Rita Guérios Bornia

Streptococcus agalactiae in Brazil: serotype distribution, virulence determinants and antimicrobial susceptibility

BackgroundGroup B Streptococcus (GBS) remains a major cause of neonatal sepsis and is also associated with invasive and noninvasive infections in pregnant women and non-pregnant adults, elderly and patients with underlying medical conditions. Ten capsular serotypes have been recognized, and determination of their distribution within a specific population or geographical region is important as they are major targets for the development of vaccine strategies. We have evaluated the characteristics of GBS isolates recovered from individuals with infections or colonization by this microorganism, living in different geographic regions of Brazil.MethodsA total of 434 isolates were identified and serotyped by conventional phenotypic tests. The determination of antimicrobial susceptibility was performed by the disk diffusion method. Genes associated with resistance to erythromycin (ermA, ermB, mefA) and tetracycline (tetK, tetL, tetM, tetO) as well as virulence-associated genes (bac, bca, lmb, scpB) were investigated using PCR. Pulsed-field gel electrophoresis (PFGE) was used to examine the genetic diversity of macrolide-resistant and of a number of selected macrolide-susceptible isolates.ResultsOverall, serotypes Ia (27.6%), II (19.1%), Ib (18.7%) and V (13.6%) were the most predominant, followed by serotypes IV (8.1%) and III (6.7%). All the isolates were susceptible to the beta-lactam antimicrobials tested and 97% were resistant to tetracycline. Resistance to erythromycin and clindamycin were found in 4.1% and 3% of the isolates, respectively. Among the resistance genes investigated, tetM (99.3%) and tetO (1.8%) were detected among tetracycline-resistant isolates and ermA (39%) and ermB (27.6%) were found among macrolide-resistant isolates. The lmb and scpB virulence genes were detected in all isolates, while bac and bca were detected in 57 (13.1%) and 237 (54.6%) isolates, respectively. Molecular typing by PFGE showed that resistance to erythromycin was associated with a variety of clones.ConclusionThese findings indicate that GBS isolates circulating in Brazil have a variety of phenotypic and genotypic characteristics, and suggest that macrolide-resistant isolates may arise by both clonal spread and independent acquisition of resistance genes.

Preeclampsia: Prevalence and perinatal repercussions in a University Hospital in Rio de Janeiro, Brazil

Preeclampsia (PE) prevalence studies in Brazil are both scarce and not divided in accordance with gestational age at delivery. We accessed PE prevalence according to delivery before 34, 37 and 42weeks in a cross-sectional study including 4464 single deliveries. PE was diagnosed in 301 cases (6.74%); Prevalence of PE was 0.78%; 1.92% and 6.74% according to deliveries before 34, 37 and 42weeks. PE was associated with fetal death, prematurity and small for gestational age newborns.

Complicações perinatais em gestantes infectadas pelo vírus da imunodeficiência humana

OBJETIVOS: analisar as complicacoes perinatais em gestantes infectadas pelo HIV. METODOS: estudo do tipo coorte, realizado em centro perinatal terciario, no periodo de 1 de janeiro de 1996 a 31 de marco de 2003. Foram selecionadas para o estudo 7698 gestacoes, cujos criterios de inclusao foram: gestacao unica e idade gestacional superior a 22 semanas. A infeccao pelo HIV foi confirmada pelos testes ELISA e Western Blot. Estudou-se a associacao entre a presenca da infeccao pelo HIV e as seguintes variaveis: ruptura prematura de membranas, parto prematuro, muito baixo peso ao nascimento, infeccao puerperal, Apgar baixo no primeiro e quinto minutos, crescimento intra-uterino restrito (CIUR) e pequeno para a idade gestacional (PIG). RESULTADOS: do total de gestantes estudadas, 228 (2,96%) estavam infectadas pelo HIV. Os resultados dos testes estatisticos indicam que a infeccao pelo HIV nao e fator de risco para a ruptura prematura de membranas (RR = 0,48, p <0,01), parto prematuro (RR = 0,92, p = 0,01), muito baixo peso ao nascimento (RR = 0,69, p = 0,54), infeccao puerperal (RR = 0,00, p = 0,31), Apgar menor do que sete no primeiro minuto (RR = 0,81, p = 0,40) e no quinto minuto (RR = 0,36, p = 0.19). Entre as variaveis estudadas, a hipotese de homogeneidade das proporcoes foi rejeitada para crescimento intra-uterino restrito (RR = 5,27, p <0,01) e pequeno para a idade gestacional (RR = 1,73, p < 0,01). CONCLUSOES: a ocorrencia de complicacoes maternas e fetais em gestantes infectadas pelo HIV nao e diferente da observada em mulheres nao infectadas, com excecao CIUR e PIG.

