Pregnant patient with prune belly syndrome: case report.

Prune belly syndrome is a rare congenital disease of unknown etiology that is present in one in every 40 thousand live births, and predominantly affects males, at a ratio of 4:1. In males, it presents with anomalies in the urinary system, absence of abdominal muscles, bilateral cryptorchidism, and infertility. In women, the syndrome has variable presentations, but fertility is preserved. Searching the medical literature, we found only one case of prune belly syndrome in pregnant women. Therefore, the patient in this report is the second case. She was primiparous, 25-years-old, with no abdominal muscles, severe congenital kyphoscoliosis, and pulmonary restriction. Elective cesarean section was performed at 37 weeks of gestation due to maternal risk of uterine rupture by transverse presentation and fetal risk of intrauterine growth restriction. The pre-anesthetic approach defined that general anesthesia might have more risks for the patient due to severe maternal lung disease compared to ultrasound-guided locoregional anesthesia. During prenatal care, there were some maternal complications, such as asthma exacerbations, abdominal pain, and constipation. The newborn was born small for gestational age and this can possibly be explained by maternal restrictive lung capacity. The newborn presented with Apgar score 8/9 and tachypnea, but improved after two hours of life.

Doppler abnormalities and perinatal outcomes in pregnant women with early-onset fetal growth restriction.

OBJECTIVE: To compare Doppler alterations and perinatal outcomes in pregnant women who evolved with early- and late-onset fetal growth restriction (FGR). METHODS: A retrospective, observational cohort study with pregnant women who evolved with FGR treated between January 2018 and April 2019, in which all live births from singleton pregnancies, over 24 weeks, with FGR ultrasound diagnosis and under 2700 g weight were included in the study. RESULTS: Pregnancies with early-onset FGR were more associated with hypertensive disorders (p = .00) and placental vascular insufficiency, resulting in a high degree of umbilical artery Doppler involvement (p = .00) in a short period of pregnancy and higher rates of adverse perinatal outcomes (p = .00). The time of prenatal follow-up of early- and late-onset FGR cases was similar, but the degree of prematurity of the former made the evolution more unfavorable. CONCLUSION: Early-onset FGR had a lower prevalence but was associated with higher maternal and fetal morbidity and mortality than late-onset FGR.

Pregnant patient with prune belly syndrome: case report

ABSTRACT Prune belly syndrome is a rare congenital disease of unknown etiology that is present in one in every 40 thousand live births, and predominantly affects males, at a ratio of 4:1. In males, it presents with anomalies in the urinary system, absence of abdominal muscles, bilateral cryptorchidism, and infertility. In women, the syndrome has variable presentations, but fertility is preserved. Searching the medical literature, we found only one case of prune belly syndrome in pregnant women. Therefore, the patient in this report is the second case. She was primiparous, 25-years-old, with no abdominal muscles, severe congenital kyphoscoliosis, and pulmonary restriction. Elective cesarean section was performed at 37 weeks of gestation due to maternal risk of uterine rupture by transverse presentation and fetal risk of intrauterine growth restriction. The pre-anesthetic approach defined that general anesthesia might have more risks for the patient due to severe maternal lung disease compared to ultrasound-guided locoregional anesthesia. During prenatal care, there were some maternal complications, such as asthma exacerbations, abdominal pain, and constipation. The newborn was born small for gestational age and this can possibly be explained by maternal restrictive lung capacity. The newborn presented with Apgar score 8/9 and tachypnea, but improved after two hours of life.

Association between dietary glycemic index and excess weight in pregnant women in the first trimester of pregnancy / Associação entre o índice glicêmico dietético e o excesso de peso em gestantes no primeiro trimestre de gestação

