Obesity and pregnancy: a transversal study from a low-risk maternity.

BACKGROUND: Obesity is a public health problem and is increasing in all populations, including pregnant women. It influences maternal and neonatal outcomes; however, data are scarce in developing countries. We aimed to compare perinatal results between obese and non-obese pregnant women in a low-risk maternity. METHODS: Transversal study of 1,779 40-week-pregnancies from 2005 to 2009 that completed a standard questionnaire with sociodemographic, obstetrical and neonatal variables and performed an ultrasound with amniotic fluid index (AFI) measurement and foetal vitality (FBP, non-stress test). They were analysed about their association with obesity on pregnancy. RESULTS: When compared with non-obese women, the group of obese patients had higher systolic (118.1 vs 109.2 mmHg; p < 0.01) and diastolic (76.6 vs 70.4 mmHg; p < 0.01) pressure levels, AFI (12.52 vs. 9.61 cm; p = 0.02), presence of meconium on labour (20.52 vs. 14.67%; p = 0.02), birthweight (3602 vs. 3437 g; p < 0.01) and caesarean section (39.74 vs. 29.98%, p < 0.01). CONCLUSIONS: Labour induction before 40 weeks in the antenatal period associated with foetal weight estimation should be considered as a recommendation for decreasing high percentages of caesarean delivery found in obese women.

Effectiveness of psychological intervention for treating symptoms of anxiety and depression among pregnant women diagnosed with fetal malformation.

OBJECTIVE: To determine the effectiveness of a psychological intervention targeting pregnant women with fetal malformation. METHODS: A clinical study was conducted that enrolled 65 pregnant women attending Clinics Hospital at Ribeirão Preto, University of São Paulo, Brazil, between February 2004 and May 2008. Participants were allocated to 1 of 4 groups: normal pregnancy (NP), fetal malformation (FM), fetal or neonatal death (FD), and control (CG). Psychological intervention-including support, empathy, education, and desensitization-was provided to the NP, FM, and FD groups. Women in CG did not receive the intervention and were assessed in the postnatal period only. Anxiety was measured using the Hospital Anxiety and Depression (HAD) scale. Depression was measured by HAD and the Edinburgh Postnatal Depression Scale. RESULTS: Significant reductions from baseline were observed in anxiety and depression scores after psychological intervention in the NP and FM groups. Symptom scores in the postnatal period were also significantly reduced among these groups (P<0.001). CONCLUSION: Psychological intervention was effective in relieving symptoms of anxiety and depression experienced by pregnant women with fetal malformation.

Changes in fetal and maternal Doppler parameters observed during acute severe hypertension treatment with hydralazine or labetalol: a randomized controlled trial.

We evaluated 16 pregnant women with gestational age between 20 and 32 weeks in acute severe hypertension which were randomly allocated to receive either hydralazine or labetalol. Blood pressure and Doppler ultrasound parameters from maternal uterine and fetal middle cerebral and umbilical arteries were assessed during acute severe hypertension and after treatment. A significant reduction in systolic and diastolic blood pressure was observed in both groups. A significant change in Doppler parameters was observed only in pregnant women who received hydralazine: an increase in uterine arteries resistance index. We concluded that both drugs were highly effective in reducing blood pressure in these women. Despite the observed increase in resistance index of uterine arteries associated with hydralazine, the use of hydralazine and labetalol were not related to any significant changes in fetal Doppler, which is reassuring about the safety of these drugs when treating acute severe hypertension in pregnancy.

Ultrasonography in pregnant women with antiphospholipid syndrome using salicylic acid and heparin.

PURPOSE: The objective of the present study was to evaluate fetal biometry, Doppler values, and perinatal outcomes in pregnant women with antiphospholipid syndrome treated with acetylsalicylic acid and heparin. STUDY DESIGN: Twenty-five pregnant women with antiphospholipid syndrome using 100 mg/day acetylsalicylic acid and 5,000 IU heparin every 12 h were evaluated in this prospective observational study. Ultrasonography was performed between 24 and 38 weeks of gestational age to assess estimated fetal weight, placental thickness, amniotic fluid index, fetal biophysical profile and Doppler evaluation of maternal uterine arteries, and fetal middle cerebral and umbilical arteries. Data regarding Apgar score, gender, delivery mode, and birth weight and length were recorded after birth. RESULTS: The observed values for ultrasonographic assessment and perinatal outcomes were not very different from the expected values for normal pregnancies. The birth weight was 2863.3 ± 737.7 g (mean ± SD) and length was 46.8 ± 4.2 cm. Only one newborn (4%) had the 1-min Apgar score <7 and all had the 5-min Apgar score >7. CONCLUSION: Gestational and perinatal evaluation of pregnant women with antiphospholipid syndrome using both acetylsalicylic acid and heparin was reassuring.

Longitudinal reference values for ductus venosus Doppler in low-risk pregnancies.

The aim of this study was to establish normal ranges of blood flow velocities and indices in the fetal ductus venosus (DV) during the second half of normal pregnancy. A Doppler study of 60 healthy pregnant women without fetal pathologies was performed during the second half of pregnancy. The peak systolic velocity (PSV), peak diastolic velocity (PDV), maximum velocity during atrial contraction (VAC), peak systolic velocity/maximum velocity during atrial contraction (S/A ratio), pulsatility index for the vein (PIV), preload index (PLI) and velocity index for the vein (VIV) were calculated from the DV at 4-week intervals. A significant increase in PSV, PDV and VAC was observed from the 20-23(6/7) to the 28-31(6/7) weeks, with stabilization of values until the end of the pregnancy. On the other hand, the study showed a significant decrease for the S/A ratio, PIV, PLI and VIV from the 20-23(6/7) to the 28-31(6/7) weeks and remaining stable from then until term.

An innovative approach to the assessment of laypersons' knowledge of contraceptive methods, followed by an educational intervention.

OBJECTIVES: To assess the knowledge of laypersons about contraceptive methods and to pilot an educational strategy. DESIGN: Cross-sectional survey using an anonymous questionnaire followed by an educational intervention. PARTICIPANTS: A total of 167 respondents to 400 invitations. METHOD: A questionnaire with 10 questions about contraceptive methods was answered before a meeting between laypersons and health professionals. Small groups facilitated by a health professional discussed the answers. One representative from each group presented the conclusions. At the end of the discussion session, gynaecologists gave lectures about contraceptive methods. RESULTS: Of the 167 people who attended, only 65 (39%) individuals handed over their anonymous answers for analysis. Those who did knew about the existence of contraceptive methods, but most of them showed incorrect or little knowledge about mechanism of action or risks. CONCLUSION: Embarrassment led many participants not to hand in their questionnaires but the results were evidence of the need for educational interventions. Lessons learnt from this experience are discussed.