Fatores clínicos e obstétricos de óbitos fetais em uma maternidade de alto risco / Clinical and obstetric factors of fetal death in a high-risk maternity

Objetivo: Caracterizar os fatores clínicos e obstétricos de mulheres que tiveram diagnóstico de óbito fetal em uma maternidade escola de alto risco. Metodologia: estudo de abordagem quantitativa, de corte transversal e caráter descritivo exploratório. Foram incluídos 354 prontuários de mulheres admitidas com diagnóstico e óbito fetal entre janeiro de 2018 a janeiro de 2022. Analisou-se os dados a partir da distribuição de frequências absolutas e relativas (%). Resultados: A idade média das participantes foi de 26 anos. A maioria era primípara sem perdas fetais prévias. Hipóxia Fetal Intraútero foi a causa de óbito mais frequente (17,8%). Conclusão: O óbito fetal intraútero ainda é um diagnóstico que requer mais visibilidade por parte do sistema de saúde. Foi constatada a deficiência dos registros em prontuário de dados importantes, ressaltando a necessidade de promover treinamento e capacitação para os profissionais que realizam assistência

Objective: To characterize the clinical and obstetric factors of women who were diagnosed with fetal death in a high-risk maternity hospital. Methodology: cross-sectional, analytical and retrospective study, carried out in a high-risk maternity hospital in the Central Region of Goiás. A total of 354 medical records of women admitted with a diagnosis and fetal death between January 2018 and January 2022 were included. Data were analyzed based on the distribution of absolute and relative frequencies (%). Results: The average age of the participants was 26 years old. Most were primiparous without previous fetal losses. Intrauterine Fetal Hypoxia was the most frequent cause of death (17.8%). Conclusion: Intrauterine fetal death is still a diagnosis that requires more visibility from the health system. It was verified the deficiency of records in medical records of important data, emphasizing the need to promote training and qualification for professionals who perform assistance

Association between coagulation function indicators and placental abruption among preeclampsia-eclampsia pregnant women / 中华预防医学杂志

Objective: To explore the association between coagulation function indicators and placental abruption (PA) in different trimesters of pregnancy among preeclampsia-eclampsia pregnant women. Methods: From February 2018 to December 2020, pregnant women who participated in the China birth cohort study and were diagnosed with preeclampsia, eclampsia and chronic hypertension with superimposed preeclampsia in Beijing Obstetrics and Gynecology Hospital were enrolled in this study. The baseline and follow-up information were collected by questionnaire survey, and the coagulation function indicators in the first and third trimesters were obtained through medical records. The Cox proportional hazards model was used to analyze the association between the coagulation function indicators and PA. A restrictive cubic spline curve was used to draw the dose-response curve between the relevant coagulation function indicators and PA. Results: A total of 1 340 participants were included in this study. The age was (32.50±4.24) and the incidence of PA was 4.4% (59/1 340). After adjusting for relevant factors, Cox proportional hazards model showed that compared with the high-level classification of fibrinogen (FIB), participants within the middle-(HR=3.28, 95%CI: 1.27-8.48) and low-level (HR=3.84, 95%CI: 1.40-10.53) classification during the first trimester and within the low-level classification (HR=4.18, 95%CI: 1.68-10.39) during the third trimester were more likely to experience PA. Compared with the middle-level classification of pro-thrombin time (PT), the risk of PA in the participants within the low-level classification (HR=2.67, 95%CI: 1.48-4.82) was significantly higher in the third trimester. The restrictive cubic spline analysis showed a linear negative association between FIB and PA in the first and third trimesters, while PT and PA showed an approximately L-shaped association . Conclusion: Among pregnant women diagnosed with preeclampsia-eclampsia, the middle-and low-level classification of FIB in the first and third trimesters and the low-level classification of PT in the third trimester could increase the risk of PA.

