Sônia Regina Cabral Madi

High prevalence of human papillomavirus type 58 in patients with cervical pre-malignant lesions in southern Brazil

Cervical cancer is the second most common type of cancer in women worldwide. Several human papillomavirus (HPV) genotypes, sexual behavior, and socioeconomic profile represent major risk factors for the development of this carcinoma. Cervical invasive cancer is preceded by cellular abnormalities that can be identified by cytological or histological exams. In order to determine the prevalence and genotypes of HPV in women with abnormal cytology or histopathology, cervical cell samples from 256 patients were evaluated for the presence of HPV/DNA by polymerase chain reaction (PCR), followed by virus genotyping by restriction fragment length polymorphism (RFLP). A total of 113 samples (51.2%) were HPV/DNA positive. Viral genotyping showed that the most prevalent genotypes were HPV 16 (34.7%) and 58 (13.8%), followed by HPV 33 (9.72%), 11 (8.33%), 18 (5.55%), 53 (5.55%), and 6 (4.2%). Four samples (5.55%) exhibited multiple infections due to the great similarity of socioeconomic characteristics and sexual behavior of HPV positive women, it was not possible to establish a risk profile for female HPV infection. J. Med. Virol. 81:1270–1275, 2009.

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.

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.

Apgar score of zero at one minute: Perinatal factors and early neonatal outcomes

Aims: To assess the perinatal results of newborns with a zero Apgar score at the first minute of life. Methods: Case-control study conducted over a period of 10 years. We assessed maternal, fetal, and neonatal variables. Data were analyzed using SPSS 19.0. Results: Of the 15,616 births occurring during the study period, 29 (0.2%) had a zero Apgar score at the first minute of life (Group I). A control group comprised three newborns with Apgar scores greater than zero for each case (Group II). Comparing cases (Group I) and controls (Group II) showed a higher rate of cesarean deliveries (69% vs. 46.7%; p < 0.05), younger gestational age (34.8 ± 5.5 years vs. 38.5 ± 2.5 years; p < 0.0001), higher incidence of hemorrhagic amniotic fluid (27.6% vs. 17.2%; p < 0.0001), lower fetal weight (2,307 ± 958 g vs. 3,069 ± 609 g; p < 0.0001), lower fifth-minute Apgar score (2.5 ± 2.0 vs. 8.9 ± 0.7; p < 0.0001), lower pH of the umbilical artery (7.01 ± 0.21 vs. 7.21 ± 0.08; p < 0.0001), need for neonatal intensive care unit (100% vs. 20.7%; p < 0.0001), and early neonatal mortality rate (n = 12, 41.4% vs. n = 0). Conclusion: The perinatal assessment of newborns with zero Apgar score in the first minute of life showed a higher rate of operative deliveries and preterm fetuses with low birth weight than in control infants. The higher need for neonatal intensive care therapy is associated with more significant fetal acidosis and apparent death.

Apresentação pélvica na gestação de termo em pacientes com partos vaginais prévios

PURPOSE: to assess the obstetric and perinatal outcomes in cases of term newborns in breech presentation, in patients with previous vaginal deliveries, comparing them to term newborns in vertex presentation. METHODS: 8,350 deliveries retrospectively from March 1998 to July 2003 were analysed. Of 419 deliveries (5.1%) in breech presentation, 58 cases were selected for the study (breech group), according to the following criteria: patients who had had one or more babies through vaginal delivery, gestational age ³37 weeks, no fetal malformation, no complications in the current pregnancy, birth weight between 2,500 and 3,750 g, and no previous cesarean section. The breech group was matched to 1,327 newborns in vertex position from pregnant women with no previous cesarean section (vertex group). Maternal age, parity, gestational age, delivery way, birth weight, meconium-stained amniotic fluid, 1- and 5-min Apgar score, need of neonatal intensive care unit, and small- and big-for-gestational age newborns were analyzed. Statistical analysis was performed by the c2 test and by Students t test, with the level of significance set at p<0.05. RESULTS: when breech and vertex groups were compared, they showed significant differences regarding the following variables: birth weight (3,091±538 g vs 3,250±497 g; p<0.01), vaginal delivery (63.8 vs 95.0%; p<0.0001), cesarean section (36.2 vs 5.0%; p<0,0001), and 1-min Apgar score (p<0.0001), respectively. CONCLUSIONS: we conclude that in term fetuses in breech position from pregnant women with previous vaginal deliveries, birth weight, delivery way, and 1-min Apgar score were different compared to fetuses in vertex position from women with the same characteristics.