Renato Luís Rombaldi

Transplacental transmission of Human Papillomavirus

This paper aimed at studying the transplacental transmission of HPV and looking at the epidemiological factors involved in maternal viral infection. The following sampling methods were used: (1) in the pregnant woman, (a) genital; (b) peripheral blood; (2) in the newborn, (a) oral cavity, axillary and inguinal regions; (b) nasopharyngeal aspirate, and (c) cord blood; (3) in the placenta. The HPV DNA was identified using two methods: multiplex PCR of human β-globin and of HPV using the PGMY09 and PGMY11 primers; and nested-PCR, which combines degenerated primers of the E6/E7 regions of the HPV virus, that allowed the identification of genotypes 6/11, 16, 18, 31, 33, 42, 52 and 58. Transplacental transmission was considered when type-specific HPV concordance was found between the mother, the placenta and the newborn or the mother and cord blood. The study included 49 HPV DNA-positive pregnant women at delivery. Twelve placentas (24.5%, n = 12/49) had a positive result for HPV DNA. Eleven newborn were HPV DNA positive in samples from the nasopharyngeal or buccal and body or cord blood. In 5 cases (10.2%, n = 5/49) there was HPV type-specific agreement between genital/placenta/newborn samples. In one case (2%, n = 1/49) there was type specific HPV concordance between genital/cord blood and also suggested transplacental transmission. A positive and significant correlation was observed between transplacental transmission of HPV infection and the maternal variables of immunodepression history (HIV, p = 0.011). In conclusion the study suggests placental infection in 23.3% of the cases studied and transplacental transmission in 12.2%. It is suggested that in future HPV DNA be researched in the normal endometrium of women of reproductive age. The possible consequence of fetal exposure to HPV should be observed.

Perinatal transmission of human papilomavirus DNA

The purpose was to study the perinatal transmission of human papillomavirus DNA (HPV-DNA) in 63 mother-newborn pairs, besides looking at the epidemiological factors involved in the viral DNA transmission. The following sampling methods were used: (1) in the pregnant woman, when was recruited, in cervix and clinical lesions of the vagina, vulva and perineal region; (2) in the newborn, (a) buccal, axillary and inguinal regions; (b) nasopharyngeal aspirate, and (c) cord blood; (3) in the children, buccal was repeated in the 4th week and 6th and 12th month of life. HPV-DNA was identified using two methodologies: multiplex PCR (PGMY09 and MY11 primers) and nested-PCR (genotypes 6/11, 16, 18, 31, 33, 42, 52 and 58). Perinatal transmission was considered when concordance was found in type-specific HPV between mother/newborn or mother/child. HPV-DNA genital was detected in 49 pregnant women submitted to delivery. Eleven newborns (22.4%, n = 11/49) were HPV-DNA positive. In 8 cases (16.3%, n = 8/49) there was type specific HPV concordance between mother/newborn samples. At the end of the first month of life three children (6.1%, n = 3/49) became HPV-DNA positive, while two remained positive from birth. In 3 cases (100%, n = 3/3) there was type specific HPV concordance between mother/newborn samples. In the 6th month, a child (2%, n = 1/49) had become HPV-DNA positive between the 1st and 6th month of life, and there was type specific HPV concordance of mother/newborn samples. All the HPV-DNA positive children (22.4%, n = 11/49) at birth and at the end first month of life (6.1%, n = 3/49) became HPV-DNA negative at the age of 6 months. The HPV-DNA positive child (2%, n = 1/49) from 1st to the 6th month of life became HPV-DNA negative between the 6th and 12th month of life and one child had anogenital warts. In the twelfth month all (100%, n = 49/49) the children studied were HPV-DNA negative. A positive and significant correlation was observed between perinatal transmission of HPV-DNA and the immunodepression of maternal variables (HIV, p = 0.007). Finally, the study suggests that perinatal transmission of HPV-DNA occurred in 24.5% (n = 12/49) of the cases studied.

