Postpartum depression epidemiology in a Brazilian sample

INTRODUCTION: Psychiatric symptoms are frequent in the postpartum period, a moment marked by hormonal alterations and changes in social character, family organization and women's identity. The Edinburgh Postnatal Depression Scale (EPDS) is a self-reporting instrument to track depression after pregnancy, unfortunately not always properly supported by health care professionals. This study aimed at verifying the prevalence of postpartum depression in women receiving care at basic health units. METHODS: Cross-sectional study including 292 women in the postpartum period (from day 31 to 180) who answered the EPDS questionnaire. Cut-off point < 12 for EPDS depression was used. RESULTS: A total of 115 women (39.4%) had scores < 12 in EPDS, classified as depressive; 177 (60.6%) had scores < 12 and were not considered depressive. Women with lower education, higher number of pregnancies, higher parity, higher number of live children and shortest relationship time had more depression. CONCLUSION: High frequency of postpartum depression is associated with social factors, which shows the importance of health care professionals in early detection of depression, with the aid of instruments such as EPDS, due to its efficacy and practicability.INTRODUÇÃO: Sintomas psiquiátricos são freqüentes após o parto, momento marcado por alterações hormonais e mudanças no caráter social, na organização familiar e na identidade feminina. A Escala de Depressão Pós-Parto de Edimburgo (EPDS) é instrumento de auto-avaliação para rastrear depressão após a gestação, nem sempre adequadamente reconhecida pelos profissionais de saúde. O objetivo deste estudo foi avaliar prevalência de depressão pós-parto em mulheres atendidas em unidades básicas de saúde. MÉTODOS: Estudo transversal com aplicação da EPDS em 292 mulheres que se encontravam entre 31 e 180 dias após o parto. Adotamos o ponto de corte < 12 na EPDS como depressão. RESULTADOS: Do total, 115 (39,4%) apresentaram escores < 12, na EPDS, foram consideradas deprimidas; 177 (60,6%), com escores < 12, foram consideradas não-deprimidas. Mulheres com menor escolaridade, maior número de gestações, maior paridade, maior número de filhos vivos e menor tempo de relacionamento apresentaram mais depressão. CONCLUSÃO: A elevada freqüência de depressão pós-parto está relacionada com fatores sociais, demonstrando a importância dos profissionais de atenção básica na detecção precoce da depressão, tendo como auxílio instrumentos como a EPDS, pela sua eficácia e praticidade.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)Santa Casa de Misericórdia do Espírito Santo Escola de Ciências Superiores Departamento de Ginecologia e ObstetríciaUniversidade Federal do Espírito Santo Departamento de EstatísticaUNIFESP, EPMSciEL

Pregnancy follow-up and outcome in a patient with Takayasu's arteritis

We describe here the pregnancy follow-up and outcome in a patient with Takayasu's arteritis, with a detailed account of the complications during gestation and delivery and the impact of the disease on the newborn's health.No presente relato, que descreve a gestação de paciente portadora de arterite de Takayasu, serão avaliadas a interação dessa afecção com a gravidez e as intercorrências materno-fetais, do parto e do recém-nascido.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Impact of clinical characteristics on human chorionic gonadotropin regression after molar pregnancy

OBJECTIVES: This study aimed to determine the effects of age, race/ethnicity, body mass index, and contraception on human chorionic gonadotropin (hCG) regression following the evacuation of a molar pregnancy. METHODS: This was a retrospective cohort study of 277 patients with molar pregnancies between January 1, 1994 and December 31, 2015. The rate of hCG regression was estimated using mixed-effects linear regression models on daily log-transformed serum hCG levels after evacuation. RESULTS: There were no differences in hCG half-lives among age (p=0.13) or race/ethnicity (p=0.16) groups. Women with obesity and hormonal contraceptive use demonstrated faster hCG regression than their counterparts (3.2&nbsp;versus.&nbsp;3.7 days,&nbsp;p=0.02 and 3.4&nbsp;versus.&nbsp;4.0 days,&nbsp;p=0.002, respectively). CONCLUSION: Age and race/ethnicity were not associated with hCG regression rates. Hormonal contraceptive use and obesity were associated with shorter hCG half-lives, but with unlikely clinical significance. It is important to understand whether the clinical characteristics of patients may influence the hCG regression curve, as it has been proposed as a way to predict the risk of gestational trophoblastic neoplasia

