Maternidade-Escola Assis Chateaubriand Research Articles

Musculoskeletal evaluation of the lower pelvic complex in women with endometriosis: A case-control study

ObjectiveMake a comparison about the presence of disorders of the pelvic loin complex between healthy women (without endometriosis) and women with endometriosis. Study DesignChronic pelvic pain (CPP) associated with endometriosis has diverse origins, including musculoskeletal factors. Musculoskeletal dysfunction in the pelvic region is theorized to result from sustained muscular contraction, triggered by altered visceral stimuli and adoption of antalgic postures, causing secondary damage to muscles, ligaments, and joints. CPP significantly impacts quality of life, relationships, sexuality, and mental health. However, limited data exists on musculoskeletal impacts of endometriosis and CPP. It was made a case-control study at Maternidade Escola Assis Chateaubriand from August 2017 to January 2021. Evaluated 71 women: 41 in endometriosis group (EG) and 30 in control group (CG). Data collection included sociodemographic questionnaires, musculoskeletal physiotherapeutic evaluations, pain mapping, pressure pain thresholds, kinesiophobia, and disability measurements. Statistical analysis was performed using Spearman's Rho test to determine correlations. ResultsMean age of participants was 31 years. EG exhibited lower pain threshold variations in lumbopelvic trigger points than CG (P < .05). Significant muscle flexibility differences between groups were observed; EG had reduced flexibility (P < .05). Most common pain areas were hypogastrium in EG (48.78 %) and left lumbar in CG (30 %). EG had higher kinesiophobia values (P = .009). Weak kinesiophobia-pressure threshold association observed in CG's lumbar pelvic region. ConclusionWomen with Endometriosis and CPP exhibit higher musculoskeletal disorder prevalence, lower pain thresholds, decreased lumbopelvic muscle range of motion, higher kinesiophobia scores, and increased disability indices with low back pain compared to healthy women.

Conhecimento de mães e familiares relacionados a cuidados dispensados a recém-nascidos a termo

Objetivo: avaliar o conhecimento de mães e familiares relacionados a cuidados dispensados aos recém-nascidos. Método: estudo descritivo, quantitativo, realizado com mães e familiares de recém-nascidos que eram atendidos e/ou acompanhados em dois Centros de Saúde e em uma Unidade de Atenção Primária à Saúde localizados no interior do Ceará, e duas maternidades, sendo uma do interior do Ceará e outra de Fortaleza. A coleta de dados ocorreu com 196 mães e familiares de agosto a dezembro de 2019, por meio de entrevistas individuais utilizando um formulário eletrônico. O estudo foi submetido e aprovado pelo Comitê de Ética em Pesquisa da Maternidade Escola Assis Chateaubriand por meio da Plataforma Brasil. Resultados: os resultados apontaram lacunas em alguns conhecimentos dos participantes quanto aos cuidados dispensados ao bebê, a saber: práticas de aleitamento materno exclusivo, cuidados de higiene geral, manejo das cólicas, sono, imunização e banho de sol do recém-nascido. Conclusão: Assim, constatou-se a necessidade de intervenções que trabalhem os conhecimentos dos cuidadores, para dessa forma, contribuir na melhor qualidade de vida e saúde dos recém-nascidos, e na redução dos índices de morbimortalidade neonatal.&#x0D;

Gestational Outcomes in Patients with Severe Maternal Morbidity Caused by Hypertensive Syndromes.