Perinatal risk factors for the occurrence of singleton apparently stillborn infants / 中国当代儿科杂志

OBJECTIVES@#To identify the perinatal risk factors for the occurrence of singleton apparently stillborn infants.@*METHODS@#This was a case-control study. A total of 154 singleton neonates with gestational age ≥28 weeks and Apgar score of 0-1 who were subsequently successfully resuscitated in the Obstetrics and Gynecology Hospital of Fudan University from January 2006 to December 2015 were enrolled as the case group (apparently stillborn group). A total of 616 singleton infants born from January 2006 to December 2015 (1-minute Apgar score >1) were randomly selected in a 1:4 ratio as the control group. Univariate analysis and multivariate logistic regression were used to analyze the perinatal risk factors for the occurrence of apparently stillborn infants.@*RESULTS@#The gestational age and birth weight in the apparently stillborn group were significantly lower than those in the control group (P<0.05). The incidences of fetal hydrops, cord prolapse, grade III meconium-stained amniotic fluid, placental abruption, breech presentation, severe pre-eclampsia, maternal general anesthesia at delivery, abnormal antenatal fetal heart monitoring and decreased fetal movement were significantly higher in the apparently stillborn group than those in the control group (P<0.05). The multivariate logistic analysis showed that the mother had general anesthesia at delivery (OR=34.520), decreased antenatal fetal movement (OR=28.168),placental abruption (OR=15.641), grade III meconium-stained amniotic fluid (OR=6.365), abnormal antenatal fetal heart monitoring (OR=5.739), and breech presentation (OR=2.614) were risk factors for the occurrence of apparently stillborn infants (P<0.05), while higher gestational age was a protective factor (OR=0.686, P<0.05).@*CONCLUSIONS@#Attention needs to be paid to mothers with abnormal prenatal fetal heart monitoring, decreased fetal movement, preterm labor, placental abruption, breech presentation, grade III meconium-stained amniotic fluid, and general anesthesia. Preparations for resuscitation should be done to rescue apparently stillborn infants.

Percepção sobre o cuidado à perda gestacional: estudo qualitativo com casais brasileiros / Perceptions on pregnancy loss care: a qualitative study with brazilian couples / Percepción sobre la atención a la pérdida del embarazo: estudio cualitativo con parejas brasileñas

Este artigo analisou a percepção e os sentimentos de casais sobre o atendimento recebido nos serviços de saúde acessados em função de perda gestacional (óbito fetal ante e intraparto). O convite para a pesquisa foi divulgado em mídias sociais (Instagram e Facebook). Dos 66 casais que contataram a equipe, 12 participaram do estudo, cuja coleta de dados ocorreu em 2018. Os casais responderam conjuntamente a uma ficha de dados sociodemográficos e uma entrevista semiestruturada, realizada presencialmente (n=4) ou por videochamada (n=8). Os dados foram gravados em áudio e posteriormente transcritos. A Análise Temática indutiva das entrevistas identificou cinco temas: sentimento de impotência, iatrogenia vivida nos serviços, falta de cuidado em saúde mental, não reconhecimento da perda como evento com consequências emocionais negativas, e características do bom atendimento. Os achados demonstraram situações de violência, comunicação deficitária, desvalorização das perdas precoces, falta de suporte para contato com o bebê falecido e rotinas pouco humanizadas, especialmente durante a internação após a perda. Para aprimorar a assistência às famílias enlutadas, sugere-se qualificação profissional, ampliação da visibilidade do tema entre diferentes atores e reorganização dos serviços, considerando uma diretriz clínica para atenção ao luto perinatal, com destaque para o fortalecimento da inserção de equipes de saúde mental no contexto hospitalar.(AU)

This study analyzed couples' perceptions and feelings about pregnancy loss care (ante and intrapartum fetal death). A research invitation was published on social media (Instagram and Facebook) and data collection took place in 2018. Of the 66 couples who contacted the research team, 12 participated in the study by filling a sociodemographic questionnaire and answering a semi-structured interview in person (n=04) or by video call (n=08). All interviews were audio recorded, transcribed, and examined by Inductive Thematic Analysis, which identified five themes: feelings of impotence, iatrogenic experiences in health services, lack of mental health care, not recognizing pregnancy loss as an emotionally overwhelming event, and aspects of good healthcare. Analysis showed experiences of violence, poor communication, devaluation of early losses, lack of support for contact with the deceased baby, and dehumanizing routines, especially during hospitalization after loss. Professional qualification, extended pregnancy loss visibility among different stakeholders, and reorganization of health services are needed to improve the care offered to grieving families, considering a clinical guideline for perinatal grief care with emphasis on strengthening the insertion of mental health teams in the hospital context.(AU)

