RESUMO
O presente estudo tem como objetivo descrever a mortalidade perinatal em gestações trigemelares, e analisar os fatores preditores dos seguintes desfechos: número de crianças vivas no momento da alta hospitalar, nenhuma criança viva no momento da alta hospitalar (desfavorável) e pelo menos uma criança viva no momento da alta hospitalar (favorável). Realizado de forma retrospectiva, envolveu pacientes com gestações trigemelares que apresentavam três fetos vivos na primeira ultrassonografia realizada após 11 semanas, no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), no período de 1998 a 2012. Foram incluídas 67 pacientes das quais 77,6% referiam concepção espontânea. Quanto à corionicidade, 49,2% eram tricoriônicas e 50,8% eram não tricoriônicas; 16,4% apresentavam antecedente clínico prévio à gestação e 49,2% eram nulíparas. Em relação às intercorrências, a incidência de complicações obstétricas e/ou clínicas na gestação foi de 52,2%, e de intercorrências fetais, 25,2%, dentre as quais: 13,4% mal formações, 7,5% sindrome da transfusão feto fetal (STFF), 5,9% óbito fetal (OF), 4,5% insuficiência placentária, 4,4% fetos unidos, 1,5% feto acárdico. A idade gestacional média do parto foi de 31,9 ± 3,1 semanas, dos quais 83,5% foram cesáreas. O peso médio dos recém-nascidos vivos de 1.683 ± 508 g. Em relação à discordância de peso ao nascer: 57% apresentaram até 20%, 23,2% entre 20 e 30% e 19,6% acima de 30%. A taxa de óbitos fetais foi de 31,7%o nascimentos (IC95%: 11,7 - 67,8) e a mortalidade perinatal 249%o nascimentos (IC95%: 189 - 317). O tempo médio de internação dos recém-nascidos, que foram de alta vivos, foi de 29,3 ± 24,7 dias. A predição dos desfechos foi investigada por meio de regressão logística "stepwise", e incluiu as seguintes variáveis: idade materna, paridade (nulípara ou um ou mais partos anteriores), antecedente clínico, idade gestacional do primeiro ultrassonografia no HCFMUSP, corionicidade (gestações...
The present study, involving triplet pregnancies, describes perinatal mortality and investigates predictors of the following outcomes: number of children alive, no child alive (unfavorable outcome) and at least one child alive (favorable outcome) at hospital discharge. It is a retrospective study involving triplet pregnancies with live fetuses at the first ultrasound scan, performed after 11 weeks of gestation, at the Department of Obstetrics and Gynecology, São Paulo University Medical School Hospital, between 1998 and 2012. Final sample included 67 women, 77.6% reported spontaneous conception. Regarding the chorionicity, 49.2% were trichorionic; 16.4% had a medical complication prior to pregnancy, and 49.2% were nulliparous. The incidence of obstetric and/or clinical complications during pregnancy was 52.2%, and fetal complications occurred in 25.2%, (13.4% of major fetal abnormalities, 7.5% twin-to-twin transfusion syndrome, 5.9% stillbirth, 4.5% placental insufficiency, 4.4% conjoined twins and 1.5% acardic twin). The average gestational age at delivery was 31.9 ± 3.1 weeks, and 83.5% were cesarean. The average birthweight was 1683 ± 508 g and birth weight discordance up to 20% occurred in 57% of the cases; 23,2% had 20 to 30% discordance and 19.6%, was greater than 30%. The rate of stillbirth was 31.7%o births (95%CI: 11.7 - 67.8) and the perinatal mortality was 249%o births (95%CI: 189 - 317). The average hospital stay was 29.3 ± 24.7 days amongst children that were discharged alive. Stepwise logistic regression analysis was used to investigate prediction according to: maternal age, parity (nuliparous/multiparous), prior clinical history, gestational age at the first ultrasound scan at HCFMUSP, pregnancy chorionicity (trichorionic/non trichorionic), occurrence of clinical and/or obstetric complications during pregnancy, occurrence of fetal complications and gestational age at delivery. Significance level was set at 0.05. The number of children alive at...
Assuntos
Humanos , Feminino , Gravidez , Morte Fetal/epidemiologia , Mortalidade Perinatal , Complicações na Gravidez , Gravidez de Trigêmeos , Diagnóstico Pré-Natal , Fatores de Risco , Ultrassonografia Pré-NatalRESUMO
OBJECTIVE: To determine the prevalence of fetal and neonatal deaths among patients with maternal near miss and the factors associated with this fatal outcome. METHODS: The authors conducted a descriptive, cross-sectional, analyzing medical records of patients admitted to the ICU of a tertiary obstetric Recife (Brazil), between January 2007 and December 2010, who had at least one criterion of near miss defined by WHO. Statistical analysis was performed with Epi-Info 3.3.2, using chi-square and Fisher's exact test, considering a significance level of 5%. For multivariate analysis was constructed as a hierarchical model with the response variable fetal and neonatal deaths. RESULTS: We included 246 cases of maternal near miss. Among women in the study, hypertensive disorders occurred in 62.7% to 41.2% in HELLP syndrome and the laboratory criteria for near miss in 59.6%. There were 48 (19.5%) stillbirths and 19 (7.7%) neonatal deaths. After analyzing the variables that remained statistically associated with fetal and neonatal deaths were: severe preeclampsia, placental abruption, endometritis, cesarean delivery, prematurity and the laboratory criteria for maternal near miss. CONCLUSION: The high incidence of fetal and neonatal deaths among patients with maternal near miss. Among these women there is an overlap of factors contributing to this fatal outcome, in our study, those who had severe preeclampsia, placental abruption, endometritis, premature birth or laboratory criteria positively associated with deaths.