Abstract Objective To assess the association between dietary glycemic index (GI) and excess weight in pregnant women in the first trimester of pregnancy. Methods A cross-sectional study in a sample of 217 pregnant women was conducted at the maternal-fetal outpatient clinic of the Hospital Geral de Fortaleza, Fortaleza, state of Ceará, Brazil, for routine ultrasound examinations in the period between 11 and 13 weeks + 6 days of gestation.Weight and height were measured and the gestational body mass index (BMI) was calculated. The women were questioned about their usual body weight prior to the gestation, considering the prepregnancy weight. The dietary GI and the glycemic load (GL) of their diets were calculated and split into tertiles. Analysis of variance (ANOVA) or Kruskal-Walls and chi-squared (χ2) statistical tests were employed. A crude logistic regression model and a model adjusted for confounding variables known to influence biological outcomes were constructed. A p-value < 0.05 was considered significant for all tests employed. Results The sample group presented a high percentage of prepregnancy and gestational overweight (39.7% and 40.1%, respectively). InthetertilewiththehigherGIvalue, therewasa lower dietary intake of total fibers (p = 0.005) and of soluble fibers (p = 0.008). In the third tertile, the dietary GI was associated with overweight in pregnant women in the first trimester of gestation, both in the crude model and in the model adjusted for age, total energy intake, and saturated fatty acids. However, this association was not observed in relation to the GL. Conclusion A high dietary GI was associated with excess weight in women in the first trimester of pregnancy.

Resumo Objetivo Avaliar a associação entre índice glicêmico (IG) dietético e presença de excesso de peso em gestantes no primeiro trimestre de gestação. Métodos Estudo transversal realizado com 217 gestantes atendidas no Ambulatório de Medicina Materno-Fetal do Hospital Geral de Fortaleza, Fortaleza, CE, para realização de exames ultrassonográficos de rotina no período entre 11 e 13 semanas e 6 dias de gestação. Peso e altura foram obtidos para o cálculo do índice de massa corporal (IMC) gestacional. As mulheres foram questionadas quanto ao peso corporal habitual anterior à gestação, considerado o peso pré-gestacional. O IG e a carga glicêmica (CG) das suas dietas foram calculados e divididos em tercis. As associações foram investigadas por análise de variância (ANOVA, na sigla em inglês) ou pelos testes Kruskal-Walls e qui-quadrado (χ2). Resultados O grupo tinha alto percentual de excesso de peso pré-gestacional (39,7%) e gestacional (40,1%). Houve menor consumo de fibras totais (p = 0,005) e fibras insolúveis (p = 0,008) no tercil de maior valor de IG. No terceiro tercil, o IG da dieta foi associado ao excesso de peso dasmulheres no primeiro trimestre de gestação, tanto no modelo bruto como no modelo ajustado para idade, consumo total de energia e de ácidos graxos saturados. No entanto, não se observou esta associação emrelação à CG. Conclusão O alto IG da dieta consumida foi associado ao excesso de peso das mulheres no primeiro trimestre da gestação.

Association between Dietary Glycemic Index and Excess Weight in Pregnant Women in the First Trimester of Pregnancy.

OBJECTIVE: To assess the association between dietary glycemic index (GI) and excess weight in pregnant women in the first trimester of pregnancy. METHODS: A cross-sectional study in a sample of 217 pregnant women was conducted at the maternal-fetal outpatient clinic of the Hospital Geral de Fortaleza, Fortaleza, state of Ceará, Brazil, for routine ultrasound examinations in the period between 11 and 13 weeks + 6 days of gestation. Weight and height were measured and the gestational body mass index (BMI) was calculated. The women were questioned about their usual body weight prior to the gestation, considering the prepregnancy weight. The dietary GI and the glycemic load (GL) of their diets were calculated and split into tertiles. Analysis of variance (ANOVA) or Kruskal-Walls and chi-squared (χ2) statistical tests were employed. A crude logistic regression model and a model adjusted for confounding variables known to influence biological outcomes were constructed. A p-value < 0.05 was considered significant for all tests employed. RESULTS: The sample group presented a high percentage of prepregnancy and gestational overweight (39.7% and 40.1%, respectively). In the tertile with the higher GI value, there was a lower dietary intake of total fibers (p = 0.005) and of soluble fibers (p = 0.008). In the third tertile, the dietary GI was associated with overweight in pregnant women in the first trimester of gestation, both in the crude model and in the model adjusted for age, total energy intake, and saturated fatty acids. However, this association was not observed in relation to the GL. CONCLUSION: A high dietary GI was associated with excess weight in women in the first trimester of pregnancy.

