Publications by authors named "Fernanda G Surita"

32 Publications

Self-concept and body image of people living with lupus: A systematic review.

Int J Rheum Dis 2021 Jul 27. Epub 2021 Jul 27.

Department Obstetrics and Gynecology, School of Medical Science, University of Campinas (UNICAMP), Campinas, Brazil.

Aim: To summarize existing evidence regarding body image in patients with systemic lupus erythematosus, with the following considerations: (a) the perceptions patients have of their body changes; (b) how patients cope with changes in their body; (c) and what their perceptions are of body changes.

Method: A systematic review of literature integrating quantitative and qualitative studies. We searched databases (PubMed, CINAHL, Embase, SCOPUS, the Web of Science, Medline, Medline Complete, and Academic Search Premier) and publications from 2010 to 2020 with "Systemic Lupus Erythematosus" AND "Self-Concept" OR "Body Image" AND "Woman" as medical subheading terms. The studies included were subjected to a thematic content analysis, which allowed subjective interpretation of data through a systematic classification process for coding themes or patterns.

Results: We identified 647 studies, of which 22 were analyzed in this study. Our results indicate that changes in the body image of people with lupus and their perception are issues that must be treated as characteristics of the disease; therefore, they need to receive the same attention as is given to physical disabilities and pain. The analysis identified 3 thematic categories: (a) depression and anxiety associated with body changes (hair loss, weight gain); (b) body image reflecting the disease; and (c) confrontations and interventions to promote acceptance and adaptation to the new image.

Conclusions: The dimensions of self-concept and body image are essential for assessing the quality of life of individuals with lupus. The formation of a adjusted self-concept can be managed by health professionals supporting these people.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/1756-185X.14187DOI Listing
July 2021

A neglected population: Sexual and reproductive issues among adolescent and young Venezuelan migrant women at the northwestern border of Brazil.

Int J Gynaecol Obstet 2021 Jun 23. Epub 2021 Jun 23.

Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil.

Objective: Adolescent and young women (10-24 years old) are a neglected group in humanitarian settings and their sexual and reproductive health (SRH) needs are habitually ignored. Our study aims to assess main SRH issues affecting migrant Venezuelan adolescents and young women in Boa Vista, Roraima at the northwestern border of Venezuela-Brazil.

Methods: A cross-sectional study with a self-responded questionnaire with information about SRH was conducted in 153 Venezuelan adolescent and young migrant women at Boa Vista, from January 18 to 23, 2021. A descriptive analysis was performed.

Results: Mean age was 17.7 years and two-thirds were under 20 years old. The majority (84%) were living on the streets. Most of them (54%) reported that they had at least one previous childbirth, 10% were pregnant at the time of the interview, 30% of them were not attending prenatal care. The main SRH concern was contraception (35%); however, 75% of those interviewed who went to a healthcare service were unable to obtain the method of their choice and for 91% no other contraceptive was offered.

Conclusion: Migrant Venezuelan adolescents and young women in Boa Vista have their SRH needs overlooked. Efforts to address these SRH needs, especially during the pandemic, require urgent attention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ijgo.13795DOI Listing
June 2021

Awareness towards an increasing concern during pregnancy: maternal and perinatal outcomes of women with cancer.

Am J Obstet Gynecol MFM 2020 08 2;2(3):100168. Epub 2020 Jul 2.

Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil.

Background: Increased incidence of cancer in women of childbearing age and improvements on treatment for preserving fertility have led to higher frequency of pregnancy during or after cancer treatment.

Objective: This study aimed to describe maternal and perinatal outcomes associated with cancer and pregnancy and, as a secondary analysis, to compare outcomes of women with active disease and with remission before pregnancy.

Study Design: We performed a retrospective study of women followed up at a referral center owing to a history of cancer or cancer diagnosed during pregnancy. Data on sociodemographic information, obstetrical history, types of neoplasia, treatments offered, antenatal follow-up, and maternal and perinatal outcomes were retrieved from medical chart review. A descriptive analysis was performed and a comparison among women with active and nonactive disease was performed using Student t-test and chi-square test.

Results: A total of 66 women were included in a 5-year period. The most frequent types of cancer were breast (33%), hematologic (21%), brain (11%), cervical (9%), and ovarian (5%) cancers. There were 39 participants (59%) who had active disease and 26 who received oncological treatment during pregnancy, and 23 (34.8%) had a vaginal delivery. There were 4 women who needed intensive care unit admission postpartum. A total of 18 (29.5%) deliveries were at term, most newborns (59%) with adequate weight for gestational age and only 1 had Apgar score lower than 7 in the fifth minute of life. There was 1 stillbirth. The active invasive cancer during pregnancy group showed a higher rate of preterm birth and lower birthweight with significant statistical difference (P=.03 and P<.01, respectively).

Conclusion: Breast cancer was the most frequent type of cancer in our cohort. Most deliveries were preterm, with adequate birthweight. Women with active cancer are more likely to have a preterm childbirth and newborns with lower birthweight.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajogmf.2020.100168DOI Listing
August 2020

Violence against women during pregnancy and postpartum period: a mixed methods study protocol.

BMJ Open 2020 10 21;10(10):e037522. Epub 2020 Oct 21.

Department of Obstetrics & Gynecology, State University of Campinas, Campinas, Brazil

Introduction: Violence against women is a public health problem that poses serious consequences for victims and their environments. The healthcare system struggles to assess this phenomenon during prenatal and postpartum care because of pregnant and postpartum women's potential vulnerabilities. The research protocol presents the aims to evaluate the prevalence of violence, the period(s) in which it occurs, aggressors and forms it takes as well as to explore how violence against women is perceived among pregnant and postpartum women.

Methods And Analysis: This mixed methods study protocol uses an explanatory sequential design and is based on the establishment of meta-inferences that result from the combination of quantitative and qualitative approaches. Probabilistic sampling will be used to select the study participants: 584 women attending prenatal and/or postpartum care outpatient services at the University of Campinas Women's Hospital, Brazil. The quantitative approach will consist of four validated questionnaires, and the qualitative approach will use focus groups that serve to deepen the understanding of participants' views about the study topic. To create the focus groups, 72 study participants will be invited and divided into 6 groups (3 adolescents and 3 adults) based on age and pregnancy/postpartum condition. Descriptive analysis of sociodemographic characteristics and questionnaire results will be used to identify the prevalence and forms of violence experienced by women during the pregnancy-puerperal cycle, the relationships between women and their aggressors, and the existence of a history of violence. A bivariate and multivariate analysis will be performed to identify the association between sociodemographic factors and violence as an outcome. Qualitative data will be analysed through Grounded Theory to understand women's perceptions of the phenomenon studied.

