Helaine Milanez

Knowledge, attitude and practice of women in Campinas, São Paulo, Brazil with respect to physical exercise in pregnancy: a descriptive study

BackgroundPregnancy is a good time to develop healthy lifestyle habits including regular exercise and good nutrition. Programs of physical exercise for pregnant women have been recommended; however, there are few references on this subject in the literature. The objective of this study was to evaluate the knowledge, attitude and practice of pregnant women with respect to appropriate physical exercise during pregnancy, and also to investigate why some women do not exercise during pregnancy.MethodsA descriptive study was conducted in which 161 women of 18 to 45 years of age were interviewed in the third trimester of pregnancy. These women were receiving prenatal care at National Health Service (SUS) primary healthcare units and had no pathologies for which physical exercise would constitute a risk. The women were selected at an ultrasonography clinic accredited to the SUS in Campinas, São Paulo. A previously elaborated knowledge, attitude and practice (KAP) questionnaire was used to collect data, which were then stored in an Epinfo database. Statistical analysis was conducted using Pearsons chi-square test and Fishers exact test to evaluate the association between the study variables (p < 0.05).ResultsAlmost two-thirds (65.6%) of the women were sufficiently informed about the practice of physical exercise during pregnancy and the vast majority (93.8%) was in favor of it. Nevertheless, only just over 20% of the women in this sample exercised adequately. Significant associations were found between an adequate knowledge of physical exercise during pregnancy and education level (p = 0.0014) and between the adequate practice of physical exercise during pregnancy and having had fewer pregnancies (p = 0.0001). Lack of time and feeling tired and uncomfortable were the principal reasons given by the women for not exercising.ConclusionThese results suggest that womens knowledge concerning the practice of physical exercise during pregnancy is reasonable and their attitude is favorable; however, relatively few actually exercise during pregnancy.

Phenotypical characteristics of group B streptococcus in parturients

Colonization by Group B Streptococcus (GBS) is highly prevalent among pregnant women, with prevalence rates ranging between 4% and 30%. The infection may be transmitted vertically and may result in serious neonatal consequences. In the period from November 2003 to May 2004, a cross-sectional study was carried out among 316 parturients at the Jundiaí Teaching Hospital to establish the prevalence of genital GBS colonization, to identify the factors associated with colonization and the characteristic phenotypes of these streptococci. Samples from rectal and vaginal areas were collected for selective culture in Todd-Hewitt broth. Susceptibility to 7 antimicrobial agents was tested using the antibiotic diffusion disk technique, and the isolated strains were classified using specific antisera. The prevalence of GBS colonization was 14.6%. No strain was resistant to penicillin, ampicillin, erythromycin or nitrofurantoin. The majority of strains were sensitive to cephalothin. Greatest resistance was to gentamicin (76.1%), followed by clindamycin (17.4%). The most frequent serotype was Ib (23.9%), followed by serotypes II and Ia (19.6% and 17.4%, respectively). There was no correlation between serotype and greater antimicrobial resistance. In conclusion, the prevalence of GBS in parturients was high and penicillin continues to be the drug of choice for intrapartum prophylaxis. The most frequent serotype (Ib) found in this study differs from those found in the majority of studies carried out in other countries, revealing the need to identify prevalent serotypes in each region so that specific vaccines can be designed.

Using A Caesarean Section Classification System Based On Characteristics Of The Population As A Way Of Monitoring Obstetric Practice.

Objectiveto compare the distribution of caesarean rates in the Robsons 10 groups classification in order to see if any change occurred after the implementation of an audit and feedback intervention. Design: cross sectional, before and after an audit and feedback study. Setting: a university hospital in Brazil.Methodsclinical records of all births during two three months-periods were evaluated. Each case of CS was classified into one of ten mutually exclusive categories according to obstetric characteristics. The proportion of CS in each group was compared in both periods.Resultstotal number of deliveries and the high rate of CS were similar in both periods. Group 3 (multiparous excluding previous CS, single, cephalic, ≥ 37 weeks, spontaneous labour) accounted for the largest proportion of deliveries, 28.5 and 26.8% in both periods. Group 1 (nulliparous, single, cephalic, ≥ 37 weeks, spontaneous labour) was the second largest one, while Group 5 (previous caesarean section, single, cephalic, and ≥ 37 weeks) was the third but the largest contributor to CS, accounting for 16.6 and 14.9% among all deliveries in both periods. Groups 2 (nulliparous, single, cephalic, ≥ 37 weeks, induction or CS before labour) and 4 (multiparous excluding previous CS, single, cephalic, ≥ 37 weeks, induction or CS before labour) were less prevalent, however had higher rates of CS. Only in Group 10 (All single, cephalic, ≤ 36 weeks, including previous CS), there was a significant decrease of CS rate from 70.5 to 42.6% between periods.ConclusionRobsons classification did not identify any significant change in the pattern of CS rates with the audit and feedback process, but showed to be useful for comparing trends among similar obstetric populations.

