Navegando por Palavras-chave "Parto pré-termo"

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    Avaliação da medida do comprimento do colo e da ausência do eco glandular endocervical para predição do parto pré-termo
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2004-04-01) Pires, Claudio Rodrigues [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Mattar, Rosiane [UNIFESP]; Kulay Júnior, Luiz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: to verify the prevalence of two sonographic findings, the cervical gland area (CGA) feature and the cervical length of less than 20 mm, and to compare these with the risk for premature delivery in pregnant women between 21 and 24 weeks' gestation. METHOD: this was a prospective, cross-sectional study in which 361 women were consecutively examined by transvaginal ultrasonography. Müllerian or other malformations, multiple gestations, fetal death, olygo- or polyhydramnios, marginal placenta previa, and conization, cerclage, amputation or other surgical procedures in the cervix, prior to or during pregnancy, were exclusion criteria. After the abdominal ultrasonographic morphological examination, we used transvaginal ultrasonography to measure the cervical length and to observe the presence of hyper- or hypoechoic area next to the endocervical canal, a feature characteristic of endocervical epithelium glands which is called CGA (cervical gland area). Qualitative variables are expressed as absolute and relative frequency. Quantitative variables are expressed as mean, median, standard deviation, minimum, and maximum values. Association between qualitative variables was detected by the c² test or by the Fisher exact test. For each variable, the relative risk and the 95% confidence interval (CI) were calculated. Logistic regression analysis was used to calculate the predictive values for premature delivery. Significance level was 95% (alpha = 5%), with descriptive (p) values equal or lower than 0.05 considered significant. RESULTS: spontaneous preterm delivery occurred in 5.0% of the patients. Cervical length was up to 20 mm in 3.3% of all studied patients and in 27.8% of those who delivered spontaneously before the end of the pregnancy. Absence of the CGA was detected in 2.8% of all patients and in 44.4% of the women who eventually developed spontaneous preterm labor. There was a statistically significant association of absence of CGA with short cervical length (p<0.001). Absence of CGA was strongly associated with spontaneous preterm delivery (relative risk of 28.57, 95% CI 14.40-56.68). CONCLUSION: the absent CGA feature is a new morphological ultrasonographic parameter that is useful in the prediction of spontaneous preterm delivery in single gestations. Our results show that the parameter can be used as an indicator of risk for premature delivery, to be confirmed by future research.
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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.