O xidative stress has been implicated as a cause of the endothelial damage seen in preeclampsia. This randomized, placebo-controlled double-blind trial involving 4 Brazilian clinical sites examined whether dietary antioxidant supplementation would reduce the incidence of preeclampsia in patients at increased risk because of the presence chronic hypertension or a history of preeclampsia.Patients were 12 to 19 weeks pregnant at enrollment and were randomly assigned to receive 1000 mg vitamin C and 400 IU vitamin E daily or placebo. Patients took 2 gel capsules containing one-half of each medication daily from enrollment to delivery or the diagnosis of preeclampsia. They were followed at periodic prenatal visits at which time blood pressure, weight, and urinary protein excretion were measured. The primary outcome was the development of preeclampsia (blood pressure of 140/90 mm Hg and 300 mg/24 h urinary protein); secondary outcomes were severity of preeclampsia (severe vs. not severe using usual internationally agreed upon criteria), gestational hypertension, abruptio placentae, premature rupture of the membranes, preterm birth, and small for gestational age, and low-birth-weight infants.Data were available for 707 of 753 women (patients were excluded due to loss to follow-up or withdrawal of consent), of whom 355 received the antioxidant vitamins and 352 placebo. The 2 groups were similar in demographic characteristics. Of those with chronic hypertension, 52.8% were receiving antihypertensive therapy when they became pregnant. Compliance rates were 84.5% and 86.9% for the vitamin and placebo groups, respectively. In the vitamin group, 13.9% of patients developed preeclampsia compared with 15.6% in the placebo group. Within both groups, no significant differences in the frequency of preeclampsia between treatment or placebo groups were noted. Only the mean arterial pressure at enrollment was significantly associated with the development of preeclampsia. In patients without chronic hypertension, 6% of the study group and 2.4% in the placebo group developed severe preeclampsia, not a significant difference. No patient died. Two patients in each group developed HELLP syndrome.Rates of gestational diabetes (3.4% vs. 3.7%), abruptio placentae (1.1% vs. 2.3%), induction of labor (14.6% vs. 18.3%), and cesarean delivery (66.0% vs. 67.6%) were not significantly different between the study and placebo groups, respectively, Premature rupture of the membranes occurred more frequently in the study patients than in the placebo group (10.6% vs. 5.5%, P = 0.015) The groups did not differ significantly in the rate of fetal and neonatal deaths, preterm delivery, low birth weight, small for gestational age, low Apgar scores at 1 and 5 minutes, and neonatal morbidities. Seven patients in the study group and 6 in the placebo group stopped taking the pills because of perceived side effects, including itching, eczema, vomiting, abdominal pain with or without diarrhea, headache, constipation, malaise, and diminished vision. One fetus in t...
OBJECTIVE To determine the effectiveness of transvaginal electrical stimulation (TES) in treating urinary incontinence, and to assess the clinical improvement 6 months after ending the treatment. PATIENTS AND METHODS In a double‐blind randomized controlled clinical trial, 36 women (24 patients and 12 controls) with stress, urge or mixed urinary incontinence were chosen to use TES or placebo (identical equipment but with no electrical current). The patients had their treatment at home twice a day (20‐min sessions) for 12 weeks. They completed a voiding diary and had a urodynamic study at the beginning and end of treatment. They were clinically re‐evaluated after 6 months. RESULTS The mean time of use of TES was similar in both groups (≈ 40 h); the treatment group had a significant increase in maximum bladder capacity (P < 0.02), a significant reduction in the total number of voids (over 24 h; P < 0.02), in the number of episodes of voiding urgency (P < 0.001) and, importantly, in the number of episodes of urinary incontinence (P < 0.001). At the first evaluation, after ending the treatment, 88% of the patients had a significant reduction in symptoms or went into remission. At the 6‐month re‐evaluation, a third of the patients required another therapeutic approach. CONCLUSION TES is a practical alternative with few side‐effects, and is effective for treating the main forms of female urinary incontinence.
The protein/creatinine ratio measured in a single urine sample taken at random from hypertensive pregnant women showed good sensitivity and specificity for the diagnosis of 24-h proteinuria > or = 300 mg and was strongly correlated with 24-h proteinuria. A ratio of 0.5 mg/mg is predictive of significant proteinuria and can be used for the diagnosis and follow-up of hypertensive pregnant women.
Chronic renal insufficiency (CRI) decreases reproductive capability. The biggest challenge in monitoring pregnant women with renal disease is to keep the intrauterine environment favorable to the fetus. One of the common prognosis in this kind of pregnancy involves premature birth, restricted growth and mental retardation. Also, the risk of developing complications is higher for the mother. This study focuses on evaluating CRI patients' clinical conditions during pregnancy, checking fetal development and birth and verifying the prevalence of CRI in pregnant women attended at Hospital de Clínicas of Porto Alegre-Brazil (HCPA). This is a retrospective study with both a control and an case group of pregnant women with CRI who delivered their babies at HCPA from 1989 to 1999. The case group is composed of pregnant women with CRI, while the control group was paired according to maternal and gestational ages and to the time of the delivery, which should be the same both in the experimental and in the control group. Among the criteria usually used to identify CRI, we chose the creatinine level higher than 1.5 mg/dL. Significance was established in 0.05%. Our results demonstrate that the prevalence of CRI was 6/10,000 births. Average maternal age was 28. Sixty five per cent of the patients, in both the groups, underwent prenatal monitoring, 40% presented preeclampsia, 48% presented urinary infection. Among the CRI complications, 48% of the cases presented anemia and 56% presented systemic hypertension. Average hematocrit was 24% while hemoglobin was 6.7 g/dL, which leads us to the conclusion that patients presented anemia during pregnancy. Average creatinine was 4.61 mg/dL. It is relevant that 64% of the CRI cases migrated to a substitutive renal therapy method. As for the fetus evolution in the case group, we confirmed the findings of previous studies, such as larger number of premature births (newborns younger than 36 weeks in 60% of the cases), larger number of cesarean section (56%), lower weight at birth (1980 gr. in average), lower APGAR scores in the first and fifth minute (4.13 and 5.08, respectively) in comparison to the control group (7.52 and 8.63, respectively). We can state that babies born from CRI patients present underdevelopment. Also, mothers with CRI develop more complications during pregnancy.