To evaluate the impact of the presence of criteria for severe maternal morbidity and maternal near miss associated with hypertensive disorders on maternal and perinatal outcomes in a maternity school. The present is a sub-analysis of a larger study involving 27 centers in Brazil that estimated the prevalence of serious maternal morbidity and near miss. It is an analytical and cross-sectional study with a quantitative approach, involving 928 women who were cared for at Maternidade Escola Assis Chateaubriand (MEAC, in Portuguese), Universidade Federal do Ceará (UFC, in Portuguese), from July 2009 to June 2010. The women were diagnosed with near miss according to the World Health Organization (WHO) criteria. The sample was divided into 2 groups: patients with (n = 827) and without hypertension (n = 101). The results were considered statistically significant when p < 0.05. The Pearson chi-squared and Fisher Exact tests were used for the categorical variables, and the Mann-Whitney U test was used for the continuous variables. In total, 51 participants with maternal near miss criteria were identified, and 36 of them had hypertensive disorders. Of these, 5 died and were obviously excluded from the near miss final group. In contrast, we observed 867 cases with non-near miss maternal morbidity criteria. During this period, there were 4,617 live births (LBs) in the institution that was studied. In the severe morbidity/maternal near miss population, the presence of hypertensive complications was prevalent, constituting a risk factor for both the mother and the fetus.

Mental disorders and obstetric diseases in high risk gestations

Objectives: To analyze the prevalence of major depression disorder, anxiety disorders and substance abuse in women with high-risk pregnancy and identify maternal-fetal pathologies and other variables associated with higher prevalence of mental disorders. Methodology: This cross-sectional study included 46 women in the high-risk gestation outpatient clinic of the Maternidade Escola Assis Chateaubriand in Fortaleza - Ceará. A sociodemographic and a clinical data questionnaire were applied, as well as Abuse Assesment Screen, Edinburgh Postpartum Depression Scale, State-Trait Anxiety Inventory and Alcohol Smoking and Substance Screening Test. Mini International Neuropsychiatry Interview (MINI) was applied to women with positive screening in the mentioned scales. Results: Using the screening tools, the prevalence was 30.4% for depression and 52.2% for anxiety; with the MINI the prevalence was 30,4% and 34,8%, respectively. Pregnant women with cardiac diseases had a 66,7% depression prevalence and a 77.8% anxiety prevalence, both higher than those with other pathologies. Depression and anxiety were also associated with unwanted pregnancy and domestic violence during life. Conclusion: The prevalence of depression and anxiety was high in this sample of pregnant women and the associated risk factors need to be understood, so that better interventions in the treatment of pregnant women can be implemented.

Fine‐needle aspiration cytology of scar endometriosis: Study of seven cases and literature review

Endometriosis is defined as the presence of endometrial-like glands and stroma outside the uterine endometrial lining. Endometrial tissue has also been identified in numerous surgical or procedure scars, including cesarean section and laparoscopic trocar tract. A prospective study was conducted at Maternidade-Escola Assis Chateaubriand, Faculty of Medicine, Federal University of Ceara, Brazil in seven patients with abdominal wall mass pathologically proven as scar endometriosis from January 2004 to December 2008. All cases were submitted to fine-needle aspiration cytology (FNAC). Age ranged from 21 to 42 years old (mean: 30) with parity ranging from 0 to 3 (mean: 1.4). The preceding history of pelvic procedures was miomectomy (1 of 7), cesarean section (3 of 7), and diagnostic laparoscopy (3 of 7). The complaints occurred about 18 months after the surgical proceeding. The FNAC findings were endometrial-like epithelial cells (6 of 7) and stromal cells (6 of 7); decidualization occurred in 2 of 7 cases. Hemosiderin-laden macrophages were present in all cases. FNAC is a fast and accurate method to make the diagnosis before the surgery, avoiding errors in the approach of the abdominal wall endometriosis' scars.

Fatores preditivos de hipertensão gestacional em adolescentes primíparas: análise do pré-natal, da MAPA e da microalbuminúria

