Mary Ângela Parpinelli

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).

Colonização bacteriana do canal cervical em gestantes com trabalho de parto prematuro ou ruptura prematura de membranas

PURPOSE to study cervical colonization in women with preterm labor or premature rupture of membranes. METHODS two hundred and twelve pregnant women with preterm labor or premature rupture of membranes were studied. Two cervical samples from each woman were collected and bacterioscopy and culture were performed. Association of cervical microorganisms and urinary tract infection, chorioamnionitis, fetal stress, antibiotic use, prematurity, neonatal infection, and neonatal death were evaluated. RESULTS the prevalence of endocervical colonization was 14.2% (CI95%=9.5-18.9%), with similar results in preterm labor or premature rupture of membranes. Group B streptococcus was the most prevalent organism (9.4%). Other organisms isolated were Candida sp, Streptococcus sp, Streptococcus pneumoniae, Escherichia coli and Enterococcus sp. The most common findings of bacterioscopy were a reduced number of lactobacilli and a great number of leukocytes. Endocervical colonization was associated with a higher occurrence of urinary tract infection (23.8 versus 5.4%; p<0.01), early-onset neonatal infection (25.0 versus 7.3%; p<0.01) and neonatal mortality (two cases in colonized women; p<0.02) when compared with a negative culture of endocervical mucus. CONCLUSIONS this study showed high prevalence of endocervical colonization despite the use of a nonselective culture media. The main microorganism isolated was group B streptococcus, but other organisms were present in one third of the studied population. More studies are needed to evaluate the influence of endocervical colonization on obstetrical outcome and on neonatal infection and mortality.

Calcified abdominal pregnancy with eighteen years of evolution: case report

CONTEXT The lithopedion (calcified abdominal pregnancy) is a rare phenomenon and there are less than 300 cases reported in the medical literature. CASE REPORT In this case, a 40 year-old patient had had her only pregnancy 18 years earlier, without medical assistance since then. She came to our hospital with pain and tumoral mass of approximately 20 centimeters in diameter. Complementary examinations (abdominal X-ray, ultrasonography and computerized tomography) demonstrated an extra-uterine abdominal 31-week pregnancy with calcification areas. Exploratory laparotomy was performed, with extirpation of a well-conserved fetus with partially calcified ovular membranes.

Cervical ripening methods for labor induction.

Tem sido mundialmente crescente a indicacao de inducao do trabalho de parto. Sabe-se que as condicoes do colo uterino estao diretamente relacionadas com o sucesso da inducao. O conhecimento da anatomia e fisiologia do colo uterino durante a gestacao, bem como as dos diversos metodos de preparo cervical, sao de fundamental importância para que possa ser indicado o melhor metodo para o preparo de colo em uma situacao especifica e consequentemente obter-se melhores resultados nas inducoes do trabalho de parto. Esse e um desafio para os obstetras de um pais em que nem todos os metodos estao disponiveis e acessiveis e com taxas de cesarianas tao elevadas quanto o Brasil. Sao discutidos alguns metodos incluindo a estimulacao dos mamilos, descolamento de membranas, relaxina, ocitocina, prostaglandinas, hialuronidase, mefiprestone, laminaria e sonda Foley.

Exercício físico no ganho de peso e resultados perinatais em gestantes com sobrepeso e obesidade: uma revisão sistemática de ensaios clínicos

This study aimed to evaluate the effects of exercise on weight gain and perinatal outcomes among overweight and obese pregnant women, through a systematic review in MEDLINE/PubMed, EMBASE, LILACS, and SciELO. We included ten clinical trials that evaluated the effectiveness of exercise with or without combined diet in the control of gestational weight gain. Three studies were randomized, and methodological quality was assessed using the CONSORT 2010 Checklist, but none met all the criteria. Four studies showed weight gain differences between groups. The majority (60%) of studies showed no differences in perinatal outcomes (mode of delivery, gestational age at birth, birth weight). In conclusion, few studies confirmed the positive effect of exercise in controlling weight gain during pregnancy, thus requiring more research in this direction. Regarding perinatal outcomes, mild to moderate exercise does not appear to be decisive for perinatal outcomes, and is safe for pregnant women with overweight and obesity.This study aimed to evaluate the effects of exercise on weight gain and perinatal outcomes among overweight and obese pregnant women, through a systematic review in MEDLINE/PubMed, EMBASE, LILACS, and SciELO. We included ten clinical trials that evaluated the effectiveness of exercise with or without combined diet in the control of gestational weight gain. Three studies were randomized, and methodological quality was assessed using the CONSORT 2010 Checklist, but none met all the criteria. Four studies showed weight gain differences between groups. The majority (60%) of studies showed no differences in perinatal outcomes (mode of delivery, gestational age at birth, birth weight). In conclusion, few studies confirmed the positive effect of exercise in controlling weight gain during pregnancy, thus requiring more research in this direction. Regarding perinatal outcomes, mild to moderate exercise does not appear to be decisive for perinatal outcomes, and is safe for pregnant women with overweight and obesity.