Ethics And Dissemination: The research protocol was approved by the Research Ethics Committee of the University of Campinas, Brazil number CAAE: 13426819.1.0000.5404. The results will be disseminated to the health science community.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2020-037522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7580047PMC
October 2020

Violence against women during the COVID-19 pandemic: An integrative review.

Int J Gynaecol Obstet 2020 Nov 23;151(2):180-187. Epub 2020 Sep 23.

Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.

Background: During the COVID-19 pandemic, incipient data have revealed an increase in violence against women (VAW).

Objective: To analyze the existing scientific literature on strategies and recommendations to respond to VAW during the implementation of social distancing measures in response to the COVID-19 pandemic.

Search Strategy: An integrative review was conducted based on articles published between December 2019 and June 2020. Suitable articles were identified from the PubMed, SciELO, and LILACS databases, using relevant terms.

Selection Criteria: Eligible studies included opinion and primary research articles describing the dynamics of VAW during quarantine and in the context of the restrictive measures taken during the COVID-19 pandemic and proposing recommendations to respond to this issue.

Data Collection And Analysis: Data were extracted from eligible publications and qualitative synthesis was used.

Main Results: The 38 articles included in the study showed that some factors increasing women's vulnerabilities to violence were exacerbated during the social distancing and lockdown period. Health professionals are essential for screening and responding to VAW during the pandemic.

Conclusions: Strategies must include integrated actions aiming to prevent and respond to violence during and after the COVID-19 pandemic. These must be designed based on lessons learned from previous public health emergencies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ijgo.13365DOI Listing
November 2020

Maternal and perinatal outcomes related to superimposed pre-eclampsia in a Brazilian cohort of women with chronic hypertension.

Int J Gynaecol Obstet 2020 May 4;149(2):148-153. Epub 2020 Mar 4.

Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.

Objective: To describe maternal and perinatal outcomes for women with chronic hypertension, comparing those with superimposed pre-eclampsia (SPE) with those without pre-eclampsia (NPE).

Methods: In a retrospective cohort study in a tertiary hospital in Brazil, the records of women with chronic hypertension were reviewed between January 1, 2012, and May 31, 2017, in order to compare maternal and perinatal outcomes among those with and without SPE. Poisson regression was performed to investigate factors independently associated with severe pre-eclampsia.

Results: Of 385 women with chronic hypertension included in the study, 167 were in the SPE group and 218 in the NPE group. The majority were white, overweight (body mass index ≥30 kg/m ), with mean age around 31 years. Adverse neonatal outcomes were significantly more prevalent among women with SPE, including small for gestational age (SPE 17.46% vs NPE 9.63%, P=0.01), low birth weight (SPE 2577 g ± 938 vs NPE 3128 g ± 723, P=0.003), neonatal intensive care unit admission (SPE 44.91% vs NPE 18.34%, P=0.08), and incidence of cesarean delivery (SPE 79.64% vs NPE 62.38%, P=0.003). Fetal growth restriction (PR [prevalence ratio] 2.62, 95% confidence interval [CI] 1.39-4.94) and previous pre-eclampsia (PR 1.96, 95% CI 1.17-3.28) were associated with severe pre-eclampsia.

Conclusion: SPE is associated with prematurity and higher rates of admission to neonatal intensive care unit. Fetal growth restriction and previous pre-eclampsia are factors associated with severe complications of pre-eclampsia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ijgo.13114DOI Listing
May 2020

Maternal and perinatal outcomes and factors associated with twin pregnancies among preterm births: Evidence from the Brazilian Multicenter Study on Preterm Birth (EMIP).

Int J Gynaecol Obstet 2020 May 2;149(2):184-191. Epub 2020 Mar 2.

Department of Obstetrics and Gynecology, Jundiai Medical School, Jundiaí, Brazil.

Objective: To compare maternal and perinatal outcomes between twin and single preterm births (PTB) and associated factors.

Methods: A cross-sectional multicenter study was conducted in Brazil with 4046 PTBs from April 2011 to July 2012. Causes of PTB, use of tocolytics, corticosteroids, and antibiotics in twin and single pregnancies, and factors possibly associated with twinning were evaluated using χ tests. Maternal and perinatal outcomes were assessed with prevalence ratios (PR).

Results: The main cause of PTB in twin pregnancy was spontaneous onset of preterm labor. Tocolytics were more frequently used in twins (26.9% vs 20.2%). Factors associated with PTB in twins were: maternal age >25 years (62.3% vs 53.4%); interpregnancy interval >3 years (39.0% vs 33.4%); no history of PTB (87.4% vs 79.6%); no previous maternal conditions (78.0% vs 73.3%); no alcohol abuse (88.5% vs 84.3%); no drug addiction (97.5% vs 94.5%); and >6 prenatal visits (46.5% vs 37.6%). Twin pregnancies run a 46% higher risk of cesarean delivery, while first and second twins face a 20% higher risk of low birth weight. Twin pregnancies run increased risks for admission to the NICU, cerebral hemorrhage, necrotizing enterocolitis, and any adverse perinatal outcome.

Conclusion: Preterm twin birth is associated with low birth weight and worse neonatal outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ijgo.13107DOI Listing
May 2020

Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials.

BMC Pregnancy Childbirth 2019 Sep 2;19(1):322. Epub 2019 Sep 2.

Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Background: High Body Mass Index (BMI) and gestational weight gain (GWG) affect an increasing number of pregnancies. The Institute of Medicine (IOM) has issued recommendations on the optimal GWG for women according to their pre-pregnancy BMI (healthy, overweight or obese). It has been shown that pregnant women rarely met the recommendations; however, it is unclear by how much. Previous studies also adjusted the analyses for various women's characteristics making their comparison challenging.

Methods: We analysed individual participant data (IPD) of healthy women with a singleton pregnancy and a BMI of 18.5 kg/m or more from the control arms of 36 randomised trials (16 countries). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to describe the association between GWG outside (above or below) the IOM recommendations (2009) and risks of caesarean section, preterm birth, and large or small for gestational age (LGA or SGA) infants. The association was examined overall, within the BMI categories and by quartile of GWG departure from the IOM recommendations. We obtained aOR using mixed-effects logistic regression, accounting for the within-study clustering and a priori identified characteristics.