Violência sexual e associação com a percepção individual de saúde entre mulheres gestantes

OBJECTIVE: To estimate the prevalence of sexual violence history among pregnant women and its association with the self-perception of health status. METHODS: Cross-sectional study including a total of 179 pregnant women older than 14 years old at gestation week 14 to 28 attending public health services in the city of São Paulo, Southeastern Brazil, between 2006 and 2007. Data collection instruments included: questionnaire on sexual violence; questionnaire on sociodemographic data; and an assessment of health-related quality of life using the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12®). Age, skin color, education, occupational and marital status, and self-perception of physical and mental health were compared between women with and without a lifetime history of sexual violence. Sexual violence was categorized as penetrative and non-penetrative sex. RESULTS: Among all women interviewed, the prevalence of sexual violence was 39.1%, of which 20% were of penetrative type by known perpetrators. In 57% of cases, the first episode of violence was before the age of 14. There were no sociodemographic differences between women with and without history of sexual violence. Mean scores of self-perception of physical health among women with history of sexual violence were lower (42.2; SD= 8.3) compared to those without history of sexual violence (51.0; SD= 7.5) (pOBJETIVO: Estimar la prevalencia de histórico de violencia sexual entre mujeres gestantes y su asociación con la percepción de salud. MÉTODOS: Estudio transversal, con 179 mujeres mayores de 14 años y embarazadas de 14 a 28 semanas, entrevistadas en servicios públicos de salud en Sao Paulo, Sureste de Brasil, entre los años de 2006 y 2007. Los instrumentos utilizados fueron: inventario de violencia sexual, inventario de datos sociodemográficos y cuestionario de calidad de vida relacionada con la salud: "Medical Outcomes 12-Item Short-Form Health Survey" (SF-12 ®). Mujeres con y sin historia de violencia sexual fueron comparadas con respecto a la edad, escolaridad, ocupación, estado civil, color de la piel y autopercepción de salud física y mental. La violencia sexual fue caracterizada en penetrativa o no penetrativa. RESULTADOS: Hubo prevalencia de 39,1% de violencia sexual entre las entrevistadas, siendo 20% del tipo penetrativo, cometida sobretodo por agresores conocidos. En 57% de las mujeres la primera agresión ocurrió antes de los 14 años. No hubo diferencias sociodemográficas entre mujeres que sufrieron y las que no sufrieron violencia sexual. Escores promedios de percepción de salud física entre las entrevistadas con antecedente de violencia sexual fueron menores (42,2; DP=8,3) con relación a las mujeres sin este antecedente (51,0; DP=7,5) (pOBJETIVO: Estimar a prevalência de histórico de violência sexual entre mulheres gestantes e sua associação com a percepção de saúde. MÉTODOS: Estudo transversal, com 179 mulheres maiores de 14 anos e grávidas de 14 a 28 semanas, entrevistadas em serviços públicos de saúde em São Paulo, SP, entre os anos de 2006 e 2007. Os instrumentos utilizados foram: inventário de violência sexual, inventário de dados sociodemográficos e questionário de qualidade de vida relacionada à saúde: "Medical Outcomes 12-Item Short-Form Health Survey" (SF-12®). Mulheres com e sem história de violência sexual foram comparadas quanto à idade, escolaridade, ocupação, estado civil, cor da pele e autopercepção de saúde física e mental. A violência sexual foi caracterizada em penetrativa ou não penetrativa. RESULTADOS: Houve prevalência de 39,1% de violência sexual entre as entrevistadas, sendo 20% do tipo penetrativo, cometida sobretudo por agressores conhecidos. Em 57% das mulheres a primeira agressão ocorreu antes dos 14 anos. Não houve diferenças sociodemográficas entre mulheres que sofreram e as que não sofreram violência sexual. Escores médios de percepção de saúde física entre as entrevistadas com antecedente de violência sexual foram menores (42,2; DP=8,3) do que das mulheres sem este antecedente (51,0; DP=7,5) (