Infection with human papillomaviruses of sexual partners of women having cervical intraepithelial neoplasia

Epidemiological studies show that human papillomaviruses (HPV) are strongly related to cervical cancer and cervical intraepithelial neoplasias (CIN). Unlike the case for women, there are no consistent data on the natural history of HPV in the male population even though these viruses are prevalent in males. We carried out a prospective study to assess the prevalence of HPV in males as well as the factors that determine such infections in 99 male sexual partners of women with CIN. The genitalia of the males were physically examined and subjected to peniscopy for the collection of scrapings which were subjected to the polymerase chain reaction and restriction fragment length polymorphism to detect HPV. Of the 99 males sampled, 54 (54.5%) were positive for HPV DNA, 24% of whom presented normal peniscopy, 28% presented evident clinical lesions and 48% isolated lesions consistent with subclinical infection. In the HPV-negative group, 53% showed normal peniscopy, 4% presented evident clinical lesions and 42% isolated lesions consistent with subclinical infection. The study detected a statistically significant association (P < 0.02, Pearson chi-square test) between HPV infection and both the mean number of sexual partners which a male had during his life and the mean number of sexual partners in the year prior to testing. Viral types 6 and 11 were most frequently encountered. The study shows that infection with HPV was frequent in male sexual partners of women with CIN.

Fatores maternos e perinatais relacionados à macrossomia fetal

PURPOSE: to identify maternal and perinatal factors related to neonates with birthweight >4,000 g. METHODS: cross-section cohort study with 411 consecutive cases of fetal macrosomia (FM) which occurred from March 1998 to March 2005. Data were compared to 7,349 cases of fetal birthweight >2,500 and <3,999 g which occurred in the same period. Maternal variables (maternal age, parity, diabetes, previous cesarean section, meconium-stained amniotic fluid, cephalopelvic disproportion, main cesarean section indications) and perinatal variables (birth injury, <7 1-min and 5-min Apgar score, fetal and early neonatal mortality range, need of neonatal intensive care unit) were analyzed. For statistical analysis the c2 test with Yates correction and Students t test were used with the level of significance set at 5%. RESULTS: FM was significantly associated with older mothers, more parous and <7 1-min Apgar score (p<0.05; OR=1.8; 95% CI: 1,4-2.5) and <7 5-min Apgar score (p<0,05; OR=2.3; 95% CI: 1.3-4,1), diabetes mellitus (p<0.05; OR=4.2; 95% CI: 2.7-6.4), meconium-stained amniotic fluid (p<0.02; OR=1.3; 95% CI: 1.0-1.7), need of neonatal intensive care unit (p<0,05; OR=2.0; 95% CI: 1.5-2.7), early neonatal mortality (p<0,05; OR = 2.7; 95% CI: 1.0-6.7), cesarean section (p < 0.05; OR = 2.03; 95% CI: 1,6-2,5) and cephalopelvic disproportion (p < 0.05;OR = 2.8; 95% CI: 1.6-4,8). There was no statistical difference between birth injury and fetal mortality range. In the FM group the main cesarean section indications were repeat cesarean sections (11.9%) and cephalopelvic disproportion (8.6%); in the normal birthweight group, repeat cesareans (8.3%) and fetal distress during labor (3.9%). CONCLUSIONS: in spite of the characteristic limitations of a retrospective evaluation, the analysis demonstrated which complications were associated with large fetal size, being useful in obstetric handling of patients with a diagnosis of extreme fetal growth. FM remains an obstetric problem of difficult solution, associated with important maternal and perinatal health problems, due to the significant observed rates of maternal and perinatal morbidity and mortality in developed and developing countries.

Prevalence of toxoplasmosis, HIV, syphilis and rubella in a population of puerperal women using Whatman 903® filter paper.

