DNA damage in Wistar Kyoto rats exercised during pregnancy

Abstract Purpose: To evaluate DNA damage levels in pregnant rats undergoing a treadmill exercise program. Methods: Wistar Kyoto rats were allocated into two groups (n= 5 animals/group): non-exercise and exercise. The pregnant rats were underwent an exercise protocol on a treadmill throughout pregnancy. Exercise intensity was set at 50% of maximal capacity during maximal exercise testing performed before mating. Body weight, blood pressure and glucose levels, and triglyceride concentration were measured during pregnancy. At day 10 post-natal, the animals were euthanized and maternal blood samples were collected for DNA damage. Results: Blood pressure and glucose levels and biochemical measurements showed no significant differences. Increased DNA damage levels were found in exercise group compared to those of non-exercise group (p<0.05). Conclusion: The exercise intensity protocol used in the study might have been exhaustive leading to maternal increased DNA damage levels, demonstrating the relevance of an adequate protocol of physical exercise.

Association of gestational age with the option of pregnancy termination for fetal abnormalities incompatible with neonatal survival / Associação da idade gestacional com a opção pela interrupção da gravidez de fetos com anomalias incompatíveis com a sobrevida neonatal

ABSTRACT Objective: To identify the profile of women seen in a Fetal Medicine unit, diagnosed with fetal abnormality incompatible with neonatal survival in their current pregnancy, and to check the association of gestational age upon diagnosis with the option of pregnancy termination. Methods: This is a retrospective cohort study carried out in the Fetal Medicine Outpatients Clinic of a university hospital, in the city of São Paulo (SP), Brazil, using medical records of pregnant women with fetus presenting abnormalities incompatible with neonatal survival. The sample comprised 94 medical records. The Statistical Package for the Social Sciences (SPSS), version 19, was used for the data statistical analysis. Results: The population of the study included young adult women, who had complete or incomplete high school education, employed, with family income of one to three minimum wages, single, nonsmokers, who did not drink alcoholic beverages or used illicit drugs. Women with more advanced gestational age upon fetal diagnosis (p=0.0066) and/or upon admission to the specialized unit (p=0.0018) presented a lower percentage of termination of pregnancy. Conclusion: Due to characteristics different from those classically considered as of high gestational risk, these women might not be easily identified during the classification of gestational risk, what may contribute to a late diagnosis of fetal diseases. Early diagnosis enables access to specialized multiprofessional care in the proper time for couple's counseling on the possibility of requesting legal authorization for pregnancy termination.

RESUMO Objetivo: Identificar o perfil de mulheres atendidas em um serviço de Medicina Fetal, que receberam diagnóstico de anomalia fetal incompatível com a sobrevida neonatal na gestação atual, e verificar a associação da idade gestacional no diagnóstico com a opção pela interrupção da gravidez. Métodos: Trata-se de um estudo de coorte retrospectivo, realizado no ambulatório de Medicina Fetal de um hospital universitário da cidade de São Paulo (SP), com prontuários de mulheres com fetos portadores de anomalias incompatíveis com a sobrevida neonatal na gestação atual. A amostra constituiu-se de 94 prontuários. Para análise estatística dos dados, utilizou-se o programa Statistical Package for the Social Sciences (SPSS), versão 19. Resultados: A população foi de mulheres adultas jovens, com escolaridade compatível com o Ensino Médio completo/incompleto, empregadas, com renda familiar entre um e três salários mínimo, solteiras, que não faziam uso de tabaco, bebidas alcoólicas ou de drogas ilícitas. Verificou-se que mulheres com maior idade gestacional na ocasião do diagnóstico fetal (p=0,0066) e/ou na chegada ao serviço especializado (p=0,0018) apresentaram menor percentual de interrupção gestacional. Conclusão: Por apresentarem características diferentes daquelas classicamente consideradas de alto risco gestacional, é possível que essas mulheres não tenham sido facilmente identificadas durante a classificação de risco gestacional, o que pode ter colaborado para o diagnóstico tardio de patologias fetais. O diagnóstico precoce possibilita acesso à assistência multiprofissional especializada em tempo adequado para aconselhamento do casal sobre a possibilidade de solicitação de autorização judicial para a interrupção gestacional.

