Francisco Herlânio Costa Carvalho

Gestação na adolescência precoce e tardia: há diferença nos riscos obstétricos?

OBJETIVOS: descrever aspectos da assistencia e resultados obstetricos da gravidez em adolescentes atendidas em um centro de atendimento terciario do Ceara e comparar os resultados maternos e perinatais entre adolescentes precoces e tardias. METODOS: em estudo transversal, analitico, avaliaram-se 2.058 casos, sendo 322 (15,6%) de adolescentes precoces e 1.736 (84,4%) tardias, atendidas no ano de 2000. Foram analisados as intercorrencias clinicas no pre-natal, tipo de parto, indicacoes de cesarea, idade gestacional no parto, peso do recem-nascido ao nascimento, adequacao do peso a idade gestacional, indices de Apgar no primeiro e quinto minuto de vida, presenca de malformacoes e obito neonatal. Utilizaram-se o teste exato de Fisher e o c2 na comparacao entre os dois grupos. Calculou-se tambem a razao de prevalencia. RESULTADOS: do total de partos ocorridos no periodo, 25,9% eram de adolescentes e a media de idade destas foi de 17,2 anos. Constatou-se que 88% frequentaram o pre-natal, sendo 60% com numero insuficiente de consultas. As intercorrencias clinicas mais frequentes foram a pre-eclâmpsia (14,7%), a anemia (12,9%) e a infeccao do trato urinario (6,4%), sem diferenca de frequencia entre os grupos. Ocorreram 31,3% de nascimentos por cesarea, sendo a pre-eclâmpsia a principal indicacao nas duas faixas etarias (25 e 23%, respectivamente). A frequencia de Apgar menor que 7 no primeiro minuto foi de 19,9% no grupo das adolescentes precoces e 14,2% entre as tardias (x²=6,96, p=0,008). Nao houve diferenca quanto a frequencia de prematuridade (20,2 vs 16,1%), recem-nascido pequeno para idade gestacional (12,4 vs 10,4%), baixos escores de Apgar de quinto minuto (5,3 vs 3,3%), malformacoes congenitas (3,1 vs 2,7%) e morte neonatal (1,6 vs 3,1%). CONCLUSOES: as gestantes adolescentes precoces e tardias apresentaram evolucao da gestacao e desempenho obstetrico semelhantes, exceto pela diferenca nos escores de Apgar no primeiro minuto.

Associated ultrasonographic findings in fetuses with microcephaly because of suspected Zika virus (ZIKV) infection during pregnancy

To describe fetal ultrasonographic findings and outcomes in a series of cases of fetal microcephaly associated with Zika virus infection.

Endothelial dysfunction after pregnancy-induced hypertension

To carry out long‐term analysis of the presence of endothelial dysfunction after the development of pregnancy‐induced hypertension (PIH).

Temporal trends and spatial distribution of unsafe abortion in Brazil, 1996-2012

OBJECTIVE To analyze temporal trends and distribution patterns of unsafe abortion in Brazil. METHODS Ecological study based on records of hospital admissions of women due to abortion in Brazil between 1996 and 2012, obtained from the Hospital Information System of the Ministry of Health. We estimated the number of unsafe abortions stratified by place of residence, using indirect estimate techniques. The following indicators were calculated: ratio of unsafe abortions/100 live births and rate of unsafe abortion/1,000 women of childbearing age. We analyzed temporal trends through polynomial regression and spatial distribution using municipalities as the unit of analysis. RESULTS In the study period, a total of 4,007,327 hospital admissions due to abortions were recorded in Brazil. We estimated a total of 16,905,911 unsafe abortions in the country, with an annual mean of 994,465 abortions (mean unsafe abortion rate: 17.0 abortions/1,000 women of childbearing age; ratio of unsafe abortions: 33.2/100 live births). Unsafe abortion presented a declining trend at national level (R2: 94.0%, p < 0.001), with unequal patterns between regions. There was a significant reduction of unsafe abortion in the Northeast (R2: 93.0%, p < 0.001), Southeast (R2: 92.0%, p < 0.001) and Central-West regions (R2: 64.0%, p < 0.001), whereas the North (R2: 39.0%, p = 0.030) presented an increase, and the South (R2: 22.0%, p = 0.340) remained stable. Spatial analysis identified the presence of clusters of municipalities with high values for unsafe abortion, located mainly in states of the North, Northeast and Southeast Regions. CONCLUSIONS Unsafe abortion remains a public health problem in Brazil, with marked regional differences, mainly concentrated in the socioeconomically disadvantaged regions of the country. Qualification of attention to women’s health, especially to reproductive aspects and attention to pre- and post-abortion processes, are necessary and urgent strategies to be implemented in the country.

