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O monitoramento da mortalidade perinatal depende da qualidade dos dados dos sistemas de informação, das fichas de investigação e, principalmente, das declarações de óbito (DO). O objetivo foi discriminar as principais inconformidades no preenchimento das Declarações de Óbitos perinatais, na Maternidade Escola da Universidade Federal do Rio de Janeiro. Trata-se estudo observacional, transversal, quantitativo e documental. Foram analisadas as DOs, os prontuários e fichas de investigação dos óbitos perinatais ocorridos na instituição nos anos de 2015 e 2016. A principal inadequação identificada esteve no campo “causa básica do óbito”, com taxa de 94,8% de erro, o que evidencia a necessidade de se trabalhar a temática não só nas estratégias de educação permanente em saúde, como também na inclusão da temática nas diretrizes curriculares do curso de graduação em medicina, fortalecendo as estratégias de evitabilidade da mortalidade infantil por causas evitáveis.

Objetivo: Descrever procedimentos metodológicos para elaboração de plano alimentar para gestantes com Diabetes Mellitus (DM) com base na Dietary Approaches to Stop Hypertension (dieta DASH). Métodos: Estudo metodológico. Etapas: revisão da literatura; tradução e adaptação da DASH original; elaboração do plano alimentar DASH adaptado, boletim de orientação nutricional, listas de substituições e materiais educativos; discussão com especialistas; comparação dos custos dos cardápios, e discussão com gestantes. Resultados: Adaptação: foram incluídos alimentos brasileiros, fontes dos nutrientes da DASH e consumidos com frequência pela população. Foram elaborados boletim de orientação nutricional, listas de substituições e, para a pesquisa de custos, cardápios, com valor energético total (VET) médio de 2300 kcal, listas de equivalentes com VETs de 2000 a 2800 kcal e materiais educativos. Foram realizadas discussões com especialistas e com gestantes com DM prévio. O custo das dietas foi distinto (R$ 19,55: DASH x R$ 16,50: tradicional), mas não foi considerado significativo por especialistas e gestantes. Conclusão: A adaptação da dieta DASH original resultou na primeira versão em português adaptada à cultura brasileira e aos hábitos alimentares de gestantes com DM prévio. Este plano alimentar poderá contribuir para a prevenção de complicações gestacionais como as Síndromes Hipertensivas da Gravidez.

OBJECTIVE To validate a combined algorithm for early prediction of pre-eclampsia (PE) in the Brazilian population. STUDY DESIGN This is an unplanned secondary analysis of a cohort study. Consecutive singleton pregnancies undergoing first-trimester screening for PE involving examination of maternal characteristics, medical history, and biophysical markers were considered eligible. Women were classified as low-or high-risk using a cutoff of 1/200, but the individual risk was not used to dictate management, as aspirin prophylaxis was given to women based solely on clinical risk factors. Receiver-operating characteristics (ROC) curves for PE, preterm PE(PE

Objective: To evaluate the impacts of maternal risk factors described by the Fetal Medicine Foundation’s 2012 algorithm (FMF2012) in a Brazilian population.Methods: All singleton pregnancie...

Pregnant women with Gestational Diabetes Mellitus (GDM) have a greater chance of developing Hypertensive Disorders of Pregnancy (HDP) by the effect of insulin resistance in nitric oxide action.This study aims to describe factors associated with the development of HDP in pregnant women with GDM, assisted in a public maternity hospital in Rio de Janeiro, Brazil. This is a cross-sectional study including 292 pregnant adult women with GDM assisted at Maternidade Escola of the Universidade Federal do Rio de Janeiro. The women were examined during pregnancy and postpartum. Data were collected between 2011 and 2014 from medical records and through in-person interviews. The Student t-test and the chi-square test were applied; additionally, the magnitude of the association between independents variables and HDP was estimated by logistic regression models. The occurrence of HDP was observed in 19.5% (n=57) of the evaluated women: 9.2% had pregnancy hypertension and 10.3% had preeclampsia. The chance of HDP was higher among women with GDM in a previous pregnancy (Odds Ratio-OR=3.8; Confidence Interval of 95%-95% CI: 1.1; 12.8) and among those who were 35 years old or older (OR 3.3; 95% CI: 1.2; 8.7) after controlling the effects of pre-gestational weight and dietary ingestion of calcium, riboflavin, thiamine, vitamin A and protein. Women that had any alteration in blood pressure in a previous pregnancy and those over 35 years old were under higher risk of HDP. The findings may help in the design of interventions aiming to prevent HDP in adult women.