Assuntos
Morte Fetal/epidemiologia , Mortalidade Infantil , Complicações na Gravidez , Descolamento Prematuro da Placenta/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Endometrite/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Pessoa de Meia-Idade , Mortalidade Perinatal , Pré-Eclâmpsia/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Sobreviventes , Adulto JovemRESUMO
OBJETIVO Analisar a evolução da mortalidade perinatal quanto à dimensão do problema e sua extensão. MÉTODOS Estudo descritivo de tendência temporal com 10.994 óbitos perinatais, de mães residentes em Salvador, BA, com idade gestacional ≥ 22 semanas, idade do recém-nascido até seis dias e 500 g ou mais de peso ao nascer, registrados de 2000 a 2009. Utilizaram-se dados do Sistema de Informações de Nascidos Vivos e do Sistema de Informações sobre Mortalidade do sitio eletrônico do Datasus/Ministério da Saúde. Calcularam-se taxas de mortalidade perinatal e fetal/1.000 nascimentos e neonatal precoce/1.000 nascidos vivos. Aplicaram-se: teste Qui-quadrado de Pearson para diferenças em proporções, teste de sequências ( runs ), cálculo de médias móveis e coeficiente de determinação linear (R 2 ) para análise de tendência. Utilizou-se a classificação de Wigglesworth para causas de morte. RESULTADOS A taxa de mortalidade perinatal mostrou tendência decrescente, sendo reduzida em 42,0% no período (de 33,1 (2000) para 19,2 (2009)), com maior contribuição da taxa neonatal precoce (-56,3%). A mortalidade fetal representou grande proporção (61,9%) da taxa de mortalidade perinatal em 2009. A classificação dos óbitos apontou como causas mais frequentes de óbito perinatal: asfixia intraparto (8,8/1.000), imaturidade (7,1/1.000) e malformações congênitas (1,3/1.000). CONCLUSÕES Mesmo em declínio, a taxa de mortalidade perinatal continua elevada e o predomínio recente da mortalidade fetal indica mudança no perfil de causas e impacto nas ações de prevenção. A consulta pré-natal de qualidade com controle de riscos e melhoria da assistência ao parto pode reduzir a ocorrência ...
OBJETIVO Analizar la evolución de la mortalidad perinatal con relación a la dimensión del problema y su extensión. MÉTODOS Estudio descriptivo de tendencia temporal con 10.994 óbitos perinatales, de madres residentes en Salvador, BA, con edad de gestación ≥ 22 semanas, edad del recién nacido de máximo 6 días y más de 500 grs de peso al nacer, registrados de 2000 a 2009. Se utilizaron datos del Sistema de Informaciones de Nacidos Vivos y del Sistema de Informaciones de Mortalidad de la página electrónica del Datasus/Ministerio de la Salud. Se calcularon las tasas de mortalidad perinatal y fetal/1.000 nacimientos y neonatal precoz/1.000 nacidos vivos. Se aplicaron: prueba de Chi-cuadrado de Pearson para diferencias en proporciones, prueba de secuencias (runs), cálculo de promedios móviles y coeficiente de determinación linear (R2) para análisis de tendencia. Se utilizó la clasificación de Wigglesworth para causas de muerte. RESULTADOS La tasa de mortalidad perinatal mostró tendencia decreciente, reduciendo 42,0% en el período (de 33,1 (2000) para 19,2 (2009)), con mayor contribución de tasa neonatal precoz (-56,3%). La mortalidad fetal representó gran proporción (61,9%) de la tasa de mortalidad perinatal en 2009. La clasificación de los óbitos apuntó como causas más frecuentes de óbito perinatal: asfixia durante el parto (8,8/1.000), inmadurez (7,1/1.000) y malformaciones congénitas (1,3/1.000). CONCLUSIONES A pesar de estar disminuyendo, la tasa de mortalidad perinatal continua elevada y el predominio reciente de la mortalidad fetal indica cambio en el perfil de causas e impacto en las acciones de prevención. La consulta pre-natal de calidad con control de riesgos y mejoría de la asistencia en el parto pueden reducir la ocurrencia de causas evitables. .
OBJECTIVE To describe and analyze the evolution of perinatal mortality with regards the scale and extent of the problem. METHODS A descriptive time trend study with 10,994 perinatal deaths to mothers living in Salvador, Bahia, Northeastern Brazil, with a gestational age of ≥ 22 weeks, newborn age of up to six days and birth weight of 500 grams or more, recorded from 2000 to 2009. Data from the Information Systems on Live Births and Mortality of DATASUS/Ministry of Health available on the website were used. Rates of perinatal and fetal mortality per 1,000 births and early neonatal mortality per 1,000 live births were calculated. The Pearson’s Qui-square test for differences in proportions, sequence (runs) test, the calculation of moving averages and linear coefficient of determination (R 2 ) were used for trend analysis. The Wigglesworth classification of causes of death was used. RESULTS The rates of perinatal mortality showed a decreasing trend, of -42.0% in the period (from 33.1 (2000) to 19.2 (2009)), with a greater share of rates of neonatal mortality (-56.3%). Fetal mortality accounted for a large proportion (61.9%) of rates of perinatal mortality in 2009. The classification of deaths showed the following most frequent causes of perinatal deaths: intrapartum asphyxia (8.8/1,000), immaturity (7.1/1,000) and congenital malformations (1.3/1,000). CONCLUSIONS :Perinatal mortality remains high despite the downward trend, and the predominance of fetal mortality indicates recent changes in the profile of causes of death and impact on prevention activities. The quality of prenatal care with risk control and improving care during the delivery may reduce the occurrence of preventable causes of death. .