Differences in Neonatal Outcome in Fetuses with Absent versus Reverse End-Diastolic Flow in Umbilical Artery Doppler

Objectives: It was the aim of this study to evaluate differences in the prognosis of fetuses with absent (AED) and reverse end-diastolic (RED) flow in the umbilical artery based on neonatal outcomes. Methods: We performed a cross-sectional study based on the records of 143 patients attending at Assis Chateaubriand Teaching Maternity between 1 January 1999 and 31 December 2005. Patients were classified according to diagnosis as having either fetal centralization (FC), AED or RED. Obstetrical findings and perinatal outcomes were compared for the 3 groups and between AED and RED by Fisher’s exact test. Perinatal outcomes were analyzed quantitatively with logistic or multinomial regression. Odds ratios were calculated for significant risk factors. Results: There was a statistically significant difference in gestational age at diagnosis, Apgar scores at 1 and 5 min, Capurro score, use of surfactant and mechanical ventilation, admission to the neonatal intensive care unit, perinatal and neonatal death. When comparing RED with AED, the odds of neonatal intensive care unit admission, mechanical ventilation, use of surfactant, neonatal mortality and perinatal mortality were 3.2, 1.4, 1.0, 5.1 and 5.3 times higher for RED. Only perinatal mortality kept statistically significant with odds of 5.2 (p = 0.043) when adjusted by gestational age (multivariate analysis). Conclusion: The incidence of perinatal mortality was observed to increase with the severity of Doppler findings, with significant differences between the AED and RED groups.

Prenatal imaging findings in fetal Zika virus infection

Purpose of review The aim of this review is to report the most recent observations concerning intrauterine Zika virus (ZIKV) infection and associated neuroimaging. Recent findings ZIKV outbreak in Brazil in 2015 was associated with an impressive registration of cases of congenital microcephaly in women with symptoms suggestive of ZIKV infection. Clinical and laboratory testing for ZIKV and hypothetic etiopathogenetic mechanisms are described. Diagnostic tests on blood, urine and amniotic fluid should be performed in all mothers with symptoms suggestive of intrauterine ZIKV infection. ZIKV causes multiple teratogenic malformations, mainly affecting the developing brain. Summary Neuroimaging investigation contributes to the prenatal detection of microcephaly and other brain abnormalities in cases of intrauterine ZIKV infection. Neuroimaging is based antenatally on two-dimensional and three-dimensional ultrasound and fetal MRI, whereas computed tomography scan is performed postnatally. Although neuropathology associated with intrauterine ZIKV infection is characterized by nonspecific findings of brain disorder, reduced cortical gyration and white-matter hypomyelination or dysmyelination and cerebellar hypoplasia have been consistently observed in the majority of fetuses and newborns. Prenatal or postnatal genetic workup should be carried out to exclude cases of primary microcephaly. Follow-up should rely upon MRI and computed tomography scan as well as neuropediatrician to better define developmental outcome in survivors.

Percepções de enfermeiras sobre a assistência prestada a mulheres diante do óbito fetal

Resumen This study aimed to assess the nurses’ perception on the nursing care provided to women facing the diagnosis of fetal death. Research with qualitative approach carried out in a maternity school in Fortaleza-CE, Brazil, from September to October 2009. The sample was composed of nine nurses who worked in the service of high-risk pregnancy. The results showed that the focus of assistance offered was the provision of psychological support, through the permission given to women or family members to see the dead fetus. The difficulties most frequently mentioned were associated with the structural issue of motherhood that did not have a specific ward for mothers with a diagnosis of fetal death. They also mentioned the heavy workload, once they had functions that were not part of the procedures of praxis. Thus, we emphasize the need for a different assistance to women facing fetal death covering, in addition to human resources, structural issues of health services.

