Associação entre via de parto e complicações maternas em hospital público da Grande São Paulo, Brasil / Association between mode of delivery and maternal complications in a public hospital in Greater Metropolitan São Paulo, Brazil

O estudo objetivou avaliar associação entre via de parto e complicações maternas. Realizou-se coorte retrospectiva com partos ocorridos durante o ano de 2003, em um hospital público. As complicações avaliadas foram: infecção, hemorragia, histerectomia, rotura uterina, lesão de órgão contíguo, trombose venosa profunda e embolia pulmonar. Utilizou-se a odds ratio (OR) e os testes de qui-quadrado de Pearson e de Fisher, além da regressão logística. Estabeleceu-se o nível de 0,05 como significante. Foram encontradas 15 complicações. Tomando-se o parto vaginal como referência, encontrou-se associação entre cesárea e as complicações tomadas em conjunto. Analisando-se variáveis confundidoras, encontrou-se associação das complicações com hipertensão, soropositividade para HIV, placenta prévia e descolamento prematuro de placenta. Após controle para estas quatro variáveis, manteve-se a associação entre cesárea e complicações (OR = 9,7; p = 0,04). Encontrou-se também associação entre complicações e cesárea eletiva comparada ao parto vaginal (OR = 4,7; p = 0,02), e maior proporção de complicações, no limite da significância estatística, nas cesáreas eletivas comparadas à "tentativa de parto vaginal" (OR = 3; p = 0,058). Conclui-se que a cesárea associa-se a complicações maternas, mesmo após a realização de vários ajustes.

The purpose of this study was to assess the relationship between mode of delivery and maternal complications, based on a retrospective cohort of all births at a public hospital in 2003. Complications included: infection, hemorrhage, hysterectomy, uterine rupture, lesions in adjacent organs, deep venous thrombosis, and pulmonary embolism. The analysis used odds ratio (OR), chi-squared test, and Fisher's exact test, besides logistic regression. Fifteen complications were identified. Taking vaginal delivery as the reference, an association was found between cesarean section and overall complications. Analysis of confounding showed an association between hypertension, HIV, placenta previa, and abruptio placentae. After controlling for these variables, an association remained between overall complications and cesarean section (OR = 9.7; p = 0.04). Another analysis comparing elective cesareans and vaginal deliveries also showed an increased risk for cesarean (OR = 4.7; p = 0.02). Finally, comparing elective cesareans with trial of labor, we found an increased proportion of complications in elective cesareans, with borderline significance (OR = 3; p = 0.058). We concluded that cesarean section is associated with maternal morbidity, even after controlling for confounders.

Placenta Praevia: Review of Clinical Presentation and Management in a Nigerian Teaching Hospital

Background: The study aims at reviewing the clinical presentation and management of placenta praevia in a tertiary health facility. Method: This is a retrospective study of 59 cases of placenta praevia managed at the Nnamdi Azikiwe University Teaching Hospital; Nnewi from January 1997 to December 2001. The case records of 44 of the patients were obtained from the hospital medical records department and analysed. Results: During the five year period; there were 3565 deliveries and 59 cases of placenta praevia giving an incidence of 1.65. Thirty four (77.3) occurred in women aged 35 years and below. The commonest was type III (12 cases; 27.3) followed by type IV (10 cases; 22.7). Previous uterine scar was associated with 22 (50.0) cases. Age had no statistically significant effect on the prevalence. The commonest GA range at presentation (13; 29.6) and at delivery (18; 40.9) was 37-40 weeks. The commonest mode of presentation was antepartum haemorrhage (34;77.3) followed by abnormal lie and malpresentation (4 each; 9.1). The average admission delivery interval was one week in 33 (75.0) cases and only two (4.5) received blood transfusion. Forty (90.9) women had caesarean delivery while 12 (27.3) babies were of low birth weight. There were only 2 (4.5) fetal deaths and one (2.3) caesarean hysterectomy. Conclusion: The commonest predisposing factor to placenta praevia in this study is previous uterine scar. Judicious use of caesarean section especially in the primigravida will help reduce the incidence of placenta praevia. Also a screening ultrasonography at 34-36 weeks gestation (especially in women with previously scarred uterus) is recommended