Prevalência de anticorpos antifosfolípides em diabéticas gestacionais e pré-gestacionais

OBJETIVO: identificar e descrever a prevalencia de anticorpos antifosfolipides (anticorpo anticardiolipina e anticoagulante lupico) em gestantes diabeticas. METODOS: estudo prospectivo de prevalencia, realizado no periodo de julho de 2003 a marco de 2004. Foram estudadas 56 gestantes diabeticas gestacionais e pre-gestacionais que ingressaram ao pre-natal e aceitaram participar do estudo. Nenhuma gestante foi excluida. Se um ou outro anticorpo estivesse presente, a gestante seria tratada com heparina e acido acetilsalicilico. Foram caracterizados os perfis da gestante, a evolucao da gestacao e o recem-nascido. RESULTADOS: foram diagnosticados anticorpos antifosfolipides em apenas quatro gestantes das 56 estudadas, o que representou prevalencia de 7% (IC 95% - 0,1-13,9). Nas gestantes diabeticas com anticorpos antifosfolipides a duracao do diabetes foi de cinco anos ou mais. A idade variou de 27 a 38 anos, sendo uma primigesta, outra secundigesta e as outras duas multiparas. As gestantes com anticorpos antifosfolipides, que foram tratadas, tiveram recem-nascidos vivos, de termo, cujos pesos variaram entre 2.650 g e 4.000 g. CONCLUSAO: a prevalencia de anticorpos antifosfolipides em gestantes diabeticas gestacionais e baixa, e similar a populacao geral de gravidas. Esta prevalencia aumenta quando a gestante e diabetica pre-gestacional.

Pharmacist interventions in high-risk obstetric inpatient unit: a medication safety issue

Objectives The aim of this study was to report number, type and severity of prescribing errors and pharmacist interventions in high-risk pregnant and postpartum women. Design A prospective cross-sectional, observational study. Setting A high-risk obstetric inpatient unit of a Womens Hospital in Brazil. Participants About 1826 electronic prescriptions for 549 women in the high-risk obstetrics inpatient unit were included. Interventions When the pharmacist detected potential prescribing errors, interventions were suggested. Main Outcome Measures Prescriptions were evaluated by clinical pharmacist to identify the type, frequency and severity of prescribing errors and rate of clinical pharmacist intervention acceptance in a high-risk obstetric inpatient. Results A total of 1826 prescriptions were reviewed with 128 errors (7.0%). The most frequent errors were drug interaction (43.8%), incorrect frequency (21.5%) and improper dose (13.1%). One-hundred and sixty-eight interventions were made by pharmacists, 98.8% of which were accepted by prescribers. Higher maternal age (OR 1.0 (95%CI 1.0-1.1)), higher number of prescribed medications (OR 1.2 (95%CI 1.1-1.3)), obstetric conditions (OR 2.2 (95%CI 1.4-3.3)) and non-breastfeeding postpartum women (OR 3.9 (95% CI 2.5-6.1)) were the independent factors associated with prescribing errors identified through multivariate analysis. Conclusions The most common prescription errors related to drug interactions, incorrect frequency and higher number of prescribed medications. The rate of pharmacist acceptance intervention was high.

Pregnancy in women undergoing hemodialysis: case series in a Southeast Brazilian reference center

PURPOSE To describe maternal and neonatal outcomes in pregnant women undergoing hemodialysis in a referral center in Brazilian Southeast side. METHODS Retrospective and descriptive study, with chart review of all pregnancies undergoing hemodialysis that were followed-up at an outpatient clinic of high- risk prenatal care in Southeast Brazil. RESULTS Among the 16 women identified, 2 were excluded due to follow-up loss. In 14 women described, hypertension was the most frequent cause of chronic renal failure (half of cases). The majority (71.4%) had performed hemodialysis treatment for more than one year and all of them underwent 5 to 6 hemodialysis sessions per week. Eleven participants had chronic hypertension, 1 of which was also diabetic, and 6 of them were smokers. Regarding pregnancy complications, 1 of the hypertensive women developed malignant hypertension (with fetal growth restriction and preterm delivery at 29 weeks), 2 had acute pulmonary edema and 2 had abruption placenta. The mode of delivery was cesarean section in 9 women (64.3%). All neonates had Apgar score at five minutes above 7. CONCLUSIONS To improve perinatal and maternal outcomes of women undergoing hemodialysis, it is important to ensure multidisciplinary approach in referral center, strict control of serum urea, hemoglobin and maternal blood pressure, as well as close monitoring of fetal well-being and maternal morbidities. Another important strategy is suitable guidance for contraception in these women.