Late Puerperium Research Articles

Case Report: Heart failure in the puerperium

BACKGROUND: Cardiomyopathies that occur de novo in relation to pregnancy or childbirth have diverse etiologies, although they are uncommon, they contribute substantially to maternal morbidity and mortality. In addition, during gestation there are hemodynamic changes that could make hidden heart disease manifest and produce ventricular remodeling with the consequent appearance of persistent or transient structural heart disease. Currently, there is little data on the prevalence of heart disease that occurs during or after pregnancy; for this reason it is of utmost importance to know the cardiovascular diseases related to this period. CASE REPORT: A 26-year-old female patient, who during her late puerperium, after her first pregnancy, terminated by cesarean section due to preeclampsia with severity criteria, presented signs and symptoms of heart failure. After evaluation, ischemic causes were ruled out, maintaining a high diagnostic suspicion of peripartum cardiomyopathy, based on the absence of a history of heart disease prior to pregnancy, the presence of preeclampsia during gestation and the clinical presentation associated with the puerperium; however, after searching for the etiology by cardiac imaging studies, suggestive data of left ventricular non-compaction cardiomyopathy was reported. EVOLUTION: After definitive diagnosis was made, optimal medical therapy for heart failure with reduced ejection fraction was established. The patient presented a favorable evolution, with symptomatic improvement and decrease of clinical and radiological signs of pulmonary congestion and was discharged with the same pharmacotherapy and indications for outpatient monitoring. CONCLUSION: In this case we are dealing with a patient with no cardiac pathology prior to pregnancy, who debuted with symptoms of heart failure in the late puerperium. Although imaging studies confirmed the diagnosis of left ventricular non-compaction cardiomyopathy, the case should be closely followed up due to the probability of reversible ventricular trabeculations associated with pregnancy and not a noncompacted left ventricular cardiomyopathy per se. Given the difficulty for diagnosis and identification of the etiology, the pathology should be studied exhaustively, especially in patients with a high probability of presenting trabeculations as part of adaptive remodeling.

Late Postpartum Posterior Reversible Encephalopathy Syndrome: Case Series and Literature Review

Abstract Posterior reversible encephalopathy syndrome (PRES) is a reversible neurological entity characterized by seizures, headache, visual symptoms and other focal neurological findings. It is caused by wide variety of causes ultimately leading to vasogenic cerebral edema of occipital and parietal lobes of the brain. Prompt and early diagnosis of PRES is key in reducing the risk of permanent neurological sequelae. Occurrence of PRES during pregnancy or early postpartum period is well known. However, occurrence of PRES between 48 hours and one month postpartum in women who had normal pregnancy and delivery and no signs of preeclampsia is rare. In this case series we present three cases of PRES that occurred in young women during late postpartum period. All these three patients were normotensive during antenatal and early puerperal period but developed hypertension and vision loss in late puerperium. The prompt diagnosis and management of symptoms resulted in complete reversal of the symptoms with no permanent neurological deficit. Posterior reversible encephalopathy syndrome (PRES) is a reversible neurological entity characterized by the presence of white matter edema affecting the occipital and parietal lobes. The predominantly affected area of the cerebral cortex determines presentation in the patient. The reversibility of these symptoms is one of the hallmarks of the disease. Diffusion-weighted MRI is the gold standard in diagnosis of PRES as it helps to distinguish between vasogenic edema from cytotoxic edema. Prompt diagnosis and initiation of early treatment may lead to complete recovery with no residual neurological deficit.

RU-Net: An improved U-Net placenta segmentation network based on ResNet

BackgroundIn recent years, with the increase of late puerperium, cesarean section and induced abortion, the incidence of placenta accreta has been on the rise. It has become one of the common clinical diseases in obstetrics and gynecology. In clinical practice, accurate segmentation of placental tissue is the basis for identifying placental accreta and assessing the degree of accreta. By analyzing the placenta and its surrounding tissues and organs, it is expected to realize automatic computer segmentation of placental adhesion, implantation, and penetration and help clinicians in prenatal planning and preparation. MethodologyWe propose an improved U-Net framework: RU-Net. The direct mapping structure of ResNet was added to the original contraction path and expansion path of U-Net. The feature information of the image was restored to a greater extent through the residual structure to improve the segmentation accuracy of the image. ResultsThrough testing on the collected placenta dataset, it is found that our proposed RU-Net network achieves 0.9547 and 1.32% on the Dice coefficient and RVD index, respectively. We also compared with the segmentation frameworks of other papers, and the comparison results show that our RU-Net network has better performance and can accurately segment the placenta. ConclusionOur proposed RU-Net network addresses issues such as network degradation of the original U-Net network. Good segmentation results have been achieved on the placenta dataset, which will be of great significance for pregnant women's prenatal planning and preparation in the future.