Placenta previa; a study to determine responsible factors

To determine the factors suspected to be associated with placenta praevia. It was a case control analytical study. Department of Obstetrics and Gynaecology Unit-I, Bahawal Victoria Hospital, Bahawalpur. This study was conducted from 13th August 2004 to 12th February 2005. 50 cases of placenta praevia was selected on the basis of ultrasonography from out patients, emergency and indoor patients. 250 controls were taken [50 for each variable i.e. age, parity, previous history of caesarean section, smoking and previous history of placenta previa] and were divided into 5 groups after matching. The study revealed that placenta praevia was more prevalent in elderly patients [72%], grand multiparas [68%] in patient with history of previous caesarean deliveries [52%] and in patients who smoked [30%] but this study did not identify previous history of placenta praevia [44%] as a risk factor for subsequent pregnancies. It was concluded that maternal and fetal mortality can be reduced by identifying high risk patients [in whom any of above mentioned risk factors were present] and educating them for care about next pregnancy

Obstetric hysterectomy: a 14-year experience of Rajavithi Hospital 1989-2002.

OBJECTIVES: To review and compare the incidence rate of obstetric hysterectomised patients between two seven-year periods. Theperiods were from October 1, 1988 to September 30, 1995 andfrom October P', 1995 to September 30th, 2002. The data included demographic characteristics, indications, possible risk factors, complications, and operative managements. MATERIAL AND METHOD: Retrospective analysis of the data that was collected from medical and labor records of the obstetric hysterectomised patientsfrom October 1, 1995 to September 30, 2002, the second seven-year period, compared with those in Pratumthong and Wattanaruangkowit's study from October 1, 1988 to September 30, 1995, the first seven-year period. RESULTS: Between 1998 and 2002, there were 201, 696 total deliveries with 111 obstetric hysterectomies. A significant increase in the average incidence rate of hysterectomy from 0.42 to 0.76/1000 deliveries and maternal age, placenta previa and blood transfusion in the second period compared with the first period (p < 0.05). Postoperative complications and the other risk factors of obstetric hysterectomy were not significant difference. CONCLUSION: The present study of obstetric hysterectomy demonstrates a significant increase in the incidence of hysterectomised rate, maternal age, blood transfusion, and placenta previa in the second period compared with the first period.

Aspectos epidemiológicos, prognósticos e de manejo nas gestações associadas a placenta prévia / Epidemiological, prognostic and management aspects in pregnancies associated with placenta previa

Entre as patologias hemorrágicas da segunda metade da gestação, a placenta prévia ocupa lugar destacado, tanto pela freqüência e características com que se apresenta clinicamente, quanto pelas formas de tratamento. Isto leva o obstetra a tangenciar entre a conduta que vai desde uma simples observação até a realização de procedimentos muitas vezes revestidos de dramático desfecho. Dentre os fatores que podem estar relacionados diretamente com seu aparecimento destacam-se, por sua relevância, a idade materna e a multiparidade, os abortamentos anteriores, as cicatrizes uterinas prévias, a gemelaridade e o tabagismo. Os autores apresentam breve atualização sobre os principais aspectos epidemiológicos e o prognóstico materno e perinatal relacionados com gestações associadas à placenta prévia e seu manejo em distintas situações de interesse clínico.

Antecedente de cesárea como fator de risco para placenta prévia / Prior history of cesarean delivery as a risk factor for placenta previa

A placenta prévia tem sido reconhecida como importante fator determinante de morbidade materna e resultados perinatais adversos. Alguns estudos têm observado aumento na freqüência de placenta prévia em mulheres com antecedente de operação cesariana, sugerindo associação com procedimentos cirúrgicos que possam prejudicar a cavidade uterina. O dano endometrial e miometrial provocado durante a cesárea podem favorecer a inserção baixa da placenta na cavidade uterina. Entre mulheres com placenta prévia, o risco de placenta acreta aumenta naquelas que apresentam história de duas ou mais cesáreas anteriores. Gestantes que optam pela cesárea (como via de parto) devem ser alertadas quanto ao maior risco para desenvolvimento de placenta prévia em gestação subseqüente.

Placenta previa and it's relation with maternal age, gravidity and cesarean section.

