RESUMO
OBJECTIVES: To determine the effects of duration of ruptured membranes (DRM) and duration of labor in HIV transmission. METHODS: A retrospective cohort study of 366 HIV-infected pregnant women and their infants analyzed the effects of these two variables; the cut-off point for transmission increase was estimated using a ROC curve. A multivariate analysis was performed with the most important risk factors according to the literature: maternal age, lymphocyte count, use of invasive procedures during gestation, antiretroviral treatment during pregnancy and labor, mode of delivery, newborn weight, DRM, labor duration, and the interaction of these last two factors. RESULTS: The cut-off points were estimated at 6 h for DRM and at 5 h for labor duration. A lymphocyte count below 500 cells/ml, use of invasive procedures, use of antiretroviral treatment during pregnancy and interaction between DRM, and labor duration remained significant in perinatal HIV transmission (P<0.05). CONCLUSIONS: An increased DRM increased perinatal HIV transmission when it was associated with prolonged labor.
Assuntos
Ruptura Prematura de Membranas Fetais/complicações , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas , Complicações do Trabalho de Parto/virologia , Estudos de Coortes , Feminino , Infecções por HIV/etiologia , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
La alfafetoproteína y la acetilcolinesterasa son dos marcadores en líquido amniótico de defectos abiertos del tubo neural (DTN) fetal, pero por su conocida capacidad de difusión a través de la membrana amniótica, aunque no de esperar en la acetilcolinesterasa por su elevado peso molecular, en gestaciones gemelares en la que un feto presente DTN, la ecografía constituiría una técnica complementaria útil en la valoración del gemelo aparentemente normal, aunque sin la fiabilidad diagnóstica suficiente para descartar con seguridad la existencia de un DTN en este gemelo, como se describe en un caso de estas características acontecido en nuestro hospital (AU)
Assuntos
Adulto , Feminino , Humanos , Diagnóstico Pré-Natal/métodos , Gravidez Múltipla/fisiologia , alfa-Fetoproteínas/análise , Líquido Amniótico/microbiologia , Acetilcolinesterase/análise , Acetilcolinesterase , Defeitos do Tubo Neural/diagnóstico , Defeitos do Tubo Neural , Amniocentese/métodos , Ultrassonografia/métodos , Cesárea/métodos , Mortalidade Infantil , Biomarcadores/análise , Eletroforese em Gel de Poliacrilamida/classificação , Eletroforese em Gel de Poliacrilamida/métodos , Eletroforese em Gel de PoliacrilamidaAssuntos
Fármacos Anti-HIV/efeitos adversos , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/efeitos adversos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Feminino , Morte Fetal , Infecções por HIV/transmissão , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Inibidores da Transcriptase Reversa/efeitos adversos , Zidovudina/efeitos adversosRESUMO
OBJECTIVE: To study the effect of intrapartum use of fetal invasive procedures (scalp electrodes or scalp pH sampling) on perinatal transmission rate of HIV. STUDY DESIGN: We compared the perinatal transmission of 57 HIV pregnancies in which invasive procedures (IP) were performed with a control group of 214 pregnancies without IP. We controlled for potentially risk factors (maternal CD4 level, gestational age, antiretroviral therapy use, duration of rupture of membranes (ROM), length of labor and mode of delivery) by stratification and logistic regression. RESULTS: Transmission rate in the group with IP was 26.3% (15/57) versus 13.6% (29/214) in the control group, relative risk (RR) 1.9, 95% CI (1.1-3.4). By logistic regression we observed three significant factors involved in transmission of HIV: low maternal CD4 level (odds ratio (OR)=3.3, 95% CI=1.2-9.4), duration of ROM (OR=2.9, 95% CI=1.1-7.9) and IP use (OR=3.5, CI 95%=1.2-9.6). Interaction between duration of ROM and IP are also significant (OR=5.1, CI 95%=1.5-17.5). CONCLUSIONS: Intrapartum use of fetal scalp electrodes or fetal scalp pH sampling increases the perinatal transmission of HIV and should therefore be avoided in HIV patients.
Assuntos
Monitorização Fetal/efeitos adversos , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez , Contagem de Linfócito CD4 , Estudos de Coortes , Eletrodos , Feminino , Humanos , Concentração de Íons de Hidrogênio , Gravidez , Estudos Retrospectivos , Fatores de Risco , Couro Cabeludo/embriologiaRESUMO
Thirty-two women, aged 21 to 44 years, who had undergone single (25) or multiple (7) heart valve replacement conceived 46 times and gave rise to 33 live-born infants. There were 12 abortions and one stillborn; a premature baby died 24 hr post-partum. Twenty-eight patients had mechanical prostheses and 4 had porcine xenografts, 29 patients being anticoagulated with acenocoumarol during the pregnancy. Cardiac status remained clinically satisfactory under medical treatment in all but one patient who developed heart failure. Fetal complications included cerebral hemorrhage in 1 premature infant, low birth weight in 3 newborns and 1 case of nasal hypoplasia. The incidence of abortion has decreased significantly during the latter part of our experience. It was significantly greater in patients with mitral prostheses. This review suggests that inadequate cardiac function, excessive anticoagulation and a history of primary infertility may increase the risk of abortion. Better control of anticoagulant therapy (accepting an elevation of the therapeutic limit) and improved prevention of pregnancy in high-risk patients are considered responsible for the improved results seen in recent years.