OBJECTIVES to determine the seroprevalence rate of toxoplasmosis, HIV, syphilis and rubella in a population of puerperal women. METHODS a prospective, cross-sectional study was performed from February 2007 to April 2008 at Hospital Geral, Universidade de Caxias do Sul in a population of 1,510 puerperal women. Women that gave birth to live born or stillborn infants were included in the study; maternal and perinatal variables were analyzed. Descriptive statistics and Pearsons chi-square with occasional Fishers correction were used for comparisons. Alpha was set in 5%. RESULTS a total of 148 cases of congenital infection (9.8%) were identified: 66 cases of syphilis (4.4%), 40 cases of HIV (2.7%), 27 cases of toxoplasmosis (1.8%) and 15 cases of rubella (1.0%). In ten cases there was co-infection (four cases of HIV and syphilis, two cases of HIV and rubella, one case of HIV and toxoplasmosis, two cases of rubella and syphilis, and one case of toxoplasmosis and rubella). In a comparison between puerperal women with and without infection there was no statistical significance in relation to incidence of abortions, small for gestational age, prematurity, live births and stillbirths, and prenatal care. Need of neonatal intensive care unit (NICU), maternal schooling, maternal age higher than 35 years and drug use (alcohol, cocaine and crack) had statistical significance. CONCLUSION the prevalence rate of infections was 9.8%. Need of NICU, maternal schooling lower than eight years, maternal age higher than 35 years and drug use were significantly associated with occurrence of congenital infection.

Meconium aspiration syndrome: obstetric and perinatal outcome analysis

PURPOSE: to analyze obstetrical and perinatal data in 26 cases of meconium aspiration syndrome (MAS). METHODS: a retrospective review was performed in 26 newborn records diagnosed with meconium aspiration syndrome. Patients were studied emphasizing average days in neonatal intensive care unit and main maternal findings and neonatal complications, correlating them with each other. RESULTS: Eighteen babies were delivered at GH-CSUF and eight out of this hospital. At this time 3,976 deliveries occurred at GH-CSUF, with an incidence of MAS of 0.45%. Nine of 18 babies were born by vaginal delivery; weight was >2,500 g in 16 cases. One-minute Apgar score was >7 in three cases (16.7%), between 4 and 6 in seven cases (38.9%), and between 0 and 3, in eight cases (44.4%). At 5 minutes, seven babies remained <7. Anoxia was the main neonatal complication (36%). The mortality rate was 7.7% and the average hospital stay was 19.9 days. CONCLUSION: MAS is a very important neonatal pathology correlated with high neonatal mortality rates, thick meconium in at least half of the cases, and with a majority of depressed newborns at delivery.

Oligodramnia sem rotura das membranas amnióticas: resultados perinatais

OBJETIVO: avaliar os resultados perinatais em casos de oligodramnia sem rotura de membranas amnioticas. METODOS: foram estudados retrospectivamente 51 casos consecutivos de oligodramnia (indice de liquido amniotico (ILA) menor que 5 cm) em nascimentos ocorridos no periodo de marco de 1998 a setembro de 2001. Compararam-se os dados obtidos aos de 61 casos com quantidade intermediaria e normal de liquido amniotico (ILA >5 cm). Analisaram-se variaveis maternas e neonatais, bem como taxas de mortalidade fetal, neonatal precoce e perinatal. As avaliacoes estatisticas foram realizadas mediante a aplicacao do teste nao parametrico do c² com a correcao de Yates, e do teste t de Student. Adotou-se o nivel de significância de 5%. RESULTADOS: nao houve diferenca significante entre os grupos estudados, ao se analisar a ocorrencia de sindrome hipertensiva, presenca de meconio, indice de Apgar inferior a sete no primeiro e quinto minuto, internacao na unidade de tratamento intensivo neonatal e prematuridade. A oligodramnia associou-se significantemente ao tipo de parto (p<0,0002; RR=0,32), sofrimento fetal agudo (p<0,0004; RR=2,2) e presenca de malformacoes fetais (p<0,01; RR=5,4). Os percentuais de malformacoes fetais foram de 17,6 e 3,3% nos grupos de oligodramnia e normal, respectivamente. As taxas de mortalidade fetal (2,0 vs 1,6%), neonatal (5,9 vs 1,6%) e perinatal (7,8 vs 3,3%), em ambos os grupos, nao apresentaram diferenca significante. CONCLUSAO: a oligodramnia se associou a um aumento do risco para operacao cesariana, sofrimento fetal agudo e malformacoes fetais.

