Search

Introduction Brazil is a country of continental dimensions with a great challenge to ascertain adequate healthcare throughout regions. The country registered increased numbers of maternal deaths and adverse perinatal outcomes in pregnant and postpartum women with COVID-19 infection, rising great concern. There is scarce data on findings among public versus private settings. Objective to compare maternal and perinatal outcomes in pregnant and postpartum women with SARS-CoV-2 infection, among admissions in public and private maternity hospitals during a period before vaccination. Study Design Secondary analysis of the REBRACO initiative, a national multicenter cohort study in Brazil, considering pregnant and postpartum women with suspected or confirmed COVID-19 infections (from February 2020 to February 2021) in 15 maternity centers (2 private and 13 public facilities). Sociodemographic and obstetric characteristics were compared according to the type of hospital care. In addition, clinical, laboratory findings and maternal and perinatal outcomes were compared in both groups. The prevalence ratio (PR) and its 95%CI for each predictor and outcome were calculated. Results Of 559 symptomatic cases tested, 289 confirmed COVID-19 cases were included, with 213 (72.7%) women in public hospitals and 76 (27.3%) women in private hospitals. SARS-CoV-2 infection frequency was not significantly different among groups. Women treated at public hospitals had lower schooling (p

Made available in DSpace on 2022-04-29T08:38:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-12-01 Introduction The aim of this study was to evaluate the clinical, epidemiological and laboratory aspects of SARS-CoV-2 infection during pregnancy and postpartum in 16 maternity hospitals. Methods and analysis A prospective multicentre study, with five axes. First, the prevalence of SARS-CoV-2 infection among women admitted for childbirth will be described in a cross-sectional study. Second, maternal and perinatal outcomes will be assessed in a prospective cohort study including pregnant or postpartum women with suspected COVID-19. Third, a cohort of positive COVID-19 cases with sampling of a variety of biological material. Histopathological and viral analysis of biological maternal and neonatal samples will be performed, and the assessment of nutritional variables to evaluate the association between vitamin D and severity of infection. Fourth, a monitoring and evaluation committee to collect relevant healthcare information and plan actions in centres facing the pandemic. Furthermore, qualitative studies will be performed to study pregnant women, their families and health professionals. Fifth, an ecological study will monitor the number of live births, stillbirths and other outcomes to explore any trend among the periods before, during and after the pandemic. Data will systematically be collected in an electronic platform following standardised operational procedures. For quantitative study components, an appropriate statistical approach will be used for each analysis. For qualitative data, in-depth interviews recorded in audio will be transcribed, checking the text obtained with the recording. Subsequently, thematic analysis with the aid of the NVivo programme will be performed. Ethics and dissemination Ethical approval was obtained (letters of approval numbers 4.047.168, 4.179.679 and 4.083.988). All women will be fully informed to sign the consent form before enrolment in the study. Findings will be disseminated through peer-reviewed journals and scientific conferences. School of Medical Sciences. Department of Obstetrics and Gynaecology State University of Campinas Faculty of Medical Sciences Department of Obstetrics and Gynaecology State University of Campinas Faculty of Medical Sciences Department of Obstetrics and Gynecology State University of Campinas Faculty of Medical Sciences Obstetrics and Gineacology State University of Campinas Faculty of Medical Sciences Obstetrics and Gyneacology State University of Campinas Faculty of Medical Sciences Department of Obstetrics and Gynecology Faculdade de Medicina de Jundiai Department of Obstetrics and Gynecology Universidade Federal Do Rio Grande Do Sul Department of Obstetrics and Gynecology Unimed Belo Horizonte Department of Obstetrics and Gynecology Sociedade de Assistencia A Maternidade Escola Assis Chateaubriand Department of Obstetrics and Gynecology UNIFESP Department of Obstetrics and Gynecology Hospital Moinhos de Vento Department of Obstetrics and Gynecology UFSCar Department of Obstetrics and Gynecology State University of Campinas Department of Obstetrics and Gynecology UFMG Department of Obstetrics Instituto Fernandes Figueira Department of Obstetrics and Gynecology UNESP Campus de Botucatu University of Pernambuco Obstetrics and Gyneacology Salvador University Santa Casa de Misericordia Do Para Belem Department of Obstetrics and Gynecology UNESP Campus de Botucatu