Background FMF2012 is an algorithm developed by the Fetal Medicine Foundation (FMF) to predict pre-eclampsia on the basis of maternal characteristics combined with biophysical and biochemical markers. Afro-Caribbean ethnicity is the second risk factor, in magnitude, found in populations tested by FMF, which was not confirmed in a Brazilian setting. Objective This study aimed to analyze the performance of pre-eclampsia prediction software by customization of maternal ethnicity. Methods This was a cross-sectional observational study, with secondary evaluation of data from FMF first trimester screening tests of singleton pregnancies. Risk scores were calculated from maternal characteristics and biophysical markers, and they were presented as the risk for early pre-eclampsia (PE34) and preterm pre-eclampsia (PE37). The following steps were followed: (1) identification of women characterized as black ethnicity; (2) calculation of early and preterm pre-eclampsia risk, reclassifying them as white, which generated a new score; (3) comparison of the proportions of women categorized as high risk between the original and new scores; (4) construction of the receiver operator characteristic curve; (5) calculation of the area under the curve, sensitivity, and false positive rate; and (6) comparison of the area under the curve, sensitivity, and false positive rate of the original with the new risk by chi-square test. Results A total of 1531 cases were included in the final sample, with 219 out of 1531 cases (14.30; 95% CI 12.5-16.0) and 182 out of 1531 cases (11.88%; 95% CI 10.3-13.5) classified as high risk for pre-eclampsia development, originally and after recalculating the new risk, respectively. The comparison of FMF2012 predictive model performance between the originally estimated risks and the estimated new risks showed that the difference was not significant for sensitivity and area under the curve, but it was significant for false positive rate. Conclusions We conclude that black ethnicity classification of Brazilian pregnant women by the FMF2012 algorithm increases the false positive rate. Suppressing ethnicity effect did not improve the test sensitivity. By modifying demographic characteristics, it is possible to improve some performance aspects of clinical prediction tests.

To examine the performance of the Fetal Medicine Foundation (FMF) 2012 predictive model and of isolated biophysical markers (uterine artery pulsatility index and mean arterial pressure) for small-for-gestational-age (SGA), in patients from Rio de Janeiro, Brazil.For this cross-sectional study, SGA was diagnosed when a newborn presented birth weight below the fifth percentile for gestational age. FMF2012 algorithm sensitivity and specificity, positive (PPV) and negative (NPV) predictive value, positive likelihood ratio (LR +) and area under the ROC curve (AUC) were calculated to predict total and preterm SGA (SGA 37). The performance of isolated biophysical markers - mean arterial pressure (MAP) and mean uterine artery pulsatility index (UtAPI) were studied.The final sample consisted of 1480 cases: 69 (4.6%) developed SGA, including 12 patients (0.8%) who were SGA 37. The AUC showed that the performances of the FMF2012 combined model for SGA prediction was 0.687 and for preterm SGA was 0.824. With risk cutoff of 1:150, SGA screening yielded the following: sensitivity, 47%; specificity, 75%; LR +, 1.88; PPV, 8.66%; NPV, 96.72%. When screening for preterm SGA, we found sensitivity 66.6%, specificity 74.59%, LR +: 2.58, PPV 2%, and NPV 99.63%.Performance of the FMF2012 algorithm in predicting SGA in our population was similar to that obtained in the reference population, according to sensitivity, but our false positive rate is significantly higher than the reference population.

