Lílian Rezende Coelho

Obstetric, clinical, and perinatal implications of H1N1 viral infection during pregnancy

To determine perinatal outcome and epidemiologic, clinical, and obstetric characteristics among pregnant women infected with the H1N1 virus admitted to a Brazilian university hospital.

Toxoplasmose e gestação: resultados perinatais e associação do teste de avidez de IgG com infecção congênita em gestantes com IgM anti-Toxoplasma gondii reagente

OBJETIVOS: verificar os desfechos perinatais em gestantes com toxoplasmose aguda e se houve associacao entre os resultados dos testes de avidez para anticorpos IgG anti- Toxoplasma gondii e a presenca ou ausencia de infeccao fetal/neonatal. METODOS: um estudo transversal incluiu gestantes com diagnostico sorologico de toxoplasmose apresentando IgM especifica reagente, atendidas no Ambulatorio de Gestacao de Alto Risco da Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, no periodo de novembro de 2002 a novembro de 2007. Resultados do teste de avidez de IgG demonstrando indices superiores a 30% foram considerados alta avidez, enquanto valores inferiores a 30% foram considerados baixa avidez. Definiram-se como sendo de infeccao fetal e/ou neonatal os casos com resultado positivo para a reacao em cadeia da polimerase no liquido amniotico ou com IgM especifica para toxoplasmose reagente no sangue do recem-nascido. RESULTADOS: considerando-se todas as gestantes referidas para o ambulatorio de gestacao de alto risco no periodo estudado, a frequencia de gestantes com IgM anti- Toxoplasma gondii reagente foi de 10,8% (176/1.634). A taxa de infeccao congenita nessas pacientes foi de 4% (7/176). O teste de avidez de IgG foi realizado em 162 gestantes (92%), encontrando-se avidez alta em 144 (88,9%). Houve associacao (p=0,003) entre avidez alta e ausencia de toxoplasmose fetal/neonatal na amostra estudada, com razao de prevalencia de 13,4 (intervalo de confianca [IC] 95% 2,2-86,6). O Valor preditivo positivo do teste de avidez (probabilidade de infeccao congenita com avidez baixa) foi de 22% (IC 95% 6%-47%), enquanto o valor preditivo negativo (probabilidade de ausencia da infeccao congenita com avidez alta) foi de 98% (IC 95% 94%-99%). CONCLUSOES: neste estudo a taxa de infeccao congenita em gestantes com diagnostico de toxoplasmose aguda foi de 4%. Nas gestantes com IgM anti- Toxoplasma gondii positiva, o resultado do teste de avidez de IgG anti- Toxoplasma gondii associou-se a presenca ou ausencia de infeccao congenita, com elevado valor preditivo negativo (ausencia de infeccao fetal/neonatal quando a avidez era alta).

Eficácia de intervenção com enoxaparina baseada em sistema de pontuação nos desfechos perinatais de gestantes com trombofilias

PURPOSES To assess whether an enoxaparin-based intervention using a score system was effective in improving perinatal outcome in women with thrombophilia. METHODS STUDY DESIGN Prospective, not randomized, uncontrolled, performed at a Clinic of High-Risk Pregnancy from November 2009 to November 2011. We included women with a diagnosis and therapeutic intervention for thrombophilia acquired and/or inherited in the current pregnancy. The obstetric and perinatal outcomes of pregnant women before the intervention were compared with outcomes after the intervention, and statistically analyzed using the χ2 test with Yates correction, considered significant when p<0.05. The initial dose of low-molecular-weight Heparin (LMWH) was guided by a scoring system based on the clinical and gestational history of the patients and screening tests for acquired and/or inherited thrombophilia. RESULTS We included 84 pregnant women with 175 pregnancies before diagnosis, 20.0% of which resulted in fetal ou perinatal death, 40.0% resulted in abortion, 17.7% developed preeclampsia/eclampsia, 10.3% resulted in full-term births, and 29.7% in premature births. In the 84 pregnancies after intervention, 6.0% resulted in fetal ou perinatal death, 1.2% in abortion, 4.8% developed preeclampsia/eclampsia, 22.6% resulted in premature birth, and 70.2% in full-term birth. A significant reduction in the rate of stillbirths/perinatal death (p<0.05) and abortion (p<0.0001) and a significant increase (p<0.05) in the number of live births were observed after intervention. CONCLUSION Enoxaparin-based intervention using a score system in pregnant women with thrombophilia is effective in improving perinatal outcome.

