Rivaldo Mendes de Albuquerque

A randomized controlled trial comparing vaginal misoprostol versus Foley catheter plus oxytocin for labor induction

Objective. To compare effectiveness and safety of 25 μg vaginal misoprostol versus Foley catheter and oxytocin for cervical ripening and labor induction in pregnant women with unripe cervices. Design. Randomized controlled trial. Setting. A public maternity in Recife, Brazil. Sample. A total of 240 pregnant women. Methods. Women with a term or post‐term, live, singleton fetus in cephalic presentation, intact membranes, Bishop score <6, not in labor, medically indicated for labor induction. They were randomly divided in Group 1, where 119 women received 25 μg of intravaginal misoprostol every 6 hours for a maximum of four doses; and Group 2, where 121 women had a 14‐F Foley catheter inserted into their cervical canal. Once past the internal os, the balloon was inflated. Intravenous oxytocin was initiated after the balloon was spontaneously extruded from the cervix or after 24 hours. Results. There were no significant differences between the groups regarding baseline characteristics. Misoprostol was more effective in inducing labor than Foley catheter and oxytocin. Mean induction‐to‐vaginal delivery time with misoprostol was shorter (17.3 vs. 20.2 hours, p = 0.016). There were more vaginal deliveries in the misoprostol group at 12 (p < 0.001) and 18 (p = 0.007) hours, but the difference was no longer statistically significant at 24 and 48 hours. There were no significant differences in uterine contraction abnormalities, puerperal infection or neonatal outcomes. Conclusions. Vaginal misoprostol is more effective than and as safe as Foley catheter and oxytocin for induction of labor in term and post‐term pregnancy.

Mortalidade materna em Recife. 1. Avaliação da subenumeração de estatísticas oficiais

Este estudo analisou os obitos de mulheres com idade entre 10 a 49 anos, ocorridos em Recife, Pernambuco, nos anos de 1992 e 1993, com a finalidade de identificar os obitos maternos neste periodo e confronta-los com as estatisticas oficiais. As informacoes foram obtidas a partir de 1.013 declaracoes de obito, sendo complementadas com consultas aos prontuarios medicos, fichas de anestesia, relatorios de enfermagem, pericias tanatoscopicas do Instituto de Medicina Legal, relatorios das necropsias do Servico de Verificacao de obitos e por meio de entrevistas com os medicos que assistiram estes obitos ou com familiares das mulheres que faleceram. Calcularam-se as razoes de mortalidade materna (RMM) para o Municipio de Recife para cada ano e para o periodo total do estudo. As 20 mortes maternas declaradas representaram 2% dos obitos entre mulheres nessa faixa etaria. Apos a investigacao encontraram-se mais 22 casos para todo o periodo. A RMM pelas estatisticas oficiais era de 37,0 por 100.000 nascidos vivos, passando a 77,7 apos a correcao. Esta diferenca representou uma subenumeracao de 52,4%. Conclui-se que, no caso de Recife, nao se poderia aplicar o fator de correcao de 3,0 recomendado para a Regiao Nordeste pelo Ministerio da Saude, porque a mortalidade materna estaria sendo entao superestimada.

Misoprostol sublingual versus vaginal para indução do parto a termo

OBJETIVO: comparar efetividade e seguranca de uso de comprimido sublingual de 25 µg de misoprostol com o comprimido vaginal de 25 µg do misoprostol na inducao do parto com idade gestacional e > 37 semanas e colo uterino desfavoravel. METODOS: realizou-se ensaio clinico controlado e aleatorizado, nao cego, na Maternidade Monteiro de Morais (CISAM-UPE), em Recife, no periodo de outubro de 2003 a fevereiro de 2004. Participaram do estudo 123 gestantes com idade gestacional e > 37 semanas, indice de Bishop <8 e fora de trabalho de parto, que apresentavam indicacao para interrupcao da gravidez. As gestantes aleatoriamente receberam 25 µg de misoprostol sublingual ou 25 µg de misoprostol vaginal a cada seis horas, ate uma dose maxima de oito comprimidos (200 µg). Para verificar diferencas entre os grupos foram utilizados media, desvio padrao, teste t de Student, c2 para tendencia e teste de Mann-Whitney. O valor de significacao estatistica adotado foi de 5%. RESULTADOS: nao houve diferenca significativa entre o numero de mulheres que tiveram parto por via vaginal no grupo do misoprostol sublingual e no vaginal (65,5% vs 75,8%, p=0,22). Tambem nao foi significativa a diferenca do intervalo de tempo entre o inicio da inducao e o parto (24 horas e 42 minutos vs 20 horas e 37 minutos, respectivamente, p=0,11) entre os grupos. Os grupos, sublingual e vaginal, nao mostraram tambem diferencas significativas em relacao a sindrome de hiperestimulacao (1,7% vs 3,2%, p=0,95), as incidencias de meconio (5,2% vs 4,8%, p=0,74), ao indice de Apgar <7 no quinto minuto (3,4% vs 4,8%, p=0,98) e a outros efeitos adversos. CONCLUSAO: o misoprostol na dose de 25 mg por via sublingual apresentou a mesma efetividade e seguranca quando comparado com a mesma dose vaginal para inducao do parto. O misoprostol por via sublingual parece representar mais uma opcao a ser considerada na inducao do parto.

