Indução do parto com misoprostol versus dinoprostone:: uma meta-análise de sete ensaios clínicos randomizados

OBJECTIVE: To compare the efficacy and safety of two prostaglandin analogs, misoprostol and dinoprostone, for labor induction of third trimester pregnancies withfetus and cervices unfavorable to oxytocin, as reported by recently published studies. METHODS: Seven randomized, controlled and prospective studies, comparing intravaginally applied misoprostol (n=500) with dinoprostone (n=498) were selectedfrom Medline. For each variable analyzed in each of the seven studies reviewed, we used SerSimonian and Laird’s method to evaluate the homogeneity of treatmenteffects. To analyze the results of each clinical trial, the relative risk was calculated with a 95% Confidence Interval; a “common” RR for different outcomes was alsocalculated using the Mantel-Haens method, with the SAS statistical package. The following outcomes were evaluated in our study: need for oxytocin augmentation;need for cesarean section; meconium passage; 1- and 5-minute Apgar scores. RESULTS: When misoprostol was used instead of dinoprostone, there was a decrease of approximately 50% in the need to use oxytocin (RR = 0.55; 0.49-0.63). No difference was found regarding the need to perform cesarean sections in the misoprostol group when compared to the dinoprostone group (RR = 1.04; 0.81-1.34). There was a slightly higher incidence of meconium passage among the group that used misoprostol (RR = 1.39; 1.03-1.86). No significant difference in the incidence of Apgar score smaller than 7 was observed between the misoprostol or dinoprostone group, either at the 1st (RR = 1.36; 0.92-2.26) or at the 5th minute (RR = 1.39; 0.36-5.36). CONCLUSIONS: For the labor induction in third trimester pregnacies, with live fetus and unfavorable cervices, misoprostol is as effective and as safe as dinoprostone. A 50 mg dose of misoprostol may cause a higher incidence of meconium passage, however, it doesn’t compromise the perinatal performance of the newborn. The cost of misoprostol treatment was significantly lower than the cost of dinoprostone treatment according to the three studies that assessed this variable.OBJETIVO: Comparar a eficácia e a segurança de dois análogos das prostaglandinas, misoprostol e dinoprostone, na indução do parto em gestações de terceiro trimestre com feto vivo e cérvice desfavorável ao uso de ocitocina, conforme relatos recentes na literatura. MÉTODOS: Foram selecionados do sistema Medline sete estudos randomizados, controlados e prospectivos, comparando misoprostol (n = 500) com dinoprostone (n = 498) utilizados por via vaginal. Utilizou-se o método de DerSimonian e Laird para avaliar a homogeneidade do efeito do tratamento para cada variável analisada pelos sete estudos. Optou-se pelo risco relativo com intervalo de confiança de 95% para avaliar o resultado de cada ensaio clínico, calculando-se também o RR “comum” para os diferentes desfechos pelo método de Mantel-Haenszel, utilizando-se o pacote estatístico SAS. Os seguintes desfechos foram analizados: uso de ocitocina; índice de cesariana; eliminação de mecônio; escore de Apgar no 1º e 5º minutos. RESULTADOS: Houve uma diminuição significativa – aproximadamente 50% – na necessidade de uso de ocitocina com a aplicação do misoprostol em relação ao dinoprostone (RR = 0,55; 0,49-0,63). Não foi encontrada nenhuma diferença na necessidade de cesariana entre o grupo que utilizou misoprostol (RR = 1,04; 0,81- 1,34) e o que utilizou dinoprostone. Houve uma incidência ligeiramente aumentada de eliminação mecônio no grupo do misoprostol (RR = 1,39; 1,03-1,86) em relação ao dinoprostone. Não foi encontrada nenhuma diferença significativa entre o grupo que utilizou misoprostol e o grupo que utilizou dinoprostone em relação à incidência de escores de Apgar menor do que 7, tanto no 1º minuto (RR = 1,36; 0,92-2,26), como no 5º minuto (RR = 1,39; 0,36-5,36).  CONCLUSÕES: O misoprostol por via vaginal é tão efetivo e tão seguro quanto o dinoprostone para a indução do parto em gestações de terceiro trimestre com fetovivo e cérvice desfavorável ao uso de citocina. A dose de 50 mg de misoprostol pode provocar um aumento na eliminação de mecônio, sem contudo comprometer odesempenho perinatal dos recém nascidos. O custo do tratamento com misoprostol foi significativamente menor nos três estudos que avaliaram este item.&nbsp