Assuntos
Adolescente , Adulto , Criança , Feminino , Humanos , Recém-Nascido , Masculino , Adulto Jovem , Mortalidade Perinatal/tendências , Brasil/epidemiologia , Causas de Morte , Morte Fetal/epidemiologia , Fatores de RiscoRESUMO
OBJETIVO: Determinar a prevalência dos óbitos fetais e neonatais entre as pacientes com near miss materno e os fatores associados a esse desfecho fatal. MÉTODOS: Realizou-seumestudo descritivo, tipo corte transversal, analisando-se prontuários das pacientes admitidas na UTI obstétrica de um hospital terciário do Recife (Brasil), entre janeiro de 2007 e dezembro de 2010, que apresentavam pelo menos um critério de near miss definido pela OMS. A análise estatística foi realizada com o programa Epi-Info 3.3.2, usando os testes Qui-quadrado de associação e exato de Fisher, considerando-se o nível de significância de 5%. Para análise multivariada foi construído um modelo hierarquizado tendo como variável resposta os óbitos fetais e neonatais. RESULTADOS: Foram incluídos 246 casos de near miss. Entre as mulheres do estudo, os distúrbios hipertensivos ocorreram em 62,7%, a síndrome HELLP em 41,2% e os critérios laboratoriais de near miss em 59,6%. Ocorreram 48 (19,5%) óbitos fetais e 19 (7,7%) óbitos neonatais. Após a análise estatística as variáveis que permaneceram associadas aos óbitos fetais e neonatais foram: pré-eclâmpsia grave, DPP, endometrite, cesariana, prematuridade e os critérios laboratoriais de near miss materno. CONCLUSÃO: É elevada a ocorrência de óbitos fetais e neonatais entre as pacientes com near miss materno. Entre essas mulheres há uma sobreposição de fatores que contribuem para esse desfecho fatal, em nosso estudo aquelas que apresentaram pré-eclâmpsia grave, DPP, endometrite, parto prematuro ou critérios laboratoriais apresentam associação positiva com os óbitos.
OBJECTIVE: To determine the prevalence of fetal and neonatal deaths among patients with maternal near miss and the factors associated with this fatal outcome. METHODS: The authors conducted a descriptive, cross-sectional, analyzing medical records of patients admitted to the ICU of a tertiary obstetric Recife (Brazil), between January 2007 and December 2010, who had at least one criterion of near miss defined by WHO. Statistical analysis was performed with Epi-Info 3.3.2, using chi-square and Fisher's exact test, considering a significance level of 5%. For multivariate analysis was constructed as a hierarchical model with the response variable fetal and neonatal deaths. RESULTS: We included 246 cases of maternal near miss. Among women in the study, hypertensive disorders occurred in 62.7% to 41.2% in HELLP syndrome and the laboratory criteria for near miss in 59.6%. There were 48 (19.5%) stillbirths and 19 (7.7%) neonatal deaths. After analyzing the variables that remained statistically associated with fetal and neonatal deaths were: severe preeclampsia, placental abruption, endometritis, cesarean delivery, prematurity and the laboratory criteria for maternal near miss. CONCLUSION: The high incidence of fetal and neonatal deaths among patients with maternal near miss. Among these women there is an overlap of factors contributing to this fatal outcome, in our study, those who had severe preeclampsia, placental abruption, endometritis, premature birth or laboratory criteria positively associated with deaths.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Adulto Jovem , Morte Fetal/epidemiologia , Mortalidade Infantil , Complicações na Gravidez , Descolamento Prematuro da Placenta/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Endometrite/epidemiologia , Modelos Logísticos , Mortalidade Perinatal , Pré-Eclâmpsia/epidemiologia , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco , SobreviventesRESUMO
OBJECTIVE: To determine the role of viral infections in causing fetal and infant death. STUDY DESIGN: We assessed a well-validated population database of fetal (≥20 weeks gestation) and infant death for infective deaths and deaths from viruses over a 21-year period (1988-2008). We analyzed by specific viral cause, timing (late fetal loss [20-23 weeks], stillbirth [≥24 weeks], neonatal death [0-27 days], and post-neonatal infant death [28-364 days]) and across time. RESULTS: Of the 989 total infective deaths, 108 were attributable to viral causes (6.5% of late fetal losses, 14.5% of stillbirths, 6.5% of neonatal deaths, and 19.4% of postneonatal infant deaths). Global loss (combined fetal and infant losses per 100,000 registerable births) was 139.6 (95% CI, 130.9-148.3) for any infective cause and 15.2 (95% CI, 12.3-18.1) for viral infections. More than one-third (37%) of viral-attributed deaths were before live birth, from parvovirus (63%) or cytomegalovirus (33%). Parvovirus accounted for 26% (28 of 108) of all viral deaths. Cytomegalovirus was associated with a global loss rate of 3.1 (95% CI, 1.8-4.4) and an infant mortality rate of 1.3 (95% CI, 0.4-2.1) per 100,000 live births; 91% of cases were congenital infections. Herpes simplex virus caused death only after live births (infant mortality rate, 1.4; 95% CI, 0.5-2.3). No changes in rates were seen over time. CONCLUSION: We have identified a substantial contribution of viral infections to global fetal and infant losses. More than one-third of these losses occurred before live births. Considering our methodology, our estimates represent the minimum contribution of viral illness. Strategies to reduce this burden are needed.