Streptococcus agalactiae carriage among pregnant women living in Rio de Janeiro, Brazil, over a period of eight years

Group B Streptococcus (GBS) carriage by pregnant women is the primary risk factor for early-onset GBS neonatal sepsis. Intrapartum antibiotic prophylaxis (IAP) can prevent this transmission route, and two main approaches are recommended to base the selection of pregnant women to be submitted to IAP: the risk-based and the culture-based strategies. In Brazil, compliance to such recommendations is poor, and not much is known about GBS carriage. In the present study, 3,647 pregnant women living in Rio de Janeiro State, Brazil, were screened for GBS anogenital colonization, over a period of 8 years (2008–2015). GBS was detected in 956 (26.2%) of them, and presence of vaginal discharge was the only trait associated with a higher risk for GBS colonization. Serotypes Ia (257; 37.3%) and II (137; 19.9%) were the most frequent among 689 (72.1% of the total) GBS isolates evaluated, followed by NT isolates (84; 12.1%), serotype Ib (77; 11.1%), V (63; 9.1%), III (47; 6.8%) and IV (24; 3.5%). Estimated coverage of major serotype-based GBS vaccines currently under clinical trials would vary from 65.2% to 84.3%. All 689 isolates tested were susceptible to ampicillin and vancomycin. Resistance to chloramphenicol, clindamycin, erythromycin, levofloxacin, and tetracycline was observed in 5% (35), 2% (14), 14% (97), 5% (35) and 86% (592) of the isolates, respectively. No significant fluctuations in colonization rates, serotype distribution and antimicrobial susceptibility profiles were observed throughout the period of time investigated. The culture-based approach for IAP recommendation showed to be the best choice for the population investigated when compared to the risk-based, since the first did not increase the number of pregnant women submitted to antibiotic therapy and covered a larger number of women who were actually colonized by GBS. The fact the not all isolates were available for additional characterization, and serotype IX antiserum was not available for testing represent limitations of this study. Nevertheless, to the best of our knowledge, this is the largest investigation on GBS carriage among pregnant women in Brazil up to date, and results are useful for improving GBS prevention and treatment strategies.

Hypertensive disorders of pregnancy in women with gestational diabetes mellitus from Rio de Janeiro, Brazil

Pregnant women with Gestational Diabetes Mellitus (GDM) have a greater chance of developing Hypertensive Disorders of Pregnancy (HDP) by the effect of insulin resistance in nitric oxide action.This study aims to describe factors associated with the development of HDP in pregnant women with GDM, assisted in a public maternity hospital in Rio de Janeiro, Brazil. This is a cross-sectional study including 292 pregnant adult women with GDM assisted at Maternidade Escola of the Universidade Federal do Rio de Janeiro. The women were examined during pregnancy and postpartum. Data were collected between 2011 and 2014 from medical records and through in-person interviews. The Student t-test and the chi-square test were applied; additionally, the magnitude of the association between independents variables and HDP was estimated by logistic regression models. The occurrence of HDP was observed in 19.5% (n=57) of the evaluated women: 9.2% had pregnancy hypertension and 10.3% had preeclampsia. The chance of HDP was higher among women with GDM in a previous pregnancy (Odds Ratio-OR=3.8; Confidence Interval of 95%-95% CI: 1.1; 12.8) and among those who were 35 years old or older (OR 3.3; 95% CI: 1.2; 8.7) after controlling the effects of pre-gestational weight and dietary ingestion of calcium, riboflavin, thiamine, vitamin A and protein. Women that had any alteration in blood pressure in a previous pregnancy and those over 35 years old were under higher risk of HDP. The findings may help in the design of interventions aiming to prevent HDP in adult women.