A four year experience of peripartum cardiomyopathy in a rural public hospital in south india

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Peripartum cardiomyopathy (PPCM), as defined by the study group on PPCM of Heart Failure Association of the European Society of Cardiology (ESC), is an idiopathic Cardiomyopathy with systolic heart failure occurring towards the end of pregnancy or in the months following delivery, in previously healthy women. The current diagnostic criteria are: - heart failure in the last month of pregnancy or in the first 5 postpartum months - absence of other causes of heart failure - absence of known heart disease predating the development of heart failure. - reduced Left Ventricular Ejection Faction (LVEF) of < 45% or Fractional Shortening < 30% The global incidence of PPCM is variable, the least reported in Japan and the most in Nigeria. The estimates of the incidence in India need more scrutiny because of the difficulties in diagnosing the condition. The current incidence in literature is 1 in 1374 live births. We conducted the study to characterize PPCM among women delivered at a resource-limited setting in South India. Aim To estimate the incidence of PPCM To describe the risk factors and Feto-maternal outcomes and associated mortality To estimate the recovery of cardiac function at the end of one year. Materials and Methods This was a prospective longitudinal study conducted in a rural public hospital in South India, from 2017 to 2020. PPCM was diagnosed in pregnant and puerperal women, in concurrence with global standards. Data included were Age, Parity, Gestational age, Risk factors, Medical Management, Pregnancy outcome and Echocardiography data on diagnosis and at 1-year follow-up. Results - 32 out of 14505 women in the 4-year study period were diagnosed with PPCM. - The incidence of PPCM was 1 in 453 live births. - The mean age was 23.2 years. - 46.8% were primigravidae. - 21.8% had pre-eclampsia. - 100% had breathlessness at presentation (62.5% were in New York Heart Association – Class III). - The mean LVEF on diagnosis was 24.5%. - The Fractional Shortening was 16%. - The Left Ventricular End Diastolic Dimension was 5.8cm. - 18.75% of women were diagnosed antenatally, 75% in the early puerperium and 6.25% in the late puerperium. - 81.3% were delivered by caesarean section. - At 1-year follow up, complete recovery of cardiac function was observed in 65.6% of the women. - There was no maternal mortality or adverse perinatal outcomes. Conclusion Although rare, PPCM is an important cause for Maternal Mortality. Being a diagnosis of exclusion, a high index of suspicion and involvement of a multi-disciplinary team will aid to optimize the Feto-maternal outcomes. Setting up a National PPCM registry will help in establishing the clinical epidemiology, risk factor assessment, screening strategies, diagnostic criteria and management options for mothers suffering from the condition.

Sentimentos vivenciados pela mulher durante o puerpério

Introdução: O puerpério se refere ao período que se inicia logo após o parto, definido por diversas transformações, além de físicas, psíquicas, constituindo como um momento de fragilidade, influenciando na transição existencial e na relação mãe-filho. Durante esse período as mulheres necessitam de atenção especial dos serviços de saúde, demandando dos profissionais um olhar atento e comprometido principalmente aos aspectos subjetivos. Objetivo: Compreender os sentimentos vivenciados pela mulher durante o puerpério. Métodos: Estudo qualitativo, não experimental, exploratório descritivo transversal realizado através entrevista semiestruturada gravada as mulheres puérperas presentes em uma Unidade Básica de Saúde de Santo Antônio do Aracanguá-SP. Resultados: Participaram do estudo 10 mulheres no período do puerpério, com idade média de 28 anos, as quais em sua maior parte eram primíparas e estavam no período tardio do puerpério durante a realização das entrevistas. Os discursos revelam diversos sentimentos positivos sobre a vivência do puerpério e a experiência de cuidar do seu filho. Conclusão: A partir da percepção das mulheres entrevistadas, o puerpério apresenta como um período de transições e novos desafios, foi possível compreender seus sentimentos, realizações, dificuldades e as mudanças ocorridas.