Fatores de risco para mortalidade materna em área urbana do Nordeste do Brasil

A case-control study was conducted to investigate risk factors for maternal mortality in Recife, Pernambuco State, Brazil, in 2001-2005. Cases were 75 maternal obstetric deaths in Recife, identified from the Mortality Information System, investigated and analyzed by an expert committee on maternal mortality. Controls, selected from the Information System on Live Births using systematic sampling, were 300 women living in Recife whose last pregnancy occurred during the same period and ended in live births. Increased risk of maternal death was associated with use of the public health system (OR = 4.47; 95%CI: 1.87-10.29), age > 35 years (OR = 3.06; 95%CI: 1.59-5.92), < 4 years of schooling (OR = 4.95; 95%CI: 2.43-10.08), cesarean section (OR = 3.06; 95%CI: 1.77-5.29), and lack of prenatal care or fewer than four prenatal visits (OR = 9.78; 95%CI: 5.52-17.34). The results confirm social inequalities in maternal mortality in Recife and indicate the need to improve healthcare for women during the prenatal period, delivery, and postpartum.

Causas e fatores associados à mortalidade de mulheres em idade reprodutiva em Recife, Brasil

Reproductive-age women, especially in developing countries, have failed to receive proper attention from the health care sector except during pregnancy. This studys objective was to contribute to the knowledge of the most frequent causes of death in this population group. The main purpose was to evaluate the occurrence and recording of deaths among women 10 to 49 years of age in Recife, Pernambuco, Brazil, during 1992 and 1993, and to identify and group the corrected causes of these deaths. It was a population-based descriptive study. After all death certificates eligible for the study were identified at the Health Secretariat of the State of Pernambuco, coding of the basic cause of death was performed. When necessary for its elucidation, a complementary investigation was also carried out at the hospital, autopsy service, and/or through an interview with the attending physician and a household visit. The 9th Revision of the ICD was used for coding the corrected basic cause of death. One thousand thirteen deaths of reproductive-age women were identified. The most frequent groups of causes of deaths were neoplasms, circulatory diseases, and external causes. Complications associated with pregnancy, delivery, and puerperium were the ninth most common cause of death in this group.

Fatores sócio-demográficos e de assistência médica associados ao óbito materno

With the purpose of identifying the social, demographic, pregnancy-related and medical care factors associated with maternal death, this study evaluated all deaths of women aged 10 to 49 years occurring in Recife, Pernambuco, Brazil, during 1992 and 1993. The data were obtained reviewing 1,013 death certificates, with 42 cases of identified maternal deaths. The data of these deaths were complemented with information from medical records, autopsies and also interviews with physicians from the hospitals where the death took place, and with the dead womens relatives. Almost two thirds (62%) of maternal deaths occurred among women aged 20 to 29 years and more than half of them were single. There was a higher number of deaths among caesarean deliveries than among vaginal ones. The majority of deaths occurred within the first three days of hospitalization and approximately 90% of hospital charges were sponsored by the National Health System (SUS).

Discrepâncias entre o informe verbal e os registros no cartão da gestante, um instrumento negligenciado

PURPOSE: To compare the filling out of the prenatal care card of pregnant women at a school-service and other services, as well as to verify the concordance between these records and verbal information provided by the puerperae. METHODS: A two-stage epidemiological, cross-sectional study was performed with stratified sampling, proportional to number of births. In the first stage, the information recorded on the prenatal care card in the school-service was compared to that recorded in units not linked to higher health education in Recife (PE). In the second stage, the information about prenatal care was collected with a semi-structured questionnaire applied to women during the puerperal period. A total of 262 puerperae older than 19 years, who had a prenatal care card at the time of delivery were included in the study from May to July 2008. Data were analyzed statistically by the χ2 test, Student´s t-test or Mann-Whitney test, all one-sided to the right, with the level of significance set at 5%. RESULTS: The information more often recorded on the prenatal care card in the school-service was: schooling (86.5 versus 70.3%; p=0.002), marital status, (83.7 versus 70.9%; p=0.01), weight prior to pregnancy (72.1 versus 46.8%; p<0.001), height (62.5 versus 45.6%; p=0.007), and educational practices (76.9 versus 11.4%; p<0.001) and, at other services, only birth weight <2,500 g (15.4 versus 27.2% at the school-service; p=0.02). There were significant discrepancies between data obtained by verbal information and the prenatal care records of the pregnant women. At the school-service, 40.3% of pregnant women received adequate prenatal care versus 20.3% at other units. CONCLUSIONS: In all services, there was a predominance of recorded information directly related to delivery, while information about actions with preventive characteristics during prenatal care was neglected.