Results: Out of 4429 women (from 33 trials) meeting the inclusion criteria, two thirds gained weight outside the IOM recommendations (1646 above; 1291 below). The median GWG outside the IOM recommendations was 3.1 kg above and 2.7 kg below. In comparison to GWG within the IOM recommendations, GWG above was associated with increased odds of caesarean section (aOR 1.50; 95%CI 1.25, 1.80), LGA (2.00; 1.58, 2.54), and reduced odds of SGA (0.66; 0.50, 0.87); no significant effect on preterm birth was detected. The relationship between GWG below the IOM recommendation and caesarean section or LGA was inconclusive; however, the odds of preterm birth (1.94; 1.31, 2.28) and SGA (1.52; 1.18, 1.96) were increased.

Conclusions: Consistently with previous findings, adherence to the IOM recommendations seem to help achieve better pregnancy outcomes. Nevertheless, even in the context of clinical trials, women find it difficult to adhere to them. Further research should focus on identifying ways of achieving a healthier GWG as defined by the IOM recommendations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12884-019-2472-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719382PMC
September 2019

The role of the respectful maternity care model in São Paulo, Brazil: A cross-sectional study.

Birth 2019 09;46(3):509-516

Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.

Introduction: The promotion of a positive birth experience has been a main goal of the World Health Organization's (WHO) recent work on improving maternity care. The purpose of this study was to assess the cesarean rates, the prevalence of birth practices, perinatal outcomes, and maternal satisfaction, in women involved with the respectful maternity care (RMC) support groups in Sao Paulo, Brazil.

Methods: This was a cross-sectional study of women with low-risk pregnancies who were assisted by professionals recommended by the RMC groups. An online questionnaire was administered. Variables to assess birth practices were classified as positive, negative, or unspecified according to the WHO guidelines. The Pearson chi-square tests and odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were computed to assess differences between the groups.

Results: Five-hundred and eighty women completed the questionnaire. The cesarean rate was 14.7%, and the operative vaginal birth rate was 9.5%. The VBAC rate was 87.1%, and there was no significant difference in risk for cesarean between women with or without a prior cesarean. Of all women, 83.1% had a midwife's assistance and 75.5% hired a doula; 81.4% gave birth in a nonlithotomic position. The practices of enema, fasting and episiotomy were all under 2%. All 5-minute Apgar scores were ≥7. Most (83.1%) women reported having a positive birth experience.

Conclusions: Woman's engagement with the birth support groups and a transdisciplinary team focused on RMC are key elements to achieve positive perinatal outcomes and high women's satisfaction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/birt.12448DOI Listing
September 2019

Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis.

BMJ Open 2019 08 1;9(8):e025620. Epub 2019 Aug 1.

Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy.

Objectives: To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment.

Design: Individual participant data meta-analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed.

Data Sources: Major electronic databases, from inception to February 2017.

Eligibility Criteria: Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education (≥tertiary) or lower education (≤secondary).

Risk Of Bias: Cochrane risk of bias tool was used.

Data Synthesis: Principle measures of effect were OR and regression coefficient.

Results: Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B -0.055; 95% CI -0.098 to -0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B -0.053; 95% CI -0.069 to -0.037,p<0.001). Physical activity based interventions did not impact GWG when stratified by education.

Conclusions: Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2018-025620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688690PMC
August 2019

Twin Pregnancy in Brazil: A Profile Analysis Exploring Population Information from the National Birth E-Registry on Live Births.

Biomed Res Int 2018 1;2018:9189648. Epub 2018 Nov 1.

Department of Obstetrics and Gynecology, University of Campinas School of Medicine, 101 Alexander Fleming Street, 13083-891 Campinas, Brazil.

Birth records as SINASC (Brazilian Live Birth Information System) are highlighted in uncommon conditions such as twin pregnancy whose prevalence rarely exceeds 2 to 3% of the total number of births. The objective of this study was to assess the prevalence of twin pregnancies in Brazil and their maternal and perinatal characteristics using data from the national birth e-Registry. All births in Brazil from 2011 to 2014 were assessed. Prevalence of twin pregnancies per region was assessed and correlated with the Human Development Index (HDI). Sociodemographic and obstetric factors and main perinatal outcomes were assessed for the first and second twin, in comparison to singletons, and the second twin compared to the first twin, with PR and 95%CI. A multiple logistic regression analysis was conducted to identify factors independently associated with a low 5-minute Apgar score in twin pregnancies. Twin pregnancy occurred in 1.13% in Brazil, with a higher prevalence in regions with a higher HDI. It was associated with a complete higher level of education (22.9% versus 16.3% for singles) and maternal age > 35 years (17.5% versus 11.4% for singles). Preterm birth <32 weeks (prevalence ratio-PR 12.13 [11.93 - 12.33]), low birth weight (PR 17.8 [17.6-18.0] for the first and PR 20.1 [19.8-20.3] for the second twin), and low Apgar score (PR 2.9 [2.8-3.0] for the first and PR 2.7 [2.6-2.8] for the second twin) were the most important perinatal outcomes associated with twin pregnancies. A 5-minute Apgar score < 7 among twins was associated with inadequate prenatal care, extreme preterm birth, vaginal delivery, intrapartum cesarean, and combined delivery. Twin pregnancy in Brazil is associated with worse perinatal outcomes, especially for the second twin.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2018/9189648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236661PMC
March 2019

Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health.

BMC Pregnancy Childbirth 2018 Nov 20;18(1):449. Epub 2018 Nov 20.

Department of Obstetrics and Gynecology, University of Campinas, Alexander Fleming Street, 101, Campinas, SP, 13083-891, Brazil.

Background: Twin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes, especially for the second twin. In addition, the maternal complications (potentially life-threatening conditions-PLTC, maternal near miss-MNM, and maternal mortality-MM) are directly related to twin pregnancy and independently associated with adverse perinatal outcome. The objective of the preset study is to evaluate perinatal outcomes associated with twin pregnancies, stratified by severe maternal morbidity and order of birth.

Methods: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), a cross-sectional study implemented in 29 countries. Data from 8568 twin deliveries were compared with 308,127 singleton deliveries. The occurrence of adverse perinatal outcomes and maternal complications were assessed. Factors independently associated with adverse perinatal outcomes were reported with adjusted PR (Prevalence Ratio) and 95%CI.

Results: The occurrence of severe maternal morbidity and maternal death was significantly higher among twin compared to singleton pregnancies in all regions. Twin deliveries were associated with higher rates of preterm delivery (37.1%), Apgar scores less than 7 at 5th minute (7.8 and 10.1% respectively for first and second twins), low birth weight (53.2% for the first and 61.1% for the second twin), stillbirth (3.6% for the first and 5.7% for the second twin), early neonatal death (3.5% for the first and 5.2% for the second twin), admission to NICU (23.6% for the first and 29.3% for the second twin) and any adverse perinatal outcomes (67% for the first twin and 72.3% for the second). Outcomes were consistently worse for the second twin across all outcomes. Poisson multiple regression analysis identified several factors independently associated with an adverse perinatal outcome, including both maternal complications and twin pregnancy.

