Maturação Cervical com Sonda de Foley: Experiência de um Centro Terciário

Overview and Aims: In the presence of an unfavorable cervix, pre-induction cervical ripening is an important part of the labour induction process. Both mechanical and pharmacological methods are available for this purpose, with Foley catheter being the most commonly used mechanical method. We intend to describe the efficacy of Foley catheter for cervical ripening and to describe maternal and neonatal outcomes. Furthermore, we analyze the same results in high risk subgroups. Study Design: Retrospective observational study Population: 44 women with a singleton pregnancy, live fetus, cephalic presentation, intact membranes, with medical indication for labour induction and Bishop score ≤6. Methods: Medical records were reviewed and analyzed. Foley catheter was introduced until expulsion or for a maximum of 24 hours. Cervical ripening was considered effective when Bishop score after catheter was ≥8. Maternal outcomes considered were tachysystole, chorioamnionitis, post-partum bleeding and uterine rupture. Neonatal outcomes assessed were Apgar score, need for hospitalization in neonatal care unit and days of hospitalization. In the subgroup analysis, we divided the risk population in two subgroups: Group 1- Fetal growth restriction and/or oligohydramnios; Group 2- Previous caesarean section. Results: 72.7% of the labour inductions were indicated by maternal or fetal disease. The efficacy of cervical ripening was 65.9% and vaginal delivery rate was 63.6%. Regarding maternal and neonatal outcomes, there were only two cases (4.5%) of clinical chorioamnionitis. In subgroup analysis, the efficacy of cervical ripening and vaginal delivery rates were, respectively, 60.9% and 69.6% in Group 1 and 72.2% and 50% in Group 2.There was one case of chorioamnionitis in each subgroup. Conclusions: Foley catheter is an effective and safe method for cervical ripening. Due to its low association with adverse outcomes, it appears to be a good alternative for high-risk populations.info:eu-repo/semantics/publishedVersio

A scoping review and thematic analysis of social and behavioural research among HIV-serodiscordant couples in high-income settings.

CAPRISA, 2015.Abstract available in pdf

Outcome of Monochorionic Twins Conceived by Assisted Reproduction

OBJECTIVE: To evaluate monochorionic twins conceived by assisted reproductive technology (ART). DESIGN: We compared perinatal outcomes of monochorionic twins conceived by ART with their dichorionic counterparts and with spontaneous monochorionic twins. SETTING: Referral center. PATIENT(S): Mothers to monochorionic and dichorionic twins conceived by ART and spontaneous monochorionic twins. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Maternal characteristics, pregnancy complications, and perinatal outcomes. RESULT(S): Monochorionic twin pregnancies (n = 25) comprise 7.2% of all ART twins and 4.9% of all monochorionic twins in this data set. Monochorionic pairs have a significantly worse outcome compared with dichorionic sets in terms of lower gestational age and birth weight. ART appears to increase the already high risk of monochorionicity compared with spontaneous conception: odds ratio (OR), 2.9 (1.1-7.3) for preterm birth at <32 weeks and OR, 5.9 (2.5-1.49) for birth weight <1,500 g. CONCLUSION(S): Monochorionic twins after ART are at increased risk of adverse perinatal outcomes compared with spontaneous monochorionic twins and with dichorionic twins conceived by ART.info:eu-repo/semantics/publishedVersio

Concurrence of Gestational Diabetes and Pre-Gravid Obesity ("Diabesity") in Twin Gestations

OBJECTIVE: To assess the effect of the concurrence of gestational diabetes mellitus (GDM) and pre-gravid obesity in twin gestations ("diabesity"). METHODS: We compared perinatal outcomes of twin gestation in mothers with GDM and pre-gravid obesity (1.7%), mothers with GDM but with normal BMI (6.2%), and obese mothers without GDM (7.0%). RESULTS: Twin pregnancies with "diabesity" were associated with significantly higher incidence of stillbirth (OR = 6.4; 95%CI = 1.4, 33.4) and existing chronic hypertension (OR = 4.2; 95%CI = 1.2, 14.8) than in GDM pregnancies without obesity, and with births at 33-36 weeks as compared with the other groups. Otherwise, the comparisons showed remarkable similar results in terms of gestational age, birth weight, preeclampsia, cesarean section rate, and fetal-neonatal outcomes. CONCLUSION: It appears that diabesity has a relatively minor effect in twins. If this will be confirmed by other studies, it would be important to elucidate how twins ameliorate the adverse outcomes of diabesity.info:eu-repo/semantics/publishedVersio