To quantify PH prevalence in primiparous adolescents; define predictive factors for the occurrence of PH and its impact on newborns. We followed 29 primiparous adolescents from the prenatal period through the 12th week of the puerperium, with a mean of sixteen years of age, served at the Outpatient Facility for Adolescents of Maternidade Escola Assis Chateaubriand (MEAC) of Universidade Federal do Ceará (Fortaleza, Brazil). The pregnant adolescents were divided into two groups, that is, those who remained normotensive (Group I) and those who developed PH (Group II). The variables investigated in the assessment of the value of predictability for the development of PH were anthropometric measures, socioeconomic aspects, smoking habit, inheritance for SAH (father/mother), prenatal tests requested in the first prenatal care visit in addition to microalbuminuria and ambulatory blood pressure monitoring (ABPM) in the 28th week of gestation. The pregnant adolescents were followed up at delivery and late puerperium (12th week after the puerperium). The newborns to the mothers included in our study were assessed at birth according to the Apgar score and the Capurro method, for weight, height and perinatal hypoxia. The prevalence of PH was 51.7%. Inheritance for SAH presented the highest predictive value for PH with an odds ratio of 10.99. Diastolic arterial pressure equal to or above 70 mmHg at the gestational age of 35 weeks was statistically significant as a predictive value for PH. At ABPM we found a predictive value for PH: diastolic pressure load during alertness, diastolic and systolic pressure load during night sleep, pressure variability and maximum diastolic pressure during sleep. Specifically a maximum diastolic arterial pressure (DAP) at ABPM during the period of night sleep (3)64 mmHg presented an odds ratio of 6 for PH with a sensitivity of 80% and a specificity of 60% for the development of PH. The research for PH predictive factors in primiparous adolescents showed to be easy to apply and useful to stratify high-risk pregnant women as regards the development of PH.

Nova formulação de misoprostol sublingual na indução do trabalho de parto

To determine effectiveness and safety of sublingual misoprostol in tablets of 25 mcg, given every 6 hours for induction of labor in high-risk pregnant women hospitalized in two teaching hospitals in the Northeast of Brazil. An open, non-randomized clinical trial was conducted, including 40 women with high-risk pregnancies hospitalized at "Maternidade-Escola Assis Chateaubriand" and "Instituto Materno-Infantil de Pernambuco". All of them had gestational age >or= 37 weeks, alive fetus with good vitality and Bishop scores <or= 7. A tablet of 25 mcg of misoprostol was administered every 6 hours, up to a maximum of 4, until active labor. Statistical analysis was performed using the public domain software Epi-Info 3.2.2. Active labor occurred in 100% of cases after misoprostol administration. The mean (+/-SD) induction-to-labor interval was 4.8(+/-3.8 hours. Interval from induction-to-delivery varied from 8 to 31 hours with 95% of the deliveries occurring in the first 24 hours with 75% of vaginal deliveries. The frequency of tachysystole was 12.5%. The women did not present relevant side effects neither were there any neonatal complications. The sublingual tablet of misoprostol of 25 mcg was shown to be effective for induction of labor in high-risk pregnant women. The efficacy and acceptability of this new route should be compared to vaginal administration of misoprostol in future prospective randomized clinical trials.

P10.28: Ductus venosus velocimetry in the prediction of fetal acidemia: which is the best parameter?

Objectives: To evaluate the prediction of fetal acidemia using ductus venosus (DV) Dopplervelocimetry and to determine the best parameter and cut-off values for this prediction in pregnancies complicated with placental insufficiency. Patients and methods: This was a prospective cross-sectional study involving forty-seven patients with placental insufficiency managed in two Brazilian hospitals (Hospital Sao Paulo and Maternidade-Escola Assis Chateaubriand) who were submitted to DV Dopplervelocimetry in the last 24 hours before delivery. All pregnancies were singleton, over 26 weeks of age and without structural or chromosome anomalies. Metabolic or mixed acidemia at birth were considered pathological. A ROC curve was calculated for each DV parameter (independent variable) and acidemia (dependent variable). A cut-off value was established and sensibility, specificity, positive and negative predictive values and positive and negative likelihood ratios were calculated. The MacNemar test was used to compare the parameters. Results: The DV S, D and A peak velocities were not good predictors of acidemia at birth. Pulsatility Index for Veins (PIV) was a good predictor of acidemia (ROC curve area 0.79, p = 0.003), as well as the S/A and (S-A)/S ratios (ROC curve area 0.818, p = 0.001). The cut off values were PIV = 0.76, S/A = 2.67 and (S-A)/S = 0.63. Conclusions: In this high-risk population angle-independent DV Doppler indexes were good predictors of birth acidemia. PIV, S/A and (S-A)/S ratios were statistically equivalent in this prediction.

