syndrome (FIRS).

Variation in the urinary protein/creatinine ratio at four different periods of the day in hypertensive pregnant women.

Objective. To assess the urine protein/creatinine ratio in urine samples of pregnant women with hypertension in regard to: 1) the presence of significant variation at different periods of the day; 2) the differences if they exist, to identify the most reliable period of the day for sampling; and 3) whether the first sample, obtained when the patient arrives at the clinic, correlates with the same accuracy, with the 24-hour proteinuria. Design. Cross-sectional study. Place. Obstetrics Emergency Department, Hospital de Clínicas de Porto Alegre, a teaching hospital in Porto Alegre, Brazil. Population. Seventy-five women with hypertension with 20-week gestation or over. Methods. Urine samples for determination of the protein/creatinine ratio were obtained on arrival (first specimen) and every 6 hours thereafter, totaling four samples in 24 hours. Four sampling periods were established: 1) from 8 am to 2 pm, 2) from 2 pm to 8 pm, 3) from 8 pm to 2 am, and 4) from 2 am to 8 am. The protein/creatinine ratio in the four different day periods were compared with the 24-hour proteinuria obtained simultaneously. The results were analyzed by the Spearman correlation and the receiver-operator characteristic (ROC) curve. Results. The urine protein/creatinine ratio is strongly correlated (Spearman correlation equal to 0.8 or greater) with the 24-hour proteinuria at all four periods of the day (p < 0.001), as well as the first sample obtained on arrival (p = 0.003). These findings were corroborated by the ROC curve in which the values of four day periods and that of the first sample were equal to or greater than 0.930. Conclusion. In hypertensive pregnant women, the single voided urine sample protein/creatinine ratio, irrespective of sampling time, is strongly correlated with the 24-hour proteinuria, as is the sample obtained on arrival.

Are insulin resistance index, IGF-1 and metabolic syndrome components correlates with severe preeclampsia?

Objective. Analyse the relation between insulin resistance and severe preeclampsia (SPE). Methods. Case control study paired by body mass index and gestational age; including 16 patients with severe SPE and 16 normotensive controls. Insulin resistance was assessed through the HOMA-IR and QUICKI-IS indexes. Results. There was no significant difference between the groups regarding the HOMA-IR and QUICKI-IS indexes and HDL cholesterol. Triglyceride levels were higher and the IGF-1 was lower in the SPE group than in the control group. Conclusions. There were no differences in the insulin resitance indexes between the group with SPE and normal controls.

Calciuria and preeclampsia: a case-control study.

Aim:  Calciuria has been reported to decrease in preeclampsia. We compared calciuria among groups of normal, hypertensive and preeclamptic pregnant women, and assessed its correlation with the severity of the disease.

Protein Creatinine Ratio in Random Urine Sample of Hypertensive Pregnant Women: Maternal and Perinatal Outcomes

Objective. To compare protein/creatinine ratio (PCR) in random urine sample levels and adverse outcomes in hypertensive pregnant women. Methods. A total of 370 medical charts from hypertensive pregnant women were reviewed and stratified into three groups according to different PCR in random urine sample levels (group 1: PCR < 0.3 mg/mg; group 2: PCR 0.3–1.99 mg/mg; group 3: PCR ≥ 2.0 mg/mg) and compared with composite maternal and perinatal outcomes. Those outcomes were severe hypertension, thrombocytopenia, high lactate dehydrogenase count, disseminated intravascular coagulation, abruptio placentae, HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, eclampsia, perinatal death, newborn cerebral hemorrhage, respiratory distress syndrome of newborn, neonatal sepsis, and newborn small for gestational age. Results. To obtain a composite maternal adverse outcome the odds ratio [ORs] between PCR groups were 1.8 (95% confidence interval [CI]: 1.1–3.2) between groups 1 and 2, and 3.1 (95% CI: 1.5–6.3) between groups 1 and 3; for composite perinatal adverse outcomes, the ORs were 3.0 (95% CI: 1.5–5.9) between groups 1 and 2, and 3.4 (95% CI: 1.6–7.5) between groups 1 and 3. Conclusions. Hypertensive pregnant women with a PCR ≥ 0.3 mg/mg, had worse maternal and perinatal outcomes than those with PCR < 0.3 mg/mg. Above the cut-off of 0.3 mg/mg, higher PCRs are not associated with a significant increase in maternal and perinatal morbidity.

Selection of developmentally competent human oocytes aspirated during cesarean section

Abstract Purpose: To evaluate the efficiency/safety of Brilliant Cresyl Blue (BCB) staining as a selection method of developmentally competent immature human oocytes. Materials and methods: Immature oocytes of 32 pregnant women were recovered during cesarean section (CS). After retrieval, 92 oocytes were randomly divided into two groups: control (directly disposed to in vitro maturation – IVM) and treated – exposed to BCB 26 μM during 60 min. After staining, the treated group was classified as cytoplasm coloration, BCB positive (blue) or negative (colorless), and then disposed to IVM. Nuclear status was checked after 24 and 48 h of IVM. Nuclear maturation (polar body extrusion), meiosis resumption (absence of germinal vesicle) and degeneration rates were evaluated among the three groups (control, BCB positive and BCB negative) using Generalized Estimating Equations, followed by Bonferroni’s correction for multiple comparisons. Results: Nuclear maturation was higher in BCB positive compared to BCB negative, after 24 and 48 h of IVM (p = .004 and p = .032). The control group was equal to BCB positive. There was no difference among groups analyzing meiosis resumption and degeneration rates. Conclusion: The BCB test can be a good marker in pre-selection procedures of developmentally competent human oocytes aspirated during CS.