Vivências de casais acerca da participação do parceiro no puerpério

Objetivo: conhecer a vivência de casais no período puerperal acerca da participação do parceiro. Método: pesquisa qualitativa descritiva, realizada por meio de entrevista semiestruturada e da Técnica de Criatividade e Sensibilidade “Almanaque”. Os dados foram analisados conforme a proposta operativa. A população do estudo foram dez casais que vivenciavam o puerpério imediato, tardio ou remoto. Resultados: foram organizados em uma categoria denominada: “o cotidiano do casal no puerpério: mudanças e participação ativa do parceiro”. Cada casal vivenciou o puerpério de acordo com sua singularidade, adaptando sua rotina e reorganizando-a. Os parceiros, que foram incluídos no puerpério, sentiram-se mais satisfeitos ao realizar os cuidados com o bebê. As puérperas também reforçaram a importância do parceiro nas atividades domésticas e nos cuidados com elas e com o bebê. Conclusão: a participação ativa dos parceiros contribuiu significativamente para que os casais vivenciassem esse período com mais satisfação, fortalecendo o vínculo pai-mãe-filho.

Postpartum program actions in primary health care: an integrative review.

Puerperium is a period of significant morbimortality for women, and Primary Health Care (PHC) is important in developing actions to meet women's health needs. This study aimed to systematize the knowledge produced on postpartum care programs actions within PHC at both national and international levels. This is an integrative review of the literature in databases LILACS (Latin American and Caribbean Health Sciences Literature), BDENF (Nursing Database), SciELO (Scientific Electronic Library Online) and PubMed (US National Library of Medicine). Search was performed in the period April-May 2017. Forty-three papers met the selection criteria. Results indicate that PHC has the physical structure to provide puerperae with care, but has a shortage of human and material resources; there is low postpartum consultation coverage and home visits; there is a good evaluation of the incentive for breastfeeding, but focused on the child; international screening of Postpartum Depression through the Edinburgh Postnatal Depression Scale and care shortage for this condition in Brazil. Postpartum care still focuses on care for the newborn and is mostly restricted to the immediate and late puerperium.

Síndrome de encefalopatía posterior reversible en lupus eritematoso sistémico

Posterior reversible encephalopathy syndrome (PRES) is a poorly recognized and reversible condition in systemic lupus erythematosus (SLE) that could mimic neuropsychiatric lupus. The manifestations of PRES are headache, seizures, altered level of consciousness and blindness. In most cases, computed tomography of the brain shows hypodense lesions in the parieto-occipital lobe. Although this syndrome is rare, rapid and accurate recognition allows early treatment with favorable results. We present a case report of a patient with the onset of SLE following the episode of eclampsia, and who during the late puerperium presented sustained hypertension associated with seizures and deterioration of the level of consciousness in the context of PRES.

A atuação do residente em Odontologia Hospitalar neonatal na abordagem multidisciplinar do SUS: relato de experiência

A reorganização dos serviços de saúde vinculada ao programa Humaniza SUS possibilita o cuidado multiprofissional do indivíduo. Neste sentido, a inclusão do cirurgião-dentista nas equipes visa somar esforços para o alcance da integralidade da atenção, a qual abrange as diversas alterações que podem acometer o sistema estomatognático de sujeitos em cuidados hospitalares. A residência em odontologia hospitalar neonatal, como parte integradora da abordagem multiprofissional, é extremamente importante para garantir a abordagem adequada de gestantes, puérperas e recém-nascidos (RN) em sua plenitude. As frentes de atuação do residente em odontologia neonatal envolvem, principalmente, o pré-natal odontológico, o puerpério imediato e mediato, a abordagem ambulatorial e as unidades de terapia intensiva neonatal e pediátrica. Este artigo objetiva relatar a experiência de atuação de residentes em odontologia hospitalar neonatal em um hospital escola pertencente ao Sistema Único de Saúde (SUS) do Paraná.

