Maternal and fetal outcome in pregnant women with Eisenmenger's syndrome.

Interruption of pregnancy is usually recommended for pregnant women with Eisenmenger's syndrome. We studied 13 pregnancies in 12 women with this syndrome, who decided to carry on with their pregnancy despite recommendation for therapeutic abortion. The mean age was 27 years. Five patients had ventricular septal defect; two, persistent ductus arteriosus; one, a combination of both; two, atrial septal defect; one, atrioventricular septal defect and one patient a combination of ventricular and atrial septal defects. Mean systolic and diastolic arterial pulmonary pressures were 112.7 and 61.7, mmHg, respectively. There were three spontaneous abortions, one premature labour at 23 weeks of gestation and two maternal deaths during the 23 and 27 weeks of gestation. Seven patients who reached the end of the second trimester were hospitalized until delivery and received heparin (20,000 to 40,000 units per day) and oxygen therapy. Caesarean section was performed in all patients as a result of worsening maternal or fetal clinical condition during the third trimester of gestation. all the mothers were discharged from hospital but one of them died on the 30th day post-partum. Five of the eight infants were premature, three were small babies for gestational age and all were discharged from hospital with the exception of one who died 48 h after birth. In conclusion, although pregnancy should be discouraged in women with Eisenmenger's syndrome, it can be successful. In this study, prolonged bed rest, the use of heparin and oxygen therapy presumably positively influenced maternal and infant outcomes.

Evoluçäo do ciclo gravídico-puerperal em portadoras de estenose mitral / Course of pregnancy and puerperium in women with mitral valve stenosis

Objetivo. Estudar a evoluçäo do ciclo gravídico-pleural (CGP) e das características dos recém-nascidos, em portadoras de estenose mitral, que iniciaram a gravidez assintomáticas ou oligossintomáticas. Métodos. Sessenta e duas gestantes divididas em grupo GE 30 portadoras de estenose mitral GN - 32 sem cardiopatia. Resultados. No grupo GE, 16(53,3//) pacientes evoluíram para classe funcional (CF) III e 10(33//) para CF IV no decorrer da gestäo. No grupo GN, 18(56,2//) evoluíram para CF II. No grupo GE o parto foi vaginal em 70,0// e aplicado o bloqueio regional em 56,6// dos casos, sem diferença significativa (P > 0,1) entre os grupos. Prematuridade (20,0//) e recêm-nascidos pequenos para a idade gestacional (PIG) (36,7//) foram significativamente (p < 0,001) mais freqüentes no grupo GE. Näo houve mortalidade materno-fetal. Conclusäo. A maioria (86,7//) das gestantes do grupo GE evoluiu para CF III/CGP. Repouso, farmacoterapia e, em um caso, a valvoplastia por cateter-baläo contribuíram para que todas as pacients alcançassem a viabilidade fetal. Entretanto, freqüência expressiva de recém-nascidos prematuros (20,0// e PIG (36,7//) foi registrada

[Course of pregnancy and puerperium in women with mitral valve stenosis]. / Evolução do ciclo gravídico-puerperal em portadoras de estenose mitral.

PURPOSE: To study pregnancy, delivery, puerperium and the newborn in cases of mitral valve stenosis, asymptomatic at conception. METHOD: Sixty-two pregnant women, 30 with mitral valve stenosis (GE group) and 32 without cardiac disease (GN group) had their functional class, kind of delivery, anesthetic technique and newborn characteristics evaluated during gestation. RESULTS: In GE group 16 (53.3%) patients changed from functional class (FC) I/II to FC III and 10 (33.3%) to FC IV. In GN group 18 (56.2%) changed from FC I to II during the gestation. Delivery was vaginal in 21 patients (70%); anesthetic technique was regional block in 17 (56.6%). These findings were not statistically different between (p > 0.1) the groups. Premature (20.0%) and small babies for gestational age (36.7%) were higher (p > 0.001) in GE group. There were no cases of maternal death. CONCLUSION: The majority of GE women who started pregnancy in FC I/II changed to FC III/IV during gestation. Probably adequate medical treatment and valvoplasty in one case allowed fetal viability; but we had higher incidence of pre-term and small for gestation age babies in the GE group.

[Trypanosoma cruzi in the milk of women with chronic Chagas disease]. / Pesquisa do Trypanosoma cruzi na secreção láctea de mulheres acometidas de doença de Chagas crônica.

Breast milk secretion is one of the possible alternative mechanisms of transmission of the parasitosis caused by Trypanosoma cruzi, but it is still needed to define its importance in terms of public health. On this aim we searched for the presence of this protozoal organism in the colostrum and breast milk of 40 women with Chagas' disease, through direct observation, culture and inoculation. We never found parasite; perhaps it might be possible with the use of more efficient procedures and a larger number of cases.