Cerclage for the prevention of prematurity: for whom should it be indicated?

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de ObstetríciaUNIFESP, EPM, Depto. de ObstetríciaSciEL

Stillbirth in a microrregion of Minas Gerais State: causes and associated factors

PURPOSE: to study the causes and associated factors of fetal death. METHODS: epidemiological descriptive study, composed of 190 cases of fetal loss amongst 11,825 pregnant women that gave birth at the two only hospitals (Casa de Saúde Divino Espírito Santo and Hospital Nossa Senhora Auxiliadora) of Caratinga City, in the State of Minas Gerais, Brazil, in the period from January 1, 1995 to April 30, 2000. The variables were the number of pregnancies, the timing of the pregnant women at the time of hospitalization, the occurrence of fetal death in relation to delivery and the cause of fetal death. Since there were no comparative groups, tables, percentages and arithmetical means were applied, following the guidelines of the Course of Statistics, of the Universidade Federal de São Paulo (UNIFESP). RESULTS: among the 189 pregnant women with fetal death, 77 were primigravidal and 76 had already been pregnant 2 to 5 times. The gestational age in 113 women was from 20 to 37 weeks. In relation to parturition, the fetal loss occurred during the antepartum period in 164 of 190 dead fetuses. The most frequently noticed death causes were: abruptio placentae in 35 cases, fetal anomaly in 12 cases, and hypertension syndrome in 8 cases. Nervertheless, there was no explanation for the etiology of 117 cases of fetal death. CONCLUSION: stillbirth has frequently been observed among the primigravidae (40.74%), in preterm period (59.79%), and in the antepartum period (86.31%). Among fetal death causes, the most frequent was a abruptio placentae (18.42%), and in 61.57% of the cases the fetal death could not be explained.OBJETIVOS: estudar as causas e fatores associados ao óbito fetal. MÉTODOS: estudo epidemiológico descritivo, que incluiu 190 casos de perdas fetais entre 11.825 gestantes que parturiram nos dois únicos hospitais (Casa de Saúde Divino Espírito Santo e Hospital Nossa Senhora Auxiliadora) de Caratinga, MG, no período de 1º de janeiro de 1995 a 30 de abril de 2000. As variáveis investigadas foram: o número de gestações, a idade gestacional no momento da internação hospitalar, a época de ocorrência do decesso fetal em relação ao parto e a causa do óbito fetal. Não havendo grupo controle comparativo, utilizou-se estatística descritiva com tabelas, porcentagens e médias aritméticas. RESULTADOS: dentre as 189 gestantes com morte fetal, 77 eram primigestas e 76 tinham entre 2 e 5 gestações. A idade gestacional variou de 20 a 37 semanas. Em relação ao parto, a perda fetal ocorreu no período anteparto em 164 dos 190 casos. As causas mais freqüentes encontradas para a morte foram: DPP em 35, anomalia fetal em 12 e síndrome hipertensiva em 8 casos. Todavia, em 117 conceptos não foi possível esclarecer a etiologia do óbito. CONCLUSÕES: a morte fetal esteve presente notadamente nas primigestas (40,74%) internadas no pré-termo (59,79%), e ocorreram no período anteparto (86,31%). Dentre as causas de morte fetal, a mais encontradiça foi o DPP (18,42%) e em 61,57% dos casos ela não pôde ser determinada.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de ObstetríciaUNIFESP, EPM, Depto. de ObstetríciaSciEL

Adverse pregnancy outcomes in women with diabetes

Pregnancy affects both the maternal and fetal metabolism and even in nondiabetic women exerts a diabetogenic effect. Among pregnant women, 2 to 17.8% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, that can predispose the fetus to many alterations in organogenesis, growth restriction and the mother to some diabetes-related complications like retinopathy and nephropathy or accelerate the course of these complications if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle modification; when these changes fail in keeping an optimal glycemic control, then insulin therapy must be considered. Women with type 2 diabetes in use of oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes must start an intensive glycemic control, preferably before conception. All these procedures are performed aiming to keep glycemic levels normal or near-normal as possible to avoid the occurrence of adverse perinatal outcomes to the mother and to the fetus. the aim of this review is to reinforce the need to improve the knowledge on reproductive health of women with diabetes during gestation and to understand what are the reasons for them failing to attend for prepregnancy care programs, and to understand the underlying mechanisms of adverse fetal and maternal outcomes, which in turn may lead to strategies for its prevention.Baurus Diabet Assoc, Dept Internal Med, BR-17012433 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Gynecol & Obstet, São Paulo, BrazilState Univ Hosp Rio de Janeiro, Diabet Unit, Dept Internal Med, Rio de Janeiro, BrazilUniversidade Federal de São Paulo, Dept Gynecol & Obstet, São Paulo, BrazilWeb of Scienc