Misoprostol versus expectant management in premature rupture of membranes at term

Objective  To compare the effectiveness of immediate induction of labour with vaginal misoprostol versus expectant management for 24 hours followed by oxytocin induction in women with premature rupture of membranes at term (term PROM).

Mother-to-child transmission of human immunodeficiency virus in aten years period

Objectivesto evaluate mother-to-child transmission (MTCT) rates and related factors in HIV-infected pregnant women from a tertiary hospital between 2000 and 2009.Subjects and methodcohort of 452 HIV-infected pregnant women and their newborns. Data was collected from recorded files and undiagnosed children were enrolled for investigation. Statistical analysis: qui-square test, Fisher exact test, Student t test, Mann-Whitney test, ANOVA, risk ratio and confidence intervals.ResultsMTCT occurred in 3.74%. The study population displayed a mean age of 27 years; 86.5% were found to have acquired HIV through sexual contact; 55% were aware of the diagnosis prior to the pregnancy; 62% were not using HAART. Mean CD4 cell-count was 474 cells/ml and 70.3% had undetectable viral loads in the third trimester. HAART included nevirapine in 35% of cases and protease inhibitors in 55%; Zidovudine monotherapy was used in 7.3%. Mean gestational age at delivery was 37.2 weeks and in 92% by caesarian section; 97.2% received intravenous zidovudine. Use of AZT to newborn occurred in 100% of them. Factors identified as associated to MTCT were: low CD4 cell counts, elevated viral loads, maternal AIDS, shorter periods receiving HAART, other conditions (anemia, IUGR (intra uterine growth restriction), oligohydramnium), coinfecctions (CMV and toxoplasmosis) and the occurrence of labor. Use of HAART for longer periods, caesarian and oral zidovudine for the newborns were associated with a decreased risk. Poor adhesion to treatment was present in 13 of the 15 cases of transmission; in 7, coinfecctions were diagnosed (CMV and toxoplasmosis).ConclusionUse of HAART and caesarian delivery are protective factors for mother-to-child transmission of HIV. Maternal coinfecctions and other conditions were risk factors for MTCT.

Implementação oportuna de intervenções para reduzir a transmissão vertical do HIV: uma experiência brasileira bem-sucedida

OBJETIVO: Descrever o impacto da implementacao oportuna de novas condutas recomendadas por consensos clinicos nacionais dirigidos a prevencao da transmissao vertical de HIV na maternidade de um hospital universitario publico no Brasil. METODO: Realizou-se um estudo retrospectivo de coorte dos partos de mulheres infectadas pelo HIV atendidos na instituicao de 1990 a 2000. As condutas adotadas nesse periodo foram: 1) ate 1994, amamentacao contra-indicada, sem uso de drogas anti-retrovirais; 2) de 1995 a 1996, uso de zidovudina (AZT) pela gestante e pelo recem-nascido; 3) de 1997 a 1998, uso de AZT conforme protocolo ACTG 076; e 4) de 1999 a 2000, terapia anti-retroviral multipla e cesarea eletiva. Em todos os periodos, a distribuicao das drogas foi gratuita. Foram calculadas as taxas de transmissao nas quatro fases e as razoes de risco de transmissao congenita para as fases e para cada intervencao profilatica (amamentacao, tipo de terapia anti-retroviral, tipo de parto). RESULTADOS: Foram estudadas 197 gestacoes. Houve reducao na transmissao vertical da primeira para a quarta fase, de 32,3 para 25,7, 2,2 e 2,9%. A maior queda, observada na terceira fase, ocorreu apos a introducao do esquema completo do ACTG 076. O uso de terapia anti-retroviral combinada aumentou de 0% na primeira fase para 46,4% na quarta fase. Nao houve nenhum caso de transmissao vertical nas gestantes tratadas com multiplas drogas. O risco de transmissao vertical foi 5 vezes maior com amamentacao do que sem amamentacao (razao de risco = 5,06), 5 vezes maior sem terapia anti-retroviral contra uso do esquema ACTG completo (razao de risco = 5,29) e 4 vezes maior para parto com forcipe contra cesarea eletiva (razao de risco = 4,13). CONCLUSAO: A adocao oportuna de intervencoes atualizadas, recomendadas por consenso nacional de especialistas, com provisao gratuita de drogas, mostrou-se eficiente para reduzir a transmissao congenita do HIV.