Translabial ultra-sonography has an important role in the assessment of women with urinary stress incontinence and intrinsic urethral sphincter deficiency.
We s t u d i e d 3 7 n u l l i p a r o u s women w i t h l a t e -o n s e t g e s t a t i o n a l h y p e r t e n s i o n a n d s i g n i f i c a n t p r o t e i n u r i a , w i t h a d i a s t o l i c b l o o d p r e s s u r e o f 1 1 0 mmHg o r h i g h e r . T h e y w e r e r a n d o m l y a s s i g n e d t o r e c e i v e i n t r a v e n o u s h y d r a l a z i n e ( 5 ou 1 0 mg) p l u s a n o r a l p l a c e b o ; o r o r a l n i f e d i p i n e ( 1 0 o r 2 0 mg) p l u s an i n t r a v e n o u s p l a c e b o , w i t h t h e g o a l o f m a i n t a i n i n g d i a s t o l i c b l o o d p r e s s u r e a t o r b e l o w 1 0 0 mmHg. A l l d r u g s w e r e a d m i n i s t e r e d i n a d o u b l e -b l i n d f a s h i o n . H y d r a l a z i n e d e c r e a s e d m e a n a r t e r i a l p r e s s u r e f r o m 1 3 6 * mmHg t o 1 0 6 k 7 mmHg, w h i l e n i f e d i p i n e d e c r e a s e d i t f r o m 1 3 5 * 8 mmHg t o 1 0 9 * 1 0 nunHg. The i n c i d e n c e of a d v e r s e m a t e r n a l a n d f e t a l e f f e c t s w e r e s i m i l a r i n t h e t w o t r e a t m e n t g r o u p s . T h i s r a n d o m i z e d t r i a l c o n t a i n e d a l i m i t e d n u m b e r o f s u b j e c t s a n d , t h e r e f o r e , d i d n o t h a v e t h e s t a t i s t i c a l p o w e r t o d e t e c t s m a l l d i f f e r e n c e s b e t w e e n h y d r a l a z i n e a n d n i f e d i p i n e . H o w e v e r , w e h a v e d e m o n s t r a t e d t h a t a t r i a l o f d r u g t h e r a p i e s f o r a c u t e h y p e r t e n s i o n i n p r e g n a n c y c a n b e s u c c e s s f u l l y b l i n d e d , a n d t h i s a p p r o a c h w o u l d b e v a l u a b l e i n a l a r g e r s t u d y c o m p a r i n g t h e t r e a t m e n t r e g i m e n s a d d r e s s e d h e r e .
Introduction COVID-19 pandemic posed major challenges in obstetric health care services. Preparedness, development, and implementation of new protocols were part of the needed response. This study aims to describe the strategies implemented and the perspectives of health managers on the challenges to face the pandemic in 16 different maternity hospitals that comprise a multicenter study in Brazil, called REBRACO (Brazilian network of COVID-19 during pregnancy). Methods Mixed-method study, with quantitative and qualitative approaches. Quantitative data on the infrastructure of the units, maternal and perinatal health indicators, modifications on staff and human resources, from January to July/2020. Also, information on total number of cases, and availability for COVID-19 testing. A qualitative study by purposeful and saturation sampling was undertaken with healthcare managers, to understand perspectives on local challenges in facing the pandemic. Results Most maternities early implemented their contingency plan. REBRACO centers reported 338 confirmed COVID-19 cases among pregnant and post-partum women up to July 2020. There were 29 maternal deaths and 15 (51.8%) attributed to COVID-19. All maternities performed relocation of beds designated to labor ward, most (75%) acquired mechanical ventilators, only the minority (25%) installed new negative air pressure rooms. Considering human resources, around 40% hired extra health professionals and increased weekly workload and the majority (68.7%) also suspended annual leaves. Only one center implemented universal screening for childbirth and 6 (37.5%) implemented COVID-19 testing for all suspected cases, while around 60% of the centers only tested moderate/severe cases with hospital admission. Qualitative results showed that main challenges experienced were related to the fear of the virus, concerns about reliability of evidence and lack of resources, with a clear need for mental health support among health professionals. Conclusion Study findings suggest that maternities of the REBRACO initiative underwent major changes in facing the pandemic, with limitations on testing, difficulties in infrastructure and human resources. Leadership, continuous training, implementation of evidence-based protocols and collaborative initiatives are key to transpose the fear of the virus and ascertain adequate healthcare inside maternities, especially in low and middle-income settings. Policy makers need to address the specificities in considering reproductive health and childbirth during the COVID-19 pandemic and prioritize research and timely testing availability.
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