BACKGROUND FMF2012 is an algorithm developed by the Fetal Medicine Foundation (FMF) to predict pre-eclampsia on the basis of maternal characteristics combined with biophysical and biochemical markers. Afro-Caribbean ethnicity is the second risk factor, in magnitude, found in populations tested by FMF, which was not confirmed in a Brazilian setting. OBJECTIVE This study aimed to analyze the performance of pre-eclampsia prediction software by customization of maternal ethnicity. METHODS This was a cross-sectional observational study, with secondary evaluation of data from FMF first trimester screening tests of singleton pregnancies. Risk scores were calculated from maternal characteristics and biophysical markers, and they were presented as the risk for early pre-eclampsia (PE34) and preterm pre-eclampsia (PE37). The following steps were followed: (1) identification of women characterized as black ethnicity; (2) calculation of early and preterm pre-eclampsia risk, reclassifying them as white, which generated a new score; (3) comparison of the proportions of women categorized as high risk between the original and new scores; (4) construction of the receiver operator characteristic curve; (5) calculation of the area under the curve, sensitivity, and false positive rate; and (6) comparison of the area under the curve, sensitivity, and false positive rate of the original with the new risk by chi-square test. RESULTS A total of 1531 cases were included in the final sample, with 219 out of 1531 cases (14.30; 95% CI 12.5-16.0) and 182 out of 1531 cases (11.88%; 95% CI 10.3-13.5) classified as high risk for pre-eclampsia development, originally and after recalculating the new risk, respectively. The comparison of FMF2012 predictive model performance between the originally estimated risks and the estimated new risks showed that the difference was not significant for sensitivity and area under the curve, but it was significant for false positive rate. CONCLUSIONS We conclude that black ethnicity classification of Brazilian pregnant women by the FMF2012 algorithm increases the false positive rate. Suppressing ethnicity effect did not improve the test sensitivity. By modifying demographic characteristics, it is possible to improve some performance aspects of clinical prediction tests.

Preeclampsia (PE) prevalence studies in Brazil are both scarce and not divided in accordance with gestational age at delivery. We accessed PE prevalence according to delivery before 34, 37 and 42weeks in a cross-sectional study including 4464 single deliveries. PE was diagnosed in 301 cases (6.74%); Prevalence of PE was 0.78%; 1.92% and 6.74% according to deliveries before 34, 37 and 42weeks. PE was associated with fetal death, prematurity and small for gestational age newborns.

Group B Streptococcus (GBS) carriage by pregnant women is the primary risk factor for early-onset GBS neonatal sepsis. Intrapartum antibiotic prophylaxis (IAP) can prevent this transmission route, and two main approaches are recommended to base the selection of pregnant women to be submitted to IAP: the risk-based and the culture-based strategies. In Brazil, compliance to such recommendations is poor, and not much is known about GBS carriage. In the present study, 3,647 pregnant women living in Rio de Janeiro State, Brazil, were screened for GBS anogenital colonization, over a period of 8 years (2008-2015). GBS was detected in 956 (26.2%) of them, and presence of vaginal discharge was the only trait associated with a higher risk for GBS colonization. Serotypes Ia (257; 37.3%) and II (137; 19.9%) were the most frequent among 689 (72.1% of the total) GBS isolates evaluated, followed by NT isolates (84; 12.1%), serotype Ib (77; 11.1%), V (63; 9.1%), III (47; 6.8%) and IV (24; 3.5%). Estimated coverage of major serotype-based GBS vaccines currently under clinical trials would vary from 65.2% to 84.3%. All 689 isolates tested were susceptible to ampicillin and vancomycin. Resistance to chloramphenicol, clindamycin, erythromycin, levofloxacin, and tetracycline was observed in 5% (35), 2% (14), 14% (97), 5% (35) and 86% (592) of the isolates, respectively. No significant fluctuations in colonization rates, serotype distribution and antimicrobial susceptibility profiles were observed throughout the period of time investigated. The culture-based approach for IAP recommendation showed to be the best choice for the population investigated when compared to the risk-based, since the first did not increase the number of pregnant women submitted to antibiotic therapy and covered a larger number of women who were actually colonized by GBS. The fact the not all isolates were available for additional characterization, and serotype IX antiserum was not available for testing represent limitations of this study. Nevertheless, to the best of our knowledge, this is the largest investigation on GBS carriage among pregnant women in Brazil up to date, and results are useful for improving GBS prevention and treatment strategies.