OBJETIVO: Avaliar a associação entre índice glicêmico (IG) dietético e presença de excesso de peso em gestantes no primeiro trimestre de gestação. MéTODOS: Estudo transversal realizado com 217 gestantes atendidas no Ambulatório de Medicina Materno-Fetal do Hospital Geral de Fortaleza, Fortaleza, CE, para realização de exames ultrassonográficos de rotina no período entre 11 e 13 semanas e 6 dias de gestação. Peso e altura foram obtidos para o cálculo do índice de massa corporal (IMC) gestacional. As mulheres foram questionadas quanto ao peso corporal habitual anterior à gestação, considerado o peso pré-gestacional. O IG e a carga glicêmica (CG) das suas dietas foram calculados e divididos em tercis. As associações foram investigadas por análise de variância (ANOVA, na sigla em inglês) ou pelos testes Kruskal-Walls e qui-quadrado (χ2). RESULTADOS: O grupo tinha alto percentual de excesso de peso pré-gestacional (39,7%) e gestacional (40,1%). Houve menor consumo de fibras totais (p = 0,005) e fibras insolúveis (p = 0,008) no tercil de maior valor de IG. No terceiro tercil, o IG da dieta foi associado ao excesso de peso das mulheres no primeiro trimestre de gestação, tanto no modelo bruto como no modelo ajustado para idade, consumo total de energia e de ácidos graxos saturados. No entanto, não se observou esta associação em relação à CG. CONCLUSãO: O alto IG da dieta consumida foi associado ao excesso de peso das mulheres no primeiro trimestre da gestação.

Simple approach based on maternal characteristics and mean arterial pressure for the prediction of preeclampsia in the first trimester of pregnancy.

AIM: To propose a simple model for predicting preeclampsia (PE) in the 1st trimester of pregnancy on the basis of maternal characteristics (MC) and mean arterial pressure (MAP). METHODS: A prospective cohort was performed to predict PE between 11 and 13+6 weeks of gestation. The MC evaluated were maternal age, skin color, parity, previous PE, smoking, family history of PE, hypertension, diabetes mellitus and body mass index (BMI). Mean arterial blood pressure (MAP) was measured at the time of the 1st trimester ultrasound. The outcome measures were the incidences of total PE, preterm PE (delivery <37 weeks) and term PE (delivery ≥37 weeks). We performed logistic regression analysis to determine which factors made significant contributions for the prediction of the three outcomes. RESULTS: We analyzed 733 pregnant women; 55 developed PE, 21 of those developed preterm PE and 34 term PE. For total PE, the best model was MC+MAP, which had an area under the receiver operating characteristic curve (AUC ROC) of 0.79 [95% confidence interval (CI)=0.76-0.82]. For preterm PE, the best model was MC+MAP, with an AUC ROC of 0.84 (95% CI=0.81-0.87). For term PE, the best model was MC, with an AUC ROC of 0.75 (0.72-0.79). The MC+MAP model demonstrated a detection rate of 67% cases of preterm PE, with a false-positive rate of 10%, positive predictive value of 17% and negative predictive value of 99%. CONCLUSION: The MC+MAP model showed good accuracy in predicting preterm PE in the 1st trimester of gestation.

Reference values of maternal ophthalmic artery doppler variables in the first trimester of normal pregnancy.

BACKGROUND: The aim of this study was to establish normative data for ophthalmic artery Doppler variables in the first trimester of normal pregnancy. METHODS: Maternal ophthalmic artery Doppler signals were recorded in 409 singleton pregnancies at 11-14 weeks' gestation, in mothers presenting consecutively for routine antenatal care. Pulsatility and resistance indices (PI, RI), peak systolic velocity (PSV), first peak diastolic velocity (PD1), and peak ratio (PR) were measured. Quartile regression was used to estimate reference ranges in the late first trimester of pregnancy. RESULTS: Mean ± SD values for maternal ophthalmic artery Doppler parameters between 11 and 14 weeks' gestation were RI = 0.81 ± 0.12, PI = 2.06 ± 0.57, PSV = 36.41 ± 12.1, PD1 = 21.07 ± 7.62, and PR = 0.58 ± 0.11. All clinical and Doppler variables were normally distributed. PD1 values were higher in patients who smoked, and in those with diabetes or a history of pre-eclampsia. PR values were higher in patients with diabetes and chronic hypertension, and lower in the nulliparous; these values declined as gestation advanced from 11 to 14 weeks, whereas the other variables remained unchanged. CONCLUSIONS: We provide reference values for maternal ophthalmic artery Doppler variables in the first trimester of normal pregnancy.