UrinarY tract inFection in HigH riSK Pregnant WoMen

Background: In this study, we aimed to verify the frequency of urinary tract infection (UTI) in pregnant women, the main etiologic agents and their antibiotic susceptibilities. Moreover, to confirm UTI as a risk factor for maternal and fetal complications. Methodology: Data collection was performed using medical records from pregnant women suffering from UTIs (the Study Group) and pregnant women without UTIs (the Control Group). Both groups of patients visited the Department of High Risk Pregnancy, University Hospital, Federal University of Mato Grosso do Sul during the period of April 2005 to April 2010. Results: Of the 864 pregnant women studied, 15.6% (135/864) had a UTI. Escherichia coli was the most frequent cause of urinary tract infections, with a frequency of 34.8% (47/135). The E. coli strains were most sensitive to norfloxacin (91.4%), nitrofurantoin (80.8%) and ceftriaxone (74.4%) and most resistant to ampicillin (42.5%), trimethoprim-sulfamethoxazole (31.1%) and first-generation cephalosporins (14.8%). There was a significant association between preterm delivery, low birth weight and UTI in pregnant women. There was no significant association with premature rupture of membranes, admission to Neonatal Intensive Care Unit (Neo ICU) and Apgar of less than 7 at 5 min. Conclusion: The use of urine culture as routine prenatal laboratorial screening allows for the early diagnosis and treatment of UTIs in pregnant women, thereby providing better perinatal conditions.

Marcadores séricos de trombofilias hereditárias e anticorpos antifosfolípides em gestantes com antecedentes de pré-eclâmpsia grave

PURPOSE To determine the frequency and the association of serum markers for inherited and acquired thrombophilias in pregnant women with a history of severe pre-eclampsia in previous pregnancies. METHODS Case-control study consisting of 81 pregnant women with a history of severe pre-eclampsia in previous pregnancies (study group) and 32 women with no history of severe pre-eclampsia in previous pregnancies (control group). The presence of inherited thrombophilia and antiphospholipid antibodies was screened in both groups. We used the chi-square test with Yates correction to assess associations and calculate the relative risks. RESULTS The presence of thrombophilia was detected in 60.0% of patients with a previous history of pre-eclampsia and in 6.0% of the control patients. A significant association was found between pre-eclampsia in a previous pregnancy and the presence of markers for hereditary thrombophilia/antiphospholipid antibodies (p<0.05). The relative risk to develop pre-eclampsia was found to be 1.57 (1.34<RR<1.84) for pregnant women with antiphospholipid antibodies, 1.53 (1.26<RR<1.86) for women with hereditary thrombophilia markers and 1.86 (1.45<RR<2.38) considering the presence of hereditary thrombophilia and/or antiphospholipid antibodies. CONCLUSION Women with serum markers for inherited or acquired thrombophilia showed a high relative risk to develop pre-eclampsia.

W049 URINARY TRACT INFECTION: ANALYSIS OF DIAGNOSTIC, THERAPEUTICAL AND PERINATAL ASPECTS IN HIGH RISK PREGNANCIES

Objectives: The study aimed to evaluate the diagnostical, therapeutical and perinatal aspects of urinary tract infection (UTI) in pregnant women. Materials: Observational and retrospective study, with comparison group, from April 2005 to April 2010 at the Clinic for High Risk Pregnancy, University Hospital (UH) College of Medicine, Federal University of Mato Grosso do Sul (FAMED-UFMS). Methods: All pregnant women who had urinary tract infection with positive urine culture results were analyzed in the period and included in the study group (SG). The same number of pregnant women without urinary tract infection were included in the Comparison Group (CG). The association between nonparametric variables were evaluated by Chi-square and two-tailed Fisher exact test on contingency tables of double entry, with the expression ’p’ and an odds ratio (OR) with confidence interval 95% (CI95%). It was accepted p < 0.05 for statistically significant associations. This study was approved by the Ethics Committee in Human Research (ECHR) Protocol No. 860 of 08/03/2007. Results: Out of 864 pregnant women studied, 15.6% (135/864) had urinary tract infection. Escherichia coli was the most frequent bacteria with frequency of 34.8% (47/135). The E. coli strains were more sensitive to norfloxacin (91.4%), nitrofurantoin (80.8%) and ceftriaxone (74.4%). There was little effect on growth inhibition in vitro to ampicillin (42.5%), trimethoprim-sulfamethoxazole (31.1%) and first generation cephalosporins (14.8%). The UTI group had rates 2.2 times higher for infants with gestational age less than 37 weeks, showing a statistically significant association (p =0.03, OR=2.43, 95%CI = 1.4 to 5.78). Also in agreement with previous results, low birth weight were presented in higher percentages in the groups with UTI (21.5%) compared to the comparison group (5.9%). This association was significant (p = 0.009, OR=4.0, 95%CI = 1.66 to 9.98). Conclusions: The use of urine culture as routine prenatal laboratorial screening allows early diagnostic and treatment of urinary infection in pregnant women, allowing better perinatal conditions.