Objetivo: elaborar um instrumento para a etapa de historico de enfermagem voltado ao servico materno-infantil. Metodo: estudo metodologico, com validacao de conteudo de um instrumento para o historico de enfermagem para o servico materno-infantil, com base no referencial de Wanda Horta. Resultados: o formulario contem as informacoes: identificacao; sinais vitais,glicemia e dados antropometricos; dados clinicos e exames laboratoriais; entrevista e observacao da paciente; exame fisico e necessidades humanas basicas; impressoes. Foram agregadas outras necessidades relacionadas a area (reproducao/crescimento e desenvolvimento) nao previstas pela teoria de base que fundamentou o estudo. Verificou-se um indice de validade de conteudo global de 0,81 para clareza, 0,85 para pertinencia, 0,92 para abrangencia e 0,81 para organizacao. Conclusao: instrumento construido e validado com base na teoria de Wanda Horta, voltado para clientela materno-infantil, fornecendo um instrumento importante para documentar a primeira etapa do processo de enfermagem .

OBJETIVOS: analisar as complicações perinatais em gestantes infectadas pelo HIV. MÉTODOS: estudo do tipo coorte, realizado em centro perinatal terciário, no período de 1 de janeiro de 1996 a 31 de março de 2003. Foram selecionadas para o estudo 7698 gestações, cujos critérios de inclusão foram: gestação única e idade gestacional superior a 22 semanas. A infecção pelo HIV foi confirmada pelos testes ELISA e Western Blot. Estudou-se a associação entre a presença da infecção pelo HIV e as seguintes variáveis: ruptura prematura de membranas, parto prematuro, muito baixo peso ao nascimento, infecção puerperal, Apgar baixo no primeiro e quinto minutos, crescimento intra-uterino restrito (CIUR) e pequeno para a idade gestacional (PIG). RESULTADOS: do total de gestantes estudadas, 228 (2,96%) estavam infectadas pelo HIV. Os resultados dos testes estatísticos indicam que a infecção pelo HIV não é fator de risco para a ruptura prematura de membranas (RR = 0,48, p