Conclusion: Twin pregnancy is significantly associated with severe maternal morbidity and with worse perinatal outcomes, especially for the second twin.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12884-018-2082-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245698PMC
November 2018

Pharmacist interventions in high-risk obstetric inpatient unit: a medication safety issue.

Int J Qual Health Care 2018 Aug;30(7):530-536

Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Alexander Fleming, 101, Campinas, SP, Brazil.

Objectives: The aim of this study was to report number, type and severity of prescribing errors and pharmacist interventions in high-risk pregnant and postpartum women.

Design: A prospective cross-sectional, observational study.

Setting: A high-risk obstetric inpatient unit of a Women's Hospital in Brazil.

Participants: About 1826 electronic prescriptions for 549 women in the high-risk obstetrics inpatient unit were included.

Interventions: When the pharmacist detected potential prescribing errors, interventions were suggested.

Main Outcome Measures: Prescriptions were evaluated by clinical pharmacist to identify the type, frequency and severity of prescribing errors and rate of clinical pharmacist intervention acceptance in a high-risk obstetric inpatient.

Results: A total of 1826 prescriptions were reviewed with 128 errors (7.0%). The most frequent errors were drug interaction (43.8%), incorrect frequency (21.5%) and improper dose (13.1%). One-hundred and sixty-eight interventions were made by pharmacists, 98.8% of which were accepted by prescribers. Higher maternal age (OR 1.0 (95%CI 1.0-1.1)), higher number of prescribed medications (OR 1.2 (95%CI 1.1-1.3)), obstetric conditions (OR 2.2 (95%CI 1.4-3.3)) and non-breastfeeding postpartum women (OR 3.9 (95% CI 2.5-6.1)) were the independent factors associated with prescribing errors identified through multivariate analysis.

Conclusions: The most common prescription errors related to drug interactions, incorrect frequency and higher number of prescribed medications. The rate of pharmacist acceptance intervention was high.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/intqhc/mzy054DOI Listing
August 2018

The impact of proteinuria on maternal and perinatal outcomes among women with pre-eclampsia.

Int J Gynaecol Obstet 2018 Oct 11;143(1):101-107. Epub 2018 Apr 11.

Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.

Objective: To assess the impact of proteinuria on pregnancy outcomes among women with pre-eclampsia.

Methods: The present retrospective cohort study included patients with pre-eclampsia who delivered at a referral maternity hospital in Brazil between January 1, 2009, and December 31, 2013. Patients were stratified into three groups based on 24-hour urinary protein excretion during pregnancy: mild (0.3-<2.0 g), severe (2.0-<5.0 g), and massive (≥5.0 g).

Results: There were 293 patients included in the study; 88, 129, and 76 had mild, severe, and massive proteinuria, respectively. Chronic hypertension was the most frequent pre-existing condition among all women (86 [29.4%]). The mean pregnancy duration at the onset of maternal pre-eclampsia was longest in the mild group compared and decreased with increasing proteinuria severity (P<0.001). Preterm delivery was recorded among 205 of 293 (70.0%) neonates; there were 66 (22.5%) neonates that were preterm and in the massive proteinuria group. The incidence of severe pre-eclampsia was lowest in the mild proteinuria group (P=0.002) and tended to occur at 34 weeks. Cesarean delivery rates exceeded 80.0% in all groups. Most patients assessed at 40-60 days postpartum remained proteinuric (40/61[66%]).

Conclusions: Quantifying the severity of proteinuria could identify a subgroup of women with pre-eclampsia at increased risk of adverse outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ijgo.12487DOI Listing
October 2018

Severe maternal morbidity and perinatal outcomes of multiple pregnancy in the Brazilian Network for the Surveillance of Severe Maternal Morbidity.

Int J Gynaecol Obstet 2017 Nov 14;139(2):230-238. Epub 2017 Aug 14.

Unit of Statistics, Jundiaí Medical School, Jundiaí, Brazil.

Objective: To compare severe maternal complications (potentially life-threatening conditions [PLTCs], maternal near miss [MNM], and maternal death) and perinatal outcomes between multiple and singleton pregnancies.

Methods: A secondary analysis was undertaken using data from the Brazilian Network for Surveillance of Severe Maternal Morbidity (prospective surveillance of morbidities in 27 Brazilian obstetric units between July 2009 and June 2010). Health indicators and criteria used for PLTCs and MNM were assessed. Adjusted prevalence ratios (PR ) with 95% confidence intervals (CIs) were calculated for perinatal outcomes.

Results: Among 267 multiple pregnancies, 235 (88.0%) were affected by PLTCs, 25 (9.4%) by MNM, and 7 (2.6%) by maternal death; these prevalences did not differ from singleton pregnancies (n=7986). Management criteria for MNM were used almost twice as much in multiple pregnancies (PR 1.85, 95% CI 1.41-2.42). Preterm birth (PR 1.62, 95% CI 1.41-1.86), low birthweight (PR 1.73, 95% CI 1.45-2.06 for the first-born vs singleton), any adverse perinatal outcome (PR 1.12, 95% CI 1.03-1.22 for the second- vs first-born), and neonatal near miss (PR 1.37, 95% CI 1.13-1.67 for the second-born vs singleton) were significantly associated with multiple pregnancy.

Conclusion: Among cases of severe maternal morbidity, perinatal but not maternal outcomes were poorer for multiple pregnancies than for singletons. Differentiated care is needed during pregnancy and childbirth.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ijgo.12287DOI Listing
November 2017

Abnormal expression of inflammatory genes in placentas of women with sickle cell anemia and sickle hemoglobin C disease.

Ann Hematol 2016 Oct 22;95(11):1859-67. Epub 2016 Aug 22.

Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas - UNICAMP, Campinas, SP, Brazil.