123 The serum behavior of lipoproteins and inflammatory substrates in the mediate and late puerperium in preeclampsia

Currently, two factors are considered important in the pathophysiology of preeclampsia: lipid peroxidation and exacerbated inflammatory response. The reduction in the clinical expression of preeclampsia 12 weeks postpartum motivates the search to recognize the behavior of lipoprotein and inflammatory substrates. Evaluate the influence of lipoprotein and inflammatory markers in women with preeclampsia during the mediate and late postpartum. Cohort study developed at the Guilherme Álvaro Hospital- Santos/Brazil. Were collected blood samples of 107 patients (48 case group and 59 control group) from January/2015 to May/2016 in the mediate postpartum. After that, the same women returned to the second sample, 12 weeks postpartum. It was a total of 31 patients (17 case group and 14 control group). Lipoprotein substrates and selected inflammatory possibly related to preeclampsia were analyzed. Group case: women with preeclampsia according to the criteria of NHBPEP – National High Blood Pressure Education Program (2000). Control group: patients after vaginal delivery with term newborn without hypertension and/or other comorbidities. Exclusion criteria: collagen disease, smoking, twin pregnancy, previous diagnosis of diabetes mellitus and fetal malformations. Variables analyzed: total cholesterol, LDL (low-density lipoprotein) fraction, triglycerides, fasting glucose, insulin, HOMA-IR, C-reactive protein (CRP), total protein, albumin, globulin, uric acid, glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), gamma-glutamyl transferase (GGT). For the descriptive measures of each variable of interest we calculate in the two evaluations. Then to study the behavior of the variables of interest in the chosen group, in the two assessments, we used the model of multivariate analysis and repeated measures. Comparison of possible lipoprotein and inflammatory markers results (∗p < 0.05) We considered p, as the variables that have changed uniformly between the groups comparing the mediate and the late puerperium. Download : Download high-res image (187KB)Download : Download full-size image The glycidic and inflammation effectors such as blood glucose, insulin, HOMA -IR, C-reactive protein and uric acid showed uniform and significant changes between the groups comparing mediate and late postpartum. Lipoproteins indicated an upward trend in women with preeclampsia, while total protein, albumin and globulin fractions seem to be reduced in this group. Comparing the mediate and late postpartum period we identified a significant difference between the serum levels of lipotoxicity and inflammatory markers.

93 Maternal and perinatal outcomes in preeclampsia according to the magnitude of proteinuria: Results from a high risk referral center in Brazil

Preeclampsia (PE) is one of the leading causes of maternal and neonatal morbidity and mortality worldwide. It is defined as new onset hypertension developing ⩾20 weeks and proteinuria or evidence of maternal organ dysfunction. The magnitude of proteinuria was a marker for severity and when higher than 2 g/24 h indicated aggressive treatment. This was recently revised and no longer defines severity, but there are still gaps in understanding how different levels of increased proteinuria impact on maternal and perinatal outcomes and its long term consequences. To review all cases of PE with proteinuria ⩾2 g/24 h followed at the State University of Campinas (UNICAMP) in a 5 year period, and compare maternal and perinatal outcomes according to the magnitude of proteinuria. Retrospective cohort of all pregnant women with proteinuria ⩾2 g/24 h followed at UNICAMP from January 2009 to December 2013. Women with previous nephropathy, without diagnosis of PE or delivery elsewhere were excluded from the analysis. Data on demographic characteristics, onset of symptoms, laboratory findings, maternal and fetal/neonatal outcomes were recorded. Data were stored and analyzed using the Epi-Info 7; continuous variables were compared using ANOVA and categorical variables analyzed by x2 or Fisher exact tests. 269 women were screened for review, 19 were excluded for delivering elsewhere, 41 were excluded due to previous nephropathy, 8 due to absence of PE and 5 for post-partum PE (with normal proteinuria during gestation). The current analysis included 196 women. The median age was 28 (±7.1), majority white (69%) and nearly half primigravidas. The average overall magnitude of proteinuria was 5.1 g/24 h (±3.7). Cesarean delivery was the most frequent route of delivery (84%) and the mean gestational age at delivery 33 weeks (±3.8). The majority of cases presented severe PE (80%). Less then half of the women attended postpartum care and among those, most remained with abnormal proteinuria in early (80%) and late (76%) puerperium (followed up to 3 months postpartum). We considered 3 groups of cases according to the magnitude of proteinuria: ⩾2 and <5 g/24 h (n = 124), ⩾5 and <10 g/24 h (n = 43) and ⩾10 g/24 h (n = 18). A summarized comparison among these groups is in Table 1. Quantification of proteinuria remains an important tool in the diagnosis of PE but its magnitude alone, should not guide management. Massive proteinuria presented significantly more in primigravida and proteinuria ⩾5 g/24 h presented decreased gestational age at resolution. Future studies must address systematic follow-up of these women during pregnancy, latency from diagnosis to resolution, and the women’s perspective upon diagnosis of massive proteinuria. A postpartum follow-up is critical, to assess long term consequences of massive proteinuria during pregnancy.