Este estudio analizó las percepciones y sentimientos de parejas sobre la atención recibida en los servicios de salud a los que accedieron debido a la pérdida del embarazo (muerte fetal ante e intraparto). La invitación al estudio se publicó en las redes sociales (Instagram y Facebook). De las 66 parejas que se contactaron con el equipo, 12 participaron en el estudio, cuya recolección de datos se realizó en 2018. Las parejas respondieron un formulario de datos sociodemográficos y realizaron una entrevista semiestructurada presencialmente (n=4) o por videollamada (n=08). Los datos se grabaron en audio para su posterior transcripción. El análisis temático inductivo identificó cinco temas: Sentimiento de impotencia, experiencias iatrogénicas en los servicios, falta de atención a la salud mental, falta de reconocimiento de la pérdida como un evento con consecuencias emocionales negativas y características de buena atención. Los hallazgos evidenciaron situaciones de violencia, comunicación deficiente, desvalorización de las pérdidas tempranas, falta de apoyo para el contacto con el bebé fallecido y rutinas poco humanizadas, especialmente durante la hospitalización tras la pérdida. Para mejorar la atención a las familias en duelo, se sugiere capacitación profesional, ampliación de la visibilidad del tema entre los diferentes actores y reorganización de los servicios, teniendo en cuenta una guía clínica para la atención del duelo perinatal, enfocada en fortalecer la inserción de los equipos de salud mental en el contexto hospitalario.(AU)

Medical treatment in pregnant women with subclinical hypothyroidism: systematic review and meta-analysis / Tratamiento médico en gestantes con hipotiroidismo subclínico: revisión sistemática y meta-análisis

Abstract Objectives: to determine the effectiveness of medical therapy in reducing complications associated with subclinical hypothyroidism during pregnancy. Methods: in 2021, a systematic review of available cohort studies was carried out in three databases, with no publication date limit. Study selection and data extraction were performed in duplicate. Random-effects meta-analysis was performed, and odds ratios were calculated, with the corresponding 95% confidence intervals. Cohort risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). The certainty of the evidence was assessed using the GRADE methodology. Results: five studies were included for qualitative and quantitative synthesis. A statistically significant relationship was found between medical treatment in pregnant women with subclinical hypothyroidism with respect to spontaneous abortion (p=0.03; OR=0.77; CI95%=0.61-0.97), and no statistically significant relationship was found for delivery preterm (p=0.46; OR=1.11; CI95%=0.85-1.44), nor for abrupt placentae (p=0.56; OR=1.60; CI95%=0.33-7.66). Three studies were at moderate risk of bias, and two were at low risk of bias. In all the results the certainty was very low. Conclusions: medical treatment of subclinical hypothyroidism during pregnancy can have a beneficial effect in reducing cases of spontaneous abortion.

Resumo Objetivos: determinar la efectividad de la terapia médica para disminuir las complicaciones asociadas al hipotiroidismo subclínico durante la gestación. Métodos: en el 2021 se realizó una revisión sistemática de estudios de cohortes disponibles en tres bases de datos, sin límite de fecha de publicación. La selección de estudios y extracción de datos se realizaron por duplicado. Se realizó metaanálisis de efectos aleatorios y se calcularon los Odds ratio, con los correspondientes intervalos de confanza al 95%. El riesgo de sesgo de las cohortes se evaluó mediante la escala de Newcastle-Ottawa (NOS). La certeza de la evidencia se evaluó con la metodología GRADE. Resultados: cinco estudios fueron incluidos para síntesis cualitativa y cuantitativa. Se encontró una relación estadísticamente significativa del tratamiento médico en gestantes con hipotiroidismo subclínico con respecto al aborto espontáneo (p=0,03; OR=0,77; IC95%=0,61-0.97), no se encontró relación estadísticamente significativa para parto pre término (p=0.46; OR=1,11; IC95%=0.85-1.44), ni para abrupto placentae (p=0.56; OR=1,60; IC95%=0.33-7.66). Tres estudios tenían riesgo moderado de sesgo, y dos tenían riesgo de sesgo bajo. En todos los resultados la certeza fue muy baja. Conclusiones: el tratamiento médico del hipotiroidismo subclínico durante la gestación puede tener un efecto beneficioso para reducir los casos de aborto espontaneo.

