Postpartum depression: in relation to life events and patterns of coping.

The purpose of this study was to estimate the prevalence of postpartum depression (PPD) and its relationship with life events (LE) and patterns for coping. We performed a cross-sectional study of 113 women, on the 10(th) day of puerperium, at the Obstetric Clinic of the São Paulo University Medical School. The study was based on the following: Pitt (1967) and Stein (1980) Scales, Beck Depression Inventory (1961), Holmes and Rahe Schedule of Recent Events (1967), Folkman and Lazarus Ways of Coping (1985) and questionnaire of social-demographic and obstetric data. Logistic regression was performed to calculate prevalence of PPD and its association with several risk factors. The significance level was defined at 5%. The prevalence of PPD was 15.9% (IC 9.7% to 24.0%). According to the multivariate analyses, the variables of coping with distancing, number of children and ethnic origin were significant. There were no association between PPD and LE. The depressed puerperal women have a low educational level, greater number of children and resort to inadequate coping strategies, such as distancing. This pattern of coping might be an etiological factor of the PPD as well as a reaction to their difficult life environment.

[Bacteremia induced by labor. Is prophylaxis for infective endocarditis necessary?]. / Bacteremia induzida pelo trabalho de parto. Cabe a profilaxia da endocardite infecciosa?

PURPOSE: To characterize the occurrence of bacteremia during delivery and to verify the necessity of prophylaxis against infective endocarditis. METHODS: The authors collected hemoculture of 100 women, 15,30 and 45 minutes after delivery. The data were collected from May 1992 until May 1993. The positive hemocultures were followed by antibiogram. RESULTS: Seven hemocultures were positive: six for Staphylococcus, one for Candida sp, Penicilium sp, Clandosporum sp and Aspergillus sp that were found in association. Four patients had prematures amniorrhexis, longer than 6 hours before delivery (p < 0.05). Six patients had labor longer than 6 hours after admission (p < 0.05). The authors did not observe differences related to vaginal delivery with or without forceps or cesarean section. The samples were all sensible to cefalotin at the antibiogram. CONCLUSION: Labor and delivery is a high risk procedure for bacteremia and so for ineffective endocarditis in susceptible patients. The statistical analysis recognize as risk factors labor longer than 6 hours inside the hospital and premature amniorrhexis. We propose the use of intravenous cefalotin 1g 60 minutes before expulsion and repeated 6 and 12 hours later.

[The porcine valve prosthesis and pregnancy]. / Prótese valvar porcina e gravidez.

Anticoagulation is the chief problem during pregnancy of women with mechanical prosthetic valves. Many studies have investigated a nonthrombogenic valve. Since 1978 we have used a biological porcine prosthetic valves in 16 pregnancies, 11 patients with regular clinical electrocardiographic, echocardiographic and chest roentgenographic follow-up. The patients' ages were 19 to 32 years during pregnancy. Nine had mitral, one aortic and one mitro-aortic prosthesis. Two patients dropped out during the study so we completed it with 14 pregnancies. Six patients coursed with grade I heart failure (HYHA), five grade II and three grade IV. All of them were treated clinically. Four valves had dysfunction and calcification during pregnancy and two before pregnancy. The pregnancies resulted in three abortions, seven normal deliveries and four caesarean section with obstetric indication. Fetal distress was not observed during or after delivery. The physiopathology of valve dysfunction during pregnancy was discussed and it was concluded that the biologic porcine prosthetic valve allows hemodynamic stabilization. If dysfunction appears it may be clinically controlled without need of anticoagulation, risk of calcification nor dysfunction during pregnancy. The biologic valves are best indicated for women who wish to become pregnant after valve substitution.