Prospective study of the hemodynamic behavior of ophthalmic arteries in postpartum preeclamptic women: A doppler evaluation

ABSTRACTThe aim of this study was to evaluate the hemodynamic behavior of the ophthalmic artery by means of the Doppler ultrasound, in postpartum preeclamptic women. It was an observational prospective study with 44 postpartum preeclamptic women (group 1) and 49 postpartum normal women with normal blood pressure and with no previous illnesses known (group 2). All the pregnant women had a Doppler ultrasound exam of the ophthalmic artery in the immediate puerperium, that is, 10 days for the delivery (time 1). Group 1 was then followed prospectively, 26 patients of which returned to the last test in the remote puerperium in 45 days (time 2) and 29 patients returned to the last test in the remote puerperium in 90 days (time 3). All these women had preeclampsia before the delivery. The resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), end diastolic flow velocity (EDV), second peak of systolic velocity (P2), and the peak ratio (PR) were calculated. The data obtained are expressed in average and standard deviation, by using the Lilliefors test for normality. The average of the Doppler indexes in groups 1 and 2 was compared by means of test t of the student. Group 1 was analyzed separately, comparing the three times, using the test of ANOVA for repetitive measures and Tukey post-hoc range test. In the “Results” section, the statically meaningful differences in RI, PI, P2, RPV, and EDV (p < 0.0001, p < 0.0001, p < 0.0009, p < 0.0001, p < 0.0028) were found in the immediate puerperium of group 1 in relation to group 2, indicating the persistence of hyperperfusion and orbital vasodilatation in the immediate postpartum period in patients who had complicated pregnancies previously due to preeclampsia. In the evolutionary analysis of group 1, comparing the Doppler indexes between the immediate and late puerperium, statistically relevant differences between the rates of RI, P2, and PR (p < 0,01) were observed, showing a raise of RI and reduction of P2 and PR, and also a tendency of normalization of these rates in the late puerperium. When the same indexes were compared (PI, P2, and PR) now in times 2 and 3, the remote, and late puerperium, respectively, there were no significant differences, indicating the stabilization of these indexes since the 45th day of the puerperium. Within 90 days, RI, PI, and PR are not stabilized yet in relation to the control, even though there is a tendency of these indexes to reach the control. In conclusion, there was persistence of signs of vasodilatation and hyperperfusion of the orbital territory, represented by Doppler of the ophthalmic artery in the immediate puerperium of preeclamptic women. A tendency of normalization of the orbital hemodynamic standard in the pregnant women from the period of the late puerperium was observed, but there was no complete normalization of the vascular pattern on the remote postpartum.

Do imaginário ao real: mitos e medos acerca do parto normal.

Objetivo: conhecer mitos e medos relacionados ao parto normal segundo primigestas ao término da gestação, e a confirmação ou não destes mitos e/ou medos durante o puerpério tardio. Método: trata-se de pesquisa descritiva com abordagem qualitativa utilizando a técnica de entrevista aberta em profundidade e aplicação de questionários em dois momentos distintos: inicialmente na condição de gestante e posteriormente como puérperas. Os dados foram levantados em uma maternidade pública na cidade de Goiânia após aprovação do comitê de ética em pesquisa (0004.0.168.000-08); análise de conteúdo foi estabelecida para identificação das categorias temáticas. Resultados: emergiram três categorias: A chegada de um bebê, O verdadeiro significado do parto normal e Mitos e medos que permeiam o nascimento. Conclusão: a dor foi identificada como principal fator cultural que interfere na escolha pelo tipo de parto em primigestas. E o parto normal esteve associado à desmistificação acerca do nascimento pelas puérperas.