Rubella Vaccination of Unknowingly Pregnant Women: The São Paulo Experience, 2001

BACKGROUND Rubella vaccination is contraindicated during pregnancy. During mass immunization of women of childbearing age against rubella, women unknowingly pregnant may be vaccinated. To evaluate the effects of rubella vaccination during pregnancy, the Brazilian state of São Paulo conducted a follow-up study of pregnant women vaccinated during a rubella campaign in 2001. METHODS Women vaccinated during pregnancy were reported to a national surveillance system. In the state of São Paulo, follow-up of vaccinated women included household interviews. Serum samples from vaccinated women were tested for antirubella antibodies to classify susceptibility to rubella infection. Children born to susceptible mothers were tested for evidence of congenital rubella infection and evaluated for signs of congenital rubella syndrome. RESULTS The São Paulo State Health Department received 6473 notifications of women vaccinated during pregnancy. Serology performed for 5580 women identified 811 (15%) that were previously susceptible. Incidence of spontaneous abortion or stillbirth among previously susceptible vaccinated women was similar to women with prior immunity. Twenty-seven (4.7%) of 580 newborns tested had evidence of congenital rubella infection; none had congenital rubella syndrome. CONCLUSIONS Mass rubella vaccination of women of childbearing age was not associated with adverse birth outcomes or congenital rubella syndrome among children born to women vaccinated during pregnancy.

Intrapartum Complications Associated With Malformations of Cortical Development

Birth asphyxia can be an early sign of cerebral palsy, the effect of an antenatal anomaly rather than its cause. The objective of this study was to evaluate the occurrence of intrapartum complications in patients with malformation of cortical development. The data were retrospectively assessed and compared with a control group of children with idiopathic epilepsy. Intrapartum complications were reported in 22 (31.5%) patients, as opposed to only 2 in the control group (p<0.001). Patients with cortical malformations frequently present intrapartum complications, which could lead to the misdiagnosis of hypoxic-ischemic encephalopathy. (J Child Neurol 2005;20:675—678).

Congenital hydrocephalus: gestational and neonatal outcomes

PurposeTo evaluate gestational and neonatal outcomes in pregnancies complicated by fetal hydrocephalus.MethodsRetrospective analysis of 287 cases of fetal hydrocephalus followed at the Fetal Medicine Unit of the University of Campinas in the period of 1996 to 2006.ResultsMean maternal age was 25 years, mean gestational age at diagnosis was 27 weeks. There were 50 cases of isolated ventriculomegaly, 95 cases of Chiari II malformation and 142 cases of ventriculomegaly associated with other malformations. Preterm delivery and vaginal delivery were more frequent in the group of ventriculomegaly associated with other malformations. Cardiac, skeletal and renal malformations were the most common associated malformations. Cesarean section was common (95%) in the Chiari II group. Fetal and neonatal death occurred more frequently (29 and 68%, respectively) in the group of ventriculomegaly associated with other malformations. Chromosomal anomalies were present in 15% of 165 investigated cases.ConclusionsFetal and neonatal prognosis and outcome are associated with the presence of associated anomalies and aneuploidy.

Audit and feedback: Effects on professional obstetrical practice and healthcare outcomes in a university hospital

Objective. To assess the effects of audit and feedback on the practice of professionals in obstetrics. Design. Before–after intervention study. Setting. Obstetric unit of a university hospital in Brazil. Methods. Before the intervention the prevalence rates of six evidence‐based interventions were assessed. Seminars and workshops were administered, with the baseline results and also the main contents from systematic reviews on the topics studied, followed by detailed discussion of each topic, based on the Reproductive Health Library. After four months, the same practices were measured again and compared with the pre‐intervention period. Main outcome measures. Selective episiotomy; continuous electronic fetal monitoring (EFM) during labor of low‐risk pregnant women; antibiotic prophylaxis in cesarean section; active management of third stage of labor; routine induction of labor at 41 weeks for uncomplicated pregnancies; and continuous support for women during childbirth. Results. Both periods showed a similar number and mode of deliveries. There was a significant reduction in episiotomies (RR = 0.84; 0.73–0.97) and an increase in continuous support for women during childbirth by a companion (RR = 1.42; 1.24–1.63). Although there was not a significant change in the use of oxytocin during the third stage of labor, there was a shift to the internationally recommended dosage of 10 IU (p<0.0001). There was no significant change in the use of antibiotic prophylaxis for cesarean section, continuous EFM, or routine induction of labor at 41 weeks for uncomplicated pregnancies. Conclusion. Audit and feedback can be used as a tool to improve obstetrical practice, at least for some interventions and when the medical staff is open and receptive to change.