P10.29: Venous‐arterial pulsatility index in the prediction of fetal acidemia in pregnancies with placental insufficiency

Objectives: To evaluate the prediction of fetal acidemia using ductus venosus (DV) Dopplervelocimetry and to determine the best parameter and cut-off values for this prediction in pregnancies complicated with placental insufficiency. Patients and methods: This was a prospective cross-sectional study involving forty-seven patients with placental insufficiency managed in two Brazilian hospitals (Hospital Sao Paulo and Maternidade-Escola Assis Chateaubriand) who were submitted to DV Dopplervelocimetry in the last 24 hours before delivery. All pregnancies were singleton, over 26 weeks of age and without structural or chromosome anomalies. Metabolic or mixed acidemia at birth were considered pathological. A ROC curve was calculated for each DV parameter (independent variable) and acidemia (dependent variable). A cut-off value was established and sensibility, specificity, positive and negative predictive values and positive and negative likelihood ratios were calculated. The MacNemar test was used to compare the parameters. Results: The DV S, D and A peak velocities were not good predictors of acidemia at birth. Pulsatility Index for Veins (PIV) was a good predictor of acidemia (ROC curve area 0.79, p = 0.003), as well as the S/A and (S-A)/S ratios (ROC curve area 0.818, p = 0.001). The cut off values were PIV = 0.76, S/A = 2.67 and (S-A)/S = 0.63. Conclusions: In this high-risk population angle-independent DV Doppler indexes were good predictors of birth acidemia. PIV, S/A and (S-A)/S ratios were statistically equivalent in this prediction.

P10.30: Transverse cerebral sinus Doppler velocimetry in the prediction of birth acidemia

Objectives: To evaluate the prediction of fetal acidemia using ductus venosus (DV) Dopplervelocimetry and to determine the best parameter and cut-off values for this prediction in pregnancies complicated with placental insufficiency. Patients and methods: This was a prospective cross-sectional study involving forty-seven patients with placental insufficiency managed in two Brazilian hospitals (Hospital Sao Paulo and Maternidade-Escola Assis Chateaubriand) who were submitted to DV Dopplervelocimetry in the last 24 hours before delivery. All pregnancies were singleton, over 26 weeks of age and without structural or chromosome anomalies. Metabolic or mixed acidemia at birth were considered pathological. A ROC curve was calculated for each DV parameter (independent variable) and acidemia (dependent variable). A cut-off value was established and sensibility, specificity, positive and negative predictive values and positive and negative likelihood ratios were calculated. The MacNemar test was used to compare the parameters. Results: The DV S, D and A peak velocities were not good predictors of acidemia at birth. Pulsatility Index for Veins (PIV) was a good predictor of acidemia (ROC curve area 0.79, p = 0.003), as well as the S/A and (S-A)/S ratios (ROC curve area 0.818, p = 0.001). The cut off values were PIV = 0.76, S/A = 2.67 and (S-A)/S = 0.63. Conclusions: In this high-risk population angle-independent DV Doppler indexes were good predictors of birth acidemia. PIV, S/A and (S-A)/S ratios were statistically equivalent in this prediction.