Sickle cell disease (SCD) is a complex disease that is characterized by the polymerization of deoxyhemoglobin S, altered red blood cell membrane biology, endothelial activation, hemolysis, a procoagulant state, acute and chronic inflammation, and vaso-occlusion. Among the physiological changes that occur during pregnancy, oxygen is consumed by fetal growth, and pregnant women with SCD are more frequently exposed to low oxygen levels. This might lead to red blood cells sickling, and, consequently, to vaso-occlusion. The mechanisms by which SCD affects placental physiology are largely unknown, and chronic inflammation might be involved in this process. This study aimed to evaluate the gene expression profile of inflammatory response mediators in the placentas of pregnant women with sickle cell cell anemia (HbSS) and hemoglobinopathy SC (HbSC). Our results show differences in a number of these genes. For the HbSS group, when compared to the control group, the following genes showed differential expression: IL1RAP (2.76-fold), BCL6 (4.49-fold), CXCL10 (-2.12-fold), CXCR1 (-3.66-fold), and C3 (-2.0-fold). On the other hand, the HbSC group presented differential expressions of the following genes, when compared to the control group: IL1RAP (4.33-fold), CXCL1 (3.05-fold), BCL6 (4.13-fold), CXCL10 (-3.32-fold), C3 (-2.0-fold), and TLR3 (2.38-fold). Taken together, these data strongly suggest a differential expression of several inflammatory genes in both SCD (HbSS and HbSC), indicating that the placenta might become an environment with hypoxia, and increased inflammation, which could lead to improper placental development.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00277-016-2780-1DOI Listing
October 2016

Moderate Exercise Attenuates Lipopolysaccharide-Induced Inflammation and Associated Maternal and Fetal Morbidities in Pregnant Rats.

PLoS One 2016 28;11(4):e0154405. Epub 2016 Apr 28.

Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.

Fetal growth restriction (FGR) and coagulopathies are often associated with aberrant maternal inflammation. Moderate-intensity exercise during pregnancy has been shown to increase utero-placental blood flow and to enhance fetal nutrition as well as fetal and placental growth. Furthermore, exercise is known to reduce inflammation. To evaluate the effect of moderate-intensity exercise on inflammation associated with the development of maternal coagulopathies and FGR, Wistar rats were subjected to an exercise regime before and during pregnancy. To model inflammation-induced FGR, pregnant rats were administered daily intraperitoneal injections of E. coli lipopolysaccharide (LPS) on gestational days (GD) 13.5-16.5 and sacrificed at GD 17.5. Control rats were injected with saline. Maternal hemostasis was assessed by thromboelastography. Moderate-intensity exercise prevented LPS-mediated increases in white blood cell counts measured on GD 17.5 and improved maternal hemostasis profiles. Importantly, our data reveal that exercise prevented LPS-induced FGR. Moderate-intensity exercise initiated before and maintained during pregnancy may decrease the severity of maternal and perinatal complications associated with abnormal maternal inflammation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0154405PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4849647PMC
March 2017

Twin Pregnancy and Severe Maternal Outcomes: The World Health Organization Multicountry Survey on Maternal and Newborn Health.

Obstet Gynecol 2016 Apr;127(4):631-641

Department of Obstetrics and Gynecology, University of Campinas, Campinas, and the Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil; Pakistan Institute of Medical Sciences, Islamabad, Pakistan; the Maternal & Child Morbidity & Mortality Surveillance Unit, Family Health Bureau, Ministry of Health, Colombo, Sri Lanka; the Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya; and the Department of Reproductive Health Research from the World Health Organization, Geneva, Switzerland.

Objective: To evaluate maternal complications (potentially life-threatening conditions, maternal near miss, and maternal death) that are mutually exclusive and severe maternal outcomes (maternal near miss or maternal death) associated with twin pregnancies.

Methods: We performed a secondary analysis of a cross-sectional World Health Organization Multicountry Survey, which was implemented in 29 countries. Data from 4,756 twin deliveries were compared with 308,111 singleton deliveries. Factors associated with maternal morbidity and twin pregnancies were reported with adjusted prevalence ratio (95% confidence interval).

Results: Potentially life-threatening conditions, maternal near miss, severe maternal outcomes, and maternal deaths were 2.14 (1.99-2.30), 3.03 (2.39-3.85), 3.19 (2.58-3.94), and 3.97 (2.47-6.38) times higher, respectively, among twin pregnancies. Maternal age older than 20 years, having a partner, multiparity, and elective cesarean delivery were associated with twin pregnancies. Postpartum hemorrhage and chronic hypertension were more frequently associated with severe maternal outcomes among twin pregnancies. Conditions indicating organ dysfunction (maternal near miss) were twofold to fivefold higher for twins. Poisson multiple regression analysis identified several factors independently associated with a severe maternal outcome, but not twin pregnancies.

Conclusion: Twin pregnancy is associated with greater severe maternal morbidity and a higher rate of maternal death than singleton pregnancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/AOG.0000000000001338DOI Listing
April 2016

Association of Nitric Oxide Synthase and Matrix Metalloprotease Single Nucleotide Polymorphisms with Preeclampsia and Its Complications.

PLoS One 2015 28;10(8):e0136693. Epub 2015 Aug 28.

Department of Obstetrics and Gynaecology, School of Medicine, University of Campinas-UNICAMP, Campinas, São Paulo, Brazil.

Background: Preeclampsia is one of the leading causes of maternal and neonatal morbidity and mortality in the world, but its appearance is still unpredictable and its pathophysiology has not been entirely elucidated. Genetic studies have associated single nucleotide polymorphisms in genes encoding nitric oxide synthase and matrix metalloproteases with preeclampsia, but the results are largely inconclusive across different populations.

Objectives: To investigate the association of single nucleotide polymorphisms (SNPs) in NOS3 (G894T, T-786C, and a variable number of tandem repetitions VNTR in intron 4), MMP2 (C-1306T), and MMP9 (C-1562T) genes with preeclampsia in patients from Southeastern Brazil.

Methods: This prospective case-control study enrolled 77 women with preeclampsia and 266 control pregnant women. Clinical data were collected to assess risk factors and the presence of severe complications, such as eclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.

Results: We found a significant association between the single nucleotide polymorphism NOS3 T-786C and preeclampsia, independently from age, height, weight, or the other SNPs studied, and no association was found with the other polymorphisms. Age and history of preeclampsia were also identified as risk factors. The presence of at least one polymorphic allele for NOS3 T-786C was also associated with the occurrence of eclampsia or HELLP syndrome among preeclamptic women.

Conclusions: Our data support that the NOS3 T-786C SNP is associated with preeclampsia and the severity of its complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136693PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552660PMC
May 2016

Longitudinal reference intervals for Doppler velocimetric parameters of the fetal renal artery correlated with amniotic fluid index among low-risk pregnancies.

Int J Gynaecol Obstet 2015 Oct 7;131(1):45-8. Epub 2015 Jul 7.

Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil. Electronic address:

Objective: To establish longitudinal reference intervals for pulsatility index (PI) and systolic velocity (SV) of the fetal renal artery, and to evaluate their correlation with the amniotic fluid index (AFI).