Rotura uterina: da suspeita ao tratamento / Uterine rupture: from suspicion to treatment

A rotura uterina durante a gravidez ou trabalho de parto é uma grave complicação obstétrica ainda responsável por elevada morbimortalidade materna e perinatal. É importante o diagnóstico diferencial de outras hemorragias da segunda metade da gravidez, como o descolamento prematuro da placenta e a placenta prévia. O diagnóstico é feito baseado em uma associação de sinais bem comuns da rotura uterina. O tratamento sempre é cirúrgico, mas varia de acordo com a classificação da emergência. A prevenção é realizada por meio da atenção obstétrica cuidadosa e com implementação das boas práticas de assistência ao parto.(AU)

Uterine rupture during pregnancy or labor is a serious obstetric complication still responsible for high maternal and perinatal morbidity and mortality. Differential diagnosis of other hemorrhages in the second half of pregnancy, such as placental abruption and placenta previa, is important. The diagnosis is made based on an association of very common signs of uterine rupture. Treatment is always surgical but varies according to the classification of the emergency. Prevention is carried out through careful obstetric care and the implementation of good childbirth care practices.(AU)

Infección por listeria monocytogenes en el embarazo, asociado a desprendimiento de placenta y complicaciones perinatales: reporte de un caso / Listeria monocytogenes infection in pregnancy, associated with placental abruption and perinatal complications: case report

INTRODUCCIÓN la listeriosis, aunque es una infección infrecuente, debe ser considerada en pacientes inmunocomprometidos y gestantes, especialmente en aquellos que consumen alimentos crudos o productos lácteos no pasteurizados, lo que pone en riesgo a un gran número de mujeres embarazadas en países de habla hispana. Es importante que el médico considere su inclusión en los posibles diagnósticos diferenciales cuando la sospecha clínica lo amerite, lo que permitirá hacer un diagnóstico temprano y por lo tanto un tratamiento oportuno, evitando así las posibles complicaciones en el binomio madre-hijo. CASO CLÍNICO clínico multigestante, con embarazo de 33 + 5 semanas, que ingresó a una institución de alto nivel de complejidad en la ciudad de Medellín, Colombia, por síndrome febril asociado a sepsis obstétrica debido a infección intraamniótica por Listeria monocytogenes, que requirió cesárea de urgencia, en donde se evidenció un desprendimiento placentario del 100 % secundario al proceso infeccioso y asociado a complicaciones neonatales. CONCLUSIONES: el diagnóstico de listeriosis gestacional supone un reto clínico por su presentación inespecífica y baja incidencia. Sin embargo, las consecuencias obstétricas arrastran una gran morbilidad de la madre y morbi-mortalidad neonatal, lo que hace de suma importancia que el clínico lo tenga presente en su arsenal diagnóstico, ya que una vez diagnosticado, el tratamiento oportuno tiene desenlaces clínicos favorables.

INTRODUCTION: although listeriosis is a rare infection, it should be considered in immunocompromised patients and pregnancy, especially in those who consume raw food or unpasteurized dairy, which puts a large number of pregnant women in Hispanic countries at risk. It is of special importance for physicians to include listeriosis among possible diagnoses when clinical suspicion arises in order to timely treat it and thus avoid the complications that may occur in the mother-child binomial. CLINICAL CASE: a pregnant woman (33 + 5 weeks) with multiple gestations, was admitted to a high level of complexity institution in the city of Medellín, Colombia, presenting a febrile syndrome associated with obstetric sepsis due to intra-amniotic infection by Listeria monocytogenes, which required emergency cesarean section where a 100 % placental abruption was evidenced secondary to the infectious process and associated with neonatal complications. CONCLUSIONS: The diagnosis of gestational listeriosis is a clinical challenge due to its nonspecific presentation and low incidence. However, the obstetric consequences drag a great maternal morbidity and neonatal morbidity and mortality, which is why it is important for physicians to consider this in the diagnostic arsenal because once diagnosed, the appropriate treatment has favorable clinical outcomes.

Smoking Exposure and Placental Vascular Compromise: A Nationwide Population-Based Study in South Korea

