José Carlos Gama da Silva

Association of anticardiolipin antibody and C677T in methylenetetrahydrofolate reductase mutation in women with recurrent spontaneous abortions: a new path to thrombophilia?

CONTEXT Recurrent spontaneous abortion (RSA) has been associated with venous thrombosis in the mother. Acquired and inherited thrombophilia factors are possible causes. OBJECTIVE To evaluate the association between thrombogenic factors and recurrent spontaneous abortion. TYPE OF STUDY Case-control study. SETTING Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas. METHODS 40 ml of blood was collected from 88 women attending an RSA clinic and 88 fertile women attending a family planning clinic, to evaluate the presence of acquired and inherited thrombophilia factors. Anticardiolipin antibodies (ACA), lupus anticoagulant and deficiencies of proteins C and S and antithrombin III were evaluated by enzyme-linked immunosorbent assay (ELISA), dilute Russell Viper Venom time (dRVVT), coagulometric and chromogenic methods. DNA was amplified by the polymerase chain reaction (PCR) to study factor V Leiden and G20210A mutations in the prothrombin gene and C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene. Data were analyzed using odds ratios and a regression model for age adjustment. Fishers exact test was used to evaluate statistical relationships between associated factors and RSA. RESULTS ACA was detected in 11 women with RSA and one fertile woman. Heterozygous C677T was detected in 59 women with RSA and 35 fertile women. Concomitant presence of ACA and C677T was found in eight women with RSA and no fertile women (p < 0.01). DISCUSSION The meaning of the association between C677T mutation in the MTHFR gene and ACA is still not clear. It is possible that an inherited factor that alone would not strongly predispose a woman to thrombosis could, when associated with an acquired factor, start the process and increase the likelihood of thrombosis expression. CONCLUSIONS ACA and C677T in the MTHFR gene are statistically associated with RSA. The association of these two conditions is a new finding in thrombogenic factors and RSA.

Accuracy of the serological ELISA test compared with the polymerase chain reaction for the diagnosis of cytomegalovirus infection in pregnancy

CONTEXT The most frequently used methods for detecting antibodies are the indirect immunofluorescence test and the enzymatic immunoassay (ELISA). The polymerase chain reaction is a molecular biology technique in which the production of large amounts of specific DNA fragments is induced from very low concentrations of complex substrates aloowing the detection of very low amounts of viral particles. OBJECTIVE To assess the accuracy of serological/ELISA tests in comparison with the polymerase chain reaction in maternal blood to diagnose cytomegalovirus infection. DESIGN A descriptive study was performed. SETTING High-risk outpatient clinic of Campinas University (Unicamp). PARTICIPANTS We selected 243 pregnant women. All of them had been indicated for blood sampling because of suspicions of cytomegalovirus infection and also because of other infections. MAIN MEASUREMENTS The group was tested for cytomegalovirus. Serological tests were run and compared to the polymerase chain reaction, which was considered to be the gold standard. Status analyses were done using Fishers exact test, via the SAS software. RESULTS The previous cytomegalovirus infection rate was 94.6%. The main reasons for inclusion in the study were fetal nervous system malformation (25.5%), maternal toxoplasmosis (25.5%) and Rh isoimmunization (14.8%). Only two women were included because of positive serological immunoglobulin M test for cytomegalovirus. The sensitivity and specificity of the serological tests were 94% and 6% for immunoglobulin G. CONCLUSION Serological tests had lower sensitivity in comparison with the polymerase chain reaction test when diagnosing cytomegalovirus infection. The consequences of positive polymerase chain reaction and negative immunoglobulin M in women remain unknown.

Resultados gestacionais e perinatais de gestações com insuficiência cervical submetidas a circlagem eletiva

OBJETIVO: descrever os resultados gestacionais de uma serie de gestantes submetidas a circlagem cervical eletiva. METODOS: estudo retrospectivo descritivo de 123 gestacoes em 116 pacientes submetidas a circlagem eletiva por insuficiencia cervical, pelas tecnicas de Espinosa-Bahamondes, Palmer ou MacDonald, e acompanhadas no Ambulatorio de Pre-Natal Especializado do CAISM/UNICAMP. As variaveis foram analisadas por meio frequencia, media e desvio-padrao e comparadas pelo teste de c2 ou o teste exato de Fisher. RESULTADOS: 73% das pacientes apresentavam pelo menos um abortamento previo, 17,9% tinham 3 ou mais abortamentos anteriores e 48% tinham antecedente de parto prematuro. A idade gestacional media de realizacao da circlagem foi 16 semanas. Houve predominio de utilizacao da tecnica cirurgica de Espinosa modificada por Bahamondes (94,3%). A incidencia de complicacoes durante a gestacao foi de 69%; a do trabalho de parto prematuro (31,7%) foi a mais frequente, seguido de vaginites/vaginose (26%), ruptura prematura pre-termo de membranas (10,5%) e obito fetal (8,7%), As principais intercorrencias clinicas associadas foram infeccao do trato urinario (5,6%), sindromes hipertensivas (4%) e diabete gestacional (2,4%). O indice de perdas gestacionais foi de 8,9% (11 obitos fetais). Houve 18% de partos prematuros e o antecedente de parto prematuro associou-se a ocorrencia de partos prematuros na gestacao em estudo. CONCLUSOES: os antecedentes obstetricos compativeis com insuficiencia istmocervical foram frequentes e o antecedente de parto prematuro associou-se a ocorrencia de partos prematuros na gestacao em estudo. A utilizacao de circlagem a Espinosa-Bahamondes resultou em taxa de 18% de partos prematuros e de 104 em mil de morte perinatal. Sao necessarios estudos prospectivos controlados para avaliar o real beneficio da circlagem cervical durante a gravidez.

Percepção materna de movimentos fetais como método de avaliação da vitalidade fetal em gestantes diabéticas

Purpose: to evaluate the accuracy of maternal perception of fetal movements (MPFM) in diabetic pregnant women, using Apgar score at the 1st and 5th min of life, intrapartum fetal distress and neonatal hypoxia as parameters. Methods: two hundred and nine diabetic women evaluated at the High Risk Prenatal Care Clinic of the Womens Hospital (CAISM) were analyzed retrospectively between June 1988 and May 1996. All patients had MPFM records within three days before delivery, fetal heart rate recordings during labor, gestational age greater than 30 weeks and a complete neonatal evaluation. MPFM was classified as normal if seven movements were recorded in 60 min. Results: the sensitivity of the test was 23 and 29% for Apgar score 7 at 5 min and neonatal hypoxia. Conclusions: MPFM is a useful test to identify diabetic women needing fetal evaluation with more complex techniques, given the high NPV, that indicates the capacity to separate the cases where the fetus is in good condition.