Methods: A prospective longitudinal study was conducted among women with low-risk pregnancies who attended outpatient clinics at the University of Campinas Medical School, Brazil, at 16-19 weeks of pregnancy between April 1, 2008, and March 31, 2010. Doppler velocimetric measurements of the fetal renal artery and assessments of the AFI were undertaken at 4-week intervals to 36 weeks, and every 2 weeks thereafter until delivery.

Results: A total of 63 women were enrolled. The PI of the fetal renal artery showed little variation during pregnancy, whereas SV values increased to 36-37 weeks of pregnancy and decreased thereafter. No correlations were found between the AFI and the fetal renal artery Doppler velocimetric parameters (P>0.05 for all). The intraclass correlation coefficients for intra-observer and inter-observer variability indicated good reproducibility of SV, but the reproducibility of PI was lower.

Conclusions: The AFI did not correlate with fetal renal artery Doppler velocimetric measures among low-risk pregnancies. However, investigations are needed among high-risk pregnancies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijgo.2015.05.010DOI Listing
October 2015

EXPERIENCE WITH THE BRAZILIAN NETWORK FOR STUDIES IN REPRODUCTIVE AND PERINATAL HEALTH: THE POWER OF COLLABORATION IN POSTGRADUATE PROGRAMS.

Rev Col Bras Cir 2015 ;42 Suppl 1:89-93

Postgraduate Program in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medical Sciences, Campinas State University, Campinas, SP, Brazil.

The scientific collaboration in networks may be developed among countries, academic institutions and among peer researchers. Once established, they contribute for knowledge dissemination and a strong structure for research in health. Several advantages are attributed to working in networks: the inclusion of a higher number of subjects in the studies; generation of stronger evidence with a higher representativeness of the population (secondary generalization and external validity); higher likelihood of articles derived from these studies to be accepted in high impact journals with a wide coverage; a higher likelihood of obtaining budgets for sponsorship; easier data collection on rare conditions; inclusions of subjects from different ethnic groups and cultures, among others. In Brazil, the Brazilian Network for Studies on Reproductive and Perinatal Health was created in 2008 with the initial purpose of developing a national network of scientific cooperation for the surveillance of severe maternal morbidity. Since the establishment of this Network, five studies were developed, some of them already finished and others almost being completed, and two new ones being implemented. Results of the activities in this Network have been very productive and with a positive impact on not only the Postgraduate Program of Obstetrics and Gynecology from the University of Campinas, its coordinating center, but also on other participating centers. A considerable number of scientific articles was published, master´s dissertations and PhD theses were presented, and post-doctorate programs were performed, including students from several areas of health, from distinct regions and from several institutions of the whole country. This represents a high social impact taking into account the relevance of the studied topics for the country. As colaborações científicas em rede podem ocorrer entre países, instituições acadêmicas e entre pares de pesquisadores e, uma vez estabelecidas, contribuem para a disseminação do conhecimento e estruturação da pesquisa em saúde. Diversas vantagens são atribuídas ao trabalho em rede como: a inclusão de maior número de participantes nos estudos; gerar evidências mais fortes e com maior representatividade da população (generalização secundária e validade externa); maior facilidade das publicações oriundas dos estudos serem aceitas em periódicos de impacto e abrangência; maior probabilidade de obtenção de verbas para financiamento; maior facilidade na coleta de dados sobre condições raras; inclusão de participantes de diferentes grupos étnicos e culturas, entre outras. No Brasil a Rede Brasileira de Estudos em Saúde Reprodutiva e Perinatal foi criada em 2008 com o objetivo inicial de desenvolver rede nacional de cooperação científica para vigilância da morbidade materna grave. Desde sua formação, cinco estudos foram desenvolvidos, alguns já encerrados e outros em fase de finalização, com outros dois em fase final de implantação. Os resultados das atividades desta Rede têm sido bastante produtivos e impactaram positivamente não apenas no Programa de Pós-Graduação em Tocoginecologia da Universidade Estadual de Campinas, seu centro coordenador, mas também o de outros centros participantes, uma vez que expressivo número de artigos científicos foi publicado, mestrados e doutorados foram defendidos e pós-doutorados finalizados, de alunos de diversas áreas da saúde, de diferentes regiões e de várias instituições de todo o país, com alto impacto social dada a relevância dos temas estudados para o país.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/0100-69912015S01027DOI Listing
October 2017

STRATEGIES IN SEARCHING HOMOGENEITY IN A FACULTY OF A POSTGRADUATE PROGRAM.

Rev Col Bras Cir 2015 ;42 Suppl 1:83-6

Postgraduate Program in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.

The professor plays a fundamental role in a graduate program, considering he/she is who plans and performs a great part of the tasks, and he/she is also responsible for spreading knowledge among students. The professor should use didactical resources for his/her continuous qualification, being responsible for situations favoring the development of students who should learn according to the best and easier way. The homogeneity in the postgraduate program consists of having subgroups of research corresponding to the Areas of Concentration, where each subgroup works with some distinct topics of research. It is desirable that the staff of postgraduate program has a significant and high quality scientific production, homogeneously distributed among them. The professors must systematically search for resources for research in agencies supporting research, not only for sponsoring the studies, but also for adding value to the researchers involved in the whole activities. The postgraduate programs need to support the professional qualification of their staff who should improve their knowledge on epidemiology for clinical studies, ethics in research and teaching skills. Two characteristics of the postgraduate system in Brazil are the nucleation and solidarity, based on the capacity and/or interest of those more structured programs to help those beginners, cooperating with their activities. The Capes (the national governmental agency responsible for coordinating and evaluating all postgraduate programs in Brazil) valorizes the social insertion in the context of postgraduate programs´ activities. It includes the recognition of activities with technological, cultural, educational and social impact as criteria for evaluation of the programs. Does exist an ideal model of postgraduate program? We think that there is no a mathematical formulae nor an ideal model for a postgraduate program. Each institution should make adaptations and search for improvements of their faculty and students´ teams. O docente tem importância fundamental no programa de pós-graduação, pois é quem planeja e executa grande parte das tarefas, sendo também o responsável por difundir conhecimentos aos alunos. O professor deve utilizar recursos didáticos que o qualifiquem continuamente, criando condições favoráveis para que o aluno se desenvolva e aprenda da melhor maneira e com mais facilidade. A homogeneidade no grupo de pós-graduação consiste da presença de subgrupos de pesquisa correspondentes às Áreas de Concentração, onde cada subgrupo trabalhe com algumas linhas de pesquisas diversificadas. É desejável que o corpo docente tenha significativa produção científica, de qualidade e distribuída homogeneamente entre os docentes. Estes devem sistematicamente buscar recursos em agências de fomento para pesquisa, tanto para o custeio dos estudos, quanto para a valorização dos pesquisadores envolvidos em todas as atividades. Os programas de pós-graduação precisam investir na formação de seus docentes, os quais devem aprimorar seus conhecimentos em epidemiologia de estudos clínicos, ética em pesquisa e em didática. Duas das características do sistema de pós-graduação no Brasil são a nucleação e a solidariedade, embasadas na capacidade e/ou interesse dos mais estruturados se solidarizarem com os programas iniciantes, cooperando com as suas atividades. A Capes valoriza a inserção social no contexto das atividades dos programas de pós-graduação, prevendo nos critérios de avaliação o reconhecimento de atividades com impacto tecnológico, cultural, educacional e social. Existe um modelo ideal de pós-graduação? Partimos do pressuposto de que não há uma fórmula matemática ou modelo ideal de pós-graduação e sim que cada instituição deve se adequar e buscar aperfeiçoar seu corpo docente e discente.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/0100-69912015S01009DOI Listing
October 2017

