ABSTRACT
ABSTRACT Toxoplasmosis in pregnant women can cause significant morbidity and mortality in the fetus, which may be mitigated by early diagnosis and treatment. Social factors have also been related to the risk of developing the congenital form of toxoplasmosis, since some of these factors interfere directly in the quality of prenatal care. This study aimed to describe the clinical, laboratory, and epidemiological data of pregnant women diagnosed with toxoplasmosis and their newborns followed up at a referral hospital in Rio de Janeiro, Brazil. This was descriptive cohort study of 334 pregnant women with toxoplasmosis followed from May 2014 to December 2017. We conducted interviews to assess knowledge about the disease and its preventive measures, analyzed clinical and laboratory data during antenatal visits, and collected data from the newborns' medical charts. Results: This was a predominantly low-income women cohort study, with little schooling, mainly referred from public health services late in pregnancy (178; 53.3%), in the second and third trimesters (286; 85.6%). Diagnosis of acute toxoplasmosis had not been confirmed in 171 cases (51.2%). Out of 183 (54.9%) women who had initiated treatment at the original health services, 45 (24.6%) received an incorrect prescription. Seventy-two amniocenteses were performed, with positive real-time polymerase chain reaction (qPCR) in the amniotic fluid in two cases (2.8%). Congenital toxoplasmosis at birth was identified in eight newborns (5.4%). Conclusion: Late referral to specialized medical services, inadequate toxoplasmosis management at the original prenatal care services, and social vulnerabilities are contributing factors to the persistent occurrence of congenital toxoplasmosis cases.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Toxoplasmosis , Toxoplasmosis, Congenital , Pregnancy Complications, Parasitic , Referral and Consultation , Brazil/epidemiology , Toxoplasmosis/diagnosis , Toxoplasmosis/epidemiology , Toxoplasmosis, Congenital/diagnosis , Toxoplasmosis, Congenital/epidemiology , Cohort Studies , Pregnancy Complications, Parasitic/diagnosis , Pregnancy Complications, Parasitic/epidemiology , HospitalsABSTRACT
Resumo Malformação congênita, segunda maior causa de mortalidade infantil, constitui condição de vulnerabilidade importante na gravidez, que repercute desfavoravelmente na saúde mental da gestante. Objetivou-se estudar o impacto do momento do diagnóstico de malformação congênita sobre a saúde mental de 66 gestantes em atendimento pré-natal. Para isso, as participantes responderam ao Questionário "Momento da notícia", o qual identifica variáveis psicossociais relativas ao momento do diagnóstico da deficiência, e as Escalas Beck, para avaliar sinais e sintomas de ansiedade (Beck Anxiety Inventory) e depressão (Beck Depression Inventory). Todas receberam a notícia através de um médico, sendo 19 no segundo trimestre gestacional. Quatorze consideraram a transmissão do diagnóstico apropriada. No entanto, quando a notícia ocorreu no primeiro trimestre, tanto indicadores de ansiedade (p = 0,0009) quanto de depressão (p = 0,000004) se associaram ao momento da comunicação do diagnóstico; diferente de quando a gestante era comunicada no segundo trimestre, ao qual esteve associado somente os indicadores de depressão (p = 0,0462). Discute-se indicadores de ansiedade e depressão na gestação relacionados ao diagnóstico de malformação congênita como agravantes da vulnerabilidade física e psíquica durante a gestação.
Abstract Congenital malformation, the second largest cause of infant mortality, is an important cause of vulnerability during pregnancy, and it has an unfavorable effect on the mental health of pregnant woman. The objective of this study was to investigate the impact of the moment of diagnosis of congenital malformation on the mental health of 66 pregnant women receiving prenatal care. The participants answered the questionnaire "Momento da notícia" (Moment of diagnosis), which identifies psychosocial variables related to the moment of diagnosis. The Beck Scales were also used to assess signs and symptoms of anxiety (Beck Anxiety Inventory) and depression (Beck Depression Inventory). All participants were given the diagnosis by a physician, and 19 were notified during the second trimester of pregnancy. The diagnosis communication was considered adequate by fourteen participants. However, when the diagnosis was notified during the first trimester of pregnancy it was associated with indicators of anxiety (p = 0.0009) and depression (p = 0.000004). Different results were found when the mother was notified during the second trimester, when only the indicators of depression were associated to the diagnosis received (p = 0.0462). The present study addressed the indicators of anxiety and depression during pregnancy associated to the diagnosis of congenital malformation as risk factors for the physical and psychological vulnerability during this period.
Subject(s)
Humans , Pregnancy , Congenital Abnormalities , Diagnosis , Mental Health , Pregnant WomenABSTRACT
Apesar das campanhas esclarecedoras, o hábito de fumar durante a gestaçäo ainda majora as estatísticas das populaçöes de pré-natal. As repercussöes atribuídas ao hábito de fumar estäo bem documentadas e seräo minudenciadas no presente trabalho, que visa analisar as possíveis repercussöes hemodinâmicas materna e fetal do fumo
Subject(s)
Humans , Female , Pregnancy , Fetus/drug effects , Hemodynamics , Pregnancy Complications , Pregnancy/drug effects , Smoking/adverse effects , UltrasonicsABSTRACT
Foram acompanhadas 180 gestantes portadoras de gestaçöes únicas através da dopplerfluxometria das artérias uterinas e umbilical. Utilizamos um aparelho duplex, composto pela unidade de Doppler UGR-34, acoplado ao ultra-som SSD-280LS, ambos da marca ALOKA, Japåo. Para a avaliaçåo da artéria uterina, calculamos inicialmente a relaçåo A/B de cada artéria, e, em seguida, a média e a diferença entre as artérias direita e esquerda. Anotamos ainda a presença ou ausência de incisuras. O estudo da artéria umbilical considerou a relaçåo A/B normal e anormal, destacando-se um subgrupo que apresentou diástole-zero. Correlacionamos esses achados com a presença ou posterior desenvolvimento de hipertensåo arterial e o resultado perinatal, avaliado pelo peso do neonato, índice de Apgar de 5 minutos, natimortalidade, neomortalidade precoce e ausência de anomalias congênitas. Observamos que a dopplerfluxometria das artérias uterinas, avaliadas pela média e diferença da relaçåo A/B, e principalmente pela presença de incisura, associa-se significativamente com o prognóstico materno, nåo aguardando associaçåo com o prognóstico fetal. Por outro lado, o doppler da artéria umbilical, avaliado pela relaçåo A/B anormal e principalmente peo achado de diástole-zero, associa-se significativamente com o mau prognóstico fetal, nåo se asociando com o prognóstico materno
Subject(s)
Humans , Female , Pregnancy , Umbilical Arteries , Prenatal Diagnosis , Ultrasonography, Prenatal , Uterus/blood supply , Arteries , Prognosis , Regional Blood FlowABSTRACT
Os autores comentam sobre o acompanhamento e a conduta, sob o ponto de vista obstétrico, da gestaçäo em paciente diabética. É considerada a utilizaçäo da ultra-sonografia, da dopplerfluxometria, da biópsia de vilo corial, da ecocardiografia, da cardiotocografia, da amniocentese e da alfafetoprotena. Por fim, säo discutidos os critérios de interrupçäo das gestaçöoes nessa populaçäo.