Dopplervelocimetria do ducto venoso na predição da acidemia fetal

To investigate the possibility of predicting acidemia at birth in pregnancies with placental insufficiency by Doppler velocimetry of the ductus venosus and to establish the best parameter and cut-off points in this prediction. This was a prospective cross-sectional study, involving 47 single pregnancies with placental insufficiency after 26 weeks of gestation, carried out at the "Hospital São Paulo (UNIFESP) and Maternidade-Escola Assis Chateaubriand (UFC)". Placental insufficiency was defined as the umbilical artery pulsatility index above the 95th percentile for gestational age. Fetuses with chromosomal or structural anomalies were excluded. The time interval between the Doppler velocimetry and the birth was of less than 24 hours. The umbilical arterial blood samples were collected immediately after birth. Acidemia was defined as umbilical arterial pH < 7.2 in the absence of uterine contractions and < 7.15 in the presence of contractions. Metabolic or mixed acidemia at birth was considered pathological. Receiver operating characteristics (ROC) curves were calculated for S, D and A-velocities, pulsatility index for veins and the S/A ratio and (S-A)/S ratio of the ductus venosus. Parameters were compared using the MacNemar Test S, D and A-velocities of the ductus venosus were poor predictors of acidemia at birth. The pulsatility index for veins (area under the curve 0.79, p=0.003), S/A ratio and (S-A)/S ratio (area under the curve 0.818, p=0.001) of the DV were strongly related to fetal acidemia. The cut-off points calculated were: pulsatility index for veins = 0.76; S/A ratio = 2.67 and (S-A)/S ratio = 0.63. The angle-independent indices of the DV Doppler are adequate for the diagnosis of fetal acidemia in gestations with placental insufficiency. No statistically significant differences were observed between these parameters.

Fatores associados ao parto vaginal em gestantes de alto risco submetidas à indução do parto com misoprostol

PURPOSE: to determine the main factors associated with vaginal delivery in high-risk pregnant women submitted to labor induction with vaginal misoprostol (50 µg). METHODS: this is a secondary analysis of an open nonrandomized clinical trial that included 61 high-risk pregnant women admitted at the Maternidade-Escola Assis Chateaubriand, Fortaleza (Ceara). All women had singleton pregnancies with alive fetuses, gestational age >37 weeks and Bishop scores 4 and interval induction to delivery 4 (OR = 3.30, 95% CI = 2.15-4.45) were significant independent predictors for vaginal delivery. In the ROC curve for parity and Bishop score, sensitivity of 63.2% and positive predictive value of 100% were found. The area under the ROC curve was 86.8%, significantly higher than 50% (p=0.023). CONCLUSIONS: the most important predictive factors for vaginal delivery after induction with misoprostol were parity and Bishop score. These characteristics should be considered when choosing schemes and doses of misoprostol for cervical ripening and labor induction.

Repercussões maternas e perinatais da ruptura prematura das membranas até a 26ª semana gestacional

PURPOSE: to evaluate maternal and perinatal outcomes of premature rupture of membranes up to the 26th week of gestation. METHODS: retrospective analysis of the cases of premature rupture of membranes up to the 26th week of gestation, without signs of labor or treatment for this condition before admission, followed up at the Obstetric Pathology Infirmary of the Maternidade Escola Assis Chateaubriand, Federal University of Ceara, from January 1994 to December 1999. The cases with gestational age less than 22 weeks and birth weight lower than 500 g were excluded. Premature rupture of membranes was confirmed by sterile speculum examination. In doubt, amniotic fluid crystallization test and pH determination were performed. All pregnant women underwent ultrasound examination to determine gestational age and amniotic fluid volume. Data concerning the result of gestation and consequences for the mother, fetus and neonate were analyzed. RESULTS: a total of 29 cases of premature rupture of membranes fulfilled inclusion criteria. The mean gestational age at rupture of membranes was 22 weeks. The mean duration of the latency period was 21.7 days. There Were 22 spontaneous vaginal and 3 induced deliveries, besides 4 cesarean sections. In six pregnant women there were signs of infection before labor. Antibiotics were administered in 37.9% of the cases and corticosteroids in 6.9%. No patient underwent tocolysis. There were 3 fetal and 25 neonatal deaths. Only one infant survived. This child remained at the neonatal care unit for 19 days due to infection and respiratory distress syndrome. There was no maternal death. CONCLUSION: the premature rupture of membranes up to the 26th week of gestation has been a fatal discase for fetuses and newborns in our institution.