The placenta provides the essential connection between the mother and the developing fetus. Placental position were routinely mentioned in an ultrasound report starting from early second trimester to the end of third trimester when asked for pregnancy evaluation. The aim of this study was to see the prevalence of lower segment placenta (placenta previa) and its relations with previous cesarean section delivery, parity and maternal age. The study conducted in Centre for Nuclear Medicine and Ultrasound (CNMU) Mymensingh in a period from January 2001 to December 2002. About 2536 pregnant women (those included in this study) underwent ultrasound examination during pregnancy at third trimester. The prevalence of lower segment placenta was 1.34%. The highest prevalence of placenta previa (2.58%) was seen in 3rd and higher gravida group. Also the highest prevalence were seen 30 yr. and above age group in compare to below 30 yr. age group. No increased prevalence of placenta previa were seen in previous cesarean section (C / S) delivery group (0.65%) in compare to normal delivery group (1.97%). From our study it was seen that development of lower segment placenta has relation with increased number of gravidity and maternal age but no increased prevalence were seen in subjects with previously done cesarean section

Placenta praevia : facteurs epidemiologiques et pronostic foeto-maternel

La Lp(a) est une lipoparticule ayant des proprietes atherogene et thrombogene. Chez le caucasien; le taux seuil atherogene est estime a 0;30 gfl. Plusieurs etudes realisees chez le sujet de race noire n'ont pas permi de definir un taux seuil. Notre etude est une metaanalyse de six travaux realises en Cote d'Ivoire dont l'objectif principal est de preciser l'interet diagnostic de la Lp(a) chez le sujet ivoirien atteint d'affections cardiovasculaires ou d'affections a risque cardiovasculaires. Celle metaanalyse a permi de montrer que: Le taux serique moyen de la Lp(a) dose chez 1'Ivoirien sain par immunonephelemetrie etait significativement plus eleve que les taux seriques moyens de Lp(a) determines par IDR(0.34 +/-0.26g/l) et par la technique ELISA (0.33 +1- 0.28 g/l). Cependant; quelque soit la technique de dosage; le taux moyen de la Lp(a) retrouve chez l'ivoirien sain est superieur au seuil de risque cardiovasculaire determine chez les caucasiens qui est de 0.3g/1. Les taux seriques moyens de la Lp(a) des sujets atteints d'affections cardiovasculaires(AVC; IDM) et d'affections a risque cardiovasculaire (Diabete; HTA) ne different pas significativement; mais sont significativement plus eleves que les taux seriques moyens observes chez les sujets sains. La distribution des taux seriques de la Lp(a) a montre que 51pour cent des taux seriques doses par immunonephelemetrie etaient superieurs a 0.3g/l; tandis que le pourcentage de taux seriques de la Lp(a) dosee par ELISA superieurs a 0.3g/1 etait de 30pour cent; chez l'ivoirien sain. 68.8pour cent des sujets diabetiques; 84pour cent des patients hypertendus et 70pour cent des sujets atteints d'AVC et d'IDM avaient un taux de Lp(a) superieur a 0.3g/l. L'etude des correlations a montre une correlation significative et positive entre Lp(a) et le cholesterol total aussi bien chez les malades que chez les temoins; et une correlation significative et positive enlie la Lp(a) et l'apoB chez les malades uniquement. La correlation observee entre Lp(a) et le cholesterol total etait plus forte chez les malades que chez les temoins. L'etude des phenotypes de l'apo(a) a permis d'identifier 15 isoformes dans la population etudiee constituee de sujets ivoiriens sains. La taille de ces isoformes varie de 13 a 33 kiingle 4. Le phenotype 54 chez les homozygotes (43;33pour cent) et S3/S4 chez les heterozygotes (20pour cent) etaient les plus frequents. Aucun phenotype nul n'a ete detecte. D'autre part; aucune correlation n'a ete retrouvee entre la taille des isoformes de l'apo(a) et les taux seriques de la Lp(a)