Increased of the carotid intima media thickness in preeclampsia

Objectives: The aim of the study was to determine carotid intima-media thickness (CIMT) values in patients who developed and did not develop preeclampsia (PE), and to determine whether CIMT values could be predictors of PE development. Methods: The study included pregnant women who were examined by regular ultrasound examination at the Materno-Infantil Presidente Vargas Hospital (HMIPV) in Porto Alegre, Brazil, from April 2016 to September 2017. The examinations were performed every three months. Patients were divided into two groups. The first group included patients diagnosed with PE (n=21) and second group included patients who did not have PE (n=199). A high frequency ultrasound device (12 MHz) with a semiautomatic method was used to estimate CIMT. Results: CIMT was significantly higher in pregnant women with PE than in women without PE (55±0.11 vs. 0.44±0.06, respectively; p0.42 mm, the probability was only 4.2%. Conclusions: An increase in CIMT was associated with the onset of PE. CIMT values were significantly higher in patients who develop PE

Histerectomias periparto ao longo de um período de quinze anos

Objective: To determine the indications and outcomes of peripartum hysterectomies performed at Hospital de Clínicas de Porto Alegre (a university hospital in Southern Brazil) during the past 15 years, and to analyze the clinical characteristics of the women submitted to this procedure. Methods A cross-sectional study of 47 peripartum hysterectomies from 2005 to 2019. Results: The peripartum hysterectomies performed in our hospital were indicated mainly due to placenta accreta or suspicion thereof (44.7% of the cases), puerperal hemorrhage without placenta accreta (27.7%), and infection (25.5%). Total hysterectomies accounted for 63.8% of the cases, andwefound no differencebetween total versus subtotal hysterectomies in the studied outcomes. Most hysterectomies were performed within 24 hours after delivery, and they were associated with placenta accreta, placenta previa, and older maternal age. Conclusion: Most (66.0%) patients were admitted to the intensive care unit (ICU). Those who did not need it were significantly older, and had more placenta accreta, placenta previa, or previous Cesarean delivery.Objetivo: Determinar as indicações e os desfechos das histerectomias periparto realizadas no Hospital de Clínicas de Porto Alegre nos últimos 15 anos, bem como analisar as características clínicas das mulheres submetidas a esse procedimento. Métodos Estudo transversal de 47 histerectomias periparto realizadas no período de 2005 a 2019. Resultados: Em nosso hospital, as histerectomias periparto foram indicadas principalmente por acretismo placentário ou sua suspeita (44,7% dos casos), hemorragia puerperal sem acretismo placentário (27,7%), e infecção (25,5%). Histerectomias totais corresponderam a 63,8% dos casos, e não encontramos diferença entre histerectomia total e subtotal para os desfechos estudados. A maioria das histerectomias foi realizada dentro de 24 horas após o parto, o que estava associado a acretismo placentário, placenta prévia, e idade materna mais avançada. Conclusão: A maioria (66,0%) das mulheres necessitou de internação em unidade de terapia intensiva (UTI); aquelas que não necessitaram eram significativamente mais velhas, e tinham mais acretismo placentário, placenta prévia, ou cesárea prévia

Indução do parto com misoprostol versus dinoprostone : uma meta-análise de sete ensaios clínicos randomizados