Effect of Obesity on Gestational and Perinatal Outcomes

Purpose To assess the impact of pre-pregnancy obesity (body mass index [BMI] ≥ 30 kg/m2) on the gestational and perinatal outcomes. Methods Retrospective cohort study of 731 pregnant women with a BMI ≥ 30 kg/m2 at the first prenatal care visit, comparing them with 3,161 women with a BMI between 18.5 kg/m2 and 24.9 kg/m2. Maternal and neonatal variables were assessed. Statistical analyses reporting the demographic features of the pregnant women (obese and normal) were performed with descriptive statistics followed by two-sided independent Students t tests for the continuous variables, and the chi-squared (χ2) test, or Fishers exact test, for the categorical variables. We performed a multiple linear regression analysis of newborn body weight based on the mothers BMI, adjusted by maternal age, hyperglycemic disorders, hypertensive disorders, and cesarean deliveries to analyze the relationships among these variables. All analyses were performed with the R (R Foundation for Statistical Computing, Vienna, Austria) for Windows software, version 3.1.0. A value of p < 0.05 was considered statistically significant. Results Obesity was associated with older age [OR 9.8 (7.8-12.2); p < 0.01], hyperglycemic disorders [OR 6.5 (4.8-8.9); p < 0.01], hypertensive disorders [OR 7.6 (6.1-9.5); p < 0.01], caesarean deliveries [OR 2.5 (2.1-3.0); p < 0.01], fetal macrosomia [OR 2.9 (2.3-3.6); p < 0.01] and umbilical cord pH [OR 2.1 (1.4-2.9); p < 0.01). Conversely, no association was observed with the duration of labor, bleeding during labor, Apgar scores at 1 and 5 minutes after birth, gestational age, stillbirth and early neonatal mortality, congenital malformations, and maternal and fetal injury. Conclusion We observed that pre-pregnancy obesity was associated with maternal age, hyperglycemic disorders, hypertension syndrome, cesarean deliveries, fetal macrosomia, and fetal acidosis.

Fatores perinatais associados a recém-nascidos de termo com pH<7,1 na artéria umbilical e índice de Apgar <7,0 no 5º minuto

PURPOSE To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7.0. METHODS Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Students t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR). The level of significance was set at p<0.05. RESULTS Of a total of 15,495 consecutive births, 25 term neonates (0.16%) had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005), cesarean section (OR=3.5, p<0.01) and modified intrapartum cardiotocography (OR=7.8, p<0.02) presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001), need for resuscitation (OR=12.2, p <0.0001) and base deficit were associated with the event (15.0 versus -4.5, p<0.0001). CONCLUSION Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes.

Chronic Hypertension and Pregnancy at a Tertiary-Care and University Hospital

Objective. Analyze maternal and perinatal aspects related to chronic hypertension (CH) in pregnancy. Methods. Cross-section and retrospective study. Maternal, obstetric, and neonatal variables inserted in a database of the SPSS program, version 16.0, were analyzed. Students t-test was applied to the continuous variables and the chi-square test to the dichotomous variables, considering as statistically significant a value of p < 0.05. Results. From March 1998 to February 2009 about 15,945 births were observed, 888 (5.5%) being related to pregnant mothers with CH. In the hypertense group, there was a higher percentage of cesarean section, preterm labor during pregnancy, abruptio placentae, small-for-gestational age babies (<2500 g), and the need for treatment in a neonatal intensive care unit (NICU). Conclusion. CH in pregnancy was significantly associated with maternal age ≥30 years, nonwhite race, low level of schooling, parity ≥3 children, weight gain ≥16 kg, greater rates of cesarean section, Apgar score at the first and fifth minutes <7, umbilical artery pH ≤7.1, fetal weight ≤2500 g, need for neonatal intensive care, preterm labor during pregnancy, abruptio placentae, birth injury, small-for-gestational age babies and higher rates of preterm babies, fetal and neonatal mortality. It should be emphasized that the variables mentioned are representative or poor birth conditions in the group of chronic hypertense pregnant women.