Assuntos
Morte Fetal/epidemiologia , Morte Fetal/virologia , Natimorto/epidemiologia , Viroses/mortalidade , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Estudos RetrospectivosRESUMO
OBJECTIVE: To describe and analyze the evolution of perinatal mortality with regards the scale and extent of the problem. METHODS: A descriptive time trend study with 10,994 perinatal deaths to mothers living in Salvador, Bahia, Northeastern Brazil, with a gestational age of ≥ 22 weeks, newborn age of up to six days and birth weight of 500 grams or more, recorded from 2000 to 2009. Data from the Information Systems on Live Births and Mortality of DATASUS/Ministry of Health available on the website were used. Rates of perinatal and fetal mortality per 1,000 births and early neonatal mortality per 1,000 live births were calculated. The Pearson's Qui-square test for differences in proportions, sequence (runs) test, the calculation of moving averages and linear coefficient of determination (R²) were used for trend analysis. The Wigglesworth classification of causes of death was used. RESULTS: The rates of perinatal mortality showed a decreasing trend, of -42.0% in the period (from 33.1 (2000) to 19.2 (2009)), with a greater share of rates of neonatal mortality (-56.3%). Fetal mortality accounted for a large proportion (61.9%) of rates of perinatal mortality in 2009. The classification of deaths showed the following most frequent causes of perinatal deaths: intrapartum asphyxia (8.8/1,000), immaturity (7.1/1,000) and congenital malformations (1.3/1,000). CONCLUSIONS: Perinatal mortality remains high despite the downward trend, and the predominance of fetal mortality indicates recent changes in the profile of causes of death and impact on prevention activities. The quality of prenatal care with risk control and improving care during the delivery may reduce the occurrence of preventable causes of death.
Assuntos
Mortalidade Perinatal/tendências , Adolescente , Adulto , Brasil/epidemiologia , Causas de Morte , Criança , Feminino , Morte Fetal/epidemiologia , Humanos , Recém-Nascido , Masculino , Fatores de Risco , Adulto JovemRESUMO
INTRODUCTION: Mortality rates in preterm births and stillbirth are high. OBJECTIVE: To identify maternal risk factors relating to stillbirth in preterm infants. MATERIAL AND METHODS: We conducted a cross-sectional, analytic study of 1,022 newborns between 20 and 36 weeks of gestation, from September 2004 to August 2005. Stillbirth was defined as fetal death prior to expulsion or extraction from the mother. Data was collected prospectively by directly interviewing the pregnant women and from the medical chart. The dependent variable was stillbirth and the independent ones were the maternal risk factors. Associations were evaluated by logistic regression. RESULTS. One thousand and twenty-four (1,024) preterm births were detected in a total of 14,882 births (6.9%/year). One hundred and fifty-two (152) were stillborn and 870 were live births. The fetal mortality rate was 10.3 per 1,000 live births. The least common maternal factors associated to stillbirth included: urinary tract infection (22/152, 14% vs. 224/869, 26%, p = 0.020), PMR > 24 h (18/152, 12% vs. 172/869, 20%, p = 0.020) and cesarean delivery (24/138, 17% vs. 344/719, 48%, p < 0.001). The crude odd risk ratios for stillbirth included spontaneous preterm delivery (OR 4.38, CI95% 2.70-7.17) and deficient prenatal care (OR 2.64, CI95% 1.83-3.82). By multivariate analysis, stillbirth predictors included: spontaneous preterm delivery (OR 4.00, CI 95% 2.61-6.61) and deficient prenatal care (OR 2.54, CI 95% 1.78-3.62). CONCLUSION: Deficient prenatal care was the only statistically significant and clinically coherent variable predicting stillbirth.
Assuntos
Hospitais Públicos/estatística & dados numéricos , Doenças do Prematuro/mortalidade , Complicações do Trabalho de Parto/epidemiologia , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Natimorto/epidemiologia , Adolescente , Adulto , Cesárea/estatística & dados numéricos , Feminino , Morte Fetal/epidemiologia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , México , Trabalho de Parto Prematuro/epidemiologia , Gravidez , Gravidez Múltipla/estatística & dados numéricos , Estudos Prospectivos , Fatores de Risco , Fumar/epidemiologia , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto JovemAssuntos
Anestesia Geral/métodos , Anestesia Intravenosa/métodos , Raquianestesia/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/métodos , Complicações Cardiovasculares na Gravidez/cirurgia , Adolescente , Adulto , Brasil/epidemiologia , Feminino , Morte Fetal/epidemiologia , Humanos , Gravidez , Adulto JovemRESUMO
BACKGROUND: happens in the womb when the death of one of the twins, it is necessary to consider the factors that influence the perinatal outcome of surviving fetus. OBJECTIVE: To review the outcome of twin pregnancies complicated by single fetal intrauterine death and how it can increase morbidity to its co-twin and its mother. MATERIAL AND METHODS: A retrospective analysis of the fifty one twin pregnancies complicated by single fetal intrauterine death in the second or third trimester in our centre from December 1999 to December 2010. RESULTS: Of the total amount of 1996 twin pregnancies attended in our centre, 51 were complicated by single fetal intrauterine death (2.5%). In 68.7% of the cases we found several maternal complications, such as 12.2% of preeclampsia and 12% of coagulopathies. As for the dead foetus, there was a 47% of malformations, a 19.6% of intrauterine fetal growth restriction and there was a 9.8% of cases complicated by twin-twin transfusion syndrome. In the group of the surviving co-twin, 9.8% developed intrauterine growth restriction, 9.8% oligohydramnios and 9.8% Doppler alterations. There was a high risk of prematurity with 43.1% of the births under 34 weeks and 13.7% under 30 weeks of pregnancy. The percentage of caesarean was 64.7%. There was 3 cases of co-twin died intra-uterus, and one more died postpartum. A 10% of the newborns had some kind of neurological disability. CONCLUSIONS: It seems that surviving co-twin prognosis is mainly compromised by prematurity and its consequences. There should be more prospective research to inform decision-making and evaluate and control the potential maternal and fetal risks.