Correlation of c-erbB-2 and p53 with malignant evolution of the hydatiform mole

Objetivos: comparar a expressao imuno-histoquimica da oncoproteina c-erbB-2 e da proteina p53, supressora de tumor, em tecido molar fixado, de pacientes que apresentaram tumor trofoblastico gestacional com a daquelas com remissao espontanea e estimar ponto de corte na imuno-expressao dessas proteinas, na avaliacao da evolucao da mola hidatiforme. Metodo: observacional descritivo com grupo de comparacao. O tamanho amostral constituiu-se por casos de mola hidatiforme com progressao para tumor trofoblastico gestacional do Setor de Doenca Trofoblastica Gestacional da UNIFESPEPM, e o grupo de comparacao a casos de mola hidatiforme, com evolucao benigna, todos com possibilidade de avaliacao imuno-histoquimica, atendidos no periodo de janeiro de 1993 a junho de 2002. 68 especimes de tecido fixado de mola hidatiforme, 36, do grupo com evolucao para tumor trofoblastico gestacional (Grupo de Estudo), e 32, do grupo com remissao espontanea (Grupo-Controle), foram submetidos ao estudo imunohistoquimico para pesquisa das proteinas c-erbB-2 e p53. Avaliou-se a expressao de c-erbB-2 segundo dois criterios: quantitativo, representado pela porcentagem de celulas com membrana citoplasmatica totalmente delineada e semi-quantitativo nas categorias: negativo, positivo fraco e positivo forte. O p53 foi avaliado segundo a porcentagem de celulas com nucleos corados. Somente apos leitura das laminas identificou-se o grupo a que cada uma das laminas pertencia. Para comparar o resultado da imuno-expressao dessas proteinas entre os dois grupos, utilizou-se: Teste t de Student e Prova de Mann- Whitney. Para estimar ponto de corte na imunoexpressao de c-erbB-2 e p53, na avaliacao da evolucao da mola hidatiforme, utilizou-se: curva ROC e analise de regressao logistica. Resultados: As imuno-expressoes das proteinas c-erbB-2 e p53 foram significantemente maiores, nas molas hidatiformes que evoluiram para malignizacao, que naquelas com remissao espontanea. As imuno-expressoes nao possibilitaram apurar ponto de corte ideal para avaliar a evolucao da mola hidatiforme. Conclusoes: a imuno-expressao de c-erbB-2 e p53, nas molas hidatiformes pode auxiliar na avaliacao das suas evolucoes, pois foi significantemente maior no grupo que evoluiu para malignidadeBV UNIFESP: Teses e dissertaçõe

Polymorphisms in VEGF, progesterone receptor and IL-1 receptor genes in women with recurrent spontaneous abortion

Hormonal, inflammatory and vascular alterations during pregnancy are thought to be involved in pregnancy loss. the role of progesterone, the actions of which involve cytokines and vascular endothelial growth factor (VEGF), has been thoroughly studied. Genetic factors are involved in modulation of these molecules, and several genes have been associated with recurrent spontaneous abortion (RSA), as well other obstetric conditions. Here we investigate the relationship between RSA and gene polymorphisms of the progesterone receptor (PROGINS), interleukin-1 receptor 1 (PstI) and vascular endothelial growth factor (VEGF) (-634, 936). This case-controlled study comprised a total of 89 women with idiopathic RSA and a control group of 191 women with at least two successful pregnancies and no miscarriages. Genomic DNA was extracted from whole blood, and polymorphism genotyping was conducted by digesting PCR products with specific restriction endonucleases. No correlations were found in any of the investigated polymorphisms, even among dominant, co-dominant and additive inheritance models and alleles. Our results support the hypothesis that these specific gene polymorphisms are not the major determinant of pregnancy success. Although we did not find any correlations, the investigation of these and other polymorphisms remains a challenge in the evaluation of RSA. (C) 2010 Elsevier Ireland Ltd. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo, Dept Obstet, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Obstet, São Paulo, BrazilFAPESP: 06/56312-7Web of Scienc

Correlation of c-erbB-2 oncogene and p53 tumor suppressor gene with malignant transformation of hydatidiform mole