Brazil presented a very high number of maternal deaths and evident delays in healthcare. We aimed at evaluating the characteristics of SARS-CoV-2 infection and associated outcomes in the obstetric population. We conducted a prospective cohort study in 15 Brazilian centers including symptomatic pregnant or postpartum women with suspected COVID-19 from Feb/2020 to Feb/2021. Women were followed from suspected infection until the end of pregnancy. We analyzed maternal characteristics and pregnancy outcomes associated with confirmed COVID-19 infection and SARS, determining unadjusted risk ratios. In total, 729 symptomatic women with suspected COVID-19 were initially included. Among those investigated for COVID-19, 51.3% (n = 289) were confirmed COVID-19 and 48% (n = 270) were negative. Initially (before May 15th), only 52.9% of the suspected cases were tested and it was the period with the highest proportion of ICU admission and maternal deaths. Non-white ethnicity (RR 1.78 [1.04–3.04]), primary schooling or less (RR 2.16 [1.21–3.87]), being overweight (RR 4.34 [1.04–19.01]) or obese (RR 6.55 [1.57–27.37]), having public prenatal care (RR 2.16 [1.01–4.68]), planned pregnancies (RR 2.09 [1.15–3.78]), onset of infection in postpartum period (RR 6.00 [1.37–26.26]), chronic hypertension (RR 2.15 [1.37–4.10]), pre-existing diabetes (RR 3.20 [1.37–7.46]), asthma (RR 2.22 [1.14–4.34]), and anaemia (RR 3.15 [1.14–8.71]) were associated with higher risk for SARS. The availability of tests and maternal outcomes varied throughout the pandemic period of the study; the beginning was the most challenging period, with worse outcomes. Socially vulnerable, postpartum and previously ill women were more likely to present SARS related to COVID-19.

To evaluate the prevalence of preeclampsia among cases of COVID-19 infection during pregnancy and the association between both conditions, in a multicenter cohort of Brazilian women with respiratory symptoms.Ancillary analysis of the Brazilian Network of COVID-19 in Obstetrics (REBRACO) study. We performed a nested case-control analysis selecting all women with COVID-19 and compared outcomes between women with and without PE.Maternal, gestational, and clinical characteristics and perinatal outcomes.Prevalence ratio (PR) and its 95%CI for each of the predictors and outcomes.A total of 203 women were included: 21 (10.3%) in PE group and 182 (89.7%) in non-PE group. Preeclampsia was not different among women with and without COVID-19 (10.3% vs 13.1%, p-value = 0.41), neither complication such as eclampsia and HELLP syndrome. Chronic hypertension (33.4%) (p 0.01) and obesity (60.0%) (p = 0.03) were the most frequent comorbidities in PE group, and they were significantly more frequent in this group. Women with PE had more cesarean section (RR 5.54 [1.33 - 23.14]) and their neonates were more frequently admitted to neonatal intensive care unit (PR 2.46[1.06 - 5.69]), most likely due to preterm-birth-related complications.The prevalence of PE among women with COVID-19 infection during pregnancy was around 10%; women with COVID-19 and a history of chronic hypertension or obesity are more likely to have preeclampsia. Cesarean section is increased among women with PE and COVID-19, with increased rates of neonatal admission to intensive care units, mostly due to prematurity.

CONTEXT: Interstitial pregnancy is a rare form of ectopic pregnancy for which the best therapeutic course of action has yet to be determined. Surgical intervention entails a high risk of hemorrhage due to the great vascularization of the cornual region of the uterus. Case descriptions facilitate the analysis of results and aid clinicians in determining the most appropriate course of action in these situations. CASE REPORT: In a patient with an ultrasound diagnosis of interstitial pregnancy, clinical treatment using methotrexate was chosen. However, after one week, there was a marked decline in the serum level of the β subunit of chorionic gonadotropin hormone, although an ultrasound examination revealed embryonic cardiac activity. A second dose of the chemotherapy was administered. Embryonic cardiac activity persisted 48 hours later. Video laparoscopy was performed to achieve right-side cornual resection, which resulted in satisfactory resolution of the case.