How do maternal factors impact preeclampsia prediction in Brazilian population

Abstract Objective: To evaluate the impacts of maternal risk factors described by the Fetal Medicine Foundation’s 2012 algorithm (FMF2012) in a Brazilian population. Methods: All singleton pregnancies submitted to first-trimester preeclampsia (PE) screening using the FMF2012 algorithm were considered for study inclusion. Maternal factors, recorded via a patient questionnaire, were described and compared between PE outcome groups. A Gaussian regression model was derived to measure the effects of maternal factors, and to identify factors that contributed significantly (p < .05) to the alteration of gestational age at delivery, in pregnancies with PE. Results: Of the 1934 cases considered for study inclusion, the final sample consisted of 1531 cases. The sample included 120 (7.8%) cases of PE, of which 26 (1.7%) were preterm PE (PE < 37 weeks) and 11 (0.72%) were early PE (PE < 34 weeks). The PE rate did not differ according to ethnicity, smoking, family history of PE, or use of assisted reproductive technology. Significant differences (p < .05) between the normal and PE groups in maternal age, maternal weight, previous history of PE, chronic hypertension, and types 1 and 2 diabetes were detected. Conclusions: The significance and magnitude of associations of maternal factors in our sample differed from those incorporated in the FMF2012 model, implying the need to derive a fitted model for our population.

Nursing care systematization in maternal and child service care: an action research

Aim: To implement the systematization of nursing care (SNC) in the Maternity School of the Federal University of Rio de Janeiro. Method: This is an action research. The theory chosen was that of Basic Human Needs as proposed by Wanda Horta. The ICNP® was selected as the single classification system for the terminology with regard to diagnoses, expected outcomes and nursing interventions. Data collection will be carried out in accordance with the implementation of the SNC in each sector of the institution, consisting of the following steps: documentary research based on documents produced by the nursing staff and on the nursing diagnoses of the patients; field research through systematic observation of the team work processes; and seminars. In order to analyze the data obtained in the survey of nursing problems, the terms extracted from the medical charts will be analyzed and classified according to the model of nursing diagnoses contained in ICNP® 2.0 .

P26.11: Ultrasound evaluation of endometrial cavity with high frequency linear transducers in patients with non-reductible genital prolapse: a case report

Objectives: To estimate the transvaginal ultrasound value in surgical correction of SI. Methods: 61 patients with SI were examined to derminate the type of SI and its severity. The echography of UVS was performed in all observed women using transvaginal probe of Voluson-730 expert (GE) before and after surgical correction. The measurements of basic angles (α and β) were performed in patients in supine position at rest and on valsalva. The ultrasound signs of urethra hypermobility were found (SI, type II) when the angle α rotation was more than 20◦. Also the cystocele presence was noted. The ratio of urethra transversal section square and urethral sphincter width was calculated by means of 3D. The signs of urethral sphincter insufficiency (SI, type III) seems to be when the ratio of urethra transversal section square and urethral sphincter width exceeded 0.74. Results: All patients were divided in 5 groups: 10 patients (16.4%) did not have any US signs of SI; 28 women (46%) had signs of urethra hypermobility; urethral sphincter insufficiency were revealed in 9 patients (14.7%); 9 women (14.7%) had the combination type of stress incontinence; only cystocele were found in 5 patients (8.2%). At rest the mean values of α and β angles in the 1st group were 27.1◦ + 2.7◦ and 115.4◦ + 14◦; in the 2nd group – 34.7◦ + 9.2◦ and 120.7◦ + 10.4◦; in the 3rd group – 31◦ + 5.4◦ and 126.1◦ + 19.1◦; in the 4th group – 32◦ + 8.4◦ and 124.6◦ + 18.5◦ respectively. All patients were operated with TVT-O only or combined with other additional surgery. All patients were underwent the postoperative dynamic follow-up and did not demonstrate neither clinical nor functional signs of SI. The positive dynamic were registrated in all operated patients. Conclusions: Transvaginal echography of urethrovesical segment can be used as a method of efficiency evaluation in surgical correction of SI.

P32.15: The impact of fetal weight estimation by ultrasonography in perinatal outcome of newborns with more than 3500 g

Objectives: Analyze the interference of ultrasound estimation of fetal weight in perinatal outcome in newborns with birth weight greater than 3500 g. Methods: It is a single center retrospective study. 118 newborns with birth weight greater than 3500 g were included. The cases were divided in two groups: 1) infants who have ultrasound estimation of fetal weight within 14 days of delivery and 2) infants who didn’t have it. Fetal weight estimation (FWE) was performed by Hadlock formula. Perinatal outcome was analyzed by cesarean section rate, 5 minutes Apgar score < 7, meconium stained newborns, shoulder dystocia occurrence and intensive care unit (ICU) admission. Statistical analysis was done by the chi square test with significant association when P < 0.05. Results: Table 1. Conclusions: Our results suggest that ultrasound FWE increases Cesarean section rate without significant improve in perinatal outcome. More studies are needed to increase the sample size and analyze ultrasound accuracy.