Assuntos
Morte Fetal/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Gravidez de Gêmeos/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos , Adulto , Cesárea/estatística & dados numéricos , Anormalidades Congênitas/epidemiologia , Doenças em Gêmeos/diagnóstico por imagem , Doenças em Gêmeos/mortalidade , Feminino , Retardo do Crescimento Fetal/epidemiologia , Transfusão Feto-Fetal/epidemiologia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Masculino , Gravidez , Complicações na Gravidez/etiologia , Prognóstico , Estudos Retrospectivos , Espanha/epidemiologia , Ultrassonografia Pré-Natal , Adulto JovemRESUMO
The aim of this study was to explore the distribution of reproductive outcomes following dengue virus infection during pregnancy (2001-2005). An ecological epidemiological study was conducted in all counties with more than 80,000 inhabitants in Southeast Brazil. The study explored the correlation between dengue incidence rates in women 15-39 years of age and selected mortality indicators (maternal, fetal, perinatal, neonatal, early neonatal, and infant) in these counties, and Spearman correlation coefficients were calculated. A positive correlation was observed between median dengue incidence in women 15-39 years of age and median maternal mortality (r = 0.88; 95%CI: 0.51; 1.00), with a determination coefficient R² = 0.78. The correlation between dengue incidence in childbearing-age women and reproductive outcomes in Southeast Brazil suggests that dengue infection during pregnancy can negatively impact its outcome and increase maternal mortality.
Assuntos
Dengue/epidemiologia , Mortalidade Materna , Complicações Infecciosas na Gravidez/mortalidade , Adolescente , Adulto , Brasil/epidemiologia , Dengue/complicações , Dengue/mortalidade , Feminino , Morte Fetal/epidemiologia , Humanos , Incidência , Mortalidade Infantil , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Gravidez , Complicações Infecciosas na Gravidez/virologia , Fatores de Risco , Adulto JovemRESUMO
O objetivo desse estudo foi explorar a distribuição de efeitos reprodutivos em decorrência da infecção por dengue durante a gestação, entre 2001 e 2005. Foi realizado estudo epidemiológico com delineamento ecológico cujas unidades de análise foram municípios com mais de 80 mil habitantes na Região Sudeste do Brasil. Nestes, foi determinada a correlação entre a incidência de dengue em mulheres de 15 a 39 anos e indicadores selecionados de mortalidade (materna, fetal, perinatal, neonatal, neonatal precoce e infantil), por meio do coeficiente de correlação de Spearman. Foi observada a presença de forte correlação positiva entre as medianas das taxas de incidência de dengue em mulheres de 15 a 39 anos e as medianas da taxas de mortalidade materna (r = 0,88; IC95%: 0,51; 1,00), com coeficiente de determinação R² = 0,78. A magnitude da correlação observada entre a incidência de dengue e a mortalidade materna na Região Sudeste é sugestiva de que a ocorrência da infecção durante a gravidez possa impactar negativamente a evolução desta, com repercussões para a mortalidade materna.
The aim of this study was to explore the distribution of reproductive outcomes following dengue virus infection during pregnancy (2001-2005). An ecological epidemiological study was conducted in all counties with more than 80,000 inhabitants in Southeast Brazil. The study explored the correlation between dengue incidence rates in women 15-39 years of age and selected mortality indicators (maternal, fetal, perinatal, neonatal, early neonatal, and infant) in these counties, and Spearman correlation coefficients were calculated. A positive correlation was observed between median dengue incidence in women 15-39 years of age and median maternal mortality (r = 0.88; 95%CI: 0.51; 1.00), with a determination coefficient R² = 0.78. The correlation between dengue incidence in childbearing-age women and reproductive outcomes in Southeast Brazil suggests that dengue infection during pregnancy can negatively impact its outcome and increase maternal mortality.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Adulto Jovem , Dengue/epidemiologia , Mortalidade Materna , Complicações Infecciosas na Gravidez/mortalidade , Brasil/epidemiologia , Dengue/complicações , Dengue/mortalidade , Estudos Ecológicos , Morte Fetal/epidemiologia , Incidência , Mortalidade Infantil , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez/virologia , Fatores de RiscoRESUMO
INTRODUCTION: Alloimmunization is the main cause of fetal anemia. There are not many consistent analyses associating antenatal parameters to perinatal mortality in transfused fetuses due to maternal alloimmunization. The study aimed to determine the prognostic variables related to perinatal death. MATERIAL AND METHODS: A cohort study analyzed 128 fetuses treated with intrauterine transfusion (IUT), until the early neonatal period. Perinatal mortality was associated with prognostic conditions related to prematurity, severity of fetal anemia and IUT procedure by univariated logistic regression. Multiple logistic regression was used to compute the odds ratio (OR) for adjusting the hemoglobin deficit at the last IUT, gestational age at birth, complications of IUT, antenatal corticosteroid and hydrops. RESULTS: Perinatal mortality rate found in this study was 18.1%. The hemoglobin deficit at the last IUT (OR: 1.26, 95% CI: 1.04-1.53), gestational age at birth (OR: 0.53, 95% CI: 0.38-0.74) and the presence of transfusional complications (OR: 5.43, 95% CI: 142-20.76) were significant in predicting fetal death. CONCLUSION: Perinatal mortality prediction in transfused fetuses is not associated only to severity of anemia, but also to the risks of IUT and prematurity.