Comparação entre ultrassonografia transvaginal e histerossonografia na avaliação de pacientes com sangramento uterino anormal

OBJECTIVE: To comparatively evaluate the effectiveness of transvaginal ultrasonography (TVUS) and sonohysterography (SHG) in the assessment of endometrial diseases in women with abnormal uterine bleeding. MATERIALS AND METHODS: Cross-sectional study with 30 patients, aged from 29 to 71 years, 21 (70%) of them premenopausal and 9 (30%) postmenopausal. Saline solution (at 9%) was utilized as contrast agent for SHG. The MacNemar test was utilized for comparison of diagnostic studies. RESULTS: Hysteroscopy diagnosed 18 cases (60%) of intracavitary alterations, and 10 polyps (33.3%). TVUS demonstrated 83.3% sensitivity and specificity, and SHG showed 94.4% sensitivity and 91.6% specificity. The MacNemar test showed similar sensitivity (p = 0.500) and specificity (p = 1.000) between TVUS and SHG in the detection of endometrial diseases. In the diagnosis of polyp, SHG showed the highest sensitivity (90.9% vs. 27.3%; p = 0.016) with similar specificity (89.5% vs. 94.7%; p = 1.000). CONCLUSION: SHG and TVUS present a good predictive value for endometrial diseases in patients with abnormal uterine bleeding. SHG and TVUS present similar sensitivity and specificity in the detection of such diseases, but SHG is more sensitive in the detection of polyps.

Fatores associados à realização de citologia para prevenção de câncer do colo uterino em uma comunidade urbana de baixa renda

Objective: To evaluate the prevalence of prevention of cervical cancer and the factors associated with annual collection.Methods: Cross-sectional study conducted between August 2010 and June 2011 through interviews with 144 women 25-52 years old in a low income urban community in Fortaleza (CE). Were used the χ2 test and ANOVA comparing the groups never did collect, held annually and not those who made an annual basis. Variables with p values <0.20 were subjected to logistic regression to estimate odds ratios (OR).Results:The proportion of women who reported annual collection was 59.3%. Remunerated employment (p=0.04), and family income (p<0.01) showed significant association. In simple logistic regression, remunerated employment (OR=2.15), economic status (OR=3.32) and the having had the maximum of one pregnancy (OR=2.73) and, in multiple logistic regression, remunerated employment (OR=2.63) and the having had the maximum of one pregnancy (OR=2.60) were associated with annually periodicity for cervicovaginal smear.Conclusion:Women with remunerated employment and had no more than one pregnancy had a greater chance of achieving an annual frequency of cytology for preventing cervical cancer.

Delivery prediction in pregnant women with spontaneous preterm birth using fetal adrenal gland biometry

Abstract Objective: To assess the prediction of delivery within 7 days in pregnant women who showed symptoms of spontaneous preterm birth (PB) by means of fetal adrenal gland biometry and to compare these predictions with the cervical length (CL) measurement. Methods: We performed a prospective cross-sectional study with 53 pregnant women between 24 and 36 weeks of gestation. An ultrasound exam was performed for each participant to obtain the CL measurement (transvaginal route) and fetal adrenal gland biometry on day 1 of their hospital admission because of symptoms of spontaneous PB. The main outcome measure was the time between the ultrasound exam and delivery, which was classified into two groups: delivery  ≤7 days and delivery  >7 days. A receiver operating characteristics (ROC) curve was performed to define the cutoffs for sensitivity and specificity. Results: The prevalence of delivery within 7 days was 35.8%, which showed a statistically significant difference from the depth of the central zone of the fetal adrenal gland (p  =  0.036). The cutoff for the depth of the central zone of the fetal adrenal gland was 7.2 mm (sensitivity 66.7%, specificity 61.8% and accuracy 63.5%). These values were not significantly different than the cutoffs for cervical length measurement: 20 mm (p  =  0.267) and 9 mm (p  =  0.118). Conclusion: The biometry for the central zone of the fetal adrenal gland predicted delivery within 7 days in pregnant women with spontaneous PB and had a predictive accuracy similar to that of CL measurement.