PURPOSE: This study aims to investigate the effects of smoking on the development of placenta-associated syndromes, including preeclampsia, abruptio placentae, and placenta previa, which share the common pathophysiology of vascular compromise of the placenta. METHODS: A total of 966,629 pregnancies identified from the Korean National Insurance Claims Database and the National Health Information Database were analyzed from 2010 to 2014. The adjusted odds ratio and attributable risk of smoking for the development of placenta-associated syndromes, such as preeclampsia, placenta previa, and abruptio placentae, were analyzed. Maternal age, alcohol consumption, exercise habit, and economic status were controlled as confounding variables. A binary logistic regression model was used, and simple and multiple logistic regression analyses were performed. RESULTS: Among 966,629 pregnancies, 11.86% of women were ever smokers. Ever smokers had a higher risk of developing placenta previa (adjusted odds ratio, 1.23; 95% confidence interval [CI], 1.18–1.29; adjusted attributable risk, 18.70%). The adjusted odds ratio of developing placenta-associated syndromes in ever smokers compared to nonsmokers over the age of 35 years with a low economic status was 1.32 (95% CI, 1.18–1.47), with an adjusted attributable risk of 23.95%. CONCLUSION: The risk of developing placenta-associated syndromes, such as preeclampsia, placenta previa, and abruptio placentae, is high in ever smokers. Pregnant ever smokers who are >35 years and belong to the lower one-third of the economic division require special care to prevent the development of placenta-associated syndromes.

First Korean case of factor V Leiden mutation in pregnant woman with a history of recurrent pregnancy loss

Thrombophilia refers to inherited or acquired hemostatic disorders that result in a predisposition to blood clot formation. When combined with the hypercoagulable state that is characteristic of pregnancy, there is an increased risk of severe and recurrent pregnancy complications. Activated protein C resistance caused by factor V Leiden (FVL) mutation is known to be the most common cause of inherited thrombophilia in Caucasian population. FVL mutation has been related to pregnancy complications associated with hypercoagulation, e.g. miscarriage, intrauterine fetal demise, placental abruption, and intrauterine growth retardation. Although the FVL mutation is easily detected using molecular DNA techniques, patients who are heterozygous for this disorder often remain asymptomatic until they develop a concurrent prothrombotic condition. Because there are potentially serious effects of FVL mutation for pregnancy, and because effective treatment strategies exist, early detection and treatment of this condition might be considered.

Management of disseminated intravascular coagulation associated with placental abruption and measures to improve outcomes

Placental abruption is a condition that should be carefully considered in perinatal management because it is associated with serious events in both the mother and neonate, such as intrauterine fetal death, cerebral palsy, obstetric critical bleeding, and uncontrollable bleeding. The concomitant presence of disseminated intravascular coagulation (DIC) more easily causes critical bleeding that may necessitate hysterectomy or multi-organ failure resulting in maternal death. Therefore, early management should be provided to prevent progression to serious conditions by performing both hemostatic procedures and DIC treatment. To take measures to improve the outcomes in both the mother and neonate, health guidance for pregnant women, early diagnosis, early treatment, development of the emergency care system, and provision of a system for transport to higher-level medical institutions should be implemented.

Disección espontánea de la arteria descendente anterior en gestante con desprendimiento prematuro de placenta normoinserta: reporte de caso / Case report spontaneous descending artery dissection in pregnant woman with premature placental abruption

La patología coronaria no es frecuente dentro de la población joven. El diagnóstico en la paciente obstétrica no es fácil dado los cambios fisiológicos que esta población presenta. La disección espontánea de una arteria coronaria es una afección muy poco frecuente que puede ser causa de isquemia miocárdica y asociarse a un síndrome coronario agudo. Se trata del caso de una paciente de sexo femenino de 38 años cursando 33 semanas de gestación, la cual presentó un síndrome coronario agudo con elevación del segmento ST, por una disección coronaria, desprendimiento prematuro de placenta normo inserta (DPPNI) y óbito fetal.

Coronary disease is infrequent among young population. Diagnosis in the obstetric population is not easy, due to the physiological changes that this population presents. Spontaneous coronary artery dissection, not a frequent medical condition, can be a cause of myocardial ischemia and be associated with and acute coronary syndrome. We present the case of a 38-year-old female patient, at 33 weeks gestation, who presented an acute coronary syndrome with ST segment elevation, caused by coronary artery dissection. This syndrome was accompanied with abruptio placentae and fetal death.