Placenta previa and the role of tocolytic therapy study at Jordan University Hospital

to study the incidence of placenta previa and aspects of its management [tocolytic treatment] at Jordan University Hospital. prospective and retrospective analysis of 115 women with placenta previa who were admitted over a 6-year period. Fifty-six cases of preterm placenta previa with initial episode of vaginal bleeding were selected. Thirty-three cases were treated with Ritodrine after documentation of uterine contractions and 23 [control group] were not treated. Outcome variables were birth weight, interval from admission until delivery, incidence of recurrent bleeding, and need for blood transfusion. the use of Ritodrine was associated with significant improvement in birth weight [2510 gm vs. 2210 gm, p<0.04 and interval from bleeding until delivery [39.6 vs. 27.4 days, p<0.02]. There was no statistical difference with regard to the incidence of recurrent bleeding, but there was a trend to postpartum blood transfusion in the treated group. Conclusions: use of tocolytic therapy may prolong pregnancy; however, its role in preventing vaginal bleeding needs further exploration

Placenta previa. incidencia, algunas consideraciones y su repercusión en la morbimortalidad perinatal y materna, 1995-1996 / Placenta previa. Incidence, some considerations and its repercussion on perinatal and maternal morbimortality, 1995-1996

Constituyendo la placenta previa una de las gestorragias frecuentes en la segunda mitad de la gestación, motivó un estudio en el Hospital Docente Ginecoobstétrico de Matanzas "Julio Alfonso Medina", durante los años comprendidos de 1995-1996 a las pacientes ingresadas en la referida institución y que se les diagnosticó una placenta previa; diagnosticada por métodos clínicos y auxiliares diagnósticos. La muestra estuvo constituida por un total de 6 398 partos, 20 de los cuales fueron clasificados como placentas previas, para una incidencia de 0,31 porciento. Se utilizó el método del tanto por ciento y se elaboraron tablas estadísticas que permitieron estudiar variables de interés que demostraron: Edades con mejores condiciones de fertilidad y a partir del segundo parto son los grupos de mayor riesgo, así como los antecedentes de aborto y cesárea anterior. Predominó el parto por cesárea en gestación pretérmino y pesos fetales bajos. Conteo de Apgar bajo no tuvo influencia ni participación en la mortalidad perinatal. Fue un terreno propicio para la morbilidad materna, no así la mortalidad

Placenta previa/acreta y cesárea previa. Experiencia de cinco años en el Instituto Nacional de Perinatología / Placenta previa/accreta and previous cesarean section. Experiencie of five years at Instituto Nacional de Perinatología

Doscientos diez casos con placenta previa fueron revisados en 1989 a 1994. En 37 (17.6 por ciento) de ellos se presentó acretismo placentario. De los casos de acretismo, solo en 26 (70.2 por ciento) se tuvo el antecedente de cesárea. La edad media fue de 31 años; el grupo de mayor riesgo fue de 35-39 años con 26 por ciento de casos de acretismo. La paridad media fue de 3; en el grupo de 5 gestas, 33.3 por ciento desarrolló acretismo placentario. En el grupo donde no se presentó antecedente de cesárea el riesgo de acretismo fue de 9.4 por ciento, con una cesárea fue de 21.1 por ciento, pero con dos o más fueron de 50 por ciento. En presencia de placenta previa, edad avanzada y dos o más cesáreas, el riesgo de acretismo placentario es alto

Placenta prévia, 33 casos ocorridos no Hospital Universitário de Santa Maria nos anos de 1982 a 1986 / Placenta praevia, 33 cases occurred in University Hospital of Santa Maria from 1982 to 1986

Os autores apresentam 33 casos de placenta prévia (PP), ocorridos no HUSM no período de 1982 a 1986. A placenta prévia constitui-se um dos acidentes hemorrágicos do 3§ semestre da gestaçäo, apresentando o seu estudo grande importância pela frequência e alteraçöes que determina puerperalidade, pela mortalidade fetal e materna ainda elevada e pela dramaticidade dos seus quadros (2). Os casos estudados no presente trabalho, tiveram na maioria boa evoluçäo

Placenta prévia: estudo de 64 casos na Maternidade da Encruzilhada em 1987 / Placenta praevia: study of 64 cases at the Maternidade da Encruzilhada in 1987

No ano de 1987, na Maternidade da Encruzilhada, Recife, entre 7.100 parturiçöes, houve 64 casos de placenta prévia, oferecendo uma incidência de 0,9%. Näo houve registro de mortalidade materna e a preinatal foi de 31,2%. O estudo oferece uma correlaçäo entre a entidade mórbida em estudo e varíaveis maternas e perinatais