OBJETIVO: avaliação da hemorragia feto-materna (HFM) nas pacientes que receberiam profilaxia da aloimunização Rh com emprego de imunoglobulina anti-D (300 mig), pós-aborto precoce. MÉTODO: foram admitidas no estudo pacientes do grupo sanguíneo Rh negativo, com parceiro Rh positivo ou ignorado, com quadro de aborto até 12 semanas de gestação internadas para curetagem uterina. Uma amostra de 5 ml de sangue venoso destas pacientes foi obtida após o procedimento, na qual realizamos o teste qualitativo de roseta para detectar quais casos necessitariam determinação quantitativa do volume de sangue fetal transferido para circulação materna, que foi então apurado pelo teste de Kleihauer-Betke (K-B). RESULTADOS: das 26 pacientes avaliadas, em uma o teste de roseta foi positivo, e o teste de K-B apontou HFM de 1,5 ml. CONCLUSÕES: a dose de imunoglobulina anti-D nos casos de abortamento até a 12ª semana de gestação deveria ser substancialmente reduzida, parecendo-nos oportuna a disponibilização no mercado nacional de apresentação com 50 mig, que representaria além da economia, maior racionalidade.OBJECTIVE: evaluation of fetomaternal hemorrhage (FMH) in patients who would need Rh alloimmunization with anti-D immunoglobulin (300 mug) prophylaxis after early miscarriage. METHOD: we included in the study Rh (D) negative blood group patients with positive or unknown Rh (D) partners, who had had a miscarriage up to 12 weeks of gestation, and had been admitted to hospital for uterine curettage. After this procedure 5 ml of venous blood was collected from the patients and the rosette test was applied to screen which patients would need quantitative determination of fetal blood transferred to the maternal circulation, by the Kleihauer-Betke test (K-B). RESULTS: out of 26 patients evaluated the rosette test was positive in one , who showed an FMH of 1.5 ml in the K-B test. CONCLUSIONS: the dose of anti-D immunoglobulin used in cases of miscarriage up to 12 weeks of gestation should be substantially reduced. The availability of preparations of 50 mug is recommended, for a more inexpensive and rational treatment.

To assess a possible association between polymorphism of the progesterone receptor gene (PROGINS) and recurrent spontaneous abortion (RSA).In this case-control study, 85 women with at least three previous spontaneous abortions without an identifiable cause (RSA Group) and 157 women with at least two previous term pregnancies without pathologies and no previous miscarriage (Control Group) were selected. An amount of 10 mL of peripheral blood was collected by venipuncture and genomic DNA was extracted by the DTAB/CTAB method, followed by the polymerase chain reaction (PCR) under specific conditions for this polymorphism and by amplification by 2% agarose gel electrophoresis. The bands were visualized with an ultraviolet light transilluminator and the gels were photographed. Differences in the PROGINS genotype and allele frequencies between groups were analyzed by the χ² test, with the level of significance set at p0.05. The Odds Ratio (OR) was also used, with 95% confidence intervals 95%CI.PROGINS genotypic frequencies were 72.3% T1T1 and 27.7% T1T2 for the RSA group and 76.4% T1T1, 22.3% T1T2 and 1.3% T2T2 for the control group. There were no differences between groups when the genotype and allele frequencies were analyzed: respectively p=0.48 (OR: 0.8) and p=0.65 (OR: 0.9).Our results suggest that PROGINS polymorphism is not associated with RSA.