Potentiating maternal immune tolerance in pregnancy: A new challenging role for regulatory T cells

The maternal immune system needs to adapt to tolerate the semi-allogeneic conceptus. Since maternal allo-reactive lymphocytes are not fully depleted, other local/systemic mechanisms play a key role in altering the immune response. The Th1/Th2 cytokine balance is not essential for a pregnancy to be normal. The immune cells, CD4+CD25+Foxp3+, also known as regulatory T cells (Tregs), step in to regulate the allo-reactive Th1 cells. In this review we discuss the role of Tregs in foeto-maternal immune tolerance and in recurrent miscarriage as well as their potential use as a new target for infertility treatment. Animal and human experiments showed Treg cell number and/or function to be diminished in miscarriages. Murine miscarriage can be prevented by transferring Tregs from normal pregnant mice. Tregs at the maternal–fetal interface prevented fetal allo-rejection by creating a “tolerant” microenvironment characterised by the expression of IL-10, TGF-β and haem oxygenase isoform 1 (HO-1) rather than by lowering Th1 cytokines. Tregs increase placental HO-1. In turn, HO-1 may lead to up-regulation of TGF-β, IL-10 and CTLA-4. In vivo experiments showed Tregs sensitisation from paternal antigens to be essential for maternal–fetal tolerance. Tregs increase throughout pregnancy and diminish in late puerperium. Recent data also support the capacity of Tregs to block maternal effector T cells, thereby reducing the maternal–fetal pathological responses to paternal antigens. These findings also permit us to consider new strategies for improving pregnancy outcomes, i.e., anti-TNF blockers and granulocyte-colony stimulating factors as well as novel approaches to therapeutically exploiting Treg + cell memory.

Ultrasound and Doppler assessment of uterus during puerperium after normal delivery

Objective: To describe the biometric and morphological characteristics of the uterus through ultrasound (US) and Doppler on the uterine arteries in the initial and late puerperium after normal delivery.Methods: This was a prospective longitudinal study on full-term singleton pregnancies without complications. The patients were divided into two groups: 31 primiparous and 28 multiparous women. Two US exams were carried out with Doppler evaluation: firstly, within the initial 48 h; and secondly, between 31 and 50 days after childbirth. The US assessed the position and biometry of the uterus, appearance of the myometrium, measurement and content of the uterine cavity, and Doppler velocimetry indices of uterine arteries. To compare the groups at the two times, the paired Student t-test, Fisher’s exact test and chi-square test were used.Results: In the initial puerperium, the position of the uterus was retroversion (98.3%); the appearance of the myometrium was heterogeneous (96.6%); the uterine cavity was filled with some type of material (72.9%). After the 30th day, a position was anteversion (74.6%); the appearance of the myometrium was homogeneous (91.5%); and the uterine cavity was empty (81.3%). There was an evolution in the pulsatility index between the two US exams, with an increase of 52.03% among the primiparous and 53.13% among the multiparous for the right uterine artery.Conclusion: Significant changes were observed in the morphological and biometric characteristics of the uteruses evaluated through US, as well as in the uterine arteries Doppler, between the initial and late puerperium.

Risk Factors on Hypertensive Disorders among Jordanian Pregnant Women

Eight percent of pregnancies involve hypertensive disorders, which can have serious complications for mothers and children. There has only been minimal research into hypertension in pregnancy in developing countries, including Jordan. Therefore, this study aimed to identify how frequent certain risk factors that apply to hypertensive disorders during pregnancy were among women in the Jordanian capital of Amman. A prospective case-control study was conducted on 184 Jordanian pregnant patients with hypertensive disorders and 172 age-matched control subjects recruited from the maternity ward of a tertiary public hospital in Ammn city; they were followed-up until 85 days after the birth (late puerperium). A standardized questionnaire pilot-tested was completed by participants that included demographic data and known risk factors for hypertension in pregnancy. Statistical analysis SPSS was conducted to compare the frequency of risk factors using Fisher’s exact test, chi-square, Student’s t-tests, as well as multivariate logistic regression was conducted to identify independent risk factors. The results showed that chronic hypertension, prenatal hypertension, family history of preeclampsia, diabetes, high BMI, nulliparity, previous preeclampsia history and low education level were identified as risk factors for hypertensive disorders in pregnancy in this population; Moreover, diabetes, chronic hypertension and family history of preeclampsia were found to be independent risk factors. The results of the study contribute to the currently limited knowledge about the modifiable risk factors for hypertensive disorders during pregnancy among the Jordanian population, and could therefore be extremely useful for clinicians providing prenatal care.