Infecção Assintomática do Líquido Amniótico

Purpose: to determine the presence of asymptomatic amniotic fluid infection in pregnant women, to identify the bacterial agents involved in the infection and to determine the antimicrobial susceptibility in vitro. Methods: amniotic fluid samples were obtained by amniocentesis from 81 pregnant women without labor signs and without suspucion of clinical infection, attended at Maternidade Escola Assis Chateaubriand from August 1997 to January 1999. The presence of aerobic bacteria, strict/facultative anaerobic bacteria and genital mycoplasmas was investigated. The anaerobic bacteria were identified by the ATB SystemO (Biolab Merieux) and mycoplasmas by the IST MycoplasmaO kit (Biolab-Merieux). Results: among the obtained samples, eight (9.8%) showed positive culture and in two samples two different strains were identified. The isolated pathogens were Ureaplasma urealyticum (7 cases, 8.6%), Mycoplasma hominis (1 case, 1.2%) and Peptostreptococcus sp (2 cases, 2.4%). The antimicrobial susceptibility was characterized by great mycoplasma resistance to erythromycin (37.5%) and no resistance to cyclins. Conclusions: the percentage of asymptomatic infections was high, and furthe research is necessary to evaluate the asymptomatic infection consequences in pregnant women and their newborns, involving methods that identify genital mycoplasmas, which were the most frequently isolated bacteria.

Estudo Comparativo dos Resultados Maternos e Perinatais entre Pacientes com Diabetes Pré-gestacional Tipo I e Tipo II

Objetivos: avaliar a evolução da gestação, controle metabólico e resultados perinatais de pacientes diabéticas pré-gestacionais e fazer um estudo comparativo entre os resultados de pacientes com diabetes insulino-dependente e não-insulino-dependente. Métodos: análise retrospectiva de prontuários de 57 pacientes com diagnóstico de diabetes pré-gestacional que iniciaram pré-natal no Serviço de Medicina Materno-Fetal da Maternidade-Escola Assis Chateaubriand da Universidade Federal do Ceará, no período de janeiro 1995 a dezembro de 1998. As 57 grávidas incluídas no estudo foram divididas em dois grupos: grupo I, composto de 28 pacientes portadoras de diabetes insulino-dependente (tipo I), e grupo II, com 29 gestantes com diabetes não-insulino-dependente (tipo II) controladas com dieta ou com hipoglicemiante oral antes da gestação. Resultados: não houve diferença estatisticamente significante entre os dois grupos em relação à necessidade de internamento para controle glicêmico (39,2% x 27,5%) e complicações maternas, tais como: hipertensão arterial crônica (14,2% x 27,5%), doença hipertensiva específica da gravidez (14,2% x 17,2%), amniorrexe prematura (3,5% x 10,3%), infecção do trato urinário (10,7% x 6,8%) e trabalho de parto prematuro (3,5% x 6,8%). Foi observado, porém, maior número de episódios de hipoglicemia materna entre as pacientes insulino-dependentes (35,7% x 3,4%). Os resultados perinatais foram semelhantes. Observamos elevados índices de malformações e morbimortalidade perinatal. Conclusão: não houve diferença na incidência de intercorrências clínicas e obstétricas entre as pacientes insulino-dependentes e não-insulino-dependentes, excluindo-se hipoglicemia materna.

Method of payment and the cesarean birth rate in a hospital in northeast Brazil.

This paper examines factors associated with the cesarean birth rate, including medical condition and method of payment, in the largest maternity hospital of Fortaleza, Brazil. Data were collected on 5996 women who delivered at the Maternidade Escola Assis Chateaubriand from October 1980 to July 1981. All women were classified according to how they paid for their care: private (financed at least part of their care with own funds), insured (federal or state), or indigent. Private patients were found to be far more likely than patients in the other two groups to have cesarean deliveries, due primarily to the high percentage of private patients recorded as having prolonged or obstructed labor, combined with a high rate of prior cesarean sections. From this data, it appears likely that financial incentives did play a role in physician decisions on whether to perform cesarean deliveries.