Considering the roles of c-erB-2 and p53 oncoproteins in tumor progression, we aimed to evaluate their expression in hydatidiform moles, and the possible predictive value of this immunoexpression in postmolar follow-up.Group I comprised 35 patients with progression to gestational trophoblastic tumor, and group II included 32 patients with progression to spontaneous remission. Immunohistochemical tests were performed by streptavidin-peroxidase method. c-erbB-2 immunoexpression was evaluated according to quantitative and semiquantitative criteria; p53 according to percentage of cells with stained nuclei. Data were analyzed by Student t-test, Mann-Whitney test, ROC curve and logistic regression analysis.c-erbB-2 and p-53 expressions were significantly increased in group I. Quantitative and semiquantitative analysis of c-erb-2 showed that its expression may be associated with mole hydatidiform progression to gestational trophoblastic tumor. Taking into account cells with complete membranous delineation we proposed a cut-off value of 10.8%. Similarly, considering the percentage of cells presenting nuclei marked by p53 we suggested a cut-off value of 40.1% for the prediction of malignant transformation of mole hydatidiform.c-erbB-2 and p53 immunoexpression in hydatidiform mole are usually increased with malignant transformation. in addition to beta-fraction of human chorionic gonadotropin, they could possibly help the establishment of a therapeutic protocol.Universidade Federal de São Paulo, Paulista Med Sch, Dept Obstet, São Paulo, BrazilUniversidade Federal de São Paulo, Paulista Med Sch, Dept Pathol, São Paulo, BrazilUniversidade Federal de São Paulo, Paulista Med Sch, Dept Obstet, São Paulo, BrazilUniversidade Federal de São Paulo, Paulista Med Sch, Dept Pathol, São Paulo, BrazilWeb of Scienc

Ciąża bliźniacza przebiegająca w postaci zaśniadu groniastego współwystępującego z żywym płodem: rozpoznanie, postępowanie oraz obserwacja po zakończeniu ciąży

Twin molar pregnancy with a hydatidiform mole and a coexisting live fetus is a rare form of gestational trophoblastic disease associated with an increased risk of obstetric complications and poor perinatal outcome. Prenatal diagnosis is essential for couple counseling and follow-up in Tertiary Reference Centers. Magnetic resonance imaging is important for the diagnostic differentiation of placental mesenchymal dysplasia and exclusion of myometrial invasion. Here we present a case of twin molar pregnancy with a hydatidiform mole and a coexisting live fetus diagnosed at gestational week 14 using two-dimensional (2D) and three-dimensional (3D) ultrasound and magnetic resonance imaging. We also describe the obstetric management and postmolar follow-up.Zaśniad groniasty stanowi łagodną postać ciążowej choroby trofoblastycznej (gestational trophoblastic disease, GTD)(1). W Brazylii ciążowa choroba trofoblastyczna stwierdzana jest 5–10 razy częściej(2) niż w Stanach Zjednoczonych i Europie(3,4). Zaśniad groniasty powstaje w wyniku nieprawidłowego zapłodnienia komórki jajowej i może przybierać dwie formy: zaśniadu groniastego całkowitego lub zaśniadu groniastego częściowego(1). Z klinicznego punktu widzenia taka reprodukcja materiału genetycznego może prowadzić do rozwinięcia się ciążowej neoplazji trofoblastu, która bez wdrożenia właściwego leczenia może skutkować śmiercią kobiety(1–4). Artykuł w wersji polskojęzycznej jest dostępny na stronie http://jultrason.pl/index.php/wydawnictwa/volume-17-no-7

A twin pregnancy with a hydatidiform mole and a coexisting live fetus: prenatal diagnosis, treatment, and follow-up

Twin molar pregnancy with a hydatidiform mole and a coexisting live fetus is a rare form of gestational trophoblastic disease associated with an increased risk of obstetric complications and poor perinatal outcome. Prenatal diagnosis is essential for couple counseling and follow-up in Tertiary Reference Centers. Magnetic resonance imaging is important for the diagnostic differentiation of placental mesenchymal dysplasia and exclusion of myometrial invasion. Here we present a case of twin molar pregnancy with a hydatidiform mole and a coexisting live fetus diagnosed at gestational week 14 using two-dimensional (2D) and three-dimensional (3D) ultrasound and magnetic resonance imaging. We also describe the obstetric management and postmolar follow-up