Severe maternal morbidity and near miss due to postpartum hemorrhage in a national multicenter surveillance study.

Int J Gynaecol Obstet 2015 Feb 6;128(2):131-6. Epub 2014 Nov 6.

Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.

Objective: To assess the occurrence of severe maternal complications owing to postpartum hemorrhage (PPH) and its associated factors.

Methods: A secondary analysis of data from a multicenter cross-sectional prospective surveillance study included 9555 cases of severe maternal morbidity at 27 centers in Brazil between July 2009 and June 2010. Complications of PPH, conditions of severity management, and sociodemographic and obstetric characteristics were assessed. Factors independently associated with severe maternal outcome (SMO) were identified using multiple regression analysis.

Results: Overall, 1192 (12.5%) of the 9555 women experienced complications owing to PPH (981 had potentially life-threatening conditions, 181 maternal near miss, and 30 had died). The SMO ratio was 2.6 per 1000 live births among women with PPH and 8.5 per 1000 live births among women with other complications. Women with PPH had a higher risk of blood transfusion and return to the operating theater than did those with complications from other causes. Maternal age, length of pregnancy, previous uterine scar, and cesarean delivery were the main factors associated with an increased risk of SMO secondary to PPH.

Conclusion: PPH frequently leads to severe maternal morbidity. A surveillance system can identify the main causes of morbidity and could help to improve care, especially among women identified as being at high risk of PPH.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijgo.2014.08.023DOI Listing
February 2015

Contribution of antepartum and intrapartum hemorrhage to the burden of maternal near miss and death in a national surveillance study.

Acta Obstet Gynecol Scand 2015 Jan 11;94(1):50-8. Epub 2014 Nov 11.

Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), School of Medicine, Campinas, SP, Brazil.

Objective: To evaluate the occurrence of severe obstetric complications associated with antepartum and intrapartum hemorrhage among women from the Brazilian Network for Surveillance of Severe Maternal Morbidity.

Design: Multicenter cross-sectional study.

Setting: Twenty-seven obstetric referral units in Brazil between July 2009 and June 2010.

Population: A total of 9555 women categorized as having obstetric complications.

Methods: The occurrence of potentially life-threatening conditions, maternal near miss and maternal deaths associated with antepartum and intrapartum hemorrhage was evaluated. Sociodemographic and obstetric characteristics and the use of criteria for management of severe bleeding were also assessed in these women.

Main Outcome Measures: The prevalence ratios with their respective 95% confidence intervals adjusted for the cluster effect of the design, and multiple logistic regression analysis were performed to identify factors independently associated with the occurrence of severe maternal outcome.

Results: Antepartum and intrapartum hemorrhage occurred in only 8% (767) of women experiencing any type of obstetric complication. However, it was responsible for 18.2% (140) of maternal near miss and 10% (14) of maternal death cases. On multivariate analysis, maternal age and previous cesarean section were shown to be independently associated with an increased risk of severe maternal outcome (near miss or death).

Conclusion: Severe maternal outcome due to antepartum and intrapartum hemorrhage was highly prevalent among Brazilian women. Certain risk factors, maternal age and previous cesarean delivery in particular, were associated with the occurrence of bleeding.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/aogs.12529DOI Listing
January 2015

The burden of eclampsia: results from a multicenter study on surveillance of severe maternal morbidity in Brazil.

PLoS One 2014 13;9(5):e97401. Epub 2014 May 13.

Center for Studies on Reproductive Health of Campinas (CEMICAMP), Campinas, São Paulo, Brazil.

Objective: Maternal mortality (MM) is a core indicator of disparities in women's rights. The study of Near Miss cases is strategic to identifying the breakdowns in obstetrical care. In absolute numbers, both MM and occurrence of eclampsia are rare events. We aim to assess the obstetric care indicators and main predictors for severe maternal outcome from eclampsia (SMO: maternal death plus maternal near miss).

Methods: Secondary analysis of a multicenter, cross-sectional study, including 27 centers from all geographic regions of Brazil, from 2009 to 2010. 426 cases of eclampsia were identified and classified according to the outcomes: SMO and non-SMO. We classified facilities as coming from low- and high-income regions and calculated the WHO's obstetric health indicators. SPSS and Stata softwares were used to calculate the prevalence ratios (PR) and respective 95% confidence interval (CI) to assess maternal characteristics, clinical and obstetrical history, and access to health services as predictors for SMO, subsequently correlating them with the corresponding perinatal outcomes, also applying multiple regression analysis (adjusted for cluster effect).

Results: Prevalence of and mortality indexes for eclampsia in higher and lower income regions were 0.2%/0.8% and 8.1%/22%, respectively. Difficulties in access to health care showed that ICU admission (adjPR 3.61; 95% CI 1.77-7.35) and inadequate monitoring (adjPR 2.31; 95% CI 1.48-3.59) were associated with SMO.

Conclusions: Morbidity and mortality associated with eclampsia were high in Brazil, especially in lower income regions. Promoting quality maternal health care and improving the availability of obstetric emergency care are essential actions to relieve the burden of eclampsia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0097401PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4019598PMC
June 2015

Physical exercise during pregnancy: a systematic review.

Curr Opin Obstet Gynecol 2012 Dec;24(6):387-94

Obstetric Unit, Department of Obstetrics and Gynecology, University of Campinas, Campinas, Sao Paulo, Brazil.