Reference range of uterine artery Doppler parameters between the 11th and 14th pregnancy weeks in a population sample from Northeast Brazil.

PURPOSE: To establish reference values for the first trimester uterine artery resistance index (UtA-RI) and pulsatility index (UtA-PI) in healthy singleton pregnant women from Northeast Brazil. METHODS: A prospective observational cohort study including 409 consecutive singleton pregnancies undergoing routine early ultrasound screening at 11 - 14 weeks of gestation was performed. The patients responded to a questionnaire to assess maternal epidemiological characteristics. The left and right UtA-PI and UtA-RI were examined by color and pulsed Doppler by transabdominal technique and the mean UtA-PI, mean UtA-RI and the presence of bilateral protodiastolic notching were recorded. Quartile regression was used to estimate reference values. RESULTS: The mean ± standard deviation UtA-RI and UtA-PI were 0.7 ± 0.1 and 1.5 ± 0.5, respectively. When segregated for gestation age, mean UtA-PI was 1.6 ± 0.5 at 11 weeks, 1.5 ± 0.6 at 12 weeks, 1.4 ± 0.4 at 13 weeks and 1.3 ± 0.4 at 14 weeks' gestation and mean UtA-RI was 0.7 ± 0.1 at 11 weeks, 0.7 ± 0.1 at 12 weeks, 0.6 ± 0.1 at 13 weeks and 0.6 ± 0.1 at 14 weeks' gestation. Uterine artery bilateral notch was present in 261 (63.8%) patients. We observed that the 5th and 95th percentiles of the UtA-PI and UtA-RI uterine arteries were 0.7 and 2.3 and, 0.5 and 0.8, respectively. CONCLUSION: Normal reference range of uterine artery Doppler in healthy singleton pregnancies from Northeast Brazil was established. The 95th percentile of UtA-PI and UtA-RI values may serve as a cut-off for future prediction of pregnancy complications studies (i.e., pre-eclampsia) in Northeast Brazil.

Reference range of uterine artery Doppler parameters between the 11th and 14th pregnancy weeks in a population sample from Northeast Brazil / Valores de referência para parâmetros doplervelocimétricos das artérias uterinas entre a 11ª e 14ª semanas de gestação em uma amostra populacional do Nordeste do Brasil

PURPOSE: To establish reference values for the first trimester uterine artery resistance index (UtA-RI) and pulsatility index (UtA-PI) in healthy singleton pregnant women from Northeast Brazil. METHODS: A prospective observational cohort study including 409 consecutive singleton pregnancies undergoing routine early ultrasound screening at 11 - 14 weeks of gestation was performed. The patients responded to a questionnaire to assess maternal epidemiological characteristics. The left and right UtA-PI and UtA-RI were examined by color and pulsed Doppler by transabdominal technique and the mean UtA-PI, mean UtA-RI and the presence of bilateral protodiastolic notching were recorded. Quartile regression was used to estimate reference values. RESULTS: The mean±standard deviation UtA-RI and UtA-PI were 0.7±0.1 and 1.5±0.5, respectively. When segregated for gestation age, mean UtA-PI was 1.6±0.5 at 11 weeks, 1.5±0.6 at 12 weeks, 1.4±0.4 at 13 weeks and 1.3±0.4 at 14 weeks' gestation and mean UtA-RI was 0.7±0.1 at 11 weeks, 0.7±0.1 at 12 weeks, 0.6±0.1 at 13 weeks and 0.6±0.1 at 14 weeks' gestation. Uterine artery bilateral notch was present in 261 (63.8%) patients. We observed that the 5th and 95th percentiles of the UtA-PI and UtA-RI uterine arteries were 0.7 and 2.3 and, 0.5 and 0.8, respectively. CONCLUSION: Normal reference range of uterine artery Doppler in healthy singleton pregnancies from Northeast Brazil was established. The 95th percentile of UtA-PI and UtA-RI values may serve as a cut-off for future prediction of pregnancy complications studies (i.e., pre-eclampsia) in Northeast Brazil.