OBJECTIVE: To compare the efficacy and safety of two prostaglandin analogs, misoprostol and dinoprostone, for labor induction of third trimester pregnancies with fetus and cervices unfavorable to oxytocin, as reported by recently published studies. METHODS: Seven randomized, controlled and prospective studies, comparing intravaginally applied misoprostol (n=500) with dinoprostone (n=498) were selected from Medline. For each variable analyzed in each of the seven studies reviewed, we used SerSimonian and Laird’s method to evaluate the homogeneity of treatment effects. To analyze the results of each clinical trial, the relative risk was calculated with a 95% Confidence Interval; a “common” RR for different outcomes was also calculated using the Mantel-Haens method, with the SAS statistical package. The following outcomes were evaluated in our study: need for oxytocin augmentation; need for cesarean section; meconium passage; 1- and 5-minute Apgar scores RESULTS: When misoprostol was used instead of dinoprostone, there was a decrease of approximately 50% in the need to use oxytocin (RR = 0.55; 0.49-0.63). No difference was found regarding the need to perform cesarean sections in the misoprostol group when compared to the dinoprostone group (RR = 1.04; 0.81-1.34). There was a slightly higher incidence of meconium passage among the group that used misoprostol (RR = 1.39; 1.03-1.86). No significant difference in the incidence of Apgar score smaller than 7 was observed between the misoprostol or dinoprostone group, either at the 1st (RR = 1.36; 0.92-2.26) or at the 5th minute (RR = 1.39; 0.36-5.36). CONCLUSIONS: For the labor induction in third trimester pregnacies, with live fetus and unfavorable cervices, misoprostol is as effective and as safe as dinoprostone. A 50 mg dose of misoprostol may cause a higher incidence of meconium passage, however, it doesn’t compromise the perinatal performance of the newborn. The cost of misoprostol treatment was significantly lower than the cost of dinoprostone treatment according to the three studies that assessed this variable.OBJETIVO: Comparar a eficácia e a segurança de dois análogos das prostaglandinas, misoprostol e dinoprostone, na indução do parto em gestações de terceiro trimestre com feto vivo e cérvice desfavorável ao uso de ocitocina, conforme relatos recentes na literatura. MÉTODOS: Foram selecionados do sistema Medline sete estudos randomizados, controlados e prospectivos, comparando misoprostol (n = 500) com dinoprostone (n = 498) utilizados por via vaginal. Utilizou-se o método de DerSimonian e Laird para avaliar a homogeneidade do efeito do tratamento para cada variável analisada pelos sete estudos. Optou-se pelo risco relativo com intervalo de confiança de 95% para avaliar o resultado de cada ensaio clínico, calculando-se também o RR “comum” para os diferentes desfechos pelo método de Mantel-Haenszel, utilizando-se o pacote estatístico SAS. Os seguintes desfechos foram analizados: uso de ocitocina; índice de cesariana; eliminação de mecônio; escore de Apgar no 1º e 5º minutos RESULTADOS: Houve uma diminuição significativa – aproximadamente 50% – na necessidade de uso de ocitocina com a aplicação do misoprostol em relação ao dinoprostone (RR = 0,55; 0,49-0,63). Não foi encontrada nenhuma diferença na necessidade de cesariana entre o grupo que utilizou misoprostol (RR = 1,04; 0,81- 1,34) e o que utilizou dinoprostone. Houve uma incidência ligeiramente aumentada de eliminação mecônio no grupo do misoprostol (RR = 1,39; 1,03-1,86) em relação ao dinoprostone. Não foi encontrada nenhuma diferença significativa entre o grupo que utilizou misoprostol e o grupo que utilizou dinoprostone em relação à incidência de escores de Apgar menor do que 7, tanto no 1º minuto (RR = 1,36; 0,92-2,26), como no 5º minuto (RR = 1,39; 0,36-5,36). CONCLUSÕES: O misoprostol por via vaginal é tão efetivo e tão seguro quanto o dinoprostone para a indução do parto em gestações de terceiro trimestre com feto vivo e cérvice desfavorável ao uso de citocina. A dose de 50 mg de misoprostol pode provocar um aumento na eliminação de mecônio, sem contudo comprometer o desempenho perinatal dos recém nascidos. O custo do tratamento com misoprostol foi significativamente menor nos três estudos que avaliaram este item