Purpose Of Review: This review aims to provide an update on the recent evidence concerning exercise during pregnancy including effects for mother and fetus and the types, frequency, intensity, duration and rate of progression of exercise performed.

Recent Findings: Exercises during pregnancy are associated with higher cardiorespiratory fitness, prevention of urinary incontinence and low back pain, reduced symptoms of depression, gestational weight gain control, and for cases of gestational diabetes, reduced number of women who required insulin. There is no association with reduction in birth weight or preterm birth rate. The type of exercise shows no difference on results, and its intensity should be mild or moderate for previous sedentary women and moderate to high for active women. The exercise recommendations still are based on the current guidelines on moderate-intensity, low-impact, aerobic exercise at least three times a week. Yet, new guidelines propose increasing weekly physical-activity expenditure while incorporating vigorous exercise and adding light strength training to the exercise routine of healthy pregnant women. In the case of other chronic diseases like hypertension, there are still few data, and therefore more studies should be performed to assess the safety of the intervention.

Summary: Physical exercise is beneficial for women during pregnancy and also in the postpartum period; it is not associated with risks for the newborn and can lead to changes in lifestyle that imply long-term benefits.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/GCO.0b013e328359f131DOI Listing
December 2012

Severe maternal morbidity due to abortion prospectively identified in a surveillance network in Brazil.

Int J Gynaecol Obstet 2012 Oct 21;119(1):44-8. Epub 2012 Jul 21.

Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.

Objective: To evaluate the occurrence of severe maternal complications associated with abortion in Brazil.

Methods: In a cross-sectional multicenter study, prospective surveillance was done for cases of potentially life-threatening conditions (PLTC), maternal near miss (MNM), and maternal death (MD) among 9555 women with obstetric complications between June 2009 and May 2010. Abortion was evaluated as a cause, and sociodemographic and obstetric characteristics, safety conditions where the abortion was performed, and the medical procedures used were also assessed. Prevalence ratios adjusted for the cluster effect of the design were calculated with 95% confidence intervals. Multiple logistic regression analysis was performed to identify factors independently associated with greater severity.

Results: For 237 women (2.5%), abortion resulted in severe complications including PLTC (81.9%), MNM (15.2%), and MD (3%). When abortion was unsafe, infectious causes were more common for PLTC, whereas management criteria were more important for MNM and MD. In multivariate analysis, the presence of previous maternal conditions (sickle cell disease, low weight, neoplasm), being transferred or referred, previous uterine scar, and delays were associated with greater severity.

Conclusion: Abortion was responsible for only a small percentage of the complications associated with pregnancy; however, the risk of abortion-related complications progressing unfavorably was higher.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijgo.2012.05.025DOI Listing
October 2012

Reference values for Doppler velocimetry of the ophthalmic and central retinal arteries in low-risk pregnancy.

Int J Gynaecol Obstet 2012 Jun 31;117(3):251-6. Epub 2012 Mar 31.

Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.

Objective: To establish reference values for Doppler velocimetry of the ophthalmic artery (OA) and the central retinal artery (CRA) in low-risk pregnancy.

Method: Between January 2008 and March 2009, 63 low-risk pregnant women underwent an ultrasound scan every 2 weeks at the Women's Hospital, Campinas, Brazil, to determine the resistance index (RI), pulsatility index (PI), and peak systolic velocity of both arteries, in addition to the flow velocity of the second peak and peak ratio (PR) of the OA. For analysis, linear regression was used with mixed models for longitudinal data, coefficient of determination, and estimates of the 5th and 95th percentiles for each parameter at each gestational age. Intra- and inter-observer variability was evaluated via the intraclass correlation coefficient.

Results: There was a trend of a reduction with gestational age in PI and RI of the OA, and PI of the CRA, but not in PR of the OA; and the respective reference values were established. Intra- and inter-observer variability was considered satisfactory.

Conclusion: Unilateral assessment of the orbital Doppler velocimetry is feasible. Establishment of reference values showed a negative correlation between gestational age and PI and RI of the OA, and PI of the CRA. The method demonstrated satisfactory reproducibility.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijgo.2012.01.012DOI Listing
June 2012

Area of Wharton's jelly as an estimate of the thickness of the umbilical cord and its relationship with estimated fetal weight.

Reprod Health 2011 Nov 4;8:32. Epub 2011 Nov 4.

Department of Obstetrics and Gynecology, School of Medical Sciences, Universidade Estadual de Campinas-UNICAMP, Campinas, São Paulo, Brazil.

Background: To build a reference curve for the area of Wharton's jelly (WJ) in low-risk pregnancies from 13 to 40 weeks and to assess its relationship with estimated fetal weight (EFW).

Methods: 2,189 low-risk pregnancies had the area of WJ estimated by ultrasound and the 10th, 50th and 90th percentiles calculated using a third-degree polynomial regression procedure. EFW by ultrasound was correlated with the measurement of the area of WJ.

Results: The area of WJ increased according to gestational age (R² = 0.64), stabilizing from the 32nd week onwards. There was a significant linear correlation between area of WJ and EFW up to 26 weeks (R = 0.782) and after that 5t remained practically constant (R = 0.047).

Conclusion: The area of WJ increases according to gestational age, with a trend to stabilize at around 32 weeks of gestation. It is also linearly correlated with EFW only up to 26 weeks of gestation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1742-4755-8-32DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219549PMC
November 2011

Perinatal outcomes associated with low birth weight in a historical cohort.

Reprod Health 2011 Jun 2;8:18. Epub 2011 Jun 2.

Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.

Objective: To identify perinatal outcomes associated with low birth weight (LBW).

Methods: A retrospective cohort study in a tertiary maternity hospital. Analysis of the database on 43,499 liveborn infants delivered between 1986 and 2004 with low (n = 6,477) and normal (n = 37,467) birth weight. Outcomes associated with LBW were identified through crude and adjusted risk ratio (RR) and 95%CI with bivariate and multivariate analysis. The main outcomes were: onset of labor, mode of delivery, indication for cesarean section; amniotic fluid, fetal heart rate pattern, Apgar score, somatic gestational age, gender and congenital malformation.

Results: LBW infants showed more frequently signs of perinatal compromise such as abnormal amniotic fluid volume (especially olygohydramnios), nonreassuring patterns of fetal heart rate, malformation, lower Apgar scores and lower gestational age at birth. They were associated with a greater risk of labor induction and cesarean delivery, but lower risk of forceps.

Conclusion: There was a clear association between LBW and unfavorable perinatal outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1742-4755-8-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118322PMC
June 2011
-->