Made available in DSpace on 2014-12-03T13:08:50Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-06-12Bitstream added on 2014-12-03T13:23:20Z : No. of bitstreams: 1 WOS000338587700001.pdf: 1013751 bytes, checksum: 143f80718582bad214462535426dfa1a (MD5) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) Background: Group B Streptococcus (GBS) remains a major cause of neonatal sepsis and is also associated with invasive and noninvasive infections in pregnant women and non-pregnant adults, elderly and patients with underlying medical conditions. Ten capsular serotypes have been recognized, and determination of their distribution within a specific population or geographical region is important as they are major targets for the development of vaccine strategies. We have evaluated the characteristics of GBS isolates recovered from individuals with infections or colonization by this microorganism, living in different geographic regions of Brazil.Methods: A total of 434 isolates were identified and serotyped by conventional phenotypic tests. The determination of antimicrobial susceptibility was performed by the disk diffusion method. Genes associated with resistance to erythromycin (ermA, ermB, mefA) and tetracycline (tetK, tetL, tetM, tetO) as well as virulence-associated genes (bac, bca, lmb, scpB) were investigated using PCR. Pulsed-field gel electrophoresis (PFGE) was used to examine the genetic diversity of macrolide-resistant and of a number of selected macrolide-susceptible isolates.Results: Overall, serotypes Ia (27.6%), II (19.1%), Ib (18.7%) and V (13.6%) were the most predominant, followed by serotypes IV (8.1%) and III (6.7%). All the isolates were susceptible to the beta-lactam antimicrobials tested and 97% were resistant to tetracycline. Resistance to erythromycin and clindamycin were found in 4.1% and 3% of the isolates, respectively. Among the resistance genes investigated, tetM (99.3%) and tetO (1.8%) were detected among tetracycline-resistant isolates and ermA (39%) and ermB (27.6%) were found among macrolide-resistant isolates. The lmb and scpB virulence genes were detected in all isolates, while bac and bca were detected in 57 (13.1%) and 237 (54.6%) isolates, respectively. Molecular typing by PFGE showed that resistance to erythromycin was associated with a variety of clones.Conclusion: These findings indicate that GBS isolates circulating in Brazil have a variety of phenotypic and genotypic characteristics, and suggest that macrolide-resistant isolates may arise by both clonal spread and independent acquisition of resistance genes. Inst Biol Exercito, Rio De Janeiro, Brazil Univ Estadual Campinas, Sao Paulo, Brazil Hosp Naval Marcilio Dias, Rio De Janeiro, Brazil Fundacao Fac Fed Ciencias Med, Porto Alegre, RS, Brazil Lab Hosp Mae de Deus, Porto Alegre, RS, Brazil Lab Sabin, Brasilia, DF, Brazil Lab Sergio Franco, Rio De Janeiro, Brazil Lab Hermes Pardini, Belo Horizonte, MG, Brazil Hosp Univ Fed Amazonas, Manaus, Amazonas, Brazil Hosp Univ Fed Maranhao, Sao Luis, Maranhao, Brazil Univ Fed Bahia, Salvador, BA, Brazil Hosp Univ Cuiaba, Cuiaba, Mato Grosso, Brazil Lab Municipal Saude Publ Recife, Recife, PE, Brazil Hosp Univ Sao Paulo, Sao Paulo, Brazil Univ Estadual Paulista, Sao Paulo, Brazil Univ Fed Triangulo Mineiro, Uberaba, MG, Brazil Univ Fed Rio de Janeiro, Maternidade Escola, Rio De Janeiro, Brazil Univ Fed Parana, Hosp Clin, Bacteriol Lab, BR-80060000 Curitiba, Parana, Brazil Univ Fed Rio de Janeiro, Inst Microbiol Paulo Goes, Dept Med Microbiol, Rio De Janeiro, Brazil Univ Estadual Paulista, Sao Paulo, Brazil

Objetivo: caracterizar o perfil sociodemografico e clinico da clientela materno-infantil em uma maternidade-escola federal. Metodo: estudo descritivo, quantitativo, com pesquisa documental em prontuarios. A coleta de dados ocorreu entre julho a dezembro de 2015. O cenario da pesquisa foi o alojamento conjunto da Maternidade-Escola da Universidade Federal do Rio de Janeiro (ME/UFRJ), localizada na cidade do Rio de Janeiro. Resultados esperados: clientela com gestacao em idade adulta mais tardia, moradia predominante na zona sul da cidade, nivel de instrucao de pelo menos ensino medio completo e pre-natal com numero de consultas adequadas e realizadas na propria instituicao de estudo ou na area adstrita de cobertura, historia pregressa de ate duas gestacoes e baixo percentual de abortos, tipo de parto cesareo dominante e hipertensao arterial ou diabetes mellitus, prodromos ou trabalho de parto como diagnosticos prevalentes na internacao.

Aim: To implement the systematization of nursing care (SNC) in the Maternity School of the Federal University of Rio de Janeiro. Method: This is an action research. The theory chosen was that of Basic Human Needs as proposed by Wanda Horta. The ICNP® was selected as the single classification system for the terminology with regard to diagnoses, expected outcomes and nursing interventions. Data collection will be carried out in accordance with the implementation of the SNC in each sector of the institution, consisting of the following steps: documentary research based on documents produced by the nursing staff and on the nursing diagnoses of the patients; field research through systematic observation of the team work processes; and seminars. In order to analyze the data obtained in the survey of nursing problems, the terms extracted from the medical charts will be analyzed and classified according to the model of nursing diagnoses contained in ICNP® 2.0 .