Calcium homeostasis in a patient with hypoparathyroidism during pregnancy, lactation and menstruation

Abstract Objective To report a case of hypoparathyroidism post-thyroidectomy in a woman with variable calcium requirements during pregnancy Methods Clinical and biochemical data were reviewed, and management of hypocalcaemia is described. Results We report on a 37-year-old pregnant woman with hypoparathyroidism post-thyroidectomy who had been on stable doses of calcitriol and calcium for many years. During her first pregnancy, her calcium requirement increased; however, she was found to be hypercalcaemic peripartum. She resumed menstruation while breastfeeding and experienced hypocalcaemic symptoms around menstruation. Her second pregnancy was complicated by profound symptomatic hypocalcaemia at 9 weeks of pregnancy, coinciding with the cessation of breastfeeding and mimicking ‘hungry bone syndrome’. This has not been described previously. Conclusion Our case confirms that the calcium requirement is increased during early pregnancy and after weaning but is decreased during late pregnancy, puerperium and lactation. This case highlights the importance of close follow-up of calcium levels in women with hypoparathyroidism during gestation and lactation, especially for consecutive pregnancies.

OP03.05: Sonographic evaluation of uterine Cesarean scar in late puerperium

OP03.05: Sonographic evaluation of uterine Cesarean scar in late puerperium

Can the delivery method influence lower urinary tract symptoms triggered by the first pregnancy?

The increase of the intensity of urinary symptoms in late pregnancy and postpartum has been well documented by several authors, but their causes remain uncertain, partly because of its probable multifactor origin. There are also controversies whether the etiology of lower urinary tract symptoms during pregnancy is the same as postpartum and whether the method of delivery could influence the risk of onset of urinary symptoms. This study aimed to evaluate the urinary symptoms triggered during pregnancy and its evolution in the late puerperium, correlating them with the delivery method. A longitudinal study was conducted, which included 75 primigravidae women, classified according to method of delivery as: (VD) vaginal delivery with right mediolateral episiotomy (n = 28); (CS) elective caesarean section (n = 26); and (EC) emergency caesarean section (n = 21). Urinary symptoms were assessed in the last trimester of pregnancy and at 45 days (± 10) of puerperium with validated versions for Portuguese language of the following questionnaires: International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB). It was observed that frequency, urgency, nocturia and urge incontinence, triggered during pregnancy, decreased significantly in the postpartum period, regardless of the delivery method (p = 0.0001). However, symptoms related to urinary loss due to stress persisted after vaginal delivery (p = 0.0001). Urgency, frequency and nocturia triggered during pregnancy tend to disappear in the late postpartum period, regardless of the delivery method, but the symptoms related to urinary loss due to stress tend to persist in late postpartum period after vaginal delivery.

Schistosomiasis: a case of severe infection with fatal outcome

Schistosomiasis is one of the most common parasitic diseases, still considered of public health significance. Acute schistosomiasis is of difficult diagnosis and therefore has been overlooked, misdiagnosed, underestimated and underreported in endemic areas. The delay between the exposure to contaminated water and the initial symptoms may explain this challenging diagnosis. Acute schistosomiasis is frequently reported in non-immune individuals while reinfection cases occurring in endemic areas is scarcely documented. The later usually shows a benign course but fatal cases do exist. The authors report a case of a young female patient, in the late puerperium, with a three-month history of weight loss, intermittent fever, cough, thoracic and abdominal pain and increased abdominal girth. Physical examination showed a tachycardia, tachypnea and hypotension. Laboratory tests showed a mild anemia, eosinophilia, and a slightly elevation of liver enzymes. Thorax and abdominal multidetector computed tomography evidenced a diffuse and bilateral pulmonary micronodules and peritoneal and intestinal wall thickening. The patient progressed rapidly to hepatic insufficiency, and death after respiratory insufficiency. An autopsy was performed and the findings were compatible with acute Schistosomiasis in a patient previously exposed to Schistosoma mansoni.