Prevalencia de preeclampsia en embarazadas en el servicio de ginecología y obstetricia del Hospital Central del Instituto de Previsión Social, 2017 / Prevalence of preeclampsia in pregnant women in the gynecology and obstetrics service of the Central Hospital of the Social Security Institute, 2017

Introducción: Los trastornos hipertensivos son la primera causa de muerte materna en los países desarrollados y la tercera causa de muerte materna en los países en vías de desarrollo. La preeclampsia es una enfermedad de origen desconocido y multifactorial cuyo tratamiento definitivo es el parto, además de ser causal de repercusiones sobre la madre y el recién nacido. Objetivo: El objetivo general del estudio fue determinar la Prevalencia de preeclampsia en embarazadas en el servicio de ginecología y obstetricia del hospital central del instituto de previsión social, 2017. Materiales y métodos: Estudio observacional descriptivo retrospectivo de corte transversal, con muestreo no probabilístico de casos consecutivos. Fueron incluidas todas las embarazadas con preeclampsia que acudieron al Servicio de Ginecología y Obstetricia del Hospital Central de Instituto de Previsión Social en el periodo comprendido entre los meses de enero a diciembre del año 2017. Resultados: Se realizó un estudio observacional descriptivo retrospectivo en 375 pacientes que acudieron al Hospital Central del Instituto de Previsión Social en el año 2017. Los resultados arrojaron que el 38,4% presentó preeclampsia de las cuales 63,2% presentaba en preeclampsia leve y 36,8% presentaba preeclampsia severa Entre los factores de riesgo el que apareció en mayor cantidad fue la Hipertensión Arterial Crónica. En cuanto a las complicaciones maternas se presentan en mayoría Hepáticas, Neurológicas y Renales. Conclusión: Los resultados de este estudio realizado en un centro de referencia nacional y de alta complejidad coinciden con estudio previo, determina datos importantes acerca de la prevalencia de preeclampsia.

Advanced maternal age and its association with placenta praevia and placental abruption: a meta-analysis / Idade materna avançada e sua associação com placenta prévia e descolamento placentário: uma metanálise / Edad materna avanzada y su asociación con placenta previa y desprendimiento de la placenta: un metanálisis

This study aimed to investigate the existence and magnitude of the association between advanced maternal age (AMA) and occurrence of placenta praevia (PP) and placental abruption (PA) among nulliparous and multiparous women, by a systematic review and meta-analysis. We searched articles published between January 1, 2005 and December 31, 2015, in any language, in the following databases: PubMed, Scopus, Web of Science, and LILACS. Women were grouped into two age categories: up to 34 years old and 35 years or older. The Newcastle-Ottawa Scale was used to evaluate the methodological quality of the studies. A meta-analysis was conducted for the PP and PA outcomes, using a meta-regression model to find possible covariates associated with heterogeneity among the studies and Egger's test to assess publication bias. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) system (CRD42016045594). Twenty-three studies met the criteria and were included in the meta-analysis. For both outcomes, an increase in age increased the magnitude of association strength, and PP (OR = 3.16, 95%CI: 2.79-3.57) was more strongly associated with AMA than PA (OR = 1.44, 95%CI: 1.35-1.54). For parity, there was no difference between nulliparous and multiparous women considered older for the PP and PA outcomes. Our review provided very low-quality evidence for both outcomes, since it encompasses observational studies with high statistical heterogeneity, diversity of populations, no control of confounding factors in several cases, and publication bias. However, the confidence intervals were small and there is a dose-response gradient, as well as a large magnitude of effect for PP.

Este estudo teve como objetivo investigar a existência e magnitude da associação entre idade materna avançada (AMA) e ocorrência de placenta prévia (PP) e descolamento placentário (DP) entre mulheres nulíparas e multíparas, por meio de uma revisão sistemática e meta-análise. Nós pesquisamos artigos publicados entre 1º de janeiro de 2005 e 31 de dezembro de 2015, em qualquer idioma, nos seguintes bancos de dados: PubMed, Scopus, Web of Science e LILACS. As mulheres foram agrupadas em duas categorias de idade: até 34 anos e 35 anos ou mais. A Escala Newcastle-Ottawa foi utilizada para avaliar a qualidade metodológica dos estudos. Uma meta-análise foi realizada para os desfechos PP e DP, usando um modelo de meta-regressão para encontrar possíveis covariáveis associadas à heterogeneidade entre os estudos e o teste de Egger para avaliar o viés de publicação. O protocolo desta revisão sistemática foi registrado no sistema PROSPERO (CRD42016045594). Vinte e três estudos preencheram os critérios e foram incluídos na meta-análise. Para ambos os resultados, um idade mais avançada aumentou a magnitude da associação, e PP (OR = 3,16, IC95%: 2,79-3,57) foi mais fortemente associado com AMA do que DP (OR = 1,44, IC95%: 1,35-1,54). Ao estratificar por paridade, não houve diferença entre nulíparas e multíparas de idade materna avançada para os desfechos de PP e DP. Nossa revisão forneceu evidências de baixa qualidade para ambos os resultados, uma vez que abrange estudos observacionais com alta heterogeneidade estatística, diversidade de populações, sem controle de fatores de confundimento em vários casos e viés de publicação. No entanto, os intervalos de confiança eram pequenos e há um gradiente dose-resposta, bem como uma grande amplitude de efeito para o PP.