OBJETIVO: Estabelecer valores de referência para os índices de resistência (UtA-IR) e de pulsatilidade (UtA-IP) das artérias uterinas em mulheres com gravidezes saudáveis do nordeste do Brasil. MÉTODOS: Um estudo de coorte observacional prospectivo, incluindo 409 gestações únicas consecutivas submetidas a exame de ultrassonografia de rotina entre 11 e 14 semanas de gestação, foi realizado. As pacientes responderam a um questionário para avaliar características epidemiológicas maternas. Os índices UtA-IR e UtA-IP das artérias uterinas esquerda e direita foram examinadas através de Doppler colorido e pulsátil por técnica transabdominal. A média UtA-IP, a média UtA-IR e a presença de incisura protodiastólica bilateral foram registradas. Regressão quartil foi utilizada para estimar os valores de referência. RESULTADOS: A média±desvio-padrão de UtA-IR e UtA-IP foram de 0,7±0,1 e 1,5±0,5, respectivamente. Quando separadas por idade gestacional, a média de UtA-IP foi de 1,6±0,5 com 11 semanas, 1,5±0,6 com 12 semanas, 1,4±0,4 com 13 semanas e 1,3±0,4 em uma gestação de 14 semanas e a média de UtA-IR foi de 0,7±0,1 com 11 semanas, 0,7±0,1 com 12 semanas, 0,6±0,1 com 13 semanas e 0,6±0,1 com 14 semanas de gestação. Incisura bilateral das artérias uterinas estava presente em 261 (63,8%) pacientes. Observou-se que os percentis 5 e 95 de UtA-IP e UtA-IR foram 0,7 e 2,3 e 0,5 e 0,8, respectivamente. CONCLUSÃO: A curva de valores de referência dos índices de dopplervelocimetria das artérias uterinas no primeiro trimestre foi estabelecida para gestações únicas e saudáveis do nordeste do Brasil. Os valores do percentil 95 para os índices UtA-IP e UtA-IR podem servir como ponto de corte para estudos de predição de complicações em gravidezes (por exemplo, pré-eclampsia) no nordeste do Brasil.

Term angular pregnancy: successful expectant management.

Interstitial pregnancy sometimes is mistakenly referred to as cornual pregnancy and is frequently confused with angular pregnancy. A strict distinction among these three conditions is clinically important because their findings, management and outcomes are different. We report an unusual case of pregnancy where interstitial pregnancy was diagnosed at 6 weeks of pregnancy, located close to the right cornual portion of the uterus. Prenatal monitoring was carried out until birth at 36 weeks' gestation with uterine conservation. Ultrasound scan and magnetic resonance imaging were realized to confirm the diagnosis and to monitor the evolution.

Depressão pós-parto: tratamento baseado em evidências / Postpartum depression: treatment based on evidences

A depressão pós-parto é uma condição clínica séria no puerpério, atingindo aproximadamente 10 a 20% das mulheres nos seis primeiros meses após o parto, sendo muitas vezes não-investigada nem diagnosticada, com impacto negativo para a mãe e a criança. Fatores de risco biológicos e psicossociais têm sido descritos na literatura, relacionados com a depressão pós-parto, porém, seu mecanismo fisiopatológico ainda não é totalmente esclarecido. Objetivou-se com este trabalho avaliar criticamente a literatura científica quanto ao tratamento da depressão pós-parto, com base na literatura disponível. Há evidência de eficácia de algumas intervenções terapêuticas como psicoterapia, antidepressivos e exercício físico no tratamento entre 1 e 12 semanas de duração. Dificuldades para a adesão e continuidade da terapia envolvem o temor de efeitos indesejáveis das medicações sobre os lactentes no início do uso destas e sobre as crianças no longo prazo, além da dificuldade de acesso ao acompanhamento psicológico.