Comparison of serum selenium levels among hypertensive and normotensive pregnant women

ABSTRACT Objective: To correlate serum selenium levels with hypertensive disorders of pregnancy (HDP) in a selected population and evaluate this mineral as a possible protective factor. Methods: This case–control study included 32 normotensive, 20 hypertensive (chronic and gestational hypertension), and 38 preeclamptic pregnant women. All patients were recruited from antenatal or obstetric admissions of a tertiary hospital in Brazil. Serum selenium was measured at the time of inclusion. Patients were followed up until hospital discharge after delivery. Results: Groups did not differ with regard to maternal age, ethnicity, educational attainment, parity, or smoking prevalence. Normotensive patients had lower body mass index and were included in the study earlier. These patients also had a higher prevalence of comorbidities other than hypertension. Continuous use of medication and a history of HDP in previous pregnancies were more common in preeclamptic patients. Serum selenium levels were not significantly different between groups, with an average of 56.4 ± 15.3 μg/L in the control group, 53.2 ± 15.2 μg/L in the hypertension group, and 53.3 ± 16.8 μg/L in the preeclampsia group (p = 0.67). Among patients with preeclampsia, 52.6% had the severe form. Serum selenium levels in these patients also did not differ significantly from those of controls (p = 0.77). Preeclampsia was associated with earlier termination of pregnancy and lower birth weight (p < 0.05). There were no significant differences across groups in other outcomes of interest. Conclusion: Serum selenium levels did not differ significantly between groups. Thus, we could not establish whether selenium is a protective factor against these conditions.

Natriuria and calciuria levels in preeclampsia : a cross-sectional study

CONTEXT AND OBJECTIVE Sodium excretion abnormalities in preeclampsia have been studied in relation to several factors. The objective of this study was to compare natriuria (mEq/24 h) and calciuria levels (mg/24 h) in preeclamptic patients. DESIGN AND SETTING An analytical cross-sectional study with a control group was conducted in the obstetric center and the high-risk pregnancy outpatient clinic at a university hospital in southern Brazil, and in a primary healthcare unit in the same city, including pregnant women with mild preeclampsia, severe preeclampsia or chronic hypertension, and women with normal pregnancies (14 patients in each group). METHOD Natriuria was measured using an ion-selective electrode in an automated clinical chemistry analyzer (Hitache 917, Roche). All the patients collected 24-hour urine, at home or at the hospital, for analysis of proteins, creatinine, calcium, sodium and uric acid. Quantitative variables with asymmetrical distribution were described using the median, minimum and maximum, and were compared using the Kruskal-Wallis test. The results were logarithmically transformed, with one-way analysis of variance (ANOVA) by ranks and then the post-hoc Tukey test, and were analyzed by means of the Spearman correlation and receiver operating characteristic (ROC) curve. The significance level used was 0.05. RESULTS There were significant differences between the groups in comparing severe preeclampsia with chronic hypertension and severe preeclampsia with controls (P < 0.0001 for both measurements). CONCLUSION Natriuria levels may be lower in preeclampsia when associated with calciuria. Natriuria assessment is an additional test for differential diagnosis of hypertensive diseases in pregnancy, but is a poor predictor when used alone.

Necrotizing Fasciitis in the Puerperium of a Woman with Complement Deficiency: Case Report and Review Literature

Complement deficiencies are uncommon types of primary immunodeficiency. Necrotizing fasciitis is a rare complication in pregnancy characterized by soft tissue invasion and necrosis of the subcutaneous and other adjacent tissues, leading to high mortality rates. We report a case of a 29-year-old pregnant woman with functional deficiency of the C4 complement component and short uterine cervix. Admitted at the hospital with preterm labor, she received multiple doses of immunoglobulin. After 8 weeks, she had a premature membrane rupture, and due to pelvic presentation she had a cesarean. The patient presented multiple obstetric complications, such as operative wound infection, endometritis, sepsis, necrotizing fasciitis and pelvic septic thrombophlebitis. She underwent multiple antimicrobial schemes, a hysterectomy and 4 extensive debridements of the abdominal wall because of significant necrosis. She stayed at the hospital for 101 days (32 of those in ICU in immediate postpartum). 41 days after cesarean, patient was discharged in good conditions. Our case emphasizes individual handling and high multiple doses of immunoglobulin for favorable outcome of the case.

Massive Splenomegaly in Pregnancy: Case Report

A 33-year-old primigravida presented to an appointment at a high-risk prenatal outpatient service due to a history of splenomegaly. Her spleen occupied of the abdominal cavity and shifted the uterus to the right side of the abdomen. During investigation, an intrauterine growth restriction (IURG) and a series of other clinical complications were discovered. We admitted her to inpatient care at 28 + 1 weeks’ gestation for a better investigation of her extensive splenomegaly and for pregnancy monitoring, with a further successful delivery.