Este estudio tuvo como objetivo investigar la existencia y la magnitud de la asociación entre la edad materna avanzada (AMA) y la aparición de placenta previa (PP) y desprendimiento de la placenta (DP) entre mujeres nulíparas y multíparas, mediante una revisión sistemática y un metanálisis. Se realizaron búsquedas en los artículos publicados entre el 1º de enero de 2005 y el 31 de diciembre de 2015, en cualquier idioma, en las siguientes bases de datos: PubMed, Scopus, Web of Science y LILACS. Las mujeres se agruparon en dos categorías de edad: hasta 34 años y 35 años o más. La Escala Newcastle-Ottawa se utilizó para evaluar la calidad metodológica de los estudios. Se realizó un metanálisis para los resultados de PP y DP, utilizando un modelo de metarregresión para encontrar posibles covariables asociadas con la heterogeneidad entre los estudios y la prueba de Egger para evaluar el sesgo de publicación. El protocolo de esta revisión sistemática se registró en el Sistema PROSPERO (CRD42016045594). Veintitrés estudios cumplieron los criterios y se incluyeron en el metanálisis. Para ambos resultados, una edad más avanzada aumentó la magnitud de la fuerza de asociación, y PP (OR = 3,16, IC95%: 2,79-3,57) se asoció más fuertemente con AMA que DP (OR = 1,44, IC95%: 1,35-1,54). Cuando se estratificó por paridad, no hubo diferencia entre las mujeres nulíparas y las multíparas consideradas mayores para los resultados de PP y DP. Nuestra revisión proporcionó pruebas de muy baja calidad para ambos resultados, ya que abarca estudios observacionales con alta heterogeneidad estadística, diversidad de poblaciones, ausencia de control de los factores de confusión en varios casos y sesgo de publicación. Sin embargo, los intervalos de confianza fueron pequeños y existe un gradiente de dosis-respuesta, así como una gran magnitud de efecto para PP.

Cesación de tabaquismo en embarazo / Smoking cessation in pregnancy

Resumen En Chile, las mujeres en edad fértil y las embarazadas presentan una alta prevalencia de tabaquismo. El consumo de tabaco durante el embarazo tiene efectos prenatales (por ejemplo, aborto espontáneo, mortinatalidad) y es un factor de riesgo de morbilidad y mortalidad infantil. Todas las mujeres en edad fértil deben ser alentadas a dejar de fumar, y las mujeres que ya están embarazadas deben ser alentadas a dejar de fumar continuamente durante todo el embarazo, desde el momento más precoz posible hasta el período posterior al parto. Se presenta un conjunto de antecedentes y recomendaciones para la cesación de tabaquismo en embarazadas, basadas en guías internacionales sobre este tema.

In Chile, women of childbearing age and pregnant women have a high prevalence of smoking. Tobacco use during pregnancy has antenatal effects (spontaneous abortion, stillbirth) and it is a risk factor for infant morbidity and mortality. All women of childbearing age should be encouraged to quit smoking, and women who are already pregnant should be encouraged to stop smoking continuously throughout the pregnancy, from the earliest possible moment to the postpartum period. We present a set of background information and recommendations for smoking cessation in pregnant women, based on international guidelines on this topic.

Evolución y aspectos ecográficos del desprendimiento crónico de placenta / Evolution and ultrasound aspects of chronic placental abruption

El desprendimiento crónico de placenta se caracteriza por la aparición de un sangrado venoso crónico intra o retroplacentario que produce la separación paulatina de la misma. Es poco frecuente y se puede presentar en pacientes sin factores de riesgo. La imagen ecográfica plantea diagnóstico diferencial con la corioamnionitis. El pronóstico fetal es malo especialmente si se asocia con oligoamnios. Se presentan cuatro casos caracterizados por imagen ecográfica característica, retraso del crecimiento fetal, alteración del Doppler, y confirmación anatomopatológica.