Postpartum depression is a serious clinical condition during the postnatal period, affecting from 10 to 20% of women during the first six months after delivery, being most of the time underscored and undiagnosed, with negative impact on the mother and the infant. Biological and psychosocial risk factors have been described in the literature, but its physiopathology is still unclear. The objective of this article was to critically appraise the literature in regards to the treatment of postpartum depression, based on evidence. There is evidence of some therapeutic interventions efficacy such as psychotherapy, antidepressant medications and physical activity between 1 and 12 weeks of treatment. Barriers to the treatment include fear of adverse effects on the infants at the beginning of the treatment and in the long term and low access to psychotherapy.

Ameaça de aborto: conduta baseada em evidências / Threatened miscarriage: conduct based on evidences

A ameaça de aborto é definida como sangramento vaginal, geralmente indolor, que ocorre na primeira metade da gravidez com concepto vivo sem dilatação cervical. Muitas intervenções são utilizadas para a ameaça de aborto espontâneo. Quando uma causa específica é identificada, o tratamento direcionado pode reduzir taxas de abortamento. No entanto, na maioria dos casos, a fisiopatologia permanece desconhecida. Intervenções inespecíficas como repouso no leito e ausência de relações sexuais, apesar de comumente aconselhadas pelos médicos, não têm comprovação de benefício. A didrogesterona, um derivado progestínico, parece reduzir o risco de abortamento. Esta revisão mostra a qualidade das evidências científicas e o grau de recomendação das várias condutas para o tratamento da ameaça de aborto, concluindo que ainda é necessário realizar outros ensaios clínicos maiores, placebo-controlados e randomizados sobre o tratamento da ameaça de aborto para definir a eficácia da maioria das intervenções

Threatened miscarriage is defined as a vaginal bleeding, usually painless, which occurs in the first half of viable pregnancy without cervical dilatation. Many interventions are used for threatened and recurrent miscarriage. When a specific cause is identified, directed treatment may reduce miscarriage rates. However, in the majority of cases, the pathophysiology remains unknown. Unspecific interventions, as bed rest and avoidance of sexual intercourse, though commonly advised, are of no proven benefit. Dydrogesterone, a progesterone derivative, may further reduce miscarriage rates. This review shows the scientific evidence and classification quality of several interventions for the treatment of threatened miscarriage. Larger, randomized and controlled trials on the treatment of threatened miscarriage are needed to support the majority of the interventions

Doppler das artérias uterinas de primeiro trimestre na predição de pré-eclâmpsia / First trimester uterine artery Doppler in the prediction of pre-eclampsia

A pré-eclâmpsia é um grave problema de saúde pública. É a principal causa de morte materna nos países desenvolvidos. Atualmente, não existe um teste ideal para a predição de pré-eclâmpsia. O método preditivo utilizado na prática clínica atual é a doplerfluxometria das artérias uterinas no segundo trimestre de gravidez; porém, nesta idade gestacional, as medidas profiláticas iniciadas não têm atingido a eficácia esperada. Nos últimos anos, os estudos doplerfluxométricos das artérias uterinas estão deixando de ser aplicados no segundo para serem realizados no primeiro trimestre de gravidez. Foi feita uma revisão da literatura para se obterem evidências científicas sobre a acurácia preditiva da doplerfluxometria das artérias uterinas no primeiro trimestre da gravidez. As evidências sugerem que a doplerfluxometria das artérias uterinas no primeiro trimestre oferece uma boa predição de pré-eclâmpsia, especialmente a pré-eclâmpsia grave de início precoce na gestação

The pre-eclampsia is a serious public health problem. It is the main cause of maternal death in developed countries. Nowadays, there is not a laboratory test that is universally accepted for the prediction of pre-eclampsia. Second trimester uterine artery Doppler velocimetry can be useful as a predictive test, but, at this gestational age, prophylactic measures have not been reaching the expected efficacy. Over the last years, the use of the uterine artery Doppler assessment to predict pre-eclampsia has shifted from the second to the first trimester. We have developed a literature review about first trimester doplervelocimetry in the prediction of pre-eclampsia. The evidence suggests that first trimester Doppler provides sensitive prediction of the pre-eclampsia development, especially of severe early onset pre-eclampsia

[The macrophages in the placenta during labor]. / Os macrófagos na placenta durante o trabalho de parto.