Assuntos
Incompatibilidade de Grupos Sanguíneos/mortalidade , Incompatibilidade de Grupos Sanguíneos/terapia , Transfusão de Sangue Intrauterina/mortalidade , Mortalidade Perinatal , Adulto , Incompatibilidade de Grupos Sanguíneos/diagnóstico , Transfusão de Sangue Intrauterina/efeitos adversos , Transfusão de Sangue Intrauterina/estatística & dados numéricos , Estudos de Coortes , Feminino , Morte Fetal/diagnóstico , Morte Fetal/epidemiologia , Morte Fetal/etiologia , Feto/imunologia , Idade Gestacional , Humanos , Gravidez , Prognóstico , Estudos Retrospectivos , Isoimunização Rh/diagnóstico , Isoimunização Rh/mortalidade , Isoimunização Rh/terapia , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: Pregnant patients with chronic renal insufficiency (CRI) have a high risk of perinatal complications and deterioration of renal filtration (RF). OBJECTIVE: To report perinatal complications and changes of RF according to disease severity. MATERIAL AND METHOD: Cross-sectional study including 28 pregnant patients grouped into three categories of CRI according to initial creatinine (Cr): mild CRI < 1.5, moderate CRI 1.5-2.5 and severe CRI > 2.5 mg/dL. Pre-labor vs initial perinatal complications and changes in endogenous creatinine clearance (CrCI) were reported. Descriptive statistics and Student t-test were used for statistical analyses. RESULTS: Mild CRI was found in 50%, moderate in 35.72% and severe in 14.28% of patients. Maternal complications were as follows. Mild CRI: Cesarean (35.72%), deterioration of RF (21.42%) and worsening of systemic arterial hypertension (SAH) (7.14%); moderate CRI: Cesarean (28.57%), deterioration of RF (28.57%) and worsening of SAH (14.28%); severe CRI: Cesarean (14.28%), deterioration of RF (14.28%) and anemia (14.28%). Fetal complications were as follows. Mild CRI: prematurity (25%), fetal growth restriction (FGR) (7.14%) and fetal death (7.14%), moderate CRI: prematurity (21.42%), FGR (3.57%) and no reassuring fetal status (NRFS) (3.57%), severe CRI: prematurity (14.28%), NRFS (7.14%) and respiratory insufficiency (7.14%). Mild CRI showed a reduction of endogenous CrCI (p = 0.03) not shown in other categories. CONCLUSION: An elevated frequency of complications was found, with the most serious occurring in patients with severe CRI. Deterioration of RF was found in patients with mild CRI.
Assuntos
Falência Renal Crônica/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Cesárea/estatística & dados numéricos , Comorbidade , Creatinina/sangue , Estudos Transversais , Progressão da Doença , Feminino , Morte Fetal/epidemiologia , Doenças Fetais/epidemiologia , Humanos , Hipertensão/epidemiologia , Recém-Nascido , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , México/epidemiologia , Trabalho de Parto Prematuro/epidemiologia , Gravidez , Resultado da Gravidez , Transtornos Puerperais/epidemiologia , Diálise Renal , Índice de Gravidade de Doença , Adulto JovemRESUMO
INTRODUCTION: the leading cause of fetal anemia is Rh isoimmunization. The timely diagnosis by ultrasound and intravascular transfusion improves the prognosis. OBJECTIVE: to evaluate the increase in hemoglobin in the fetus and correlate the red cell transfusion volume with elevation of hemoglobin and perinatal outcome. PATIENTS AND METHODS: prospective, case series study. We included 17 patients with fetal anemia detected by measuring the peak systolic velocity of middle cerebral artery and determination of fetal hemoglobin before and after cordocentesis. After confirmation of fetal anemia (Hb <10 g/dL), was held fetal transfusion with 50 mL/kg estimated fetal weight, with packed red blood cells type O Rh negative. RESULTS: In 17 cases fetal anemia was diagnosed, of which 11 (64%) had Rh isoimmunization and 6 (36%) were not immune. The 17 cases received 27 intravascular transfusions, in 75% hemoglobin rose to 10 g/dL, 45% in the first transfusion, 25% in the second and 10% in the third transfusion. Fetal hemoglobin between before and after transfusion was 6.5 and 12.9 g/dl, respectively (p<0.001) and allowed to continue the pregnancy from 3 to 12 weeks from the first transfusion. There were 4 deaths (2 stillbirths and 2 neonatal), but only one was related to the procedure. the survival rate was 76%, mortality in the presence of hydrops was 30% and no deaths in patients without hydrops. CONCLUSIONS: Mortality in fetal anemia was 23.6% and only one case was related to intravascular transfusion. In cases of survival to birth, pregnancy lasted >30 weeks gestation. Hemoglobin rose from 27 to 300% of the initial fetal hemoglobin. The presence of fetal hydrops significantly increases mortality.
Assuntos
Anemia Hemolítica/terapia , Transfusão de Sangue Intrauterina/estatística & dados numéricos , Doenças Fetais/terapia , Resultado da Gravidez , Isoimunização Rh , Anemia Hemolítica/epidemiologia , Anemia Hemolítica/etiologia , Velocidade do Fluxo Sanguíneo , Transfusão de Sangue Intrauterina/efeitos adversos , Transfusão de Sangue Intrauterina/métodos , Cordocentese , Eritroblastose Fetal/epidemiologia , Eritroblastose Fetal/etiologia , Feminino , Sangue Fetal/química , Morte Fetal/epidemiologia , Morte Fetal/etiologia , Doenças Fetais/sangue , Doenças Fetais/epidemiologia , Doenças Fetais/etiologia , Hemoglobinas/análise , Humanos , Hidropisia Fetal/etiologia , Hidropisia Fetal/mortalidade , Recém-Nascido , Artéria Cerebral Média , Gravidez , Estudos Prospectivos , Natimorto/epidemiologiaRESUMO
BACKGROUND: Gestational diabetes is one of the most common diseases during pregnancy. Despite this situation, there is still no consensus on methods for screening and diagnosis of this disease. OBJECTIVE: To assess perinatal outcomes of patients with gestational diabetes diagnosed using three different methods. PATIENTS AND METHODS: Clinical observational, longitudinal, randomized trial at the National Institute of Perinatology Isidro Espinosa de los Reyes. We included all patients admitted to the Institute for a period of three months without pregestational diabetes. Patients were screened for gestational diabetes with an oral load of 50 g of glucose. Patients with a positive screen were randomized by a computer program that randomly chose patients and made a curve according to the criteria of the American Diabetes Association 75 g or 100 g and another group with 75 g according to the criteria of the World Health Organization. Patients with gestational diabetes were followed throughout pregnancy until its reclassification in the puerperium. RESULTS: Screening was performed in 863 patients and 87 were diagnosed with gestational diabetes. Perinatal outcomes were similar in patients with gestational diabetes diagnosed using different methods, but there was a higher frequency of pregnancy-induced hypertension in patients diagnosed with the curves of the American Diabetes Association 75 and 100 g compared with the curve of the World Health Organization. CONCLUSIONS: The American Diabetes Association diagnostic method as the World Health Organization are acceptable forms to diagnose gestational diabetes.