Gestação na paciente dialítica / Pregnancy in dialysis patients

A gestação em pacientes com insuficiência renal e em terapia dialítica constitui uma situação desafiadora. Desde a sua primeira descrição em 1971, um crescente número de casos é relatado com informações conflitantes e discordantes quanto ao prognóstico materno e fetal. As principais intercorrências clínicas e obstétricas encontradas no manejo dessas pacientes são: hipertensão arterial, polidrâmnio, restrição de crescimento fetal e prematuridade. As consequências neonatais são complicações clínicas diversas, decorrentes, principalmente, da prematuridade tais como: pneumotórax, síndrome da angústia respiratória do recém-nato, sepse, enterocolite necrosante, doença pulmonar crônica, hemorragia intraventricular e surdez. Este artigo tem por objetivo revisar o tema apresentando os resultados maternos e perinatais mais recentes relatados na literatura, discutir as controvérsias no manejo dessas gestantes e apresentar a conduta obstétrica tanto no pré-natal como na assistência ao parto.

Pregnancy in insufficiency renal and dialysis patients is a challenging situation. Since its first description in 1971, a growing number of cases have been described with conflicting information about maternal and fetal outcome. The main obstetrical adverse outcomes on the management of these patients are: arterial hypertension, polihydramnios, intrauterine growth restriction and prematurity. The neonatal complications are consequences of prematurity and include pneumothorax, respiratory distress syndrome, sepsis, necrotizing entercolitis, chronic lung disease, intraventricular hemorrhage and deafness. This article aims to review the literature presenting the outcome of the most recent maternal and perinatal outcomes, discussing the controversies in the treatment of these patients and presenting the main steps in prenatal care as well as during labor.

Predicao da acidose no nascimento em gestacao com diastole zero ou reversa a dopplervelocimetria das arterias umbilicais / Predicting acidosis at birth in pregnancies with absent or reverse end-diastolic flow velocity diagnosed through dopplervelocimetry of the umbilical arteries

A diastole zero e a diastole reversa demonstram grave insuficiencia placentaria, merecendo intensiva vigilancia do bem estar fetal. O conhecimento de um teste de avaliacao da vitalidade fetal de predicao da acidose no nascimento em casos de diastole zero ou diastole reversa a dopplervelocimetria das arterias umbilicais pode facilitar a escolha do melhor momento para interrupcao da gestacao diminuindo assim a mortalidade e a morbidade perinatal nestes casos

Rotura prematura de membranas antes de la viabilidad fetal: resultados maternos y perinatales / Premature rupture of membranes before fetal viability: maternal and perinatal results

Objetivo: evaluar prospectivamente los resultados perinatales con un manejo expectante en rotura prematura de membranas (RPM) de segundo trimestre. Ingresaron 17 pacientes con RPM entre 18 y 26 semanas. Se analizan las complicaciones maternas y los resultados perinatales. La edad gestacional media al ingreso fue de 20+4 semanas. El período de latencia y la incidencia de corioamnionitis (18 por ciento) no fue diferente entre pacientes con y sin DIU. Se realizó amniocentesis con 92 por ciento de éxito. Hubo tres casos de infección intraamniótica asintomática (IIA); recibieron antibioticoterapia y no desarrollaron corioamnionitis. La edad gestacional media al parto fue de 24+5 semanas. En los casos con aumento del líquido amniótico en el segundo examen ecográfico, hubo una sobrevida neonatal significativamente mayor. La sobrevida perinatal fue de un 35 por ciento y de 50 por ciento la sobrevida intacta al año. La RPM del segundo trimestre puede manejarse expectamtemente considerando la amniocentesis y ecografía frecuente. Esto permite identificar precozmente la IIA y establecer el pronóstico perinatal

Maternal perception of sound-provoked fetal movement as a test of antepartum fetal wellbeing.

Maternal perception of sound-provoked fetal movement test was studied on 506 occasions in 443 women with obstetric or medical antenatal risk factors after 26 weeks gestation. The response was compared with a nonstress test (NST) performed immediately after a three-second vibroacoustic stimulation with an electronic artificial larynx. A positive response to sound stimulation, recorded as a fetal movement by the mother, occurred on 497 occasions (97.3%) and was accompanied by a reactive NST on 484 occasions; giving a specificity of 99.6 per cent and a negative predictive value of 97.4 per cent. An inconclusive or negative response to sound (2.7%) had a sensitivity of 35.0 per cent and a positive predictive value for a nonreactive NST of 77.8 per cent. Results of sound-provoked fetal movement test and NST, performed within a week of delivery, in 434 women were compared with fetal outcome. The maternal perception of sound-provoked fetal movement test had better specificity (99.1% vs 96.9%), positive predictive value (55.6% vs 35.0%) for poor fetal outcome than the NST, although its sensitivity (50.0% vs 70.0%) and negative predictive value (98.8% vs 99.3%) were lower. Maternal perception of sound-provoked fetal movement test may suffice as an inexpensive and simple method of evaluating antepartum fetal well-being in risk situations. When the mother does not feel any sound provoked fetal movement, NST is then performed. This clinical application can be helpful in a primary health care setting where rapid assessment of fetal health at risk is required.