Edson Gomes Tristão

Tele-obstetric ultrasound: analysis of first-trimester ultrasound images transmitted in realtime.

We evaluated the diagnostic quality of first-trimester ultrasound images transmitted in realtime using low-cost telecommunications. A prospective sample of fetal ultrasound images from 11 weeks to 13 weeks and six days of pregnancy was obtained from pregnant women over 18 years old. The examinations were transmitted in realtime to three independent examiners who carried out a qualitative assessment based on parameters established by the Fetal Medicine Foundation. All fetal structures could be viewed and the quality of images received by the examiners was considered normal. There were significant differences for crown-rump length and nuchal translucency in the transmitted images but the loss in definition was acceptable. Thus the quality of images transmitted via the Internet through the use of low-cost software appeared suitable for screening for chromosomal abnormalities in the first trimester of pregnancy.

Morbidade e mortalidade neonatais relacionadas à idade materna igual ou superior a 35 anos, segundo a paridade

OBJETIVO: avaliar a morbidade e a mortalidade neonatais relacionadas a idade materna igual ou superior a 35 anos. METODOS: de 2.377 nascimentos em um ano, 316 (13,6%) eram de gestantes com idade igual ou superior a 35 anos. As gestantes selecionadas foram comparadas com mulheres entre 20 a 29 anos, randomicamente selecionadas entre 1170 delas (49,2%). Foram incluidas gestantes com idade gestacional acima de 22 semanas e recem nascido (RN) acima de 500 g. Foram excluidos 14 gemelares. Para avaliar a morbidade e a mortalidade foram consideradas as seguintes variaveis: indice de Apgar, peso ao nascer, malformacoes congenitas, adequacao do peso ao nascer e a mortalidade neonatal ate a alta hospitalar. RESULTADOS: quando avaliadas em conjunto nuliparas e multiparas, as gestantes com idade igual ou superior a 35 anos apresentaram uma proporcao significativamente maior de resultados perinatais desfavoraveis, o que nao se manteve quando foram excluidas as nuliparas. Multiparas com idade igual ou superior a 35 anos apresentaram maior proporcao de indice de Apgar baixo no 1o minuto: 21,3 e 13,1% (p = 0,015); RN pequeno para a idade gestacional: 15,2 e 6,7% (p < 0,02); RN grande para a idade gestacional: 5,7 e 0,0% (p < 0,02); baixo peso ao nascer: 23,8 e 14,5% (p < 0,01) e prematuridade: 16,7 e 6,7% (p < 0,005), respectivamente. Nao foram encontradas diferencas significativas para o indice Apgar baixo no 5o minuto, malformacoes congenitas, condicoes do recem-nascido no momento da alta hospitalar e mortalidade neonatal. CONCLUSOES: ocorreu um aumento da morbidade neonatal nas gestantes com idade igual ou superior a 35 anos, porem sem aumento da mortalidade neonatal.

Vertical mother-to-child HIV transmission in babies born in a tertiary hospital in southern Brazil

Abstract Purpose: Programs for the elimination of mother-to-child transmission of human immunodeficiency virus (HIV) are essentially focused on prevention actions that occur during prenatal care. This study aimed to evaluate the mother-to-child vertical transmission (MCVT) rate, and identify its possible causes, in a sample of pregnant women with HIV. Materials and methods: This was a retrospective and descriptive study. The sample was composed of HIV-positive pregnant women who delivered a live infant in the maternity ward at the hospital of the Federal University of Parana in Brazil, between January 2007 and December 2012. Results: The calculated MCVT rate in this study was 5.1%. Comparisons between MCVT cases and control pregnant women with HIV but without MCVT showed that the highest risk factors for MCVT were: the detection of HIV infection status only at delivery; non-attendance to high risk prenatal care; unknown viral load; and late onset of highly active antiretroviral therapy (HAART). Conclusions: Our results corroborate the assertion that viral replication control is essential for HAART, and that adherence to therapy is essential for such control. Factors that influence adherence to the use of antiretroviral therapy (ART) must be identified, and medical, psychological, or social assistance must be properly provided to these mothers.