Chronic placental abruption is due to intra or retroplacental insidious bleeding that causes progressive separation from the uterine wall. It is a rare condition and can occur in low risk patients. Chronic abruption imaging poses differential diagnosis with infectious TORCH chorioamnionitis. Fetal prognosis is ominous especially in the presence of oligohydramnios. We present four cases with a common ultrasound appearance, fetal growth restriction, Doppler abnormalities and pathological confirmation.

Evaluation of the Success Rate Following Amnioinfusion in Pregnant Women Undergoing External Cephalic Version after Initial Failure

PURPOSE: To evaluate the success rate following amnioinfusion in pregnant women undergoing external cephalic version (ECV) after initial failure. METHODS: This prospective study enrolled 17 consecutive pregnant women from October 2013 to May 2015. ECV was performed with amnioinfusion after initial failure. The success rates of ECV and vaginal delivery, including pregnancy outcomes, were analyzed. RESULTS: ECV was performed at an average of 37.3±0.6 weeks of gestational age. Eight of seventeen patients were nulliparous. The estimated fetal weight was 2,688±279 g, and the amniotic fluid index was 6.4±2.6 cm. The overall success rate of ECV was 70.6% (12/17), and the success rates in nulliparous and multiparous women were 75.0% (6/8) and 66.7% (6/9), respectively. The rate of emergent cesarean section within 24 hours was 11.8% (2/17). Excluding one women who were lost to follow-up, the rate of normal vaginal delivery was 81.8% (9/11) among the women who had successful ECV. We did not observe any complications such as uterine rupture, placental abruption, or intrauterine fetal death. CONCLUSION: Although ECV with amnioinfusion after initial failure might help increase the success rate of ECV, it needs to be further evaluated in larger studies.

Grandmultiparas; frequency of hypertension placental abruption and postpartum haemorrhage in

Intrapartum complications that are classically associated with grandmultiparas include fetal malpresentation, dysfunctional labour, chronic hypertension, abruptio placentae, postpartum haemorrhage and macrosomic babies. Excellent maternal and fetal outcome is possible in grandmultiparas with improvement in health care system and free provision of health facilities to all pregnant women. The objective of the study was: to find the frequency of hypertension, placental abruption and primary postpartum hemorrhage in grandmultiparas. It was a prospective study with descriptive pattern. Gynaecology and Obstetric unit-I of Allied Hospital, Punjab Medical College Faisalabad. January to June 2006. Eighty patients were included in the study. Eighty grandmultiparas were randomly selected for the study. Detailed evaluation of all patients was done by thorough history, examination and investigation. Patients were analyzed for complications during pregnancy, labour and delivery, especially hypertension, placental abruption and primary post partum haemorrhage. Hypertensive disorders found to be in 32 [33.8%], placental abruption in 7[8.8%] and postpartum hemorrhage in 19[23.8%] of grandmultiparas. It was concluded from the result of my study that grandmultiparity is still a major obstetric hazard in developing countries like Pakistan with higher incidence of complications. Safe maternal and perinatal outcome is possible in grandmultiparas with improvement in health care system and free provision of health care facilities to all pregnant women

Domestic violence causing abruptio placenta and feto-maternal death: case report on autopsy

A 22 year old primigravida with 28 weeks/7 months pregnancy was brought in police custody 10 hours after her death reported at a Tertiary Care Center, Karachi. There was a history of soft tissues direct abdominal trauma 10 hours back. On complete physical examination there were no external marks of violence except a contusion on her back of 5 cm diameter. The internal examination after opening the uterus, placenta was separated and baby was delivered after opening the amniotic sac. A fresh still birth of male baby with 1.5 kg was delivered. The chemical and histopathology report evidenced that uterus, fallopian tubes and ovaries had decidua with necrotic tissues, edema and congestion. The final opinion after receiving the chemical/histopathology reports on this post mortem was that the death occurred due to fetal hypoxemia developing secondary to maternal shock as a result of direct uterine trauma and disseminated intravascular coagulation [DIC]. DIC develops due to circulating placental products responsible for fetal losses. This case reports fetal hypoxemia developing secondary to maternal shock, maternal hypotension, abruptio placentae, direct uterine trauma and disseminated intravascular coagulation [DIC]

Descolamento prematuro de placenta / Placental abruption

O objetivo deste artigo é a revisão bibliográfica sobre descolamento prematuro de placenta, abordando suas manifestações clínicas, diagnóstico e manejo específico.

The purpose of this paper is a literature review on clinical manifestations, diagnosis and specific management of placental abruptio.