Assuntos
Diabetes Gestacional/diagnóstico , Teste de Tolerância a Glucose/normas , Resultado da Gravidez , Glicemia/análise , Anormalidades Congênitas/epidemiologia , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/terapia , Feminino , Morte Fetal/epidemiologia , Macrossomia Fetal/epidemiologia , Seguimentos , Teste de Tolerância a Glucose/estatística & dados numéricos , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Programas de Rastreamento , México , Trabalho de Parto Prematuro/epidemiologia , Gravidez , Gravidez Múltipla , Estudos Prospectivos , Natimorto/epidemiologia , Estados Unidos , Instituições Filantrópicas de Saúde , Organização Mundial da SaúdeRESUMO
BACKGROUND: Auditing of sentinel health events based on best-practice protocols has been recommended. This study describes a population-based investigation on adverse perinatal events including severe acute maternal morbidity (near-miss), maternal and perinatal mortality, as a health intervention to help improve the surveillance system. METHODS: From October to December 2005, all cases of maternal death (MD), near-miss (NM), fetal deaths (FD), and early neonatal deaths (END), occurring in Campinas, Brazil, were audited by maternal mortality committees. RESULTS: A total of 4,491 liveborn infants (LB) and 159 adverse perinatal events (35.4/1000 LB) were revised, consisting of 4 MD (89/100.000 LB) and 95 NM (21.1/1000 LB), 23.7 NM for each MD. In addition, 32 FD (7.1/1000 LB) and 28 END (6.2/1000 LB) occurred. The maternal death/near miss rate was 23.7:1. Some delay in care was recognized for 34%, and hypertensive complications comprised 57.8% of the NM events, followed by postpartum hemorrhage. CONCLUSION: Auditing near miss cases expanded the understanding of the spectrum from maternal morbidity to mortality and the importance of promoting adhesion to clinical protocols among maternal mortality committee members. Hypertensive disorders and postpartum hemorrhage were identified as priority topics for health providers training, and organization of care.
Assuntos
Morte Fetal/epidemiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Feminino , Humanos , Mortalidade Infantil , Recém-Nascido , Mortalidade Materna , Auditoria Médica , Morbidade , Vigilância da População/métodos , Gravidez , Complicações na Gravidez/mortalidade , Adulto JovemRESUMO
Objetivo: Identificar los factores de riesgo sociodemográficos, obstétricos y perinatales que con más frecuencia se asocian a muerte fetal en embarazos mayores de 27 semanas. Método: De enero de 2004 a junio de 2009 en el Hospital Civil de Guadalajara, se realizó un estudio de casos y controles con 528 casos de muerte fetal de más de 27 semanas de gestación y 528 neonatos vivos cuyo nacimiento ocurrió inmediatamente después. Se comparó la frecuencia de diferentes variables maternas y fetales que en forma previa se han reportado asociadas a muerte fetal, por medio de Chi2 y prueba exacta de Fisher; se estimó la fuerza de asociación entre estas variables y muerte fetal con la razón de momios, con un intervalo de confianza del 95 por ciento. Resultados: De los factores de riesgo estudiados se asociaron con muerte fetal: edad materna mayor de 35 años, escolaridad baja, multiparidad, antecedente de aborto y de muerte fetal, atención prenatal deficiente, complicaciones en el embarazo, líquido amniótico anormal, doble circular de cordón umbilical al cuello del producto y malformaciones congénitas mayores del recién nacido. No se asoció con muerte fetal, el estado civil soltero, ser primigesta, tabaquismo, sexo masculino del feto, circular simple al cuello y macrosomía fetal. Conclusiones: De los factores de riesgo asociados con muerte fetal, resalta la atención prenatal deficiente que de ser mejorada, podría disminuir la fuerza de asociación de algunas de las otras variables que se asociaron a muerte fetal.
Objective: To identify sociodemographic, obstetric and perinatal factors most frequently associated with fetal death in pregnancies over 27 weeks. Methods: From January 2004 to June 2009 at the Civil Hospital of Guadalajara, we performed a case-control study of 528 stillbirths over 27 weeks gestation and 528 living infants whose birth occurred immediately afterwards. We compared the frequency of maternal and fetal variables that previously have been reported associated with fetal death by means of Chi2 and Fisher exact test, we estimated the strength of association between these variables and fetal death with odds ratios with a confidence level of 95 percent. Results: The studied risk factors associated with fetal death was: maternal age older than 35 years, low schooling, multiparity, history of abortion and stillbirth, poor prenatal care, pregnancy complications, abnormal amniotic fluid, circular double umbilical cord around the neck of product and major congenital malformations of the newborn. Single marital status, primiparity, smoking, male fetus, simple circular neck and fetal macrosomia, was not associated with fetal death. Conclusions: Risk factors associated with fetal death, like poor prenatal care emphasizes that, if improved, could decrease the strength of association of some of the other variables associated with fetal death.