PURPOSE: to verify the amount of CD68+ cells in chorionic villosities in placentae from gestations submitted or not to labor. METHODS: transversal study with healthy near-term pregnant women, among whose placentae, 31 have been examined by immunohistochemical technique. Twenty placentae were obtained after vaginal delivery (VAGG) and eleven after elective cesarean sections (CESG). Slides were prepared with chorionic villosities samples and labeled with anti-CD68 antibody, specific for macrophages. Labeled and nonlabeled cells were counted inside the villosities. Non-parametric statistical tests were used for the analysis. RESULTS: among the 6,424 cells counted in the villosities' stroma from the 31 placentae, 1,135 cells (17.6%) were stained by the CD68+. The mean of cells labeled by the anti-CD68 was 22+/-18 for the VAGG group and 20+/-16 for the CESG, in each placentary sample. CONCLUSIONS: there were no significant differences in the percentage of macrophages (CD68+) in association with labor.

Os macrófagos na placenta durante o trabalho de parto / The macrophages in the placenta during labor

OBJETIVO: verificar a quantidade de células CD68+ no estroma das vilosidades coriônicas na placenta de gestações submetidas ou não ao trabalho de parto. MÉTODOS: estudo transversal, com gestantes saudáveis a termo, das quais 31 placentas foram examinadas pela técnica de imunoistoquímica. Vinte placentas foram obtidas após partos vaginais (GVAG) e 11 obtidas em cesarianas eletivas (GCES). Lâminas foram preparadas com amostras de vilosidades coriônicas e submetidas à marcação com anticorpo anti-CD68, específico para macrófagos. Foram contadas as células marcadas e as não marcadas dentro das vilosidades. Testes estatísticos não-paramétricos foram utilizados para a análise. RESULTADOS: entre 6.424 células contadas no estroma das vilosidades das 31 placentas, 1.135 células (17,6%) foram marcadas pelo CD68+. Em cada amostra placentária, a média de células coradas pelo anticorpo anti-CD68 foi de 22±18 para o grupo GVAG e de 20±16 para o grupo GCES. CONCLUSÕES: não houve diferenças significantes no percentual de macrófagos (CD68+) em associação com o trabalho de parto.

PURPOSE: to verify the amount of CD68+ cells in chorionic villosities in placentae from gestations submitted or not to labor. METHODS: transversal study with healthy near-term pregnant women, among whose placentae, 31 have been examined by immunohistochemical technique. Twenty placentae were obtained after vaginal delivery (VAGG) and eleven after elective cesarean sections (CESG). Slides were prepared with chorionic villosities samples and labeled with anti-CD68 antibody, specific for macrophages. Labeled and nonlabeled cells were counted inside the villosities. Non-parametric statistical tests were used for the analysis. RESULTS: among the 6,424 cells counted in the villosities' stroma from the 31 placentae, 1,135 cells (17.6%) were stained by the CD68+. The mean of cells labeled by the anti-CD68 was 22±18 for the VAGG group and 20±16 for the CESG, in each placentary sample. CONCLUSIONS: there were no significant differences in the percentage of macrophages (CD68+) in association with labor.

A Invasão trofoblástica e a sua importância clínica / The Invasion of trophoblast cells and its clinical consequence

A Placenta é um órgão importante para o desenvolvimento fetal e para a saúde materna. Durante o início da gravidez humana, os citotrofoblastos extravilosos invadem o útero e transformam as artérias espiraladas em grandes vasos de baixa resistência. A inadequada invasão das artérias espiraladas por estes trofoblastos extravilosos resulta em isquemia placentária e no desenvolvimento de complicações obstétricas como pre-eclâmpsia e a restrição do crescimento fetal intra-útero (RCIU). A alta resistência do fluxo arterial uterino pode ser detectado pela dopplerfluxometria das artérias uterinas. Conseqüentemente, achamos interessante explicar como e quando ocorrem as invasões trofoblásticas na decídua e no miométrio