A cohort of 297 HIV-infected pregnant women was followed from January 1996 to December 2001. The overall transmission rate was 3.57% and remained constant over time. Low birth-weight was independently associated with a higher risk of vertical transmission (P=0.0072), whereas a longer duration of antiretroviral drugs during pregnancy was independently associated with a lower risk of transmission (P=0.0084). Further decreases in transmission should be obtained by initiating prophylaxis earlier in pregnancy.
OBJECTIVE: To describe trends in sociodemographic, immunological and virological profiles and interventions to decrease the risk of mother-to-child HIV transmission. METHODS: Retrospective cohort study conducted at a tertiary institution in Rio de Janeiro, Brazil from January 1996 to December 2004. Analysis was performed by stratification in three time periods: 1996-1998 (P1), 1999-2001 (P2) and 2002-2004 (P3). RESULTS: In 9 years, 622 pregnancies occurred. Complications included: maternal mortality 0.3%, stillbirths 2.5%, miscarriages 0.6%, neonatal mortality 1.1%, prematurity 9.9%, low birth weight (LBW) 16.5%, congenital malformations 2.2%. The number of HIV-infected pregnant patients grew threefold over time reflecting increased prevalence of disease and patient identification. HIV diagnosis before pregnancy increased from 30% in P1 to 45% in P3. The proportion of pregnant women receiving highly active antiretroviral therapy increased from none (P1) to 88% (P3) with a significant trend towards women delivering at undetectable viral loads in later years despite a higher frequency of advanced disease. Scheduled cesarean deliveries increased from 35% in P1 to 48% in P3. Perinatal transmission rates were 2.4% with a decline from 3.5% in P1 to 1.6% in P3. Neonatal outcomes tended to remain constant or improve with time. A slight rise in LBW and congenital malformations were observed. CONCLUSIONS: During the observational period, HIV+ pregnant women presented with more advanced disease and lower socio-economic status. However, improved management of HIV-infected patients (associated with increased identification and increased availability of treatment) resulted into very low transmission rates similar to those of developed countries with overall improvement of patient outcomes.
Cases of mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV-1) in a prospective cohort study in Latin America and the Caribbean were analyzed. Eight of 820 eligible infants became infected [transmission rate, 0.98% (95% CI = 0.45-1.96%)]. Five cases (62%) represented missed opportunities for prevention of MTCT of HIV-1, suggesting the need for ongoing training and education of clinicians regarding prevention of MTCT of HIV-1.
RESUMO -O diagnóstico de um tumor cerebral durante a gravidez é um fato raro que coloca a mãe e o concepto em risco de vida. Objetivo: Avaliar a melhor forma de conduzir uma paciente grávida portadora de um tumor cerebral. Método: Realizamos análise retrospectiva dos prontuários e imagens de seis pacientes grávidas portadoras de tumor cerebral. Resultados: Vários tipos histológicos de tumor cerebral podem estar associados à gravidez. O meningioma é o mais freqüente. Nessa série não observamos óbito cirúrgi-co materno. Em duas pacientes, o parto ocorreu antes da craniotomia e em outras quatro o parto foi realizado após a neurocirurgia. Conclusão: O momento mais adequado para a realização da craniotomia para remoção tumoral irá depender da gravidade do quadro neurológico, do tipo histológico presumível da lesão, e da idade gestacional do embrião. PALAVRAS-CHAVE: gravidez, tumor cerebral, meningioma, microneurocirurgia. Brain tumors and pregnancyABSTRACT -Background: Despite not being a common fact, the occurrence of brain tumors during pregnancy poses a risk to both the mother and infant. Aim: To identify the best medical procedure to be followed for a pregnant patient harboring a brain tumor. Method: The records of 6 patients with brain tumors, diagnosed during pregnancy were examined. Results: Several types of brain tumors have been associated with pregnancy, but the meningioma is, by far, the most frequent. It seems that pregnancy aggravates the clinical course of intracranial tumors. There were no operative mortality in these series. In 2 patients the labor occurred before the craniotomy and in others, the delivery occurred after the surgery. Conclusion: The best moment to recommend the craniotomy and the neurosurgical removal of the tumor will depend of the mother's neurological condition, the tumor histological type as well as the gestational age. RJ -Brasil. E-mail: cneuroamericas@uol.com.br O diagnóstico de um tumor cerebral durante a gravidez é um evento extremamente raro [1][2][3][4][5][6][7][8][9][10][11] . Dr. José Carlos Lynch -Rua Jardim Botânico 600 / 605 -22461-000 Rio de JaneiroO surgimento de um tumor cerebral durante uma gestação coloca a mãe e concepto em risco de vida 4,7,10,11 , e também suscita dilemas de ordem neurocirúrgica, clínica, obstétrica, ética e psicológica. A utilização de uma abordagem multidisciplinar para essas pacientes é fundamental porque se está lidando com pacientes que se encontram em um momento crítico de suas vidas, quando ocorrem profundas mudanças orgânicas e psíquicas.Analisamos seis casos de nossa experiência. MÉTODOEntre os anos de 1996 e 2005, 6 mulheres que se encontravam no período gestacional e com o diagnóstico de tumor cerebral foram tratadas no Serviço de Neurocirurgia do Hospital dos Servidores do Estado (HSE), no Rio de Janeiro.As pacientes também foram acompanhadas pelos serviços de obstetrícia, psicologia e anestesia que discutiram entre si e determinaram, juntamente com as famílias e as pacientes, as condutas que foram instituídas. Todos os pós-oper...
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