Efeitos do tipo de parto sobre os niveis do cortisol plasmatico materno e fetal. / Effects of the type of delivery on maternal and fetal cortisol levels

Foram determinados os niveis plasmaticos maternos e fetais de cortisol e a sua relacao com o tipo de parto, em 24 gestacoes a termo. As taxas plasmaticas de cortisol no sangue periferico materno foram significativamente maiores nos partos vaginais (112,54 +/- 28,09ug/100) que nas cesarianas (76,32 +/- 24,53 microgramo/100ml). Da mesma maneira, os niveis fetais de cortisol plasmatico na arteria e veia umbilicais foram significativamente maiores nos partos vaginais (32,37 +/- 9,40 micrograma /100 e 31,53 +/- 8,3 100ml, respectivamente) que nas cesarianas (22,92 +/- 8,07 microgramo/100 ml e 22,36 +/- 7,28 microgramo/100 ml, respectivamente). As dosagens efetuadas no espaco intervilositaria, entretanto, nao mostraram diferencas significativas entre ambos os tipos de parto.O aumento do cortisol plasmatico no parto vaginal pode ser atribuido, entre outras, ao maior stress materno e fetal

Niveis plasmaticos de corticol materno e fetal em gestacoes normais e patologicas. / Plasmatic levels of maternal and fetal cortisol in normal and complicated pregnancies

Foram determinados os niveis plasmaticos de cortisol, mediante o metodo fluorimetrico de Mattingly, em gestacoes normais e patologicas. As determinacoes foram realizadas em amostras de sangue materno, periferico e do espaco intervilositario, e fetal entre gestacoes toxemicas e normais.Da mesma maneira, nao houve diferencas entre os niveis plasmaticos de cortisol nas gestacoes de pos-data, quando confrontadas com as gestacoes de termo. O grupo de gestacoes com isoimunizacao, entretanto, apresentou niveis inferiores do cortisol no plasma periferico materno e no plasma fetal da arteria e veia umbilicais que o grupo de gestacoes normais. O planejamento experimental, em forma de um estudo de tipo caso-controle, permitiu determinar a influencia de algumas patologias sobre os niveis plasmaticos de cortisol, eliminando-se fatores que poderiam mascarar os resultados, como tipo de parto e duracao do trabalho de parto

Niveis do cortisol plasmatico materno e fetal em relacao a duracao do trabalho de parto. / Maternal and feral plasmatic levels of cortisol in relation to duration of labour

Foram correlacionados os niveis de cortisol plasmatico materno e fetal com a duracao do trabalho de parto. Nos partos vaginais, foi demonstrada ao nivel do sangue do espaco intervilositario da placenta.Nos partos cesareos, nao foi encontrada correlacao entre niveis de cortisol plasmatico nos quatro compartimentos estudados e a duracao do trablaho de parto. A diferenca de comportamento do cortisol plasmatico em partos vaginais e cesareos poderia ser explicada pelo stress materno e fetal durante o periodo expulsivo

O eritrograma na gravidez normal. / Hematimetric values in normal pregnancy

O comportamento dos parametros do eritrograma foi estudado em 79 gravidas consideradas clinicamente normais, distribuidas em diferentes periodos gestacionais (4 entre as 10 primarias semanas; 32 entre a 11a. e a 20a. semana; 25 entre a 21a. e a 30a. e 18 entre 31 e 40 semanas),comparando-se os resultados aos obtidos para um grupo controle constituido de 39 nao-gravidas normais. Encontrou-se diminuicao significativa nos valores de globulos vermelhos, hemoglobina e hamatocrito, que se manifesta precocemente ao redor da 10a.semana, alcancando valores minimos ao redor da 20a. semana e com discreto aumento a partir dai. Em relacao aos indices corpusculares, verificou-se diminuicao significativa para o volume corpuscular medio entre a 11a. e a 20a. semana e a 30a. 40a.semana, aumento nos valores de hemoglobina corpuscular media e da concentracao de hemoglobina corpuscular media (esta ultima com significancia entre a 11a. e a 20a.semana). Ha ainda, aumento do numero de reticulocitos para todos os periodos analisados, embora sem significancia estatistica. Tecem-se consideracoes sobre tais modificacoes, e os autores sugerem que os indices corpusculares, principalmente o volume corpuscular, sejam tomados preferentemente como indicadores de anemia na gravidez

Cardiopatia e gravidez - conduta clinica e obstetrica. / Cardiopathy in pregnancy - clinical and obstetrical management

Discute-se a conduta do grupo formado por cardiologista e obstetras, da Santa Casa de Sao Paulo, diante da paciente gravida e cardiopata. Sao abordadas as valvulopatias, miocardiopatias, cardiopatias congenitas e arritmias. Finalmente sao feitas consideracoes sobre a anticoncepcao neste grupo particular de pacientes