Correlation between late cord clamping and phototherapy and other neonatal unfavorable outcomes : a randomized clinical trial

Background: Recently, late umbilical cord clamping is generally recommended, which decreases neonatal anemia; however, it may also increase neonatal jaundice and some other poor outcomes. Objectives: We here attempted to determine whether late clamping actually increases the incidence of phototherapy for jaundice and other poor outcomes of the term “low-risk newborns”. Methods: With the approval of the Brazilian Registry of Clinical Trials (REBEC), a total of 357 low-risk newborns (singleton, uncomplicated pregnancy/delivery, in a Brazilian public institution) were randomized into two groups: group I (n = 114): cord clamping < 1 minute (early clamping) or group II (n = 243): cord clamping between 1 - 3 minutes (late clamping). Statistics were used appropriately (i.e., measures of central tendency, dispersion for continuous variables, Shapiro-Wilk, Mann-Whitney test, or Chi-square test). Results: Phototherapy was performed in 5.3% in both groups. Also, there were no statistical differences in the occurrence of secondary outcomes, such as sepsis, neonatal ICU admission, and transient tachypnea of the newborns: i.e., 0.9%, 15.8%, and 3.5%, respectively for group I versus 1.2%, 15.6%, and 5.8%, respectively for group II. Conclusion: Late umbilical cord clamping does not increase the need for phototherapy in low-risk neonates. This result corroborates the current recommendation of late cord clamping, whenever appropriate

Maternal effects of immediate versus delayed umbilical cord clamping : a randomized clinical trial

OBJECTIVE: To compare maternal preoperative and postoperative hemoglobin variation after cord clamping. METHODS: Randomized clinical trial performed in Porto Alegre, RS from January to December 2012. It was included 356 women with habitual risk gestations. In the immediate cord clamping group, the umbilical cord section was realized between 0 and 60 s (group 1) while in the delayed cord clamping group it was realized >60 s (group 2). RESULTS: The mean (±standard deviation [SD]) preoperative hemoglobin was 12.13 ± 1.06 in the group 1 and 12.13 ± 1.11 in the group 2. The mean (±SD) postoperative day 2 hemoglobin level was 10.19 ± 1.46 in the group 1 and 10.24 ± 1.42 in the group 2. CONCLUSIONS: Delayed umbilical cord clamping resulted in a similar maternal hemoglobin level reduction at postoperative day 2

Female sexual function after surgical treatment of urinary incontinence

Introduction: Urinary incontinence is a common problem that can affect the quality of life of women of all ages and can negatively influence the exercise of sexuality. Aim: The aim of this study was to compare sexual function of women before and after surgical treatment for urinary incontinence. Method: The sample consisted of 38 women with urinary incontinence and surgical treatment (Burch or Sling procedure). The Female Sexual Function Index (FSFI) was used to evaluate sexual dysfunction before and after surgical treatment. Results: The mean age of the women in the study was 48 ± 8.8 years, and 58% were 50 years old or younger. By analyzing FSFI, it was observed that the majority of subjects had an overall index of sexual dysfunction (score < 26 points) before surgery. The desire and arousal domains improved significantly after surgery for all women included in the study. It was also observed that women with higher levels of education had more positive results related to desire. Conclusions: In our sample, in general, sexual function improved after surgical treatment of urinary incontinence, regardless of technique used, particularly in the discounter and pain domain. There was a substantial improvement of the sexual function among women who had presented with cystocele. Desire and arousal improved significantly after surgery, very likely due to the improvement of self-esteem after surgery