Legal abortion in Brazil and the knowledge of health professionals

Universidade Federal de São Paulo (UNIFESP) Departamento de ObstetríciaUNIFESP, Depto. de ObstetríciaSciEL

Obesity and pregnancy

Universidade Federal de São Paulo (UNIFESP)Universidade Federal de São Paulo (UNIFESP) Departamento de ObstetríciaFaculdade de Medicina do ABCOrganização Mundial da Saúde Departamento de Saúde Reprodutiva e Pesquisa Unidade de Saúde Materna e PerinatalUNIFESP, Depto. de ObstetríciaSciEL

Sexuality in pregnancy: are Brazilian physicians prepared to conduct these questions?

Universidade Federal de São Paulo (UNIFESP) Departamento de ObstetríciaUNIFESP, Depto. de ObstetríciaSciEL

Inhibitory serum factor of lymphoproliferative response to allogeneic cells in pregnancy

INTRODUCTION: An inhibitory serum factor of mixed lymphocyte culture (MLC) has been associated with successful pregnancy after lymphocyte transfusion in women with unexplained recurrent spontaneous abortions (RSA). OBJECTIVE: Investigate whether the inhibitory serum factor of MLC is essential for a successful pregnancy. METHOD: Sera from 33 healthy pregnant women and from 40 women with RSA were assessed by a one-way MLC in which the woman's lymphocytes were stimulated with her partner's lymphocytes or with third party lymphocytes. RESULTS: An inhibitory serum effect (inhibition > 50% as compared to normal serum) was detected in 45% of the pregnant women who had at least 1 previous parity, in 8% of the primigravidea, in 29% of those with one abortion and in 58% of those with more than one abortion. CONCLUSION: MLC inhibitory serum factor does not seem to be an essential factor for pregnancy development. Therefore, it should not be considered as a parameter for the assessment of RSA patients.INTRODUÇÃO: A presença de fator sérico inibidor de cultura mista de linfócitos (CML) tem sido associada ao sucesso gesticional observado em mulheres com história de abortameneto de repetição sem etiologia (AER-SED) submetidas a transfusão de linfócitos. OBJETIVO:Investigar se a presença de fator sérico inibidor de CML é essencial para o sucesso gestional. MÉTODO: Soros de 33 gestantes saudáveis e 40 mulheres com AER-SED foram avaliados em CML unidericional, em que os linfócitos das mulheres foram estimulados por linfócitos de seus parceiros ou de indivíduos não aparentados. RESULTADOS: Um efeito inibidor (inibição > 50% quanto comparado com soro normal) foi detectado em 45% das gestantes a partir da 2ªgestação 8% das primegestas, em 29% das abortadeiras primárias e, em 58% das secundárias. CONCLUSÃO: Este fator não parece ser elemento essencial para o sucesso gestional. Portanto, não deve ser considerado parâmetro para avaliação de pacientes com ARE-SED.Universidade Federal de São Paulo (UNIFESP) EPM Pediatrics DepartmentUNIFESP, EPM, Pediatrics DepartmentSciEL

Neurofunctional Evaluation of Young Male Offspring of Rat Dams with Diabetes Induced by Streptozotocin

Diabetes mellitus (DM) is a complex disease, being one of the most prevalent diseases worldwide. As a consequence, pregnancy-associated diabetes is increasingly common. Given the numerous studies about the influence of diabetes on offspring of diabetic rat dams, the neurological outcome is of outmost importance. This paper aimed at evaluating the neurofunctional performance of young male offspring of rat dams with diabetes induced by streptozotocin. Diabetes was induced in Wistar female rats by streptozotocin administration, while control groups received vehicle injection. At two-month survival period, male offspring from each group were randomized to the water maze Morris test, in order to assess their neurofunctional status. There was no significant difference between the groups as assessed by the Morris water maze test for spatial reference task. Our results point to the need of further investigation on the offspring neurofunctional performance

The practice of episiotomy in Brazil

Universidade Federal de São Paulo (UNIFESP) Departamento de ObstetríciaUniversidade Cidade de São PauloUNIFESP, Depto. de ObstetríciaSciEL