A angiogênese é um processo essencial para a formação placentária. Dentre os muitos fatores envolvidos neste evento biológico, destaca-se de forma preponderante o Fator de Crescimento Endotelial Vascular (VEGF), cuja produção é controlada por genes, que podem apresentar variantes polimórficas diversas. As conseqüências funcionais destas variações não estão ainda completamente elucidadas, embora algumas tenham sido já associadas a um comprometimento da angiogênese em diversos sistemas biológicos. Por outro lado, alterações morfológicas na formação, distribuição e arranjo dos vasos placentários foram descritas na placenta de gestantes com distúrbios hiperglicêmicos como a Diabete mellitus e a hiperglicemia moderada. Particularmente nos casos de hiperglicemia moderada, a adaptação vascular observada parece estar relacionada à manutenção da capacidade funcional placentária. Na diabete, este achado foi correlacionado à expressão protéica e gênica atípica de determinados fatores angiogênicos na interface materno-fetal, enquanto que em outras condições hiperglicêmicas a provável participação destes fatores ainda não foi completamente determinada. Desta forma, partindo da hipótese de que as alterações placentárias vasculares em gestantes hiperglicêmicas podem ser decorrentes da expressão ou produção atípica do VEGF e que esta por sua vez pode ser decorrente de polimorfismos gênicos, o objetivo deste estudo foi avaliar polimorfismos do gene deste fator de crescimento em placentas de gestantes com distúrbios hiperglicêmicos. Foi realizada a análise dos polimorfismos -460C/T, -634G/C e 936C/T do gene do VEGF em fragmentos de vilos coriônicos de gestantes normoglicêmicas, com hiperglicemia moderada e com Diabete mellitus prévia à gestação, denominados respectivamente de grupo IA, IB e IIB. Todo o material foi fornecido pelo Serviço de Diabetes e Gravidez da Faculdade de Medicina de Botucatu UNESP. A genotipagem dos polimorfismos do VEGF foi realizada através da Reação de Polimerase em Cadeia (PCR), seguida de digestão por enzima de restrição. As freqüências de distribuição genotípica e alélica dos polimorfismos do VEGF foram comparadas entre os grupos hiperglicêmicos (IB e IIB) e 6 o grupo controle. As freqüências genotípicas estavam em equilíbrio de Hardy-Weinberg. Foram observadas diferenças significantes nas freqüências genotípicas e alélicas do polimorfismo -460C/T do gene do VEGF em placentas de gestantes hiperglicêmicas (grupos IB e IIB) quando comparadas entre si, mas não com o grupo controle. Diferenças estatísticas nas freqüências genotípicas e alélicas do polimorfismo -634G/C VEGF foram detectadas nos grupos hiperglicêmicos em geral comparados ao grupo controle. Não foram identificadas diferenças nas freqüências genotípicas e alélicas do polimorfismo 936C/T do VEGF entre os grupos avaliados. Em conjunto, nossos achados sugerem que a resposta placentária a distúrbios hiperglicêmicos pode estar correlacionada à presença dos dois polimorfismos: -460C/T e 634C/G. No entanto, nenhuma correlação direta funcional positiva foi observada com a angiogênese observada nas placentas de gestações associadas à hiperglicemia moderada. The angiogenesis is a process essential for placental formation. Among the many factors involved in this biological event, the factor most active is the vascular endothelial growth factor (VEGF), whose production is controlled by genes, which may present different polymorphic variants. The functional consequences of these changes are not yet fully elucidated, although some have been associated with an impairment of angiogenesis in various biological systems. Moreover, morphological changes in distribution and arrangement of the placental vessels were described in the placenta of pregnant women with hyperglycemic disorders such as diabetes mellitus and mild hyperglycemia. Particularly in cases of mild hyperglycemia, the observed vascular adaptation seems to be related to the maintenance of functional placenta. In diabetes, this finding was correlated with the atypical gene and protein expression of certain angiogenic factors in maternalfetal interface, while in other hyperglycemic conditions the likely participation of these factors has not been fully determined. Thus, based on the hypothesis that placental vascular changes in hyperglycemic pregnant women may be due to atypical expression or production of VEGF and that this in turn may be caused by gene polymorphisms, the objective of this study was to assess polymorphisms of this gene factor growth in placentas of women with hyperglycemic disorders. The analysis of the polymorphisms of the VEGF gene was performed in fragments of chorionic villi of normoglycemic, mild hyperglycemic and diabetic pregnant women, respectively named of group IA, IB and IIB. All specimens were provided by the Serviço de Serviço de Diabetes e Gravidez da Faculdade de Medicina de Botucatu UNESP. Genotyping of the VEGF gene polymorphisms -460C/T, -634G/C and 936C/T was done by the polymerase chain reaction (PCR) and restriction fragment length polymorphism methods. The frequency of VEGF alleles and genotype distribution were compared among the hyperglycemic and control groups. The genotype frequencies were in Hardy-Weinberg equilibrium. We have observed significant differences of VEGF -460C/T polymorphism between the hyperglycemic placentas (IB X IIB), but not compared to control group. Statistical differences in the genotypic and allelic frequencies of C of VEGF -634G/C were detected 8 in hyperglycemic groups in general in comparison to controls. There were no significant differences in allelic or genotype frequencies among the evaluated groups. Taken together our findings suggest that the placental response to hyperglycemic disturbs may be correlated to the presence of both -460C/T and -636C/G polymorphism of the VEGF gene. However, no direct functional correlation was detected between these VEGF polymorphisms and the intense angiogenesis seen in placentas of mild hyperglycemiaassociated gestation.