Navegando por Palavras-chave "Comprimento cervical"

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    Avaliação ultrassonográfica do colo uterino no trabalho de parto pré-termo
    (Universidade Federal de São Paulo (UNIFESP), 2016-12-31) Maia, Maria Carolina Andrade [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To evaluate, by transvaginal ultrasound, cervical patients with preterm labor, aiming to predict the birth within seven days of admission before 34 weeks and before 37 weeks of gestation. Method: The study included 95 women with singleton pregnancies, intact membranes and diagnosis of labor between 25 and 34 weeks and 6 days of gestation. Was preceded transvaginal ultrasound and analyzed the following variables: cervical length in milimeters, zeta score cervical length, funneling, endocervical glandular echo and sludge. The results were evaluated within seven days and before 34 and 37 weeks of gestation. Results: The median gestational age at admission was 31.9 weeks (range between 26 and 34.9). The median cervical length at sonographic examination admission was 22.3 mm (range 0 to 42.8). It was considered short by zeta score 60%. It was observed funneling in 27.4%, absence of glandular echo in 55.8% and the presence of sludge in 6.3%. Delivery occurrence was evident within seven days of hospital admission in 13 (13.7%) cases. Delivery before 34 weeks occurred in 16 (16.8%) cases and 40 before 37 weeks (42.1%) cases. Logistic regression analysis showed an independent significant predictor of delivery within 7 days of the cervical length in milimeters (OR 0.918, 95% CI ranging from 0.862 to 0.978; p = 0.008). For birth before 34 weeks gestational age at admission (OR 0.683, 95% CI ranging from 0.539 to 0.866; p = 0.002) and before 37 weeks, the presence of funneling (OR 3.778, 95% CI ranging from 1,460 - 9.773, p = 0.006). Conclusion: The evaluation of the cervix by transvaginal ultrasound was correlated with the occurrence of preterm birth, being able to help distinguish between true and false labor.
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    Significado clínico do sinal de "sludge" do líquido amniótico no parto pré-termo
    (Universidade Federal de São Paulo (UNIFESP), 2017-05-30) Hatanaka, Alan Roberto [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Mattar, Rosiane [UNIFESP]; http://lattes.cnpq.br/1993353561775961; http://lattes.cnpq.br/0197731060424158; http://lattes.cnpq.br/3509453567791268; Universidade Federal de São Paulo (UNIFESP)
    Objective: To determine the incidence and the clinical significance of amniotic fluid ‘sludge’. Study Design: A retrospective and prospective study was conducted between October 2010 and January 2015 in 395 pregnant women between 16 and 26 weeks. Of these, 49 patients were excluded. In 26 women it was not possible to obtain the perinatal results, in 18 the gestation was terminated before 37 weeks by medical indication, in 4 patients the fetuses were diagnosed with malformation and one pregnancy resulted in spontaneous late abortion at 18 weeks and 4 days. In all patients, transvaginal ultrasonography was performed for morphological assessment of the cervix according to the routine of the institution. The perinatal results were obtained in 346 pregnant women and were compared with the presence of amniotic fluid ‘sludge’, cervical length < 25mm and high risk for spontaneous preterm delivery. Results: Amniotic fluid ‘sludge’ affected 24.9% (86/346) of the pregnancies. A preliminary analysis was performed considering patients who were attended between October 2010 and October 2012, in a total of 130 pregnant women, of whom 22 presented amniotic fluid ‘sludge’. Pregnant women with ‘sludge’ had a higher risk of spontaneous birth before 35, 34, 32 and 28 weeks and the logistic regression analysis demonstrated that ‘sludge’ is an independent risk factor for spontaneous birth before 35 weeks with an odds ratio of 4,950 (95% CI, 1,110 - 22,222), 34 weeks with an odds ratio of 11,905 (95% CI, 1,634 - 9,091) and 32 weeks with an odds ratio fof 10,000 (95% CI, 1,130 - 90,909). After these results, the Department of Obstetrics of Federal University of São Paulo decided to institute antibiotic therapy for patients with "sludge". Considering all patients included, having used antibiotics or not, the presence of ‘sludge’ continued to increase the number of spontaneous preterm births before 35 weeks (14.0% (14/86) vs 5.8% (15/260), p = 0.014) (9/8), before 34 weeks (12.8% (11/86) vs 3.8% (10/260), p = 0.03) and before 32 weeks (9.3% (8/86) vs 3.5% (9/260), p = 0.029). Logistic regression analysis still demonstrated that the amniotic fluid "sludge" is an independent risk factor for spontaneous birth below 34 Abstract xviii weeks with an odds ratio of 2,611 (95% CI, 1,018 to 6,711). An historical cohort was performed comparing patients with sludge who did not use antibiotics (n = 22) and those who used (n = 64). In patients with amniotic fluid "sludge" who had a concomitant cervical length < 25mm or a history of high risk for spontaneous preterm delivery, the use of antibiotics reduced the chance of preterm birth before 34 weeks with an odds ratio of 0.242 (CI 95%, 0.058 to 0.998). Conclusion: Amniotic fluid "sludge" is an independent risk factor for spontaneous preterm delivery before 35, 34 and 32 weeks. After antibiotic therapy, it remains an independent risk factor for spontaneous birth before 34 weeks. In patients with a "sludge" signal associated with neck length <25mm or high risk for preterm labor, the use of antibiotics reduces the chance of spontaneous birth before 34 weeks.