Assuntos
Humanos , Adulto , Feminino , Gravidez , Morte Fetal/epidemiologia , Cuidado Pré-Natal , Fatores Etários , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Idade Gestacional , México , Complicações na Gravidez , Fatores de Risco , Fatores SocioeconômicosRESUMO
OBJECTIVES: Evaluation of the consequences of diabetes mellitus (DM) on maternal and fetal morbidity and mortality at Universidade Federal do Triângulo Mineiro. MATERIALS AND METHODS: A retrospective review of medical records of pregnant women with diabetes was carried out at the hospital between 1990-2009, focusing on maternal and neonatal data and complications. RESULTS: The last pregnancy of 93 diabetics was evaluated. In thirty-four patients with type 1 diabetes a higher incidence of birth trauma (p = 0.023) and retinopathy (p = 0.023) was observed. Twenty-one type 2 DM subjects required progressively increased insulin therapy (p < 0.01) and showed a higher prevalence of smoking (p = 0.004). Thirty-eight had gestational diabetes. Their diabetic follow-up started at a later gestational age (p < 0.001), had more fetal macrosomia histories (p = 0.028) and cardiovascular risk factors. CONCLUSIONS: Despite improvement of glycemic control during pregnancy neither group attained the glycemic target. However, the majority of DM pregnancies evaluated in our group presented successful outcomes.
Assuntos
Complicações do Diabetes/prevenção & controle , Diabetes Mellitus Tipo 1/mortalidade , Diabetes Mellitus Tipo 2/mortalidade , Serviços de Saúde Materna/normas , Resultado da Gravidez/epidemiologia , Gravidez em Diabéticas/mortalidade , Adulto , Brasil/epidemiologia , Complicações do Diabetes/mortalidade , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Métodos Epidemiológicos , Feminino , Morte Fetal/epidemiologia , Hospitais Universitários , Humanos , Monitorização Fisiológica/normas , Mães/estatística & dados numéricos , Mortalidade Perinatal , Gravidez , Gravidez em Diabéticas/terapiaRESUMO
BACKGROUND: The incidence of multiple pregnancies has increased on the last decade resulting in a rise of premature and underweight newborns infants, with increase of the perinatal morbidity and mortality. OBJECTIVE: To determine the impact of perinatal mortality of multiple pregnancies in the total perinatal mortality. PATIENTS AND METHOD: perinatal mortality rate of multiple pregnancies treated in the Unidad Médica de Alta Especialidad No. 23, Monterrey, Nuevo León (Mexico) were analized, from 2002 to 2008. The prevalence of multiple pregnancies, the rate of premature births, the incidence of low-birth weight products and perinatal mortality was estimated. The difference between overall mortality and multiple pregnancy rate was measured by chi2. RESULTS: Of the 144,114 births, there were 1076 (0.8%) fetal deaths and 1,617 (1.10%) neonatal deaths. There were 110 high-order fetal pregnancies (more than three fetuses): 92 triplets, 14 quadruplets, 3 quintuplets and 1 sextuplet, producing a total of 353 newborns. Multiple pregnancies represent 2.8% (59/2093) of the total perinatal mortality (p = 0.3). 79.9% (1674/2093) of the total perinatal mortality were newborns weighing less than 2500 g. In the group of multiple pregnancies, all perinatal deaths occurred in products weighing less than 2500 g. CONCLUSIONS: The perinatal mortality of multiple pregnancies does not impact significantly overall perinatal mortality.
Assuntos
Mortalidade Infantil , Gravidez Múltipla/estatística & dados numéricos , Adulto , Peso ao Nascer , Feminino , Morte Fetal/epidemiologia , Maternidades/estatística & dados numéricos , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Masculino , México , Trabalho de Parto Prematuro/epidemiologia , Gravidez , Prevalência , Estudos RetrospectivosRESUMO
BACKGROUND: Recently assisted reproduction techniques are more common, which increases multiple pregnancies and adverse perinatal outcomes. Some authors report increased mortality in multiple pregnancies products obtained by techniques of assisted reproduction vs. conceived spontaneously, although other authors found no significant difference. OBJECTIVE: To evaluate mortality rate of multiple pregnancies comparing those obtained by assisted reproduction vs. spontaneous conception. PATIENTS AND METHOD: Retrospective, observational and comparative study. We included pregnant women with 3 or more products that went to the Unidad Médica de Alta Especialidad No. 23, IMSS, in Monterrey, NL (Mexico), between 2002-2008. We compared the number of complicated pregnancies and dead products obtained by a technique of assisted reproduction vs. spontaneous. RESULTS: 68 multiple pregnancies were included. On average, spontaneously conceived fetuses had more weeks of gestation and more birth weight than those achieved by assisted reproduction techniques (p = ns). 20.5% (14/68) of multiple pregnancies had one or more fatal events: 10/40 (25%) by assisted reproduction techniques vs. 4/28 (14%) of spontaneous multiple pregnancies (p = 0.22). 21/134 (16%) of the products conceived by assisted reproduction techniques and 6/88 (7%) of spontaneous (p < 0.03) died. CONCLUSIONS: 60% of all multiple pregnancies were obtained by a technique of assisted reproduction and 21% of the cases had one or more fatal events (11% more in pregnancies achieved by assisted reproduction techniques). 12% of the products of multiple pregnancies died (9% more in those obtained by a technique of assisted reproduction).